Ohio’s Early Childhood Mental Health Initiative March 14, 2008

Babies on Couches

Early Childhood Mental Health Promoting the emotional and social development and well-being of young children and their families.

Image of a newspaper cartoon “He’s 2 ½ day sold and he’s already had nine time-outs!”

ODMH EARLY CHILDHOOD MENTAL HEALTH INITIATIVE Advisory Council includes: –ODJFS – child welfare and child care –ODE –ODH – Help Me Grow –MR/DD –ODADAS –ODDC –OFCF –OAIMH –OCCRRA –Head Start –Children’s Hospital Association –Local and state children’s advocacy organizations –Local ADAMHS Boards –Local mental health providers –Families –ODMH staff

Early Childhood Mental Health (ECMH) State Plan for Ohio Goal (Service Continuum) Goal (Training) Goal (Funding/Financing) Goal (Public Awareness & Advocacy) Goal (Evaluation/Research)

Logo of the ABC Access to Better Care Initiative

ABC Values and Principles The ABC workgroup established core principles and committed to: Expand development of and access to priority areas (prevention, early intervention, treatment). Emphasize community-based, family-centered solutions. Strengthen and support parent involvement. Support outcome-based, effective services and evidenced based programs where possible. Increase collaboration and accountability between child serving agencies Align and redirect resources in addition to increasing capacity

Major Access to Better Care Recommendations: Focus Prevention Efforts Continue support for early childhood mental health professionals and target resources to school districts on academic watch. Offer the Partnerships for Success strategic planning model to additional counties. Target resources to prevent and address Fetal Alcohol Spectrum Disorder.

Major Access to Better Care Recommendations: Intervene Earlier with Children and Their Families Expand proven effective parent and caregiver training and education. Increase awareness regarding maternal depression. Conduct behavioral health assessments in early childhood settings Conduct behavioral health assessments in schools through the Columbia Teen Screen Program for suicide prevention. Expand effective school and community partnerships for youth at risk.

Major Access to Better Care Recommendations: Reduce treatment gaps and empower parents so children with behavioral disorders do not fall through the cracks, and families do not have to trade custody for care.

Early Childhood Mental Health Program Strengths ECMH programming and services are characterized by flexibility. ECMH specialists are knowledgeable and skilled. Strength-based approaches are used. Evidence-based programs are employed. Strong community relationships exist.

Early Childhood Mental Health Consultation Increase knowledge, awareness, resources and skills necessary for communities to meet the behavioral health needs of young children and their families, especially those at risk for abuse, neglect and mental health issues. building protective factors in young children and increasing competencies and skills of parents and early childhood providers

CRITERIA FOR CONSULTANTS It is recommended that mental health consultants be licensed mental health professionals with certain skills and areas of expertise including but not limited to: –child development –cultural competence –dynamics of early childhood care settings –sensitivity to the community’s attitudes and strengths –recognition of indicators of child abuse and neglect –family-centered, strength-based practice –understanding of Ohio’s public mental health system

10 most frequent issues for consultation 1)aggression and anger issues 2)typical development of children, behavioral and emotional development and developmental delays in young children 3)noncompliance to the directives of teachers and parents as well as working with oppositional children 4)inattentiveness and ADHD symptoms and identification 5)adjustment to traumatic life events (death, divorce, removal from home for abuse/neglect) 6)self-regulation, tantrums, impulse control and out of control behaviors 7)behavior problems in early childhood settings such as biting, acting out at transition times, and verbal and physical aggression 8)peer social skill problems and social skills training 9)engaging parents and family communication patterns 10)mood, anxiety, depression, and withdrawal

ECMH Funding Sources SFY 2007 GRF –$1.4 ECMH Initiative ($1 million ECMH Consultation) –$261,306 Treatment CBCAP –$1.5 ECMH Consultation IVB Part 2 –$167,359 Incredible Years TSIG –$300,000 Local Funds –$1.4 approximately each year

Early Childhood Mental Health Consultation SFY ,021 children in group settings received consultation services 6,951 families of young children received consultation services 6,186 infants, toddlers, and preschoolers received individual services 3,469 early childhood providers received specialized early childhood consultation and training supports 1,029 early childhood programs sites and child-serving agencies received consultation on individual children and/or their social and emotional learning environments for young children »166 ECMH Consultants

ECMH Consultation Programs/ Sites 433 Childcare Centers 206 Head Start and Early Head Start Sites 41 Help Me Grow Program Sites 156 Public and Private Preschools 15 Family Childcare Homes 63 Public Children’s Services Agencies 115 Other »Total of 1,029 programs/sites reported as receiving services

ECMH Consultation Education and Training Education and Training for Parents and Early Childhood Staff totaled: –1,653 sessions held –3,597 parent participants –5,641 early childhood staff participated Cross-Systems Training for Other Child- serving Professionals included: –375 trainings held –3066 professional participants

ECMH Consultation Education and Training Topical sessions focused on: behavior management of young children observation and assessment of young children early childhood growth and development social and emotional processes of young children 77 - family & community relations 60 - professional development 44 - learning environment and experiences of young children 32 - health, safety and nutrition needs of young children 77 - a wide spectrum of other topical areas

Satisfaction with ECMH Consultation Services 99.4% overall rate of parent satisfaction with the consultation services.  offered support and encouragement  easy to contact and schedule 97% overall rate of early childhood providers satisfaction with the consultation services provided.  had strong understanding of child development, behavior and mental health issues  easy to contact and schedule

SFY 2007 Outcomes Child-specific consultations were provided for 1163 children at risk of removal from an early childhood setting children that received consultation services, approximately 90%, were maintained in their setting. For those children that were not able to be maintained in a setting, the most common reasons given included: –children were removed by parents who then chose to care for the child at home or in relative care. –qualified for other programs specifically designed to meet special needs, or –enrolled in a different, and many times, a more appropriate setting to meet the children’s needs.

SFY 2007 Outcomes Forty-five boards reported using the DECA program as an integral part of their consultation services for FY 2007 and completing 8,506 individual assessments

Parent/caregiver Training and Education Goal: Expand proven effective parent and caregiver training and education that research has shown to prevent abuse and neglect and severe behavioral, emotional and developmental problems in children through training and education designed to enhance the knowledge, skills and confidence of parents and other caregivers.

The Incredible Years 32 Boards reported using IY programs as part of ECMH services Parent Group –161 groups –1062 parents Dinosaur Child Small Group –30 groups –191 children Classroom Dinosaur Group –168 classrooms –3030 children Teacher Classroom Management –17 groups –239 teachers Increase of 21.6% in positive parent practices Decrease of 23.6% in negative parenting behaviors Satisfaction measure data – 93.4%

Maternal Depression Goal: Increase awareness regarding the effects of maternal depression through general training for early childhood service providers and piloting identification and linkages to services for at-risk families.

Maternal Depression screening for maternal depression for mothers of infants 4-12 weeks of age a collaborative effort of 7 local mental health boards and Help Me Grow programs. 28 boards reported that as part of ECMH services, mothers, and in a few areas fathers as well, are being routinely screened for signs of maternal and other depressive symptoms. 569 mothers screened as part of pilot program 54 referred for further services

Ohio TSIG Goal: Promote Early Screening Collaborate with other systems (e.g., physical health, schools, prisons, senior centers, etc.) to provide prevention and early mental health screening assessment across the lifespan. Strategy – Promote, enhance and support the positive social and emotional development of Ohio’s young children through building professional development, infrastructure, and family and community engagement.

Ohio TSIG 1.Expand the use of the “Incredible Years” program 2.Develop competencies for Early Childhood Mental Health Professionals 3.Provide cross-system training on the use of the screening tool Ages and Stages Questionnaire: Social Emotional (ASQ:SE). 4. Provide early childhood professional development and training on the use of the Devereux Early Childhood Assessment Program (DECA). 5. Provide Maternal Depression training and materials to Help Me Grow and mental health professionals 6. Increase education and public awareness to all parents and caregivers on children’s social and emotional development 7. Establish uniform data collection and reporting for ECMH consultation services

ODMH Early Childhood Mental Health Initiative For more information contact: Marla Himmeger Mental Health Administrator Ohio Department of Mental Health 30 East Broad Street, 8th Floor Columbus, Ohio (614) (614) fax