Implementing Part C Provisions Required Under CAPTA and IDEA

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• Implementing Part C Provisions Required Under
  CAPTA and IDEA

Steven Rosenberg, Ph.D. Cordelia Robinson, Ph.D.,
RN University of Colorado at Denver and Health
Sciences Center
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Child Welfare and Part C
In the past three years the Child Abuse
Prevention and Treatment Act (CAPTA), and the
Individuals with Disabilities Education Act
(IDEA) have been amended to require state child
welfare and Part C early intervention systems to
establish procedures for the referral of
maltreated and drug exposed infants and toddlers
to Part C early intervention services.
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Child Welfare and Part C
The report language that accompanied the final
IDEA conference bill indicated that every child
described in Sec. 637(a)(6)(A) and (B) should be
screened by a Part C provider or designated
primary referral source to determine whether a
referral for an evaluation for Part C early
intervention services is warranted. IDEA does not
require every child to receive full evaluations
or be enrolled in Part C early intervention
services.
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Child Welfare and Part C

• How common are developmental problems in young
  maltreated children?

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Young Children Are at Greater Risk of Maltreatment

• Children ages birth to 3 years had the highest
  rates of victimization at 16.0 per 1,000 children
  
• (U.S. Department Health and Human Services, 2004)

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Proportion of Children in Out-of-Home Placements

• Although we often think of children who
  receive child welfare services as those children
  who live in foster care 85 of all victimized
  children are not removed from their homes.
• From Child Maltreatment 2003 (ACYF, 2005)

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Children in the Child Welfare System Have High
Rates of Disability

• Studies indicate high rates of developmental
  problems among maltreated children.
• Findings limited by sampling
• Often clinical samples of children in foster care
• Often do not include very young children
• No nationally representative samples

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A Representative Sample is Needed

• The National Survey of Child and Adolescent
  Welfare (NSCAW) provides developmental
  assessments of a nationally representative sample
  of very young maltreated children.

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NSCAW Developmental Measures

• Cognitive Abilities
• Battelle Developmental Inventory Cognitive
  Scale
• Developmental Delay Communication
• Preschool Language Scale-3 - Total Communication
  Score
• Daily Living Skills
• Vineland Screener Daily Living Skills

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Rate of Developmental Delays Narrow Eligibility
Criteria

• Children scoring below 1.5 sd on two measures
  or below 2 sd on one measure

Summary of NSCAW Assessments Estimated Population Size Percent of Total 95 Confidence Interval 95 Confidence Interval
Summary of NSCAW Assessments Estimated Population Size Percent of Total Lower Upper
No Delay 109,920 70.4 64.5 75.7
Delay 46,178 29.6 24.3 35.5
Number of cases surveyed 1138 Estimated number
of victimized children under 3 156,000
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Rate of Developmental Delays Moderate
Eligibility Criteria

• Children scoring below 1 sd on two measures or
  below 1.5 sd on one measure

Summary of NSCAW Assessments Estimated Population Size Percent of Total 95 Confidence Interval 95 Confidence Interval
Summary of NSCAW Assessments Estimated Population Size Percent of Total Lower Upper
No Delay 83,435 53.5 46.2 60.5
Delay 72,664 46.5 39.5 53.8
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Summary

• Substantial numbers of young children who are
  maltreated have developmental delays that make
  them likely to be eligible for Part C services

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CAPTAs Possible Impact on Part C Enrollment

• Part C serves about 2 percent of the population
  under three years of age (227,000).
• About 1 percent of all children, under three
  years of age, are substantiated as victims of
  abuse or neglect (125,000).
• Based on counts for the year 2000

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CAPTAs Possible Impact on Part C Enrollment
Narrow Eligibility Criteria

• If we assume that 30 percent of maltreated
  children are Part C eligible
• That 25 percent of these children are already
  enrolled in Part C, refuse services or cannot be
  contacted
• We estimate an increase in Part C enrollment of
  about 12 percent.

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CAPTAs Possible Impact on Part C Enrollment
Moderate Eligibility Criteria

• If we assume that 47 percent of maltreated
  children are Part C eligible
• That 25 percent of these children are already
  enrolled in Part C, refuse services or cannot be
  contacted
• We estimate an increase in Part C enrollment of
  about 19 percent.

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Question

• Can Child Protection caseworkers accurately
  identify young children with developmental
  delays?

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Agreement Between Caseworker Identification and
Developmental Assessments

Child need for developmental or behavioral
services
Assessed Delay Worker Identification Percent of Total 95 Confidence Interval 95 Confidence Interval
Assessed Delay Worker Identification Percent of Total Upper Lower
Delayed -Narrow Identified 25.8 18.8 34.3
Delayed -Narrow Not Identified 74.2 65.7 81.2
No Delay Identified 14.8 11.1 19.5
No Delay Not Identified 85.2 80.5 88.9
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Summary

• Based upon NSCAW findings child protection
  caseworkers are unable to identify most children
  who need developmental services

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Summary

• In many communities the Part C systems capacity
  to serve a large influx of children and families
  from child welfare could be limited by
• Insufficient service capacity
• Difficulty in coordinating funding
• Lack of staff prepared to work with children, who
  are maltreated, and their families

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Implementation of CAPTA AND IDEA

• Systems will need to coordinate regarding
• Compatibility of Policies and Procedures
• Coordination of Funding Streams
• Workforce Capacity
• Workforce Skill Sets

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Essential Participants

• Part C
• Social services, Child Protective Services
• Health care systems
• Representatives of the courts, Guardians ad
  litem, CASA volunteers

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Implementation of CAPTA AND IDEA

• Processes that need to be addressed
• Referrals
• Screening
• Evaluation
• Services and supports
• Coordination of funding

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Questions about Child Characteristics

1. What is Part C definition in the state?
2. What percent of the 0-3 population is being
   served?
3. Is there much local variability in who is served?

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Questions about Child Characteristics

1. Is the Part C population representative of the
   state?
2. What are the characteristics of the CPS
   population in the state?
3. What proportion of birth to three are in out of
   home placement? Kinship care?

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Implementation will Require Interagency
Collaboration

• Shared meaning and understanding among systems
• Investment at all levels State and local
  supervising and direct care
• Processes to facilitate referrals
• Responsiveness across systems

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Implementation will Require Coordination of
Funding Steams

• What role does Medicaid play in funding Part C
  screening and evaluations in your state?
• How is behavioral health care accessed by young
  children?
• What role does Medicaid play for children in
  child protection

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Implementation will Require Adequate Workforce
Capacity

• Staff are needed to
• Implement screening
• Implement evaluations
• Provide services
• Coordinate service plans

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Implementation will Require Different Skills Sets

• Staff will need to be able to
• Engage families
• Provide instruction on basic care nutrition,
  sleep, consistency in routines
• Address social-emotional development and
  challenging behaviors
• Provide direct instruction to caregivers

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Implementation will Require Coordination with
Primary Health Care

• Determine state requirements regarding children
  being seen by a physician
• What role does/could primary care play in
  screening and evaluation?
• May have good rapport with family
• Need to authorize care

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Experience from the Field

• New Mexico
• Andy Gomm, Program Manager
• Long Term Services Division, State Department of
  Health
• Delaware
• JoEllen Kimmey, Division of Family Services
  Liaison
• and Family Services Coordinator
• Georgia
• Stephanie Moss, Part C Coordinator
• Office of Children with Special Needs, Babies
  Can't Wait Program
• Division of Public Health, Family Health Branch

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This work has been supported by grants from the
U.S. Department of Education, OSEP,
H324T99026 Maternal and Child Health Bureau
6T73MC00011-05 Administration for Developmental
Disabilities 99DD0561