EARLY INTERVENTION SERVICES

WHAT ARE EARLY INTERVENTION SERVICES AND WHY ARE THEY IMPORTANT?

Part C of the Individuals with Disabilities Education Act (IDEA) provides funds for states to establish Early Intervention (EI) programs, which offer services for infants and toddlers (birth to age 3) with disabilities or developmental delays, regardless of family income.1 States must develop a set of eligibility criteria and then identify, evaluate, and provide appropriate services and therapies to all children who meet the state’s thresholds for delays, disabilities, or risk for delayed development. State EI programs have a variety of names (e.g., “Birth to Three” in Connecticut, “Early Childhood Intervention” (ECI) in Texas, and “First Steps” in Kentucky), but this report uses Early Intervention or EI for consistency across states.

Access to EI Services Can Prevent Further Delays and Reduce the Need for Special Education Services

Access to EI services (such as speech therapy for a child with language delays, or physical therapy for a child with motor challenges) can improve the developmental trajectories of infants and toddlers and prevent further delays. Timely services may also reduce the need for special education or more intensive supports when children are older.2 Family-centered services that involve parents have been shown to be more effective than therapies for children alone,3 because caregivers can learn how to interact with and care for their child in a way that will best support the child’s development.

EI Services Can Save States Money in the Long Run

A recent analysis of six states found that Early Intervention services helped between 760 and 3,000 children per state to avoid special education services at age 3, with a 1-year cost avoidance of between $7.6 million to $68.2 million depending on the state.4 Three-year cost avoidance estimates, which accounted for children re-entering special education services after an initial exit, still projected substantial cost savings.5

State EI Programs Face a Variety of Challenges, Including Inadequate Funding and Inequities in Children’s Access

The number of children enrolled in Early Intervention services has consistently trended upwards in the past two decades, but federal per-child Part C funding has declined, requiring greater state support for services.6 State leaders consistently report that ensuring adequate funding remains one of the most critical challenges for their EI programs.7

The percentage of children ages birth to 3 who are served (on both a point-in-time and cumulative basis) varies significantly across states,8 in part because of differences in state eligibility policies;9 states’ outreach efforts to hospitals, child care centers, and other organizations;10 and resource availability.11

States also vary in how consistently they refer children who have experienced abuse and neglect to EI programs. A study of children ages birth to 3 involved in child welfare investigations estimated that over 35% had delays or risk factors that would make them eligible for EI services, but only 12.7% of those in need were receiving services.12 Rates of service are also inequitable across race and ethnic groups;13 national data show that Black children are served in EI at lower rates than their White peers,14 and in many states, Hispanic and multiracial children face significant gaps in access as well.15

Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on Early Intervention services.

WHAT IMPACT DO EARLY INTERVENTION SERVICES HAVE?

The most rigorous evidence suggests that Early Intervention services can improve children’s outcomes in areas including cognitive development, language/communication skills, behavior, and motor skills.

Access to EI Services is Inequitable by Race and Ethnicity

Evidence reveals that children from lower-income families and communities of color do not have equitable access to EI services.16 The most recent national data show that 6.6% of Black children ages birth to 3 are served in EI over the course of a year, compared to 7.4% of White children.17 A widely cited study found that by 24 months old, Black children identified as likely eligible for EI were five to eight times less likely to receive services than White children, depending on the reason for eligibility.18 A study of low birthweight infants found significantly lower EI referral rates for infants of Black non-Hispanic mothers than all other racial groups.19 These inequities in EI access may contribute to disparities in children’s later outcomes.

For more information on what we know and what we still need to learn about Early Intervention services, see the evidence review on Early Intervention services.

HOW CAN STATES EFFECTIVELY IMPLEMENT EARLY INTERVENTION SERVICES?

In contrast to the evidence for the five state-level policies that are included in this Roadmap, the current evidence base does not identify a specific policy lever that states should adopt and fully implement to effectively provide Early Intervention services to all of the children who need the services. In the absence of an evidence-based state policy lever to ensure EI services effectively provide children and families the support they need, we present several choices that states can make to more effectively implement their EI programs. Additionally, we leverage available data to assess state variation in EI services across a range of factors to identify the leaders among states in implementing their Part C programs, and to demonstrate what progress states are making relative to one another.

State Leaders in EI Services:

  • Serve a high share of their infants and toddlers relative to other states;
  • Allow children with less severe delays to qualify for EI services and allow children to qualify through a wide variety of medical conditions and risk factors, which may include low birthweight and prematurity;
  • Access a variety of funding streams beyond the federal Part C allocation to ensure that sufficient resources are available to provide eligible infants and toddlers with timely therapies and treatments; and
  • Foster collaboration with other state agencies and systems.

Policy and Administrative Choices States Make Affect the Implementation of Their EI Programs

State EI programs vary considerably in the percentage of children under age 3 who are served, their eligibility criteria, the funding streams states access to support their programs, the level of collaboration between Part C programs and other state agencies, such as Medicaid and child welfare, and in other ways that have implications for the strength of a state’s program.

The Percentage of Children Served by Early Intervention Services Is the Most Consistent Measure to Compare States’ Success

The share of children served is one of the only indicators allowing for a consistent, meaningful comparison of states’ EI programs across the country; in most other ways, states’ programs are so different and context-dependent that it is difficult to compare them to one another meaningfully based on a single indicator.

Several factors influence the percentage of children that states serve in EI over the course of a 12-month period, including states’ eligibility criteria and the resources states marshal (funding and personnel) to identify, evaluate, and serve children.

States’ Eligibility Criteria for Early Intervention Services Can Be More Inclusive to Serve Children at Risk for Developmental Delays

States set specific thresholds for developmental delays (e.g., a 30% or greater delay in one or more developmental areas) and self-declare whether their eligibility criteria are broad (most inclusive, serving less severe delays), moderately inclusive, or narrow (requiring the most severe delays). Using a broad eligibility threshold means that a state may serve children with less severe delays than states that report moderately inclusive or narrow criteria, but states with broader eligibility criteria do not necessarily serve more children than states with more restrictive criteria.

In addition to developmental delays, children may be eligible for EI based on a state’s unique list of qualifying diagnosed/established conditions (often including very low birthweight and prematurity, at various thresholds). Allowing children to qualify based on medical conditions is important for serving the youngest infants, who may not show developmental delays until later. In at least six states, children may be eligible if they are determined to be at risk for delays or disabilities based on a state’s list of risk factors, even if children do not yet exhibit a qualifying developmental delay or have an established condition.

States Can Use a Variety of Funding Streams to Support EI, and Maximizing Medicaid Funding Is a Cost-Effective Approach to Serve More Children

In addition to eligibility criteria that are inclusive of children with less severe delays and children at risk for delays, the available resources that states can marshal to support EI are critical to serving a higher percentage of children. Part C federal funds allocated to states are intended to supplement, not supplant, state resources, and therefore, most states access a variety of funding streams beyond the federal Part C allocation to serve more children. Over time, as the federal per-child amount has declined, states have begun to invest more of their own state resources, and many have set up the necessary infrastructure to allow EI programs to bill private insurance and have reduced or eliminated the collection of family fees.

One of the most important funding sources for EI services is Medicaid, and states vary in the extent to which they take advantage of Medicaid funding to support their EI programs. States that have fostered closer partnerships between their Medicaid agencies and Part C programs have been able to maximize federal Medicaid matching dollars and increase the number of children they serve.

Collaborations Among Multiple State Agencies Can Promote More Seamless Services for Children

In addition to fostering collaboration with Medicaid, states whose Part C programs work closely with other agencies, including child welfare and state public education systems, have been able to ensure that children experiencing maltreatment receive the services they need, and ensure that children experience a more seamless transition from Part C to special education services at later ages, respectively.

WHAT PROGRESS HAVE STATES MADE IN THE LAST YEAR TO MORE EFFECTIVELY IMPLEMENT EARLY INTERVENTION SERVICES?

States have substantial latitude in how they implement their EI programs. Over the last year, several states took legislative or administrative action to enhance their EI services, specifically through increasing access to EI services for many families and improving the funding of their programs.

Examples of states that expanded access to services include Delaware, which passed a bill that will require child care providers to ensure that children between ages 0 and 5 are screened to identify developmental delays and social-emotional needs. Delaware also changed the agency that administers its EI program in an effort to provide a more seamless transition for children from Part C services (ages 0 to 3) to Part B services in preschool (ages 3 to 5). Both programs are now housed under the state’s Department of Education. Illinois passed legislation to allow toddlers who turn 3 years old during the summer to continue to receive EI services until the school year begins. And Colorado passed a bill to ensure that Child Find efforts are led by the same agency that administers its other EI services (the Department of Human Services). Connecticut passed legislation that eliminated the collection of family fees, which will expand access to services for low-income families.

HOW DO EARLY INTERVENTION SERVICES VARY ACROSS STATES?

States Vary Considerably in the Percentage of Children Under Age 3 Served in EI

Available state data show the percentage of children served in EI out of all infants and toddlers ages 0 to 3, but do not indicate the percentage of children served out of those who are eligible or in need of services. National research suggests that the prevalence of children under age 3 with delays and disabilities whose development could improve with EI services is between 13% and 20%.20

Recent national data show that 7.3% of children in the US under age 3 received any EI services over a 12-month period, but this percentage varies considerably by state, from a low of approximately 2% in Arkansas to a high of 22% in New Mexico. Massachusetts is another standout state in the percentage of children served, with over 20% of infants and toddlers receiving EI services over the course of a year. Twelve states serve 10% or more of infants and toddlers in EI services, and eight states serve 5% or fewer over the course of a year.

When EI service rates are calculated using a point-in-time approach, rather than a cumulative count over a full year, the national percentage of children served is 3.7%. States range from serving approximately 1% (Arkansas) to 10.6% (Massachusetts) of their 0-to-3 population on any given day.21 We use the cumulative, rather than point-in-time data in this Roadmap based on recommendations from national experts in Early Intervention.22 The cumulative data capture services received throughout the year, rather than just services provided on the day that a point-in-time count occurred.

Rates of low birthweight and prematurity can serve as proxies for different levels of need across states, because research shows that low birthweight and prematurity are risk factors for the kinds of delays and disabilities that may improve if children receive EI services.23 A total of 33 states qualify children born low birthweight for EI (using various thresholds, often requiring very low birthweight of <1,500 grams, or approximately 3 pounds and 5 ounces) and 23 states qualify children born premature (often requiring very preterm or extremely preterm birth, born earlier than 32 or 28 weeks).24 However, some states with high rates of low birthweight or prematurity do not include these conditions as part of their EI eligibility policies.

States Vary in the Extent to Which Children Are Served in EI Equitably

Although national data show that 7.3% of children in the US under age 3 received any EI services over the most recent 12-month reporting period, nationally, only 6.6% of Black children ages 0 to 3 are served in EI over the course of a year, compared to 7.4% of White children.25 Hispanic children are served at a rate of 7.6%, and children classified as “Other” for race/ethnicity are served at a rate of 6.6%.26

Rates of Low Birthweight Across Race and Ethnicity Can Shed Light on the Need for EI Across Race and Ethnicity

Low birthweight is a common risk factor for later delays and disabilities that can improve with EI therapies,27 and in 33 states, low birthweight (of various thresholds) can qualify a child for EI services, either alone or in combination with other factors, depending on the state. Most states require very low birthweight, of less than 1,500 grams, or extremely low birthweight, of less than 1,000 grams, to qualify for EI. The rate of low birthweight (based on a standard of 2,500 grams) by race and ethnicity may serve as a rough proxy to indicate variation in the need for EI across race and ethnicity. In the US, Black children are substantially more likely to be born low birthweight than White or Hispanic children, so it is critical to ensure that they have equitable access to EI services.28

States Set Their Own Eligibility Policies, Including Which Diagnosed or Established Conditions and Risk Factors Qualify Children for EI Services

Each state develops its own EI eligibility requirements within federal guidelines, including the threshold for the severity of developmental delays children must exhibit to qualify for EI, the list of diagnosed or established conditions, and the additional risk factors that may entitle a child to EI services. A total of 15 states report broad criteria, 24 report moderately inclusive criteria, and 12 report narrow criteria.29 However, within each of these self-declared categories, the specific thresholds and requirements vary. Using a broad eligibility threshold means that a state may serve children with less severe delays than states that report moderately inclusive or narrow criteria, but states with broader eligibility do not necessarily serve more children than states with more restrictive criteria.

In addition to developmental delays, children may be eligible for EI based on a state’s unique list of qualifying diagnosed/established conditions or its list of risk factors. As mentioned, a total of 33 states include low birthweight, very low birthweight, or extremely low birthweight on these lists, and each state sets its own threshold in grams under which an infant can qualify.30 A total of 23 states include preterm, very preterm, or extremely preterm birth on their lists, and each state sets a specific threshold (weeks at birth) that may qualify a child for services. States can determine whether low birthweight and prematurity can continue to qualify children for services for the full 3 years, or whether children can only qualify for services based on low birthweight/prematurity until age 18 months or 2 years of age, for example.

Six states (California, Massachusetts, New Hampshire, New Mexico, Florida, and West Virginia) report to the federal government that they choose to serve children who are at risk for delays or disabilities, even if children do not have an established delay or disability.31 Each of the six states has a specific list of risk factors that can qualify a child for EI services, and the states can determine how many risk factors children must have to qualify (some states require five or more risk factors to be present simultaneously, for example). Some of these risk factors include social circumstances such as low income or homelessness, but others are more clinical, such as low Apgar scores or prenatal drug exposure.

States can also choose whether at-risk children can receive services for the entire 0-to-3 period, or only until a certain age. These states may also limit which EI services at-risk children can receive, and for how long, to ensure that sufficient resources remain available for children with established delays and medical conditions.

Other states, including Illinois and Rhode Island, serve children who are at risk based on their state policies, but they do not report this practice to the federal government in the same way as the six states listed above.32

States Use a Variety of Key Funding Streams for EI, Including Medicaid

Per federal law, Part C federal funds allocated to states are supposed to be the “payor of last resort” for EI services, and are meant to supplement state funds for services.33 Federal Part C funds are meant to fund the coordination and administration of existing state EI services.34 The portion awarded to each state is based on the number of children under age 3 in a state as compared to other states, rather than based on the number of children actually served in EI, and therefore, states that serve more children than other states typically must invest more of their own state resources.35

States vary in whether they primarily rely on federal funding, state resources, or local funding to support their EI systems. In a 2021 survey, a total of 32 states (out of 49 that responded) reported that they rely most heavily on their own state resources to sustain their EI programs.36 In the survey, 17 states reported that they rely to some extent on family fees to pay for services (Connecticut’s legislature eliminated family fees through S.B. 2 after the survey, bringing the count to 16 states), whereas most states do not report this practice. If states can leverage sufficient funding from other sources and eliminate the use of family fees, this may help more low-income families to access EI services.37 In the survey, 31 states reported billing private insurance to cover EI services, which can free up public funding to serve children without private coverage. Five states are designated as “birth mandate” states, which means that children with disabilities are guaranteed free public education services from ages 0 to 21, including EI services from ages 0 to 3 for those eligible, and family fees are therefore prohibited.38

One of the most important funding sources for EI services is Medicaid,39 and states vary in the extent to which they take advantage of Medicaid funding to support their EI programs.40 States that have fostered closer partnerships between their Medicaid agencies and Part C programs (Massachusetts, Rhode Island, Connecticut, and South Carolina, among others) have been able to increase the number of children they serve.41 For example, states may cross-reference Medicaid and Part C data to identify children in Part C who are also eligible for Medicaid, to ensure that their EI providers bill Medicaid.42 This practice can free up other funding streams to allow states to serve more children who are not Medicaid-eligible.

States’ efforts to maximize Medicaid are critical because Part C federal funding to the states is based on a state’s overall infant/toddler population, whereas federal Medicaid matching funds are not limited in this way.43 Per the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provision in federal law, Medicaid-enrolled children under age 21 are entitled to any services that are deemed “medically necessary” by a qualified provider, and this may include EI services.44

States Vary in How Their EI Programs Serve Children Affected by Maltreatment

Children involved in the child welfare system have been found to be at increased risk for developmental delays given the effects of physical and psychological maltreatment,45 and the federal Child Abuse Prevention and Treatment Act, or CAPTA (passed in 1974 and amended numerous times since) requires that states develop processes and procedures to refer children who have experienced substantiated abuse or neglect to EI programs.46

States vary in how consistently they make these referrals. Only nine states report that they refer 100% of eligible children who have experienced substantiated maltreatment to Part C agencies, based on 2019 federal data, and almost half of states were not able to report any data on their referrals.47 States have discretion to refer children in substantiated cases directly to an evaluation, or to instead require that child welfare systems do a pre-screening to determine whether an EI evaluation is necessary. In a 2020 survey, only 12 states reported that they refer children directly to an evaluation, without requiring a pre-screening.48

Explore more of the New York Roadmap

  1. Dragoo, K. (2019). The Individuals with Disabilities Education Act (IDEA), Part C: Early Intervention for infants and toddlers with disabilities. Congressional Research Service. https://sgp.fas.org/crs/misc/R43631.pdf
  2. Ullery, M. A. & Katz, L. (2016). Beyond Part C: Reducing middle school special education for Early Intervention children with developmental delays. Exceptionality, 24(1), 1-17. https://doi.org/10.1080/09362835.2014.986601
  3. Shonkoff, J. & Hauser-Cram, P. (1987). Early intervention for disabled infants and their families: A quantitative analysis. Pediatrics, 80(5), 650–658. https://pediatrics.aappublications.org/content/80/5/650 [Early Intervention Evidence Review Study F]
  4. Emerald Consulting. (n.d.). Cost avoidance return on investment. Document provided to the Prenatal-to-3 Policy Impact Center by Maureen Greer, Executive Director at the IDEA Infant & Toddler Coordinators Association, via email on April 1, 2020.
  5. Emerald Consulting. (n.d.). Cost avoidance return on investment. Document provided to the Prenatal-to-3 Policy Impact Center by Maureen Greer, Executive Director at the IDEA Infant & Toddler Coordinators Association, via email on April 1, 2020.
  6. Early Childhood Technical Assistance Center. (2021). Part C Infant and Toddler Program Federal Appropriations and National Child Count 1987-2020. https://ectacenter.org/partc/partcdata.asp#appropriations
  7. IDEA Infant & Toddler Coordinators Association. (2020). Tipping points survey: Demographics and challenges. https://www.ideainfanttoddler.org/pdf/2020-Tipping-Points-Survey.pdf
  8. Point-in-time service percentages. Number of infants and toddlers ages birth through 2 and 3 and older, and percentage of population, receiving early intervention services under IDEA, Part C, by age and state. https://www2.ed.gov/programs/osepidea/618-data/static-tables/2019-2020/part-c/child-count-and-settings/1920-cchildcountandsettings-1.xlsx; Cumulative service percentages: Numerators from US Department of Education, EDFacts Metadata and Process System (EMAPS). (July 8, 2020). IDEA Part C Child Count and Settings Survey, 2019-2020. https://www2.ed.gov/programs/osepidea/618-data/state-level-data-files/part-c-data/child-count-and-settings/cchildcountandsettings2019-20.csv. Denominators from US Census Bureau, Population Division. (2020). Annual state resident population estimates for 6 race groups (5 race alone groups and two or more races) by age, sex, and Hispanic origin: April 1, 2010 to July 1, 2019 – sc-est2019-alldata6.csv [Data Set]. Retrieved June 30, 2020 from https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-detail.html.
  9. Barger, B., Squires, J., Greer, M., Noyes-Grosser, D., Martin, J., Rice, C., Shaw, E., Surprenant, K., Twombly, E., London, S., Zubler, J., & Wolf, R. (2019). State variability in diagnosed conditions for IDEA Part C eligibility. Infants & Young Children, 32(4), 231–244. http://doi.org/1097/IYC.0000000000000151
  10. Part C Child Count and Settings. SY 2019-20 Reporting Year. Data Notes. https://www2.ed.gov/programs/osepidea/618-data/collection-documentation/data-notes/part-c/child-count-and-settings/c-childcountsettings-datanotes-2019-20.pdf
  11. Texans Care for Children. (2020). Supporting Texas infants and toddlers with disabilities during the pandemic. https://static1.squarespace.com/static/5728d34462cd94b84dc567ed/t/5fab103aec781e3dbf1edc63/1605046345289/2020-eci-report.pdf
  12. Casanueva, C., Cross, T., & Ringelsen, H. (2008). Developmental needs and Individualized Family Service Plans among infants and toddlers in the child welfare system. Child Maltreatment, 13(3), 245–258. https://doi.org/10.1177%2F1077559508318397
  13. The Education Trust. (2021). Our youngest learners: Increasing equity in Early Intervention. https://edtrust.org/increasing-equity-in-early-intervention/
  14. Cumulative service percentages: Numerators from US Department of Education, EDFacts Metadata and Process System (EMAPS). (July 8, 2020). IDEA Part C Child Count and Settings Survey, 2019-2020. https://www2.ed.gov/programs/osepidea/618-data/state-level-data-files/part-c-data/child-count-and-settings/cchildcountandsettings2019-20.csv. Denominators from US Census Bureau, Population Division. (2020). Annual state resident population estimates for 6 race groups (5 race alone groups and two or more races) by age, sex, and Hispanic origin: April 1, 2010 to July 1, 2019 – sc-est2019-alldata6.csv [Data Set]. Retrieved June 30, 2020 from https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-detail.html.
  15. Advocates for Children of New York and Citizens’ Committee for Children of New York, Inc. (2019). Early inequities: How underfunding Early Intervention leaves low-income children of color behind. https://cccnewyork.org/data-publications/early-inequities-how-underfunding-early-intervention-leaves-low-income-children-of-color-behind/
  16. Advocates for Children of New York and Citizens’ Committee for Children of New York, Inc. (2019). Early inequities: How underfunding Early Intervention leaves low-income children of color behind. https://cccnewyork.org/data-publications/early-inequities-how-underfunding-early-intervention-leaves-low-income-children-of-color-behind/
  17. Cumulative service percentages: Numerators from US Department of Education, EDFacts Metadata and Process System (EMAPS). (July 8, 2020). IDEA Part C Child Count and Settings Survey, 2019-2020. https://www2.ed.gov/programs/osepidea/618-data/state-level-data-files/part-c-data/child-count-and-settings/cchildcountandsettings2019-20.csv. Denominators from US Census Bureau, Population Division. (2020). Annual state resident population estimates for 6 race groups (5 race alone groups and two or more races) by age, sex, and Hispanic origin: April 1, 2010 to July 1, 2019 – sc-est2019-alldata6.csv [Data Set]. Retrieved June 30, 2020 from https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-detail.html.
  18. Feinberg, E., Silverstein, M., Donahue, S., & Bliss, R. (2011). The impact of race on participation in Part C Early Intervention services. Journal of Developmental & Behavioral Pediatrics, 32, 284–291. https://dx.doi.org/10.1097%2FDBP.0b013e3182142fbd
  19. Barfield, W., Clements, K., Lee, K., Kotelchuck, M., Wilber, N., & Wise, P. (2008). Using linked data to assess patterns of Early Intervention (EI) referral among very low birth weight infants. Maternal and Child Health Journal, 12, 24–33. https://doi.org/10.1007/s10995-007-0227-y
  20. Grant, R. & Isakson, E. (2013). Regional variation in early intervention utilization for children with developmental delay. Journal of Early Intervention, 17, 1252–1259. https://doi.org/10.1007/s10995-012-1119-3
  21. Point-in-time service percentages. Number of infants and toddlers ages birth through 2 and 3 and older, and percentage of population, receiving early intervention services under IDEA, Part C, by age and state. https://www2.ed.gov/programs/osepidea/618-data/static-tables/2019-2020/part-c/child-count-and-settings/1920-cchildcountandsettings-1.xlsx
  22. M. Greer, Executive Director, IDEA Infant & Toddler Coordinators Association, personal communication, May 24, 2021. S. Smith, Co-Director, National Center for Children in Poverty, personal communication, May 18, 2021.
  23. Rauh, V., Achenbach, T., Nurcombe, B., Howell, C., & Teti, D. (1988). Minimizing adverse effects of low birthweight: Four-year results of an early intervention program. Child Development, 59(3), 544–553. https://www.ncbi.nlm.nih.gov/pubmed/2454783 [Early Intervention Evidence Review Study D]
  24. Early Childhood Technical Assistance Center (2021). State and jurisdictional eligibility requirements for infants and toddlers with disabilities under IDEA Part C. https://ectacenter.org/topics/earlyid/state-info.asp; Some state policies confirmed via correspondence with ECTA Center staff and Part C coordinators in June 2021.
  25. Cumulative service percentages: Numerators from US Department of Education, EDFacts Metadata and Process System (EMAPS). (July 8, 2020). IDEA Part C Child Count and Settings Survey, 2019-2020. https://www2.ed.gov/programs/osepidea/618-data/state-level-data-files/part-c-data/child-count-and-settings/cchildcountandsettings2019-20.csv. Denominators from US Census Bureau, Population Division. (2020). Annual state resident population estimates for 6 race groups (5 race alone groups and two or more races) by age, sex, and Hispanic origin: April 1, 2010 to July 1, 2019 – sc-est2019-alldata6.csv [Data Set]. Retrieved June 30, 2020 from https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-detail.html.
  26. Cumulative service percentages: Numerators from US Department of Education, EDFacts Metadata and Process System (EMAPS). (July 8, 2020). IDEA Part C Child Count and Settings Survey, 2019-2020. https://www2.ed.gov/programs/osepidea/618-data/state-level-data-files/part-c-data/child-count-and-settings/cchildcountandsettings2019-20.csv. Denominators from US Census Bureau, Population Division. (2020). Annual state resident population estimates for 6 race groups (5 race alone groups and two or more races) by age, sex, and Hispanic origin: April 1, 2010 to July 1, 2019 – sc-est2019-alldata6.csv [Data Set]. Retrieved June 30, 2020 from https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-detail.html.
  27. Rauh, V., Achenbach, T., Nurcombe, B., Howell, C., & Teti, D. (1988). Minimizing adverse effects of low birthweight: Four-year results of an early intervention program. Child Development, 59(3), 544–553. https://www.ncbi.nlm.nih.gov/pubmed/2454783 [Early Intervention Evidence Review Study D]
  28. Vital Statistics from CDC WONDER 2019 Natality Expanded.
  29. IDEA Infant & Toddler Coordinators Association. (2020). Tipping points survey: Demographics and challenges. https://www.ideainfanttoddler.org/pdf/2020-Tipping-Points-Survey.pdf; J. Kaufman, Rhode Island Part C coordinator, personal communication, August 3, 2021; C. Scott, Colorado EI Director, personal communication, July 13, 2021; S. Evans, New Jersey Part C Coordinator, personal communication, July 13, 2021.
  30. Early Childhood Technical Assistance Center (2021). State and jurisdictional eligibility requirements for infants and toddlers with disabilities under IDEA Part C. https://ectacenter.org/topics/earlyid/state-info.asp. Our Center used the Early Childhood Technical Assistance (ECTA) Center’s state eligibility pages and individual state policy manuals to collect these data, and we corresponded with Part C coordinators and ECTA Center staff in spring and summer 2021 to resolve discrepancies between sources.
  31. Early Childhood Technical Assistance Center (2021). State and jurisdictional eligibility requirements for infants and toddlers with disabilities under IDEA Part C. https://ectacenter.org/topics/earlyid/state-info.asp
  32. K. Berman, Director of Illinois Policy, Start Early, personal communication, August 4, 2021; J. Kaufman, Rhode Island Part C Coordinator, personal communication, August 3, 2021; L. Barrett, Senior Policy Analyst, Rhode Island KIDS COUNT, personal communication, August 3, 2021.
  33. Individuals with Disabilities Education Act. Sec. 303.510 Payor of last resort. https://sites.ed.gov/idea/regs/c/f/303.510
  34. Grant, R. (2005). State strategies to contain costs in the Early Intervention program: Policy and evidence. Topics in Early Childhood Special Education, 25(4), 243–250. https://doi.org/10.1177%2F02711214050250040501
  35. Dragoo, K. (2019). The Individuals with Disabilities Education Act (IDEA), Part C: Early Intervention for infants and toddlers with disabilities. Congressional Research Service. https://fas.org/sgp/crs/misc/R43631.pdf
  36. IDEA Infant & Toddler Coordinators Association. (2021). Funding structure. https://www.ideainfanttoddler.org/pdf/Funding-Structure.pdf; State profiles https://www.ideainfanttoddler.org/state-resources.php; M. Greer, Executive Director, IDEA Infant & Toddler Coordinators Association, personal communication, June 25, 2021. Note: Territories such as American Samoa, Guam, the Northern Marianas, the Virgin Islands, and Puerto Rico also responded to the survey, but are not included in this count. New York and Kansas did not respond, bringing the responses counted here to 49, down from 51 responses (50 states and DC).
  37. Grant, R. (2005). State strategies to contain costs in the Early Intervention program: Policy and evidence. Topics in Early Childhood Special Education, 25(4), 243–250. https://doi.org/10.1177%2F02711214050250040501
  38. Michigan Association of Administrators of Special Education. (May 2014). Comparing early childhood systems: IDEA Early Intervention systems in the birth mandate states. http://maase.pbworks.com/w/file/fetch/96292569/MAASE%20Birth%20Mandate%20States%20Report%20FINAL%2005.20.14.pdf; M. Greer, Executive Director, IDEA Infant & Toddler Coordinators Association, personal communication, June 9, 2021.
  39. Vail, C., Lieberman-Betz, R., & McCorkle, L. (2018). The impact of funding on Part C systems: Is the tail wagging the dog? Journal of Early Intervention, 40(3), 229–245. https://doi.org/10.1177%2F1053815118771388
  40. Smith, S., Ferguson, D., Burak, E. W., Granja, M. R., & Ortuzar, C. (2020). Supporting social-emotional and mental health needs of young children through Part C early intervention: Results of a 50-state survey. National Center for Children in Poverty, Bank Street Graduate School of Education, and the Georgetown University Health Policy Institute’s Center for Children and Families. https://www.nccp.org/wp-content/uploads/2020/11/Part-C-Report-Final.pdf
  41. E. W. Burak, M. Greer, K. Johnson, S. Smith, and E. Shaw, personal communication, July 28, 2021.
  42. Smith, S., Ferguson, D., Burak, E. W., Granja, M. R., & Ortuzar, C. (2020). Supporting social-emotional and mental health needs of young children through Part C early intervention: Results of a 50-state survey. National Center for Children in Poverty, Bank Street Graduate School of Education, and the Georgetown University Health Policy Institute’s Center for Children and Families. https://www.nccp.org/wp-content/uploads/2020/11/Part-C-Report-Final.pdf
  43. IDEA Infant & Toddler Coordinators Association. (2010). Options and considerations when accessing Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) for Part C Services. https://www.ideainfanttoddler.org/pdf/EPSDT_Paper.pdf; IDEA Infant & Toddler Coordinators Association. (2005). Medicaid resource and technical assistance paper. https://www.ideainfanttoddler.org/pdf/Medicaid_Paper05.pdf
  44. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). Medicaid.gov. https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html
  45. Casanueva, C., Cross, T., & Ringelsen, H. (2008). Developmental needs and Individualized Family Service Plans among infants and toddlers in the child welfare system. Child Maltreatment, 13(3), 245–258. https://doi.org/10.1177%2F1077559508318397
  46. US Children’s Bureau. Child Maltreatment (2019). https://www.acf.hhs.gov/cb/report/child-maltreatment-2019. See Table 6-9 on p. 95.
  47. US Children’s Bureau. Child Maltreatment (2019). https://www.acf.hhs.gov/cb/report/child-maltreatment-2019. See Table 6-9 on p. 95.
  48. Smith, S., Ferguson, D., Burak, E. W., Granja, M. R., & Ortuzar, C. (2020). Supporting social-emotional and mental health needs of young children through Part C early intervention: Results of a 50-state survey. National Center for Children in Poverty, Bank Street Graduate School of Education, and the Georgetown University Health Policy Institute’s Center for Children and Families. https://www.nccp.org/wp-content/uploads/2020/11/Part-C-Report-Final.pdf