Massachusetts Early Childhood Linkage Initiative: Taking CAPTA Pilot to Scale

National Early Childhood Partners Meeting, Baltimore, MD March 14, 2008 Kate Roper, MECCS, Massachusetts DPH

Based on presentation by John A. Lippitt, Ph.D., Massachusetts DPH

From Policy to Implementation

  MECLI piloted referrals from child welfare (CW) to Part C Early Intervention (EI) 3 Pilot sites in MA, Nov. 2002 – Dec. 2004  Both CW and EI were supportive  Robust EI system able to handle referrals

The MECLI project was funded by the U.S. DHHS, ACF, Children's Bureau; The A.L. Mailman Family Foundation; The Annie E. Casey Foundation; and The Frank and Theresa Caplan Endowment for Early Childhood and Parenting Education at The Heller School for Social Policy and Management, Brandeis University.

MECLI Findings: Referrals

 540 children offered referral to EI  18% of parents refused the referral  19% of families referred did not engage with EI  40% of children were assessed

MECLI Findings: Eligibility

 74% of children assessed were eligible under MA broad eligibility criteria (161/218)  49% had an eligible delay  17% eligible due to 4 of 20 risk factors  1% eligible by established condition or judgment  6% eligibility criterion unknown

MECLI Findings: Delays

      40% language delay (84/211) 24% adaptive / self-help delay 23% gross motor delay 21% fine motor delay 20% cognitive delay 15% social-emotional delay

MECLI Findings: Risk Factors

 CW involvement 69% (145/211)  Parental chronic illness or disability 35%  Domestic violence 25%  Substance abuse 25%  Multiple traumas or losses 17%  Inadequate food, shelter, or clothing 14%  Family lacking social supports 13%

Challenges

      Establishing new policy Resources: time, money, expertise Collaboration Increased referrals Who to refer Screening vs. assessment

Challenges (cont’d)

      Appropriate assessment and services Engagement of referred families Working with families facing multiple challenges Rate of eligibility Confidentiality and information sharing Local variation

Success Factors & Strategies

     Clear policies and procedures Clear roles and responsibilities Obtain buy-in & develop shared vision Referral coordinators and collaboration facilitator Attainable goals and objectives

Success Factors & Strategies

(cont’d)

 Funding for service delivery  Training  Time for collaboration & case management  Expertise on social-emotional development & ECMH  Diversity & cultural competence

Taking it to Scale: Current Status

 Policy guidance drafted fall 2005  DSS work in process with 2 unions:  Social Worker and NAGE  Hope to roll out state-wide spring 2008  Some area offices already implementing  Training for 29 area offices will include EI staff and EI parents as presenters

Professional Development for EI and DSS workforce

 Department of Public Health   EI Interagency Coordinating Council exploring use of reliable, valid social-emotional assessment tool(s) One provider agency developed, provided, evaluated 30-hour Infant Mental Health Training in 3 sites (75 trained).

 Department of Social Services  Child Welfare Institute  MECCS:  Web-based Behavioral Health Resource

Conclusions

 CW to Part C EI referrals will identify eligible kids  Multiple implications for Part C EI systems  Build collaboration among CW, Part C EI, and the courts  Work with biological and foster families  Hard work but can be done and can improve outcomes for children and families

DPH Substance Exposed Newborns Pilot: “A Helping Hand: Mother to Mother”

 Director: John Lippitt, former MECLI Director    1 of 4 federal demonstration projects Develop model for implementation of notification of child welfare (DSS) and plan of safe care for SENs Integrates the delivery of substance use, child welfare, child development, mental health, health, and other social services

Vision and Goal

 VISION: Substance exposed newborns have the opportunity to achieve their full potential through nurturing caregiving  GOAL: Enhance identification and services for substance exposed newborns (SENs), their mothers and families

Research and Data

     Growing body of evidence that, except for alcohol, the compromised parenting of the post-natal environment has greater impact on the infant than pre-natal exposure Good data on SENs are hard to get SAMHSA: 3.5% of newborns exposed to illegal drugs MA: ~3,000 SENs per year Under-reported on electronic birth certificates and to DSS

Service Elements

 Voluntary, enhanced service thru DSS  Family Support Specialist (FSS): a peer, a mother in recovery    Services are individualized, strength-based, and family-centered, as well as gender and culturally appropriate Engage and maintain mother in substance abuse treatment Developmental assessment for infant and services if indicated

Service Elements, cont’d

 Family participation in decision making  Continuity of nurturing caregiving  Newborn: infant under 90 days old  Substance exposed newborn (SEN): any illegal use of a substance during pregnancy

Key Partners and Roles

  Identification:  Birthing hospitals and other early childhood providers   Identify best practices for SEN identification and response See

Issues and Options for Substance Exposed Newborn Identification and Response

Service delivery:   DSS: central office and area offices Early Intervention (EI): DPH & local programs   Substance abuse (SA): DPH BSAS & Institute for Health & Recovery Parent-to-parent support: Federation for Children with Special Needs

Progress to Date

    Cambridge-Somerville site:     Started in February 2007 25 SEN cases at DSS 13 offered and accepted AHH A wide range of outcomes Fitchburg-Leominster site:  Starting in February 2008 Springfield site  Start targeted for Sept.

DSS and BSAS funding $25,000 each for this year and next for FS Specialists at the 2 newer sites

Contact Information

Kate Roper,

MECCS Project Director [email protected].

ma.us

617-624-5919

John Lippitt,

A Helping Hand Project Director [email protected].

ma.us

617-624-6017 Massachusetts Department of Public Health Division of Perinatal, Early Childhood & Special Health Needs 250 Washington Street, 5 th Floor Boston, MA 01208 Massachusetts Department of Public Health Division of Perinatal, Early Childhood & Special Health Needs 250 Washington Street, 5 th Floor Boston, MA 01208