Tag: intervention

  • Belonging Intervention Improves Pass Rates

    Belonging Intervention Improves Pass Rates

    Sense of belonging is a significant predictor of student retention and completion in higher education; students who believe they belong are more likely to bounce back from obstacles, take advantage of campus resources and remain enrolled.

    For community colleges, instilling a sense of belonging among students can be challenging, since students often juggle competing priorities, including working full-time, taking care of family members and commuting to and from campus.

    To help improve retention rates, the California Community Colleges replicated a belonging intervention developed at Indiana University’s Equity Accelerator and the College Transition Collaborative.

    Data showed the intervention not only increased students’ academic outcomes, but it also helped close some equity gaps for low-income students and those from historically marginalized backgrounds.

    What’s the need: Community college students are less involved on campus than their four-year peers; they’re also less likely to say they’re aware of or have used campus resources, according to survey data from Inside Higher Ed.

    This isolation isn’t desired; a recent survey by the ed-tech group EAB found that 42 percent of community college students said their social life was a top disappointment. A similar number said they were disappointed they didn’t make friends or meet new people.

    Methodology

    Six colleges in the California Community Colleges system participated in the study, for a total of 1,160 students—578 in the belonging program and 582 in a control group. Students completed the program during the summer or at the start of the term and then filled out a survey at the end.

    Moorpark Community College elected to deliver the belonging intervention during first-semester math and English courses to ensure all students could benefit.

    How it works: The Social Belonging for College Students intervention has three components:

    1. First, students analyze survey data from peers at their college, which shows that many others also worry about their academic success, experience loneliness or face additional challenges, to help normalize anxieties about college.
    2. Then, students read testimonies from other students about their initial concerns starting college and how they overcame the challenges.
    3. Finally, students write reflections of their own transition to college and offer advice to future students about how to overcome these concerns or reassure them that these feelings are normal.

    The goal of the exercise is to achieve a psychological outcome called “saying is believing,” said Oleg Bespalov, dean of institutional effectiveness and marketing at Moorpark Community College, part of the Ventura Community College District in California.

    “If you’ve ever worked in sales, like, say I worked at Toyota. I might not like Toyota; I just really need a job,” Bespalov said. “But the more I sell the Toyota, the more I come to believe that Toyota is a great car.” In the same way, while a student might not think they can succeed in college, expressing that belief to someone else can change their behaviors.

    Without the intervention, students tend to spiral, seeing a poor grade as a reflection of themselves and their capabilities. They may believe they’re the only ones who are struggling, Bespalov said. Following the intervention, students are more likely to embrace the idea that everyone fails sometimes and that they can rebound from the experience.

    At Moorpark, the Social Belonging for College Students intervention is paired with teaching on the growth mindset, explained Tracy Tennenhouse, English instructor and writing center co-coordinator.

    “Belonging is a mindset,” Bespalov said. “You have to believe that you belong here, and you have to convince the student to change their mindset about that.”

    The results: Students who participated in the belonging program were more likely to re-enroll for the next term, compared to their peers in the control group. This was especially true for students with high financial need or those from racial minorities.

    In the control group, there was a 14-percentage-point gap between low- and high-income students’ probability of re-enrolling. After the intervention, the re-enrollment gap dropped to six percentage points.

    Similarly, low-income students who participated in the intervention had a GPA that was 0.21 points higher than their peers who did not. Black students who participated in the exercise saw average gains of 0.46 points in their weighted GPA.

    To researchers, the results suggest that students from underrepresented backgrounds had more positive experiences at the end of the fall term if they completed the belonging activity. Intervention participants from these groups also reported fewer identity-related concerns and better mental and physical health, compared to their peers who didn’t participate.

    What’s next: Based on the positive findings, Moorpark campus leaders plan to continue delivering the intervention in future semesters. Tennenhouse sees an opportunity to utilize the reflection as a handwritten writing sample for English courses, making the assignment both a line of defense against AI plagiarism and an effective measure for promoting student belonging.

    Administrators have also considered delivering the intervention during summer bridge programs to support students earlier in their transition, or as a required assignment for online learners who do not meet synchronously.

    In addition, Tennenhouse would like to see more faculty share their own failure stories. Research shows students are more likely to feel connected to instructors who open up about their own lives with students.

    How does your college campus encourage feelings of belonging in the classroom? Tell us more here.

    Source link

  • Philadelphia Kids Face Delays Accessing Early Intervention Services – The 74

    Philadelphia Kids Face Delays Accessing Early Intervention Services – The 74


    Join our zero2eight Substack community for more discussion about the latest news in early care and education. Sign up now.

    When Kimberly Halevy’s son Joshua was 3, she started hearing from his preschool that he was acting out. He rarely participated in circle time and had trouble playing with other kids.

    Halevy’s friend had recently opened the preschool, and she liked that someone she knew took care of her son. But eventually, the preschool said it would only allow him back if he had a 1-to-1 aide to address his “disruptive” behavior, Halevy said.

    At first, Halevy thought getting him that aide would be straightforward. But she now describes the effort to get her kid support through Philadelphia’s federally mandated, publicly funded early intervention system as exhausting.

    Though state evaluators found Joshua should receive multiple forms of therapy each week, it took months for any services to begin, Halevy said. Then, once providers contacted her, she said it became a “guessing game” whether her son would receive the home-based occupational therapy and specialized instruction he qualified for every week.

    “I kept being mad at myself for not pushing,” Halevy said. “But now I realize that it’s just the program.”

    Across Philadelphia, young kids like Joshua are waiting months and sometimes years for early intervention services that they are legally entitled to, according to families, therapy providers, and advocates Chalkbeat spoke with.

    Federal law states a child must receive services as soon as possible after an evaluation team completes their Individualized Education Program, or IEP. Pennsylvania has interpreted that to mean 14 days. But one provider said the list she can access of children waiting for speech therapy — one of several early intervention services — is sometimes more than 2,000 families long.

    Early intervention providers are under strain nationwide, with not enough funding or staffing to meet the need. But in Philadelphia — home to 16% of the state’s early intervention population — one player is largely responsible for the system: a 170-year-old nonprofit called Elwyn that the state pays to manage the publicly funded program.

    As Philly’s early intervention system struggles to meet the needs of all kids, some providers and advocates say neither Elwyn nor the state officials who oversee the program are doing enough to ensure kids get services on time.

    In response to Chalkbeat’s questions, Elwyn President and CEO Charles McLister said Elwyn does not comment on specific cases, but the organization works quickly to assess children and provide them with services. “For the vast majority of cases, services are provided within the defined window,” said McLister.

    But McLister acknowledged that there can be delays due to family communication, transportation, scheduling, provider availability, and severe staffing shortages across the sector.

    Erin James, press secretary at the Pennsylvania Department of Education, said in a statement that the department stays in close contact with Elwyn throughout the year “to remind them of their legal obligations.”

    James did not respond to questions about service delays for Philadelphia families. But she said that early intervention programs often lack resources. “Current funding levels for EI [early intervention] services are not sufficient because the population of students who qualify for EI services has been increasing for years,” James said.

    In Philadelphia, the program’s delays are a key reason many of the city’s most vulnerable kids fall behind before they even start kindergarten, advocates say. Data from early intervention program reports the state publishes shows Philly children in early intervention programs lag behind their peers elsewhere in key growth areas, like developing social emotional skills.

    “The whole idea of having to wait more than the required time is really putting kids at a disadvantage,” said Inella Ray, director of parent advocacy and engagement at the advocacy organization Children First. “Because when kids don’t have the support that they need, in today’s current education or environment, they get pushed out.”

    Parents face delays accessing early intervention services

    Early intervention is part of the landmark Individuals with Disabilities Education Act, which dictates that all children with disabilities must have access to a free and appropriate public education. Though each state creates and manages its own program, all kids through age 5 who are identified as having a developmental delay or disability are eligible.

    In Pennsylvania, the Department of Education oversees local early intervention programs for preschool-age kids. In almost every county, families get connected with services through an intermediary unit, a kind of regional education service agency.

    But in Philadelphia, things work differently. The state pays Elwyn a combination of state and federal dollars to administer the city’s preschool early intervention program, along with a much smaller program in Chester. Last fiscal year, its contract was worth around $90 million. Elwyn is in charge of assessing children, developing their IEPs, and subcontracting with a network of providers for services they qualify for.

    When Halevy’s kids’ preschool said her son needed an aide, the preschool owner gave Halevy advice: phone Elwyn. So she did, and she was relieved when the organization told her they could fit Joshua in to begin his evaluation later that week.

    That was July 2024. She hoped Joshua would have services in time to be back at preschool by the following September. But soon, Halevy said she began hitting roadblocks.

    In August, she said she didn’t hear much from Elwyn. Like other early intervention programs statewide, Elwyn often takes a two-week service break at the end of summer — one of many scheduled break periods during the year.

    But then when she did hear back that September, she learned Elwyn wouldn’t consider providing a 1-to-1 aide without observing Joshua in his educational environment. But the preschool said he couldn’t return to class unless he had someone there to specifically support him.

    At the end of September, when evaluators wrote Joshua’s initial IEP, they documented that they discussed adding an aide to assist Joshua at preschool. But they wrote that because they could not observe Joshua in his educational environment, they did not have enough information to support that recommendation. “[T]he family is in a difficult position,” the team wrote on the IEP, which Chalkbeat has reviewed.

    Joshua’s IEP states that he should receive occupational therapy and specialized instruction each week. The law requires services to begin within 14 days. But more than a month after, Joshua still wasn’t receiving services, Halevy said.

    At the time, Halevy was stretched thin. She was also working to get services for her 2-year-old daughter, who struggled with speech, through the separate early intervention program that serves children up to age 3 run by the city.

    For Halevy, sorting out her daughter’s services in the birth to 3 program was simple. Service providers quickly began contacting her and therapists started showing up for sessions. But for her son, nothing.

    “One day, I’m like, ‘Oh my gosh, what’s going on with Josh?’ and I start calling every number I had at Elwyn,” said Halevy.

    It wasn’t until two more months later, in November, when he finally began to receive occupational therapy, she said recently after reviewing text messages. In December, she said his special instruction began.

    Early intervention IEPs not always followed

    Elwyn’s Philadelphia program is the largest in the state, serving around 11,000 preschool-age children, according to the most recent data from the 2023-24 school year. The organization first won its contract for early intervention services in Philadelphia in 1998.

    But its outcomes for kids are behind the rest of Pennsylvania.

    The state requires early intervention programs to report data on how kids progress in certain areas, like social emotional learning and acquiring new skills. State program reports show that for the last five years of data, children in Elwyn’s Philadelphia program have been less likely to progress in all three growth categories compared with the state average.

    Margie Wakelin, a senior attorney at the Pennsylvania-based Education Law Center, said her team has assisted more than 80 Philadelphia families in the last year whose kids’ education was disrupted at least in part because they couldn’t access appropriate services from Elwyn. The vast majority of those children, she said, were Black and Brown kids affected by poverty.

    Some families hire attorneys to help them access the services they’re entitled to, or get pro bono representation from organizations like the Education Law Center. Many who win their cases get compensatory education, often in the form of money the family can use to pay for services after the case is over.

    But that doesn’t make up for lost time as children quickly age out of early intervention. Research shows that children’s brains develop more rapidly between birth to 5 than any other time of their life. Many families, Wakelin said, have also had their children suspended from preschool or made to only attend partial days because of their disabilities.

    “It’s such a critical period for kids to have access to high quality education,” said Wakelin. A system that identifies children as needing services but doesn’t follow through, she added, is “really failing our kids.”’

    McLister, Elwyn’s CEO, said the organization has learned that, in some cases, children are suspended from their preschool programs because of learning or behavioral needs. “Elwyn is not part of this decision making and often learns about it after the fact,” he said. He added that the organization is developing tools “that will help us understand the frequency in which this happens” and is creating additional resource materials for families.

    State reports show that Elwyn’s program is successful in some areas, like evaluating 97% of kids within 60 days, the state-required timeline. But that’s just the first step in what advocates say often becomes a month-long process to get services.

    Though the law is clear that kids should receive services within 14 days of their IEP being written, the state does not publish information on how long kids wait for services after an evaluation, or how many service interruptions they’ll experience when providers are no longer available.

    When it comes to Elwyn’s performance, CEO McLister said that students’ growth data does not account for the unique challenges of providing services in Philadelphia. The children Elwyn serves have higher needs than the state average, he said, with higher incidences of developmental delays and a greater prevalence of multiple other challenges, such as limited English proficiency, economic disadvantages, and other social risk factors.

    “For younger children, these factors produce more modest gains,” said McLister.

    McLister emphasized that Elwyn has been successful in evaluating the vast majority of children on-time, and said the most common reason an evaluation falls outside the 60-day window is a parent cancelling an initial evaluation appointment and needing it to be rescheduled.

    He said delays in getting kids services are often the result of scheduling challenges and staffing shortages — 95% of service issues related to speech and language services, he said, are due to a lack of staff. He said other delays occur when families move or change their child’s preschool enrollment, and when providers return kids to the “needs list,” meaning they stop service for that child, which happens “for a variety of reasons.”

    For Joshua, getting a consistent special instructor, a position meant to support Joshua’s learning, has been impossible, Halevy said. Her text history, which she reviewed recently, documents the challenges: The first special instructor who contacted her never visited and stopped responding to texts, she said. The next person was more helpful and saw Joshua a few times, but then abruptly quit. Now, after more than a month of no special instruction, a new provider comes mostly regularly, Halevy said.

    Access to occupational therapy has been slightly better, Halevy said. For the first several months of service, Joshua’s occupational therapist showed up inconsistently and seemed rushed, Halevy said. Now, after working out a schedule, she consistently comes around once a week.

    Early childhood intervention needs more funding, some say

    These and other challenges aren’t unique to Philadelphia families. But preschool operators and early intervention providers say there are particular and longstanding problems in Philly.

    Two years ago, Sharon Neilson, former director of the Woodland Academy Child Development Center in West Philadelphia, was part of a group pushing to bring attention to problems in the city’s early intervention program. Council members held a hearing about parents’ challenges accessing services, and Neilson and other providers met with Elwyn.

    At the time, Neilson said, she was hopeful that things would improve. But since then, she said, “we’ve actually seen it get worse.”

    Neilson, who now works as support staff at Woodland Academy, said of the 22 children enrolled at the preschool, about four currently receive services from Elwyn, and three more are going through the process of getting evaluated.

    The preschool helps families navigate the process, in part because submitting required paperwork and scheduling evaluations can create additional barriers, she said. But even with additional help, in her experience it still usually takes months for kids to be evaluated and services to begin, she said.

    “I think that’s the saddest thing for me,” Neilson said. “The families are very frustrated because they don’t know what to do — they just know that they need help for their child, but it’s just very hard to navigate.”

    Officials say a lack of resources is largely to blame. Over the past decade, the number of preschool-age children in Pennsylvania receiving early intervention services has grown by a third, and funding hasn’t kept up.

    Pennsylvania Department of Education spokesperson Erin James said that is why Gov. Josh Shapiro proposed increasing funding for preschool early intervention by $14.5 million in the state budget. However, months past the budget deadline, lawmakers remain at an impasse over the budget and early education providers are further strained.

    One provider who contracts with Elwyn said concerning inequities exist in Elwyn’s program. (Chalkbeat is not naming the provider due to her fears of retaliation from Elwyn.) It’s an accepted norm, the provider said, that kids in nicer neighborhoods get picked up for service much faster than those in poorer neighborhoods.

    “There’s an access and equity issue across the board,” said the provider. “And that’s exacerbated by the shortage of providers.”

    Asked about those access and equity concerns, McLister said that to address some related challenges, this year Elwyn is implementing more targeted training for staff and plans to develop a family resource center. He said the organization has also employed internal speech language pathologists to assign to high-priority cases.

    When families reach out to Elwyn, McLister said staff provide them with documentation and verbal explanations of how the process works to ensure families understand their rights, next steps, and how to give consent for evaluations.

    The organization also periodically notifies providers of historically underserved ZIP codes to encourage providers to serve kids equitably across the city, and includes provisions in its contracts meant to “promote fairness and accountability.” McLister said Elwyn places subcontractors on corrective action plans if the organization “detects patterns of non-acceptance that disproportionately impacts underserved areas.”

    As for Halevy, she says her family has gotten relatively lucky. They were able to get Joshua started on an evaluation quickly. And she’s been able to get new therapists when others stop showing up.

    But her family’s biggest piece of luck, she said, is that her husband recently got a new job with better health insurance. She plans to use that to get some of the services her kids need. That means she no longer will completely rely on Elwyn.

    She just wishes she could erase the months of waiting and worrying about why Joshua’s services took so long to start.

    “Basically, what happened is we fell through the cracks,” she said.

    Chalkbeat is a nonprofit news site covering educational change in public schools. This story was originally published by Chalkbeat. Sign up for their newsletters at ckbe.at/newsletters.


    Did you use this article in your work?

    We’d love to hear how The 74’s reporting is helping educators, researchers, and policymakers. Tell us how

    Source link

  • 3 Considerations for “Nudging” Intervention in Higher Ed

    3 Considerations for “Nudging” Intervention in Higher Ed

    Nudging systems are low-cost, simple mechanisms colleges can deploy to ensure students stay on track with enrollment. They can have a long-term impact on student success, creating socioeconomic mobility and closing equity gaps for students from historically marginalized backgrounds. But how does a college create effective nudging measures to enhance student success?

    The nonprofit group ideas42 conducted a field review of available research on educational nudging and its impact on student outcomes and identified promising practices in an April report.

    Over all, researchers found nudges that reduced students and parents’ mental load and simplified processes, such as prefilled forms, were tied to higher educational outcomes, compared to messages that required additional processes or complex decision-making.

    A Slice of Research

    Ideas42’s report addresses the entire education pipeline, from kindergarten to higher education. This article focuses only on processes implemented in university settings or related to enrollment in higher education.

    The background: Behavioral science principles have been applied to higher education for decades with the goal of supporting students and families as they navigate complex institutions. Called nudges, these interventions happen in admissions, financial aid and the registrar’s offices, and can take place via email, learning management systems and texts, to help students meet deadlines.

    Large-scale nudging interventions at the state and national level have been shown to be less effective than smaller-scale outreach from groups students are familiar with. A more recent study from Georgia State University found that time-sensitive nudges, or those related to high-stakes tasks, were more likely to encourage student behavior.

    Methodology: In the report, researchers define nudges as “interventions that change student behavior by modifying their decision-making context, without meaningfully restricting available choices or exerting coercive influence through large incentives or penalties.”

    The report authors focused on three types of nudges that address students’ bounded awareness, rationality and self-control—subconscious factors that may limit an individual’s decision-making, willpower or information-seeking abilities.

    Nudges were categorized by whether they add or subtract elements from student-facing processes. For example, an additive nudge requires students to interact with a new product or service or complete additional tasks, whereas a subtractive nudge reduces the tasks students have to complete or eliminates products (for example, texts to a student rather than notifications through a portal). Researchers also evaluated whether the nudges increased students’ cognitive load, requiring additional processing and decision-making, or reduced mental pressure to help them focus attention and process information.

    The findings: Researchers found that the most effective nudges in improving student outcomes are those that reduce unnecessary steps, simplify processes and make it easier for individuals to complete their goals—such as prefilled financial aid applications or streamlined enrollment forms.

    However, nudge designers often lean toward creating more steps or introducing new tools and activities, such as a texting campaign to connect students to resources about late course withdrawal, that don’t reduce the effort required by students. This can overload them and fail to benefit them in the intended ways, adding confusion.

    Instead, campus leaders should prioritize subtraction in the number of messages and steps a student may receive in the hopes of reducing their mental burden.

    Some additive measures can be helpful, such as creating a tool for students and families to evaluate various options in a choice set, because it makes decision-making easier or enables action in a simpler manner.

    But in general, the best practice is to reduce the complexity of processes and the cognitive demands of the task.

    Making changes: To enhance nudging systems, the ideas42 review suggested education leaders consider the following:

    • Focus on the messenger. Often, nudge development focuses on the content of the message, but identifying a trusted and recognized source to deliver the message can increase its credibility. Messengers who are trusted, local and human are more likely to engage recipients than generic, institutional or automated senders.
    • Forget the low-hanging fruit. Nudges can be developed as a cost-effective and scalable intervention, but they may neglect the deeper, more systemic solutions that could generate long-term student success. “This focus on cheap and incremental solutions also risks exacerbating inequities in educational outcomes, because the barriers faced by historically marginalized communities often require deeper solutions,” the report says.
    • Evaluate the problem thoroughly. The nudge design process can begin with a predetermined solution, rather than a diagnosis-driven approach, which doesn’t necessarily fit the need at hand. Campus leaders should seek to understand the barriers students face and create nudges that touch the root of the problem.

    Get more content like this directly to your inbox. Subscribe here.

    Source link

  • Early intervention services can help premature children thrive, but too few receive them

    Early intervention services can help premature children thrive, but too few receive them

    JOLIET, Ill. — After several challenging and stressful months in the neonatal intensive care unit, Karen Heath couldn’t wait to take her triplet sons home. The boys had been born severely premature at 25 weeks, each weighing a bit over a pound. In the early hours, doctors cautioned they would not survive long. The triplets, thankfully, proved the doctors wrong. But for about three months, Heath was not allowed to hold them, satisfying herself with photos, videos and kisses blown.

    The long-anticipated discharge in the early summer of 2019 was joyful, but also rushed and, as Heath recalls it, somewhat cavalier. An hour before release, a physical therapist showed Heath how to help the babies gain strength by gently stretching their legs out. A nurse gave her a quick tutorial on how to use the oxygen tanks they would need for the next couple of months. And Heath gathered together basic necessities and a few mementos: diapers, pacifiers, blood pressure cuffs and tiny hospital bands.

    But no one at the hospital, one of Chicago’s largest, told Heath or her husband what she felt would have been the most helpful advice in the long run: The triplets’ low birth weight alone meant they were automatically eligible for what’s known as early intervention services, which can include speech, physical, occupational and other therapies.

    “This should have been a conversation way before the boys were even released,” said Heath, who lives in Joliet, a city in the suburbs of Chicago. (She declined to identify the hospital to The Hechinger Report because her children still receive regular treatment there.) 

    Related: Our biweekly Early Childhood newsletter highlights innovative solutions to the obstacles facing the youngest students. Subscribe for free.

    Doctors, and science more broadly, have made astounding gains in their capacity to save the lives of extremely premature babies, defined as those born before 28 weeks. In the 1960s, just 5 percent of premature infants with respiratory distress survived; now it’s about 90 percent.

    Despite these encouraging gains, there’s an abysmal record across the country, exemplified by Chicago, of helping these babies after they exit the NICU, particularly with access to the therapies that most reduce their risk of needing intensive, and expensive, special education services as schoolchildren. Many children who receive early intervention do not require special education services in kindergarten, including slightly less than half of those with developmental delays, according to one 2007 study.

    “We have so much information on early brain development now,” said Alison Liddle, a physical therapist in Chicago who is part of a team that studied access to early intervention in the city. One of the findings was that the system is difficult for parents to navigate. “Support systems have to catch up. We have a critical window to help families.” 

    Three of Vasquez’ four children received early intervention services as infants and toddlers. Credit: Camilla Forte/The Hechinger Report

    Federal law says children with developmental delays, including newborns with significant likelihood of a delay, can get early intervention from birth to age 3. States design their own programs and set their own funding levels, however. They also set some of the criteria for which newborns are automatically eligible, typically relying on qualifying conditions like Down syndrome or cerebral palsy, extreme prematurity or low birthweight. Nationally, far fewer infants and toddlers receive the therapies than should. The stats are particularly bleak for babies under the age of 1: Just 1 percent of these infants get help. Yet an estimated 13 percent of infants and toddlers likely qualify.

    “It’s like people being told at 65 that they are eligible for Social Security and a year later they are not on either Social Security or Medicare,” said Dr. Michael Msall, a neurodevelopmental pediatrician who has led efforts on early intervention access at the University of Chicago’s hospital system and is on the study team. “We’d have riots in the streets.”

    The stakes are high for these fragile, rapidly growing babies and their brains. Even a few months of additional therapy can reduce a child’s risk of complications and make it less likely that they will struggle with talking, moving and learning down the road. In Chicago and elsewhere, families, advocates and physicians say a lot of the failures boil down to overstretched hospital and early intervention delivery systems that are not always talking with families very effectively, or with each other hardly at all. “They really put the onus of helping your child get better outcomes on you,” said Jaclyn Vasquez, an early childhood consultant who has had three babies of her own spend time in the NICU.

    Related: Black and Latino infants and toddlers often miss out on early therapies they need

    Hospitals use different processes for educating families about early intervention, which often occurs at an overwhelming time for parents. “That initial connection with the families is tricky because the families tend to be very busy when they take the baby home,” said Dr. Raye-Ann deRegnier, the lead physician on the study and director of the Early Childhood Clinic at Lurie Children’s.

    At Lurie and Chicago’s Prentice Women’s Hospital, where deRegnier works, the physical therapists are generally responsible for informing families of early intervention. “I wouldn’t say that happens in every NICU,” she said. “Sometimes it’s discharge nurses, sometimes discharge coordinators, sometimes others.”

    Under the current landscape, it’s helpful when physical therapists have conversations with families early and often, deRegnier said. But even when that happens, miscommunications can occur. The doctor said she recently made a point to talk to a mother about early intervention, and the woman said she had never heard of it. Yet the physical therapist had previously had a lengthy conversation with the mother about the program.

    In Illinois three years ago, the state’s Legislative Black Caucus urged the creation of demonstration projects at neonatal intensive care units in hospitals, intended to model how to better connect families to services. The state’s General Assembly supported the idea, but no funding was attached to the recommendation, and it has not become a reality.

    However, a coalition of therapists and hospital physicians, including deRegnier, has been working on a pilot study that included a look at barriers that families face after they leave the NICU at several of Chicago’s largest hospitals. 

    Their findings, published in late December, show that only 13 percent of the 60 families — all of them Medicaid eligible and with infants who automatically qualified for early intervention — were receiving those therapies three to four months after discharge. In Illinois, the therapies are overseen by the state’s Department of Human Services and its Division of Early Childhood. While the specific reasons varied, most of it came down to bureaucracy and bad communication, according to the study team. 

    “When you make the system so difficult to navigate, families give up,” Liddle said. “There were many families just waiting out there for services that they really need.”

    Every weekday afternoon after play time, Karen Heath’s children, including her 5-year-old triplets, read books with their grandmother. Credit: Camilla Forte/The Hechinger Report

    By the end of June 2019, Heath’s triplets were all at home along with their 1-year-old brother. Although her husband had to return to work, Heath’s mother was around to help. The family had little idea of how best to support their growth. Doctors had warned her that the boys might never be able to sit up, walk or communicate like other children. “My main focus for so long was on coming home,” she said. “Once we got home, I’m like, ‘Now what?’”

    About two weeks after the homecoming, a nurse from the county stopped by to check in on the 6-month-olds. Heath can’t say for sure, but she believes that the woman must have made a referral to early intervention because several weeks later, in August, the family got a call saying that the triplets might be eligible for therapy. By that time, they were more than 7 months old.

    Heath leapt at the opportunity, but the process moved slowly after the initial call. In October, when the boys were 9 months, Heath got word that they had been automatically eligible all along because of low birth weight. But it wasn’t until early 2020, after the boys celebrated their first birthday, that the therapy was scheduled to start.

    Then the pandemic hit, so the initial physical and developmental therapy sessions with three near-toddlers were all attempted over Zoom. “The boys were uninterested,” their mother recalled. “Try doing therapy on an iPad with triplets and (a toddler) hanging around.” 

    It wasn’t until the summer, when the children were 18 months, that they got their first in-person therapy. “The hospital should have had something in place so these kids could have gotten the services as soon as they came home,” Heath said. “I really feel like they dropped the ball. No one can blame the pandemic because they came home way before Covid started.”

    Family photos, including from her triplets’ lengthy stays in the hospital, line the walls of Karen Heath’s living room. Credit: Camilla Forte/The Hechinger Report

    The families participating in the multihospital pilot study had a leg up on Heath: They were at least told about early intervention, with an initial referral made before leaving the NICU. But even that was not enough for most of them to connect successfully with help. A lot of the struggle came down to “logistical and technological barriers,” said Zareen Kamal, a policy specialist in Illinois for Start Early, which advocates on early childhood issues.

    The early intervention system in Illinois is decentralized, with 25 coordinating offices across the state. Caseloads are supposed to be capped at 45, but due to underfunding and short staffing, average much higher, with some reports of service coordinators juggling over 100 families. Many of the offices rely on fax for communications, with no statewide electronic system in place. Incoming phone calls to families from the coordinators often register as spam. And most of the offices don’t staff the phones in the evening or weekends, when working parents are most likely to reach out. 

    All this means that case workers sometimes remove families from their list as “uninterested” when, in fact, the parents are unaware, or unsure how to take the next step.

    Related: Six ideas to ease the early intervention staffing crisis

    The state is currently taking steps to ensure equitable access to early intervention, said a spokeswoman for the Department of Human Services in an e-mail. That includes updating the standardized referral form and exploring options for electronic referrals.

    “We realize that technology needs to be modernized,” wrote Rachel Otwell, the spokesperson.

    That said, phone and fax remain the primary means of communication due to privacy concerns, she said.

    Otwell said the agency is engaged in ongoing surveys and focus groups with thousands of early childhood community members. The state has made progress with staffing vacancies in early intervention, she added, and remains focused on “lowering caseloads to recommended levels.” 

    As the early intervention system currently exists in many cities and states, inequities are baked into every step of the process. Lower-income families are less likely to receive timely referrals, get screened and approved expeditiously, and then connect with therapists available for in-person work. Families with private insurance can often bypass the multistep bureaucratic process by having the therapies covered through those benefits. Studies have shown that Black newborns for a host of reasons, including higher poverty rates and weaker early medical care on average, are five times less likely than white ones to receive early intervention services.

    In addition to early exposure to critical therapies, Vasquez says that strong sibling relationships and support has helped her children to thrive. Credit: Camilla Forte/The Hechinger Report

    For newborns there is pervasive confusion around who is automatically eligible, even among those who work in the early intervention system, Liddle says. “Some children are turned away from receiving services despite being autoeligible, because they do not show a delay on a specific assessment tool,” she said.

    Complicating matters, states have different eligibility criteria: In some states, an infant with lead poisoning or a parent with a mental health diagnosis qualifies for the therapies, whereas in others they do not.

    There’s also a disconnect between the medical and early intervention systems, said Msall, the University of Chicago-based physician. His colleagues in NICUs routinely fax referrals over to early intervention, he said, but the information disappears into the ether, with no follow up or technology in place for the physician to know if the connection was made or what an initial evaluation found. DeRegnier agreed that the follow-up process is complicated, partly because families may need to sign a consent form for information to be shared even with physicians.

    In a nutshell, families too often have to navigate through the system entirely on their own — with only the most knowledgeable and well resourced likely to find their way to a successful outcome.

    Vasquez felt immensely grateful her background as a special education teacher made it easier to supplement the work of overstretched hospital staff when her twin daughters were born at 27 weeks four years ago. The smaller of the two spent over a year so medicated in a Chicago NICU that she was essentially in a medical coma. But as soon as possible, Vasquez and her husband stepped in to help provide some early therapies. Following the advice of hospital therapists, they helped her sit up, roll over, learn to play with toys and regularly gave her full body massages. (She didn’t want to name the hospital because she believes any shortcomings were reflective of systemic issues, not specific to that hospital.)

    Then, when the baby was finally released after 19 months in the NICU, Vasquez knew to call early intervention without delay. The family wasn’t more than five minutes into their drive home before she picked up her cellphone and rang them up from the back seat. “There was no second to lose,” said Vasquez, whose work as an early childhood consultant focuses on equity.

    Within weeks of arriving home, the baby started upward of a half dozen different therapies, including speech, nutrition and mobility. 

    Partly because of the quick introduction to therapies, formal and informal, Vasquez’s daughter is thriving today at the age of 4. The girl had to spend only a few months in a self-contained classroom for children with severe disabilities before teachers said she was ready to join the “blended” class. It’s a milestone that seemed unreachable just a couple of years ago.

    “After six months (in school), they said she is doing awesome,” Vasquez said. “I was told my child would need a wheelchair by kindergarten. She is running, dancing, chasing siblings, dancing on trampolines — all because of the amount of time we poured into therapies at a very young age.”

    Jaclyn Vasquez plays outdoors with her children on a fall weekend afternoon. She says her background in special education made it easier to help with early therapies they needed. Credit: Camilla Forte/The Hechinger Report

    Physicians, advocates and families all agree that parents shouldn’t have to wait until leaving the NICU to begin lining up services. The coalition of groups working on the study recommend staff embedded at the hospitals who can help families enroll in early intervention before discharge. Each family who is automatically eligible would also leave the hospital with a legal document entitling them to therapy. “Our ultimate dream is to have the connection between [early intervention] and families be completed before they go home, and have the therapist assigned before they leave,” said deRegnier.

    Many advocates also believe that for those babies on an extended stay in the hospital, those therapies should be available in the NICU. “Early intervention is birth to 3 — it shouldn’t matter if you are living in the hospital or at home,” Liddle said. “You are still entitled to those services.”

    Related: OPINION: Early screening and intervention can help young children get much-needed post-pandemic support

    In Illinois, advocates say they hope to get funding to pilot a program at a few NICUs that would finally create the demonstration sites the Legislative Black Caucus called for years ago. If successful, the model could be expanded statewide. “Even if we are in one or two NICUs and can see how it turns out, that would be helpful,” says Illinois state Rep. Joyce Mason, who chairs the House committee focused on early childhood education.

    In the meantime, too many families still find the crucial therapies to be elusive.

    Even when Heath’s children finally started in-person therapy, it was limited in scope. The physical therapist, who Heath describes as an “angel,” quickly recognized that they should also be receiving other help as well, including speech and occupational therapy. Yet by the time the family worked through the bureaucratic machinery to get some of those in place, the boys were nearly 3 — close to aging out of early intervention. They received a few months of speech, but never got the occupational therapy they were entitled to.

    If they had gotten the therapies earlier, “they would be in a different place at this point,” Heath says. The boys, who were diagnosed with cerebral palsy shortly before their fourth birthdays, struggle with speech and reading skills, in particular, with one of them requiring a device in order to express himself. “If you don’t know them well, it’s hard to understand what they are saying all the time,” Heath says. “If they had gotten all the services right off the bat, they wouldn’t be as far behind.” 

    Yet the triplets have long surpassed doctors’ early warnings that they might never sit up, walk or reach other developmental milestones. Newly arrived home from school on a clear fall afternoon not long before Halloween, the triplets, now in kindergarten and dressed as Spider-Man for “superhero” day, played exuberantly in a finished basement space. They cried out gleefully while zooming after each other in miniature bumper cars.

    Heath is grateful her sons are progressing with the help of school, devoted family and the committed physical therapist, who still works with the boys. But she looks back at their first nine months and laments that, so focused on how to help the babies survive, no one in a vast team of doctors, nurses and social workers thought to discuss how the family could best help them thrive. “There was no next step for my family when we left the hospital,” she said. “It was all on us.”

    Contact Sarah Carr at [email protected].

    This story about early intervention services was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Carr is a fellow at New America, focused on reporting on early childhood issues.

    The Hechinger Report provides in-depth, fact-based, unbiased reporting on education that is free to all readers. But that doesn’t mean it’s free to produce. Our work keeps educators and the public informed about pressing issues at schools and on campuses throughout the country. We tell the whole story, even when the details are inconvenient. Help us keep doing that.

    Join us today.

    Source link