Department of Health Systems, Management and Policy, Colorado School of Public Health, Children's Outcomes Research Group, Children's Hospital Colorado, 13001 E. 17th Place, MS B117, Aurora, CO, 80045, USA,
Matern Child Health J. 2014 May;18(4):1031-7. doi: 10.1007/s10995-013-1332-8.
To examine if state differences in early intervention (EI) utilization can be explained by recent restrictions on EI state eligibility policy. The sample (n = 923), derived from the 2009/10 National Survey of Children with Special Health Care Needs, included CSHCN who were ages 0-3 with a developmental delay or disability that affected their function. Multi-level logistic modeling was used to describe state differences in EI utilization and to determine if narrower state eligibility policy explained these differences. EI utilization ranged from 6 to 87 % across states. Having a severe condition (β = 0.99, SE = 0.28) and a usual source of care (β = 0.01, SE = 0.001) was associated with higher odds of utilizing EI. Compared to a diagnosed disability, having a developmental delay (β = -0.61, SE = 0.20) was associated with lower odds of utilizing EI. Living in a state with narrow and narrower state eligibility policy (β = -0.18, SE = 0.06) was significantly associated with lower odds of EI utilization, and this effect was strongest for children with the most severe functional impairments. Significant state variation in EI rates exists that can be explained, in part, by the restrictiveness of state eligibility criteria. Children with the most severe functional impairments appear to be least likely to utilize EI in states with the most restrictive eligibility policies.
为了考察早期干预（EI）的使用是否可以用最近对 EI 州立资格政策的限制来解释，本研究从 2009/10 年国家特殊儿童健康照护需求调查中选取了 923 名年龄在 0-3 岁之间、存在影响其功能发育迟缓或残疾的儿童样本。采用多水平逻辑回归模型描述了 EI 利用方面的州差异，并确定更严格的州资格政策是否可以解释这些差异。各州 EI 的利用率在 6%到 87%之间不等。患有严重疾病（β=0.99，SE=0.28）和有常规照护来源（β=0.01，SE=0.001）与更高的 EI 利用率相关。与诊断出的残疾相比，患有发育迟缓（β=-0.61，SE=0.20）与 EI 利用率较低相关。居住在州立资格政策较窄和更窄的州（β=-0.18，SE=0.06）与 EI 利用率较低显著相关，对于功能障碍最严重的儿童，这种效果最强。EI 使用率存在显著的州际差异，部分原因是州资格标准的严格程度。在资格政策最严格的州，功能障碍最严重的儿童似乎最不可能使用 EI。
