Discussion
EI Participation Rates and Prevalence
of Developmental Delay
Based on the population-based risk factors analyzed, these
results strongly suggest that there is a substantial population
of infants and young children who needed EI services
and did not receive them. Early Intervention has been
developed as an entitlement program under federal law,
Individuals with Disabilities Education Act (IDEA) Part C.
The degree to which potentially eligible children did not
receive needed services (beginning with a multi-disciplinary
evaluation to determine eligibility), and especially the
significant regional disparities in utilization, are a source of
concern.
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For the purposes of federal monitoring, a national baseline
(target) of 2 % EI participation (percentage of age-eligible
children based on census count who have an Early Intervention
Individual Family Service Plan or ‘‘IFSP’’) was established
early in the program’s history [32]. This 2 % baseline,
which state EI programs were expected to meet or exceed,
seems to have been based prevalence of a narrow set of
diagnosed developmental disabilities, e.g., as tracked by the
Metropolitan Atlanta Developmental Disabilities Study [33].
By 2009, however, states were no longer required to
comply with any specific target for EI participation. Instead
states were evaluated for whether they served a higher or
lower percentage of population from 1 year to the next.
Because there was no target, an increase from a relatively low
participation rate of, for example, 1.4–1.5 % the following
year would be evaluated positively as ‘‘progress’’ while a
change from a relatively high participation rate of 4.5–4.4 %
the following yearwould elicit a negative programassessment
as ‘‘slippage.’’ [34] This change in federalmonitoring of each
state’s EI participation from a compliance indicator to a performance
indicator has allowed states with low EI utilization
to grow only slightly and remain below the national ratewhile
nonetheless meeting federal requirements and being assessed
positively on program review.
While the 2 % target is no longer enforced, the fact that
the national EI participation rate has consistently been
close to 2 % suggests that it has influenced the national
scope of the EI program. Unfortunately this baseline figure
is not consistent with epidemiological data. It is generally
accepted, based on evidence from multiple prevalence
studies, that early developmental delay is present in not
less than 10