Infusing Mental HealthServices and Supports in Early

Childhood Settings

Deborah Perry, PhD

Georgetown University

Center for Child and Human Development

May 11, 2006

WHY NOW?

Increased awareness of problems of young children

Brain development research

Increased use of psychotropic medications

Problems in child care and early education settings

Emergence of infant and early childhood mental health as a field

Importance of environment and relationships

Relationship between healthy social and emotional development and later school success

EARLY CHILDHOODMENTAL HEALTH

For young children, mental health is:The social, emotional, and behavioral well-being of young children and their families.

The developing capacity to experience, regulate, and express emotion;

Form close, secure relationships;

Explore the environment and learn.(Adapted from ZERO TO THREE)

Estimated PrevalenceNo national epidemiological data In studies of health care visits, rates of psychosocial problems=10-21%; externalizing problems=7-17%In Head Start, externalizing problems=10-23% 10-15% typical preschoolers have chronic mild/moderate behavior problemsNo data for children under age of 2

Center for Evidence-Based Practice: Young Children with Challenging Behavior

School Readiness Skills

Emotional self-regulationBehavioral self-regulationEmpathy and perspective takingCommunicating needs, desires & interests in pro-social wayUnderstanding cause & effect sequencesInterest, motivation, persistence

Early Childhood Resource Center, RTI

EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF CAREFosters the social and emotional well-being of infants toddlers, preschool-age children and their families

VALUES

Family Voice

Child and Family Centered

Relationship Based

Culturally Competent

Infused into Natural Settings and Services

Grounded in Developmental Knowledge

Prepared Workforce

Interagency Partnerships

Maximized and Flexible Funding

Building Blocks

Promotion Prevention Intervention

Supports for Parents and

Families

Supports for Other

Caregivers

Services for Children and Families

Services and Supports

Outcome Evaluation

Strategic Planning,

Policies, and Procedures

Developed by Roxane Kaufmann, GUCCHD

THE SYSTEM OF CARECONCEPT AND VALUES

A philosophy or framework about the way services should be delivered to children and families based on core values and principles

Not a model or single definable thing – It is a community specific design built within this framework; around local/state leadership, political context and funding; and to fit with other early childhood initiatives and partnerships

The Pyramid

Levels and Types of Intervention

Intervention/Targeted

Prevention/Indicated

Promotion/Universal

Promotion

Developmental and social-emotional screening in primary care and early care and education programs

High quality child care

High quality training on social-emotional development

Use of an evidence-based early childhood curriculum

Dissemination of information promoting healthy social-emotional development

Prevention

Home visitation programs

Mental health consultation

Family mentors

Social skills curricula

Family supports

Caregiver supports

Intervention

Intervention

On-site mental health consultation

Crisis teams

Wraparound services

Relationship-based therapy

Hotline for families

Behaviorally-based programs in a variety of settings

In-home treatment

ECMH SYSTEM OF CARE VALUES AND PRINCIPLES

Family Voice

Child and Family Centered

Relationships Based

Culturally Competent

Continuum of ECMH Services and Supports

Infused into Natural Settings and ServicesGrounded in Developmental Knowledge

PromotionPreventionIntervention

Why Culture Matters

Because it affects…

Attitudes and beliefs about mental health

Expression of symptoms

Coping strategies

Help-seeking behaviors

Utilization of services

Appropriateness of services and supports

Lazear, K., (2003). Primer Hands On

Work Force Issues

Lack of trained personnel

Stigma

Barriers in communication between early childhood and mental health

Changing practices from reactivity to prevention

Lack of ongoing support to providers

Work Force Issues

Allocation of limited resources to multitude of needs

Limited access to higher education

High staff turnover

Need for evidence-based models and training approaches

Core Competencies

Values/Beliefs

Knowledge of ECMHEarly childhood development

Importance of relationships

Risk/protective factors

Skills

Florida IMH Levels of Service

Level 1 Services to strengthen caregiver skills and relationship with child

Level 2 Services for families and children with identified social risks, delays, special

health needs, and disabilitiesLevel 3 Services to families of children diagnosed

with serious emotional disorders or severe mental/ behavioral health problems

Source: Infant Mental Health Services for Young Children and Families. Florida State University, Center for Prevention and Early Intervention Policy. © 2000

Implications for FL Workforce

Building infrastructure to support training

Level 1: Target all child-serving staff in ECE, home visitors, schools, faith based, law enforcement, judicial systems

Level 2: families and professionals involved with Part B and C of IDEA, child protection, social workers, therapists, health care practitioners

Level 3: new university graduate programs to train clinicians in IMH psychotherapy

Merrill-Palmer Institute

Wayne State University in Detroit, MI

Graduate Certificate Program in Infant Mental Health

Graduate Certificate Program in IMH

Intro to Infant Mental HealthTheory and PracticeInfant Mental HealthPsychology of Infant Behavior and DevelopmentAssessmentFamily studyClinical Practicum

Supervised experience in assessment, observation, intervention

ConnecticutChart-a-Course

Early care and education professionals

Training

Early Childhood Consultation Partnership

Mental health consultation to early care and education professionals

11 master’s level mental health professionals

Educating Practices in the Community

Health care practitioners

Kids Care InitiativeSystems-level training across multiple child-serving agencies

What is Connecticut Charts-A-Course?

Connecticut Charts-a-Course (CCAC) is the statewide system of career development for early care & education, and school-age care.

Who funds CCAC?CCAC is funded by state quality enhancement funds for school readiness from Department of Social Services and Education.

Investments made from FY98-02:• Children’s Fund of Connecticut $340,000$340,000• Department of Social Services $3,755,000$3,755,000

CCAC is a special initiative of the Connecticut Community Colleges and is connected to the

Chancellor’s Office.

CCAC is a special initiative of the Connecticut Community Colleges and is connected to the

Chancellor’s Office.

What is the goal of CCAC?To promote quality in early care & education by:

Supporting the career development of early care & education providers in all settingsIncreasing the early care & education workforce capacityPromoting early care & education as a viable career choiceDecreasing staff turnoverSupporting program improvement and quality initiatives

How does CCAC support the early care & education provider?

Scholarships

Access to training

Career counseling

Certificate of recognition

Career ladder

What is the Training Program in Child Development?

Quality education and training for early care & education providers

180 hours of non-credit training delivered over four modules

Content is distributed through the Core Areas of Knowledge

10 years of success8,500 CCAC members2,500 scholarships5,000 training participants40% of CT CDAs are CCAC funded780 approved trainers230 career counseling sessions265 accredited centers12 colleges/universities in ECE articulation planChild Care Apprenticeship Program

Highlights 1/98 – 6/02

• More than 5,000 participants to date• Over 213,000 hours of training delivered• 25 training organizations• Statewide accessibility – over 30 locations• All 180 hours of CCAC curriculum offered• 20% of training in Spanish

How was the outcome evaluation conducted?

Pre and post observation of participants in Modules I and II

ECERS, FDCRS or HOMEArnett

Interviews with participants who completed Module IV

OutcomesTraining is making a difference:

-child care providers consistently demonstrate positive changes related to the learning opportunities and environments they offer and the quality of their interactions with young children.

Largest increases in the areas of language and reasoning, program and interaction (ECERS, FDCRS, HOME)

Significant increases in providers’ responsiveness and decreases in harshness and detachment (ARNET)

CT KIDS CARE INITIATIVE

Institutes on competency based training to support implementation of systems of care

Five days of training for teams

Competency matrix addresses attitudes, knowledge and skills for community based care

Direct care, supervisor and management

Children w/ MH needs and families

Training of trainers model

Core Curriculum

Day 1: Systems of care 101

Day 2: Understanding the strengths and needs of children and their families

Day 3: Individualized strategies in response to the strengths and needs of children and families

Day 4: building equal partnerships with parents and children

Day 5: Interagency and community collaboration

Training Implementation Goals

Provide strength based training that emphasizes individuals and families as partners in community-based planning and behavioral health care

Train 300 to 5000 individuals from diverse agencies (including all child welfare and public mental health staff), families, advocates, community providers, consumers

VERMONT--System of Care

CMHS grant to integrate mental health into child health, early care and education

Multi-faceted intervention: Prevention-treatment

ECMH competencies for providers, and training

4 DOMAINS: child, family, community and teamwork

Vermont Competencies

Articulation of “Vermont Culture”

10 Guiding Principles

4 domainsKnowledge

Practices

Action/Learning PlanSpecific goals

Strategies

Resources

Timelines

Teamwork (example)

I know about… I am able to do…My own biases, values, strengths and vulnerabilities in forming relationships with families, children and other team members

• Familiar with

• Less familiar, like to learn more

• We can identify someone within our community who is knowledgeable

• This is a high priority for my learning

State and Local ResponsibilitiesSTATE:

Clear point of responsibility/accountability in Exec. Branch

Committee on interagency collaboration at senior level

Regular feedback from community and families

Policy shifts related to funding and HRD

State family organization/coalition

COMMUNITY:

Local cross-system team responsible for planning, policy development, resource identification, training,monitoring

Strong family involvement on this management committee

Interagency review mechanism

System for referrals

Local family supports

Lessons Learned in Vermont

You don’t build a freestanding mental health system of care for young children.

This is a cultural exchange process.

Intervention isn’t enough.

There are many new opportunities to blend funding.

There are too few staff trained in early childhood mental health. We must grow our own.Two-year process to create the Knowledge and Practices document

Common Elements of Effective ECMH Systems

Involve different catalysts and different leadership

Involve partnerships and many stakeholders

Emphasize prevention and early intervention, not only “treatment”

Involve different entry points and build on existing early childhood programs

Develop creative fiscal strategies

Develop the workforce

Work toward policy and systems change

10 Action Steps

1. Raise awareness

2. Test new approaches

3. Develop cross training

initiatives

4. Build collaborative

approaches

5. Identify existing

services/programs

6. Develop common service definitions

7. Involve families and child care

community

8. Utilize existing data

9. Gather outcome data

10. Start Somewhere and Just do it