children

Access to Child Services Linked to Race, Neighborhood and Income, Analysis Finds

A playground in the north Bronx, an area where a large share of young kids don't get evaluations or services following referrals to Early Intervention.
A playground in the north Bronx, an area where a large share of young kids don’t get evaluations or services following referrals to Early Intervention. Photo: Elissa Hersh

A new analysis building on city health records previously obtained by Measure of America and THE CITY finds that kids referred to special education evaluations are least likely to get screenings in low-income neighborhoods where most residents are people of color.

Those neighborhoods are also overrepresented among those where the highest numbers of children do not receive Early Intervention services following an evaluation, according to the report from the groups Citizens Committee for Children and Advocates for Children, released Thursday.

Coordinated and funded through the city Department of Health and Mental Hygiene, the federally mandated Early Intervention program provides free services to children up to age 3 who show signs of delays and disabilities, such as autism spectrum disorders.

The city budgeted $218.8 million for the program this year, and about 30,000 young New Yorkers received its services between 2016 and September 2018.

Earlier this year, Measure of America and THE CITY handed off the data, obtained via a Freedom of Information Law request, to the two child advocacy nonprofits, which carried out an analysis over the course of three months.

“The analysis confirms what we’ve seen on the ground,” said Randi Levine, the policy director at Advocates for Children. She said the organization regularly “gets calls from families who are having difficulty accessing the early intervention services that their children need.”

In June, Measure of America and THE CITY reported on the struggles some families have obtaining services, a problem particularly acute in some areas of the city far from Manhattan.

Race Link

The new analysis finds a strong link between the race or ethnicity of children referred for an evaluation and the likelihood that child will receive that evaluation — odds higher if those children are not black or Hispanic.

On average, the analysis concludes, the more children of color there are in a neighborhood’s referral pool, the lower the rates of evaluation.

Photo: Advocates for Children/Citizens Committee for Children

The five neighborhoods where children are least likely to receive evaluations are clustered in the South Bronx and Harlem — neighborhoods where nearly one in five children referred for an evaluation never received one.

Those evaluations serve as the gateway to free government services such as speech and occupational therapy.

Neighborhood View

The review also found disparities between neighborhoods in how many children actually end up receiving services after being evaluated.

The report looks at participation in the program by race and ethnicity in each of the 42 health districts in the city. Previously, the Department of Health and Mental Hygiene only made borough-level data available to public health specialists working to increase access to the program in underserved communities.

“We really saw the value of looking at the neighborhood level to see what is actually happening so that we can make sure that the city and the state have an approach that really recognizes that we do see disparities in access,” said Alice Bufkin, the director of policy at the Citizens’ Committee for Children.

Downtown Brooklyn-Park Slope has the city’s third lowest rate of children receiving services, largely driven by poor outcomes for black children. In this neighborhood, 16.4% of eligible black children did not receive services, compared to only 4.5% of eligible white children.

Overall, most children across the city do at least get screened after a referral, the data shows. Nearly 90% of the 71,000 referred to the program between 2016 and September 2018 received an evaluation.

The dearth of providers has become an obstacle to children receiving services after evaluation. Since 2010, the state — which partially funds the program and sets provider payment rates — cut the program budget twice and did not increase payment rates until this past year.

In light of the findings, the two organizations behind the report recommended that the state increase payment rates and fund a corresponding cost-study to determine fair rates.

They also called on the City Council to enact a bill that would mandate the Department of Health to publish this data on a zip-code level annually and develop a plan to address the data-backed disparities.

When presented with the findings, a spokesperson for the state’s health department highlighted a newly convened task force on provider workforce capacity and a recent 5% increase in reimbursement rates. The city Health Department declined to comment prior to the report’s release.

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