Children and Youth Services Review 33 (2011) 1419–1425

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Children and Youth Services Review

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Early childhood interventionists' perspectives on serving maltreated infantsand toddlers

Robert Herman-Smith ⁎University of North Carolina, Charlotte, 9201 University City Blvd. Department of Social Work, CHHS 4th Floor, Charlotte, NC 28223, United States

⁎ Tel.: +1 704 687 7180.E-mail address: bherman@uncc.edu.

0190-7409/$ – see front matter © 2011 Elsevier Ltd. Aldoi:10.1016/j.childyouth.2011.04.013

a b s t r a c t

a r t i c l e i n f o

Available online 14 April 2011

Keywords:Early childhood interventionService providersChild welfareIDEA Part CMeasures

A 2003 amendment to the Child Abuse Prevention and Treatment Act (CAPTA) required states to createdevelopmental screening programs for maltreated infants and toddlers. Programs authorized under Part C ofthe Individuals with Disabilities Education Act (IDEA) were directed to work with state and local child welfareauthorities to develop the screening program. They were also to ensure that additional assessment andintervention was provided when needed. The degree to which this mandate has been implemented varieswidely between state and local programs. Some early intervention experts and Part C program administratorshave expressed concerns about providers' willingness to serve families referred from child welfare, but therehas been no systematic research on this issue. The Professional Interventionist CAPTA Survey (PICS) is a newlydeveloped measure of early childhood intervention providers' perceptions of their responsibilities underCAPTA. The first aim of this study was to conduct analysis of the PICS using a national sample of providers.This study also reports the perceptions of early childhood interventionists about their responsibilitiesunder CAPTA and examines the relationship between worker characteristics and how they perceive theseresponsibilities. The PICS appears to be useful for examining early childhood intervention providers'responses to CAPTA.

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1. Introduction

Since 2003, an amendment to the Child Abuse Prevention andTreatment Act (CAPTA) has required states to develop developmen-tal screening programs for children under the age of three in thechild welfare system. Child welfare agencies in each state weredirected to work collaboratively with early childhood intervention(ECI) programs funded under Part C of the Individuals with Dis-abilities Education Act (IDEA) of 1997, referred to hereafter as Part C.If screenings indicated the need for further assessment or interven-tion services for the child, Part C programs were to ensure they wereprovided. However, programs funded under Part C of IDEA were firstestablished to meet the needs of infants and toddlers up to 36 monthsof age with diagnosed developmental disabilities, such as Downsyndrome, cerebral palsy, autism, or speech delays. Serving childrenand families with mental health needs has not been the primary focusof the program.

Most states have formal agreements to provide developmentalscreening, but many programs at the local level are fragmented or notfully implemented (Barth et al., 2008; Rosenberg, Smith, & Levinson,2005). The reasons for the delayed implementation of Part C screeningand intervention programs are not clear, but the literature has posited

three possibilities. First is the lack of implementation funding. Themandate to screen maltreated children under the age of three camewith no additional implementation funds; therefore Part C programshave no funding for supplies, training, or additional staff. Second,both child welfare and Part C programs are complex, hierarchicallyadministered, and publicly funded programs. It is not unusual forlarge human service systems to experience problems with programcollaboration due to competing mandates, limited budgets, andproscriptions on the type of work they are asked to do. Third, someexperts and administrators are concerned that early childhood inter-ventionists are not willing to serve families involved with thechild welfare system (Barth et al., 2008; Herman-Smith, 2009). Thismight be related to lack of training, confidence, or desire to serve thispopulation.

2. The significance of provider perceptions for services

This study is concerned with Part C providers' perceptions of theirresponsibilities under CAPTA. Research in related fields has shownhow human service providers' impressions of their work play a largerole in determining how, and to what extent, policy objectives areimplemented (Glisson & James, 2002; Hedeker, Gibbons, & Flay, 1994;Raudenbush & Bryk, 2002). Although not studied in Part C or otherECI providers specifically, previous research has found that humanservice providers often reject practices that conflict with their ownunderstanding of an organization's core activities (Meyers, Glaser, &

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MacDonald, 1998; Lin, 1998; Sandfort, 1999). Given that CAPTAlegislation mandated service to a new population for which Part Cproviders have limited training and were given no implementationresources, it is reasonable to think they might be skeptical or evenresistant about following through.

3. Concerns about the role of service providers

There are two major concerns about early childhood interven-tionists' responses to their role under CAPTA. One of these concerns isparent engagement. The overwhelming majority of children involvedwith child welfare remain in their parents' custody. The CAPTA amend-ment authorizing developmental screening programs was explicitthat parents have the right to refuse Part C early intervention services.Therefore, most parents are going to be highly involved in decision-making about services their children receive. Parents involved withthe child welfare system due to child abuse and neglect are often over-whelmed by other difficult issues such as substance abuse, domesticviolence, or chronic disorganization. They may be mistrustful of oroverwhelmed by new service programs. In such a context, engagingparents for ECI is likely to be challenging. Providers' attitudestoward the family and willingness to work with them may make thedifference in whether families accept or decline services.

Another concern about Part C providers serving families referredfrom child welfare is their level of expertise about the social and emo-tional challenges presented by this population. Abused and neglectedchildren often show a wide range of negative behaviors that mightinclude withdrawal, aggression, or over-compliance toward interven-tionists. Most early childhood interventionists have preservice back-grounds in special education or allied health disciplines such as speechand language therapy or physical therapy (Hebbeler et al., 2007;Herman-Smith, 2009). Neither parent engagement nor early childhoodmental health is the focus of most Part C providers' preservice orinservice supervision and training programs. The lack of resources forPart C providers to implement CAPTA means that future inserviceopportunities will likely be limited; therefore, concerns about theirpreparation to workwith families referred from child welfare programsmay be justified.

4. Measure of ECI provider perceptions

This author developed the Professional Interventionist CAPTASurvey (PICS), a measure of Part C providers' perceptions of theirresponsibilities related to CAPTA (Herman-Smith, 2009). Pilot testingindicated the entire measure takes about 15 min to complete. ThePICS has two sections. Section I consists of 15 items. All items useLikert-type scaling with a range of 1 (strongly disagree) to 9 (stronglyagree); higher scores indicate more positive perceptions. Scale itemswere selected using prior research about the concerns of ECI providersand focus groups of Part C providers in one southeastern state. Thescale was then completed by 293 ECI providers employed in Part Cprograms. Exploratory factor analysis yielded three subscales thatreflected the original conceptualization of the measure. The ProviderResources subscale assesses whether Part C providers believe theyhave the skills needed to successfully serve families referred fromchild welfare. TheMission Fit subscale assesses providers' perceptionsthat the CAPTA legislation fits with the primary mission of the Part Cprogram. The Parent Involvement subscale examines the extent towhich Part C providers believe that parents referred by the childwelfare system are competent partners in services for their children.Alpha reliabilities were within acceptable limits (Aday, 1996) for theProvider Resources (α=.83; M=36.66, SD=9.64) and Mission Fitsubscales (α=.70; M=22.48, SD=7.71), but not for the ParentInvolvement subscale (α=.59; M=15.72, SD=5.71).

Section II of the PICS consists of 12 items requesting informationabout professional characteristics (e.g., years in the field, preservice

training, and whether one is a supervisor) and personal characteris-tics (e.g., age, sex, and race). Professional and personal items wereselected based on prior research examining pediatric human servicepractitioners' willingness to involve parents in treatment decision-making. Although the number of studies is relatively small, there isempirical support for the assertion that child service providers'professional training and personal characteristics impact attitudestoward their work with children and families. Higher levels of educa-tion have been positively associated with adoption of new initia-tives (Aarons, 2004; Ogborne, Wild, Newton-Taylor, & Braun, 1998).In a study of attitudes toward parent participation in health care,Gill (1987) found that nurses who were married or were parentsthemselves had significantly more positive perceptions of involvingparents in their children's health care. Letourneau and Elliott (1996)found that older providers were more likely than younger providersand physicians were less likely than other professionals to practicefamily-centered care. Years of education, marital status, being aparent, and academic discipline were included in Section II of thePICS. Other characteristics of interest to this researcher, such as race,gender, and number of years in the field, were also included in thescale.

The PICS is the only available measure of Part C providers' percep-tions of CAPTA. A major limitation is that it was developed using asample drawn from one state. States vary considerably in theiradministration and implementation of Part C ECI programs (Spiker,Hebbeler, Wagner, Cameto, & McKenna, 2000). This variation couldhave a significant impact on professionals' perceptions of theirCAPTA-related responsibilities. In addition, one of the PICS subscaleshad a relatively low Cronbach's alpha. More studywith a larger, multi-state provider sample was needed to further assess the measure.

5. Methods

This study had three aims. The primary aim was to conductadditional analysis of the PICS using a national sample of Part Cproviders. The second aim was to assess perceptions of earlychildhood interventionists about their responsibilities under CAPTA.The third aimwas to examinewhether there is a relationship betweenworker characteristics and how they perceive their responsibilitiesunder CAPTA.

5.1. Recruitment

The fifty states were divided into four geographic regions: East,Midwest, South, and West. Two states from each regional list wereselected randomly for a total of eight states. Each state's Part Ccoordinator was contacted for permission to approach individualservice providers in local Part C agencies within their respectivestates. All states that were initially selected agreed to participate withone exception; that state was replaced with another randomlyselected state from the corresponding regional list. Part C directorswere asked for a full list of their states' local provider agencies whenthese were not publicly available. In each of the eight selected states, atotal of 12 local Part C provider agencies were then randomly selectedfrom a list of the state's providers. Seven surveys were sent to eachagency with instructions for the local director to distribute them toproviders in their respective agencies. A total of 749 surveys were sentby mail to participating agencies. The total number of surveys sentwas based on an anticipated response rate of 50%, which is consistentwith previous studies of pediatric health service providers (O'Donnell,2004; Silverstein, Grossman, Koepsell, & Rivara, 2003) and earlychildhood interventionists (Herman-Smith, 2009). The survey enve-lopes also included a $1.00 token incentive and a pre-addressedstamped envelope for returning the survey. Data collection continuedfor 6 weeks.

Table 1Study sample characteristics.

Variable Percentage

Professional characteristicsYears of education

Bachelors 40.9Masters 48.4Doctorate 5.5Medical Degree 2.0Other 3.2

Academic disciplineSpecial education 18.5Social work 17.5Speech/Language pathology 11.0Education 10.5Psychology 8.0Occupational therapy 7.0Physical therapy 5.0Human services 4.7Nursing 4.5Business 1.2Audiology 0.5Medicine 1.0Nutrition 0.2Other 10.4

Current titleService coordinator 31.4Speech/language pathologist 9.7Occupational therapist 7.0Director 6.5Social worker 4.5Physical therapist 4.0Nurse 2.0Educational diagnostician 1.5Psychologist 1.4Physiciana 0.4Audiologist 0.2Nutritionist 0.2Other 31.2

SupervisionHas supervisory responsibilities 25.9No supervisory responsibilities 74.1

Time in agencyLess than 1 year 2.71 to 3 years 24.64 to 6 years 17.27 to 10 years 22.3More than 10 years 33.2

Time in fieldLess than 1 year 7.21 to 3 years 14.04 to 6 years 16.27 to 10 years 16.0More than 10 years 46.6

Hours of CAPTA training1 to 5 h 35.96 to 10 h 13.711 to 15 h 8.316 to 20 h 5.7More than 20 h 36.4

Personal characteristicsRacial/ethnic group

African American 7.7Asian 0.7Hispanic/Latino 2.7Native American 1.2White/Caucasian 83.0Other 4.9

GenderMale 7.7Female 92.3

Marital statusSingle 17.2Married 75.3Separated 1.2Other 6.3

(continued on next page)

Table 1 (continued)

Variable Percentage

Parental statusIs a parent 84.3Is not a parent 15.7

Current age21 to 30 12.731 to 40 26.941 to 50 24.951 to 60 27.7Over 60 7.3

Note: n=401.a Collapsed physician and physician's assistant.

(continued)

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5.2. Sample characteristics

Participant professional and personal characteristics wereobtained from Section II of the PICS; these are summarized inTable 1. Professional characteristics are those related to providers'jobs in Part C programs. These include level of education, academicmajor, current job title, having supervisory responsibilities, number ofyears in the field of ECI, and number of years the participant hadworked in their respective agencies. A bachelor's degree was held byjust over 40% of participants and amaster's degree was held by almosthalf. A medical degree or doctoral degree was held by 5.5% and 2% orthe participants, respectively. The sample represented 14 academicdisciplines. Providers with special education degrees and social workdegrees represented the largest groups, followed by speech/languagetherapy and education. The remaining participants had degrees inphysical therapy, occupational therapy, and psychology. Almost one-third of the participants in this study were service coordinators.Service coordinators in Part C often function as case managers butmay also provide some limited intervention services. Thirteen percentof the participants were employed as speech/language pathologists.The “Other” job title was selected by a large minority of the par-ticipants (31.2%). The remaining 12 job titles were selected by 9.7% tob1% of the sample. Only two Physician's Assistants and one Physicianresponded to the survey, so these were collapsed into the Physiciancategory. Slightly more than one quarter of the participants hadsupervisory responsibilities. One-third of the participants had beenwith their current agencies for more than 10 years. About 40% hadbeen with their agencies for 1 to 10 years, with the remaining havingbeen with their agencies less than 5 years. One relatively large groupof providers reported having been in the early childhood field formore than 10 years and another large group had been in the field for 1to 5 years.

Personal characteristics are unrelated to job qualifications. Theseinclude race, sex, marital status, parenting status, and age. The par-ticipants were overwhelmingly white, with only 7.7% identifying asAfrican American, 2.7% as Hispanic/Latino, 1.2% as Native American, and.7% as Asian. Participants in this study were overwhelmingly female,married, and had at least one child. Approximately 80% of participantswere between 30 and 60 years of age.

6. Results

6.1. Response rate

Of the 749 surveys sent to Part C providers, 418 surveys werereturned, for an overall response rate of 55.8%. Seventeen surveyswere not used because more than 5% of the responses were missing.Missing data in the remaining surveys constituted less than 2% of thetotal number of values. No single itemwasmissingmore than 1.52% ofits values. The missing data on Section I of the PICS (the scaled items)were imputed using mean substitution, which is acceptable when

1422 R. Herman-Smith / Children and Youth Services Review 33 (2011) 1419–1425

used with variables missing less than 2% of their values (Saunderset al., 2006).

6.2. Analysis of PICS Section I responses

The 15 items from Section I of the PICS (Herman-Smith, 2009)use a 9-point Likert scale. Higher scores indicate more positiveperceptions about working with families referred from child welfare;four items are reverse scored. Box plots and Mahalanobis distance(see Tabachnick & Fidell, 2001) revealed no univariate or multivar-iate outliers. Responses spanned the entire range for each of theitems. Using a range of +1 to −1 for evaluating skew and kurtosiscoefficients, there were no significant normality violations for any ofthe items. An examination of normal probability plots of residualsrevealed no concerns about normality, linearity, or homoscedasticityof data. Table 2 presents the mean and standard deviation for eachPICS item, grouped by subscale.

6.3. Factor analysis

Previous research indicated that Part C providers' perceptions maybe separated into different constructs (see Herman-Smith, 2009).However, there are no measures similar to the PICS with which toestablish concurrent validity. There is no overall theory to guideidentification of appropriate constructs and insufficient evidence tospecify a specific model. Thus, an exploratory factor analysis was usedin analyzing results (Henson & Roberts, 2006).

Factorability of the PICS was examined using two measures — theKaiser–Meyer–Olkin (KMO) index and Bartlett's test of sphericity. TheKMO is a measure of sampling adequacy. Items that yield an index ofat least .5 are considered to be satisfactory for factor analysis. TheKMO index was .85. Bartlett's test of sphericity is an indicator of thestrength of the relationship among variables. A significant findingindicates a strong relationship among variables. Bartlett's test ofsphericity was significant (χ2 (105)=2371.38, pb .001).

Items from the PICS were then examined to identify a viable factorstructure. SPSS 17.0 principal axis factoring (PAF) using Varimax(oblique) rotation was used. PAF was constrained to three factors,the same number of factors anticipated in the survey's design anddemonstrated in the PICS pilot study (Herman-Smith, 2009). None ofthe items had a communality below .30, which would have resulted intheir elimination from the scale (Hair, Anderson, Tatham, & Black,1998). Items with factor loadings ≥.40 and ≤.90 as well as items thatloaded on only one factor were retained in the scale (Carmines &Zeller, 1979). Three items not meeting the criteria were removed,

Table 2Item means and standard deviations for the PICS by subscale.

M SD

Provider resourcesEarly interventionists competent with families 7.09 2.02Early interventionists competent with children 7.13 1.92Early intervention are knowledgeable 6.47 2.26

Mission fitCAPTA reflects mission 4.27 2.60Serve even if no delays 3.85 2.57Population is a priority 5.71 2.30Early intervention an appropriate referral source 6.09 2.37

Parent involvementParents have too many issues 6.42 2.30Including parents decreases effect 7.04 2.16Early intervention burdens these parents 5.89 2.24Families better served by another program 5.77 2.41

Notes: n=401.Response scale is 1 to 9; items on the Parent Involvement subscale have been reversecoded.

reducing the original 15 item scale to 11 items. The factor loadingmatrix and communalities for the final solution are presented inTable 3.

Eigenvalues were obtained using the unrotated factor matrix.Using Kaiser's K1 rule, the results supported a three-factor solutionwith the first factor explaining 31.9% of the variance, the second factor13.8%, and the third factor 9.6%. Additional analyses found no othersolutions that contributed significantly to explained variance. Factor 1consists of three items that involve providers' perceptions of theirskills and competencies about families referred by child welfareagencies. These items formed the Provider Resources subscale. Factor2 consists of four items concerned with whether Part C programsshould be serving the child welfare population. These items formedthe Mission Fit subscale. Factor 3 consists of four items examining theextent to which providers should work with the families referredfrom child welfare. These items formed the Parent Involvementsubscale.

6.3.1. Internal consistencyComposite scores were developed for each of the three factors —

Provider Resources, Mission Fit, and Parent Involvement. Cronbach'salpha was computed for each. A higher Cronbach's alpha indicatesthat questions in the scale yield a consistent measure of a concept(Aday, 1996). Cronbach's alpha for the Provider Resources subscalewas .90 (M=20.69, SD=5.66). Cronbach's alpha for Mission Fitwas.73 (M=19.92, SD=4.98) and Parent Involvement was .71(M=14.88, SD=6.65).

6.3.2. Provider perceptions of CAPTAA second aim of this research was to assess the perceptions of Part

C providers about their responsibilities under CAPTA. Responses to theProvider Resources subscale suggested that participants generallyhave positive perceptions of the competencies, skills, and knowledgeneeded to serve families referred from child welfare. Scores wereabove the mid-point of the scale for all items relating to providers'competencies. Participants also indicated that program administra-tors have kept them informed of the means by which child welfarereferrals were to be processed.

Responses to the Mission Fit subscale clustered around the centerof the scale regarding whether serving families referred from childwelfare is part of Part C's program mission. Participants were positiveabout the need for these families to be referred. Theywere slightly lesspositive about serving children who do not have developmentaldelays, although examining the standard deviations for these itemsindicated that responses were somewhat variable.

Participants were generally positive about working with parentsreferred from the child welfare system. Based on responses to items

Table 3Factor loadings and communalities based on principal factor analysis of the PICS(n=401).

Item Providerresources

Missionfit

Parentinvolvement

Communality

Competence with families .89 .84Competence with children .88 .85Know about CAPTA .85 .73CAPTA reflects mission .77 .60Serve referrals w/ no delays .72 .53CAPTA population a priority .69 .53Part C a good referral source .58 .38 .63Parents have too many issues .83 .69Parents harm intervention .73 .53Intervention burdens parents .71 .52Families go to other program .46 .52

Notes: Bolded items in each column loaded on the corresponding factor; Factorloadings b.3 are suppressed; Part C refers to services under Part C of IDEA; CAPTA refersto the Child Abuse Prevention and Treatment Act amendments of 2003.

Table 5Summary of hierarchical regression analysis on Mission Fit.

Model 1 coefficient Model 2 coefficient

Professional characteristicsEducation level −.10 −.11Discipline .01 .01Supervisor status −.03 −.02Number served child welfare .05 .06Time in current agency .04 −.05Time in field of ECI −.02 −.03Hours of inservice −.18⁎ −.19⁎

Personal characteristicsRace – .07Sex – .04Marital status – −.07Parent status – −.01Age – .05

Model 1 F (8, 261)=1.45, p=.18; R2=.043; Adj. R2=.013; Δ R2=.043.Model 2 F (5, 256)=1.14, p=.66; R2=.055; Adj. R2=.007; Δ R2=.012.⁎ pb .01.

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on the Parent Involvement subscale, providers do perceive a potentialfor partnering with parents who have previously abused or neglectedtheir children. Doing so is consistent with the Part C of IDEA, as well asbest practice initiatives in the field of early childhood interventionthat emphasize the role of the family. Few participants indicated thatECI was too burdensome on families referred by the child welfaresystem or that parent involvement would diminish the impact of ECIservices.

6.4. Perceptions of CAPTA and participant characteristics

The third aim of this researchwas to explore possible relationshipsbetween Part C provider characteristics and perceptions of theirCAPTA responsibilities. A series of hierarchical regression analyseswas used to assess the relative contribution of professional and per-sonal characteristics to each of the three criterion variables: ProviderResources, Mission Fit, and Parent Involvement. Professional charac-teristics were variables related to providers' work qualifications,professional training, and work experience. These included level ofeducation, academic discipline, supervisor status, experience withfamilies referred from child welfare, years in the agency, years in thefield, and hours of inservice training related to CAPTA. Since over 30%of participants chose “Other” as the job title, this item was notincluded in the analysis. Personal characteristics were variablesunrelated to job qualifications and included race, sex, marital status,parental status, and age. Professional and personal characteristicswere entered in blocks using SPSS 17.0. Professional characteristicswere entered first followed by personal characteristics.

6.4.1. Provider ResourcesTable 4 presents a summary of the criterion variables regressed on

Provider Resources, that is, participants' perceptions that theiragencies have the resources needed to provide services to familiesreferred from child welfare. Professional characteristics did not resultin a statistically significant model, F (8, 261)=.77, p=.62. Likewise,no personal characteristics were associated with Provider Resources.Adding personal characteristics did not result in a statisticallysignificant model, F (8, 256)=.69, p=.72, and contributed to lessthan 1% of the variance. The beta coefficients represent the effect of aone-unit change in the predictor variable.

6.4.2. Mission FitTable 5 presents a summary of the criterion variables regressed on

Mission Fit, the perception that serving families referred from childwelfare is part of Part C's program mission. Professional characteristicsdid not result in a statistically significant overall model, F (8, 261)=1.45, p=.18. However, more inservice training about CAPTA was

Table 4Summary of hierarchical regression analysis on Provider Resources.

Model 1 coefficient Model 2 coefficient

Professional characteristicsEducation level −.01 −.02Discipline −.01 −.02Supervisor status −.11 −.10Number served child welfare −.01 .01Time in current agency −.01 −.01Time in field of ECI −.03 −.03Hours of inservice −.11 −.11

Personal characteristicsRace – .06Sex – .05Marital status – −.05Parent status – .01Age – .06

Model 1 F (8, 261)=.77, p=.62; R2=.023; Adj. R2=−.007; Δ R2=.023.Model 2 F (10, 274)=1.89, pb .05; R2=.034; Adj. R2=−.015; Δ R2=.011.

associated with a decrease in perceptions that Part C programs shouldserve families referred from child welfare agencies (t=−2.94, pb .01).Otherwise, there were no significant associations between professionalcharacteristics and Mission Fit. There were no significant associationsbetween personal characteristics and Mission Fit. Including personalcharacteristics did not result in a statistically significant model, F (5,256)=1.14, p=.66, and contributed to less than 1% of the variance.

6.4.3. Parent InvolvementTable 6 presents the criterion variables regressed on Parent

Involvement, the degree to which parents referred from child welfareagencies are considered partners in ECI. The first model, whichincluded only professional characteristics, was not statistically sig-nificant, F (8, 261)=.69, p=.70. The second model, which includedpersonal characteristics, likewise did not produce a significant model,F (5, 256)=1.01, p=.41, and accounted for less than 1% of thevariance.

7. Discussion

Federal policy nowmandates child welfare and Part C programs ineach state to develop developmental screening systems for abusedand neglected children under 3 years of age. Part C programs mustensure that children who qualify receive other intervention as well.This represents a serious effort to address the developmental andsocial impact of child abuse and neglect as early in the life of thechild as possible. However, the policy comes with a number of imple-mentation challenges. One of these challenges is ensuring that Part Cprofessionals are prepared, supported, and confident as they beginto work with this population. Previous research has shown theimportance of human service providers' perceptions of their work(Glisson & James, 2002; Meyers et al., 1998; Raudenbush & Bryk,2002).

7.1. The utility of the PICS

The primary aim of this study was to examine the performance ofthe PICS, a measure of Part C ECI providers' perceptions about servingfamilies referred from child welfare agencies following a substantia-tion of child maltreatment. The PICS assesses whether early childhoodintervention providers perceive their CAPTA responsibilities assomething they should do and have the capacity to do. A previousstudy using a single state sample found the PICS to be promising forthis purpose but a national validation study was needed (Herman-Smith, 2009).

Table 6Summary of hierarchical regression analysis on Parent Involvement.

Model 1 coefficient Model 2 coefficient

Professional characteristicsEducation level −.02 −.02Discipline −.02 −.02Supervisor status .01 .01Number served child welfare .02 .05Time in current agency .01 .02Time in field of ECI .06 .05Hours of inservice −.07 −.07

Personal characteristicsRace – .11Sex – .03Marital status – −.02Parent status – −.07Age – .02

Model 1 F (8, 261)=.69, p=.70; R2=.021; Adj. R2=−.009; Δ R2=.021.Model 2 F (5, 256)=1.01, p=.41; R2=.040; Adj. R2=−.009; Δ R2=.019.

1424 R. Herman-Smith / Children and Youth Services Review 33 (2011) 1419–1425

In the current study, the PICS was administered to a multi-statesample. There is no reliable information about the demographiccharacteristics of Part C providers nationally, though it can be inferredfrom previous research that the workforce is overwhelmingly white,female, and college-educated (see Council for Exceptional Children,2001; Cross & Billingsley, 1994; Hebbeler et al., 2007). Participants inthis study were overwhelmingly white, female and highly educated;therefore, they were representative of providers nationally in at leastsome respects.

Factor analysis demonstrated that the PICS reflects the threedimensions it was designed to assess: Provider Resources (providers'perceptions that they have the skills needed to successfully servefamilies referred by child welfare), Mission Fit (providers' perceptionsthat the CAPTA mandate fits with the purpose of the Part C program),and Parent Involvement (providers' perceptions that parents referredby the child welfare system will be competent partners in ECI).Findings are consistent with the pilot study results. The factor analysisin this study resulted in item reduction from a 15-item scale to an 11-item scale, suggesting that additional study of this measure could stillprove useful.

Reliability estimates for each subscale were within acceptablelimits (Aday, 1996). A previous study (Herman-Smith, 2009) found arelatively low Cronbach's alpha of .59 on the Parent Involvementsubscale. In the current study, Cronbach's alpha on this subscale was.71, which is considered to be in the acceptable range (Aday, 1996).Cronbach's alpha increased on both the Mission Fit and ParentInvolvement subscales as well. There were 293 participants in theprevious study and 401 in the current study. Increased alpha on eachof the subscales might be due to the higher numbers of participants inthe study reported here since higher numbers of participants oftenincrease Cronbach's alpha (Carmines & Zeller, 1979).

Overall, the PICS appears to be useful as an efficient and reliablemeasure of Part C providers' perceptions regarding their CAPTA-mandated responsibilities. The PICS might be particularly useful inthree ways. First, state or local Part C agencies that are only nowimplementing CAPTAmightfind the PICS useful for obtaining providers'baseline perceptions of their new responsibilities. For example, the PICSmight be useful in pre- and post-comparisons of agencies' inservicetraining efforts in regard to working with families referred from childwelfare. A second potential use of the PICS is for local and state Part Cprogram evaluation. The PICS might be useful in identifying potentialprogram needs regarding CAPTA, including conflict between programand individual provider expectations. Finally, the PICS might proveuseful to researchers interested in CAPTA implementation in Part Cagencies at the local, state, or national levels.

7.1.1. Provider perceptions of CAPTAA second aim of this research was to examine ECI providers'

perceptions of their responsibilities related to CAPTA. Responses tothe PICS indicated that Part C providers have generally positiveperceptions of their competencies to work with families referred fromchild welfare. This study did not assess Part C ECI providers' actualskills, only their self-perceptions of their skills. Part C programadministrators have expressed concern that the Part C work force is, infact, under-prepared to meet the needs of families referred from childwelfare. Perhaps Part C providers have overrated their competencieswith families referred from child welfare and administrators arecorrect in their concerns about providers' actual competencies.Regardless, provider responses in this study do not support the ideathat they lack confidence or are unwilling to work with thispopulation.

Findings in this study yielded two interesting provider perceptionsthat warrant further exploration. First, participants were a bit moreskeptical about serving children who do not have developmentaldelays. This finding is not altogether surprising given the local andstate level policies that have come to guide Part C programs over time.Under Part C of IDEA (1997), programs are required to serve twogroups of children: 1) those who meet diagnostic criteria for devel-opmental delay based on a developmental evaluation and 2) thosewith “established risk conditions” that come with a high probabilityof developmental delay, such as Down syndrome. States have theoption to serve children without substantiated developmental delaysif they experience biological and/or environmental factors associatedwith delays, such as severe poverty. Currently, only five states servechildren who are “at risk” but do not meet diagnostic criteria fordevelopmental delay or an established risk condition (Barth et al.,2008; Shackelford, 2006). None of the state Part C agencies selectedfor this study served “at risk” children. Providers in these states, likethe overwhelming majority of states, have probably been trained toview children without clear delays or established risk conditions asoutside their service population. The trend toward restricted access toPart C services is at odds with the intent of the 2003 CAPTA mandateto serve maltreated infants and toddlers as an “at risk” population.Nevertheless, participants in this study had positive perceptions aboutserving children from child welfare. Only time will tell if increasinglyexclusive eligibility policies or lack of resources will erode theirsupport for providing services to maltreated children.

The PICS responses also indicated some reservations aboutwhether parents involved in the child welfare system want ECIservices. One explanation for this finding is that Part C has alwaysbeen a “voluntary” program. Under the CAPTA amendments per-taining to Part C, parents cannot be mandated to participate in ECIprograms. Part C providers may nevertheless have concerns thatparents referred from the child welfare system are participating inservices because they feel pressured by courts, child protectionworkers, or child advocates to do so. Alternately, providers' might beresponding to rejection experiences. The preliminary results of at leastone previous study indicate that parents referred from child welfareagencies refuse ECI at a relatively high rate (Ames, 2007). Someproviders might be concluding, over time, that many parents are notinterested in their services.

7.2. CAPTA and provider characteristics

The final aim of this study was to examine possible associationsbetween participants' demographic characteristics and their percep-tions of CAPTA. None of these characteristics significantly contributedto their perceptions about CAPTA with one exception. There was asmall but statistically significant negative relationship between thenumber of hours in CAPTA-related inservice training and theperception that serving children referred from child welfare is partof Part C program's mission. The reason for this finding is still not

1425R. Herman-Smith / Children and Youth Services Review 33 (2011) 1419–1425

clear. Perhaps additional training increases providers' awarenessthat Part C providers do not have the types of skills and trainingopportunities needed to offer adequate support to develop theseskills. It is also possible that the process, content, or frequency oftraining has not met expectations, which discourages work with thispopulation. Yet another possibility is that program administrators areconveying negative messages to Part C providers about deliveringservices to this population. Qualitative study, in conjunction with thePICS might help to clarify this concern.

7.3. Limitations

This research had a least four limitations. First, in an effort toguarantee participants' anonymity, this researcher did not trackparticipants by state. It is possible that state-specific barriers andsupports result in response variance. Furthermore, without trackingreturn rates by state, the researcher cannot determine each state'srelative contribution to the overall results. Future research shouldconsider tracking this information. Second, the PICS did not requestinformation on the content or quality of inservice training programs.Additional information would be helpful in understanding howincreased discussion about maltreated infants and toddlers mightlead providers to think service to this population is not the mission ofPart C programs. Third, factor analysis of the PICS resulted in theelimination of three items; this resulted in a 12-item scale for Section I.Additional study using the reduced scale should be pursued in order tosupport its final factor structure. Finally, on Section II of the PICS, whichrequested demographic information, approximately 30% of participantsindicated a job title other than the 16 provided on the PICS. Thiscomplicatedmeaningful examination of the results by job title. Many ofthewrite-in responseswere “casemanager.” It is possible that providersin a service coordination role use “case manager” as their job title andwere not acquainted or comfortablewith the “service coordinator” title.Improving the measure could involve asking all participants to write inthe title themselves, especially when the PICS is used in a multi-stateresearch by researchers who are unfamiliar with states' personnelclassification systems.

8. Conclusion

The 2003 amendment to CAPTA is one of the first major federalpolicy efforts to address thedevelopmental challenges of young childrenin the childwelfare system. There are probably a number of reasons thatservices asmandated by CAPTA are fragmented or underutilized.Whilehuman service providers' impressions of their work certainly impactshow policy objectives are implemented (Glisson & James, 2002;Hedeker et al., 1994; Raudenbush & Bryk, 2002), the results of thisstudy do not support the idea that service fragmentation is due to Part Cproviders' reluctance or resistance to their CAPTA-mandated responsi-bilities. Part C service providers appear to be willing to work with thispopulation despite the lack of resources.

While Part C providers are interested in work with this population,thiswork is likely to be a new experience formany of them.Historically,Part C was focused on remediation of developmental delay. Maltreatedchildren often experience developmental delay; however, the primaryfocus of intervention for these children is usually behavioral and social.While providers' intentions and attitudes are positive, the success ofCAPTAmayultimately dependon state and local Part C programs' abilityto marshal resources to support them.

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