2014 Capstone of the Year

Leah van Lingen

Research has demonstrated that early childhood is a crucial time in a child’s development and future well-being. Services provided during early childhood can significantly reduce risk of delinquency as a child ages. KidSTART is a program that identifies children with developmental and mental health needs, and connects them to services. One goal of the program is to reduce future delinquent behavior. KidSTART provides comprehensive Screening, Triage, Assessments, Referral, and Treatment for children with complex developmental problems, ages birth through five years (0-5). KidSTART services are delivered by an integrated, trans-disciplinary team of clinicians and specialists. The KidSTART model includes collaboration with existing systems to surround and support children and families who need intensive services. Originally only for children involved in the child welfare system, KidSTART has since expanded; non-dependent siblings of CWS clients can now participate in services at KidSTART as well as other children from the general population.

The County’s KidSTART program has also begun to administer testing for an Adverse Childhood Events (ACE) score. Research on ACEs was pioneered by San Diego Kaiser Permanente physician Dr. Filletti who correlated childhood trauma to a myriad of adult outcomes after studying 17,000 Kaiser members. The correlations included a propensity towards substance abuse, various medical diseases and even premature death. There are also behavioral associations such as risk for intimate partner violence and unintended pregnancies. By testing for ACEs, KidSTART will be able plan interventions and link children to resources that will support the prevention of long term health/behavioral challenges.

To develop and sustain KidSTART, workgroups were held with community stakeholders to obtain input on program design and determine creative and diversified funding options to continue the program. Stakeholder meetings were held in December 2012 and were well-attended. Feedback provided during these meetings was positive both in terms of the services established by KidSTART and the intensive amount of time it takes to create new services for children. Additionally, many constructive ideas were shared regarding how to build on existing program components such as including the child’s primary medical doctor as part of the integrated clinical team.

KidSTART has partnered with other community agencies to ensure all early childhood efforts are well coordinated. In particular, KidSTART has an ongoing collaboration with the Developmental Screening and Enhancement Program (DSEP). DSEP and KidSTART are two unique and complementary programs within the County’s comprehensive approach that support young children. Together, these two programs form a continuum of care that ranges from universal early identification of developmental and social-emotional concerns, to trans-disciplinary intervention for children with complex needs. DSEP provides developmental and social-emotional/behavioral services to child welfare involved youth, including early identification, case management, intervention and caregiver education for children birth through 5 years, 11 months. DSEP also provides training to child welfare staff. When DSEP’s evaluation reveals a need to address complex developmental problems, DSEP refers the child to KidSTART, and both entities collaborate about shared or potential clients. DSEP provides an initial developmental assessment to identify needs and link the child to service resources and continuing case management until all linkages are in place. KidSTART provides high level trans-disciplinary assessment and intervention addressing developmental, mental health, medical and family functioning.

According to Julie McCormack, Manager of the DSEP and Kristin Gist, Senior Director of the San Diego Division of Developmental Services, “CWS and DSEP have created a system that ensures over 95% of the children entering out-of-home care receive a developmental and social emotional screening, and for those children who need additional evaluation or treatment services post-screening, the linkage to service rate is over 85%. This is well above the rates of 13-31% noted in published literature.” Because of these efforts, children involved with DSEP have seen reduced behavioral problems and delinquency.

Despite these great successes, San Diego has faced several challenges, particularly diminishing funding. KidSTART and DSEP are only included in the County’s First 5 Strategic Plan for funding through 2015. Though KidSTART diversified the population served (beyond CWS children) the revenue from that was not substantial. Still, utilizing funding wisely (such as increasing direct client service time and decreasing time to train community partners) has allowed the programs to continue fruitful operation.

The leadership teams of both DSEP and KidSTART also did a detailed analysis of recent referrals to determine whether the DSEP-KidSTART referral pathway required any refinement. Initially DSEP was referring clients to KidSTART that could be served by community service providers, which resulted in the referral being rejected/triaged out. Now the two programs have monthly meetings to discuss acceptance criteria and potential service options. Decreasing the rejection rate is crucial as both programs want to meet their referral contract goal numbers, so now, only truly eligible children are referred to KidSTART. Additionally, when clients are accepted by KidSTART, the DSEP and KidSTART workers meet the client for a joint appointment for a warm hand off where important information is shared and effective collaboration takes place.

Additionally, as KidSTART expanded in hopes of serving the greatest number of children in need, the caseload size proved to be a challenge, making difficult to provide the intensive services KidSTART families require. Program leadership has taken a three-pronged approach to this challenge. First, KidSTART leadership has been reviewing the program’s capacity and scope of work to ensure that Care Coordination services are of the highest possible quality and effectiveness. Second, the program’s service target goal numbers and inclusion criteria have been refined to reduce the number of children being served, while ensuring the right children are served. Third, time and resources were focused on recruiting and retaining qualified Care Coordinators so that vacant positions do not undermine the efforts to reduce caseload sizes.

Overall, Leah believes the County’s early childhood programs are very successful – she calls the leadership in San Diego’s youth-serving systems “strong, creative and flexible by placing the needs of children as the first priority.” By serving children below age 5 – a crucial time of development – these community leaders are able to foster successful growth for San Diego children and reduce their risk of delinquency as adolescents. Because the leadership acts on the necessity to intervene early in a child’s life to create a richer future for youth, Leah also calls their effort one that moves “from absence [of intervention opportunities] to presence, from isolation to integration. [Their work] develops and relies upon organizational relationships with others outside of the workgroup in order to accomplish specific goals that are beyond the ability of a single organizational unit itself.”

Leah states that the Center for Juvenile Justice Reform certificate program was “integral in [her] project’s success. Attending the program fueled an unparalleled zeal to see change happen…I cannot say enough about the sustained impact it has had on me.” Leah believed the instructors and classmates at the certificate program provided invaluable insight and inspiration, as well as a diverse look at initiatives and challenges faced by other jurisdictions.

We congratulate Leah on her selection as the recipient of the 2014 Capstone of the Year Award and we look forward to her ongoing efforts to improve the lives of youth in San Diego County
Leah was a participant in CJJR’s 2009 Multi-System Integration Certificate Program – a week-long, intensive course designed to cover the variety of issues impacting crossover youth and multi-system reform to prepare leaders to undertake a wide-range of reforms in their community. Upon completion of the Certificate Program, participants become CJJR Fellows by designing and implementing a Capstone Project focused on multi-system reform in their jurisdiction. CJJR currently has nearly 400 Fellows that benefit from being part of a growing network of mutually supportive leaders and receive ongoing support for their systems change work.

A KidSTART Success Story

Care Coordination: “Patrick” and his brother “Eric” (not their real names) were 2 and 4 years old, respectively, when they were referred to KidSTART by their CWS Social Worker. Both boys had several concerns that prompted their referral: Patrick had a suspected speech/language delay, possible Fetal Alcohol Spectrum Disorder, and sensory processing concerns. Eric was referred largely due to his caregivers’ concerns about what they described as “hyperactivity.” He also had a trauma history and possible speech needs. Their mother was a single mother raising four children. She shared that she had struggled with depression, and had a history of traumatic experiences herself. She and her boys had experienced a number of moves in recent years, and the boys had experienced a lot of chaos in their young lives.

KidSTART’s Clinical Psychologist invited one of KidSTART’s Care Coordinators to sit-in on a portion of the children’s developmental evaluations in order to meet the family. The Care Coordinator arrived at the same time mom received a phone call from her landlady informing her that she would be evicted from her home. Understandably, mom’s emotions quickly escalated and she stopped the boys’ evaluations as she thought she had to get home immediately to avoid being evicted. The Care Coordinator was able to help mediate the situation by separating mom from the boys so they didn’t see her upset, and by calling the landlady to learn more about the eviction. The Care Coordinator provided assistance with clarifying the housing situation for mom and provided information about housing resources on the spot.

Once mom realized she would not lose her home that day, she was able to refocus on the children’s evaluations, and both appointments were successfully completed. Ultimately Patrick and Eric were both triaged into KidSTART. The boys are currently scheduled for further assessments, and their Integrated Clinical Team meetings are pending. The Care Coordinator has helped mom find a stable living arrangement, and she began seeing a psychologist for her own mental health needs. At mom’s request, KidSTART also helped her access trauma counseling services for her two older children, due to their exposure to domestic violence.

This story helps illustrate what many KidSTART families experience on a daily basis. More and more, families are being referred to KidSTART in “crisis mode” and the everyday/extenuating circumstances they are dealing with make identifying their children’s needs, and securing the appropriate treatment for those needs, all the more difficult. By providing support, resources, and on-site assessment and treatment for this family, Patrick and Eric now have a better chance to receive the services they need.