Laying the Groundwork in Policy and Practice: The Massachusetts Early Childhood Linkage Initiative

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Laying the Groundwork in Policy and Practice The
Massachusetts Early Childhood Linkage Initiative 

• Children and Family Futures
• February 1, 2007
• Institute for Health and Recovery
• The Heller School, Brandeis University

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Laying the Groundwork in Policy and Practice

• Science-based policy for young children
• Effective implementation
• Collaboration
• Evidence-based practice
• Appropriate resources funding, expertise

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Who We Are

• Katharine Thomas, Assistant Director, Institute
  for Health and Recovery (IHR), since
  20062001-2006, Policy Director, Part C Early
  Intervention, MA DPH1991-2001, Systems Developer
  at IHR
• John Lippitt, Ph.D, Project Director,
  Identification and Treatment of Infants and
  Families (MA DPH), since 20062003-2006 , Senior
  Research Associate, Heller School for Social
  Policy and Management, Brandeis University,
  Waltham, MA

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Institute for Health and Recovery

• State resource for development of family focused
  substance abuse services
• History of systems work with providers,
  communities, state agencies
• Outside agency ability to transcend perceived
  turf issues
• Inside agency partner with state agencies as
  arm for specialized services

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Institute for Health and Recovery Core
Principles

• Establish collaborative models of service
  delivery
• Integrate gender-specific, trauma-informed, and
  relational/cultural models
• Foster family-centered, strengths-based
  approaches support resiliency
• Advance multicultural competency within service
  delivery

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Institute for Health and Recovery

• 1989 Federal grant integrate parenting support
  and skill-building into womens residential
  substance abuse treatment
• 1990 Contract state Bureau of Substance Abuse
  Services to build capacity in womens SA
  treatment system
• 1994 Manage central access to Family Residential
  Programs

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Institute for Health and Recovery

• Tobacco addiction education/policy
• WELL Project Integrate substance abuse, mental
  health, and trauma services for women and their
  children
• WELL Child Curriculum developed to build
  resilience in children of substance abusers

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Massachusetts Department of Public Health

• .To promote healthy people, healthy families,
  healthy communities and healthy environments
  through compassionate care, education and
  prevention.
• Lead Agency in MA for Part C Early Intervention
  Services

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Early Intervention (EI) in Massachusetts

• MA Department of Public Health (MDPH)
• Bureau of Family and Community Health
• Division for Perinatal, Early Childhood and
  Special Health Needs (DPECSHN)

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EI Program History in MA

• Early 70s EI system in clinical settings,
  DMH/DMR
• 1983 MGL 111G
• 1985 EI Medicaid reimbursement begins
• 1986 Individuals with Disabilities Education
  Act, reauthorized in 1997
• 1990 Legislation mandating private insurance
  coverage of EI

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EI Program History in MA(continued)

• 2001 Insurance legislation revised to include
  reimbursement for developmental specialists (aka
  early childhood educators)
• 2004 Annual insurance cap increased from
  3200-5200
• 2004 IDEA re-authorized, adds language regarding
  specific populations

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MA General Law (MGL) Chapter 111G, 1983

• Named DPH as Lead Agency
• Ensured universal access to EI
• Specified inclusion of staff of different
  disciplines
• Provided EI option to children with established,
  environmental, and biological risk

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EI In Massachusetts 3 Broad Categories

• Established Condition / Diagnosis
• Developmental Delay (25 in one domain)
• At Risk (optional category for states) 4 of 20
  risk factors, including CW case, SA, DV,
  homeless, lacking social supports
• MA serves highest percentage of birth to
  three-year-olds nationally

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Child Well-Being and Development
From Neurons to Neighborhoods Published in
2000 National Research Council / Institute of
Medicine Jack Shonkoff Deborah Phillips
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Child Well-Being and Development

• TOXIC STRESS in early childhood
• Strong, frequent or prolonged activation of
  bodys stress management system
• Impacts brain architecture particularly in the
  absence of nurturing parent or caregiver
• Distinguished from
• Positive stress moderate, short-lived normal
  part of life essential to healthy development
• Tolerable stress significant but infrequent
  nurturing parent or caregiver helps child feel
  safe calms stress response

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Child Well-Being and Development

• Neurons to Neighborhoods Recommendation
• require that all children who are referred to a
  protective services agency for evaluation of
  suspected abuse or neglect be automatically
  referred for a developmental-behavioral screening
  under Part C of the Individuals with Disabilities
  Education Act.

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Child Well-Being and Development

• Child safety, health, and all the developmental
  domains are inextricably intertwined
• Nurturing relationship with parents or other key
  caregivers is essential to safety and development
• Child maltreatment and parental SA put both
  safety and development at high risk

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Young Children at Risk

• Lack of resources, substance abuse, mental
  health, family violence, and increased family
  stress impact child development
• Physical (motor challenges, unsafe spaces)
• Social-emotional ( insecure attachment, behavior,
  low self-esteem)
• Cognitive (lack of appropriate stimulation,
  fears/worries may affect ability to focus)
• Communication (limited or inappropriate language
  stimulation/interaction)
• Adaptive (inability to develop needed
  independence and skills for self-care)

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Massachusetts Early Childhood Linkage Initiative
(MECLI)

MA DSS
MA DPH


MECLI
LOCAL EI Programs
HELLER SCHOOL Brandeis University

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MECLI Overview

• Goal Refer all young children under three years
  of age involved with a newly substantiated case
  of child abuse or neglect to 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.
  Department of Health and Human Services,
  Administration for Children and Families,
  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. We thank these organizations for
  their support but acknowledge that the findings
  and conclusions presented in this report are
  those of the author(s) alone and do not
  necessarily reflect the opinions of these
  organizations.

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MECLI Goals

• Support referrals through local collaborations
  (EI Programs and DSS Area Offices)
• Anticipate CAPTA/IDEA requirements to refer
  children from CW to EI services
• Collect data on offering of referral at CW and
  engagement in EI

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MECLI Goals (continued)

• Collect data on EI eligibility and services
• Enhance understanding of impact of
  bio-psycho-social factors on young childrens
  development
• Identify strategies to engage and serve
  children/families

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MECLI Results

• 540 children offered referral to EI
• 18 of parents refused the referral (99)
• 19 of families referred did not engage with
  EI (103)
• 40 of children were assessed (218)

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MECLI Results (continued)

• 74 of children assessed were eligible (161/218)
  under MA broad eligibility criteria
• 49 had an eligible delay (107/218)
• 17 eligible due to 4 of 20 risk factors (37/218)
• 1 eligible by established condition or clinical
  judgment
• 6 eligibility criterion unknown

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CAPTA, June 2003 New Language Highlights

• The Keeping Children and Families Safe Act
  reauthorizes CAPTA, requires states to
  establish
• provisions and procedures for referral of a
  child under the age of 3 who is involved in a
  substantiated case of child abuse or neglect to
  early intervention services funded under Part C
  of the Individuals with Disabilities Education
  Act
• AND

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CAPTA, June 2003 New Language Highlights

• policies and procedures to address the needs
  of infants born and identified as being affected
  by illegal substance abuse or withdrawal symptoms
  resulting from prenatal drug exposure, including
  a requirement that health care providers involved
  in the delivery or care of such infants notify
  the child protective services system and the
  development of a plan of safe care for the infant

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IDEA, December 2004 New Language Highlights

• a description of the State policies and
  procedures that require the referral for early
  intervention under this part of a child under the
  age of 3 who
• (A) is involved in a substantiated case of
  abuse or neglect or
• (B) is identified as affected by illegal
  substance abuse, or withdrawal symptoms resulting
  from prenatal drug exposure
• ..premature infants, or infants with other
  physical risk factors associated with learning or
  developmental complications.
• underserved groups, including minority,
  low-income, homeless, and rural families and
  children with disabilities who are wards of the
  State

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ACF-Funded Projects 2005

• Model Development or Replication to Implement the
  CAPTA Requirement to Identify and Serve Substance
  Exposed Newborns (CFDA 93.551)
• Denver Department of Human Services, Denver, CO
• University of Oregon, Office of Research Services
  and Administration, Eugene, OR
• Saint Vincent Mercy Medical Center, Toledo, OH
• Department of Public Health, Boston, MA

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Substance Exposed Newborns

• A combination of bio-medical and environmental
  conditions
• Demonstration project builds on MECLI
• Uses 2 of 3 pilot sites
• Builds on inter-agency relationships
• Adds SA and other services to MECLI collaboration

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Substance Exposed Newborns (continued)

• Identification and Treatment for substance
  exposed Infants and their Families (ITIF)
• A Helping Hand Mother to Mother
• The Family Support Specialist a peer mentor,
  support, advocate
• Enhanced care coordination at CW
• Use one-time grant funding to do pilot to work
  toward full implementation

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Systems Change

• Begin by Identifying
• Barriers/Gaps
• Common values
• Common goals based on values
• Key resources system wide
• Stakeholders
• Key resources

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Conclusions

• CW and SA treatment need to build linkages with
  developmental services
• Family-centered and strengths-based to engage and
  motivate parents AND keep families together
• Build collaborations for comprehensive,
  coordinated services

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Conclusions (continued)

• Part C Early Intervention for children from birth
  to 3rd birthday
• Part C EI needs resources funding and enhanced
  expertise
• Part C systems roles and eligibility criteria
  vary by state
• Part C eligibility should address key
  environmental conditions

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Conclusions (continued)

• Some environmental conditions present similar
  likelihood of developmental problems as
  bio-medical conditions
• Child abuse or neglect
• Parental substance abuse
• Parental mental health problems, especially
  maternal depression
• Intimate partner violence

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Conclusions (continued)

• WE MUST ADDRESS
• Turf issues
• Differing systems characteristics, including
  eligibility and policies
• Resources
• Together we CAN do a better job of supporting
  child well-being including safety and healthy
  development, which are key to good family
  outcomes

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Institute for Health and Recovery (IHR)

•  
• Katharine Thomas
• 349 Broadway
• Cambridge, MA 02139
• Ph 617.661.3991 Fax [phone]
• Email katharinethomas_at_healthrecovery.org
• www.healthrecovery.org

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Massachusetts Department of Public Health

•  
• John Lippitt
• 250 Washington Street, 5th Floor
• Boston, MA 02108
• Ph 617.624.6017 Fax [phone]
• Email John.Lippitt_at_state.ma.us
• www.mass.gov/dph/fch