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Am J Perinatol
DOI: 10.1055/a-2662-8594
Original Article

Challenges with Access to Early Intervention Services Following NICU Discharge in California

Marinthea Richter 
1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
,
Polly Kellner
1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
,
Jenny Kwon
2   Kaiser Permanente, Orange County, California
,
Lisa G. Vargas
3   Division of General Pediatrics, Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, California
4   Division of General Pediatrics, Department of Pediatrics, Baylor College of Medicine at Christus Children's Hospital, San Antonio, Texas
,
Manoj Biniwale 
5   Division of Neonatology, Cedars Sinai Guerin Children's, Cedars Sinai Medical Center, Los Angeles, California
,
Amy Yeh
3   Division of General Pediatrics, Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, California
,
Roberta Pineda 
1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
6   Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California
7   Washington University, Program in Occupational Therapy, St. Louis, Missouri
› Author Affiliations
Funding None.
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Abstract

Objective

Early alterations in function are evident in preterm infants during their neonatal intensive care unit (NICU) hospitalization. Therefore, it is common for preterm infants to be referred to early intervention (EI) as they transition from hospital to home. Access to EI is often assumed, but understanding gaps in service delivery is important. The aims of this project were to (1) determine rates of EI access at the first high-risk infant follow-up (HRIF) appointment (4–8 months corrected age) at a safety-net hospital in Los Angeles, and (2) identify relationships between infant, clinic, and EI factors with EI service uptake.

Study Design

Through a retrospective medical record review, EI utilization at the first HRIF appointment was documented among 189 NICU-graduate preterm infants born ≤32 weeks estimated gestational age who had their first HRIF visit (4–8 months corrected age) between January 2019 and November 2020.

Results

Ninety-two (49%) of the infants were receiving EI at their first HRIF appointment at 4 to 8 months corrected age. Extremely preterm infants were more likely to receive EI services than those born very preterm (p = 0.005). No other relationships between factors were identified.

Conclusion

Successful uptake of EI services cannot be assumed. Challenges with access to EI persist, even within systems designed to foster identification and access to therapy following NICU discharge. Future research is needed to identify the reasons for the lack of access to EI and to identify the impact of different types of programming to aid access to EI for high-risk populations.

Key Points

  • EI access for a safety-net population is challenging.

  • Only 49% of preterm infants received EI at 4 to 8 months corrected age.

  • Extremely preterm infants were more likely to access EI.

  • EI access was higher for infants hospitalized in the NICU associated with the HRIF.

Keywords

healthcare service delivery - health equity - therapy - infant - preterm

Ethical Approval

This study was approved by the USC IRB (approval no.: UP-20-01339). This study had a waiver of informed consent, which enabled data collection of factors related to EI access retrospectively. This research was approved by the Human Research Protection Office at the University of Southern California, Los Angeles, CA.




Publication History

Received: 30 May 2025

Accepted: 22 July 2025

Article published online:
04 August 2025

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