Research, Policy, and Practice: The Challenge of Early Childhood Mental Health Jane Knitzer, Ed.D. Director, National Center for Children in Poverty Mailman School of Public Health, Columbia University Systems of Care Institute, San Francisco June 24, 2004

Four Questions What is early childhood mental health? What invest? What are early lessons from practice and policy initiatives? What are key policy challenges and opportunities?

What is Early Childhood Mental Health (ECMH) ECMH is the development of age appropriate social, emotional and behavioral skills in infants, toddlers and preschoolers, especially re how they: manage emotions (e.g.anger, frustration); relate to adults (parents, foster parents, child care teachers); relate to peers, and feel about themselves (curious, safe in exploring the world, etc.)

Why Invest? Field Perspectives ECE concerns: –Too many children are “bad, mad and sad” and being kicked out of ece programs –Don’t know how to help children & families affected by violence, maternal depression & substance abuse Kindergarten/school concerns –Too many children at risk of early school failure (can’t follow directions, listen to teachers etc. Both –Pressures (no naps or recess or testing)

Why Invest? Research Perspectives Early emotional development matters Many risk factors are known AND the more risk factors the greater the odds of poor outcomes. Early learning involves both social,emotional, and cognitive development The early years are known windows of opportunities for early intervention for some disorders (e.g. conduct disorders).

Why Invest: Policy Perspectives Consistent with national policy goals New Freedom Commission Report –Calls for public health/mh prevention,ei focus Goal I Educate America – ALL children shall enter school “ready to learn” Serving “Hard to Employ” Parents –Risk factors for parents are risk factors for young children

Early Lessons: ECMH Through a System Lens Focus is on prevention and early intervention = risk reduction &resilience promotion etc.) Many risks are known: challenge, organizing interventions to address them –Poverty and low-income status –Parental psychosocial risk factors (depression, sa, dv especially) that affect the caregiving environment –Environmental risk factors (lead) –Chronic parental or child health problems or disabilities –Poor quality non-family early care environments

Early Lessons About ECMH Systems (cont) Joins developmental, clinical knowledge & family systems knowledge Is, or should be a “family affair” “Systemness” takes from both public health and mental health Uses multiple words (S/E/B ECMH, etc.)

Goals for Intentional ECMH/S/E/B Strategies Promote emotional health and school readiness in young children Help parents (foster parents, kinship relatives, etc.) be more effective nurturers and teachers (two-generational challenge) Expand the competencies of other adults ( child care providers, teachers) to promote s/e health and school readiness Ensure that young seriously troubled children and their families get help

Examples of Types of Strategies Evidence-based population-based prevention/promotion Consultation strategies More intensive strategies in the context of ece settings (EHS) Strategies for young children with diagnoses Strategies for more burdened parents with young children.

Building Systems: Common Challenges Attitudes & Language (they will outgrow it- for crazies, don’t label, etc.) Understanding how the same and different from SOC Too narrow a view of school readiness and early child development Funding (p/c therapy; at risk not SED; using Medicaid EPSDT & MH) Two-generational mh system challenges (adult/child)

Building Systems: Early Lessons Infusion of mh into ece. Build on what exists Developmental knowledge key Use multiple entry points Partnerships are key (ece, mh, dv, sa, mh(adult) and engage families Emphasize prevention and EI, but don’t forget about more intensive treatment Do fiscal as well as programmatic planning START SOMEWHERE

The National Center for Children in Poverty (esp Promoting Resilience Series) NCSEFL The Center for Evidence-Based Practices Georgetown University Portland Research and Training Center Zero To Three National Organizations with ECMH Resources and Information

If you would like more information, contact: Jane Knitzer at Or visit the NCCP web site