When Kimberly Halevy鈥檚 son Joshua was 3, she started hearing from his preschool that he was acting out. He rarely participated in circle time and had trouble playing with other kids.

Halevy鈥檚 friend had recently opened the preschool, and she liked that someone she knew took care of her son. But eventually, the preschool said it would only allow him back if he had a 1-to-1 aide to address his 鈥渄isruptive鈥� behavior, Halevy said.

At first, Halevy thought getting him that aide would be straightforward. But she now describes the effort to get her kid support through Philadelphia鈥檚 federally mandated, publicly funded early intervention system as exhausting.

Though state evaluators found Joshua should receive multiple forms of therapy each week, it took months for any services to begin, Halevy said. Then, once providers contacted her, she said it became a 鈥済uessing game鈥� whether her son would receive the home-based occupational therapy and specialized instruction he qualified for every week.

鈥淚 kept being mad at myself for not pushing,鈥� Halevy said. 鈥淏ut now I realize that it鈥檚 just the program.鈥�

Across Philadelphia, young kids like Joshua are waiting months and sometimes years for early intervention services that they are legally entitled to, according to families, therapy providers, and advocates Chalkbeat spoke with.

Federal law states a child must receive services as soon as possible after an evaluation team completes their Individualized Education Program, or IEP. Pennsylvania has interpreted that to mean 14 days. But one provider said the list she can access of children waiting for speech therapy 鈥� one of several early intervention services 鈥� is sometimes more than 2,000 families long.

Early intervention providers are , with not enough funding or staffing to meet the need. But in Philadelphia 鈥� home to 16% of the state鈥檚 early intervention population 鈥� one player is largely responsible for the system: a 170-year-old nonprofit called Elwyn that the state pays to manage the publicly funded program.

As Philly鈥檚 early intervention system struggles to meet the needs of all kids, some providers and advocates say neither Elwyn nor the state officials who oversee the program are doing enough to ensure kids get services on time.

In response to Chalkbeat鈥檚 questions, Elwyn President and CEO Charles McLister said Elwyn does not comment on specific cases, but the organization works quickly to assess children and provide them with services. 鈥淔or the vast majority of cases, services are provided within the defined window,鈥� said McLister.

But McLister acknowledged that there can be delays due to family communication, transportation, scheduling, provider availability, and severe staffing shortages across the sector.

Erin James, press secretary at the Pennsylvania Department of Education, said in a statement that the department stays in close contact with Elwyn throughout the year 鈥渢o remind them of their legal obligations.鈥�

James did not respond to questions about service delays for Philadelphia families. But she said that early intervention programs often lack resources. 鈥淐urrent funding levels for EI [early intervention] services are not sufficient because the population of students who qualify for EI services has been increasing for years,鈥� James said.

In Philadelphia, the program鈥檚 delays are a key reason many of the city鈥檚 most vulnerable kids fall behind before they even start kindergarten, advocates say. Data from early intervention the state publishes shows Philly children in early intervention programs lag behind their peers elsewhere in key growth areas, like developing social emotional skills.

鈥淭he whole idea of having to wait more than the required time is really putting kids at a disadvantage,鈥� said Inella Ray, director of parent advocacy and engagement at the advocacy organization Children First. 鈥淏ecause when kids don鈥檛 have the support that they need, in today鈥檚 current education or environment, they get pushed out.鈥�

Parents face delays accessing early intervention services

Early intervention is part of the landmark Individuals with Disabilities Education Act, which dictates that all children with disabilities must have access to a free and appropriate public education. Though each state creates and manages its own program, all kids through age 5 who are identified as having a developmental delay or disability are eligible.

In Pennsylvania, the Department of Education oversees local early intervention programs for preschool-age kids. In almost every county, families get connected with services through an intermediary unit, a kind of regional education service agency.

But in Philadelphia, things work differently. The state pays Elwyn a combination of state and federal dollars to administer the city鈥檚 preschool early intervention program, along with a much smaller program in Chester. Last fiscal year, its contract was worth around $90 million. Elwyn is in charge of assessing children, developing their IEPs, and subcontracting with a network of providers for services they qualify for.

When Halevy鈥檚 kids鈥� preschool said her son needed an aide, the preschool owner gave Halevy advice: phone Elwyn. So she did, and she was relieved when the organization told her they could fit Joshua in to begin his evaluation later that week.

That was July 2024. She hoped Joshua would have services in time to be back at preschool by the following September. But soon, Halevy said she began hitting roadblocks.

In August, she said she didn鈥檛 hear much from Elwyn. Like other early intervention programs statewide, Elwyn often takes a two-week service break at the end of summer 鈥� one of many scheduled break periods during the year.

But then when she did hear back that September, she learned Elwyn wouldn鈥檛 consider providing a 1-to-1 aide without observing Joshua in his educational environment. But the preschool said he couldn鈥檛 return to class unless he had someone there to specifically support him.

At the end of September, when evaluators wrote Joshua鈥檚 initial IEP, they documented that they discussed adding an aide to assist Joshua at preschool. But they wrote that because they could not observe Joshua in his educational environment, they did not have enough information to support that recommendation. 鈥淸T]he family is in a difficult position,鈥� the team wrote on the IEP, which Chalkbeat has reviewed.

Joshua鈥檚 IEP states that he should receive occupational therapy and specialized instruction each week. The law requires services to begin within 14 days. But more than a month after, Joshua still wasn鈥檛 receiving services, Halevy said.

At the time, Halevy was stretched thin. She was also working to get services for her 2-year-old daughter, who struggled with speech, through the separate early intervention program that serves children up to age 3 run by the city.

For Halevy, sorting out her daughter鈥檚 services in the birth to 3 program was simple. Service providers quickly began contacting her and therapists started showing up for sessions. But for her son, nothing.

鈥淥ne day, I鈥檓 like, 鈥極h my gosh, what鈥檚 going on with Josh?鈥� and I start calling every number I had at Elwyn,鈥� said Halevy.

It wasn鈥檛 until two more months later, in November, when he finally began to receive occupational therapy, she said recently after reviewing text messages. In December, she said his special instruction began.

Early intervention IEPs not always followed

Elwyn鈥檚 Philadelphia program is the largest in the state, serving around 11,000 preschool-age children, according to the from the 2023-24 school year. The organization first won its contract for early intervention services in Philadelphia in 1998.

But its outcomes for kids are behind the rest of Pennsylvania.

The state requires early intervention programs to report data on how kids progress in certain areas, like social emotional learning and acquiring new skills. show that for the last five years of data, children in Elwyn鈥檚 Philadelphia program have been less likely to progress in all three growth categories compared with the state average.

Margie Wakelin, a senior attorney at the Pennsylvania-based Education Law Center, said her team has assisted more than 80 Philadelphia families in the last year whose kids鈥� education was disrupted at least in part because they couldn鈥檛 access appropriate services from Elwyn. The vast majority of those children, she said, were Black and Brown kids affected by poverty.

Some families hire attorneys to help them access the services they鈥檙e entitled to, or get pro bono representation from organizations like the Education Law Center. Many who win their cases get compensatory education, often in the form of money the family can use to pay for services after the case is over.

But that doesn鈥檛 make up for lost time as children quickly age out of early intervention. Research shows that than any other time of their life. Many families, Wakelin said, have also had their children or made to only attend partial days because of their disabilities.

鈥淚t鈥檚 such a critical period for kids to have access to high quality education,鈥� said Wakelin. A system that identifies children as needing services but doesn鈥檛 follow through, she added, is 鈥渞eally failing our kids.鈥濃��

McLister, Elwyn鈥檚 CEO, said the organization has learned that, in some cases, children are suspended from their preschool programs because of learning or behavioral needs. 鈥淓lwyn is not part of this decision making and often learns about it after the fact,鈥� he said. He added that the organization is developing tools 鈥渢hat will help us understand the frequency in which this happens鈥� and is creating additional resource materials for families.

State reports show that Elwyn鈥檚 program is successful in some areas, like evaluating 97% of kids within 60 days, the state-required timeline. But that鈥檚 just the first step in what advocates say often becomes a month-long process to get services.

Though the law is clear that kids should receive services within 14 days of their IEP being written, the state does not publish information on how long kids wait for services after an evaluation, or how many service interruptions they鈥檒l experience when providers are no longer available.

When it comes to Elwyn鈥檚 performance, CEO McLister said that students鈥� growth data does not account for the unique challenges of providing services in Philadelphia. The children Elwyn serves have higher needs than the state average, he said, with higher incidences of developmental delays and a greater prevalence of multiple other challenges, such as limited English proficiency, economic disadvantages, and other social risk factors.

鈥淔or younger children, these factors produce more modest gains,鈥� said McLister.

McLister emphasized that Elwyn has been successful in evaluating the vast majority of children on-time, and said the most common reason an evaluation falls outside the 60-day window is a parent cancelling an initial evaluation appointment and needing it to be rescheduled.

He said delays in getting kids services are often the result of scheduling challenges and staffing shortages 鈥� 95% of service issues related to speech and language services, he said, are due to a lack of staff. He said other delays occur when families move or change their child鈥檚 preschool enrollment, and when providers return kids to the 鈥渘eeds list,鈥� meaning they stop service for that child, which happens 鈥渇or a variety of reasons.鈥�

For Joshua, getting a consistent special instructor, a position meant to support Joshua鈥檚 learning, has been impossible, Halevy said. Her text history, which she reviewed recently, documents the challenges: The first special instructor who contacted her never visited and stopped responding to texts, she said. The next person was more helpful and saw Joshua a few times, but then abruptly quit. Now, after more than a month of no special instruction, a new provider comes mostly regularly, Halevy said.

Access to occupational therapy has been slightly better, Halevy said. For the first several months of service, Joshua鈥檚 occupational therapist showed up inconsistently and seemed rushed, Halevy said. Now, after working out a schedule, she consistently comes around once a week.

Early childhood intervention needs more funding, some say

These and other challenges aren鈥檛 unique to Philadelphia families. But preschool operators and early intervention providers say there are particular and longstanding problems in Philly.

Two years ago, Sharon Neilson, former director of the Woodland Academy Child Development Center in West Philadelphia, was part of a group pushing to bring attention to problems in the city鈥檚 early intervention program. Council members about parents鈥� challenges accessing services, and Neilson and other providers met with Elwyn.

At the time, Neilson said, she was hopeful that things would improve. But since then, she said, 鈥渨e鈥檝e actually seen it get worse.鈥�

Neilson, who now works as support staff at Woodland Academy, said of the 22 children enrolled at the preschool, about four currently receive services from Elwyn, and three more are going through the process of getting evaluated.

The preschool helps families navigate the process, in part because submitting required paperwork and scheduling evaluations can create additional barriers, she said. But even with additional help, in her experience it still usually takes months for kids to be evaluated and services to begin, she said.

鈥淚 think that鈥檚 the saddest thing for me,鈥� Neilson said. 鈥淭he families are very frustrated because they don鈥檛 know what to do 鈥� they just know that they need help for their child, but it鈥檚 just very hard to navigate.鈥�

Officials say a lack of resources is largely to blame. Over the past decade, the number of preschool-age children in Pennsylvania receiving early intervention services has grown by a third, and funding hasn鈥檛 kept up.

Pennsylvania Department of Education spokesperson Erin James said that is why Gov. Josh Shapiro proposed increasing funding for preschool early intervention by $14.5 million in the state budget. However, months past the budget deadline, lawmakers remain at an impasse over the budget and .

One provider who contracts with Elwyn said concerning inequities exist in Elwyn鈥檚 program. (Chalkbeat is not naming the provider due to her fears of retaliation from Elwyn.) It鈥檚 an accepted norm, the provider said, that kids in nicer neighborhoods get picked up for service much faster than those in poorer neighborhoods.

鈥淭here鈥檚 an access and equity issue across the board,鈥� said the provider. 鈥淎nd that鈥檚 exacerbated by the shortage of providers.鈥�

Asked about those access and equity concerns, McLister said that to address some related challenges, this year Elwyn is implementing more targeted training for staff and plans to develop a family resource center. He said the organization has also employed internal speech language pathologists to assign to high-priority cases.

When families reach out to Elwyn, McLister said staff provide them with documentation and verbal explanations of how the process works to ensure families understand their rights, next steps, and how to give consent for evaluations.

The organization also periodically notifies providers of historically underserved ZIP codes to encourage providers to serve kids equitably across the city, and includes provisions in its contracts meant to 鈥減romote fairness and accountability.鈥� McLister said Elwyn places subcontractors on corrective action plans if the organization 鈥渄etects patterns of non-acceptance that disproportionately impacts underserved areas.鈥�

As for Halevy, she says her family has gotten relatively lucky. They were able to get Joshua started on an evaluation quickly. And she鈥檚 been able to get new therapists when others stop showing up.

But her family鈥檚 biggest piece of luck, she said, is that her husband recently got a new job with better health insurance. She plans to use that to get some of the services her kids need. That means she no longer will completely rely on Elwyn.

She just wishes she could erase the months of waiting and worrying about why Joshua鈥檚 services took so long to start.

鈥淏asically, what happened is we fell through the cracks,鈥� she said.

Chalkbeat is a nonprofit news site covering educational change in public schools. This story was originally published by Chalkbeat. Sign up for their newsletters at .

Yet as her 30th anniversary working as a special education teacher for the approaches, Lengen increasingly feels disillusioned: still happy in her work, but distraught about remaining in what may be the only profession in New York that hasn鈥檛 gotten a substantive raise 鈥� in absolute terms, much less adjusting for inflation 鈥� in three decades. Any modest rate increases the state鈥檚 early intervention providers (which include teachers like Lengen and a range of therapists) have benefited from, were generally counterbalanced by cuts. 鈥淎s a 30-year veteran with a master鈥檚 degree, I am working twice as hard as when I started in early intervention, and making less now,鈥� Lengen said.聽

Over the same time period, New York鈥檚 hourly minimum wage has , from $4.25 in the mid-鈥�90s to more than $15 now. The average salary for public school teachers jumped from in the mid 1990s to about in 2023-24, according to the National Education Association. And, while New York state data is elusive, nationally the for chief executives climbed from nearly $6.4 million in 1995 to more than $20 million in recent years.

The Economic Policy Institute’s Elise Gould, who researches wages and economic inequality, said she knows of no precedent for a job where the absolute pay hasn鈥檛 risen in 30 years. 鈥淚t鈥檚 a little hard to believe,鈥� she said.

Early intervention providers deliver critical services including speech, physical and occupational therapy to children from birth through age 3 who have a range of developmental delays and disabilities. When done well and promptly, that it can reduce the need for costly special education services, as well as other public assistance down the road, and improve life outcomes. 

Early intervention systems are state-led and designed, and the mix of specific funding sources can vary considerably across states. New York relies on a combination of private insurance dollars and county, state and federal funding, including Medicaid, to serve approximately 70,000 children. 

Many of the therapists, special education teachers and others who provide early intervention services are not salaried employees. In New York, they are paid a fee for service rate that is set by the state. After providing the service, they submit a claim for reimbursement and are paid either by Medicaid if the child is eligible, or by the state, which draws from a combination of funding streams. 

For many services, including the specialized therapy and support that Lengen provides, that rate was higher in the 1990s when early intervention began in New York state, than it is today. For instance, a published by The Children鈥檚 Agenda, a Rochester-based group which has advocated for increased pay for providers over the years, found that a standard visit 鈥� at least 30 minutes 鈥� was reimbursed at a statewide average of $79 in 1994, compared to $69 in 2022. Brigit Hurley, chief program officer at the group, said that according to a recent staff analysis, 鈥渞eimbursement rates would need to increase by 240% to have the same spending power as it did when the early intervention program began.鈥�

People in the field say it鈥檚 typical for therapists, who all have at least a master鈥檚 degree, to earn between $50,000 and $70,000 a year 鈥� far less than they could make doing the same work in a different, often less stressful, setting.

鈥淚f you were a governor or a legislator and were stuck at your 1995 salary, would you stick around for that job?鈥� said Amanda Wilbert, the regional director of Step by Step Pediatric Services in Rochester, an agency that coordinates early intervention services. Two of the young occupational therapists Wilbert oversees left earlier this year for jobs doing the same work in a nursing home. The positions came with an approximately $30,000 raise, bringing their pay from about $60,000 to $90,000, and better benefits, Wilbert said.

Partly because of that pay-induced exodus, advocates say that New York in terms of timely delivery of early intervention services to kids. In the spring of 2024, after a long, hard battle by advocacy groups, a pay boost appeared to be on the horizon. a 5% rate increase for in-person early intervention services, plus an additional 4% for those working in rural and underserved parts of the state. But so far, therapists have yet to see that bump, with final approval pending with the federal Centers for Medicare & Medicaid Services. (In late September, federal officials did approve the 4% for those working in underserved areas, but it鈥檚 unclear when it will be implemented, or how many providers it will reach.)

Meanwhile, with the Trump administration having recently slashed Medicaid by trillions of dollars, the long-delayed full increase might not get the federal stamp of approval for the indefinite future, according to advocates, and the system will likely continue to bleed providers. Said Lengen: 鈥淚n the end these kids are losing out, and it鈥檚 a very vulnerable population.鈥�

New York is hardly an anomaly. Other states 鈥� both red and blue 鈥� report similar challenges, including Texas, Rhode Island and Illinois. In Illinois, a 2024 into the finances and pay in early intervention found that the median annual income for independent contractors in the field was about $71,000, which is significantly lower than typical incomes for similar roles in the state. According to the Bureau of Labor Statistics, the median annual wages for a speech and language pathologist in various settings in Illinois is about $88,000 and for physical therapists, it鈥檚 about $104,000. As in New York, that disparity has caused many early intervention professionals to leave the field, with the number of speech therapists in the program dropping 13% between 2018 and 2023, and physical therapists falling 16%, according to the 2024 report.

The problem is only likely to worsen nationally, said Elisabeth Burak, a senior fellow at Georgetown鈥檚 Center for Children and Families. States will struggle to raise rates for any service that鈥檚 funded partially through Medicaid, she said. 

No one knows exactly what the fallout from the Medicaid cuts will be, but untold numbers of families with children could be booted off the program. At the same time, the amount of money states get for Medicaid-eligible families could shrink, forcing state policymakers to make tough decisions about how to make up the losses. 鈥淪tates are already having a hard time but it has the potential to get a lot worse,鈥� said Burak.

New York鈥檚 early intervention program was created in 1993 and it鈥檚 had a rocky history with compensation. The first significant rate decrease occurred in the late 1990s, according to the state compiled by The Children鈥檚 Agenda. Rates stayed the same for over a decade. And then , there were two cuts, said Brigit Hurley, chief program officer at the group.

A few years ago, in 2022, some providers in New York, including physical and speech therapists, . But that 鈥渄idn鈥檛 bring the pay above when the program started,鈥� said Hurley. And the across-the-board pay bump that the brought hope to many providers, but without final approval at the federal level for the 5% bump, they still haven鈥檛 seen the increase. 

鈥淚鈥檝e had providers tell me they are getting paid less now than when they graduated 30 years ago with a master鈥檚 degree,鈥� said Hurley. 鈥淚t鈥檚 a really dire situation.鈥� 

Much 鈥� and on particularly bad days, most 鈥� of early intervention professionals鈥� work is uncompensated: travel time to homes; 鈥渘o shows鈥� when the families aren鈥檛 available; lesson planning and other preparation for the sessions; communication with families between visits; equipment and supplies; mandated annual continuing education sessions; extensive reporting that鈥檚 required on each case.

鈥淭his year and last year 鈥� I come home after seeing four to nine kids and I鈥檓 at the computer for two to three hours doing reports,鈥� Lengen said. 鈥淲ith [26] kids on my caseload, that鈥檚 a lot of reports to do.鈥�

Lengen, 62, graduated in 1985 with a bachelor鈥檚 degree in special education and, a few years later, earned a master鈥檚 in reading. She worked for nearly a decade in K-12 classrooms, and then shifted to early intervention around the time the program debuted in New York in the 1990s. Initially, she worked for an agency and made a full-time salary. But she left the staff position in 2004 when the agency stopped providing early intervention services. 鈥淭he pay was decent, but it was a big learning curve on my part,鈥� she said.聽

Today, Lengen works in homes and child care programs, supporting kids and their caregivers, often coaching the latter on how to manage challenging behaviors. She also winds up filling gaps left by other holes in the intervention system, like supporting children with autism in their sensory development. 鈥淚 end up doing a lot of sensory play since most of the kids don鈥檛 have occupational therapists 鈥� ,鈥� she said. 

Since she began working independently over 20 years ago, the demands of the job 鈥� including higher caseloads and increased reporting requirements 鈥� have increased but the stagnant pay hasn鈥檛 come close to keeping up with inflation and the rising cost of living. There were the two pay cuts across the board 鈥� 10% in 2010 followed by another 5% in 2011 鈥� and, nearly a decade later, special educators were overlooked when some therapists got the modest bump in 2022. 鈥淎t that point, I was really thinking long and hard about leaving early intervention,鈥� Lengen said. 

Despite her financial advisor鈥檚 recommendation that she at least consider working in a school district, Lengen decided to stick around, noting that she loves the work and didn鈥檛 want to start over late in her career. But many other early intervention providers have left the field.

When Sandra Ribeiro started providing physical therapy through early intervention in 2000, she said, 鈥渨e were some of the highest paid across our profession, and we had support.鈥�

At that time, all of the early intervention providers involved in a child鈥檚 case would gather monthly with each family to coordinate services and brainstorm what could be changed or improved. But that practice began to erode more than a decade ago when the state stopped paying professionals for the time spent in those meetings. 

Ribeiro has a doctorate in physical therapy, and is fluent in five languages (Portuguese, French, Italian, Spanish and English). That鈥檚 a huge asset in the many multilingual homes she鈥檚 visited. She points out that providing in-home therapy to an incredibly diverse group of families 鈥� some cooperative and supportive of her efforts and others less so 鈥� is a complicated assignment. 

鈥淚t requires a high skill level to be able to work with a very young child to start with,鈥� she said, 鈥渁nd then you have to be able to incorporate the family.鈥� Still, she found it deeply rewarding to see the progress a child could make when delays and challenges were addressed early in life. One grateful family still sends her a Christmas card every year, even though the 鈥渃hild鈥� she helped is now 24 years old. 鈥淚 don鈥檛 think you can get that in other settings 鈥� you鈥檙e not a fixture of the home,鈥� she said.

Over the years, not only did Ribeiro鈥檚 pay fail to rise significantly, but it also became much more difficult to get reimbursed for her work at all. 鈥淚f you forget to do one little thing on your paperwork it gets kicked back and it can be months before you get paid,鈥� she said. Over the last decade, there have been some in the program, and that has led to stepped up reporting requirements and auditing for all. 

On weeks when everything went very smoothly 鈥� and there were no last-minute cancellations or no shows 鈥� Ribeiro would clear $1,500. But many weeks there were hiccups beyond her control that cut into that income. Two and a half years ago, she decided she had had enough and left early intervention for a job teaching physical therapy at LaGuardia Community College in New York City. Most experienced therapists she knows have also left the state-run program over the years, Ribeiro said. 

鈥淲e all know that when you go into health care it鈥檚 not for the money,鈥� she said. 鈥淏ut you have to be able to say to yourself, 鈥楳y work is worth something.鈥� And a lot of therapists have been so demoralized they shy away from early intervention even though in our hearts we would love to still be in those homes.鈥� 

Since Ribeiro left the field, the payment issues have only gotten worse. Over the last year, scores of New York providers have faced because of glitches with the state鈥檚 new data and payment portal, the .

Meanwhile, across New York state, countless families no longer have access to critical therapies because of the steady attrition from the field. Rural families have been especially hard hit. In the remote Tri-Lakes region of northern New York, Katie Wheeler鈥檚 3-year-old daughter missed months of early intervention services that she was entitled to because of a shortage of providers. 

Diagnosed with autism around the age of 2, the child qualified for in-home special education services and speech therapy. In early 2024, she was assigned a special ed teacher who came to her home two or three times a week, but a few months later, when the state dissolved the agency providing those special education services, the toddler lost access to that support for about a year. She received speech therapy virtually last winter; in-person early intervention sessions weren鈥檛 an option due to the lack of providers in the region. The virtual sessions went surprisingly smoothly for the toddler. 鈥淚t worked so well, I was surprised,鈥� said Wheeler. 鈥淭hey really pour their heart into what they are doing, and she grew immensely.鈥�

At the start of 2025, however, New York鈥檚 virtual early intervention providers learned that they would be getting a sizable pay cut. Ironically, the rate cut for telehealth services, as they are officially known, was initiated to free up funds for the pending 5% increases for in-person services in the state, which is still awaiting approval from the federal Medicaid office.

Wheeler鈥檚 daughter鈥檚 speech therapist, along with most other virtual providers in her county, promptly quit, which Wheeler says she entirely understands. 鈥淲e were not given anyone else because there was no one else to be given,鈥� she said. The family did pay out of pocket for some speech therapy, but in the six months that her daughter went without early intervention services over the winter and spring, Wheeler said she could see significant regression. When she was in speech therapy, the child could name an animal when shown a picture, and make its sound, for instance; but without services, much of that language slipped away. 

When the girl became old enough to receive special education services through school, there was another months-long delay to get services set up. In an effort to access more robust special education services, the family recently moved to nearby St. Lawrence County. Wheeler knows that most families would not be able to take such an extreme and expensive step.

With the recent loss of virtual providers, she said, 鈥渢here are going to be so many kids without anything.鈥�

Research has shown that timely receipt of early intervention, in the years when the brain is developing far more rapidly than at any other point, is critical to child development, and can improve life outcomes far down the road. Many children who receive early intervention do not in kindergarten, including slightly less than half of those with developmental delays, according to one 2007 study.

When delays and challenges aren鈥檛 addressed in the early years, they show up 鈥� often aggravated 鈥� in schools, where there鈥檚 rarely the time and resources to address them. 鈥淜ids are going to preschool and kindergarten with lower skills than ever,鈥� said Amanda Wilbert. 鈥淭hey鈥檝e never gotten services, and they desperately need them.鈥�

There are many reasons, advocates say, that it鈥檚 been such a long struggle to increase pay for early intervention providers in New York. The isolated instances of fraud have been cited by some state officials as a reason for not investing more, said Hurley.

But the unprecedented rate freeze 鈥� which long predates the fraud 鈥� also speaks to the societal and political invisibility of babies with developmental delays and disabilities, according to early childhood advocates. And it speaks to the invisibility of an overwhelmingly female labor force whose work occurs largely in the private space of the home. 

For now, with the slashes to Medicaid, the push to increase rates in New York is on the back burner, although it is not totally off the table. Hurley and others say they remain committed to advocating for changes that will improve the system, including studying alternative models for delivering services.

Lengen said that many months ago, she stopped looking for the 5% rate increase promised a year and a half ago to finally provide a small boost to her income. 鈥淎t some point, you stop believing that it鈥檚 going to come,鈥� she said.

But unlike so many others, she has no plans to go anywhere. 鈥淚 hate the fact that the state and county don鈥檛 think we are worth giving money to,鈥� she said. 鈥淏ut I love the job and the families,鈥� she added, noting the joy that comes from teaching and playing with the littlest learners on their level.

鈥淚 will work in early intervention until the day I can not get up off that floor.鈥�

One of the first of the many trips she鈥檚 taken as CEO brought her to Hawaii in July, where she met a little boy who announced he was getting ready for the holidays.

The holidays? In July? Her young friend was talking about Halloween, and he presented her with a drawing he鈥檇 made of the jack-o鈥�-lantern he was planning.

Erhardt Preitauer, CEO of CareSource and a member of the Easterseals national board of directors, praises Davenport鈥檚 leadership and her energy, saying, 鈥淜endra is somebody to be reckoned with. She’s got a wonderful leadership quality, and she clearly has passion for serving people with disabilities.鈥�

Here are some of the ways Davenport is honoring Easterseals鈥� legacy and retooling systems to increase impact.

Early intervention. According to the , 6% of children age 3-17 have a diagnosed developmental disability. The number grows every year, leaving parents and caregivers stressed and often unprepared. Easterseals鈥� helps them track the development of children from birth through five. Davenport says that the free, comprehensive and confidential online screening tool can reassure nervous first-time parents who wonder if their infants and toddlers are developing appropriately, meeting critical milestones during the important first five years. 聽Easterseals is there as soon as developmental issues arise鈥攚hich is the optimal time to intervene. 鈥淲e were still in the Neonatal Intensive Care Unit,鈥� recalls triplet mom Shana Fryar, 鈥渨hen one of the nurses mentioned getting them into developmental therapies early, and she said that Easterseals Arkansas was a fabulous facility.鈥�

Inclusive learning. In addition to receiving therapy services through the , the Fryars also enrolled Ryan, Alexa and Jacob in , which is designed to educate children with and without disabilities. (As an added bonus, the triplets鈥� therapy sessions are integrated right into their preschool days.)

As Davenport explains, integrating children of all abilities 鈥渞emoves barriers, unconscious bias and stigma while increasing the quality of care. It鈥檚 what I鈥檇 want for my own children.鈥�

Experts agree: 鈥淚nclusive preschool classrooms are in the best interest of all young children,鈥� . 鈥淚ncluding children with disabilities results in greater empathy and acceptance of differences among all children and in improved academic, social and behavioral outcomes for children with disabilities.鈥澛� That is the philosophy behind .

Bridging generations. S. Surgeon General Dr. Vivek Murthy has sounded the alarm about the 鈥渓oneliness epidemic,鈥� to that of tobacco, obesity and substance use disorders. Undoubtedly, seniors are among the loneliest Americans.

Nina Blachman, director of the geriatrics fellowship program at NYU Langone Health, that loneliness 鈥渃an play a role in worsening all of [an older adult鈥檚] conditions. It鈥檚 associated with an increased risk of dementia, an increased risk of stroke. And of course, an increased risk of depression.鈥�

Davenport understands that young children can be part of the solution. Her mother, who passed away recently, used to leave her grandchildren鈥檚 handprints all over the sliding glass patio doors of her home because they reminded her of their presence.

Many of Easterseals鈥� child care sites, including the one I visited in Silver Spring, Md., are co-located with senior centers so that the oldest and youngest can see each other and interact.

Forging connections for military families. finds only 0.5% of today鈥檚 American adults has served in the armed forces, noting 鈥淲ith the shrinking size of the military in recent decades there are now fewer connections between the military and the civilian world.鈥�

Davenport鈥檚 father and husband served, and she has empathy for the challenges faced by active-duty families, especially those with special-needs children. In the D.C. area, for example, provides scholarships and other services for children of wounded warriors.

Other programs serve veterans in need of training or help in marketing themselves to find meaningful work. 鈥淭he life skills you gain in the military definitely translate to civilian life,鈥� she says. 鈥淏ut a lot of people need help with that transition, and a lot of it comes down to relationships.鈥�

鈥淓ach Affiliate comes with its own budget, its own challenges and opportunities,鈥� says Davenport. 鈥淲e work with each of them to ensure that children and adults become full and equal participants in society.

Dignity features in each and every way to work toward that goal.鈥� This value has always been a part of the Easterseals story and takes center stage in the organization鈥檚 first national TV commercial, premiering in September. Rather than putting a celebrity face on the screen, the spots show families and program beneficiaries telling their own stories. Ideally, the commercials will also help the public recognize the full scope of Easterseals鈥� work, and not just those stamps.