Impact of COVID-19 on early intervention referrals (Zellner et al., 2025)

Purpose: We sought to examine changes in national Part C early intervention (EI) service provision associated with the onset of the COVID-19 pandemic. Additionally, we explored the extent to which this association differed geographically by U.S. state.

Method: We obtained monthly service provision data, including new referrals and enrollments, from 2015 through 2021 from 44 Part C coordinating agencies. Using Bayesian-interrupted time series segmented regression analysis, we then examined the impact of the pandemic on EI at three key timepoints: April 2020, September 2020, and September 2021.

Results: Overall, we found large decreases in service provision rates for the first 2 timepoints; however, by September 2021, rates had moved closer to expected prepandemic levels. Referrals and enrollments followed similar patterns. Notably, states varied widely in the degree of EI disruption associated with the pandemic at each timepoint.

Conclusions: The onset of the pandemic was associated with significant disruption to EI service provision, the magnitude of which varied across states. Variance in state COVID-19 policies, particularly regarding telehealth implementation, may explain state differences. Children who were not referred to EI services during the pandemic may require additional support from school-age programs; however, further research is necessary to understand COVID-19-related changes to EI intervention hours and time to therapy onset.

Supplemental Material S1. Referral and initial Individualized Family Service Plan counts by state and timepoint.

Supplemental Material S2. Bayesian interrupted time series model summaries.

Supplemental Material S3. Plots of trend change for referrals and enrollments.

Zellner, M. A., Kaat, A. J., & Roberts, M. Y. (2025). The impact of COVID-19 on early intervention referrals and enrollments: An interrupted time series analysis. American Journal of Speech-Language Pathology, 34(4), 2334–2341. https://doi.org/10.1044/2025_AJSLP-24-00513