title: Understanding Barriers to Early Intervention Services for Preterm Infants: Lessons From Two States.
abstract: OBJECTIVE
  To explore existing barriers and challenges to Early Intervention (EI) referral, enrollment, and service provision for very low birth weight (VLBW; <1500 g) infants.
  
  
  METHODS
  We conducted 10 focus groups with parents of VLBW children (n = 44) and 32 interviews with key informants from EI (n = 7), neonatal intensive care units (n = 17), and outpatient clinics (n = 8) at 6 sites in 2 states. We used grounded theory to identify themes about gaps in services.
  
  
  RESULTS
  Both parents and providers found EI helpful. However, they also identified gaps in the current EI system at the levels of eligibility, referral, family receptivity, and service provision and coordination with medical care. Inadequate funding and variable procedures for evaluation may affect children's eligibility. Referrals can be missed as a result of simple oversight or communication failure among hospitals, EI, and families; referral outcomes often are not formally tracked. Families may not be receptive to services as a result of wariness of home visits, social stressors, denial about potential developmental delays, or lack of understanding of the benefits of EI. Once a child is deemed eligible, services may be delayed or terminated early, and EI providers may have little specialized training. Communication and coordination with the child's medical care team is often limited.
  
  
  CONCLUSIONS
  Systemic barriers, including funding and staffing issues, state and federal regulations, and communication with families and medical providers, have led to gaps in the EI system. The chronic care model may serve as a framework for integrating community-based interventions like EI with medical care for VLBW children and other vulnerable populations.
authors.affiliation: Center for Policy, Outcomes and Prevention & Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Alison A
authors.initials: AA
authors.lastname: Little
authors.affiliation: Center for Policy, Outcomes and Prevention & Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Karen
authors.initials: K
authors.lastname: Kamholz
authors.affiliation: Center for Policy, Outcomes and Prevention & Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Corwin
authors.affiliation: Center for Policy, Outcomes and Prevention & Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Barrero-Castillero
authors.affiliation: Center for Policy, Outcomes and Prevention & Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA. Electronic address: cjwang1@stanford.edu.
authors.forename: C Jason
authors.initials: CJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D002658:Developmental Disabilities / Q000523:psychology / Q000628:therapy*; D018479:Early Intervention, Educational; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000523:psychology / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010290:Parents; D013022:South Carolina; D055815:Young Adult
keywords: IDEA Part C; VLBW infants; early intervention; preterm infants