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Starting Young
Applying the Science of Early Childhood to
Well-being Permanency
Judith Silver, Ph.D. Director, Child Welfare
Early Childhood Initiative The Starting Young
Program The Childrens Hospital of Philadelphia
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Why Focus on Infants Toddlers?

• Babies vulnerability to neglect
• Largest age-group of victims w/ substantiated
  abuse neglect
• Half of all substantiated medical neglect cases
• Limited exposure to other mandated reporters
• National Child Abuse Neglect Data System
• Childrens Bureau

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Infants in Foster Care Especially Vulnerable

• More likely to enter
• Longer length of stay
• Highest rate of re-entry
• Multistate FC Data Archive, Chapin Hall,
• University of Chicago

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Distinctive Issues for Infants Toddlers

• Most Rapid Period of Brain CNS Development
• Multi-Disciplinary approach essential
• Intertwined, Interdependent
• Mental Health
• Physical Health Growth
• Development

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Health Development ofChildren Teens in
Foster CareHigher rates of

• Acute Illnesses
• Chronic Medical Conditions
• Developmental Delays
• Dental Decay
• Vision Problems
• Emotional/Behavioral Problems

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Limited Access to Health CareDuring Foster
Placement

• Most children need MORE than routine health care
  (specialists)
• Many do not receive routine health care
• Many are underimmunized
• Missing medical records

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Starting Young Program

• Ages 4 to 33 months
• Open DHS cases
• Interdisciplinary Pediatric Developmental
  Evaluations

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Services Needed

• Primary Health Care 70
• Early Intervention (DD) 47
• Allied Health Specialists 45
• Medical Specialists 26

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Did They Receive Needed Services?

• Early Intervention 64
• Medical Specialists 64
• Hearing Test 26
• HIV Screening 25

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Promoting Healthy Outcomes What Works?

• Comprehensive Primary Pediatric care
• Schedule of recommended visits (Amer. Academy
  of Pediatrics)
• 2, 4, 6, 9, 12, 15, 18, 24, 30 36 months
• Annually thereafter (PA regs)
• Early Intervention Services for Delayed
  Development
• Early Childhood Education (Head Start)
• Checklist for Healthy Development

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Use Promoting Healthy Outcomes Checklist in Court
Cases

• Connects healthy development with permanency
• To improve accountability that child receives
  services
• Based on checklist developed by NY Permanent
  Judicial Commission on Justice for Children
• Ensuring the Healthy Development of Foster
  Children A Guide for Judges, Advocates and Child
  Welfare Professionals. NYS Permanent Judicial
  Commission on Justice for Children

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What are this childs medical needs?

• Does the child have an identified Primary Health
  Care Provider and insurance?
• Received a full well child/EPSDT visit according
  to Amer.Acad.Pediatrics schedule
• Received health screenings recommended for age
  (newborn hearing, lead, anemia, TB)
• Had medical evaluation by the primary care doctor
  since placement in foster care?
• Immunizations up to date?

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Does the child have any risk factors for
significant medical illness?

• Prematurity
• Past Hospitalizations or Surgeries
• Daily Medications
• Allergies to medication or food
• Followed by any medical specialists
• Special equipment required (e.g. nebulizer)
• Risk factors for HIV

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What are the developmental needs of this young
child?

• What are the infants risks for developmental
  delay or disability?
• Has the child had a developmental
  screening/assessment?
• Has the infant or toddler been referred to the
  Early Intervention Program?
• Has the 3 to 5 year old been screened for
  preschool special education services?

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Has parental consent been obtained?

• For all needed
• Medical Records
• Assessments
• Recommended Non-Routine Treatments

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The End