| In 1986 federal law established a discretionary program to provide screening, identification, referral, and treatment services to infants and toddlers less than three years of age with or at risk for developmental disabilities through early childhood intervention programs. The assumption was that early intervention, as a preventive measure, would reduce the social, medical, and economic impact of risk of disability for both the child and society. This investigation examined risk factors related to developmental disability of children entering early intervention services without categorical disabilities. The objectives were to identify differences between children with and without disability, distinguish differences between children who left without a disability and later returned, and characterize children lost to care. Risk factors were examined by viewing the child within the context of the family and community. The cohort included children who entered the California Early Start program in 1998.; Using Cox proportional hazards analysis, age at entry interacting with gender and delays in the physical, communication, and social/emotional developmental areas were the strongest predictors of time to disability. The family risk factors included Medi-Cal eligibility, number of telephone numbers, and number of addresses.; Children who return for services with a disability had an increased risk of ill-defined conditions indicating an uncertainty of defining a categorical diagnosis. They also had a high risk of cognitive delay at entry to early intervention services, but a low risk of a diagnosis of mental retardation. There was an autism-male gender interaction, but only if the autism-communication delay interaction remained in the model. Children with bilingual mothers were also at greater risk.; A two-level hierarchical linear model examined the probability of loss to care with children/families level-one and regional centers level-two. Risk factors for children lost to care included age six months less, Hispanic or race/ethnicity unknown, premature birth, persistent tonal problems, and hyperbilirubinemia. Family risks for attrition included maternal age less than 20, no maternal education beyond high school, families without Medi-Cal eligibility, and families without transportation services. There appear to be differences in attrition by regional center not explained by the percent of services purchased or provided. |
