Title: Early Childhood Development—Challenges Providing and Accessing Services Description: Parents know that the first few years of a child's life include so many critical milestones. During those first few years, it's critical to identify any developmental delays a child might have and provide early intervention services. The federal government provides hundreds of millions of dollars in funding to states for early intervention services. But there are concerns about differences in how services are provided and whether they are equitable. We find out more from GAO’s Jackie Nowicki. Related GAO Work: GAO-24-106019, Special Education: Additional Data Could Help Early Intervention Programs Reach More Eligible Infants and Toddlers Released: October 2023 [Music] [Jackie Nowicki:] For kids at risk for developmental delays, early intervention services like speech therapy can make a really big difference in their outcomes later in life. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report. Your source for fact-based nonpartisan news and information from the U.S. Government Accountability Office. I'm your host, Holly Hobbs. Parents know that the first few years of a child's life include so many critical milestones—things like their first smile, first words, first steps. And because of this, during those first few years, it's critical to identify any developmental delays a child might have and provide early intervention services such as speech or physical therapy. The federal government provides hundreds of millions of dollars in funding to states for early intervention services. But there are concerns about differences in how services are provided and whether they are equitable. Joining us to talk about this issue is GAO’s Jackie Nowicki—an expert on early childhood education who has a new report out today. Thanks for joining us, Jackie. [Jackie Nowicki:] Thanks for having me, Holly. [Holly Hobbs:] So, Jackie, maybe we can start with how are developmental delays identified in infants and toddlers in the first place and what's supposed to happen next? [Jackie Nowicki:] So identifying a kid can be as simple as a parent or a health care provider notices a child isn't reaching a developmental milestone when expected. So, like not giggling at six months or, you know, maybe not crawling or beginning to walk by 18 months. Health care providers would generally do an initial screening, and, if warranted, families are referred to their state's early intervention program. From there, the EI program will determine if the child is actually eligible for services. So that would be things like speech therapy or physical therapy. Every state's a little different, but generally that's how the process works. [Holly Hobbs:] And do we know how often infants and toddlers who are identified actually receive services? [Jackie Nowicki:] Somewhat. So, Education does not have the authority to collect data on children in the pipeline prior to when they start receiving services. So, we surveyed the states to see what data they might collect on kids so that we could answer the exact question that you're asking. And the rates vary widely by state, but overall, about 50% of kids referred for evaluation, ultimately received services. And about 90% of kids who were determined to be eligible received services. So that gap isn't necessarily a bad thing, but we certainly think it's worth looking into. So, for example, if half the kids referred for services don't ever wind up receiving services, it could suggest that health care providers are referring a lot of kids who aren't eligible, and they might benefit from some training. [Holly Hobs:] So then what happens to these toddlers and infants who maybe should have been identified or were identified, but did not receive services? [Jackie Nowicki:] So when kids in need of services are identified late in the game or not at all, they miss out on critical support needed to meet their developmental milestones. And that makes it harder for them over the long term—academically, behaviorally, socially, developmentally. There is a lot of evidence showing that early intervention can dramatically improve outcomes for kids. It's also far more cost effective to intervene earlier rather than later. [Holly Hobbs:] Jackie, you said that that each state has different definition for what qualifies as a developmental delay. Do we know what those differences look like and what impact they could have on kids? [Jackie Nowicki:] We do. So, by law, states have flexibility to develop their own definitions for what constitutes a developmental delay. And they're also permitted to develop their own eligibility criteria. So, for example, in Illinois, children who have at least a 30% delay in one or more developmental areas are eligible for services. Whereas in Vermont, a child is eligible if they have an observable and measurable developmental delay in one or more developmental areas. So you can see how different they are. One is qualitative, one is quantitative. And one of the effects of giving states those flexibilities is that a child could be eligible for services in one state, move to another state and find themselves ineligible for services. [Holly Hobbs:] So the states themselves are managing these programs. What did state officials tell us about any challenges they face in providing services? [Jackie Nowicki:] So we asked states to tell us their top three challenges. Forty-six states listed a lack of qualified service providers as one of their top three challenges. The other challenge most commonly cited was staffing challenges in the state agency responsible for administering the early intervention program. So, what does that look like? Service Coordinators play an important role in helping families understand and navigate the whole process. But staffing challenges mean that many service coordinators are responsible for a lot of other activities beyond service coordination. So that can make it really difficult to provide timely quality service. We also heard that states have trouble attracting and retaining quality candidates. [Holly Hobbs:] This report also looked at whether services were being provided equally to children of different races. What can you tell us? [Jackie Nowicki:] So this was difficult to answer with the limited data that we had available. So Education does not have authority to collect data, demographic or otherwise, on children prior to them receiving services. So, we surveyed states to see what they were able to tell us. We found wide variation along racial lines for children referred for evaluation compared to those actually evaluated. There was much less variation in who received services once they were evaluated and determined eligible. {MUSIC} [Holly Hobbs:] So, Jackie just told us that while early intervention is critical, there can be wide differences across states in determining whether a child is qualified to receive services or even referred for evaluation. So, Jackie, what more do we think the Department of Education needs to be doing to ensure infants and toddlers have access to the early intervention services they need? [Jackie Nowicki:] So we recommended that the department encourage all states to look at the demographic data they already collect on things like race and ethnicity and to see if there are opportunities to improve access to early intervention services, because doing so could help states identify and serve more infants and toddlers who need support sooner. [Holly Hobbs:] What about this issue you talked about where the Department of Education lacks the authority to collect some of the data it needs. What do we think needs to happen there? [Jackie Nowicki:] So we also think there are opportunities for Congress to consider providing additional authority to Education so that it would be able to require states to collect this kind of demographic data in all stages of the process. We also encourage Congress to consider requiring Education to use that data to figure out where states might benefit from assistance, like with identifying and addressing access issues. [Holly Hobbs:] And last question, what's the bottom line of this report? [Jackie Nowicki:] So for kids at risk for developmental delays, early intervention services—like speech therapy— can make a really big difference in their outcomes later in life. That's why it's really important for the Department of Education to be able to collect demographic data to understand what's going on at different points in the process and to use that data to help increase access to services as much as they can. [Holly Hobbs:] That was Jackie Nowicki talking about GAO's new report on early childhood intervention. Thanks for your time, Jackie. [Jackie Nowicki:] Thanks for having me, Holly. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, Spotify, or wherever you listen and make sure to leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.