The Department Children Families Children Aged Zero Five

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The Department Children Families Children Aged Zero Five

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The Department of Children and Families Early Childhood Practice Guide for Children Aged Zero to Five

The Department of Children and Families

Early Childhood Practice Guide for Children Aged Zero to Five

Section Title
Introduction Very Young Children in Child Welfare Understanding the Importance of Attachment in Early Years The Impact of Trauma on Early Childhood Development Child Development Social and Emotional Milestones (Charts) Assessing Safety and Risk for Children 0‐5 – Intake and Ongoing Services Quality Early Education and Care Parents with Disabilities Parents Who were in DCF Care as Children Early Childhood – Adolescent Services Visitation The Role of Supervision in Early Childhood (Ages zero to five) Consults Foster Care: Focusing on Children Entering and In‐Care‐Birth to Age 5 DCF’s Teaming Continuum Appendices
Appendices Index
Introduction The Impact of Trauma on Early Childhood Development Child Development Developmental Milestones Attachment Resources – Children’s Social and Emotional Competence Cultural Considerations Assessing Home Environment Assessing Parenting and Parent/Child Relationship Assessing Parental Capacity Assessment of the Parent’s Perception of Child Failure To Thrive Abusive Head Trauma (Shaken Baby) Foster Care Fatherhood Initiative Programs at CJTS Resources by Region (Separate Document)

3 4 4 10 14 17 26 38 39 43 45 46 48 50 51 53 55
56 57 61 65 70 74 75 76 78 78 79 80 80 81 82 See “Resources”

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Early Childhood Practice Guide for Children Aged Zero to Five


The Department of Children and Families supports healthy relationships, promotes safe and healthy environ‐ ments and assures that the social and emotional needs of all children are met. The 0‐5 population comprises a third of our overall caseload and we know by virtue of age, they are among the most vulnerable in our society. The work we do with young children and their families early on sets the stage for their future success. The intent of the Early Childhood Practice Guide is to provide a framework and important information to support child welfare staff in their work with young children and their families. In the past few decades, there has been over‐ whelming research that highlights the significance of the first years of development and the impact of early adversity on long‐term health outcomes. The Early Childhood Practice Guide is designed to inform child welfare staff of this research and articulate the practical application of that research and knowledge in direct service with young children and families.
This Practice Guide is designed to build upon the many strengths of our practice and provide further guidance and information that support comprehensive assessments and engagement with families and our community partners. The Early Childhood Practice Guide and Appendices provide tools, resources, and information that address essential areas of our work, including developmental milestones (incorporating social and emotional development), understanding the importance of attachment, the impact of trauma, assessing safety and risk, and the role and importance of supervision in our work with families with young children.

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The Department of Children and Families

Early Childhood Practice Guide for Children Aged Zero to Five


Children’s early experiences can have a profound impact on their development and well‐being now and later in life. Research on the developing brain clearly demonstrates that these early experiences are incredibly powerful. During the earliest years of life—the first five years—the brain is more easily impacted by outside experiences than at any other stage of life. The developing brain is shaped in very important ways by these experiences. Positive experiences, such as loving attention, calm routines, sights, sounds and other sensory experiences that are varied but not over‐stimulating, can directly impact the brain’s architecture.

Because the brain is so sensitive during this early stage, however, extremely stressful or traumatic experiences

can also have powerful repercussions. Almost 200,000 children in the US under the age of 3 come into contact

with the child welfare system every year. This population also has the highest rate of child fatalities. For young

children, this threat arises at a crucial time in life,

when early experiences are shaping the brain’s ar‐

chitecture into a foundation for learning, health, and future success.

One of the most important influences on a young child’s growth and development is

The traumatic experiences that bring children into his/her relationship with a caring and nurturing

our care (e.g., physical and sexual abuse or severe adult beginning at birth. This relationship is

neglect) affect the basic foundation of the devel‐ oping brain. Such experiences make it more diffi‐ cult for a child to develop the cognitive, emotional and sensorimotor skills they will need to meet life’s

the basis for an infant’s ability to form a secure attachment, which sets the stage for their cognitive, social, and emotional development.

challenges. Research suggests that the more harm‐

ful experiences a child is exposed to, the more likely the child is to have difficulty with social and emotional

functioning, exhibit cognitive problems and fall behind in school.1

This early stage in life is also unique because the well‐being of a young child is particularly shaped by the rela‐ tionship the child has with his or her primary caregiver. The quality of interactions between the caregiver and child shapes the child’s developing brain and creates the context through which learning occurs.

Trauma in early childhood—particularly trauma that impacts the relationship between caregiver and child—can have a cascading effect on a child’s well‐being. Not only can the brain be shaped by experiences of neglect and/or abuse at the hands of the caregiver, but these experiences also leave the child with the message that adults cannot be trusted.

Research has found that children who have insecure relationships with their primary caregivers are more likely to struggle both academically and in developing healthy relationships with others. Children who develop inse‐ cure attachments to their caregivers are also at increased risk for mental health problems like depression and

1 Center on the Developing Child, Harvard University. InBrief- The Impact Of Early Adversity On Children’s Development.

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Early Childhood Practice Guide for Children Aged Zero to Five

anxiety.2 A growing body of research has shown that adverse environments and experiences place young chil‐ dren at risk for limited language and cognitive skills, difficulties interacting effectively with their peers, insecure attachments, developmental delays, behavioral and mental health problems, and an array of health problems and conditions (e.g., lung disease, cancer, depression, or alcoholism) later in life.

Working with very young children can be especially challenging since they often have not yet developed the skills to tell you what has happened to them, what they are feeling, or what they need. An important part of your role as a CPS worker is to learn to interpret children’s expressions, body language, behavior, and emotions so that you can make sure they get the help and support they need to thrive.

2 Jakobsen, I.S., Horwood, L.J., & Fergusson, D.M. (2012). Childhood Anxiety/Withdrawal, Adolescent Parent-Child Attachment and Later Risk of Depression and Anxiety Disorder. Journal of Child and Family Studies, 21(2).

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Early Childhood Practice Guide for Children Aged Zero to Five


A young child’s connection and bonding experience are formative in the early years. Relationships matter…and in order to understand a child, we must be willing to explore and understand the relationship between a par‐ ent/caregiver and child.

The first years of life are almost entirely about building trust and security. The quality of the parent/child rela‐

tionship creates a foundation for a child’s future development.

Young children, through physical and emotional contact and in‐ teraction, create and sustain attachments.

The quality of the attachment is one of the strongest predictors of

Understanding the attachment patterns and the outcomes for

later development.

young children has great implications for child welfare practice

in regards to planning transitions, placement of children in care, the reunification process, observation of par‐

ent/caregiver child interactions, and ultimately our case planning decisions. These decisions must support and

promote nurturing and stable relationships in the lives of infants, toddlers, and preschoolers if we hope to

achieve improved outcomes for the children and families we serve.

Attachment research tells us the quality of the parent/child relationship can be captured in two major catego‐ ries:

 Secure Attachment = healthy relationships  Insecure Attachment = disrupted relationships


A secure attachment is characterized by the child’s ability to use his or her parent as a source of comfort and a “secure base” from which to explore. A key principle of attachment theory is that dependence leads to inde‐ pendence. In other words, it is only when a child feels confident in his parent’s availability that he can fully explore and play on his own.

Many research studies have shown that sensitive, responsive parenting promotes secure attachment.

When a parent/caregiver responds sensitively and consistently to a child’s needs, the child is able to:  Gain confidence that his or her needs will be recognized and responded to  Develop healthy relationships  Regulate or manage his or her emotions  More easily comfort him‐ or herself  Feel safe exploring the world around him or her  Cooperate with and help others  View him‐ or herself and others positively

What do healthy toddler and young child behaviors look like with secure attachments?:  Interested and confident to explore in the presence of an attachment figure

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Early Childhood Practice Guide for Children Aged Zero to Five

 When hurt, going to an attachment figure for comfort (i.e., not a stranger)  Seeking help when needed  Willingness to comply with requests with minimal conflict  No pattern of controlling or directing the behavior of caregivers (no role reversal)

What do healthy parental behaviors look like with secure attachments?:  Sensitive and responsive care  Clear, consistent, developmentally appropriate expectations and supervision  Warm, positive, and responsive verbal interaction  Seeing the child as a unique individual, having insight into the child (i.e., why he does what he does)  “Holding the child in mind” (i.e., awareness of and ability to reflect on the parent’s own feelings and responses to the child)

A child who had a secure attachment with her parent as an infant is more likely in childhood to be independent and self‐confident; to have appropriate interactions with peers and teachers; to manage her emotions, to be focused, curious and motivated in school; and to have strong problem solving skills.

INSECURE ATTACHMENT – DISRUPTED RELATIONSHIPS. An insecure attachment is characterized by the child’s inability to use his or her parent for comfort or as a secure base. Insensitive, rejecting, or inconsistent parenting has been linked to insecure attachment.

There are three types of insecure attachment:

1. When a parent is unavailable or rejecting, a child may become "avoidantly" attached, meaning that the child adapts by avoiding closeness and emotional connection. It is a strategy often developed by an infant whose parents have discouraged overt signs of either affection or distress, and who do not readily offer sympathy or comfort (Karen, 1994). The insecure avoidant infant rarely cries when separated from the primary caregivers and avoids contact upon his or her return (Papalia et al., 1999).
2. An "ambivalently" attached child experiences the parents' communication as inconsistent and at times intrusive. Because the child can't depend on the parent to connect or respond, he develops a sense of anxiety and feelings of insecurity. The lack of consistent nurturing and protection from the parent makes it hard for the infant to feel that exploring the world is a safe option. Thus the child has a low threshold for distress, but no confidence that comfort will be forthcoming.
3. "Disorganized" attachment occurs when the child's' need for emotional closeness remains unseen or ignored, and the parents’ behavior is a source of disorientation or terror. When children have experiences with parents that leave them overwhelmed, traumatized, and frightened, children become disorganized and chaotic. Disorganized attachment leads to difficulties in the regulation of emotions, social communication, and academic reasoning, as well as to more severe emotional problems.3

3 Parenting: Attachment, Bonding and Reactive Attachment Disorder. Children’s Problems and Behaviors Related to Stress: Help with Stressed Kids for Parents and Educators.

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Early Childhood Practice Guide for Children Aged Zero to Five

Insecure Attachments can result in the child:  Having difficulty developing healthy relationships  Lacking confidence in the predictability of the world around him/her  Struggling to manage his or her emotions  Lacking the skills to comfort him/herself  Feeling unsafe and unwilling to explore the world around him/her  Being aggressive or withdrawn

What do the toddler and young child behaviors look like when an insecure attachment is developed?  Excessive dependence  Marked shyness, withdrawal, or unfriendliness  Failure to seek contact and comfort when needed  Indiscriminate friendliness or contact‐seeking  Punitive, bossy behaviors  Over‐concern with the parent’s well‐being (i.e., role reversal)  Disoriented or frightened in presence of the parent, such as approaching while looking away, stilling, freezing, or rocking  Promiscuous, sexualized behavior  Viewing him/herself and others negatively
What do the parental behaviors look like when an insecure attachment has developed? o Interfering with the child’s attempts at exploration (i.e., intrusive, overly controlling) o Unclear, inconsistent, developmentally inappropriate expectations and supervision o Ignoring the child’s needs and cues o Inconsistent, unreliable responsiveness o Hostile, threatening, and frightening behaviors o Prioritizing the parent’s needs over the child’s (i.e., self‐absorbed) o Behaving like a child or treating the child as though he/she is in charge (i.e., role‐reversal) o Marked withdrawal, fright, hesitancy or timidity around the child o Sexualized or overly‐intimate behaviors

A core question for all young children is grounded in attachment: Do I have an adult who cares about me and will keep me safe? What does it mean and what do I do when that adult who is supposed to care about me and
keep me safe is also the same adult who is scary and hurtful?

To encourage attachment, staff can suggest the following activities:  Explain the importance of skin‐to‐skin contact between baby and the parents  Parents hold the baby while feeding  Parents make eye contact with the baby  Parents talk to the baby in a soothing voice  Parents talk to the baby while doing natural daily activities (feeding, diaper changes, playing, going shopping etc.)

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Early Childhood Practice Guide for Children Aged Zero to Five

SERVE AND RETURN: HOW INTERACTIONS BUILD BRAINS Brain structures are built through the interactive influences of genes and early experiences. The active ingredient is the “serve and return” relationships that children have with caregivers in their families or communities. Like the process of serve and re‐

Toxic Stress: When strong, frequent, or prolonged adverse experiences such as extreme poverty or repeated abuse are experienced without the buffering of
adequate adult support.

turn in games such as tennis and volleyball, young children natu‐

rally reach out for interaction with others. A caregiver who is sensitive and responsive to a young child’s signals

provides an environment rich in “serve and return” experiences. When a child’s caregiver is unable to provide

these experiences or provides inappropriate responses, some brain structures may not form as they should.

Inadequate interaction has huge negative implications for later learning, the development of skills and abili‐

ties, behavior, and health. When children have adverse early experiences that include chronic physical and emo‐

tional neglect, recurrent abuse, and parental addiction, it can lead to the development of toxic stress in a child’s

environment and can have a tremendous impact on his or her overall health and development.

SERVE AND RETURN IN EARLY CHILDHOOD4 The interactive serve and return between a child and a caregiver – cooing, making facial expressions, and bab‐ bling back and forth – literally builds the architecture of the developing brain. Having a positive, nurturing rela‐ tionship with a caregiver early in childhood is one of the most important ways to promote healthy social, emo‐ tional, and cognitive development. A disturbance in any one of these domains, including adverse events, can lead to problems in other areas. For example, children who are unable to regulate their emotions are not likely to make many friends, which can limit their social development. An absence of friends is associated with poor academic achievement even at early ages, which can hamper some aspects of cognitive development. In this way, these capacities are connected over the course of the developmental period and help lay a foundation for lifelong health and well‐being.

RISK FACTORS AND ATTACHMENT Maternal depression, anxiety disorders and other forms of chronic depression often disrupt the parent‐child bond because parents with untreated mental health disorders are often less able to provide developmentally appropriate stimulation and parent‐child interactions.5 Parenting and child development are most affected when depression simultaneously occurs with other factors such as extreme poverty, substance abuse, adoles‐ cence and maltreatment.6 Infants of clinically depressed mothers often withdraw from their caregivers, which ultimately affects their language skills, as well as their peer relationships and difficulties in school. 7

The attachment that a child develops in the early years of his or her life dictates the outcome for the child into adulthood. Helping parents develop a secure relationship with their child is equally as important as providing consistency in care of the child. Responding quickly to a baby’s cry, exuding warmth and being sensitively at‐ tuned promote a sense of security and trust in children. When children develop a secure attachment, they can thrive in every facet of their lives‐educationally, relationally, occupationally, etc.

For more information, please review Appendices, beginning on page 19.

4 See 5 Administration for Children and Families. (2000). Summary of Current Literature – Maternal depression. 6 Gurian, A. (2003). Mother Blues – Child Blues: How Maternal Depression Affects Children. New York University Child Study Center
Letter, 7(3). 7 Knitzer, J. (1996). Meeting the Mental Health Needs of Young Children and Families: Service Needs, Challenges, and Opportunities.
Children’s Mental Health: Systems of Care in a Changing Society. Baltimore, MD: Brookes, P.H.:Ed. Stroul, B., 553‐572.

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Research has shown us that traumatic experiences hold the potential for strong and lasting impact on the nor‐ mal development of a child’s brain. During early childhood, the brain is developing the framework for learning, planning, making connections, and abstract thinking. When the architecture of that framework is impacted by trauma, there can be adverse effects to the cognitive capacity, emotional experiences, and ability to manage and control their behaviors, ultimately impacting their interpersonal relationships8. The significance of this is even stronger when you consider that 47% of children experiencing trauma do so by the age of 59.
While trauma can impact any child, children involved in child welfare are at a much higher risk of experiencing trauma and its consequences. This is in part due to the complex nature of the trauma, stemming from their primary attachment figures (traumatic loss, separation, intimate partner violence, impaired caregiver, emo‐ tional abuse, neglect, physical abuse, and sexual abuse), and also because of the chronicity of traumatic experi‐ ences for many in the child welfare system. Adults may see young children adapt to these repeated traumatic events and experiences with behaviors that are sometimes confusing and displaced. Young children can learn at a very early age how to cope with trauma and may present with behaviors or actions that are often misinter‐ preted by adults. For example, a child may present as very clingy with a caregiver but is unable to calm down when the caregiver tries to comfort him. The child becomes more upset and may hit or push away the caregiver, refusing to accept comfort. The caregiver responds by putting the child down; the child then tries to climb back up onto the caregiver’s lap.
Children who have experienced trauma in their early developmental years are more prone to perceive threats in their environment, exhibit impulsive or inhibited behaviors, and have difficulty trusting others. Most traumas experienced by children under the age of 5 are not explicit and instead are held in the body and can result in physical sensations, distress, and dysregulation.
The impact on children exposed to early trauma is often reflected in developmental delays. A national survey conducted of children in the child welfare system found that 35% of children who experienced trauma had developmental delays in the following areas:
 motor skills;  speech and language development;  emotional/behavioral regulation; and  cognitive functioning.

8 The National Child Traumatic Stress Network, pp. 28‐29. 9 U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and
Families, Children’s Bureau. (2015). Child maltreatment 2013, p. 31. Available from‐data‐technology/statistics‐research/child‐maltreatment.

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