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Massachusetts Early Childhood Linkage Initiative: Taking CAPTA Pilot to Scale
National Early Childhood Partners Meeting, Baltimore, MD March 14, 2008Kate Roper, MECCS, Massachusetts DPHBased on presentation by John A. Lippitt, Ph.D., Massachusetts DPH
From Policy to Implementation
MECLI piloted referrals from child welfare (CW) to Part C Early Intervention (EI)
3 Pilot sites in MA, Nov. 2002 – Dec. 2004
Both CW and EI were supportive Robust EI system able to handle referrals
The MECLI project was funded by the U.S. DHHS, ACF, Children's Bureau; The A.L. Mailman Family Foundation; The Annie E. Casey Foundation; and The Frank and Theresa Caplan Endowment for Early Childhood and Parenting Education at The Heller School for Social Policy and Management, Brandeis University.
MECLI Findings: Referrals 540 children offered
referral to EI 18% of parents
refused the referral 19% of families
referred did not engage with EI
40% of children were assessed
MECLI Findings: Eligibility
74% of children assessed were eligible under MA broad eligibility criteria (161/218)
49% had an eligible delay 17% eligible due to 4 of 20 risk factors 1% eligible by established condition or
judgment 6% eligibility criterion unknown
MECLI Findings: Delays
40% language delay (84/211)
24% adaptive / self-help
delay 23% gross motor delay 21% fine motor delay 20% cognitive delay 15% social-emotional
delay
MECLI Findings: Risk Factors
CW involvement 69% (145/211)
Parental chronic illness or disability 35% Domestic violence 25% Substance abuse 25% Multiple traumas or losses 17% Inadequate food, shelter, or clothing 14% Family lacking social supports 13%
Challenges
Establishing new policy Resources: time, money,
expertise Collaboration Increased referrals Who to refer Screening vs. assessment
Challenges (cont’d)
Appropriate assessment and services Engagement of referred families Working with families facing multiple
challenges Rate of eligibility Confidentiality and information sharing Local variation
Clear policies and procedures Clear roles and responsibilities Obtain buy-in & develop shared
vision Referral coordinators and
collaboration facilitator Attainable goals and objectives
Success Factors & Strategies
Success Factors & Strategies (cont’d) Funding for service delivery Training Time for collaboration & case
management Expertise on social-emotional
development & ECMH Diversity & cultural competence
Taking it to Scale: Current Status Policy guidance drafted fall 2005 DSS work in process with 2 unions:
Social Worker and NAGE Hope to roll out state-wide spring 2008
Some area offices already implementing Training for 29 area offices will include EI
staff and EI parents as presenters
Professional Development for EI and DSS workforce Department of Public Health
EI Interagency Coordinating Council exploring use of reliable, valid social-emotional assessment tool(s)
One provider agency developed, provided, evaluated 30-hour Infant Mental Health Training in 3 sites (75 trained).
Department of Social Services Child Welfare Institute
MECCS: Web-based Behavioral Health Resource
Conclusions
CW to Part C EI referrals will identify eligible kids
Multiple implications for Part C EI systems Build collaboration among CW, Part C EI,
and the courts Work with biological and foster families Hard work but can be done and can
improve outcomes for children and families
DPH Substance Exposed Newborns Pilot:“A Helping Hand: Mother to Mother” Director: John Lippitt, former MECLI Director 1 of 4 federal demonstration projects Develop model for implementation of notification of
child welfare (DSS) and plan of safe care for SENs Integrates the delivery of substance use, child
welfare, child development, mental health, health, and other social services
Vision and Goal
VISION: Substance exposed newborns have the opportunity to achieve their full potential through nurturing caregiving
GOAL: Enhance identification and services for substance exposed newborns (SENs), their mothers and families
Research and Data
Growing body of evidence that, except for alcohol, the compromised parenting of the post-natal environment has greater impact on the infant than pre-natal exposure
Good data on SENs are hard to get SAMHSA: 3.5% of newborns exposed to illegal
drugs MA: ~3,000 SENs per year Under-reported on electronic birth certificates and to
DSS
Service Elements Voluntary, enhanced service thru DSS Family Support Specialist (FSS): a peer, a mother in
recovery Services are individualized, strength-based, and
family-centered, as well as gender and culturally appropriate
Engage and maintain mother in substance abuse treatment
Developmental assessment for infant and services if indicated
Service Elements, cont’d
Family participation in decision making Continuity of nurturing caregiving Newborn: infant under 90 days old Substance exposed newborn (SEN): any
illegal use of a substance during pregnancy
Key Partners and Roles Identification:
Birthing hospitals and other early childhood providers Identify best practices for SEN identification and response See Issues and Options for Substance Exposed Newborn
Identification and Response
Service delivery: DSS: central office and area offices Early Intervention (EI): DPH & local programs Substance abuse (SA): DPH BSAS & Institute for Health &
Recovery Parent-to-parent support: Federation for Children with
Special Needs
Progress to Date Cambridge-Somerville site:
Started in February 2007 25 SEN cases at DSS 13 offered and accepted AHH A wide range of outcomes
Fitchburg-Leominster site: Starting in February 2008
Springfield site Start targeted for Sept.
DSS and BSAS funding $25,000 each for this year and next for FS Specialists at the 2 newer sites
Contact InformationKate Roper,MECCS Project [email protected]
Massachusetts Department of Public Health
Division of Perinatal, Early Childhood & Special Health Needs
250 Washington Street, 5th Floor
Boston, MA 01208
John Lippitt,A Helping Hand Project
Massachusetts Department of Public Health
Division of Perinatal, Early Childhood & Special Health Needs
250 Washington Street, 5th Floor
Boston, MA 01208
