First 5 Center for Children's Policy

September 11th, 2020

New Interactive Tool Shows Complexity of Early Identification, Intervention System

California’s families with low income must navigate an incredibly complex system when their children have a developmental concern, and this complexity often hinders timely intervention. A new interactive flowchart by the First 5 Center for Children’s Policy maps the system so stakeholders can better understand it and advocate for changes that support families.

Seventy percent of children with developmental delays aren’t known to have delays until they enter kindergarten. And regardless of when delays are detected, families face a number of obstacles in accessing services, in part due to the complexity and inefficiency of the early identification and intervention (EII) system.

“We know that when developmental delays are identified early, interventions are more effective and yield greater life-long outcomes, but many California families still face barriers to access timely screening and services,” said Sarah Crow, Managing Director of the First 5 Center for Children’s Policy. “This new tool will help advocates and policymakers better understand what families and providers face when navigating the EII system, and where improvements can be made.”

The interactive flowchart walks users through a variety of pathways a family might follow after a child is screened for a developmental concern. These pathways diverge at a number of points, including the nature of the concern, the child’s eligibility for certain programs and services, the type of Medi-Cal insurance the child has, and whether or not services meet criteria to be deemed medically necessary.

The flowchart is accompanied by a report with key takeaways gleaned from research and interviews, as well as composite and actual stories of family experiences with the EII system.

In one story, San Francisco mother Karla recounts her experience with her daughter Brianna, who has a genetic neurological disorder called Rett syndrome. Brianna’s pediatrician initially dismissed concerns Karla raised when Brianna was four months old. After eventually agreeing to do a screening that showed global delays, the pediatrician then failed to send Brianna’s referral to the regional center for services. As a result, Brianna didn’t receive services until she was one year old; her actual diagnosis wasn’t made until she was two.

Compared to other states, developmental screening rates remain low in California, especially among children of color and children in households with low income. As the Center’s Key Takeaways report notes, there is also widespread confusion about which system should provide children’s mental health services. System complexity, inconsistencies in how services are delivered across the state, and narrower eligibility requirements for early intervention than in other states also hinder access to services in California.

“For years, families have voiced their frustration with the state’s EII system when seeking services for their children,” said Alexandra Parma, senior policy research associate at the First 5 Center for Children’s Policy. “The system complexity and its flaws, like a lack of clarity about the rules, a lack of providers, and lack of care coordination, makes it hard for families to find the right services for their little kids. The pandemic has made this even harder, as families have fewer touchpoints with providers.”

The suite of resources is available here.

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About First 5 Center for Children’s Policy

Grounded in the experience of First 5s around the state, the First 5 Center for Children’s Policy studies and disseminates best practices and solutions in early childhood development. The center convenes experts inside and outside the early childhood space to inform policy, and evaluates solutions within and outside California that can be adapted for the state. Learn more at

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