Impact of physicians' referral procedures on rates of initial contact with early intervention

Objective:

To determine whether physicians' referral procedures influence the likelihood that children with suspected speech/language delay will make initial contact with early intervention programs.

Background:

Research demonstrates that children with speech/language delays have improved outcomes when early intervention services are received during their early developmental stages. Little is known, however, about whether referral procedures are related to the likelihood of initial program contact.

Methods:

874 children ages 0-35 months were referred to the early intervention program in Baltimore, Maryland between 1/1/05 and 12/31/06 based on physicians' concern about speech/language development. Rates of initial contact were compared using chi-square analyses.

Results:

In 25% of cases, physicians placed referrals directly as opposed to recommending that referrals be placed by others, such as the child's parent. Children directly referred by physicians were slightly younger at the time of referral (23.0 vs. 24.3 months, respectively, p<0.01). Contrary to expectations, however, children failed to make initial contact with the early intervention program more than twice as often when physicians directly placed the referral, compared with recommending that the referral be placed by others (30.6% vs. 14.9% respectively, p<0.001). Children who made initial contact with the early intervention program were equally likely to be eligible for services whether referrals were made directly by a physician or merely recommended (55.2% vs. 58.7%, p=0.43).

Conclusions:

Children are less likely to make initial contact with early intervention programs if physicians directly place the referral. Further investigation is required to explore the reasons behind this unexpected finding.