Rolling over. Sitting up. Crawling, walking, talking. First teeth, first friends. The first five years of life are crowded with critical developmental and emotional milestones. It's a period when developmental or learning delays will first become apparent, and can be most effectively treated.

But for children in care of the child welfare system, the kinds of continuous observation and monitoring of individual growth and progress that make early intervention possible are interrupted. How can the states, the courts, social workers and medical professionals do a better job connecting young children in foster care to the medical care and related services they need? The National Center for Children in Poverty looks at the barriers to continuity of services, and at some programs that work to overcome them, in Improving the Odds.

A Growing Group
First and most important, this issue brief makes clear that this is a growing population, and one that faces a particularly high risk of medical problems and learning disabilities. Each year, about 150,000 children under five are placed in foster care by court order, representing about 30 percent of all children in foster care. Within the past 10 years, the foster care population overall has risen by 50 percent. But the number of children under age five in care has gone up by 110 percent.

These children face special threats to their healthy growth and development. Nearly 40 percent are born low birth weight and/or premature. More than half suffer from serious physical health problems. In addition, over half experience developmental delays. That is four to five times the rate at which such delays are found among children in the general population.

Add that to the heightened risk of emotional and behavioral problems faced by children in care, and the importance of continuous, careful assessment of these children's physical and mental health becomes clear.

Five Strategies
Improving the Odds proposes five strategies for improving the continuity of care for these young children, and gives brief descriptions of programs that successfully address each strategy.

For instance, the first strategy is to provide "developmentally appropriate health care to young children in the context of comprehensive health care for all children in foster care." One example: the ENHANCE program in Syracuse, New York. ENHANCE—which stand for Excellence in Health Care to Abused and Neglected Children—offers pediatric health care, child development and mental health services 24 hours a day, 7 days a week, to more than 600 children in Onondaga County. It's a joint program of the State University of New York Upstate Medical Center in Syracuse, and the Onondaga Country Department of Social Services.

ENHANCE staff includes two pediatricians, a clinical child psychologist, a child development specialist, and two pediatric nurse practitioners. Specialists at the university hospital can be called in as needed. Foster parents receive a typed summary of every visit a child makes to ENHANCE, so that a comprehensive record of findings and recommendations is created. When children are discharged from placement, their guardian attends a meeting to review the child's medical history and to have any questions answered about the child's needs and the services provided.

The second strategy, "ensure access to early intervention services for children and toddlers in foster care," highlights the importance of the Early Intervention Program of the federal Individuals with Disabilities Education Act, or IDEA. This part of the act requires that infants and toddlers with developmental delays, a high probability of delay, or even, in some states, simply a risk of developing delays, must receive services. Foster parents and relatives can access these services, but often either are unaware of this resource, or can't meet state requirements for parental consent.

Among the examples of effective programs is the Starting Young Program of the Children's Hospital of Philadelphia, which evaluates children under 31 months who are referred by child welfare agencies. Children are assessed by a pediatrician, child psychologists, speech-language pathologist and physical therapist, who provide developmental evaluations. The assessment team works with child welfare social workers to develop a service plan for each, and biological parents and caregivers are kept informed of all findings and recommendations. Two or three months later, the program social worker follows up with caregivers to make sure the recommendations are being followed, and services are being provided.

Three other strategies are identified:

• Create monitoring and tracking mechanisms to ensure that needed health, developmental and mental health services are provided.
• Ensure that young children in foster care have access to quality early care and learning experiences.
• Use the oversight authority of the courts to ensure that children in foster care receive needed health, developmental/early intervention, and mental health services as a part of permanency planning.

As Improving the Odds makes clear, these approaches will only work if courts, child welfare agencies, health care providers and early childhood agencies work together. And they will only work if court personnel, child welfare workers, biological and foster parents and other caregivers have information about the children in care, their needs and their challenges.

Susan Phillips is managing editor of Connect for Kids.