Transcript Healthy Beginnings

Healthy Beginnings
A Collaborative Infant Mental
Health Intervention in a Public
Health Clinic
What Is an Infant Mental Health
Intervention?
Focuses on infants and children 0-5 years
of age
Seeks to optimize social and emotional
development of young children
Is a multi-disciplinary approach involving
psychiatry, psychology, social work, and
pediatrics
2000 MCH Needs Assessment
#1 Priority = Mental Health Access
Homicide Rates – New Orleans
Age (years)
Rate per 100,000
1-4
10
5-14
14
15-24
211
25-34
287
Healthy People 2010 goal < 7.2.
2000 MCH Needs Assessment
#1 Priority = Mental Health Access
Suicide Rates – New Orleans
Age (years)
Rate per 100,000
15-24
93
Healthy People 2010 goal = 9.6
2000 MCH Needs Assessment
Suicide and Homicide rates far exceed
2010 goal
Community surveys list substance abuse
and homicide as primary concerns
Mental health access to services ranked
#1 priority
Must begin in infancy to prevent
adolescent problems
Collaborators
Tulane Child Psychiatry Department
Children’s Bureau
LA Office of Public Health
Region I Office of Mental Health
Institute for Mental Hygiene
New Orleans Health Department
Collaborator Roles
Tulane Child Psychiatry:
– provides:
two part-time supervising psychologists
psychiatry fellow
senior psychiatry faculty supervision
one full-time clinic psychologist
(program director)
– administers the HB grant from IMH
Collaborator Roles
Children’s Bureau: provides two social workers
and one case manager
LA Office of Public Health: funds Children’s
Bureau social workers and NOHD MCH nurse
coordinator
Region I Office of Mental Health: provides half
time social worker
Collaborator Roles
Institute for Mental Hygiene: provides funding
through $125,000 grant to Tulane
New Orleans Health Department:
– provides:
primary care (EPSDT) and WIC services
referrals to Healthy Beginnings Program
nursing and clerical support
physical space in Mary Buck Clinic (paid by grant)
Governance
MOA written with help of facilitator and signed in
fall of 2001
Operations Committee: senior representation
for each organization; meets quarterly
Evaluation Committee: oversees research,
data management, and program outcomes
Clinic Coordinating Committee: oversees
clinic policies, forms, referrals, and feedback to
providers
Clinic Operations
Children with risks identified are invited to
schedule an appointment with a HB social
worker
An assessment is conducted over several visits
and immediate and long-term treatment goals
are formulated with the caretaker
A home visit is conducted as part of the
assessment
Family is given choice of clinic or home for future
sessions
Clinic Operations
All assessment data is entered into the
database
A caseworker links family with needed
community social services
Interdisciplinary case conferences are held
weekly with clinic and HB staff
Families are followed until goals are met
or family is lost to follow-up
Achievements in First Two Years
A 30 hour training was held for 3 clinic
physicians and 33 nurses in identifying
infant mental health problems
Facility was renovated to accommodate
HB staff using grant funds
Achievements in First Two Years
Undoing Racism workshop held
Over 143 children were served; 33 are still
active
Assessment process was shortened
Collaborator relationships continue to
develop
Demographics of Population
Served
66% males; 34% females
Average age 24 months
Average income below $10,000
93% African American, 4.8% Caucasian,
1.6% Hispanic, .8% Pakistani Indian
Referral Concerns
Physical aggression
Temper tantrums
Hyperactivity
Inattention
Developmental
Delays
Anxiety disorders
Feeding disorders
Adjustment problems
Withdrawn behaviors
Childhood depression
Maternal depression
(approximately 50%)
Domestic violence
Physical abuse
Parenting concerns
Assessment Tools
Achenbach Child Behavior Checklist
(CBCL) Ages 1 1/2 - 5
Infant Toddler Social Emotional
Assessment (ITSEA) Competence Scale
Disturbances of Attachment Interview
(DAI)
Parent-Child Interaction
Assessment Tools
Beck Depression Inventory (BDI-II)
Parent Perception Interview
Partner Violence Inventory (PVI)
Omitted:
HOME inventory
Vineland
Maternal Self-Efficacy Scale
Lessons Learned
Early mental health intervention is possible
in a public health clinic with limited funding
Collaborative efforts can bring costeffective, state of the art interventions
Communication between collaborators is
key; cultural, professional, and institutional
barriers need to be expected and
addressed
Key Players
• Tulane: Paula Zeanah, PhD, MSN
Julie Larrieu,PhD
Shana Bellow, PhD
• NOHD: Susan Berry, MD, MPH
Donna Malus, RN, BSN
Pat Delaune, RN
Mary Burns, RN
Key Players
OMH: Guilda Butler, LCSW
• Children’s Bureau: Ron McClain,
LCSW, Letia Bailey, LCSW
• OPH: Stacia Loveall, MSW, MPH
•