Objective

To determine whether the New York State Department of Health (Department) is effectively administering the Early Intervention Program (Program) in compliance with all applicable laws and regulations and ensuring equitable and timely access to services for children across the State. The audit covered the period from July 2018 through February 2022.

About the Program

When a child has a developmental delay or disability, their early years provide a critical window of opportunity to intervene. Research shows that the earlier a developmental delay or disability is identified, and the sooner services begin, the less likely it is that the child will need more intensive and expensive special education services later. Young children missing these opportunities for early intervention services are potentially at greater risk of significant developmental and learning delays.

The mission of the Program is to identify and evaluate as early as possible those infants and toddlers whose healthy development is compromised and provide appropriate intervention to improve child and family developments. The Department oversees both the Program and contracts with the 57 counties in the State and New York City (referred to as “municipalities”) that administer the Program at the local level.

The federal Individuals with Disabilities Education Act and State Public Health Law include specific requirements and time frames for the provision of Program services. One requirement is that the Department must develop a comprehensive Child Find system (Child Find) that ensures eligible children in the State are identified, located, and referred to the Program. Generally, after referral, children should be evaluated by qualified professionals through a multidisciplinary evaluation (MDE). If the evaluator determines a child has a disability or developmental delay, the municipality is responsible for convening a meeting to develop an initial Individualized Family Service Plan (IFSP) for therapeutic services and supports from a qualified service provider.

The Department uses a web-based system, New York State Early Intervention System (NYEIS), to manage the Program and exchange information among municipalities. According to NYEIS, from July 1, 2018 through February 14, 2022, approximately 189,000 new children with a suspected or confirmed disability and 19,000 new children at risk of disability were referred to the Program. As of February 14, 2022, there were about 36,000 children enrolled in the Program with an active IFSP.

Key Findings

• Many children who would benefit from the Program aren’t receiving services, and children who are receiving them aren’t always getting them in a timely manner.
  • Of the approximately 189,000 new children who were referred to the Program during our audit scope, over 27,000 (14%) never received an MDE.
  • Of the nearly 98,000 children who were evaluated and deemed eligible to receive services, about 2,000 (2%) never received an IFSP.
  • Of the nearly 95,000 children with an approved IFSP, approximately 27,000 (28%) did not begin receiving therapeutic services within 30 days of when they were authorized to start.
  • Many eligible children likely did not receive services because Program officials didn’t have parental consent, which occurred for a wide variety of reasons. Further, insufficient provider capacity is a key reason why services were not always provided in a timely manner. The Department needs to do more to identify and address the underlying reasons why children are not receiving valuable Program services that they are entitled to and can benefit from. This includes determining why officials were not able to obtain parental consent for Program services and doing more to improve provider capacity.
• Limited guidance and oversight from the Department has resulted in significant differences in Child Find’s outreach and awareness activities across the State. Our sample review found that municipalities that conducted the least amount had a lower percentage of children in the population with an IFSP, whereas those that did considerably more outreach served a higher percentage of children.
• There are disparities across the State in the referral and inclusion of children into the Program as well as in the availability of providers and access to Program services. Equity is also an issue, with White children generally being referred at a younger age and Black children being less likely to receive services within the prescribed time frame. While the Department has demonstrated it recognizes the importance of equity, more work must be done to identify and fully address barriers to equitable access to the Program.
• NYEIS does not have the functionality or accuracy municipalities need to administer the Program efficiently and effectively at the local level. While the Department is working with a contractor to implement a new web-based system, EI-HUB, progress has been delayed multiple times.

Key Recommendations

• Take steps to identify and address the underlying reasons why children are not always receiving the services they are entitled to and why services are not always provided on time.
• Develop and include more specific goals, tasks, and/or objectives on future municipal workplans related to Child Find’s outreach and awareness activities.
• Take steps to better understand Program disparities and develop an action plan to improve equitable access to Program services.
• Work with the EI-HUB contractor to expedite release of the new system as soon as practicable.