Missed Opportunities in the Referral of High-Risk Infants to Early Intervention

Abstract

OBJECTIVE: Using a statewide population-based data source, we describe current neonatal follow-up referral practices for high-risk infants with developmental delays throughout California. METHODS: From a cohort analysis of quality improvement data from 66 neonatal follow-up programs in the California Children’s Services and California Perinatal Quality Care Collaborative High-Risk Infant Follow-Up Quality of Care Initiative, 5129 high-risk infants were evaluated at the first visit between 4 and 8 months of age in neonatal follow-up. A total of 1737 high-risk infants were evaluated at the second visit between 12 and 16 months of age. We calculated referral rates in relation to developmental status (high versus low concern) based on standardized developmental testing or screening. RESULTS: Among infants with low concerns (standard score >70 or passed screen) at the first visit, 6% were referred to early intervention; among infants with high concerns, 28% of infants were referred to early intervention. Even after including referrals to other (private) therapies, 34% infants with high concerns did not receive any referrals. These rates were similar for the second visit. CONCLUSIONS: In spite of the specialization of neonatal follow-up programs to identify high-risk infants with developmental delays, a large proportion of potentially eligible infants were not referred to early intervention.

Predictors of Language Outcome for Children Born Preterm: Implications for Early Intervention

“…Several of the families that we have seen have expressed concern about their child's language development, suspecting a delay, and yet a significant number of these families have not pursued or received language intervention. This is not an isolated occurrence as other researchers have reported the lack of referral for children born preterm [4].…”

Programmatic and Administrative Barriers to High-Risk Infant Follow-Up Care

“…Additional details regarding the organizational structure of this statewide network of HRIF programs are described in previous studies. 15,16…”

Quality of neonatal healthcare in Kilimanjaro region, northeast Tanzania: learning from mothers' experiences

“…However, in developing countries social-demographic factors of mothers, including area of residence, husbands’ age, maternal height, ethnicity, education, occupation, and cultural barriers have all been shown to affect neonatal health [9,29]. Additionally, there are some delays in receiving health care that influence mothers to have poor neonatal outcomes [30]. These delays include mothers’ failure to recognize problems, delaying a decision to seek care, and delaying to reach a health facility due to lack of transportation funding or distance [31].…”