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

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  • Healthy BeginningsA Collaborative Infant Mental Health Intervention in a Public Health Clinic

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

  • 2000 MCH Needs Assessment #1 Priority = Mental Health AccessHomicide Rates New OrleansHealthy People 2010 goal < 7.2.

  • Healthy People 2010 goal = 9.62000 MCH Needs Assessment #1 Priority = Mental Health Access

    Suicide Rates New Orleans

  • 2000 MCH Needs AssessmentSuicide and Homicide rates far exceed 2010 goalCommunity surveys list substance abuse and homicide as primary concernsMental health access to services ranked #1 priorityMust begin in infancy to prevent adolescent problems

  • CollaboratorsTulane Child Psychiatry DepartmentChildrens Bureau LA Office of Public HealthRegion I Office of Mental HealthInstitute for Mental HygieneNew Orleans Health Department

  • Collaborator RolesTulane Child Psychiatry: provides: two part-time supervising psychologistspsychiatry fellow senior psychiatry faculty supervisionone full-time clinic psychologist (program director)

    administers the HB grant from IMH

  • Collaborator RolesChildrens Bureau: provides two social workers and one case manager

    LA Office of Public Health: funds Childrens Bureau social workers and NOHD MCH nurse coordinator

    Region I Office of Mental Health: provides half time social worker

  • Collaborator RolesInstitute for Mental Hygiene: provides funding through $125,000 grant to Tulane

    New Orleans Health Department: provides:primary care (EPSDT) and WIC servicesreferrals to Healthy Beginnings Programnursing and clerical supportphysical space in Mary Buck Clinic (paid by grant)

  • GovernanceMOA written with help of facilitator and signed in fall of 2001Operations Committee: senior representation for each organization; meets quarterlyEvaluation Committee: oversees research, data management, and program outcomesClinic Coordinating Committee: oversees clinic policies, forms, referrals, and feedback to providers

  • Clinic OperationsChildren with risks identified are invited to schedule an appointment with a HB social workerAn assessment is conducted over several visits and immediate and long-term treatment goals are formulated with the caretakerA home visit is conducted as part of the assessmentFamily is given choice of clinic or home for future sessions

  • Clinic OperationsAll assessment data is entered into the databaseA caseworker links family with needed community social services Interdisciplinary case conferences are held weekly with clinic and HB staffFamilies are followed until goals are met or family is lost to follow-up

  • Achievements in First Two YearsA 30 hour training was held for 3 clinic physicians and 33 nurses in identifying infant mental health problems

    Facility was renovated to accommodate HB staff using grant funds

  • Achievements in First Two YearsUndoing Racism workshop heldOver 143 children were served; 33 are still active Assessment process was shortenedCollaborator relationships continue to develop

  • Demographics of Population Served

    66% males; 34% femalesAverage age 24 monthsAverage income below $10,000 93% African American, 4.8% Caucasian, 1.6% Hispanic, .8% Pakistani Indian

  • Referral ConcernsPhysical aggressionTemper tantrumsHyperactivityInattentionDevelopmental DelaysAnxiety disordersFeeding disorders

    Adjustment problemsWithdrawn behaviorsChildhood depressionMaternal depression (approximately 50%)Domestic violencePhysical abuseParenting concerns

  • Assessment ToolsAchenbach Child Behavior Checklist (CBCL) Ages 1 1/2 - 5Infant Toddler Social Emotional Assessment (ITSEA) Competence ScaleDisturbances of Attachment Interview (DAI)Parent-Child Interaction

  • Assessment ToolsBeck Depression Inventory (BDI-II)Parent Perception Interview Partner Violence Inventory (PVI)

    Omitted:HOME inventoryVinelandMaternal Self-Efficacy Scale

  • Lessons Learned

    Early mental health intervention is possible in a public health clinic with limited fundingCollaborative efforts can bring cost-effective, state of the art interventionsCommunication between collaborators is key; cultural, professional, and institutional barriers need to be expected and addressed

  • Key PlayersTulane: Paula Zeanah, PhD, MSNJulie Larrieu,PhDShana Bellow, PhD

    NOHD: Susan Berry, MD, MPHDonna Malus, RN, BSNPat Delaune, RNMary Burns, RN

  • Key Players OMH: Guilda Butler, LCSWChildrens Bureau: Ron McClain, LCSW, Letia Bailey, LCSWOPH: Stacia Loveall, MSW, MPH


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