Social influences and financial stressors may keep some low-income black and Hispanic families from using early intervention (EI) services for developmental delays (DD), a new study found.
Pediatricians should work to better engage and support these families, authors said in the study “Beliefs Regarding Development and Early Intervention Among Low-Income Black and Hispanic Mothers” (Magnusson DM, et al. Pediatrics. Oct. 16, 2017, https://doi.org/10.1542/peds.2017-2059).
Previous studies have shown only 25% of children with DD who are eligible for EI services are using them, and rates of use are especially low for black and Hispanic children.
Researchers set out to study the disparity by conducting open-ended interviews with 22 low-income black and Hispanic mothers of children 36 months and younger with DD.
Five themes emerged from the interviews:
- Mothers compared their child to others.
- They believed children develop at their own pace and their child would catch up.
- They relied on opinions of family and friends more than pediatricians.
- They juggled competing priorities and struggled with limited finances.
- They received limited or conflicting information about EI services.
Black and Hispanic mothers shared many of the same beliefs, but there was a difference in why some agreed to go along with EI services. Some Hispanic mothers did not feel their child was delayed but deferred to the doctor’s opinion, while some black mothers agreed to avoid trouble or judgment. In either case, authors wrote, the mothers became more disengaged.
“These findings underscore the importance of eliciting mothers’ concerns and expectations early in the help-seeking pathway, and engaging them as equal partners throughout the decision-making process,” authors wrote.
They also suggested using screening tools that would help mothers visualize typical development, engaging close family and friends in the process, addressing socioeconomic needs and improving coordination between primary care and EI providers.
In a related commentary, authors suggested using systemwide approaches, including improved coordination between providers, peer-led screening and clinic-based programs.
“Our concern is that without a larger commitment to developing alternative approaches to screening — and to viewing retention of screen-detected populations in the developmental treatment cascade as an integral part of the screening process — we will continue to place the primary burden of engagement on parents and clinicians,” they wrote.