Best Practices in Providing Part C Early Intervention Services to Families Involved with Child Protective Services

Background and Purpose: Abused and neglected children are at higher risk for developmental delays than the general population. Early intervention (EI) services present one pathway to addressing the Grand Challenge of giving these children a good and healthy start in life. In 2003, an amendment to the federal Child Abuse Prevention and Treatment Act (1974) required states to have policies ensuring all abused or neglected children under age three are referred to Part C EI services for developmental screenings. Inconsistent EI referral and service utilization by young children involved with child protective services (CPS) has been attributed to variation in policies adopted between states. However, significant variation also exists within states, with some EI programs serving a high proportion of families involved with CPS, despite sharing a geographic service area with programs engaging few CPS-involved families. Little is known about the factors associated with higher referral rates and successful engagement of these high-risk and difficult to serve families. This study sought to identify a range of best practices for EI referral, engagement, and service use for CPS-involved families.

Methods: This qualitative study conducted in Massachusetts was designed to identify best practices by examining EI programs that successfully receive referrals, engage, and serve CPS-involved families. These high-performing programs (n=26) were identified by analysis of statewide EI program data. A total of 25 semi-structured qualitative interviews were conducted with directors (n=9), supervisors (n=5) and front-line workers (n=11) in the nine EI programs selected in a purposeful sample. Providers from various disciplines (e.g., social workers, developmental specialists) were included. Interview transcripts were coded and analyzed in Dedoose software using a process of coding consensus, co-occurrence, and comparison. A hierarchical codebook included major areas of inquiry from the interview guide and additional topics that emerged from the interviews.

Results: Results revealed that key strategies for successful referral include the necessity for streamlined procedures between EI and CPS, including multiple referral modes (e.g., telephone, website, fax) and a single contact person responsible for referrals in each EI and CPS office. Engagement of CPS-involved families was most successful when EI providers were persistent in contacting families, clearly delineated the role of EI versus CPS, and emphasized the voluntary nature of EI services. Best practices in providing ongoing services to CPS-involved families included conducting joint EI-CPS home visits, coordinating service plans and services to avoid duplication, and being forthright with CPS-involved families when an EI provider must report child maltreatment. Underlying these three successful practices was an established history of interagency collaboration and strong program leadership at both agencies.

Conclusions and Implications: These practical strategies suggest novel methods for connecting CPS-involved families to EI services, a key strategy for child abuse treatment and prevention of maltreatment recurrence. The CAPTA provision was enacted to ensure that this particularly vulnerable population of children receives developmental screening and services. Effective implementation is essential to ensure that all children meet the Grand Challenge of a good start in life, increasing the odds of greater well-being in childhood and across the lifespan.