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Healthy Beginnings

Healthy Beginnings. A Collaborative Infant Mental Health Intervention in a Public Health Clinic. What Is an Infant Mental Health Intervention?. Focuses on infants and children 0-5 years of age Seeks to optimize social and emotional development of young children

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Healthy Beginnings

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  1. Healthy Beginnings A Collaborative Infant Mental Health Intervention in a Public Health Clinic

  2. What Is an Infant Mental Health Intervention? • Focuses on infants and children 0-5 years of age • Seeks to optimize social and emotional development of young children • Is a multi-disciplinary approach involving psychiatry, psychology, social work, and pediatrics

  3. 2000 MCH Needs Assessment #1 Priority = Mental Health Access Homicide Rates – New Orleans Healthy People 2010 goal < 7.2.

  4. 2000 MCH Needs Assessment#1 Priority = Mental Health Access Healthy People 2010 goal = 9.6

  5. 2000 MCH Needs Assessment • Suicide and Homicide rates far exceed 2010 goal • Community surveys list substance abuse and homicide as primary concerns • Mental health access to services ranked #1 priority • Must begin in infancy to prevent adolescent problems

  6. Collaborators • Tulane Child Psychiatry Department • Children’s Bureau • LA Office of Public Health • Region I Office of Mental Health • Institute for Mental Hygiene • New Orleans Health Department

  7. Collaborator Roles • Tulane Child Psychiatry: • provides: • two part-time supervising psychologists • psychiatry fellow • senior psychiatry faculty supervision • one full-time clinic psychologist (program director) • administers the HB grant from IMH

  8. Collaborator Roles • Children’s Bureau:providestwo social workers and one case manager • LA Office of Public Health: funds Children’s Bureau social workers and NOHD MCH nurse coordinator • Region I Office of Mental Health: provides half time social worker

  9. Collaborator Roles • Institute for Mental Hygiene: provides funding through $125,000 grant to Tulane • New Orleans Health Department: • provides: • primary care (EPSDT) and WIC services • referrals to Healthy Beginnings Program • nursing and clerical support • physical space in Mary Buck Clinic (paid by grant)

  10. Governance • MOA written with help of facilitator and signed in fall of 2001 • Operations Committee: senior representation for each organization; meets quarterly • Evaluation Committee: oversees research, data management, and program outcomes • Clinic Coordinating Committee: oversees clinic policies, forms, referrals, and feedback to providers

  11. Clinic Operations • Children with risks identified are invited to schedule an appointment with a HB social worker • An assessment is conducted over several visits and immediate and long-term treatment goals are formulated with the caretaker • A home visit is conducted as part of the assessment • Family is given choice of clinic or home for future sessions

  12. Clinic Operations • All assessment data is entered into the database • A caseworker links family with needed community social services • Interdisciplinary case conferences are held weekly with clinic and HB staff • Families are followed until goals are met or family is lost to follow-up

  13. Achievements in First Two Years • A 30 hour training was held for 3 clinic physicians and 33 nurses in identifying infant mental health problems • Facility was renovated to accommodate HB staff using grant funds

  14. Achievements in First Two Years • Undoing Racism workshop held • Over 143 children were served; 33 are still active • Assessment process was shortened • Collaborator relationships continue to develop

  15. Demographics of Population Served • 66% males; 34% females • Average age 24 months • Average income below $10,000 • 93% African American, 4.8% Caucasian, 1.6% Hispanic, .8% Pakistani Indian

  16. Physical aggression Temper tantrums Hyperactivity Inattention Developmental Delays Anxiety disorders Feeding disorders Adjustment problems Withdrawn behaviors Childhood depression Maternal depression (approximately 50%) Domestic violence Physical abuse Parenting concerns Referral Concerns

  17. Assessment Tools • Achenbach Child Behavior Checklist (CBCL) Ages 1 1/2 - 5 • Infant Toddler Social Emotional Assessment (ITSEA) Competence Scale • Disturbances of Attachment Interview (DAI) • Parent-Child Interaction

  18. Assessment Tools • Beck Depression Inventory (BDI-II) • Parent Perception Interview • Partner Violence Inventory (PVI) Omitted: • HOME inventory • Vineland • Maternal Self-Efficacy Scale

  19. Lessons Learned • Early mental health intervention is possible in a public health clinic with limited funding • Collaborative efforts can bring cost-effective, state of the art interventions • Communication between collaborators is key; cultural, professional, and institutional barriers need to be expected and addressed

  20. Key Players • Tulane: Paula Zeanah, PhD, MSN Julie Larrieu,PhD Shana Bellow, PhD • NOHD: Susan Berry, MD, MPH • Donna Malus, RN, BSN • Pat Delaune, RN • Mary Burns, RN

  21. Key Players • OMH: Guilda Butler, LCSW • Children’s Bureau: Ron McClain, LCSW, Letia Bailey, LCSW • OPH: Stacia Loveall, MSW, MPH

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