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Mental Health

Mental Health. Impacts on Child Development Jacqui Van Horn, MPH, IMH-E jacquivanhorn@comcast.net. Co-creating Mental Health. Early Childhood Mental Health. Begins before birth; Inextricably connected to: The health (physical, mental, spiritual) of the parents;

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Mental Health

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  1. Mental Health Impacts on Child Development Jacqui Van Horn, MPH, IMH-E jacquivanhorn@comcast.net

  2. Co-creating Mental Health

  3. Early Childhood Mental Health • Begins before birth; • Inextricably connected to: • The health (physical, mental, spiritual) of the parents; • All other areas of health and development; • Is formative and provides the basic structure within which all development unfolds throughout our lives.

  4. Across the Lifespan . . . Human relationships, and the effects of relationships on relationships, are the building blocks of healthy development. From the moment ofconception to the finality of death, intimate and caring relationships are the fundamental mediators of successful human adaptation. (From Neurons to Neighborhoods, p. 27)

  5. Mentally healthy people . . . • Experience, express, respond to and manage a full range of emotions in ways that support their ability to function across contexts and settings; • Their own emotions; and • The emotions of others. • Successfully engage in a range of relationships with others within a range of social contexts. • Can recognize and repair disruptions in relationships.

  6. Irreducible Needs • Ongoing, nurturing relationships • Physical protection, safety and regulation • Experiences that are developmentally appropriate and tailored to individual differences • Limit setting, structure and expectations • Stable, supportive communities and cultural continuity (Brazelton & Greenspan, 2000)

  7. Ongoing, nurturing relationships Physical protection, safety and regulation Experiences that are developmentally appropriate and tailored to individual differences Limit setting, structure and expectations Stable, supportive communities and cultural continuity (Brazelton & Greenspan, 2000) Chronic stress Emotionally unavailable caregivers Maltreatment Foster Care Homelessness Domestic Violence Drug and alcohol exposure NeedsVulnerabilities

  8. Development is Impacted • Brain development is impacted by stress. • Babies experience (and remember) stress when: • Their signals are not responded to sensitively • Their attachment figure does not help them feel safe and cared for • Their attachment figure is not physically or emotionally available to them National Clearinghouse on Child Abuse and Neglect Information

  9. Healthy Child Neglected Child Both size and functioning of the brain are impacted.

  10. Development is Impacted • The brain organizes itself to support survival in either a positive environment OR a negative environment. • The early organizational structures continue to influence behavior and development over time. National Clearinghouse on Child Abuse and Neglect Information

  11. Impacts of Trauma • Structural changes occur to the brain: • Less brain mass • Less brain tissue connecting the hemispheres • Neuronal pathways become over-sensitized • Areas of the brain involved with fear/anxiety responses can become over-developed – other areas are then under-developed • When the brain’s resources are focused on survival, other aspects of development suffer – the child has fewer resources available for learning. • These physiological changes are associated with changes in cognitive functioning National Clearinghouse on Child Abuse and Neglect Information

  12. Many “Wake Up!” Calls • High rates of maltreated infants, toddlers and young children present with significant physical, cognitive, social-emotional, relational and psychological problems. • Most children placed in foster care have a history of severe neglect or abuse and have experienced significant stress during critical periods of early brain development. Shaw, E. and Goode, S. (2008)

  13. Many “Wake Up!” Calls • Young children in foster care have higher rates of chronic health conditions and special needs than national estimates for children living at home. • Very young children exposed to domestic violence may experience extreme stress that can have a potentially serious impact on brain development. • Homeless children are twice as likely to experience learning disabilities and three times as likely to experience an emotional disturbance as other children. Shaw, E. and Goode, S. (2008)

  14. Stay Awake! Approximately 10-15% of all typically developing preschool children have chronic mild to moderate levels of behavior problems. Children who are poor are much more likely to develop behavior problems with prevalence rates that approach 30%. Children who are identified as hard to manage at ages 3 and 4 have a high probability of continuing to have difficulties into adolescence. Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

  15. Still Awake? • Behavior problems in a child’s preschool career are the single best predictor of delinquency in adolescence, gang membership, and adult incarceration. • If challenging behaviors are not altered by the end of the third grade, it appears that they should be treated as a chronic condition; hopefully kept somewhat in check by continuing and ever more costly intervention. Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

  16. Looking Ahead • Children who grow into adolescence with challenging behaviors are likely to drop out of school, be arrested, abuse drugs and alcohol, have marginalized adult lives, and die young. • There is evidence to show that young children with challenging behavior are more likely to experience: • early and persistent peer rejection • mostly punitive contacts with teachers • family interaction patterns that are unpleasant for all participants • school failure • high risk of fatal accidents, substance abuse, divorce, unemployment, psychiatric illness, and early death Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

  17. Looking Back Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, et al JS. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine. 1998;14:245-258.

  18. AdverseChildhoodExperiences  Emotional Abuse  Physical Abuse  Sexual Abuse Emotional Neglect  Physical Neglect Mother Treated Violently  Household Substance Abuse  Household Mental Illness  Parental Separation or Divorce  Incarcerated Household Member http://www.cdc.gov/nccdphp/ace/findings.htm

  19. ACE Study Basics • The ACE Study is the largest study of its kind ever conducted (more than 17,000 study participants) and the range of adverse childhood experiences and health related outcomes studied was unprecedented. • An unexpectedly high number of adults who came to the Department of Preventive Medicine for comprehensive medical screening had experienced significant abuse or household dysfunction during their childhoods (only 1/3 reported no ACEs). http://www.cdc.gov/nccdphp/ace/findings.htm

  20. ACE Study Findings • ACEs were not only unexpectedly common, but their effects were found to be cumulative. • As the ACE score increased the chances of being a user of street drugs, tobacco or having problems with alcohol abuse increased in a stepwise fashion. • As the ACE score increased the number of risk factors for the leading causes of death increased. http://www.cdc.gov/nccdphp/ace/findings.htm

  21. ACE Scores have demonstrated As the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion: • alcoholism and alcohol abuse • chronic obstructive pulmonary disease (COPD) • depression • fetal death • health-related quality of life • illicit drug use • ischemic heart disease (IHD) • liver disease • risk for intimate partner violence • multiple sexual partners • sexually transmitted diseases (STDs) • smoking • suicide attempts • unintended pregnancies http://www.cdc.gov/nccdphp/ace/findings.htm

  22. Those with an ACE score of 4 or more were: • Twice as likely to be smokers, • 12 times more likely to have attempted suicide, • 7 times more likely to be alcoholic, and • 10 times more likely to have injected street drugs. (compared to score of “0”) • The behaviors such as alcohol or drug abuse, smoking, or sexual promiscuity are likely the result of the effects of ACEs on childhood development, which we now know to be neurodevelopmental in nature. http://www.cdc.gov/nccdphp/ace/findings.htm

  23. Adverse childhood experiences would typically go undetected because of shame, secrecy and social taboo.

  24. The fallout from various forms of child abuse & household dysfunction is monumental, costing Americans untold sums of money because of the health risks such as the use of street drugs, tobacco, alcohol, overeating and sexual promiscuity. Not the least of these high-ticket medical costs is due to: cardiovascular disease, cancer, AIDS and other sexually transmitted diseases, unwanted often-high-risk pregnancies, chronic obstructive pulmonary disease, and a legacy of self-perpetuating child abuse.

  25. Early Childhood Mental Health Promotion Preventive Intervention Treatment

  26. ECMH Promotion • A population-based strategy that highlights the necessity for predictable, nurturing, sensitive caregiver-child interactions: • Public Awareness • Universal screening systems that: • Systematically address all developmental issues, including social and emotional development; and • Are conducted in collaboration with parents and other primary caregivers and seen as informative and supportive; and • Result in appropriate supports, referrals and interventions.

  27. Opportunities to Promote Nurturing Interactions • Well Child Visits • WIC • Early Care and Education Settings • Child Care • Early Head Start & Head Start • Universal Home Visiting Services • IDEA, Part C Programs • Others?!

  28. Pitfalls of Developmental Screening • Waiting until a problem is observable • Ignoring screening results • Relying on informal methods • Using a measure that is not suitable • Assuming services are limited or nonexistent www.dbpeds.org/articles/detail.cfm?TextID=5

  29. For More Information • Facts about Developmental Screening Tools http://www.cdc.gov/ncbddd/child/tools.htm • Developmental screening and assessment instruments with an emphasis on social and emotional development for young children ages birth through five. www.nectac.org/~pdfs/pubs/screening.pdf • Early Identification/Developmental Screeninghttp://www.aap.org/healthtopics/early.cfm • Pediatric Developmental Screening: Understanding and Selecting Screening Instruments http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=614864

  30. Screen . . . and then what? • Identify community resources • Identify service accessibility and availability challenges • Collaborate . . . start with what “is”; work toward “good enough” . . . (for now); and collaborate to achieve a high quality system of caring for all children and families.

  31. Supporting Mental Health to Positively Impact Child Development

  32. jacquivanhorn@comcast.net

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