213 - Service Gaps in Federally Mandated Early Childhood Special Education

Publication Number: 3205.213

Caroline Cotto, University of Illinois Chicago, Chicago, IL, United States; Reshma Shah, University of Illinois College of Medicine, Chicago, IL, United States; Raphael D. Kinney, University of Illinois Chicago - Institute for Health Research and Policy, Chicago, IL, United States; Oksana Pugach, Institute for Health Research and Policy, UIC, Chicago, IL, United States; HAI M. Nguyen, University of Illinois at Chicago - Institute for Health Research and Policy, Cambridge, MA, United States; Kathleen R. Diviak, University of Illinois At Chicago, Chicago, IL, United States; Tina Schuh, univers, Chicago, IL, United States

Background: Early Childhood Special Education (ECSE) services are federally mandated under Individuals with Disabilities Education Act (IDEA) for eligible preschool-aged children with developmental delays and disabilities (DD), yet many remain without access. Existing data primarily come from national surveys that neither capture clinic-based populations where developmental concerns are first identified nor reflect the experiences of families in clinical settings that historically face large inequities in access to care.

Objective: To describe the prevalence and timeliness of ECSE access among preschool-aged children with DD enrolled in an NIH-funded trial testing a community-clinical linkage model in in two real-world service delivery contexts -federally qualified health centers and academic-affiliated clinics- serving historically disinvested Chicago communities.

Design/Methods: This cross-sectional analysis used baseline data from 320 parent-child dyads recruited from federally qualified health centers and an academic-affiliated pediatric clinic in Chicago. All children screened positive for DD but were not receiving ECSE services at enrollment by design. Outcomes included: 1) ECSE process milestones (request for evaluation, completion of evaluation, eligibility determination, and IEP development); and 2) timeliness from the child's third birthday to each milestone. Descriptive analyses summarized patterns of access and delays.

Results: Children were on average 3.6 years (SD = 0.7); 86% had public health insurance; 37% were Latine and 57% non-Latine Black. Despite universal developmental concern, only 3% were receiving clinic-based services, and 29% of families had requested an Individualized Education Plan (IEP) evaluation at baseline. Although 47% were enrolled in early childhood education, only 13% had completed an IEP evaluation, 12% were found eligible, and 6% had an IEP developed. Families frequently reported delays exceeding state-mandated timelines from request to evaluation initiation. Drop-off at each referral stage underscored early fragmentation between clinical and educational systems.

Conclusion(s): Given the low proportion of children receiving clinic-based developmental services, timely access to ECSE is critical to address unmet needs. Substantial service gaps persist among preschoolers with DD in urban settings. While all met criteria for developmental concern, most had not initiated or completed the ECSE evaluation process. Findings underscore the need for system-level interventions that bridge healthcare and education to ensure equitable, timely access to early developmental supports.

Participant Demographic Characteristics