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

2. Why Focus on Infants & Toddlers? Babies’ vulnerability to neglect Largest 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 System Children’s Bureau

3. Infants in Foster Care: Especially Vulnerable More likely to enter Longer length of stay Highest rate of re-entry Multistate FC Data Archive, Chapin Hall, University of Chicago

4. Distinctive Issues for Infants & Toddlers Most Rapid Period of Brain & CNS Development Multi-Disciplinary approach essential Intertwined, Interdependent: –Mental Health –Physical Health & Growth –Development

5. Health & Development of Children & Teens in Foster Care Higher rates of: Acute Illnesses Chronic Medical Conditions Developmental Delays Dental Decay Vision Problems Emotional/Behavioral Problems

6. Limited Access to Health Care During Foster Placement Most children need MORE than routine health care (specialists) Many do not receive routine health care Many are underimmunized Missing medical records

7. Starting Young Program Ages 4 to 33 months Open DHS cases Interdisciplinary Pediatric Developmental Evaluations

8. Services Needed: Primary Health Care70% Early Intervention (DD) 47% Allied Health Specialists45% Medical Specialists26%

9. Did They Receive Needed Services? Early Intervention64% Medical Specialists 64% Hearing Test26% HIV Screening25%

10. 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

11. 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

12. 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?

13. –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?

14. 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?

15. Has parental consent been obtained? For all needed: Medical Records Assessments Recommended Non-Routine Treatments

16. The End