Healing the child in juvenile court applying an infant mental health approach
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Healing the Child in Juvenile Court: Applying an Infant Mental Health Approach. Joy D. Osofsky, Ph.D. LSU Health Sciences Center, New Orleans In collaboration with Judge Cindy Lederman 11 th Circuit Juvenile Court, Miami University of Oregon Law School, March, 2006.

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Healing the child in juvenile court applying an infant mental health approach

Healing the Child in Juvenile Court: Applying an Infant Mental Health Approach

Joy D. Osofsky, Ph.D.

LSU Health Sciences Center, New Orleans

In collaboration with Judge Cindy Lederman

11th Circuit Juvenile Court, Miami

University of Oregon Law School, March, 2006


Portrait of young children in foster care in u s

Portrait of Young Children in Foster Care in U.S.

  • Children under age 5 are the fastest growing population in child welfare

  • Infants comprise 1 in 5 children in foster care

  • Infants remain in foster care twice as long


Prevalence rates of developmental delay

FOSTER CARE

Overall Delay: 60%

Language – 57%

Cognitive – 33%

Gross motor – 31%

Growth problems – 10%

GENERAL POPULATION

Overall Delay:

4% to 10%

Leslie, L.K. et al (2004) Journal of Developmental and Behavioral Pediatrics

Prevalence Rates of Developmental Delay


Prevalence of psychiatric problems

FOSTER CARE

-25% to 40% under age 6 have significant behavioral problems, most displaying externalizing behaviors (aggression, anger)

GENERAL POPULATION

3% to 6%

Leslie, L.K. et al. (2004). Journal of Developmental and Behavioral Pediatrics

Prevalence of Psychiatric Problems


Consequences of developmental and behavioral problems

Consequences of Developmental and Behavioral Problems

  • Problems in both of these areas have been correlated with longer stays in care

  • Reduced likelihood of reunification or adoption

  • School related problems

  • Adolescent at risk behaviors

  • Placement changes


Trauma for infants and toddlers in foster care

Trauma for infants and toddlers in foster care

  • Separation from parents, usually sudden and traumatic

  • Difficult experiences precipitating placement

  • Frequently leads to temporary or permanent impairment in all areas of development


11 month old traumatized child

11 month old traumatized child


What we know

What We Know

  • Early interventions increase the odds for favorable developmental outcomes

  • The developing brain has the ability to compensate for early deprivation

  • Early intervention can decrease later problems, such as juvenile arrests and school dropout


Healing the child in juvenile court applying an infant mental health approach

OUR TOOLS:The lawand science


Adoption and safe families act of 1997

Adoption and Safe Families Act of 1997

  • Child’s health and safety are paramount concerns in court proceedings

  • Emphasis on permanency and adoption

  • Stronger court role in monitoring the process


Asfa regulations

ASFA Regulations

  • Federal ASFA regulations specifically hold States accountable for providing services to address the "safety, permanency and well-beingof children and families." (45 C.F.R. Part 1357 §1355.33 b (2))

  • States must ensure that:

    • "families have enhanced capacity to provide for their children's needs;

    • children receive appropriate services to meet their educational needs; and

    • children receive adequate services to meet their physical and mental health needs." (45 C.F.R. Part 1357 §1355.34 b(1)(iii))


A focus on healing while adjudicating the case

A focus on healing while adjudicating the case

  • Understanding what babies in juvenile court need

  • Changing the idea that babies are notreally harmed

  • Introducing evaluations of babies and toddlers

  • Making referrals for services


It is rarely the case that a maltreated infant has no symptomatology

It is rarely the case that a maltreated infant has no symptomatology.


Relationship specific traumatization in 2 year old

Relationship Specific Traumatization in 2 year old


Healing the child in juvenile court applying an infant mental health approach

Consequences of Child Maltreatment

  • Maltreatment places children at risk

    • INFANCY & TODDLERHOOD (0-5)

      • poor attachment

      • delayed developmental milestones

    • SCHOOL AGE (6-12)

      • aggressive behavior

      • social isolation

      • learning problems

    • ADOLESCENCE (13-18)

      • school failure and school dropout

      • delinquency and later criminal behavior


From neurons to neighborhoods the science of early childhood development

From Neurons to Neighborhoods: The Science of Early Childhood Development

Committee on Integrating

the Science of Early Childhood Development

Board on Children, Youth, and Families

Institute of Medicine

National Research Council


Core concepts of development

Core Concepts of Development

  • Early environments matter and nurturing relationships are essential

  • Human relationships, and the effects of those relationships, are the building blocks of development.

  • The course of development can be altered in early childhood by effective interventions that change the balance between risk and protection

  • Both biology and experience matter : nature and nurture.

    From Neurons to Neighborhoods,2000


Healing the child in juvenile court applying an infant mental health approach

How children feel is as important as how they think, and how they are treated is as important as what they are taught, particularly with respect to their readiness to succeed in school.


Healing the child in juvenile court applying an infant mental health approach

  • How Early Experiences Affect Brain Development

  • Parents play a crucial role in providing the nurturing and stimulation that children require

  • A child’s experience in the first few years determines how his brain will develop

  • They need information and support to develop good parenting skills

  • Starting Smart: How Early Experiences Affect Brain Development.

  • An Ounce of Prevention Fund and Zero to Three Paper, 1998.


Pruning

Pruning

Early Childhood

Later Childhood

Newborn


The still face

The Still Face


Healing the child in juvenile court applying an infant mental health approach

Signs in the baby that emotional needs are not met

  • Sad affect

  • Lack of eye contact

  • Weight loss

  • Lack of responsiveness

  • Sensory processing problems

  • Rejects being held or touched


Healing the child in juvenile court applying an infant mental health approach

Signs of emotional problems

In toddlers/ preschoolers

  • Very aggressive behavior

  • Attentional problems and deficits

  • Lack of attachment

  • Sleep problems or disorders


Healing the child in juvenile court applying an infant mental health approach

Conditions of the caregivers

that contribute to baby’s

emotional problems

  • Drug addictions

  • Untreated depression

  • Domestic violence

  • Parent’s own past history and experiences

  • Otherwise emotional unavailability


Depressed caregiver

Depressed Caregiver


Empirical findings

Empirical Findings

  • Well designed interventions can enhance the short term performance of children living in poverty

  • The impact on the cognitive development of at risk young children is greater when the intervention is goal-oriented and child-directed

  • Fade-out phenomenon exists


Healing the child in juvenile court applying an infant mental health approach

The Infant Health and Development ProgramAn 8 site clinical trial designed to evaluate the efficacy of comprehensive early intervention in reducing developmental and health problems in low birth weight, premature infants

  • 985 infants

  • 5 ½ pounds or less

  • Gestational age of 37 weeks or less

  • 3 year study


Healing the child in juvenile court applying an infant mental health approach

Random Assignment

  • INTERVENTION GROUP

  • Pediatric surveillance

  • Home visits (weekly for first year, biweekly thereafter)

  • Infant enrolled in Child Development Center

  • Parent education meetings

  • FOLLOW-UP GROUP

  • Pediatric surveillance


Healing the child in juvenile court applying an infant mental health approach

Results

  • The Intervention Group children showed a significant difference in cognitive development: from 6 to 13 IQ points higher

  • The Intervention Group mothers reported significantly fewer child behavior problems

  • The Intervention Group children did not have more health problems despite their participation in group care


The chicago child parent center cpc program

The Chicago Child-Parent Center (CPC) Program

15 year longitudinal study of the effects of early childhood interventions on educational achievement and juvenile arrest

Reynolds, Temple Robertson and Mann,

JAMA, May 9, 2001


Results

Results

  • Higher rate of high school completion (49.7% vs. 38.5%)

  • More years of completed education

    (10.6 vs. 10.2)

  • Lower rates of juvenile arrest

    (16.9% vs. 25.1%)

  • Less violent arrests (9% vs. 15.3%)

  • Fewer school dropouts (46.7% vs. 55%)


Healing the child in juvenile court applying an infant mental health approach

Prenatal and Infancy Home Visitation

Olds, et al. 1997, 1998, 2002, 2004


Healing the child in juvenile court applying an infant mental health approach

Elmira Home Visitation Program:the mother

  • 79% fewer verified cases of child maltreatment

  • 33% fewer subsequent births

  • Longer intervals between births

  • Less substance abuse

  • 81% fewer arrests and convictions

  • 30 fewer months on welfare


Healing the child in juvenile court applying an infant mental health approach

HOME VISITATION: the child (at 15 years)

  • Fewer sex partners

  • Reduced cigarette smoking

  • Reduced alcohol consumption

  • 50% decrease in delinquency through age 15

  • 60% decrease in running away

  • 56% fewer arrests

  • 81% fewer convictions and probation violations


Replication of home visitation findings

Replication of Home Visitation Findings

  • Three trials conducted with different populations –Elmira, Memphis, Denver

    • Fewer subsequent pregnancies and births

    • Some impact on intellectual and language functioning, esp. for low resource mothers

    • Generally more duration of partner relationships and less domestic violence

    • Effects due to improved prenatal, parental caregiving and maternal life course


Juvenile court can facilitate healing

Juvenile Court Can Facilitate Healing

  • Children in child welfare have been beaten, raped, ignored, and abandoned

  • The juvenile court needs to help these maltreated babies

  • We must break the intergenerational cycle of abuse and neglect


The case of katrina

The Case of Katrina


Katrina as a child

Katrina as a child

  • Born 1984

  • Six siblings

  • Removed from mother first in 1994, reunified and removed again in 1997

  • IQ of 68, diagnosed with adjustment disorder


Healing the child in juvenile court applying an infant mental health approach

“The children of this family have been exposed to chronic emotional neglect and are experiencing symptoms of depression, emotional impoverishment and low self-esteem, low academic achievement and aggression. There are strong indications that they have been exposed to long term family and community violence.”


Reasons for removal

home unfit for human habitation

filthy

insect infested

foul odor

no food

children dirty

7 year old retarded sibling left alone

Mother gave food stamps to her boyfriend

home site of drug related activities

children begging for food

allegations of physical abuse by boyfriend

Reasons for removal


Katrina as a mother

Katrina as a mother

  • Charles born February 1999

  • Removed from Katrina in May 1999 after Katrina ran away from foster home and left Charles with her mother

  • Father unknown

  • Termination of Parental Rights petition filed in December 2000


Interventions parent child evaluation

Interventions:Parent-Child Evaluation

  • Affect neutral to positive

  • Unable to allow exploration and initiation

  • Speech & articulation poor

  • Minimal play interactions- Mo. attempts to label and teach


Parent effectiveness

Pre and post-test measures indicate that therapy and other support services provided through the infant mental health interventions had a positive impact on both the infant and the caregiver.

Pre and post observational measures of the infant-caregiver relationship indicated important improvements in both parental sensitivity to the children and in the children’s emotional responsiveness and behaviors.

Parent Effectiveness


Changes in the child

More positive emotions

Less withdrawal

Less depression

Less irritability

Less anger

More compliance

Increased enthusiasm

More persistence

Increased emotional and behavioral responsiveness

Changes in the child


Parents reports of satisfaction

Parents’ Reports of Satisfaction

95% improved relationship with baby

83% positive changes in child

77% improved parenting

73% improved family life


Additional benefits

Additional Benefits

Of the first 59 children involved in this project, it is important to note that the mothers had a total of156children and the fathers had a total of 138children.


Outcomes for those that completed treatment

OutcomesFor those that completed treatment

No further abuse or neglect reports in 100% of the cases.

100% rate of reunification


What courts can do

What Courts Can Do


Read the research science can inform the work

Read the research: Science can inform the work


Healing the child in juvenile court applying an infant mental health approach

It includes our attachment and bonding experience in the first 18 months of life, as well as how exploration and aggressiveness were handles during toddler hood (terrible two’s) and how we learned self-control or self-regulation of impulses by the time we turned five and went to kindergarten.

Because it is not until school that most of the problems show up on the radar screen. For a few of the most severe, we can spot them by age three or four. They are the ones being kicked out of daycare and preschool for uncontrollable behaviors.

But for the majority, we don’t identify them up until they start failing in school, or get involved in the juvenile justice system, or become a teen parent.

However, we are NOT saying that all mental disorders are a result of what happens in the first few year of life. Some mental illnesses are rooted in genetics and/or biochemistry, such as schizophrenia, bipolar disease, and other neurophysiological disorders such as autism.

NOR are we saying that all children who have bad experiences during the 0-3 years “turn into toast” or become criminals. We cannot oversimplify human development. It is complex, transactional, and unique.

What we ARE saying is that the experience and quality of caregiving received by infants and young children during those critical first few years of life when the brain is being wired, so to speak, has long lasting impact on the future of that child.


Healing the child in juvenile court applying an infant mental health approach

Make sure all babies under the age of 3 are referred for a Part C screening pursuant to the Individuals with Disabilities Act (IDEA)


Healing the child in juvenile court applying an infant mental health approach

Part CIndividuals with Disabilities Education Act

  • Multidisciplinary evaluation for children age 3 and younger

  • When established conditions have a high probability of resulting in developmental disabilities or delays

  • Must be a 25% delay in at least one area of development

  • No cost to family


Healing the child in juvenile court applying an infant mental health approach

Refer pregnant women and children into the Healthy Start or home visitation program in your community


Healing the child in juvenile court applying an infant mental health approach

Make Appropriate Child Care Referrals:EARLY HEAD STARTHEAD START

In Miami there are 1300 day care centers and only 120 are accredited. This is a consistent problem across the country.


Early head start research

Early Head Start Research

  • Higher scores for language development

  • Higher Bayley (developmental) scores

  • Positive parenting outcomes

  • Fewer “at risk’ scores

  • Fewer subsequent births

  • Positive father-child interactions

    DHHS, June 2002


Bad parenting

BAD PARENTING?


Parenting programs what they should include

Parenting Programs: What They Should Include

  • Evidence based

  • Pre test and post test

  • Measured observations of parent with child at least twice during program

  • Uniform detailed reports provided to the court with testing and observational scale included

  • No more “Certificates of Completion”


Conclusions

Conclusions

  • The complexity of the problems caused by traumatization of infants and toddlers must be matched by the comprehensiveness of our efforts to:

    • minimize their suffering

    • reduce their developmental deviations

    • enhance their development

    • promote their competence

    • support their parents/caregivers


Websites

WEBSITES

  • WWW.MIAMISAFESTARTINITIATIVE.ORG

  • WWW.FUTUREUNLIMITED.ORG


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