New York state’s Early Intervention Program is ranked last in the nation for the timely delivery of services, like physical and speech therapy, to young children with developmental delays.
Right now, only half of the children who qualify for therapy are actually getting it, and that's having an impact on both the children and the education system they enter.
Many children aren't getting the services they need because there aren't enough early intervention therapists. That's due to consistently low pay, a lack of benefits, and a series of recent events that include the COVID-19 pandemic, a stalled rate increase, and the disastrous release of a new online platform, EI HUB.
With long wait times, many children never receive services
Early intervention is a federally mandated program that is run individually by states and administered at the county level.
New York’s Early Intervention Program serves about 70,000 kids between the ages of 0 and 3 who have developmental delays or disabilities.
Or at least, it’s supposed to.
"For example, we have no occupational therapists in southern Washington County, like at all," said Autumn Headwell, a service coordinator for the Washington County Early Intervention Department. "So if there's a child that has sensory concerns with fine motor concerns, we can't provide them services."
Headwell said other services, like speech therapy, are also severely limited. She said in many cases, there's a single therapist serving a large area. That means they are obligated to take on all the children who have that need.
But once their schedule is full, they have to start reducing visits. Say, a child who is supposed to be seen twice a week is seen just once a week.
The situation in Washington County isn't an anomaly. It’s more the standard, especially in rural areas, Headwell said.
"Any kind of shortage you have in an urban area is so much worse in a rural area."
A problem that's been a long time coming
Therapists who work in New York’s Early Intervention Program say it's been in decline for a long time, with fewer and fewer people choosing to work in the field.
The many reasons can essentially be boiled down to pay.
Early intervention therapists are treated as independent contractors and paid by the hour. That hourly pay is actually lower today than it was in the 1990s, when the program began.
"We have providers starting [at] less than what I started in 1998," said Christy Bezrutczyk, who lives in Plattsburgh. She worked as an early intervention therapist from 1998 to 2018.
"The money just does not make sense," she said.
EI therapists are doing state work, but they don't get state benefits or wages.
"We're New York state-certified teachers and providers, and we can't tap into a New York state health care system, retirement system or a tiered pay system," said Bezrutczyk.
Bezrutczyk is also the former co-owner of an early intervention agency that provided services to kids all over Clinton County and beyond from 2004 until 2024.
"Finances were always tough, always difficult," she said.
That pay has stayed low over the course of many different New York governors and administrations, on both sides of the aisle. Proposed rate increases have been vetoed by Govs. George Pataki, Andrew Cuomo and Kathy Hochul.
Bezrutczyk said that disinvestment has pushed agencies like hers out of business and moved therapists to look for jobs elsewhere, like in hospitals, for insurance companies, or most commonly, in a school district. She said the pay, benefits and support are all better there.
"When you just look side by side, it's a no-brainer," she said. "You can't blame someone for wanting to do better for their family."
Bezrutczyk said for many early intervention therapists, it's also an issue of respect. The low pay feels like a message: What you're doing isn't valued by the state.
In recent years, blow after blow
In recent years, there have been other significant blows to the EI system in New York.
About 2,000 therapists left the field during the COVID-19 pandemic.
More have left since October 2024, after the disastrous rollout of a new web platform for paperwork and billing, called EI Hub. Despite negative feedback from testers, the state implemented a bug-ridden system that was much slower and more difficult to use than the previous platform. Critically, it had serious billing issues, and many therapists went unpaid or underpaid for months.
Then, there's the matter of a 5% rate increase that was promised in the 2024 New York state budget. Over a year later, it still hasn’t taken effect — but a decrease in the rate for telehealth services has.
"The fact that the rate increase was promised and has not come into place is incredibly discouraging," said Brigit Hurley, chief program officer at The Children’s Agenda, a state advocacy group that’s been pushing for early intervention reform. "And of course, they [therapists] are just leaving."
She said the therapists left in the system are doing it despite their pay and overtaxed working conditions.
"The folks who are left providing early intervention services in New York state are heroes," said Hurley. "It's just not a tenable employment right now."
New York breaking federal law
The severe lack of therapists in New York is having devastating impacts on kids and their families — and the school districts they go into, Hurley said.
About half of the kids who are supposed to be getting things like speech and physical therapy at a young age to address delays and disabilities are not.
Hurley said that means they’re missing the window during which therapy is most effective.
"When you provide therapies to a child who's 18 months old, they have a much greater chance of making progress than if you wait until they're 5, 6, 7, or 8 years old," she said.
Hurley said it’s unfair to New York families that this federally mandated service is not being provided.
"Kids have a right to these services. They have a right to these services in a particular time frame," said Hurley. "And those rights are being violated."
Within the state Department of Health, the Division of Family Services oversees the Bureau of Early Intervention.
In repeated media requests by NCPR, the Department of Health has stated via email that it is “committed to supporting and enhancing early intervention services,” but has never directly addressed the state’s failure to get 50% of the children who are eligible for therapy that care.
'We want our children to be the best version of themselves'
This leaves parents in a role of having to fight for their child's rights, and when therapies are not available, taking on a lot of detective work and guesswork to help their child.
That's certainly been the case for 33-year-old Kailey Yeager. Her son Matthew has autism, and around his second birthday, Yeager and her husband got him evaluated for early intervention services.
"It showed the need for speech and OT," she said.
The Yeagers live in Hamlin, a town in Monroe County that's about 30 minutes west of Rochester.
While they got a year of speech therapy for Matthew, the therapist shortage meant they only got a month of occupational therapy before he aged out of the early intervention system.
Yeager says he saw incredible progress in speech therapy, and she wonders what a year of occupational therapy could have done for her son and the skills he struggles with. She said those include "how to hold a pencil, how to cut with scissors, how to walk up and down the steps safely."
In lieu of professional help, Yeager has tried to learn as much as she can about occupational therapy.
"I try to do as much research as I can," she said. "Do I know it all? No ... it's just been a little frustrating to say the least."
Yeager stopped working to care for her son full-time, but she said that’s not something everyone can do.
"So us speaking out on this topic is also for all those parents who are working a nine-to-five plus, or just don't have the ability to advocate the way that we do," Yeager said.
It shouldn’t be this hard, she said. A parent shouldn’t have to be chasing down help.
"New York dtate is in a crisis, and they're breaking federal law," Yeager said. "This is our future ... we want our children to be the best version of themselves. And the way to do that is to set them up for success."
Yeager said the state isn’t doing that, and that’s a choice: to not raise pay, to not incentivize therapists to join early intervention.
She also said that in light of a consistent, years-long therapist shortage, parents like her would appreciate access to other resources for families that can’t get therapy.
She floated the idea of a video series explaining activities that would help address different motor skill issues, or one-time consultations with therapists.
"I wish I had at least had some pointers [about occupational therapy]," she said. "It would be nice to just have a consultation with an occupational therapist and just figure out baseline stuff that you could potentially work on with your child."
The cost of delayed services, to children and to taxpayers
Experts say the issue with a young child with delays not receiving timely intervention is that they grow up, and the delays compound and become more difficult and costly to address.
Brigit Hurley, from the Children’s Agenda, said that when kids don't receive therapy when they’re younger, they head into public school with bigger issues, which cost more money.
"When you wait, it's a lot more expensive and you don't make as much progress with that child," Hurley said.
She said what can cost a couple thousand dollars from 0-3 years old costs taxpayers between $14,000 and $18,000 annually on the K-12 level.
"Not to mention the impact on that child and the family, and honestly, the community in the long term, because that child may need lots of services as an adult," Hurley said.
Christy Bezrutczyk, the former early intervention therapist in Plattsburgh, now works for a pediatric office helping to address developmental delays. She’s also getting her Ph.D. through Johns Hopkins University, and her dissertation is on New York’s early intervention system.
She said she believes it’s no coincidence that New York ranks last in the country for delivery of early intervention therapy, and is also the highest user of special education services in the continental U.S.
"What does that tell you? When you kind of zoom back and you're looking at all of these kids that we could have provided early intervention services to," Bezrutczyk said.
She said anyone who’s studied childhood development can tell you, it matters when you address delays.
"Those numbers would decrease significantly if we were in there during those critical windows of brain development, and we're not."
She said children, their families, and their communities all pay the price, because in the end, the buck has to stop somewhere.