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Addressing the Developmental Needs of Children in Child Welfare

Addressing the Developmental Needs of Children in Child Welfare. Presenters: Mimi Graham, EdD FSU Center for Prevention & Early Intervention Policy. Trajectory of Development. Healthy. At-Risk. Delayed or Disordered. Ready to Learn. Most Maltreated Children Have Developmental Problems.

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Addressing the Developmental Needs of Children in Child Welfare

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  1. Addressing the Developmental Needs of Children in Child Welfare Presenters: Mimi Graham, EdD FSU Center for Prevention & Early Intervention Policy

  2. Trajectory of Development Healthy At-Risk Delayedor Disordered Ready to Learn

  3. Most Maltreated Children Have Developmental Problems

  4. Nurturing & Responsive Relationships Pyramid for Promoting Social Emotional Competence in Infants & Young Children 5% Treatment 15% Prevention 80% Universal Promotion The Center on the Social and Emotional Foundations for Early Learning

  5. Enriched Environments Can Improve Development • Early Head Start • Accredited childcare – NationalAssoc.for the Education of Young Children

  6. 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. 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 • Childcare Screening • CAPTA • Comprehensive Health Assessment • Comprehensive Behavioral Health Assessment

  9. Developmental screening required for All children in subsidized childcare

  10. Understand Children’s Underlying Emotional Needs in Challenging Behaviors • Signs of Trauma in Toddlers • Biting, kicking, tantrums, unprovoked aggression • Lack of verbal skills toexpress emotions • Disengagement with others • Indiscriminate preferencesof caregivers • Skill regression

  11. 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 meanin 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… Source: NSCAW I and II 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

  14. Mental Health Needs of Children Investigated for Maltreatment: NSCAW 1 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, U.S. Department of Health and Human Services. • 26% of children birth to 2and 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

  15. National Longitudinal Studyof 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 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 PediatricsRecommendations for Health Care of Young Children in Foster Care • Initial health screening (within 72 hours) • Comprehensive healthassessment (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 HealthAssessment (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;

  20. 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.”

  22. Untreated Adverse Early Childhood Events Only Exacerbate Over Time 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 InfantMental Health12th 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 Childcare Home Visiting Child Welfare & Baby Courts

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