Intentional Policy-making to Support Young Children !

Establishing Conditions for Optimum Child Development in the Early Years

Janice L. Cooper, PhD

Interim Director, NCCP

Early Childhood Mental Health Blue Ribbon Policy Denver, CO | May 19, 2010

Who We Are  NCCP is the nation’s leading public policy center dedicated to the economic security, health, and well being of America’s low-income children and families.

 Part of Columbia University’s Mailman School of Public Health, NCCP promotes family-oriented solutions at the state and national levels.

 Our ultimate goal: Improved outcomes for the next generation.

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NCCP’s Early Childhood Team and FES Team that Contribute to Our ECMH Work        Sheila Smith, PhD, Director Yumiko Aratani, PhD, Assoc. Research Scientist Vanessa Wight, PhD, Demographer David Seith, Research Analyst Liz Isakson, MD Louisa Higgins, MA, Project Thrive Coordinator Will Schneider, Data Manager, ITO www.nccp.org

Outline  Setting the Context  Why Social-emotional Development Matters?

 What Do We Know about Systematic Efforts to Develop Policies that Facilitate S-E Development?

 Recommendations www.nccp.org

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Research Also Shows that Exposure to Multiple Risks Matter   The more risk factors, in general, the worse the outcomes, regardless of what they are  Infants, toddlers and parents who face 4+ demographic risk factors in EHS benefit less than other children (impacted about 26% of the sample).

Multiple risks increase the odds of poor outcomes exponentially  Child with 1 risk factor has nearly 2 times   Child with 2 risk factors has nearly 3.3 times, Child with 3 risk factors has over 4.5 times   Child with 4 risk factors has more than 15 times Higher odds of experiencing poor health or developmental delays than a child with no risk factors www.nccp.org

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Young child poverty by percent of young children with 3 or more risk factors, 2008 Low Less than 6% of young children have at least 3 risk factors Moderate 6-10% of young children have at least 3 risk factors High More than 10% of young children have at least 3 risk factors Low Less than 15% of young children live in families at or below the FPL AK, HI, MD, NH, UT, VT Young Child Poverty Moderate 15-19% of young children live in families at or below the FPL High 20% or more of young children live in families at or below the FPL IA, ID, WY ND CT, NJ, WA CO, DE, IL, MA, ME, MN, NE, OR, PA, VA, WI IN, KS, MI, MO, MT, OK, OH, SD NV AL, AR, AZ, CA, DC, FL, GA, KY, LA, MS, NC, NM, NY, RI, SC, TN, TX, WV www.nccp.org

Setting the Context

Poverty rate rising

 Overall poverty rate rose from 12.5% to 13.2%; the first statistically significant increase since 2004.

 Child poverty increased a full percentage point— rising from 18% to 19%.   Latest data show that 14.1 million children live in poverty.

Children of color living in poverty increased:    Asian-Pacific Islander (from 12.7% to 15.0%) Hispanic heritage Latino (28.7% to 30.5%) American-Indian children (25.7% to 31.3%) www.nccp.org

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KIDSCOUNT: Colorado’s Data Shows  Ranks in middle in child poverty   Experienced greatest 10 yr in US Child poverty rate 10% to 15% over 10 yrs  Growth # children of first gen Americans above US  230% growth vs 90% Sources: Kids Count 2010, Kaiser 2010 www.nccp.org

KIDSCOUNT: Your Own Data Shows  Too many uninsured children Poor Children <100% FPL  CO (30.6) vs. US (18.1)  Children as a percentage of the uninsured:  CO (21.2) vs. US (17) www.nccp.org

NCCP’s Early Child Profile Shows that Colorado  Made several important recent decisions to put children first, even in these difficult times. A few examples:  Provides relative generous eligibility levels for public health insurance Medicaid, CHIP- 250% FPL (children 0-5 yrs.); temp. coverage for pregnant women up to 200% FPL  CO is one of the states that funds a pre-K/Head Start ($28.4 m in 2008), but from prior year  CO has implemented a statewide childcare Quality Rating Improvement System (QRIS) and a statewide home visiting program (NCCP new study stresses “I” in QRIS) www.nccp.org

WHY SOCIAL-EMOTIONAL DEVELOPMENT MATTERS?

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Poor Mental Health Outcomes Start Early Young Children with “challenging behaviors” and social- emotional problems:  Often fare poorly in achieving benchmarks for early school success   Are 3X more likely to be expelled from pre-school than children/youth K-12 More likely to experience problems later such as conduct disorder, anti-social behaviors and serious mental health conditions www.nccp.org

Colorado Simulator

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Basic Budget Needs: Selected Localities www.nccp.org

What does it take to make ends meet?

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Social emotional development for young children  Far-reaching consequences and implications for the life span of an individual and ultimately of a nation  Indicators of good social emotional development include:    positive peer relationships positive child adult relationships language development—expanding ability to use vocabulary including emotional vocabulary, and expanding ability to express needs and relationship with world and manage emotion . www.nccp.org

Social emotional development for young children  Prenatally we can prepare for a child’s social emotional development:   good spacing between children health before, during and after pregnancy can reduce the risks for conditions (including depression)  From birth we can provide parents with supports that:     they need to help children to develop relationships that are healthy support their individual ways of learning, their efforts to learn new things and their ability to get along with their peers prevents and treats maternal depression support parents through effective parenting education, provide supports for positive alternatives to help parents parent! www.nccp.org

Why NCCP interested in Social-Emotional Development in Early Childhood

Key Take Home Messages from Child Development Research

1.

Income matters 2.

Early experiences and relationships have lasting consequences 3.

Multiple risk factors increase the chances of harmful effects www.nccp.org

Income Matters  Net of any other changes, increased income improves school readiness  Financial hardship reduces parents ability to invest in time and resources to promote positive outcomes  Financial stress has been linked to parenting, relationship challenges and poor mental health outcomes  Recent synthesis of literature on the impact of homelessness on child functioning found across studies poverty matters [1/2 homeless children 0-5] www.nccp.org

CHILD MENTAL HEALTH

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Children’s Mental Health Today Courtesy Bruner

Research Shows Vast Needs that Go Unmet  Social-emotional/behavioral problems common among young children  9.5-14% problems impact learning, functioning, achievement  Family, Environmental and Neighborhood Risk Factors may Compound Vulnerability:  Family risks factors (eg poverty) increase odds of behavioral problems that impact development  40% of 2 yos in ec settings experience poor/insecure attachments  Yet research shows that 50% of the impact of income could be mediated by strategies that focused on parenting www.nccp.org

Research Suggests Disparities in Access for Young Children  Differences in access by race/ethnicity, age  Between 80-97% very young children do not get access to early childhood mental health services  Disproportional pre-school expulsions based on race/ethnicity  African-American preschoolers 3X White, 5X API www.nccp.org

In Colorado, Office of Health Disparities’ 2009 Report on Racial & Ethnic Disparities showed

American Indian/Alaska Native

Unemployment 11%

Rest of State

6% Smoking Obesity 30% 27% 19% 18% www.nccp.org

In Colorado, Office of Health Disparities’ 2009 Report on Racial & Ethnic Disparities showed

African American Rest of State

Unemployment Child Poverty 10% 33% 6% 15% Prenatal Stressors (3+) 44% 27% Infant Mortality (per 1K live births) Perinatal Mortality (per 100K fetuses) 17% 12% 6% 4% www.nccp.org

In Colorado, Office of Health Disparities’ 2009 Report on Racial & Ethnic Disparities showed

Hispanic/Latino Rest of State

Not graduate HS Child Poverty Unmet child dental health needs Lack of Adult Health Insurance Obesity 43% 30% 15% 40% 24% 25% 15% 8% 17% 14% www.nccp.org

State of Services and Supports for Young Children  Difficult to Fund and Sustain in Many States:  Effective two generation strategies and those that build and support parent-child relationships  Strategies such as mental health consultation, social emotional learning  Standardized screening tools to ensure accurate identification  Social emotional learning in schools and child care settings www.nccp.org

State of Services and Supports for Young Children  Inadequate Infrastructure Supports Hamper Progress:  Poor provider capacity  Shortage and competencies in early childhood development  Mental well-being of non-relative care givers  Inadequate appropriate developmental fit for some diagnostic procedures and failure to either fund based on risk or systematic adopt a cross-walk like DC 0-3R to maximize reimbursement for needed services  Few statewide training institutes to improve the quality of interventions across domains  Insufficient focus on outcomes for young children www.nccp.org

The Core Findings Unclaimed Children: Early Childhood   44 states reported one or more early childhood initiatives; 37 states CMHA funded early childhood mental health services directly. In only half of these states is at least one initiative statewide.

 Initiatives encompass early childhood specialists in CMHC’s (N=21); ECE mental health consultation programs (N=26); reimbursement for social & emotional screening tools; working with adult mental health (N=15). www.nccp.org

Type of ECMH Initiatives* CMHA funds (N=51) *Includes infrastructure building related initiatives www.nccp.org

Examples of Systematic Efforts to Develop Policies that Facilitate S-E Development in Early Intervention  Strengthening ECMH training for Part C providers.

Eg: New Mexico and Kansas adopted the MI Association for Infant Mental Health Endorsement System.

 Using a risk-assessment tool to determine eligibility for early intervention services.

Eg: MA and KS include child and parental factors such as: parental behavioral health conditions, and lack of social supports  Requiring core competencies for EI specialists. Eg: In MA, knowledge of "how children learn through relationships" and skills in using strategies to "engage and support caregivers in positive interactions with their infants and toddlers that promote healthy social-emotional development.

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Examples of Systematic Efforts to Develop Policies that Facilitate S-E Development  Strengthening early identification and treatment of maternal depression –  WIC screening in MD  IL leveraging funding incentives, validated tools  ECMH consultation statewide  IL – all child care programs reflective supervision Erikson Inst.

   MD using Georgetown model CT - all child care programs reflective supervision, Yale AZ including home visiting, reflective supervision, training attachment, trauma – quality monitoring www.nccp.org

Examples of Systematic Efforts to Develop Policies that Facilitate S-E Development  

Child screening validated tools and enhance rates use in PC settings

 MN DOH instruments SE   MI NC

Provider training and support PITC (Pgm Infant/Toddler Caregiver)

 FL, IL, IN, IA, KS, MN, MS  ND, NM, TX, OH, OK,  SC, SD, WY www.nccp.org

Recommendations for Policy Action 

Fund effective two generation strategies and those that build and support parent-child relationships



Reimburse strategies such as validated assessments, mental health consultation, and social emotional learning

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Infuse funding and support for young children in both education and human services’ strategic agenda

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Address the pervasive shortage among mental health providers including those with expertise in early childhood

 Require a focus to reduce based on age, race/enthicity and

language related disparities including public reporting on outcomes

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Recommendations for Policy Action 

Address the need for effective parenting programs

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Take to scale effective strategies to all young children and their parents

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Require that agencies that touch children and families have a shared goal for social-emotional healthy children and are held accountable for meeting this goal. That means matching financing to support this goal.



Support efforts to reduce the impact of income on

poor young child outcomes.

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For More Information, Contact Janice Cooper [email protected]

Or Visit NCCP web site www.nccp.org

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