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Child Welfare Early Intervention Initiative in Philadelphia

Jan 22, 2016




Child Welfare Early Intervention Initiative in Philadelphia. Julia Alexander, M.S. Department of Human Services, Philadelphia, PA. Session Outline. Scientific Context: Wellbeing, Risk & Prevention Policy & Law Models & Implementation Responding to Challenges. Children’s Wellbeing. - PowerPoint PPT Presentation

  • Child Welfare Early Intervention Initiative in PhiladelphiaJulia Alexander, M.S.Department of Human Services, Philadelphia, PA

  • Session OutlineScientific Context: Wellbeing, Risk & PreventionPolicy & LawModels & ImplementationResponding to Challenges

  • Childrens WellbeingResilience an individuals positive adjustment despite experiencing adversity & significant threats to wellbeingProtective Factors characteristics located within individuals and their environments that serve to increase resilience and positive adjustment

    Garmezy, 1970; Masten and Coatsworth, 1998

  • ResilienceEarly examinations of resilience focused on childrens characteristics e.g., good health, self-regulation, self-esteem, etc.Subsequent research examined characteristics of families and communitiesMore recently, resilience is being viewed as multidimensional children can make positive adaptions in some domains but remain vulnerable in other domainsLuthar, Cicchetti & Becker, 2007

  • Protective FactorsIntelligence multidimensional!Temperament easy, difficult, slow to warm upCoping styles talking it out vs. acting outPositive social supportRacial socialization and racial identityLuthar, Cicchetti & Becker, 2007; Miller, 1999

  • Scientific Context of Individuals with Disabilities Improvement Act and Keeping Children and Families Safe Act (CAPTA)Many of the risk factors that are associated with public child welfare system intervention are also associated with developmental delays among infants, toddlers and young children. Secondary conditions related to early delays include behavioral health problems and poor school achievement.Strong evidence-base confirming relationships among risk factors and childrens outcomes supported advocates efforts to change the law to drive systems collaboration.

    Aber, Jones & Cohen, 2000; Anderson et al, 2003; Bolger & Patterson, 2001.

  • Eligibility for Part C Infant-Toddler Early Intervention

    Presence of a specific developmental delay cognitive, language, socioemotional, or motor.Medical condition with a high probability of delay e.g., Trisomy 21 (Down Syndrome), Failure to Thrive, Fetal Alcohol Syndrome, microencephaly, etc. Judy Silver, Ph.D., The Childrens Hospital of Philadelphia

  • Risk Factors & Developmental DelayOther conditions and environmental risk factors associated with delays: PovertyLead exposureLow birth weight Parental substance abuseExposure to community and family violence

  • Risk Factors & Developmental DelayRisk factors are known to:

    Occur in clustersOccur at more than one level of the ecological model (person, family and/or community levels)Have exponentially cumulative effects

    Beckwith, 2000; Bronfenbrenner, 1979

  • PovertyInfants and toddlers are more vulnerable to the effects of poverty compared to individuals experiencing poverty at later stages of development.Family characteristics with the strongest relationship to poverty among children under age 5 years are parental education, marital status and employment status.

  • PovertyPoverty is also associated with several conditions that raise the risk of poor outcomesLow birth weightLead exposureSingle parent householdCognitive delays

    Zeanah, Boris & Larrieu, 1997

  • Low Birth WeightNeonatal weight of less than 2500 grams (5 lbs., 8 oz.) affects approximately 10% of live US births.Advances in neonatal medicine have resulted in increasing numbers surviving.Increased risk of poor health, sensory impairments, cognitive and motor delays, learning disordersCigarette smoking, exposure to alcohol and other drugs, poor maternal health & nutrition and adolescent motherhood are mechanisms linking poverty to low birth weight.Aber, Jones & Cohen, 2000; Meyers, Alexander, Silver & Vogel; Minde, 2000

  • Lead Exposure

    Children most often exposed by eating leaded paint chips or breathing the dust of old deteriorating urban housing.Urban children have lead levels up to 8 times higher than non-urban children.Exposure linked to growth stunting, hearing impairments, kidney damage, decreased intelligence scores, reading disorders, behavioral problems, poor achievement.Brookes-Gunn& Duncan, 1997: Lanphear, Dietrich, Auinger & Cox, 2000

  • Parental Substance AbuseAt least 70% of the families who enter the child welfare system have substance abuse as an issue related to impaired parental role functioningFamilies most often headed by single parenting women with a complex array of problems e.g., abuse, poor educational and employment histories, inadequate housing, etc.Increased likelihood of child neglectWomen more likely to relapse due to pressures of single parenthoodNational Center on Addiction and Substance Abuse, 2001; Semidei, Radel & Nolan, 2001

  • Exposure to Violence - Child MaltreatmentStrongest single predictor of poor outcomes including delays, poor achievement & behavioral disordersEarly discussions focused on the physical injuries of the battered child.Maltreated children now understood to be at greater risk due to the impact of adverse experiences on their maturing cognitive, emotional and other systems. Kempe et al, 1962; Kim & Cicchetti, 2004

  • Exposure to Violence Child MaltreatmentCompromised capacity to resolve stage- salient developmental challenges at their optimal timeHigher likelihood of developmental delaysHigher rates of internalizing and externalizing symptoms, problems with peers, poor school adjustmentHigher likelihood of experiencing other traumatic events e.g., domestic violence, loss of a parent, etc.Bolger & Patterson, 2001; Kaufman & Henrich, 2000: Rogosch, Cicchetti & Aber, 1995

  • Cognitive Development & Language AcquisitionMaltreated children less able to using words to describe thoughts and feelingsStudy found that maltreated children had smaller vocabularies, less word knowledge and greater rates of syntactic delaysMaltreating mothers language impoverished even after controlling for education and socioeconomic status Sequelae of speech and language problems include learning and behavioral disordersEigsti & Cicchetti, 2004

  • Language Development, Maltreatment and School ReadinessSchool readiness = pre-academic cognitive skills and socioemotional characteristics assess prior to beginning first gradeEmergent literacy = the precursor skills and behaviors that precede formal readingEmergent literacy facilitated in linguistically rich environmentsKnowledge & skills children demonstrate at the start of first grade contributes the most to early academic achievement even when socioeconomic status is controlled Byrnes, 2006; La Paro & Piata, 2000

  • Language Development, Maltreatment & Self-RegulationLanguage acquisition has a strong relationship with socioemotional development Infants cues for care and comfort are among the earliest language precursors.Caregivers interpreting and responding appropriately sets the foundations for more complex preverbal communications.Insensitive or frightening caregiver responses impact infants developing stress regulatory systems.Fewer resources to devote to typical maturational challenges

    Prizant, Wetherby & Roberts, 2000

  • Language Development, Maltreatment & Self-RegulationInfants modulation of arousal is adaptiveReduces negative affective statesMaintains arousal to an optimal, performance-enhancing rangeSupports attention to stimuliHelps to preserve relationshipsReduces likelihood of behavioral problemsBraungart-Rieker & Stifter, 1996; Rothbart & Bates, 1998

  • How does early intervention help?

  • Interventions as Protective FactorsProtective factors serve to increase childrens resilience in high risk circumstances and help to avert poor outcomes.An empirical grasp of protective factors is essential to the task of focusing interventions on areas theory & research suggest will have the most impactMasten & Coatesworth, 1998; Olds, 2005

  • Interventions as Protective factorsIn program planning, nodal points within the ecological/transactional model become the loci of interventions.Risk factors affecting the caregiving context are transmitted through interactions between parents and their childrenUnderstanding of the role of parents as mediators of risk and childrens outcomes points to the importance of family-focused interventionsSameroff & Fiese, 2000

  • Early Intervention ServicesAn evidence-based has been established for the efficacy of early intervention services for samples of infants and toddlers who fall within specific disability and risk categories, e.g., cognitive delays, parental substance abuse, etc.Guralnick, 1997

  • Early Intervention ServicesOccupational, Physical, Speech/Language Therapies, Special instruction, Assistive Technology Devices, Nutrition Services

    Case management & some health-related services such as transportation assistance

    Parent training & support to enhance their childs development

    Respite care.

    Spiker & Silver, 1999

  • Early Intervention ServicesIn addition to the impact of early intervention on specific areas of delay, services affect mechanisms by which risks are transmitted:Quality of parent-child interactions (e.g., intrusiveness, sensitivity, etc.)Parent-mediated play (e.g., developmentally appropriate toys, games, etc.)Parent-mediated social experiences (e.g., supervised peer interactions, community events, etc.)Guralnick, 1997

  • Early Intervention ServicesStrong philosophical orientation toward caregiver-child relationships and natural environmentsFamily focus with home visiting improves access and pa