CWW Vol 23: Recommendations and Solutions

This issue of the Watch focuses on the city’s youngest residents: babies and toddlers. We explore the impact of chronic stress on young children’s brain development and present national research around interventions aimed to buffer that effect and to better support the parents of young children. More than 6 percent—or 518,000—of New York City’s 8.1 million residents are under 5 years of age. A handful of local programs work with the families of young children who are affected by poverty, chronic stress and trauma, including some innovative programs for the child welfare involved parents of young children. We highlight the need for more of this type of expertise and illuminate the dearth of government funding and services targeted for caregivers seeking help for young children. Following are recommendations and solutions proposed by the Child Welfare Watch advisory board: The New York State Office of Mental Health (OMH) and the city’s Department of Health and Mental Hygiene should provide consistent, adequate funding for early childhood mental health treatment, and for professional training.

Providing early help to infants and toddlers who need it can prevent more costly, intensive and potentially invasive interventions later in life. Nobel prizewinning economist James Heckman has demonstrated that investing in effective early childhood interventions can yield huge cost savings—and that there is a steep decline in the value of these savings as early as the end of a child’s third year of life. However, state and city government funding for treatment is very limited and few professionals are trained to provide treatment to this age group. A 2012 analysis by the Citizens’ Committee for Children estimated that state-licensed mental health clinics had treatment spots for only 1 percent of children age 0 to 4 who needed them in three of New York City’s boroughs. Slots were most scarce in community districts considered high risk due to factors such as economic poverty and safety. Government and society are missing the opportunity to provide young children with appropriate treatment before their needs and symptoms compound. Some clinics and organizations providing early mental health treatment are reimbursed a small amount through Medicaid or, in some cases, by their referring foster care agencies. Many families are not eligible for these funds, or are served outside of clinics. Today, the City Council is one of the few sources of government funding for community-based early mental health treatment, but its support is not solely for treatment or for training clinicians to work with infants and toddlers; it must also cover the cost of screenings and evaluations. What’s more, this modest support of $1.25 million is not “baselined” into the mayor’s budget and is therefore at risk of elimination each year. We urge the city and state to recognize the need for more treatment options—including intensive, dyadic therapy, which is most lacking—for this vulnerable group of New Yorkers. There is also a great need to build a viable workforce able to work with children under 5 and their parents.

The city, state, and nonprofit organizations should co-locate infant and toddler mental health services in the places where young children and their parents already go: pediatric clinics, foster care and preventive agencies, family court, homes, community centers and child care programs.

Parenting young children while living in poverty or with other sources of chronic stress is taxing. Parents and young children who could benefit from treatment will be far more likely to find help if it is located in the places where parents already go. This makes services easier to access, reduces the stigma frequently associated with mental health treatment and allows infant mental health specialists to educate other professionals who work with babies—such as child care workers, judges, pediatricians, home visiting nurses and preventive workers—about the social and emotional development of young children.

The State Department of Health should provide professionals in the Early Intervention Program with comprehensive training in the social and emotional development of young children.

Early Intervention is the city’s largest, most comprehensive program for treating kids under 3. In theory, Early Intervention can work with children under 3 whose only issues are social-emotional. In practice, the program largely focuses on addressing developmental delays and disabilities, making it a missed opportunity to help the families of babies who are struggling with the effects of trauma or chronic stress. To help nudge Early Intervention closer to becoming a system able to address early childhood mental health, Early Intervention professionals should receive comprehensive training around the mental health needs of young children, with a focus on how to address and recognize the effects of trauma in this age group.

The state OMH should track the number of state-licensed mental health clinics—also known as Article 31 clinics—that have the capacity to treat infants and toddlers.

Few clinics have the capacity to provide mental health treatment to infants and toddlers. No government agency tracks the number that do serve very young children and their families. This makes it extremely difficult to address the citywide gap between treatment need and capacity.

The state OMH and the city’s Human Resources Administration and Department of Health and Mental Hygiene should collaborate with parents and community organizations to create an advertising campaign that promotes positive, supportive parenting of young children.

A growing body of research suggests that “supportive parenting”—a reflective, child-centered approach to parenting that stresses sensitivity, warmth, and responsiveness—is a key to buffering the potentially lifelong toxic effects of a childhood marred by stress, violence and trauma. New York should mount a campaign dedicated to educating parents about the benefits of supportive parenting and provide powerful examples of what it means to be responsive to the developmental needs of infants and toddlers.

The Administration for Children’s Services (ACS) should require foster care agencies to ensure that babies and toddlers in foster care are screened for mental health impairments, in addition to standard developmental evaluations.

Last year, there were more than 3,050 children under age 5 in New York City foster care. Young children often come into care with tumultuous histories that put them at high risk of medical, emotional and developmental problems. Once in the system, many of them continue to experience turbulence, moving from caregiver to caregiver while being separated from their families. When foster care is necessary, it should be maximized as an opportunity to nurture children’s developmental health. In the past decade, ACS has made great progress in the effort to ensure that children receive developmental screenings when they enter care. These screenings focus primarily on cognitive and physical delays, rather than on the more subtle impacts of disrupted relationships and stressful experiences that threaten babies’ emotional wellbeing. Unfortunately, mental health assessments often don’t happen until children are older and demonstrate obvious behavioral symptoms of emotional distress. Some agencies have developmental specialists on staff to ensure that developmental screenings take place, and to follow kids who demonstrate special needs. This systematic approach should be instituted at all agencies, with a similar level of attention paid to mental health screenings for children of all ages.

ACS and the state Office of Court Administration (OCA) should routinely train frontline staff and contract employees on the developmental needs of infants and very young children.

Removing babies and toddlers from their homes disrupts their attachments to caregivers and can have lifelong negative consequences. Frontline workers at foster care agencies, as well as child protective specialists and key Family Court staff, attorneys and judges, should be regularly trained in the particular developmental, emotional and mental health needs of infants and very young children—including the damage that can be caused by repeated disruptions in care. I n the past, a privately funded court commission ran an initiative that educated court staff about infant development, while also providing guidelines and checklists to help judges and attorneys make sure that babies received appropriate care. In the absence of outside funding, ACS and the courts should continue these practices. OCA should consider designating social workers to follow infants’ cases in court, ensuring that they receive developmentally appropriate services. Along with frontline case workers, Family Court judges should consider conducting analyses of babies’ existing attachments before making placement decisions. OCA should also consider the feasibility of creating specialized court parts for babies and very young children, staffed by judges with particular training in early childhood mental health, and who are fully informed of resources in the community for infants and their parents.

ACS and nonprofit family support organizations should ensure that parenting classes engage in active skillbuilding, supporting parents to understand and nurture their children’s development.

Too often, parenting classes are didactic exercises in compliance, instructing parents in basic skills they may already know. These classes—in conjunction with family visits—should be used as an opportunity to support parents’ meaningful interaction with their children, building skills that encourage nurturance and children’s secure attachments. With the recent introduction of its ChildSuccessNYC initiative, ACS has taken steps toward incorporating a focus on children’s developmental and emotional needs, and on the positive, crucially important role a parent plays in her child’s development. Under the initiative, parents participate in facilitated groups that promote both instruction and discussion, including concrete information about strategies to support infant brain development and mitigate the potential harm caused by trauma or neglect. The implementation of ChildSuccessNYC should not preclude parents and foster care agencies from pursuing alternative approaches, however. Specifically, there ought to be more opportunities for parents to learn about child development in environments where they can interact with their children, supported by facilitators who help them build understanding of real-life issues in real time. The ‘Baby & Me’ program at SCO Family of Services is one example of this kind of program. Parents and their children participate in a structured playgroup, in which facilitators discuss elements of development, demonstrate strategies to support that development, and then provide opportunities for parents to interact one-on-one with their children. Support groups and instruction are both valuable, but they should be closely connected to visitation experiences for parents and their children in foster care—and parents themselves should have both the information they need and the freedom to choose the most appropriate programs.