An Opportunity to Improve Developmental Health Outcomes for Children in Foster Care

Young children in foster care often experience developmental health concerns and delays, which builds a foundation for continued adverse outcomes later in life. When families reunite after foster care, parents have a vital opportunity to promote their children’s developmental health and ultimately improve their life-long health outcomes.

“Parents are their children’s earliest teachers and biggest advocates,” says NICHQ Project Director Loraine Swanson, MPH. “Foster care, while necessary, interrupts the biological parent and child relationship; but when families reunite, parents can be given tools to better understand child development, how to identify their children’s needs, and how to better respond to their children with respect and empathy to ultimately become more conscious of and attuned to their needs. We just need to make sure they have tools to take that on—this is where systems-improvement comes into play.”

Swanson leads NICHQ’s work on the Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN), a HRSA MCHB funded initiative seeking to improve early childhood service systems across 12 states. As part of the initiative, the Partnership of Maternal and Child Health of Northern New Jersey (the Partnership)—one of 24 place-based community teams participating on ECCS CoIIN—is partnering with New Jersey’s Department of Child Protection and Permanency (DCP&P) to improve their reunification system by giving families an opportunity to learn about and practice developmental health promotion. Their goal is to engage an early childhood specialist to work with families in reunification and coach them on learning activities that support developmental health.

“I’ve worked with foster and adopted families and children for most of my career, and there’s definitely been a lack of engaging services for families at the reunification stage,” says Stefani Moon, the program manager for the Partnerships’ Early Childhood Program. “It’s a lot of checking boxes—I went to court; I got the crib—but it isn’t often about parents interacting and engaging with their child. We want to help families take an active, involved role in their child’s development, so they feel excited not just that their child is coming home, but also that they’ve learned these skills and tried these activities and are ready to continue to move their child’s development forward.”

New Jersey is in the initial stages of planning and testing strategies for providing developmental promotion support for families living in Passaic County. As their work develops, they hope to spread and scale improvements to counties across the state. Given that more than 50 percent of children in out of home placement will be reunited with their families and thus will go through the reunification process, New Jersey’s lessons learned could have a national impact for children in the child welfare systems across the country.

Keep reading to learn more about New Jersey’s vision for families in reunification.

How the coaching will work

Before parents are reunited with their children, they attend regular, supervised visits. These visits are optimal times for families to learn about the impact the early years have on children’s future health and well-being, and practice developmental promotion activities, such as reading out loud, practicing “tummy time,” and playing age-appropriate puzzle games. New Jersey plans to provide developmental promotion coaching during their scheduled visits, which will empower families to champion their child’s developmental health once they bring their child home.

Rather than set the coaching up as another mandatory box to check, which could feel overwhelming, families will opt-in to working with the early childhood specialist. “We don’t want families to feel forced, because we want them to have a sense of ownership in this,” says Marie Kinsella, the Passaic County Team Lead for ECCS CoIIN. “We hope that when they start learning about this service, they’ll be excited and want to find out how they can help their child reach their developmental milestones.”

To help incite interest among families, the Partnership is developing one-page flyers that illustrate the importance of developmental health promotion. The posters will be shared throughout the community—in Women Infants and Children offices, local food banks, pediatricians’ offices, and at community events. The posters not only share the option for coaching, but also let families know that the Partnership is available to answer questions outside of the scheduled visits. “We want them to know we are always there for them,” says Kinsella.

Supporting continuity and connectivity

Along with encouraging families to practice activities they can do with their child at home, New Jersey also wants to help parents track their child’s developmental progress while they’re still in foster care. During scheduled visits, they plan to give parents the option to fill out developmental passports, which provide information on and track developmental milestones and activities. Those same passports will travel back to the child’s foster family, who can fill them out too.

“With this, parents will be able to see what’s happening when they’re not there,” says Moon. “We hope this continuity will help them feel connected to their children, which will really support healthy relationships once the child is back under their care.”

Why a community partner is important

Families who have lost custody of their child may understandably feel wary of child protective services, especially as they work to fill all the requirements for reunification. Ensuring that a community partner leads the developmental health promotion effort makes it more likely that families will participate and trust the process.

“It’s important that families know this is not another DCP&P program, but it is one more service under the Partnership,” says Kinsella. “We’ve been around for 27 years and have a reputation for promoting healthy birth outcomes and positive parenting in our communities. We’re hoping that this will also melt away some of that mistrust parents might feel, and really just help normalize developmental promotion—it’s just one more service that is available to them.”

How collaboration has accelerated systems-improvement in New Jersey

Every other month, the New Jersey ECCS CoIIN team holds a meeting where they invite key stakeholders to discuss early childhood system improvements. A representative from the DCP&P attended one of the meetings, learned about the early childhood specialist and the CoIIN’s goals, and became a champion for supporting the reunification project.

“Because of these meetings, we were able to connect with a DCP&P partner who then connected us with her entire division,” says Kinsella. “Since then, we’ve met with a number of stakeholders, from supervisors to case managers, and the energy and excitement this has prompted has been infectious. People are just starting to see the true benefits they can receive from being connected.”

Developing a comprehensive early childhood system requires cross-sector collaboration, which makes New Jersey’s successful partnerships an example for other states seeking system-wide improvement. Interested in learning how other ECCS CoIIN teams are building cross-sector collaboration? Read about the success of Chelsea Massachusetts’ early childhood coalition.