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Early Childhood Special Education (ECSE) is a federally mandated school-based service that can improve developmental, educational, and health outcomes for children with developmental delays and disabilities. However, despite the potential benefits, disparities in access and timeliness persist. A parent's request for an Individualized Education Program (IEP) evaluation is often the first step toward accessing school-based services, yet little is known about what shapes whether and when parents initiate a request. This study examined factors associated with requesting an IEP evaluation and the timeliness of requests among preschool-aged children with developmental delays.
Methods
This cross-sectional study used baseline data from 320 parent-child dyads recruited from an urban pediatric clinic and enrolled in an NIH-funded clinical intervention trial designed to improve access to ECSE services for preschool-aged children with developmental delays. Logistic regression models estimated the odds of requesting an IEP evaluation. Piecewise Cox proportional hazards models were used to examine the timeliness of parents’ IEP evaluation requests, measured in months from the child’s birth to the time of request. Covariates included child age, gender, prematurity, receipt of Early Intervention (EI) services, therapy/clinic services, autism diagnosis, parent education, household income, insurance type, race/ethnicity, primary language, and neighborhood context.
Results
Overall, 26.5% of parents reported requesting an IEP evaluation. In adjusted logistic models, each additional month of child age was associated with greater odds of requesting an IEP evaluation (OR = 1.06, 95% CI [1.02, 1.09], p = .001). Prior EI services, which provide developmental support before school entry, were also associated with higher odds of requesting an IEP evaluation (OR = 2.93, 95% CI [1.53, 5.61], p = .001). Autism diagnosis was also associated with higher odds of requesting an IEP evaluation (OR = 3.25, 95% CI [1.72, 6.15], p < .001). Parents with some college education had higher odds of requesting an IEP evaluation (OR = 2.81, 95% CI [1.46, 5.40], p = .002) than those with a high school diploma or less. In piecewise Cox models, prior EI services were strongly associated with higher instantaneous probability of IEP evaluation requests before 36 months (HR = 3.63, 95% CI [1.12, 11.77], p = .03) and beyond 36 months (HR = 2.35, 95% CI [1.42, 3.90], p =.001). Autism diagnosis (HR = 2.68, 95% CI [1.62, 4.43], p < .001), and parents with some college education (HR = 2.21, 95% CI [1.34, 3.66], p = .002) were also associated with higher instantaneous probability of IEP evaluation requests. In contrast, children 36 months and older were associated with a lower instantaneous probability of a request (HR = 0.88, 95% CI [0.83, 0.93], p < .001).
Conclusions and Implications
Our findings highlight critical gaps in ECSE access and timing. Attention must shift upstream to address disparities in ECSE access that may begin before parents request an IEP evaluation. These findings also identify an early point in the ECSE process at which pediatric, educational, and family-serving systems, including social work, can intervene to strengthen coordination and promote equitable access to school-based services.