Report to the Community

Community Expert Forum on Childhood Emotional and Behavioral Health and Prevention Strategies

Report to the Community

Community Expert Forum on Childhood Emotional and Behavioral Health and Prevention Strategies

September 2005

Lynn Chaiken, MSW, LSW

Scott Rosas, PhDMarihelen Barrett, RN, MSNLinda Tholstrup, MS, CHES

Southern Delaware Office543 Shipley StreetSeaford, DE 19973

302-628-8418

Main Office252 Chapman Road

Christiana Building; Suite 200Newark, DE 19702

302-444-9100

www.Nemours.org

AcknowledgementsMany caring individuals contributed to the creation ofthis report. Nemours Health and Prevention Services(NHPS) is grateful to the members of our Delawarereview group for the time they spent and attention theypaid, both before and after the forum, to identifying keyissues around children’s emotional and behavioral healthneeds in Delaware’s communities and for their valuablefeedback on our proposed strategies to meet thoseneeds. The members of the review group included thefollowing:

Debby Boyer, MS, CDS Co-Director, Center for DisabilitiesStudies, University of Delaware Mary Dozier, PhD, Professor, Clinical Psychology, Universityof DelawareCarlyse Giddins, Director, Division of Family Services,Delaware Department of Services for Children, Youth, and TheirFamiliesElton Grunden, LCSW, Director of Behavioral Health, CatholicCharitiesRebecca King, RN, MSN, NCSN, President Elect, DelawareSchool Nurse AssociationJim Lafferty, Executive Director, Mental Health Association inDelawareLaura Miles, Deputy Director, Division of Family Services,Delaware Department of Services for Children, Youth, and TheirFamiliesMary Moor, Project Director, FACT Project, Division of ChildMental Health Services, Delaware Department of Services forChildren, Youth, and Their FamiliesDorothy Onn, Director of Prevention Services, Children andFamilies First of DelawareBetty Richardson, MEd, Head Start State Collaboration Director,Delaware Department of Education Marc Richman, PhD, Child Psychologist Supervisor, Divisionof Child Mental Health Services, Delaware Department of Servicesfor Children, Youth, and Their FamiliesDennis Rubino, MSW, MPH, Director, Programs for Childrenwith Special Healthcare Needs, Division of Public Health, DelawareDepartment of Health and Social ServicesDana Sawyer, MPA, LCSW, Administrator, Office ofPrevention and Early Intervention, Delaware Department of Servicesfor Children, Youth, and Their FamiliesCarol Ann Schumann, MA, Training Administrator, Birth toThree Early Prevention System, Delaware Department of Health andSocial ServicesDebbie Simon, MA, Disability Mental Health Specialist,Wilmington Head StartSharon Stull, Family and Workplace Connection

NHPS also thanks all of the work group participantswho participated in our Community Expert Forum. Thetremendous input provided by these individuals, fromchild care, school, primary care and communitysettings in Delaware, can be found in the “Voices fromDelaware” section of this report. A comprehensive listof these participants is in the Appendices of this report.

A number of individuals considered national, state andlocal experts in the field of children’s emotional andbehavioral health granted interviews with NHPS toshare their insights about the promotion and preventionfield. Those we interviewed included the following:

Mark Greenberg, PhD, Director, Prevention ResearchCenter, Pennsylvania State UniversityNeil Halfon, MD, MPH, Director, Center for HealthierChildren, Families and Communities, University of California,Los AngelesCatherine Hess, MSW, Health Policy ConsultantNeva Kaye, Program Director, National Academy of StateHealth PolicyJane Knitzer, EdD, Director, National Center for Children inPoverty, Columbia UniversityJohn Landsverk, PhD, Director, Child and AdolescentServices Research Center, Center for Child Protection, SanDiego State UniversityCraig Ramey, PhD, Director, Georgetown University Centeron Health and EducationMyrna Shure, PhD, Research Professor, Drexel UniversityDoug Tynan, PhD, ABPP, A.I. duPont Hospital for ChildrenMark Weist, PhD, Director, Center for School Mental HealthAssistance, University of Maryland-Baltimore

Among the interviewees, several provided specificinformation on promising programs being implementedin other states, including the following:

Jennifer Atler, Executive Director, Invest in Kids, ChicagoAnita Berry, Director, Healthy Steps, ChicagoSue Christensen, Family Connections (Early Years Count),IndianaSarah Dinklage, LICSW, Executive Director, Rhode IslandStudent Assistance Services, Rhode Island EmployeeAssistance ProgramPaula Duncan, MD, Youth Health Director, Vermont ChildHealth Improvement Program

Anita Fong, San Francisco High Quality Mental Health ConsultationAnn-Linn Glaser, Consultant, I Can Problem Solve, NewJerseyPeggy Harris, Promoting Alternative Thinking Strategies,BaltimoreAnnette Jacobi, Director, Children First, OklahomaVickie Kropenske, Director, Hope Street Family Center, LosAngelesJudy Owens, Project Leader, Character Plus (Caring SchoolCommunity), MissouriKim Paul, Project Director, Vermont Child HealthImprovement ProgramJames Swanson, Cuidar, California

The Delaware leaders who provided interviews includedthe following:

Tim Brandau, Executive Director, YMCA Resource CenterElton Grunden, Director of Behavioral Health, CatholicCharities (review group)Bruce Kelsey, Executive Director, Delaware Guidance ServicesMike Kerstetter, Executive Director, People’s Place IIJim Lafferty, Executive Director, Mental Health Association inDelaware (review group)Pat Tanner Nelson, EdD, Professor, Early LearningCenter/Cooperative Extension, University of DelawareDory Zatuchni, Executive Director, Jewish Family Services

A special thank you is extended to numerousCommunities That Care® implementers in New York,Ohio, and especially Pennsylvania, for their enthusiasticinput that helped us learn more about this approach.

NHPS also thanks Claudia Williams, MS, at AZAConsulting for conducting a number of these interviewsand compiling the best practices found in this report’sAppendices.

We would like to acknowledge the leadership of DebbieChang, MPH, Senior Vice President and ExecutiveDirector. Her guidance and insight throughoutthe planning and report writing process were invaluable.

Thanks also go to the following NHPS staff whocontributed their time and attentiveness to editing thisreport:

Karen Bengston, Communications and Public RelationsManager Kerry Bennett, MA, Web Content Editor

Table of ContentsSpecial pull out section - Voices from Delaware: Strategies Suggested by Work Group Participants(front pocket)

Introduction .....................................................................................................1

Proposed NHPS Emotional and Behavioral Health Options for Action Plan ......................... 4

Appendices

A. Summaries of Presentations at the Community Expert Forum on Emotional and Behavioral Health and Prevention Strategies .................................................11

• Planting the Seeds for Better Health .................................................. 11Debbie I. Chang, MPH

• The Promotion of Mental Health and Prevention of Mental Disorders: A Federal Perspective .................................................................11

Pat Shea, MSW, MA

• NHPS Review and Assessment of Children’s Emotional and Behavioral Health Strategies ...................................................................... 12

Scott Rosas, PhD

• Implementation of Integrated Community-Based Social and Behavioral Health Services for Children and Families.......................................... 14

Sherrie Segovia, PsyD, MA

• Experiences from Vermont: Partnerships to Promoting Well-being for Children and Youth through Improvements in Primary Health Care Quality....................14

Paula Duncan, MD

• Challenges in Implementation in the Schools.........................................15Ann-Linn Glaser, BS

B. Promising Programs for Promoting Healthy Emotional and Behavioral Development in Children ........................................................................................16

C. List of Participants .............................................................................. 23

IntroductionThe NHPS Philosophy: A Shift in Thinkingabout Children’s Emotional andBehavioral Health

Along with our community partners, we atNemours Health and Prevention Services (NHPS)are acutely aware of the growing numbers ofchildren in Delaware experiencing mental healthdisorders and problems that require intensiveinterventions. It is estimated that nearly ninepercent of children in Delaware between the ages3-17 have moderate or severe difficulties in theareas of emotion, concentration, behavior orbeing able to get along with other people.1 Whilework to improve and expand the children’smental health treatment system is criticallyneeded, a complementary approach that focuseson health promotion and prevention is ofparticular importance. Prevention can reduce theburden upon the children’s mental healthservices system. It is the goal of NHPS todevelop and support strategies that seek toextend the continuum of available preventionprograms and health promotion supports forDelaware’s children and families.

Promoting emotional and behavioral health andpreventing mental disorders requires a shift inhow we look at children’s emotional andbehavioral health needs. Typically, children’smental health is associated with images oftreatment--children in play therapy withcounselors at clinics or getting medication fordiagnosed disorders. More rarely is emotionaland behavioral health associated with addressingthe needs of children in a whole school, a wholeneighborhood or a whole county. Indeed, severalresearchers have emphasized that the nation’sburden of emotional and behavioral problemscould never be relieved by one person, onerelationship or one problem at a time.2 Some,like Cowen, urged the mental health disciplinesto expand beyond reliance on treatment servicesto the development and application of strategiesto prevent emotional and behavioral disorders.

Population-based promotion and prevention strategiesoffer a pathway beyond symptoms and disorders to anunderstanding of environments that influence children’semotional and behavioral health. NHPS is working withthis knowledge to realize a vision where whole schools,child care centers, families, community organizations,pediatric practices, and/or communities in Delawareemploy health promotion and prevention strategies thatreduce risks and enhance the resilience of children in andacross those settings.

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1U.S. Department of Health and Human Services. (2003). National Survey of Children’s Health (NSCH), Washington, D.C.2Albee, G.W. (1982). Preventing psychopathology and promoting human potential. American Psychologist, 37, 1043-1050.Caplan, G. (1964). Principles of preventive psychiatry, New York: Basic Books.Cowen, E.L. (1973). Social and community interventions. In P. Mussen & M. Rosen (Eds.) Annual Review of Psychology, 24, 423-472.

HEALTH CONTINUUM

Individual Community

Treatment Disease Prevention Health Promotion

During the afternoon session, four workgroups(focused on the areas of child care,community, primary care and school) exploredand traced the connections between theprevention activities that are currentlyoccurring and the activities that are needed inDelaware.

About This Report

This report shares the recommendations foraction that were generated by the forum andpresents a set of options for NHPS programapproaches in the area of emotional andbehavioral health for Delaware’s children. Theinput from the forum formed the core of ourproposed plan for action to help youth,families, schools, pediatricians, child care staffand community organizations build andreinforce children’s emotional and behavioralhealth to prevent clinical problems.

Key Messages from Forum Presenters

Forum presenters highlighted several keymessages for consideration as NHPS builds itspromotion and prevention work:

- Prevention efforts can be cost effective. - NHPS’ efforts should focus on strengthening

children’s resilience (ability to adapt understress or adversity).

- Promotion and prevention work should • Focus on skill building• Work with adults in children’s lives• Pay attention to the child’s environment

and risks• Take a close look at the content of pro-

grams• Look at issues through the lens of child

development- Comprehensive social and behavioral health

services for children can be designed usingcommunity engagement and be coordinatedby a lead community agency, such as thepractice at the Hope Street Family Center inLos Angeles.

- Evaluation and research in the healthpromotion and disease prevention field canbuild the evidence base about what does anddoes not work.

Background Investigation about Children’sEmotional and Behavioral Health

Based on our philosophy, we set out to investigatethe state of children’s emotional and behavioralhealth in Delaware to help us determine optionsfor our program approaches. We conductedextensive literature reviews, interviews withexperts in the field and interviews with Delawareleaders. We learned that in Delaware:

- Children need more services from treatment toprevention.

- Prevention efforts are lacking, especially inmiddle schools.

- Parenting education efforts are in place, butare fragmented.

- Infrastructure exists that can be used as abase for prevention services, e.g. child caretraining network focused on social andemotional wellness, High School WellnessCenters.

We learned from other states about models thatwork such as I Can Problem Solve, Vermont’sYouth Health Improvement Initiative and HealthySteps, a primary care strategy focused on childdevelopment sponsored by the CommonwealthFund, a foundation based in Massachusetts.

NHPS Community Expert Forum

On December 7, 2004, we held our firstCommunity Expert Forum on Emotional andBehavioral Health and Prevention Strategies inDover, Delaware, with more than 75 peoplerepresenting various community agencies,schools, primary care practices, state governmentagencies and child care settings spanning the stateof Delaware. We held the forum to help determinehow we could best contribute to a system ofpromotion and prevention supports for children’semotional and behavioral health in Delaware.

During the forum’s morning session, presentersprovided background information for discussion anddescribed programs and early successes inpromoting healthy emotional development inchildren.

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More informationon backgroundwork, the forumand presentationsis available inAppendices A, Band C and thepull-out section.

Community Recommendations

Child care, community, school and primary carerepresentatives offered many recommendationsin the afternoon workgroups, including thefollowing suggestions that NHPS

- Train providers, teachers and parents aboutbehavioral health

- Provide technical support for providers andagencies to help them apply training andimplement programs effectively

- Formally engage families and youth inplanning and program development

- Address gaps in what we know aboutparenting as a strategy for prevention, andconsider combining parenting education withother approaches

- Enhance the use of developmental specialistsin the system of care

- Generate increased opportunities to gatheremotional/behavioral health information toimprove program planning, including• Creating a parent survey for primary care

offices regarding child behavior • Surveying child care providers about child

behavior issues- Contribute to the sustainability of prevention

efforts through coordination of stakeholders,using data to communicate the costs andbenefits of prevention services

NHPS Roles and First Steps

In response to the numerous recommendationsmade, three areas emerged in which NHPS canlead promotion and prevention efforts aroundchildren’s emotional and behavioral health inDelaware:1. Analysis and Evaluation: Helping our commu-

nity partners uncover and understandchildren’s many emotional and behavioralhealth needs;

2. Program Content: Bringing the latestevidence-based practice information topartners;

3. Technical Assistance: Helping our partnersensure a high level of quality in the applicationof strategies.

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Summary of Proposed Action Plan Based onCommunity Expert Input

NHPS’ plans for promotion and prevention aroundchildhood emotional and behavioral health consider bothlong-term and short-term approaches. Potential areas oflong-term focus may span from developing acomprehensive Delaware early childhood initiative, toexamining the feasibility of health promotion services inschools. Over the next year we are taking some initialsteps based on the Delaware input we received to helpcoordinate prevention efforts across agencies. We willalso continue with data collection and analysis to furtherdevelop strategies to be initiated in 2007.

Initial Steps:1. Conduct analysis of baseline data on early childhood

behavioral assessment.2. Support Delaware’s “Partners in Excellence” program

for early childhood providers (PIE).3. Further assess the potential of bringing the

“Communities that Care” (CTC) model to Delaware in collaboration with state and local partners. This may include a pilot test of the model in one to two communities. CTC uses community-focused coalitionsto plan activities that address risk and protective factors for youth.

4. Conduct feasibility studies to further explore and develop partnerships with parents including parent education and support.

5. Test the feasibility of bringing health promotion activities to middle and high school students by building upon the infrastructure of Delaware’s high school Wellness Centers.

Future Options to Explore: Ideas under consideration aswe refine our plans and solicit additional input from keyDelaware stakeholders.

6. Develop a parent-focused strategy such as an NHPSParent-Caregiver Academy, a center to partner withparents and study the most effective ways to developparenting as a prevention strategy.

7. Enhance physician-parent exchange of social-emotionaldevelopment information through application of somecomponents of the Healthy Steps model in primarycare settings.

8. Develop emotional and behavioral materials for childrenand parents in conjunction with KidsHealth staff, withinNHPS’ Center for Children’s Health Media.

Proposed NHPS Emotional and BehavioralHealth Action Plan Based on Community andExpert Input

NHPS’ plans for health promotion and prevention aboutchildhood emotional and behavioral health aremultifaceted. Using input from the forum and nationaland local interviews, we crafted a set of options that willrequire further development. With agency and communitypartners, NHPS will be creating program plans fromthese options that will be phased in over time. We intendto consider methods of contributing to a comprehensiveplan that links the system of prevention and promotion to the treatment system.

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Support for Childcare SettingsWhat we heard about child care settings Proposed Response

From child care forum work group input:

• Train teachers in classroom management

• Educate parents about child development and behavior

• Provide technical support for Partners in Excellence

• Start as early as possible with young children

• Survey child care settings about child behavior issues

From pre-forum national/local interviews:

• Focus on teacher and caregiver interactions with children

• Build skills that transfer across settings

• Focus on environmental and risk factors

• Provide opportunities for affective education

Devereux Early Childhood Assessment (DECA)Analysis Project NHPS will be looking at pre-existing social and emotionalwellness information collected on approximately 500children in fourteen child care centers across the state ofDelaware. While there is data available for children in eachindividual center, NHPS is interested in understanding howthis data looks when combined across centers. Since thisdata specifically describes child strengths and behavioralchallenges, NHPS seeks to learn how children are doingsocially and emotionally across many centers. Thesefindings can help support NHPS work with Delaware’s childcare and Head Start sites to support children’s social andemotional development.

Partners In Excellence (PIE)Another potential step for NHPS is to provide supportiveservices to the Partners In Excellence initiative. Thistraining framework sponsored by the Delaware Departmentof Education focuses on building the skills of providers tosupport young children’s social and emotionaldevelopment. NHPS is considering providing four types ofsupportive services to Partners in Excellence: assistancewith training for staff; on-site support to help providers putthe training into practice; assistance with evaluationtechniques; and educational materials and/or activities.

Family Child Care Project DevelopmentFamily child care sites do not typically benefit from thesupports made available to larger center-based providersand Head Start centers. NHPS will consider supplyinghealth promotion materials or programs to these sites,tying together information about healthy eating, physicalactivity and emotional and behavioral health.

Partners In Excellence (PIE):

Delaware Department of Education sponsored framework for training andtechnical assistance to promote social and emotional development of childrenin child care settings. The Center for the Social and Emotional Foundations forEarly Learning (CSEFEL), University of Illinois-Urbana-Champaign, funded bythe Child Care Bureau and the Head Start Bureau, created the PIE program inorder to strengthen the capacity for Head Start and child care programs.CSEFEL’s assistance to Delaware ends in June 2006.

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Support for CommunitiesWhat we heard about community settings Proposed Response

From community forum work group input:

• Contribute to sustainability of prevention efforts through coordination of stakeholders

• Formally engage youth in planning and development

• Evaluate and disseminate current evidence-based practices

• Improve and build relationships between community, school and family

• Improve communication channels using consistent messages

• Advocate for coordination

• Work with faith-based organizations

Communities That Care® (CTC)NHPS plans to engage a variety of state and local partnersin discussion about bringing Communities That Care (CTC)to Delaware. Initial steps may include piloting the model inone or two communities. A community-wide strategy forcoordinating prevention efforts, the CTC process works bybringing a network of organizations together to identify andplan for the needs of youth in their community. Thenetwork surveys the neighborhood environmentalconditions that encourage risk behaviors in youth andthose that promote healthy behaviors. Based on theresults of its survey, the network implements specificprograms, selected from a pool of proven strategies, tobest support those youth. The lynchpin to a CTC network’ssuccess is the opportunity for youth to bond with adultsand peers, thus promoting and reinforcing healthybehavior.

Resource Center based at NHPSAs a health promotion resource for the Delawarecommunity, NHPS is exploring hosting training sessions,helping organizations design their programs and housingprevention and promotion tools such as programs, booksand videos for use by outside organizations. The purposeof these activities is to help the community by providingresources and information to support and promotechildren’s emotional and physical health.

Communities That Care (CTC):

A community mobilization system, founded by Drs. David Hawkins and RichardCatalano at the University of Washington, to prevent problem behaviors andpromote positive youth development through the systematic identification ofrisk and protective factors that impact youth in particular communities. Oncerisk factors (such as family conflict, academic failure, lack of attachment,norms favorable to drug use) and protective factors (such as bonding, healthybeliefs, clear standards, opportunities and skills) are identified, communitiescan draw from a pool of evidence-based programs to enhance protectivefactors and reduce risk factors.

CTC has been implemented in sites across the U.S. and in the UK.Pennsylvania is an example of broad implementation of CTC.

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Support for FamiliesWhat we heard about families Proposed Response

From forum work group input across areas:

• Work with families; parent education is lacking

• Train parents and caregivers

• Produce parent education materials

• Address lack of family awareness of risk factors; address lack of neighborhood resources for children and families

From pre-forum national/local interviews:

• Treat families as a discipline for study and intervention

• Obtain more information about how to engage families in partnerships

• Address gaps in what we know about parenting as a strategy for prevention

• Focus on teaching parents (among other adults) to interact and respond to children

• Combine parenting education with other approaches

Parent and Family DevelopmentNHPS will start to formally identify a plan for partneringwith parents and families in providing health promotionand disease/risk prevention programs. NHPS will bedeveloping a set of principles and a structure to ensurethat engaging and involving families is a priority across allof its efforts.

Parent/Caregiver AcademyOnce NHPS determines how the organization can bestwork with families, we will explore the feasibility of aParent/Caregiver Academy as a place to partner with andengage parents and study the most effective ways toprovide caregivers with the learning opportunities, trainingand resources necessary to help them develop strongparenting and leadership skills. This academy couldsupport a variety of efforts including parent support andeducation; support for initiatives led by families/parents;and education and training for practitioners in working withfamilies, all with the intent of promoting child health.

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Support for Primary CareWhat we heard about primary care Proposed Response

From primary care forum work group input:

• Offer emotional/behavioral health education for pediatricians and staff

• Generate increased opportunities to gather emotional/behavioral health information

• Create parent survey for primary care offices regarding child behavior

• Provide professional development opportunities for physicians

• Advocate for reimbursement of prevention activities

From pre-forum national/local interviews:

• Involve entire pediatric staff - nurses facilitate parent groups

• Start with early adopters

• Add developmental specialists to primary care practices

• Increase medical professionals’ comfort with developmental approaches

Child Developmental Specialists in Primary Care SitesHealthy Steps, a proven model program that could bepiloted in primary pediatric healthcare settings, uses ateam approach to primary care encompassing emotional,behavioral, intellectual and physical health information.NHPS is considering using the approach taken withHealthy Steps that brings child developmental specialistsinto primary care settings, in order to increase theavailability of developmental/behavioral information toparents. NHPS is also looking at ways for primary carepractices to work with insurers to encouragereimbursement of prevention activities.

Collection of Social-Emotional DataNHPS is exploring how more social and emotionalinformation can be collected in primary care settings,possibly through the Electronic Medical Record. This datacould help to increase the physician-parent/caregiverexchange of emotional and behavioral information aboutchildren during an office visit. NHPS will explore the use oftechnology to streamline developmental screening and toprovide information to parents and providers efficiently.This data could also serve to guide physicians as theycounsel and inform families about their children’s socialand emotional needs.

Healthy Steps:

Brings trained child development specialists into pediatric practices. Thesespecialists help develop the healthy start interventions including enhancedwell-child and home visits. A national experiment designed by the BostonUniversity School of Medicine and The Commonwealth Fund, Healthy Stepsincorporates enhanced preventive, developmental, and behavioral servicesinto primary care for children from birth to age 3.

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Support for SchoolsWhat we heard about schools Proposed Response

From school forum work group input:

• Provide professional development opportunities for teachers

• Cultivate prevention programs that have referral mechanisms

• Improve relationships between community, school and family

• Promote skill-building educational activities

• Consider promotional services that reach a middle school population

From pre-forum national/local interviews:

• Consider schools as a primary vehicle and context for change

• Combine academic and socio-emotional curricula, which is promising, yet untested

• Help teachers to use different communication approaches with children and families

Pilot for Wellness Centers to Increase Prevention ActivityNHPS is considering providing support to four high schoolwellness centers to operate a proven prevention program,keepin’ it REAL (Refuse, Explain, Avoid, Leave). This is aschool-based program for students ages 10 to 17 thatteaches communication and life skills in order to combatnegative peer and other influences that contribute to riskbehaviors. Over the course of ten lessons, keepin’ it Realuses videos that depict teens in real-life situations to showhow teens can build up their internal strengths, developresistance and avoid engaging in risk behaviors.

Youth Development ProjectsIn the interest of building assets in youth, NHPS is workingon youth development projects, many of which haveemotional and behavioral health components. NHPS definesyouth development as the process in which all young peopleare engaged to meet their needs and build competencies sothat they choose healthy behaviors and make positivecontributions to their community. A project underconsideration, PhotoVoice, is one in which youth will takeand narrate photos of places, people and things in theirenvironments that positively and negatively affect theiremotional well-being.

Additional School-Based ProgramsSchools communicated to NHPS that they want social,emotional and behavioral skill-building programs forstudents that provide a link to services when children havetreatment needs. Several proven programs, such as PATHS(Promoting Alternative Thinking Strategies) are available forelementary to high schools that offer emotional andbehavioral skill-building activities for students and also havebuilt- in referral mechanisms to appropriate school staff orother mental health professionals. NHPS will be consideringhow to bring these types of programs to Delaware schoolsand examine their relationship to academic achievement.

Appendix A:

Summaries of Presentations at the Community Expert Forumon Emotional and Behavioral Health

Appendix A:

Summaries of Presentations at the Community Expert Forum on Emotional and Behavioral Health

“Planting the Seeds for BetterHealth”Debbie I. Chang, MPH Senior Vice President and Executive DirectorNHPS Health and Prevention Services

Executive Director Debbie Chang launched the forum withan overview of the creation of NHPS, along with itsmission and vision. NHPS became operational in 2004 tocomplement the pediatric treatment, teaching andresearch programs of the Nemours organization by takinga holistic view of the child-health as well as health care.Ms. Chang reviewed how NHPS’ centers will coordinatetheir work to take the lead in shifting child healthpromotion beyond a purely medical approach to a morecomprehensive approach that examines the environmentsin which children and their families live and function.

Ms. Chang shared how emotional and behavioral health isconsidered but one “petal” of a child’s overall health,which includes a balance of physical, emotional, cognitiveand social wellbeing. In 2004, NHPS started a strategicassessment process for this arena through interviewswith community stakeholders and national program andpolicy experts, culminating in a community forum inDecember.

Ms. Chang concluded with the charge of the forum: tolearn from Delaware front line organizations invested inchildren’s health: child care, schools, primary care andcommunity organizations.

“The Promotion of Mental Healthand Prevention of Mental Disorders:A Federal Perspective”Pat Shea, MSW, MA Public Health AdvisorCenter for Mental Health Services, Substance Abuse andMental Health Services Administration (SAMHSA)

Ms. Shea discussed how federal-level interest inemotional and behavioral health promotion is growing,demonstrated in part by the President’s New FreedomCommission on Mental Health. Reasons for growinginterest in this area include 1) the connection betweenchildhood disorders and later disorders in adulthood, and2) the high prevalence of mental health problems in thepopulation (five of the top ten causes of disability aremental disorders). In order to build continued support formental health promotion, Shea urged stakeholders tostrengthen the argument that prevention efforts will notonly reap health benefits for children, but also thatprevention efforts can be cost effective.

Ms. Shea shared how SAMHSA is structured to supporthealth promotion and disease prevention in the area ofchildhood emotional and behavioral health. SAMHSAdeveloped a Strategic Prevention Framework that “is anordered set of steps taken to promote individual, familyand community resistance to mental and behavioraldisorders, support recovery and prevent relapse.” Withinthis framework, SAMHSA collects and evaluatesevidence-based mental health promotion and mentaldisorder prevention programs on its National Registry ofEffective Programs, available on the Internet for publicuse. www.modelprograms.samhsa.gov

Shea defined prevention as a term that suggests not onlypreventing the onset of a disorder but that also suggestspreventing co-morbidity, relapse and disability. Effortstoward prevention assume that both risk and protectivefactors in a child’s life can be altered.

Key recommendations from Ms. Shea’s presentation arepromoting mental health of young children and buildingon research to promote resilience. Shea defined resilienceas a child demonstrating adaptation by behaving in a

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competent manner when experiencing a “significantthreat to the individual” or adversity. Signposts ofresilience in children are good problem solving skills, aproactive coping style and capacity to understanddifferent points of view. Children tap into environmentalresources that can build these skills. Optimally, resourcesare caring adults in their lives, good schools, safeneighborhoods and pro-social friends.

In conclusion, Ms. Shea challenged the audience to movetowards an environmental approach to health promotionand disease prevention, quoting Sun Sze-Mo, an eighth-century Chinese physician, “The lower doctor heals theillness; the median doctor heals the whole person; thehigher doctor heals the human society.”

“NHPS Review and Assessment ofChildren’s Emotional and BehavioralHealth Strategies”

Scott Rosas, PhD Senior Program and Policy AnalystNemours Health and Prevention Services

Dr. Rosas shared results from a series of interviews andreport reviews conducted by NHPS in the effort to identifyissues around childhood emotional and behavioral health. This background research pulled information from 12programs in states outside of Delaware; 17 keyinformants from Delaware; 10 in-depth interviews withnational experts; and a review of five major reports.

Dr. Rosas indicated that the objective of the backgroundreview was fourfold: 1) To identify from systematic reviews what are important

considerations in children’s’ emotional health andbehavioral development;

2) To identify how others from across the country wereaddressing the complex issues of supportingchildren’s healthy emotional and behavioraldevelopment in a variety of settings;

3) To identify what stakeholders in the state of Delawareviewed as important considerations for children’semotional and behavioral development as well as whatareas were not being addressed and;

4) To identify what the field has learned from researchand practice and where there might be opportunities tobridge the two areas.

From the wealth of information shared at the forum,several themes emerged as recommendations for NHPS’swork: - Focus on skills development- Work with adults- Pay attention to environment and risks- Look closely at content of prevention programs- Evaluate process as well as progress - Frame issues through the lens of children’s development

to shape promotion and prevention strategies

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Details on Recommendations

Focus on skills development: Promotion and preventionprograms should emphasize development of skills inchildren that can be used across situations and contexts.For example, children need skills that can be practiced orapplied at school, at home, at the doctor’s office or in therecreation center.

Work with adults: Focus on teaching adults how tointeract and respond to children. Inform programdevelopers and implementers about what children intoday’s families experience, particularly risk factors suchas poverty, family violence, parental substance abuse orharsh discipline.

Pay attention to environment and risks: In thedevelopment of promotion and prevention strategies, it isimportant to be aware of the ways that the environmenteither inhibits or supports child and family emotional andbehavioral health. Equally important is being realistic inour ability to change the environment to meet healthneeds--it is often difficult and requires substantial effort.

Look closely at the content and delivery of preventionprograms: In order to be effective in shaping children’shealthy emotional and behavioral development, it is criticalto emphasize the use of strategies that have been shownto work, to understand what, how and where programs areactually being delivered and to identify how variationsaffect the outcome of programs.

Evaluate process as well as progress: Evaluation is anecessary (and often undervalued) component to ensuringquality implementation, to determining benefits andestablishing sustainability of prevention programs andstrategies. The need for implementation and evaluationsupports exist at every level of the system and are criticalto furthering the field’s understanding of what works forwhom and under what conditions.

Frame issues through a lens of children’s development:The way we view children’s emotional and behavioralhealth needs will drive how we respond. Recognizing thatchild’s growth and development occurs across severalnested systems (child, family, community) enables theidentification of multiple risks and strengths, helps tofocus on the relationships between contexts (child-parent,parent-school), and helps to identify when and howchange occurs.

Reports we reviewed:

Greenberg, M., Domitrovich, C., and Bumbarger, B.(2000). Preventing Mental Disorders in School-AgeChildren: A Review of the Effectiveness ofPrevention Programs. From Contract No.98M002805, Department of Health and HumanServices, Substance Abuse and Mental HealthServices Administration, Center for Mental HealthServices.

Kauffman Foundation. (2002). Set for Success:Building a Strong Foundation for School ReadinessBased on the Social-Emotional Development ofYoung Children. Kansas, MO: The Ewing MarionKauffman Foundation.

Olds, D., Robinson, J., Song, N., Little, C., and Hill,P. (1999). Reducing Risks for Mental DisordersDuring the First Five Years of Life: A Review ofPreventive Interventions. Submitted to the Centerfor Mental health Services (CMHS).

Simpson, J., Jivanjee, P., Koroloff, N., Doerfler, A.,and Garcia, M. (2001). Systems of Care:Promising Practices in Children’s Mental Health,2001 Series, Volume III. Washington, D.C.: Centerfor Effective Collaboration and Practice, AmericanInstitutes for Research.

U.S. Public Health Service. (2000). Report of theSurgeon General's Conference on Children'sMental Health: A National Action Agenda.Washington, D.C.: Department of Health andHuman Services.

13

“Implementation of IntegratedCommunity-Based Social andBehavioral Health Services forChildren and Families”Sherrie Segovia, PsyD, MA, Social ServicesCoordinator Hope Street Family Center/California Hospital MedicalCenter

Dr. Segovia presented information about the Hope StreetFamily Center in Los Angeles, CA, which exemplifies anintegrated approach to emotional and behavioral health inchildren and their families. The center provides an arrayof services, covering children’s needs through all phasesof development, to families in Central and South LosAngeles. Beginning in 1992 as a collaborative effortbetween UCLA, California Hospital and residents ofCentral Los Angeles, the Hope Street Family Center nowhas programs ranging from early head start, youth centerand family literacy, to prenatal and early childhood nursehome visitation.

The Hope Street Family Center demonstrates linkages thatcan be created, using community engagement anddevelopment, between the center’s programs and theservices of more than 25 partner organizations that coverhousing, medical, legal, employment, counseling, arts,faith-based and social services. Hope Street has amemorandum of understanding with each of thesepartners.

Strengths and strategies contributing to the success ofthe Hope Street Family Center are:- Fostering a sense of connectedness by focusing on

community capacity building. - Creating an accessible and approachable agency with

interdisciplinary staff that reflects the populations theyserve.

- Using an ecological model and approach that developsand designs services that are comprehensive, long-termand co-located.

- Working with families, including specific outreach tofathers.

Dr. Segovia ended her presentation by sharing severalconditions that pose challenges to sustaining this level ofservice delivery and partnership--funding, staff retention,staff support and space (facilities). These conditionsgenerate the need to prioritize allocation of resources; Dr.Segovia shared how when she prepares budgets, sheprioritizes her staff’s salaries.

“Experiences from Vermont:Partnerships to Promoting Well-being for Children and Youth throughImprovements in Primary HealthCare Quality”Paula Duncan, MD, Youth Health Director University of Vermont - School of Medicine Vermont Child Health Improvement Program (VCHIP)

Dr. Duncan discussed two Vermont projects that promotechild emotional and behavioral wellness throughpreventive service visits for young children and youth 8-18. The Vermont Youth Health Improvement Initiative(VYHII) is one program for 8-18 year-olds whereasHealthy Development focuses on children birth to five.Both projects involve screening assessments, communitycollaboration and parent involvement.

Youth Health Improvement InitiativeYouth Health Improvement Initiative provider screeningstake into account risk and protective factors as well as aset of youth assets. In Vermont, providers screen youthfor risk and protective factors, both pre-intervention andpost-intervention. Providers address youth risk behaviorusing the CRAFFT survey (see below) and buildrelationships with youth, addressing protective factorsand strengths, with the HEADSS and READY models.When youth have identified behavioral health concerns,follow-up includes further assessment, officeinterventions, or referrals to professionals outside theprimary care office.

CRAFFT SurveyC - Have you ever ridden in a CAR driven by someone(including yourself) who was “high” or had been usingalcohol or drugs?R - Do you ever use alcohol or drugs to RELAX, feelbetter about yourself, or fit in?A - Do you ever use alcohol/drugs while you are byyourself, ALONE?F - Do you ever FORGET things you did while usingalcohol or drugs?F - Do your family or FRIENDS ever tell you that youshould cut down on your drinking or drug use?T - Have you gotten into TROUBLE while you were usingalcohol or drugs?

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READYR - Relationships with friends, other students, co-workersand familyE - Energy to find things you enjoyA - Awareness of the world around you, your place in theworld and your contributionD - Independent Decision Maker- knows how to getthings done and can control behaviorY - Say “Yes” to healthy behavior- Eat well, play hard,work hard

HEADSSH - HomeE - EducationA - ActivitiesD - DrugsS - Sexual Activity/

Sexual IdentityS - Suicide/DepressionS - Safety

Healthy Development ProgramFor infants and children up to age five, the HealthyDevelopment Program’s developmental and psychosocialscreening is accomplished using parent questionnairesand chart audits in family medicine and pediatricpractices (PEDS or ASQ). This activity enables enhancedwell-child visits that can include anticipatory guidance.

As a final point, Dr. Duncan re-emphasized parent andcommunity expertise as integral to the process.

“Challenges in Implementation in theSchools”

Ann-Linn Glaser, BS Educational Consultant and “I Can Problem Solve” Trainer

Ms. Glaser discussed the benefits and challenges ofimplementing the school-based prevention program, “ICan Problem Solve” (ICPS). “I Can Problem Solve” is aninterpersonal problem-solving curriculum developed forpreschoolers, which is also used in primary schools up tothe fifth grade. ICPS provides teachers with a protocol toteach children how to solve their own problems.

Ms. Glaser first made several recommendations to helpimplementers to align their efforts with the ICPSphilosophy, “Ask, don’t tell.” Successful implementationof ICPS relies on gaining buy-in from schooladministrators and teachers. Gaining administrativeinvolvement early in the planning process will positivelydemonstrate their support for the program to staff. Inaddition to supplying and generating early buy-in, schooladministrators would most ideally be trained in the ICPSprogram, which enables them to be in-house resourcesthat are also equipped to identify staff responsible forICPS implementation.

Within the ICPS implementation process, teachers needto be consulted and involved in a core group for decision-making. Once a site is established, teachers can not onlyplay the role of guiding the process in a core group, butalso provide teacher-to-teacher training and follow-up, alltowards sustainability. Additional attractive features arethat ICPS curriculum is consistent with many school corecurriculum standards and that it can also supplementhealth education curriculum.

Parental buy-in is also critical to program success.Conducting outreach to parent-teacher associations canassist in building support and marketing ICPS. Additionalefforts to promote parent buy-in include training forfamilies in topics such as “Raising a ThinkingChild/Preteen,” along with other incentives.

In summary, gaining buy-in from administrators, teachersand parents is central to success in implementing ICPS.

(Assessing for-BelongingMasteryGenerosity/IndependencePhysical Activity/Nutrition)

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Appendix B:

Promising Programs for Promoting Healthy Emotionaland BehavioralDevelopment in Children

This list of promising programs was

compiled to provide examples of strategies

different communities have implemented

that have shown success. This is not an

inclusive list, but it is intended to stimulate

thinking about various opportunities.

Many of the programs are becoming

nationally known and some have been

rigorously evaluated. The list was

compiled from a review of the

literature, national model

programs and information

obtained from personal

interviews. The strategies

are organized into groups

based on the following

program types: early

development; home

visiting; school-

based; and

parenting

education.

Appendix B:

Promising Programs for Promoting Healthy Emotional and Behavioral Development in Children

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Early Development

Vermont Child Health ImprovementInitiativehttp:// www.med.uvm.edu/vchip

Audience: Early Childhood, Clinicians

Description: This overall project includes two relevantcomponents, both of which are part of a broad statewideeffort to improve the quality of pediatric care in Vermont.

The Developmental Services initiative is developing alearning collaborative for 15 pediatric practices in thestate to improve the provision of anticipatory guidance,parent education and other developmental services forchildren under 5.The practices will develop to detectchildren at risk of psychosocial and behavioral problems,build practice capacity to support parent education andestablish better linkages with community agencies. Thecollaborative will also engage state and local policymakers to learn about practice-level and state-level effortsand policy changes to support improvements in care.

The Home Visiting initiative has worked to increasequality of and access to home visiting services in thestate. The approach includes parent education, medicaland child care provider training in the “touchpoints”approach and reorganization and streamlining of services.

Wisconsin Early Childhood CollaboratingPartnershttp://www.dpi.state.wi.us/dpi/dltcl/bbfcsp/eccopthm.html

Audience: Child Care and Preschool

Description: This effort is trying to create a system orsocial commitment to early childhood development in thestate. The collaborative has been working to increase thequality of child care, including the development anddissemination of early childhood education standards,with a strong focus on behavioral and emotionaldevelopment.

Project CornerstoneAudience: All Ages, Community

Description: Project Cornerstone is a county-widecollaborative in Santa Clara County, California, to fosterthe Search Institute’s developmental assets framework.The initiative is working with schools, based on theoutcomes of a countywide assets survey. The board ischaired by the former mayor of San Jose. It is not clearhow active the initiative is.

This is an example of using the Search Institute’sFramework to develop programs and initiatives at thelocal level. www.search-institute.org

San Francisco High Quality Child CareMental Health ConsultationAudience: Early Childhood, Child Care and Home

Description: The initiative (a collaborative effort of theMayor’s office and SF DPH) provides mental healthservices to 50 center-based and 100 family day careproviders serving low-income families. The programprovides consultation to child care providers andtherapeutic services delivered to children at the child caresite.

This is an extensive and well-developed model ofproviding mental health consultation in a child caresetting.

Starting Early, Starting Smarthttp://www.jhsph.edu/PreventYouthViolence/Community/SESS.html

Audience: Early Childhood, Child Care, Clinical and Home

Description: The program delivers integrated behavioralhealth interventions in early childhood education settingsand primary care settings to examine impact on thefollowing outcomes:

• Access to and use of services• Social, emotional and cognitive outcomes for children• Caregiver-child interaction outcomes• Family functioning

The primary care settings focus on infants and children upto age 3, while the child care setting works with childrenaged 3 to 5.

This is an interesting model of providing earlydevelopmental interventions in both the home and clinicalsettings, integrating a variety of interventions as well asbasic support services for children. The current sites arepart of the initial implementation program for this largenational study sponsored by SAMSHA and the Annie E.Casey Foundation.

Healthy Steps Chicago(An initiative of the Commonwealth Fund)

Audience: Early Childhood, Clinical

Description: The Healthy Steps program introduces atrained child development specialist to pediatric practices.This trained person (either a new or original staff person)helps develop the healthy start interventions, includingenhanced well-child and home visits.

A recent national evaluation of the original sites showedthat Healthy Steps families were more likely to discussdevelopmental issues with their providers and useappropriate parenting in stimulating, communicating withand disciplining their children as well as matching parentbehavior to the developmental stage of the child.

Advocate Health Care in Chicago, leads Chicago-areaefforts by integrating Healthy Steps into pediatric andfamily medicine practices. In addition, Advocate continuesto work with DuPage County in its effort to build HealthySteps into its public health system. The IllinoisDepartment of Human Services is closely watching thisprogram for possible replication. Advocate is also workingto integrate the approach into pediatric residency training.

Hope Street Family Centerhttp://www.healthychild.ucla.edu/HopeStreetFamilyCenter.asp

Audience: All Ages, Home, Child Care

Description: The Center was established as a public/privatepartnership (California Hospital Medical Center andCHCFC). The center uses an ecological approach to servicedelivery addressing both the child and the family and thesocial environment in which the child lives.

The center offers early childhood services and programssuch as prenatal care, health care, home visiting and on-site child care. Preschool-age children are eligible toparticipate in HSFC’s Child Development Center as well asenroll in a family literacy program with their parents.

The home visiting model relies on the “Partners inParenting” and “Creative Curriculum” models.

Cuidar Attention and Learning Program http://www.cuidar.net

Audience: Early Childhood, Community, School andClinical

Description: Cuidar is a program designed to optimizecognitive and social development in young children whilepreventing or minimizing impairment in children beforethey enter school. It provides a parent education programcalled “COPE” for parents of preschoolers exhibitingattentional problems. A program for social skillsdevelopment in children is offered concurrently. Theconcept is that parent training and behavior interventionshould occur first, before families schedule a clinical visitto identify and diagnose ADHD. With appropriate skills andknowledge, many families will not need to seek furtherdiagnosis or treatment. Participating families can follow-up at the Cuidar Clinic.

Illinois Healthy BeginningsAudience: Early Childhood, Clinical

Description: Conduct training and outreach in three clinicalsettings – Federally Qualified Health Center, local healthdepartment and private practice –to promote appropriatedevelopmental and mental screening and referral in theprimary care setting. In addition to this intensiveintervention, the state pediatric association will develop abroad-based approach to promoting more appropriatescreening and referral.

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Home Visiting

Children First Programhttp://www.health.state.ok.us/program/c1/

Audience: Early Childhood, Home

Description: The Department of Justice and theAdministration for Children and Families funded thereplication of the Olds model in Oklahoma. In 1997 theOklahoma legislature adopted the model for the entirestate. The program is for first-time parents with limitedfinancial resources. The program provides developmentaland health assessments, parenting education and linkingto other services. At one point in 2000, 5,000 families inOklahoma were participating in the program. A familyparticipating completely in the program might haveapproximately 50 home visits by a public health nurse:

• Weekly visits during the first month of pregnancy • Biweekly visits until delivery • Weekly visits during first six weeks after delivery• Every other week visits until 21st month of childhood• Monthly visits until child reaches 2 years of age.

Initial results in Oklahoma showed a decrease in smoking,better prenatal health and lowered risk of maltreatment,although it is unclear whether the program had an impacton the emotional health of children. The experience of thisprogram can shed light on the challenges, issues andoutcomes of applying the Olds model at a state level.

Louisiana Home Visiting Programshttp://www.oph.dhh.state.la.us/maternalchild/nursehome/http://www.oph.dhh.state.la.us/maternalchild/parahome

Audience: Early Childhood, Home

Description: Louisiana’s MCH department appears to beimplementing two different models for home visiting.They are implementing the Olds model in 4 regions withabout 300 families participating. At the same time theyare implementing the Healthy Families model—with afocus on child abuse prevention—usingparaprofessionals.

Examining Louisiana’s experience would provideperspective on a state that has tried two differentmodels—one professional and one paraprofessional—and has changed approaches mid-stream because ofoutcome information.

Prenatal to Threehttp://www.co.sanmateo.ca.us/smc/department/home/0,,1954_194745_194736,00.html

Audience: Early Childhood, Home

Description: A home visiting model (using elements ofOlds) for Medi-Cal families in San Mateo County. It is acollaborative of the San Mateo County Health ServicesAgency, the Health Plan of San Mateo and the PeninsulaPartnership for Children, Youth and Families. The typeand amount of home visiting varies by family risk. Homevisits begin in the prenatal period and about one-third offamilies get services for more than one year. Tailoredhome visiting is offered for families in need of mentalhealth or substance abuse services.

Culturally specific parenting classes are offered as well asparent support groups using the “Touchpoints” approach.

Prenatal to Three gives us an opportunity to investigate aprogram with different levels of service based on need, aculturally-specific approach to parenting education andspecialized “mental health” home visiting for families inneed.

Also see: “Invest in Kids”* (Parenting) and “Hope StreetFamily Center”* (Early Development)

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School-Based Programs

Character Plus (Caring School CommunityProgram)http://csd.org/characterplus/

Audience: Elementary School, Schools

Description: The Child Development Project (now calledthe “Caring School Community” program) is a multi-faceted program to develop a more cooperative andcaring school environment promoting student self-control, parent involvement and better relationshipsamong all in the school community. The program showedreduced use of alcohol and marijuana and violence-related activity. It also created a higher sense of efficacy,better conflict resolution skills, greater liking of schooland higher academic motivation. Some studies showedprogram effects for “high change” schools but not for“low change” ones.

An important innovation of this approach is that it istrying to reform the whole school environment, not justaffect individual behaviors.

Promoting Alternative Thinking Strategies(PATHS), BaltimoreAudience: Elementary School, School

Description: The PATHS program is a curriculumdesigned to promote social and emotional competence,prevent violence, aggression and other behaviorproblems, improve critical thinking skills and enhance theclassroom climate. Students have a chance to practiceand apply identifying feelings, self-calming skills andsolving interpersonal problems. Approach includesclassroom meetings, goal-setting and planning skills.Baltimore is implementing the program in a number ofschools using a federal grant.

Two published studies and one unpublished study haveshown improved academic performance and reducedaggression and hyperactive-disruptive behavior (as ratedby peers) among first-graders in regular educationclasses and more positive teacher-rated behaviors relatedto emotional adjustment, lower teacher-rated behavioralimpulsivity and higher parent-rated social competenceamong deaf children in grades 1-6 (Casel).

Early Years Countwww.earlyyearscount.org

Audience: Early Childhood, Preschools and Home

Description: The community foundation of St. Joseph’sCounty, Indiana, used a $5 million grant from The LillyFoundation to begin Early Years Count. The programpromotes early childhood education by implementingHigh/Scope in preschools and working with parents usingthe Parents as Teachers approach.

The High/Scope program uses active learning to promotesocial competencies, confidence and readiness forschool. The program provides a warm home-likeenvironment, focused on the quality of the adult/childinteraction and ongoing child assessment. The programprovides a framework for daily routine, classroom andoutdoor play organization and teacher-child interactions.The program has been implemented in preschools andHead Start. It also incorporates a home visitingcomponent.

The model is based on 40 years of evaluation with long-term research results showing higher income, homeownership and a lower likelihood of having been arrestedfor program participants. High/Scope females were morelikely to be married and less likely to have had childrenout of wedlock. At age 19, the High/Scope group hadhigher general literacy. At age 14 they scored higher onschool achievement tests. Cost-benefit analysis estimatesthat the High/Scope preschool program saves the public$7.16 for every dollar spent.

Parents as Teachers is a parenting education programdeveloped in Missouri and now operating in 49 states andDC through more than 2,500 sites serving over 260,000families. Almost two-thirds of the programs aresponsored by school systems. The program uses trainedparent-educators to provide parenting education throughhome visits and other interventions.

The program has been widely adopted, including inDelaware. Study results show positive impact on parentinvolvement, school readiness and social development.Many evaluations focus more on the academic aspects ofthe program’s impact than the social and emotionalissues.

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The Early Years Count program showed improvementsafter implementation of High Scope in day care in manyareas including conflict resolution by children,encouragement for peer interactions and independentproblem solving.

This is an interesting model of a community foundationworking to promote a particular intervention andapproach throughout the community.

Prince George’s Comer SchoolDevelopment Programhttp://www.pgcps.org/~comer

Audience: All Ages, Schools

Description: This is a whole-school or comprehensiveschool reform model developed by Yale researchers. Oneof the cornerstones of the model is the idea of promotinghealthy development across many domains includingchildren’s physical, cognitive, psychological, language,social and ethical development.

Several evaluations have shown that the programproduced school climate changes associated withacademic improvement, less acting out and lowerabsenteeism. However, a local evaluation in PrinceGeorge’s County did not show these results.

The program includes the development of three teams: • The school planning and management team• Student and staff support team• Parent team

These teams develop a school plan, conduct staffdevelopment and periodic assessments focused ondeveloping problem-solving processes, consensusdecision-making and collaboration.

The program has evolved from focusing on individualschools to a focusing on the school system, school boardand school system staff.

“I Can Problem Solve Program”in New JerseyAudience: Elementary School, Schools

Description: A theory-based interpersonal problem-solving curriculum to help children problem-solve andprevent anti-social behavior. The approach was originallydeveloped for preschoolers but has been implemented inprimary schools up to fifth grade.

Evaluation results show that ICPS improves children’sbehavior and increases peer acceptance, consequentialthinking skills and academic achievement test scores(although it is unclear whether these persist over time).Results include improved problem-solving and reducedinhibition and impulsivity. ICPS is most effective inchildren who receive two years of intervention. Otherevaluations show that ICPS improves problem-solvingskills and promotes pro-social behaviors.

Social Decision-Making ProgramAudience: Elementary School, School

Description: Developed by Jersey City Schools thisschool-based program is designed to give studentsproblem-solving skills to make a successful transition tomiddle school. The program also provides materials(books, cable TV and a web site for parents).

Participating students were better-adjusted, able to handlemiddle-school stress, more self-reliant and showed moreself-control.

Jersey City is adopting this approach in six of its schools.

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22

Parenting Education

Rhode Island Student Assistance Serviceshttp://www.risas.org

Audience: Elementary and Middle, Schools and Home

Description: Rhode Island Student Assistance Servicesimplements the Strengthening Families program,originally developed by the University of Utah forimproving the skills of families with substance-abusingparents. The approach is now used widely. SFP has beenmodified for African American, Asian/Pacific Islander,Hispanic and American Indian families, rural families andfamilies with early teens. The curriculum is available inSpanish and English. Children and parents meetconcurrently and then together to engage in groupactivities.

The program draws on different theories and approaches:• The Parent Training includes basic behavioral parent

training techniques developed by Dr. Gerald Patterson. • The Children’s Social Skills component took elements

from Dr. Myrna Shure’s “I Can Problem Solve.”• The Family Skills Training component uses family

communication exercises based on Dr. BernardGuerney’s Family Relationship Enhancement Program,family meetings used in many effective programs andgame techniques developed by Dr. Robert McMahonand Dr. Rex Forehand for Helping the Non-compliantChild Program.

The original program has been evaluated 17 times byfederal grants and more than 150 times by states. Theprogram has been shown to improve child managementpractices, increase parent-child communication, decreasedepression and conduct problems in children, increasefamily affective quality and lower alcohol use by youth.The differences between program and control youthincreased over time.

SFP is an excellent example of a program that is skills-based, concurrent, has been extensively evaluated andreplicated and has developed a Spanish language version.

Invest in Kidshttp://www.iik.org

Audience: Elementary School, Schools and Preschools

Description: “Invest in Kids” is a nonprofit in Coloradodedicated to promoting research-based programs topromote the emotional, cognitive and developmental wellbeing of children throughout the state. Its first majorinitiative was to invest in the “Nurse Family PartnershipModel.” Its second initiative is to promote and fund theIncredible Years model.

Incredible Years is a comprehensive curriculum forparents, teachers and children to promote emotional andsocial competency. Two randomized trials showed thefollowing program impacts:

• Increased children’s appropriate cognitive problem-solving strategies

• Increased children’s use of pro-social conflictmanagement strategies with peers

• Increased children’s social competence and appropriateplay skills

• Reduced conduct problems at home and school

The Colorado example is interesting because it is state-wide, the organization chose the approach based onevidence and it is implementing two programs of interest:Invest in Kids and Nurse Family Partnership.

Also see: “Early Years Count” (School-Based Program)

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Appendix C:

List of Forum Participants

Germaine Adams, La Fiesta Director, Latin American Community Center

Barbara Akenhead, Clinic Manager, Child Development Watch

Janet Arns Ray, Education Associate for Health Education, Delaware Department of Education

Raye Avery, Executive Director, Christiana Cultural Arts Center

Nancy Backus, Psychologist, Indian River School District

Donald Bates, Supervisor, Special Services, Smyrna School District

Sandra Battaglia, Parent Representative

Kelly Benz, Staff Teacher, St. Michael’s School

Timothy Brandau, PhD, Executive Director, YMCA Resource Center

Suzanne Burnette, Supervisor, Early Childhood Assistance Program, Delaware Early Childhood Center

Trent Camp, DC, Chiropractor, Camp Chiropractic

Janet Carter, Education Specialist, Department of Education

Kim Christie, RN, BSN, Family Service Coordinator, Child Development Watch

Rosi Crosby, Program Director, Social Venture Partners Delaware

Susan Cycyk, M.ED, CRC, Division Director, DSCYF/Child Mental Health Services

Scott Daniels, School Psychologist, Colonial School District/McCullough

Darryl Dawson, Deputy Director, Department of Services for Children, Youth & Their Families

Bobbie DeBastiani, RN, MS, School Psychologist, Cape Henlopen School District

Joseph DiSanto, MD, Community Pediatrician, Brandywine Pediatrics

Kimberly Fisher, Pediatric Nurse Case Manager, Schaller Anderson

Gail Fowler, Director of Special Services, Laurel School District

Tasheena Friend, Education Coordinator, Police Athletic League

Siobhan Gannon, Learning Center, Latin American Community Center

Carlyse Giddins, Director, Division of Family Services

Teresa Goins, Child Care Director, Neighborhood House, Inc.

Robert Hall, MDiv, PAPA, Executive Director, DE Ecumenical Council on Children and Families

Andrew Hove, Individual Service Director, Boys & Girls Club of Delaware

Howard Isenberg, MA, Executive Director, Open Door, Inc.

Gloria James, PhD, Director, School-Based Health Centers, Department of Health and Human Services, Delaware

Division of Public Health

Joyce James, LCSW, Children’s Clinical Care Manager-Behavioral Health, Blue Cross/Blue Shield Delaware

Dave Jefferson, School Psychologist, Cape Henlopen School District

Evelyn Keating, Provider Services Director, The Family & Workplace Connection

Jack Kemp, Director, Substance Abuse Services, Division of Substance Abuse & Mental Health

Rebecca King, RN, MSN, NCSN, President-Elect, Delaware School Nurses Association

Heather Kucharski, Director of Program Development, NAMI-DE

Chad Laurence, DC, Chiropractor, Corrective Chiropractic

Jim Lesko, EdD, Education Associate, Delaware Department of Education

Deborah Lockerman, Parent Advocate

Bill Lybarger, EdD, Director, School Support Services, Delaware Department of Education

Jane Maroney, Former State Representative, State of Delaware

Maria Matos, Executive Director, Latin American Community Center

Betty Mauté, Consumer Health Librarian, Delaware Academy of Medicine

George Meldrum, Prevention Director, Delaware Council on Gambling Problems

Dave Michalik, Sr. Administrator, Delaware Division of Social Services

Michael Minor, School Psychologist, Brandywine School District

Joanne Miro, Education Associate, Department of Education

Tobi Montgomery, Pediatric Care Coordinator, Schaller Anderson

Kate Morgan, Program Director, Police Athletic League

Ian Nathanson, MD, Director, Nemours Clinical Management Program

Dorothy Onn, Director of Prevention Services, Children & Families First

Michele Ostafy, Director, Family Support & Parent Education, Child, Inc.

Michael Partie, Coordinator, Positive Behavior Intervention Project, Center for Disabilities Studies

Julia Pillsbury, DO, Vice Chair, Dept. of Pediatrics, Kent General Hospital

Loydine Poloske, School Psychologist, Colonial School District

Tom Ragonese, Board President, Delaware Federation of Families for Children’s Mental Health

John Ray, Education Specialist, Delaware Department of Education

Jennifer Reges, MA, Senior Community Educator, Mental Health Association in Delaware

Agnes Richardson, DSL, RN, Assistant Professor of Nursing, Delaware State University

Betty Richardson, Head Start State Collaboration Director, Delaware Department of Education

Diane Rineer, Staff Teacher, St. Michael’s School

Ryan Robinson, Curriculum Coordinator, Because We Care Middle School

Heather Rooks, DC, Chiropractor, Corrective Chiropractic

Dennis Rubino, Director, Programs for Children with Special Health Care Needs, Department of Health and Human

Services, Delaware Division of Public Health

Karen Rucker, Director, University of Delaware

Stephen Schlesinger, MD, FAAP, College Physician, Wesley College

Carol Ann Schumann, Training Administrator, Birth to Three Early Intervention

Kevin Sheahan, MD, Chief, Nemours Pediatrics

Jennifer Shroff Pendley, PhD, Psychologist, Alfred I. duPont Hospital for Children

Barbara Stewart Boyles, NP, Coordinator, Stevenson House Wellness Center, Christiana Care

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Lois Studte, RN, LMS Health & Education Consulting, NHPS Advisory Council Member

Pat Tanner Nelson, EdD, Professor, Early Learning Center/Cooperative Extension, University of Delaware

Barry Tonkon, PhD, Clinical Director, NorthEast Treatment Center

Douglas Tynan, PhD, Psychologist, Alfred I. duPont Hospital for Children

Pat Whildin, Community Relations Representative, Rockford Center

Glyne Williams, Cost Containment Specialist, Division of Social Services/Medicaid

Bruce Wright, Administrator, First State Community Action

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www. Nemours.org