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

Infusing Mental Health
Services and Supports in Early
Childhood Settings
Deborah Perry, PhD
Georgetown University
Center for Child and Human Development
May 11, 2006
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
EARLY CHILDHOOD
MENTAL HEALTH
For young children, mental health is:
The social, emotional, and behavioral wellbeing 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)
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
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
EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF CARE
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
Supports for
Parents and
Families
Culturally Competent
Infused into Natural
Settings and Services
Grounded in
Developmental Knowledge
Strategic
Planning,
Policies, and
Procedures
Promotion
Supports for
Other
Caregivers
Services for Children
and Families
Building Blocks
Maximized and
Flexible
Funding
Interagency
Partnerships
Prevention
Developed by Roxane Kaufmann, GUCCHD
Prepared
Workforce
Outcome
Evaluation
Intervention
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
The Pyramid
Levels and Types of Intervention
Intervention/Targeted
Prevention/Indicated
Promotion/Universal
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 socialemotional development
Prevention
Home visitation programs
Mental health consultation
Family mentors
Social skills curricula
Family supports
Caregiver supports
Intervention
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
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
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
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
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
Core Competencies
Values/Beliefs
Knowledge of ECMH
Early childhood development
Importance of relationships
Risk/protective factors
Skills
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
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
Merrill-Palmer Institute
Wayne State University in Detroit, MI
Graduate Certificate Program in Infant
Mental Health
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
Connecticut
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 childserving agencies
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.
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.
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
How does CCAC support the early
care & education provider?
Scholarships
Access to training
Career counseling
Certificate of recognition
Career ladder
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
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
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
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
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)
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
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
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
VERMONT--System of Care
CMHS grant to integrate mental health into
child health, early care and education
Multi-faceted intervention: Preventiontreatment
ECMH competencies for providers, and
training
4 DOMAINS: child, family, community and
teamwork
Vermont Competencies
Articulation of
“Vermont Culture”
10 Guiding Principles
4 domains
Knowledge
Practices
Action/Learning Plan
Specific goals
Strategies
Resources
Timelines
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
State and Local Responsibilities
STATE:
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
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
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
10 Action Steps
1. Raise awareness
6. Develop common service definitions
2. Test new approaches
7. Involve families and child care
community
3. Develop cross training
initiatives
4. Build collaborative
approaches
5. Identify existing
services/programs
8. Utilize existing data
9. Gather outcome data
10. Start Somewhere and Just do it