Please use the chart paper to share your thoughts on the following question:

1
Please use the chart paper to share your thoughts
on the following question
Consider your work with families experiencing
abuse and neglect--- what challenges do you
encounter?
2

Meeting the Requirements of CAPTA and
IDEAImplications for Part C Early Intervention

• Marian Jarrett, Ed.D.
• Karin Spencer, MA
• George Washington University

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Session Agenda

• Requirements of CAPTA and IDEA
• Challenges for Early Intervention
• Abuse and Neglect of Infants and Toddlers
• Red Flags
• Assessment
• Intervention Strategies

4
CHILD ABUSE AND NEGLECT DEVELOPMENTAL
CONSEQUENCES

• Difficulty forming relationships in preschool and
  early adolescence
• Lower levels of school achievement, especially in
  adolescence
• More likely to require special education72 by
  3rd grade
• More behavior problems
• More likely to use drugs and alcohol

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CAPTA

• The Keeping Children Safe Act of 2003 amended the
  Child Abuse Prevention and Treatment Act (CAPTA)
• As of July 1, 2004, referral required 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 (Sec.106(b)(A)(xxi)).

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PART C of IDEA 2004

• SEC. 637.State Application and Assurances
• . . . require the referral for early
  intervention services under this part of a child
  under the age of 3 who
• (A) Is involved in a substantiated case of child
  abuse or neglect or
• (B) Is identified as affected by illegal
  substance abuse, or withdrawal symptoms resulting
  from prenatal drug exposure

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IMPORTANCE OF CAPTA

• Children reported to CPS and/or in foster care
  experience many developmental delays including
  social-emotional delays.
• Infants and toddlers referred to CPS need access
  to services provided by early intervention system

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THE INTENTION OF THE LAW

• Every child referred under CAPTA shall be
  screened by a Part C provider or designated
  primary referral source to determine if a
  referral for an evaluation for EI service is
  warranted.
• All children are to be screened, but not all will
  be referred.
• (IDEA Infant and Toddler
  Coordinators Association (ITCA), 2004)

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CHALLENGESPredicted Increases in Part C

• Before CAPTA, 7 of infants and toddlers in Part
  C were also in Child Welfare System
• After CAPTA, predictions
• 70 increase in referrals
• 20-30 increase in enrollment
• What is actually happening??

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THE CULTURE OF THE CHILD WELFARE SYSTEM

• Life and death responsibilities
• Staff shortages/high caseloads
• Inadequate supervision
• Public expectation of a punitive system of
  accountability
• Risk of violence
• Adversarial relationships with families
• Voluntary or mandated services
  

• (Cohen, 2005)

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THE CULTURE OF THE EARLY INTERVENTION SYSTEM

• Each state defines eligibility criteria
• Comprehensive, multidisciplinary evaluations and
  intervention
• Meet developmental needs of child and needs of
  the family
• Family centered services based on the IFSP
• Services are voluntary

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NEED FOR COLLABORATION BETWEEN EI CW

• Clear definition of roles and responsibilities
• Development of trust
• Explanation of EI and CW to families
• Joint visits to families
• Procedures to follow when families refuse
  services
• 
  
  (Cohen, 2005)

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CHALLENGES TO EARLY INTERVENTION

• Increased workload
• Assessments to identify social emotional needs
• Interventions with children and parents
• Enhance ability to address parental issues that
  affect infant mental health

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CAPTA CHALLENGES TO CHILD WELFARE

• Work to educate families to accept referral to EI
• CW does not know the potential of EI
• Limited staff available/capacity to address
  developmental problems
• Supervisors do not want to add another mandate to
  workers job
• Confidentiality issues

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CHALLENGES OF WORKING WITH PARENTS

• Majority living in poverty
• Poor housing conditions
• Parental substance abuse and mental health issues
  are common
• Mothers in abusive relationships
• Multi-stressed, chaotic and unstable
• families

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CHALLENGES OF WORKING WITH PARENTS

• Inadequate basic care giving skills
• Lack structure, limits and routines
• Many lack knowledge of typical child development,
  behaviors and needs
• Discipline is punitive in nature expression of
  parents frustration

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CHALLENGES OF WORKING WITH PARENTS

• Lack formal and informal supports
• Difficulty trusting others and forming healthy
  relationships
• History of poor relationships and experiences
  with other helping professionals
• Generational cycle of abuse
• Overwhelmed by their own needs

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EVERYDAY IN AMERICA

• 4 children are killed by abuse or neglect
• 2,383 children are confirmed as abused or
  neglected.
• 
  (Childrens Defense Fund,
  2007)

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Everyday In America

• (Childrens Defense Fund, 2007)

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Virginias Children
Child Population 1,789,782 Living in Poverty
238,312 Child AN Victims 6,959
(CLASP, 2006)
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ABUSE AND NEGLECT AND DEVELOPMENTAL DISABILITIES

• Children who experience abuse and neglect are at
  high risk for
• developmental delays
• psychological, behavioral and health problems
• Social emotional development

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ABUSE AND NEGLECT AND DEVELOPMENTAL DISABILITES

• 53 of all children 3-24 months whose families
  were investigated for maltreatment were
  classified as high risk for developmental delay
  or neurological impairment.

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MALTREATED INFANTS AND TODDLERS

• Infants represent 5 of the children in the US
  and 10 of all child maltreatment victims. (ACF,
  2005).
• Infants and toddlers most likely to experience
  recurrence of maltreatment
• Child victims with a disability-- over 50 more
  likely to experience recurrence maltreatment

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INFANTS AND TODDLERS IN FOSTER CARE

• 80 with prenatal drug exposure
• 40 born low birthweight/premature
• Many with acute and chronic health problems
• More than 50 have developmental delays or
  disabilities few linked to EI
• One-third of infants discharged will
• re-enter the child welfare system

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THE BRAIN AND EMOTIONAL DEVELOPMENT

• Infants need sensitive, responsive care for parts
  of brain that control emotions to develop
  properly
• Caregivers effectively manage babys emotional
  states
• Baby develops neurological and emotional
  foundations
• Enables baby to gradually learn to regulate
  emotions on her own

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ASSOCIATED FACTORS

• Factors associated with abuse and neglect
  contribute to developmental problems
• Poverty
• Poor nutrition
• Lack of prenatal and medical care
• Substance abuse
• (Shonkoff Phillips,
  2000)

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CONSISTENT, RESPONSIVE CARE NEEDED

• But - some parents/caregivers
• Reject bids for emotional/physical closeness
• Are punitive and abusive
• Suffer from depression
• Abuse drugs
• Are overwhelmed by meeting own needs and need of
  their children

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MENTAL HEALTH IS

• The successful performance of mental function,
  resulting in
• Productive activities
• Fulfilling relationships
• Ability to adapt to change and to cope with
  adversity
• Mental health is the springboard of thinking and
  communication skills, learning, emotional growth,
  resilience, and self esteem.

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INFANT MENTAL HEALTH IS

• The developing capacity to experience, regulate
  and express emotions
• Form close and secure interpersonal relationships
• Explore the environment and learn
• In the context of family, community and cultural
  expectations for young children
• Synonymous with healthy social emotional
  development

(Hunter, 2006 Adapted from Zero to Three)
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SOCIAL EMOTIONALRED FLAGS

• Behavioral responses to stress and trauma of
  abuse and neglect
• Anger and rage
• Anxiety and hyper vigilance
• Emotional shut down
• Bodily reactions

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SOCIAL EMOTIONAL RED FLAGS

• Chronic sleeping, feeding problems
• Excessive fussiness, crying
• Unusually difficult to be consoled
• Minimal interest in social interaction
• Avoids eye contact and physical closeness
• Does not turn to familiar adult for comfort
• Unable to comfort or console self

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SOCIAL-EMOTIONAL ASSESSMENTS

• Hawaii Early Learning Profile (HELP)
• Ages Stages Questionnaire Social-Emotional
  (ASQSE)
• Brief Infant-Toddler Social Emotional Assessment
  (BITSEA)
• Infant-Toddler Social Emotional Assessment
  (ITSEA)
• The Ounce Scale, Social Emotional Development

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SOCIAL EMOTIONAL ASSESSMENTS

• Early Coping Inventory
• Devereux Early Childhood Assessment (DECA)
• Vineland SEEC Vineland Social- Emotional Early
  Childhood Scale
• The Functional Emotional Assessment Scale
  (Greenspan DeGangi)

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INTERVENTIONSThings to remember...

• Build relationships over time
• Introduce self, program, purpose
• Review confidentiality policy
• Take cues from parents
• Keep visits and be on time
• Basic needs come first

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INTERVENTIONSFostering resilience

• Establish and facilitate caring relationships
• Communicate high expectations
• Provide opportunities for participation

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INTERVENTIONSHome Visit Tips

• Relate to the parent first
• Avoid bonding directly with the child
• Ask open ended questions
• Ask about pregnancy, infancy and parenthood
• Avoid making too many suggestions
• Listen, listen, listen

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INTERVENTIONSEnhancing parent-child relationships

• Relationships change relationships-use the
  parallel process
• Parents experiences as a child
• Notice and comment on parental, child and
  relationship strengths
• Use natural environment
• Incorporate activities that involve interaction
• Dispel myths

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INTERVENTIONSStrategies

• Offer developmental guidance
• Celebrate milestones
• Speak for the baby
• Develop strategies and supports together

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INTERVENTIONSSTRATEGIES

• Bringing it back to baby
• Being OK with silence
• When a family no shows
• When parents are clearly unable to engage

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PART C PROGRAMS AND PROVIDERS CAN

• Provide high quality home visits
• Emphasis on Service Coordination
• Focus on social-emotional domain
• Learn about local Child Welfare system and
  services
• Take care of ourselves as we do this important
  work

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TAKING CARE OF OURSELVES

• Be self aware
• How we are is as important as what we do
• Beware of burn out
• Know our limits
• Pay attention to our own feelings
• Remember that parents are responsible for the
  choices they make, not us

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INSPIRATIONFROM A PARENT

• Courage doesnt always roar.
• Sometimes courage is the quiet voice at the end
  of the day saying,
• I will try again tomorrow.
• -Anonymous-

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CONTACT INFORMATION

• Marian H. Jarrett, EdD
• mjarrett_at_gwu.edu
• Karin H. Spencer, MA
• kspencer_at_gwu.edu

44
REFERENCES RESOURCES

• Barnett, D. (1997). The effects of early
  intervention on maltreating parents and their
  children. In M. J. Guralnick (Ed.), The
  effectiveness of early intervention (pp.
  147-170). Baltimore Paul H. Brookes.
• Bono, K. E., Bolzani Dinehart, L. H., Claussen,
  K. G., Mundy, P. C., Katz, L. F. (2005). Early
  intervention with children prenatally exposed to
  cocaine Expansion with multiple cohorts. Journal
  of Early Intervention, 27(4), 268-284.
• Cohen, E. P. (2005). Building bridges between
  child welfare and early intervention programs.
  George Washington University Community Forum,
  February 11, 2005, Washington, DC.

45
REFERENCES RESOURCES

• Department of Health and Human Services (2005).
  Child maltreatment 2003 Reports from the states
  to the National Child Abuse and Neglect Data
  Systems - national statistics on child abuse and
  neglect. Washington, DC U.S. Government Printing
  Office.
• Dicker, S., Gordon, E., New York State
  Permanent Judicial Commission on Justice for
  Children (Eds.). (2004). Ensuring the healthy
  development of infants in foster care a guide
  for judges, advocates and child welfare
  professionals. Washington, DC Zero To Three.
• Early Head Start National Resource Center at Zero
  to Three. (n.d.). In Home visitor's hand book
  for the Head Start home-based program option.
  Retrieved from http//www.headstartinfo.org/pdf/EH
  S-Home-VisitorHdbk.pdf

46
REFERENCES RESOURCES

• Early Identification Project University of
  Colorado Health Sciences Center (Eds.). (2003).
  Interagency collaboration A guidebook for child
  welfare and Part C agencies (Vol.). Denver JFK
  Partners.
• Egeland, B., Erickson, M. F. (2004). Lessons
  from STEEP Linking theory, research and practice
  for the well-being of infants and parents. In
  A.J. Sameroff, S.C. McDonough K.L. Rosenblum
  (Eds.), Treating parent-infant relationship
  problems strategies for intervention (pp.
  213-242). New York The Guilford Press.
• Erickson, M. F., Kurz-Riemer, K. (1999).
  Infants, toddlers and families A framework for
  support and intervention. New York The Guilford
  Press.

47
REFERENCES RESOURCES

• Hawley, T., Gunner, M. (2000). Starting smart
  How early experiences affect brain development
  (2nd ed.). Washington, DC Ounce of Prevention
  Fund and Zero to Three. Lippitt, J. A. (2005).
  Implementing referrals of abused or neglected
  children to EI The MECLI. George Washington
  University Community Forum, February 11, 2005,
  Washington, DC.
• Jaudes, P. K., Shapiro, L. D. (1999). Child
  abuse and developmental disabilities. In J. A.
  Silver, B. J. Amster T. Haecker (Eds.), Young
  children in foster care A guide for
  professionals (pp. 213-234). Baltimore Paul H.
  Brookes.
• Ounce of Prevention ZERO TO THREE. (1998).
  Ready to succeed The lasting effects of early
  relationships. Authors.

48
REFERENCES RESOURCES

• Pawl, J. H. (1995). The therapeutic relationship
  as human connectedness Being held in another's
  mind. Zero To Three, 15(4), 1-5.
• Rosenberg, S., Robinson, C. (2003). Is Part C
  ready for substantiated abuse and neglect? Zero
  to Three, 24(2), 45-47.
• Sameroff, A. J., McDonough, S. C., Rosenblum,
  K. L. (Eds.). (2004). Treating parent-infant
  relationship problems Strategies for
  intervention. New York The Guilford Press.
• Shonkoff, J. P., Phillips, D. A. (Eds.).
  (2000). From neurons to neighborhoods The
  science of early childhood development.
  Washington, DC National Academy Press.
• ZERO TO THREE Infant Mental Health Resource
  Center. (n.d.). About mental health. Retrieved
  October 4, 2005, from http//www.zerotothree.org/S
  earch/index2.cfm