I want to take the time to discuss a topic that I, as a DBH, am passionate about. Early Intervention (EI) programs and Quality Improvement. Based on my research, there are still service gaps in Early Intervention. EI agencies and treatment clinics partner with the New York City Department of Health and Mental Hygiene (NYCDHM). Additional services provided by EI include speech, occupational therapy, and special instruction using applied behavior analysis methodology (Romo et al., 2020). 

Unfortunately, pediatricians who identify developmental delays/risks are not always knowledgeable about autism and the EI referral process. Parents and educators also think that all licensed clinicians that diagnose development delays follow the screening protocol recommended by the American Academy of Pediatrics (AAP) to identify patients (Wallis et al., 2020).  In some cases, clinicians are not following recommended screening protocols. Another problem is that some underserved populations, including black and brown communities, are not consistently referred to EI services at the same rate as wealthier communities. Children born underweight are at higher risk of having social, cognitive, and communication impairments (Little et al., 2015). Research has shown limited collaboration between EI and neonatal intensive care units.

            The job of a DBH is to find a problem and bring a solution. That’s where Quality Improvement (QI) services come in. QI consultation provided by a DBH results in using evidence-based interventions to eliminate gaps in services.  Gaps in services can be identified as barriers. What barriers in EI need to be tackled by a DBH? In addition to language barriers, lack of parent education, bias based on cultural differences, lack of insurance coverage, and poor economic status making it challenging to access EI, other components need to be addressed. According to research, the following problems keep at-risk children from getting services:  Limited eligibility, referral, family receptivity, service provision, insufficient coordination, and inadequate funding.

So, what’s going on? As mentioned earlier, referrals can be missed due to medical personnel neglecting to conduct required screening when families are concerned about possible delays. Families may not be receptive to services due to the stress of having home visits, social and economic stressors, denial about developmental delays, or lack of awareness of the benefits of EI. Then there is a lack of trained EI staff and limited communication and coordination with the child’s medical care team (Little et al., 2015).          

As a DBH, I will bring your organization the tools to combat these barriers giving the organization a completive advantage.  How do you increase program enrollment, create profitable partnerships, and grow resources? The answer is to find the right integrative care model/approach for your organization. DBHs are skilled in finding a suitable model for your organization. Consultation with someone with my credentials can significantly reduce barriers to your success as a business. Let’s set up an appointment to discuss this further.  

References

Little A.A., Kamholz, K., Corwin B.K., Barrero-Castillero A., Wang C.J. (2015). Understanding Barriers to Early Intervention Services for Preterm Infants: Lessons From Two States. Acad Pediatr. Jul-Aug;15(4):430-8. doi: 10.1016/j.acap.2014.12.006. PMID: 26142069; PMCID: PMC4862651. Romo, M. L., McVeigh, K. H., Jordan, P., Stingone, J. A., Chan, P. Y., & Askew, G. L. (2020). Birth characteristics of children who used early intervention and special education services in New York City. Journal of Public Health, 42(4), e401–e411. https://doi.org/10.1093/pubmed/fdz179