California Early Start Policy Primer:
Where Do We Go From Here?
Marie Kanne Poulsen, Ph.D
Keck School of Medicine
Children’s Hospital Los Angeles
University of Southern California
California Families
Infants & Toddlers: Birth to Three
 1,500,000 babies
birth to three
 34,000 families with
babies with special
needs
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California Early Start
Early Intervention Services
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1986: Individuals with Disabilities Education Act
(IDEA): Part C
1993: California Early Intervention Services Act
(CEISA): Early Start (Family) Program
California Early Intervention Services Act
Early Start for Infants, Toddlers & Families
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Family Centered
Multidisciplinary
Interagency
Comprehensive
Coordinated
Statewide system
CA Government Code, 95002
Part C Federal Requirements
CA Early Start Program
 Designated lead agency  DDS w/ CDE as partner
 All Regional Centers & school districts provide
intervention & educations services.
 DDS: Administration & coordination of the statewide
delivery system
 CDE: Solely low incidence & maintenance of effort
Part C Federal Requirements
CA Early Start Program
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$53 million federal support, with $ 256 M from state
general fund = $309,000,000
Federal mandates, including Performance Plan and
Annual Report on 10 indicators of compliance
2014 Added Requirement of a State Systemic
Improvement Plan addressing an outcome for high
interest but low performance indicator
CA Early Start Federal Requirement
Definition of State Eligibility
 Infants and Toddler: Birth to three years
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Significant developmental delay (33%)
Established condition
High risk of experiencing developmental delay
or disability due to a combination of biomedical
risk factors (removed 2009 restored 2015)
Part C Federal Eligibility Requirements
Established Condition & Significant Delay
Developmental Areas
 Cognitive
 Physical & Motor
 Communication
 Adaptive
 Social-Emotional
CA Early Start State Requirement
Eligibility: 2 Biomedical Factors
 Low birth weight
 Assisted ventilation
 Small for gestation
 Asphyxia
 Prenatal exposure
 Neonatal seizure
 CNS lesion
 Failure to thrive
Part C Federal Requirements
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Child Find
Evaluation
Individualized Family
Service Plan
Early Intervention Services
Mediation/ Due Process
State Interagency
Coordinating Council
Part C Federal Requirements
Service Coordination
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assistive technology
audiology
family supports
health services
medical evaluations
nursing services
nutrition services
occupational therapy
language therapy
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physical therapy
psychological services
respite care
service coordination
social work services
special instruction
transportation
vision services
2012 California Legislative Changes
Utilization of Private Insurance
Regional Centers can access a parent’s private
insurance benefits to pay for early intervention
medical and health care services.
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Qualified personnel
Natural environments
Collaboration/coordination
Deductibles and Co-pays
Part C Federal Requirements State
Performance Plan & Annual Report
Compliance to the 10 Federal Indicators
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Timely Assessment and IFSP in 45 days
Positive social-emotional, use of knowledge &
language, adaptive self-help skills outcomes
Early Start Services helped families
Child find percentage of population
Transition
2014 Part C Federal Requirement
State Systemic Improvement Plan (SSIP)
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Increases capacity of Early Intervention Services
to implement, scale up, and sustain evidencebased practices
2014 Part C Federal SSIP Requirement
2020 Achievable Measureable Result
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15
Improves outcomes for
infants and toddlers
and their families
Based on State data and
Stakeholder input
Recommended by the
State Systemic
Improvement Plan
Task Force
2014 Part C Federal Requirement
State Systemic Improvement Plan (SSIP)
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Identify a significant state challenge
Identify root causes for low performance
Develop Theory of Action
Build EI program and EI provider capacity to
achieve the chosen State Identified
Measureable Result by 2020
State Identified Measurable Result
Social and Emotional Development
 Turns to caregivers for TLC,
solace, attention & guidance
 Manages emotions &
behaviors to developmentally
appropriate expectations
 Has the initiative to explore,
discover, learn & make friends
State Identified Measureable Result
Social and Emotional Development
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High parent priority
Infant brain research
Critical preschool inclusion indicator
Critical resilience indicator
Lowest Annual Report indicator
State Identified Measureable Result
Enhance Social and Emotional Development
Identified Root Causes:
Lack of skills of professionals who provide
Early Intervention services related to
social-emotional development
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Lack of family-centered approaches in
service delivery that address mother-child
interaction & promote first relationships
State Identified Measureable Result
Enhance Social and Emotional Development
Identified improvement strategies:
Sustainable professional development on
infant-family mental health
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Strengthen parent-child interactions
through relationship based practices
Strengthen families through community
services and supports to complement Part C
1997 White House Conference
Brain Development in Young Children
Insights on Early Mother-Child Nurturing Relationships
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Influence how the intricate circuitry
of the brain is wired
Influence extremity and frequency of stress
levels of cortisol
Interpersonal interaction, not sensory
stimulation, as the key to healthy
development
1999 White House Conference
on Mental Health
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Infants as young as one month can
sense when their parents are angry,
anxious or depressed
Babies as young as 3-4 months can
experience symptoms of depression
when separated from their mothers
Roots of Social-Emotional Development
Responsive Meaningful Caregiving
Poulsen/ USC UCEDD
Relationship:
Centrality of Social-Emotional Development
Maternal
Emotional
Availability
Infant
Emotional
Availability
Relation
-ship
 “The emotional well-being of young children
is directly tied to the emotional functioning
of their care givers and the families in which
they live.’
-- Center on the Developing Child (2008)
Harvard University
Poulsen/ USC UCEDD
Mothers of Babies with Delays, Disabilities
and Biomedical Risks
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May be first time moms
May be experiencing anxiety
or depression
May be experiencing birth-related
posttraumatic stress disorder
May be alone
May be worried about family circumstance
Poulsen/ USC UCEDD
California’s Challenging
Family Circumstances
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24% live below federal poverty level
46% babies live in low income families
32% live in single parent families
45% babies born to foreign-born mothers
10-15% on new mothers experience
postpartum depression
Caregiving as Modifier of the Brain
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Babies of mothers w/ postpartum depression
 Infants withdrawn & less active
 Infants with shorter attention
 Elevated heart rates and cortisol levels
 75% with less frontal brain activity
 Greatest risk between 6 and 18 months
 Brain activity normalizes when mother has
treatment
California’s Challenging
Family Circumstances
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19% of mothers did not finish high school
12% live in families with parents who are
unemployed
23% of babies experience high mobility
65% of babies have at least one risk factor
known to increase the chance of poor
health, school & developmental outcome
Early Childhood Summit 2010
Impact of ACE on Child-Well Being!
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Infants and young children absorb stresses
within their families, increasing cortisol
level & reactivity.
Adverse childhood experiences can effect the
architecture of the brain, the ways of
responding to the world, and long term
health and mental health.
Social-Emotional Development Outcomes
Cumulative Risk
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The notion of CUMULATIVE RISK asserts
that the greater the number of adverse
child experiences, the greater is the risk for
negative developmental, mental health and
health outcomes.
Policy Voices from the Field
Social-Emotional Development
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Financially support a community
comprehensive system of care* for children
and their families that promotes protective
factors and responds to biological,
psychosocial & environmental risks to child
well-being
--- Strengthening Families, MCHB
Center for the Study of Social Policy
Key System of Care Partner
Early Start Family Resource Centers
47 Centers: Primarily parent driven & parent run
 Parent to parent support
 Many languages / Culturally responsive
 Resource libraries, Information & Referral
 System navigation
 Transition assistance to families
 (2011) Prevention Resource & Referral Services
CEISA: 1998 Amendment
Policy Voices from the Field
Social-Emotional Development
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“Expertise in the identification, assessment and
treatment of young children with mental health
problems should be incorporated into early
intervention programs.”
--- National Scientific Council on the Developing Child
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“Require a professional with expertise in social –
emotional development to sit on the {Part C}
multidisciplinary evaluation team.”
--- National Center for Children in Poverty
Policy Voices from the Field
Social-Emotional Development
 “Establish comprehensive screening protocols for
social-emotional, developmental, autism and
maternal depression as part of well child visits.”
Provide written guidelines to establish common
procedures for screening for all Medi-Cal Managed
Care well-visits. Adopt quality measures to ensure
statewide consistency
---First 5 Association of California
Early Childhood Mental Health Project
Policy Voices from the Field
Social-Emotional Development
 Ensure greater reimbursement for maternal
depression & early childhood mental health
screening.
 Develop a state level policy proposal that requires
statewide collaboration & coordination to increase
utilization of existing reimbursement mechanisms.
--- First 5 Association of California
Early Childhood Mental Health Project
Policy Voices from the Field
Social-Emotional Development
“Promote universal adoption of CA Training
Guidelines and Personnel Competencies for
Infant-Family and Early Childhood Mental
Health by state and local agencies and
institutes of higher education.”
Project
--- First 5 Association of California
Early Childhood Mental Health
Policy Voices from the Field
Social-Emotional Development
 “Promote state-level coordination and
collaboration to develop a statewide system
for training early childhood professionals
from multidisciplinary backgrounds to attain
the Infant-Family and Early Childhood
Mental Health Competencies.”
Project
--- First 5 Association of California
Early Childhood Mental Health
Social-Emotional Development
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Enhancing Part C through Policy
Community supports to strengthen families
Establish screening protocols and funding through
medi-cal as part of primary health care visits
Require infant-family mental health specialist as
member of Part C multidisciplinary team
Develop a statewide system for training early
childhood providers from multidisciplinary back
grounds to attain infant-family mental health
assessment and intervention competencies.
State Identified Measureable Result
Social-Emotional Well-Being
Relationships: Getting Leads to Giving and Resilience!
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