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

3. 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 education—72% by 3rd grade • More behavior problems • More likely to use drugs and alcohol

5. 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)).

6. 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;”

7. 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

8. 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)

9. 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??

10. 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)

11. 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

12. 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)

13. 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

14. 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

15. 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

16. 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 parent’s frustration

17. 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

18. EVERYDAY IN AMERICA • 4 children are killed by abuse or neglect • 2,383 children are confirmed as abused or neglected. (Children’s Defense Fund, 2007)

19. Everyday In America (Children’s Defense Fund, 2007)

20. Virginia’s Children Child Population 1,789,782 Living in Poverty 238,312 Child A&N Victims 6,959 (CLASP, 2006)

21. 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

22. 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.

23. 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

24. 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

25. THE BRAIN AND EMOTIONAL DEVELOPMENT • Infants need sensitive, responsive care for parts of brain that control emotions to develop properly • Caregivers effectively manage baby’s emotional states • Baby develops neurological and emotional foundations • Enables baby to gradually learn to regulate emotions on her own

26. 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)

27. 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

28. MENTAL HEALTHIS… • 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.

29. 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)

30. 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

31. 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

32. SOCIAL-EMOTIONAL ASSESSMENTS • Hawaii Early Learning Profile (HELP) • Ages & Stages Questionnaire: Social-Emotional (ASQ:SE) • Brief Infant-Toddler Social Emotional Assessment (BITSEA) • Infant-Toddler Social Emotional Assessment (ITSEA) • The Ounce Scale, Social & Emotional Development

33. 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)

34. 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

35. INTERVENTIONSFostering resilience • Establish and facilitate caring relationships • Communicate high expectations • Provide opportunities for participation

36. 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

37. INTERVENTIONSEnhancing parent-child relationships • Relationships change relationships-use the parallel process • Parent’s experiences as a child • Notice and comment on parental, child and relationship strengths • Use natural environment • Incorporate activities that involve interaction • Dispel myths

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

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

40. 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

41. 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

42. INSPIRATIONFROM A PARENT Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying, “I will try again tomorrow.” -Anonymous-

43. CONTACT INFORMATION • Marian H. Jarrett, EdD mjarrett@gwu.edu • Karin H. Spencer, MA kspencer@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/EHS-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/Search/index2.cfm