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Disparities in Part C Early Intervention Service Access for Drug-Exposed Infants with
Positive Toxicology Screens at Birth in Massachusetts
Taletha Derrington, M.A., PhD Candidate, Brandeis University, [email protected]
Background
Referral Disparity
Results
80
•Federal law requires drug-exposed infants (DEI) to be
referred to Part C Early Intervention (EI) services.1
•Methods to estimate the number of drug-exposed
infants (DEI) in a state are limited.
•There are no population-based data on subsequent
referral, evaluation, and eligibility of DEI once identified.
•There is evidence of bias in performing toxicology
screens at birth based on non-clinical factors;2 is there
bias in referral after a positive screen?
70
% of DEI
60
Pos. Tox. + Public Pos. Tox. + Private
Ins.
Ins.
Interaction P < .05
Discussion
Drug Exposed Infant Identification Algorithm
• General utility as a Public Health screening
tool.
• May identify only more serious drug users.
• Retrospective cohort, secondary data analysis using the Pregnancy to
Early Life Longitudinal (PELL) data system, a population-based,
longitudinally linked data system (Boston University School of Public
Health, the MA Dept. of Public Health, and the Centers for Disease
Control and Prevention). PELL links birth certificates of live births in
MA hospitals to MA residents to birth hospital records for the mother
and child (99% linkage rate); pre- and postnatal hospital inpatient,
emergency, & observational stay records of the mother and child; & EI
records.
• Developed the Drug-exposed Infant Identification Algorithm (DEIIA).
• Referral identified by linkages to EI data; generalized estimating
equations that account for maternal clustering used to model referral
predictors.
DEIIA Using PELL
Maternal prenatal records
(DOB – Gest. Age)
Stage 1: Positive
toxicology screen on
birth certificate
n = 905
624,269 live births
from 1998-2005
Stage 2: DEIIA flag
in prenatal and/or
birth hospital records
n = 6,943
Stage 3: DEIIA flag
in post-birth
hospital records
n = 722
Non-birth Hospital Discharge
Observational Stays
Hospital Discharge
Birth (Child)
30
0
Methods
Hospital Discharge
Delivery (Mother)
Referred
Not Referred
10
How are positive toxicology screens on the birth
certificate, maternal sociodemographic characteristics,
and institutional characteristics related to EI referral of DEI
in Massachusetts ?
Birth
Certificate
40
20
Study Question
CORE
50
Address referral disparities
• Positive toxicology screens should trigger
referral regardless of insurance.
• Investigate why privately insured not being
referred.
• Disparities found for Asian/Pacific Islanders,
mothers aged 17-24, mothers with some
college education or more, & rural residence.
• Target outreach to lower level of maternity
care hospitals.
• EI referrals must be made by directly by birth
hospitals before discharge; do not assume
other agencies will make referral or that
family will follow up on referral suggestion.
7,348 Drug-Exposed Infants
Emergency Department
Child post-birth records
(to age 3)
Stage 1 only: 124, 2%
Stage 2 only: 5,963, 81%
Stage 3 only: 283, 4%
Stages 1 & 2: 744, 10%
Stages 1 & 3: 3, 0%
Stages 2 & 3: 202, 3%
All 3 Stages: 34, 0.5%
96% identified by high validity indicators & 84% @ birth
Acknowledgements
This project is dedicated to the memory of Lorraine Vogel Klerman, DrPH
Dissertation funding support
•
•
Nancy Lurie Marks Institute on Disability Policy Fellowship
Grants from the Heller Alumni Association and the Office of the Provost, Brandeis University
Special thanks to:
Goal: Identify children affected by illegal substance abuse,
or withdrawal symptoms resulting from prenatal drug exposure
References
1
2
Individuals with Disabilities Education Improvement Act (2004). 20 U.S.C. §1400
Ellsworth, M.A., Stevens, T.P., & D’Angio, C.T. (2010). Infant race affects application of clinical
guidelines when screening for drugs of abuse in newborns. Pediatrics, 125(6): e1379-85.
•
•
•
•
Dr. William McAuliffe, Harvard University
Massachusetts Department of Public Health
Massachusetts Early Intervention Program
Boston University School of Public Health, Community Health Sciences Dept
Dissertation Committee: Marji Erickson-Warfield, PhD, Chair; Milton Kotelchuck, PhD, MPH;
Jody Hoffer-Gittell, PhD; and Dominic Hodgkin, PhD