New Report Details Inequality in State’s Early Intervention Program

According to a new report CCC has co-written with Advocates for Children of New York, inadequate funding from New York State has caused major racial and socio-economic disparities in access to Early Intervention services.

Early Intervention provides evaluations and services children under age three with developmental delays and disabilities and their families, providing speech therapy, physical therapy, and other critical services.

The report, titled “Early Inequities: How Underfunding Early Intervention Leaves Low-Income Children of Color Behind”, found disparities in access to Early Intervention evaluations and services vary by borough, neighborhood demographics, and race.

History of the program

When New York State’s Early Intervention program was launched in 1992, it was praised as a model for the rest of the country

However, over the past two decades, inadequate State investment has put children’s access to the program at risk. After years of stagnant payment rates and multiple cuts imposed by the State, agencies in New York City and around the State have closed their EI programs.

Even after Gov. Andrew Cuomo provided a modest rate increase in the 2019-2020 fiscal year for occupational therapists, physical therapists, and speech-language pathologists, payment rates for EI providers are still lower than they were in the 1990s.

Impact of the Cuts

To check out additional maps, graphs, data, interviews with families, and more, download the full report here.

A growing number of families are being told their children will have to wait for services because no providers are available.

In 2018, 1 out of every 4 children found eligible for EI services in New York State did not receive services in the legally required time frame, losing valuable opportunities to address their developmental delays.

In the Bronx, for instance, 61% of children found eligible for EI services received them by the 30-day legal deadline — less than in any other borough.

Children Are “Dropping Off” Before Receiving Services

Our analysis examined the data tracking children’s progress through the EI program — from referral, to evaluation, to eligibility determination, to receiving services.

Typical progression through the Early Intervention program:

Our analysis found:

• The neighborhoods where children referred for EI evaluations are least likely to receive evaluations are consistently low-income communities of color.
• The neighborhoods where children found eligible for EI services are least likely to receive those services are primarily low-income communities of color.
• Even in neighborhoods where higher rates of eligible children receive services, there are significant racial disparities, with Black children being less likely to receive services than White children.

Dropoff Point No. 1: Referral to Evaluation

On average across New York City, the citywide dropoff rate between referral and evaluation is 11.9%.

However, this average fluctuates significantly depending on race.

The neighborhoods where children who are referred for EI evaluations are least likely to receive evaluations are consistently low-income communities of color. Over the course of three years, the largest average drop-off rates between referral and evaluation were in:

1. Hunts Point-Mott Haven, Bronx (average 19.3% decline)
2. Crotona-Tremont, Bronx (average 19.3% decline)
3. Central Harlem-Morningside Heights, Manhattan (average 18.9% decline);
4. High Bridge-Morrisania, Bronx (average 18.6% decline)
5. East Harlem, Manhattan (average 18.0% decline).

Drop-Off Point #2: Eligibility to Service Receipt

The average citywide drop-off rate between evaluation and receiving services is 5.4%.

Again, this average fluctuates based on race.

The neighborhoods with the lowest percentages of EI-eligible children receiving any services are primarily—though not exclusively—low-income communities of color. Between 2016 and 2018, the neighborhoods with the largest average drop-offs from eligibility determination to service receipt were:

1. Central Harlem-Morningside Heights, Manhattan (average 8.3% decline);
2. High Bridge-Morrisania, Bronx (average 7.9% decline)
3. Downtown Brooklyn-Park Slope (average 7.2% decline);
4. Southwest Queens (average 7.2% decline);
5. Bedford Stuyvesant-Crown Heights, Brooklyn (average 7.1% decline).

What Can New York State and City Do

Our report outlines several steps State and City leaders can take to address these disparites.

New York State should:

1. Increase rates for EI evaluators, service providers, and service coordinators by ten percent in the New York State Fiscal Year 2020-2021 budget to help address provider shortages and ensure all young children who need evaluations and services can access them regardless of neighborhood, socioeconomic status, or race.
2. Fund a cost-study to assess and recommend changes to the methodology used to determine payment for EI evaluations, service provision, and service coordination to help address capacity challenges in low-income and underserved communities.
3. Adopt policies to ensure that commercial health insurance companies pay their fair share to help cover the cost of EI services.
4. Conduct a statewide analysis of disparities in access to evaluations and services and develop a plan to address such disparities.

New York City should:

1. Enact Intro. 1406-2019, requiring the City to issue annual public reports on the provision of EI evaluations and services so the public can hold the City and State accountable for addressing disparities and ensuring children receive their mandated services.
2. Analyze the disparities in access to EI evaluations and services and develop a plan to address such disparities, including plans to recruit evaluators and providers for underserved neighborhoods, train service coordinators and providers in culturally responsive practices, and follow up with families whose children have not received evaluations or services.