Research has shown that children who receive early special education services are more likely to exit out of the special education program during their school career and are less likely to repeat a grade. For every dollar we spend on early intervention we will see a $5-7 savings over the child's life. Yet most children with disabilities and delays are under identified and not found eligible for special education until they are school age, when they are already significantly behind their peers. Children who qualify for special education can begin receiving services at age two, giving them three years of intervention before they reach kindergarten. Children with disabilities or delays who are not identified lose out on three years of intervention that could literally change their lives, giving them an opportunity to catch up to their peers, increase their language development, monitor their progress, and provide a strong foundation they will build on throughout their school career.
Every year we run into kindergarteners who were not identified, but should have been. Many of their parents come to us and openly state that they have concerns. Some are worried that their five year old never began to talk, some are worried about how their five year old handles new situations, or how their five year old has developed self-help skills. These parents questioned their doctors about their child's development only to be told that everything was fine. Their five year old without language was "developing normally". In fact, the doctor even signed the school physical form saying that the child without language was developing as expected.
As far as I know, doctors do not have to do anything extra if they are concerned about a child's development other than referring them to Child Find, a service that screens young children for disabilities. What is suppose to happen is that doctors refer children to Child Find, who then runs a series of evaluations on a child to determine whether or not that child is eligible for services. If the child is eligible they can receive instruction in their home, or in one of the preschool programs, all for free through IDEA. The doctors here are the first line of defense and most of the identification falls into their hands since many of our students cannot afford daycare or preschool.
I've written about this before because nothing makes me more upset than knowing a child could have been receiving services for three years and yet did not because a doctor never took the time to truly examine the child, listen to the parents' concerns, or just recommend that the parent contact Child Find if they are truly concerned. I do not understand what is so hard about referring children to Child Find. And why we end up with so many children who go unidentified for so long simply because the pediatrician just signed off on the "well-child" visits without actually examining the child's development.
Our families are limited in the doctors they can see because they must find someone who takes Medicaid. A good friend who works in a doctors practice told me what little reimbursement doctors get for taking Medicaid. Any procedure, she said, is really only reimbursed about $25. Medicaid patients are being served, but in an already strapped practice doctors are most likely busy and not likely to spend extra time with patients whose treatments will never fully be paid for. Let alone, for many of our families, there is a language barrier. What could be a 15 minute doctors appointment could turn into a 30 or 40 minute appointment with a parent who is trying to communicate through limited English. I imagine this situation is frustrating for doctors and patients and ends with parents leaving with their forms filled out but without the answers they need.
Last Wednesday night in one of my grad classes the director from DCPS' Early Stages program came to speak to us on the work Early Stages does in the District to increase early identification and early intervention. I was floored with how much the organization does and does successfully within the limitations of DCPS. For the first time I found myself very jealous of something within DCPS and wish we could recreate that program in my nearby county.
The executive director of Early Stages happens to be a pediatrician himself. This has allowed him to make connections with the primary Medicaid caregivers in DC to help inform them on important indicators to look for when identifying a child for Child Find, helping to train them in the most beneficial diagnostic tools, making sure they know the procedure for how to recommend a child to Child Find, and even helping them with the Medicaid billing codes so that they can be reimbursed for diagnostic screenings.
This is exactly what needs to happen in my community. At some point we need to connect with these doctors and make sure they know the procedures for recommending children to Child Find, help them to understand why it is important, and what indicators Child Find is looking for. Increasing early intervention could lead to giving so many more children language development and intervention, allowing them to catch up with their peers.
I wish I had the time to investigate the doctors in my community to gain a better understanding of the problem so we can begin to identify a solution. Early Stages seems to be on to something, which is going to make huge strides for the development of the children of DC. Now, if we can just copy it...
*I hope to write more about Early Stages later, when I'm not suppose to be working on a paper. I was amazed and in awe of the program and how much they do "right".
I knew that our ESD did early childhood services (I think from before age 2), but I never thought about parents making that connection. I know it because I work in the schools. It is awful to think a kid could be getting help but because of a rushed doctor or a parent without information that they may not get it.
I'm going to take this to my district tomorrow. I'm curious what is done to help these families. Thanks for the important post.
It is not just Medicaid doctors who will brush off parent's concerns. My youngest has a speech delay. Since he was my youngest, we were pretty sure he had a speech delay. Our doctor wasn't concerned, until we were clear that we knew our son had a problem. After driving him 160 miles round trip for therapy, the therapist told us about in home services. The doctor's office didn't say a word about it. My husband and I are relatively high income, college educated professionals. English is our native language. I don't know how people who have fewer resources, or whose first child has issues would know what to do.
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