Law Times

Page 12 February 10, 2014 • Law Times www.lawtimesnews.com Training for lawyers planned development trajectories of young children. Yet the child welfare and legal systems haven't functioned to safeguard infant mental health. "Everyone is so focused on older kids," says Chaya Kulkarni, director of infant mental health promotion at the Hospital for Sick Children in Toronto. "eir issues and problems are so difficult and immediate that you can't ignore them. e system has to respond immediately. e little ones aren't in anyone's view." Kulkarni points to the Jef- frey Baldwin case as an ex- ample where the system failed to monitor development. "Jef- frey came into the system and was placed in the care of his grandparents who neglected him horribly. He died at age five weighing 21 pounds. at highlights for us that if it was a requirement in the system for the agency to watch develop- ment, someone would have picked that up." In the hopes of developing a system that's responsive to the risks of delay, the infant psychia- try department at SickKids has tried a number of projects, includ- ing an attempt to set up a thera- peutic justice model locally. Dr. Deborah Goodman, director of the Child Welfare Institute at the Children's Aid Society, prepared a report in 2010 to support the project that describes therapeutic jurisprudence as an intellectual framework for interdisciplinary approaches to studying mental health law. "A tenet of the con- ceptual framework is that the law and its players [lawyers, judges, and therapists] can either produce therapeutic or non-therapeutic consequences," she says. e report detailed the suc- cess of a similar project in Florida where there were no further re- ports of abuse for any of the study participants and interventions resulted in permanency plans for all of the children. e health and developmental status of infants improved, as did parent-child functioning, and caregivers re- ported a reduction in depressive symptoms. ere were also sub- stantial cost savings as a result of a decrease in mistreatment. e local project was a court- based model meant to empower the Brampton, Ont., courthouse to be a therapeutic agent on be- half of infants and their families. "We had it all up and ready," says Dr. Jean Wittenberg, chairman of the infant psychiatry program at SickKids. "We created a network of agencies that were prepared to deem people going through the court system as a priority. Usu- ally, it takes months to get assess- ments." Unfortunately, the Peel Children's Aid Society, which was the central welfare agency in the scheme, made a decision that it didn't have enough children of that age to warrant the program. "Once the main catchment group drops out, the network falls apart," says Wittenberg. Since then, Infant Mental Health Promotion has been work- ing to advocate, educate, and de- velop tools to track development in children under three years old who are involved in the court sys- tem. Judges are potential leaders in this area. "If judges don't lead, nothing will happen," says Witten- berg. "But judges alone won't work either. e whole system needs to be aware of the issues." He identifies lawyers as anoth- er key target group. "It's essentially a collaborative model as opposed to adversarial. If one part is work- ing adversarially, it won't work." Dr. Jean Clinton of McMaster University is currently working on a policy paper for the Ontar- io Centre of Excellence for Child and Youth Mental Health that supports mental health in the early years. "We will be mention- ing in the dra paper the need for those involved in the legal system to have an understand- ing of infant brain development and that babies' brains don't go on hold until decisions are made. ere is a pressing need for case law and legal literature on this important issue." Advocacy work is underway to provide more information to all of the key stakeholders. "We are working at the frontline level on the need to look at children's development in a structured way and present it in a more effective way in court," says Kulkarni. "Ad- vocates need to have an under- standing of what infant mental health and trauma looks like." Infant Mental Health Promo- tion is also promoting the use of development screens and devel- opment plans that identify goals for each child. Kulkarni has en- countered some territorialism in this area. "Some disciplines believe they're the only ones with the ability to do screening. For a full-blown assessment, I would agree. e beauty of development screening is that many other disci- plines can do it. It is not diagnostic. It sends up red flags." In 2013, Infant Mental Health Promotion successfully complet- ed a pilot project with the Chil- dren's Aid Society applying the model development screens. "We had our control group and our in- tervention group," says Kulkarni, who notes a high percentage of the children involved already had an established risk for delay. "If it weren't for the fact that we hap- pened to be there, it would have been business as usual for them." At the end of the project, the intervention group had higher scores. Following the success of the pilot, a revised model is in the final stages of review. "is is mostly directed at child welfare workers," says Kulkarni. "In the past 18 months, we have really focused on rolling out a way for child welfare agen- cies to serve infants and toddlers and prepare the worker for when they go to court." She's already observing a change in the culture of the court. "Judges have begun to ask for development screens. at's a big step in this field. Now we have funding to create three online training modules that will be housed on the Na- tional Judicial Institute portal. at's a federal organization, but provincial judges go there to look for training, too." Infant Mental Health Promo- tion is also attempting to connect with agency lawyers and the fam- ily law bar as a whole, says Kulkar- ni. "We are planning a training ses- sion in the spring to give lawyers a better sense of how to use the development screens and support plans. 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