Jazz was deaf, which made the situation even more extraordinary. Jazz was diagnosed “profoundly hearing impaired” shortly after his early hearing tests were failed. Before his parents could fully grieve the loss, Mississippi’s early intervention program intervened. Jazz was 3 months old when the First Steps program began enrolling him in speech, occupational, and physical therapy. Three years later, Jazz was able to read lips and sign language. He also had the ability to understand the sounds that his cochlear implant enabled him to hear. Jazz is now in fourth grade and takes mainstream classes. Jazz’s voice is sharp and high-pitched when he uses his mom’s iPhone to chat. His only sign of hearing impairment is the white cochlear implants that poke through his hair. Amy Witkowski, his mother, stated that they taught him how to live in the hearing world. Without First Steps, he wouldn’t be the person he is today – an above average student with above-average language skills. He’s still an average student in math. Although he’s not the best in math, he’s still average in many other areas. Rita Hall, Rita’s former First Steps speech therapist, stated that she enjoys working with young children. Hall stated that the progress you make with babies is simply not comparable. “You can make a huge difference in just a few sessions.” This is due to neuroplasticity, which allows the mind to grow and create new connections. Neuroplasticity is a high level in young children, but it decreases as we age. Since the 1980s, the federal government has spent billions of dollars in early intervention programs such as First Steps in every state. Mississippi is one of the states that has accepted federal funds. It must provide treatment for any child below three years old who qualifies. Mississippi doesn’t provide these services to all children who are eligible. Mississippi Today heard from parents that their children were referred to services only to have them delay for months or not materialize. According to Mississippi Today employees and more than 20 therapists, the reason for the inability to provide services is the critical underfunding of the program. First Steps received $4.1million in federal funds this year for its program, which is comparable to amounts given to neighboring states. However, Mississippi only contributed $1.3 million, which is a small amount compared with its neighbors. Grayson’s therapist had to stop providing services after the Department of Health, citing administrative issues, ordered them to cease services to hundreds of children in their program. Patton stated that she is still waiting for services restart to resume ten weeks later. In the meantime, Patton is trying to prevent Grayson’s loss of the skills he learned. Patton works full-time and spends hours every week trying to learn the same lessons Grayson’s therapist gave him. Sometimes, she watches YouTube videos of physical therapy sessions. Grayson’s therapist sometimes gives Grayson pointers on the phone. The difference in Grayson’s progress is evident. It’s a daily struggle. Patton stated that he is not an expert. “… It’s either that, or I let him slide behind. According to experts in early intervention, underfunding First Steps will eventually lead to the state spending more money. The Heckman Equation, which was later to be known as the Nobel Prize-winning economist James Heckman, was first proposed over a decade ago. He argues in it that every dollar a government spends on early intervention will yield a return of up to 13 percent. He said that children who perform better at school will have higher earning potential. The government will also spend less on expensive remedial education, healthcare and imprisonment. Spending dollars later in a child’s life may yield returns, but they are diminished. Change is more difficult and expensive as neuroplasticity decreases. “Why would anyone not make this investment?” Melody Musgrove, of the University of Mississippi’s Graduate Center for the Study of Early Learning, stated that most investors would accept a 13 percent return on their investment and then run to the bank. Before this, she was the director of the Office of Special Education Programs of the U.S. Department of Education. Karen Price, a speech-language pathologist, runs a therapy clinic for south Mississippi. She said that she regularly sees the return on this investment. A month ago, a child came to her clinic “pitching an fit”. His mother was frustrated by his behavior and wanted to refer him to a mental hospital. Price, his therapist, diagnosed him with auditory processing disorder. Price said to the boy’s mother, “I said, ‘Give us three months,'” Price explained. “Lots and lots of times, biting, hitting — frustration with communicative efforts. They can overcome this if they are given the tools to communicate. This is a child who won’t experience any delays when he begins school.” A child who is in regular classes is more likely to graduate high school than one who is in special education. Only 65 percent of special education students graduate in time nationally, which is well below the overall 83 percent rate. According to the Hechinger report, Mississippi’s disparity is even worse: Only 30% of special education students graduate on-time. Even those who graduate high school are less likely to go on to college or make less once they get into the workforce. Musgrove’s colleague from the Graduate Center for the Study of Early Learning Cathy Grace calls early intervention “an investiment not an entitlement” and said that if the state made a significant investment in early intervention it would see “dramatic reductions in special (educational) referrals.” Dr. Susan Buttross of the University of Mississippi Medical Center’s Center for the Advancement of Youth stated, “I feel like everybody needs to understand the urgency of what we do.” “The brain grows so quickly in the first three year of life that it’s impossible to wait until a child enters kindergarten.” Buttross stated that “It’s all our responsibilities to ensure that every child has a fair chance in life. If they do, it will be very likely that they’ll make good contributions to society.” It’s an investment Mississippi has repeatedly declined to make. Mississippi spent $1.3 million from its $6 billion state budget this year on early intervention. Tennessee, which is roughly half the size of Mississippi, spent 10 times as much — $12.9million — in comparison. Alabama and Louisiana, which have a population 50-60 percent greater than Mississippi, spent $8.1 and $11.7 million on early intervention programs. It’s obvious that Mississippi spends very little on its early intervention programs, but it’s not clear why. First Steps funding comes from a variety of sources. The Department of Health has allocated $389,000 to the program from its state general funds for 2019. Additional $189,000. is provided by state tobacco funds. The program also received $700,000.000 from the Department of Education. This is because the program is a hybrid of educational and medical, even though it is administered by the Department of Health. The doctors make the initial diagnosis and refer patients. However, the therapies mix medical treatments such as speech and physical therapy with special education techniques like special instructors. Insurance companies rarely pay for these special education techniques. Hall, Jazz’s former speech therapy therapist, said that it is a unique program and when it works, it is a truly wonderful program. The program’s unique hybrid approach makes it vulnerable to being overlooked and underfunded, as no agency is responsible for it. “The pendulum has been swinging back and forth all this time. Roy Hart, who managed the program from the mid-1990s to 2005, stated that “early intervention should not be part education, it should be part health.” “Nobody wanted it to be a permanent home. So the leadership never knew how much energy they could put behind it legislatively.” The program is funded by both the state Health and Education Departments. However, neither agency has a budget line for Early Intervention. Michael Cruthird, the former district coordinator for the Coast, said that “it’s a bastard programme.” He retired in 2015 after serving more than 20 years. “It’s not only public health, so there were always struggle within the agency to advocate for funds.” While First Steps currently has 3,000 Mississippi children enrolled, lawmakers are still unaware of its ongoing problems. The chairmen of the public and appropriations committees stated that they were unaware of any problems or concerns with the program during a recent legislation. Rep. John Read (R-Gautier), who chairs the Appropriations Committee, said, “I haven’t heard of any problems with that area.” “But I’m trusting the agency head to guide me. You could always use more funding but sometimes you have to make difficult decisions. Cruthird stated that advocacy for the program’s funding has often fallen on the shoulders of the Department of Health. It also sets reimbursement rates to contracted providers. These rates are much lower than those in neighboring states, and have been partially blamed for the state’s provider shortage. However, overall funding for state healthcare has been extremely tight in recent years. In the past five years, the state general fund appropriations fell 17 percent from $36million in 2014 to just under $30 million for fiscal 2019. Last year, the department decreased the number of public healthcare districts that supervise its First Steps divisions from nine to three. “I believe the Health Department has been living in survival mode for the past four years. Cruthird stated that you can’t expect to achieve your goals if there is so much instability over such a short time. It’s a long-term investment, though. Hart, who was the program’s previous director, acknowledged that this makes it less attractive for legislators who are elected every four years. Hart stated, “Even though it’s going to save money over the long-term, (their] vision right now is to ensure that any action you take must demonstrate an immediate cost saving or have no merit.” However, not all children will see rapid change. Many children struggle for years to make incremental improvement for every delay that is removed before they start school. Many children with severe cerebral palsy may struggle for years to learn how to sit unassisted. Some people never reach that level. Even incremental improvements can lead to savings. According to a 2008 study published in Developmental Medicine and Child Neurology, if a child with cerebral paralysis can learn to sit up and eat by the age of 14, his life expectancy will more than double, going from 28 to 64 years. His risk of serious complications also drops. Many therapists argue that the impact these treatments have on families with severely disabled children is just as important. Many parents, like Amy Witkowski spend many months grieving the lives they planned for their child. Price stated that First Steps transforms not only the child’s life but also the parents’ relationship with their child. Price stated that it is important to understand how First Steps gives parents tools to help their child. It also helps them to have hope. “You can see the changes in the child’s behavior and in the behavior of the parents because they feel like there is something there. It gives them hope.” Price said. Musgrove stated that this kind of return is economically sound, especially in a state such as Mississippi which needs all it can get.