California Early Start Policy Primer: Where Do We Go From Here?

Marie Kanne Poulsen, Ph.D

Keck School of Medicine Children’s Hospital Los Angeles University of Southern California

California Families

Infants & Toddlers: Birth to Three



1,500,000 babies birth to three

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34,000 families with babies with special needs

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California Early Start

Early Intervention Services

 1986: Individuals with Disabilities Education Act

(IDEA): Part C

 1993: California Early Intervention Services Act

(CEISA): Early Start (Family) Program

California Early Intervention Services Act Early Start for Infants, Toddlers & Families

     

Family Centered Multidisciplinary Interagency Comprehensive Coordinated Statewide system

CA Government Code, 95002

Part C Federal Requirements

CA Early Start Program



D esignated lead agency



DDS w/ CDE as partner

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All Regional Centers & school districts provide intervention & educations services.

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DDS: Administration & coordination of the statewide delivery system

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CDE: Solely low incidence & maintenance of effort

Part C Federal Requirements

CA Early Start Program

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$53 million federal support, with $ 256 M from state general fund = $309,000,000

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Federal mandates, including Performance Plan and Annual Report on 10 indicators of compliance

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2014 Added Requirement of a State Systemic Improvement Plan addressing an outcome for high interest but low performance indicator

CA Early Start Federal Requirement

Definition of State Eligibility



Infants and Toddler: Birth to three years

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Significant developmental delay (33%) Established condition High risk of experiencing developmental delay or disability due to a combination of biomedical risk factors (removed 2009



restored 2015)

Part C Federal Eligibility Requirements Established Condition & Significant Delay Developmental Areas

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Cognitive Physical & Motor Communication Adaptive Social-Emotional

CA Early Start State Requirement

Eligibility: 2 Biomedical Factors

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Low birth weight Assisted ventilation Small for gestation Asphyxia Prenatal exposure Neonatal seizure CNS lesion Failure to thrive

Part C Federal Requirements

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Child Find Evaluation Individualized Family Service Plan Early Intervention Services Mediation/ Due Process State Interagency Coordinating Council

Part C Federal Requirements

Service Coordination

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assistive technology audiology family supports health services medical evaluations nursing services nutrition services occupational therapy language therapy

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physical therapy psychological services respite care service coordination social work services special instruction transportation vision services

2012 California Legislative Changes

Utilization of Private Insurance Regional Centers can access a parent’s private insurance benefits to pay for early intervention medical and health care services.

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Qualified personnel Natural environments Collaboration/coordination Deductibles and Co-pays

Part C Federal Requirements

State Performance Plan & Annual Report

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Compliance to the 10 Federal Indicators

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Timely Assessment and IFSP in 45 days

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Positive social-emotional, use of knowledge & language, adaptive self-help skills outcomes Early Start Services helped families Child find percentage of population Transition

2014 Part C Federal Requirement State Systemic Improvement Plan (SSIP)

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Increases capacity of Early Intervention Services to implement, scale up, and sustain evidence-

based practices

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2014 Part C Federal SSIP Requirement 2020 Achievable Measureable Result

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Improves outcomes for infants and toddlers and their families

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Based on State data and Stakeholder input

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Recommended by the State Systemic Improvement Plan Task Force

2014 Part C Federal Requirement State Systemic Improvement Plan (SSIP)

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Identify a significant state challenge Identify root causes for low performance Develop Theory of Action Build EI program and EI provider capacity to achieve the chosen State Identified Measureable Result by 2020

State Identified Measurable Result Social and Emotional Development

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Turns to caregivers for TLC, solace, attention & guidance

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Manages emotions & behaviors to developmentally appropriate expectations

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Has the initiative to explore, discover, learn & make friends

State Identified Measureable Result

Social and Emotional Development

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High parent priority Infant brain research Critical preschool inclusion indicator Critical resilience indicator Lowest Annual Report indicator

State Identified Measureable Result Enhance Social and Emotional Development Identified Root Causes:

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Lack of skills of professionals social-emotional development who provide Early Intervention services related to

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Lack of family-centered approaches in service delivery that address mother-child interaction & promote first relationships

State Identified Measureable Result Enhance Social and Emotional Development Identified improvement strategies:

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Sustainable professional development on infant-family mental health

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Strengthen parent-child interactions through relationship based practices

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Strengthen families through community services and supports to complement Part C

1997 White House Conference Brain Development in Young Children Insights on Early Mother-Child Nurturing Relationships

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Influence how the intricate circuitry of the brain is wired Influence extremity and frequency of stress levels of cortisol Interpersonal interaction, not sensory stimulation, as the key to healthy development

1999 White House Conference on Mental Health

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Infants as young as one month can sense when their parents are angry, anxious or depressed

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Babies as young as 3-4 months can experience symptoms of depression when separated from their mothers

Roots of Social-Emotional Development Responsive Meaningful Caregiving

Poulsen/ USC UCEDD

Relationship: Centrality of Social-Emotional Development

Maternal Emotional Availability

Relation -ship

Infant Emotional Availability

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“The emotional well-being of young children is directly tied to the emotional functioning of their care givers and the families in which they live.’

-- Center on the Developing Child (2008) Harvard University

Poulsen/ USC UCEDD

Mothers of Babies with Delays, Disabilities and Biomedical Risks

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May be first time moms May be experiencing anxiety or depression May be experiencing birth-related posttraumatic stress disorder May be alone May be worried about family circumstance

Poulsen/ USC UCEDD

California’s Challenging

Family Circumstances

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24% live below federal poverty level 46% babies live in low income families 32% live in single parent families 45% babies born to foreign-born mothers 10-15% on new mothers experience postpartum depression

Caregiving as Modifier of the Brain

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Babies of mothers w/ postpartum depression Infants withdrawn & less active

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Infants with shorter attention Elevated heart rates and cortisol levels 75% with less frontal brain activity Greatest risk between 6 and 18 months Brain activity normalizes when mother has treatment

California’s Challenging

Family Circumstances

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19% of mothers did not finish high school 12% live in families with parents who are unemployed 23% of babies experience high mobility 65% of babies have at least one risk factor known to increase the chance of poor health, school & developmental outcome

Early Childhood Summit 2010 Impact of ACE on Child-Well Being!

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Infants and young children absorb stresses within their families, increasing cortisol level & reactivity.

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Adverse childhood experiences can effect the architecture of the brain, the ways of responding to the world, and long term health and mental health.

Social-Emotional Development Outcomes Cumulative Risk

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The notion of CUMULATIVE RISK asserts that the greater the number of adverse child experiences, the greater is the risk for negative developmental, mental health and health outcomes.

Policy Voices from the Field

Social-Emotional Development



Financially support a community comprehensive

system of care*

for children and their families that

promotes protective factors

and

responds to

biological, psychosocial & environmental

risks

to child well-being --- Strengthening Families, MCHB Center for the Study of Social Policy

Key System of Care Partner

Early Start Family Resource Centers 47 Centers: Primarily parent driven & parent run

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Parent to parent support

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Many languages / Culturally responsive Resource libraries, Information & Referral System navigation Transition assistance to families (2011) Prevention Resource & Referral Services CEISA: 1998 Amendment

Policy Voices from the Field

Social-Emotional Development

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“Expertise in the identification, assessment and treatment of young children with mental health problems should be incorporated into early intervention programs.” --- National Scientific Council on the Developing Child

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“Require a professional with expertise in social – emotional development to sit on the {Part C} multidisciplinary evaluation team.” --- National Center for Children in Poverty

Policy Voices from the Field

Social-Emotional Development

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“Establish comprehensive screening protocols for social-emotional, developmental, autism and maternal depression as part of well child visits.” Provide written guidelines to establish common procedures for screening for all Medi-Cal Managed Care well-visits. Adopt quality measures to ensure statewide consistency -- First 5 Association of California

Early Childhood Mental Health Project

Policy Voices from the Field

Social-Emotional Development

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Ensure greater reimbursement for maternal depression & early childhood mental health screening.

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Develop a state level policy proposal that requires statewide collaboration & coordination to increase utilization of existing reimbursement mechanisms.

--- First 5 Association of California Early Childhood Mental Health Project

Policy Voices from the Field

Social-Emotional Development



“Promote universal adoption of

CA Training Guidelines and Personnel Competencies for Infant-Family and Early Childhood Mental Health

by state and local agencies and institutes of higher education.” --- First 5 Association of California Early Childhood Mental Health Project

Policy Voices from the Field

Social-Emotional Development

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“Promote state-level coordination and collaboration to develop a statewide system for training early childhood professionals from multidisciplinary backgrounds to attain the Infant-Family and Early Childhood Mental Health Competencies.” --- First 5 Association of California Early Childhood Mental Health Project

Social-Emotional Development Enhancing Part C through Policy

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Community supports to strengthen families Establish screening protocols and funding through medi-cal as part of primary health care visits Require infant-family mental health specialist as member of Part C multidisciplinary team Develop a statewide system for training early childhood providers from multidisciplinary back grounds to attain infant-family mental health assessment and intervention competencies.

State Identified Measureable Result Social-Emotional Well-Being Relationships: Getting Leads to Giving and Resilience !

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