Gap can leave families for years without developmental support

Prince Lacroix’s mother, Eva Santiago, knew there was something different about her son early on. He was late to walk, late to babble, and he played with toys differently than other kids his age. She was a first-time mother at the time, staying in a shelter, and when she asked her pediatrician for support, he referred her to Early Intervention (EI), a federal-state partnership program aimed at supporting infants and toddlers at risk of or with developmental delays. A team from Bay Cove, one of the state’s Early Intervention providers, came out to evaluate him and at around two years old, Prince was enrolled.

Early Intervention became a one hour per week part of both Santiago and Prince’s life. An occupational therapist came to their home, worked with Prince directly, and spent time teaching Santiago activities and strategies she could use between visits to support his development. Slowly, Santiago began to notice a change: Prince started building with Legos, went on playdates through the program, and learned a few songs.

When Prince turned three, in mid-February, his Early Intervention services stopped, as they do for every child in Massachusetts, regardless of how much progress they have made or how much support they still need. It took about another six months, until that September, before he began special education services through Boston Public Schools. In the meantime, there was no developmental support.

Once Prince started preschool, the services were comprehensive, Santiago said. But the months in between left an impact. “I believe that changing the end mark of EI from three years old to when kids step foot into public school, would be really beneficial,” she said, arguing that her son lost valuable learning time waiting for his special education services to begin.

Prince’s diagnoses qualified him for special education services through his school district after he was no longer eligible for Early Intervention. For him, there was developmental support waiting in the distance. But for many children across the state who do not qualify for those services, what happens after they turn three can look very different.

“There are many kids that, when their services are dropped, are lost temporarily for two years. Parents will come in [to the office] and be frustrated about finding an affordable, accessible preschool to support their child’s development,” said Dr. Theresa Callahan, a Leominster-based pediatrician. “Those are the kids that fall behind, and the ones that do not start with their toes on the starting line for kindergarten.”

Early Intervention, which falls under the jurisdiction of the Department of Public Health (DPH) in Massachusetts, is designed to identify children at risk of developmental delays early and broadly. A child can qualify because of a measurable developmental delay, a diagnosed condition like autism, or a range of social and environmental circumstances that put a child at risk, from homelessness to lead exposure. The program is free, and services are delivered in a home or community setting rather than in a clinic.

Special education, which is overseen by the Department of Elementary and Secondary Education (DESE), takes over once a child turns three and works differently. To qualify for an Individualized Education Program (IEP) and receive special education services, a child must fall into one of 13 federally recognized disability categories, and, most importantly, that disability has to interfere with the child’s ability to learn in a school setting. It is a higher, differently shaped bar than the developmental-delay standard Early Intervention uses.

“In the school system, they are looking at academics [and] is this child going to be able to participate in a regular school setting,” said Maura Buglione, director of development at Thom Child & Family Services, an Early Intervention provider that works with more than 10,000 infants, toddlers, and families statewide. “Whereas in EI, some of the things that we are working on are social, emotional, and behavioral. … There is such a close focus in EI on the parent-child relationship and supporting healthy relationships existing within the home.”

For students who exit Early Intervention at three and do not meet the bar for an IEP, there exists a two-year period — roughly ages three to five — between Early Intervention services and public kindergarten during which many parents and caregivers are left to figure out how to pay for developmental support options.

“Oftentimes, because the criteria to qualify for an IEP is a little bit different than the criteria to qualify for EI, you will have kids who did meet the criteria for EI but do not meet the disability status that is required to get an IEP,” said Buglione. Children with milder speech or language issues, borderline autism traits, or subtle sensory or motor delays often fall into that space, she said. “Their needs are not considered profound enough to qualify for an IEP.”

Planning a family’s transition out of Early Intervention is built into the program. Federal law requires that every child receiving services have a transition plan in place at the latest 90 days before their third birthday. If a child is eligible for special education, that transition plan also notifies the family’s local school district and hosts a “transition conference,” bringing together the family, the Early Intervention team, and school representatives to discuss what comes next before the services end.

IEP evaluations are conducted by local school districts and if a child qualifies, the IEP must be fully developed and in effect by their third birthday. If that birthday falls during the summer, the child’s IEP team, including parents, work together to determine the date when services under the IEP start.

Regardless of whether that child ultimately qualifies for an IEP, “we still work on a full-blown transition plan to whatever the next steps are,” said Buglione.

Some choose to continue pursuing development support through private insurance or out-of-pocket pay.

Others enroll in private preschools. Massachusetts has no universal, publicly funded pre-K program for children whose families are unable to afford either. The closest thing, Head Start, only accepts children based on federal income guidelines or who are homeless, in foster care, or receiving public assistance.

The clearest snapshot of the transition comes from state data on the roughly 19,000 children who exited Early Intervention statewide between July 2022 and June 2023. About 40% were found eligible for special education services. Another 13% completed their Early Intervention services before turning three. Close to 10% of exiting children were determined not eligible for special education. The remaining children either did not have their eligibility for special education determined, were withdrawn from early intervention services, or did not respond to the survey.

There is no state count of how many of those children went on to find support elsewhere and how many did not. The DPH collects data inside Early Intervention programs and DESE tracks whether eligible children referred from EI have an IEP implemented by their third birthday. Neither system looks at what happens to a child who exits EI without a referral, or is evaluated and found ineligible, once they leave.

A handful of newer state initiatives addresses the edges of this gap, though none of them address the gap itself. A section of the new state budget calls for automatically referring children entering shelters to Early Intervention.

Separately, DESE launched a pilot during the 2025-2026 school year called the Preschool Itinerant Team Initiative. It offers roughly $250,000 in grants to help school districts build “traveling teams” of special educators and therapists to deliver IEP services directly inside community preschools, rather than requiring separate public-preschool enrollment. Districts that fall short of state benchmarks for transitioning children from Early Intervention into special education are given priority for the funding.

There also exists a federal program, called the Part C Extension Option, that would give states the option to extend Early Intervention services for students who qualify for an IEP up to age five instead of cutting them off at three. That would allow them to continue with the same EI structure rather than moving to a preschool setting. Several states, including Connecticut, Maryland, and Colorado, have adopted it. Massachusetts has not, in part, because doing so would require substantial new investment both from the state and from private insurers.

“There would be a lot of people interested in that extension,” said Buglione. “It probably has not been discussed in a super meaningful way at this point here in Massachusetts because we know that the mechanism is not there for us to be able to do it. But I do think if the option was there to apply for this program, a lot of the Early Intervention vendors in Massachusetts would go for it.”

This article was originally published on commonwealthbeacon.org.