PA_Bar052407 - Pennsylvania Bar Association
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Transcript PA_Bar052407 - Pennsylvania Bar Association
Judith Silver, Ph.D. Director,
Child Welfare Early Childhood Initiative &
The Starting Young Program
The Children’s Hospital of Philadelphia
Why Focus on
Infants & Toddlers?
Babies’ vulnerability
to neglect
Largest age-group of victims w/
substantiated abuse & neglect*
Half of all substantiated medical
neglect cases*
Limited exposure to other
mandated reporters
*National Child Abuse & Neglect Data System
Children’s Bureau
Infants in Foster Care:
Especially Vulnerable
More
likely to enter
Longer length of stay
Highest rate of re-entry
Multistate FC Data Archive, Chapin Hall,
University of Chicago
Distinctive Issues for
Infants & Toddlers
Most
Rapid Period of Brain & CNS
Development
Multi-Disciplinary approach
essential
Intertwined, Interdependent:
– Mental Health
– Physical Health & Growth
– Development
Health & Development of
Children & Teens in Foster Care
Higher rates of:
Acute
Illnesses
Chronic Medical Conditions
Developmental Delays
Dental Decay
Vision Problems
Emotional/Behavioral Problems
Limited Access to Health Care
During Foster Placement
Most
children need MORE than
routine health care (specialists)
Many do not receive routine health
care
Many are underimmunized
Missing medical records
Starting Young Program
Ages
4 to 33 months
Open DHS cases
Interdisciplinary Pediatric
Developmental
Evaluations
Services Needed:
Primary
Health Care
Early Intervention (DD)
Allied Health Specialists
Medical Specialists
70%
47%
45%
26%
Did They Receive Needed
Services?
Early
Intervention
Medical Specialists
Hearing Test
HIV Screening
64%
64%
26%
25%
Promoting Healthy Outcomes:
What Works?
Comprehensive Primary Pediatric care:
Schedule of recommended visits (Amer. Academy
of Pediatrics):
– 2, 4, 6, 9, 12, 15, 18, 24, 30 & 36 months
– Annually thereafter (PA regs)
Early Intervention Services for Delayed
Development
Early Childhood Education (Head Start)
Checklist for Healthy Development
Use Promoting Healthy
Outcomes Checklist in Court
Cases
Connects healthy development with
permanency
To improve accountability that child
receives services
Based on checklist developed by NY
Permanent Judicial Commission on
Justice for Children*
– Ensuring the Healthy Development of Foster Children: A
Guide for Judges, Advocates and Child Welfare
Professionals. NYS Permanent Judicial Commission on
Justice for Children
What are this child’s
medical needs?
Does the child have an identified Primary
Health Care Provider and insurance?
– Received a full well child/EPSDT visit
according to Amer.Acad.Pediatrics schedule
– Received health screenings recommended for
age (newborn hearing, lead, anemia, TB)
– Had medical evaluation by the primary care
doctor since placement in foster care?
– Immunizations up to date?
Does the child have any
risk factors for significant
medical illness?
– Prematurity
– Past Hospitalizations or Surgeries
– Daily Medications
– Allergies to medication or food
– Followed by any medical specialists
– Special equipment required (e.g.
nebulizer)
– Risk factors for HIV
What are the developmental
needs of this young child?
What are the infant’s risks for developmental
delay or disability?
Has the child had a developmental
screening/assessment?
Has the infant or toddler been referred to the
Early Intervention Program?
Has the 3 to 5 year old been screened for
preschool special education services?
Has parental consent been
obtained?
For all needed:
Medical Records
Assessments
Recommended Non-Routine
Treatments
The End