Commentary on “Therapy Use for Children With Developmental Conditions: Analysis of Colorado Medicaid Data”

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“How should I apply this information?”
The finding that children with a developmental diagnosis receive less specialized physical therapy (PT) and occupational therapy (OT) in early intervention (EI) than children with developmental delay (DD) highlights that a diagnosis is not a “ticket” to PT and OT services. While children may meet their states' criteria for EI eligibility, referral sources should not assume that children receive specialized PT and OT in EI. Referral to EI may need to be supported by a navigator to help parents advocate for specialized service. Likewise, this information could be interpreted as a difference in approaches to therapy for the 2 groups: focus on ameliorating delay with higher-intensity intervention for children with DD versus learning to participate in society with the disability for children with a diagnosis using a lower intensity of services. Therapist should be mindful of including parents in decision-making processes on the purpose or focus of intervention using the best available evidence.
“What should I be mindful about when applying this information?”
The data are from only Colorado and children with Medicaid; thus, it may not reflect services for all children. The higher number of children with DD than children with a diagnosis may reflect a “wait and see” approach to definitive diagnosis and thus an undercategorization of children who are later determined to have a developmental diagnosis. Research on the efficacy of interventions typically focuses on children with a specific diagnosis or risk factors. The lack of data on specific diagnosis makes it difficult to determine whether all children with a diagnosis are receiving fewer services than children with DD or how the frequency of services relates to current evidence on the efficacy of intervention for each diagnosis. Therapists should be mindful that analysis of data on the access to and utilization of services needs to be repeated frequently within the changing health care systems, EI legislation, and state eligibility systems.
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