Children’s Assessment Center
Martha's Place: Childrens' Assessment Center
The early years of children’s lives are vital. During this time, the child’s ongoing growth and development are affected by intertwining social and biological factors that contribute to long-term success or failure. Just as premature birth, prenatal exposure to alcohol or drugs, or poor maternal nutrition can harm fetal brain development, family violence, substance abuse in the family, or maternal depression can interfere with the child’s brain development after birth.
In recognition of these potential difficulties for children, a team of community leaders came together in September 2004 to develop a comprehensive model of outreach and treatment for children in San Luis Obispo County. The overall process was driven by the team’s vision for San Luis Obispo County:
Vision
The community of San Luis Obispo County is dedicated to ensuring that all children will receive any interventions, treatment and support they may need to reach their highest level of growth and development; that they will live safely in their homes, succeed in school, have meaningful friendships and grow up to be healthy, strong, and resilient citizens of our community
Background
Responding to the issues facing children and families in San Luis Obispo County, a team was organized in April 2003 to develop a strategic plan for promoting the early identification and treatment of women using drugs or alcohol during pregnancy. The team consisted of representatives from the County’s various agencies, as well as community-based professionals in obstetrics, pediatrics, early childhood education, hospital administration, mental health, substance abuse treatment, and child protection.
As a result of that planning effort, in 2004, pregnant women enrolled in prenatal care throughout San Luis Obispo County were screened with the 4P’s Plus©, a screening instrument designed to identify those women at highest risk for using alcohol, tobacco, and illegal drugs. Eighteen of twenty-one obstetric providers in the County integrated the screen into routine prenatal care. Those women with a positive screen underwent a more thorough assessment for substance use through a follow-up structured clinical interview conducted at the same prenatal visit.
There are approximately 2,600 deliveries per year in San Luis Obispo County. Of these, 1,305 women were screened at their first prenatal visit in 2004. Among these women, 18% were smoking cigarettes in early pregnancy before they knew they were pregnant, 35% were drinking alcohol, and 11% were using both cigarettes and alcohol. Overall, 42% of the women had a positive screen; that is, they were using alcohol and/or tobacco during the early pregnancy.
The screening and assessment process in San Luis Obispo County found alcohol to be the major substance of abuse. This has tremendous implications for children being born here, since even small amounts of alcohol can affect fetal brain development and affect long term behavior, learning and mental health.
Development of Children’s Assessment Center
As a result of the emerging information and the documented numbers of children being born exposed to alcohol and illicit drugs during the prenatal period, a second group of community professionals met in September 2004 to examine issues of risk for children in San Luis Obispo County. This group represented a wide range of disciplines, agencies, and institutions:
Shirley Bianchi |
Community Representative |
Katcho Achadjian |
County Board of Supervisors |
Judge Teresa Estrada-Mullaney |
Superior Court Services |
Renee Bravo, MD |
Pediatrician and First Five Commission |
David Edge, CAO |
San Luis Obispo County |
Gerry Shea |
District Attorney, San Luis Obispo County |
Jan Campbell |
MCAH Director, San Luis Obispo County Public Health Dept. |
Greg Thomas, MD |
Public Health Director, San Luis Obispo County Public Health Dept. |
Star Graber |
San Luis Obispo County Drug and Alcohol Services |
Kim Barrett |
San Luis Obispo County Probation Department |
Lisa Fraser |
SLOCAP |
Brad Sunseri |
San Luis Obispo County Department of Mental Health |
Dr. Doug Murphy |
Community psychiatrist |
Frank Bush |
Tri-Counties Regional Center |
Biz Steinberg |
Economic Opportunity Commission |
Alan Hilton |
San Luis Obispo County Office of Education |
The core strategy was determined to be the development of a comprehensive Early Childhood Assessment and Treatment Center, anchored by universal screening of children birth to five years of age throughout the county. As a next step, this team of professionals worked with their consultants, Dr. Ira Chasnoff and Dr. Richard McGourty of the National Training Institute in Chicago, to develop a plan for community-wide outreach, comprehensive screening, follow up assessment, and universal access to treatment services.
A Model of Care was developed based on the successful work of Dr. Ira Chasnoff and the Child Study Center in Chicago, Ill. Since 1990, the Child Study Center has been providing quality evaluation, treatment planning, and therapeutic services for children and adolescents and their families. Their primary focus is to improve the quality of life for all children with special needs or children at risk for developmental, behavioral, psychological, or educational problems. Children’s Research Triangle has been in the forefront of many issues related to maternal substance abuse in pregnancy, the outcomes of children prenatally exposed to drugs, and the child welfare implications of substance abuse in families.
Through closely working with Dr. Chasnoff, the team is modeling San Luis Obispo’s Children’s Assessment Center after that of the center in Chicago. Our Model of Care integrates systems of health and behavioral health to ensure access to appropriate early intervention services for children from birth through five years of age in San Luis Obispo County. This Model is based on three over-arching strategies – community-based identification, center-based assessment and accessible treatment – anchored by four core functions: Screening, Assessment, Referral, and Treatment.
The Children’s Assessment Center will provide the earliest identification and intervention for many children who currently are not identified until they experience failure in school and/or enter the juvenile justice system.
Key Elements of the Center
- Single point of entry for all children
- Family-focused approach
- Multidisciplinary staffing: physicians psychologist, occupational therapist, physical therapist, speech & language therapist, infant mental health specialists and early childhood & developmental specialists
- Assessment completed at a single visit
- Family Resource Specialist
- Co-Location of exiting assessment resources with multi-agency teams
Tri-County Regional Center
Mental Health
County Office of Education/Special Education
Child Welfare
- Comprehensive treatment plan based on the needs of the child-not driven by eligibility criteria
Treatment
- Family resource specialist will serve as a case manager to ensure access for the family and to provide feedback to the team at the center.
- Treatment may occur at the center until appropriate services can be established in underserved areas of the County.
- Each child will return to the center for follow up evaluation as indicated by the child’s clinical course.
Cost to maintain the Children’s Assessment Center is estimated to be $1.2 million a year. We are anticipating funding from insurance reimbursement, public agencies, foundations, and private donations to sustain services for these high-risk children.
