title: Maternal socio-economic and race/ethnic characteristics associated with early intervention participation.
abstract: OBJECTIVE
  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<or=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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Community Health, Massachusetts Department of Public Health, 250 Washington St., 5th Floor, Boston, MA 02108, USA. karen.clements@state.ma.us
authors.forename: Karen M
authors.initials: KM
authors.lastname: Clements
authors.forename: Wanda D
authors.initials: WD
authors.lastname: Barfield
authors.forename: Milton
authors.initials: M
authors.lastname: Kotelchuck
authors.forename: Nancy
authors.initials: N
authors.lastname: Wilber
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000208:ethnology / Q000628:therapy*; D018479:Early Intervention, Educational / Q000706:statistics & numerical data*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008404:Massachusetts; D016017:Odds Ratio; D012959:Socioeconomic Factors; D044465:White People; D055815:Young Adult