Lynne Katz

THE DEVELOPMENT AND EVALUATION OF THE INTERVENTION MODEL FOR THE FLORIDA INFANT MENTAL HEALTH PILOT PROGRAM

The focus of this paper is on the development and evaluation of an intervention model for Floridas Infant and Young Child Mental Health Pilot Program, designed to identify families with children at risk for abuse and neglect, and to provide clinical evaluation and treatment services. The evaluation model, intervention strategies, and results presented in this paper are all part of the Florida pilot project developed as a response to the recommendations of the states Strategic Plan for Infant Mental Health. Funded by the Florida legislature, the 3-year, multisite pilot was designed to provide earlier identification, better evaluation, and more effective treatment services for high-risk children under the age of three. The target population was children either at risk for out-of-home placement due to abuse and neglect, or those already in the child welfare system or adjudicated dependent by the state. The goals of the pilot project were: 1) to reduce the occurrence and re-occurrence of abuse and neglect; 2) to enhance the childs developmental functioning; 3) to improve the parent-child relationship; 4) to increase expeditious permanency placements; 5) to develop a model for intervention and treatment that could potentially be replicated in different sites; and 6) to document the components of a quality infant mental health intervention model and evaluate its effectiveness.

Effects of Three Levels of Early Intervention Services on Children Prenatally Exposed to Cocaine

Cocaine use during pregnancy is a high-risk indicator for adverse developmental outcomes. Three levels of intervention (center, home, and primary care) were compared in a full service, birth to age 3, early intervention program serving children exposed to cocaine prenatally. Data were collected on 130 children from urban, predominantly poor, primarily minority families. At 36 months, statistically significant, moderate to large intervention effects were found for cognition, receptive and expressive language, and gross motor development. Small effects were observed for behavior problems, and no statistically significant effects were found for fine motor or prosocial skills. Center-based care was most effective for improving language. These findings provide support that the center- and home-based early intervention programs examined in this study had positive effects on children at risk due to prenatal cocaine exposure.

Early Intervention with Children Prenatally Exposed to Cocaine: Expansion with Multiple Cohorts

Prenatal cocaine exposure is an indicator for adverse developmental outcomes. To prevent developmental disabilities, an early intervention program for children birth to 3 years was developed that included three groups: center-based, home-based, and primary care comparison. The intervention was implemented across 10 years and data were collected on 342 children and families who were primarily urban, poor, and members of traditionally underrepresented groups. At 36 months of age, center and home-based intervention participants had more advanced cognitive and language abilities and fewer behavior problems than the primary care group participants. In addition, center-based participants had more advanced language abilities than home-based participants. The findings indicate that the early intervention impact is sustainable over time and has a positive effect on children at risk due to prenatal cocaine exposure.

Legacy for ChildrenTM: a pair of randomized controlled trials of a public health model to improve developmental outcomes among children in poverty

BackgroundOne in five Americans under age 18 lives in a family below the Federal poverty threshold. These more than 15 million children are at increased risk of a wide variety of adverse long-term health and developmental outcomes. The early years of life are critical to short- and long-term health and well-being. The Legacy for ChildrenTM model was developed in response to this need and marries the perspectives of epidemiology and public health to developmental psychology theory in order to better address the needs of children at environmental risk for poor developmental outcomes.Methods/designThe Legacy for ChildrenTM group-based parenting intervention model was evaluated as a pair of randomized controlled trials among low-income families in Miami and Los Angeles. The study was designed to allow for site-stratified analysis in order to evaluate each model implementation separately. Evaluation domains include comprehensive assessments of family, maternal, and child characteristics, process outcomes, and prospective programmatic cost. Data collection began prenatally or at birth and continues into school-age.DiscussionThe societal costs of poor developmental outcomes are substantial. A concerted effort from multiple sectors and disciplines, including public health, is necessary to address these societal concerns. Legacy uses a public health model to engage parents and promote overall child well-being in families in poverty through rigorous evaluation methodologies and evidence-based intervention strategies. This study collects rich and modular information on maternal and child outcomes, process, and cost that will enable a detailed understanding of how Legacy works, how it can be refined and improved, and how it can be translated and disseminated. Taken together, these results will inform public policy and help to address issues of health disparities among at-risk populations.Trial registrationNCT00164697

When the bough breaks the cradle will fall: Promoting the health and wellbeing of infants and toddlers in juvenile court*

Approximately one-third of the children in the child welfare system are under the age of 6. These children are almost invisible in our juvenile courts. Living in emotional and environmental impoverishment and deprivation provides a poor foundation for healthy development. These very young and vulnerable children are exhibiting disproportionate developmental and cognitive delays, medical problems, and emotional disorders. However, there is growing evidence that early planned interventions can help. The juvenile court must take a leadership role in focusing on the very young child and learning more about risk, prevention, and early intervention in order to facilitate the healing process.

A year in words: The dynamics and consequences of language experiences in an intervention classroom

Children from low SES backgrounds hear, on average, fewer words at home than those from high SES backgrounds. This word gap is associated with widening achievement differences in children’s language abilities and school readiness. However relatively little is known about adult and child speech in childcare settings, in which approximately 30% of American children are enrolled. We examined the influence of teacher and peer language input on children’s in-class language use and language development in an intervention classroom for low-SES, high-risk 2- to 3-year-olds. Over the course of a year, day-long recordings of the classroom were collected weekly with LENA recorders. Using LENA software algorithms, we found that language input from peers was positively related to children’s in-class language use, both in-the-moment and over the course of each day, as were the number of conversational turns in which children and teachers engaged Both peer input and conversational turns with teachers were also positively related to children’s language development rates, as indexed by increases in vocabulary size. Together these results indicate the importance of child-specific rates of classroom language input in the language development of high-risk, preschoolers.

The Positive Impact of Early Intervention for Children With Developmental Delays, Gestational Cocaine Exposure, and Co-Occurring Risk Factors

ABSTRACT This article examined transition rates of young children (n = 102) from an early intervention program at the Linda Ray Intervention Program (LRIP) who had documented developmental delays and co-occurring prenatal drug exposure often coupled with verified child maltreatment. Findings indicated that there was significant group improvement from entrance to exit across all six Battelle Domains at the p < .05 level. Also, children who were enrolled for a longer period of time saw significantly better adaptive, personal-social, communication, and Battelle total scale scores at the p < .05 level. Finally, data revealed that boys were 5 times more likely than girls to be transitioned to Part B services after exit from LRIP. A longitudinal study of a subgroup of these children indicated that LRIP children who were in grades K–3 needed fewer special education services in elementary school than they needed at age 36 months, indicating a further reduction in special education needs for these children.

Mitigating the Effects of Poverty and Crime: the Long-Term Effects of an Early Intervention Programme for Children who were Developmentally Delayed and Prenatally Exposed to Cocaine

Abstract This study explores the long-term impact on participation in the Linda Ray Intervention Program (LRIP) for children (n = 54) who were developmentally delayed and prenatally exposed to cocaine. By identifying a group of programme graduates from a high crime/high poverty neighbourhood in Miami-Dade County using ArcGIS 10.2 software, a quasi-experimental design was used to compare children living in this area who participated in the centre-based modality (5 h a day; 5 days a week) to children living in this area who participated in the home-based modality (3 h per week) on their Florida Comprehensive Assessment Test (FCAT) reading and math scale scores in public school. The children who participated in the centre-based modality reported stronger outcomes in both math and reading FCAT scale scores at the p < .05 level and also out-performed their school-age peers on both math and reading FCAT scores at the p < .05 level.

Beyond Part C: Reducing Middle School Special Education for Early Intervention Children with Developmental Delays

ABSTRACT This study examined the rates of special education placement during middle school grades (sixth through eighth) among children who participated in the Linda Ray Intervention Program (LRIP) center-based and home-based learning modalities. The study sample included 113 children in Miami Dade County Public Schools who had gestational cocaine exposure and received early intervention services due to developmental delays. This study found that children who participated in the center-based (25 hours per week) learning modality had a significantly lower rate of special education placement (14%) than the students in the home-based (three hours per week) learning modality (30%) in middle school. Also, results indicated that children who were socioeconomically disadvantaged (free/reduced lunch) and in the home-based learning modality were three to four times more likely to be in special education. This study provides evidence for the long-term impact of the LRIP center-based modality on special education outcomes.