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

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  • FORMING HEALTH ATTACHMENTS FOR OUR MOST VULNERABLE POPULATION NADCP 12 th Annual Drug Court Training Conference June 22, 2006 The Honorable Peggy Walker Victoria Youcha, Ed.D.
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  • 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
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  • 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
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  • Physical Development Involvement 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
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  • 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
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  • Black infants under age 2 involved with CWS at particularly high risk for developmental delay National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005
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  • Cognitive Delays Children age 3 and younger were at very high risk of having below average cognitive development National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005
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  • 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
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  • Temperament/Emotional Regulation For children up to age 3 Higher rates of insecure attachment Lower rates of compliance National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005
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  • Behavior Problems Two and three year olds were five times more likely to have behavior problems than the norm National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005
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  • John Video
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  • Access to Services Fewer than half the toddlers and preschoolers who needed services were receiving them National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005
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  • 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 National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005
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  • Children remaining in the home were far less likely to receive services than those in foster care. National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005
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  • 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. National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005
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  • 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. National Survey of Child and Adolescent Well-Being (NSCAW), CPS Sample Component, Wave 1 Data Analysis Report, April 2005
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  • 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, Childrens Bureau, April 2005.
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  • 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
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  • 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.
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  • From Neurons to Neighborhoods: The Science of Early Childhood Development Committee on Integrating the Science of Early Childhood Development Board on Children, Youth, and Families Institute of Medicine National Research Council
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  • 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
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  • 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
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  • 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 brains ability to change as a result of experience. Therefore, positive early experiences are essential to healthy development in children
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  • Brain Growth Image: www.brainconnection.com. 1999 Scientific Learning Corporation
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  • Pruning Newborn Early Childhood Later Childhood
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  • 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
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  • Video Still face
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  • 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
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  • Very aggressive behavior Attentional problems and deficits Lack of attachment Sleep problems or disorders Signs of emotional problems In toddlers/ preschoolers
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  • 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.
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  • Violence Begets Violence Childhood abuse increases the odds of future delinquency and adult criminality by 40% The Cycle of Violence (Cathy Spatz Widom)
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  • 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%
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  • To develop a childs mind, we must first nurture a childs heart.
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  • 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)
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  • 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)
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  • 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
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  • Commitments for Caseworkers Strive for permanency by the childs first birthday or within 1 year from initial placement through Stable placements in foster to adopt homes Frequent visit