September 2013

Module 1 Why Early Childhood Matters

Module 1: Learning Objectives 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 Why it is important to focus on early childhood?

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, social- emotional) Most opportunity for intervention and action leading to positive long-term outcomes

Young Children Are Vulnerable 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 ; Child Abuse and Neglect Fatality Victims by Age, 2010www.childwelfare.gov

Young Children are more likely to die as a result of child abuse and neglect Source: Child Maltreatment 2010 at ; Child Abuse and Neglect Fatality Victims by Age, % of fatalities are children younger than 4 years old

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:

In Oklahoma Number of children in out of home care on January 31, 2014 Children In Care Children Birth to Three Statewide10,5303,708 Tulsa Co588

Why Focus on Early Childhood? 2. To set the trajectory for a healthy, happy life

Adverse Childhood Experiences (ACEs) Study: What happens between infancy and adulthood can create a lifetime of addictions, abuse and mental health problems. Available at The Relationship between ACEs and Adult Health

ACE Study Findings 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 Compared with people with no ACEs, those with four or more ACEs: Source: Adverse Childhood Experiences (ACE) Study. Information available at

Untreated Adverse Early Childhood Events Only Exacerbate Over Time Source: Adverse Childhood Experiences (ACE) Study. Information available at

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.

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)NSCAW II Wave 2 Report: Child Well-Being

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) Data on referrals (2010) 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) ntent/articles/ capta-reauthorization.html

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 G FU EI DD EA RN AC LE

21 G FU EI DD EA RN AC LE 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

Ongoing Federal Plans Our obligation to detail and demonstrate our performance regarding safety, well-being and permanency.

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. 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 well- being

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 % of children ages 3 to 5 with identified behavioral health needs do not receive services Source: Cooper, Masi, & Vick, 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, 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!