Birth characteristics associated with early intervention referral, evaluation for eligibility, and program eligibility in the first year of life

Objectives: The Individual with Disabilities Education Act mandates Early Intervention (EI) services for infants and toddlers with developmental delay. We assessed the percentage of infants at risk for developmental delay due to characteristics present at birth who were referred to Massachusetts EI within 1 year of birth, evaluated for eligibility, and eligible for services. In addition, we identified birth characteristics that independently predicted 0-1 year program referral, evaluation, and eligibility. Methods: The Pregnancy to Early Life Longitudinal (PELL) data system linked birth certificate, hospital discharge, and EI program data of 219,037 infants born in Massachusetts, 1998-2000. Multivariate logistic regressions identified independent infant predictors of referral, evaluation, and eligibility. Results: Of 219,037 births, 14,852 (6.8%) were referred to EI within 1 year. Birthweight <1200 g (OR=9.7, 95% CI 3.3-12.9) and birthweight 1200-1499 g (OR=7.4, 95% CI 5.8-9.5) strongly predicted referral. Referral was high (88%) among infants with two or more birth risks. Among referrals, 88% were evaluated for eligibility. The strongest predictor of evaluation was triplet birth (OR=4.3, 95% CI 1.6-11.8). Among infants evaluated, 85% were determined to be eligible. Conclusion: EI referral and evaluation are high among infants born at risk for delay in Massachusetts. Some characteristics not included in the state's high-risk definition (e.g. birthweight 1200-1499 g) were identified that predicted referral. Most referrals were eligible for services. Results demonstrate the value to states of using linked population and program data for program evaluation.