Transcript Early Childhood Mental Health Consultation

Barbara Parks, LICSW
Shana Bellow, Ph.D.
J’Wan Griffin, LICSW
DC Department of Behavioral Health
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1) List examples of two best practice models of
early childhood mental health interventions.
2) Identify 3 positive social-emotional outcomes as
a result of the implementation of two early
childhood mental health interventions.
“Could someone help me with these?
I’m late for math class.”
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Individual: Genetics, developmental delays,
temperament, physical illness
Family: Overt family conflict, abuse/neglect,
alcoholism, family mental health history.
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Environment: Access to firearms, substances,
poverty, lack of support network
Community: Socio-economic disadvantage,
homelessness, disaster, discrimination
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Cumulative & simultaneous risk factors
increase the chances of poor developmental
outcomes.
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Academic- retention, expulsion
Social-Emotional- behavioral problems,
affect regulation
Familial- high levels of stress, out of home
placements, abuse/neglect
Interpersonal-low self-esteem, isolation,
depression, substance abuse, criminality.
“What, how, and how much a child learns in
school will depend in large part on the social
emotional competence they have developed
as preschoolers… Children who do not begin
kindergarten socially and emotionally competent
are often not successful in the early years of
school and can be plagued by behavioral,
emotional, academic and social development
problems that follow them into adulthood”
(Peth-Pierce, 2000).
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Of 4,000 classrooms studied nationally, 10.4% had
expulsions within the last year. (Gilliam, 2008)
Boys were more than 4.5x more likely to be
expelled than girls. Rates were highest for older
pre-schoolers and African-Americans.
6.7 per 1,000 pre-schoolers were expelled.
Overall rate of Pre-K expulsions was more than
three times greater than the national rate of
expulsion in grades K-12.
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Early Childhood Mental Health Consultation
50% reduction in expulsion rates in
classrooms that have access to an early
childhood mental health consultant (Gilliam,
2008)
Definition of Early Childhood
Mental Health Consultation:
“A problem-solving and capacity–building intervention
implemented within a collaborative relationship between a
professional consultant with mental health expertise and one
or more individuals with other areas of expertise - primarily
child care, child development, and families – or individuals with
child care responsibilities.”
(Cohen & Kaufmann, 2000)
Media Version
An Emerging Framework for
Quality ECMH Consultation
What Works?
Georgetown University,
Center for Child and Human
Development
15
Quality Services: Frequency and Caseload
• Clinician embedded in centers 1 to ½ day per
week
• Each consultant provides early childhood
mental health consultation to 6-7 Centers each
week
• Relationship with centers starts with a Center
Director guided needs assessment and
implementation plan
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Licensed MH clinician
with early childhood
experience
Trained in ECMHC
through University of
Maryland and
Georgetown
University
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Provision of early
childhood mental
health consultation
to 6-7 Centers
Spend one day or
half day per week at
each center
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Formal and Informal
Classroom
observation
Development of
Classroom Plans
Prevention and Early
Intervention
Activities
Modeling and
Coaching
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Support and Guidance
around Social
Emotional Screening
Promote Team
Building and
Communication
Staff Training A – Z
Classroom Set-up and
Environment
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Child observations
Home Visits
Parent and Staff
Training and Skills
Workshops
Classroom and
family consultation
regarding
challenging
behaviors
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Social Emotional
Screening and
Assessment
Developing and
Monitoring
Individual
Intervention Plans
Promotion of Early
Childhood Mental
Health
Community
Referrals
Activity
Measurement Tool(s)
Frequency and intensity of
consultation service
Consultation log
Impact of consultation on the
social-emotional quality of CDCs
•Goal Achievement Scale (GAS)
•Job Stress Index
•Teacher Survey
Satisfaction of ECMHC services
Year End Director’s Survey
Social-emotional climate of
classrooms
•Pre-School Mental Health Climate
Survey (Year 1)
•CLASS (Year 2)
•Arnett Caregiver Interaction Scales
(Year 3)
Child specific consultation
outcomes
Devereux Early Childhood
Assessment
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• Every year, Healthy Futures
consultants serve child
development programs that
enroll more than 1,200
children under 5.
◦ Healthy Futures expulsion
rates have averaged 3.3 per
1300 across all 3 years of
operation (well below
national average of 6.7)
◦ In Year 4 Healthy Futures
centers had 0 expulsions
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Classroom Environment Teacher Skill and
Knowledge
Children’s Behaviors
Improved child
interactions with staff
and peers
Increased teacher
ability to manage
challenging behaviors
Improved social
emotional development
Reduced Punitive
Behaviors from staff
Improved staff
awareness of potential
classroom challenges
and ability to avert
problems
Increased protective
factors: attachment,
initiative, and self
regulation
Improved Emotional
Support and
Engagement from staff
Improved comfort in
referring and
knowledge of
behavioral health
referral resources
Significant reduction in
parent and teacher
report of behavioral
concerns
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3
2.75
2.5
2.35
2.25
2.06
2
1.88
1.75
1.5
1
0.5
0
Manage Behaviors
Know How to Refer
Fall
Feel Comfortable Referring
Spring
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60
50
DECA T-scores
40
Pre
30
Post
20
10
0
n = 39
Attachment
Initiative
Self-Regulation
Total protective Factors
60
59
58
DECA T-scores
57
56
Pre
55
Post
54
53
52
51
50
Parents
n=6
Teachers
n = 13
PRIMARY PROJECT
- A “school-based” Intervention
J'Wan Griffin, LICSW, School Primary Project Program Manager
Department of Behavioral Health, School Mental Health Program, Washington, DC
What is “Primary Project”?
• an evidence-based, early intervention/prevention
program
• developed over 50 years ago by the Children’s
Institute, Rochester, New York
• adopted by Department of Behavioral Health in 2008
• for children pre-kindergarten through 3rd-grade
identified as having “mild” problems with socialemotional adjustment in the classroom, i.e., shy and
withdrawn, have limited or poor eye contact, have
limited self-confidence, are slightly overactive or
distractible, may display mild aggression, at times
What is “Primary Project”? (continued)
• Five (5) Components:
• 1) screening for early identification and
intervention
• 2) intervention - one-to-one, non-directive (childled) play sessions with a trained paraprofessional
• 3) collaboration with a mental health professional
to enhance the “continuum” of mental health
service provision
• 4) ongoing supervision, training, and program
evaluation; and
• 5) integration into the school community
Determining Eligibility –
The Teacher-Child Rating Scale (T-CRS)
• the T-CRS is a valid measure
• consists of 32 questions completed by the teacher
• reflects the ‘teacher’s perception’ of each child’s
classroom performance in the following domains:
• task orientation
• behavior control
• assertiveness
• peer social skills
• not ‘time-consuming’ – takes less than 5 minutes
• Assessment Report generates immediately
Primary Project Screening
(31-100%)
“Normative” Range
(15-30%)
Teacher-Child
Rating Scale results
Primary Project
Range
(0-14%)
Mental Health
Range
Parent/guardian
Permission Letter
sent home
Mental Health
Referral to DBH
Clinician generated
The “Intervention”
• a play room or area consisting of a special arrangement of expressive
toys, i.e., playdoh, dolls, cars, trucks, crayons, markers, puppets, etc.
• the play session is one-to-one, and, non-directive (“child-led”)
• conducted by a “Child Associate”, trained paraprofessional who uses
specific communication techniques during the play session in interaction
with the child
• 15 or 20-minute play sessions are conducted weekly for 8 to 15 weeks
• The child controls the play session and can play with whatever they
want; 3 rules apply during the play session (the Child Associate explains
the rules to each student before play sessions begin):
• 1) you cannot harm yourself
• 2) you cannot harm the Child Associate; and
• 3) you cannot destroy the toys
“I’ve learned that people will
forget what you said, people
will forget what you did, but
people will never forget how
you made them feel.”
Maya Angelou (1928-2014)
Quoted in the local Express newspaper on May 29, 2014
The Child-Child Associate Interaction
• The child-Child Associate ‘relationship’ during play
sessions has a total ‘interaction time’ of only 4-8 hours
during the school year
• Yet, the relationship has a powerful IMPACT on the
child’s social-emotional development, i.e., decrease in
shy and/or withdrawn behaviors, increase in verbal
responses, improved decision-making, heightened
self-confidence, etc.
• Enhances school-related competencies in four (4)
domains, i.e., task orientation, behavior control,
assertiveness, and, peer social skills
“Benefits” of Primary Project
• It’s an evidence-based program
• Provides “early”:
• 1) detection of adjustment problems in young children
• 2) identification of need for mental health intervention
• 3) intervention to minimize/eliminate adjustment problems
• Promotes pro-social behaviors, i.e., self-regulation, decision-making,
positive self-esteem, improved self-confidence, etc.
• Improves school readiness and enhances school-related
competencies
• “Observable” changes at school and home are reported by school
staff, clinicians, Child Associates, and, parents/guardians
• The program enhances the DBH “continuum” of school-based mental
health services for children
• School-based intervention – occurs during the school day
SY2013-14 Teacher-Child Rating Scale Results
SY2013-14 Associate-Child Rating Scale Results
Primary Project Screening Results
(2008-2013)
Students
SY2008- SY2009 SY2010 SY2011 SY2012- SY20132009
-2010
-2011
-2012
2013
2014
# screened
991
1435
835
1445
2664
3031
# positive
for Primary
Project
355
(36%)
522
(36%)
323
(39%)
497
(34%)
579
(22%)
567
(19%)
269
328
247
354
(24%)
785
(29%)
868
(29%)
# of
participants 164
329
206
# positive HF/SMHP
service
99
(7%)
105
(13%)
65
(7%)
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Barbara Parks – [email protected]
Shana Bellow – [email protected]
J’Wan Griffin– [email protected]