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This is an excerpt from the full report.
Introduction: Why Focus on Mental Health in the Child Welfare System?
The early years of life present a unique opportunity to lay the foundation for healthy development. It is a time of great growth and of vulnerability. Research on early childhood has underscored the impact of the first five years of a child’s life on his/her social-emotional development. Negative early experiences can impair children’s mental health and affect their cognitive, behavioral, and social-emotional development. Developmental research has shown that consistent, responsive, and nurturing early relationships foster emotional well-being in young children, as well as create the foundation for the behavioral, social, and cognitive development essential for school readiness. Parents are one of the primary influences on a child’s healthy development. Given parents’ central role, it is not surprising that children’s experience of abuse and neglect especially in early childhood can pose major risks to their development.
Children younger than three years of age are the most likely of all children to be involved with child welfare services,3 and young children who have been maltreated are subsequently at risk for experiencing developmental delays. Maltreatment in children younger than 3 years of age has been found to be associated with concurrent gross and fine motor delays, failure to thrive, heightened arousal to negative emotions, speech and language delays,and hypervigilance.
Age of the first episode of maltreatment is associated with mental health problems in adulthood. For example, maltreatment at age 2 to 5 has been linked with anti-social personality disorder by age 29. Younger ages of onset (birth to 2) were associated with depression and other internalizing disorders by age 40.
Research on preschoolers exposed to family violence showed increased rates of disturbances in self-regulation and in emotional, social, and cognitive functioning. Placement out of the child’s home also increased the risk for mental health problems for young children. Infants who experience maltreatment and placement in foster care faced the greatest risk for emotional and behavioral problems. Infants in foster care had longer placements, higher rates of reentry into foster care (experiencing recurrent maltreatment and disruption of family bonds), and high rates of behavioral problems, developmental delays, and health problems.
Child welfare agencies have historically focused on children’s safety and placement options but have been ill equipped to address children’s developmental needs and to access necessary and comprehensive referrals for early intervention services. Since 2000, the Federal Government has assessed states on their “substantial conformity” with federal requirements designed to promote positive outcomes in the areas of safety, permanency and well-being for children in the child welfare system. The process results in a state Child and Family Services Review (CFSR) report and a Program Improvement Plan.
In an analysis of 2002 Child and Family Services Reviews (CFSRs) reports and Program Improvement Plans (PIPs) from 32 states, investigators indicated that 97 percent of those states did not meet the standard in providing adequate services to meet the “physical and mental well-being” of the children under their care. Only two states rated mental health for the children they served as a strength of their system. The most common challenges included lack of service capacity and poor quality (11 states); lack of standardization in use and types of health, mental health, and developmental assessments (six states); inability to appropriately match children with needed services (15 states); poor family involvement (15 states); and the absence of appropriate placement options for children (nine states).15 In general, states performed poorly when it came to mental health compared to other indicators of child well-being. Only one state in the review indicated they had a developmental assessment appropriate for very young children.
Changes to federal policy through the Child Abuse and Prevention Treatment Act (CAPTA) in 2003 required child welfare agencies to have provisions in place to identify and refer young children to early intervention services. The role of child welfare workers to address children’s mental health was therefore greatly expanded under such legislation. How have child welfare workers addressed this new role? How is the mental health and development of young children in the child welfare system being addressed?
This issue brief explores what we currently know about the prevalence of young children (ages birth to 5) in the child welfare system, how the occurrence of maltreatment or neglect affects their development, and the services currently offered versus needed for these young children. It is based on the “Strengthening Early Childhood Mental Health Supports in Child Welfare Systems” emerging issues roundtable convened by NCCP in New York City in June 2009. The meeting brought together child welfare research, policy, and practice experts and family leaders to discuss the mental health needs of young children and suggest new directions for policy and practice. (See Appendix for list of participants.) We also present our analyses based on the National Child Abuse and Neglect Data System (NCANDS) Child File, 2006. NCANDS is a voluntary national data collection and analysis system established as a result of the requirements of the CAPTA.