Editor’s note: This story led off this week’s Early Childhood newsletter, which is delivered free to subscribers’ inboxes every other Wednesday with trends and top stories about early learning. 

Eighty-seven percent of states lack enough speech language pathologists to reach all the infants and toddlers in need. Eighty-two percent suffer from physical therapist shortages. And among the service coordinators who organize critical therapies for America’s youngest children, the turnover rate is a stunning 42 percent, according to information compiled by the IDEA Infant and Toddler Coordinators Association from a survey that had 45 state respondents. (The K-12 teacher turnover rate, by contrast, only reached a mere 10 percent during the pandemic.)

With all the attention recently to the teacher and child care worker shortages in communities across America, the sector facing the most severe crisis has received comparatively little notice from policy makers, the media or the general public: those providing critical early intervention therapies for children under age 3 with developmental delays.

Last March, I published a story for Hechinger and USA Today on longstanding racial inequities in terms of who can, and has, accessed these therapies. One Rhode Island mother, for instance, missed out on early intervention entirely for her daughter because the toddler’s speech delay was attributed to the family’s bilingualism. “We missed that window from 1 to 4, which is such a precious age,” the mother told me.

Quality early intervention is critical for millions of families — and significantly reduces the likelihood that a child will need special education services in kindergarten. Most of the challenges and inequities in the system connect back to workforce issues. Staffing shortages are most severe in predominantly low-income communities, meaning longer waitlists when services are even available at all. Meanwhile, there’s a striking lack of diversity among early intervention personnel. One recent survey found that nearly 90 percent of early childhood special education personnel are white, 97 percent are female, and only 6 percent speak Spanish, according to Mary Bruder, the director of the University of Connecticut Center for Excellence in Developmental Disabilities Education, Research, and Service.

Increased funding for early intervention — translated into increased pay for therapists and case managers — is essential yet insufficient on its own. Both Rhode Island and Illinois are among the states that have significantly upped pay rates for early intervention personnel in recent years and continue to lack critical staff. “There has been a big effort to raise wages and have sign-on bonuses but still it hasn’t been enough,” said Leanne Barrett, a senior policy analyst at Rhode Island Kids Count.

The workforce shortage “is at crisis proportions,” said Bruder.

In the last month, I interviewed a half dozen experts about potential strategies for expanding and diversifying the workforce. Here are some of the takeaways:

Expand mentoring and apprenticeships

Apprenticeships are underutilized throughout education, and could be especially helpful in the early intervention workforce, particularly for those from lower-income backgrounds who can’t afford to enter often pricey training programs without an income. “They would be getting funding while completing the credentials they need,” said Catherine Main, director of early childhood education at the University of Illinois Chicago.

Create a pipeline from related jobs

In communities facing teacher shortages, education officials have tried to increase the number of paraprofessionals and teachers’ aides certified to lead their own classrooms. The same pathway could and should exist in early special education services, with aides and others in lower-paid jobs in the field encouraged and offered financial support to get trained as therapists and service coordinators.

Offer perks to those already in the profession

Staff retention is key to meeting the needs of surging caseloads. States have talked about such incentives as repaying loan debt for early intervention professionals who make a commitment to stay in the field, and providing them with free child care (as Kentucky has done with child care workers). Barrett says there’s a need to “think creatively” and do more to make the jobs both appealing and sustainable.

Build in more culturally relevant curriculum and training

Many potential therapists, particularly people of color, don’t pursue or stay in training programs because the preparation is “very western and Eurocentric,” said Evandra Catherine, an assistant professor in the early childhood program at Arizona State University. Catherine added that both in academic and in-service training, there should be a focus on “affirming the identities of the families and communities they are servicing,” and the curriculum should feature research and literature by a more diverse array of scholars and practitioners. Among other things, there needs to be discussion of historic linkages between disability and race. “At one point in time, if you were Black you were considered disabled,” she said. To better relate to families today, providers need to understand that history, Catherine added.

Streamline higher education bureaucracy

The path to working in early intervention is not always easy or clear, with entirely different training programs and licensure requirements for a developmental therapist working with 2-year-olds vs. a special education teacher working with 3-year-olds — even though the training required is very similar, said Catherine Main. The different agencies that run early intervention and special education need to coordinate to better allow for staff crossover and sharing. That includes building more accessible pathways from community college programs into early intervention. “If our agencies came together to have a more uniform qualification system that would be really helpful,” Main said.

Support, support, support

Early intervention personnel and experts have told me of a surge in the number of toddlers trying to access the services, partly due to pandemic backlogs and delays. That’s been hard for providers, many of whom have seen their caseloads grow. “A lot are looking to leave the field because of stress due to growing caseloads,” said Bruder. We’re “seeing this dissatisfaction more than we have seen before.” Pay and benefits help but so does ongoing support, particularly in the form of mentorship and stability, for a job that even under the best of circumstances can bring unexpected challenges nearly every day.

More on early intervention

I found in my reporting that Black and Hispanic children not only receive less early intervention, but the services are lower in quality and less targeted to their specific needs. For instance, Spanish speaking children are more likely to get general speech services while English speaking ones receive help with specific articulation problems. That story is available in Spanish here.

Last month, in a similar piece, the Associated Press examined how the pandemic exacerbated early intervention staff shortages in Illinois and nationwide. 

This story about early intervention was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education.

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