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Infusing Mental HealthServices and Supports in Early
Childhood Settings
Deborah Perry, PhD
Georgetown University
Center for Child and Human Development
May 11, 2006
WHY NOW?
Increased awareness of problems of young children
Brain development research
Increased use of psychotropic medications
Problems in child care and early education settings
Emergence of infant and early childhood mental health as a field
Importance of environment and relationships
Relationship between healthy social and emotional development and later school success
EARLY CHILDHOODMENTAL HEALTH
For young children, mental health is:The social, emotional, and behavioral well-being of young children and their families.
The developing capacity to experience, regulate, and express emotion;
Form close, secure relationships;
Explore the environment and learn.(Adapted from ZERO TO THREE)
Estimated PrevalenceNo national epidemiological data In studies of health care visits, rates of psychosocial problems=10-21%; externalizing problems=7-17%In Head Start, externalizing problems=10-23% 10-15% typical preschoolers have chronic mild/moderate behavior problemsNo data for children under age of 2
Center for Evidence-Based Practice: Young Children with Challenging Behavior
School Readiness Skills
Emotional self-regulationBehavioral self-regulationEmpathy and perspective takingCommunicating needs, desires & interests in pro-social wayUnderstanding cause & effect sequencesInterest, motivation, persistence
Early Childhood Resource Center, RTI
EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF CAREFosters the social and emotional well-being of infants toddlers, preschool-age children and their families
VALUES
Family Voice
Child and Family Centered
Relationship Based
Culturally Competent
Infused into Natural Settings and Services
Grounded in Developmental Knowledge
Prepared Workforce
Interagency Partnerships
Maximized and Flexible Funding
Building Blocks
Promotion Prevention Intervention
Supports for Parents and
Families
Supports for Other
Caregivers
Services for Children and Families
Services and Supports
Outcome Evaluation
Strategic Planning,
Policies, and Procedures
Developed by Roxane Kaufmann, GUCCHD
THE SYSTEM OF CARECONCEPT AND VALUES
A philosophy or framework about the way services should be delivered to children and families based on core values and principles
Not a model or single definable thing – It is a community specific design built within this framework; around local/state leadership, political context and funding; and to fit with other early childhood initiatives and partnerships
The Pyramid
Levels and Types of Intervention
Intervention/Targeted
Prevention/Indicated
Promotion/Universal
Promotion
Developmental and social-emotional screening in primary care and early care and education programs
High quality child care
High quality training on social-emotional development
Use of an evidence-based early childhood curriculum
Dissemination of information promoting healthy social-emotional development
Prevention
Home visitation programs
Mental health consultation
Family mentors
Social skills curricula
Family supports
Caregiver supports
Intervention
Intervention
On-site mental health consultation
Crisis teams
Wraparound services
Relationship-based therapy
Hotline for families
Behaviorally-based programs in a variety of settings
In-home treatment
ECMH SYSTEM OF CARE VALUES AND PRINCIPLES
Family Voice
Child and Family Centered
Relationships Based
Culturally Competent
Continuum of ECMH Services and Supports
Infused into Natural Settings and ServicesGrounded in Developmental Knowledge
PromotionPreventionIntervention
Why Culture Matters
Because it affects…
Attitudes and beliefs about mental health
Expression of symptoms
Coping strategies
Help-seeking behaviors
Utilization of services
Appropriateness of services and supports
Lazear, K., (2003). Primer Hands On
Work Force Issues
Lack of trained personnel
Stigma
Barriers in communication between early childhood and mental health
Changing practices from reactivity to prevention
Lack of ongoing support to providers
Work Force Issues
Allocation of limited resources to multitude of needs
Limited access to higher education
High staff turnover
Need for evidence-based models and training approaches
Core Competencies
Values/Beliefs
Knowledge of ECMHEarly childhood development
Importance of relationships
Risk/protective factors
Skills
Florida IMH Levels of Service
Level 1 Services to strengthen caregiver skills and relationship with child
Level 2 Services for families and children with identified social risks, delays, special
health needs, and disabilitiesLevel 3 Services to families of children diagnosed
with serious emotional disorders or severe mental/ behavioral health problems
Source: Infant Mental Health Services for Young Children and Families. Florida State University, Center for Prevention and Early Intervention Policy. © 2000
Implications for FL Workforce
Building infrastructure to support training
Level 1: Target all child-serving staff in ECE, home visitors, schools, faith based, law enforcement, judicial systems
Level 2: families and professionals involved with Part B and C of IDEA, child protection, social workers, therapists, health care practitioners
Level 3: new university graduate programs to train clinicians in IMH psychotherapy
Merrill-Palmer Institute
Wayne State University in Detroit, MI
Graduate Certificate Program in Infant Mental Health
Graduate Certificate Program in IMH
Intro to Infant Mental HealthTheory and PracticeInfant Mental HealthPsychology of Infant Behavior and DevelopmentAssessmentFamily studyClinical Practicum
Supervised experience in assessment, observation, intervention
ConnecticutChart-a-Course
Early care and education professionals
Training
Early Childhood Consultation Partnership
Mental health consultation to early care and education professionals
11 master’s level mental health professionals
Educating Practices in the Community
Health care practitioners
Kids Care InitiativeSystems-level training across multiple child-serving agencies
What is Connecticut Charts-A-Course?
Connecticut Charts-a-Course (CCAC) is the statewide system of career development for early care & education, and school-age care.
Who funds CCAC?CCAC is funded by state quality enhancement funds for school readiness from Department of Social Services and Education.
Investments made from FY98-02:• Children’s Fund of Connecticut $340,000$340,000• Department of Social Services $3,755,000$3,755,000
CCAC is a special initiative of the Connecticut Community Colleges and is connected to the
Chancellor’s Office.
CCAC is a special initiative of the Connecticut Community Colleges and is connected to the
Chancellor’s Office.
What is the goal of CCAC?To promote quality in early care & education by:
Supporting the career development of early care & education providers in all settingsIncreasing the early care & education workforce capacityPromoting early care & education as a viable career choiceDecreasing staff turnoverSupporting program improvement and quality initiatives
How does CCAC support the early care & education provider?
Scholarships
Access to training
Career counseling
Certificate of recognition
Career ladder
What is the Training Program in Child Development?
Quality education and training for early care & education providers
180 hours of non-credit training delivered over four modules
Content is distributed through the Core Areas of Knowledge
10 years of success8,500 CCAC members2,500 scholarships5,000 training participants40% of CT CDAs are CCAC funded780 approved trainers230 career counseling sessions265 accredited centers12 colleges/universities in ECE articulation planChild Care Apprenticeship Program
Highlights 1/98 – 6/02
• More than 5,000 participants to date• Over 213,000 hours of training delivered• 25 training organizations• Statewide accessibility – over 30 locations• All 180 hours of CCAC curriculum offered• 20% of training in Spanish
How was the outcome evaluation conducted?
Pre and post observation of participants in Modules I and II
ECERS, FDCRS or HOMEArnett
Interviews with participants who completed Module IV
OutcomesTraining is making a difference:
-child care providers consistently demonstrate positive changes related to the learning opportunities and environments they offer and the quality of their interactions with young children.
Largest increases in the areas of language and reasoning, program and interaction (ECERS, FDCRS, HOME)
Significant increases in providers’ responsiveness and decreases in harshness and detachment (ARNET)
CT KIDS CARE INITIATIVE
Institutes on competency based training to support implementation of systems of care
Five days of training for teams
Competency matrix addresses attitudes, knowledge and skills for community based care
Direct care, supervisor and management
Children w/ MH needs and families
Training of trainers model
Core Curriculum
Day 1: Systems of care 101
Day 2: Understanding the strengths and needs of children and their families
Day 3: Individualized strategies in response to the strengths and needs of children and families
Day 4: building equal partnerships with parents and children
Day 5: Interagency and community collaboration
Training Implementation Goals
Provide strength based training that emphasizes individuals and families as partners in community-based planning and behavioral health care
Train 300 to 5000 individuals from diverse agencies (including all child welfare and public mental health staff), families, advocates, community providers, consumers
VERMONT--System of Care
CMHS grant to integrate mental health into child health, early care and education
Multi-faceted intervention: Prevention-treatment
ECMH competencies for providers, and training
4 DOMAINS: child, family, community and teamwork
Vermont Competencies
Articulation of “Vermont Culture”
10 Guiding Principles
4 domainsKnowledge
Practices
Action/Learning PlanSpecific goals
Strategies
Resources
Timelines
Teamwork (example)
I know about… I am able to do…My own biases, values, strengths and vulnerabilities in forming relationships with families, children and other team members
• Familiar with
• Less familiar, like to learn more
• We can identify someone within our community who is knowledgeable
• This is a high priority for my learning
State and Local ResponsibilitiesSTATE:
Clear point of responsibility/accountability in Exec. Branch
Committee on interagency collaboration at senior level
Regular feedback from community and families
Policy shifts related to funding and HRD
State family organization/coalition
COMMUNITY:
Local cross-system team responsible for planning, policy development, resource identification, training,monitoring
Strong family involvement on this management committee
Interagency review mechanism
System for referrals
Local family supports
Lessons Learned in Vermont
You don’t build a freestanding mental health system of care for young children.
This is a cultural exchange process.
Intervention isn’t enough.
There are many new opportunities to blend funding.
There are too few staff trained in early childhood mental health. We must grow our own.Two-year process to create the Knowledge and Practices document
Common Elements of Effective ECMH Systems
Involve different catalysts and different leadership
Involve partnerships and many stakeholders
Emphasize prevention and early intervention, not only “treatment”
Involve different entry points and build on existing early childhood programs
Develop creative fiscal strategies
Develop the workforce
Work toward policy and systems change
10 Action Steps
1. Raise awareness
2. Test new approaches
3. Develop cross training
initiatives
4. Build collaborative
approaches
5. Identify existing
services/programs
6. Develop common service definitions
7. Involve families and child care
community
8. Utilize existing data
9. Gather outcome data
10. Start Somewhere and Just do it