EARLY 

HEAD 

START 

NATIONAL R C ESOURCE ENTER

Technical Assistance Paper No. 

9 

Supporting Infants 

and Toddlers 

in the 

Child Welfare System: 

The Hope

of Early Head Start

U.S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth and Families 

Head Start Bureau 
EARLY 

HEAD 

START 

NATIONAL 

RESOURCE 

CENTER
 

4 

Supporting Infants and Toddlers 

in the Child Welfare System: 

The Hope of Early Head Start 

Technical Assistance Paper No. 9 

First Printing: 2005 

U.S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth, and Families 

Head Start Bureau 

Photo Disclaimer:
 

The children and families appearing in the photographs in this document are for publication purposes only and 


are not being portrayed as recipients of child welfare services.
 

Prepared for the Head Start Bureau, under contract # HHSP23320042900YC, by the 

Early Head Start National Resource Center @ ZERO TO THREE. 
Technical Assistance Paper No.
 

9
 Supporting Infants and Toddlers 

in the Child Welfare System: 

1 

The Hope

of Early Head Start


I

nfants and toddlers in the 

child welfare system face 

numerous developmental risks 

and pose a complex challenge 

to the Early Head Start (EHS) programs that have the opportunity to 

nurture and support these vulnerable 

children and families. EHS programs 

are in a position to identify signs of 

potential abuse or neglect and are 

required to report their suspicion to 

authorities [1304.52(k)(3)(i)]. Along 

with this responsibility comes an 

opportunity to partner with vulnerable families in desperate need of 

support and intervention. In addition, as all EHS programs commit to 

serve the children who are most in 

need in their community, staff members 

in these programs, regardless of their 

formal collaboration with their local 

child welfare agencies, should be 

aware of the special needs of children 

in the child welfare system and 

should be prepared to provide support 

and resources to them should it 

become necessary. 

Child welfare is a term used to 

describe social services for children 

and their families, services that 

include foster care, adoption, family 

preservation, and family support. 

Children enter the child welfare system when they are victims of abuse 

or neglect or when they lack parents 

or other legal guardians who can 

provide adequate care. In some cases, 

their involvement is temporary and 

brief. In other cases, children are 

permanently removed from their 

homes. Often, children remain in 

the home while the children and 

families receive support, services, 

and monitoring by Child Welfare 

Services (CWS). Some children 

enter, leave, and reenter the child 

welfare system numerous times. 

Children in the following groups 

experience the kinds of circumstances 

that lead to their involvement in the 

child welfare system: 

Newborn infants whose parents have 

exposed them to drugs or alcohol 

and who lack a suitable or willing 

caretaker—Sometimes, these 

children are removed from their 

mother’s care while she undergoes 

drug treatment; occasionally, these 

children are abandoned at the 

hospital. 

Children whose parents have died, 

been incarcerated, or hospitalized— 

When no suitable caretaker is 

available, these children become 

wards of the state and are put 

either in foster care or in a permanent adoptive home. 
2 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

Children who have been physically, 

sexually, or emotionally abused— 

Examples of abuse fall into three 

categories: (a) beating, shaking, 

hitting, burning, pulling hair, 

breaking bones, or not letting a 

child eat, drink, or use the bathroom; (b) inappropriate touching 

or exposure to sexual materials; 

and (c) abusive and threatening 

language. 

Children who have been neglected— 

Neglect may involve not meeting 

a child’s need for food, clothing, 

shelter, or safety; leaving a young 

child unattended or in an unsafe 

environment; failing to provide 

necessary medical care; or preventing 

a child from attending school. 

According to the latest statistics 

from the Child Welfare League of 

America (Child Welfare League of 

America, 2005), an estimated 

895,569 children were victims of 

abuse and neglect in 2002, and children 

under the age of 3 years had the 

highest rate of maltreatment. Each 

year, about 150,000 children under 

the age of 5 are placed in foster care. 

Among those children, infants make 

up the group that is increasing fastest 

and that is the largest cohort of children in foster care; each year, 39,000 

babies enter foster care each year, 

nearly a third of them directly from 

the hospital. Half of all children who 

were admitted into foster care before 

their first birthday remained in care 

for more than 2 years (ZERO TO 

THREE, 2003). This technical assistance paper will discuss the health, 

developmental, and mental health 

risks to infants and toddlers in the 

child welfare system and how EHS 

can have a positive effect. The second 

half of the paper will highlight some 

of the unique ways that EHS programs 

participating in a demonstration 

project have established formal 

partnerships with their local child 

welfare agencies to better meet the 

needs of the children and families 

who are involved in the child 

welfare system in their communities. 
Risks and 

Vulnerabilities 

of Infants and 

Toddlers in the 

Child Welfare 

System 

Children who are involved in the child welfare system are 

likely to have a number of negative 

life experiences that put them at risk 

for problems related to physical health, 

mental health, and development. In 

this section, we discuss these three 

broad areas in detail and identify 

how EHS has the opportunity to 

buffer some of these challenges. 

HEALTH CARE 

The health of children in the child 

welfare system is notoriously poor. A 

majority of the children have been 

exposed to prenatal risks such as 

exposure to drugs or other toxic 

substances, or they have suffered circumstances at birth (low birth 

weight, prematurity) that result in 

(a) health problems such as neurological or respiratory conditions 

or (b) developmental delays and 

disabilities. 

To complicate matters, children in 

the child welfare system receive 

spotty medical care. They may 

receive medical care from different 

medical providers with each new 

placement, and their medical records 

may not follow them from one 

provider to another. Incomplete or 

delayed immunizations are common. 

Some of the barriers to receiving 

medical care include inadequate 

funding, poor planning and coordination among child welfare agencies 

and health-care providers, and lack 

of access to community health 

providers who will accept Medicaid 

or state funded health insurance. 

To combat these issues, the American Academy of Pediatrics formed a 

Committee on Early Childhood 

Adoption and Dependent Care and 

issued guidelines for health care to 

young children in foster care (American Academy of Pediatrics, 2002). 

These guidelines include the 

following recommendations: 







All children entering foster care 

should receive an initial physical 

exam before or soon after placement in foster care to identify any 

immediate or urgent medical 

needs. 

All children in foster care should 

have a comprehensive physical as 

well as a mental health and developmental evaluation within 1 

month of placement, which should 

be done by a pediatrician who is 

willing to provide the child’s 

ongoing primary health services. 

The results and recommendations 

of all health assessments should be 

included in the individual courtapproved social service case plans. 

TECHNICAL ASSISTANCE PAPER NO .9 

The physical, developmental, and 

mental health status of children in 

foster care should be monitored 

more frequently than that of children living in stable homes. 

DEVELOPMENTAL DELAY 

Over half of the children in the 

child welfare system have developmental delays or disabilities. Because 

of this high probability for 

developmental concerns, the American Academy of Pediatrics and the 

Child Welfare League of America 

recommend that every child in foster 

care receive a formal, comprehensive 

developmental evaluation within 1 

month of his or her placement. The 

federal early intervention program 

for infants and toddlers with disabilities, known as Part C of the 

3 
4 

E ARLY HEAD START NATIONAL RESOURCE CENTER 

Individuals with Disabilities Education 

Act, entitles children to a multidisciplinary evaluation and, if they 

meet eligibility criteria, to an 

Individualized Family Service Plan 

detailing family needs, resources, 

and goals. 

Each state determines its own criteria 

for Part C program eligibility. Infants 

and toddlers who have either a 

developmental delay or a condition 

that has a high probability of resulting 

in a developmental delay (e.g., 

cerebral palsy, fetal alcohol syndrome, 

failure to thrive, or severe attachment 

disorders) are entitled to early 

intervention services. In some states, 

children can also qualify for services 

without meeting other criteria if the 

“informed clinical opinions” of qualified professionals determine that the 

child is at risk for developmental delay. 

A majority of children in the child 

welfare system meet these eligibility 

requirements. The services that may 

be available include occupational, 

physical, or speech therapy; special 

instruction; mental health treatment; 

hearing and vision screening and 

treatment; assistive devices; and 

transportation to early intervention 

services. The early intervention 

program is required to provide service 

coordination to ensure that families 

(including foster families and other 

legal guardians) are informed of their 

rights and to help them navigate the 

system and meet their needs. All 

services must be provided in the 

child’s natural environment, which 

may be the home, child care, or 

whatever setting is appropriate for 

that child and family. 

MENTAL HEALTH 

In addition to the health and developmental concerns listed above, 

children in the child welfare system 

are faced with a host of mental 

health challenges. The circumstances— 

abuse or neglect—that lead to their 

involvement with CWS are likely to 

leave emotional scars. The experience of being separated from their 

parents, even if for their own 

safety, is likely to cause emotional 

distress. And the child’s current 

circumstances, such as his or her 

relationships with foster parents or 

visitation with family members, 

bring additional challenges. 

The primary mental health need 

during infancy is to have at least one 

adult who provides unconditional 

love and who is devoted to the child’s 

care and well-being. An infant 

develops attachment to significant 

caretakers over time as that care 

provider (or providers) consistently 

meets his or her physical and 

emotional needs. Healthy attachment 

during infancy is understood to be a 

precursor for healthy relationships 

throughout life. In circumstances 

where these important attachments 

are disrupted, children can experience an inability to relate to others, 
TECHNICAL ASSISTANCE PAPER NO .9 

deficits in language and other 

cognitive skills, and serious emotional disturbances. Some of the red flags 

for emotional health problems 

during infancy include excessive 

fussiness; chronic eating or sleeping 

problems; an inability to be consoled; 

and “failure to thrive,” the 

unexplained lack of growth or 

weight gain. 

One of the first developmental 

tasks of infancy is self-regulation. 

Self-regulation involves the ability 

to take in sensory information, 

attend to people and things in the 

environment, and ultimately, to 

control emotions and behavior. Selfregulation begins to develop in early 

infancy through sensitive and 

responsive caregiving during daily 

routines. For example, parents help 

their infant regulate emotions, or 

states of arousal, as they tend to the 

baby’s need for food, sleep, activity, 

or physical comfort. The caregiver’s 

appropriate response to an infant’s 

need brings the baby to a calm, quiet 

state when the child is most open for 

social interaction and exploration. 

Familiar adults who learn how to 

"read" a baby’s unique cues are better 

able to support the child’s self-regulation; they are also forming the 

bonds that children need to develop 

loving and trusting relationships. 

Perhaps, then, the biggest threat 

to emotional health for very young 

children in the child welfare system 

is disrupted relationships. Infants are 

developing their basic trust or mistrust of the world around them in 

the first months of life. Will I be fed 

when I am hungry? Does someone 

come when I cry? Am I held, tended 

to, and loved? Am I handled roughly, 

left alone to cry, or frequently 

hungry and unfed? Unfortunately, 

children who have been abused or 

neglected have too often experienced a lack of nurturing and 

responsive care and may not have 

access to healthy, available caregivers 

with whom to develop the bonds 

that are necessary for healthy 

attachment. Foster care is often 

characterized by multiple changes in 

caregivers. Although foster parents 

may be responsive and nurturing, 

these constant changes are harmful 

to children at any age and can be 

particularly problematic in the first 3 

years of life. 

5 
E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

6 

EHS Services for 

Children 

Involved With 

Child Welfare 

A comprehensive child development and family support program 

such as EHS can play a pivotal role 

in the lives of children and families 

in the child welfare system. In addition to providing or linking families 

with needed services—medical, 

mental health, nutrition, and education—EHS can provide a place for 

children to experience consistent, 

nurturing relationships and stable, 

ongoing routines. This stability and 

consistency may buffer some of the 

upheaval in other areas of the 

children’s lives. EHS can also be a 

safe, neutral place where people 

involved in a child’s custody can 

meet for visitation, training, or 

observation. EHS staff members 

need training on the prevalent issues 

facing these children, and program 

policies and practices should reflect 

this knowledge. 

Transportation as a Barrier 

to Receiving Services 

The issue of accessible and reliable transportation is an issue for many low-income families, but it seems to be an even greater barrier 

to services for children in the child welfare system. Specific issues to 

consider include the following: 

Children involved with the child welfare system are often involved 

in a number of intervention services and have an increased number of 

appointments outside the home. 

Foster families typically have additional children in the house, and 

it is burdensome to bring them all along for an appointment. 

Children with attachment issues may have particular difficulty if 

they must go with yet another unfamiliar adult to an appointment. 

Children may be placed in foster care outside of their home area, 

and the travel distance to access services is increased. 

Families involved in the child welfare system often lack social 

support and cannot rely on family members or friends to help with 

transportation. 

The funding for transportation services is unstable. 

There are no easy answers to removing these barriers. Some EHS 

programs have been successful in developing community partnerships 

with groups such as faith-based organizations that can provide 

transportation resources. Other programs have provided gas vouchers 

or bus tokens, accessed Medicaid to pay for transportation to medical 

appointments, or partnered with local auto repair shops to help families 

find reliable used cars. 
TECHNICAL ASSISTANCE PAPER NO .9 

EHS programs are required by the 

Head Start Program Performance 

Standards to provide many of the 

services that address the risks and 

concerns with respect to children in 

the child welfare system, including 

the following: 

Finding a medical home— 

Grantees are required to ensure 

that each child has a continuous 

source of accessible, coordinated 

health care [1304.20(a)(1)(i)]. 

Programs can address barriers such 

as lack of transportation, locating 

providers, financial resources, or 

language issues. 

Ensuring that well-child care, 

including immunizations and dental care, are up to date—Grantees 

are expected to collaborate with 

parents or other legal guardians to 

make arrangements for any necessary examinations and immunizations [1304.20(a)(1)(ii)(A)]. 

Conducting health and developmental screenings—Within 45 

days of entry into the program, 

grantees must screen children to 

identify concerns with respect to a 

child’s developmental, visual, 

auditory, behavioral, motor, language, social, cognitive, perceptual, and emotional skills 

[1304.20(b)(1)]. 

Tracking and record 

keeping—Procedures must 

be in place to ensure that 

appointments are kept and 

services are provided in a 

timely and quality manner 

[1304.20(a)(1)(ii)(C)]. 

Identifying nutritional 

needs and providing 

healthy meals and 

snacks—Grantees are 

responsible for assessing 

children’s nutritional status 

and working with parents 

to address concerns 

[1304.23(a)]. 

Grantees must also design 

and implement a nutrition 

program that meets the 

nutritional and feeding 

requirements of each child 

[1304.23(b)(1)]. 

Providing an environment that is safe, clean, 

and inviting as well as one 

that promotes learning— 

The physical environment, including toys, equipment, materials, and 

furniture, have a direct effect on 

the development of children’s 

cognitive, social, emotional, and 

physical skills. EHS grantees are 

expected to provide a variety of 

toys and materials that promote 

active exploration and learning as 

well as emotional comfort and 

safety [1304.53(b)(I-vii)]. 

Providing relationships that are 

consistent and secure—EHS 

programs help infants and toddlers 

develop secure relationships by 

limiting the number of caregivers 

and the group size in center-based 

settings to one teacher for a group 

of four children [1304.52(g)(4)]. 

Staff members are expected to 

support the social and emotional 

development of infants and toddlers in an approach to education 

that is individualized for each 

child [1304.20(f)] and that includes 

a focus on self-awareness, autonomy, 

self-expression, and communication [1304.21(b)(2)(i-ii)]. 
8 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

Providing parenting education 

and other family support services—Head Start programs are 

required to partner with families 

to help them meet their goals and 

nurture the development of their 

children. Parents or other legal 

guardians are invited to be 

involved in all aspects of the 

program [1304.40]. 

Collaborating and coordinating 

with community agencies— 

Grantees must build on and support 

the goals of preexisting family 

plans such as those stipulated by 

child welfare agencies or through 

Part C early intervention programs. 

Grantees develop strategies with 

other community agencies to share 

information and ensure that the 

responsibility for delivering services 

to the family is properly shared 

[1304.40(a)(3)]. 

EHS programs can have a dramatic 

effect on the lives of children in the 

child welfare system if services are 

coordinated, timely, and responsive 

to individual child and family needs. 

Paramount for these children is the 

need for relationships that are warm, 

trusting, and available over time. All 

children who are involved in the 

child welfare system have experienced trauma and loss; thus, their 

needs are intensified, especially the 

need for love and security, the need 

for predictable routines, and the 

need to know that their needs will 

be met—that they will be fed when 

hungry, held when scared, and 

allowed to sleep when tired. 

Many children in the child welfare 

system have experienced multiple 

losses, thus further increasing their 

vulnerability as well as their risk for 

attachment disorders and other 

social and emotional problems. 

Compounding this issue is an often 

seen “cyclical effect” wherein the 

parents of children in the child 

welfare system have also been 

involved with CWS in their own 

childhoods. In many cases, these 

parents have also suffered trauma 

and multiple losses that have affected 

their ability to develop healthy 

relationships with staff members, 

peers, their families, and their children. 

EHS offers children and parents 

the opportunity to develop meaningful relationships with their EHS 

teachers or home visitors, and care 

should be taken to minimize further 

loss with unnecessary changes in the 

program. For example, consider 

policies such as primary caregiving 

and continuity of care. Primary 

caregiving is a term that refers to the 

practice of assigning one teacher to 

be primarily responsible for the care 

of a child during the course of the 

child’s enrollment in the program. 

This person would be the key contact 

for the family and would be the person 

who provides most of the child’s 

direct care during the day. Continuity 

of care is the practice of keeping 

young children in the same group 
TECHNICAL ASSISTANCE PAPER NO .9 

with the same caregiver for as long 

as possible. This practice honors the 

relationships in the lives of very 

young children and recognizes the 

negative consequences of repeatedly 

moving children from one group to 

another as they age. In work with 

parents, staff members should also be 

sensitive to issues such as building 

trust, looking for strengths, and 

being consistent. 

A potential challenge for staff 

members is how to develop supportive relationships with both foster 

parents and biological parents. Staff 

members may see the foster parents 

on a daily basis and have little to no 

contact with biological parents. Staff 

members may also have strong feelings 

about the circumstances that led to 

the foster care placement, and those 

feelings can be a barrier to supporting 

the biological parents. Training and 

supervision provide opportunities to 

help staff members overcome these 

obstacles, dispel stereotypes, and 

recognize their critical importance 

in the long-term goal of family 

reunification. 

PROGRAM VOICES 

Teachers in the center-based program keep journals of the 

children’s activities and achievements to share with parents 

as children make the transition back to living with their 

biological families. Staff members also make regularly 

scheduled phone calls and intermittent home visits to help 

facilitate the transition. 

San Diego, CA 
10 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

Suspecting and 

Reporting Child 

Abuse and 

Neglect 

One of the most difficult and sensitive issues confronting 

professionals who work with children and families is the suspicion of 

child abuse or neglect. Staff members 

may have fears or concerns that they 

are mistaken about the signs of abuse 

or neglect, or they may have 

concerns that parents will be come 

angry with the staff member or 

program or that parents will perhaps 

further injure the child. 

Every program needs a crisis 

protocol to help staff members know 

when to report suspected child abuse 

and neglect. The crisis protocol 

should include the following: 

Designated people to consult with 

and procedures to follow— 

The decision to report should
 

never be made alone. 


Documentation procedures— 

Documentation is critically important and should include a record 

of observations and interactions. 

Reporting procedures— 

Protocols should be established to 

decide (a) whether and when 

parents should be involved in the 

reporting process and (b) who 

should be involved in the reporting. 

Follow-up—Procedures should be 

identified for following up with 

the reporting agency to learn the 

outcome of the report. 

Confidentiality procedures— 

Protocols about protecting family 

privacy should detail the kind of 

records to keep, for how long, and 

who has access to the information. 

If a child is removed from the care 

of his or her parents, the child benefits greatly if the EHS program can 

arrange with the CWS agency to 

keep the child in the EHS program 

to promote continuity and consistency. 

Programs need to consider how to 

ensure the child’s and the staff’s safety, 

how to support parents who have 

had their child removed, and how to 

work effectively with the 

foster family. Strong collaborative 

relationships with CWS are essential. 

When a report leads to an open 

case in which the child and family is 

involved with CWS but the child is 

able to remain in the home, it is 

equally beneficial for EHS programs 

to work collaboratively with the 

CWS agency. Often, the family’s 

involvement in EHS provides additional services that the child welfare 

agency may not be able to provide. 

And the relationships that have 

been established in the EHS program 

provide a foundation to strengthen 

family partnerships during a time of 

crisis and high level of need. 

Staff members should know that 

laws are in place to protect those 

who report in good faith, and 

although it is true that parents may 

become very angry or leave the 

program, it is also true that some 

parents may be desperate for help 

and be relieved that someone has 

noticed and taken action. 

Program leaders have the responsibility for ensuring that staff members 

have an appropriate outlet for the 

intense feelings they will likely 

experience after making a report of 

suspected abuse or neglect. Staff 

members may need extra emotional 

or practical support to continue to 

function well on the job. Program 

leaders set the tone for how this type 

of support is provided. Practices such 

as reflective supervision recognize 

and honor the importance of relationships in all aspects of the work. 

PROGRAM VOICES 

We found that if the CWS worker 

accompanies the EHS home visitor on 

the first visit with the family, it helps 

the family realize how EHS can help 

meet the requirements of their CWS 

case plan and that increases their 

motivation to participate in EHS. 

Marion, IN 
11 

TECHNICAL ASSISTANCE PAPER NO .9 

Partnering With 

the Child 

Welfare Services 

System 

EHS and CWS are two large systems, and each has its own 

history, philosophy, training, goals, 

and regulations. EHS programs can 

be successful providing services to 

children in the child welfare system 

only to the extent that they are able 

to work effectively with that system. 

Individuals working in each system 

need to understand the other and 

recognize the strengths that each can 

bring to working collaboratively for 

healthy child and family outcomes. 

Strategies for collaborating include 

the following: 

Planning and offering joint 

training sessions to learn more 

about each system and the specific 

roles of various staff members 

Inviting child welfare workers to 

EHS workshops on child development and other relevant topics 

Offering space for child welfare 

workers to meet or conduct trainings 

Inviting child welfare workers 

with children enrolled in EHS to 

use EHS facilities for parent–child 

visitation or other family meetings 

Establishing formal memoranda 

of understanding to coordinate 

referrals and other services 

Gaining familiarity with referral 

procedures 

Providing service coordination, 

when needed, and ensuring that 

staff members from each entity 

jointly participate in meetings 

about individual children 

Establishing communication systems with confidentiality guidelines 

to enhance information sharing 

Joining community groups or 

boards related to child welfare issues 

Forming relationships between 

the two agencies at both the management and direct service levels 

to ensure support for collaboration 

among agency leaders and to 

enable those working directly with 

the children and families to have 

working relationships 

PROGRAM VOICES 

Our partnership with CWS has led to benefits for both systems. For EHS, we have more referrals, a greater awareness 

of our program, and better access to CWS as a resource. 

The benefits for the child welfare agency include access to the 

resources EHS has to offer, the continuity that EHS brings, 

and more services they can offer families. 

Sedalia, MO 
E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

12 

Supporting Staff 

Members 

The maltreatment of a child, especially one so innocent and 

helpless as an infant, evokes strong 

emotional reactions from staff members. Some common reactions might 

include denial (“No one could do 

that on purpose.”), anger (“If I ever 

see who did that to this baby, I’ll 

...”), and depression and despair 

(“This world is a terrible place. How 

could this happen to a child?”). 

Teachers may have a strong desire to 

"rescue" the child, wanting to take 

him or her into their own home. 

Staff members may also feel frustration and anger toward “the system” if 

professionals appear to be not acting 

in the best interest of the child or 

when policies are counterproductive, 

for example, when barriers prevent 

information sharing that could benefit the child. 

Supportive, or reflective, supervision 

provides staff members an opportunity 

to express and understand these 

normal reactions and work through 

them with a trusted supervisor in 

ways that enable them to continue 

working effectively with children 

and families. Reflective supervision 

occurs on a regular basis and 

involves a collaborative relationship 

between staff member and supervisor 

PROGRAM VOICES 

Our EHS program has a strong mental health component. The 

infant mental health specialist meets with EHS and CWS staff on a 

monthly basis to discuss the needs and progress of each family, and is 

available for phone consultation at any time. He is seen as a neutral 

person, so both EHS and CWS staff can bring up issues and can 

problem solve without feeling threatened. 

Lake County, OH 
TECHNICAL ASSISTANCE PAPER NO .9 

to reflect on their work. Ideally, staff 

members have a regular, scheduled 

opportunity to speak candidly with 

their supervisor about their work, to 

develop self-awareness, and to get the 

support they need to do their job well. 

The relationships that staff members 

build with children and families can, 

and do, make a tremendous difference. 

Staff members may not be aware of 

the power of their words, for example, 

how an offhand comment to a 

parent who is dropping off his or her 

child at the center in the morning 

can stay with that parent throughout 

the day. Similarly, helping a harried 

parent disengage from a clinging 

toddler with compassion, empathy, 

and respect helps the parent feel 

cared for and supported rather than 

judged as doing a poor job. These 

positive feelings can, in turn, help 

parents have more compassion and 

empathy for their child’s struggle. 

Even brief encounters with parents 

provide opportunities for listening, 

sharing information, providing 

resources, and showing respect and 

concern for families and can combat 

the risk factors for troubled 

parent–child relationships such as 

isolation, lack of support, lack of 

information related to infant development and behavior, and limited 

strategies for positive discipline. 

Perhaps nothing is as divisive and 

alienating as the mistreatment of a 

child, yet these instances are when 

children most need the adults in 

their lives to coalesce and strengthen 

the fragile bonds that will make 

healing possible—whether these 

bonds connect their troubled parents 

or connect children to others who 

have been entrusted with their care. 

The complex web of relationships 

that a child in the child welfare 

system encounters—foster parents, 

social workers, child protective 

services workers, and other legal 

representatives 1 as well as the existing relationships with biological 

parents, extended family, and childcare providers—offers the potential 

either to unravel and divide or to 

hold that child firmly in the center 

of a strong, collaborative system of 

support and care. The section that 

follows describes the efforts of three 

EHS programs and their partnerships 

with local CWS agencies to 

strengthen the support made available to vulnerable children in their 

communities. 

PROGRAM VOICES 

13 

EHS staff members play a 

critical role. And what 

they do is such a gift to 

children and families. The 

staff who are enthused and 

passionate about what they 

do make such a difference 

for these families. 

Tulsa, OK 

1 Children in the child welfare system may be assigned a guardian ad litem, which is a legal representative appointed by the court to advocate for and protect the best interests of the child. 
14 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

The Early Head 

Start–Child 

Welfare Services 

Initiative 

I

n October 2002, the Head Start 

Bureau initiated a demonstration 

project to award grants to 24 EHS 

programs to promote and increase 

the collaborative partnerships 

between EHS programs and their 

local CWS agencies. See Appendix 

A for a list of participating programs. 

Each EHS grantee, in collaboration with its local CWS agency, 

developed a program to meet the 

needs of children and families who 

are within the child welfare system 

in their community. Local and 

cross-site evaluation are part of the 

project. Each of the EHS–CWS 

grantees is expected to conduct its 

own local evaluation and is being 

provided with evaluation training 

and technical assistance, as necessary, 

through James Bell Associates, the 

evaluation contractor (see Local 

Evaluations of Child Welfare Services 

Projects section in this paper). 

Each program is unique and varied 

in their goals and services. The projects 

include, for example, services to 

pregnant women in the child welfare 

system; children who are at-risk for 

abuse or neglect; children whose 

parents have developmental delays; 

families whose children live with 

them but who are receiving services 

from a child welfare protection 

agency because of neglect, abuse, or 

both; and children whose parents are 

in substance abuse treatment. The 

following sections describe several 

examples of participating EHS programs and their CWS partnerships. 

After each program description is 

short vignette of an actual child and 

family who have benefited from the 

program. 2 

FAMILY SERVICES OF GRANT 

COUNTY, MOSES LAKE, WA 

This program is designed to help 

children in foster care by focusing on 

family reunification. Biological parents 

spend 3 days a week in a center-based 

program learning parenting skills, 

and they participate in monthly 

home visits with their child. Families 

have access to mental health services 

and other community resources. 

Program Description 

Family Services of Grant County was 

formed in 1983 by a grass roots citizen’s 

group to assist teen parents to 

nurture their children and remain in 

high school. Since that time, the 

agency has continued to meet community needs by expanding existing 

programs and developing new services. 

The agency became the grantee for 

the Family Planning program in 

1993 and Head Start in 1996; in 

1998, the agency began delivering 

EHS. Today, the program serves 169 

Head Start children and 56 EHS 

children in five rural communities. 

Moses Lake, the largest community, 

has a population of approximately 

16,000. The remaining communities, 
TECHNICAL ASSISTANCE PAPER NO .9 

including Quincy, Soap Lake, Ephrata, 

and Grand Coulee, all have 

populations of fewer than 7,000. 

Grant County has a significant 

number of issues that place children 

at risk of child abuse, neglect, and 

subsequent placement into foster care: 

1. The birth rate in Grant County 

is high. At the time of writing the 

grant for the EHS-CWS initiative, 

Grant County’s birth rate was 95.2 

per 1,000 as compared with Washington State’s birth rate of 62.7 

per 1,000. Also, the number of 

births to mothers ages 10 to 17 

years was more than double the 

state rate. Abortion and adoption 

rates are comparatively low, and 

proportionally more young mothers 

raise their babies. 

2. Poverty in Grant County is 

high; 18.7% of all children in 

Grant County live in poverty. 

Over 30% of working families 

with children in Grant County 

qualify as low-income. Agriculture 

provides the largest source of 

employment in the county and 

draws to the area a significant 

number of undocumented laborers 

who do not qualify for needed 

services. 

3. Domestic violence arrests have 

steadily increased over the past 

decade. In 1998, the state rate was 

7.29 per 1,000, and Grant County’s 

rate was 11.86 per 1,000. 

4. Alcohol- and drug-related 

arrests for children ages 10–14 in 

Grant County are more than twice 

the state rate. 

5. Violent crime arrests among the 

same age group are also twice the 

state rate. 

In addition to the bleak economic 

picture and high birth rate, rural 

central Washington has extremely 

limited resources for families in crisis. 

With Grant County’s high birth rate, 

poverty rate, and violent crime rate, 

more and more children are at risk 

each year, and no intervention services 

have previously been available. 

In response to this situation, Family 

Services of Grant County and the 

local CWS program came together 

to develop the PACT (Parents and 

Children Together) collaboration 

project. This EHS–CWS collaboration 

is a partnership between Head Start’s 

Pregnancy to Three program and 

Washington State’s Child and Family 

Services (CFS) to provide specialized 

services for children in foster care. 

The project is able to serve eight 

children, their parents, and their 

foster parents in the Moses Lake 

area. Qualifying children and 

families are referred to the project 

through CFS. 

2 The names and indentifying information of all parties have been changed to protect confidentiality. 

15 
E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

PACT’s goal is to support the 

reunification of children with their 

biological families. The project staff 

members create a positive, secure, 

and educationally rich environment 

for children to meet their needs for 

nurturing, physical care, and learning. 

In this secure environment, staff 

members extend a partnership to the 

children’s parents to increase their 

knowledge and skill in parenting. 

The project assists parents to 

improve their ability to understand 

their child’s verbal and nonverbal 

cues and effectively meet their 

child’s needs. To accomplish PACT’s 

goal, Family Services PACT employees build relationships with the 

children’s biological parents, foster 

parents, social workers, and child-care 

providers. The PACT class is structured to welcome biological parents, 

foster parents, and other providers at 

any time. In their efforts to ensure 

consistent care for each child, staff 

members also meet with or routinely 

contact these important people in 

the child’s life. PACT offers a 

16 

neutral place for those who love and 

care for the child to work together in 

the child’s best interests. 

The children participating in 

PACT meet 3 days per week— 

Tuesday, Wednesday, and Thursday— 

for 7 hours each day. Transportation 

and meals are offered to parents who 

desire to take part in the class. Parents 

are informed at the outset that 

regular written reports are made to 

CWS describing the quality of their 

participation and observations of 

their interaction with their child. 

Each parent has the opportunity to 

read these reports and provide input 

before the reports are sent to CWS. 

This initial intervention enables the 

parent to grasp a crucial concept— 

that PACT is a place to develop and 

demonstrate their skills. This intervention is the parent’s opportunity 

to demonstrate that he or she wants 

to, and has the ability to, parent his 

or her child. At first, parents are 

sometimes angry because they do not 

have their children, and they blame 

PACT. But, eventually, they come to 

understand that PACT offers them 

not only daily opportunities to see 

their child but also a way to 

demonstrate to the state that they 

can improve the way they care 

for their child. 
17 

PACT in Action 

Kaylee was 5 months old when she 

was referred to the PACT program 

in the summer of 2003. She displayed signs of developmental delay 

and some physical characteristics 

consistent with fetal alcohol syndrome (FAS). Her physician had 

scheduled a variety of diagnostic 

tests to discover more about the 

delay and the abnormalities of her 

appearance. Child and Family Services had, at her birth, removed 

Kaylee from the care of her parents, 

Will and Stacey, and had placed 

Kaylee in foster care because of 

concerns with respect to parenting 

skills and the lack of a safe and stable 

home environment. Stacey also had 

a developmental delay caused by in 

utero exposure to drugs and alcohol. 

In addition, Stacey had a history of 

abuse and neglect in childhood and 

was herself a recipient of CWS as a 

child. Kaylee’s father had a history of 

alcohol abuse as well as numerous 

undiagnosed and untreated health 

complaints. Neither parent was 

employed, and they had no 

transportation because Will’s license 

to drive had been suspended. 
18 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

Kaylee’s parents were very cooperative with their social worker and 

with PACT staff members on 

enrollment. They verbalized and 

demonstrated their willingness do 

whatever they could to be able to 

have their child returned home. 

PACT’s individual support to the 

parents taught them how to observe 

Kaylee’s cues and offer appropriate 

caregiving responses. Daily parent 

training provided information on 

safety, appropriate nutrition, child 

development, parenting, and other 

relevant topics. In addition, PACT’s 

daily observations and weekly reports 

to CWS provided regular feedback 

that helped Will and Stacey improve 

their skills. 

Stacey attended regularly, but Will 

had occasional difficulty participating 

because of his health problems. He 

was motivated to attend, in spite of 

the challenging PACT schedule (3 

days a week for 7 hours each day), by 

the opportunity to spend time with 

his daughter. The chest pains and 

stomach problems that Will regularly 

experienced made participation more 

difficult; for example, when the 

group would go for a walk, he would 

often ask to be excused. It was 

obvious to the staff members that 

Will was suffering from some physical 

problem, so the staff members and 

the social worker worked with CFS 

to obtain a medical assessment. The 

doctor recommended that further 

diagnostic evaluation be done and 

provided medication to manage 

some of Will’s symptoms. 

Stacey’s developmental delay 

caused difficulty for her with information processing. For example, if 

she was focused on a conversation 

happening within the group, she 

would not be able to notice and 

acknowledge Kaylee’s cues. She also 

required very specific teaching about 

safety and appropriate routine care 

for Kaylee. Furthermore, once she 

learned best practice guidelines, she 

had difficulty in being flexible as 

Kaylee grew and developed more 

independent and challenging behavior. Staff members accommodated 
TECHNICAL ASSISTANCE PAPER NO .9 

these needs by individualizing their 

instruction and support for Stacey. 

Will and Stacey were elected as 

Policy Council Representative and 

Alternate, respectively. In addition, 

they were very active as leaders on 

the Parent Center Committee. Last 

September, Family Services invited 

them to participate in a mental 

health conference panel to share 

with other programs how PACT has 

had an effect on their lives. Stacey 

described, “In spite of my disability I 

can feed her, I can change her, and I 

can give her a bath.” Will described 

how he gets down on the floor with 

their daughter, in spite of his health 

problems, and how he sings silly 

songs and reads to her. “I read her 

cues, and she reads mine,” Will said 

of his baby girl. “I don’t think that 

would have happened without 

PACT.” These successes and opportunities for leadership roles helped 

to encourage the parents, even in 

the face of setbacks and challenges. 

Several days before the mental 

health conference, Stacey and Will 

were informed that the plan for 

unsupervised visitation was being 

eliminated because it was reported 

that Stacey had been seen purchasing 

alcohol. In addition, Will suddenly 

had criminal activity show up on his 

background check. In spite of these 

unforeseen problems, Will and 

Stacey, although disheartened, 

continued to make efforts to prove 

themselves as parents. Both continued 

their participation in PACT and 

displayed their commitment to 

their child. 

Later, it was established that the 

criminal activity was a result of 

identity theft and that alcohol use 

was never substantiated. Eventually, 

unsupervised visitation was again 

planned and, then, reunification. 

After Kaylee’s return home, Will 

began complaining less about his 

19 
20 

E ARLY HEAD START NATIONAL RESOURCE CENTER 

physical symptoms, and his affect 

was brighter. He became highly 

motivated to regain his driver’s 

license and find work. Although he 

had to pay a substantial fine and 

suffer some rejections for employment, 

eventually he regained his license 

and was able to obtain work as a 

cabulance driver for individuals 

who need medical care. He later 

commented that perhaps some 

depression had been exacerbating 

his symptoms. 

Through this program, Will and 

Stacey were able to prove to the 

state, and ultimately to the courts, 

that they were capable of parenting. 

Will and Stacy believe they and 

their daughter have benefited from 

PACT. To be better parents, both 

Will and Stacey overcame the 

challenges that their disabilities presented. Will is the custodial parent 

and must be available to supervise 

Kaylee; when he is working, Kaylee 

goes to daycare. CWS staff members 

have expressed that they believe 

these parents would not have been 

able to be reunified with their child 

if it had not been for PACT. 

Although Kaylee qualified for special 

services because of a motor delay, it 

was eventually established that 

Kaylee’s delays were not a result of 

drug or alcohol effects. 

In its work with families, Family 

Services of Grant County has 

learned to define its program as a 

“proving ground,” while still maintaining a family support and 

strengths-based perspective. Several 

keys to this organization’s successes 

include intensive center-based 

services with an integrated mental 

health component; strong relationships 

with parents, foster parents, and 

social workers; and firm, clear 

boundaries. Parents are aware that 

the PACT program offers them an 

opportunity to prove themselves by 

showing their capability and by 

improving their parenting skills and 

their responsiveness to their child. 

CROSSROADS: LAKE COUNTY 

ADOLESCENT COUNSELING 

SERVICE, MENTOR, OH 

An infant mental health perspective 

is infused throughout the Crossroads 

program. Home visits focus on helping parents read their child’s cues 

and respond to their needs. 

Program Description 

Crossroads is a private, nonprofit 

corporation in Lake County, Ohio, 

which provides a comprehensive 

continuum of mental health and 

chemical dependency services exclusively for children, adolescents, and 

their families. Crossroads Early Head 

Start (CEHS) program was developed 
TECHNICAL ASSISTANCE PAPER NO .9 

in 1998–1999 and is in its sixth year 

of program operation. The CEHS 

program is founded in a relationshipbased infant mental health model of 

service, recognizing two important 

concepts: (a) everything that occurs 

for the child happens in the context 

of relationships and (b) the “parallel 

process” that occurs in the relationships between the parent and infant, 

between the child-care provider or 

other caregiver and infant, between 

the parent and child-care provider or 

other caregiver, between the home 

visitor and parent or other caregiver, 

and between the home visitor and 

supervisor hold special significance. 

In January, 2003, CEHS and Lake 

County Department of Job and 

Family Services (LCDJFS) initiated 

a joint planning and training process 

to prepare for the CWS initiative. 

Staff members from LCDJFS met 

with CEHS staff members to orient 

them to the child welfare system, the 

variety of programs at LCDJFS, and 

the processes and procedures involving families in the child welfare 

system. Both programs participated 

in an orientation to CEHS and in a 

joint training with respect to infant 

mental health. The Crossroads infant 

mental health specialist provided the 

training for staff members from both 

agencies to ensure that both agencies 

would be equal partners in all aspects 

of the project. Involving an infant 

mental health expert was critical to 

promote an effective 

partnership between the agencies, 

provide reflective supervision with 

the service providers, and promote 

community training and development 

in the area of infant mental health. 

We began providing services to 

families in March 2003. 

CEHS–CWS is funded to serve 10 

children who are involved in the 

child welfare system in either foster 

care or protective supervision. 

Parent participation is voluntary. 

Parents are usually court ordered to 

participate in a parenting program 

but are not obligated to attend any 

specific program. Since the inception 

of the program, a total of 23 children 

have received services and all 

openings have been filled consistently. 

Families receive one or more home 

or supervised visits per week that last 

from 1 to 2.5 hours per visit. The 

number of visits is flexible to meet 

the changing needs of the family. 

Visits with parents have taken 

21 
22 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

place in the home, at a relative’s 

home, during supervised visitation at 

LCDJFS, in the county jail, at a neutral site in the community such as a 

restaurant, at the daycare center, at 

the site of the Early Intervention 

service provider, and during supervised visitation at CEHS. 

Maintaining a flexible approach to 

providing service is an important 

contributing factor to the success of 

the project because it enables project 

staff members to meet changing 

needs of the family and the case 

plan. Strong emphasis is placed on 

supporting the development of relationships between the children and 

their biological parents and other 

caregivers as well as on providing 

continuity for the child among all 

caregivers. Services are provided to 

biological parents, other relative 

caregivers, foster parents, and daycare 

providers as the project provides the 

comprehensive services of the EHS 

program and supports continuity of 

caregiving for the child. An initial 

infant mental health assessment 

includes an Indicators of Attachment screening, a Temperament 

Assessment, and administration of 

the Functional Emotional Assessment 

Scale for children 7 months–3 years. 

In addition to weekly home or 

supervised visits for the child and 

parent (or parents), families are able 

to participate in socialization 

opportunities, which include weekly 

playgroups, educational programs 

such as a Health and Safety series, 

and Family Celebrations, which are 

provided twice annually. The CWS 

initiative provides transportation 

through the public bus system as 

needed. Parents have the opportunity 

to participate in family partnership 

activities and receive a monthly 

calendar of family programs. They 

also receive a monthly family 

newsletter to which they can 

contribute recipes and through 

which they share parent pride with 

respect to their children’s accomplishments, and they participate in 

parent surveys and elections. Parents 

can also participate in the EHS Policy 

Council and Parent Committee. 

A strong partnership between 

CEHS and LCDJFS is critical to the 

success of the project and is based 
TECHNICAL ASSISTANCE PAPER NO .9 

on relationships that have developed 

over time between participating staff 

members from both agencies; frequent communication between the 

service providers from both agencies; 

joint meetings with the family initially 

and as needed to clarify roles and the 

communication process, review the 

CWS case plan, and to address 

family needs; and monthly 3-hour 

meetings for case review and 

reflective supervision that are 

attended by the service providers 

from both agencies, the supervisors, 

and the CEHS infant mental health 

specialist. The infant mental health 

specialists provide regular progress 

letters to LCDJFS and the court 

system with respect to the family’s 

participation in the EHS program, 

progress on family goals, and 

recommendations. Participating staff 

members from both agencies worked 

together to develop a logic model 

and outcome measures for the 

evaluation of the project as well as 

to participate in semiannual focus 

groups to provide feedback and 

evaluate the progress of the project. 

CEHS–Child Welfare System in Action 

Marcy, a 42-year-old single mother 

with a long history of alcoholism and 

mental health issues, was referred to 

the program after the birth of her 

only child, Jessica, who was born 

after having been exposed to alcohol 

during the prenatal period and who 

tested positive for cocaine at birth. 

Jessica was diagnosed with failure to 

thrive and had significant delays in 

motor development and speech–language skills. She eventually needed a 

surgically inserted feeding tube to 

promote weight gain and to provide 

the nourishment necessary for brain 

growth and overall development. 

Jessica also had a tethered spinal 

cord, which is a closed type of spina 

bifida. She underwent surgery to 

correct this problem. 

Marcy and Jessica were involved 

with the local CWS agency once 

they were discharged from the hospital. 

When Jessica was 3 months old, she 

was placed in emergency temporary 

custody after Marcy became 

intoxicated to the point of losing 

consciousness in the presence of the 

baby. Marcy worked intensively 

through an outpatient chemical 

dependency program and with an 

infant mental health specialist. She 

participated in regular visitation 

with Jessica over a 6-month period, 

after which Marcy and Jessica were 

reunited. Unfortunately, 6 months 

after reunification, Jessica was again 

placed in emergency temporary custody 

because of Marcy’s alcohol use and 

her neglect of Jessica. Marcy, the 

23 
24 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

CWS social worker, and the infant 

mental health specialist met with 

Marcy’s chemical dependency counselor together. Marcy was able to 

reconnect with her psychiatrist, 

continue to work with her chemical 

dependency counselor and with the 

infant mental health specialist, and 

again participate in regular visitation 

with Jessica for the next year. Marcy 

and Jessica, with much support, have 

recently attained the goal of reunification. Even with this success, it is 

clear that Marcy will need ongoing 

support to address the complex issue 

of chemical dependency and the 

demands of parenting. 

The infant mental health specialist 

who was available through the EHS 

program was instrumental in the 

successful reunification of Marcy and 

Jessica. The intensity of services 

included 1.5 to 5 hours per week of 

supervised visits, home visits, and 

visits within the community, including 

medical appointments and hospital 

visits. During weekly home visits 

with Marcy and Jessica, the infant 

mental health specialist observed 

their interactions and helped Marcy 

read her daughter’s cues and respond 

appropriately to her needs. The 

infant mental health specialist also 

helped Marcy to arrange for appointments with medical specialists and 

for hospital visits; to prepare herself 

emotionally for these appointments; 

and to explore her feelings—particularly guilt, fear, and anxiety—after 

these appointments to keep her 

feelings from interfering with her 

follow-through. Collaborative home 

visits were completed with the Early 

Intervention social worker, the CWS 

social worker, and developmental 

therapists as necessary to facilitate 

discussion of observations and concerns 

and to coordinate services. 

The infant mental health specialist’s 

participation in supervised visits, 

additional home visits, and coordination with the CWS social worker 

and other professionals allowed for 

more accurate assessment of Marcy 

and Jessica’s concerns and needs as 

well as the opportunity to give 

honest feedback and maintain open 

communication with Marcy. The 

close collaboration with the CWS 

social worker, therapy professionals, 

and infant mental health specialist 

allowed for regular communication 

and opportunities to compare observations, share professional opinions, 

and develop a plan of action. The 

close communication with the foster 

mother, the CWS social worker, and 

infant mental health specialist 

facilitated not only the sharing of 

medical, developmental, and daily 

routines with the mother but also 

direct communication and coordination between the foster mother and 

the mother. 
TECHNICAL ASSISTANCE PAPER NO .9 

During the course of the infant 

mental health specialist’s work with 

Marcy and Jessica, all involved 

learned a variety of lessons: 

Strong relationships with the 

family and all parties involved in 

the providing of services are 

essential to success. 

Services for high-risk families 

who experience frequent crisis 

periods should be delivered over 

time to provide ongoing support 

that helps the families stabilize 

and make new progress. 

Respecting, supporting, and 

collaborating with foster parents 

and relative caregivers, who 

develop a strong protective bond 

with the child, can be a resource 

or a barrier to reunification of the 

child and biological parent. 

Ongoing intensive involvement 

with high-risk families is necessary 

to make informed recommendations to the CWS and the legal 

system with respect to case 

planning, ongoing monitoring of 

concerns, and the reunification 

process. 

CHILDREN’S THERAPY 

CENTER, SEDALIA, MO 

The EHS–CWS worker completes 

two or more home visits per week 

and monthly socialization groups to 

enhance parent–child interaction. 

EHS is helping to develop a protocol 

for CWS workers to use that will 

enhance continuity for the child 

when removing a child from the 

home. 

Program Description 

The Children’s Therapy Center 

EHS–CWS project is located in a 

rural community in central Missouri. 

Located in a county with a population of fewer than 40,000, this EHS 

program is funded to serve a total of 

131 infants, children, and pregnant 

women. The program has multiple 

options for enrolled families. Fifty of 

the families receive home visiting 

that focuses on pregnant women and 
26 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

families who are not yet in the work 

force. Thirty-four children in families 

with parents who are working or in 

school receive full-day, full-year, 

center-based care at two sites that 

the program owns and operates, and 

an additional 42 children receive 

care through child-care partnerships. 

Finally, the program is funded to 

provide services for five infants and 

toddlers in its CWS project. 

Before the Children’s Therapy 

Center EHS had the opportunity to 

apply for EHS–CWS funding, its 

EHS program had learned from 

experience what the national EHS 

research (Mathmatica Policy 

Research, 2002) later revealed—that 

there was a population of EHS-eligible families who were not benefiting 

from EHS. The Children’s Therapy 

Center EHS had experienced failure 

with some families who faced multiple 

challenges, and staff members were 

struggling to understand these 

failures. With the announcement of 

the opportunity for this project, staff 

members saw the chance to provide 

services that were extremely 

intensive and flexible and that might 

come closer to meeting the needs of 

the families who previously had not 

been reached. 

The center began this project with 

strong collaboration between CWS 

and EHS. Joint planning meetings 

between the two offices led to an 

application that brought not only 

the strengths of both programs to the 

project but also a foundation of collaboration that continues to support 

their work. This planning led to two 

critical aspects of this EHS–CWS 

program. The first aspect, which staff 

members were hoping would lead to 

success, was a small caseload, which 

would allow great flexibility in 

meeting the needs of families with 

multiple challenges. Given what the 

program had learned from working 

with EHS families who faced multiple 

challenges and from the CWS 

knowledge base of families receiving 

their services, the EHS–CWS project chose a flexible, intensive home 

visiting model in which the 

EHS–CWS home visitor would have 

a caseload of five children. 

The second critical aspect of the 

EHS–CWS project was the co-location of the EHS–CWS staff member, 

which was intended to support the 

intended system outcomes. This 

EHS–CWS home visitor is an EHS 
employee, but her office is located at 

the CWS office. The decision for 

this physical arrangement was born 

out of the strong collaboration 

between the local CWS office and 

the center’s EHS program as well as 

out of a desire to achieve systems 

outcomes along with the family 

outcomes that were intended 

through the project. This co-location of staff has led to many 

opportunities to take collaboration 

to even stronger levels in the 

implementation of the project. 

Children’s Therapy Center in Action 

The following brief description of a 

child and family enrolled in this 

EHS–CWS project will highlight 

how the project’s collaboration 

works. 

Joey came to the attention of the 

CWS office because of the unsanitary 

conditions in his home. He had been 

removed from his home twice before 

involvement in this project and, at 

the age of almost 2 years, was in 

foster care at the time of enrollment 

in EHS–CWS. His father, Sam, had 

been his primary caregiver; an aunt 

and two teens made up the rest of 

the household. 

Having the project’s EHS–CWS 

home visitor located at the CWS 

office provides great convenience for 

the referral process. In ongoing 

meetings between EHS and the 

TECHNICAL ASSISTANCE PAPER NO .9 

CWS county director and supervisor, 

staff members created an eligibility 

checklist for this project. This 

checklist and other project 

information is shared with CWS 

caseworkers. Therefore, when Joey 

entered the CWS system, those 

caseworkers knew to talk with the 

EHS–CWS home visitor about a 

referral. This time, the project had 

an opening, and Joey and his father 

were enrolled. 

A great benefit that the flexibility 

of such a small caseload offers is 

that the project’s EHS–CWS home 

visitor can provide very intensive 

services with a family. In this case, 

the home visitor provided frequent 

and intensive home visits with Sam. 

Early discussions with Sam centered 

on his meeting the criteria for reunification set by CWS and his 

understanding of what would be 

needed to provide Joey with a safe 

and healthy environment. Sam made 

a decision and set a goal to move out 

of his current living situation, which 

he understood was chaotic and was 

interfering with Joey’s safety, and 

move in to a new location with his 

girlfriend. He also got a job and has 

maintained employment for more 

than 5 months. Currently, the 

family is not dependent on food 

stamps, cash assistance, or 

community assistance. 

27 
28 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

A second early focus of the home 

visitor’s work with Joey was to supervise visits between Joey and Sam. 

Through a collaborative agreement 

with CWS, she has been able to 

supervise significantly more 

father–son visits than the CWS 

system alone can support. This relationship-building work between 

home visitor and father as well as 

between father and son led to smooth 

preparation for Joey’s transition back 

into his home. The home visitor and 

Sam discussed Joey’s possible 

responses not only to moving back 

with his father but also to moving 

into a new household. 

A regular aspect of the project’s 

collaboration is that the EHS–CWS 

home visitor attends all family support team meetings. She takes an 

active role in the case, bringing her 

perspective of the situation to the 

group and keeping lines of communication clear. In this case, the home 

visitor’s level of support for Sam and 

Joey changed the predicted outcomes 

of the case and affected the Juvenile 

Office’s opinion of Sam’s success. 

The resulting trial placement of Joey 

back into his father’s new home has 

been monitored and facilitated by 

the EHS–CWS home visitor. 

In her ongoing work with Joey and 

Sam, the home visitor has learned 

that Sam himself was a product of 

the CWS system during his own 

childhood. Her awareness of the 

potential effect of this history has 

helped focus her work to support 

Sam’s determination to be his child’s 

father in both fact and practice. 

They have focused on child development and appropriate expectations 

as a means of further support for Sam 

and Joey’s relationship. Additionally, 

she has encouraged Sam’s communication with CWS and other 

monitoring agencies to strengthen 

his skills in being his child’s primary 

advocate. The family continues to 

set goals and have now initiated 

consultation with the home visitor 

on more mundane topics—potty 

training and discipline. 

In the process of transformation 

led by the family, it is heartening to 

see the focus of their work shift from 

meeting criteria for reunification to 

topics that typically consume all 

parents of toddlers. Through flexible, 

intensive, collaborative services— 

and a relationship built on 

trust—the EHS–CWS project has 

supported a change in the predicted 

trajectory of Sam and Joey. Where 

history and expectations predicted 

failure, we now see a path leading to 

success. 
TECHNICAL ASSISTANCE PAPER NO .9 

LOCAL EVALUATIONS OF 

CHILD WELFARE SERVICES 

PROJECTS 

An important component of the 

EHS–CWS initiative is the local 

evaluations. The 24 EHS programs 

participating in the initiative 

designed local evaluations to assess 

how they are implementing their 

EHS services for children and 

families involved in child welfare. 

Agencies were able to design a 

program that would meet the specific 

needs of their families and communities and, at the same time, assess a 

variety of ways to work with families 

as a strategy to learn about what is 

most effective. Agencies developed 

their own “theory of change,” or 

how they believe their services can 

have an effect, which guided their 

program models and their local 

evaluations. 

James Bell Associates (JBA) provides 

technical assistance to support the 

programs in their evaluation efforts. 

The role of JBA is to help build the 

capacity of agencies to conduct a 

local process-and-outcome evaluation. For the most part, agencies do 

not have the resources to contract 

with a third-party evaluator; thus, 

the grantee agency staff members are 

performing a self-evaluation of their 

programs. JBA provides assistance to 

grantees through the following: 

Providing site visits 

Conducting workshops at conferences 

Offering individual consultation 

during conferences or through 

telephone calls 

Reviewing evaluation plans and 

data collection instruments 

Collecting progress reports 

Providing written comments 

and feedback 

JBA also helps grantees to structure 

the type of ongoing data they submit 

by preparing semiannual reports that 

include suggested topics and formats 

for reporting outcome data and by 

synthesizing the findings from the 

grantees’ progress reports. The 

primary emphasis on the local evaluations has been (a) to implement a 

strong “process evaluation,” which 

provides information the programs 

29 
30 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

can use to help improve program 

services; and (b) to increase knowledge about not only the factors that 

contribute to successful EHS–CWS 

partnerships but also the challenges 

that exist in bringing the two systems 

together. A number of the local 

evaluations are also exploring child 

outcomes in the areas of safety, 

permanency, and well-being. 

Each agency has a site-specific 

evaluation plan that identifies its 

theory of change. A number of 

agencies are addressing the same outcomes using similar measures. JBA’s 

initial work was focused on ensuring 

that all agencies had developed a 

“logic model” to guide their evaluation activities. In addition, JBA 

developed a cross-site evaluation 

framework (see box “Early Head Start 

Child Welfare Services Evaluation 

Framework”) that identified the 

program’s theories of change, or how 

different agencies were attempting 

to have a positive effect on the 

children and families. This framework 

helped promote discussion among 

grantees with respect to the goals 

that they shared in common and 

similar change theories they were 

following in their local evaluations. 

Through the use of this framework, 

several agencies gained an increased 

understanding of the plausible 

changes to expect as a result of the 

services provided. These agencies 

also recognized that they could 

collect data to address a number of 

outcomes that other grantees also 

were addressing, which were 

appropriate for their own local, 

theory-driven evaluations. 
TECHNICAL ASSISTANCE PAPER NO .9 

Early Head Start Child Welfare 

Services Evaluation Framework 

SERVICE DELIVERY OUTPUTS IMMEDIATE OUTCOMES LONG-TERM OUTCOMES 

(Activities/Intervention) Child and Family Well-Being 

31 

Parents participate in their 

scheduled weekly home visits 

Parents adhere to the 

established visitation plan 

Parents attend the group 

socialization meetings that 

are offered to them 

Parents referred to mental 

health services will attend 

therapy/counseling sessions 

Parenting offered parenting 

education classes will 

attend the sessions 

Families who need emergency resources and 

supports will receive the 

resources needed 

Child welfare agency and 

EHS staff adhere to the 

new case planning process 

There will be improved 

child development outcomes 

SAFETY 

Children will be safe in 

their homes (no subsequent 

reports of abuse or neglect) 

PERMANENCY 

Children in foster care will 

be reunified with parents 

or placed with a permanent 

caretaker 

SYSTEMS LEVEL OUTCOMES 

There will be improved 

access to services 

Provide EHS home-based 

early childhood education 

weekly visits to parents 

Develop plan for onsite 

visitation between biological parent and children in 

foster care 

Provide group socialization 

meetings for parents to interact with other parents and 

learn about parenting issues 

For parents needing mental 

health services, make 

appropriate referrals for 

mental health assessment 

and therapy 

Provide parenting education 

classes that address positive 

approaches to discipline, 

home safety, and home 

management skills 

Provide case management 

services and referrals for 

emergency resources for 

families who need assistance or support 

Develop Family Partnership 

agreement/case plan jointly, 

with EHS staff, child welfare 

agency staff, and parent 

Eligibility 

Criteria & 

Referral 

Procedures 

Target 

Population 

Program 

Objectives 

PARENT OUTCOMES 

There will be improved 

parent involvement with 

their children 

There will be an increase in 

parents' ability to cope 

with stress in healthy ways 

Parents will show increased 

knowledge of parenting 

practices and skills 

There will be an improvement in the overall safety 

conditions of the home 

environment 

There will be an increase in 

collateral information available to make reunification 

and/or permanency decisions 

There will be improved 

coordination of family case 

planning 

Parents will demonstrate improved 

family functioning 

Parents will demonstrate positive 

parenting and 

improved interactions 

with their child 

The agencies implementing a 

CWS project have made considerable progress in expanding their 

knowledge about evaluation concepts and in building their capacity 

to undertake a program evaluation at 

the local level. This progress is 

particularly evident with respect to 

their process evaluations. Several 

agencies have also examined outcome 

goals such as improvements in 

parenting practices, parenting skills 

and involvement, parenting attitudes, 

and safety as well as decreased 

parenting stress. 

Through the 24 local evaluations 

that currently are under way, some 

important lessons are already emerging 

with respect to the capacity of 

agencies to take on evaluation tasks 

without additional resources or the 

assistance of a third-party evaluator. 

First, several agencies learned 

that data collection was a far more 

labor-intensive and challenging 

process than they had anticipated. 

Difficulties were attributed to factors 

such as parents’ reluctance to give 

informed consent to participate in 

the evaluation or parents’ dropping out of the program and no 

longer being available to complete 

data collection instruments. Other 

programs learned that it was not as 
32 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

easy as they originally expected to 

establish a data-sharing agreement 

with their CWS partners or other 

community partners, which created 

delays in their access to necessary 

evaluation data. 

Second, agencies learned (a) 

that it takes significant time to 

train staff members to use data 

collection instruments that are 

unfamiliar to them and (b) that 

there are challenges in getting 

staff members to use the 

instruments in a consistent manner. 

When agencies attempted to 

recruit volunteers such as graduate 

students to help them in collecting 

data, they experienced delays in 

trying to locate someone with the 

right “fit” to help with the evaluation. Also, when the academic 

semester ends, the students often 

leave school and, consequently, 

agencies found it was necessary to 

retrain someone else to assume the 

data collection tasks. 

Third, a number of agencies 

that were conducting a self-evaluation found that, even though 

their knowledge about evaluation 

and how to implement a local 

evaluation had been enhanced, 

their capacity to do so was hindered 

by the amount of time needed to 

focus on the evaluation when they 

also were responsible for overseeing 

implementation of the program. 

Being able to focus exclusively on 

the evaluation was not possible, 

and often, the evaluation did not 

receive as much attention because 

of other pressing issues related to 

program implementation. 

The agencies participating in the 

EHS–CWS initiative have discovered 

a number of important factors that 

contribute to a successful evaluation. 

These include needing good 

relationships with families to obtain 

reliable data; drawing on professional 

help such as a consultant to help 

with the local evaluation, when 

resources permit it; encouraging EHS 

staff members to develop a receptive 

and enthusiastic attitude about data 

collection; limiting the number of 

data collection instruments to avoid 

overburdening participating families 

and staff members; updating children’s 

case files frequently if these are to 

be used as a data source for the 

evaluation; and developing evaluation 

tools, including logic models, early 

during the project startup period so 

existing data sources can be identified and decisions can be made 

sooner with respect to what new 

data needs to be gathered. 

34 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

Resources
 

American Academy of Pediatrics. (2000). 

Developmental issues for young children 

in foster care. Pediatrics, 

106(5), 1145–1150. 

American Academy of Pediatrics. (2002). 

Health care of young children in foster 

care. Pediatrics, 109(3), 536–541. 

Child Welfare League of America. (1998). 

Standards for health care services for 

children in out-of-home care. 

Washington, DC: Author. 

Child Welfare League of America. 

(2005). National Fact Sheet. 

Washington, DC: Author. 

Dicker, S., & Gordon, E. (2004). Ensuring 

the healthy development of infants in 

foster care: A guide for advocates and 

child welfare professionals. Washington, 

DC: ZERO TO THREE. 

Feeney, S., & Freeman, N. K. (1999). 

Ethics and the early childhood educator: 

Using the NAEYC code. Washington, 

DC: National Association for the 

Education of Young Children. 

Fenichel, E. (Ed.). (1992). Learning 

through supervision and mentorship to 

support the development of infants, 

toddlers, and their families. A sourcebook. Washington, DC: 

ZERO TO THREE. 

Honig, A. (2002). Secure relationships: 

Nurturing infant and toddler attachment 

in early care settings. Washington, DC: 

National Association for the Education of 

Young Children. 

Koralek, D. (1992). Caregivers of young 

children: Preventing and responding to 

child maltreatment. Washington, DC: 

National Center on Child Abuse and 

Neglect. 

Maternal Child Health Bureau. (1994). 

Responding to abuse and neglect: 

A continuing challenge. Washington, 

DC: U.S. Department of Health and 

Human Services. 

Mathematica Policy Research. (2002). 

Making a difference in the lives of 

infants, toddlers, and their families: The 

impacts of Early Head Start. Princeton, 

NJ: Author. 

Olsen, M., & Hyson, M. (2003). Early 

childhood educators and child abuse 

prevention. Washington, DC: National 

Association for the Education of Young 

Children. 

Oser, C., & Cohen, J. (2003). America’s 

babies: The ZERO TO THREE policy 

center data book. Washington, DC: 

ZERO TO THREE. 

Parlakian, R. (2001). Look, listen, and 

learn: Reflective supervision and 

relationship-based work. Washington, DC: 

ZERO TO THREE. 

Parlakian, R. (Ed.). (2002). Reflective 

supervision in practice: Stories from the 

field. Washington, DC: 

ZERO TO THREE. 

Parlakian, R., & Seibel, N. L. (2001). 

Being in charge: Reflective leadership in 

infant/family programs. Washington. 

DC: ZERO TO THREE. 

Repucci, N. D., Britner, P. A., & Woolard, 

J. L. (1997).Preventing child abuse and 

neglect through parent education. 

Baltimore: Paul H. Brookes. 

U.S. Department of Health and Human 

Services. (1996–2005).Early Head Start 

Research. Available online at 

http://www.acf.hhs.gov/programs/opre/eh 

s/ehs_resrch/index.html 

U.S. Department of Health and Human 

Services, Children’s Bureau, Office on 

Child Abuse and Neglect. (2004). 

Child maltreatment 2002. Washington, 

DC: U.S. Government Printing Office. 

ZERO TO THREE. (2003). America’s 

Babies. Washington, DC: Author. 
TECHNICAL ASSISTANCE PAPER NO .9 

Appendix A
 

EARLY HEAD START/CHILD 

WELFARE SERVICES 

(EHS–CWS) INITIATIVE 

Project Contact Information 

(current as of May 31, 2005) 

Karen Reed 

Neighborhood House Association
 

5660 Copley Drive
 

San Diego, CA 9211[AQ: 


Please provide full zip code.]
 

Phone: 858-715-2642 

E-mail: kr@neighborhoodhouse.org 

Cherie Dakota 

B-H-K Child Development Board 

700 Park Avenue 

Houghton, MI 49931 

Phone: 906-482-3663 

E-mail: ccdakota@bhkfirst.org 

Donna Ditrio 

New Opportunities, Inc. 

232 North Elm Street 

Waterbury, CT 06702 

Phone: 203-759-0841 

E-mail: dditrio@newopportunitiesinc.org 

Valerie Lane 

Children’s Therapy Center 

Family & Child Development 

Department 

600 E. 14th Street 

Sedalia, MO 65301 

Phone: 660-826-4400 

E-mail: vlane@chs-mo.org 

Jane Robinson 

Miami Dade County Community 

Action Agency 

395 N.W. 1st Street, Suite 103 

Miami, FL 33128 

Phone: 305-347-4633 

E-mail: jwrobin@miamidade.gov 

Sonia Gonzalez-Cruz 

Northside Center for Child Development, Inc. 

1301 Fifth Avenue 

New York, NY 10029 

Phone: 212-426-3491 

E-mail: SGCruz@northsidecenter.org 

Odette Watson 

East Central Illinois Community 

Action Agency 

56 North Vermilion Street 

Danville, IL 61832 

Phone: 217-443-2705 

E-mail: owatson@comaction.org 

Sherri Lookner 

Miami Valley Child Development 

Center 

215 Horace Street 

Dayton, OH 45407 

Phone: 937-226-5664 

E-mail: slookner@mvcdc.org 

Martha Arntson 

Childcare Network of Evanston 

1416 Lake Street 

Evanston, IL 60201 

Phone: 847-475-2661 

E-mail: 

arntsonM@childcarenetworkofevanston.org 

Carla Unkefer 

Community Action Wayne/Medina 

2375-B Benden Drive 

Wooster, OH 44691 

Phone: 303-264-8677 

E-mail: cunkefer@cawm.org 

Jane Mahurin 

Shawne Williams 

Hamilton Center, Inc. 

620 8th Avenue 

P.O. Box 4323 

Terre Haute, IN 47804 

Phone: 812-231-8336 

E-mail: 

jmahurin@hamiltoncenter.org
 

swilliams@hamiltoncenter.org
 

Sharon Daniels 

Rebecca Stewart 

Ironton-Lawrence County CAO 

305 North Fifth Street 

P.O. Box 517 

Ironton, OH 45638 

Phone: 740-532-3745 

E-mail: 

skdaniels@cloh.net
 

bstewartehs@yahoo.com
 

35 
36 

E ARLY HEAD S TART NATIONAL RESOURCE C ENTER 

Kim Hollies 

Melody Sandifer 

Carey Services, Inc. 

2724 South Carey Street 

Marion, IN 46953 

Phone: 888-668-8961 

E-mail: khollies@careyservices.com 

msandifer@careyservices.com 

Kathy Vavro
 

Sharon Altland 


Crossroads Early Childhood Services 

41 E. Erie Street, Lower Level 

Painesville, OH 44077 

Phone: 440-358-7370 

E-mail: kvavro@crossroads-ecp.org 

saltland@crossroads-ecp.org 

Judith Mower 

Volunteers of America of North 

Louisiana 

1808 Roselawn Avenue 

Monroe, LA 71202 

Phone: 318-322-2272 

E-mail: jmower@voanorthla.org 

Caren Squires 

Community Action Program of 

Tulsa County, Inc. 

717 S. Houston Avenue, Suite 200 

Tulsa, OK 74127 

Phone: 918-382-3251 

E-mail: csquires@CAPTC.org 

Patti Woolley 

Kennebec Valley Community 

Action Program 

97 Water Street 

Waterville, ME 04901 

Phone: 207-859-1617 

E-mail: pattiw@kvcap.org 

Gail Boyle 

Community Action Program 

1001 SW Baseline Road 

Hillsboro, OR 97123 

Phone: 971-223-6040 

E-mail: gboyle@capwash.org 

MaDonna Adkins 

EightCAP, Inc. 

904 Oak Drive–Turk Lane 

P.O. Box 368 

Greenville, MI 48838 

Phone: 616-754-9315 x 3359 

E-mail: Madonna@8cap.org 

Paula Margraf 

Community Services for Children 

1520 Hanover Avenue 

Allentown, PA 18109 

Phone: 610-437-6000 

E-mail: pmargraf@cscinc.org 

Shirl Smith 

Cen-Clear Child Services, Inc. 

1633 Philipsburg Bigler Highway 

Philipsburg, PA 16866 

Phone: 814-342-5678 

E-mail: ssmith@cenclear.org 

Nancy Langdon 

South Plains Community Action 

Association, Inc. 

P.O. Box 610 

411 Austin 

Levelland, TX 79336 

Phone: 806-744-3572 

E-mail: Nancy.langdon@twc.state.tx.us 

Sally Gundry 

EHS Director 

Family Services of Grant County 

1402 E. Craig Street 

Moses Lake, WA 98837 

Phone: 509-766-9877 

E-mail: sallykg@familyservicegc.net 

Elizabeth Olsen 

Dane County Parent Council, Inc. 

2096 Red Arrow Trail 

Madison, WI 53711 

Phone: 608-275-6740 

E-mail: Elizabeth.Olsen@dcpcinc.org 
EARLY HEAD START NATIONAL RESOURCE CENTER