Infusing Mental Health Services and Supports in Early Childhood Settings

1. Infusing Mental HealthServices and Supports in Early Childhood Settings Deborah Perry, PhD Georgetown University Center for Child and Human Development May 11, 2006

2. 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

3. 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)

4. Estimated Prevalence • No 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 problems • No data for children under age of 2 Center for Evidence-Based Practice: Young Children with Challenging Behavior

5. School Readiness Skills • Emotional self-regulation • Behavioral self-regulation • Empathy and perspective taking • Communicating needs, desires & interests in pro-social way • Understanding cause & effect sequences • Interest, motivation, persistence • Early Childhood Resource Center, RTI

6. EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF CARE Fosters the social and emotional well-being of infants toddlers, preschool-age children and their families Services and Supports VALUES Family Voice Child and Family Centered Relationship Based Culturally Competent Infused into Natural Settings and Services Grounded in Developmental Knowledge Supports for Parents and Families Supports for Other Caregivers Services for Children and Families Building Blocks Strategic Planning, Policies, and Procedures Maximized and Flexible Funding Interagency Partnerships Prepared Workforce Outcome Evaluation Promotion Prevention Intervention Developed by Roxane Kaufmann, GUCCHD

7. 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

8. The Pyramid Levels and Types of Intervention Intervention/Targeted Prevention/Indicated Promotion/Universal

9. 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

10. Prevention • Home visitation programs • Mental health consultation • Family mentors • Social skills curricula • Family supports • Caregiver supports • Intervention

11. 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

12. Family Voice Child and Family Centered Relationships Based Culturally Competent Continuum of ECMH Services and Supports Infused into Natural Settings and Services Grounded in Developmental Knowledge Promotion Prevention Intervention ECMH SYSTEM OF CARE VALUES AND PRINCIPLES

13. 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

14. 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

15. 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

16. Core Competencies • Values/Beliefs • Knowledge of ECMH • Early childhood development • Importance of relationships • Risk/protective factors • Skills

17. 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 disabilities Level 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

18. 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 Implications for FL Workforce

19. Merrill-Palmer Institute • Wayne State University in Detroit, MI • Graduate Certificate Program in Infant Mental Health

20. Graduate Certificate Program in IMH • Intro to Infant Mental Health • Theory and Practice • Infant Mental Health • Psychology of Infant Behavior and Development • Assessment • Family study • Clinical Practicum • Supervised experience in assessment, observation, intervention

21. Chart-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 Initiative Systems-level training across multiple child-serving agencies Connecticut

22. 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.

23. 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 • Department of Social Services $3,755,000 CCAC is a special initiative of the Connecticut Community Colleges and is connected to the Chancellor’s Office.

24. 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 settings • Increasing the early care & education workforce capacity • Promoting early care & education as a viable career choice • Decreasing staff turnover • Supporting program improvement and quality initiatives

25. How does CCAC support the early care & education provider? • Scholarships • Access to training • Career counseling • Certificate of recognition • Career ladder

26. 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

27. 10 years of success • 8,500 CCAC members • 2,500 scholarships • 5,000 training participants • 40% of CT CDAs are CCAC funded • 780 approved trainers • 230 career counseling sessions • 265 accredited centers • 12 colleges/universities in ECE articulation plan • Child Care Apprenticeship Program

28. 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

29. How was the outcome evaluation conducted? • Pre and post observation of participants in Modules I and II • ECERS, FDCRS or HOME • Arnett • Interviews with participants who completed Module IV

30. Outcomes • Training 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)

31. 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

32. 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

33. 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

34. 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--System of Care

35. Articulation of “Vermont Culture” 10 Guiding Principles 4 domains Knowledge Practices Action/Learning Plan Specific goals Strategies Resources Timelines Vermont Competencies

36. 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

37. STATE: 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 State and Local Responsibilities

38. 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

39. 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

40. 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 10 Action Steps