November 2005Vol. 6, No. 9Reducing Medical Neglect of Infants and Toddlers
Young children involved with the child welfare system have an urgent need for comprehensive health and developmental assessments, and they often need medical services. However, obtaining assessments and services for these infants and toddlers is challenging, especially for those in foster care. Responding to these needs, the Children's Hospital of Philadelphia developed the Starting Young program, which provides evaluations and referrals for early intervention services, primary health care, and medical specialty care for children under 3 who are in foster care, kinship care, or living with biological parents with child welfare involvement. Children are referred to the program by child welfare workers from many different agencies throughout the region.
As part of the Starting Young program, an interdisciplinary team conducts an extensive pediatric developmental evaluation for each child that includes:
- Speech and language assessment
- Gross motor development assessment
- Cognitive development assessment
- Assessment of child’s behavioral health
- Pediatric assessment, including physical health and growth
- Interviews with the family’s social worker, parent(s) and/or foster parent(s)
In order to help ensure that infants have access to Early Intervention (EI) services to which they are entitled (Part C services under the Individuals with Disabilities Education Act/IDEA), a service coordinator from the county’s EI program is a member of the clinical team. This service coordinator facilitates the development of an EI Individual Family Service Plan (IFSP) for those children whose Starting Young evaluation indicates eligibility for EI. Immediately after the assessment, a preliminary report and recommendations are shared with the parent or foster parent and with the family’s social worker. Evaluation follow-up is carried out by a research assistant who checks with the infant’s caregiver and caseworker to see if referrals and recommendations are being followed and identifies any barriers to accessing needed services. The team conducts an extensive re-evaluation of children every 6 months.
Besides conducting the hands-on assessments of infants and toddlers referred to the program, the Starting Young clinical team provides training for child welfare workers on the importance of linking young children to health care, specialty care, and early intervention services. They also offer educational programs for foster parents and for health care professionals. Clinical training is provided to graduate and postgraduate health care professionals, allowing them to work with the interdisciplinary evaluation team and providing exposure to situations involving the child welfare system.
Now in its fourth year, the Starting Young program is conducting an ongoing evaluation of its activities and outcomes. Preliminary results indicate that successful strategies include the use of an interdisciplinary team, comprehensive clinical assessment practices, collaboration with caregivers and social workers, educational programs, and alliances with community groups. Challenges have included difficulty in obtaining parental permission for sharing of information, and the fact that certain recommendations are less likely to be followed, notably, referrals for hearing evaluations with pediatric audiologists and testing for HIV infection. Preliminary results suggest that this nonoptimal compliance is due to (1) problems obtaining consent to authorize these recommended tests and (2) the fact that child welfare caseworkers and supervisors are not convinced of the urgency of these recommendations for infants and toddlers.
Through collaboration, assessment, training, and education, Starting Young is changing the culture of child welfare workers and improving health care for young children in the child welfare system in greater Philadelphia. Community partners report that child welfare workers are much more aware of the need to refer infants and toddlers for comprehensive assessments. The Starting Young program has demonstrated the value of providing interdisciplinary assessments and is making referrals that have been shown to help these at-risk children access the health and developmental services they need.
For more information about the Starting Young program at Children's Hospital of Philadelphia, contact:
Dr. Judith Silver, Program Director
Starting Young Program
Children's Hospital of Philadelphia
3615 Civic Center Boulevard
Philadelphia, PA 19104-4318
Phone: 215.590.7723
Email: silverj@email.chop.edu
Note: The Starting Young Project was funded by the Children's Bureau, Grant 90-CA-1697, under the Children’s Bureau Priority Area: 2001B3: Field-Initiated Demonstration Projects Advancing the State of the Art in the Child Abuse and Neglect Field. This article is part of a series highlighting successful Children's Bureau Grant-funded projects around the country, emerging from official Children's Bureau site visits.
