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Infants in placement

  1. 1. Copyright 2011 ZERO TO THREE. All rights reserved. For permission requests, visit A Call to Action for Infants and Toddlers in Foster Care MATTHEW E. MELMED ZERO TO THREE, Washington, DCA buse and neglect—and how our child welfare systems principle: The care of very young children often respond—threaten the healthy future of thousands known to the child welfare system must be of infants and toddlers. Their brains are developing at life- designed according to—and with the goal altering rates of speed. Maltreatment chemically alters of meeting—their developmental needs. that development and can lead to permanent damage to Policymakers at all levels of government and infant–toddler practitioners need to place a the brain’s architecture. Every year, 196,476 children from high priority on meeting the needs of this age birth to 3 years old come into contact with the child welfaresystem (U.S. Department of Health and Human Services [DHHS], 2010b);76,862 are removed from their parents’ care (DHHS, 2010a). As a society, we have a moral imperative to practice on this age group with its unique Abstractprotect children. This is especially so in cases developmental needs and opportunities. The Almost 200,000 infants and toddlerswhere it is determined that children need to threats to young children who are at risk for come into the child welfare systembe removed from their parents or caregivers. abuse or neglect or who are placed in fos- each year. They do so during the periodWe must do all that we can to ensure that all ter care are significant; however, very few of the most rapid brain development.children are in a safe environment and that initiatives, policies, or practices recognize Maltreatment can damage theno child falls through the cracks. We can- their special vulnerabilities. Current prac- architecture of the developing brain,not afford to discard potentially productive tices compound the effects of maltreatment. with lifelong consequences for bothmembers of our workforce by ignoring their When young children are placed in nonfam- baby and society. The child welfaredevelopmental needs. Put another way, we ily group settings, moved from home to home system has not done well at addressingcannot afford to burden our economy with in foster care, denied developmental assess- the developmental needs of infants andthe demands that maltreated babies will make ments and services, and kept from frequent toddlers (in some instances, actuallyas they grow up. Costs associated with special visits with parents and siblings, developmen- doing more harm). The author, theeducation programs, foster care, incarcera- tal damage continues to escalate. We have executive director of ZERO TO THREE,tion, mental health services, drug and alcohol an opportunity to protect these children and argues for a policy agenda makingrehabilitation, and the risk of continuing the resolve the developmental damage caused by vulnerable infants and toddlers acycle of maltreatment with their own chil- early maltreatment. priority and creating a developmentaldren are burdens our society can ill afford. It is time for a call to action on behalf approach to their care, with a call However, there has been no concerted of these extremely vulnerable infants and to action for policymakers andeffort to focus child welfare policy and toddlers and their families. The guiding practitioners to join this effort. January 2011 Z e ro to Three 2 9
  2. 2. 2002). The most recent look at data on infants and toddlers in foster care, reported At a Glance: Facts About by Wulczyn, Chen, Collins, and Ernst (this Infants and Toddlers issue, p. 4) shows that these trends continue. • Children between birth and 1 year old Unquestionably, infants and toddlers are have the highest rates of victimization the most vulnerable age group (see box At a (DHHS, 2010b). Glance). They constitute almost one third of all children who are abused or neglected. Of • Infants and toddlers constitute more the estimated 1,740 children who died from than one quarter of all children who are abuse and neglect in 2008, more than three abused or neglected (DHHS, 2010b). quarters (79.8%) were 3 years old or younger • Every day, 210 babies are removed from (DHHS, 2010b). their homes because their parents cannot Children who initially enter the foster care take care of them (DHHS, 2010a). system as infants have considerably different • Infants and toddlers accounted for 31% discharge patterns than their counterparts of children who entered foster care in who enter foster care at older ages. 2009—the largest single group of Infants are much less likely to achieve children entering care (DHHS, 2010a). reunification with their families than chil- Sixteen percent were less than 1 year old.Photo: Marilyn Nolt dren in any other age group. As Wulczyn and • Once they have been removed from their colleagues (this issue, p. 4) illustrate, infants homes and placed in foster care, infants who enter foster care before they are 3 months and toddlers are more likely than older old are unlikely to return to their parents. For children to be abused and neglected and those infants who do achieve reunification, to stay in foster care longer (Wulczyn & one third will re-enter the child welfare sys- Hislop, 2002). Infants are much less likely to achieve tem (Wulczyn & Hislop, 2000). Almost half reunification with their families than • A total of 1,740 children died from abuse (49%) of the children waiting to be adopted in children in any other age group. and neglect in 2008; more than three FY2009 were 3 years old or younger when they quarters (79.8%) of these children were were removed from their parents or caretak- 3 years old or younger (DHHS, 2010b). group, raising awareness, designing policies, ers; 25% were less than 1 year old. However, and implementing practices to ensure that only 2% of children adopted in FY2009 were (a) when infants and toddlers are known to less than 1 year old, because of the length of the child welfare system but remain with their time it takes to go through the process leading architecture of the developing brain, prevent- families, there are preventive services avail- to adoption (DHHS, 2010a). ing infants and toddlers from fully developing able to support the protective factors that Approximately one third of infants and the neural pathways and connections that promote healthy development; and (b) when toddlers investigated by child welfare ser- facilitate later learning. Maltreatment experi- infants and toddlers must be removed from vices have a developmental delay. Data from ences alter the brain’s architecture (Shonkoff, their homes, the foster care that ensues and the National Survey of Child and Adolescent 2007). These changes in the brain give rise to the supports offered to their parents will help Well-Being indicate that 35% of children several psychological difficulties—cognitive heal the effects of maltreatment and support from birth to age 3 years who were involved delays, poor self-regulation, and difficulty in healthy development. The federal govern- in child welfare investigations were in need paying attention (Jones Harden, 2007). ment should show leadership in creating such of early intervention services. However, only a focus. However, state and local child wel- a small number (12.7%) of these children Infants and Toddlers Need at Least One fare agencies, as well as local communities in need were receiving the Individualized Nurturing Relationship to Thrive and practitioners, are in a position to make Family Service Plans to which they were enti- The first relationships a child forms real changes in how the needs of very young tled under federal law (Casanueva, Cross, & with adults have the strongest influence on children and their families are met and should Ringeisen, 2008). social and emotional development (National also move forward to meet this goal. Research Council & Institute of Medicine, The Developing Brain Is Harmed by 2000). Infants and toddlers rely on their A Portrait of Infants and Toddlers Abuse and Neglect closest caregivers for security and comfort. in the Child Welfare System Neuroscientific research on early brain Those who are able to develop secure attach- I nfants and toddlers are the largest sin- gle group of children entering foster care. Of the children who entered foster care during fiscal year 2009 (FY2009), 31% were less than 3 years old (DHHS, 2010a). Forty- development indicates that young chil- dren warranting the greatest concern are those growing up in environments, start- ing before birth, that expose them to abuse and neglect. It is during the first years of ments are observed to be more mature and positive in their interactions with adults and peers than children who lack secure attach- ments (National Research Council & Institute of Medicine, 2000). They also show a greater five percent of all infant placements occurred life when the brain undergoes its most dra- capacity for self-regulation, effective social within 30 days of the child’s birth. Once they matic development and children acquire the interactions, self-reliance, and adaptive cop- have been removed from their homes and abilities to think, speak, learn, and reason. ing skills later in life (Goldsmith, Oppenheim, placed in foster care, infants and toddlers are Early experiences, both positive and nega- & Wanlass, 2004). Those who do not form an more likely than older children to be abused tive, have a decisive effect on how the brain is attachment with at least one trusted adult suf- and neglected and to stay in foster care lon- wired (National Research Council & Institute fer, and their development can deteriorate ger. Half of the babies who enter foster care of Medicine, 2000). In fact, early and sus- rapidly, resulting in delays in cognition and before they are 3 months old spend 31 months tained exposure to risk factors such as child learning, relationship dysfunction, and dif- or longer in placement (Wulczyn & Hislop, abuse and neglect can influence the physical ficulty expressing emotions. Young children 3 0 Z e ro to Three January 2011
  3. 3. with unhealthy attachments are also at much Research confirms that the early yearsgreater risk for delinquency, substance abuse, present an unparalleled window of oppor-and depression later in life. Researchers have tunity to effectively intervene with at-riskfound that approximately 82% of maltreated children (National Research Council &infants show disturbances in their attachment Institute of Medicine, 2000). Intervening into their caregivers (Goldsmith et al., 2004). the early years can lead to significant cost sav- ings over time through reductions in childInfants and Toddlers Are Vulnerable abuse and neglect, criminal behavior, welfareto the Effects of Maltreatment and dependence, and substance abuse. To be effec-Negative Experiences Related to Foster tive, interventions must begin early and beCare designed with the characteristics and experi- Research indicates that each domain of ences of these infants, toddlers, and familiesdevelopmental functioning is affected by the in mind (Jones Harden, 2007). If services areearly experience of maltreatment. Negative not provided until a child is 6, 7, or 8 yearsfoster care experiences may extend and com- old, the most critical opportunity for preven-pound these developmental impairments tion and intervention is missed (Infant Mental(Jones Harden, 2007). Separation from par- Health Project, Center for Prevention andents, sometimes sudden and usually traumatic, Early Intervention Policy, 2010). A study ofcoupled with the difficult experiences that may the cumulative costs of special education from Photo: Andrea Booherhave precipitated out-of-home placement, birth to age 18 years found that intervening atcan leave infants and toddlers dramatically birth resulted in lower costs over the courseimpaired in their emotional, social, physical, of childhood than services started later in lifeand cognitive development (Lieberman & Van (approximately $37,000 when services wereHorn, 2007). Research shows that young chil- begun in infancy, 28% to 30% lower than whendren who have experienced physical abuse begun after age 6 years; Wood, 1981).have lower social competence, show less Given this window of opportunity, there The care of very young children knownempathy for others, have difficulty recogniz- are a number of ways that policymakers and to the child welfare system must being others’ emotions, and are more likely to be practitioners can intervene to improve out- designed with the goal of meeting theirinsecurely attached to their parents (National comes. The bottom line is that child welfare developmental needs.Research Council & Institute of Medicine, practices that are largely focused on child2000). According to the National Survey of safety often are not structured to promoteChild and Adolescent Well-Being, half of mal- healthy development and the formation of a been called “the heart of permanencytreated infants exhibit some form of cognitive secure attachment. In fact, they may actually planning” (Hess & Proch, 1988), isdelay. They are more likely to have deficits in play a negative role in early development. A widely viewed as the most impor-IQ scores, language ability, and school per- reorientation of thinking is needed to reform tant strategy for reunifying familiesformance than other children who have not approaches to infants and toddlers who land and achieving permanency (Haight,been maltreated (National Research Council in the child welfare system at such a develop- Sokolec, Budde, & Poertner, 2001).& Institute of Medicine, 2000). Maltreated mentally critical time. Very young children need to see theirinfants and toddlers are also more likely to parents every day if possible, andhave physical health difficulties—greater neo- Toward a Developmental those visits need to be supported innatal problems, higher rates of failure to thrive, Approach to Child Welfare Policy ways that help repair and strengthenand dental disease. and Practice for Infants and the parent–child bond. However, cur- Toddlers rent state child welfare policies vary EMaltreated Infants and Toddlers in lements of an agenda focused on widely and may call for visits once aFoster Care May Not Realize Their Full infants, toddlers, and their families week or even less frequently. LittlePotential should follow a framework of guiding information is available on how often The toll extracted by maltreatment and principles for infant and toddler development visits actually occur. For infants andthe inadequate response of the child welfare as well as knowledge of the protective fac- toddlers, infrequent visits are notsystem through inadequate policies, programs, tors that help families mitigate the trauma of enough to establish and maintain aand responses can resonate throughout a maltreatment and provide a nurturing envi- healthy parent–child relationship.child’s life. Disproportionate exposure to ronment for young children. Visitation for infants and toddlersearly trauma and other developmental risk should be as frequent as possiblefactors can result in a variety of mental health • Stable caring relationships are essential for (e.g., daily or multiple times perdisorders. Physical abuse impairs a young healthy development. At least one loving, week) and be conducted in locationschild’s social adjustment, including elevated nurturing relationship is the linchpin that are familiar to the child (Joneslevels of aggression that are apparent even of positive early development. Federal, Harden, 2007).in toddlers. Long-term negative outcomes state, and local child welfare policies — Incidence of multiple placements:include school failure, juvenile delinquency, and practices should make supporting Children in foster care frequentlysubstance abuse, and the continuation of the responsive, secure bonds between the experience multiple moves. In onecycle of maltreatment into future generations. youngest children and their parents and state, 25% of infants and toddlers hadToo often, foster children become parents caregivers a central goal. Key areas of three or more moves within the firstthemselves too soon and have little experience concern are as follows: 3 months of care (Hornby, Zeller, &with loving, nurturing relationships to guide — Lack of emphasis and support for paren- Cotton, 2009). Multiple moves placetheir own parenting. tal visitation. Visitation, which has children at an increased risk for poor January 2011 Z e ro to Three 3 1
  4. 4. for infants and toddlers is not system- atically used, and often an alternate permanency plan is considered only when reunification fails to occur. Concurrent planning means that chil- dren have two permanency goals, typically reunification and placement with a relative. Both goals are actively pursued at the same time. Infants and toddlers need a stable, loving family as soon as possible. The shift in philoso- phy required by concurrent planning, coupled with real barriers including providing adequate supportive ser- vices to parents and locating family members or other potential adop-Photo: Jonathan B. Rivera tive homes, can be difficult to achieve. However, it creates opportunities for innovation in supporting young chil- dren and families and an impetus for robust efforts to provide services to parents. New models of foster parent- ing need to be explored so that, when Infants and toddlers are more likely than older children to be abused and neglected and initially removed from their par- to stay in foster care longer. ents, very young children are placed with families who are able to support outcomes with regard to social– toward the goal of making the first reunification efforts with the parents emotional health and the ability to placement the last placement. but who would provide a permanent develop secure healthy attachments — Use of congregate care: Some infants home if reunification is not possible. (Gauthier, Fortin, & Jéliu, 2004). and toddlers are still placed in congre- • Early intervention can prevent the When a baby faces even one change gate care—group settings, typically consequences of early adversity. Federal, in placement, fragile new relation- with rotating, 24-hour child care state, and local policies, as well as child ships with foster parents are severed, staff (Jones Harden, 2007). Data sug- welfare practice, should ensure that reinforcing feelings of abandonment gest that institutional care for infants the developmental needs of infants and distrust. Even very young babies leads to a range of harmful develop- and toddlers, as well as those of their grieve when their relationships are mental outcomes including motor parents, are identified and addressed. disrupted, and this sadness adversely and language delays and a variety of This means routinely using screening affects their development. Policies social–emotional deficits, such as and assessments and intervening early and practices for infants and toddlers lack of attachment, lack of a sense with developmental services. As noted in foster care need to be reoriented of trust, and absence of social play by Hudson (this issue, p. 23), policy (Jones Harden, 2002). Researchers and practice at all levels must ensure have also documented elevated levels a focus on the needs of parents as well of cortisol, a stress hormone, in these as those of children. Often services are Learn More children. Although the use of con- lacking, especially to strengthen the gregate care facilities has increased parent–child relationship. Without ZERO TO THREE Policy Network over the past 2 decades because of adequate supports for parents to the crack/cocaine and methamphet- provide a healthy environment for their Join the ZERO TO THREE Policy Network amine epidemics and the decrease in child, very young children can suffer and access resources and tools to help you in the number of available foster homes, depression and other mental health advocating effectively for infants, toddlers, no very young child should be placed problems. Practitioners and services and their families. Learn more about the in congregate care facilities unless for infant and early childhood mental public policy process and download tools in a facility with her parent (Jones health—which differ substantially from to advocate for infants, toddlers, and their Harden, 2007). those for older children—are scarce. families. The ZERO TO THREE Policy Center — Length of time to permanency: During However, an overarching principle of is a nonpartisan, research-based resource for the earliest years of life when growth infant mental health intervention is federal and state policymakers and advocates and development occur at a pace far that relationships (e.g., between parent on the unique developmental needs of infants exceeding that of any other period and child as well as between family and and toddlers. The Policy Center brings to bear of life, time goes by quickly. Babies interventionist) are the conduit for ZERO TO THREE’s more than 30 years of can drift for years in foster care, from change in the young children and families research-based expertise on infant and toddler one foster home to another. Standard served (Jones Harden, 2007). For young development to ensure that public policies child welfare practice is to seek reuni- children in child welfare, healing the reflect best practices and current research in fication when in the best interest of relationship between the baby and parent support of our nation’s very young children. the child, but this may take several is critical; however, services remain months or years. Concurrent planning extremely limited and reimbursement 3 2 Z e ro to Three January 2011
  5. 5. for child–parent therapy is often problematic. • Every child welfare decision and service should have a goal of enhancing the well- being of infants, toddlers, and their families to set them on a more promising develop- mental path. Federal, state, and local child welfare policy, as well as practice, should be focused on building and maintain- ing a well-trained child welfare, social service, early childhood, and legal work- force educated in the science of early childhood development and informed by the most relevant and recent data. This would require ongoing training and con- tinuing education, sound recruitment and retention policies, improved super- vision, and appropriate workloads for Photo: Andrea Booher workers. • Families and communities must be key part- ners in efforts to ensure the well-being of every child. The child welfare system cannot go it alone. It is important that we support child welfare policy that seeks to encour- age coordination among agencies whose Each domain of developmental functioning is affected by the early experience of goal is to assist at-risk families. Assisting maltreatment. at-risk families will require a comprehen- sive approach that seeks to “break down the silos” that currently exist. We should THREE has convened a national coalition of encourage and support the development organizations that are leaders in child welfare Matthew E. Melmed, JD, executive director of community-based networks of social policy, including the Child Welfare League of of ZERO TO THREE, has significantly expanded service supports to assist infants, tod- America, the Children’s Defense Fund, the the organization’s impact in promoting the health dlers, and their families known to the Center for the Study of Social Policy, and the and development of infants and toddlers. Mr. child welfare system. For at-risk fami- American Humane Association, to develop Melmed is committed to translating what we know lies with young children, building strong and implement a shared child welfare policy into what we do for America’s youngest children. friendships and connections to their com- agenda for infants and toddlers. The shared munity that reduce isolation is critical to agenda will raise awareness of these critical Since 1995 he has guided the considerable growth providing a network of support during issues and seek to make them a priority at of the organization’s activities in support of pro- challenging times. all levels of government. Our ultimate goal fessionals, policymakers, and parents in their • Child welfare administration at the federal, is to ensure that the practices used in the efforts to improve the lives of infants and toddlers. state, and local level must include a focus on child welfare system incorporate what we Under his leadership ZERO TO THREE has infants, toddlers, and their families in such know from the science of early childhood launched a number of major programmatic and functions as data collection, research, and development into what we do for the policy initiatives. attention to special populations. Too often youngest children. Our national partners Mr. Melmed currently serves as the first elected we find we just do not know enough about each bring their own historical knowledge, chair of the Children’s Leadership Council, a what is occurring with the youngest chil- wealth of experience, and perspective coalition of 55 leading national policy and advo- dren in the child welfare system or about about the needs of young children in the cacy organizations working to improve the health, what works best in addressing their needs. child welfare system, which is crucial in education and well-being of America’s children The youngest children are overlooked in developing a joint agenda. Through this and youth. In addition, he serves as vice-chair on research design, data collection, and anal- unique partnership, we hope to highlight and the board of Generations United and was recently ysis. Placing a priority on addressing the lend urgency to opportunities for both short- elected a trustee of the Turrell Fund in New Jersey. needs of infants and toddlers in the child and long-term policy changes at the federal, welfare system means ensuring that they state, and local levels to benefit infants and Mr. Melmed served for 13 years as executive direc- are considered in every aspect of program toddlers in the child welfare system. tor of the Connecticut Association for Human administration. It is clear that the effect of maltreatment Services and prior to that was a managing attor- and negative foster care experiences on ney for Connecticut Legal Services. He is a PhiA Call to Action healthy development can have lifelong Beta Kappa graduate of SUNY BinghamtonE very day in the United States, 210 implications if not properly addressed. We and received his Juris Doctor degree from SUNY infants and toddlers leave their at ZERO TO THREE call on policymakers at Buffalo. parents and are placed in the care of all levels of government and infant–toddlersomeone else, often a stranger. We believe practitioners to act now to ensure that ourthat these babies cannot wait until someone nation’s most vulnerable infants and toddlersnotices them later in their lives, most likely get the best possible start in life. Afor the wrong reason. Accordingly, ZERO TO January 2011 Z e ro to Three 3 3
  6. 6. References Documents/OklahomaDHSPerformanceAudit. development in court. Washington, DC: ZERO TO pdf THREE. Casanueva, C., Cross, T., & Ringeisen, H. (2008). Hudson, L. (2010). Parents were children once too. U.S. Department of Health and Human Services, Developmental needs and individualized family Zero to Three, 31(3), 23–28. Administration for Children and Families. service plans among infants and toddlers in the Infant Mental Health Project, Center for (2010a). The AFCARS report: Preliminary FY 2009 child welfare system. Child Maltreatment, 13(3), Prevention and Early Intervention Policy. estimates as of July 2010 (17). Retrieved August 10, 245–258. (2010). Children with infant mental health 2010, from Gauthier, Y., Fortin, G., & Jéliu, G. (2004, July). needs [Web page]. Tallahassee: Florida State research/afcars/tar/report17.htm Clinical application of attachment theory in University. Available at U.S. Department of Health and Human Services, permanency planning for children in foster care: programArea.cfm?programAreaID=1 Administration for Children and Families. The importance of continuity of care. Infant Jones Harden, B. (2002). Congregate care for (2010b). Child maltreatment 2008. Washington, Mental Health Journal, 25(4), 379–396. infants and toddlers: Shedding new light on an DC: U.S. Department of Health and Human Goldsmith, D., Oppenheim, D., & Wanlass, J. old question. Infant Mental Health Journal, 23(5), Services. Retrieved from (2004). Separation and reunification: Using 476–495. Wood, M. E. (1981). Costs of intervention programs. attachment theory and research to inform Jones Harden, B. (2007). Infants in the child welfare In C. Garland, N. W. Stone, J. Swanson, & decisions affecting the placements of children system: A developmental framework for policy and G. Woodruff (Eds.), Early intervention for children in foster care. Juvenile and Family Court Journal, practice. Washington, DC: ZERO TO THREE. with special needs and their families: Findings and 55(2), 1–13. Lieberman, A., & Van Horn, P. (2007). Assessment recommendations (Westar Series Paper No. 11). Haight, W., Sokolec, J., Budde, S., & Poertner, J. and treatment of young children exposed to Seattle: University of Washington. (2001). Conducting parent–child visits [Research traumatic events. In J. Osofsky (Ed.), Young Wulczyn, F., Chen, L., Collins, L., & Ernst, M. integration document]. Urbana–Champaign, children and trauma: Intervention and treatment (2011). The foster care baby boom revisited: IL: Children and Family Research Center, (pp. 111–138). New York: Guilford Press. What do the numbers tell us? Zero to Three, 31(3) School of Social Work, University of Illinois at National Research Council & Institute 4–10. Urbana–Champaign. of Medicine. (2000). From neurons to Wulczyn, F., & Hislop, K. (2000). The placement of Hess, P., & Proch, K. O. (1988). Family visiting in out- neighborhoods: The science of early childhood infants in foster care. Chicago: Chapin Hall Center of-home care: A guide to practice. Washington, DC: development. Committee on Integrating the for Children, University of Chicago. Child Welfare League of America. Science of Early Childhood Development. Wulczyn, F., & Hislop, K. (2002). Babies in foster Hornby, H., Zeller, D. E., & Cotton, E. (2009, In J. P. Shonkoff & D. A. Phillips (Eds.). care: The numbers call for attention. Zero to February). Oklahoma Department of Human Washington, DC: National Academies Press. Three, 22(4), 14–15. Services performance audit. Troy, NY: Hornby Shonkoff, J. (2007). Interviewed in Helping babies Zeller Associates. Available at from the bench: Using the science of early childhood Find it Now on Securing a Bright Future Policy Guide Download this policy brief from the Early Experiences Matter Policy Guide which provides tools for taking action and improving public policies that impact the lives of infants, toddlers, and their families. It includes mini policy briefs, practical tools, in-depth policy papers, and more. Ensuring the Healthy Development of Infants in Foster Care: A Guide for Judges, Advocates and Child Welfare Professionals This booklet offers guidelines for child advocates on ensuring healthy infant development and addressing the developmental and emotional needs of infants and their caregivers. Infants in the Child Welfare System: A Developmental Framework for Policy and Practice Preview a chapter from the book by Brenda Jones Harden. Using extensive research, Dr. Jones Harden explains some of the basic theories of child development that are especially relevant to the experiences of infants and toddlers in the child welfare system and offers infant-centered policy and practice strategies.3 4 Z e ro to Three January 2011