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Babies and Toddlers With Developmental Delays Are Entitled to Care. Many Aren't Getting It

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Reyna Balladares and her 3-year-old foster child play on the roof of their building in San Francisco on Mar. 9, 2024. (Martin do Nascimento/KQED)

View the full episode transcript.

Every child in California under 3 is entitled to early intervention services like physical, speech, and occupational therapy if they show signs that they need developmental support. Experts say getting these services early and in-person is critical for babies’ development, and that it can actually reduce the need for special education services later in life.

But many families aren’t receiving the care they need. KQED’s Daisy Nguyen explains why.


Episode Transcript

This is a computer-generated transcript. While our team has reviewed it, there may be errors.


Ericka Cruz Guevarra: I’m Ericka Cruz Guevarra and welcome to the Bay. Local news to keep you rooted. Baby brains have lots to absorb early on. They’re learning how to walk and talk, and their brains are most adaptable in the first three years of life. That makes it a crucial period, because if the child shows signs of delays in their development, those first three years are the time to intervene.

Daisy Nguyen: Receiving early intervention services could really change the developmental path of a child. It could make a big difference, but it has to be given during this period.

Ericka Cruz Guevarra: In California, babies are entitled to help from the state. They show signs of developmental delay, and it happens through a program known as Early Start. But many of the neediest families aren’t getting that help today. I talked with KQED early childhood education reporter Daisy Nguyen about the barriers to getting babies crucial, life altering services on time.

Daisy Nguyen: Reyna Balladares, is a foster parent who lives in the tenderloin.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: Then she became a foster parent, during the pandemic. She told me that at the time when the, you know, the world was shutting down, she wanted to open up her home to help foster children. She first took care of a baby boy for about six months. And, I think that was a really good experience for her, even though ultimately, you know, that the child was placed in a different home.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: And then she met this little girl, this newborn baby in 2021.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: She told me that she just remembered the the baby’s smile and just how sweet her face was. How she lit up when she saw her second city.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: You know, it broke her heart that the situation, that in which this girl came to her. But the little glimmer of hope when she saw that the girl was making some progress in her development, really reinforced her desire to want to advocate for this, for this little girl.

Reyna Balladares: [speaking spanish]

Ericka Cruz Guevarra: When did Reyna start to notice this little girl struggling a little bit in her development?

Daisy Nguyen: She said this child was just slow to begin walking and talking. And I think because Reyna had raised two daughters, she had some personal experience.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: She just felt something wasn’t right. And she she said she mentioned this to doctors who initially told her this is normal. That was slightly dismissive. But she was certain that there was something going on. And ultimately, after seeing specialists, it was confirmed to her that this little girl needed a lot of early intervention services, essentially to help her reach her potential. It was recommended that this little girl receives a physical therapy, speech therapy, occupational therapy, and feeding therapy.

Ericka Cruz Guevarra: We’re talking about really important services that kids need very early on. And I mean, I have to imagine time is of the essence. Why was it so hard for Rina to get the services that she needed for this baby girl? Why did she have to push so hard?

Daisy Nguyen: When I learned was just that the regional center has been overwhelmed, especially since the pandemic, with just a high caseload of children seeking services and probably some staffing shortages, not only at the regional center, but also with a shortage of early intervention providers. Families have to really push to get the services that they need in a timely manner and in the way that they want it to receive it, meaning if they want it to happen in the natural environment of the child.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: Reyna said that what she stumbled upon was just a lot of resistance by the therapist to come to the tenderloin, where she lives. She told me that the regional center coordinators told her that the therapists were just afraid to come to the tenderloin because they felt unsafe.

Ericka Cruz Guevarra: What does Reyna say about what it was like to not have therapists willing to meet with her foster daughter in person?

Daisy Nguyen: She just felt it was unjust that it was because of where she lives. The therapists weren’t coming there to provide the services that her foster daughter crucially needed.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: What happened instead was that she was given an alternative, but it wasn’t what she wanted. So the Golden Gate Regional Center was telling her that she could take her foster child to the different clinics across San Francisco to make all these different appointments, which kind of stacked up during the week for her. She had to take a lot of time out of her working days.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: But the other alternative was to have these services done through zoom.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: It wasn’t ideal. She said her foster child would not respond to the therapist or just not want to sit in front of a screen.

Ericka Cruz Guevarra: I want to step back a little bit, Daisy, and talk a little bit more about what early intervention services are, what kind of services are we talking about? Exactly? And I know these services are also things that families are entitled to. Right.

Daisy Nguyen: Children with developmental delays are entitled to receive a host of early intervention services to enhance their ability to sit or walk or talk. The services could include physical therapy, speech therapy, occupational therapy. It could even include equipment that helps young children maintain or improve certain skills, or parents could also receive some counseling and training to support their child’s developmental needs.

Daisy Nguyen: Getting the services as early as possible is crucial for children. Experts say that’s because this is a period when children’s brain are rapidly developing, and so they’re more adaptable. So receiving early intervention services could really change the developmental path of a child. It could make a big difference.

Daisy Nguyen: But it has to be given during this period. This is a federal program that’s administered in California by a network of nonprofit regional centers. So in the Bay area, the Golden Gate Regional Center is responsible for coordinating these services for families in San Francisco, Marin, and San Mateo County.

Ericka Cruz Guevarra: What are the bigger systemic problems with the state system for these early intervention services?

Daisy Nguyen: This program has always been plagued by understaffing and underinvestment by the government. The therapist who would provide these services. They are not paid a competitive rate. The rates in which the providers get paid have never been as competitive as what the private market is able to pay for these services, and so they’re just less incentivized to to provide services through this program.

Daisy Nguyen: And so they’re in demand, which means that the number of families who who need the service, who requested these services and are eligible for these services have to kind of wait sometimes just to get it. The other issue is that they don’t get paid to travel to a family’s home.

Daisy Nguyen: So as an alternative, what they’re able to offer to families is appointments in their offices or through telehealth, meaning appointments through zoom. And but for these some of these families, this is not what they considered an ideal way for their children to receive these services. They consider it substandard.

Ericka Cruz Guevarra: Coming up, how underfunding has hurt those who need the most help and how do we fix this? Stay with us.

Ericka Cruz Guevarra: I want to talk more Daisy through, I guess, some of the consequences of this inadequate funding, as you were kind of just starting to talk about. What did you find?

Daisy Nguyen: Doctor Jennifer Albon is a pediatrician at UCSF.

Dr. Jennifer Albon: Most of my young patients are needing early intervention services.

Daisy Nguyen: So she just is seeing, you know, growing geographic and socioeconomic disparities when it comes to who gets early intervention services in their home.

Dr. Jennifer Albon: I have many families who, like, live in certain neighborhoods of San Francisco, and the regional center has flat out told them and told us that there’s not providers who will go to your neighborhood, even within San Francisco.

Ericka Cruz Guevarra: What does Doctor Albon say about the importance of providing this treatment in these children’s homes, but specifically no matter where they live?

Daisy Nguyen: She says it’s just more ideal because children learn best when they’re in familiar surroundings.

Dr. Jennifer Albon: You know, they get scared of coming into like, offices and other things like that. So it’s harder for them to participate when it’s not like their natural environments.

Daisy Nguyen: The parents are also receiving some of the training themselves, so that for the rest of that week, when there’s no therapy, they’re able to practice what they’ve been trained to, you know, by the therapists to do.

Dr. Jennifer Albon: The goal for it to be kind of in their natural environment is that they have all of their regular things. And the and the therapists are showing the family what to do with what they have at home or in these natural environments.

Daisy Nguyen: And I should add that it is it’s a lot. It’s a law where it says that services should ideally be provided in the natural environment. The growth in online therapies have made it accessible for many people. But I think in the case with young children, it’s it’s created more inequities.

Ericka Cruz Guevarra: Will these issues that we’re talking about are systemic, as you described earlier, and they’re also not all new, but what can we do to fix this problem?

Daisy Nguyen: I spoke with leaders of the regional centers, and they say that’s really like the you know, they recognize that this is a distressing situation that they’ve been trying to address for a long time, and they can’t compel therapists to see children in person if they’re just not getting, you know, they’re not being paid enough to do it. And so they’re really calling for greater investment by the state and federal government in the program.

Daisy Nguyen: The state has been gradually been increasing the reimbursement rates for early intervention services. But this budget year, Governor Gavin Newsom wants to delay full implementation of the increases, and the regional center leaders are saying like they they really don’t think delay is a good idea, because increasing the rate is encouraging the therapists to do the work to go and see children in the natural environment. And also it’s encouraging them to to hire more people.

Daisy Nguyen: Ultra regional center services Sacramento and about 9 or 10 surrounding counties, and they receive some federal pandemic aid money to implement a pilot project, where they offered an incentive to therapists to go to underserved zip codes and also hard to reach areas in their region. And they noticed that these incentives, which is I think it was something like $200 per visit, that they saw an increase in the number of children seen in these underserved areas. So clearly, you know, money talks.

Ericka Cruz Guevarra: Coming back to Reyna Balladares, what is she going to do next?

Daisy Nguyen: Her foster child just turned three, which means she is, quote unquote, aged out of, early intervention services. And Raina believes that she could have made much more progress if she had received consistent services. Her daughter now will need more, special education services through the San Francisco Unified School District.

Ericka Cruz Guevarra: That is kind of heartbreaking, because it sounds like she wasn’t able to get the critical services she needed on time. But at the same time, Raina seems like this very active parent who knows a lot and who really pushed to make sure her kid got the services she needed. But I also imagine there’s probably lots of families who struggle to navigate these services, or maybe just don’t even have the time to and I mean, just maybe give up.

Daisy Nguyen: I think that’s what compelled, Reyna to speak with me, because she would she wanted to speak out on behalf of those parents who you can imagine. I think having a child who, if you’re. Especially if you’re a first time parent, just absorbing the news that your child has a developmental delay. These families are often in crisis, and they don’t have the time to make constant calls to the regional center and push for these types of services.

Reyna Balladares: [speaking spanish]

Ericka Cruz Guevarra: Ultimately, Reyna wants to adopt the the baby girl, right?

Daisy Nguyen: She fell in love with this child.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: She is much closer to getting the adoption approved bundle.

Reyna Balladares: [speaking spanish]

Daisy Nguyen: And when I met with them, I mean, you can just see this clear bond. And, she she just wants to do what’s best for this little girl.

Ericka Cruz Guevarra: Well, Daisy, thank you so much for breaking this down for us. I really appreciate it.

Daisy Nguyen: Yeah. No problem.

Ericka Cruz Guevarra: That was Daisy Nguyen, an early childhood education reporter for KQED. This 38 minute conversation with Daisy was cut down and edited by our intern, Ellie Prickett-Morgan and our senior editor, Alan Montecillo. Maria Esquinca is our producer. She scored this episode and added all the tape music courtesy of the Audio Network. Special thanks as well to Carlos Cabrera-Lomelí.


Ericka Cruz Guevarra: By the way, did you know that the Bay is listener supported? Meaning our funders are people just like you? So if you appreciate the value that the Bay brings to your life, consider becoming a KQED member. Just go to KQED.org/Donate. The Bay is a production of listener supported KQED in San Francisco. I’m Ericka Cruz Guevarra. Thanks for listening. Talk to you next time.

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