Winter 1997, Volume 2, Number 2 HELPING CHILDREN WITH SPECIAL NEEDS

Children’s Services Practice Notes is a news- When a child is diagnosed with a medi- We also feature an important resource letter for North Carolina’s child welfare work- cal condition, there are often serious for families and practitioners working ers produced four times a year by the North Carolina Division of Social Services and the implications for the child and her birth, with children with special needs: the Family and Children’s Resource Program, part foster, or adoptive family. To support Family Support Network. of the Jordan Institute for Families and the these children and their caretakers, help- School of Social Work at the University of North ing professionals need information. Carolina at Chapel Hill. In this issue we present you with In summarizing recent research, we try to give basic information on Fetal Alcohol Syn- you new ideas for refining your practice. How- drome, Failure to Thrive, and Attention ever, this publication is not intended to replace regular supervision and peer consultation— Deficit Disorder. In addition to descrip- only to enhance them. tions that will help you recognize and understand the nature of these condi- Let us hear from you! If you would like to comment about something tions, we offer you guidelines for work- that appears in this or any other issue of ing with and supporting these families. Children’s Services Practice Notes, please do so! Address your comments to: NEGLECT AND FAILURE TO THRIVE John McMahon Jordan Institute for Families The girl lying in the crib has thin arms Doctors compare the infant’s weight UNC–CH School of Social Work and legs and wispy, dull hair. She looks and height and assess how that fits to Chapel Hill, NC 27599-3550 State Courier Number: 14-24-11 weak, underfed. The child’s cries standard weight/height charts. Tel: (919) 962-6484. Fax: (919) 962-3653. sound hungry to you, but her mother A child is said to be suffering from E-mail: [email protected] makes no move to feed or comfort failure to thrive when a doctor or medi-

Newsletter Staff her. As you explain that her daughter cal professional finds the child’s 1) Joanne Caye, MSW, Advisor needs to be examined by a physician, weight for his or her height is below Lane Cooke, MSW, Advisor you wonder: is failure to thrive always the 5th percentile of the population on John McMahon, MA, Editor Karen Randolph, MSW, Writer caused by neglect? a standard weight/height curve; 2) This article will explore the relation- actual weight is 20% or more below ship between failure to thrive and ne- the ideal weight for height; 3) weight glect, outline the characteristics of gain is significantly slower than nor- high risk groups, and discuss success- mal; 4) triceps skinfold thickness (a ful intervention strategies. measurement of the total body fat) is THE CONDITION below the 15th percentile for the popu- lation (Schmitt & Mauro, 1989). Less In the medical profession, the term precise indicators can be found in the failure to thrive (FTT) is used to diag- sidebars on pages 2 and 3. nose children, primarily infants, who are underweight and malnourished. continued on page 2 1 NEGLECT AND FAILURE TO THRIVE from page 1

Despite the scientific criteria doctors Joseph Fischoff and collegues have con- use, failure to thrive is difficult to detect— Mothers of infants ducted a study concluding that mothers of it is often misdiagnosed for people who with nonorganic nonorganic FTT infants tend to have char- are short, normally lean, or for infants who failure to thrive acter disorders, such as narcissistic per- have rapid shifts in their height, especially prioritized their sonality disorder or dependent personality between 6 and 12 months of age. Usu- needs as more disorder (Fischoff, Whitten & Pettit, 1971). ally FTT infants are delivered at full term important than their People with character disorders create chal- and are healthy at birth. child’s and blamed lenges for successful intervention because Failure to thrive can occur due to or- their babies for not their behaviors are ingrained and difficult ganic or nonorganic reasons, although gaining weight. to change. many infants with FTT have both types. Another study found that mothers of FTT Organic failure to thrive results from infants tended to blame their babies for fail- congential or genetic causes, such as illnesses that affect ing to gain weight, interpreted the meaning of their ba- the respiratory or cardiovascular systems. Nonorganic fail- bies’ crying in negative ways, and had difficulty bonding to ure to thrive results from accidental, neglectful, or deliber- their infants because they prioritized their own needs as ate action on the caretaker’s part. The majority of the more important (Haynes, Cutler, Gray, O’Keefe & Kempe, nonorganic FTT cases are due to caretaker neglect. Be- 1983). cause of this, FTT has long been a concern of child pro- INTERVENTIONS tection workers. Early intervention is important with FTT children and their CHILDREN AT RISK families. Those children who go untreated experience con- Children at high risk for nonorganic failure to thrive often tinued growth deficits, mental retardation, deficits in cog- come from families in which the mothers have experienced nitive skills (especially language), and problems in person- abuse and neglect in their childhood. These mothers of- ality development. Treatment of children with failure to thrive ten have difficulty relating to others, suffer from chronic involves close monitoring of the child’s growth, nutrition, depression, and feel overwhelmed and inadequate. They and developmental status over a long period of time. Chil- may be uncooperative with social workers or medical staff. dren sometimes require remedial help such as infant stimu- lation programs (Hathaway, 1989). RECOGNIZING THE SIGNS Because of the nature of The figure at left the symptoms, working with illustrates the a child who has been diag- differences nosed as failure to thrive re- between ad- quires collaboration with doc- equately fed tors and other medical staff. children (child “A” These professionals are man- and “C”) and dated by law to report sus- those who should pected cases of neglectful be examined for nonorganic failure to thrive to failure to thrive their local CPS agency. (child “B” and “D”).

Illustrations courtesy of G. S. In addition to the collabo- Huntington & N. Simeonsson, N. North Carolina Weight Gains Study. ration requirement in FFT AB C D Illustrations by Gina Harrison. Used with permission. cases, social workers often Girl, age 26 months Boy, age 13 months must decide whether to re-

2 TRAITS ASSOCIATED WITH FAILURE TO THRIVE

Growth Retardation Psychological Description Developmental Retardation • Child falls below the 3rd • Sadness • Motor percentile in weight and height • Expressionless face • Language Physical Description • General lethargy • Social • Wasted body, thin arms and legs • Withdrawal, detachment • Intellectual • Large stomach • Unresponsiveness • Elimination • Red, cold and wet hands and • Depression feet • Bursting into tears, frequent Source: Iwaniec, D., Herbert, M., • Thin, wispy, dull, and sometimes whining & McNeish, A. (1985). Social falling hair work and failure-to-thrive chil- • Little or no smiling • Dark circles around the eyes dren and their families. Part I: • Diminished vocalization Psychosocial factors. British Physical Symptoms Journal of Social Work, 15, • Staring blankly at people or objects • Refusal to take food 243–259. • Lack of cuddliness • Vomiting • Lack of proper stranger anxiety • Diarrhea move the child from the home. The criteria used to make better relationships between mother and child, research- this decision usually include the severity of the child’s con- ers used behavioral techniques. These involved role-play- dition, the mother’s openness to intervention, and whether ing and coaching the desired behaviors (e.g., how to give a plan of safety involving a relative, neighbor, or other a child positive cues during mealtimes) and a lot of praise interested person can be established. and positive reinforcement. In some cases, a placement decision may be postponed After the situation stabilized, the intervention focused because the baby requires hospitalization. This type of on long-term needs, such as the mother’s relationship to separation provides an opportunity to assess the mother’s her infant, her depression, and so on. Out of 18 cases, ability and willingness to care for the child upon discharge, only one child had to be readmitted to the hospital after while ensuring the child’s safety during the hospital stay. the intervention had ended more than one year later. u If the decision is made to keep the child at home, inten- References sive support of the family often leads to successful recov- Fischoff, J., Whitten, C. F., & Pettit, M. (1971). A psychiatric study of moth- ery. In a paper published in the British Journal of Social ers with infants with growth failure secondary to maternal deprivation. Work (1985), Dorota Iwaniec, Martin Herbert, and A.S. Journal of Pediatrics, 79, 209–215. Hathaway, P. (1989). Failure to thrive: Knowledge for social workers. Health McNeish reported on one such intensive in-home program and Social Work, 14(20), 122–126. working with FTT infants and their caretakers. Haynes, C., Culter, C., Gray, J., O’Keefe, K., & Kempe, R. (1983). Non-or- Once the child had been diagnosed, the immediate fo- ganic failure to thrive: Implications of placement through analysis of vid- eotaped interactions. Child Abuse and Neglect, 7, 321–328. cus was on attending to the safety and needs of the child Iwaniec, D., Herbert, M., & McNeish, A. (1985). Social work and failure-to- and family. The child was enrolled in day care, and rou- thrive children and their families. Part I: Psychosocial factors. British Jour- nal of Social Work, 15, 243–259. tine, ongoing contact in the home was scheduled with health Iwaniec, D., Herbert, M., & McNeish, A. (1985). Social work and failure-to- visitors, volunteers, and neighbors to provide moral sup- thrive children and their families. Part II: Behavioural social work inter- port and assistance with child care. If the family needed vention. British Journal of Social Work, 15, 375–389. Schmitt, B., & Mauro, R. (1989). Nonorganic failure to thrive: An outpatient help with housing or other issues of subsistence, that was approach. Child Abuse and Neglect, 13, 235–248. addressed. To accomplish specific treatment goals, such as creat- The NC Department of Human Resources does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability in employment or the provision of services. 2,700 ing calm feeding of the child by the mother and facilitating copies printed at a cost of $ or $ per copy. 3 SUPPORTING FAMILIES WHOSE CHILDREN HAVE F.A.S. One out of every 750 children born in the U.S. has fetal abilities, seizures, developmental delays, and behavioral alcohol syndrome (Merolla, 1993). Fetal alcohol effect (FAE) disorders. and fetal alcohol syndrome (FAS), the more severe mani- Other common effects of FAS include sleep distur- festation, are organic brain disorders in children caused bances, difficulty in peer and sibling relations, hyperactiv- by a mother’s use of alcohol during pregnancy. Poor ity, difficulty developing independent skills, and excessive parenting after birth does not cause FAE or FAS. These talkativeness (Guiunta & Streissguth, 1988; Vaitenas, 1981; are lifelong conditions that can affect anyone, regardless NCFCRP, 1994). It is important to resist the temptation to of race or economic status (Montana FAS/FAE Program, focus strictly on the negative traits of children with FAS: 1996). parents and those who work them have also found these THE CONDITION children to be socially engaging, interested in others, af- fectionate, and good with animals. (See sidebar below.) Fetal alcohol syndrome is caused when a mother drinks Children with FAS cannot be diagnosed definitively until alcohol during pregnancy, injuring the fetus by destroying three years of age because they are developmentally inca- and damaging cells in the central nervous system. This pable of completing the tests until then. However, children destruction of brain cells results in malformations in the and families benefit significantly from an early diagnosis— developing brain structures. Several studies indicate that even a preliminary one. This information can help them the severity of the disability has to do with the amount of shape their expectations and obtain support and interven- prenatal exposure to alcohol (NCFCRP, 1994). Most chil- tion for the child, and so avoid the cycle of failure at home dren with FAS are born to women who are chronic alcohol- and school that is almost certain without diagnosis. ics, although even moderate use of alcohol during preg- nancy can result in FAE or FAS (Coles, Smith & Falek, 1987). SUPPORTING PARENTS When they are born, children with FAS are frequently The first thing parents need is understandable, practical small and have a low birth weight. Often they are born information about FAE and FAS. Given this information and prematurely. Physical characteristics of children with FAS the proper amount of support, caretakers will begin to get include abnormally small heads, facial irregularities (such a realistic view of the child’s current and future function- as thin or wide lips or malformed or misalligned teeth), ing; from there they can develop reasonable expectations. widely spaced eyes, short noses, flat cheeks, limb and Parents also need a substantial amount of support. Chil- joint abnormalities, poor coordination, and heart defects. dren with FAE/FAS require a great deal of supervision, and (See sidebar on page 5 for illustration.) Central nervous this can be exhausting for birth, foster, and adoptive par- system damages sometimes are manifested as develop- ents. Day care, respite care, and other relief from parenting mental disabilities, attention deficit disorder, learning dis- alllow caretakers to rejuvenate and reenergize. Siblings may also have needs to be addressed (Montana, 1996). Birth mothers may require special support. They are A BEHAVIOR PROFILE OF FAS likely to be active or recovering alcoholics who need help • Extremely active • Socially engaging addressing their substance abuse and the affects it may • Easily Distracted • Interested in others have had on numerous areas in their lives. They may ben- • Impulsive • Affectionate efit from substance abuse counseling, parenting classes, • Poor judgement • Loving or nutritional counseling. The stress of caring for a child • Poor communication • Talkative with behavioral and medical problems may make it more • Problems with transitions • Good with animals difficult for these women to maintain sobriety. Some moth- • Hard time bonding/keeping • Makes friends easily ers may also need help working through feelings of guilt friends (Giunta & Streissguth, 1988). Source: Montana Fetal Alcohol Syndrome/Effects Program, Department of Medi- When it is necessary to place children with FAS in fos- cal Genetics, Shodair Hospital, Helena, Montana. Reprinted with permission. ter care, there are certain characteristics to look for in

4 FACIAL CHARACTERISTICS OF FETAL ALCOHOL SYNDROME

Photos courtesy of Carole T. Giunta and Ann Pytkowicz Streissguth, from the their article “Patients with Fetal Alcohol Syndrome and Their Caretakers,” Social Casework, Sept. 1988. Publisher: Families International, Inc.

Above: children with FAS. Right: Diagram of facial features of FAS. Any one or two of the characteristics at right may be nor- mal, given genetic predetermination. It is the collection of char- • Epicanthal foldsfolds: fold of skin at inside corner of eye acteristics which assumes diagnostic significance. The features • Microcephalyocephaly: small head circumference on the left are those most frequently seen in people with FAS. • Micrognathiaognathia: small jaw Those on the right are also seen with increased frequency in • Palpebral fissuree: opening of eye from side to side the normal population (Little & Streissguth, 1982). Note: in the • Philtrumum: vertical grooves between base of nose and upper lip absence of the above external physical characteristics associ- ated with full FAS, a person with Fetal Alcohol Effects (FAE) may Illustration adapted from Little & Streissguth, A. P. (1982). Unit 5: Alcohol, pregnancy, and fetal alcohol syndrome. In Project Cork (Ed.), Alcohol Use and Its Medical Consequences, A Comprehensive Teaching still have significant organic brain differences. Program for Biomedical Education. Dartmouth, ME: Dartmouth Medical School. Reprinted with permission. foster homes. Giunta and Streissguth recommend placing cific instructional plans to meet the child’s learning needs. these children in homes of parents “who are calm and low- Preschool activities should also be considered, not only key individuals, secure and comfortable with themselves, to maximize the child’s development, but also to provide and who live stable and predictable lives” (p. 457). The au- respite to the caretaker. thors found that parents who led busy, complex lives were Finally, caseworkers need to work with caretakers to more inclined to be dissatisfied with FAS children’s slow de- advocate for children with FAS. Parents will need help velopment (Giunta & Streissguth, 1987). exploring all avenues for financial assistance, since FAS Those who are new to parenting this type of child may children have specialized and often costly medical and find connecting with other parents of kids with FAS helpful. educational needs. u Caretakers can benefit from a support group with caretak- References ers of other children with the condition. The Parent-to-Par- Coles, C., Smith, I., & Falek, A. (1987). Prenatal alcohol exposure and in- ent program is another resource that helps parents of chil- fant behavior: Immediate effects and implications for later development. Advances in Alcohol and Substance Abuse, 6(4), 87–104. dren with special needs in North Carolina connect with one Giunta, C., & Streissguth, A. (1988). Patients with fetal alcohol syndrome another. To contact this program, call 1-800-852-0042. and their caretakers. Social Casework, 69(7), 453–459. Collaboration with the school system is also critical for Merolla, C. (1993, July 19). Could I give this child back? First for Women, 5(29), 80–82. social workers serving children with FAS. Because kids with Montana Fetal Alcohol Syndrome/Effects Program. (1997). Facts about FAS this condition have special educational needs—they func- and FAE (On-line). Available: http://members.aol.com/jshawdna/fas2.htm. tion best in a small classroom with clear guidelines and North Carolina Family and Children’s Resource Program. (1994). Fetal alco- hol effect/fetal alcohol syndrome. In Caye, J. (Ed.) Performance Based plenty of individual attention—social workers often have to Core Curriculum in Child Welfare, pp 6-19 through 6-20. Chapel Hill, advocate for appropriate educational services. Periodic test- NC: author. ing is recommended to assist teachers in designing spe- Vaitenas, R. (1981). Children with special needs: Perinatal education for adoption workers. Child Welfare, 60(6), 405–411.

5 GETTING TO KNOW ADD AND ADHD ADD and ADHD. We’ve all heard the terms, and by the presence of an attention disorder: self- many of us seen behaviors associated with esteem, frustration management, and a them. Still, what is attention deficit disorder? In sense of self control. this article we describe these conditions and It was thought until recently that ADD and provide some tips for working with children di- ADHD are conditions only applicable for chil- agnosed as ADD/ADHD and their families. dren, and that they can outgrow it. Increas- Attention deficit disorder with and without ingly, experts believe that for some people it hyperactivity (ADD/ADHD) is a neurological con- ADD and ADHD can can be a lifelong problem. dition that impairs a child’s learning, social and undermine a child’s The causes of attention deficit disorders self-esteem, ability emotional functioning. It has no known cure. are not totally known. Until recently, many to manage frustra- Symptoms include inattention, impulsivity people thought ADHD and ADD were caused tion, and his sense by the overconsumption of sugar, food addi- and hyperactivity at age-inappropriate levels of self control. and can vary in degree (Aust, 1994). Inatten- tives and dyes, vitamin deficiencies, or lead tion behaviors may include poor listening skills, difficulty poisoning. While these aspects may exacerbate symptoms completing tasks, daydreaming, and/or inability to com- or functioning difficulties, the most recent medical research plete projects. Impulsive behaviors may include low frus- indicates that ADHD and ADD may be genetic. tration tolerance, interrupting often, acting before think- AD(H)D is difficult to diagnose. Symptoms vary from ing, losing things and/or rushing through assignments. child to child and the problems often coexist with various Hyperactive children can be overactive (fidgeting, squirm- learning, social, and emotional problems (Aust, 1994). If ing, climbing), underactive (appearing confused, lethargic, ADD or ADHD is suspected, it is critical that a thorough sluggish and/or daydreaming), or over-focused (working evaluation be conducted by trained medical personnel. u slowly, intolerant of minor distractions, checking and re- Aust, P. (1994). When the problem is not the problem: Understanding attention checking work). Children with mild symptoms function fairly deficit disorder with and without hyperactivity. Child Welfare, 74,(3), 215–227. North Carolina Family and Children’s Resource Program. (1994). What is ADD/ normally both in the home environment and in school. Chil- ADHD. In Caye, J. (Ed.) Performance Based Core Curriculum in Child Wel- dren with severe symptoms can be affected in all areas of fare, pp 6-45 through 6-49. Chapel Hill, NC: author. their daily living. Ziegler and Holden (1988) identify three Ziegler, R. & Holden, L. (1988). Family therapy for learning disabled and at- tention-deficit disordered children. American Journal of Orthopsychiatry, important aspects to a child’s development undermined 58(2), 196–210.

STEPS YOU CAN TAKE GUIDELINES FOR PARENTS

• Provide opportunities for the child and family to become • Assign only one task at a time and have the child educated about AD(H)D so everyone understands the repeat the instructions. biochemical nature of the problem, and that sometimes the • Soak success in praise and pride. child may be unable more than unwilling. • Expectations and consequences should be worked • Have the child seen by a physician to determine if medication out in advance and followed consistently by all adults could be useful. in the home and at school. • Ensure that an appropriate educational plan is in place, and • Focus on shaping new positive behaviors rather than that school personnel are equipped to teach in a manner in eliminating the negative ones. which the child can flourish. • Develop and maintain a predictable daily schedule, • Link caretakers to training in behavior management especially for completing homework assignments techniques, and ensure an adequate support system. • Anticipate and plan for sleep problems; seek medical • Set up individual, small group, or family counseling to help assistance if they become severe. address daily living problems that accompany parenting a • Seek counseling and consultation to help with the day child with AD(H)D. to day management of the child. Source: Aust (1994, p. 224–225) Source: (Aust, 1994; NCFCRP, 1994) 6 NORTH CAROLINA ISSUES CHALLENGE FOR CHILDREN Citing the success of the Families for FitzGerald writes, “our Families for Although a final list was not avail- Kids counties, the North Carolina Divi- Kids initiative has demonstrated that able at press time, at least 58 coun- sion of Social Services began 1997 important progress is possible ties accepted the challenge by the by challenging county departments of through establishing backlog reduc- April 15 deadline. “We’re very ex- social services to reduce the amount tion and ‘one year to permanence’ as cited—the response has really been of time children spend in DSS custody. a clear agency priority.” By increas- great,” says Sara Anderson-Mims, Currently the median length of stay in ing the amount of teamwork in their Community Coordinator for the Divi- DSS custody for a child in North Caro- agencies, collaborating with other sion. Following is a partial list of those lina is 518 days, according to the N.C. agencies, and involving the commu- who have accepted the challenge. u Child Placement Information and Track- nity, he says, “the Families for Kids ing System. counties have reduced the number of CHALLENGE FOR In a letter sent out in January, N.C. children in the backlog by 5 percent.” CHILDREN COUNTIES Division of Social Services Director Those county DSS’s that accept the Prelminiary List Kevin M. FitzGerald issued a “Chal- Challenge for Children have been lenge for Children” and asked each of asked to submit a statement of ac- Alamance Macon the directors of social services in the ceptance to the N.C. Division of So- Alexander Madison state’s 100 counties to make reduc- cial Services bearing the signatures Alleghany Martin tion of the foster care backlog a top of all of the agency’s child welfare Anson Mecklenburg priority during 1997. The “backlog” is social work and supervisory staff. So Avery Mitchell made up of all children who remain in that the state can track their success Buncombe* Nash the custody or placement responsibil- at reducing the backlog, each partici- Burke Orange ity of a county department of social pating county must also submit de- Cabarrus Pasquotank services for more than 12 months. mographic information for each child Caldwell Pender Part of the inspiration for the chal- who was in the backlog on January 1, Caswell Randolph lenge comes from the Families for Kids 1997. Next year, the Division will ask Catawba* Richmond* initiative. “Although this goal (reduc- for information on children in the back- Cleveland* Rockingham ing the backlog) seems challenging in log on January 1, 1998. Craven Rowan light of available resources,” The Division will publicly recognize Dare Rutherford those counties that Davidson Scotland succeed in making Davie Stanly HOW DOES NORTH CAROLINA COMPARE? significant reduc- Edgecombe* Stokes How does North Carolina match up to other states tions in the foster Forsyth Surry when it comes to the length of time children spend care backlog during Franklin Transylvania in state custody? The figures in the following table 1997. Recognition Gaston Union represent the median length of stay during 1988– will come in the form Guilford* Wake 93. The median length of stay in North Carolina of news releases, Halifax Washington today is 17.3 months. press conferences, Harnett Watauga State Months in Care celebrations in the Haywood Wayne* Texas 8.7 counties, and letters Hoke Wilkes Michigan 12 of commendation to Iredell* Wilson North Carolina 18 boards of county Jackson Yadkin California 18.1 commissioners, Jones Yancey New York 24.5 county managers, Lee Illinois 35.8 and legislative repre- Lincoln Sources: Multistate Data Archive and the N.C. Child Welfare Database. sentatives. *Families for Kids counties 7 HOTLINE OFFERS INFORMATION ON SPECIAL NEEDS What do you do when the child you are working with has a Here is an example of a typi- medical condition you know nothing about? Where can you cal call to the CDR: the caller iden- get information about this condition to give to foster par- tifies herself as a social worker ents and others who are providing services to him? from eastern North Carolina. A One option is to call the Family Support Network of few hours earlier, her agency North Carolina. Since 1985, the Family Support Network took custody of a child with has been providing support and information for families of Prader-Willi Syndrome, and she children with special needs and the professionals who serve knows little about this condition. them. To meet the needs of these families, this organiza- The resource specialist informs Need to know more tion maintains a network of parent-to-parent programs her that the CDR has material de- about a medical condi- across the state, organizes parent/professional training scribing the syndrome, as well as tion? Call the Family Support Network toll activities, and runs the Central Directory of Resources. material to help the foster parents free at 1-800-852-0042. The Central Directory of Resources (CDR) is a comput- with whom she will place the child. erized resource that can be reached by calling (800) 852- The resource specialist promises to send the material 0042. In the CDR’s extensive database are printed materi- immediately, along with names of organizations that can als about various disabilities, illnesses and conditions, as provide more information about Prader-Willi Syndrome. She well as articles on behavior management and family is- also encourages the caller to have the child’s foster par- sues. The CDR’s database also contains a comprehensive ents call the CDR if they would like to talk to another par- list of agencies and organizations, in North Carolina and ent whose child also has Prader-Willi Syndrome. across the country, that provide services and support for The Family Support Network’s Central Directory of Re-

people with disabilites. sources can be reached by calling: 1-800-852-0042. u

IN THIS ISSUE: HELPING CHILDREN WITH SPECIAL NEEDS SPECIAL WITH CHILDREN HELPING ISSUE: THIS IN

State Courier # 14-24-11 # Courier State

Chapel Hill, NC 27599-3550 NC Hill, Chapel

Campus Box 3550 Box Campus

UNC–School of Social Work Social of UNC–School

Jordan Institute for Families for Institute Jordan

Family & Children’s Resource Program Resource Children’s & Family

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