September 2013

Module 5 Helping Children Thrive

Module 5 Learning Objectives Participants will: Understand importance of stable and nurturing relationships for young children especially when Child Welfare involved. Understand the concept of taking an All, Some and Few approach to service provision. Identify community supports to help young children and their families. Describe and be able to access specific services available in Washington to children involved with child welfare. Modified by Children’s Administration 5/2014

What is needed for children like Billy to thrive? What does the research tell us? Why will it help? What are the evidenced-based practices? What is the role of child welfare professionals? Who are key partners?

Addressing the Needs of All, Some and Few IECMH Intervention Part C Early Intervention and Targeted Supports High-Quality Early Learning Environments and Home Visiting Nurturing Relationships Stability Modified by Children’s Administration 5/2014

Helping Children Thrive Support and promote stability in all aspects of their lives. Ensure they have nurturing and responsive relationships with caregivers, caseworkers, child care providers, etc. Ensure ALL young children have access to high-quality early learning environments and evidence-based home visiting programs. Provide Early Intervention and Targeted Supports when identified (SOME). Provide quality, effective intensive infant and early childhood mental health interventions when needed (FEW) Engage multiple partners from the community in helping children thrive Modified by Children’s Administration 5/2014

Promoting Stability & Nurturing Relationships Modified by Children’s Administration 5/2014

Each additional placement during the first year decreases the chances of achieving permanency by another 32% National Clearinghouse on Child Abuse and Neglect Information. (2005).

Challenges to Stability Some evidence suggests that a single change in social workers decreases chances of permanency within 12 months by 52%. National Clearinghouse on Child Abuse and Neglect Information. (2005). Modified by Children’s Administration 5/2014

Frequent Visitation Supports Stability Frequent and meaningful visitation is vital for young children Evidence suggests visitation is linked to permanency and well-being Withholding visitation should not be used as a threat or punishment American Academy of Pediatrics Committee on Early Childhood, Adoption and Dependent Care (2000).

Benefits of Frequent Visitation Establishes and strengthens the parent-child relationship Eases the pain of separation and loss for the child and parent Enhances parents’ motivation to change Involves parents in their child’s everyday activities Helps parents gain confidence and practice new skills Allows for coaching and modeling positive parenting skills Provides information to the court on the family’s progress to determine whether reunification is the best permanency option for the child Helps with the transition to reunification American Bar Association and Zero to Three. (2007)

Physical Contact is Key Young children need physical contact to create and sustain relationships.

“… their time together was perceptively nourished by their relationship.” Unhurried Attuned Focused attention Gentle Respectful Responsive The Art of Caregiving Nurturing & Responsive Relationships

To decrease the child’s stress and increase the child’s sense of security, adults must learn how to: Read the child’s cues Comfort the child Anticipate triggers for emotional outbursts Modified by Children’s Administration 5/2014

Levels of Discrimination Between Infants and Caregivers Recognition/ Familiarity Familiarity/ Comfort Comfort/ Pleasure Pleasure/ Reliance Reliance/ Preference Used with permission by the author. From: Zeanah, C.H. & Smyke, A.T. (2009). Disorders of attachment. In C.H. Zeanah (Ed.), Handbook of infant mental health, 3rd Edition, (pp ). New York, Guilford Press. It’s not just attached or not attached …

Stable, Nurturing & Responsive Relationships Support Emotional Health Provide routine – all children thrive on routines (mealtimes, bedtime, daily activities) which allow them to feel more secure and in control Include consistent, familiar people who feel safe Encourage security blankets Provide reassurance Tolerate clinging behavior and the need for reassurance

Nurturing & Responsive Relationships The brain is not fully formed at birth Experiences and relationships “grow” the brain

Addressing the Needs of All, Some and Few IECMH Intervention Part C Early Intervention and Targeted Supports High-Quality Early Learning Environments and Home Visiting Nurturing Relationships Stability Modified by Children’s Administration 5/2014

Where do children in care spend their days? Biological home Relative home Foster home Child care Neighborhood

High Quality Environments Quality early childhood environments enhance development and relationships Enhance development Larger vocabularies Better reading skills Higher math competencies Higher IQ and school readiness scores Foster relationships Improved social- emotional development Reduced behavior challenges Protective factor for maltreatment

High Quality Environments High quality early childhood programs can produce long term benefits

Feds Push Relationships with Early Learning Systems Head Start and Early Start Eligibility (ACF-IM-HS-10-04) Child Care Subsidies Modified by Children’s Administration 5/2014

Washington State – Children in Foster Care Only 3% of WA slots in Early Head Start, Head Start or the Early Childhood Education Assistance Program (ECEAP) are filled with children in foster care. House Bill FAR workers must assess for child safety and well-being when working with a family to identify the need for childcare, preschool, or home visiting services for non-school-age children. Children who need these services should be referred to programs rated levels 3, 4 or 5 in the Department of Early Learning’s (DEL) Early Achievers Program. Opportunities for Visitation Modified by Children’s Administration 5/2014

Finding High Quality Care in WA Department of Early Learning Early Achievers – –DEL partners with Child Care Aware Washington and the University of Washington to offer Early Achievers statewide. Child Care Aware of Washington – – –Modified by Children’s Administration 5/2014 –Online Statewide Referral DatabaseOnline Statewide Referral Database Modified by Children’s Administration 5/2014

Home Visiting Improves Maternal and prenatal health Infant and child health Child development and school readiness Parenting skills Knowledge of child development outcomes Referrals to community services Positive behavior management Reduce accidents and emergency room visits Modified by Children’s Administration 5/2014

WA Evidenced Based Home Visiting Programs Support Development & Reduce Child Abuse and Neglect Department of Early Learning Thrive by Five Washington Fight Crime Invest in Kids, Washington Modified by Children’s Administration 5/2014

Addressing the Needs of All, Some and Few IECMH Intervention Part C Early Intervention and Targeted Supports High-Quality Early Learning Environments and Home Visiting Nurturing Relationships Stability Modified by Children’s Administration 5/2014

Early Intervention for Delays and Disabilities and Targeted Social Emotional Supports Early intervention (IDEA Parts C & B) In-home supports, parenting education, and relationship focused supports Early childhood mental health consultants to child care, early intervention, home visiting and child welfare.

Early Support for Infants and Toddlers Family Health Hotline Modified by Children’s Administration 5/2014

Targeted Social Emotional Supports Provide in-home supports through a multidisciplinary team approach to prevent removal in the first place Modified by Children’s Administration 5/2014

Targeted Social Emotional Supports Help parents and caregivers understand children's underlying emotional needs

Parenting Classes Should Help Parents to: Understand baby’s cues and respond appropriately Know baby can’t be spoiled by meeting his or her needs Have realistic expectations Support development and provide enriching experiences Ensure safe, appropriate environments Beckmann, K., Knitzer, J., Cooper, J. & Dicker, S. Supporting parents of young children in the child welfare system. February National Center for Children in Poverty.

Children’s Administration Evidence-Based Parenting Programs Triple P: Positive Parenting Program Incredible Years SafeCare Parent Child Interaction Therapy Promoting First Relationships Modified by Children’s Administration 5/2014

What can improve parents’ capacity for nurturing? Address parents' issues so their problems do not interfere with caregiving

Early Childhood Mental Health Consultation Reduces children’s problem behaviors when least costly and most amenable to intervention and reduces the likelihood of later behavior problems.

Early Childhood Mental Health Consultants In Child Care Improve sense of job control and satisfaction Improve sensitivity and classroom management Improve classroom climate Create more positive interactions Develop more skill for handling difficult behavior Lower stress among teachers Reduce challenging behaviors Georgetown Early Childhood Mental Health Consultation Center

Addressing the Needs of All, Some and Few IECMH Intervention Part C Early Intervention and Targeted Supports High-Quality Early Learning Environments and Home Visiting Nurturing Relationships Stability Modified by Children’s Administration 5/2014

Infant mental health enhancing relationships to help children thrive

Infant Mental Health and Well-Being The Capacity To: Experience, regulate, and express emotions Form close, and secure relationships Explore the environment and learn Modified by Children’s Administration 5/2014

Intensive Intervention Babies can suffer and need specialized services Modified by Children’s Administration 5/2014

Intensive Intervention Multi-Generational Approaches to Treatment The most promising programs for preventing and treating mental health problems in young children are multigenerational approaches, which provides therapeutic intervention to address the child's needs and simultaneously address the primary needs of the caregivers. Source: National Scientific Council on the Developing Child. (2008/2012). Establishing a Level Foundation for Life: Mental Health Begins in Early Childhood: Working Paper 6. Updated Edition.

Infant Early Childhood Mental Heath in Washington Use of the DC:0-3R Approved –Included in Access to Care Standards – Medicaid Treatment Child Care (MTCC). Available in King and Yakima Counties High Variability in Capacity by RSN –Do you use the DC:0-3R? –Do you treat dyads? (children and parents or caregivers together) –Do you take an IMH relationship-based approach? WA – Association for Infant Mental Health – –Endorsements Expected Spring 2015 ( ) Modified by Children’s Administration 5/2014

Summary: Applying science to help children thrive. What can you do? At every juncture, ask: How can we reduce stress and increase security? Support maximal stability Support and promote nurturing and responsive relationships in the life of the child Consider the age of the child, the attachment with the biological parent, the effect of the attachment disruption and the nurturing of the foster parent or relative in all decisions

Summary: Applying science to help children thrive. What can you do? Provide intensive multigenerational infant and early childhood mental health interventions. (FEW) Provide early intervention and target supports as indicated. (SOME) Ensure access to early learning environments and home visiting programs. (ALL) IECMH Intervention Part C Early Intervention and Targeted Supports High-Quality Early Learning Environments and Home Visiting Nurturing Relationships Stability Modified by Children’s Administration 5/2014

Who are your community partners? 45

Nurturing & Responsive Relationships Everyone can help support loving and nurturing relationships Judges Providers Case workers GALs Attorneys CASAs Veteran Parent Mentors Bio Parents Relative, Suitable & Foster Placements Communities