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Home > Addressing the Needs of Young Children in Child Welfare: Part C ' Early Intervention Services > 2. Promising Strategies
Addressing the Needs of Young Children in Child Welfare: Part C -- Early Intervention Services
Bulletin for Professionals
Author(s): Child Welfare Information Gateway
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| Year Published: 2007 |
2. Promising Strategies
Many States are developing policies and procedures to implement the Part C referral provisions of CAPTA and the IDEA more effectively. Additionally, many localities and individual provider agencies have developed initiatives to ensure that children who are abused and neglected are linked to the EIP. All of these strategies address existing barriers to identifying, evaluating, engaging, and serving maltreated children and their families. This section will describe many strategies that have been tried and provide specific State and local examples.
Collaboration
States have found that successful Part C implementation requires extensive interagency collaboration, not just between child welfare and EIP but among all relevant agencies and stakeholders. This includes Medicaid, mental health, public health, maternal and child health, developmental disabilities, Early Head Start/Head Start, education, and the courts.
In South Carolina, for example, an extensive collaborative group has signed a memorandum of agreement to ensure the coordination of BabyNet, a statewide, comprehensive interagency system of early intervention services for all eligible children in accordance with Federal and State laws. Participating agencies include the State's Department of Disabilities and Special Needs, the Department of Health and Environmental Control, the Department of Health and Human Services, the Department of Mental Health, the Department of Social Services, the Department of Education, and the School for the Deaf and the Blind. www.scdhec.net/health/mch/cshcn/programs/babynet/
Collaborative efforts have been found to help child welfare and EIP administrators do the following:
- Clarify and share information about each system's procedures
- Identify and convene leaders to facilitate implementation of the referral provisions and ensure compliance with all Federal and State laws and regulations (e.g., ASFA, CAPTA, IDEA)
- Identify and tap available funding streams
- Develop written interagency agreements that establish workable referral and information-sharing procedures and ongoing communication mechanisms
- Promote clearer understanding of staff roles in each agency
- Develop consistent guidelines for processes such as obtaining consent, conducting evaluations, and appointing surrogate parents
- Create opportunities for cross-disciplinary training
At the practice level, collaboration between child welfare and the EIP staff can help:
- Spotlight the safety and well-being needs of individual children and families
- Integrate child welfare and early intervention service goals and services
- Ease child welfare workload burdens by engaging the EIP service coordinator as a partner
- Identify new resources for consultation and technical assistance
As the examples on the next several pages will demonstrate, comprehensive and creative collaborations between State child welfare and the EIP systems have overcome many of the barriers to identifying, referring, and serving abused and neglected children under the EIP.
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Delaware
Since 1996, Delaware child welfare and EIP agencies have had policies and agreements in place to refer children involved in substantiated abuse and neglect cases to the EIP and to share resources. An Operations Agreement between the two agencies defines staff roles for each step in the EIP process, clarifies expectations for information sharing between child welfare workers and EIP staff, and outstations child welfare staff at the EIP to serve as liaisons. These staff use a developmental checklist created by the EIP and built in to the child welfare computerized tracking system to conduct preliminary screenings of children for referral to the EIP. They also monitor the status of all referred children. The liaisons, funded by Part C, provide case management on individual cases and offer training and technical assistance to staff in both systems.
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Identification and Referral
The 2004 reauthorization of the IDEA requires States to develop a comprehensive Child Find system that ensures eligible children, including infants and toddlers in foster care or those with substantiated abuse or neglect, are identified, located, and referred to the EIP. Child Find efforts usually include outreach to child protection and preventive services agencies, as well as to hospitals and clinics that are likely to see infants and toddlers who have been abused or neglected.
Many States have developed policies to address this requirement. For example:
- Massachusetts, Ohio, Nebraska, Vermont, and West Virginia now require automatic referral of child abuse and neglect cases by child welfare workers to the EIP.
- In Idaho, New Hampshire, New Mexico, and North Dakota, all children under age 3 with substantiated cases of abuse and neglect are automatically referred to the EIP and receive a multidisciplinary evaluation conducted and funded under the State EIP.
Any EI service, including State-initiated screening, must be performed by a qualified professional as defined under the IDEA. Some States provide training for child welfare staff in screening for developmental issues. In Utah, trained child welfare workers use a valid and reliable screening tool (normed for the purpose of screening children referred to child welfare), undergo a rigorous training utilizing a field-tested curriculum, and receive ongoing supervision from a clinical supervisor. Other States have child welfare staff rely on EI staff, who have had extensive training to conduct these screens. In Philadelphia, all children, including all children with substantiated cases of abuse and neglect ages birth to 4.9 years, receive developmental screening by the EIP.
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Massachusetts
The Massachusetts Early Childhood Linkage Initiative (MECLI) was established in 2002 to create a formal link between the child protection system and the EIP. The project brings together Brandeis University, the EIP, and the Departments of Public Health and Social Services in a partnership to maximize early identification and intervention for young children who are at heightened risk for serious developmental problems. As an initial step, MECLI seeks to have the child protection system refer all children under 3 years of age with a newly opened case to the Part C system. MECLI tracks the number of children referred, evaluated, determined eligible, and enrolled. A large percentage (51%) of MECLI-referred children have developmental delays rendering them eligible for Early Intervention.
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Parental Consent
Once referred to the EIP, children involved in substantiated cases of abuse and neglect often face barriers to obtaining an assessment for needed services. Parents of children who have substantiated reports of abuse and neglect may be unknown or unable to be found to consent to EIP assessment and services. Parents also may be unwilling to participate, fearing intrusion by another State agency. EIP professionals may be unfamiliar with child welfare procedures or strategies for engaging parents who are involuntarily referred to the child welfare system.
Potential strategies to address these challenges include:
- Involve court personnel. A parent's approval to have a child evaluated for EI services may demonstrate to the court that the parent is willing and able to act in the child's best interest. A discussion along these lines may be more effective if initiated by the parent's lawyer or the child's attorney or court appointed special advocate (CASA).
- Involve public health nurses. Some States and localities have successfully used public health nurses to work with families. In Delaware, a Memorandum of Understanding between child welfare and the Division of Public Health allows child welfare staff to refer a child to a public health nurse if the family is reluctant to consent to a formal EIP multidisciplinary assessment.
- Appoint surrogate parents. The Early Intervention law defines "parent" broadly to include biological and adoptive parents, a relative with whom the child is living, a legal guardian, and in some instances, a foster parent. The law specifically excludes State officials from acting as a parent. It also provides for the appointment of a surrogate parent if the child has no parent as defined under the Early Intervention law. Under the 2004 IDEA, courts are authorized to order a surrogate parent to represent the child (§614(D)(iii)(II)(cc); §615 (b)(209A)(i)). The role of the surrogate parent is limited to representing the child in all matters related to the EIP. Nothing in the Federal law prohibits a foster parent from serving as the surrogate parent; however, States may have laws that limit foster parents serving as surrogates or otherwise acting as parents.
At both the child welfare and EIP agencies, States have found that formal written agreements and easy-to-use forms that describe interagency policy and operations for seeking parental consent and appointing surrogate parents are helpful.
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Suffolk County, New York
In Suffolk County, New York, the Departments of Health Services and Social Services provide home visits by public health nurses to all high-risk children, including those in the child welfare system, once every 6 months for basic health assessments and monitoring. For children under age 6, the nurse conducts a developmental screening and refers eligible children to Part C. Children who are ineligible for the EIP receive follow-up developmental assessment and tracking. Where appropriate, reports of the visits are sent to the foster care division of the Department of Social Services. The nurses also provide valuable health education to foster families. The home visits and developmental screens are funded by the EIP as part of Child Find.
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Interagency Training
Cross system training on the Federal law provisions, operations of each other's systems, and relevant procedures help ensure that all stakeholders share the same knowledge and understand one another's language. Cross training can also help identify and address systemic barriers to accessing services from the EIP. It can provide ongoing opportunities for discourse and relationship-building among the leadership and staff in each agency, improving their ability to shape clinical recommendations and resolve difficult cases. Since the court is a central decision maker in all child protective cases, interdisciplinary training on infant development and EIP involving judges and court staff has been found to be helpful.
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Nebraska
To assist child welfare staff in meeting the Federal mandate to refer children under age 3 involved in cases of substantiated abuse and neglect to the EIP, Nebraska has developed several interdisciplinary, collaborative opportunities for information-sharing and training. These include joint video conferences, a child welfare representative on the Early Childhood Interagency Coordinating Council, and stakeholder meetings.
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Tracking and Oversight
Referral alone will not necessarily ensure enrollment and services. Several States have developed policies and programs to track both individual children and aggregate case data. In Delaware, for example, child welfare staff use a computerized tracking system to monitor the status of all children referred to the EIP on a monthly basis. In Massachusetts, MECLI (see Identification and Consent section) captures the number of children referred, evaluated, determined eligible, and enrolled in the EIP.
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Philadelphia, Pennsylvania
The Philadelphia Child Welfare Early Intervention Initiative is a collaborative effort between the Philadelphia Department of Human Services' Office of Behavioral Health and the Early Intervention (ChildLink) and Preschool Special Education (Elwyn) programs to ensure identification, facilitate referral, and track all children birth to age 5 in the child welfare system.
A panel that includes representatives from each agency plans, implements, and monitors the initiative. The panel developed policy and procedures for accessing early intervention services. A shared database tracks movement of children into the early intervention system, including identification of children under age 3 for referral, monitoring of developmental screenings and assessments, and development of IFSPs. An advisory group composed of child welfare and EIP representatives guides the project, and an implementation evaluation is being conducted to determine how well program objectives are achieved. To date, monthly reports suggest that the number of referrals is steadily growing, and provider program managers are aware of the new policy to monitor the participation of eligible children and refer all children under age 6 for developmental screening.
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Some States use the courts to help ensure referral to and enrollment in the EIP. Under Federal child welfare laws, every child in foster care has hearings to review case status and assess permanency goals. These hearings present opportunities to inquire into the well-being of young children.
In some States, formal mechanisms have been developed to share information with those decision-makers responsible for advocating on behalf of abused and neglected children, including judges, attorneys for children and parents, guardians ad litem, and CASAs. Courts have the opportunity to inquire as to whether infants and toddlers are referred to and enrolled in the EIP and ensure relevant information is shared.
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New York State
The New York State Permanent Judicial Commission on Justice for Children has developed the Healthy Development Checklist and the Infant Checklist. These checklists contain key questions that spotlight children's needs (including referral to the EIP) and help ensure that at least one person involved in every child welfare case'a judge, a lawyer, a caseworker, or a CASA'asks critical questions about a child's health and development.
The Commission's Babies Can't Wait Initiative promotes a steady focus on the needs of infants in foster care to ensure court-based leadership and oversight. Additionally, CASAs throughout New York State are specifically assigned to cases of children in foster care under age 5, working alongside the judge, attorneys, and social workers to identify health and developmental needs and, for those under age 3, to facilitate and track referral to the EIP.
New York's 2005 Permanency Act builds upon the Babies Can't Wait Initiative by requiring courts to inquire into children's well-being, including referral to the EIP. A key component of the project is a statewide interdisciplinary training effort on the most critical guideposts for infant health, including infant development and the EIP, for judges, courts, and child welfare staff.
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This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.
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