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Please use the chart paper to share your thoughts on the following question:. Consider your work with families experiencing abuse and neglect--- what challenges do you encounter?. Meeting the Requirements of CAPTA and IDEA Implications for Part C Early Intervention. Marian Jarrett, Ed.D.

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Please use the chart paper to share your thoughts on the following question l.jpg

Please use the chart paper to share your thoughts on the following question:

Consider your work with families experiencing abuse and neglect---

what challenges do you encounter?


Marian jarrett ed d karin spencer ma george washington university l.jpg

Meeting the Requirements

of CAPTA and IDEAImplications for Part C

Early Intervention

Marian Jarrett, Ed.D.

Karin Spencer, MA

George Washington University


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Session Agenda

  • Requirements of CAPTA and IDEA

  • Challenges for Early Intervention

  • Abuse and Neglect of Infants and Toddlers

  • Red Flags

  • Assessment

  • Intervention Strategies


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CHILD ABUSE AND NEGLECT:DEVELOPMENTAL CONSEQUENCES

  • Difficulty forming relationships in preschool and early adolescence

  • Lower levels of school achievement, especially in adolescence

  • More likely to require special education—72% by 3rd grade

  • More behavior problems

  • More likely to use drugs and alcohol


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CAPTA

  • The Keeping Children Safe Act of 2003 amended the Child Abuse Prevention and Treatment Act (CAPTA)

  • As of July 1, 2004, referral required “of a child under the age of 3 who is involved in a substantiated case of child abuse or neglect to early intervention services funded under Part C of the Individuals with Disabilities Education Act (Sec.106(b)(A)(xxi)).


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PART C of IDEA 2004

SEC. 637.State Application and Assurances

“. . . require the referral for early intervention services under this part of a child under the age of 3 who—

(A) Is involved in a substantiated case of child abuse or neglect; or

(B)Is identified as affected by illegal substance abuse, or withdrawal symptoms resulting from prenatal drug exposure;”


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IMPORTANCE OF CAPTA

  • Children reported to CPS and/or in foster care experience many developmental delays – including social-emotional delays.

  • Infants and toddlers referred to CPS need access to services provided by early intervention system


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THE INTENTION OF THE LAW

  • Every child referred under CAPTA shall be screened by a Part C provider or designated primary referral source to determine if a referral for an evaluation for EI service is warranted.

  • All children are to be screened, but not all will be referred.

    (IDEA Infant and Toddler Coordinators Association (ITCA), 2004)


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CHALLENGESPredicted Increases in Part C

  • Before CAPTA, 7% of infants and toddlers in Part C were also in Child Welfare System

  • After CAPTA, predictions:

    • 70% increase in referrals

    • 20-30% increase in enrollment

      What is actually happening??


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THE CULTURE OF THE CHILD WELFARE SYSTEM

  • Life and death responsibilities

  • Staff shortages/high caseloads

  • Inadequate supervision

  • Public expectation of a punitive system of accountability

  • Risk of violence

  • Adversarial relationships with families

  • Voluntary or mandated services

(Cohen, 2005)


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THE CULTURE OF THE EARLY INTERVENTION SYSTEM

  • Each state defines eligibility criteria

  • Comprehensive, multidisciplinary evaluations and intervention

  • Meet developmental needs of child and needs of the family

  • Family centered services based on the IFSP

  • Services are voluntary


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NEED FOR COLLABORATION BETWEEN EI & CW

  • Clear definition of roles and responsibilities

  • Development of trust

  • Explanation of EI and CW to families

  • Joint visits to families

  • Procedures to follow when families refuse services

    (Cohen, 2005)


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CHALLENGES TO EARLY INTERVENTION

  • Increased workload

  • Assessments to identify social emotional needs

  • Interventions with children and parents

  • Enhance ability to address parental issues that affect infant mental health


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CAPTA CHALLENGES TO CHILD WELFARE

  • Work to educate families to accept referral to EI

  • CW does not know the potential of EI

  • Limited staff available/capacity to address developmental problems

  • Supervisors do not want to add another mandate to workers’ job

  • Confidentiality issues


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CHALLENGES OF WORKING WITH PARENTS

  • Majority living in poverty

  • Poor housing conditions

  • Parental substance abuse and mental health issues are common

  • Mothers in abusive relationships

  • Multi-stressed, chaotic and unstable

    families


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CHALLENGES OF WORKING WITH PARENTS

  • Inadequate basic care giving skills

  • Lack structure, limits and routines

  • Many lack knowledge of typical child development, behaviors and needs

  • Discipline is punitive in nature – expression of parent’s frustration


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CHALLENGES OF WORKING WITH PARENTS

  • Lack formal and informal supports

  • Difficulty trusting others and forming healthy relationships

  • History of poor relationships and experiences with other “helping professionals”

  • Generational cycle of abuse

  • Overwhelmed by their own needs


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EVERYDAY IN AMERICA

  • 4 children are killed by abuse or neglect

  • 2,383 children are confirmed as abused or neglected.

    (Children’s Defense Fund, 2007)


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Everyday In America

(Children’s Defense Fund, 2007)


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Virginia’s Children

Child Population1,789,782

Living in Poverty 238,312

Child A&N Victims 6,959

(CLASP, 2006)


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ABUSE AND NEGLECT AND DEVELOPMENTAL DISABILITIES

  • Children who experience abuse and neglect are at high risk for

    • developmental delays

    • psychological, behavioral and health problems

    • Social emotional development


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ABUSE AND NEGLECT AND DEVELOPMENTAL DISABILITES

53% of all children 3-24 months whose families were investigated for maltreatment were classified as high risk for developmental delay or neurological impairment.


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MALTREATED INFANTS AND TODDLERS

  • Infants represent ~5% of the children in the US and 10% of all child maltreatment victims. (ACF, 2005).

  • Infants and toddlers most likely to experience recurrence of maltreatment

  • Child victims with a disability-- over 50% more likely to experience recurrence maltreatment


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INFANTS AND TODDLERS IN FOSTER CARE

  • 80% with prenatal drug exposure

  • 40% born low birthweight/premature

  • Many with acute and chronic health problems

  • More than 50% have developmental delays or disabilities; few linked to EI

  • One-third of infants discharged will

    re-enter the child welfare system


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THE BRAIN AND EMOTIONAL DEVELOPMENT

  • Infants need sensitive, responsive care for parts of brain that control emotions to develop properly

  • Caregivers effectively manage baby’s emotional states

  • Baby develops neurological and emotional foundations

  • Enables baby to gradually learn to regulate emotions on her own


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ASSOCIATED FACTORS

  • Factors associated with abuse and neglect contribute to developmental problems

    • Poverty

    • Poor nutrition

    • Lack of prenatal and medical care

    • Substance abuse

      (Shonkoff & Phillips, 2000)


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CONSISTENT, RESPONSIVE CARE NEEDED

But - some parents/caregivers:

  • Reject bids for emotional/physical closeness

  • Are punitive and abusive

  • Suffer from depression

  • Abuse drugs

  • Are overwhelmed by meeting own needs and need of their children


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MENTAL HEALTHIS…

  • The successful performance of mental function, resulting in:

    • Productive activities

    • Fulfilling relationships

    • Ability to adapt to change and to cope with adversity…

  • Mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience, and self esteem.


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INFANT MENTAL HEALTH IS…

  • The developing capacity to experience, regulate and express emotions

  • Form close and secure interpersonal relationships

  • Explore the environment and learn

  • In the context of family, community and cultural expectations for young children

  • Synonymous with healthy social emotional development

(Hunter, 2006: Adapted from Zero to Three)


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SOCIAL EMOTIONALRED FLAGS

Behavioral responses to stress and trauma of abuse and neglect

  • Anger and rage

  • Anxiety and hyper vigilance

  • Emotional shut down

  • Bodily reactions


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SOCIAL EMOTIONAL RED FLAGS

  • Chronic sleeping, feeding problems

  • Excessive fussiness, crying

  • Unusually difficult to be consoled

  • Minimal interest in social interaction

  • Avoids eye contact and physical closeness

  • Does not turn to familiar adult for comfort

  • Unable to comfort or console self


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SOCIAL-EMOTIONAL ASSESSMENTS

  • Hawaii Early Learning Profile (HELP)

  • Ages & Stages Questionnaire: Social-Emotional (ASQ:SE)

  • Brief Infant-Toddler Social Emotional Assessment (BITSEA)

  • Infant-Toddler Social Emotional Assessment (ITSEA)

  • The Ounce Scale, Social & Emotional Development


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SOCIAL EMOTIONAL ASSESSMENTS

  • Early Coping Inventory

  • Devereux Early Childhood Assessment (DECA)

  • Vineland SEEC: Vineland Social- Emotional Early Childhood Scale

  • The Functional Emotional Assessment Scale (Greenspan & DeGangi)


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INTERVENTIONSThings to remember...

  • Build relationships over time

    • Introduce self, program, purpose

    • Review confidentiality policy

    • Take cues from parents

    • Keep visits and be on time

  • Basic needs come first


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INTERVENTIONSFostering resilience

  • Establish and facilitate caring relationships

  • Communicate high expectations

  • Provide opportunities for participation


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INTERVENTIONSHome Visit Tips

  • Relate to the parent first

  • Avoid bonding directly with the child

  • Ask open ended questions

  • Ask about pregnancy, infancy and parenthood

  • Avoid making too many suggestions

  • Listen, listen, listen


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INTERVENTIONSEnhancing parent-child relationships

  • Relationships change relationships-use the parallel process

  • Parent’s experiences as a child

  • Notice and comment on parental, child and relationship strengths

  • Use natural environment

  • Incorporate activities that involve interaction

  • Dispel myths


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INTERVENTIONSStrategies

  • Offer developmental guidance

  • Celebrate milestones

  • Speak for the baby

  • Develop strategies and supports together


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INTERVENTIONSSTRATEGIES

  • Bringing it back to baby

  • Being OK with silence

  • When a family “no shows”

  • When parents are clearly unable to engage


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PART C PROGRAMS AND PROVIDERS CAN…

  • Provide high quality home visits

  • Emphasis on Service Coordination

  • Focus on social-emotional domain

  • Learn about local Child Welfare system and services

  • Take care of ourselves as we do this important work


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TAKING CARE OF OURSELVES

  • Be self aware:

    • How we are is as important as what we do

    • Beware of burn out

    • Know our limits

    • Pay attention to our own feelings

  • Remember that parents are responsible for the choices they make, not us


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INSPIRATIONFROM A PARENT

Courage doesn’t always roar.

Sometimes courage is the quiet voice at the end of the day saying,

“I will try again tomorrow.”

-Anonymous-


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CONTACT INFORMATION

  • Marian H. Jarrett, EdD

    mjarrett@gwu.edu

  • Karin H. Spencer, MA

    kspencer@gwu.edu


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REFERENCES & RESOURCES

Barnett, D. (1997). The effects of early intervention on maltreating parents and their children. In M. J. Guralnick (Ed.), The effectiveness of early intervention (pp. 147-170). Baltimore: Paul H. Brookes.

Bono, K. E., Bolzani Dinehart, L. H., Claussen, K. G., Mundy, P. C., & Katz, L. F. (2005). Early intervention with children prenatally exposed to cocaine: Expansion with multiple cohorts. Journal of Early Intervention, 27(4), 268-284.

Cohen, E. P. (2005). Building bridges between child welfare and early intervention programs. George Washington University Community Forum, February 11, 2005, Washington, DC.


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REFERENCES & RESOURCES

Department of Health and Human Services (2005). Child maltreatment 2003: Reports from the states to the National Child Abuse and Neglect Data Systems - national statistics on child abuse and neglect. Washington, DC: U.S. Government Printing Office.

Dicker, S., Gordon, E., & New York State Permanent Judicial Commission on Justice for Children (Eds.). (2004). Ensuring the healthy development of infants in foster care: a guide for judges, advocates and child welfare professionals. Washington, DC: Zero To Three.

Early Head Start National Resource Center at Zero to Three. (n.d.). In Home visitor's hand book for the Head Start home-based program option. Retrieved from http://www.headstartinfo.org/pdf/EHS-Home-VisitorHdbk.pdf


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REFERENCES & RESOURCES

Early Identification Project & University of Colorado Health Sciences Center (Eds.). (2003). Interagency collaboration: A guidebook for child welfare and Part C agencies (Vol.). Denver: JFK Partners.

Egeland, B., & Erickson, M. F. (2004). Lessons from STEEP: Linking theory, research and practice for the well-being of infants and parents. In A.J. Sameroff, S.C. McDonough & K.L. Rosenblum (Eds.), Treating parent-infant relationship problems: strategies for intervention (pp. 213-242). New York: The Guilford Press.

Erickson, M. F., & Kurz-Riemer, K. (1999). Infants, toddlers and families: A framework for support and intervention. New York: The Guilford Press.


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REFERENCES & RESOURCES

Hawley, T., & Gunner, M. (2000). Starting smart: How early experiences affect brain development (2nd ed.). Washington, DC: Ounce of Prevention Fund and Zero to Three. Lippitt, J. A. (2005). Implementing referrals of abused or neglected children to EI: The MECLI. George Washington University Community Forum, February 11, 2005, Washington, DC.

Jaudes, P. K., & Shapiro, L. D. (1999). Child abuse and developmental disabilities. In J. A. Silver, B. J. Amster & T. Haecker (Eds.), Young children in foster care: A guide for professionals (pp. 213-234). Baltimore: Paul H. Brookes.

Ounce of Prevention & ZERO TO THREE. (1998). Ready to succeed: The lasting effects of early relationships. Authors.


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REFERENCES & RESOURCES

Pawl, J. H. (1995). The therapeutic relationship as human connectedness: Being held in another's mind. Zero To Three, 15(4), 1-5.

Rosenberg, S., & Robinson, C. (2003). Is Part C ready for substantiated abuse and neglect? Zero to Three, 24(2), 45-47.

Sameroff, A. J., McDonough, S. C., & Rosenblum, K. L. (Eds.). (2004). Treating parent-infant relationship problems: Strategies for intervention. New York: The Guilford Press.

Shonkoff, J. P., & Phillips, D. A. (Eds.). (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.

ZERO TO THREE Infant Mental Health Resource Center. (n.d.). About mental health. Retrieved October 4, 2005, from http://www.zerotothree.org/Search/index2.cfm


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