Michigan’s Early Childhood Mental Health Services

Sheri Falvay, Michigan Department of Community Health, Mental Health Services

to Children and Families

Michigan’s Efforts to Support Early Childhood Mental Health

Intervention

Prevention

Promotion

Promotion

1. High quality training on social-emotional development

• For Child Care Providers and Parents:– MI4C/Child Care Resource and Referral– Michigan State University and – Child Care Expulsion Prevention– All funded with Child Care Development

Block Grant Dollars earmarked for 0-3 Quality.

Promotion• Collaboration agreement between MI4C,

MSU-E and CCEP was developed.– Agreed to use common Social and

emotional definition across trainings:Within the context of one’s family, community and cultural background it is the child’s developing capacity to: Experience and regulate emotions,Form secure relationships andExplore and learn (adapted from 0-3)

– Agreed to create an expanded state level social and emotional training committee and to involve all early childhood partners, i.e. Part C, Head Start

Promotion• Will work on (7) training recommendations :

– Use the same definition and source for the topic of temperament.

– Provide referral information for all three projects at trainings.

– Emphasize the importance of the caregiver’s emotional health.

– Emphasize the importance of nurturing, responsive caregiving and the importance of having a primary caregiver.

– Use a common source for social-emotional milestones.

– Emphasize the importance of true partnerships between parents and caregivers in promoting social-emotional health.

Promotion

2. High quality training on social-emotional development

• For Front line staff: (IMH, Mental Health consultants, Health workers, etc)

– Michigan Association for Infant Mental Health Endorsement

Michigan Association for Infant Mental

Health Endorsement

CCEP, 07/20/07

What is the Value of Endorsement?

•Provides a level of assurance to families, agencies and the public at large that the person delivering services meets professional standards.

•Provides a pathway for development in the infant and family field for the span of one’s career.

•Provides a set of competencies to guide training, service and research.

CCEP, 07/20/07

Development of a Professional System

1997, MI-AIMH designed a 4-level framework for an interdisciplinary professional development system to recognize competency:

•Infant Family Associate – Level One•Infant Family Specialist – Level Two•Infant Mental Health Specialist – Level Three

•Infant Mental Health Mentor – Level Four

CCEP, 07/20/07

Framework for Endorsement: Component Parts

MI-AIMH identified the following endorsement criteria to assure best practice outcomes for infants, toddlers & families:

– specific educational experiences– work experiences with infant, toddlers &

families– competency-based, in-service training

experiences – reflective supervision/consultation

experiences

CCEP, 07/20/07

Additional Criteria for Endorsement

•Infant Mental Health Code of Ethics

•Reference ratings from 3 professionals

•Successful completion of a 3-hour written exam for level 3 & 4 candidates

•Membership in an IMH professional organization

CCEP, 07/20/07

Steps to Endorsement

– Inquiry

– Applications

– Portfolio preparation

– Documentation

– Endorsement

How is MI Infusing Endorsement?

• DCH requiring Level II endorsement by 2009 for all home based staff working in early childhood

• DCH, early childhood mental health consultation program (CCEP) requires all staff to be endorsed at Level II.

Michigan’s Efforts to Support Early Childhood Mental Health

Intervention

Prevention

Promotion

Prevention• Early Childhood Mental Health Consultation

– Child Care Expulsion Prevention• Started in 1999, the Department of Human

Services (DHS) made an interdepartmental agreement with the Michigan Department of Community Health, to establish one Child Care Expulsion Prevention (CCEP) project to support the mental health needs of young children in early care and education settings.

• Now- 16 project in 31 counties

CCEP’s Goal“To support families and child care providers in successfully nurturing

the social and emotional development of infants, toddlers and young children (0-5) who are

in child care.”

The Cornerstones

• Programmatic and child-family centered consultation

• Skilled consultants• Reflective supervision• Technical assistance• Evidence-based practice• Collaboration

Programmatic Consultation:What Do We Do?

• Intake• Observation• Standardized Social and Emotional Assessment

of Programs• Planning• Coaching• Build Relationships!

CCEP Core Trainings

– New (3-hour) standardized modules:

– Social and Emotional – Development– Challenging Behavior– Conflict Resolution– Caring for the Caregiver

CCEP Child/Family Consultation

Child-Family Centered Consultation

• Referral and Intake• Observation and Assessment• Meetings to Develop Positive Child Guidance

Plans and Programmatic Plans to support child

• Support for the Family and Provider to Implement Plans

• Social-Emotional Trainings• Referrals to Outside Services as Needed• Follow-up Services (optional)

Why are Children Referred?

• Children are referred for many reasons but most often for;

• Aggression (25%)– For example, biting, hitting, swearing, destroying

property

• Regulatory issues (27%)– For example, Child has difficulty adjusting to changes

in routine, does not sleep or rest as needed, has toileting problems or feeding difficulties.

• Developmental concerns (23%)– For example, child is clingy, has problems focusing,

does not listen to care provider or parent, impulsive, or has problems with play (initiating, maintaining)

What Happens with Support?(2007 data)

• 83% of children referred to CCEP stayed in the program. 92% percent of these children had positive outcomes (17% moved or data was not completed for extenuating circumstances)

• 56% stayed in the same child care setting with positive results

• 23% transferred to a more appropriate child care setting with agreement from all involved

• 13% of children “graduated” on to Kindergarten successfully or with appropriate support services

• 4% of the children were expelled with no follow up• Another 4% were expelled but received services at

a new site from CCEP

Skilled Consultants & Reflective Supervision

• Master’s Degree in Mental Health Related Field

• Level II MI-AIMH Endorsement

• Twice Monthly Reflective Supervision

State-Level Technical Assistance for CCEP

Projects and Others

• Quarterly meetings in two regional locations• Monthly Training and Evaluation meetings for

administrators of CCEP programs• On-site visits• Statewide and national training• Uniform forms and materials• Email group

Evidence-Based Practice

• Devereux Early Childhood Assessment for Infants, Toddlers and Preschoolers

• Evaluation!– Data collection (child, care provider, family,

and CCEP process)– Case Studies– Control Sample

Michigan’s Efforts to Support Early Childhood Mental Health

Intervention

Prevention

Promotion

Intervention

• Home-based Services for infants-toddlers, young children (0-3, 4-7) and their parents

• Infant Mental Health Services• Parent Education• Other CMHSP Services (i.e. respite,

case management services, etc.)

What is Happening?

• Revised 0-3 and 4-7 access criteria• Requirement of MIAIMH endorsement for

staff working in early childhood services• State level committee charged with

researching social and emotional assessments to support eligibility(18 tools researched)

• DECA-I/T chosen for piloting• Still researching an adult/child interaction

tool

What is the DECA-IT?

• The Devereux Early Childhood Assessment for Infants and Toddlers (DECA-IT) is a premier instrument for assessing protective factors and screening for potential risks for social and emotional development in very young children 4 weeks to 36 months.

What Protective Factors Does the DECA-IT

Measure?The Infant Assessment measures:

Initiative andAttachment/Relationships

The Toddler Assessment measures:Initiative

Attachment/Relationships andSelf-Regulation

What Ages Does it Cover?There are two assessments.

• The Infant assessment covers from 4 weeks up to 18 months- It also has four scoring profiles:– 4 weeks to 3 months– 3 months up to 6 months– 6 months up to 9 months– 9 months up to 18 months

• The Toddler assessment covers from 18 months to 36 months- It has one scoring profile

Is it a Viable Assessment?

• The DECA-IT meets or exceeds professional standards of quality in terms of:– Reliability– Validity

• The DECA-It had a national standardization sample of 2,185 infants and toddlers from across the U.S.

Efforts Towards Universal Use

• Part C piloted the use of the DECA-I/T in combination with developmental assessment

• Early Head Start has purchased kits for all sites with training to follow

• All CCEP sites use the DECA for 0-3 and the Preschool DECA

For More Information

• Please Contact Sheri Falvay at:– Falvay@michigan.gov– 517/241-5762

• For information on CCEP or the DECA-I/T contact Mary Mackrain at:– Mackrain@aol.com– 248/594-3250