Disparities in Early Intervention service access for drug exposed infants with positive toxicology screens at birth in Massachusetts

Background: Federal law requires drug-exposed infants (DEI) to be referred to Part C Early Intervention (EI) services to support healthy development, yet there are no studies examining DEI referral to EI. This study examined how positive toxicology screens on the birth certificate, maternal sociodemographic characteristics, and institutional characteristics relate to EI referral of DEI in Massachusetts. Methods: This was a retrospective cohort study of 7,290 in-state hospital livebirths among 624,269 livebirths to Massachusetts residents from 1998-2005 who were identified using the Drug Exposed Infant Identification Algorithm, and who survived the neonatal period (28 days). Data came from a longitudinal, population-based data system, using linkages between birth certificates, maternal and child hospital records, and EI data. Adjusted odds of referral associated with sociodemographic, institutional (public insurance, hospital maternity level of care, status at birth hospital discharge), and clinical characteristics (e.g., positive toxicology screen, low birthweight) were calculated using generalized estimation equation models to account for family clustering. Results: Positive toxicology screens at birth (OR 1.4) and public insurance (OR 2.3) were associated with an increased odds of referral. There was a significant interaction between insurance and toxicology screens; 75% of publicly insured infants with a positive screen were referred, compared with only 36% of privately insured DEI with positive screens. Discussion: DEI should be referred to EI regardless of their other characteristics, but especially if they have a positive toxicology screen at birth. Referral differences based on insurance type indicate disparities in service access for DEI with private insurance.