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Infants in placement
1. Copyright 2011 ZERO TO THREE. All rights reserved. For permission requests, visit www.zerotothree.org/permission
A Call to Action for Infants and
Toddlers in Foster Care
MATTHEW E. MELMED
ZERO TO THREE, Washington, DC
A
buse and neglect—and how our child welfare systems principle: The care of very young children
often respond—threaten the healthy future of thousands known to the child welfare system must be
of infants and toddlers. Their brains are developing at life- designed according to—and with the goal
altering rates of speed. Maltreatment chemically alters of meeting—their developmental needs.
that development and can lead to permanent damage to Policymakers at all levels of government and
infant–toddler practitioners need to place a
the brain’s architecture. Every year, 196,476 children from
high priority on meeting the needs of this age
birth to 3 years old come into contact with the child welfare
system (U.S. Department of Health and Human Services [DHHS], 2010b);
76,862 are removed from their parents’ care (DHHS, 2010a).
As a society, we have a moral imperative to practice on this age group with its unique Abstract
protect children. This is especially so in cases developmental needs and opportunities. The Almost 200,000 infants and toddlers
where it is determined that children need to threats to young children who are at risk for come into the child welfare system
be removed from their parents or caregivers. abuse or neglect or who are placed in fos- each year. They do so during the period
We must do all that we can to ensure that all ter care are significant; however, very few of the most rapid brain development.
children are in a safe environment and that initiatives, policies, or practices recognize Maltreatment can damage the
no child falls through the cracks. We can- their special vulnerabilities. Current prac- architecture of the developing brain,
not afford to discard potentially productive tices compound the effects of maltreatment. with lifelong consequences for both
members of our workforce by ignoring their When young children are placed in nonfam- baby and society. The child welfare
developmental needs. Put another way, we ily group settings, moved from home to home system has not done well at addressing
cannot afford to burden our economy with in foster care, denied developmental assess- the developmental needs of infants and
the demands that maltreated babies will make ments and services, and kept from frequent toddlers (in some instances, actually
as they grow up. Costs associated with special visits with parents and siblings, developmen- doing more harm). The author, the
education programs, foster care, incarcera- tal damage continues to escalate. We have executive director of ZERO TO THREE,
tion, mental health services, drug and alcohol an opportunity to protect these children and argues for a policy agenda making
rehabilitation, and the risk of continuing the resolve the developmental damage caused by vulnerable infants and toddlers a
cycle of maltreatment with their own chil- early maltreatment. priority and creating a developmental
dren are burdens our society can ill afford. It is time for a call to action on behalf approach to their care, with a call
However, there has been no concerted of these extremely vulnerable infants and to action for policymakers and
effort to focus child welfare policy and toddlers and their families. The guiding practitioners to join this effort.
January 2011 Z e ro to Three 2 9
2. 2002). The most recent look at data on
infants and toddlers in foster care, reported
At a Glance: Facts About
by Wulczyn, Chen, Collins, and Ernst (this Infants and Toddlers
issue, p. 4) shows that these trends continue.
• Children between birth and 1 year old
Unquestionably, infants and toddlers are
have the highest rates of victimization
the most vulnerable age group (see box At a
(DHHS, 2010b).
Glance). They constitute almost one third of
all children who are abused or neglected. Of • Infants and toddlers constitute more
the estimated 1,740 children who died from than one quarter of all children who are
abuse and neglect in 2008, more than three abused or neglected (DHHS, 2010b).
quarters (79.8%) were 3 years old or younger • Every day, 210 babies are removed from
(DHHS, 2010b). their homes because their parents cannot
Children who initially enter the foster care take care of them (DHHS, 2010a).
system as infants have considerably different • Infants and toddlers accounted for 31%
discharge patterns than their counterparts of children who entered foster care in
who enter foster care at older ages. 2009—the largest single group of
Infants are much less likely to achieve children entering care (DHHS, 2010a).
reunification with their families than chil- Sixteen percent were less than 1 year old.
Photo: Marilyn Nolt
dren in any other age group. As Wulczyn and
• Once they have been removed from their
colleagues (this issue, p. 4) illustrate, infants
homes and placed in foster care, infants
who enter foster care before they are 3 months
and toddlers are more likely than older
old are unlikely to return to their parents. For children to be abused and neglected and
those infants who do achieve reunification, to stay in foster care longer (Wulczyn &
one third will re-enter the child welfare sys- Hislop, 2002).
Infants are much less likely to achieve
tem (Wulczyn & Hislop, 2000). Almost half
reunification with their families than • A total of 1,740 children died from abuse
(49%) of the children waiting to be adopted in
children in any other age group. and neglect in 2008; more than three
FY2009 were 3 years old or younger when they
quarters (79.8%) of these children were
were removed from their parents or caretak-
3 years old or younger (DHHS, 2010b).
group, raising awareness, designing policies, ers; 25% were less than 1 year old. However,
and implementing practices to ensure that only 2% of children adopted in FY2009 were
(a) when infants and toddlers are known to less than 1 year old, because of the length of
the child welfare system but remain with their time it takes to go through the process leading architecture of the developing brain, prevent-
families, there are preventive services avail- to adoption (DHHS, 2010a). ing infants and toddlers from fully developing
able to support the protective factors that Approximately one third of infants and the neural pathways and connections that
promote healthy development; and (b) when toddlers investigated by child welfare ser- facilitate later learning. Maltreatment experi-
infants and toddlers must be removed from vices have a developmental delay. Data from ences alter the brain’s architecture (Shonkoff,
their homes, the foster care that ensues and the National Survey of Child and Adolescent 2007). These changes in the brain give rise to
the supports offered to their parents will help Well-Being indicate that 35% of children several psychological difficulties—cognitive
heal the effects of maltreatment and support from birth to age 3 years who were involved delays, poor self-regulation, and difficulty in
healthy development. The federal govern- in child welfare investigations were in need paying attention (Jones Harden, 2007).
ment should show leadership in creating such of early intervention services. However, only
a focus. However, state and local child wel- a small number (12.7%) of these children Infants and Toddlers Need at Least One
fare agencies, as well as local communities in need were receiving the Individualized Nurturing Relationship to Thrive
and practitioners, are in a position to make Family Service Plans to which they were enti- The first relationships a child forms
real changes in how the needs of very young tled under federal law (Casanueva, Cross, & with adults have the strongest influence on
children and their families are met and should Ringeisen, 2008). social and emotional development (National
also move forward to meet this goal. Research Council & Institute of Medicine,
The Developing Brain Is Harmed by 2000). Infants and toddlers rely on their
A Portrait of Infants and Toddlers Abuse and Neglect closest caregivers for security and comfort.
in the Child Welfare System Neuroscientific research on early brain Those who are able to develop secure attach-
I nfants and toddlers are the largest sin-
gle group of children entering foster care.
Of the children who entered foster care
during fiscal year 2009 (FY2009), 31% were
less than 3 years old (DHHS, 2010a). Forty-
development indicates that young chil-
dren warranting the greatest concern are
those growing up in environments, start-
ing before birth, that expose them to abuse
and neglect. It is during the first years of
ments are observed to be more mature and
positive in their interactions with adults and
peers than children who lack secure attach-
ments (National Research Council & Institute
of Medicine, 2000). They also show a greater
five percent of all infant placements occurred life when the brain undergoes its most dra- capacity for self-regulation, effective social
within 30 days of the child’s birth. Once they matic development and children acquire the interactions, self-reliance, and adaptive cop-
have been removed from their homes and abilities to think, speak, learn, and reason. ing skills later in life (Goldsmith, Oppenheim,
placed in foster care, infants and toddlers are Early experiences, both positive and nega- & Wanlass, 2004). Those who do not form an
more likely than older children to be abused tive, have a decisive effect on how the brain is attachment with at least one trusted adult suf-
and neglected and to stay in foster care lon- wired (National Research Council & Institute fer, and their development can deteriorate
ger. Half of the babies who enter foster care of Medicine, 2000). In fact, early and sus- rapidly, resulting in delays in cognition and
before they are 3 months old spend 31 months tained exposure to risk factors such as child learning, relationship dysfunction, and dif-
or longer in placement (Wulczyn & Hislop, abuse and neglect can influence the physical ficulty expressing emotions. Young children
3 0 Z e ro to Three January 2011
3. with unhealthy attachments are also at much Research confirms that the early years
greater risk for delinquency, substance abuse, present an unparalleled window of oppor-
and depression later in life. Researchers have tunity to effectively intervene with at-risk
found that approximately 82% of maltreated children (National Research Council &
infants show disturbances in their attachment Institute of Medicine, 2000). Intervening in
to their caregivers (Goldsmith et al., 2004). the early years can lead to significant cost sav-
ings over time through reductions in child
Infants and Toddlers Are Vulnerable abuse and neglect, criminal behavior, welfare
to the Effects of Maltreatment and dependence, and substance abuse. To be effec-
Negative Experiences Related to Foster tive, interventions must begin early and be
Care designed with the characteristics and experi-
Research indicates that each domain of ences of these infants, toddlers, and families
developmental functioning is affected by the in mind (Jones Harden, 2007). If services are
early experience of maltreatment. Negative not provided until a child is 6, 7, or 8 years
foster care experiences may extend and com- old, the most critical opportunity for preven-
pound these developmental impairments tion and intervention is missed (Infant Mental
(Jones Harden, 2007). Separation from par- Health Project, Center for Prevention and
ents, sometimes sudden and usually traumatic, Early Intervention Policy, 2010). A study of
coupled with the difficult experiences that may the cumulative costs of special education from
Photo: Andrea Booher
have precipitated out-of-home placement, birth to age 18 years found that intervening at
can leave infants and toddlers dramatically birth resulted in lower costs over the course
impaired in their emotional, social, physical, of childhood than services started later in life
and cognitive development (Lieberman & Van (approximately $37,000 when services were
Horn, 2007). Research shows that young chil- begun in infancy, 28% to 30% lower than when
dren who have experienced physical abuse begun after age 6 years; Wood, 1981).
have lower social competence, show less Given this window of opportunity, there The care of very young children known
empathy for others, have difficulty recogniz- are a number of ways that policymakers and to the child welfare system must be
ing others’ emotions, and are more likely to be practitioners can intervene to improve out- designed with the goal of meeting their
insecurely attached to their parents (National comes. The bottom line is that child welfare developmental needs.
Research Council & Institute of Medicine, practices that are largely focused on child
2000). According to the National Survey of safety often are not structured to promote
Child and Adolescent Well-Being, half of mal- healthy development and the formation of a been called “the heart of permanency
treated infants exhibit some form of cognitive secure attachment. In fact, they may actually planning” (Hess & Proch, 1988), is
delay. They are more likely to have deficits in play a negative role in early development. A widely viewed as the most impor-
IQ scores, language ability, and school per- reorientation of thinking is needed to reform tant strategy for reunifying families
formance than other children who have not approaches to infants and toddlers who land and achieving permanency (Haight,
been maltreated (National Research Council in the child welfare system at such a develop- Sokolec, Budde, & Poertner, 2001).
& Institute of Medicine, 2000). Maltreated mentally critical time. Very young children need to see their
infants and toddlers are also more likely to parents every day if possible, and
have physical health difficulties—greater neo- Toward a Developmental those visits need to be supported in
natal problems, higher rates of failure to thrive, Approach to Child Welfare Policy ways that help repair and strengthen
and dental disease. and Practice for Infants and the parent–child bond. However, cur-
Toddlers rent state child welfare policies vary
E
Maltreated Infants and Toddlers in lements of an agenda focused on widely and may call for visits once a
Foster Care May Not Realize Their Full infants, toddlers, and their families week or even less frequently. Little
Potential should follow a framework of guiding information is available on how often
The toll extracted by maltreatment and principles for infant and toddler development visits actually occur. For infants and
the inadequate response of the child welfare as well as knowledge of the protective fac- toddlers, infrequent visits are not
system through inadequate policies, programs, tors that help families mitigate the trauma of enough to establish and maintain a
and responses can resonate throughout a maltreatment and provide a nurturing envi- healthy parent–child relationship.
child’s life. Disproportionate exposure to ronment for young children. Visitation for infants and toddlers
early trauma and other developmental risk should be as frequent as possible
factors can result in a variety of mental health • Stable caring relationships are essential for (e.g., daily or multiple times per
disorders. Physical abuse impairs a young healthy development. At least one loving, week) and be conducted in locations
child’s social adjustment, including elevated nurturing relationship is the linchpin that are familiar to the child (Jones
levels of aggression that are apparent even of positive early development. Federal, Harden, 2007).
in toddlers. Long-term negative outcomes state, and local child welfare policies — Incidence of multiple placements:
include school failure, juvenile delinquency, and practices should make supporting Children in foster care frequently
substance abuse, and the continuation of the responsive, secure bonds between the experience multiple moves. In one
cycle of maltreatment into future generations. youngest children and their parents and state, 25% of infants and toddlers had
Too often, foster children become parents caregivers a central goal. Key areas of three or more moves within the first
themselves too soon and have little experience concern are as follows: 3 months of care (Hornby, Zeller, &
with loving, nurturing relationships to guide — Lack of emphasis and support for paren- Cotton, 2009). Multiple moves place
their own parenting. tal visitation. Visitation, which has children at an increased risk for poor
January 2011 Z e ro to Three 3 1
4. for infants and toddlers is not system-
atically used, and often an alternate
permanency plan is considered only
when reunification fails to occur.
Concurrent planning means that chil-
dren have two permanency goals,
typically reunification and placement
with a relative. Both goals are actively
pursued at the same time. Infants and
toddlers need a stable, loving family as
soon as possible. The shift in philoso-
phy required by concurrent planning,
coupled with real barriers including
providing adequate supportive ser-
vices to parents and locating family
members or other potential adop-
Photo: Jonathan B. Rivera
tive homes, can be difficult to achieve.
However, it creates opportunities for
innovation in supporting young chil-
dren and families and an impetus for
robust efforts to provide services to
parents. New models of foster parent-
ing need to be explored so that, when
Infants and toddlers are more likely than older children to be abused and neglected and initially removed from their par-
to stay in foster care longer. ents, very young children are placed
with families who are able to support
outcomes with regard to social– toward the goal of making the first reunification efforts with the parents
emotional health and the ability to placement the last placement. but who would provide a permanent
develop secure healthy attachments — Use of congregate care: Some infants home if reunification is not possible.
(Gauthier, Fortin, & Jéliu, 2004). and toddlers are still placed in congre- • Early intervention can prevent the
When a baby faces even one change gate care—group settings, typically consequences of early adversity. Federal,
in placement, fragile new relation- with rotating, 24-hour child care state, and local policies, as well as child
ships with foster parents are severed, staff (Jones Harden, 2007). Data sug- welfare practice, should ensure that
reinforcing feelings of abandonment gest that institutional care for infants the developmental needs of infants
and distrust. Even very young babies leads to a range of harmful develop- and toddlers, as well as those of their
grieve when their relationships are mental outcomes including motor parents, are identified and addressed.
disrupted, and this sadness adversely and language delays and a variety of This means routinely using screening
affects their development. Policies social–emotional deficits, such as and assessments and intervening early
and practices for infants and toddlers lack of attachment, lack of a sense with developmental services. As noted
in foster care need to be reoriented of trust, and absence of social play by Hudson (this issue, p. 23), policy
(Jones Harden, 2002). Researchers and practice at all levels must ensure
have also documented elevated levels a focus on the needs of parents as well
of cortisol, a stress hormone, in these as those of children. Often services are
Learn More children. Although the use of con- lacking, especially to strengthen the
gregate care facilities has increased parent–child relationship. Without
ZERO TO THREE Policy Network over the past 2 decades because of adequate supports for parents to
www.zerotothree.org/public-policy/action-center/ the crack/cocaine and methamphet- provide a healthy environment for their
Join the ZERO TO THREE Policy Network amine epidemics and the decrease in child, very young children can suffer
and access resources and tools to help you in the number of available foster homes, depression and other mental health
advocating effectively for infants, toddlers, no very young child should be placed problems. Practitioners and services
and their families. Learn more about the in congregate care facilities unless for infant and early childhood mental
public policy process and download tools in a facility with her parent (Jones health—which differ substantially from
to advocate for infants, toddlers, and their Harden, 2007). those for older children—are scarce.
families. The ZERO TO THREE Policy Center — Length of time to permanency: During However, an overarching principle of
is a nonpartisan, research-based resource for the earliest years of life when growth infant mental health intervention is
federal and state policymakers and advocates and development occur at a pace far that relationships (e.g., between parent
on the unique developmental needs of infants exceeding that of any other period and child as well as between family and
and toddlers. The Policy Center brings to bear of life, time goes by quickly. Babies interventionist) are the conduit for
ZERO TO THREE’s more than 30 years of can drift for years in foster care, from change in the young children and families
research-based expertise on infant and toddler one foster home to another. Standard served (Jones Harden, 2007). For young
development to ensure that public policies child welfare practice is to seek reuni- children in child welfare, healing the
reflect best practices and current research in fication when in the best interest of relationship between the baby and parent
support of our nation’s very young children. the child, but this may take several is critical; however, services remain
months or years. Concurrent planning extremely limited and reimbursement
3 2 Z e ro to Three January 2011
5. for child–parent therapy is often
problematic.
• Every child welfare decision and service
should have a goal of enhancing the well-
being of infants, toddlers, and their families
to set them on a more promising develop-
mental path. Federal, state, and local child
welfare policy, as well as practice, should
be focused on building and maintain-
ing a well-trained child welfare, social
service, early childhood, and legal work-
force educated in the science of early
childhood development and informed by
the most relevant and recent data. This
would require ongoing training and con-
tinuing education, sound recruitment
and retention policies, improved super-
vision, and appropriate workloads for
Photo: Andrea Booher
workers.
• Families and communities must be key part-
ners in efforts to ensure the well-being of every
child. The child welfare system cannot go
it alone. It is important that we support
child welfare policy that seeks to encour-
age coordination among agencies whose Each domain of developmental functioning is affected by the early experience of
goal is to assist at-risk families. Assisting maltreatment.
at-risk families will require a comprehen-
sive approach that seeks to “break down
the silos” that currently exist. We should THREE has convened a national coalition of
encourage and support the development organizations that are leaders in child welfare Matthew E. Melmed, JD, executive director
of community-based networks of social policy, including the Child Welfare League of of ZERO TO THREE, has significantly expanded
service supports to assist infants, tod- America, the Children’s Defense Fund, the the organization’s impact in promoting the health
dlers, and their families known to the Center for the Study of Social Policy, and the and development of infants and toddlers. Mr.
child welfare system. For at-risk fami- American Humane Association, to develop Melmed is committed to translating what we know
lies with young children, building strong and implement a shared child welfare policy into what we do for America’s youngest children.
friendships and connections to their com- agenda for infants and toddlers. The shared
munity that reduce isolation is critical to agenda will raise awareness of these critical Since 1995 he has guided the considerable growth
providing a network of support during issues and seek to make them a priority at of the organization’s activities in support of pro-
challenging times. all levels of government. Our ultimate goal fessionals, policymakers, and parents in their
• Child welfare administration at the federal, is to ensure that the practices used in the efforts to improve the lives of infants and toddlers.
state, and local level must include a focus on child welfare system incorporate what we Under his leadership ZERO TO THREE has
infants, toddlers, and their families in such know from the science of early childhood launched a number of major programmatic and
functions as data collection, research, and development into what we do for the policy initiatives.
attention to special populations. Too often youngest children. Our national partners
Mr. Melmed currently serves as the first elected
we find we just do not know enough about each bring their own historical knowledge,
chair of the Children’s Leadership Council, a
what is occurring with the youngest chil- wealth of experience, and perspective
coalition of 55 leading national policy and advo-
dren in the child welfare system or about about the needs of young children in the
cacy organizations working to improve the health,
what works best in addressing their needs. child welfare system, which is crucial in
education and well-being of America’s children
The youngest children are overlooked in developing a joint agenda. Through this
and youth. In addition, he serves as vice-chair on
research design, data collection, and anal- unique partnership, we hope to highlight and
the board of Generations United and was recently
ysis. Placing a priority on addressing the lend urgency to opportunities for both short-
elected a trustee of the Turrell Fund in New Jersey.
needs of infants and toddlers in the child and long-term policy changes at the federal,
welfare system means ensuring that they state, and local levels to benefit infants and Mr. Melmed served for 13 years as executive direc-
are considered in every aspect of program toddlers in the child welfare system. tor of the Connecticut Association for Human
administration. It is clear that the effect of maltreatment Services and prior to that was a managing attor-
and negative foster care experiences on ney for Connecticut Legal Services. He is a Phi
A Call to Action healthy development can have lifelong Beta Kappa graduate of SUNY Binghamton
E very day in the United States, 210 implications if not properly addressed. We and received his Juris Doctor degree from SUNY
infants and toddlers leave their at ZERO TO THREE call on policymakers at Buffalo.
parents and are placed in the care of all levels of government and infant–toddler
someone else, often a stranger. We believe practitioners to act now to ensure that our
that these babies cannot wait until someone nation’s most vulnerable infants and toddlers
notices them later in their lives, most likely get the best possible start in life. A
for the wrong reason. Accordingly, ZERO TO
January 2011 Z e ro to Three 3 3
6. References Documents/OklahomaDHSPerformanceAudit. development in court. Washington, DC: ZERO TO
pdf THREE.
Casanueva, C., Cross, T., & Ringeisen, H. (2008). Hudson, L. (2010). Parents were children once too. U.S. Department of Health and Human Services,
Developmental needs and individualized family Zero to Three, 31(3), 23–28. Administration for Children and Families.
service plans among infants and toddlers in the Infant Mental Health Project, Center for (2010a). The AFCARS report: Preliminary FY 2009
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in foster care. Juvenile and Family Court Journal, practice. Washington, DC: ZERO TO THREE. with special needs and their families: Findings and
55(2), 1–13. Lieberman, A., & Van Horn, P. (2007). Assessment recommendations (Westar Series Paper No. 11).
Haight, W., Sokolec, J., Budde, S., & Poertner, J. and treatment of young children exposed to Seattle: University of Washington.
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integration document]. Urbana–Champaign, children and trauma: Intervention and treatment (2011). The foster care baby boom revisited:
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Hess, P., & Proch, K. O. (1988). Family visiting in out- neighborhoods: The science of early childhood infants in foster care. Chicago: Chapin Hall Center
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Hornby, H., Zeller, D. E., & Cotton, E. (2009, In J. P. Shonkoff & D. A. Phillips (Eds.). care: The numbers call for attention. Zero to
February). Oklahoma Department of Human Washington, DC: National Academies Press. Three, 22(4), 14–15.
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Find it Now on www.ZEROTOTHREE.org
Securing a Bright Future Policy Guide
www.zerotothree.org/brightfuture
Download this policy brief from the Early Experiences Matter Policy Guide which provides tools for taking action and improving public policies that
impact the lives of infants, toddlers, and their families. It includes mini policy briefs, practical tools, in-depth policy papers, and more.
Ensuring the Healthy Development of Infants in Foster Care: A Guide for Judges, Advocates and Child Welfare Professionals
www.zerotothree.org/ensuringhealthydevelopment
This booklet offers guidelines for child advocates on ensuring healthy infant development and addressing the developmental and emotional needs of
infants and their caregivers.
Infants in the Child Welfare System: A Developmental Framework for Policy and Practice
www.zerotothree.org/developmentalframework
Preview a chapter from the book by Brenda Jones Harden. Using extensive research, Dr. Jones Harden explains some of the basic theories of child
development that are especially relevant to the experiences of infants and toddlers in the child welfare system and offers infant-centered policy and
practice strategies.
3 4 Z e ro to Three January 2011