March 29, 2021
“He finally said mama!” Sam’s mom sat across from his pediatrician in the exam room beaming with pride and relief. It had been eight months since the difficult discussion about her son’s probable diagnosis of autism and six months since he started receiving therapies through the state’s Early Intervention program. Sam’s progress was slow but steady, and with the patience and commitment of his therapists, in partnership with his mother, he had started to express himself with a few words.As pediatricians, we regularly refer our patients to Early Intervention, an evidence-based program that provides evaluations and services to children under age three with developmental delays or disabilities. The program has been shown to dramatically improve functional outcomes of infants with delay or disability, and interventions occurring in early childhood allow high risk children to catch up to peers and achieve their highest developmental potential.
However, as pediatricians in one of New York City’s most underserved communities, we see first-hand how frustratingly difficult the referral process can be for our patients and their families because of long existing inequities within the Early Intervention system. For every few Sams we encounter, there is another child who is referred into the system and never connected to therapies. Citywide, between 2016 and 2018, only 70.9 percent of children, on average, received Early Intervention services within 30 days of their initial service plan meeting, as is required by law. This rate is even lower in low-income communities such as the Bronx, where only 61 percent of children received services on time.
Data consistently shows that children living in the low-income communities of color that we serve are less likely than their white peers to receive Early Intervention evaluations following referral. Nearly one in five children referred in these communities never receive their evaluation. And children of color who are able to receive an evaluation and deemed eligible are still less likely than their white peers to actually receive services. Without additional resources, the Early Intervention system will continue to reinforce disparities rather than level the playing field for at-risk children.
The COVID-19 pandemic has only worsened access problems for at-risk infants and toddlers. During the height of the pandemic, there was an 82 percent decline in Early Intervention referrals compared to prior years, meaning that an estimated 3,000-6,000 young children in New York City with potential disabilities were never even assessed. Families have been unable to receive in-person therapies during the pandemic, and many families lack the technology needed for virtual therapies. The result is that thousands of children in New York City are missing out on the therapy they urgently need for future success.
Even though the need is greater than ever, Gov. Andrew Cuomo’s budget proposes cutting funding to Early Intervention services. These resources should be enhanced and expanded, not cut.
In addition, we believe the state must ensure that insurance companies pay their fair share into the system. Currently, commercial insurance plans reimburse a shockingly low 15 cents on the dollar for Early Intervention services. By holding insurers responsible for paying their fair share, more Early Intervention providers will be drawn to this system that so desperately needs them.
Fortunately, the Senate and Assembly are fighting for a version of the budget that rejects cuts to Early Intervention and makes sure commercial insurers are contributing more to these services. We need to fight for a budget that protects and expands services for young children with developmental delays and disabilities.
As pediatricians, we are acutely aware that Early Intervention changes the trajectory of a child’s life, but we have a finite time to intervene. There is no time to waste – patients like Sam need therapies and they need them now. Investing in children’s development is investing in our future.
Shyam Desai, Morgan Finkel, Casey Mason, and Erica McArthur are pediatricians in Upper Manhattan in New York City.