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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 Mental Health Approach 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 Mental Health Approach

Overall Delay: 60%

Language – 57%

Cognitive – 33%

Gross motor – 31%

Growth problems – 10%


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 Mental Health Approach

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


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 Mental Health Approach

  • 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 Mental Health Approach

  • 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 Mental Health Approach

What we know
What We Know Mental Health Approach

  • 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

OUR TOOLS: Mental Health ApproachThe lawand science

Adoption and safe families act of 1997
Adoption and Safe Families Act of 1997 Mental Health Approach

  • 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 Mental Health Approach

  • 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 Mental Health Approach

  • 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

Consequences of Child Maltreatment symptomatology

  • Maltreatment places children at risk


      • 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 Childhood 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

How children Childhood Development 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.

  • 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 Childhood Development

Early Childhood

Later Childhood


The still face
The Still Face Childhood Development

Signs in the baby that emotional needs are not met Childhood Development

  • Sad affect

  • Lack of eye contact

  • Weight loss

  • Lack of responsiveness

  • Sensory processing problems

  • Rejects being held or touched

Signs of emotional problems Childhood Development

In toddlers/ preschoolers

  • Very aggressive behavior

  • Attentional problems and deficits

  • Lack of attachment

  • Sleep problems or disorders

Conditions of the caregivers Childhood Development

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 Childhood Development

Empirical findings
Empirical Findings Childhood Development

  • 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

The Infant Health and Childhood Development 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

Random Assignment Childhood Development


  • Pediatric surveillance

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

  • Infant enrolled in Child Development Center

  • Parent education meetings


  • Pediatric surveillance

Results Childhood Development

  • 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 Childhood Development

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 Childhood Development

  • 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%)

Prenatal and Infancy Home Visitation Childhood Development

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

Elmira Home Visitation Program: Childhood Developmentthe 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

HOME VISITATION: Childhood Developmentthe 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 Childhood Development

  • 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 Childhood Development

  • 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 Childhood Development

Katrina as a child
Katrina as a child Childhood Development

  • Born 1984

  • Six siblings

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

  • IQ of 68, diagnosed with adjustment disorder

Childhood DevelopmentThe 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 Childhood Development


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 Childhood Development

  • 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: Childhood DevelopmentParent-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 support services provided through the infant mental health interventions had a

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 support services provided through the infant mental health interventions had a

95% improved relationship with baby

83% positive changes in child

77% improved parenting

73% improved family life

Additional benefits

Additional Benefits support services provided through the infant mental health interventions had a

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
Outcomes support services provided through the infant mental health interventions had a For 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 support services provided through the infant mental health interventions had a

Read the research science can inform the work
Read the research: support services provided through the infant mental health interventions had a Science can inform the work

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.

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

Part C Part C screening pursuant to the Individuals with Disabilities Act (IDEA)Individuals 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

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

Make Appropriate Child Care Referrals: home visitation program in your communityEARLY 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 home visitation program in your community

  • 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 home visitation program in your community PARENTING?

Parenting programs what they should include
Parenting Programs: What They Should Include home visitation program in your community

  • 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 home visitation program in your community

  • 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 home visitation program in your community