1. 1 Implementing Part C Provisions Required Under CAPTA and IDEA Steven Rosenberg, Ph.D. Cordelia Robinson, Ph.D., RN University of Colorado at Denver and Health Sciences Center

2. 2 Child Welfare and Part C In the past three years the Child Abuse Prevention and Treatment Act (CAPTA), and the Individuals with Disabilities Education Act (IDEA) have been amended to require state child welfare and Part C early intervention systems to establish procedures for the referral of maltreated and drug exposed infants and toddlers to Part C early intervention services.

3. 3 Child Welfare and Part C The report language that accompanied the final IDEA conference bill indicated that every child described in Sec. 637(a)(6)(A) and (B) should be screened by a Part C provider or designated primary referral source to determine whether a referral for an evaluation for Part C early intervention services is warranted. IDEA does not require every child to receive full evaluations or be enrolled in Part C early intervention services.

4. 4 Child Welfare and Part C How common are developmental problems in young maltreated children?

5. 5 Young Children Are at Greater Risk of Maltreatment Children ages birth to 3 years had the highest rates of victimization at 16.0 per 1,000 children (U.S. Department Health and Human Services, 2004)

6. 6 Proportion of Children in Out- of-Home Placements Although we often think of children who receive child welfare services as those children who live in foster care 85% of all victimized children are not removed from their homes. From Child Maltreatment 2003 (ACYF, 2005)

7. 7 Children in the Child Welfare System Have High Rates of Disability Studies indicate high rates of developmental problems among maltreated children. Findings limited by sampling –Often clinical samples of children in foster care –Often do not include very young children –No nationally representative samples

8. 8 A Representative Sample is Needed The National Survey of Child and Adolescent Welfare (NSCAW) provides developmental assessments of a nationally representative sample of very young maltreated children.

9. 9 NSCAW Developmental Measures Cognitive Abilities –Battelle Developmental Inventory – Cognitive Scale Developmental Delay Communication – Preschool Language Scale-3 - Total Communication Score Daily Living Skills –Vineland Screener – Daily Living Skills

10. 10 Rate of Developmental Delays Narrow Eligibility Criteria Children scoring below 1.5 sd on two measures or below 2 sd on one measure Summary of NSCAW Assessments Estimated Population Size Percent of Total 95% Confidence Interval LowerUpper No Delay 109,92070.4%64.5%75.7% Delay 46,17829.6%24.3%35.5% Number of cases surveyed = 1138 Estimated number of victimized children under 3 = 156,000

11. 11 Rate of Developmental Delays Moderate Eligibility Criteria Children scoring below 1 sd on two measures or below 1.5 sd on one measure Summary of NSCAW Assessments Estimated Population Size Percent of Total 95% Confidence Interval LowerUpper No Delay 83,43553.5%46.260.5 Delay 72,66446.5%39.553.8

12. 12 Summary Substantial numbers of young children who are maltreated have developmental delays that make them likely to be eligible for Part C services

13. 13 CAPTA’s Possible Impact on Part C Enrollment* Part C serves about 2 percent of the population under three years of age (227,000). About 1 percent of all children, under three years of age, are substantiated as victims of abuse or neglect (125,000). *Based on counts for the year 2000

14. 14 If we assume that 30 percent of maltreated children are Part C eligible; That 25 percent of these children are already enrolled in Part C, refuse services or cannot be contacted; We estimate an increase in Part C enrollment of about 12 percent. CAPTA’s Possible Impact on Part C Enrollment Narrow Eligibility Criteria

15. 15 If we assume that 47 percent of maltreated children are Part C eligible; That 25 percent of these children are already enrolled in Part C, refuse services or cannot be contacted; We estimate an increase in Part C enrollment of about 19 percent. CAPTA’s Possible Impact on Part C Enrollment Moderate Eligibility Criteria

16. 16 Question Can Child Protection caseworkers accurately identify young children with developmental delays?

17. 17 Agreement Between Caseworker Identification and Developmental Assessments Child need for developmental or behavioral services Assessed Delay Worker Identification Percent of Total 95% Confidence Interval UpperLower Delayed - Narrow Identified25.8%18.8%34.3% Not Identified74.2%65.7%81.2% No Delay Identified14.8%11.1%19.5% Not Identified85.2%80.5%88.9%

18. 18 Summary Based upon NSCAW findings child protection caseworkers are unable to identify most children who need developmental services

19. 19 In many communities the Part C system’s capacity to serve a large influx of children and families from child welfare could be limited by: Insufficient service capacity Difficulty in coordinating funding Lack of staff prepared to work with children, who are maltreated, and their families Summary

20. 20 Implementation of CAPTA AND IDEA Systems will need to coordinate regarding: Compatibility of Policies and Procedures Coordination of Funding Streams Workforce Capacity Workforce Skill Sets

21. 21 Essential Participants Part C Social services, Child Protective Services Health care systems Representatives of the courts, Guardians ad litem, CASA volunteers

22. 22 Implementation of CAPTA AND IDEA Processes that need to be addressed: Referrals Screening Evaluation Services and supports Coordination of funding

23. 23 Questions about Child Characteristics 1.What is Part C definition in the state? 2.What percent of the 0-3 population is being served? 3.Is there much local variability in who is served?

24. 24 Questions about Child Characteristics 4.Is the Part C population representative of the state? 5.What are the characteristics of the CPS population in the state? 6.What proportion of birth to three are in out of home placement? Kinship care?

25. 25 Implementation will Require Interagency Collaboration Shared meaning and understanding among systems Investment at all levels: State and local; supervising and direct care Processes to facilitate referrals Responsiveness across systems

26. 26 Implementation will Require Coordination of Funding Steams What role does Medicaid play in funding Part C screening and evaluations in your state? How is behavioral health care accessed by young children? What role does Medicaid play for children in child protection

27. 27 Implementation will Require Adequate Workforce Capacity Staff are needed to: Implement screening Implement evaluations Provide services Coordinate service plans

28. 28 Implementation will Require Different Skills Sets Staff will need to be able to: Engage families Provide instruction on basic care – nutrition, sleep, consistency in routines Address social-emotional development and challenging behaviors Provide direct instruction to caregivers

29. 29 Implementation will Require Coordination with Primary Health Care Determine state requirements regarding children being seen by a physician What role does/could primary care play in screening and evaluation? May have good rapport with family Need to authorize care

30. 30 Experience from the Field New Mexico Andy Gomm, Program Manager Long Term Services Division, State Department of Health Delaware JoEllen Kimmey, Division of Family Services Liaison and Family Services Coordinator Georgia Stephanie Moss, Part C Coordinator Office of Children with Special Needs, Babies Can't Wait Program Division of Public Health, Family Health Branch

31. 31 This work has been supported by grants from the U.S. Department of Education, OSEP, #H324T99026 Maternal and Child Health Bureau #6T73MC00011-05 Administration for Developmental Disabilities #99DD0561