California Early Start Policy Primer:

Where Do We Go From Here?

Marie Kanne Poulsen, Ph.DKeck School of Medicine

Children’s Hospital Los AngelesUniversity of Southern California

California FamiliesInfants & Toddlers: Birth to Three

1,500,000 babies birth to three

34,000 families with

babies with special needs

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California Early StartEarly Intervention Services

1986: Individuals with Disabilities Education Act (IDEA): Part C

1993: California Early Intervention Services Act (CEISA): Early Start (Family) Program

California Early Intervention Services ActEarly Start for Infants, Toddlers & Families

Family Centered Multidisciplinary Interagency Comprehensive Coordinated Statewide system CA Government Code, 95002

Part C Federal RequirementsCA Early Start Program

Designated lead agency DDS w/ CDE as partner

All Regional Centers & school districts provide intervention & educations services.

DDS: Administration & coordination of the statewide delivery system

CDE: Solely low incidence & maintenance of effort

Part C Federal RequirementsCA Early Start Program

$53 million federal support, with $ 256 M from state general fund = $309,000,000

Federal mandates, including Performance Plan and Annual Report on 10 indicators of compliance

2014 Added Requirement of a State Systemic Improvement Plan addressing an outcome for high interest but low performance indicator

CA Early Start Federal Requirement

Definition of State Eligibility

Infants and Toddler: Birth to three years

Significant developmental delay (33%) Established condition High risk of experiencing developmental delay

or disability due to a combination of biomedical risk factors (removed 2009 restored 2015)

Part C Federal Eligibility RequirementsEstablished Condition & Significant Delay

Developmental Areas

Cognitive Physical & Motor Communication Adaptive Social-Emotional

CA Early Start State Requirement

Eligibility: 2 Biomedical Factors Low birth weight Assisted ventilation Small for gestation Asphyxia Prenatal exposure Neonatal seizure CNS lesion Failure to thrive

Part C Federal Requirements

Child Find

Evaluation Individualized Family

Service Plan Early Intervention Services Mediation/ Due Process State Interagency

Coordinating Council

Part C Federal Requirements Service Coordination

assistive technology audiology family supports health services medical evaluations nursing services nutrition services occupational therapy language therapy

physical therapy psychological services respite care service coordination social work services special instruction transportation vision services

2012 California Legislative Changes

Utilization of Private Insurance

Regional Centers can access a parent’s private insurance benefits to pay for early intervention medical and health care services.

Qualified personnel Natural environments Collaboration/coordination Deductibles and Co-pays

Part C Federal Requirements State Performance Plan & Annual Report

Compliance to the 10 Federal Indicators Timely Assessment and IFSP in 45 days Positive social-emotional, use of knowledge &

language, adaptive self-help skills outcomes Early Start Services helped families Child find percentage of population Transition

2014 Part C Federal RequirementState Systemic Improvement Plan (SSIP)

Increases capacity of Early Intervention Services to implement, scale up, and sustain evidence-based practices

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2014 Part C Federal SSIP Requirement2020 Achievable Measureable Result

Improves outcomes for infants and toddlers

and their families

Based on State data and Stakeholder input

Recommended by the State Systemic Improvement Plan Task Force

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2014 Part C Federal RequirementState Systemic Improvement Plan (SSIP)

Identify a significant state challenge Identify root causes for low performance Develop Theory of Action Build EI program and EI provider capacity to

achieve the chosen State Identified Measureable Result by 2020

State Identified Measurable ResultSocial and Emotional Development

Turns to caregivers for TLC, solace, attention & guidance

Manages emotions & behaviors to developmentally appropriate expectations

Has the initiative to explore, discover, learn & make friends

State Identified Measureable Result

Social and Emotional Development

High parent priority Infant brain research Critical preschool inclusion indicator Critical resilience indicator Lowest Annual Report indicator

State Identified Measureable ResultEnhance Social and Emotional Development

Identified Root Causes: Lack of skills of professionals who

provide Early Intervention services related to social-emotional development

Lack of family-centered approaches in service delivery that address mother-child interaction & promote first relationships

State Identified Measureable ResultEnhance Social and Emotional Development

Identified improvement strategies: Sustainable professional development on infant-family

mental health

Strengthen parent-child interactions through relationship based practices

Strengthen families through community services and supports to complement Part C

1997 White House Conference Brain Development in Young Children

Insights on Early Mother-Child Nurturing Relationships

Influence how the intricate circuitry of the brain is wired

Influence extremity and frequency of stress levels of cortisol

Interpersonal interaction, not sensory stimulation, as the key to healthy development

1999 White House Conferenceon Mental Health

Infants as young as one month can sense when their parents are angry, anxious or depressed

Babies as young as 3-4 months can experience symptoms of depression when separated from their mothers

Poulsen/ USC UCEDD

Roots of Social-Emotional DevelopmentResponsive Meaningful Caregiving

Maternal Emotional Availability

Infant Emotional Availability

Relation-ship

Relationship: Centrality of Social-Emotional Development

Poulsen/ USC UCEDD

“The emotional well-being of young children is directly tied to the emotional functioning of their care givers and the families in which they live.’

-- Center on the Developing Child (2008)

Harvard University

Poulsen/ USC UCEDD

Mothers of Babies with Delays, Disabilities and Biomedical Risks

May be first time moms May be experiencing anxiety

or depression May be experiencing birth-related

posttraumatic stress disorder May be alone May be worried about family circumstance

24% live below federal poverty level 46% babies live in low income families 32% live in single parent families 45% babies born to foreign-born mothers 10-15% on new mothers experience

postpartum depression

California’s Challenging Family Circumstances

Caregiving as Modifier of the Brain

Babies of mothers w/ postpartum depression Infants withdrawn & less active Infants with shorter attention Elevated heart rates and cortisol levels 75% with less frontal brain activity Greatest risk between 6 and 18 months Brain activity normalizes when mother has

treatment

19% of mothers did not finish high school 12% live in families with parents who are

unemployed 23% of babies experience high mobility 65% of babies have at least one risk factor

known to increase the chance of poor health, school & developmental

outcome

California’s Challenging Family Circumstances

Early Childhood Summit 2010 Impact of ACE on Child-Well Being!

Infants and young children absorb stresses within their families, increasing cortisol level & reactivity.

Adverse childhood experiences can effect the architecture of the brain, the ways of

responding to the world, and long term health and mental health.

Social-Emotional Development OutcomesCumulative Risk

The notion of CUMULATIVE RISK asserts that the greater the number of adverse child experiences, the greater is the risk for negative developmental, mental health and health outcomes.

Policy Voices from the FieldSocial-Emotional Development

Financially support a community comprehensive system of care* for children and their families that promotes protective factors and responds to biological, psychosocial & environmental risks to child well-being

--- Strengthening Families, MCHB Center for the Study of Social Policy

Key System of Care Partner Early Start Family Resource Centers

47 Centers: Primarily parent driven & parent run Parent to parent support Many languages / Culturally responsive Resource libraries, Information & Referral System navigation Transition assistance to families (2011) Prevention Resource & Referral Services

CEISA: 1998 Amendment

Policy Voices from the FieldSocial-Emotional Development

“Expertise in the identification, assessment and treatment of young children with mental health problems should be incorporated into early intervention programs.”

--- National Scientific Council on the Developing Child

“Require a professional with expertise in social – emotional development to sit on the {Part C} multidisciplinary evaluation team.”

--- National Center for Children in Poverty

Policy Voices from the FieldSocial-Emotional Development

“Establish comprehensive screening protocols for social-emotional, developmental, autism and maternal depression as part of well child visits.”

Provide written guidelines to establish common procedures for screening for all Medi-Cal Managed Care well-visits. Adopt quality measures to ensure statewide consistency

---First 5 Association of California

Early Childhood Mental Health Project

Policy Voices from the FieldSocial-Emotional Development

Ensure greater reimbursement for maternal depression & early childhood mental health screening.

Develop a state level policy proposal that requires statewide collaboration & coordination to increase utilization of existing reimbursement mechanisms.

--- First 5 Association of California Early Childhood Mental Health Project

Policy Voices from the FieldSocial-Emotional Development

“Promote universal adoption of CA Training Guidelines and Personnel Competencies for Infant-Family and Early Childhood Mental Health by state and local agencies and institutes of higher education.”

--- First 5 Association of California

Early Childhood Mental Health Project

Policy Voices from the FieldSocial-Emotional Development

“Promote state-level coordination and collaboration to develop a statewide system for training early childhood professionals from multidisciplinary backgrounds to attain the Infant-Family and Early Childhood Mental Health Competencies.”

--- First 5 Association of California

Early Childhood Mental Health Project

Social-Emotional DevelopmentEnhancing Part C through Policy

Community supports to strengthen families Establish screening protocols and funding through

medi-cal as part of primary health care visits Require infant-family mental health specialist as

member of Part C multidisciplinary team Develop a statewide system for training early

childhood providers from multidisciplinary back grounds to attain infant-family mental health assessment and intervention competencies.

State Identified Measureable ResultSocial-Emotional Well-Being

Relationships: Getting Leads to Giving and Resilience!

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