FORMING HEALTH ATTACHMENTS FOR OUR MOST VULNERABLE POPULATION NADCP 12 th Annual Drug Court Training Conference June 22, 2006 The Honorable Peggy Walker

FORMING HEALTH ATTACHMENTS FOR OUR MOST VULNERABLE POPULATION

NADCP 12th Annual Drug Court Training ConferenceJune 22, 2006

The Honorable Peggy WalkerVictoria Youcha, Ed.D.

Portrait of Young Children in Foster Care in U.S.

• Infants are largest single group of children entering care

• More likely to be abused and neglected

• Remain in placement longer

• 33% return to placement

• 81% of child fatalities occur under age 4

• Lower rate of reunification

• Developmental delay is 4 to 5 times greater than children in general population

• Almost 80% have prenatal exposure to maternal drugs

• More than half suffer from serious physical health problems

Trauma for infants and toddlers in foster care

• Separation from parents, usually sudden and traumatic

• Difficult experiences precipitating placement

• Frequently leads to temporary or permanent impairment in all areas of development

Physical DevelopmentInvolvement with CWS correlated with negative

impact on physical development

• Shorter

• Smaller head circumference

• 59% either over/underweight – 3X normal population

* National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005

High Risk for Developmental Delay

High Risk of Developmental Delay

More than half of the infants and toddlers involved with CWS were at high risk for developmental delay or

neurological impairment

National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005

Black infants under age 2 involved with CWS at

particularly high risk for developmental delay


Cognitive Delays

Children age 3 and younger were at very high risk of having below average

cognitive development


Language Delays

• 14% of children age 5 and younger score lower than 2 SD below mean

• Older preschoolers have lower language scores than infants

• Overall children involved with CWS score somewhat below average

• National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005

Temperament/Emotional Regulation

For children up to age 3• Higher rates of insecure attachment• Lower rates of compliance


Behavior Problems

Two and three year olds were five times more likely to have behavior problems

than the norm


John Video

Access to Services

• Fewer than half the toddlers and preschoolers who needed services were receiving them


Likelihood of Receiving Services

Most Likely: Children in foster care and those with active protective services cases

Least Likely: Children where there was no active CWS involvement


Children remaining in the home were far less likely to receive services than those in foster care.


Age Disparities

• Infants and toddlers were much less likely to receive services than preschoolers.

• Only 1 of every 10 babies needing services was receiving them compared to one of every three preschoolers.


Racial Disparities

• Black children were more likely than white children to be placed in foster care.

• Black children were only about half as likely to receive services as white children.


Factors Predicting Timely Permanency

• Caseworker consistency – a single change of caseworker reduced likelihood of permanency by 52%

• Fewer placements – each additional placement reduced odds of permanency within 12 months by 32%

Concurrent Planning: What the Evidence Shows. Research to Practice in Child Welfare. US Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, April 2005.

Permanency Factors Continued

• Poverty – extremely poor children were 90% less likely to achieve permanence in 1 year

• Substance abuse – presence increased likelihood of permanency by 23%

• Weekly visitation – each additional day of visitation per week tripled the odds of permanent placement within 1 year

What We Know

• Abused and Neglected infants are at very high risk for poor outcomes

• Children who spend their early years in foster care are more likely to drop out of school, become parents at a young age, enter the juvenile justice system, become homeless, incarcerated as an adult and addicted to drugs.

From Neurons to Neighborhoods: The Science of Early Childhood

DevelopmentCommittee on Integratingthe Science of Early Childhood Development

Board on Children, Youth, and FamiliesInstitute of Medicine

National Research Council

Core Concepts of Development

• Early environments matter

• Human relationships are the building blocks of development

• The course of development can be altered in early childhood by effective interventions that change the balance between risk and protection

From Neurons to Neighborhoods,2000

NATURE

Biology wires the brain for learning.

Nurture

Nurturing relationships are what the brain thrives on to develop.

National Center for Infants, Toddlers and Families

BOTH NATURE AND NURTURE

Critical Information from Brain Research

• Biology wires the brain for learning• The brain is not fixed, but flexible• The groundwork is laid in the first years• Plasticity – The brain’s ability to change

as a result of experience.

Therefore, positive early experiences are essential to healthy development in children

Brain Growth

Image: www.brainconnection.com© 1999 Scientific Learning Corporation

http://www.brainconnection.com/

Pruning

Newborn Early Childhood

Later Childhood

It is rarely the case that a maltreated infant has no

symptomatology.

Larrieu, 2002, Institute of Infant and Early Childhood Development, Tulane University Medical Center

Video• Still face

•Sad affect•Lack of eye contact•Weight loss•Lack of responsiveness•Sensory processing problems•Rejects being held or touched

Signs in the baby that emotional needs are not met

• Very aggressive behavior

• Attentional problems and deficits

• Lack of attachment

• Sleep problems or disorders

Signs of emotional problemsIn toddlers/ preschoolers

Exposure to Violence . . .

• increases cortisol levels in the brain;

• increases activity in the brain involved in vigilance and arousal (the “flight or fight” responses);

• the brain interprets others’ actions as threatening and in need of an aggressive response.

Violence Begets Violence

Childhood abuse increases the odds of future delinquency and adult criminality by 40%

The Cycle of Violence (Cathy Spatz Widom)

The Link Between Dependency & Delinquency

Being abused or neglected as a child increases the likelihood of

–arrest as a juvenile by 59%

–arrest as an adult by 28%

–arrest for a violent crime by 30%

To develop a child’s mind, we must first nurture a child’s heart.

Key Elements

• Enduring emotional relationship with a specific person

• That person provides a sense of safety, comfort and pleasure

• Loss or threat of loss of that person evokes intense distress (Putnam, p.5)

Prevention

• Adequate nutrition• Stimulating early environment in critical

years of 0 to 3• Healthy secure and loving relationship

with a primary caregiver • Estimates that investment of $1 in

prevention saves $3 in effective prevention programs (Putnam, p. 7)

Critical Roles for Ensuring Healthy Development

• The role of the caseworker• The role of the foster parent• The oversight of the courts• The role of the medical/health community

Commitments for Caseworkers

• Strive for permanency by the child’s first birthday or within 1 year from initial placement through – Stable placements in foster to adopt

homes– Frequent visitation (more than weekly)– Adequate support for possible

reunification

Commitments Continued

• Access available assessments through

programs such as – Babies Can’t Wait – Head Start– Public Health


• Facilitate placement and regular participation in appropriate programs to address the needs in the areas of development – Social– Emotional – Physical


• Establishing and maintaining a “Medical Home”.• Regularly scheduled communication and

documentation of– Progress– Appointments– Court proceedings– Therapies– Well being assessments: physical, social and

emotional


• Assuming responsibility for providing and training foster parents in using a well organized, individualized record of information that stays with the child and is useful in a continuity of care.

» Important so that trauma is minimized in cases where changes in placement are unavoidable.

• Determining if the child shows attachment to the caregiver

• Determining if the caregiver reads the child’s signals and responds in a consistent, nurturing way (see Baby Cues: A Child’s First Language)

Indicators to Identify Families With Lower Chance of Reunification

• Parent previously killed or seriously harmed another child

• Parent has repeatedly and with premeditation harmed a child

• Parent’s only visible support system is a drug culture, with no significant effort to change over time

• Parent has significant, protracted, and untreated mental health issues

• Parent’s rights to another child have been involuntarily terminated

*It should be noted that with the passage of the Adoption and Safe Families Act and corresponding legislation, attempts to

reunite families are not typically required when a parent has killed or seriously or repeatedly harmed a child as described in the first two bullets

http://nccanch.acf.hhs.gov/pubs/issue_briefs/concurrent_evidence/concurrent_evidence.pdf

COURT TEAMS FOR MALTREATED INFANTS AND

TODDLERS• Based on Miami-Dade Model begun in 1997• Federally-funded pilot program in

– Polk County, IA– Fort Bend County, TX– Forrest County, MS

• Judicial leadership plus community partners =enhanced and more coordinated services

• Mental health intervention for parent/baby together

Goals: Reduce recurrence of maltreatment and improve outcomes

• Increase referrals to early intervention services (Part C)

• Improve developmental outcomes– Comprehensive health care– Frequent visitation– Stable placements– Monthly reviews

• Develop new materials for legal and judicial personnel

Community Partners in Texas

• CASA• Health• Mental Health • Substance abuse• County attorney• District Clerk• Child Protective

Services• Private attorneys

• Early intervention• Foster parents• Faith community• Community foundation• Early childhood

community• Parenting education• Private foster care

agency

Court Team Model Key Components

• Judicial leadership• Partnership with child development/mental

health• Community team• Training/technical assistance• Services for children - addendum to court

order• Monthly case reviews• Mental health intervention

Use Evidence Based Models to Prevent Child Abuse and Neglect

Well-designed services with explicitly defined goals

• Change parenting practices and influence parent-child interactions.

• Ultimately result in less maltreatment.

Recommendation #1

• Support & training for foster parents and newly reunified biological parents

• Placement in a foster-to-adopt home in case reunification efforts not successful

Recommendation #2

Prevent Multiple Placements for Infants and Toddlers in Foster Care

Implement Developmentally Appropriate Visitation Practices

• Predictor of reunification is frequency of visits.

• Visits should occur: • frequently.• for a long enough period of time.• in a comfortable and safe setting.

Recommendation #3

Ensure Ongoing Post Permanency Services and Supports

• Challenging behaviors and emotional issues create stress for adoptive and biological families.

• Increased risk of adoption and reunification failure.

• Services and supports for families can help stabilize and preserve placements

Recommendation #4

Assure Comprehensive Health Care

• Comprehensive developmentally appropriate health care.

• Consistent provider.

• Immunizations.

• Regular developmental screenings.

Recommendation #5

Ensure Access to Part C Services

• Efforts underway at federal and state level to build stronger connections between the child welfare system and the Part C system:

• CAPTA reauthorization• IDEA reauthorization

• Challenge to help states build the capacity of their Part C systems.

Recommendation #6

Assure Early Childhood Mental Health Assessment and Services

• Untreated mental health disorders can have disastrous effects on children’s functioning now and in the future.

• Research-based interventions can help to prevent and treat these serious disorders.

Recommendation #7

Provide Quality Early Learning Opportunities

• All babies and toddlers need positive early learning experiences.

• Maltreated infants and toddlers need additional supports that can be addressed by comprehensive, research-based, early childhood programs such as EHS.

Recommendation #8

Recommendation #9

Implement Concurrent Planning– Research shows increased likelihood of

permanence within 12 months

Use Court Oversight To Ensure Safety and Permanence

• Judges responsible for well-being of children in their courts.

• Judges can be powerful agents of change.

• Court/ Community Teams can be effective strategy.

Recommendation #10

Goals of Court Oversight

• Recognizing and addressing substance abuse issues that negatively impact children in the system.

• Requiring and reviewing comprehensive case files from multi-agency/service providers for determining status of cases.

• Oversight of implementation of developmentally appropriate visitation practices.

Goals of Court Oversight, cont.

• Fast tracking cases in compliance with the Adoption and Safe Families Act of 1997.

• Assuring compliance with the referrals mandated in the Child Abuse Prevention and Treatment Act (CAPTA), P.L. 93-247 14.

Assessments

• Objective, comprehensive and timely

• Collateral information

• Impact of substance abuse on the family

• Employment

• Housing

• Other relationships

• ASAM level

Treating Dual Diagnosis

• Screen for mental health issues• Treat dual diagnosis parents to address the

underlying mental health issue in conjunction with substance abuse problem. Fifty percent of those with mental health diagnosis also have substance abuse problems.

• Thirty seven percent of alcohol abusers and fifty three percent of drug abusers also have at least one serious mental illness (NAMI, 2005)

Attitudes

• The attitude of parents about substance abuse depends upon the stage they are in with regard to abuse and recovery

• Recognition of the stages makes those who work with addicts more effective

Adoption and Safe Families Act

• Goal is to reunify with 365 days from the date of removal

• Reviews are scheduled within ninety days of disposition or within first six months following removal

• No progress consider contempt or begin implementing a concurrent plan

Relapse

• Relapse is often a part of recovery

• Parents are vulnerable when relapse occurs

• Increased risk of suicide and abandonment (giving up) of the child or children

Questions To Ask

Has the child received: • a comprehensive health assessment• referral to Part C for a developmental

evaluation• mental health screening and services• referral to high-quality early childhood

program

For More Information…

• ZERO TO THREE http://www.zerotothree.org/policy/ Scroll down the right hand navigation bar until you come to Court Teams. Here you will find links to all the organizational resources noted here.

• ABA Center on Children and the Lawhttp://www.abanet.org/child/home2.html

• National Council of Juvenile and Family Court Judgeshttp://www.ncjfcj.org/content/view/82/146/

• The New York Permanent Judicial Commission on Justice for Children has published questions judges, advocates and child welfare professionals should ask about infants in foster care. http://www.courts.state.ny.us/ip/justiceforchildren/PDF/Infant%20Booklet.pdf

http://www.zerotothree.org/policy/



http://www.abanet.org/child/home2.html

http://www.ncjfcj.org/content/view/82/146/

http://www.courts.state.ny.us/ip/justiceforchildren/PDF/Infant%20Booklet.pdf


• Putnam, Frank W.; “The Impact of Trauma on Child Development;” Juvenile and Family Court Journal; Winter 2006; Vol. 57, No. 1, pp. 1-11. www.ncjfcj.org

• “Excessive Stress Disrupts the Architecture of the Developing Brain,” National Scientific Council on the Developing Child, Working Paper # 3, Summer, 2005. www.developingchild.net


The end!


ZERO TO THREE:National Center for Infants, Toddlers and Families

2000 M Street, N.W., Suite 200Washington, D.C. 20036

Phone: 202-638-1144

Fax: 202-638-0851

For publications only: 800-899-4301

E-Mail Address: [email protected] Address: http://www.zerotothree.org


Documents

FORMING HEALTH ATTACHMENTS FOR OUR MOST VULNERABLE POPULATION NADCP 12 th Annual Drug Court Training Conference June 22, 2006 The Honorable Peggy Walker