Early Intervention Enrollment Among Substance-exposed Infants in Massachusetts: A Population-level Analysis

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ABSTRACT Neonatal abstinence syndrome (NAS) is an automatically qualifying diagnosis for enrollment in early intervention (EI) in Massachusetts (MA) given the increased risk of developmental challenges among infants and toddlers exposed to illicit substances in utero. Rates of referral and enrollment among these infants and toddlers with and without a diagnosis of NAS have not been well established at the population level. Objective: This study aimed to assess EI referral and enrollment rates among substance-exposed newborns (SENs) with and without a diagnosis of NAS in MA and to compare rates to infants and toddlers without known substance exposure. Methods: We analyzed the 2013–2020 Pregnancy to Early Life Longitudinal dataset, which includes maternal-infant birth hospitalization records linked with EI data. SEN and NAS were identified using ICD-9/10 codes. We conducted descriptive statistics and bivariate analysis to compare EI referral and enrollment between (1) SENs with and without NAS diagnoses and (2) SENs and the unexposed population. Results: Among 6565 SENs, 85.3% (n = 5602) were referred to EI, and of those referred, 49.5% (n = 2775) enrolled. Compared with SENs without an NAS diagnosis, SENs with an NAS diagnosis were more likely to be referred to (87.6%, n = 4242 vs 79.0%, n = 1360) and enroll in (53.2%, n = 2255 vs 38.2%, n = 520) EI. Among infants and toddlers without identified substance exposure, referral rates were lower (34.6%), but enrollment rates were higher among those referred (56.7%). Conclusion: Substance-exposed newborns in MA had relatively high rates of EI referral but lower rates of enrollment compared with the general population, particularly among SENs without a diagnosis of NAS, suggesting a referral-to-enrollment gap.

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