608 - Assessing Determinants of Access to Clinic- and School-Based Supports for Preschool-Aged Children with Developmental Delays and Disabilities

Poster Number: 608
Publication Number: 608.1908

Background: Less than 25% of preschool-aged children with developmental delays and disabilities (PCw/DD) currently receive recommended therapies (e.g., speech therapy) with children from historically marginalized communities disproportionately impacted. Because therapeutic services are associated with improved school readiness and subsequent educational and health outcomes, a lack of therapies during this period can be responsible for substantial morbidity among children and their caregivers.

Objective: Our aim was to identify multilevel facilitators of receiving therapeutic services (clinic and school) among PCw/DD from predominantly historically marginalized communities through a retrospective chart review.

Design/Methods: We used a cross-sectional design to review charts from patients aged 36-60 months who had their initial visit at the UI Health Developmental and Behavioral Pediatrics Department between September 1st, 2021 - June 30th, 2023. Our objective was to assess the receipt and identify predictors of access to clinic- and school-based therapies based on Anderson’s Behavioral Model of Health Services Use. Data were then coded for descriptive analysis (means, percentages, and proportions) and logistic regressions to assess the relationship between predisposing, enabling, and need-based factors with access to school- and/or clinic-based therapeutic services.

Results: The majority of patients (N=194) were non-white (88%) and received Medicaid (87%). 90% of PCw/DD were not receiving any form of clinical therapy, and nearly 60% were without school-based services. Of the 58% of PCw/DD enrolled in preschool, 31% of these families reported their children were not receiving school-based services. More than half (55%¬) of parents reported their child did not have an established Individualized Education Plan (IEP). A history of early intervention was strongly associated with preschool enrollment (p=0.002) and receipt of school-based therapies (p < 0.001). While not statistically significant, race played a small role in access to preschool enrollment as 68% of white patients were enrolled in school versus 51% of black PCw/DD (p=0.09).

Conclusion(s): Our study illustrates the overwhelming absence of access to clinical and school-based therapies and legally required formal education plans for PCw/DD in an urban setting. Further studies are needed to determine the full impact of predisposing, enabling, and need-based factors among marginalized children in accessing services essential for academic, cognitive, and social/emotional skills.