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Children's Voice Article

The Infant Team

Early Intervention for Abused and Neglected Infants and Toddlers

Children need lots of stability and love, especially in the first four years of life. During these initial 48 months, children grow in leaps and bounds, usually under the watchful and loving gaze of parents who nurture and care for them. Not every child has this opportunity, however. Sometimes, parents lack needed skills and resources, and their children may be placed in the foster care system due to abuse or neglect. Unfortunately, young children are more vulnerable to a host of developmental issues if they remain in foster care.

In December 1994, Jefferson Parish, Louisiana, implemented a prevention program--the Tulane/Jefferson Parish Human Services Authority Infant Team--to address the needs of very young children in out-of-home care. The program is a partnership among Tulane University Child Psychiatry staff; Jefferson Parish Human Services Authority, the public agency that works with individuals with mental health problems, developmental disabilities, and substance abuse issues; and the Office of Community Services (OCS), which administers the state's child welfare system. Funding for the Infant Team comes from the state and from private foundations.

Team member Valerie Wajda-Johnston says, "The Infant Team is made up of a wonderful group of people," including child psychiatrists, clinical and developmental psychologists, clinical social workers, and paraprofessionals with expertise in infant and child development and developmental psychopathology. "The families we work with present a number of therapeutic and emotional challenges, and everyone on the Infant Team rises to the occasion to provide the best services possible to ensure the best quality of life for the child."

The program provides intensive services to abused and neglected children, less than 48 months of age, who are placed in foster care. The effort integrates and coordinates comprehensive interventions for birthfamilies, from parent-child therapy to medication management to assistance with housing, allowing families to obtain a range of services in a single setting, and the court to obtain assessments and progress reports from a single source.

"Our goal is to provide integrated, cutting-edge infant mental health services comprehensively to young children and their families," explains Team Director Charles Zeanah. "We try to give biological parents opportunities to address their problem areas, but we also emphasize the need to do so within a time frame appropriate for a young child."

The program consists of two components--assessment and intervention. All children younger than 48 months who are removed from their homes due to abuse or neglect are referred to the Infant Team. The child, birthparents, and foster parents undergo 15-20 hours of assessment--including home and clinic observations, interviews, standardized screenings, and self-reporting measures--to review the child's caregiver relationships. The Infant Team then develops an intervention plan for the child and family, based on the assessment, and briefs the appropriate court on the plan.

During the intervention phase, the program sets goals for the birthparents and applies specific treatments to help parents achieve those goals. "The primary goal of intervention is help-ing parents provide 'safe enough' parenting through individual psychotherapy for the parents, therapy for the parents and the child, and any necessary crisis intervention," says Associate Team Director Julie Larrieu. "We are not expecting the parents to become perfect, just good enough." A necessary condition for this goal is that parents accept responsibility for their child's abuse or neglect and learn to place the child's needs ahead of their own.

Renee's and Maria's Stories*

Eighteen-month-old Renee was removed from her parents due to neglect. She and her mother were living in a home where crack was being used and sold. Her father, Edward, was working out of state and unavailable to care for her. OCS placed Renee with warm, responsive foster parents whose nurturing stimulated her social, emotional, and cognitive development. Renee and her father came to the Infant Team when he returned to take on more parenting responsibilities and attempt reunification.

Initially, Renee was hesitant in her father's presence, and Edward felt awkward and unsure of what he should say or do. But through a number of interactive sessions, guided by a team clinician and reassured by Renee's foster mother, Rose, father and daughter gradually began to connect. The clinician's feedback provided Edward with powerful information that gave him confidence and direction on how to develop his new relationship with Renee. Edward learned that Renee's capacity to form a connection with Rose created a foundation for his daughter to connect with him. He learned the importance of patience and consideration of Renee's feelings.

In succeeding weeks, Edward was able to relax and appreciate the small steps he was making in establishing a relationship with Renee. He discussed with a therapist his feelings of rejection and anxiousness. He matured greatly in his ability to relate to Renee, learned the importance of meeting Renee's needs before his own, and made major strides in meeting his parenting responsibilities. After 16 weeks, Edward and Renee were reunited.

Tina, 25, and her 3-year-old daughter, Maria, were referred to the Infant Team because of neglect. Tina came to the Infant Team with severe depression. Maria was an active child who clearly wanted her mother's attention. With support from the Infant Team, Tina was able to take advantage of individual therapy to unearth the root of her depression. Tina had been abandoned in childhood by both parents and was raised by relatives. She harbored a great fear of betrayal and was afraid to get too close to her own daughter.

To help Tina learn to interact with Maria appropriately and lovingly, the Infant Team had them participate in infant-parent psychotherapy. During these sessions, Tina learned how to interact with Maria as a loving parent while setting limits and offering structure and stability to Maria's life. Tina and Maria were unified after 18 months of intensive work.

Program Evaluation

A formal evaluation of the program included 240 children less than 48 months of age who entered foster care between January 1991 and December 1998. The intervention group included 95 children who were in foster care at some point between 1995 and 1998. The evaluation relied on case records for 145 young children in care between 1991 and 1994 as a comparison group.

The evaluation reported results for the type of permanent plan outcome (reunification, termination, surrender, and relative placement); length of time in foster care; and child or maternal recidivism (whether a child returned to foster care or whether a mother had another child placed in care due to maltreatment). According to Zeanah, a thorough, timely report of intervention results allows the court to make a more informed decision about a permanent plan outcome for the child.

For children in the treatment group, returns went down and terminations went up, but ultimately they were less likely to linger in foster care or experience additional episodes of abuse or neglect. Children's ages, genders, and ethnicity were unrelated to length of time in care or recidivism. Fourteen children in the control group--but only three in the treatment group--returned to out-of-home care. Overall, the risk reduction for reentering out-of-home care was 67%.

The Infant Team then examined recidivism rates for birthmothers, that is, the same mother having another child placed in out-of-home care. Ten mothers in the control group had a second child placed in out-of-home care, but only three in the treatment group had another child returned to care--a risk reduction of 64.2%. This finding demonstrates a primary prevention "sleeper effect" of the intervention--mothers who participated in the program were less likely to have another child enter care later.

The team is beginning follow-up evaluations with the children in the original study, examining social, emotional, and cognitive development outcomes in children who were freed for adoption compared with children placed with relatives and children returned to birthparents.

Growth and Replication

The Infant Team now serves four parishes and acts as a training site for mental health professionals statewide. Nationally, the Infant Team has joined four other universities in an effort supported by the Substance Abuse and Mental Health Services Administration to develop innovative treatments for traumatized young children.

Program Evaluator Sherry Heller observes that the program's "multidisciplinary makeup and strong team orientation are important variables in its success, given the intense and difficult nature of the cases." The Infant Team has hosted professionals from three continents interested in developing similar programs in their own countries.

Fast Track is a new component of the program that works with children immediately after placement, before a formal adjudication of the alleged maltreatment. These early assessments help identify behavior problems, determine developmental delays, and recognize potential foster parent mismatches. The Infant Team engages birthparents in Fast Track cases following adjudication.

Research and replication aside, perhaps the strongest testaments to the Infant Team's success come from the families of the children the program has served. Foster/adoptive parent Robin Servat says,
The Infant Team was very helpful in [the adopted child's] transition. We had some specific questions, and the Infant Team was very helpful. One of the psychologists came to our house when we needed help with the transitioning…She is now 11 years old and has really flourished in our home.
Foster/adoptive parent Joy Sibley offers similar praise:
The Infant Team is awesome. I met some really wonderful people there. We wouldn't have made it through the system without them…The counseling sessions were wonderful, and all of the early intervention for [the foster child] were wonderful. She was recommended for and received speech therapy through the Infant Team, and then they placed her in a special school for children with language delays…We appreciate everything the Infant Team has done for us, and I brag to whoever will listen on how wonderful they are.
*The names of the children and their parents have been changed

Levels of Research Rigor


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