Health Needs and Use of Services Among Children with Developmental Disabilities - United States, 2014-2018.

Developmental delays, disorders, or disabilities (DDs) manifest in infancy and childhood and can limit a person's function throughout life* (1-3). To guide strategies to optimize health for U.S. children with DDs, CDC analyzed data from 44,299 participants in the 2014-2018 National Health Interview Survey (NHIS). Parents reported on 10 DDs,† functional abilities, health needs, and use of services. Among the approximately one in six (17.3%) U.S. children and adolescents aged 3-17 years (hereafter children) with one or more DDs, 5.7% had limited ability to move or play, 4.7% needed help with personal care, 4.6% needed special equipment, and 2.4% received home health care, compared with ≤1% for each of these measures among children without DDs. Children with DDs were two to seven times as likely as those without DDs to have taken prescription medication for ≥3 months (41.6% versus 8.4%), seen a mental health professional (30.6% versus 4.5%), a medical specialist (26.0% versus 12.4%), or a special therapist, such as a physical, occupational, or speech therapist, (25.0% versus 4.5%) during the past year, and 18 times as likely to have received special education or early intervention services (EIS) (41.9% versus 2.4%). These percentages varied by type of disability and by sociodemographic subgroup. DDs are common, and children with DDs often need substantial health care and services. Policies and programs that promote early identification of children with developmental delays and facilitate increased access to intervention services can improve health and reduce the need for services later in life.§ Sociodemographic inequities merit further investigation to guide public health action and ensure early and equitable access to needed care and services.

Breakdancing Movement Based on Image Recognition Promotes Preschool Children's Executive Function and Intervention Plan.

With the continuous development of science and technology, people can apply more and more technology to the cultivation of children's abilities. In the process of cultivating children's ability, the most fancy is the study of executive function, and this is the research topic of this article. In the past, training methods such as music, mindfulness, and exercise have been used in the study of children's executive abilities to promote the development of preschool children's executive functions. While various approaches have had some effect, researchers have been exploring more comprehensive approaches to effective training. This article is aimed at studying how to use image recognition technology to conduct an intervention analysis of breakdancing in promoting the executive function of preschool children. For this reason, this paper proposes image recognition technology based on deep learning neural network and conducts research, analysis, and improvement on related technologies obtained from deep learning. This makes it more suitable for the research topic of this article and design-related experiments and analysis to explore its related performance. The experimental results in this paper show that the improved image recognition technology has improved accuracy by 31.2%. And the performance of its algorithm is also improved by 21%, which can be very effective in monitoring preschool children during breakdancing.

Does introduction of continuous glucose monitoring at diagnosis of type 1 diabetes increase uptake in children and adolescents?

OBJECTIVE: To assess whether introduction of continuous glucose monitoring (CGM) at diagnosis of type 1 diabetes (T1D), leads to greater uptake and continuation at 12 and 24 months, in a population-based pediatric diabetes clinic. RESEARCH DESIGN AND METHODS: All T1D children and adolescents diagnosed in the 12 months following full government subsidization of CGM were offered CGM from diagnosis at Women's and Children's Hospital, SA (Cohort 1). Uptake and continuation of CGM was compared to those diagnosed in the preceding year, who were started on CGM after diagnosis, but otherwise had identical diabetes management (Cohort 2). Demographic and clinical data were collected prospectively. The primary outcome variable was CGM wear >75% of the time at 12 and 24 months. RESULTS: In Cohort 1, 84% were started on CGM at diagnosis. 88% had commenced CGM by 12 months and 90% by 24 months. In Cohort 2, CGM was started on average 10 months after diagnosis (range 1-25 months), with 81% started on CGM within 24 months of subsidization. At 24 months, 78% of Cohort 1 and 66% of Cohort 2 were wearing CGM >75% of the time (p = 0.26), higher than the WCH Clinic as a whole (58%). There was no difference in HbA1c between cohorts. CONCLUSION: Starting CGM at diagnosis of T1D is feasible and well received by families, with high uptake across all ages. Although CGM continuation (wearing CGM >75% of the time) was slightly higher in Cohort 1 than Cohort 2, this did not reach statistical significance.

Late start of early intervention in children with Down syndrome. / Inicio tardío de programas de atención temprana en niños y niñas con síndrome de Down.

INTRODUCTION: Early intervention (EI) is key in the lives of children with Down syndrome (CHwDS). Starting it befo re 60 days of life (DOL) has better results in future development. OBJECTIVE: To assess the factors that delay the beginning of EI in CHwDS. SUBJECTS AND METHOD: Parents of CHwDS who attended EI pro grams during their first year of life participated. Social, family, and health factors that could influence the time of initiation of EI were evaluated and compared according to the start of EI (before vs after 60DOL). For the analysis of categorical variables, Fisher's exact test was used and for the association between the numerical ones, the Student T-test for independent samples. RESULTS: 125 questionnaires were analyzed. 51.2% started EI after 6ODOL, and of them, 25% started after 6 months of age. Late initiation of EI was associated with hospitalization before 3 months of age (OR = 2.5), long hospital stays (OR = 2.4), lower educational level of the father (OR = 4.7) and of the mother (OR = 3.4), birth in the public health system (OR = 11.8), and access to free EI centers (OR = 2.4). The high socioe conomic level was the only protective factor (OR = 0.4) for early initiation. CONCLUSIONS: More than 50% of CHwDS begin EI programs late. This was associated with early hospitalization, prolonged hospital stays, and socioeconomic status. It is urgent to allocate resources and generate public policies that allow guaranteed access to EI programs.

A Preliminary Investigation of Psychoneurological Symptoms in Low-Income Mothers.

BACKGROUND: Exposure to chronic stressors may contribute to the development of psychoneurological symptoms (i.e., fatigue, cognitive dysfunction, sleep disturbance, depressed mood, and pain) that can compromise maternal function. OBJECTIVES: In two studies of low-income mothers, we investigated the presence of psychoneurological symptoms and explored associations between mothers' stressors and psychoneurological symptoms as well as between symptoms and function. We also considered the possible mediating role of the symptoms between stressors and function. METHODS: We conducted secondary analyses of psychoneurological symptoms in two studies of low-income mothers of infants and toddlers in the United States. Study 1 sampled Latina women with limited English proficiency, whereas Study 2 was conducted with English-speaking women from diverse backgrounds. In both studies, symptoms were measured using items from the Center for Epidemiological Studies Depression Scale and the Medical Outcomes Study Short-Form Health Survey. Maternal function was measured through self-report and researcher observation. In Study 2, stressors were measured using the Everyday Stressors Index. Multiple linear regressions were used to investigate associations while controlling for relevant covariates. RESULTS: In both studies, mothers endorsed a wide range of psychoneurological symptoms. In Study 1, psychoneurological symptoms had significant negative associations with role function, social function, and developmental stimulation. In Study 2, psychoneurological symptoms had significant negative associations with role function, social function, and physical function. Using Aroian test for mediation, we found that psychoneurological symptoms mediated all significant relationships between stressors and maternal functions in Study 2. DISCUSSION: In two samples of low-income mothers, psychoneurological symptoms were prevalent and associated with chronic stressors and with maternal function and may mediate the association between those two factors. These findings extend prior research on depressive symptoms in mothers by investigating pain as an additional key symptom. The studies advance symptom science by highlighting psychoneurological symptoms in a heterogeneous sample without known health conditions.

Developmental Service Referrals and Utilization Among Young Children in Protective Custody.

Children in foster care are at high risk for developmental delay. In this retrospective cohort study of young children presenting to a foster care clinic, 77% were not receiving developmental services and 75% failed developmental screening. Of those potentially eligible, 60% were not referred for developmental services.

Rural and Racial/Ethnic Differences in Children Receiving Early Intervention Services.

A review of the literature shows that racial and ethnic minority children (eg, African American, Asian, and Hispanic) received diagnoses for developmental concerns later in life compared with their age-matched white counterparts. Research has also documented disparities in access to and receipt of health care services among children with developmental concerns as compared with children with other disabilities. OBJECTIVES: We examined health care providers' (HCPs') responses to parents' developmental concerns about their children. We looked at the association with race, ethnicity, gender, rurality, and time to diagnosis. METHODS: All data were secondary and derived from the Centers for Disease Control and Prevention's Survey of Pathways to Diagnosis and Services. Participants consisted of 1321 parents of children who had received early intervention services as reported by respondents' data collected in 2011. RESULTS: From a nationally representative sample of families receiving early intervention services, 76% were white, 10% were African American, 3% were Asian, 5% were Native American, and 9% were Hispanic. Families who were Hispanic were more likely to have received only a delaying response from HCPs. The average time to a developmental delay diagnosis was 5 months longer for families who received a delaying HCP response. CONCLUSIONS: Families who were Hispanic or who were from rural areas were most likely to receive a delayed HCP response; for parents who received a delayed HCP response, a developmental delay diagnosis took 5 months longer than for families from the other groups listed.

Oferta de programas para el desarrollo integral de la primera infancia en Chile: revisión exploratoria / Program offer for the integral development of early childhood in Chile: scoping review

OBJETIVO: Describir la oferta programática en primera infancia destinada a favorecer el desarrollo infantil integral en Chile. MÉTODO: Se realizó una revisión exploratoria siguiendo el marco método lógico del Joanna Briggs Institute. La búsqueda fue realizada por un investigador y los criterios de inclusión fueron: programas gubernamentales destinados al desarrollo integral en menores de 5 años en Chile. Los datos fueron organizados y sintetizados para describir características del programa y de la o las prestaciones que entrega. RESULTADOS: La búsqueda identificó 2060 documentos y 72 cumplieron los criterios de inclusión. Se describen 59 programas vigentes que abarcan la primera infancia, es tando principalmente a cargo de los Ministerio de Justicia, Educación, Salud y Desarrollo Social. Los programas están destinados en su mayoría a la promoción e intervención, se encuentran focalizados en población vulnerable, son intersectoriales y utilizan diversas estrategias para su implementación. CONCLUSIÓN: La oferta programática en Chile para la primera infancia presenta características sugeridas como efectivas para favorecer el desarrollo infantil.

OBJECTIVE: To describe the program offering designed to promote comprehensive early childhood de velopment in Chile. METHOD: A scoping review was carried out following the Joanna Briggs Institute's methodological framework. A researcher conducted the review considering as inclusion criteria go vernment programs aimed at the comprehensive development of children under 5 years of age in Chile. The data were organized and synthesized to describe the characteristics of the program and the service(s) it provides. RESULTS: The search identified 2.060 documents and 72 met the inclusion crite ria. 59 current programs are covering early childhood, which are mainly managed by the Ministries of Justice, Education, Health, and Social Development. Most of the programs are aimed at promotion and intervention, focusing on vulnerable populations, are cross-sectoral, and use different strategies for their implementation. CONCLUSION: The program offering in Chile for early childhood has charac teristics suggested as effective to promote child development.

Sustainability of and Adherence to Preschool Health Promotion Among Children 9 to 13 Years Old.

BACKGROUND: Long-term evaluations of child health promotion programs are required to assess their sustainability and the need for reintervention. OBJECTIVES: This study sought to explore the long-term impact of a preschool health promotion intervention delivered in an urban low-income area of Colombia (phase 1) and to assess the effect of a new community-based intervention (phase 2). METHODS: In phase 1, a cross-sectional analysis of knowledge, attitudes, and habits (KAH) toward a healthy lifestyle and ideal cardiovascular health (ICH) scores of 1,216 children 9 to 13 years old was performed. Of the total, 596 had previously received a preschool health promotion intervention at 3 to 5 years old, whereas the remaining 620 were not previously intervened (intervention-naive group). In phase 2, all children were cluster randomized 1:1 to receive either a 4-month educational intervention (the SI! Program) to instill healthy behaviors in community centers (24 clusters, 616 children) or to control (24 clusters, 600 children). Previously intervened and intervention-naive children were not mixed in the same cluster. The primary outcomes were the change from baseline in KAH and ICH scores. Intervention effects were tested for with linear mixed-effects models. RESULTS: In phase 1, ∼85% of children had nonideal cardiovascular health, and those who previously received a preschool intervention showed a negligible residual effect compared with intervention-naive children. In phase 2, the between-group (control vs. intervention) differences in the change of the overall KAH and ICH scores were 0.92 points (95% confidence interval [CI]: -0.28 to 2.13; p = 0.133) and -0.20 points (95% CI: -0.43 to 0.03; p = 0.089), respectively. No booster effect was detected. However, a dose-response effect was observed, with maximal benefit in children attending >75% of the scheduled intervention; the difference in the change of KAH between the high- and low-adherence groups was 3.72 points (95% CI: 1.71 to 5.73; p < 0.001). CONCLUSIONS: Although overall significant differences between the intervention and control groups were not observed, high adherence rates to health promotion interventions may improve effectiveness and outcomes in children. Reintervention strategies may be required at multiple stages to induce sustained health promotion effects (Salud Integral Colombia [SI! Colombia II]; NCT03119792).

Prevalence and predictors of expulsion in home-based child care settings.

This study explored the prevalence of expulsion in home-based child care (HBCC) settings using a nationally representative sample of HBCC providers from the National Survey of Early Care and Education. In addition to prevalence, enrollment and provider characteristics that predicted expulsion were examined. Although there is increasing awareness of the prevalence of early childhood suspension and expulsion in early care and education settings and the negative effects it has on children's development, few studies have included or focused on HBCC, where many children receive care. This study highlights that many home-based providers, especially listed providers, report that they expelled at least one child within the last year. Significant predictors of expulsion emerged, including enrollment characteristics such as caring for children with disabilities, enrolling more children, and caring for children unrelated to the provider. Provider characteristics, including years of experience, provider education, and provider age, also predicted provider report of expulsion. These results provide insight as to possible strategies that may be effective in reducing expulsion rates in this caregiving context.

Este estudio exploró la prevalencia de expulsión en escenarios de cuidado infantil con base en el hogar usando una muestra nacionalmente representativa de proveedores de cuidado infantil con base en el hogar de la Encuesta Nacional de Cuidado y Educación Temprana. Además de la prevalencia, se examinaron el número de inscripciones y las características del proveedor que predecían la expulsión. A pesar de que aumenta el conocimiento acerca de la prevalencia de la suspensión y expulsión en la temprana niñez en escenarios de cuidado y educación temprana y de los efectos negativos que la misma tiene en el desarrollo de los niños, pocos estudios han incluido o se han enfocado en el cuidado infantil con base en el hogar, donde muchos niños reciben el cuidado. Este estudio subraya el hecho de que muchos proveedores con base en el hogar, especialmente proveedores que son parte de una lista, reportan que ellos expulsaron por lo menos un niño dentro del último año. Surgieron significativos factores de predicción de la expulsión, incluyendo características de la inscripción tales como el cuidar a niños con discapacidades, el inscribir a más niños y el cuidar a niños que no están relacionados con el proveedor. Las características del proveedor, incluyendo los años de experiencia, la educación del proveedor y la edad del proveedor, también predijeron el reporte del proveedor sobre la expulsión. Estos resultados aportan una percepción en cuanto a las posibles estrategias que pudieran ser efectivas para reducir el porcentaje de expulsión en este contexto de prestación de cuidado.

Cette étude a exploré la prévalence de l'expulsion dans les contextes de crèches à domicile / familiales en utilisant une échantillon représentatif de l'Inventaire national américain des crèches et des institutions éducatives appelé National Survey of Early Care and Education. En plus de la prévalence, l'admission et les caractéristiques de l'assistante maternelle prédisant l'expulsion ont été examinées. Bien qu'il y ait une prise de conscience de la prévalence de la suspension et de l'expulsion de la petite enfance dans les contextes de modes de garde de l'enfant ainsi que des effets négatifs que celles-ci peuvent avoir sur le développement de l'enfant, peu d'études ont porté sur les soins en crèches familiales, où beaucoup d'enfants sont accueillis. Cette étude met en évidence le fait que bien des crèches familiales, et surtout celles qui apparaissent sur les listes de crèches, signalent avoir renvoyé au moins un enfant en une année. Des facteurs de prédiction importants ont émergé, y compris les caractéristiques de l'inscription et de l'admission comme le fait de prendre soin d'enfants handicapés, le fait d'accepter plus d'enfants, et le fait de prendre soin de plus d'enfants sans lien avec la crèche. Les compte rendus d'expulsion montrent que les caractéristiques de l'assistante maternelle, y compris les années d'expérience, l'éducation, et l'âge étaient également des facteurs de prédiction d'expulsion. Ces résultats donnent une idée de stratégies possibles qui peuvent s'avérer efficaces pour la réduction des taux d'expulsion dans ce contexte de mode de soin.

[Program offer for the integral development of early childhood in Chile: Scoping review]. / Oferta de programas para el desarrollo integral de la primera infancia en Chile: Revisión exploratoria.

OBJECTIVE: To describe the program offering designed to promote comprehensive early childhood de velopment in Chile. METHOD: A scoping review was carried out following the Joanna Briggs Institute's methodological framework. A researcher conducted the review considering as inclusion criteria go vernment programs aimed at the comprehensive development of children under 5 years of age in Chile. The data were organized and synthesized to describe the characteristics of the program and the service(s) it provides. RESULTS: The search identified 2.060 documents and 72 met the inclusion crite ria. 59 current programs are covering early childhood, which are mainly managed by the Ministries of Justice, Education, Health, and Social Development. Most of the programs are aimed at promotion and intervention, focusing on vulnerable populations, are cross-sectoral, and use different strategies for their implementation. CONCLUSION: The program offering in Chile for early childhood has charac teristics suggested as effective to promote child development.

Examining the relationship between intergroup relations and head start use in the south.

This study examines how Black and Hispanic parents' report of intergroup relations measured through group identity, linked fate, competition, and conflict are related to their utilization of Head Start services in a region that experienced Hispanic population growth. Surveys were conducted with 227 Black and 130 Hispanic parents in poverty in a mid-sized city in the South. For Hispanic parents, a sense of linked fate within their ethnic group is associated with a lower likelihood of enrollment, however, measures of intergroup relations are not related to the Head Start enrollment status of Black parents. Implications for policies on preschool expansion are discussed.

Reciprocal Relations Between Maternal Depression and Child Behavior Problems in Families Served by Head Start.

This study used longitudinal cross-lagged modeling to examine reciprocal relations between maternal depression and child behavior problems. Data were drawn from 3,119 children (40% Hispanic, 30% African American, 20% White, and 10% other) from the Family and Child Experiences Survey of 2009 (a nationally representative sample of children served by Head Start). Results documented reciprocal relations between maternal depression and child behavior problems across early childhood (i.e., child age 3-5). Furthermore, the effect of child behavior problems on maternal depression was moderated by child race/ethnicity during children's first year in Head Start, such that the negative effect of child behavior problems on African American mothers' depression was more pronounced compared to Hispanics and other racial/ethnic groups.

Early Intervention Referral Outcomes for Children at Increased Risk of Experiencing Developmental Delays.

OBJECTIVES: The primary goal was to examine outcomes of Part C early intervention (EI) referrals from a high-risk infant follow-up program and factors associated with success. A secondary aim was to determine how many referred children not evaluated by EI would have likely qualified by either automatically meeting state eligibility criteria with a condition associated with "high-probability" for developmental delays or having test scores evidencing developmental delays. METHODS: Participants included 77 children referred directly to EI from a high-risk infant follow-up program. Scores on the Bayley Scales of Infant and Toddler Development-III, basic demographics, and medical variables were extracted from electronic medical records. Information regarding referral outcomes was gathered via follow-up phone calls to EI programs several months after referral. RESULTS: Results indicate 62% of EI referrals resulted in evaluation, with 69% of those evaluated being found eligible for services. Overall, 34% of referrals resulted in EI enrollment. Of those who were not evaluated, 71% were likely to have qualified based on state eligibility criteria. Follow-up phone call results indicated the majority of families not evaluated (64%) were never successfully contacted by the EI program. CONCLUSIONS: Findings from the present study illustrate the extent of challenges in connecting families with needed EI services and indicate an opportunity for improvement in EI referral processes to increase enrollment for eligible children. Improved communication between referral sources and service providers could support enrollment with detailed documentation of prior testing and explicit reasons for referral. Follow-up calls to confirm receipt of referral may also be necessary.

Race/ethnicity, human capital, and the selection of young children into early childhood education.

Mexican-origin families face complex ethnic and immigration-based barriers to enrollment in early childhood education programs. As such, reducing barriers to enrollment for this population requires a better understanding of how Mexican-origin families work with, against, or around both general and group-specific constraints on educational opportunities. Using the Early Childhood Longitudinal Study-Birth Cohort, this study tailored broad social theory to the experience of Mexican-origin families to examine associations between human capital considerations and early childhood education enrollment within this population. Results supported the hypothesis that human capital considerations would be associated with early childhood care and education and provide limited evidence for the expectation that this link would be stronger for Mexican-origin families.

Mental health impairment among children with atopic dermatitis: A United States population-based cross-sectional study of the 2013-2017 National Health Interview Survey.

BACKGROUND: Atopic dermatitis (AD) is associated with mental health disorders, but its impact on global mental health symptoms is less clear. OBJECTIVE: To determine the association between pediatric AD and mental health impairment. METHODS: In a cross-sectional study using 2013-2017 United States National Health Interview Survey data, children with and without AD were assessed for mental disorder with impairment (MDI) using a validated behavioral screening questionnaire. Mental health services utilization was also reported. RESULTS: The prevalence of any MDI was 26.7% (95% confidence interval [CI], 25.1-28.3) among children with AD and 17.7% (95% CI, 17.2-18.2) among those without AD, with severe MDI being present in 10.9% (95% CI 9.9-12.1) and 6.2% (95% CI 5.9-6.5), respectively. Adjusted for sociodemographic factors, AD was associated with higher odds of MDI (odds ratio, 1.52; 95% CI, 1.39-1.67), including impairments in conduct, emotions, peer relationships, and attention. Among children with AD, 19.9% (95% CI, 16.6-23.8) and 53.5% (95% CI, 48.5-58.5) of those with mild or severe MDI, respectively, had seen a mental health professional in the last year. LIMITATIONS: Misclassification bias may arise from self-reported data. CONCLUSION: AD is associated with clinically significant mental health symptoms, but many affected children may not seek or receive care for their symptoms.

Timing of Referral to Early Intervention Services in Infants With Severe Bronchopulmonary Dysplasia.

This study is a secondary analysis of an observational prospective case series of 50 infants with severe bronchopulmonary dysplasia that describes patient factors associated with the time between initial hospital discharge and referral to early intervention (EI) services. It also evaluates associations between (1) timing of EI referral and reception of EI services and (2) early referral to EI and developmental outcomes at 18 to 36 months corrected age. The results demonstrated that a referral from a neonatologist versus a pediatrician was associated with fewer days between discharge and EI referral. Earlier EI referrals were associated with a shorter time to intake evaluation and service initiation. The Bayley-III (Bayley Scales of Infant and Toddler Development, 3rd Edition) scores at 24 months corrected age (n = 28) were not associated with timing of EI referral. In conclusion, an early referral to EI promoted earlier evaluation and initiation of EI services and should be standard for high-risk infants.

Underutilization of Early Intensive Behavioral Intervention Among 3-Year-Old Children with Autism Spectrum Disorder.

Funding for early intensive behavioral intervention (EIBI) for children with autism spectrum disorder is rapidly expanding. Yet we know little about children's utilization, and research on inequities in utilization is lacking. We examined the relationship between utilization during the first year of EIBI and (a) child race-ethnicity and (b) neighborhood characteristics. Using a sample of children eligible for a Medicaid waiver through a novel policy of presumptive eligibility (N = 108), we estimated a series of two-level growth curve models. Children's average utilization ranged between 24 and 48% of weekly hours, and utilization did not differ by race-ethnicity or neighborhood during the first year. Findings underscore the need to monitor utilization of EIBI and warrant research on the feasibility of EIBI provision in the general population.

Treatment Utilization Trajectories among Children with Autism Spectrum Disorder: Differences by Race-Ethnicity and Neighborhood.

Health coverage of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder is expanding. Yet there is no longitudinal research on patterns of or inequities in utilization of EIBI. We integrated state administrative records with Medicaid and Census data for children enrolled in an EIBI Medicaid waiver (N = 730) to identify and describe the type and prevalence of treatment utilization trajectories, and to examine the association between trajectory types and (a) child race-ethnicity and (b) neighborhood racial composition, poverty, affluence, and urbanicity. We identified four utilization trajectories (Low, Low-Moderate, Moderate, and High users). Race-ethnicity and neighborhood affluence were associated with trajectory membership. As coverage expands, policy makers should consider strategies to improve overall treatment utilization and enhance equity.

Social and Functional Characteristics of Receipt and Service Use Intensity of Core Early Intervention Services.

OBJECTIVE: Describe children's diagnostic, social, and functional characteristics associated with the use of core early intervention (EI) services. METHODS: The sample included infants and toddlers (N = 2045) discharged from an urban EI program (2014-2016). Adjusted logit models estimated the marginal effects and 95% confidence intervals (CIs) of receipt of any of the 4 core EI services, controlling for the child's developmental condition type, race and ethnicity, primary language, sex, insurance type, age at referral, and functional performance at EI entry. Adjusted median regression estimated EI core service intensity controlling for child characteristics. RESULTS: The median per-child EI service intensity was less than 3 h/mo (median, 2.7; interquartile range, 2.1-3.5). Children whose primary language was English were 6% more likely to receive occupational therapy (marginal effect = 0.063; 95% CI, 0.010-0.115). Compared to infants, 1- to 2-year-old children were less likely to receive physical therapy and occupational therapy but more likely to receive speech therapy. Compared to infants, 1-year-olds received more intensive speech therapy (ß = 0.42; 95% CI, 0.10-0.70), and 2-year-olds received less intensive occupational therapy (ß = -0.70; 95% CI, -1.35 to -0.10). Children's functional performance at EI entry was significantly associated with the receipt and intensity of EI services. CONCLUSIONS: Many EI-enrolled children received low-intensity services, a result that was associated with the primary language of the caregiver and the child's age and functional status. Results suggest the need for interventions to improve service delivery for vulnerable EI subgroups.