Judith Silver, Ph.D. Judith Silver, Ph.D. Director, Child Welfare Early Childhood Initiative & The Starting Young ProgramThe Children’s Hospital of PhiladelphiaThe Children’s Hospital of Philadelphia

Why Focus on Infants & Toddlers? Babies’ vulnerability to neglectLargest age-group of victims w/

substantiated abuse & neglect*Half of all substantiated medical neglect

cases*Limited exposure to other mandated

reporters*National Child Abuse & Neglect Data SystemChildren’s Bureau

Infants in Foster Care: Especially Vulnerable

More likely to enterLonger length of stayHighest rate of re-entry

Multistate FC Data Archive, Chapin Hall,University of Chicago

Distinctive Issues for Infants & Toddlers

Most Rapid Period of Brain & CNS Development

Multi-Disciplinary approach essential

Intertwined, Interdependent:– Mental Health– Physical Health & Growth– Development

Health & Development ofChildren & Teens in Foster CareHigher rates of:

Acute IllnessesChronic Medical ConditionsDevelopmental DelaysDental DecayVision ProblemsEmotional/Behavioral Problems

Limited Access to Health CareDuring Foster Placement

Most children need MORE than routine health care (specialists)

Many do not receive routine health care

Many are underimmunized Missing medical records

Starting Young Program

Ages 4 to 33 monthsOpen DHS casesInterdisciplinary Pediatric

Developmental Evaluations

Services Needed:

Primary Health Care 70%Early Intervention (DD) 47%Allied Health Specialists 45%Medical Specialists 26%

Did They Receive Needed Services?

Early Intervention 64%Medical Specialists 64%Hearing Test 26% HIV Screening 25%

Promoting Healthy Outcomes: What Works?

Comprehensive Primary Pediatric care: Schedule of recommended visits (Amer. Academy

of Pediatrics): – 2, 4, 6, 9, 12, 15, 18, 24, 30 & 36 months– Annually thereafter (PA regs)

Early Intervention Services for Delayed Development

Early Childhood Education (Head Start) Checklist for Healthy Development

Use Promoting Healthy Outcomes Checklist in Court

Cases Connects healthy development with

permanency To improve accountability that child

receives services Based on checklist developed by NY

Permanent Judicial Commission on Justice for Children*

– Ensuring the Healthy Development of Foster Children: A Guide for Judges, Advocates and Child Welfare Professionals. NYS Permanent Judicial Commission on Justice for Children

What are this child’s medical needs?

Does the child have an identified Primary Health Care Provider and insurance?– Received a full well child/EPSDT visit

according to Amer.Acad.Pediatrics schedule

– Received health screenings recommended for age (newborn hearing, lead, anemia, TB)

– Had medical evaluation by the primary care doctor since placement in foster care?

– Immunizations up to date?

– Prematurity– Past Hospitalizations or Surgeries– Daily Medications– Allergies to medication or food– Followed by any medical specialists– Special equipment required (e.g.

nebulizer)– Risk factors for HIV

Does the child have any risk factors for significant

medical illness?

What are the developmental needs of this young child?

What are the infant’s risks for developmental delay or disability?

Has the child had a developmental screening/assessment?

Has the infant or toddler been referred to the Early Intervention Program?

Has the 3 to 5 year old been screened for preschool special education services?

Has parental consent been obtained?

For all needed:Medical RecordsAssessmentsRecommended Non-Routine

Treatments

The End