Information on infants and toddlers from birth to 36 months of age was obtained at baseline, and again 12, 18, and 36 months later. Changes in low scores on developmental measures and risk status when children were older were examined.
Shortly after the time of the initial investigation of child maltreatment 49% of infants and toddlers aged 0 to 36 months were reported to have a Measured Delay (see Exhibit 5). A small proportion (3%) of children in the Measured Delay category had an established risk condition associated with developmental delay, making them eligible for Part C services regardless of documented delay. In almost all cases, these children also had a low score on one or more developmental measure. The remaining children without a measured delay were classified as having 5 or more risk factors associated with poorer developmental outcomes (High Risk, 28%) or having fewer than five risk factors (Lower Risk, 23%).
At the 18-month follow-up when children were approximately 18 to 54 months of age, the distribution of children in these categories remained similar (50%, 29%, and 21% respectively). Approximately half of the children with a Measured Delay (52%), a third of High Risk (36%) and a third of Lower Risk (33%) were still classified as such, as can be seen in Exhibit 5. However many individual children changed classification. Of those classified as having a Measured Delay at baseline, 31% were described as High Risk and 18% Lower Risk 18 months later.
|Approximately 18 months after Baseline
(18-54 months in age)
|Baseline (0-36 months in age)||Measured Delay (50%)||High Risk (29%)||Lower Risk (21%)|
|Measured Delay (49%)||52||31||18||100|
|High Risk (28%)||43||36||22||100|
|Lower Risk (23%)||56||11||33||100|
Note: Numbers in bold report the percentages of children who did not change classification between baseline and 18 months later. Numbers in italic report the percentages of children who moved into the Measured Delay classification based on the proportion reported at baseline.
Looking at High Risk children (28%) at baseline in Exhibit 5, about a third (36%) of them were described that way 18 months later. Forty-three percent of children had moved into the Measured Delay category and 22% were classified as Lower Risk. Likewise only 33% of Lower Risk (23%) at baseline were still classified as such, with more than half (56%) reported to have a Measured Delay, and 11% being classified High Risk 18 months after baseline.
There was substantial movement of children to the Measured Delay category in the first 18 months after entrance into Child Welfare Services. Among the 28% of children who were High Risk at baseline, about twice as many (43%) moved into the Measured Delay category as moved into the Lower Risk (22%) category. Among the 23% of children who started as Lower Risk, 56% moved into the Measured Delay category 18 months after baseline. This was a larger proportion than what remained in the Lower Risk (33%) or became High Risk (11%). Taken together, although there is movement across categories, the proportion of children in the Measured Delay category remains almost unchanged (49% to 50%) as is true of the other categories.
As shown in Exhibit 6, between 18 and 36 months there was somewhat more stability in the DRIG status of children at least for the Measured Delay and Lower Risk groups. Among children with Measured Delay (50%) at 18 months, 57% of them remained in that status. Among children who were Lower Risk (21%) at 18 months, 72% remained there at 36 months. At the same time, among children who were High Risk (29%) at 18 months, a substantial proportion (37%) had a Measured Delay by 36 months and among those with Lower Risk (21%) at 18 months after baseline, 22% of those were subsequently classified in the Measured Delay category. The proportion of children in the Measured Delay category does decline from 50% of children at 18 months to 42% of children by 36 months. The percentage of children in the High Risk classification declined by more than half from 29% to 13% and children in the Lower Risk category more than doubled from 21% to 45%.
|Approximately 36 months after Baseline
(3-6 years of age)
|18 months after Baseline
(18-54 months in age)
|Measured Delay (42%)||High Risk (13%)||Lower Risk (45%)|
|Measured Delay (50%)||57||10||33||100|
|High Risk (29%)||37||28||35||100|
|Lower Risk (21%)||22||6||72||100|
Note: Numbers in bold report the percentages of children who did not change classification between 18 and 36 months after baseline. Numbers in italic report the percentages of children who moved into the Measured Delay classification, based on the proportion reported 18 months after baseline.
Reasons for change in DRIG status are not directly discernable from these data. Multiple influences may be at play. Change in the number of risk factors may be reflective of changes in who is caring for the child. Children placed into foster care can be expected to have a lowered level of risk. Among children who remained in the home, reduction in the number of risk factors may reflect the effect of intervention services provided to caregivers aimed at reducing developmental risk in the childs caregiving environment. Changes in classification are also influenced by the challenges inherent in measuring developmental status in young children, particularly infants. A large proportion of the children at baseline classified as having a Measured Delay (38%) were younger than 12 months of age at that time.
The data show no overall change in the proportion of children in the Measured Delay and High Risk categories in the first 18 months after involvement with Child Welfare Services. After 18 months we would expect that some children would be improving, and they do. By 36 months, the findings are more positive and show a modest reduction(50% to 42%) in the proportion of children in the Measured Delay category and a large increase in those who have shown improvement by moving into the Lower Risk group (comprising 45% of all children assessed at 36 months).
Comparing the classification of children investigated by Child Welfare Services longitudinally reveals that about half of the children move from being classified as having a Measured Delay to not having one. Conversely, about half of the children are indicated to have a Measured Delay in at least one area at two time points over an 18-month interval.
This pattern of findings highlight the potential value of providing these children with a formal screening and intervention process prior to three years of age to determine the nature of their delays and their possible eligibility for Part C services and their ongoing risk of developing developmental delays. It is apparent that many of these children with low scores on a developmental measure who might not meet the local criterion for Part C services or who have multiple risk factors might benefit from child care services or home visiting programs focused on providing a stimulating environment to enhance their developmental outcomes and social-emotional well-being (National Scientific Council on the Developing Child, 2007).
On a positive note, it seems likely that the reduction of the proportion of High Risk children might be credited to the intervention of child welfare services. This pattern suggests that the reduced risk in some of the childrens caregiving environments would contribute to supporting more optimal outcomes for children maltreated as infants and toddlers.
Examining the relationship of multiple risks to developmental scores at baseline demonstrates a direct connection. When substantiated infants and toddlers are grouped according to the number of risk factors they were reported subject to, a linear relationship can be observed (see Exhibit 7). Only 5% of children exposed to a single risk factor in addition to maltreatment have a measured delay, whereas the percentage of infants and toddlers reported to have a measured delay ranges from 76% to 99% for children subject to 5, 6, or 7 risks.
It has been demonstrated that a single risk factor such as poverty (Duncan, Brooks-Gunn, Klebanov, 1994) or maternal mental health (Laucht, Esser, & Schmidt, 2001) can be associated with poorer developmental outcomes for infants and toddlers. The least positive developmental outcomes are, however, associated with the cumulative effect of a range of multiple risk factors (Rutter, 1979; Sameroff, Seifer, Zax, & Barocas, 1987; Sameroff, 1998). Infants and toddlers may be at risk for poorer outcomes by having been the victims of maltreatment; however the clustering of multiple risks has been shown to be strongly associated with increases in the likelihood of poorer developmental outcomes.
Setting and measured delay and risk. At baseline, 40% of infants and toddlers were in home care receiving Child Welfare Services, 30% were in home care not receiving Child Welfare Services, 18% were in foster care, and 9% were in kinship care (see legend in Exhibit 8).
Of the children in home and not receiving Child Welfare Services, 65% had a Measured Delay. Fifty-one percent of those in home care receiving Child Welfare Services had a Measured Delay. Of children in foster homes, 38% had a Measured Delay as well as 22% of those in kinship care.
Those in kinship care were the most highly represented in the High Risk category (58%). Children remaining at home without Child Welfare Services had higher rates, overall, of a Measured Delay (65%).
Reduction in the number of risk factors would be hypothesized to positively affect child outcomes. Brooks-Gunn and colleagues (1992) found among preschoolers that the number of years a child lived in poverty, not the current economic status of the family, was a stronger predictor of developmental status. Similarly for maltreated infants and toddlers, it could be that those who continue to be reared in a caregiving environment subject to multiple risks would be anticipated to have poorer outcomes than children who have a significant reduction or elimination of contextual risk. Research is becoming conclusive regarding the negative impact of such experiences on adult outcomes in cognitive, economic and mental health domains (Anda et al., 2006; Knudsen, Heckman, Cameron & Shonkoff, 2006; Shonkoff & Phillips, 2000). As found in this study, of the 28% of children in the High Risk category shortly after the initial investigation 79% were High Risk or had a Measured Delay approximately 18 months later. Eighteen months later, of the 29% classified as High Risk 18 months after baseline, 28% remain High Risk, and 37% have a Measured Delay. Hence, concern regarding the occurrence of abuse and other commonly co-occurring problems (e.g., poverty) on infants and toddlers is well justified. These findings provide an even stronger basis for assessing the level of environmental risk to children and making referrals for Part C early intervention services based on the assessment of those risks. Information from risk assessment instruments, used in virtually every state during routine child welfare practices, could be used to generate developmental risk scores that would indicate the approximate risk of experiencing a measured developmental delay.