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