Massachusetts Early Childhood Linkage Initiative: Taking CAPTA Pilot to Scale National Early Childhood Partners Meeting, Baltimore, MD March 14, 2008 Kate Roper, MECCS, Massachusetts DPH Based on presentation by John A. Lippitt, Ph.D., Massachusetts DPH

From Policy to Implementation MECLI piloted referrals from child welfare (CW) to Part C Early Intervention (EI) 3 Pilot sites in MA, Nov – Dec Both CW and EI were supportive Robust EI system able to handle referrals The MECLI project was funded by the U.S. DHHS, ACF, Children's Bureau; The A.L. Mailman Family Foundation; The Annie E. Casey Foundation; and The Frank and Theresa Caplan Endowment for Early Childhood and Parenting Education at The Heller School for Social Policy and Management, Brandeis University.

MECLI Findings: Referrals 540 children offered referral to EI 18% of parents refused the referral 19% of families referred did not engage with EI 40% of children were assessed

MECLI Findings: Eligibility 74% of children assessed were eligible under MA broad eligibility criteria (161/218) 49% had an eligible delay 17% eligible due to 4 of 20 risk factors 1% eligible by established condition or judgment 6% eligibility criterion unknown

MECLI Findings: Delays 40% language delay (84/211) 24% adaptive / self-help delay 23% gross motor delay 21% fine motor delay 20% cognitive delay 15% social-emotional delay

MECLI Findings: Risk Factors CW involvement 69% (145/211) Parental chronic illness or disability 35% Domestic violence 25% Substance abuse 25% Multiple traumas or losses 17% Inadequate food, shelter, or clothing 14% Family lacking social supports 13%

Challenges Establishing new policy Resources: time, money, expertise Collaboration Increased referrals Who to refer Screening vs. assessment

Challenges (cont’d) Appropriate assessment and services Engagement of referred families Working with families facing multiple challenges Rate of eligibility Confidentiality and information sharing Local variation

Clear policies and procedures Clear roles and responsibilities Obtain buy-in & develop shared vision Referral coordinators and collaboration facilitator Attainable goals and objectives Success Factors & Strategies

Success Factors & Strategies (cont’d) Funding for service delivery Training Time for collaboration & case management Expertise on social-emotional development & ECMH Diversity & cultural competence

Taking it to Scale: Current Status Policy guidance drafted fall 2005 DSS work in process with 2 unions:  Social Worker and NAGE Hope to roll out state-wide spring 2008  Some area offices already implementing Training for 29 area offices will include EI staff and EI parents as presenters

Professional Development for EI and DSS workforce Department of Public Health EI Interagency Coordinating Council exploring use of reliable, valid social-emotional assessment tool(s) One provider agency developed, provided, evaluated 30-hour Infant Mental Health Training in 3 sites (75 trained). Department of Social Services Child Welfare Institute MECCS: Web-based Behavioral Health Resource

Conclusions CW to Part C EI referrals will identify eligible kids Multiple implications for Part C EI systems Build collaboration among CW, Part C EI, and the courts Work with biological and foster families Hard work but can be done and can improve outcomes for children and families

DPH Substance Exposed Newborns Pilot: “A Helping Hand: Mother to Mother” Director: John Lippitt, former MECLI Director 1 of 4 federal demonstration projects Develop model for implementation of notification of child welfare (DSS) and plan of safe care for SENs Integrates the delivery of substance use, child welfare, child development, mental health, health, and other social services

Vision and Goal VISION: Substance exposed newborns have the opportunity to achieve their full potential through nurturing caregiving GOAL: Enhance identification and services for substance exposed newborns (SENs), their mothers and families

Research and Data Growing body of evidence that, except for alcohol, the compromised parenting of the post-natal environment has greater impact on the infant than pre-natal exposure Good data on SENs are hard to get SAMHSA: 3.5% of newborns exposed to illegal drugs MA: ~3,000 SENs per year Under-reported on electronic birth certificates and to DSS

Service Elements Voluntary, enhanced service thru DSS Family Support Specialist (FSS): a peer, a mother in recovery Services are individualized, strength-based, and family-centered, as well as gender and culturally appropriate Engage and maintain mother in substance abuse treatment Developmental assessment for infant and services if indicated

Service Elements, cont’d Family participation in decision making Continuity of nurturing caregiving Newborn: infant under 90 days old Substance exposed newborn (SEN): any illegal use of a substance during pregnancy

Key Partners and Roles Identification:  Birthing hospitals and other early childhood providers Identify best practices for SEN identification and response See Issues and Options for Substance Exposed Newborn Identification and Response Service delivery:  DSS: central office and area offices  Early Intervention (EI): DPH & local programs  Substance abuse (SA): DPH BSAS & Institute for Health & Recovery  Parent-to-parent support: Federation for Children with Special Needs

Progress to Date Cambridge-Somerville site:  Started in February 2007  25 SEN cases at DSS  13 offered and accepted AHH  A wide range of outcomes Fitchburg-Leominster site:  Starting in February 2008 Springfield site  Start targeted for Sept. DSS and BSAS funding $25,000 each for this year and next for FS Specialists at the 2 newer sites

Contact Information Kate Roper, MECCS Project Director ma.us Massachusetts Department of Public Health Division of Perinatal, Early Childhood & Special Health Needs 250 Washington Street, 5 th Floor Boston, MA John Lippitt, A Helping Hand Project Director ma.us Massachusetts Department of Public Health Division of Perinatal, Early Childhood & Special Health Needs 250 Washington Street, 5 th Floor Boston, MA 01208