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.

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Implementing Part C Provisions Required Under

CAPTA and IDEA

Steven Rosenberg, Ph.D.Cordelia Robinson, Ph.D., RNUniversity of Colorado at Denver and Health Sciences Center

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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.

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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.

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Child Welfare and Part C

How common are developmental problems in young maltreated children?

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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)

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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)

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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

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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.

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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

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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

Lower Upper

No Delay 109,920 70.4% 64.5% 75.7%

Delay 46,178 29.6% 24.3% 35.5%Number of cases surveyed = 1138Estimated number of victimized children under 3 = 156,000

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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

Lower Upper

No Delay 83,435 53.5% 46.2 60.5

Delay 72,664 46.5% 39.5 53.8

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Summary

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

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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

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• 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

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• 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

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Question

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

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Agreement Between Caseworker Identification and

Developmental Assessments Child need for developmental or behavioral services

Assessed Delay

Worker Identification

Percent of Total

95% Confidence Interval

Upper Lower

Delayed -Narrow

Identified 25.8% 18.8% 34.3%

Not Identified 74.2% 65.7% 81.2%

No DelayIdentified 14.8% 11.1% 19.5%

Not Identified 85.2% 80.5% 88.9%

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Summary

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

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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

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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

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Essential Participants

• Part C

• Social services, Child Protective Services

• Health care systems

• Representatives of the courts, Guardians ad litem, CASA volunteers

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Implementation of CAPTA AND IDEA

Processes that need to be addressed:

•Referrals

•Screening

•Evaluation

•Services and supports

•Coordination of funding

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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?

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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?

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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

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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

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Implementation will Require Adequate Workforce Capacity

Staff are needed to:

• Implement screening

• Implement evaluations

• Provide services

• Coordinate service plans

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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

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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

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Experience from the Field

New MexicoAndy Gomm, Program ManagerLong Term Services Division, State Department of Health

Delaware JoEllen Kimmey, Division of Family Services Liaison and Family Services Coordinator

GeorgiaStephanie Moss, Part C CoordinatorOffice of Children with Special Needs, Babies Can't Wait ProgramDivision of Public Health, Family Health Branch

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This work has been supported by grants from the U.S. Department of Education, OSEP,

#H324T99026Maternal and Child Health Bureau

#6T73MC00011-05Administration for Developmental Disabilities

#99DD0561