September 2013
Module 1
Why Early Childhood Matters
http://youtu.be/GbSp88PBe9E
http://youtu.be/GbSp88PBe9E
Module 1: Learning Objectives
Why it is important to focus on early childhood?
•
It is the population of highest risk that we serve
•
What happens to us early in life affects us for
the rest of our lives
•
Federal obligations require us to
•
We need to recognize problems so we can both
intervene early and set reasonable expectations
•
We may be doing harm otherwise if we don’t focus on
the needs and well-being of this population
Vicarious trauma –take
care of yourself
Why Focus on Early Childhood?
1. To protect the largest and most
“vulnerable” population in child
welfare
We must protect the most “vulnerable”
population
• Largest population in child welfare both in
terms of numbers and percent
• Most developmentally vulnerable across
various domains (health, cognitive, socialemotional)
• Most opportunity for intervention and action
leading to positive long-term outcomes
Young Children Are Vulnerable
Maltreated Children
Ages 0-3
Older than 3
General Child Population
Ages 0-3
23%
34%
66%
Older Children
77%
34% of abused and neglected children are between the ages of 0-36
months old, but only make up 23 % of the general child population.
Source: Child Maltreatment 2010 at www.childwelfare.gov ; Child Abuse and Neglect Fatality Victims by Age, 2010
Young Children are more likely to die as a
result of child abuse and neglect
8-21
years
9%
4 to 7 years
11%
1 to 3 years
32%
Younger than 1
year
48%
79.4 % of
fatalities are
children
younger than
4 years old
Source: Child Maltreatment 2010 at
www.childwelfare.gov ; Child Abuse and
Neglect Fatality Victims by Age, 2010
Young children are over-represented
in foster care nationally
• Over 1 in 4 children in foster care are 0-3
• Younger children have longer durations in care
(30 months for infants 0-3 months)
• Young children have the lowest rates of
reunification
• At least 1 in 4 re-enter care after return home
Source: http://www.acf.hhs.gov/programs/cb/pubs/cm10/
In Oklahoma
Number of children in out of home care on January 31, 2014
Statewide
Tulsa Co
Children
In Care
Children
Birth to
Three
10,530
3,708
588
Why Focus on Early Childhood?
2. To set the trajectory for a healthy,
happy life
Adverse Childhood Experiences (ACEs) Study:
The Relationship between ACEs and Adult Health
What happens between infancy and adulthood can
create a lifetime of addictions, abuse and mental
health problems.
Available at www.cdc.gov/ace/index.htm
ACE Study Findings
Compared with people with no ACEs, those with four or more ACEs:
• Seventeen times more likely to have learning and behavior
problems in school (51% vs 3%) (Burke et al 2011)
• Twice as likely to smoke
• Seven times as likely to be alcoholics
• Six times as likely to have had sex before age 15
• Twice as likely to have cancer or heart disease
• Twelve times more likely to have attempted suicide
Source: Adverse Childhood Experiences
(ACE) Study. Information available at
http://www.cdc.gov/ace/index.htm
Untreated Adverse Early Childhood Events
Only Exacerbate Over Time
Source: Adverse Childhood Experiences (ACE) Study.
Information available at
http://www.cdc.gov/ace/index.htm
Neglect
Extensive biological and developmental
research shows significant neglect—the ongoing
disruption or significant absence of caregiver
responsiveness—can cause more harm to a
young child’s development than overt physical
abuse, including subsequent cognitive delays,
impairments in executive functioning, and
disruptions of the body’s stress response.
http://developingchild.harvard.edu/resources/multimedia/videos/inbrief_series/inbrief_neglect/
Developmental Delays Emerge Early
• Young children who are maltreated are behind their peers
developmentally, yet still are unlikely to get services
• Child welfare law (Child Abuse and Prevention Treatment Act)
and disability law (Individuals with Disabilities Education Act)
have come into alignment to address this challenge
o Focused on Part C Early Intervention Services
Source: NSCAW II Wave 2 Report: Child Well-Being (July 2012)
Why focus on Early Childhood?
3. Federal Mandates, Guidance &
Plans.
CAPTA and IDEA Requirements
Child Abuse Prevention
and Treatment Act
•
Procedures for the referral of
children (under three) with
substantiated cases of child
abuse/neglect to early
intervention services funded by
Part C of (IDEA)
(2003)
Individuals with
Disabilities Education Act
•
Matching language was included in
the IDEA that requires Part C Early
Intervention programs to reach out to
child welfare.
(2004)
(2011
Regulations)
•
Data on referrals
(2010)
http://apps.americanbar.org/litigation/committees/childrights/co
ntent/articles/010311-capta-reauthorization.html
F
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R
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U
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Administration on Children, Youth,
and Families
(April 2012)
• Priority on improving social and emotional
well-being outcomes for children and youth to
achieve better systems outcomes
• Emphasizes the importance of understanding
the impact of abuse and neglect impact
neurobiology
Information Memorandum ACYF-CB-IM-12-04
www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf
F
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R
A
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G
U
I
D
A
N
C
E
Waiver Demonstration Sites
May 2012
• Engaging Parents
– WA: Family Assessment Response
• Enhancing Social-Emotional
Well-Being and Permanency
– WA: Permanency Push
– WA: Promoting EBPs
ACYF-CB-IM-12-05
www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1205.pdf
21
Ongoing Federal Plans
• Our obligation to detail and demonstrate our
performance regarding safety, well-being and
permanency.
www.acf.hhs.gov/sites/default/files/cb/im1106.pdf
Why Focus on Early Childhood?
4. To help everyone have realistic
expectations about child
development
Why? To help everyone have realistic
expectations about child development.
Knowledge of child development
is one protective factor
for maltreatment.
http://www.ok.gov/health/Child_and_Family_Health/Family_Support_a
nd_Prevention_Service/Strengthening_Families_Initiative/
Knowledge of typical child development
helps us recognize atypical development.
Atypical development is most effectively
treated when identified early during brain
plasticity when most amenable to change.
Why Focus on Early Childhood?
5. To do no harm and focus on wellbeing
Myths about trauma
and children
• Too young to remember
• Babies don’t say
anything
• No scars = no harm
Unmet Well-Being Needs for
Young Children in Child Welfare
•
Less than 1% of children with emotional and behavioral
problems are identified early
•
2-3 times more preschool age children have trauma-related
symptoms than are diagnosed.
•
80-97% of children ages 3 to 5 with identified behavioral health
needs do not receive services
Source: Cooper, Masi, & Vick, 2009. What Every Policymaker Should Know. Social-emotional Development
in Early Childhood. National Center for Children in Poverty. Mailman School of Public Health. Columbia
University.
Unmet Well-Being Needs for
Young Children in Child Welfare
• Young Children Less Likely to Receive
Services Compared to Older Children
– 35% - of school-age children involved with child welfare
– 13% - of children 0-5 involved with child welfare
• Infants and Toddlers Ages 0 to 2
– Least likely to receive developmental services
Source: Cooper, Masi, & Vick, 2009. What Every
Policymaker Should Know. Social-emotional Development
in Early Childhood. National Center for Children in Poverty.
Mailman School of Public Health. Columbia University.
In Summary, Why Focus on Early Childhood?
• To protect the largest and most vulnerable population
• To set the trajectory for a healthy, happy life
• To focus on well-being in addition to safety and
permanence as required by Federal mandates,
guidance and plans.
• To help everyone have realistic expectations for
children’s development
• To recognize problems early and intervene in a timely
manner
• To do no harm – now and for the future
Knowing the Science of Early Childhood Can
Better Inform Our Decision Making in Key
Events in Dependency
•
•
•
•
•
Removal and placement
Case planning
Court appearances
Visitation and family time
Reunification, adoption & termination
Keys to healthy development
• A balanced approach to emotional, social, cognitive and
language development starting in the earliest years of life
• Supportive relationships and positive learning
experiences that begin with parents but are strengthened
by others outside the home
• Highly specialized interventions as early
as possible for children and families experiencing
significant adversity
Source: Center on the Developing Child
at Harvard University (2011).
Summary of Attachment
• Infants are strongly biologically predisposed to attach
to caregivers
• Adults are strongly biologically predisposed to attach
to babies
• Once babies reach a cognitive age of 7-9 months,
their attachments begin to consolidate and focus
on specific individuals
• Attachment is a process which develops over the first
several years of life based upon nurturing experiences
with caregivers
• Attachments may be different with different caregivers
Relationships matter
• Attachment is a process
• Relationships develop over time
• Relationships buffer stress
• Disrupted relationships are painful
• Children experience loss and grief even at
very young ages
• What does this mean for child welfare?
What does all this mean for child welfare?
Support and promote nurturing and stable
relationships in the life of the child.
• Provide in-home supports to prevent removal in
the first place
• Don’t move children to different homes, child care or
schools at critical developmental periods
• Make the first placement the only placement
• Ensure frequent and meaningful visitation
• Concurrent planning for reunification and permanency
Summary:
Understanding the Impacts of Maltreatment
• Children who have been abused, neglected and/or
maltreated are more likely to experience toxic stress
• The impacts of abuse, neglect and/or maltreatment
can negatively influence all developmental domains
• These delays persist through a child’s life, making it
harder for them to do well in school and adulthood
• Early and periodic medical, dental and
developmental screening and referrals to
appropriate interventions can change life
trajectories.
• The “buffering” relationship with a loving, stable
caregiver remains key to alleviating these negative
impacts. It’s never too late!