1. Infusing Mental Health Services and Supports in Early Childhood Settings
Deborah Perry, PhD
Georgetown University
Center for Child and Human Development
May 11, 2006

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. The Pyramid Levels and Types of Intervention Intervention/Targeted
Prevention/Indicated
Promotion/Universal

9. 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

10. Prevention Home visitation programs Mental health consultation
Family mentors
Social skills curricula
Family supports
Caregiver supports
Intervention

11. 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

12. 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

13. 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

14. 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

15. 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

16. Core Competencies Values/Beliefs Knowledge of ECMH Skills
Early childhood development
Importance of relationships
Risk/protective factors
Skills

17. 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

18. 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

19. Merrill-Palmer Institute
Wayne State University in Detroit, MI
Graduate Certificate Program in Infant Mental Health

20. 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

21. 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

22. 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.

23. 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.

24. 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

25. How does CCAC support the early care & education provider?
Scholarships
Access to training
Career counseling
Certificate of recognition
Career ladder

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. Vermont Competencies Articulation of “Vermont Culture”
10 Guiding Principles
4 domains
Knowledge
Practices
Action/Learning Plan
Specific goals
Strategies
Resources
Timelines

36. 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

37. 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

38. 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

39. 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

40. 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