US study: high developmental and health care needs found in children involved in child welfare systems

In the US, legislation requires that states develop provisions and procedures for referring child maltreatment victims to early intervention services. These studies utilized data from a national longitudinal study. The first study examines: 1) the level of developmental need in young children investigated by child protective services (CPS), 2) early intervention service use among infants and toddlers in CPS, and 3) need and service use variations based on the substantiation status of the child maltreatment investigation. The second study explores levels of special health care need (SHCN), defined as a chronic health condition or "special need," among children in CPS and how these needs may effect children's functioning.

The results indicate that approximately 35% of children involved with CPS were in need of developmental services at baseline based on the two state-mandated eligibility categories (children with a developmental delay and children diagnosed with a mental or medical condition likely to result in developmental delay). Only about 13% of these children identified as in need and entitled to services had received an individualized family service plan (IFSP) by age three. A child's substantiation status and level of CPS involvement were significant predictors of having an IFSP such that children with substantiated reports were more likely to have an IFSP even though children with unsubstantiated reports had more developmental needs at baseline and similar levels of need at follow-ups.

The second study results indicate that 35.1% of children involved with CPS had SHCNs at baseline Approximately 50% of the children had at least one SHCN at some point during the study period. Adopted and foster children were significantly more likely to have had SHCNs than children in other living arrangements. At any point during the study period, between 14.9% and 19.2% of children had a chronic health condition; the most common condition was asthma. Between 20.6% and 22.2% of children were reported to have had a special need. The most commonly reported special need was a learning disability. Children with a SHCN were significantly more likely than children who never had any form of SHCN to have a functioning problem. Overall, 56.1% of children with either form of SHCN had at least 1 of the 7 developmental problems studied.

The data indicate that there are high rates of developmental problems, chronic health conditions, and special needs among children within the CPS population. These findings suggest that there is a need to refer a large percentage of children involved with CPS to developmental services, including early health services and special education. The early identification of developmental problems and SHCNs may offer the opportunity to foster positive functioning or simultaneously identify co-occurring problems. In addition, these findings have important policy implications as the developmental needs of many children with unsubstantiated reports were clearly overlooked.