Why is Early Identification and Intervention Important for Child Welfare?
Infants begin learning from the moment they are born and undergo significant brain changes in their early years of life. The importance of their relationship with their caretaker is considerable. There is no substitute for nurturance and responsiveness. Early relationships shape a young child's social, emotional, cognitive and language development. When the caretaker relationship is compromised by absence or inconsistency, abuse or maltreatment, the effect can be devastating. Left without intervention, the impact can be life altering. These early years set the stage. They hold the greatest danger for long-term damage and fortunately, the greatest potential for successful intervention.
Our youngest children are at highest risk. More than 40 percent (42.2%) of all fatalities were children younger than 1 year. In 2007, the rate of maltreated children under age one was nearly 12 percent. This was the highest rate for any age. Twenty-five percent of the children were under the age of 3. According to the National Survey of Child and Adolescent Well-Being, 85 percent of maltreated children under three have a moderate to high risk for developmental delays. Recent research indicates that children who are under 3 years of age in child welfare who have been maltreated are at a substantially risk for experiencing developmental problems. Nearly half of all infants and toddlers have a low score on a developmental measure. Not surprisingly, this higher risk of delay does not differ from children who are associated with an allegation determined to be substantiated or not. The multitude of risk factors which bring children to the attention of child welfare such as: poverty, domestic violence, substance abuse, caretaker age, mental health status, parenting skill, etc. also place children at risk for delays. These delays can impact school readiness, relationships, and emotional health which can effect family or placement stability, reunification and overall outcomes for the child.
History of child welfare and CAPTA.
In 1986 the federal education disability law (P.L.-99-457) was enacted. Now called the Individuals with Disabilities Act (IDEA) Part C, provides financial assistance to states to provide early intervention services for infants and toddlers with disabilities. Although not required to, California (along with all states) participates. Part C has been reauthorized many times. In 1997 it was amended to encourage states to increase opportunities for children under 3 who are at risk of delays if they do not receive the early intervention services. This change provided for improved collaboration and service expansion targeting children at high risk. In 2004 it was amended again to, among other things, be consistent with the Child Abuse Prevention and Treatment Act (CAPTA) enacted in 2003. These changes were intended to broaden the referral sources and highlighted officials and staff in the child welfare system. One of the many requirements for states to receive funding under Part C is to submit policies and procedures consistent with federal regulations. Child welfare is also required to have membership on the state interagency coordinating councils and have a description of protocols and procedures requiring the referral to early intervention services of a child under the age of 3 who is:
- Involved in a substantiated case of child abuse of neglect; or
- Is identified as affected by illegal substance abuse, or withdrawal symptoms resulting from parental drug exposure.
How is California's Child Welfare Community Responding?
Since 2006, the California Department of Social Services has required counties to ensure policies and procedures are in place to refer children, birth to three, to early intervention services using multiple strategies. Counties are encouraged to identify these children by screening for delays using reliable screening tool and a validated tool is highly recommended.
Child Welfare has recognized that early identification and intervention is critical giving children involved with child welfare better outcomes. Child welfare is challenged in a number of ways to serve these vulnerable children and meet the CAPTA requirements. Child welfare needs to be able to identify the children at risk, to partner with agencies who fully understand the complexities of the children and families they serve; and engage families in a meaningful and consistent manner to ensure service provision.
Social workers responding to referrals of maltreatment and foster parents caring for very young children are uniquely positioned to identify delays and engage parents about age-appropriate development. Infants and toddlers who are identified for protection are at a critical period. These early years are significant in determining a child's physical, cognitive and emotional growth. Child welfare may be the first contact with the opportunity to influence an assessment of a child's development. They in turn can guide families to their primary care providers, early intervention service or provide resources for parents to better support the delays of early childhood.
Screening tools to assess delays involve caretaker assessments and can be used as a resource to engage parents and educate them on age-appropriate milestones and care.
Developmental Screening?
Developmental screening is the standard to assess children for delays. Using a validated, reliable screening tool can identify a child whose development (physical or emotional) needs further assessment. The American Academy of Pediatrics recommends that all children receive health exams which include a developmental and mental health screening. The California Department of Health Care Services, in December 2009, issued a revised section of the Developmental Guidelines Section of the CHDP Health Assessment Guidelines (HAGs), entitled “Developmental and Socio-Emotional/Behavioral Surveillance, Screening and Anticipatory Guidance.” The revision requires CHDP providers to adhere to the AAP recommendations for developmental screening.
Developmental screening tools are a set of simple, quickly administered questions or activities that will evaluate a child's development and whether further evaluation by a medical professional is needed. Using a standardized developmental screening tool can identify 70 to 80 percent of developmental or behavioral delays. In California, a statewide Screening Collaborative website can be found at https://www.ceitan-earlystart.org/collaborations/statewide-screening-collaborative/. The website provides basic information regarding screening and offers California agencies a discount for tools that meet the recommended validation and reliability thresholds. http://www.dhcs.ca.gov/services/chdp/Pages/Pub156.aspx.
Finding developmental delays early is the main benefit of screening. Screening is also a process that allows social workers and agencies staff to collaborate with parents to monitor and discuss all domains of a child's development.