BACKGROUND: The Early Intervention (EI) Program of the New York City (NYC) Department of Health and Mental Hygiene provides therapeutic services to children under 3 years of age with developmental delays or disabilities. Although the EI Program targets delivery of services within 21 days of the meeting at which the Individualized Family Service Plan (IFSP) is developed, the designation of a service provider alone often takes longer than that. OBJECTIVE: This study examined associations between individual and neighborhood characteristics and timeliness of provider designation in NYC. METHODS: Multivariable logistic regression analyses were performed for 14,623 children who had their initial IFSPs developed in Fiscal Year 2004. RESULTS: Provider designation was delayed 13.4% of the time for speech therapy, 10.0% of the time for special instruction, 8.2% of the time for occupational therapy, and 4.2% of the time for physical therapy. Individual characteristics independently associated with provider designation delay were: being older than 24 months, having the IFSP meeting between July and December, having an adaptive delay, and having speech therapy or special instruction in the IFSP. Neighborhood characteristics independently associated with provider designation delay included living in a low-income neighborhood and living in a heavily Spanish-speaking neighborhood. CONCLUSION: Delayed provider designation occurs because of both individual and neighborhood factors. Interventions are needed to address shortages of providers in certain neighborhoods or with specific skills, and to address surges in administrative program functions at certain times of the year.
BACKGROUND: The Early Intervention (EI) Program of the New York City (NYC) Department of Health and Mental Hygiene provides therapeutic services to children under 3 years of age with developmental delays or disabilities. Although the EI Program targets delivery of services within 21 days of the meeting at which the Individualized Family Service Plan (IFSP) is developed, the designation of a service provider alone often takes longer than that. OBJECTIVE: This study examined associations between individual and neighborhood characteristics and timeliness of provider designation in NYC. METHODS: Multivariable logistic regression analyses were performed for 14,623 children who had their initial IFSPs developed in Fiscal Year 2004. RESULTS: Provider designation was delayed 13.4% of the time for speech therapy, 10.0% of the time for special instruction, 8.2% of the time for occupational therapy, and 4.2% of the time for physical therapy. Individual characteristics independently associated with provider designation delay were: being older than 24 months, having the IFSP meeting between July and December, having an adaptive delay, and having speech therapy or special instruction in the IFSP. Neighborhood characteristics independently associated with provider designation delay included living in a low-income neighborhood and living in a heavily Spanish-speaking neighborhood. CONCLUSION: Delayed provider designation occurs because of both individual and neighborhood factors. Interventions are needed to address shortages of providers in certain neighborhoods or with specific skills, and to address surges in administrative program functions at certain times of the year.