Healthy Beginnings A 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 age Seeks to optimize social and emotional development of young children Is a multi-disciplinary approach involving psychiatry, psychology, social work, and pediatrics

2000 MCH Needs Assessment #1 Priority = Mental Health Access 2000 MCH Needs Assessment #1 Priority = Mental Health Access Age (years) Rate per 100, Homicide Rates – New Orleans Healthy People 2010 goal < 7.2.

Age (years) Rate per 100, Suicide Rates – New Orleans Suicide Rates – New Orleans Healthy People 2010 goal = MCH Needs Assessment #1 Priority = Mental Health Access

2000 MCH Needs Assessment Suicide and Homicide rates far exceed 2010 goal Community surveys list substance abuse and homicide as primary concerns Mental health access to services ranked #1 priority Must begin in infancy to prevent adolescent problems

Collaborators Tulane Child Psychiatry Department Children’s Bureau LA Office of Public Health Region I Office of Mental Health Institute for Mental Hygiene New Orleans Health Department

Collaborator Roles Tulane Child Psychiatry: –provides: two part-time supervising psychologists psychiatry fellow senior psychiatry faculty supervision one full-time clinic psychologist (program director) (program director) –administers the HB grant from IMH

Collaborator Roles Children’s Bureau: provides two social workers and one case manager LA Office of Public Health: funds Children’s Bureau social workers and NOHD MCH nurse coordinator Region I Office of Mental Health: provides half time social worker

Collaborator Roles Institute for Mental Hygiene: provides funding through $125,000 grant to Tulane New Orleans Health Department: –provides: primary care (EPSDT) and WIC services referrals to Healthy Beginnings Program nursing and clerical support physical space in Mary Buck Clinic (paid by grant)

Governance MOA written with help of facilitator and signed in fall of 2001 Operations Committee: senior representation for each organization; meets quarterly Evaluation Committee: oversees research, data management, and program outcomes Clinic Coordinating Committee: oversees clinic policies, forms, referrals, and feedback to providers

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

Clinic Operations All assessment data is entered into the database A caseworker links family with needed community social services Interdisciplinary case conferences are held weekly with clinic and HB staff Families are followed until goals are met or family is lost to follow-up

Achievements in First Two Years A 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 Years Undoing Racism workshop held Over 143 children were served; 33 are still active Assessment process was shortened Collaborator relationships continue to develop

Demographics of Population Served 66% males; 34% females Average age 24 months Average income below $10,000 93% African American, 4.8% Caucasian, 1.6% Hispanic,.8% Pakistani Indian

Referral Concerns Physical aggression Temper tantrums HyperactivityInattention Developmental Delays Anxiety disorders Feeding disorders Adjustment problems Withdrawn behaviors Childhood depression Maternal depression (approximately 50%) Domestic violence Physical abuse Parenting concerns

Assessment Tools Achenbach Child Behavior Checklist (CBCL) Ages 1 1/2 - 5 Infant Toddler Social Emotional Assessment (ITSEA) Competence Scale Disturbances of Attachment Interview (DAI) Parent-Child Interaction

Assessment Tools Beck Depression Inventory (BDI-II) Parent Perception Interview Partner Violence Inventory (PVI) Omitted: HOME inventory Vineland Maternal Self-Efficacy Scale

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

Key Players Tulane: Paula Zeanah, PhD, MSN Tulane: Paula Zeanah, PhD, MSN Julie Larrieu,PhD Shana Bellow, PhD NOHD: Susan Berry, MD, MPH Donna Malus, RN, BSN Pat Delaune, RN Mary Burns, RN

Key Players OMH: Guilda Butler, LCSW OMH: Guilda Butler, LCSW Children’s Bureau: Ron McClain, LCSW, Letia Bailey, LCSW Children’s Bureau: Ron McClain, LCSW, Letia Bailey, LCSW OPH: Stacia Loveall, MSW, MPH OPH: Stacia Loveall, MSW, MPH