MECLI and Referrals of Abused or Neglected Children to Early Intervention John A' Lippitt, Ph'D'

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MECLI and Referrals of Abused or Neglected
Children to Early Intervention John A.
Lippitt, Ph.D.
Institute for Child, Youth, and Family
Policy The Heller School for Social Policy and
Management, Brandeis University
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The Massachusetts Early Childhood Linkage
Initiative (MECLI)
The MECLI project was funded by the U.S.
Department of Health and Human Services,
Administration for Children and Families,
Children's Bureau The A.L. Mailman Family
Foundation The Annie E. Casey Foundation and
The Frank and Theresa Caplan Endowment for Early
Childhood and Parenting Education at The Heller
School for Social Policy and Management, Brandeis
University. We thank these organizations for
their support but acknowledge that the findings
and conclusions presented in this report are
those of the author(s) alone and do not
necessarily reflect the opinions of these
organizations.
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Massachusetts Early Childhood Linkage Initiative
- MECLI

• Objective
• Refer young children under three years of age
  with newly substantiated cases of child abuse or
  neglect to EI
• Partner Organizations
• Massachusetts Department of Social Services
  (MDSS)
• Massachusetts Department of Public Health (MDPH)
• Early Intervention programs (EI)
• The Heller School for Social Policy and
  Management, Brandeis University

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Why Refer Children from Child Welfare Systems to
Early Intervention?

• Children who have been abused or neglected have
• High incidence of developmental delays and risk
  factors that are addressed by Early Intervention
• The key, nurturing relationship with parents has
  been seriously disrupted
• Experiences that are highly stressful and
  possibly traumatic

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Stress in Early Childhood

• TOXIC STRESS
• Strong, frequent or prolonged activation of
  bodys stress management system
• Can impact brain architecture in the absence of a
  nurturing caregiver, typically a parent
• Affects development, as well as long-term health
  and mental health

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Stress in Early Childhood

• Positive stress moderate, short-lived stress
  response
• Normal part of life
• Learning to handle this type of stress is
  essential to healthy development
• Tolerable stress strong stress response
• Generally infrequent and for brief periods
• Nurturing caregiver provides a safe environment
  that helps the child calm down, reduces the
  stress level, and avoids harmful brain impacts

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Why Refer Children from Child Welfare Systems to
Early Intervention?

• Key environmental conditions that can lead to
  toxic stress are
• Child abuse and neglect
• Parental substance abuse
• Parental mental health problems, notably maternal
  depression
• Violence in the home

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MECLI Background

• Guided by the science of early childhood
  development
• Goal to close the gap between what we know and
  what we do to support healthy child development
• Objective have MDSS refer all young children
  under 3 years of age with newly substantiated
  cases of child abuse or neglect to EI programs
• Both CW and EI in Massachusetts were supportive
• Robust EI system able to handle referrals

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MECLI Background

• In Massachusetts in FY 2003
• 5,000 children under 3 were involved in new,
  substantiated child maltreatment cases
• 6 of all children under the age of 3 (roughly
  15,000) were served by EI (only 2 nationally)
• For MECLI study
• Selected 3 pilot sites in Massachusetts - 3
  of 28 Area Offices of MDSS - served by 6 of 65
  EI programs

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MECLI Pilot Sites
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The MECLI Referral Process
MDSS supports a case involving a child under 3
MDSS offers EI referral to family
Parent accepts referral, signs consent form
EI receives form contacts family
Child is assessed by EI for eligibility
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MECLI Findings Referrals

• 540 childrens families were offered a referral
  to EI by MDSS
• 18 of parents refused the referral (99)
• 19 of families who initially accepted the
  referral did not engage with EI (103)
• 40 of children were assessed for EI eligibility
  (218)

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MECLI Findings (contd) Eligibility

• 74 of children assessed were eligible
  (161/218) under MA broad eligibility criteria
• 49 had an eligible delay (107/218) (25 delay
  required)
• 17 eligible due to 4 of 20 risk factors
  (37/218)
• 1 eligible by established condition or clinical
  judgment
• 6 eligibility criterion unknown

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MECLI Findings (contd) Delays

• 40 language delay (84/211)
• 24 adaptive / self-help delay (50/211)
• 23 gross motor delay (49/211)
• 21 fine motor delay (45/211)
• 20 cognitive delay (43/211)
• 15 social-emotional delay (32/211)

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MECLI Findings (contd) Risk Factors

• CW involvement 69 (145/211)
• Parental chronic illness or disability 35
  (74/211)
• Domestic violence 25 (53/211)
• Substance abuse 25 (52/211)
• Multiple traumas or losses 17 (35/211)
• Inadequate food, shelter, or clothing 14
  (30/211)
• Family lacking social supports 13 (28/211)

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Challenges forChild Welfare Systems

• Who to refer
• Whether to screen
• If screening, how and by whom
• How to offer a referral consistently
  effectively

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Challenges for Early Intervention Systems

• Increased numbers of referrals
• Engagement of referred families
• Increased number eligible
• Appropriate assessments
• Appropriate services
• Work with biological and foster families

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Challenges Success Strategies for Early
Intervention Systems

• Resources
• Time
• Money
• Expertise
• Expertise on social-emotional development and
  behavioral issues, i.e., early childhood mental
  health

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Challenges Success Strategies for Collaboration

• Buy-in and shared vision
• Policies and procedures
• Roles and responsibilities
• Referral coordinators and collaboration
  facilitators
• Time for collaboration

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Challenges Success Strategies Across Agencies

• Attainable goals and objectives
• Data collection for monitoring and CQI
• Training
• Diversity and cultural competence
• Local variation
• Confidentiality and information sharing

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Conclusions

• Referrals from child welfare system to EI will
  identify children eligible for EI
• These referrals have many implications,
  particularly for EI
• Implementing this federally mandated policy will
  be challenging, but possible
• EI services will improve well-being of some
  children and families