Healthy BeginningsHealthy Beginnings

A Collaborative Infant Mental A Collaborative Infant Mental Health Intervention in a Public Health Intervention in a Public

Health ClinicHealth Clinic

What Is an Infant Mental Health What Is an Infant Mental Health Intervention?Intervention?

Focuses on infants and children 0-5 years Focuses on infants and children 0-5 years of ageof age

Seeks to optimize social and emotional Seeks to optimize social and emotional development of young childrendevelopment of young children

Is a multi-disciplinary approach involving Is a multi-disciplinary approach involving psychiatry, psychology, social work, and psychiatry, psychology, social work, and pediatricspediatrics

2000 MCH Needs Assessment 2000 MCH Needs Assessment #1 Priority = Mental Health Access#1 Priority = Mental Health Access

Age (years)Age (years) Rate per 100,000Rate per 100,000

1-41-4 1010

5-145-14 1414

15-2415-24 211211

25-3425-34 287287

Homicide Rates – New Orleans

Healthy People 2010 goal < 7.2.

Age (years)Age (years) Rate per 100,000Rate per 100,000

15-2415-24 9393

Suicide Rates – New OrleansSuicide Rates – New Orleans

Healthy People 2010 goal = 9.6

2000 MCH Needs Assessment #1 Priority = Mental Health Access

2000 MCH Needs Assessment2000 MCH Needs Assessment

Suicide and Homicide rates far exceed Suicide and Homicide rates far exceed 2010 goal2010 goal

Community surveys list substance abuse Community surveys list substance abuse and homicide as primary concernsand homicide as primary concerns

Mental health access to services ranked Mental health access to services ranked #1 priority#1 priority

Must begin in infancy to prevent Must begin in infancy to prevent adolescent problemsadolescent problems

CollaboratorsCollaborators

Tulane Child Psychiatry DepartmentTulane Child Psychiatry Department

Children’s Bureau Children’s Bureau

LA Office of Public HealthLA Office of Public Health

Region I Office of Mental HealthRegion I Office of Mental Health

Institute for Mental HygieneInstitute for Mental Hygiene

New Orleans Health DepartmentNew Orleans Health Department

Collaborator RolesCollaborator Roles

Tulane Child Psychiatry:Tulane Child Psychiatry: – provides: provides:

two part-time supervising psychologiststwo part-time supervising psychologistspsychiatry fellow psychiatry fellow senior psychiatry faculty supervisionsenior psychiatry faculty supervisionone full-time clinic psychologist one full-time clinic psychologist

(program director)(program director)

– administers the HB grant from IMH administers the HB grant from IMH

Collaborator RolesCollaborator Roles

Children’s Bureau:Children’s Bureau: providesprovides two social workers two social workers and one case managerand one case manager

LA Office of Public Health:LA Office of Public Health: funds Children’s funds Children’s Bureau social workers and NOHD MCH nurse Bureau social workers and NOHD MCH nurse coordinatorcoordinator

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

Collaborator RolesCollaborator Roles

Institute for Mental Hygiene: Institute for Mental Hygiene: provides funding provides funding through $125,000 grant to Tulanethrough $125,000 grant to Tulane

New Orleans Health Department:New Orleans Health Department: – provides:provides:

primary care (EPSDT) and WIC servicesprimary care (EPSDT) and WIC services

referrals to Healthy Beginnings Programreferrals to Healthy Beginnings Program

nursing and clerical supportnursing and clerical support

physical space in Mary Buck Clinic (paid by grant)physical space in Mary Buck Clinic (paid by grant)

GovernanceGovernance

MOAMOA written with help of facilitator and signed in written with help of facilitator and signed in fall of 2001fall of 2001

Operations Committee:Operations Committee: senior representation senior representation for each organization; meets quarterlyfor each organization; meets quarterly

Evaluation Committee:Evaluation Committee: oversees research, oversees research, data management, and program outcomesdata management, and program outcomes

Clinic Coordinating Committee:Clinic Coordinating Committee: oversees oversees clinic policies, forms, referrals, and feedback to clinic policies, forms, referrals, and feedback to providersproviders

Clinic OperationsClinic Operations

Children with risks identified are invited to Children with risks identified are invited to schedule an appointment with a HB social schedule an appointment with a HB social workerworkerAn assessment is conducted over several visits An assessment is conducted over several visits and immediate and long-term treatment goals and immediate and long-term treatment goals are formulated with the caretakerare formulated with the caretakerA home visit is conducted as part of the A home visit is conducted as part of the assessmentassessmentFamily is given choice of clinic or home for future Family is given choice of clinic or home for future sessionssessions

Clinic OperationsClinic Operations

All assessment data is entered into the All assessment data is entered into the databasedatabase

A caseworker links family with needed A caseworker links family with needed community social services community social services

Interdisciplinary case conferences are held Interdisciplinary case conferences are held weekly with clinic and HB staffweekly with clinic and HB staff

Families are followed until goals are met Families are followed until goals are met or family is lost to follow-upor family is lost to follow-up

Achievements in First Two YearsAchievements in First Two Years

A 30 hour training was held for 3 clinic A 30 hour training was held for 3 clinic physicians and 33 nurses in identifying physicians and 33 nurses in identifying infant mental health problemsinfant mental health problems

Facility was renovated to accommodate Facility was renovated to accommodate HB staff using grant fundsHB staff using grant funds

Achievements in First Two YearsAchievements in First Two Years

Undoing Racism workshop heldUndoing Racism workshop held

Over 143 children were served; 33 are still Over 143 children were served; 33 are still active active

Assessment process was shortenedAssessment process was shortened

Collaborator relationships continue to Collaborator relationships continue to developdevelop

Demographics of Population Demographics of Population ServedServed

66% males; 34% females66% males; 34% females

Average age 24 monthsAverage age 24 months

Average income below $10,000 Average income below $10,000

93% African American, 4.8% Caucasian, 93% African American, 4.8% Caucasian, 1.6% Hispanic, .8% Pakistani Indian1.6% Hispanic, .8% Pakistani Indian

Referral ConcernsReferral Concerns

Physical aggressionPhysical aggression

Temper tantrumsTemper tantrums

HyperactivityHyperactivity

InattentionInattention

Developmental Developmental DelaysDelays

Anxiety disordersAnxiety disorders

Feeding disordersFeeding disorders

Adjustment problemsAdjustment problems

Withdrawn behaviorsWithdrawn behaviors

Childhood depressionChildhood depression

Maternal depression Maternal depression (approximately 50%)(approximately 50%)

Domestic violenceDomestic violence

Physical abusePhysical abuse

Parenting concernsParenting concerns

Assessment ToolsAssessment Tools

Achenbach Child Behavior Checklist Achenbach Child Behavior Checklist (CBCL) Ages 1 1/2 - 5(CBCL) Ages 1 1/2 - 5

Infant Toddler Social Emotional Infant Toddler Social Emotional Assessment (ITSEA) Competence ScaleAssessment (ITSEA) Competence Scale

Disturbances of Attachment Interview Disturbances of Attachment Interview (DAI)(DAI)

Parent-Child InteractionParent-Child Interaction

AssessmentAssessment Tools ToolsBeck Depression Inventory (BDI-II)Beck Depression Inventory (BDI-II)

Parent Perception Interview Parent Perception Interview

Partner Violence Inventory (PVI)Partner Violence Inventory (PVI)

Omitted:Omitted:

HOME inventoryHOME inventory

VinelandVineland

Maternal Self-Efficacy ScaleMaternal Self-Efficacy Scale

Lessons LearnedLessons Learned

Early mental health intervention is possible Early mental health intervention is possible in a public health clinic with limited fundingin a public health clinic with limited funding

Collaborative efforts can bring cost-Collaborative efforts can bring cost-effective, state of the art interventionseffective, state of the art interventions

Communication between collaborators is Communication between collaborators is key; cultural, professional, and institutional key; cultural, professional, and institutional barriers need to be expected and barriers need to be expected and addressedaddressed

Key PlayersKey Players• Tulane: Paula Zeanah, PhD, MSNTulane: Paula Zeanah, PhD, MSN

Julie Larrieu,PhDJulie Larrieu,PhD

Shana Bellow, PhDShana Bellow, PhD

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

Key PlayersKey Players

• OMH: Guilda Butler, LCSWOMH: Guilda Butler, LCSW• Children’s Bureau: Ron McClain, Children’s Bureau: Ron McClain,

LCSW, Letia Bailey, LCSWLCSW, Letia Bailey, LCSW• OPH: Stacia Loveall, MSW, MPHOPH: Stacia Loveall, MSW, MPH