Children Aged Birth to Five
0070-527.10 | Revision Date: 2/28/2024

Overview

This policy is designed to strengthen existing practice guidelines around engaging, assessing and servicing newborns, toddlers, preschoolers and their caregivers. 

Table of Contents

Version Summary

This policy was designed to strengthen existing practice and policy guidelines around engaging, assessing, and servicing, newborns, infants, toddlers, and preschoolers (ages birth to five) and their parents/caregivers.  Children ages birth to five who have suffered abuse and neglect, especially those that are separated from their primary parents/caregivers, are extremely vulnerable due to the critical period of physical and socio-emotional development. Children of this age deserve a loving and attuned caregiver that can meet their physical and socio-emotional needs.  Parents/caregivers of this age group will need a lot of support to help them read their children’s cues and meet their needs. 

POLICY

The goal of this policy is to strengthen practice guidelines around the unique needs of children aged birth to 5 and their caregivers. By looking at the child and caregiver(s) together as a unit, it is easier to identify areas of concerns and/or protective capacities of each, expressed through their relationship.  When looking at the child and caregiver(s) relationship the following is to be considered:

  • The importance of children having safe, protected, calming and nurturing environments.
  • Positive child-caregiver(s) relationships promote healthy development.
  • The importance of Teaming when working with families who have children aged birth to five.
  • A child’s primary caregiver(s) can be a variety of people, not just their biological parents, it can also be grandparents, godparents, parent’s partners, older siblings, etc.
  • Children come with complexities, abilities, vulnerabilities, and differences in how they present.
  • It is important to assess who the child relies on for their primary caregiving and emotional support from their perspective.

The aim of this policy is to encourage social workers to be curious and ask questions about a child’s experience in the context of their relationship with their primary caregiver(s), to understand what is going on with regards to safety and wellbeing.  Early in a child’s development the caregiver(s) must learn how their child communicates their needs and how to develop a nurturing relationship with them. When working with families who have young children, it is important to withhold judgement and stay neutral as CSWs assess the caregiver-child relationship, understanding that this is a vulnerable time as they are just starting to know each other.

It is also important to note how culture including cultural perspectives on gender identity can influence how we understand and respond to behaviors. What may be perceived as normal in one culture may not be in other cultures. Throughout this policy, keep cultural norms and practices in mind when working with and assessing families.

Background

Children experience the most brain development in the early years of life with 80% of a child’s brain developing by age three.  Young children are like sponges and every interaction with the adults around them impact their development, their ability to form heathy relationships/attachments and to feel safe in the world.  When young children experience abuse and/or neglect, it can have very detrimental impacts on all aspects of their life.  However, young children's brains are the most malleable which means that the earlier we can intervene to support nurturing supportive relationships between children and their caregivers, the more likely we can have a positive impact on their life trajectory. 

Key data points for children aged Birth to Five:

  • As of the first quarter of 2022, children aged birth to five make up 51% of all foster care entries in LA County. (Child Welfare Indicators Project, UC Berkeley)
  • In 2021, children ages birth to five made up 75% of all child fatalities in families with child welfare history. (Child Fatality Report to the Board June 30, 3022)
  • Of all High Risk/Complex needs youth, over 50% were known to us at or before age 5 (2017 study of High-Risk Cases)

Caregiver Definition

For the purposes of this policy, caregiver is defined as a person responsible for meeting the daily physical and emotional needs of a child and who is entrusted to provide a loving and supportive environment for the child to promote stability and healing from trauma. A caregiver can include a parent, resource parent, legal guardian, prospective adoptive applicant/parent or other individual assuming a role as a caregiver.  However, it is to be noted that per Structured Decision Making (SDM) policy 0070-548.24 a caregiver is defined as, “An adult, parent, or guardian in the household who provides care and supervision for the child.”

Practice Tip-Parent Trauma

For parents who have suffered childhood trauma, having and raising young children may also trigger some of their past trauma.  It will be important for them to recognize and address these triggers and past trauma.  Conversations on how past childhood trauma impacts current parenting may help parents understand this connection and address any concerns.

Fathers

For the rest of the policy, fathers will be part of the universal term “caregivers.” However, it is important to highlight their role in a young child’s life. When a father is involved, children have increased attachments, better emotional security, increased social skills, and are better able to manage their emotions. Additional information on locating and engaging fathers can be found in the Father Engagement 0080-506.11 policy.

A few important things to note about fathers:

  • Make sure to see a father interact with his child(ren).
  • Ask a father what he needs to care/support his child(ren).
  • Ensure that resources are given to fathers to help them support their children.
  • Ask the father about his support system both formal and informal, especially about his family.
  • Explore the six protective factors with father.
  • Assess a father who is non-offending as you would a non-offending mother.
  • Be aware of any biases towards fathers.
  • Mothers and fathers may interact differently with their children. The best way to assess the interaction is to observe it in person and note if the child is engaged/responsive.
  • Even if a father does not have a current relationship with a child, it does not mean the father can’t begin developing a relationship or be an appropriate caregiver.
  • Provide guidance/education to mothers and caregivers on the potential benefits of having a father involved in the child’s life.

Perinatal

The perinatal period (between pregnancy and birth) can be a difficult adjustment for any mother and father and may trigger unexpected physical and emotional reactions that may impact the quality of their response to the infant.  Ask mothers and fathers about their feelings pre and post-partum and refer out to professional support (I.e., a healthcare provider) if depression or other health concerns are suspected. Mothers are especially vulnerable to societal pressures or judgement during this vulnerable period, make sure questions are open-ended and non-judgmental.

A few things to consider exploring when caregiver(s) are expecting:

  • Asking about prenatal doctor visits
  • Being curious with parents about how the pregnancy was and the delivery was
  • Showing concern for how the caregiver(s) is doing
  • Asking about how each caregiver(s) is feeling about having a baby
  • Asking caregiver(s) if they have a plan for when the baby arrives
  • Asking caregiver(s) what they need to feel more prepared to parent
  • Asking caregiver(s) what supports they have after the baby arrives
  • Asking caregiver(s) what they know/understand about breastfeeding

Refer to policy Assessing Expectant Parents and Parenting Families of Newborns

0070-548.07.

Teaming to Support Caregivers and Children

Young children require a lot of support for healthy development.  When children aged birth to five and their caregivers are experiencing hardships, it is important to gather a targeted dedicated team that supports strengthening the parent-child relationship. As a lot of development is happening quickly at this young age, it is important to bring multiple systems together. Consider the following when building a team:

  • Be intentional about who should be part of the team for each age group.
  • Establish a minimum standard of teaming frequency and key participants. Also consider expanding the team membership and/or frequency when there are additional concerns. The minimum frequency standard can be weekly, monthly, etc. depending on the needs of the child/family.  Consult with your supervisor on what the minimum should be.
  • Team members should support bridging connections between the biological parents and resource parents and/or caregivers(s). Resource parents can be both a concrete support and a social support to the family.
  • Establish a specified person who can bridge the gap of communication between resource parents and parents, as needed, before the team is formed.
  • Each team member should be a resource to the child, parent(s) and/or caregiver(s).

Once a team is established, it is important to hold initial and ongoing staff engagement meetings to share information and to brainstorm case plans.  Staff engagements, especially for young children, should address the relationship between a young child, their caregivers and the caregivers' support.   This should be followed by a Child and Family Team Meeting.

It is important to note that a CSW should always consult with their SCSW about next steps.

Other Considerations

It is important to focus on supporting the whole family system and what stressors may arise when there are multiple children in the home or other difficult situations.  Consider that stressful living situations will impact a caregiver’s emotional resources so it will be important to ensure a lot of support for the caregivers in these situations so they can be emotionally available to the young child. As mentioned earlier, approach families with empathy and cultural humility while staying strength-based and non-judgmental.

Infants: Children Aged Birth to 1 Year Old

Newborns and Infants are solely dependent on others to take care of all their needs.  Caregiver(s) of newborns/infants need a lot of support to learn how to read the newborn’s cues and respond to them appropriately. New or inexperienced caregiver(s) are especially vulnerable to misread or misunderstand the newborn/infant’s communication and behavior. Infants thrive in nurturing, supportive and stable environments provided by their caregivers.   

Assessing Infants

Below are specific areas of development to look at during initial and monthly home visits with newborns, infants, and caregivers. Babies must be awake during the assessment. It is important to note that these categories are fluid, and strengthening one area will support another.  Each category is different, but they are all interconnected.

  1. Caregiver(s) and Infant Relationship, Communication and Feelings

A healthy caregiver(s) and child relationship will display significant amounts of face-to-face, back and forth interactions which include smiling, cooing, talking, and playing.  Caregiver(s) may need support in learning when and how to respond to the infant’s cues, soothe them when they are upset and seek appropriate medical care when needed.

Explore the communication between the infant and caregiver(s) by asking the following:

    • How do you know when this baby wants/needs something?
    • How do you know when this baby is happy, sad, afraid or sick?
    • What is easy about raising this baby?
    • What is difficult about raising this baby?

Observe the infant’s facial expression during their interactions with the caregiver, paying close attention to the following:

    • Back and forth interactions between caregiver(s) and infant.
    • Shared moments of contentment or joy. (This point is very important)
    • Whether this baby is comforted by their caregiver(s) when they are in distress.

Be curious about behaviors that may lead to concerns which include, but are not limited to the following:

    • Infant ignores or pushes caregiver away (seems to relate better to strangers).
    • Caregiver(s) describes this infant in negative terms (spoiled, difficult, bad). (Keep in mind cultural practices around child rearing.)
    • There is no evidence of shared happiness/joy between this infant and caregiver(s).
  1. Infant Self-soothing Behaviors and System Functions

Successful development during the first year of life is dependent on the infant’s ability to regulate behaviors and bodily functions (sleeping, eating, bowel movements, and crying) in response to their environment. Struggles in these areas can signal sensory (i.e., baby’s aversion/sensitivity to touch and possible food textures at feeding) processing problems.

Explore with caregiver(s) the infant’s behaviors by asking the following: 

    • Do you have any concerns with this baby’s eating/bowel movements?
    • Any concerns with the amount and quality of this baby’s sleep?
    • Does this baby cry excessively or not cry at all? Is this baby colicky?

Observe and document the following:

    • Note how many hours a day the baby is sleeping.
    • Note if the baby is having regular bowel movements and if not, ask why.
    • Note how much the baby is eating, what types of food and any struggles with eating routines.

Be curious about behaviors that may lead to concerns which include substantial delays or regression in any of the following areas and may warrant additional professional assessment:

    • Sleeping, eating, pooping/peeing, soothing/calming when upset.
  1. Infant Growth and Movement

An infant’s physical appearance and movements can indicate if the baby is in good health and reaching development milestones. Consider using a checklist from the CDC (https://www.cdc.gov/ncbddd/actearly/milestones/index.html) to guide your assessment.

Explore with the caregiver expectations for growth and movement by asking the following:

    • What does the doctor say about this baby’s growth and development?
    • Do you have any concerns with this baby’s growth and development?

Observe and document any noticeable changes in the following:

    • Child’s size (height/weight/head size) appropriate for their age.
    • Observing the baby’s growth from one visit to the next.

Be curious about behaviors that may lead to concerns which include, but are not limited to the following:

    • Body is too rigid/too limp
    • There is little to no movement, or there are jerky body movements
    • The infant is losing weight instead of gaining

Teaming/Support (Age Birth to 1)

DCFS must support creating a team, especially when it comes to children this young. Below is a list of possible some team members to engage/consult or invite to a team meeting. Consult first with the DCFS Coordinated Services Action Team (CSAT) coordinator or co-located DMH staff, whenever possible, for the most up-to-date clinical resources available.  Here are some examples:

    • Family members and any other natural supports
    • Co-located DMH partners to find an early childhood specialist/clinician
    • Post-partum/ parents’ needs: Consult with DMH duty staff for guidance
    • Regional Center Staff/Representative
    • PHN / Medical Social Worker / HUB / Pediatricians
    • MAT Assessors
    • Court Appointed Special Advocate (CASA) (https://casala.org/refer-a-child/)
    • Alternate caregivers /holder with developmental decision-making rights
    • Birth to 5 champions /services within regional office
    • Childcare provider
    • Educational rights/developmental services decision-maker
    • Monitors for visits/HSAs

Additional Areas of Concern about (Age Birth to 1)

Concerns will require action. Being curious and exploring with the caregivers regarding infant concerns is a good place to start. Talk with the caregivers to gauge their awareness/ concern. It is important to note that if there are any concerns, CSWs should be consulting with their SCSWs to discuss next steps. Below is a list of possible concerns that should be followed up with during subsequent visits.

    • Absence of emotion in child, or no crying
    • Changes or delays in smiling, crying and cooing
    • Lack of tracking caregiver with the eyes
    • Being non-responsive to voices or loud sounds
    • A baby not making any sounds at all and/or difficulties communicating
    • Has glassy eyes or blank stare, like they are not connecting with the caregiver or looking through them
    • Caregiver ignores child’s cries, cooing, or babbling
    • Multiple missed well-child visits
    • Child’s condition or illness is not improving
    • Caregiver is unaware of previous or upcoming well-child visits
    • Caregiver is unaware of treatment plan or not following medical recommendations
    • A collateral has concerns for the child’s safety or the caregiver’s ability to adequately care for the child
    • A newborn was hospitalized for an extended period-of-time

Practice Tip-Infant Communication

Babies communicate with their eyes, face, voice, and body movement. Babies can exhibit smiles, laughing and changes in tone, high-pitched crying, yelling, screaming, or no sounds.  A responsive caregiver will recognize the baby’s different cries and sounds as well as shared joy with their young child.  Ask the caregiver(s) about the baby’s different cries/sounds/movements and what they mean.  Additionally, ask the caregiver(s) what they enjoy most about their child.

Toddlers: Children Aged 2 to 3

Toddlers are all about exploration and learning.  They are learning about what they can do with their bodies, their emotions, and their surroundings, including the people in their environment. This can be a scary time for parents and caregivers as these children are very active, agile and can easily get hurt if not adequately supervised.

Assessing Toddlers

Below are specific areas of development to look at during initial and monthly home visits with toddlers and caregivers. It is important to note that the categories below are fluid, and we cannot address one area without supporting the other.  Each category is different but are all interconnected.

  1. Caregiver(s) and Toddler Relationship, Communication and Feelings

Toddlers start to take interest in specific people, activities, environments and       foods.  They start to understand meaning of words and start to talk.  They begin   to have their own sense of independence in the world and communicate likes and dislikes to others. They have limited vocabulary to express big feelings, so    they are often misunderstood as being “bad” or “difficult.”

Explore the communication/feelings between the toddler and caregiver(s) by asking the following:

    • How does this toddler show you affection and love? 
    • How does this toddler tell you when they need attention? 
    • How does this toddler show you when they are nervous, scared, sad, upset (other negative feelings) versus happy, excited (other positive feelings)? 

Observe the toddler’s facial expression and body language during their interactions with the caregiver(s), paying close attention to the following:

    • Is there a mutual connection between the toddler and the caregiver(s) (e.g., looking at each other, shared moments of joy/laughter, tracking each other’s movements when one moves around the room, etc.)?
    • Can the caregiver(s) help calm the child when they are in distress (i.e., offering to hold them, using a calm voice, soothing pat on the back, etc.)?
    • Are caregivers able to understand what the child is trying to communicate/express (e.g., can make out the toddler’s “baby talk” and body language that others cannot), or make attempts to understand (e.g., ask the toddler to repeat/show again what they were trying to communicate and make guesses, etc.)?

Be curious about behaviors that may lead to concerns which include, but are not limited to the following:

    • The toddler is showing discomfort with or fear of the caregiver(s) and moves away from them.
    • The toddler’s behavior and feelings change after a visit with a parent.
    • Explore the reasons for both positive and negative changes
    • The caregivers do not understand the toddler’s babble and body language expressions and do not make attempts to learn about the child’s attempts to communicate.
    • The caregiver displays increasing frustration and shortness with the inability to manage the toddler’s behavior or understand the toddler’s efforts to communicate.
    • Explore reasons for the caregiver’s frustration.
  1. Toddler Self-Soothing Behaviors

Toddlers should be able to self-soothe and/or be calmed by significant adults when upset. They need a consistent eating, sleeping and playing schedule that can provide them a predictable and safe environment. Toddlers should also be    able to tolerate low levels of stress.  For example, they should be able to tolerate a caregiver stepping away for a few minutes.  

Explore and/or observe with the caregiver(s) the toddler’s routines surrounding sleeping, eating, crying, pooping, and peeing by asking the following:

    • Does the toddler sleep at night? Do they nap during the day?
    • Does the caregiver(s) have any worries/concerns about potty-training?
    • What does this toddler eat throughout the day and how often?  
    • Does the caregiver(s) have any worries/concerns during feeding time?
    • When the toddler is upset, how long does it take for them to be comforted and soothed by the caregiver(s)?

Be curious about behaviors that may lead to concerns which include, but are not limited to the following:

    • Caregiver(s) lets the toddler cry for a long time without attempts to soothe them.
    • There are no routines for eating, sleeping and toilet training, and the caregiver(s) has no plans to start.
    • The toddler does not nap or sleeps too much during the day.
    • The caregiver has no plans to toilet-train, when age or developmentally appropriate.
    • The caregiver displays increasing frustration with the toilet-training process.
  1. Toddler Growth and Movement

Toddlers are very active and are always exploring.  They have good command of their bodies for investigating and manipulating objects and environments. They want to test their bodies by jumping, climbing or throwing things, so they are very prone to injury when not closely supervised. 

Explore with the caregiver(s) the toddler’s appearance and movements by asking the following:

    • When did this toddler first start walking independently? 
    • What happens when this toddler falls (e.g., do they attempt to get back up, cry for help)?

Observe the caregiver(s) and the toddler during play, paying close attention to the following:

    • When the toddler falls, do they seek out the caregiver(s) for comfort or help? 
    • How far can the toddler walk independently on their own? 
    • Can the toddler hold and carry objects/toys of different sizes successfully from point A to point B?

Be curious about behaviors that may lead to concerns which include, but are not limited to the following:

    • The toddler’s movements appear stiff (unable to bend joints with ease) or limp/fragile (poor muscle tone)
    • The toddler seems clumsy and falls or trips easily
    • The toddler is not active or curious or appears to be disinterested with surroundings/lack of activity.

Teaming/Support (Ages 2 to 3)

It is important to support the creation of a Child and Family Team (CFT) for children this young. Below is a list of possible team member(s) to engage/consult or invite to a team meeting. Consult first with the DCFS CSAT coordinator or co-located DMH staff, whenever possible, for the most up-to-date clinical resources available. Here are some examples:

    • Family members and any other natural supports
    • Consult with co-located DMH partners to find an early childhood specialist/ clinician
    • Parents’ emotional needs (depression, anxiety, etc.): Consult with DMH duty staff for guidance
    • Regional Center Staff/Representative
    • PHN / Medical Social Worker / HUB / Pediatricians
    • MAT Assessors
    • Court Appointed Special Advocate (CASA) (https://casala.org/refer-a-child/)
    • Alternate caregivers /holder with developmental decision-making rights
    • 0-5 champion leads/services within region, when available in each office
    • Childcare provider
    • Preschool teacher/ early childhood education director
    • Educational rights holder and/or developmental decision-maker

Additional Areas of Concern (Ages 2 to 3)

While toddlers may have more language skills and mobility than infants, it remains important to be curious and observe their interactions with others in the home. Asking caregivers regarding their concerns for the toddler is a good place to start. CSWs should consult with their SCSWs to discuss next steps and ensure to follow up with the caregiver during subsequent visits.

  • Caregivers and the child are not playing together  
  • Caregivers are not in-tune with the child’s expression/communication 
  • Caregivers are not responsive to meet the child’s needs 
  • Not walking by 18 months and/or unusual walking patterns  
  • Caregivers continue to fail to show up to appointments 
  • Lack of follow through by the caregivers 
  • Caregivers are not able to provide proof of completed appointments 
  • Child is being described in negative terms

Practice Tip-Toddler Development

Toddlers are very curious and continue to explore their environment, test their bodies and test their limits. Their bodies are getting stronger, and they are gaining better control of their movements. Their vocabulary is increasing as their speech and language continue to develop. Loss of vocabulary, loss of social skills and eye contact, or new unusual movements can signal red flags. A responsive caregiver will recognize the toddler’s loss of words or that they no longer respond to their name. Ask the caregiver(s) about the toddler’s new or different abilities and behaviors, when they began and how the caregiver responds when they happen.  

Preschoolers: Children Aged 4 to 5

Preschoolers are very imaginative, creative and are developing relationships outside their immediate families. Children this age may make up stories about what they do or what happens to them which can be misinterpreted as a “lie”  At this age they are starting to understand social structures and rules but are also likely to test them. 

Assessing Preschoolers

A healthy parent/caregiver and child relationship includes allowing the child to lead playful social interactions.  Imaginary play and social play with other children are strongly encouraged. A small set of simple rules may also help children feel safe.

  1. Caregiver(s) and Preschooler Relationship, Communication and Feelings

Explore the interaction between the preschooler and the caregiver(s) while they play, interact, and to see how the preschooler responds to simple directions or requests made by the caregiver. You may also want to use the Three Houses Tool assessment technique to find some of this information.

    • How does the preschooler interact with and play with adults and other children and what do they enjoy playing with most?
    • Does this preschooler hold attention like other children their age?
    • How is the preschooler involved in helping around the home or with chores?
    • What does their teacher report about the child at preschool and their interactions and behaviors with their peers?

Observe the preschooler’s immediate response to your presence in the home and their interactions with the caregiver(s) and others in the home. Observe their transition time and how they respond to new situations during your visit.

    • Was the preschooler able to continue their activities without much struggle upon your presence in the home?
    • When asked to get something for the caregiver, is the preschooler able to locate the object requested or pointed out to them?
    • How does the caregiver make their requests and communicates with the preschooler and how the child responds to the caregiver.

Be curious about behaviors that may lead to concerns which include, but are not limited to the following:

    • Child doesn’t play with other children or acts in a very aggressive way.
    • Child doesn’t show empathy – for example, doesn’t try to comfort others who are hurt or upset.
    • Child appears very afraid, unhappy or sad a lot of the time.
    • Caregiver(s) expresses controlling behavior and/or show signs of jealousy with child.
    • Child's play repeatedly portrays abuse, family violence or explicit sexual behavior.
    • Child is excessively clingy, shows excessive attention-seeking behaviors with adults, or refuses to speak.
  1. Preschooler Behaviors

Explore the preschooler’s daily activities and routines with the caregiver(s) by asking the following:

    • How does the child start their day and what are they able to do on their own, such as eating with utensils, bathing, drinking from a cup without dribbling, dressing themselves, and following multiple steps when completing tasks?
    • What are their favorite foods?
    • What are their sleeping patterns, sleeping schedules, and do they wake up rested and ready for the new day? Does the child have frequent nightmares or is unable to sleep alone in their bed?

Observe and document the following:

    • The preschooler’s interactions with others in the household, interactions with their caregiver(s) and how caregiver(s) and child respond to each other.
    • How the child reacts when they do not get what they want.

Be curious about behaviors that may lead to concerns which include, but are not limited to the following:

    • Child doesn’t show empathy – for example, doesn’t try to comfort others who are hurt or upset or seems to intentionally cause harm to another person/child
    • Child appears upset or fearful around the caregiver(s)
    • Child has difficulty eating, dressing or using the toilet
    • Child is excessively clingy or shows excessive attention-seeking behaviors with adults, or refuses to speak
    • Child has signs of, or caregiver(s) reports the preschooler has self-injurious behaviors such as picking at skin, sucks excessively on skin/bangs head on surfaces, or is eating non-food items (pencils, dirt, paint off the wall)
  1. Preschooler Growth and Movement

Explore with the caregiver(s) expectations for growth, physical activity and the preschooler’s motor development by asking the following:

    • How does this child interact with their siblings, peers, and pets? Are they in anyway aggressive or fearful towards them?
    • Can the child use scissors, crayons, Legos, etc.?
    • Does the child engage in imaginary play and storytelling?
    • Does this child recognize colors and shapes?

Observe and document the following:

    • How the child plays with their pets, siblings, or others in the home and if they use too much force.
    • What the caregiver(s) shares about the child’s interest in crafts, activities, and if they have any of their school crafts.
    • Ask the child to tell you about their drawing and if they are aware of colors and shapes.

Be curious about behaviors that may lead to concerns which include, but are not limited to the following:

    • The caregiver(s) does not have any interest in enrolling child in a preschool/involve the child in preschool activities, or activities where they have social interactions with other children and adults.
    • The child is intentionally kept home with minimal physical activity, interactive/creative activity and/or social interactions.
    • The caregiver(s) speaks of the child in negative terms or reports the child is not interested in anything or anyone.

Teaming/Support (ages 4 to 5)

DCFS is to support creating a team, especially when it comes to children this young. Below is a list of possible team member(s) to Engage/Consult or invite to a team meeting. Coordinate first with the DCFS CSAT coordinator or co-located DMH staff whenever possible, for the most up-to-date clinical resources available. Here are some examples:

  • Family members and any other natural supports
  • Consult with co-located DMH partners to find an early childhood specialist/clinician
  • Parents’ health/ wellness needs: Consult with DMH duty staff for guidance
  • Regional Center Staff/Representative
  • PHN / Medical Social Worker / HUB / Pediatricians
  • MAT Assessors
  • Court Appointed Special Advocate (CASA) https://casala.org/refer-a-child/
  • Alternate caregivers/holders of developmental decision-making rights
  • 0-5 champion leads/services within region, when available in each office
  • Childcare provider/early childhood education director
  • Afterschool provider
  • School teacher/camp counselor
  • Educational rights holder and/or developmental decision-maker

Additional Areas of Concerns (Ages 4 to 5)

Being curious and exploring with the caregivers regarding preschooler’s concerns is a good place to start. Talk with the caregivers to gauge their awareness/concern. It is important to note that if there are any concerns, CSWs should consult with their SCSWs to discuss next steps.  Also, concerns should be followed up during subsequent visits.

  • Caregivers misunderstanding a child’s imaginary play and some aggressive behaviors as their child being defiant or a liar  
  • Caregivers are not able to provide proof of completed appointments
  • A preschooler at this age who can't tell stories
  • Caregiver indicating that the child is having difficulties when going to school and doesn’t know how to support them

Practice Tip-Gender Identity

Gender identity typically develops in stages. Around age two, children become conscious of the physical differences between boys and girls. Before their third birthday, most children can easily label themselves as either a boy or a girl. By age four, some children have a stable sense of their gender identity. Transgendered or non-binary children may also recognize this by age 5 and may ask to use another name or dress in non-traditional ways. Listen for these cues about the child’s development and ask the caregiver if they have any questions about gender identity. Consult with knowledgeable professionals as needed.

Supporting Child(ren) During Transitions: Removals/Replacements/Return Home/Adoption

Due to the nature of the Child Welfare System, children birth to five may experience numerous caregivers in a short timeframe when abuse and or neglect is present.  These transitions are severely detrimental to a child’s social-emotional development and should be avoided whenever possible. However, when it cannot be avoided, it is important to minimize the traumatic impact of the loss of a caregiver and aim to create a slow transition process so the child can adjust to a new caregiver. It should be noted that transitions for young children begin the moment child welfare becomes involved in a child’s life.

Removal from a Primary Caregiver(s)

  • It is important to work towards not only ensuring a child’s physical safety but also their emotional well-being, especially during a transition.
  • Whenever possible, try to keep siblings placed together to minimize the negative impact of a separation. If the child does not have siblings, work to maintain regular contact with other relatives or extended social support network.

  • For children who have experienced significant changes in caregivers during their life, it can be more difficult for them to develop a relationship with new caregivers. This impacts the quality of their relationships with caregivers and the ability to form and maintain connections to include family members, social supports and more.

  • Some questions to ask the child when verbal in preparation for and/or during a transition:

  • Who are the people who have taken care of them or have been actively involved in their life?
  • How can DCFS (and others) tell when they like and/or misses those people who they are attached to?
  • Some questions to ask the caregiver in preparation of and/or during a transition:

  • Who are the people in this child’s life that will keep the child safe (in the home, resource home, and in the community)?

  • What items help this child feel safe (routine, blanket, stuffed animal, food preferences/allergies, clothing preferences, pacifier, music, books)?

  • What information can we tell this child to feel safer (where they are going, if more changes are coming)?

  • Does this child act their age (younger or older)?

  • Is this child on target with eating, sleeping, moving, pooping, communicating, engaging with others?

  • How does this child play with other kids and adults?

  • What can DCFS (and others) do to support this child’s emotional development?

  • Encourage the current caregiver to maintain contact with the child, if appropriate. Maintain connections with parents and/or previous caregivers can ease the transition.

Practice Tip-Transitions

Moving away from a caregiver and a familiar home environment can be very scary and unsettling for any child. Ensuring that a child has a familiar transitional object will help them feel emotionally safe and can help them reach a state of calm sooner during the move. Attempt to pick one transitional object to support the child using each of the 5 senses (i.e., something that smells familiar, tastes familiar, feels familiar, etc.). It can be something that they normally sleep with, or something that reminds them of their previous caregiver or previous home (i.e., picture of their caregivers and/or family, favorite plush toy or book, blanket, parent’s t-shirt with their scent, etc.).

Practice Tip-Interpersonal Violence

All forms of Domestic Violence (DV)/Intimate Partner Violence (IPV)   (e.g., verbal, psychological and physical) can have negative consequences and impact a child’s development if left unaddressed.  When supporting a young child who is experiencing DV/IPV in their home, it is key to observe the relationship the child has with each parent to inform any safety concerns and next steps.  It is impossible to do a thorough safety assessment without these observations. If these observations are not possible, interview knowledgeable people about their observations of the caregiver/child relationship.  Please refer to relational concerns in children noted in previous sections of the policy.

Practice Tip-Family Time

Making a Family Time Plan is equally important to helping alleviate a child’s fears of separation from their caregiver and ensuring continuity of contact and relationship.  In addition to family time with caregivers, it is important for a child to have visits with their siblings and other important family members or extended family. Also, it important to consider the child’s schedule (i.e., naptime and/or bedtime) when making a family time plan. Finally, anticipate that the child may have behaviors that let you know they are having a hard time with the change in routine, environment, expectations, etc.

Practice Tip-Substance Use in Parents

When a baby and or birthing parent tests positive for substances at birth, it is key to observe the caregiver's ability to bond and understand the needs of the young infant. Substance use alone is not sufficient reason for detention.  Giving birth to a baby can be a stressful time for any new caregiver therefore it is important to assess the caregiver’s plan for safely caring for their baby, what supports the caregiver has available and what else is needed to support the young child and the new caregiver‘s relationship.  Refer to the Assessment of Drug and Alcohol Use/Abuse policy 0070-521.10 for further information.   

 

Child and Adolescent Needs and Strengths (CANS)

An additional tool that the information in this policy supports is the CANS assessment. The CANS assessment must be completed on every child with an open case.  The CANS has a specific section for children ages birth to five and can be used to support current needs and provide a picture of progress when the CANS is updated. Following the guidance from the Birth to Five policy will facilitate gathering the necessary information to fill out the CANS correctly. Below are some of the areas of the CANS assessment that this policy aligns to:

  • EC5 Attachment Difficulties
  • EC6 Adjustment to Trauma
  • EC7 Regulatory
  • EC9 Sleep
  • EC10 Family Functioning
  • EC12 Social and Emotional Functioning
  • EC13 Developmental/Intellectual
  • EC14 Medical/Physical
  • EC17 Prenatal Care
  • EC27 Natural Supports
  • EC29 Relationship Permanence
  • EC30 Playfulness
  • EC32 Emotional Responsiveness of Caregiver
  • EC33 Caregiver Adjustment to Trauma Exposure

Please refer to the Child and Adolescent Needs and Strengths (CANS) 0070-548.26

policy for additional guidance on the use of the assessment.

PROCEDURE

Assessing the Relationship Between Children Ages Birth to Five and Their Caregivers

ER/ERCP/DI/Case-Carrying/Adoptions CSW Responsibilities

Face-to-Face Contact

  1. Prior to face-to-face contact: 
    1. Review case records for the family to get a sense of the family dynamics and any possible concerns for caregivers. A case records review includes assessment results from CANS, Newborn Risk Assessment, MAT, HUB, HEP, Regional Center, etc.
    2. Review early childhood milestones prior to visits with children (CDC Milestone Link).
    3. Prior to a new investigation or a monthly home visit on an open case, the CSW should consult with their SCSW and appropriate service providers. Consider using the Consultation Worksheet which can provide guidance on protective factors.
    4. Using the guidance noted in the previous section, refer to the most supportive resources for the family.
    5. When a medical or developmental concern is noted or suspected, consult with PHN prior to the next visit.

Assessment During Visit

  1. During any face-to-face visit with a young child and their caregiver(s), the CSW should intentionally observe one or more of the following to assess for any strengths or concerns in the relationship:  
    1. Back and forth interactions and/or communication between the young child and the caregiver  
    2. Feeding interaction between a caregiver and a young child (breastfeeding, bottle feeding or chair feeding) 
    3. The caregiver and young child engaging in play 
    4. How a caregiver responds to the young child’s emotional cues (e.g., crying, asking for items, etc.) 
  1. What to ask caregivers during a visit about young children:
    1. Infants age birth to one: caregiver(s) and infant relationships, communication and feelings, infant self-soothing behaviors, infant growth and movement
    2. Toddlers aged two to three: caregiver(s) and toddler relationships, communication and feelings, toddler self-soothing behaviors, toddler growth and movement
    3. Preschoolers-Children aged four to five: caregiver(s) and preschooler relationships, communication and feelings, preschooler self-soothing behaviors, preschooler growth and movement
  1. When a concern is identified:  
    1. Be curious and explore with the caregiver(s) regarding the concern and gauge their awareness and their plan to address the concern. It is important to note that if there are any concerns that are not being addressed, CSWs should consult with their SCSWs to discuss next steps.

Documentation

  1. During or shortly after visiting with a child(ren) birth to five, the CSW should document the following:

    1. The observed back and forth interactions between caregiver(s) and child or the lack there of
    2. Information gathered regarding a child’s eating, sleeping and pooping patterns
    3. Any developmental strengths and concerns
    4. Any relationship strengths and concerns
    5. A caregiver(s)’s ability to respond to a young child’s needs (e.g., if a baby is crying, does the caregiver help soothe the baby)
    6. Any positive/happy interactions between a child and their caregiver(s)
    7. Any medical information and/or provider information
    8. Any natural supports important to the caregiver/child relationship
    9. Any significant change in the child or the child/caregiver relationship since the last visit

ER/ERCP/DI/Case-Carrying/Adoptions SCSW Responsibilities

  1. Complete a case consultation for all children birth to five from the first point of contact and ongoing at every contact/visit that includes the following:

    1. Identify the Worry Statement
    2. Consider assessing at least two of the six protective factors from the Consultation Worksheet, (which can provide guidance on protective factors) in order of priority beginning with Nurturing and Attachment, Social Connections, Knowledge of Child Development, and Social-Emotional Competence of Children
    3. Consider incorporating assessment results from other assessment tools and reports (e.g., CANS, Newborn Risk Assessment, MAT, HUB, HEP, Regional Center, etc.)
    4. Ensure that CSW documents in the case contact any assessment information about the child and caregiver and any observation about their relationship during their face-to-face visits
    5. Identify professionals that can be members of the Child and Family Team.
    6. Ensure that CSW has followed up on any referrals to and from the HUB, PHN, Regional Center, child’s primary care provider, MAT assessor, or any other medical/mental health specialist
    7. Consider accompanying the CSW on a home visit and modeling or coaching on observing child-caregiver interactions to reinforce their practice with children ages birth to five
  1. If the CSW needs additional training and support on Worry Statements and Protective factors, seek out the Regional Coach Developers or Countywide Coach Developers. Coaches can walk the CSWs through protective factors and worry statements using a real case vignette.

Servicing Children Birth to Five and Their Parents and Caregivers

ER/ERCP/DI/Case-Carrying/Adoptions CSW Responsibilities  

Teaming

The Department must support creating a team that includes all pertinent natural supports and professionals to ensure that they are talking to each other about the safety worries, especially when it comes to children this young. Below is a list of possible team member(s) to engage/consult or invite to a team meeting. Coordinate first with the DCFS CSAT coordinator or co-located DMH staff, whenever possible, for the most up-to-date clinical resources available. Here are some examples;

  • Child’s natural support system (family, friends, neighbors, etc.)
  • Consult with co-located DMH staff to find an early childhood specialist/clinician
  • Post-partum/ parents’ needs: Consult with DMH duty staff for guidance.
  • Regional Center Staff/Representative
  • PHN / Medical Social Worker / HUB / Pediatricians
  • MAT Assessors
  • Court Appointed Special Advocate (CASA) if appointed
  • Alternate caregivers/holder with education and/or developmental decision-making rights
  • 0-5 champion leads/services within region, when available in each office
  • Childcare provider
  • Preschool teacher/early childhood education director
  • Afterschool provider
  • School teacher/camp counselor
  • Cultural/Tribal representative
  • Parents in Partnership (PIPs)
  • LGBTQ+/SOGIE support/champion, as needed

Child and Family Team Meetings

  1. Staff engagements -
    1. As listed in the CFT policy and above, ensure that the correct team members are included in the staff engagement.
    2. Identifying protective capacities (the Consultation Worksheet can provide guidance on protective factors)
    3. Identify strengths and concerns in the relationship between the caregiver(s) and the child(ren)
  1. Family Engagement -
    1. Ensuring that at least one primary caregiver, if not all, is engaged for the CFT process.
    2. The Family engagement can be a good opportunity to explore:
       
      1. Goals the family has connected to strengthening the caregiver(s)-child(ren) relationship and what kind of parenting practices will support a healthy, safe relationship.
      2. Moments of shared happiness/joy between the caregiver(s) and child(ren)
      3. Worries the caregivers have about being parents
      4. Explore how key natural supports can support the relationship
  1. Child and Family Team Meeting (Planning) should include discussions on -
    1. Family Time w/ Parents and Siblings
    2. What is needed to strengthen the parent-child relationship
    3. Who can support (natural or professional) the parent-child relationship

ARA Responsibilities

  1. During a case consultation for a child aged birth to five, especially for decision making points: (Examples of areas where ARAs can use consultations: Domestic Violence/Intimate Partner Violence cases, when thinking about detaining a young child, releasing a young child to parents, VFMs)

    1. Ensure all staff know how to observe and assess child/parent relationships and can speak to any worries regarding these.
    2. Ensure all staff know how to form teams that help mitigate safety worries and support the parent/child relationship.  
    3. Ensure that CSWs and SCSWs can identify worry statements and assess for protective factors, especially Nurturing and Attachment and Social connections.
    4. With complex birth to five cases, use the Consultation Worksheet to guide case consultation, assessment of the child and family, and CFT development.
    5. Ensure that CANS assessment results are included in consultations where applicable or that information during the consultation can be used to inform scoring on the CANS assessment.
  1. Work with Regional Coach Developers or Countywide Coach Developers to ensure every Supervisor and Social Worker can clearly identify worry statements and are knowledgeable about protective factors especially, Nurturing and Attachment and Social Connections.
APPROVALS

None

HELPFUL LINKS

Attachments

Three Houses Tool

Three Houses-blank sheet

Young Children in Care Birth to Five Program Flyer

Young Children in Care Birth to Five Case Presentation Form and Instructions

Resources

The following list of resources is not all-inclusive.  Staff are encouraged to review these resources, each of which offers an array of services to support young children and their families. Coordinate first with the DCFS MAT coordinator, whenever possible, for the most up-to-date clinical resources available.

CASA https://casala.org/refer-a-child/

LACOE HSEL Prek-kid website  https://prekkid.org

Help Me Grow LA

First 5 LA https://www.first5la.org

LA County Libraries and Parks

Zero to Three https://www.zerotothree.org

Women, Infants, and Children (WIC),

Breastfeed LA,

California Breastfeeding Coalition

South LA Health Projects,

Forms

DCFS 6075, Consultation Worksheet

0-5 Developmental Milestones Checklist

0-5 Developmental Milestones Checklist (Spanish)

Referenced Policy Guides

0070-521.10 Assessment of Drug and Alcohol Use/Abuse

0700-504.20 Referring Children for Special Education or Early Intervention Services

0070-516.10 Assessing a Child s Development Referring to a Regional Center

0070-548.07 Assessing Expectant Parents and Parenting Families of Newborns

0070-548.01 Child and Family Teams

0080-506.11 Father Engagement

0400-504.00 Family Time

0070-548.24 Structured Decision Making (SDM)

0070-548.26 Child and Adolescent Needs and Strengths (CANS)

0070-537.10 Assessment of Domestic Violence

0600-530.00 Public Health Nurses (PHNs): Roles and Responsibilities

FYI #23-11 Consultation Worksheet

FYI #23-01 Partnerships for Families

FYI#22-20 New Born Assessment Tool

FYI#19-25 Multidisciplinary Assessment Team/Child and Family Team Meeting (MAT/CFT)

Statutes

Welfare and Institutions Code (WIC) 706.6. (a) - states that services to minors are best provided in a framework that integrates service planning and delivery among multiple service systems, including the mental health system, using a team-based approach, such as a child and family team

Welfare and Institutions Code (WIC) 361.8(a) - The newborn of the parenting minor or NMD parent shall not be considered to be at risk of abuse or neglect solely on the basis of information concerning the their placement history, past behaviors, or health or mental health diagnoses occurring prior to the pregnancy, although that information may be taken into account when considering whether other factors exist that place the newborn at risk of abuse or neglect

WIC Section 306(f)(3) – States, in part, that "Before taking a child into custody, a social worker shall consider whether the child may remain safely in his or her residence. The consideration of whether the child may remain safely at home shall include, but not be limited to, the following factors:. (3) Whether a nonoffending caretaker can provide for and protect the child from abuse and neglect and whether the alleged perpetrator voluntarily agrees to withdraw from the residence, withdraws from the residence, and is likely to remain withdrawn from the residence."

California Department of Social Services Manual of Policy and Procedures, Division 31.320.111 – Specifies in pertinent part that the purpose of social worker contact with the child is to verify the location of the child, monitor the safety of the child, assess the child’s well-being and to gather information to assess the effectiveness of services provided to meet the child’s needs, to monitor the child’s progress.

California Department of Social Services (CDSS) Manual of Policies and Procedures (MPP) Division 31-125 – summarizes the protocol for the social worker initially investigating a referral to determine the potential for the existence of any condition(s) which places the child, or any other child in the family or household, at risk and in need of services and which would cause the child to be a person described by Welfare and Institutions Code Sections 300(a) through 300(j).

California Department of Social Services (CDSS) Manual of Policies and Procedures (MPP) Division 31-201 – requires that when it has been determined that child welfare services are to be provided the social worker shall complete an assessment for each child for whom child welfare services are to be provided, and includes gathering and evaluating information relevant to the case situation and appraising case service needs.