Although establishing effective interventions for young maltreated children and their families in their communities is essential, it is not sufficient (Conroy & Brown, 2004). There is evidence to suggest that maltreated children may slip through the cracks because of various factors, including young age, ethnicity status, military status, lack of health insurance, misinformation with respect to early intervention eligibility and policy, and inadequate coordination of services (Lane, Rubin, Monteith, & Christian, 2002; Leslie et al., 2000; Harbin et al., 2004; Horwitz et al., 2000; Koyanagi & Semansky, 2002; Rosenberg, Smith, & Levinson, 2006; Shapiro & Derrington, 2004). Although the previous research suggests that these factors interfere with the process of identifying and enrolling children in early intervention programs, research also suggests that motivating children and their families to attend and participate in early intervention programs, regardless of maltreatment status, is a challenge (Brotman et al, 2005; Faver, Crawford, & Combs-Orme, 1999; McGoey, DuPaul, Eckert, Volpe, & Van Brakle, 2005; Zahr, 2000; Zeanah et al., 2001). Consequently, children still face obstacles to receiving developmentally beneficial treatments. Research and policy efforts are now shifting toward addressing these limitations and hindrances.
Communication campaigns, training, and specific interventions have been created to promote intervention for maltreated infants and children and remedy disparities in access to services. The goal of these projects is to raise awareness concerning common symptoms of child abuse and neglect, reporting protocol, and early intervention policy among those people most apt to notice or witness child maltreatment. For instance, an education intervention for maltreatment has been created for police officers who investigate domestic violence (Osofsky, 2004). Goals include equipping police officers with information that they can provide to families about crisis services, shelters, and early intervention opportunities as a way to help infants and young children who are exposed to domestic violence. Physicians, teachers, psychologists, and social workers are professionals who have also benefited from educational interventions with respect to maltreatment (Malone et al., 2000; Shapiro, Derrington, & Smith, 2003). There is also evidence that increasing parental education with respect to normal development as well as early intervention and prevention-based programs for maltreated infants, toddlers, and preschoolers increases enrollment and parental involvement in early intervention programs (Baxter & Kahn, 1999; Burgess & Wurtele, 1998).
Further, the importance of using proper diagnostic tools cannot be overstated. Standardized, reliable diagnostic assessments and evaluations during intakes are critical in identifying maltreated children, determining eligibility, and ascertaining who are the most likely to benefit from intervention because of medical, social, and emotional needs (Kolko et al., 2003). Policies mandating that assessments be conducted in a timely fashion, combined with adequate infrastructure, can help ensure that children receive quick professional attention (Mahler et al., 2002; Silver et al., 1999). Nevertheless, not every maltreated child demonstrates a need for intervention. Likewise, maltreated children with intervention needs should be matched to the appropriate services. As research begins to identify child and family characteristics that contribute to treatment success, the ability to create individualized treatment plans for maltreated children increases (Bradley et al., 2001). Unfortunately, this line of research has become increasingly important just as early intervention and prevention programs face resource limitations.
Interventions to reform systems have also been implemented to more quickly assess maltreated infants and enroll them in the appropriate early intervention programs. In Miami-Dade County, Florida, juvenile judges and various child development specialists are working together to ensure that maltreated infants and toddlers entering the Juvenile and Family Court system are assessed and receive comprehensive care to address their problems (Malik, Lederman, Crowson, & Osofsky, 2002; Osofsky & Lederman 2004). Interventions may include infant-parent psychotherapy, Early Head Start, medical treatment, occupational therapy, and social services, along with substance abuse programs and mental health services for parents. The multidisciplinary team monitors infant and family progress toward specific goals through monthly meetings. Although program evaluation is forthcoming, creating a team of judicial and child development professionals who are dedicated to the development and safety of maltreated infants has proven to be effective in quickly identifying and enrolling maltreated infants to the appropriate services. Building on the work in Miami-Dade County, ZERO TO THREE has created the Court Teams for Maltreated Infants and Toddlers Project in Fort Bend County, Texas; Hattiesburg, Mississippi; and Des Moines, Iowa (Youcha, Hudson, Rappaport, 2006). Continued efforts on this front will increase the number of referrals to prevention and early intervention programs. It is important to note that enrolling children in programs designed to support their development is only half the battle. In many instances, especially in rural settings increasing the knowledge, skills and expertise of needed services provides such that they are able to provide services to the youngest children is a constant challenge. This is especially true in rural settings where there are simply not enough trained professionals to deal with needs as was discovered through focus group discussions with experts from around the country concerned about the meeting the needs of maltreated young children.
Research on treatment attendance has highlighted ways to keep maltreated children and families participating in early intervention, a known factor related to treatment effectiveness (Hill et al., 2003; Shonkoff & Phillips, 2000). Protecting continuity of care is one important factor. Reducing failed placements and employee staff turnover are two ways to increase the likelihood that children with developmental needs have their intervention plans reviewed, managed, and followed (Clyman et al., 2002). Another method to increase treatment participation is to reduce the stress and obstacles families face in coming to treatment. Suggestions include providing transportation to and from the treatment center (Kuchler-O'Shea, Kritikos, & Kahn, 1999) and creating a culturally sensitive climate that is free of judgment (Unger, Jones, Park, & Tressell, 2001). When necessary, involving the entire family in treatment or providing babysitting is also a helpful technique (Turbiville & Marquis, 2001). Finally, placing effective treatments within systems in which parents are already involved is another way to increase attendance. The Resilient Peer Mediated Treatment (Fantuzzo et al., 2005) and Webster-Stratton Parenting training (Hughes & Gottlieb, 2004; Webster-Stratton, 1998) are particularly promising in this regard because these treatments can be incorporated into an existing child development program (i.e., Head Start) with which parents and children have extensive contact. This factor increases the likelihood that children and their parents will receive the needed treatments at the appropriate doses. Finally it is important to reiterate that in instances where children require placement in foster care, it is important to address the overall level of training and support foster parents require to meet the needs of children in their care as discussed on pages 15-17 of this review.