Defining the Intervention


In October 2010, California had 19,647 children under the age of 6 in supervised foster care.  Due to these alarming numbers, the child welfare system is being called upon to focus attention on this very young, vulnerable, and typically silent population.  



More children are entering foster care in the early years of life than ever.  In California, of the 19,467 children under the age of 6 in supervised foster care (October, 2010):

  • 3313 children under 1 year old
  • 7586 1-2 year olds
  • 8747 3-5 year olds
  • 34% of the all children (57,954) in California are in Foster Care

When child are not attached to or bonded with parents, parental figures, siblings, and other caretakers, this causes an array of problems which show up acutely in foster care.  The impacts are this:   

  •  Developmental Delays – physical, cognitive, and emotional.
    • Lack of consistent and enriched experiences in early childhood can result in delays in motor, language, social and cognitive delays.
  • Eating problems – hoarding, odd eating patterns, eat as if it is the last meal, failure to thrive, swallowing problems, throwing up food
  • Emotional Functioning – depression and anxiety
    • May see indiscriminate affection with strangers
  • Inappropriate Modeling – Children may model adult behavior
  •  Aggression – children may lack empathy and have poor impulse control



Birth to Six is a series of interventions recommended to child welfare staff that they implement as a way to mimimize trauma for young and vulnerable children.  It focuses on the need for child welfare and related systems to respond more sensitively to the developmental, soical and emotional well-being of children from birth to six.  Child welfare agencies will look to further enhance their practices to foster healthy attachment in these young children as they assess their current delivery system. While some children must be separated from their parents for protection, the initiative will provide tools to aid in decreasing trauma and stress for children, when they enter foster care.   

The interventions focus on activities to support brain development, attachment and bonding that occur during the early years of life.  According to Bruce Perry, M.D., Ph.D., expert in child trauma, attachment is the following:

  • Special enduring form of “emotional” relationship with a specific person
  • Involves soothing, comfort and pleasure
  • Loss or threat of loss of the specific person evokes distress
  • The child finds security and safety in context of this relationship

Bonding is the process of forming an attachment. When children enter foster care they are impacted by neglect and abuse. When young children enter foster care, these early experiences can impact their ability to form secure, healthy attachments. On top of this, if children experience multiple placements and multiple caregivers, they are doubly impacted.



  1. Meet the developmental needs of children in Foster Care
  2. Minimize the impact of separation and trauma on the development of young children
  3. Decrease the number/rate of children in Foster Care
  4. Decrease the length of stay of children in Foster Care


  1. The child welfare system will increase assessments of children
  2. Children will recieve a greater number of referrals for health screenings, dental screenings & evaluation 
  3. Child welfare staff and partners will receive training in assessment, visitation, and the rerferral protocol process



logic model was developed to show a depiction of the process of implementation and portray the things needed for the successful implementation of a Birth-to-Six initiative. 

  • The resources (inputs) show a list of all of the potential stakeholders that may be involved in such a project. 
  • The activities (outputs) are the interventions employed at the organizational level. 
  • The short, medium and long term outcomes are the desired improvements for children. 

Philip Fischer at the Oregon Social Learning Center and Mary Dozier at the University of Delaware state: “Children in this age group are especially vulnerable, due to the combined effects of maltreatment, relationship disruptions, and caregiver transitions.” It is in these early years when brain development is most active. The structures that govern learning processes, coping with stress, trauma, and emotions are established. Any negative environmental conditions, including neglect and abuse, separation from a primary caregiver, etc., influence and may impair brain development.

Timing is Everything

Attachment has been defined as a deep, intimate emotional two-way connection between caregiver and child which has its roots in sensitive, predictable care. It is an enduring emotional bond between the infant/young child and the primary caregiver. One area of recent research focuses on biological markers in young children as a physical indication of the level of stress they are experiencing. These biological factors may indicate these children are ill-prepared to manage stress and may put them at risk to develop psychiatric disorders (Dozier & Fisher, 2006).

Promising work in Biobehavioral and other therapeutic foster care models reveal some hope for helping to mend faulty attachment in young children. “Having at least one adult who is devoted to and loves a child unconditionally, is prepared to accept and value that child…this is the key to helping a child overcome the stress and trauma of abuse and neglect.”(Pediatrics, 2000, 106(5), 1145-1149). The paramount charge for child welfare is to find and foster the attachment between the primary caregiver (biological parent as well as foster parent) and the child.



A comprehensive infant mental health evaluation can identify previously unknown and unmet emotional and developmental needs and clarify differential diagnoses.  Three issues must be addressed when assessing infant mental health:

  1. Developmental perspective
  2. Interdisciplinary input
  3. Involvement of parent or foster parent

See this document for explanatory information about child assessment

The Ages and Stages Questionnaire is designed for professionals to assess development and social-emotional behavior in children from the ages of 0 - 5.5 years old.  The assessment tool attempts to identify strengths and challenges.  It helps to educate parents about developmental milestones.  

For more information about Ages and Stages: