Risk factors associated with children lost to care in a state early childhood intervention program.

Researchers looked at why families drop out of California’s Early Start program. They used state records to spot patterns in who leaves early. The team checked birth records, insurance status, and family details like mom’s age and education.

Two things stood out: no ride to the clinic and losing Medi-Cal. These beat every other reason for quitting. Young moms and parents who didn’t finish high school also left more often. Premature babies were at extra risk, but the fixable barriers were transport and insurance gaps.

Capio et al. (2013) ran parent-training groups and saw the same story: once a family piles up three or more risks, they walk. Lancioni et al. (2006) said younger moms drop out of PCIT faster—same red flag here. Twardzik et al. (2018) looked at kids who age out instead of dropping out; those kids later need special-ed at twice the rate, showing any service gap hurts. Knight et al. (2019) added distance: every extra mile to an ASD clinic lowers show-up rates, backing the transport finding.

You can’t change a mom’s age, but you can fix rides and insurance. Call the family before the first visit. Ask, “Do you have a way to get here?” If they ride the bus, hand them a transit pass. If Medi-Cal lapsed, walk them through renewal on the spot. These two moves cut dropout more than any fancy intervention.