Supporting Young Homeless Children with Developmental Delays: A Successful Cross- System Model July 10, 2007

Philadelphia Office of Supportive Housing (OSH) The Partners Traveler’s Aid Kirkbride Family Shelter RHD Woodstock Family Shelter Philadelphia Health Management Corporation (PHMC) Homeless Programs Philadelphia Infant/Toddler Early Intervention Providers Philadelphia Department of Behavioral Health/ Mental Retardation Services Infant/Toddler Early Intervention

Federal Program Entitlement for Eligible Children – Eligibility guidelines may vary from state to state Family Centered Approach to Service Delivery Services Delivered in the Natural Environment – Services embedded in family’s typical routines and activities and delivered in the home and community ‘Child Find’ activities are federally mandated Preschool Early Intervention

Homelessness in Philadelphia City’s Office of Supportive Housing (OSH) is central point of entry for shelter system Over 10,000 homeless children birth – 18 years of age 50+ shelters/transitional housing facilities with women and children (40% of the population) 10% of those in shelters were aged 0 – 5 in FY 2005.

Planning Process Meetings with OSH Meetings with EI service providers Meetings with shelter directors Meetings with shelter case managers All partner meeting at each shelter Resident community meetings Regular review meetings The Foundation of Good Collaboration is Great Communication (start-up and ongoing) Meetings, Meetings, Meetings, Meetings, Meetings!

Program Overview Shelter/EI Children’s Specialist administers the ASQ (Ages and Stages Questionnaire) Findings are shared with the families and all families are offered a multi-disciplinary evaluation for their child Those who give approval for an evaluation are scheduled for a MDE Those who prefer not to be referred are added to the ‘at-risk’ tracking and monitoring program

Program Overview (cont’d) The shelter service coordinator arranges a MDE appointment to occur in the shelter’s bright space. MDE slots are set aside for the shelter program IF the child is eligible, the Individual Family Service Plan (IFSP) is written at the MDE Family is offered a choice of service providers, if no preference, Child services are picked up by the agency serving the families in that shelter. Services are delivered in the shelter and are continued if the family leaves the shelter.

‘Child Find’: Children at Risk for Delay State identifies vulnerable and underserved populations at risk for developmental delay Children who are Homeless – These children are vulnerable and underserved because: Limited resources Poorly educated parents Changing caregivers and changing homes and environments Developmental concerns low priority until child is school age Other vulnerable (‘at-risk’) populations for Early Intervention are children who were premature or had a stay in the NICU, children with prenatal drug exposure, low birth weight babies and children with high lead levels.

Risk Factors Identified Of 62 children assessed, these are the risk factors identified Exposure to Violence – 4 children Prenatal D/A Exposure – 4 children No Prenatal Care – 2 children Loss of Caregiver – 2 children

Role of EI Service Coordinator Every Family referred to early intervention is assigned a service coordinator Schedules an initial visit with family within 48 hours of receiving referral completes a child and family assessment questionnaire Completes intake and registration, obtains information and schedules Multidisciplinary Evaluation (MDE) Obtains necessary consents Arranges services for children who are eligible Supports EI providers to connect/re-connect with families who miss services

Role of the EI Providers Accept Referrals of children in Shelter and assign staff to provide services to children found eligible Work with families to learn interventions to support their child’s development Interface with shelter staff to establish a presence and familiarity with shelter staff and families Develop and conduct other developmentally appropriate activities in the shelter to help families learn more about EI and child development Re-establish contact with family of eligible child if they leave the shelter while the child is receiving early intervention.

Role of Shelter Staff To identify all children birth – 2.10 months entering the shelter To ensure that all children birth to 2.10 months sees PHMC’s Children’s Specialist no later than 30 days after entering shelter To provide copies of daily census to PHMC’s Children’s Specialist To develop and update service plan to include early intervention services To monitor,support and reinforce family’s participation in the early intervention process To coordinate discharge and transition of early intervention services

Role of Shelter/EI Children’s Specialist Attend Shelter Community Meetings and Shelter Case management meetings Check in with shelter staff to determine any changes in census (new families or families that have left the shelter) Assess Talk with each family and complete a ‘Child Find’ demographic form Conduct a developmental assessment using the Ages and Stages Questionnaire for each child 0 – 2.10 months of age entering the shelter

Role of Shelter/EI Children’s Specialist (continued) Share findings of ASQ with family, identifying children with concerns Offer all parents the option of having their child evaluated. (MDE:Multidisciplinary Evaluation) Interface with shelter staff to establish a presence and familiarity with shelter staff and families Develop and conduct other developmentally appropriate activities in the shelter to help families learn more about EI and child development

Issues Identified During Assessment Behavior – 4 children Communication/Speech – 9 children Gross Motor – 2 children Learning Disability – 2 children Parent’s concern (child above ASQ cut-off) – 12 children

Duration of Homelessness

Dedicated Staff Needed Barriers Shelter crisis driven, population in transition One phone for resident’s use Adult focused system Difficulty making, rescheduling appointments Space is limited Solutions CS receives daily census CS meets with each parent in person to complete ASQ and demographic form EI family centered system CS schedules apps. for parents CS schedules Bright Spaces for Med's and ongoing EI services

Benefits to the model Vulnerable children are identified and served Cross systems collaborations closes the gaps in service delivery Provides an opportunity to teach parents about importance of child development ( thru the MDE, the provision of early intervention services and EI sponsored parenting groups) Relationships/Services with early intervention established while in the shelter (designated service coordinator, designated service providers-challenges) Services established in the shelter more likely to follow the child

Funding Foundation Grants aimed at homeless families with young children Local Office of Shelter Services Early Intervention Child Find Money – Screening vs. Evaluation