For children at risk of developmental disorders, early detection and intervention can make a critical difference and have lifelong consequences. Unfortunately, children of color are more likely to miss this critical opportunity for early intervention. For example:
- On average, minority children are diagnosed with autism two years later than white children.
- Once diagnosed, children of color are far less likely to receive the services of developmental pediatricians or psychologists.
What causes those disparities, and what can be done to eliminate them?
To understand these questions, the Connecticut Health Foundation awarded a grant to Connecticut Children’s Medical Center to study pediatric offices that had high screening and referral rates for children at risk of developmental issues – those that could offer insights into what might help.
Dr. Thyde Dumont-Mathieu, a developmental-behavioral pediatrician, led the effort. She found that a key factor in the practices that do a good job at screening and referring children is commitment: They reach out to Birth to Three – Connecticut’s state-run early intervention program – when needed, and make sure to do the paperwork required for families to get help. They make sure things don’t fall through the cracks.
Dumont-Mathieu’s research as part of the CT Health grant made clear that everyone involved – parents, pediatricians, and Birth to Three staff – welcomed the opportunity to communicate more. However, while the willingness to work together was a critical first step, there wasn’t a formal structure to ensure that it happens.
Those findings led to another grant from the foundation that is enabling Connecticut Children’s to pilot a new arrangement. Birth to Three early intervention staff will be embedded in two hospital-run pediatric offices and will be available to consult with the medical staff and to meet with families in person.
For some families, it can be a struggle to recognize that their child might have a developmental issue. Others are hesitant to have a stranger come to their home – as Birth to Three staff typically do. In some cases, families don’t make the phone call to set up the appointment. Given all these potential obstacles, it could make a difference to have that introduction occur in person, with a person the family already trusts – the child’s pediatrician.
The benefits of having an on-site developmental specialist could extend to the medical staff too, Dumont-Mathieu said: If there’s someone available to answer questions about screening or developmental concerns, the doctors might be more likely to screen their patients or pursue questions.
As part of the grant, Dumont-Mathieu and her team will study whether this arrangement increases screening and referral rates. They will also examine barriers to integrating early intervention services in pediatric offices and develop financial models that could support this type of program.
If it proves successful and sustainable, the model of embedding Birth to Three staff in pediatric offices could be replicated or built upon.
Dumont-Mathieu’s work to examine the factors behind a disparity and pilot a potential solution is a great example of the type of systems change the foundation supports. This work has the potential to extend far beyond the two pediatric offices where the model is being tested.
“We are hopeful that this approach can lead to broader change by identifying models that improve care,” said Tiffany Donelson, the foundation’s vice president of program.