Young Children with Disabilities Deserve a Strong Early Intervention and Early Childhood Special Education Workforce

Blog Post
Overhead view of a toddler in a green shirt going up the stairs with the support of a physical therapist in pink scrubs
March 13, 2024
This graphic shows the way in which we conceptualize IDEA for the purposes of this blog series. Age ranges and terminology may differ slightly in different states and circumstances.

A quick Google search of the workforce crisis in early care and education (ECE) results in hundreds of news articles. There are daily headlines about families struggling to find care for their children and programs closing down due to staffing shortages.

At the same time, a separate, but related crisis receiving much less news coverage is the shortage of early intervention (EI) and early childhood special education (ECSE) service providers. Nationally, we are serving far fewer children than are eligible. There are long waitlists for referrals and evaluations, which are steps that need to happen before children begin to receive services (see graphic below for an overview of this process).

This graphic shows the different stages of the process to receive EI/ECSE services. In practice, families may repeat certain stages multiple times and terminology may differ slightly among states.

The EI/ECSE workforce shortage was ranked a top priority by EI professionals in roundtable discussions we held last year. It is also an issue that state Part C and Part B Section 619 coordinators (who are responsible for implementing EI and ECSE services, respectively) commonly report as a concern. As we work towards addressing the staffing shortages of the broader ECE field, we cannot sideline the EI/ECSE workforce as all of these professionals play important roles in shaping young children’s early development.

Who exactly are we referring to when we say the EI/ECSE workforce? A survey conducted by the Early Childhood Personnel Center lists 24 professional disciplines providing services to children from birth to age five and their families under Part C and Part B Section 619 of the Individuals with Disabilities Education Act (IDEA) (see Table 1). Professionals providing non-academic supports, such as speech and language therapy or occupational therapy, are often referred to as related service providers. Related service providers are licensed professionals who work with children found eligible for services in a range of settings, including in families’ homes, child care, Head Start/Early Head Start programs, and other school- and community-based early learning programs. They can be full-time salaried employees, paid based on a set rate for the services delivered, or independent contractors.

Table 1.

Source: Early Childhood Personnel Center, National Landscape of Early Childhood Personnel Standards for Professionals Serving Infants and Young Children with Disabilities and Their Families under 619 and Part C of the IDEA, 2019

Data suggest that the demographics of professionals in the EI/ECSE fields are predominantly white, female, and monolingual. A recent survey on ECSE personnel conducted by the National Institute for Early Education Research (NIEER) found that “nearly 90 percent of early childhood special education personnel are white, 97 percent are female, and only 6 percent speak Spanish”.[1] Because the EI/ECSE workforce encompasses so many professional disciplines and employment structures, it can be difficult to collect information on the entire workforce in a systematic and consistent way, especially if the data are not required for federal IDEA grant reporting. In a 2021 survey, less than half of state Part C and Part B Section 619 administrators reported collecting workforce data on race/ethnicity, gender, and language in their data systems.

There are common EI/ECSE recruitment and retention challenges across states. To start, some state administrators have reported a decline in higher education program offerings in these professional disciplines. Barriers to enrolling in and completing such programs, particularly for people of color and people who speak languages other than English, may be a reason for the lack of demographic alignment between the workforce and the children and families receiving services (see maps below).

In addition, staff turnover is high because of inadequate wages. A 2019 study of the Rhode Island EI workforce found that 82 percent would consider leaving their jobs if salaries did not improve and that about half of the surveyed staff reported having looked for another job in the past six months to find a higher-paying position. Job satisfaction is also impacted by high caseloads, long hours, and more time spent on service coordination rather than service delivery. In rural and remote areas, EI/ECSE staff can spend a lot of time driving to meet children and families with no mileage reimbursement. An EI service provider in Rhode Island works with 24 to 33 families at any given time; this number increases when a staff member leaves.

Understanding who makes up the EI/ECSE workforce is useful for identifying why other work alternatives can be more attractive. Many of these professionals have master’s and doctorate level degrees and have a broad market for their professions including school-based employment, private clinics, and hospitals. Also, some service providers may prefer to work as independent contractors when school districts may need to hire full-time employees. For others, working as independent contractors may not be a viable option if they need stable pay and benefits. All of these complexities and challenges may motivate the EI/ECSE workforce to pursue other work options that offer higher wages, better work hours, and lower stress.

All states are grappling with the EI/ECSE shortage and addressing it in different ways. One of the main strategies has been to increase compensation for the workforce. A primary strategy in EI is increasing reimbursement rates, which set the amounts at which service providers are paid. In many states, these rates have remained at the same levels for years and have not been updated to keep up with inflation. Illinois and Rhode Island are good examples of efforts underway to address this workforce crisis. In 2022, advocates in Rhode Island successfully secured a 45 percent Medicaid rate increase for EI service providers after the rates had stayed the same for 20 years. In 2023, Illinois secured a 10 percent rate increase for EI service providers and last fall, Illinois Governor J.B. Pritzker used American Rescue Plan Act funds for one-time incentive payments to EI professionals. Some states have embarked on cost modeling efforts to measure the true costs of providing EI or ECSE services (similar to modeling the true costs of providing quality child care) to adjust reimbursement rates or funding formulas to adequately cover the costs of those services.

Other state-based efforts have focused on higher education as many service providers have accumulated student debt to earn their qualifications and thus may need to seek the highest paying jobs they can find (which may not be in EI/ECSE). In 2023, Rhode Island advocates introduced a bill that would have set aside ten awards for a state student loan reimbursement program for qualified EI professionals, with bill language emphasizing the need for bilingual EI professionals.

In addition to the state efforts mentioned above, national advocacy organizations and researchers have developed tools to support efforts to bolster the EI/ECSE workforce. Start Early has state and federal policy recommendations for building a stable and diverse workforce to support young children with developmental delays and disabilities. A new Early Childhood Intervention Personnel Center for Equity has just launched at the University of Connecticut Center for Excellence in Developmental Disabilities. And soon, the National Institute for Early Education Research will release a report on their national survey of the early childhood special education workforce.

By no means an exhaustive piece on the EI/ECSE workforce, we hope this blog serves as a starting point for ongoing conversation about who they are and possible strategies to address the shortage of professionals working in these fields. In future blogs, we will write about the connection between workforce shortages and workforce wellbeing as well as how a specific lack of multilingual providers and providers of color impact family experiences.

This blog post was written in consultation with Karen Berman and Mina Hong from Start Early.

[1] Allison H. Friedman-Krauss, W. Steven Barnett, Tracy Jost, and Karin A. Garver, Early Intervention and Early Childhood Special Education National Workforce Survey Results (New Brunswick, NJ: National Institute for Early Education Research, n.d.)

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Early Development and Disability