Early Intervention in Child Welfare
Early intervention can both prevent and mitigate long-term harm.
Forty-one percent of the total foster care population is comprised of children and babies who are five years old and younger.1 Many of the babies that come into foster care are prenatally exposed to substances, are born underweight and have developmental delays. In fact, developmental delays occur at rates that are four to five times greater than that of children not involved in the child welfare system.2
The Adverse Childhood Experience (ACE) study found that adverse childhood experiences have a profound negative impact on adult health and are a prime determinant3 of poor adult health status in the United States.4 There is great need for early intervention and early childhood education services among young children in foster care or at risk for child welfare involvement as a result of their developmental, emotional and behavioral problems.
Fortunately, federal policy exists that require states to develop procedures for referral of a child under age three who is involved in a substantiated case of child abuse or neglect.5
Services that are available for eligible children include:6
- Family training, counseling and home visits
- Nursing, health, and nutrition services
- Service coordination
- Medical services for diagnostic or evaluation purposes
- Occupational and physical therapy
- Psychological and social work services
- Vision, orientation, and mobility services
- Speech-language pathology services
- Transportation services
- Age-appropriate special education services
Programs such as Early Head Start, that serve infants and toddlers under the age of three, provide intensive comprehensive child development and family support services to low-income infants and toddlers and their families. Babies in foster care are categorically eligible for Early Head Start regardless of their income level. In 2016, Head Start programs served 17,672 children in their programs which children in foster care, ages three to five are also categorically eligible.8
Other resources available for young children in need of early intervention services include early childhood mental health consultants who work with caregivers to reduce behavioral problems, helping young children prepare to enter preschool and kindergarten. Infant mental health specialists help provide intensive intervention for infants, babies and toddlers who are struggling with infant depression, attachment with a caregiver, inability to self-regulate and lacking motivation or interest in exploring their environment. There are also a number of infant mental health treatment/intervention models that are evidenced-based.
While it is important for many young children to receive early intervention services, placing a very young child in a low- or poor-quality child-care situation may cause further harm to a child already suffering from developmental or mental health issues. Things to be aware of are the quality of teacher training, teacher-to-child ratio, and rate of staff turnover, as it is important for young children to have consistent adults in their lives. One study actually found that experiencing multiple types of early care and education is a risk factor for foster placement.9
A national study found that 32% of children age 0-5 needed early intervention, yet only 13% had a service plan indicating services.
- Ensure that infants, babies and toddlers are assessed and enrolled in the Medical Assistance Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program and receive comprehensive evaluations.
- Include parents and caregivers in treatment for the young child. Multi-generational approaches to treatment have been found to be the most promising in preventing and treating mental health problems in young children.
- Encourage families to enroll babies and young children in quality child care settings and/or Early Head Start and Head Start programs. While there may not always be an Early Head Start or Head Start program in proximity to the child’s home, there are safeguards that can be put in place to make sure the child is attending a quality program.
- Ensure that caregivers of young children have information on the child’s medical and developmental needs and have received training and support to be effective providers.
- Advocate for children with disabilities ages three to five and make sure they have been referred and evaluated, and receiving appropriate preschool early intervention programs under the Individual with Disabilities Education Act (IDEA).
- Identify community partners who can help identify and provide appropriate services to the child and their families. Educate others who work with the family about the developmental risks to the child when they don’t have stable placements, consistent environments and the same caseworker over the course of the case.
- Learn about infant mental health concerns and programs and supports for helping babies and their caregivers with these issues.
- Support and promote nurturing and stable relationships in the child’s life. Babies and young children thrive when they have secure attachments with their primary caregivers. Help support these relationships by helping the caregiver with things they need so they can be ready and able to focus on the baby.
- Talk to families about their important role in early childhood and brain development including the need for early interventions.
Kids in Transition to School (KITS)
Oregon
Kids in Transition to School – or KITS – is an evidence-based school readiness program developed at the Oregon Social Learning Center. It is a short-term, intensive intervention designed to enhance psychosocial and academic school readiness in children at high risk for school difficulties. The program provides a boost to children’s literacy, self-regulation, and social skills just prior to kindergarten via a system of positive teaching and behavior change strategies. The program focuses on both children and their families.
A randomized control trial of the Kids in Transition to School (KITS) showed that children in foster care participating in this pre-kindergarten program were reported to show considerably less aggressive or oppositional classroom behavior than a comparison group.
To learn more: http://www.kidsintransitiontoschool.org/about-us/
211 Quality Child Care Organization, Quality Checklists 12
This resource from the Office of Child Development provides checklists to assist in identifying quality child care. Checklists include: Infant Toddler Check List, Preschool Check List, School Age Check List and Health and Safety Check List for Homes with Young Children
CAPTA requires states to develop policies and procedures for referral of a child under age thee who is involved in a substantiated case of abuse or neglect to Part C services under IDEA. This resource provides updates to existing policies and new recommendations for services.
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program 14
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.
Head Start and Early Head Start 15
This resource provides information on the application process for enrolling a child in a Head Start or Early Head Start program. Of note is the qualification: Children in foster care, homeless children, and children from families receiving public assistance (Temporary Assistance for Needy Families or Supplemental Security Income) are categorically eligible for Head Start and Early Head Start services regardless of income.
Individuals with Disabilities Education Act (IDEA), Part B and C 16
This is the go-to site for information on the rights of young children with disabilities through Part C services (0-3) and Part B services (3-5). In addition to many resources, information about local and state programs that are available to provide services, can be found on this site.
Sample evidenced-based infant mental health treatment/intervention models
Attachment and Behavioral Catch-Up 18
Attachment and Biobehavioral Catch-up (ABC) is a parent-training intervention aimed primarily at children between 6 and 24 months of age and their caregivers. ABC targets young children who have experienced early adversity, such as maltreatment or disruptions in care, and addresses several issues that have been identified as problematic among children who have experienced early adversity, including behaving in ways that push caregivers away and behavioral and biological dysregulation.
The Circle of Security Network provides attachment based consultation, outpatient therapy, in home therapy for parents and caregivers of children from birth through adolescence who have experienced significant challenges or disruptions to their relationships and/or attachment bonds with their parents or other caregivers.
Parent-Child Interaction Therapy (PCIT) 20
PCIT is an evidence-based treatment for young children with emotional and behavioral disorders that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. Children and their caregivers are seen together in PCIT. Most of the session time is spent coaching caregivers in the application of specific therapy skills.
Triple P (Positive Parenting Program) 21
Triple P gives parents simple and practical strategies to help them build strong, healthy relationships, confidently manage their children’s behavior and prevent problems developing.
- Source: https://www.acf.hhs.gov/opre/resource/nscaw-ii-wave-3-report-wave-3-tables
- Ibid.
- See Issue Brief “Impacts of trauma on development”
- Source: www.cdc.gov/ace/index.htm
- See the Child Abuse and Prevention Treatment Act (CAPTA) and Part C under the Individuals with Disabilities Education Act (IDEA).
- See Issue Brief “Assessing the needs of young children impacted by abuse and neglect” to learn more on qualifying for services
- https://eclkc.ohs.acf.hhs.gov/policy/head-start-act/sec-642b-head-start-collaboration-state-early-education-care
- https://www.nhsa.org/files/resources/2016_head_start_foster_care_fact_sheet.pdf
- Klein, S., Fires, L., & Emmons, M.M. (September 2017). Early Care and Education Arrangements and Young Children’s Risk of Foster Placement: Findings from a National Child Welfare Sample. Children and Youth Services Review.
- See Issue Brief “Assessing the needs of young children impacted by abuse and neglect.”
- http://www.kidsintransitiontoschool.org/about-us/
- http://www.211childcare.org/parents/quality-checklists/
- http://ectacenter.org/topics/earlyid/capta.asp
- https://www.medicaid.gov/medicaid/benefits/epsdt/index.html
- https://www.benefits.gov/benefits/benefit-details/616
- https://www2.ed.gov/about/inits/ed/earlylearning/early-intervention-specialed-30th.html
- https://www.zerotothree.org/
- https://nrepp.samhsa.gov/ProgramProfile.aspx?id=68
- https://www.circleofsecurityinternational.com/
- http://www.pcit.org/
- http://www.triplep.net/glo-en/home/