The Early Intervention Referral Process for Rural Infants and Toddlers with Delays or Disabilities: A Family Perspective

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Springer Science and Business Media LLC


Introduction: Early intervention (EI) services provide essential support to families of children with delays or disabilities. Children can enter EI via a variety of routes, though all begin with a referral, and for children who require additional services, subsequent referrals are generally warranted. The referral process may be complicated by rurality, but little is known about families’ experiences with EI referrals in rural areas. This study focuses on better understanding rural families’ perspectives of the EI referral process. Methods: Families with children in Part C services throughout Montana (N = 30) were interviewed regarding their referral experiences. A layered analysis was used to analyze initial and subsequent referrals, and investigate families’ experiences regarding the referral process. Results: Families’ reports regarding which professionals provided referrals and who they provided referrals to were diverse. As part of qualitative content analysis three themes emerged: 1) the referral process is both challenging and complex; 2) professionals facilitate connections; and, 3) some professionals may have misconceptions or misunderstandings. Some families discussed how aspects of rurality may have exacerbated the complexities and challenges of the EI referral process. Discussion Based on families’ experiences, professional development related to when, how, and who to refer to EI services, and subsequent support of families during the referral process, may be of utmost importance. Furthermore, families discussed rurality in relationship to turnover rates, limited access to services or specialized knowledge, and travel distance required to receive services, demonstrating the importance of training and retaining rural EI professionals.


This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at:


rural infants


Decker, K. B., Williams, E. R., Cook, G. A., & Fry, M. M. (2021). The early intervention referral process for rural infants and toddlers with delays or disabilities: A family perspective. Maternal and Child Health Journal, 25(5), 715-723.
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