Maternal and Child Health Journal

, Volume 12, Issue 6, pp 708–717 | Cite as

Maternal Socio-Economic and Race/Ethnic Characteristics Associated with Early Intervention Participation

  • Karen M. ClementsEmail author
  • Wanda D. Barfield
  • Milton Kotelchuck
  • Nancy Wilber


Objectives To evaluate whether Massachusetts Early Intervention (EI) serves children at risk of developmental delay due to social factors, we identified socio-demographic characteristics associated with program enrollment and examined predictors of participation at each stage from referral to enrollment. Methods The Pregnancy to Early Life Longitudinal (PELL) data system linked birth certificate, hospital discharge, and EI data for all Massachusetts births, 1998–2000. We identified predictors of enrollment among births and predictors of referral, eligibility evaluation among those referred, and enrollment among eligible children using multivariate modified Poisson models to adjust for medical risks. Results Overall, 29,950 children (13.7% of births) enrolled in EI. Most social risk indicators predicted enrollment, including maternal government insurance (RR = 1.32, 95% CI 1.29–1.36) and maternal education ≤10 years (RR = 1.36, 95% CI 1.30–1.42). Having a foreign-born (RR = 0.77, 95% CI 0.74–0.80), non-English speaking (RR = 0.93, 95% CI 0.89–0.97) or Asian (RR = 0.88, 95% CI 0.82–0.94) mother was negatively associated with enrollment. Of births, 18.6% were referred to EI. Similar socio-demographic variables predicted referral as predicted enrollment. Among referrals, 87.7% received an evaluation. Evaluation was negatively associated with young maternal age, black maternal race, and high poverty level. Of eligible children, 93.0% enrolled. Enrollment among eligible children was negatively associated with young maternal age and high poverty level. Conclusion In Massachusetts, children born with social risk factors have high EI participation. Nevertheless, children in immigrant communities may face barriers to initial contact with EI, while children from low socioeconomic environments may be at risk for not enrolling after EI referral.


Early Intervention Early childhood development Program evaluation Race-ethnic disparities Socio-economic disparities 



The PELL data system is supported by the Centers for Disease Control grants S1887—21/23 and S3485—23/23. Additional funding for Early Intervention program evaluation was provided by US Department of Education Early Intervention grant 45139021. We would like to thank Steven Evans, Mark McLaughlin, and Jean Shimer for their assistance in preparing the data files, and Howard Cabral for his careful review of the manuscript.


  1. 1.
    Miller, J. E. (1998). Developmental screening scores among preschool-aged children: the roles of poverty and child health. Journal of Urban Health, 75(1), 135–152.PubMedCrossRefGoogle Scholar
  2. 2.
    Najman, J. M., Bor, W., Morrison, J., Andersen, M., & Williams, G. (1992). Child developmental delay and socio-economic disadvantage in Australia: A longitudinal study. Social Science & Medicine, 34(8), 829–835.CrossRefGoogle Scholar
  3. 3.
    To, T., Guttmann, A., Dick, P. T., Rosenfield, J. D., Parkin, P. C., Tassoudji, M., Vydykhan, T. N., Cao, H., & Harris, J. K. (2004). Risk markers for poor developmental attainment in young children: results from a longitudinal national survey. Archives of Pediatrics & Adolescent Medicine, 158(7), 643–649.CrossRefGoogle Scholar
  4. 4.
    Duncan, G. J., Brooks-Gunn, J., & Klebanov, P. K. (1994). Economic deprivation and early childhood development. Child Development, 65(2 Spec No), 296–318.PubMedCrossRefGoogle Scholar
  5. 5.
    Berlin, L. J., Brooks-Gunn, J., McCarton, C., & McCormick, M. C. (1998). The effectiveness of early intervention: Examining risk factors and pathways to enhanced development. Preventive Medicine, 27, 238–245.PubMedCrossRefGoogle Scholar
  6. 6.
    Campbell, A., & Ramey, C. T. (1994). Effects of early intervention on intellectual and academic achievement: A follow-up study of children from low-income families. Child Development, 65(2), 684–698.PubMedCrossRefGoogle Scholar
  7. 7.
    Garber, H., & Heber, R. (1977). The Milwaukee project: Indications of the effectiveness of early intervention and preventing mental retardation. In P. Mittler (Ed.), Research to practice in mental retardation. Care and intervention (Vol. I, pp. 119–127). Baltimore: University Park Press.Google Scholar
  8. 8.
    Johnson, D. L., & Walker, T. (1991). A follow-up evaluation of the Houston Parent-Child Development Center: School performance. Journal of Early Intervention, 15(3), 226–236.Google Scholar
  9. 9.
    Wasik, B. H., Ramey, C. T., Bryant, D. M., & Sparling, J. J. (1990). A longitudinal study of two early intervention strategies: Project Care. Child Development, 61(6), 1682–1696.PubMedCrossRefGoogle Scholar
  10. 10.
    Adler, N. E., & Ostrove, J. M. (1999). Socioeconomic status and health: What we know and what we don’t. Annals of the New York Academy of Sciences, 896, 3–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Clements, K. M., Barfield, W. D., Kotelchuck, M., Lee, K. G., & Wilber, W. (2006). Birth characteristics associated with early intervention referral, evaluation for eligibility, and program eligibility in the first year of life. Maternal and Child Health Journal, 10(5), 433–441.PubMedCrossRefGoogle Scholar
  12. 12.
    Scarborough, A. A., Spiker, D., Mallik, S., Hebbeler, K., Bailey, D., & Simeonsson, R. J. (2004). A national look at children and families entering early intervention. Exceptional Children, 70(47), 469–483.Google Scholar
  13. 13.
    Buysse, V., Bernier, K. Y., & McWilliam, R. A. (2002). A statewide profile of early intervention services using the Part C data system. Journal of Early Intervention, 25(1), 15–26.CrossRefGoogle Scholar
  14. 14.
    Hanley, J. A., Negassa, A., Edwardes, M. D., & Forrester, J. E. (2003). Statistical analysis of correlated data using generalized estimating equations: An orientation. American Journal of Epidemiology, 157, 364–375.PubMedCrossRefGoogle Scholar
  15. 15.
    Scott, G., & Ni, H. (2004). Access to health care among Hispanic/Latino children: United States 1998–2001. Advance Data, 24(344), 1–20.Google Scholar
  16. 16.
    Yu, S. M., Nyman, R. M., Kogan, M. D., Huang, Z. J., & Schwalberg, R. H. (2004). Parent’s language of interview and access to care for children with special health care needs. Ambulatory Pediatrics, 4(2), 181–187.PubMedCrossRefGoogle Scholar
  17. 17.
    Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. (2002). Disparities in health care by race, ethnicity, and language among the insured: Findings from a national sample. Medical Care, 40(1), 52–59.PubMedCrossRefGoogle Scholar
  18. 18.
    Goel, M. S., Wee, C. C., McCarthy, E. P., Davis, R. B., Ngo-Metzger, Q., & Phillips, R. S. (2003). Racial and ethnic disparities in cancer screening: The importance of foreign birth as a barrier to care. Journal of General Internal Medicine, 18(12), 1028–1035.PubMedCrossRefGoogle Scholar
  19. 19.
    Woloshin, S., Schwartz, L. M., Katz, S. J., & Welch, H. G. (1997). Is language a barrier to the use of preventive services? Journal of General Internal Medicine, 12(8), 472–477.PubMedCrossRefGoogle Scholar
  20. 20.
    Ronsaville, D. S., & Hakim, R. B. (2000). Well child care in the United States: Racial differences in compliance with guidelines. American Journal of Public Health, 90(9), 1436–1443.PubMedCrossRefGoogle Scholar
  21. 21.
    Wang, N. E., Gisondi, M. A., Golzari, M., van der Vlugt, T. M., & Tuuli, M. (2003). Socioeconomic disparities are negatively associated with pediatric emergency department aftercare compliance. Academic Emergency Medicine, 10(11), 1278–1284.PubMedCrossRefGoogle Scholar
  22. 22.
    Scarfone, R. J., Joffe, M. D., Wiley, J. F., Loiselle, J. M., & Cook, R. T. (1996). oncompliance with scheduled revisits to a pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 150(9), 948–953.Google Scholar
  23. 23.
    Basic Facts About Low-Income Children in the United States: Birth to Age 3. National Center for Children in Poverty. Accessed August 8, 2006.
  24. 24.
    El-Mohandes, A. A., Katz, K. S., El-Khorazaty, M. N., McNeely-Johnson, D., Sharps, P. W., Jarrett, M. H., Rose, A., White, D. M., Young, M., Grylack, L., Murray, K. D., Katta, P. S., Burroughs, M., Atiyeh, G., Wingrove, B. K., & Herman, A. A. (2003). The effect of a parenting education program on the use of preventive pediatric health care services among low-income, minority mothers: A randomized, controlled study. Pediatrics, 111(6), 1324–1332.PubMedCrossRefGoogle Scholar
  25. 25.
    Williamson, D. L., & Drummond, J. (2000). Enhancing low-income parents’ capacities to promote their children’s health: Education is not enough. Public Health Nursing, 17(2), 121–131.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Karen M. Clements
    • 1
    Email author
  • Wanda D. Barfield
    • 2
  • Milton Kotelchuck
    • 3
  • Nancy Wilber
    • 1
  1. 1.Center for Community HealthMassachusetts Department of Public HealthBostonUSA
  2. 2.Division of Reproductive HealthCenters for Disease ControlAtlantaUSA
  3. 3.Department of Maternal and Child HealthBoston University School of Public HealthBostonUSA

Personalised recommendations