Developmental Status and Early Intervention Service Needs of Maltreated Children. Finding #9: Increased training and collaboration of Child Welfare and Part C service providers may be a useful approach to facilitate CAPTA compliance and enhance developmental outcomes for children

04/01/2008

There are clear differences between the Part C and Child Welfare systems in their general approaches or philosophy and clients served.  For example, the focus of Child Welfare Services is on protecting the childs safety and dealing with the perpetrator and Part Cs focus is providing services to children with disabilities and their families.  Also, maltreated children and their families may present new challenges to Part C practitioners. These differences create a gap between staff hired to serve child welfare population who are now being asked to recognize the developmental needs of children, and Part C practitioners trained to work with children with disabilities and their families. Our discussions with experts have identified ways to possibly address this issue.

Previous Research

As stated earlier, maltreated children receiving services bring a new set of challenges to many Part C service providers.  In addition to their developmental problems, maltreated infants and children may bring behavior problems, problems in the family of origin, substitute caregivers who may not be knowledgeable about the child, multiple service providers and payment sources, and other challenges for interventionists to resolve (Vig et al., 2005).  Previous research also supports the idea that increasing interventionists knowledge will improve services and outcomes.  Vig et al. argue that early intervention providers may not be well prepared to address these special considerations when working with maltreated children.

The training, collaboration, and knowledge of child welfare staff could have important ramifications.  There is evidence to suggest that Part C and other early intervention programs may be underutilized (Horwitz, Owens, & Simms, 2000; Robinson & Rosenberg, 2004). This underutilization is associated with the inability of some child welfare professionals to recognize potential developmental problems (which result in low referral rates), as well as low intervention participation (and high attrition) among parents and caregivers (Giardino, Hudson, & Marsh, 2003; Hurlburt et al., 2004).  Having better trained staff could potentially improve referral rates. 

Among agencies providing services for maltreated children there is a gap between advances in basic science (what we believe works) and what is provided (Barth et al., 2005; Wolfe & Wekerle, 1993).  Although most practitioners who work with maltreated children and their families want to provide the best treatment possible, they do not have the opportunity, financial resources, knowledge, training, or incentives to provide best practices.  Experts consulted have suggested the following strategies for closing the gap:  (a) financial changes and incentives (e.g., increased programmatic funding for education and direct costs for hiring more educated workers, higher reimbursement for empirically-based treatments, only paying for empirically-based treatments), and (b) a variety of dissemination plans including providing materials, training, supervision and consultation opportunities from universities, research society conferences, and in-house training facilities (Brown, Zaslow, Weitzman, 2006; Mahler et al., 2002; Malone, McKinsey, Thyer, & Straka, 2000). 

Study Findings

During discussions with Part C and Child Welfare experts, an issue raised was that increased training and collaboration of Child Welfare and Part C service providers could be a useful approach to facilitate CAPTA compliance and enhance developmental outcomes for children.

Experts we spoke with were concerned about both Part C and Child Welfare workers being able to manage high-risk families in the Part C service environment.  According to the experts, very few Part C providers have both early intervention and social work training and knowledge.  Many states hire BA-level Child Welfare front-line workers who do not have a social work, psychology, or human services background.  At the most basic level, Child Welfare workers may not be able to identify infants and toddlers who need developmental services and will need more training to know which children to refer.  Referring based on substantiation is likely to result in many false positives (substantiated cases with no need for developmental services) and many false negatives (unsubstantiated cases with a need for developmental services).  Therefore, the experts suggest that additional training is needed for these workers.

The experts suggest cross-training, better developmental education for front-line Child Welfare workers, and specialized case coordination.  Specific topical areas for training for Child Welfare workers include:

  • Basic infant development
  • How and when to make referrals

The experts suggest training for both Child Welfare Services and Part C workers in these areas:   

  • Infant mental health problems and interventions
  • Understanding of the specific roles and functions of Part C and Child Welfare Services

The experts made a point to emphasize that both Part C and Child Welfare front-line workers and supervisors need to be trained.  According to the experts, supervisors have an important role in helping front-line staff understand the collaborative system between Part C and Child Welfare Services.  Supervisors need to understand the specific roles and functions of Part C and Child Welfare Services and to be able to train their own staff on these issues.

In addition to training, enhanced collaboration could also facilitate CAPTA compliance and improve child outcomes.  Experts expressed concern over the lack of centralized authority or responsibility for implementation of the CAPTA requirements.  In the majority of jurisdictions, the lead agency for Part C is not the department of social services.  Thus, coordination between Part C and Child Welfare Services can be challenging.

An added element to the coordination mix is that the court system may be involved. One of many issues that does require a coordinated response involves the handling of court-ordered services  quite common in cases in which child maltreatment is substantiated  but not familiar to Part C providers, because Part C services are voluntary.  When family involvement in Part C services is mandated by the courts, this creates many new issues to be resolved regarding confidentiality, reporting back to the courts, protocol for noncompliance by the family, and the unfamiliarity and likely discomfort of the Part C provider with the role of mandated service provider. 

Ideally, states need to have effective collaborative service plans.  While this project did not conduct a comprehensive analysis of existing models across the nation, during conversations with experts, Delaware and Utah were identified as states that have successful collaborative models.  Alaska has acted to bring all prevention services together under Child Welfare Services. Colorado has also just moved their lead Part C services agency from education to health services.  Potentially, other states could look at the work in these four states to determine if any promising practices could be implemented in their own state.

Implications

Of course, any implementation of a training curriculum or enhanced collaboration model may have cost implications.  Training needs vary by state.  A few states have negotiated agreements between Part C and Child Welfare agencies, so that child welfare workers become a designated referral source responsible for screening prior to referral, with training provided by Part C agencies. States already providing Part C services to children at-risk seemed to need less procedural change to serve maltreated infants and toddlers. Screening does not seem to be a problematic issue for these states. States that have a tradition of working with at-risk children are likely better prepared to provide services to maltreated infants and toddlers.

However, the majority of states do not have a tradition of working with at-risk children or a collaborative working relationship between Child Welfare Services and Part C, nor does there appear to be a system of accountability, except perhaps in those states where the same lead agency is responsible for both systems. Opportunities for joint Part C and Child Welfare Services trainings would enable staff and supervisors from both systems to better understand their specific roles and functions.

As our findings demonstrate, Part C professionals are somewhat familiar with maltreating and very high-risk families, as demonstrated by the 28% of infants and toddlers with an IFSP 12 months after baseline. However, those children were receiving services prior to the CAPTA mandate and as such likely represent voluntary participation in Part C. Part C service providers (e.g., physical therapists, speech therapists, developmental specialists) are typically not trained to work with infant and particularly not adult mental health issues. To meet the needs of child developmental problems rooted in dysfunctional child/caregiver interactions will require Part C or Child Welfare Services to access Infant Mental Health services in behalf of these children.

Footnotes

[3] The report, Literature Review: Developmental Problems of Maltreated Children and Early Intervention Options for Maltreated Children, available at http://aspe.hhs.gov/hsp/07/Children-CPS/litrev/index.htm, provides additional information on this topic.

[4] The CBCL version used in NSCAW has two scales. The first is for children 2- to 3-years old and the second is for children 4 years and older.

[5] 27% of the referrals were not received by Part C:  18% refused the referral, 19% accepted the referral but for various reasons did not engage with Part C.

[6] Eligibility can be lost in several ways. For example, in some states children deemed eligible because of clinical opinion must be evaluated within 6 months. At that time the child must meet eligibility criteria for services to continue. Similarly, children are periodically reevaluated while receiving Part C services. If the degree of delay no longer meets criteria or if the child has met IFSP objectives the child will no longer be eligible for services. In states that designate eligibility based on risk status, if the number of required risks is no longer evident the child will lose eligibility. Infants with an IFSP based on risk may lose eligibility, after a period of time, if no delay is apparent.  Another likely source of decline in IFSP rates is family choice not to continue receiving services.

[7] As children approach age 3, the local education agency (LEA) determines eligibility for Part B Section 619 preschool services. Section 619 services are provided through Part B of IDEA. Eligibility for Section 619 services is different than Part C. Risk status does not influence eligibility for Part B services. Section 619 services are for children with a disability including: mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities who need special education and related services. There is an optional category of developmental delay for children ages 3 through 9, at the discretion of the state and the LEA, for children experiencing developmental delays in one or more of these areas:  physical development, cognitive development, communication development, social or emotional development, or adaptive development (Danaher, 2005).

 

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