State Child Welfare Policy Guide: Part of the Policy Matters Series

10.1 Individualized and comprehensive assessments and planning

An essential step to determine a child’s safety, cognitive physical, emotional, and social development is a comprehensive assessment and corresponding plan of services.

A comprehensive assessment is necessary to effectively determine the child’s

1. safety;

2. cognitive, social, emotional and physical development; and

3. the nurturing capacity of their family environment.

Studies profiling the health status of children and adolescents entering foster care demonstrate high rates of acute and chronic medical problems, developmental delays, educational disorders and behavioral health conditions ^[i] , finding that children in foster care are almost four times as likely as other children to have a disability. ^[ii] It is clear that periodic health and mental health assessments of children in foster care can minimize problems and ensure that the child’s needs are met, particularly when conducted at the time of initial placement and any changes in placement, as recommended by the Child Welfare League of America-American Academy of Pediatrics standards on health care for children in foster care. As of 2002, fewer than half of state child welfare agencies reported having adopted these standards. [iii]

Individualized child assessment: Determining the safety, well-being and developmental status of children involved in the child welfare system is necessary to identify the appropriate response and the services they need.  Further, to achieve the healthy development of children in the child welfare system, a comprehensive assessment is necessary to effectively meet their critical social, emotional and physical needs. An assessment should include a family assessment that identifies the assets and challenges within the child’s environment together with an assessment of the child’s’:

• Medical  (Pediatric developmental assessment);

• Dental;

• Mental health; and,

• Cognitive/educational development.

The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program is a part of the Medicaid program that finances pediatric services and is mandatory for children in federally assisted foster care.  EPSDT is the primary source of health care funding for children in foster care since the majority of child welfare agencies lack independent financing for primary health services.   EPSDT is especially critical, since treatment of diagnosed conditions is both mandatory and eligible for federal Medicaid reimbursement.

Programs that involve interdisciplinary teams, have specific settings prepared for initial foster care screenings, rely on EPSDT-trained professionals, have presumptive Medicaid eligibility, and provide enhanced rates for EPSDT screens on foster children appear to ensure the most comprehensive and consistent quality of care. [iv]  

EPSDT programs developed in Oregon and West Virginia incorporate the use of screening tools that include mental health and substance abuse, can be rapidly administered, and provide immediately available results findings. [v]   HealthWorks of Illinois, implemented by the Department of Children and Family Services in collaboration with the Department of Public Aid and the Department of Human Services, uses a community-based approach to serve all children in custody. Children are screened within 24 hours of entry and receive a comprehensive evaluation within 21 days.  The program ensures ongoing comprehensive health care, including access to specialized services, and documentation of health care history through a Health Passport . ^[vi] In Ohio the Thomas W. Blazey Diagnostic Center is a one-stop clinic where children receive a complete physical examination at the time of placement and follow up assessments occur upon any placement change and prior to discharge. The center houses medical, dental and psychosocial services. ^[vii]

Educational assessments are mandated through Part C and Part B of the Individuals with Disabilities Education Act (IDEA), a federal law established to ensure that all children with disabilities receive a free appropriate public education. IDEA requires states to “identify, locate, and evaluate all children with disabilities, aged birth to 21, who are in need of early intervention or special education services” [viii] . Part C, which focuses on early intervention, applies to children birth to 3 years of age, and Part B, which addresses special education, targets children 3 years old and above. As of 2003, the Child Abuse Prevention and Treatment Act (CAPTA) requires that states have procedures to refer children who are the subject of an abuse or neglect referral and under the age of three to the early intervention services funded by Part C [ix] . However, partnerships between Part C providers, Part B special education programs and child welfare agencies have generally been inadequate to meet these requirements. Massachusetts has piloted the Early Childhood Linkage Initiative designed to address this mandate and create a partnership between child welfare and early childhood services. In the first three years, the Initiative found that 74 percent of children assessed were eligible for services under the state’s criteria, and 49% had an eligible delay under federal requirements. [x]

Comprehensive family assessments : A comprehensive family assessment provides information about the child’s home and community that is vital to understanding his/her health and developmental progress as well as information about the family’s strengths, needs and resources for nurturing the child.  This assessment must examine:

·         Safety and risks (including domestic violence) within the home,

·         Parental mental health,

·         Substance abuse issues, and

·         Economic and material well-being (housing stability, food security, etc.).

The federal Administration for Children and Families developed guidelines for comprehensive family assessments noting that “If comprehensive family assessment is not undertaken as part of developing the service plan, we often miss the opportunity to develop interventions that contribute to lasting change”. [xi]

The Illinois Department of Children and Family Services produced a comprehensive family assessment tool for child welfare, which includes a set of questions concerning changes in the child's life during the past year, such as: victimization/neglect, death of a family member, new school, lost relationship, serious illness/injury, incarceration of a parent, parental unemployment, economic loss, change of residence, and witness of a violent crime [xii]

In El Paso County, Colorado, the Department of Human Services’ child welfare program and the family economic support program collaborated to address child safety and family poverty regardless of which program came in contact with the family. As a result of a broad range of reform activities and a shared vision by both programs, a comprehensive assessment was developed to ensure that family income and child protection were effectively addressed. [xiii] (See also Strong Families A6)

The Family Program in Westchester County, NY is a collaborative effort between the Westchester Institute for Human Development and the Westchester County Department of Social Services that is designed to meet child welfare permanency goals by providing developmental and mental health assessments and services to all children in family foster care, their birth parents and their foster families. The initial intake assessment consists of a comprehensive developmental assessment for the child and a functional assessment of birth parents. Based on the results of the intake assessment, other evaluations are completed as necessary by members of the child development team including developmental pediatrics, child psychiatry, a psycho-educational specialist, speech/language pathology, occupational and physical therapy, and audiology. [xiv]  

Policy Options : States can enhance assessments and planning by adopting one or both of the following policies:

·         EPSDT include IDEA Parts B and C evaluations and thorough mental health assessments

 

·         Comprehensive family assessment is required, including safety and risk (including domestic violence), mental health, substance abuse, and economic and material well-being (housing stability, food security, etc.)

 

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