Child welfare system involvement may improve diagnosis of developmental delays – Penn State University

Report on Child Welfare System Efficacy in Advancing Sustainable Development Goals for At-Risk Children

Introduction and Alignment with Global Goals

A study published in JAMA Health Forum examines the relationship between a child’s involvement with the Pennsylvania child welfare system (CWS) and the diagnosis of developmental delays. The findings indicate that CWS involvement, particularly placement in foster care, significantly increases the likelihood of early diagnosis and connection to intervention services. This report analyzes these findings through the lens of the United Nations Sustainable Development Goals (SDGs), highlighting the system’s role in promoting:

• SDG 3: Good Health and Well-being: By facilitating early identification and treatment of developmental delays in vulnerable children.
• SDG 4: Quality Education: By providing early intervention that mitigates learning challenges and improves long-term academic outcomes.
• SDG 10: Reduced Inequalities: By ensuring at-risk children gain access to essential health and developmental services they might otherwise miss.
• SDG 16: Peace, Justice and Strong Institutions: By demonstrating the effectiveness of a state institution in protecting children and connecting them to vital support systems.

Study Methodology and Scope

The research analyzed records from 31,913 infants and young children receiving Medicaid support in Pennsylvania between 2015 and 2017. The study categorized children based on their level of interaction with CWS before their third birthday following a confirmed instance of neglect or abuse.

1. Children on Medicaid with no CWS involvement.
2. Children with confirmed maltreatment but not receiving CWS services.
3. Children receiving in-home services from CWS.
4. Children placed in foster care.

Key Findings: CWS Involvement and Diagnosis of Developmental Delays

The study revealed a direct correlation between the level of CWS involvement and the rate of developmental delay diagnosis, a critical step toward achieving SDG 3 (Good Health and Well-being). Early identification is paramount, as untreated delays can impede progress toward SDG 4 (Quality Education) by causing lower academic achievement.

• No CWS Contact: 32% of children were identified with a developmental delay.
• CWS Involvement, No Services: 36% of children were identified.
• CWS In-Home Services: 45% of children were identified.
• Foster Care Placement: 63% of children were identified.

The data indicates that diagnoses often occurred immediately following placement in foster care, suggesting the system facilitates identification rather than causing the delays.

Impact on Access to Healthcare and Early Intervention Services

Increased CWS involvement was linked to greater access to preventive medical care and early intervention services, directly addressing SDG 10 (Reduced Inequalities) by bridging the gap between vulnerable populations and necessary healthcare. Children with CWS involvement, especially those in foster care, were more likely to receive:

• On-time medical well-visits with physicians.
• Early intervention supports, including home visits and assessments.
• Referrals for speech, physical, or occupational therapy.

Institutional Role in Promoting Child Well-being (SDG 16)

The findings underscore the function of the child welfare system as a strong institution, a core component of SDG 16 (Peace, Justice and Strong Institutions). By systematically evaluating children under its care, the CWS acts as a crucial safety net. The research concludes that CWS, and the foster care system in particular, are effective in connecting vulnerable children to beneficial supports, a function that may be attributed to caseworker advocacy or shifts in medical decision-making when the system is involved.

Conclusion and Policy Implications

The Pennsylvania child welfare system demonstrates significant success in identifying developmental delays and connecting at-risk children to essential services, thereby advancing multiple SDGs. The positive outcomes suggest that the CWS model provides valuable lessons for other sectors.

• The success of the foster care system in ensuring children receive diagnoses and services should be studied and replicated.
• Other systems, including education, general welfare, and healthcare, should adopt similar proactive strategies to ensure all at-risk children are identified and supported early.
• By improving early detection and intervention across all systems, progress can be accelerated toward achieving universal health, quality education, and reduced inequalities for all children.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article directly addresses this goal by focusing on the health of young children. It discusses how mistreatment leads to “a wide range of developmental delays and health problems.” The entire study revolves around diagnosing these delays and connecting children with “preventive medical care and early intervention services” to improve their health and well-being as they grow.

• SDG 16: Peace, Justice and Strong Institutions

  This goal is relevant because the article examines the impact of violence against children, specifically those who are “abused or neglected.” It analyzes the role of a key institution—the Pennsylvania child welfare system (CWS)—in protecting these children and influencing their access to necessary services. The study shows how an effective institution can lead to better outcomes for vulnerable populations.

• SDG 4: Quality Education

  The article connects early childhood health to future educational outcomes. It states that if developmental delays are “left unidentified or unaddressed, the more likely a child is to experience lower academic achievement.” By focusing on early intervention, the issues discussed are foundational to ensuring children are prepared for and can succeed in the education system.

• SDG 10: Reduced Inequalities

  This goal is addressed by focusing on a vulnerable and economically disadvantaged group: “infants and young children receiving Medicaid support.” The study highlights inequalities in health outcomes and access to services, demonstrating how intervention by the CWS can reduce these disparities for at-risk children compared to those in similar households without CWS involvement.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.2: End preventable deaths of newborns and children under 5 years of age. While not directly about mortality, the article’s focus on addressing developmental delays and health problems in children under three is crucial for ensuring their survival and healthy development, which aligns with this target’s broader goal.
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services. The article explicitly discusses connecting children to “preventive medical care,” “early intervention services,” “medical well-visits,” and therapies (speech, physical, occupational), which are all components of essential healthcare services.

2. SDG 16: Peace, Justice and Strong Institutions

   • Target 16.2: End abuse, exploitation, trafficking and all forms of violence against and torture of children. The core population of the study consists of children who have experienced a “confirmed instance of neglect or abuse,” directly addressing the need to end violence against children. The article evaluates the effectiveness of the CWS in responding to this violence.

3. SDG 4: Quality Education

   • Target 4.2: By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education. The article’s central theme is the identification and treatment of “developmental delays” in children under three. Addressing these delays through early intervention is a fundamental aspect of ensuring quality early childhood development, which prepares them for future education.

4. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social… inclusion of all, irrespective of age… or other status. The research demonstrates how an institutional intervention (CWS) can reduce inequalities in health outcomes for a highly vulnerable group (young children who have been mistreated), promoting their inclusion in essential health and developmental support systems.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions several quantitative and qualitative indicators that can be used to measure progress:

1. Indicators for SDG 3 (Good Health and Well-being)

   • Proportion of children with developmental delays identified: The article provides specific data, stating that the identification rate ranged from 32% for children with no CWS contact to 63% for children in foster care. This directly measures access to diagnostic services.
   • Rate of access to early intervention services: The article notes that “children were more likely to receive services to treat the delays as their level of CWS involvement increased,” implying this is a measurable outcome.
   • Rate of on-time medical well-visits: The study found that “children in foster care were more likely to attend well-child visits with physicians,” which serves as an indicator of access to preventive healthcare.

2. Indicators for SDG 16 (Peace, Justice and Strong Institutions)

   • Proportion of children experiencing abuse or neglect: The study’s methodology relies on identifying children with a “confirmed instance of neglect or abuse before their third birthday,” which is a direct indicator of violence against children.
   • Proportion of abused/neglected children receiving institutional support: The article states that “around one third of the children who had been abused or neglected received CWS services,” which measures the reach and response of protective institutions.

3. Indicators for SDG 4 (Quality Education)

   • Prevalence of developmental delays in early childhood: The article measures the failure to reach milestones in “physical growth targets or skills like rolling over, smiling and language development.” The rate of diagnosis of these delays is a key indicator of early childhood development status.

4. Indicators for SDG 10 (Reduced Inequalities)

   • Disparities in diagnosis rates based on CWS involvement: The difference in identification rates between children with no CWS contact (32%) and those in foster care (63%) is a clear indicator of how institutional intervention can reduce inequality in access to diagnosis for a vulnerable population.

4. Table of SDGs, Targets, and Indicators

Source: psu.edu