Massachusetts faces critical gap in support for children with developmental delays after early intervention ends

A growing number of children in Massachusetts are falling through the cracks between early intervention services and school-based special education, raising concerns about support gaps during crucial developmental years.

Prince Lacroix’s early years showed the warning signs that often prompt families to seek help: he was slow to walk, slow to babble and did not play in quite the same way as other children. His mother, Eva Santiago, was a first-time parent living in a shelter when a paediatrician referred him to Early Intervention, the state’s free programme for infants and toddlers with developmental delays or risks. After an assessment by Bay Cove, one of Massachusetts’ Early Intervention providers, he began receiving support at about age two.

For Santiago, the service was more than a weekly appointment. An occupational therapist visited the family at home, worked directly with Prince and coached Santiago on activities she could use between visits. Over time, she said, he began stacking Lego bricks, joining playdates through the programme and learning songs. But when he turned three in mid-February, the support ended, as it does for children across Massachusetts, even when they still need help. It was another six months before special education services started through Boston Public Schools.

That gap is at the centre of a growing debate over how Massachusetts supports young children with developmental needs. Early Intervention, run under the Department of Public Health, serves children from birth to age three in natural settings such as homes and childcare environments. Special education, overseen by the Department of Elementary and Secondary Education, begins at age three and requires a child to meet a narrower legal threshold: a disability that affects learning in a school setting. In practice, that means some children who qualify for Early Intervention do not qualify for an individualised education programme, or IEP, leaving families to bridge the gap on their own.

Pediatrician Theresa Callahan said that is where many children fall through the cracks. She described families who struggle to find affordable preschool or other developmental support in the two years between Early Intervention and kindergarten. Maura Buglione of Thom Child & Family Services, which supports more than 10,000 infants, toddlers and families statewide, said the difference between the systems is significant: Early Intervention often focuses on social, emotional and behavioural development, as well as the parent-child relationship, while school-based special education is centred more tightly on academic access and classroom participation.

The problem is visible in the state’s own numbers. Of roughly 19,000 children who left Early Intervention in Massachusetts between July 2022 and June 2023, about 40% were found eligible for special education, according to state data. Around 13% completed Early Intervention before their third birthday, and nearly 10% were judged ineligible for special education. The state does not track what happens to children who exit EI without school-based services, so there is no clear count of how many find another form of support and how many simply go without.

There are some attempts to narrow the divide, but none closes it. A new budget provision directs children entering shelters to be automatically referred to Early Intervention. The state education department has also launched a pilot programme, the Preschool Itinerant Team Initiative, to fund travelling teams of specialists who can deliver IEP services inside community preschools rather than requiring a separate public pre-K placement. Beyond Massachusetts, some states have adopted a federal option that would let children with IEPs stay in Early Intervention until age five, but Massachusetts has not taken that step, in part because it would require fresh state and insurer funding. For families like Santiago’s, the issue is not abstract: it is whether a child keeps receiving help during the months and years when progress can be most fragile.