Promoting Early Intervention and Child Welfare Collaboration: One Conversation at a Time

1. Promoting Early Intervention and Child Welfare Collaboration: One Conversation at a Time Haidee Bernstein (DaSy), Evelyn Foard Shaw (ECTA), Lenita Hartman (Colorado DHS), Jennifer Kaufman (Rhode Island EOHHS), Darlene Magaw (Rhode Island ) Donna Spiker (DaSy) Division for Early Childhood Conference Orlando, FL; October 2018 Center for Youth with Multi-System Involvement at Westat

2. Welcome: Who we are! Center for Youth with Multi-System Involvement at Westat

3. Welcome: Getting to know you • Show of hands, are you: • With a state government/agency? • With a local government/agency? • With a federal agency? • A parent or family member of someone with a disability? • Higher education • Professional development providers • A student? • A therapist (Speech, OT, PT, Psychologist, etc.)? • Other? Center for Youth with Multi-System Involvement at Westat

4. Session goals are to….. • Increase knowledge about CAPTA and IDEA regulations and state and local issues • Gain understanding about approaches to support CAPTA goals • Learn state strategies to strengthen coordination between early intervention and child welfare systems to support children and families Center for Youth with Multi-System Involvement at Westat

5. DEC’s Position Statement on Child Maltreatment • DEC has taken a stand because: • Young children are disproportionately affected by child maltreatment. • Children who have a disability are at a higher risk for maltreatment. • Children who have experienced maltreatment are at a higher risk of developing a disability. • Young children who have been maltreated are participants in early childhood programs. https://www.cec.sped.org/Policy-and-Advocacy Center for Youth with Multi-System Involvement at Westat

6. DEC’s Position Statement on Child Maltreatment (continued) • Individual Responsibilities: • Be vigilant in our role as mandated reporters and aware of personal biases. • Work toward prevention and intervention. • Use strength-based and family-centered approaches. • Organizational Responsibilities: • Meaningfully collaborate across service systems (e.g. child welfare). • Incorporate content related to this topic into existing coursework in pre-service programs and into professional development opportunities. Center for Youth with Multi-System Involvement at Westat

7. DEC recommended practices relevant to this session include… • L10 Leaders ensure practitioners know and follow professional standards and all applicable laws and regulations governing service provision. Center for Youth with Multi-System Involvement at Westat

8. DEC recommended practices relevant to this session include… • L14 Leaders collaborate with other agencies and programs to develop and implement ongoing community-wide screening procedures to identify and refer children who may need additional evaluation and services. Center for Youth with Multi-System Involvement at Westat

9. DEC recommended practices relevant to this session include… • L6 Leaders establish partnerships across levels (state to local) and with their counterparts in other systems and agencies to create coordinated and inclusive systems of services and supports. Center for Youth with Multi-System Involvement at Westat

10. Different approaches to reaching common goals:What are the policies and procedures in your locality?

11. What is known about child maltreatment in infants and toddlers? • FFY 2016, there were an estimated 676,000 victims of abuse and neglect nationally, 3.0% higher than in FFY 2012 estimate. • More than one-fourth of victims (28.5% ) were under age three. • This is the largest group across all maltreatment types, including physical abuse, medical neglect, and neglect. • Children younger than one year have the highest victimization rate at 24.8 per 1,000 children in the national population for this age group. From: U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2018). Child Maltreatment 2016. Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.

12. What is the federal Child Abuse Prevention and Treatment Act (CAPTA)? • 2003: Applications for funding shall contain a description of • policies and procedures (including appropriate referrals to child protection service systems and for other appropriate services) to address the needs of infants born and identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure • provisions and procedures for referral 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

13. What is CAPTA? (continued) • Updated in 2016: • policies and procedures (including appropriate referrals to child protection service systems and for other appropriate services) to address the needs of infants born with and identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder From: https://www.acf.hhs.gov/sites/default/files/cb/capta2003.pdf

14. How does early intervention supporting young children who are maltreated? • IDEA 2004: Applications for funding shall contain a description of the State policies and procedures that require the referral for early intervention services under this part of a child under the age of 3 who: • is involved in substantiated case of child abuse or neglect; or • is identified as affected by illegal substance abuse, or withdrawal symptoms resulting from prenatal drug exposure

15. What are the data reporting requirements for CAPTA? • Number of children referred to child protective services to address the needs of infants born with and affected by substance abuse, withdrawal symptoms or a Fetal Alcohol Spectrum Disorder; and • Number of children under the age of three involved in a substantiated case of child abuse or neglect that were eligible to be referred to agencies providing early intervention services under Part C of the Individuals with Disabilities Education Act (IDEA), and • Number of these children actually referred to Part C

16. What are the CAPTA data reporting requirements for Child Find in early Intervention? • EI needs to report: • Number of children birth to one who have active IFSPs (point in time and cumulative). • Number of children birth to three who have active IFSPs (point in time and cumulative). • Part C 618 data on child find does not require reporting of referral sources. • States may track referrals in state databases. • IDEA Infant Toddler Coordinators Association (ITCA) 2015 Data Survey indicates that about half of the states had some linkages or share data between the two programs

17. What is the timeline for child welfare data collection and reporting? • 1988: US HHS Secretary established the National Child Abuse and Neglect Data System (NCANDS) as a voluntary national reporting system. • 2010: new data collection requirement, # of maltreated children eligible for referral to Part C, and the number referred. • 2012: fields added to NCANDS data system. • 2015: Child Maltreatment began reporting # eligible for referral and # referred – not all states are reporting • 2016: new data collection requirement, # of substance exposed infants reported to state Child Protective Services • 2018: fields will be added to NCANDS data system • 2018: anticipated that Child Maltreatment will begin reporting

18. What state data do we have so far on CAPTA referrals to EI? Table 6–9 IDEA: National Data on Victims Who Were Both Eligible and Referred to Part C Agencies

19. The Future is Data Linking

20. Table Discussion Questions • How familiar were you with CAPTA and IDEA-related legislation? • How familiar are you with DEC Position Statements? • What does this information mean to me in my work?

21. Questions? Center for Youth with Multi-System Involvement at Westat

22. Colorado’s Story

23. Colorado Statistics Served: 15,000 children in early intervention (2017) • Overall, 41% referred through CAPTA went on to evaluation • Of the children that were evaluated 40.8 % were found eligible • Of the children that are referred due to neglect: 80% of cases have substance abuse involvement • 20 Local Early Intervention programs • 64 counties (Most have local DHS offices) • 178 School Districts

24. Where We Started Last eight years: • Began with a need for an updated MOU between child welfare and early intervention • Process resulted in the development of common understanding of the work and shared language to use with local programs • Due to new ability to match data, found only 30% of CAPTA referrals were reaching early intervention • 820 out of 2,278 possible

25. What We Did As a result of cross-collaboration efforts between child welfare and early intervention, within 3 years there was: • An ongoing CAPTA workgroup • An updated state-level MOU • A Frequently Asked Questions online tool for local programs and; • Due to changes to both data systems: 100% of referrals were being received by EI Colorado programs

26. What We Did cont. Additional efforts included: • Joint visits across the state to local programs (EI & Child Welfare) • Monthly monitoring of data and reporting to CDHS leadership • The creation of a cross-system process template for local programs to use as a companion to the MOU

27. Barriers to Success • Differing and competing agency Responsibilities • The use of multiple developmental screenings and evaluations • Family engagement • Staff turnover • Inherent difficulties associated with assessing young children

28. Set-Backs • Set-Backs: • In August 2018, the Child Welfare data system lost functionality and referrals are once again not automated. • This means currently all CAPTA referrals must be sent manually which has resulted in a lower referral rate. • Position changes in key leadership has created the need to increase communication efforts to ensure cohesiveness in messaging between child welfare and early intervention collaboration.

29. Next Steps • With support from leadership at the CDHS, joint guidance was shared with county DHS and early intervention programs that will require caseworkers to: • Contact families to ensure they know about early intervention, and • Follow-up with local early intervention programs on all ongoing child welfare cases to make sure the family has been contacted about early intervention services. • These new activities will be tracked and reported on monthly and we anticipate increased participation.

30. Next Steps (continued) • Emphasis is on reaching case workers during initial training with greater detail about early intervention and how to talk to families about the benefits of EI. • Raise awareness about EI at two major Colorado conferences Fall 2018 (primary audience: child welfare). • Online CAPTA FAQ will be moving to the training website instead of being housed in the general child welfare website.

31. Next Steps (continued) •  October 2018-Development of a Performance and Partnerships Exchange • The purpose is to create an opportunity for counties to learn from one another and to highlight successful practices that may work in other counties.  State program staff interview well-performing counties and Community Centered Boards to determine best practices • Share these practices statewide through webinars and workshops (EI and local DHS)

32. What is Working in Colorado • The focus on building relationships at all levels • Identification of discrepancies in understanding, willingness to come to consensus about processes and agree upon common language • Use of data to inform decisions • Engagement in an iterative process: try something, revisit, and make adjustments

33. Rhode Island’s Story

34. RI’s System of Care – Shift in Practice Background Information • ICC Child Welfare subcommittee formed in 2005 • Purpose to develop a System of Care • Focus on ensuring CAPTA referrals • CAPTA referrals increased over time, then held steady at 60-65% • System of Care grant • Early Childhood Liaison placement in DCYF office • Linked to regional and state department leadership

35. RI’s System of Care – Shift in Practice Background Information • Leadership change within DCYF • MCH (Title 5), MIECHV and EI funding helped to support Family Visiting programs • Improvements in Child Welfare (DCYF) • Referrals now generated electronically • Collaboration with EI Data system

36. This work led to…. • A need to refine the CAPTA referral Policy and Procedure to ensure all children are referred for screening. • A need to improve collaboration with early intervention’s system of care. • A need to identify and eliminate barriers to ensure referrals are made.

37. Establishing a Need for a New CAPTA Policy/Procedure • Data showed that potentially eligible infants-toddlers were not being referred for screening. • There were inconsistencies with data match between DCYF and EI. • There was a need to eliminate the barrier of requiring parent consent for the referral.

38. Development of the New CAPTA Policy/Procedure • Utilization of established ICC Child Welfare Sub-committee • Wanted participation and input from a variety of stakeholders • Members represented variety of stakeholder groups: DCYF, EI, DOH Family Visiting, RI KidsCount • Members represented State Leads, Program Management Staff, and direct care staff • DCYF Early Childhood Liaison worked with legal department around consent –vs– notification.

39. Development of the new CAPTA Policy/Procedure Several PDSA Cycles Process Mapping Impact Matrix

40. The Final Product: The Nutshell Version Investigation of abuse/neglect – indicated for child under 3 Investigator provides information about Developmental Screening Referral to First Connections for Screening No Suspect of Delay? Pass Fail Yes After Screening/Evaluation is completed – results sent to DCYF to track data Referrals for Family Home Visiting and Other Community Supports Referral to EI

41. We have a new CAPTA Policy and Procedure… Now what? • Director-level approval was required from DCYF – difficult until a change in directorship occurred. • Prepared for full implementation June 2017 • Early Childhood Liaison and EI Referral Liaison embedded in the DCYF office • Liaisons joined to develop and train all DCYF staff • RI EI Technical Assistance Center provided training for EI staff

42. Number of Children referred to First Connections or EI % of children under 3 in indicated cases referred to either First Connections or EI Of the children referred, % of children who had an evaluation and found eligible for EI ** **Based on referrals made directly to EI. No data yet on children who were screened through FC, then referred to EI.

43. Next Steps for Rhode Island • Continue Cohort Study and analyze data. • Improve training and technical assistance efforts. • Develop and implement strategic plan from ICC Child Welfare Sub-committee (see next slide) • Identify barriers to completion of referrals/evaluations, then identify activities/strategies to improve rates. • Identify barriers to family engagement and then identify activities/strategies to improve it • Identify areas of improvement for communication and collaboration between DCYF, DOH (First Connections) and EI

44. Mapping Program Participation for DCYF Involved Families

45. Table Discussion Questions • What do you do related to CAPTA and IDEA Legislation • What resonates with you about this presentation? • What challenges do you face? • What are your successes? Center for Youth with Multi-System Involvement at Westat

46. Wrap Up and Final thoughts Center for Youth with Multi-System Involvement at Westat

47. Important Next Steps • We need to find ways to: • Build better communication between Part C and Child Welfare • Establish effective referral processes to Part C • Increase data and data sharing to support collaboration Center for Youth with Multi-System Involvement at Westat

48. Important Next Steps • Providers in Child Welfare and Part C need a greater understanding of each other • Get to know each other’s program • The Culture of the two programs are different • Goals of Child Welfare are family preservation and child safety • Goals of Part C are to promote child development, support families to do so. Part C is family-driven and strength-based. • The programs differ somewhat regarding biological and foster parents Center for Youth with Multi-System Involvement at Westat

49. IDEA Definition of Parent (34 CFR 303.27) • A biological or adoptive parent of a child; • A foster parent, unless State law, regulations, or contractual obligations with a State or local entity prohibit a foster parent from acting as a parent; • A guardian generally authorized to act as the child’s parent, or authorized to make early intervention, educational, health or developmental decisions for the child (but not the State if the child is a ward of the State); • An individual acting in the place of a biological or adoptive parent (including a grandparent, stepparent, or other relative) with whom the child lives, or an individual who is legally responsible for the child's welfare; or • A surrogate parent who has been appointed in accordance with Part C of IDEA. NOTE A Biological/Adoptive Parent, who retains their rights, always is considered the “parent under IDEA.” Center for Youth with Multi-System Involvement at Westat

50. IDEA Definition of Parent (continued) • If the biological/adoptive parent retains rights to make early intervention decisions, only they can give consent for IDEA purposes, regardless of where the child is living. • If a parent, who retains their rights under IDEA, declines to proceed with a referral, the referral to Part C is closed. • If the child is living in foster care and the parent’s rights have been terminated, the foster parent may be considered the parent under IDEA as long as this is consistent with your state law. Center for Youth with Multi-System Involvement at Westat