Infusing Mental Health Into an Early Childhood System of Care

Image of a crisis clinic about to go over a cliff

Early Childhood Mental Health  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

Values and Principles INFUSE Mental Health in early childhood natural settings – “where kids are” Supports for care givers, parents, services for children and families USE PUBLIC HEALTH MODEL (intervention is not enough)  Promotion - for healthy social emotional development of all kids and families  Prevention - focus supports for at risk children and families  Intervention - services to kids with diagnosis ACCEPT THAT THIS IS A CULTURAL EXCHANGE PROCESS Engaging and involving families, caregivers, early childhood providers, mental health providers, and community at large.

Strategic Planning Why?

Mental Health Issues for Young Children and Their Families in Vermont, 1996 What kind of mental health issues do you experience or encounter among the families and young children whom you serve? Parents of Young Children: Depression Substance abuse Domestic violence Young Children: Behavioral and emotional challenges

We know more now about the importance of early life experience than we ever have. We know more now about what works than we ever have. We know more about strengths of families than we ever have. We know more about the power of community than we ever have. The time to invest in the future is now.

"Face to face with the second step" Image of an animal climbing up stairs

The Department of Developmental and Mental Health Services applied for and received from the Center for Mental Health Services  Services Initiative Grant  $5.7 Million Dollars  Five Years Duration

STRATEGIC PLANNING Interagency Partnership

Children & Families Agency of Human Services Central Office Head Start – State Collaboration Success By Six Regional Planning Parent-Child Centers Domestic Violence Network Child Welfare Department Protective Services & Family Support Child Care Child Care Subsides & Fee Scales Health Department Healthy Babies Women, Infants, Children (WIC) Family, Infant, Toddler (FIT) (Part C) Alcohol & Drug Abuse Programs Education Department Early Education Initiative Early Essential Education Private Child Care Centers Day Care Homes Vermont Early Childhood System & Work Group

An Invitation to Promote Children’s Upstream Services (CUPS)

Regional Planning Process  Management team  Priority needs and services  Budgets  Fiscal agent  Local outcomes

Who participated?  Family members  Early childhood System of Care (including health)  Systems of Care for Children with Emotional and Behavioral Challenges (school-ages)  Other community agencies and leaders

Identified Top 3 Community Survey and Forum Priorities  Parenting and child care training opportunities.  Behavioral consultation in child care settings and school settings.  In-home direct therapeutic and consultation services.

State Outreach Team  Family members and  Representatives from: Agency of Human Services Department of Developmental and Mental Health Services Department of Health Department of Social Welfare, Social and Rehabilitation Services (child welfare) Department of Education

Never, ever, think outside the box

Mice in a maze

SERVICES AND SUPPORTS What?

Cartoon saying “Only I can prevent forest fires? Don’t you think I should share some of the responsibility?”

Regional Services: 26 FTE’s hired statewide Outreach, information and referral Interagency training and technical assistance Consultation to early childhood care and education, primary care providers Direct intervention Crisis outreach Observations, assessments and referrals Case management and service coordination Collaborative treatment planning Intensive home-based services Respite care Intensive childcare-based services

DIFFERENT SERVICES  Consultation without identified client  Cross training of early childhood caregivers DIFFERENT PLACES TO SERVE  Childcare  Parent Child Centers  Pediatric practices

PREPARED WORKFORCE HOW and WHO?

Learning Team Commitments  Operate as “learning organization”  Strengthen existing skills, knowledge and systems of care  Build competent workforce  Strive for meaningful family participation  Make community priorities our priorities  Address needs of under-served families

CUPS Learning Team Initiatives  Coordinate with early childhood initiatives  Provide philosophical leadership  Identify core competencies  Address local training priorities  Conduct statewide learning series  Collaborate with Family Consortium  Facilitate network for reflective supervision  Provide training scholarships  Explore higher education and in-service training opportunities

Knowledge and Practices Early Childhood Mental Health Knowledge and Practices Document Includes A description of the field of early childhood mental health. A set of Guiding Principles underlying all services, supports and practices in the field. Core Competencies organize into four domains Child Family Community Interpersonal relationships and teamwork A Personal or Team Summary

CUPS HANDBOOK: FINDING HELP WITH SOCIAL-EMOTIONAL- BEHAVIORAL PROBLEMS FOR YOUNG CHILDREN & THEIR FAMILIES TABLE OF CONTENTS Introduction  1.Families in the 21st. Century 2.Assessment as Discovery 3.Early developmental delays and differences 4. Teen parenting 5. Trauma to the child including sexual and physical abuse 6.Domestic violence witnessed by the child 7.Neglect of the child 8.Challenging behaviors  9.Parent substance abuse and chemical addictions 10.Parent psychosocial/developmental challenges 11.Environmental stressors APPENDIX I: Legal Definitions APPENDIX II:General Resources, State-wide (Vermont) APPENDIX III:General Resources, National & International

Financing How?

Early Childhood Mental Health Service: Financing Map Organizational Chart detailing General Funding Streams and Flow of Funds at the Federal, State, City and County levels.

BIG QUESTIONS How to leverage Federal dollars for these services that don’t identify a specific client?  Promoting public health model.  Consulting and providing Technical Assistance to early childhood providers.  Screening all children for social and emotional issues.

FINANCING How?  Many new partners, many new opportunities to blend resources.  Early Childhood providers fear of Medicaid and diagnosis.  Use of “V” codes  Use of treatment planning

Evaluation  134 parents of children ages1 to 6 participated in the evaluation  Significant positive changes were reported after six-months of services; they appear to have been maintained after one year.  Children’s emotional problems decreased.  Parent’s stress was reduced.  Parent’s were more satisfied with their children’s progress than before service.

Key Findings  Parents felt that services helped their family.  Parents were satisfied with their child’s progress.  Children demonstrated improved social and emotional outcomes.

 Billy’s story

Risk and Protective factors  Resilient children tend to have had environments that are supportive in critical ways and the capacity for resilience develops over time in the context of environmental support (Egeland, Carlson & Sroufe,1993)

Protective Factors  Positive self-esteem  Active style of responding to stress  Ability to elicit positive attention form adults

Services and Supports Prepared Workforce Interagency Partnerships Maximized and Flexible Funding Building Blocks PromotionPreventionIntervention Supports for Parents and Families Supports for Other Caregivers Services for Children and Families Outcome Evaluation Strategic Planning, Policies, and Procedures Developed by Roxane Kaufmann, GUCCHD EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF CARE Fosters 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

Promotion  Dissemination of information promoting healthy social- emotional development  Developmental screening  High quality child care  Use of an evidence- based curriculum

Prevention  Home visiting  Mental health consultation  Family mentors  Social skills curricula  Family supports  Caregiver supports

Intervention  On-site mental health consultation  Crisis teams  Wraparound services  Relationship-based therapy  Hotlines for families  Behaviorally-based programs provided in a variety of settings  In-home treatment

Achieving System Reform Goals  Work together  Emphasize shared values  Learn from differences  Engage key stakeholders  Focus on the philosophy and values

Charlie Biss, Director Child, Adolescence & Family Unit Phone: (802) Fax: (802) Division of Mental Health 108 Cherry Street PO Box 70 Burlington, VT Website: Click on mental health Click on mental health again to get to DMHS You will then click on research publications Once you get to publications, click on child & adolescent Click on CUPs handbook Then click on knowledge and practices