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UNITED STATES

ROADMAP POLICIES AND STRATEGIES

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EFFECTIVE STRATEGIES

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EARLY INTERVENTION SERVICES

WHAT ARE EARLY INTERVENTION SERVICES AND WHY ARE THEY IMPORTANT?

Part C of the federal 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 the Roadmap 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 alone3 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 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 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

Children from lower-income families and communities of color do not have equitable access to EI services. The most recent national data show that 6% of Black children ages birth to 3 are served in EI over the course of a year, compared to 7.1% of White children.12 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.13 A study of low birthweight infants found significantly lower EI referral rates for infants of Black non-Hispanic mothers than all other racial groups.14 These inequities in EI access may contribute to disparities in children’s later outcomes.

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.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. Other evidence suggests positive outcomes for parental health and wellbeing, such as maternal self-confidence and role satisfaction.

More Research Is Needed to Determine the Potential of Early Intervention Services to Decrease Racial and Ethnic Disparities

Children from families with lower incomes and communities of color do not have equitable access to Early Intervention services and often experience disruptions and roadblocks from referral to evaluation and enrollment. Rigorous evidence suggests children with mothers who have more education or families with higher incomes benefit more from Early Intervention services.16,17 Additionally, Black or Hispanic children in one study did not improve cognitive scores as much as children who identified as White, Asian, or Other.18 

The reasons for these disparities should continue to be studied and rectified to ensure all infants and toddlers can benefit and reach their developmental potential, regardless of race, ethnicity, or socioeconomic status. 

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.

WHAT ARE THE KEY POLICY LEVERS TO SUPPORT EARLY INTERVENTION SERVICES?

In contrast to the evidence for the four 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 the children who need the services.

We identified three key policy levers that states can implement to support Early Intervention services. The policy levers include:

  • Include very low birthweight in the state’s diagnosable or at-risk eligibility criteria,
  • Allow at-risk for delay as a qualifier for EI services, and
  • Eliminate family fees for children receiving EI services.

Each policy lever and the variation in state implementation is discussed in greater detail below.

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. 

As of June 2021, a total of 15 states report broad criteria, 22 report moderately inclusive criteria, and 14 report narrow criteria. However, within each of these self-declared categories, the specific thresholds and requirements vary.

Key Policy Lever: Very Low Birthweight as a Diagnosable or At-Risk Qualifying Condition

In addition to thresholds for 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). No state includes low birthweight (defined as <2,500 grams or approximately 5 pounds, 8 ounces) as a diagnosable or at-risk eligibility criteria.

However, a total of 18 states qualify children born very low birthweight for EI (defined as of <1,500 grams, or approximately 3 pounds and 5 ounces). States may also define very low birthweight differently or require extremely low birthweight (defined as <1,000 grams) to qualify for services.

23 states qualify children born premature (often requiring very preterm or extremely preterm birth, born earlier than 32 or 28 weeks, respectively). However, some states with high rates of low birthweight or prematurity do not include these conditions as part of their EI eligibility policies.

Key Policy Lever: Serving At-Risk Children Under Federal Part C Policies

Beyond eligibility for diagnosed developmental delays, allowing children to qualify based on a set of biological, environmental, or social risk factors is important for serving the youngest infants, who may not show developmental delays until later. Six states (California, Florida, Massachusetts, New Hampshire, New Mexico, 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. 

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 birth-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 may serve children who are at-risk based on their state policies, but the states may not report this practice to the federal government in the same way as the six states listed above.19

States Can Use a Variety of Funding Streams to Support EI

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.

The portion of federal Part C funds 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 or in need of EI services, and therefore, states that serve more children than other states typically must invest more of their own state resources.22

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.

States vary in whether they primarily rely on federal funding, state resources, or local funding to support their EI systems. In a 2023 survey, a total of 33 states reported that they rely most heavily on their own state resources to sustain their EI programs; 15 states reported relying most heavily on federal funds, and 3 reported local funding as their primary funding source.20

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 (Iowa, Maryland, Michigan, Minnesota, and Nebraska) 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 birth to age 3 for those eligible, and family fees are therefore prohibited.21

Key Policy Lever: Eliminating Family Fees

In addition to federal, state, and local funding sources, states may rely on cost-sharing measures, such as assessing family fees, often on a sliding scale.22 Research has shown that implementing family fees for EI services may reduce children with low incomes’ participation in the program, even when sliding scales would preclude them from out-of-pocket costs, because parents may not be aware of the financial assistance available to them and may be deterred from pursuing services.23

In the 2023 survey, 17 states reported that they rely to some extent on family fees to pay for services, whereas most states do not report this practice. Including the birth mandate states, 34 states report eliminating family fees. 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.24

Maximizing Medicaid Funding Is a Cost-Effective Approach to Serve More Children

One of the most important funding sources for EI services is Medicaid,25 and states vary in the extent to which they take advantage of Medicaid funding to support their EI programs.26 States that have fostered closer partnerships between their Medicaid agencies and Part C programs have been able to increase the number of children they serve.27 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.28 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.29 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.30

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.

Children involved in the child welfare system have been found to be at an increased risk for developmental delays given the effects of physical and psychological maltreatment.31 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.32

States vary in how consistently they make these referrals. Only seven states report that they refer 100% of eligible children who have experienced substantiated maltreatment to Part C agencies, based on 2021 federal data, and half of states were not able to report any data on their referrals.33 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.34

For more information on the state policy levers that help maximize the effectiveness of Early Intervention programs see our State Policy Lever Checklists.

HOW DOES ACCESS TO EARLY INTERVENTION SERVICES VARY ACROSS STATES?

State EI programs vary considerably in the percentage of children under age 3 who are served, which is impacted by policy choices regarding 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 that allow 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.

Available state data show the percentage of children who are served in EI out of all infants and toddlers ages birth to 3, but the data 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%.35

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

Recent national data show that, in the median state, 6.4% of children 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 nearly 21% in Massachusetts. Ten states serve 10% or more of infants and toddlers in EI services, and 11 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 less than 2% (Arkansas, Mississippi, and Oklahoma) to 10.0% (Massachusetts) of their birth-to-3 population on any given day. We use the cumulative, rather than point-in-time data in this Roadmap based on recommendations from national experts in Early Intervention.36 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 can serve as a proxy for different levels of need across states, because research shows that low birthweight is a risk factor for the kinds of delays and disabilities that may improve if children receive EI services.37 Comparing the rate of babies born low birthweight overall and by race and ethnicity in a state to the share of children served in EI can highlight states’ progress in serving children in need and doing so equitably.

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

Most states require very low birthweight (less than 1,500 grams), or extremely low birthweight (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 if access to EI services was equitable, a relatively higher percentage of Black children should receive EI services compared to their White or Hispanic counterparts. Yet, a smaller percentage of Black children actually receive EI services. Nationally, only 6.2% of Black children ages birth to 3 are served in EI over the course of a year, compared to 7.3% of White children. Hispanic children are served at a rate of 7.2%, and children classified as “Other” for race/ethnicity are served at a rate of 5.6%.

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 California, which enacted legislation to require infants and toddlers eligible for EI services be assessed at least 90 days before age 3 and to suspend fees until June 30, 2024. The same legislation also requires the translation and provision of materials in the participant family’s native language in an effort to remove language barriers to service. Similarly, Connecticut enacted legislation to require individualized family service plans and EI services be translated and provided in Spanish, effective July 1, 2023.

Several states took steps to increase connections to EI services for additional populations. West Virginia enacted legislation to establish eligibility for adopted children for Birth to Three EI services, effective January 1, 2024. Wyoming enacted legislation to establish a plan of safe care for infants born with substance use withdrawal and ensure that appropriate referrals are made for the infant and affected family members or caregivers upon discharge from the hospital, including a referral to a local early intervention and education programs. Maine enacted legislation to establish a pilot program to deliver the services provided by the Child Development Services System for children birth to age 6, ensuring the provision of birth-to-3 early intervention services for eligible children, among other services (applications for the pilot program will be requested by June 1, 2024).

Mississippi enacted legislation which establishes a task force to develop recommendations on reforming the current early intervention system and laws in the state, with a goal of increasing access to services for children from birth to age 3 through the First Steps Early Intervention Program. The task force must submit a report that proposes legislation and rule changes based upon its recommendation by December 1, 2023. Oregon enacted legislation to create the Child Care Infrastructure Fund within the Oregon Business Development Department to provide grants and financial assistance for activities that promote increased early learning and care capacity across the state, including programs that provide early intervention services.

Unsuccessful legislation was also introduced in several other states to expand access to EI services and provide workforce supports to those providing EI services. For example, Rhode Island legislators introduced bills to provide wage supplements to bring compensation for Part C professionals in line with similarly qualified K-12 professionals. The state also proposed legislation to address its EI staffing crisis and reduce the number of infants and toddlers on waitlists for services by offering tax credits to applicants who are employed by EI agencies, such as speech language pathologists, occupational therapists, physical therapists, or other qualified professions. Ultimately, none of the introduced bills advanced before Rhode Island’s legislative session ended.

  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/10.1080/09362835.2014.98660
  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. US Department of Education. (July 6, 2022). Number of infants and toddlers and percentage of population, receiving early intervention services under IDEA, Part C, by age and state: 2021 [Data Set]. Retrieved on June 1, 2023 from https://data.ed.gov/dataset/idea-section-618-data-products-static-tables-part-c; Cumulative service percentages: Numerators from US Department of Education. (July 6, 2022). Cumulative number of infants and toddlers ages birth through 2 receiving early intervention services under IDEA, Part C, by race/ethnicity and state: 2021 [Data Set]. Retrieved on June 1, 2023 from https://data.ed.gov/dataset/idea-section-618-data-products-static-tables-part-C
    Denominators from US Census Bureau, Population Division. (2022). 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, 2020 to July 1, 2021 – scest2021-alldata6.csv [Data Set]. Retrieved August 31, 2022 from https://www.census.gov/data/tables/timeseries/demo/popest/2020s-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/10.1097/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. Numerators from US Department of Education. (July 6, 2022). Cumulative number of infants and toddlers ages birth through 2 receiving early intervention services under IDEA, Part C, by race/ethnicity and state: 2021 [Data Set]. Retrieved on June 1, 2023 from https://data.ed.gov/dataset/idea-section-618-data-products-static-tables-part-c
    Denominators from US Census Bureau, Population Division. (2022). 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, 2020 to July 1, 2021 – scest2021-alldata6.csv [Data Set]. Retrieved August 31, 2022 from https://www.census.gov/data/tables/timeseries/demo/popest/2020s-state-detail.html.
  13. 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-lowincome-children-of-color-behind/
  14. 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/
  15. 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
  16. Teti, D., Black, M., Viscardi, R., Glass, P., O’Connell, M., Baker, L., Cusson, R., & Reiner Hess, C. (2009). Intervention with African American premature infants: Four-month results of an Early Intervention program. Journal of Early Intervention, 31(2), 146–166. https://doi.org/10.1177%2F1053815109331864 [Early Intervention Evidence Review Study B]
  17. Ramey, C., Bryant, D., Wasik, B., Sparling, J., Fendt, K., & LaVange, L. (1992). Infant Health and Development Program for low birth weight, premature infants: Program elements, family participation, and child intelligence. Pediatrics, 3, 454–465. https://pediatrics.aappublications.org/content/89/3/454.long [Early Intervention Evidence Review Study C]
  18. Ramey, C., Bryant, D., Wasik, B., Sparling, J., Fendt, K., & LaVange, L. (1992). Infant Health and Development Program for low birth weight, premature infants: Program elements, family participation, and child intelligence. Pediatrics, 3, 454–465. https://pediatrics.aappublications.org/content/89/3/454.long [Early Intervention Evidence Review Study C]
  19. 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.
  20. IDEA Infant & Toddler Coordinators Association. (2023). Funding structure. Retrieved on August 5, 2023, from https://www.ideainfanttoddler.org/pdf/Funding-Structure.pdf
  21. IDEA Infant & Toddler Coordinators Association. (2023). Funding structure. Retrieved on August 5, 2023, from https://www.ideainfanttoddler.org/pdf/Funding-Structure.pdf
  22. 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
  23. 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
  24. IDEA Infant & Toddler Coordinators Association. (2023). Funding structure. Retrieved on August 5, 2023, from https://www.ideainfanttoddler.org/pdf/Funding-Structure.pdf
  25. 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
  26. 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
  27. IDEA Infant & Toddler Coordinators Association. (2023). Funding structure. Retrieved on August 5, 2023, from https://www.ideainfanttoddler.org/pdf/Funding-Structure.pdf
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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
  33. US Children’s Bureau. Child Maltreatment (2021). https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2021.pdf
  34. 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
  35. 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
  36. 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.
  37. 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]
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Peabody College of Education & Human Development

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