Fewer kids in Colorado are getting services to address potential developmental problems early, raising the possibility they’ll need more intensive help down the road.
Referrals to the state’s Early Intervention services for developmental delays were down last year, and about 20% fewer Colorado kids received them in January 2021 than in March 2020, according to the annual Kids Count report.
The programs enroll children up to 2 years old, and can include services ranging from physical and speech therapy to hearing aids and counseling for parents about how to manage kids’ challenging behaviors.
That matters because the sooner children start receiving services, the more likely it is that they’ll return to a typical developmental track by the time they reach school, said Bill Jaeger, vice president of early childhood and policy initiatives at Colorado Children’s Campaign. The brain is most easily shaped in the first three years of life, so while it’s possible to address developmental delays later, it typically requires more intensive and expensive services, he said.
“The earliest years of life are this amazing window,” he said.
Often, referrals come from well-child check-ups or when a teacher in a preschool or child care center notices a child is struggling, but kids had fewer eyes on them last year due to the pandemic, Jaeger said. About one in five families skipped at least some scheduled well-child visits last year, where their children would normally be screened for developmental delays, according to the Kids Count report.
Parents can ask for an assessment themselves if they’re concerned about their children’s development, but most don’t know they have the option.
“The decline referrals probably isn’t because we have fewer kids with developmental delays,” he said.
The American Academy of Pediatrics recommends that all children be screened for developmental delays at 9 months, 18 months and 2 1/2 years, and for autism at 2. When a screening suggests children might be developing more slowly than expected, they’re referred to the state’s Early Intervention program, which uses a team to determine if they have a delay, and whether it’s severe enough to qualify for services.
The number of kids referred largely has rebounded, but not the number served, said Christy Scott, Early Intervention program director at the Colorado Department of Human Services. That’s probably due to at least two factors: the state changed eligibility criteria, and it’s been challenging to match families and providers who have the same preference for in-person or virtual services, she said.
“Some families are just choosing not to get services now, or not to get services through Early Intervention,” she said.
Tighter eligibility rules
In July 2020, the state tightened eligibility criteria for children to receive Early Intervention, as a cost-saving measure the pandemic, said Jennifer Levin, director of public policy for The Arc of Colorado. That automatically prevented kids with less severe needs from getting services, she said.
“Before the emergency rule change, those children would be covered,” she said.
Previously, children who were 25% behind their peers could get services, but that’s been raised to 33%. For example, a 2-year-old whose developmental skills were more like an 18-month-old’s previously would have been eligible, but now the child would have to be functioning at a 16-month-old’s level to qualify.
Two months “doesn’t seem dramatically different, but the trajectory of early childhood development is pretty rapid,” said Jodi Litfin, a clinical child psychologist and deputy program officer at Rocky Mountain Human Services, which provides Early Intervention services for children in Denver.
There’s no plan to change the eligibility cutoff again, even if the budget situation changes, Scott said. The state is working on building and funding a “more flexible” Early Start program for kids with less severe delays, so Early Intervention focuses on the kids with the greatest needs, she said. The new program is scheduled to start enrolling kids in July 2022.
“If we’re able to get these children in, look at this child’s and this family’s needs, maybe we can connect them with already existing resources,” she said.
While fewer kids were served last year, the state deserves credit for continuing to work with families through virtual sessions, Jaeger said. Early Intervention largely relies on teaching parents exercises and strategies for supporting their child’s development, which can be done remotely, he said.
Litfin said the rule changes are one factor in the reduced number of kids they’re serving, but families also have more barriers to getting the services they need. It’s not an easy process, even in normal times, she said, and some of the most vulnerable families aren’t participating in the numbers that they did pre-pandemic: those from low-income neighborhoods, who had a baby in a neonatal intensive-care unit, or who speak a language other than English or Spanish.
“I think with all the stressors that families were experiencing during the pandemic, it became even more challenging” to get help, she said.
Participating families in Denver tended to need more support during the pandemic than in previous years, because many were facing financial stress and trying to help older children learn from home while also working with their younger ones, Litfin said. Service coordinators helped connect parents to resources for food and rental assistance, and some parents got “respite care” to keep an eye on their older children while they had appointments, she said.
In Denver, the city was able to put some money toward setting up a program for kids with less severe needs, called Early Step, which launched in April, Litfin said. They also received a grant to fund a “family navigator,” who will direct families getting care at Denver Health’s clinics toward Early Intervention, Early Step and other resources to support their kids’ development, she said.
Going forward, those kinds of partnerships are going to be more important as families continue to deal with the effects of the pandemic, Litfin said.
“No one agency and certainly no one program can meet all of the needs,” she said.
Need for more help
If children’s needs aren’t identified early, they may need more help when they get to school. Miranda B. Kogon, associate chief of student equity and opportunity at Denver Public Schools, said they’re working with groups serving younger children with developmental delays to ensure a smooth transition for families as their kids reach preschool. They’re also preparing to adjust if families have different concerns than they did pre-pandemic, she said in a statement.
“For instance, many families are going to prioritize their child’s social-emotional learning because of the drastic reductions in opportunities their child had to same-age peers during the pandemic,” she said.
It will be difficult to tease out any lingering effects of delayed interventions from the other challenges children faced in 2020, Jaeger said. Many families faced financial stress, food insecurity, isolation and mental health problems, all of which can impact a child’s development, he said.
That doesn’t mean kids will be scarred for life, but they will need more support from caring adults, Jaeger said. Children don’t always automatically bounce back from challenges in their first years, but they tend to do well when they receive targeted help and know their parents and others believe in their abilities, he said.
“Kids have a tremendous ability to overcome adversity,” he said. “It’s about all of us doing everything we can to support our children’s full potential.”
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