Draft 14 White Paper - Oregon's Health and Mental Health Consultation Systems Planning

8/8/2019 Draft 14 White Paper - Oregon's Health and Mental Health Consultation Systems Planning

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Oregons Early Childhood

Health and Mental Health Consultation

System Planning

A report to Health Matters

From the Child Care Health and MentalHealth Consultation

Priority Action Work Group

December 2010

Print


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We wish to acknowledge the following individuals and organizations

for their vision, expertise and guidance in creating this report and the

underlying documents, which can be viewed at

http://healthoregon.org/hcco.

Name Agency

Beth Green .............................................. NPC Research

Betty Shuler ............................................. Neighbor Impact

Bruce Spilde ............................................ Multnomah County Mental Health and

Addictions Services

Candace Artemenko ................................ Oregon Center for Children and Youth with

Special Health Needs

Charlotte Schley ...................................... Oregon Center for Children and Youth with


Cynthia Hurkes........................................ Oregon Child Care Resource and Referral Network

David Anderson ....................................... Oregon Public Health Division Offi ce of

Family Health

David Willis ............................................. The Artz Center

Dawn Sly ................................................. Mental health consultant

Deanna Humphry ................................... Oregon Public Health Division Offi ce of

Family Health

Deborah Murray ..................................... Peninsula Childrens Center

Dell Ford .................................................. Oregon Head Start Collaboration Project

Diana Stotz .............................................. Washington County Commission on Children

and Families

Diane Ponder ........................................... Zero To Three

Diane Smith............................................. Child Care Resource and Referral of

Clackamas County

Dianna Pickett ......................................... Oregon Public Health Division Offi ce of

Family Health

Donalda Dodson ..................................... Oregon Child Development Coalition

Farzana Siddiqui ...................................... Community Action Head StartWashington County

Gerry Morgan ......................................... Early Childhood Cares

Gil Nicholson-Nelson .............................. Valley Mental Health

Ginna Oliver ............................................ Oregon Department of Education

Gracie Lee ............................................... Multnomah County Health Department


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Janelle McCleod ...................................... Clackamas County Health Department

Jean Johnson ............................................ Oregon Public Health Division Offi ce of

Family Health

Jeanette Ewald ......................................... Oregon Child Care Resource and

Referral Network

Jennifer Haake ......................................... Early Intervention, Klamath Falls, CitySchool District

Jennifer Olsen .......................................... Oregon Child Development Coalition

Jill Archer ................................................. Washington County Mental Health Organization

Jill Dale .................................................... Oregon Addictions and Mental Health Division

Jin Song ................................................... Oregon Public Health Division

Offi ce of Family Health

Joanne Trzcinski ...................................... Oregon Addictions and Mental Health Division

Joy Rowley ............................................... Oregon Child Development Coalition

Judy Cleave .............................................. Marion County Health Department

Julie Dotson ............................................. Mental health consultant, Central Oregon

Karen Hamilton .................................... Head Start of Lane County

Karen VanTassel ...................................... Oregon Commission on Children and Families

Kathryn Falkenstern ................................ Morrison Child & Family Services

Kathy Seubert ......................................... Oregon Addictions and Mental Health Division

Katrina Miller ......................................... Morrison Child & Family Services

Kevin Burns ............................................. Family Relief Nursery

Katrina Miller ......................................... Morrison Child & Family Services

Kevin Burns ............................................ Family Relief Nursery

Kim Ashley .............................................. Oregon Child Care Resource and

Referral Network

Kim Cardona .......................................... Oregon Commission on Children and Families

Kristen Becker ........................................ Oregon Public Health Division Offi ce of

Family Health

Laurie Danahy ......................................... Oregon Department of Education Head Start

Lucia Aleman .......................................... Oregon Child Development CoalitionLynne Reinoso ......................................... Oregon Department of Education Child Nutrition

Program

Maria Everhart ........................................ The Childrens Institute

Marilyn Berardinelli ................................ Oregon Center for Children and Youth with



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Marilyn Hartzell ...................................... Oregon Center for Children and Youth with


Marilyn Kennelly .................................... Yamhill County Commission on Children

and Families

Mark Anderson ........................................ Oregon Child Care Resource and

Referral NetworkMarti Franc ............................................. Clackamas County Health Department

Mary Rumbaugh ..................................... Clackamas County Mental

Health Organization

Maureen Short, RN................................. UCAN Head Start assistant director

Michele Limpens ..................................... Morrison Child & Family Services

Patricia Blasco ......................................... Oregon Health & Science University, Portland

State University, Western Oregon University,

Early Childhood Inclusion Project

Patricia Trow ........................................... Oregon Child Development CoalitionPatti Blasco .............................................. Portland State University,

Western Oregon University

Paula Zaninovich ..................................... Multnomah County Mental Health and Addiction

Services Division

Shawna M. Rodrigues ............................. Clackamas County Childrens Commission

Head Start

Stacy Liskey ............................................. Oregon Child Care Resource and

Referral Network

Ted Keys .................................................. Department of Human Services Children Adultsand Families Division

Teresa Cooper ......................................... Washington State Department of Health

Terry Butler ............................................ Inclusive Child Care Program

Tom Olsen ............................................... Employment Department Child Care Division

Tom Udell ................................................ Western Oregon University

Wendy Nakatsukasa-Ono ........................ Child Care Health Consultation

Network Support


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Executive summary

Quality child care is essential to the health and safety of our children, our

families and our society. Daily experiences, both positive and negative, are the

raw materials that build childrens brain structure and functioning, includingintelligence and personality. Because the majority of young children are in child

care, early care and education providers play an essential role in

their development.

Children face some important challenges in early care and education settings while

their parents are working or away. Care environments and practices powerfully

affect their safety, health and well-being. For example:

Children attending early childhood care and education (ECCE) programsare at much higher risk of exposure to infectious diseases, gastrointestinal

illness, upper respiratory disease and ear infections than those cared for at

home

They are exposed to challenging behavior or engage in challenging

behavior with both adults and other children.

Children are cared for by a work force that receives low wages, has a

historically low level of education with frequent turnover, and works inrelative isolation with limited infrastructure for support.

To address these needs, the Child Care Health and Mental Health Consultation

Priority Action Work Group (PAWG) proposes a statewide early childhood health

and mental health consultation system to provide services in early childhood care

and education settings. This system must be developed based on a clear vision for

system infrastructure, a consultation delivery model and consultation services. This

report outlines the essential system elements, as well as a logic model summarizing

resources and actions to reach the desired outcomes of an effective child care

consultation system. The PAWG report also describes the infrastructure that

supports the consultation work force with training and technical assistance and

proposes an evaluation strategy to measure effects. Finding sustainable funding is

essential and likely to be challenging in the current fiscal environment. Finally, this

report explores the costs of services and potential funding sources. It is intended as

a condensed description and summary with recommended next steps. In addition,

the PAWG developed a variety of products available online at

http://healthoregon.org/hcco.


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The PAWG recommends the following steps in the development of a

consultation system:

Build consensus on priority and direction with the Health Matters, Early

Learning Matters and Family Matters committees and the Early Childhood

Matters Advisory Council.

Ensure that early childhood health and mental health are included as

priorities in current health reform activities.

Conduct a comprehensive statewide assessment of the health and mental

health consultation services now available in the state to use in program

development and as a baseline to measure the effect of future efforts. The

assessment should include a focus on gaps in services, as well as information

on target population, model designs, funding resources, evidence-based

practices used, and evaluation processes and tools.

Explore sustainable funding strategies to address the need for consultation in

multiple types of early care and education programs.

Explore short- and long-term strategies for staging services as funding

is available.

Introduction

Quality child care is essential to the health and safety of our children, our families

and our society. Early childhood care and education (ECCE) enables parents to

work, attend school, contribute to the well-being of their families and participate in

their communities. Skilled child care providers play a key role in young childrenslives creating opportunities for them to learn new skills, develop friendships and

prepare for a lifetime of success in education, relationships and careers.

An enormous number of children in the United States 63 percent are in some

type of formal or informal child care; 18.5 million of those children are under the

age of 5. Nationally, preschoolers spent an average of 32 hours per week in child care.1

In Oregon only 32.9 percent of children in care under the age of 4 were in paid (usually

licensed) child care in 2008.2

Childrens daily experiences have long-term effects on them, their families and

society. The ECCE work force, composed of teachers working in child carecenters and caregivers working in homes, is foundational to young childrens daily

experiences. Warm, nurturing and stimulating interactions between teachers/

caregivers and children is the single most important predictor of positive child

outcomes from child care and early education. Though only 10 percent of child

care is estimated to be of poor quality, most of child care is considered of fair or

minimal quality, which does not offer the ideal safe and nurturing environment for

these children.3 Clearly, there is work to be done to improve child care quality.


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Children in safe and healthy environments are more likely to grow into healthy

adults. Warm, nurturing and attuned responses from caring adults within

the context of sound physical health provide the foundation for early brain

development and are associated with a broad range of abilities and learning

capacities. Infants and young childrens early relationships, family, community and

culture support their healthy growth and development.Skilled ECCE providers can preserve, protect and promote childrens health

through daily opportunities for healthy meals and regular physical activity;

protection from communicable disease by sanitary practices and community

connections to health insurance and to routine health, mental health and dental

care services as needed.

Research consistently suggests that higher levels of provider education and

training predict program quality in child care settings.4 Professional development

encompasses education, training and related activities such as consultation. Most

of the related activities involve individualized instruction and are sometimes

described as relationship-based professional development. Education and

training that increase positive interactions between adults and children affect

multiple areas of the childrens development.

Problem

Although the professionalism of child care is gaining momentum, this work

force which fills such a critical function for families and our society needs

substantially more support.There are major problems facing children in early care and education settings.

Children attending ECCE programs are at much higher risk of exposure to

infectious diseases, gastrointestinal illness, upper respiratory disease and ear

infections than those cared for at home.4 Caregivers must provide healthy, safe,

nurturing environments while simultaneously responding to the challenges

posed by increasingly diffi cult behaviors from young children in their care. This

demanding work is done by caregivers who are paid a marginal wage, generally

work in isolation and are characterized by historically low levels of education and

high job turnover.

Parents, as well as early childhood care and education (ECCE) providers, have

concerns regarding the experiences of children in ECCE settings and the quality

of their care, health and safety. Of all Oregon parents with children in ECCE

settings, 16 percent reported their children did not always feel safe in child

care. Only 44 percent agreed with the statement, My child always got a lot of

attention, and 53 percent agreed that My childs caregiver/teacher was always

open to new learning.5


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Children arrive in child care with health risks and challenges. Poor health in

children can lead to chronic disease as adults. Obesity, hypertension and diabetes

are on the rise in children. In the United States, 11 percent of children age 2 to

5 are considered obese. In Oregon in 2005 nearly 25 percent of Oregon eighth

graders were overweight or at risk for being overweight.7 More than 20 percent of

Oregons 2-year-olds are not fully immunized against serious childhood diseases.8

There was a drop in the number of uninsured children (under the age of 18)

between 2008 and 2009 from approximately 109,200 (12.5 percent) to 90,500 (10.4

percent); however, the uninsured rate for Oregons children under the age of 18 was

higher than that of 40 other states in 2009.9

It is estimated that between 9 percent and 14 percent of children from birth to 5

years of age experience social and emotional problems that negatively affect their

functioning and development. These are expressed by behaviors such as aggression

and tantrums or through withdrawal and lack of engagement. According to the

Center on the Social and Emotional Foundations for Early Learning(CSEFEL), therate of expulsion for preschool children is three times that of school-age children.

In very young children these behaviors can be severe enough to overwhelm their

caregivers and warrant their removal from their preschool programs, setting into

motion a cascade of negative experiences.6

How can we best solve these problems and facilitate a system of early childhood

care and education that contributes to childrens healthy development? Because

childrens physical, cognitive and emotional capabilities are integrated, early

care and education practices are most successful when they incorporate health

and mental health approaches. The positive effects of this holistic approach aremagnified for children from disadvantaged situations or with special needs.

The authors of this report are convinced that an effective system of consultation

that helps ECCE providers and families best meet childrens needs is fundamental

to healthier children. The reports goal is to engage support to implement a

statewide health and mental health consultation program that approaches

childrens health and mental health needs in a well-coordinated, holistic way.

Background

Oregons early childhood system has one overarching goal: Children are healthy,

growing and learning. Over the last decade, a group of cross-agency, public

and private partners have collaborated to develop the vision for Oregons early

childhood system, supported by legislation (ORS 417.727) that led to the early

childhood system.. In March 2008 the Governors Summit on Early Childhood

engaged Oregons most influential partners in meaningful dialogue and action

around Early Childhood Matters, Oregons framework for a statewide birth-

through-5 early childhood system.7 The committees charged with developing the


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system and integrating suggestions from the summit into strategies and actions

included Early Learning Matters, Family Matters and Health Matters.

Following the Governors Summit, Health Matters charged the Priority Action

Work Group (PAWG) with developing approaches to expand and sustain

statewide early childhood health and mental health consultation in child care.

The Child Care Health and Mental Health Consultation Priority Action WorkGroup (PAWG) consisted of more than 50 people representing state and local

early childhood, health, mental health and special needs communities across the

state. The work group used technologies such as teleconferencing and interactive

websites that allowed for participation from a distance. Smaller groups developed

to address specific tasks and responsibilities.

PAWG members were charged with developing the following products:

Approaches to consultation, which incorporate the essential elements, a

logic model and identification of outcomes at the system and servicedelivery levels;

Survey to determine what is occurring across the state;

Needed supports including consultant competencies, training, supports and

supervision (in particular, consultants need reflective supervision);

An evaluation approach that would monitor implementation and outcomes

of a system of early childhood care and education health and mental health

consultation services; and

Funding and sustained resources necessary for an ongoing system ofhealth and mental health consultation in early childhood care and

education settings.

These products are available at http://healthoregon.org/hcco.

Putting these components together, the group developed a statewide approach

with a consultation delivery model that can be implemented in urban or rural

settings, with incremental implementation as resources are available.

DefinitionsCommon language that supports clarity and understanding among partners from

multiple disciplines is essential.

The following working definition used to describe consultation provides key

context to the PAWGs work. It is derived from the Early Childhood Mental

Health Consultation Evaluation Tool Kit.8


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Early childhood consultation includes developmentally appropriate, culturally

sensitive and primarily indirect services for children in child care and early

education settings. Services build capacity of staff and family members to

support healthy child development. This may include observing children and the

caregiving environment; identifying concerns and needs; and problem solving

and recommending interventions that involve changes in the environments, skills,

knowledge, attitudes and behavior of caregivers. Early childhood consultants

collaborate with administrators, staff, family members and caregivers who

intervene directly with children in child care, early education and/or home settings.

Figure 1 Consultation dynamics

The consultants primary goal is to strengthen the ECCE providers knowledge

and skills to assure high-quality care of all children. The solid arrows in Figure

1 show the direct relationship between the consultant and the ECCE provider,

as well as between the provider and the child and family. However, children in

child care with higher needs and those children who are at risk for poor health

and mental health outcomes (refer to Definitions in appendix) can also benefit

from consultation that includes early identification, screening and referral tomore intensive services. The goal of consultation focused on individual children

is to meet their needs and keep them in child care. The consultant offers

recommendations for the childs care based on a professional assessment for use in

planning with both the ECCE provider and the family. The consultants indirect

relationship with the child and family represents a general approach to making

referrals out for treatment needs rather than providing direct health or mental

health treatment. This indirect relationship is shown with an intermittent arrow.

Child and familyEarly care

and education

providers

Health andmental health

consultants

Infrastructuresupports health and

mental healthconsultation for childcare providers and the

childs family.
http://healthoregon.org/hccohttp://healthoregon.org/hcco


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System infrastructure

Delivery model supportshigh quality health and mental

health consultation

Services provided by consultant

to assist child care providers and/orthe child and family

Building toward a statewide health and mental health

consultation system

An effective system of health and mental health consultation has at its core a

strong and coordinated state and local infrastructure supporting high-quality

services that meet the needs of ECCE providers, children and their families. This

system assumes close collaboration among early childhood partners to develop askilled consultant work force; makes use of relevant research and evidence-based

tools; secures adequate and sustainable funding; and provides process and

service evaluation.

The Child Care Health and Mental Health Consultation Priority Action Work

Group proposes the following vision and steps for building toward a statewide

health and mental health consultation system.

Essential elements

The following essential elements of a statewide health and mental healthconsultation program are strongly interconnected: a consistent, statewide

infrastructure at the system level; a regional or local consultation delivery model;

and consultation services in the early childhood care and education setting.

Figure 2 Essential elements


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The logic model

The essential elements describe a vision for health and mental health

consultation that promotes health and mental health and prevents problems

during the early years. How can Oregon create a system and services based

on this vision? The logic model presents strategies that support this visionand meet both system and service delivery outcomes. The logic model

includes strategies to support:

Cross-disciplinary partnerships, relationships and services;

Evidence-based consultation practice and tools;

Quality assurance;

Adequate and sustainable funding.

These strategies are relevant to the needs of ECCE providers, families and

children and address state and community priorities.

Collaboration among partners at both the state and community levels and

across health, mental health and child care disciplines is critical. Champions

and leaders who are committed to this vision must emerge at both the

state and community levels to support the effort. Leaders must set to work

exploring and securing needed funding to build the system. Processes

must be put in place to provide a system of coordination and oversight andassure high-quality services through work force development and support.

Evaluation of the effect of services is essential.


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Logicmodels

ummaryforastatewidehealthandmentalhealthconsultationsy

stem

Part1.Statew

ideconsultationsystem

Goal1:Oregonchildcarehealthandmentalhealthconsultationserviceswillbesupportedbyastrongpartnershipof

bothstateandlocallevelstakeholders.

Inputs

Strategie

s

Outputs

Outcomes

Communication

andplanning

discussionsamong

potentialpartnersa

nd

stakeholdersabout

the

developmentofah

ealth

andmentalhealth

consultationsystem

for

childcare.

a.Completeabaselineassessmentof

currenthealthandm

entalhealth

consultationservices;

b.Identifysharedvalue

sanddevelopa

sharedvisionandm

ission;

c.Developstateandloc

alprocessesfor

communication,sha

reddecision

makingandfunding

;

d.Createstateandloca

l

interagencyagreements;

e.Cultivatecross-system

relationships

thatsupportreferralandaccessto

communityhealth,mentalhealth

andsocialresources

forcareproviders

andfamilies;

f.Conductlocalcommunityneeds

assessmenttoidentifylocalpriorities;

g.Providelocalprogram

oversightto

assuretheprogram

meetstheessential

elementsandaddresseslocaland

partnerpriorities.

a.Thecompletionofabaseline

assessmentandreport;

b-c.The

completionofapartnership

documentthatincludesavisionand

missionstatementandprocessesfor

comm

unication,shareddecision

makingandfunding;

d.Signedmemorandaof

understandingamongstateand

local

agencies;

e.Thedevelopmentofcross-system

relationshipsthatsupportreferral

anda

ccesstocommunityhealth,

mentalhealthandsocialresources

forca

reprovidersandfamilies;

f.Theco

mpletionoflocalcommunity

needsassessments;

g.Thed

evelopmentoflocal

progr

amoversight.

1.Thereisanobjective

descriptionof

systemprocesses

andtheoutcomesof

consultationservices.


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Logicmodelsumma

ryforastatewidehealthandmentalhealthconsultationsystem

Goal2:Therewillbead

equatefundingtoinitiatea

ndsustainastatewidesyste

mofconsultationservices.

Inputs

Strategies

Outputs

Outcom

es

Costestimatesfor

asystem,basedon

identifiedneeds

thatprovide

essentialelements.

a.Developstrategiesto

fundconsultation

servicesstatewide;

b.Createandimplementa

plan,includingstepsand

atimeline,todevelopand

sustainneededresources.

a.Thedevelopmentofalist

of

strategiesandcostestima

tesfor


b.Thecompletionofaplan

tofundand

sustainservicesstatewide

.

2.Adequatefund

ingisdedicatedto

initiateandsu

stainasystemof

consultations

ervicesatstatewide

andcommunitylevels.

Goal3:Skilledandcom

petenthealthandmentalh

ealthconsultantswillprovideservicestochildcarepro

viders

acrossOregon.

Inputs

Strategies

Outputs

Outcom

es

Essentialelements:

Consultation

servicemodel;

Consultation

servicestandards;

Qualityassurance

procedures

andconsultant

competencies;

Consultationwork

forcetraining

andtechnical

assistanceneeds.

a.Developaplanforastatewide

systemincludingatimeframe

andmeasurablesteps;

b.Createstrategiesto

implementand

evaluatestatewide;

c.Createstate-levelteamto

assurequalityhealthand

mentalhealth


d.Developstatewidetraining

andtechnicalassistance

strategiesforconsultants.

a.Thedevelopmentofan

implementationplan;

b.Thedevelopmentofstrategies

thatsupporthigh-qualityhealth

andmentalhealthconsu

ltation

servicesinchildcareand

supporta

competenthealthandmental

healthconsultationwork

force;

c.Thecreationofastate-lev

el

implementationteam;

d.Thedevelopmentoftrainingand

technicalassistancestrategies.

3.High-qualitya

ndevidence-

basedconsultationservicesare

providedstatewide;

4.Consultantsar

eskilled

andcompeten

t.


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Funding and support

The vision for statewide health and mental health consultation presented here is

likely to require some new funding.

Potential sources of public and other funding include the following:

Medicaid;

Early Head Start/Head Start;

Individuals with Disabilities Education Act (IDEA Part B,

Section 619, Part C);

Mental Health and Substance Abuse Block Grants;

Child Care and Development Fund, including funding for quality;

Child welfare funds, such as Title IVE of the Social Security Act;

Maternal and Child Health BlockGrant under Title Vof the Social

Security Act;

Temporary Assistance to Needy Families (TANF);

Supplemental Security Income (SSI, Title XVI of the Social Security Act);

Private insurance coverage;

Child care licensing fees; 9

Service fees.

Costs ofhealth and mental health consultation

Oregon consultation program strategies differ from each other in depth and

intensity. An informal scan of Oregons known health and/or mental health

consultation service budgets was conducted. Oregon programs with more

consultant staff tend to receive more prevention services. Those with fewerconsultants tend to focus on children with special needs and serious behavior

issues. Cost levels are higher when programs employ more consultants or

services include consultation covering the continuum from promotion and

prevention to treatment.

The scan compared information about costs from programs within Oregon and

from other states to develop an estimateof costs for health and/or mental health

consultation. While these programs have differences, they have the common

element of consultation. The cost-per-child in Oregon programs ranged from $258

to $348. One Oregon program has 342 children per consultant.In comparison, the

Massachusetts-Worcester and South County Together For Kids (TFK) program

has a cost-per-child of $295 with 200 children per consultant. Estimated return

for Together For Kids is $1.67to $2.23 for every dollar invested.10Summaries

of other mental health consultation programs, including program costs andstaff

compositions, can be obtained from What Works? A Study of Effective Early

Childhood Mental Health Consultation Programs.11


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The current federal and state economic environment has severely limited available

funding for most services. It is unlikely that the vision for statewide health and

mental health consultation can be realized without new funds. A recommended

strategy for building the necessary statewide infrastructure and services may be

to stage them over time, beginning with limited services and the infrastructure to

support them and expanding as funds become available. Effectively leveragingfunds where possible and including private funds such as grants or fees for services

should be considered. Collaboration that results in braided funding streams and

builds on existing services could reduce the amount of new funds needed.

Recommendations and next steps

Build consensus on priority and direction with the Health Matters, Early

Learning Matters and Family Matters committees and the Early Childhood

Matters Advisory Council.

Ensure that early childhood health and mental health are included as

priorities in current health reform activities.

Conduct a comprehensive statewide assessment of the health and mental

health consultation services now available in the state to use in program

development and as a baseline to measure the effect of future efforts. The

assessment should include a focus on gaps in services, as well as information

on target population, model designs, funding resources, evidence-based

practices used, and evaluation processes and tools.

Explore sustainable funding strategies to address the need for consultation in

multiple types of early care and education programs.

Explore short- and long-term strategies for staging services as funding

is available.

For additional information contact:

Dianna Pickett, 971-673-0259, [email protected], or;

Kathy Seubert, 503-947-5526, [email protected]


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References1.Census report on child care. (2005). Based on 2002 data.

2. 2008 Oregon Child Care Research Partnership (June 2009). Child care and education in

Oregon and its counties.

3.

Vandell, D.L. and Wolfe, B. (May 2000). Child care quality: Does it matter and does it needto be improved? Institute for Research on Poverty. University of WisconsinMadison.

http://aspe.hhs.gov/hsp/ccquality00/ccqual.htm#quality.

4.NICHD Early Child Care Research Network. (2001). Child care and common communicable

illnesses: Results from the National Institute of Child Health and Human Development Study

of Early Child Care. Archives of Pediatrics & Adolescent Medicine, 155, 481-488.

5.Region population survey. (2008).

6..Gilliam, W.S. (May 2005). Expulsion rates in state prekindergarten programs. FDC policy

brief series no. 3.

7. National Health and Nutrition Examination Survey (NHANES), 2005-2006. (Obese is

defined as M 95th percentile BMI-for-age using the 2000 CDC growth chart for children

aged 2 years or older.)

8.ALERT Immunization Information System, Oregon Immunization Program, Department of

Human Services. (2009). www.oregon.gov/DHS/ph/imm/docs/county/OREGON.pdf.9.

Duran,

F. B., Hepburn, K.S., Kaufmann, R. K., Le, L.T., Allen, M.D., Brennan, E.M. and Green, B.L.

Research synthesis: Early childhood mental health consultation. The Center on the Social and

Emotional Foundations for Early LearningVanderbilt University.http://csefel.vanderbilt.edu/resources/research.html.

9.. U.S. Census Bureau, American Community Surveys, 2009 and 2009.

10..

Warfield, M.E. (2006).Assessing the known and estimated costs and benefits of providing

mental health consultation services to preschool-age children in early education and care

centers in Massachusetts: An economic evaluation of the Together For Kids (TFK) Project.

P. 6. Downloaded Aug. 31, 2010. www.hfcm.org/CMS/images/Final%20Full%20TFK%20

Economic%20Report%20June%202006.doc.

11.

Duran, F., Hepburn, K., Irvine, M., Kaufmann, R., Anthony, B., Horen, N. and Perry, D.

(August 2009). What works? A study of effective early childhood mental health

consultation programs. Washington, DC: Georgetown University Center for Child

and Human Development.

Return to last page read
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This document can be provided upon request in alternative formats for

individuals with disabilities. Other formats may include (but are not limited to)

large print, Braille, audio recordings, Web-based communications and other

electronic formats. E-mail [email protected], call 503-971-0259

(voice) to arrange for the alternative format that will work best for you.

Documents

Draft 14 White Paper - Oregon's Health and Mental Health Consultation Systems Planning