P0074 - Factors determining early intervention referrals and successful evaluation

Background: Part C of the Individuals with Disabilities Education Act (IDEA) aids states in implementing the Early Intervention (EI) program for children with developmental delays.1 EI program helps children under 3 years of age with developmental delay by providing services like speech therapy and physical therapy to those who are determined eligible, as defined by New York State.2 There are many steps involved in the EI process, and failure at any step can result in a child with a developmental delay not getting the services he or she needs.

Objective: We aim to get a comprehensive understanding of the EI evaluation. Our goal is to eliminate the obstacles toward a successful EI referral, evaluation, and intervention in order to provide all children with the developmental delays with timely essential services they need.

Methodology: We plan to use the Plan, Do, Study, Act (PDSA) Cycle to help us achieve our goals. Our Information Technologist (IT) has helped us create a monthly list of all patients seen for their well-child visits at 9, 18, 24, and 30 months of age. We looked at all the patients referred to EI on a monthly basis. We worked with our healthystep specialist and followed patients and their families going through the EI evaluation. We then looked at obstacles toward a timely EI evaluation and implement a plan to remove those obstacles by means of the PDSA Cycle.

Discussion: From April to November of 2019, 466 patients were seen at their well-child visits at 9, 18, 24, and 30 months of age. Of those, 427 (91.6%) were screened with SWYC while the remaining 39 patients were reported to have normal development by the clinical judgment of the physician. Of the 427 patients screened, 49 (11.4%) failed their SWYC screen whereas 54 (12.6%) were referred to EI, of which 5 were referred out of physician concern despite normal SWYC score. These 5 patients on follow-up were never evaluated by EI due to parental refusal (60%). Of the 54 patients who were referred to EI, only 33 (61%) patients were evaluated. Of the 33 patients who were evaluated by EI, 21 (63%) patients were qualified but only 17 (51%) patients received therapy.

Conclusion: From this study, it was evident that there are obstacles toward a timely EI evaluation. Although proper referrals were made at the initial screening visit, we speculate the delay is likely due to a lack of parental education or a lack of proper follow up by the physician. We plan to identify all obstacles and implement plans to address the challenges faced by families, healthystep specialists, and physicians as a timely intervention are critical for the better outcome of our patients.