Racial disparities in how children with and without established qualifying conditions participate in Part C early intervention services for young children

Many children with developmental delays, particularly Black children, fail to receive early intervention (EI) services. We analyzed data from over 1,000 participants in the nationally representative Early Child Longitudinal Study, Birth Cohort to determine how the child's qualifying condition contributes to racial disparities in receipt of EI services. Birth weight <1000 grams, a medical condition associated with developmental delay, or low scores on a standardized measure of developmental performance were used to define EI eligibility. Receipt of services was ascertained from parental self-report. Reflecting distinct pathways into EI, qualifying condition was dichotomized as established conditions (low birthweight/genetic conditions), which are easily recognized, versus developmental delay alone, which is identified only through active screening/surveillance. We estimated multivariate logistic regression models to discern the relationship between race and qualifying condition with respect to EI service receipt at ages 9 and 24 months. Race was a predictor of service receipt at 24 but not 9 months. Black children were less likely to receive services than Whites (aOR 0.18; 95% CI 0.07-0.51). There was no evidence of confounding by qualifying condition. At 24 months, qualifying condition significantly modified the relationship between race and service receipt. In adjusted models, similar proportions (almost 1 of 4) of Black and White children qualifying for EI services based on established conditions received services. Among children qualifying for services based on developmental delay alone, 1 of 4 Whites versus 1 of 100 Blacks received services. Future research should explore how parental and provider behaviors may contribute to this disparity.