Developmental Status and Early Intervention Service Needs of Maltreated Children. Finding #6: A sizeable proportion of infants and toddlers with substantiated maltreatment were reported to have an Individualized Family Service Plan (IFSP), reflecting eligibility for Part C services


Previous Research

Little information is available on the use of Part C services by children involved with Child Welfare Services. A notable exception is a demonstration project implemented by The Massachusetts Early Childhood Linkage Initiative (MECLI, 2005). This project attempted to refer all children younger than three years of age involved in substantiated cases of maltreatment to Part C early intervention at three pilot sites in Massachusetts between November 2002 and December 2004. Over the course of the project, 540 children were offered a referral to early intervention.[5]  The majority (82%) of parents or guardians accepted the referral. Of those offered a referral, 40% (218 children) were eventually evaluated to determine eligibility for services (Lippitt, 2007). Of those evaluated, 74% were deemed eligible (see Exhibit 12).  Interpretation of the findings in terms of the proportion of children eligible for services are complicated by the fact that a sizable proportion of families were not offered a referral based on the discretion of the local child welfare workers (Mills, 2007). Although these data are from only one state, they provide a rare glimpse at the patterns of referral, service acceptance by parents, and eligibility. Additional information is now available based on our analyses of NSCAW and NEILS data.


Exhibit 12.
Part C Eligibility of MECLI
Referred and Assessed Infants and Toddlers
  Number Percentage
Total 218 100
Eligibility among those assessed 161 74
    Developmental Delay 107 49
    At risk 37 17
    Professional judgment 2 <1
    Established risk condition 1 <1
    Unknown 14 6
Source: MECLI Report, 2005.

Part C early intervention services are provided to infants and toddlers with disabilities to maximize the childs developmental potential. Eligibility for Part C services extends from birth to 36 months of age. The types of Part C services received nationally by infants and toddlers with disabilities can be seen in Exhibit 13.


Exhibit 13.
Infants and Toddlers Ages Birth through Two Receiving Services under IDEA, Part C, in the U.S. and Outlying Areas, 2003
Part C Service Total Percent
Assistive Technology 8,121 3.0
Audiology 13,756 5.0
Family Training 52,300 19.1
Health Services 6,496 2.4
Medical Services 7,256 2.6
Nursing Services 9,693 3.5
Nutrition Services 9,959 3.6
Occupational Therapy 89,840 32.7
Physical Therapy 90,231 32.9
Psychological Services 7,110 2.6
Respite Care 9,161 3.3
Social Work Services 16,187 5.9
Special Instruction 125,327 45.7
Speech Language 133,768 48.7
Transportation 15,599 5.7
Vision Services 5,934 2.2
Other Services such as interpretation or behavioral analysis 22,171 8.1
Source:  U.S. Department of Education, Office of Special Education Programs, Data Analysis System (DANS).  Report of early intervention services on IFSPs provided to infants and toddlers and their families in accordance with Part C," 2003.  Data updated as of July 30, 2005.
Notes:  Percent = Number reported in the service category divided by the 2003 child count multiplied by 100. The denominator is not available in the report.

Study Findings

An Individualized Family Service Plan (IFSP) is a formal document designating eligibility for Part C services and an agreement between service providers and caregivers regarding the type and amount of services to be provided. In the NSCAW data we examined the proportion of substantiated infants and toddlers reported to have received Part C services. Twelve months after baseline, when maltreated infants and toddlers ranged in age from approximately 12 to 48 months of age, 28% of children still younger than 36 months of age were reported by caseworkers to have an IFSP (see Exhibit 14). This proportion of substantiated infants and toddlers receiving Part C services is prior to implementation of the CAPTA requirement of referral of substantiated cases. Information regarding the type of Part C services children and families received was not available.

Among children reported to have an IFSP 12 months after baseline, the largest proportions were among those who were between 0 to 12 months (29%) and 25 to 36 months (27%) of age at baseline (Exhibit 14). Eighteen months after baseline, when children were approximately 18 to 42 months of age, the proportion with an IFSP was slightly less (20%). At this time point the proportion with an IFSP among children 0 to 12 months at baseline dropped from 29% to 22%, whereas the proportion of those with an IFSP who were between 13 to 24 months at baseline remains fairly stable at 19% compared to 20%, at the 12-month follow-up.

By the 36-month follow-up only children who were between 0-12 months of age at baseline were still age eligible for Part C, and 13%, down from 29% and 22% at earlier time points, were reported to have an IFSP. (Because of study procedures, some of the interviews from the 36-month wave occurred after children were three years of age  this could have resulted in a lower estimate of the proportion of children who were identified as having an IFSP in the 18 months prior to data collection 36 months after baseline.)


Exhibit 14.
Percentage of Children Reported to Have an IFSP by Age
at Baseline, 12, 18 and 36 Months Later

Exhibit 14. Percentage of Children Reported to Have an IFSP by Age at Baseline, 12, 18 and 36 Months Later. See text for explanation.

Source:  NSCAW.  Child Welfare providers supply information regarding the IFSP.

Overall, these findings suggest that the reduction in the proportion of children with an IFSP among those investigated as infants 0 to 12 months of age may be attributable to loss of Part C eligibility. Loss of eligibility can be due to no longer needing or qualifying for services or the parents choice to no longer participate in services. NEILS found that 16% of children entering Part C in 1997/98 left Part C prior to 36 months of age when Part C eligibility ends (Hebbeler et al., 2007). Data reported by individual states in 2002/03 showed 20% of children who received services left Part C prior to 36 months of age because they no longer required services (U.S. Department of Education, 2004).[6]

The more stable proportion of children 13 to 24 months of age at baseline with an IFSP over time suggests the possibility that a higher proportion of these children were deemed eligible for Part C because of a documented delay, rather than risk status. Children eligible because of risk factors are often deemed eligible shortly after birth, whereas children with developmental delays have to be old enough to demonstrate the required discrepancy between their developmental status and their chronological age. Often developmental delays due to chromosomal or neurological disorders are not remediable. Many of these children remain eligible and receive special education services when they become school age.[7]  Some will receive special education services until they age out of the special education system at 21 years of age. In NEILS 58% of children who entered Part C services in 1997/98, had an Individualized Education Program in kindergarten, indicating the receipt of special education services. Another 10% had a disability, but were not receiving special education services (Hebbeler et al., 2007).

NEILS found that 63% of the children who entered Part C services went on to receive preschool special education services (Hebbeler et al., 2007). Numbers from the individual states indicate that 43% of children who received Part C services were Part B eligible (U.S. Department of Education, 2005).

The proportion of maltreated infants and toddlers with an IFSP suggest that many came to the attention of Part C agencies prior to CAPTA reforms that now require the referral of substantiated cases. A high percentage of maltreated infants and toddlers (28% at 12 months after baseline) were reported to have an IFSP, indicating eligibility for Part C services compared to the percentage of children (2.4%) the same age receiving Part C services in the U.S. (U.S. Department of Education, 2005).

Some similarities can be seen in examining the proportions of infants and toddlers by age at entry to Part C services in NEILS. Of children entering Part C nationally 38% are less than 12 months of age, 28% are 12 to 24 months, and 34% are older than 24 months of age. The higher representation among children younger than 12 months and older than 24 months is similar to maltreated infants and toddlers with an IFSP. Children younger than 12 months of age tend to enter Part C because of biomedical or environmental risk factors or established risk conditions rather than developmental delays whereas children 24 months of age and older tend to enter Part C because of documented developmental delay (Scarborough et al., 2004).

The number of maltreated infants and toddlers who received Part C services prior to CAPTA was not officially recorded. The information presented is based on data collected as part of a survey of maltreated children, and portrays a national picture of the receipt of Part C services among substantiated cases of maltreatment of infants and toddlers investigated in 1999 and 2000. Since the implementation of CAPTA, a few states have begun to keep records on the number of referrals from child welfare and the children deemed eligible for services; that information is not currently available.


The Massachusetts Early Childhood Linkage Initiative (MECLI) demonstration project referring families to Part C resulted in rates of substantiated cases being found eligible for services that were higher than those found in NSCAW.  The differences could be partially attributable to different data collection methods at different points in time. The differences may, however, result from the efforts in Massachusetts to refer all substantiated cases of maltreated infants and toddlers to Part C early intervention services and, more generally, to respond to the needs of children at high risk for developmental delay. Massachusetts is one of the five states providing services to at-risk children. This is accomplished through funds available from public health insurance for children that is used to help pay for Part C services. MECLI findings show that a larger proportion of substantiated cases of maltreated infants and toddlers with families willing to pursue a Part C evaluation were found eligible for Part C services, than those reported to have an IFSP in NSCAW. MECLI also found that some child welfare workers used their own discretion as to who should be referred. Some of this unofficial screening and family self-selection likely served to increase the proportion of assessed children found eligible (74%). Though the capacity of child welfare workers to screen for referral may be arguable, this process is supported by some Part C providers because it enables them to expend limited resources to determine the eligibility of children who may have a developmental delay, rather than on those who clearly do not.

In 2003, the federal government amended CAPTA, which required states to have provisions and procedures in place for the referral of children younger than the age of three years with substantiated maltreatment. CAPTA does not require that every child younger than the age of three who is involved in a substantiated case of child abuse or neglect be referred to Part C services. States have the discretion to refer every such child younger than the age of three for Part C early intervention services or to use a screening process to determine whether a referral is needed.

The 2004 reauthorization of IDEA included similar changes in Part C child find practices by requiring states to have a description of the policies and procedures that require the referral for early intervention services of a child under the age of three who is involved in a substantiated case of child abuse or neglect. To receive Part C federal funds, states must have child find efforts in place to locate eligible children. Part C requires that infants and toddlers with substantiated cases of maltreatment be screened by a Part C provider or designated primary referral source to determine whether a referral for an evaluation for early intervention services under Part C is warranted. If the screening indicates the need for a referral, a referral is expected to be made. IDEA specifies that this provision is not intended to require that every child involved in a substantiated case of child abuse or neglect receive an evaluation or early intervention services under Part C.

The numbers of children that might be referred to Part C is dependent on many factors including the number of substantiated cases of maltreatment. Variation in the rates of substantiation ranges from less than 2% to over 40% among states (U.S. DHHS, 2007). This variation coupled with differences in eligibility criteria among individual states, limits the ability to make inferences regarding the extent to which CAPTA legislation might affect the number of referrals to Part C. In many states, the number of infants and toddlers involved in Child Welfare Services outstrips the numbers being provided with Part C services. Child Welfare Services is usually unable to determine the proportion of substantiated cases that subsequently receive Part C services. This is often unknown because Child Welfare Services can only verify that the referral process is explained to the family, but has no court-ordered justification to determine whether services are received. This is the case because much of the information regarding eligibility for Part C is confidential and except in a few states is not related to maltreatment status. In some states, evidence of participation in Part C services may help caregivers fulfill their court-ordered service plans. This area of coordination needs additional research and analysis to determine typical and best practices (Stahmer, et al, 2008).

Additionally there are substantial challenges in verification of what happens after referrals are made. States in which Child Welfare Services and Part C services are housed within the same agency have information systems that are configured to allow for better coordination of information and accountability. During expert interviews, some practitioners reported that a shared database was in the process of being developed. Substantiated cases of maltreatment that can be identified in case record systems will improve the efficiency of referrals, and likely improve knowledge of whether Part C services were received.

In order to expedite referrals some states have initiated joint training. This involves training sessions in the screening and referral procedure included in orientation sessions of all new child welfare workers. Training in using a simple screening instrument is included. The Utah Part C agency developed a book and curriculum to train child welfare workers. In Utah, children substantiated for abuse must be interviewed by Child Welfare Services. For infants and toddlers this interview, which utilizes a screening tool, constitutes screening for referral. Utah uses the Nipissing Developmental screen, a normed checklist developed in Canada, derived from Ages and Stages Questionnaires (ASQ):  A Parent-Completed, Child-Monitoring System (Bricker & Squires, 1999). The ASQ is one instrument that is frequently used for screening young children for developmental problems, as is the Battelle Developmental Inventory Screener (Newborg, 2004). New Mexico Part C trains guardian ad litem, judges, and child welfare personnel, but acknowledges the challenges involved in repeated training because of changing personnel. The positive aspect of training sessions is the result of contributing to the formation of county teams to address the needs and referrals of maltreated infants and toddlers.

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