Sustained Effectiveness of a 211 Call Center With Early Childhood Care Coordination.

Abstract

Early identification of developmental disabilities and timely services can improve outcomes, yet delays and disparities persist. The Los Angeles (LA) County 2-1-1 call center implemented early childhood care coordination that we tested in a randomized trial with demonstrated effectiveness in increasing referrals to and receipt of services after 6 months. This study followed the sample for 24 months to investigate whether gains were sustained and whether children in intervention received earlier services. Children aged 11 to 42 months without developmental delays were recruited from 4 clinic systems, screened for developmental risk, and randomized to intervention (care coordination with the Information and Referral Federation of Los Angeles County [211LA]) or control (usual care alone). At 12 and 24 months, families were asked whether referrals were made, whether children received services, and starting dates. Mixed effects logistic regression models were used to estimate odds of referrals and receipt of services, adjusting for covariates. Survival analyses estimated the time-to-service receipt difference between groups. Among 565 children randomized (282 intervention, 283 control), 521 (92%; 260 intervention, 261 control) were observed up to 24 months. More children assigned to intervention were referred to (43% vs 35%) and enrolled in (28% vs 20%) services by 24 months. Higher enrollment in services was driven by children with moderate to high developmental needs (54% vs 37.5%), and survival analyses demonstrated earlier service receipt for intervention children. Up to 24 months after baseline, care coordination through 211LA resulted in more referrals and services compared with usual care, and intervention group children were connected to services earlier.