integrating early childhood social emotional development into early childhood systems deborah f....
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Integrating Early Childhood Integrating Early Childhood Social Emotional Development Social Emotional Development into Early Childhood Systemsinto Early Childhood Systems
Deborah F. Perry, PhDDeborah F. Perry, PhDGeorgetown UniversityGeorgetown University
Center for Child & Human DevelopmentCenter for Child & Human DevelopmentAugust 2010August 2010
OverviewOverview
Define early childhood social emotional Define early childhood social emotional developmentdevelopment
Explore the role of early brain Explore the role of early brain development on trajectories of development on trajectories of developmentdevelopment
Describe policy implications for Part C Describe policy implications for Part C systemssystems
The Context The Context Young children are: Young children are: – Being kicked out of child care settingsBeing kicked out of child care settings– Showing the impacts of maternal depressionShowing the impacts of maternal depression– Dealing with multiple family risks (parental Dealing with multiple family risks (parental
substance abuse, domestic violence and substance abuse, domestic violence and mental illness)mental illness)
School Readiness SkillsSchool Readiness Skills
Estimated PrevalenceEstimated PrevalenceNo national epidemiological data No national epidemiological data Early Childhood Longitudinal Study: 10% Early Childhood Longitudinal Study: 10% of all kindergarten children show of all kindergarten children show problematic behaviorproblematic behaviorRates are two to three times as high in Rates are two to three times as high in low-income samples low-income samples Clinical level problems are lower (4-10%)Clinical level problems are lower (4-10%)
Social Emotional DevelopmentSocial Emotional Development
Inter-relatedness of Inter-relatedness of domainsdomains
Intimately tied to Intimately tied to caregivers’ mental caregivers’ mental healthhealth
Core tasks:Core tasks:– AttachmentAttachment– BehaviorBehavior– CompetenceCompetence
Neurons to NeighborhoodsNeurons to Neighborhoods
Shonkoff and Phillips, 2000
…virtually every aspect of early human development, from the brain’s evolving circuitry to the child’s capacity for empathy is affected by the environments and experiences that are encountered in a cumulative fashion, beginning in the prenatal period and extending throughout the early childhood years.”
Role of Early ExperienceRole of Early ExperienceConnections between neurons are Connections between neurons are strengthened through repeated strengthened through repeated exposure/useexposure/use
Connections that are not used often are Connections that are not used often are pruned awaypruned away
Environmental influences shape the Environmental influences shape the architecture of the brainarchitecture of the brain
Quality and Quantity of Quality and Quantity of ExperiencesExperiences
Frequent, regular, predictableFrequent, regular, predictableOccur in the context of warm, supportive Occur in the context of warm, supportive relationshipsrelationshipsAre associated with positive emotionsAre associated with positive emotionsInvolve several sensesInvolve several sensesAre responsive to the child’s interests or Are responsive to the child’s interests or initiativeinitiativeEarly Childhood Resource Center, RTIEarly Childhood Resource Center, RTI
Early Childhood Mental HealthEarly Childhood Mental HealthThe social, emotional and The social, emotional and behavioral well-being of behavioral well-being of young children and their young children and their familiesfamiliesThe developing capacity The developing capacity to experience, regulate, to experience, regulate, express emotionexpress emotionForm close, secure Form close, secure relationshipsrelationshipsExplore the environment Explore the environment and learnand learn
Adapted from ZERO TO THREEAdapted from ZERO TO THREE
Experience and Regulate Emotions
INFANT Behaviors: Smiling Cooing and Babbling Fussing when hungry or tired Kicking legs when excited Quieting when held by a familiar adult
TODDLER Behaviors: Laughing Goes to familiar adult for comforting Able to move from one activity to the next Growing ability to focus Calms with help from a familiar caregiver
Form Secure Relationships
INFANT Behaviors: Smile at and back to a familiar caregiver Anticipates being held Likes to look at and be near familiar caregiver Shows preference for parent or caregivers face and voice Stretches arms up to be held
TODDLER Behaviors: Explores but checks in with familiar caregiver Shows affection for familiar caregivers Responds to his/her name Makes needs known to a familiar caregiver
Explore and Learn
INFANT Behaviors: Reaches for and grasps things Enjoys simple games like peek-a-boo Imitates others actions Smiles or plays with self in the mirror
TODDLER Behaviors: Keeps looking for a toy Tries new things Shows interest in other people Imitates others actions
Goodness of FitGoodness of Fit
Extent to Extent to which the which the temperament temperament of the child is of the child is compatible compatible with the with the environment, environment, expectations expectations and demands and demands
Adversity in Early Childhood Can Have Long-Lasting Consequences
Adverse Childhood Experiences Study (ACES) has documented the long term effects of earlier exposure to significant stressors
Explains the link between early childhood brain development and long term health and mental health outcomes
Adverse Childhood Experiences Are Common Substance abuse 27%
Parental sep/divorce 23%Mental illness 17%Battered mother 13%Criminal behavior 6%
Household dysfunction:
Abuse: Psychological 11% Physical 28% Sexual 21%
Neglect: Emotional 15% Physical 10%
Adverse Childhood Adverse Childhood Events and Adult Events and Adult
DepressionDepression
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
0
1
2
3
4
5+
Odd
s R
atio
Adverse EventsChapman et al, 2004
Adverse Childhood Events and Adult Substance Abuse
0
2
4
6
8
10
12
14
16
0 1 2 3 4+
0
5
10
15
20
25
30
35
40
0 1 2 3 4 5+
%
Self-Report: Alcoholism Self-Report: Illicit Drug UseDube et al, 2002 Dube et al, 2005
%
Adverse Childhood Events and Adverse Childhood Events and Adult Ischemic Heart DiseaseAdult Ischemic Heart Disease
0
0.5
1
1.5
2
2.5
3
3.5
0
1
2
3
4
5,6
7,8
Dong et al, 2004 Adverse Events
Odd
s R
atio
Levels of StressLevels of Stress
Positive Stress: normative, helps in Positive Stress: normative, helps in developmentdevelopment
Tolerable Stress: outside the normal Tolerable Stress: outside the normal range, one time events, buffered by range, one time events, buffered by caregiverscaregivers
Toxic Stress: prolonged activation of the Toxic Stress: prolonged activation of the stress response system, in absence of stress response system, in absence of buffering adultbuffering adult
Harvard Center for the Developing Child
EmotionalStimulus
PIT
Cortisol CortisolCRH
Amygdala Hippocampus
AdrenalCortex
HypothalamusPVN
LeDoux, Synaptic Self
HPA Pathway Control
ACTH
Charles Zeanah PPT
Interaction of the Brain and Immune System
Hypothalamus
PituitaryGland
Immune Organs
Locus Ceruleus
CRF
ACTH
Cortisol
Co
rtis
ol
Cytokines SympatheticNervous system
Vag
us
Ner
ve
Adrenal Gland
Immune Cells
CRH
Charles Zeanah PPT
Impact of Stress on Development
How depression affects How depression affects developmentdevelopment
Specific aspects of parenting behavior:Specific aspects of parenting behavior:– Maternal responsivityMaternal responsivity– Maternal sensitivityMaternal sensitivity– Emotional availabilityEmotional availability– Negative mood (intrusive/hostile)Negative mood (intrusive/hostile)– Inconsistency in disciplineInconsistency in discipline– Modeling negative affectModeling negative affect– Inability to assist with emotional regulationInability to assist with emotional regulation
Consequences of Maternal Consequences of Maternal DepressionDepression
Mothers’ well-beingMothers’ well-being– Decreased Maternal Self-EfficacyDecreased Maternal Self-Efficacy
Fathers’ well-beingFathers’ well-being– Increased depression & marital stressIncreased depression & marital stress– Increased concern of infants Increased concern of infants
Infant developmentInfant development– Emotion dysregulationEmotion dysregulation– Cognitive and language delaysCognitive and language delays– Increased risk for psychopathologyIncreased risk for psychopathology
Mother-infant interactionMother-infant interaction– Mothers: understimulating or Mothers: understimulating or overstimulatingoverstimulating– Infants: Infants: Less responsive, more gaze avoidant, more Less responsive, more gaze avoidant, more
distressdistress
Field, 1997; Milgrom & McCloud, 1996; O’Hara, 1994
Challenges & OpportunitiesChallenges & Opportunities
Address the mental Address the mental health needs of young health needs of young children and their children and their caregivers in context caregivers in context of their network of of their network of services and supportsservices and supports
Integrate the best Integrate the best available science on available science on what works for what works for preventing and preventing and treating mental health treating mental health needs of young needs of young children and their children and their families families
Challenges to Integration of ECMH Challenges to Integration of ECMH into EC Systems-Buildinginto EC Systems-Building
Need to address complex, multi-factorial problems Need to address complex, multi-factorial problems that evolve over time and across settingsthat evolve over time and across settings– Focus on caregivers (parents and child care Focus on caregivers (parents and child care
providers)providers)
Lack of fit between increasing specialization & Lack of fit between increasing specialization & real needs of young children & their caregiversreal needs of young children & their caregivers
Requires integration & adaptation of evidence-Requires integration & adaptation of evidence-based practices (EBP)based practices (EBP)
An Early ChildhoodAn Early Childhood Systems’ Framework Systems’ Framework
Developed by Roxane Kaufmann, GUCCHD; design by: Lucia Foley, Hampshire Educational Collaborative
System of Care Values/PrinciplesSystem of Care Values/Principles
Infused Into Natural Settings and ServicesInfused Into Natural Settings and Services– Stand-alone early childhood mental health Stand-alone early childhood mental health
systems won’t worksystems won’t work
Grounded in Developmental KnowledgeGrounded in Developmental Knowledge– Lifespan approach, different approaches Lifespan approach, different approaches
needed for infants, toddlers, preschoolersneeded for infants, toddlers, preschoolers
Risk & ResilienceRisk & Resilience– Building family and community assetsBuilding family and community assets
Need for Focus on Relationship-Need for Focus on Relationship-Based StrategiesBased Strategies
Dyadic interventionsDyadic interventions
Two-generation modelsTwo-generation models
Family systems frameworkFamily systems framework
Relationships between MH and other Relationships between MH and other service systemsservice systems
Relationships with stakeholders in Relationships with stakeholders in systems buildingsystems building
Best Scientific EvidenceBest Scientific Evidence
Growing number of evidence-based Growing number of evidence-based prevention and treatment models prevention and treatment models – Developed through rigorous scientific Developed through rigorous scientific
experimentsexperiments– Need for adaptation for local context, but with Need for adaptation for local context, but with
eye to fidelityeye to fidelity– Difficulties in bringing these to scaleDifficulties in bringing these to scale
How to value “practice-based evidence” How to value “practice-based evidence” and “family wisdom”and “family wisdom”
Pyramid ModelPyramid Model
PromotionPromotion
Developmental and social-emotional screening Developmental and social-emotional screening in primary care and early care and education in primary care and early care and education programsprograms
High quality training on social-emotional High quality training on social-emotional development for Part C providers and child development for Part C providers and child care communitycare community
Dissemination of information promoting Dissemination of information promoting healthy social-emotional developmenthealthy social-emotional development
PreventionPrevention
Screening for caregiver depressionScreening for caregiver depression
Mental health consultation in child care Mental health consultation in child care and integration of MH into Part C systemsand integration of MH into Part C systems
Social skills curricula (i.e., Second Step)Social skills curricula (i.e., Second Step)
InterventionIntervention
Positive Behavioral SupportPositive Behavioral Support
Intensive mental health consultation in homes Intensive mental health consultation in homes and child care settings to support children with and child care settings to support children with IFSPsIFSPs
Relationship-based therapy (e.g., PCIT)Relationship-based therapy (e.g., PCIT)
In-home treatment for children with mental In-home treatment for children with mental health diagnoses and depressed caregivershealth diagnoses and depressed caregivers
Moving ForwardMoving Forward
Consider how current eligibility criteria and Consider how current eligibility criteria and procedures for Part C reflect the fundamentals of procedures for Part C reflect the fundamentals of early childhood social-emotional developmentearly childhood social-emotional developmentBroaden networks of providers who are Broaden networks of providers who are screening families (caregivers and children) for screening families (caregivers and children) for social-emotional riskssocial-emotional risksEstablish cross-sector competencies for all Establish cross-sector competencies for all providers working with young children and providers working with young children and familiesfamiliesSupport integration of mental health consultants Support integration of mental health consultants in Part C systems in Part C systems