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Journal Article


Barriers to Evaluation for Early Intervention Services: Parent and Early Intervention Employee Perspectives

The Issue

Pediatricians are encouraged to refer parents of infants and toddlers with developmental delays to government-funded, early intervention programs that can improve outcomes, reduce behavioral problems, and help families care better for their children. Yet despite the clear benefits of early intervention, up to 90 percent of eligible children never receive these services. Commonwealth Fund–funded researchers designed this study to find out why so many children referred to early intervention services are not evaluated and to determine how to make the referral process more successful.

What the Study Found

The researchers interviewed parents of children who had undergone evaluation and parents of children who had not, as well as early intervention staff. The interviews identified five common barriers: 

  • Communication problems between families and pediatricians, including failure to fully explain the referral process.
  • Parents’ belief that they are the experts on their child’s development and will decide for themselves whether evaluation is needed.
  • Parents’ belief that their child’s delays will resolve on their own or with their help.
  • Practical difficulties related to contacting early intervention providers.
  • Parents’ concerns, as reported by early intervention staff, that evaluators arriving at their home are from child protective services.


Effective communication between pediatricians and families is the most important factor in bridging the gap between the number of children identified with developmental delays and the number evaluated for early intervention services. The researchers recommend that pediatricians be trained in shared decision-making techniques that acknowledge parents’ expertise and involve them more actively in care decisions. Pediatricians should also better educate themselves and parents about the referral process.

Publication Details



M. E. Jimenez, F. K. Barg, J. P. Guevara, et al., “Barriers to Evaluation for Early Intervention Services: Parent and Early Intervention Employee Perspectives,” Academic Pediatrics, Nov.–Dec. 2012 12(6):551–57.