Early Intervention Referral and Developmental Delay
Early Intervention Referral and Developmental Delay
Birthweight, gestational age, and other birth characteristics were collected by NYC DOHMH during the process of registering births. The institution of birth reported exact birthweight; follow-back was routinely done to correct missing birthweights and, for all infants weighing <1,000 g, to verify weight. Birthweight (BW) categorizations were chosen to reflect common thresholds used in practice and by EI programs: <1,000 g, 1,000–1,249 g, 1,250–1,499 g, 1,500–2,499 g, and 2,500 g or more. Clinical estimate of gestational age was reported on the birth certificate in completed weeks, and reflects the birth attendant's best estimate of the infant's gestation based on perinatal factors and assessments. Gestational age (GA) was categorized into <28 completed weeks, 28–29 weeks, 30–31 weeks, 32–33 weeks, 34–36 weeks, 37–38 weeks, and 39 weeks or greater. Plurality, also reported by the facility, was defined as the number of fetuses delivered live or dead at any time in the pregnancy. Mother's education level, age, and race/ethnicity were self-reported at the time of birth.
The EI administrative database included information on all children referred to the NYC EI Program from 1999 through 2004, irrespective of whether eligibility was established or services were ultimately provided. A child may be referred to the New York City EI Program by a doctor, parent, or appropriate professional if either:
Correlation between birthweight and gestational age was estimated using the Pearson correlation coefficient (rho). Frequencies and proportions were used to describe maternal demographic characteristics and birth outcomes for children referred and eligible for EI, as well as the percent of children referred to EI for specific BW–GA categories. Since frequencies were calculated in the entire population of NYC births, sample statistics (e.g., P-values) used to make inferences about a population from a sample were not applicable. A logistic model was used to estimate the predicted risk of diagnosed developmental delay in the population of NYC births; terms in the model included birthweight, gestational age, and the interaction between the two characteristics. Predicted risk of delay for a given combination of birthweight and gestational age was able to be directly estimated from this model given the longitudinal nature of the study and because values for all independent variables were specified, p. 10). Finally, we created cumulative frequency distributions to illustrate the proportion of children referred to the program by a given age; in order to include only those children who fall under EI's purview, these distributions were limited to those who were referred and ultimately determined to be eligible for EI services. Separate graphs comparing these cumulative percents for different gestational ages were produced for those with a birthweight <1,000 g and 1,000–1,249 g. All statistical analyses were performed using the SAS System. This study was approved by the NYC DOHMH's Institutional Review Board.
Variables
Birth Certificate
Birthweight, gestational age, and other birth characteristics were collected by NYC DOHMH during the process of registering births. The institution of birth reported exact birthweight; follow-back was routinely done to correct missing birthweights and, for all infants weighing <1,000 g, to verify weight. Birthweight (BW) categorizations were chosen to reflect common thresholds used in practice and by EI programs: <1,000 g, 1,000–1,249 g, 1,250–1,499 g, 1,500–2,499 g, and 2,500 g or more. Clinical estimate of gestational age was reported on the birth certificate in completed weeks, and reflects the birth attendant's best estimate of the infant's gestation based on perinatal factors and assessments. Gestational age (GA) was categorized into <28 completed weeks, 28–29 weeks, 30–31 weeks, 32–33 weeks, 34–36 weeks, 37–38 weeks, and 39 weeks or greater. Plurality, also reported by the facility, was defined as the number of fetuses delivered live or dead at any time in the pregnancy. Mother's education level, age, and race/ethnicity were self-reported at the time of birth.
Early Intervention
The EI administrative database included information on all children referred to the NYC EI Program from 1999 through 2004, irrespective of whether eligibility was established or services were ultimately provided. A child may be referred to the New York City EI Program by a doctor, parent, or appropriate professional if either:
he/she was suspected or known to have a developmental delay. A multi-disciplinary evaluation was then used to determine the presence of a significant developmental delay, which would then make them eligible for EI services. A significant EI-diagnosed developmental delay, herein referred to as "developmental delay," was defined as (a) a 12-month delay, 33% delay or a score of two or more standard deviations below the mean on an appropriate standardized instrument, in at least one of five developmental areas (adaptive, cognitive, communication, social-emotional, and physical) or (b) in at least two of these areas, a 25% delay or a score of 1.5 standard deviations or more below the mean.
The/she was diagnosed with an established condition. Although also evaluated, a child diagnosed with an established condition was automatically eligible to receive EI services. (See http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/2005-02/docs/multidisciplinary_summary.pdf for list of eligible diagnosed conditions). Statistical Analysis
Correlation between birthweight and gestational age was estimated using the Pearson correlation coefficient (rho). Frequencies and proportions were used to describe maternal demographic characteristics and birth outcomes for children referred and eligible for EI, as well as the percent of children referred to EI for specific BW–GA categories. Since frequencies were calculated in the entire population of NYC births, sample statistics (e.g., P-values) used to make inferences about a population from a sample were not applicable. A logistic model was used to estimate the predicted risk of diagnosed developmental delay in the population of NYC births; terms in the model included birthweight, gestational age, and the interaction between the two characteristics. Predicted risk of delay for a given combination of birthweight and gestational age was able to be directly estimated from this model given the longitudinal nature of the study and because values for all independent variables were specified, p. 10). Finally, we created cumulative frequency distributions to illustrate the proportion of children referred to the program by a given age; in order to include only those children who fall under EI's purview, these distributions were limited to those who were referred and ultimately determined to be eligible for EI services. Separate graphs comparing these cumulative percents for different gestational ages were produced for those with a birthweight <1,000 g and 1,000–1,249 g. All statistical analyses were performed using the SAS System. This study was approved by the NYC DOHMH's Institutional Review Board.
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