Transcript Addressing the Developmental Needs of Children in Child

Addressing the
Developmental Needs of
Children in Child Welfare
Presenters:
Mimi Graham, EdD
FSU CENTER FOR PREVENTION & EARLY INTERVENTION POLICY
Trajectory of Development
Poverty
Maltreatment
Lack of Health
Services
Toxic Stress
Healthy
Ready to Learn
At-Risk
Delayed
or Disordered
Nurturing
Family
PreK & Quality
Child Care
Targeted
Supports
Health Services
Intensive
Intervention
Most Maltreated Children Have
Developmental Problems
Cognitive
Problems
Speech
Delays
Health
Problems
Motor
Delays
Mental
Problems
• 23 – 65%
• 14 – 64%
• 22 – 80%
• 4 – 47%
• 10 – 61%
3
Pyramid for Promoting Social
Emotional Competence in Infants &
Young Children
5%
15%
80%
Intensive
Intervention
Targeted Social
Emotional
Supports
High Quality
Environments
Nurturing & Responsive
Relationships
Nurturing & Responsive
The Center on the Relationships
Social and Emotional Foundations for Early Learning
4
Enriched Environments Can Improve
Development
 Early Head Start
 Accredited childcare – National Assoc.
for the Education of Young Children
Standardized Test Scores
115
110
Treated
Control
105
100
95
90
85
80
0
1
2
3
5
8
Age of children in years
5
18
Left Behind By Kindergarten:
Children living in poverty average 15 IQ points below their peers.
Vocabulary at Age 3
Poor children: 525 words
Working class: 749 words
Professional: 1,116 words
By age 4, the average child in a poor family
might have been exposed to 13 million fewer
words than child in a working class family and
30 million fewer words than a child in a
professional family.
7
Intensive
Intervention
Targeted Social
Emotional
Supports
High Quality
Environments
Nurturing & Responsive
Relationships
Targeted
Supports
• Developmental screening
• Early Intervention
• Early childhood mental
health consultants to
childcare
• Specific counseling
• Support to siblings,
biological and foster
families
8
Opportunities for Developmental
Screening for Child Welfare
1.
2.
3.
4.
Childcare Screening
CAPTA
Comprehensive Health Assessment
Comprehensive Behavioral Health
Assessment
1. Developmental screening required for
All children in subsidized childcare
10
Intensive
Intervention
Targeted Social
Emotional
Supports
High Quality
Environments
Nurturing & Responsive
Relationships
Understand Children’s Underlying
Emotional Needs in Challenging
Behaviors
Signs of Trauma in Toddlers
• Biting, kicking, tantrums,
unprovoked aggression
• Lack of verbal skills to
express emotions
• Disengagement with others
• Indiscriminate preferences
of caregivers
• Skill regression
2. Federal Mandate for Developmental
Screening of Maltreated Children
CAPTA: 108-36
2003 Child Abuse Prevention &
Treatment & Adoption Reform
Requires states to have
procedures for the
referral of children
under 3 involved in
substantiated cases of
child abuse or neglect
to early intervention
services
12
Few children in child welfare qualify for
needed Part C intervention because of the
increasingly restrictive criteria.
2 Standard Deviations below mean
in 1 area or 2 areas with 1.5 Standard Deviation delays
13
Unmet Developmental Needs Of
Children Investigated For Maltreatment
A national study found that…
• NSCAW I: 1990-2000: 35% of
children birth to 3 years need
Part C early intervention
services at time of contact
with CWS
• Only 12% had an IFSP by age
3 indicating services
Source: NSCAW I and II
14
Mental Health Needs of Children Investigated
for Maltreatment: NSCAW 1
• 26% of children birth to 2
and 32% of children 3-5 years
have emotional or behavioral
problems
• Almost 80% do not receive
timely intervention/treatment
or primary care services
• 30% of infants in care show
behavioral problems at school
entry
Source: Casanueva, C., Smith, K., Dolan, M., & Ringeisen, H. (2011). NSCAW II Baseline Report: Maltreatment.
OPRE Report #2011-27c, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families,
15
U.S. Department of Health and Human Services.
National Longitudinal Study
of the Developmental Needs of
Children Encountering Child
Welfare with a Measured Delay
– 65% of children not receiving any services
– 51% of children receiving services at home
– 38% of children in foster homes
– 22% of children in kinship care
Source: Casanueva, C., Ringeisen, H., Wilson, E., Smith, K., & Dolan, M. (2011). NSCAW II Baseline Report: Child Well-Being.
OPRE Report #2011-27b, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families,
U.S. Department of Health and Human Services.
16
Estimated Children Encountering Florida
Child Welfare System With Delay(s)
& Not Receiving Part C Services
Children 0-3 in
Florida Child Welfare,
SFY 2009-2010
National Study
Percentages of Children
with Measured Delays
Estimated No. of Florida
Children in Child Welfare
with Delay
19,247
65%
12,511
Children Not Served or Referred
to Prevention Programs*
8,476
65%
5,509
Children Served at Home
9,015
51%
4,598
Children Served Out of Home
14,680
38%
5,578
Total # Children in all Situations
51,418
Type of Child Welfare
Involvement
Investigations with “No Findings”
Total Estimated # Child Welfare
Children Served by Part C**
Estimated # of children with delays not getting Part C
28,196
2,652
25,544
Source: Radigan, Hogan & Graham, (2011). Helping the Child Welfare Population in Early Intervention:
Implications for Practice. Available at www.cpeip.fsu.edu.
17
3. American Academy of Pediatrics
Recommendations for Health Care of Young
Children in Foster Care
• Initial health screening
(within 72 hours)
• Comprehensive health
assessment (within 30 days of removal) and
must address the physical, behavioral,
dental and developmental
• Well Child Check-ups completed with EPSDT
periodicity schedule.
(1, 2, 4, 6, 9, 12, 15, 18 months; then
annually from age 2)
American Academy of Pediatrics, Committee on Early Childhood, Adoption, and Dependent
Care. (2002). Health care of young children in foster care. Pediatrics, 109(3), 536-541
18
DCF/CBC Requirements
• Initial Health Screening
(within 72 hours)
• Comprehensive Health Assessment (within 30 days of
removal) and must address the physical, behavioral,
dental and developmental
• Comprehensive Health Plan
19
4. Comprehensive Behavioral Health
Assessment 0-5
Medicaid Handbook, (page 2-2-6) The assessment must include, at a minimum, the following
information related to the child and the child’s family:
• Reason for referral;
• Personal and family history;
• Placement history, including adjustment to a new care giver and home;
• Sources of information (i.e., counselor, hospital, law enforcement);
• Interviews and interventions;
• Cognitive functioning. Screening for emotional-social development, problem solving, communication,
response of the child and family to the assessment and ability to collaborate with the assessor;
• Previous and current medications including psychotropics;
• Last physical examination, and any known medical problems including pre-natal, pregnancy and delivery
history which may affect the child’s mental health status, such as prenatal exposure, accidents, injuries, etc.;
• History of mental health treatment of parents and child’s siblings. The mother’s history, including a
depression screen;
• History of current or past alcohol or chemical dependency of parents and child;
• Legal involvement and status of child and family;
• Resources including income, entitlements, health care benefits, subsidized housing, social services, etc.;
• Emotional status – hands on interactive assessment of the infant regarding
sensory and regulatory functioning, attention, engagement, constitutional
characteristics, and organization and integration of behavior;
• Educational analysis – daycare issues concerning behavioral and developmental concerns;
• Functional analysis – presenting strengths and problems of both child and family;
Unhealed Trauma
63% of Foster Children Have
Mental Health Problems
At least one diagnosis in lifetime
National Survey for Child and Adolescent Well-Being II (NSCAW)
White, Havalchak, Jackson, O’Brien & Pecora, 2007.
21
Observations
Need for trauma based mental health interventions.
• 15 month old KH was drug exposed during pregnancy. No
recommendations in CBHA to address development nor future
assessments.
• 3.5 year old DL. Foster parent has concerns re: his nightmares/ does
not sleep at childcare/no assessment
• 2.5 year old EJ. Described in chart as “very hyper”
• 4 year-old has behavioral problems in childcare---bites and kicks,
defecates in his pants
• 2 year old CH “cries a lot”.
• 5.5 year old CP. Foster parent reports that behavior is
“problematic- doesn’t listen, doesn’t want to be told what to do.”
Untreated Adverse Early Childhood
Events Only Exacerbate Over Time
Childhood
Adolescence
Adulthood
• Developmental
Delays
• Expulsion
• Delinquency
• Mental Health
• Sexual Activity
• Drugs & Alcohol
• Violence
• Psychiatric
Problems
• Drug Abuse
• Alcohol
• Crime
Source: Adverse Childhood Experiences (ACE) Study. Available at www.cdc.gov/ace/index.htm
23
What Does Children Like Billy
Need to Thrive?
• Nurturing responsive emotionally available
caregiver
• Enriched environment with early
childhood mental health consultation to
address his trauma & needs
• Medical evaluation to address failure to
thrive, nutrition, physical issues.
• Developmental assessment with
appropriate early intervention services
• Frequent contact with mom
• IMH evaluation of parent/child
relationship and dyadic therapy to
improve repair and enhance
24
Florida Association for Infant Mental Health
12th Annual Conference
June 12, 2013 Tampa FL
Infusing Infant Mental Health into Early
Childhood Systems:
• How to Screen,
• How to Intervene &
• How to Fund IMH Services
Early Steps
Child Welfare & Baby Courts
Home Visiting
Childcare