Early Intervention Enrollment Among Substance-exposed Infants in Massachusetts: A Population-level Analysis.
Elizabeth Peacock-Chambers, Katie Q Gu, Emma Miller and 7 others
Substance-exposed infants in Massachusetts were referred to early intervention at high rates, but only 49.5% of those referred enrolled.
The gap was widest for infants without a NAS diagnosis, where 38.2% of referred children enrolled.
Key findings
1Among 6,565 substance-exposed newborns in Massachusetts, 85.3% (5,602) were referred to early intervention, but only 49.5% (2,775) of those referred enrolled.
2Infants with a NAS diagnosis were more likely to be referred (87.6% vs 79.0%) and to enroll (53.2% vs 38.2% of referred) than substance-exposed infants without NAS.
3Referral rates were higher for substance-exposed infants (85.3%) than for those without substance exposure (34.6%), but enrollment among those referred was lower (49.5% vs 56.7%).
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What it does not show
Substance exposure was identified by ICD-9/10 codes from birth hospitalization records, which may miss nonopioid drug exposures or misclassify the type of exposure. The study could not determine whether non-enrolled infants received developmental services outside the EI system, so the true service gap may be smaller than reported. Eligibility determinations made by individual EI programs were not captured in the dataset, so it is unclear how many referred families were found ineligible versus how many simply did not follow through. The study period (2013–2020) includes the COVID-19 pandemic, during which referral and enrollment patterns may have been disrupted. Findings are specific to Massachusetts, which has more inclusive EI eligibility criteria than many states, and cannot be generalised to other states or to national practice. Referral source (who made the referral) was not available, limiting understanding of why some families were referred and others were not.
Declared interests
The authors declare no conflict of interest.
The easy way to misread this
Do not read the 85.3% referral rate as evidence that most substance-exposed infants are receiving early intervention. Only 49.5% of those referred enrolled, and for infants without a NAS diagnosis the enrollment rate was 38.2%. A referral on a database is not a child in a therapy room.
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