Infusing Mental Health Services 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 CHILDHOOD MENTAL 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 Prevalence No 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 problems No data for children under age of 2 Center for Evidence-Based Practice: Young Children with Challenging Behavior

School Readiness Skills Emotional self-regulation Behavioral self-regulation Empathy and perspective taking Communicating needs, desires & interests in pro-social way Understanding cause & effect sequences Interest, motivation, persistence Early Childhood Resource Center, RTI

EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF CARE Building Blocks Fosters the social and emotional well-being of infants toddlers, preschool-age children and their families Services and Supports VALUES Family Voice Child and Family Centered Relationship Based Culturally Competent Infused into Natural Settings and Services Grounded in Developmental Knowledge Supports for Parents and Families Supports for Other Caregivers Services for Children and Families Building Blocks Strategic Planning, Policies, and Procedures Maximized and Flexible Funding Interagency Partnerships Prepared Workforce Outcome Evaluation Promotion Prevention Intervention Developed by Roxane Kaufmann, GUCCHD

THE SYSTEM OF CARE CONCEPT 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 Services Grounded in Developmental Knowledge Promotion Prevention Intervention

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 ECMH Skills Early 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 disabilities Level 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 Health Theory and Practice Infant Mental Health Psychology of Infant Behavior and Development Assessment Family study Clinical Practicum Supervised experience in assessment, observation, intervention

Connecticut Educating Practices in the Community Kids Care Initiative Chart-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 Initiative Systems-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 Department of Social Services $3,755,000 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 settings Increasing the early care & education workforce capacity Promoting early care & education as a viable career choice Decreasing staff turnover Supporting 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 What can you do with the training? CDA Credential The 180 hours of training fulfills the training requirement needed to apply for a CDA Credential. College Credit The 180 hrs. of training provides the knowledge needed to pass the Early Childhood Pathways Exams from Charter Oak. Passing the two exams earns 6 college credits. Who delivers the training 20 Training Organizations Statewide 8 Community Colleges 5 RESCs (Regional Education Service Centers) 5 Non profit agencies UConn Cooperative Extension, Hartford College for Women

10 years of success 8,500 CCAC members 2,500 scholarships 5,000 training participants 40% of CT CDAs are CCAC funded 780 approved trainers 230 career counseling sessions 265 accredited centers 12 colleges/universities in ECE articulation plan Child 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 HOME Arnett Interviews with participants who completed Module IV

Outcomes Training 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) Impact of training on graduates The most useful and informative aspects of the program were child development and disabilities/special needs The highest scores were for the impact training had on “respect for skills as a child care professional” and “plans for additional training or education” Providers in the three types of child care settings were very strongly committed to staying in the field of early childhood despite the lack of substantive change in salary or benefits

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 domains Knowledge Practices Action/Learning Plan Specific 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 Responsibilities 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