Judith Silver, Ph.D. Director, Child Welfare Early Childhood Initiative &

1. Starting Young Applying the Science of Early Childhood to Well-being & Permanency Judith Silver, Ph.D. Director, Child Welfare Early Childhood Initiative & The Starting Young Program The Children’s Hospital of Philadelphia

2. 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

3. 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

4. Distinctive Issues for Infants & Toddlers • Most Rapid Period of Brain & CNS Development • Multi-Disciplinary approach essential • Intertwined, Interdependent: • Mental Health • Physical Health & Growth • Development

5. Health & Development ofChildren & Teens in Foster CareHigher rates of: • Acute Illnesses • Chronic Medical Conditions • Developmental Delays • Dental Decay • Vision Problems • Emotional/Behavioral Problems

6. Limited Access to Health CareDuring Foster Placement • Most children need MORE than routine health care (specialists) • Many do not receive routine health care • Many are underimmunized • Missing medical records

7. Starting Young Program • Ages 4 to 33 months • Open DHS cases • Interdisciplinary Pediatric Developmental Evaluations

8. Services Needed: • Primary Health Care 70% • Early Intervention (DD) 47% • Allied Health Specialists 45% • Medical Specialists 26%

9. Did They Receive Needed Services? • Early Intervention 64% • Medical Specialists 64% • Hearing Test 26% • HIV Screening 25%

10. 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

11. 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

12. 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?

13. 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

14. 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?

15. Has parental consent been obtained? For all needed: • Medical Records • Assessments • Recommended Non-Routine Treatments

16. The End