The new and reviewed findings presented suggest several potentially important directions for future research. New research can help inform how service providers for Child Welfare and Part C early intervention interact with clients as well as each other. Some areas are:
Matching level of service with the needs of children and their families is important only if the services are effective. Intervention research to demonstrate methods, test the impact of variation of the intensity and duration of service, and present results to the field is needed. Very little information is available to show which methods have the greatest impact on the development of maltreated children or on the development of children served under Part C. Intervention trials are needed and could teach us about drop-out rates, which children are not benefiting, and which children receive the greatest boost from which interventions.
Characteristics of families.
Research is needed to better understand certain sub-groups of families who receive Child Welfare and Part C Services. One expert mentioned that we should improve our understanding of effective services for older mothers who often have several children, a history of domestic violence, substance abuse, and repeatedly have children entering into Child Welfare Services. Another sub-group of interest is caregivers with disabilities.
Substantiation as a criterion for CAPTA-mandated referrals.
Another area requiring further investigation is the extent to which substantiation status is the optimal indicator of which children reported to Child Welfare Services may need developmental assistance. Taken in combination with prior findings (e.g., Hussey et al., 2005), this research suggests children who are not substantiated for maltreatment are at similar developmental risk as those who are. This study provides information suggesting that the count of environmental and biomedical risk factors may be a robust indicator of future developmental delay and may be a useful indicator of which children should be referred for Part C early intervention services. A more precise calculation of which risks and what count of risks are the best indicators of poorer developmental outcomes would likely result in referrals with a more empirical basis than the current reliance on substantiation status.
Development of intervention practices.
For many Part C providers, working with children and families involved with Child Welfare Services is an unfamiliar experience. Conversely, for many Child Welfare workers, experience with services designed to address a childs developmental needs may be limited. It is not clear to what extent Child Welfare and Part C practices can be adapted and when new methods will have to be developed. We expect that considerable advances in parent engagement and training approaches employed by Child Welfare Services and Part C will be necessary for the provision of effective services. In particular, this research highlights the need for new expertise and interventions for infants (i.e., the first year of life).
Best practices on collaboration models.
Central to identification of eligible children and effective service delivery is collaboration between Child Welfare and Part C professionals. However, in many areas Part C and Child Welfare providers have not worked together often in the past. As a result, they must learn to collaborate with each other to maximize the efficiency of referrals and the efficacy of services provided. Experts often pointed out that service providers often do not have a basic competency in each others knowledge base or practice methods. As a consequence, research on best practices in collaboration could help to identify innovations in referrals, screening, assessment, communications between Part C and Child Welfare Services and Part C and the courts, and interactions between Child Welfare Services, Early Head Start, and Part C and, later, school-based services. These innovations could help ensure that children had the level of service that was most commensurate with their developmental needs.
Through discussion with experts we learned that a number of states are now placing Part C Services under the same umbrella agency as Child Welfare Services, along with other health services. Organizational structures may influence accountability and thus the effective delivery of services and this possibility could also be further analyzed.
Funding models and services receipt.
An area which might benefit from additional research is the issue of funding sources for services and types of services provided. Experts almost uniformly mentioned that these policies were passed without any additional federal funding authorizations for Part C or CAPTA. Experts also suggested that what services are provided to children involved with Child Welfare Services depend on what funding authorities are willing to pay for. State-run childrens health insurance programs, Medicaid, Part C, private insurers, and other payment sources have an important role in determining what services will be received. The effects of eligibility criteria, compensation systems, and payment amounts on services should be investigated. The extent to which providers and case coordinators are knowledgeable of these issues may also play a role.
Additional NSCAW research would be helpful in understanding the longer-term developmental implications of early maltreatment and early intervention on childrens development. Of particular interest would be the school-readiness of the NSCAW sample of children. This research found them to be at-risk and often measurably delayed in one or more developmental domains. Recently, a 66 month follow-up was completed with children in NSCAW who were 0 to 12 months old at baseline (i.e., the infants). Ranging in age from approximately 5 ½ to 6 ½ these children are now entering the educational system through kindergarten or first grade. It remains to be seen if their problems have persisted and what factors might have promoted developmental recovery (e.g., interventions from child welfare or others). More comprehensive measures of development would help to identify genuine developmental aberration, acknowledging that the inherent variation associated with testing the rapidly changing developmental status of young children is challenging, particularly in a non-clinical setting.
Opportunities for new research exist at all levels of Child Welfare and Part C programming. A better understanding of the effects of maternal age, substance abuse, and other child, family and case characteristics is necessary for the development of new developmental intervention strategies. In addition, further research is needed to help practitioners from both Child Welfare and Part C systems communicate with each other and collaborate more effectively. Finally, new research may help enhance understanding the role that local, state, and federal funding plays in service delivery to maltreated children with developmental needs. Because resources are limited in both Part C and Child Welfare systems, it is important that services be delivered in the most effective and efficient manner possible. Obtaining the knowledge to achieve this goal requires more investigation.