Early Childhood Mental Health Consultation as Part of a Continuum of Early Childhood Mental Health S

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Early Childhood Mental Health Consultation as
Part of a Continuum of Early Childhood Mental
Health Services

• Mary Beth Jackson
• Beth Jordan Armstrong

Childrens Health Innovation Project Annual
Conference November 15, 2007 Syracuse, NY
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Early Childhood Mental Health

• The social, emotional and behavioral well-being
  of young children and their families
• The developing capacity to experience, regulate,
  express emotion
• Form close, secure relationships
• Explore the environment and learn
• Adapted from ZERO TO THREE

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Why is ECMH important The view from policy

• Fits with school readiness goals
• Children who lack social and emotional skills may
  not succeed in school
• It is not cognitive or social and emotional, it
  is both
• Research suggests three pathways
• Promoting family economic security
• Ensuring quality early care and learning
  experience
• Delivering intentional social /emotional
  strategies

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The Context

• Child care providers and early childhood
  educators can foster social and emotional
  development in early childhood settings.
  (Capizzano Adams, 2003).
• However, many young children have been exhibiting
  either challenging or troubling behavior in early
  care to the point of being expelled (Gilliam
  Shahar, 2005).
• Children are
• Being kicked out of child care settings
• Struggling with the effects of violence (HS 17)
• Showing the impacts of maternal depression
• Dealing with multiple family risks (parental
  substance abuse, domestic violence and mental
  illness)

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Estimated Prevalence

• No national epidemiological data
• Early Childhood Longitudinal Study 10 of all
  kindergarten children show problematic behavior
• Rates are two to three times as high in
  low-income samples
• Clinical level problems are lower (4-10)

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Benefits of Intervening Early

• Early identification intervention for children
  with emotional disturbances should be promoted by
  system of care to enhance the likelihood of
  positive outcomes
• Preventive measures often reduce the impact of
  risk factors for mental health disorders and
  improve the chance for children's positive social
  and emotional development
• Early experiences can function as either risk
  factors or protective factors for a childs
  future health and development

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Benefits of Intervening Early contd

• (Zeanah, Nagle, Stafford, Rice, Farrer, 2005)
• Surgeon Generals Report, 1999
• Presidents New Freedom Commission on Mental
  Health, 2003

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Public Health Prevention Model
Intensive 1-5
Targeted 5-15
Universal 80-90
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Universal Interventions and Supports

• Training
• Typical Child development
• Attachment
• Classroom management
• Family engagement
• Community opportunities and supports

• Interventions
• Classroom observation
• Classroom-wide Devereux Early Childhood
  Assessment (DECA)
• Consultation

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Targeted Interventions and Supports

• Training
• Functional behavior assessment
• Problem solving
• Anger management
• Disorders usually seen in childhood
• Parent education
• Atypical child development

• Interventions
• Family therapy
• Parent Child Interaction Therapy
• Play Therapy
• Collateral consultation
• Parent education
• Parent-infant dyadic therapy

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Intensive Interventions and Supports

• Interventions
• Family therapy
• Parent Child Interaction Therapy
• Parent-infant dyadic therapy
• Play therapy
• Referral for medication evaluation
• Referral to service coordination
• Collateral consultation
• Parent education support
• referral to other services

• Training
• Parent Child Interaction Therapy
• Play therapy
• Abuse indicators
• Working with children who have been abused
• Training on specific diagnoses

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ECMH Consultation

• Early childhood mental health consultation
  includes
• services offered by providers with formal
  preparation and experience in childrens mental
  health and experience working with young children
  and their families
• who collaborate with administrators, staff, and
  family members of children from birth through six
  years of age participating in group care and
  early education settings
• in order to promote childrens social and
  emotional development and to address challenging
  behaviors. (Allen, Brennan, Perry, Kaufmann,
  Hepburn, 2006).

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Types of Mental Health Consultation

• Early childhood mental health consultation
  practices consist of up to four levels of
  consultation
• child-level consultation,
• parent-level consultation,
• staff-level consultation, and
• program-level consultation

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Child- or Family-Centered Consultation
The most traditional form of mental health
consultation whose primary goal is to address the
factors that contribute to a childs (and/or
familys) difficulties in functioning well in the
early childhood setting
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Programmatic Consultation
This form of mental health consultation focuses
on improving the overall quality of the program
or agency and/or assisting the program to solve a
specific issue that affects more than one child,
staff member, and/or family.
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Attributes of a Mental Health Consultant

• Knowledge

• Normal growth and development
• Atypical behavior
• Concepts of social-emotional development
• Medical and genetics
• Child development milestones

• Alternatives in treatment
• Family systems
• Early childhood, child care, family support, and
  early intervention systems
• Adult learning principles

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Skills and Experience
Attributes of a MentalHealth Consultant

• Integrate mental health activities and
  philosophies in group settings
• Observation, listening, interviewing, assessment
• Work with adults

• Sensitive to community
• Cultural competence
• Diverse perspectives
• Communication, facilitation
• Interventions

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Early Childhood Consultation Study

• Research Team
• Eileen M. Brennan
• Mary Dallas Allen
• Deborah F. Perry
• Jennifer R. Bradley

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The Need for a Systematic Review of the Research

• Policymakers and practitioners have emphasized
  the importance of using evidence-based strategies
  with young children.
• Effectiveness of mental health consultation had
  not been established by syntheses of existing
  research and evaluative studies.
• Intent was to examine the design elements and
  findings of studies of consultation in early
  childhood settings and determine level of
  evidence for effectiveness in terms of child and
  family outcomes.

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Research Review Questions

• How effective is mental health consultation in
  promoting social and emotional development of
  young children and in reducing difficult or
  troubling child behavior?
• What are the effects of mental health
  consultation on families receiving services?

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Search Methodology

• Electronic databases
• Online early childhood databases
• National organization, government, and
  university-based websites
• Contact with experts in mental health
  consultation regarding unpublished literature.

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Inclusion Criteria

• Empirical researcheither quantitative or mixed
  methods.
• Focused on MH consultation, not health
  consultation, or early intervention.
• Research on consultation for programs serving
  children birth to 8 years.
• Investigations conducted between 1985 and 2007.
• Included child or family outcomes.

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Key Findings Child Outcomes

• Greater gains on socialization, emotional
  competence, and communication
• Improved social skills and peer relationships
• Improved social skills particularly found in
  children with internalizing behaviors
• Improvement in classroom climates
• Decreased problem behaviors
• Decreased numbers of children expelled for
  behavior

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Key Findings Family Outcomes

• Family access to mental health services
• Improved communication with staff
• Parenting skills improved
• Parenting stress unaffected by consultation

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EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF
CARE Fosters the social and emotional well-being
of infants toddlers, preschool-age children and
their families
VALUES Child and Family Centered Relationship
Based Culturally Competent Infused into natural
settings/services Grounded in developmental
knowledge
Roxane Kaufmann, Georgetown University Child
Development Center
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Collaborative Planning for Kentuckys ECMH Program

• Started as interagency ECMH workgroup
• Developed training plan in collaboration with
  Public Health, Healthy Start
• KDE, DPH, DMHRMS, CMHCs planned developed
  logic model for statewide program
• Incorporated into KIDS NOW in fiscal year 2004

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Kentucky ECMH Program Overview

• Initiated in 2003
• Among last of program components to be added to
  KIDS Now
• Built upon existing ECMH Healthy Start in
  Childcare efforts (Healthy Childcare America
  initiative)
• Co-administered by KY DPH DMHMRS
• Contracted to 14 Regional MHMR Boards

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Funding

• Tobacco Settlement funds housed at DPH
• Majority of dollars contracted with DMHMRS
• DMHMRS subcontracts with 14 Regional MHMR Boards
  to hire ECMH Specialists
• DPH has university contracts
• EKU for evaluation and resource
• UK for training consultation
• ECCS funds used to support training and
  evaluation
• HRSA maternal depression grant will support
  training in assessment and treatment EBP through
  UL contract

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Program Implementation

• Overarching goal to build capacity across state
  to work effectively with children 0-5, and their
  families. This is done through
• Program child-level consultation to child care
  programs regarding social, emotional,
  behavioral issues,
• Training on working with young children with
  social, emotional, behavioral needs their
  families to child-serving agencies individuals,
  and
• Evaluation, assessment, therapeutic services
  for children age 0-5 their families.

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Program Implementation contd

• 1.0 FTE ECMH Specialists in regions provide
• consultation education
• assessments treatment
• community resource identification access
• training
• community planning
• supervision / case review
• Time divided between direct services, outreach,
  training, education

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ECMH Specialist Duties

• Provide
• Consultation education for child care staff
• Information resources to agencies,
  pediatricians, child-serving programs
• Training on ECMH to other MH professionals
• Assessment of children 0-5 in child care
• Referral to other services as needed
• Treatment of children 0-5 who have mental health
  needs

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ECMH Specialist Duties contd

• Collaborate with other agencies/programs serving
  children age 0-5 their families
• Assist families in accessing resources
• Foster community planning in ECMH
• Attend training on ECMH / further professional
  development
• Collect submit client and program data
• Attend quarterly meetings of all ECMH Specialists

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ECMH Clinical Program Structure

• DMHMRS funds distributed evenly across 14 CMHCs
• Each CMHC employs 1 full-time ECMH Specialist
  (see handout for job qualifications)
• Some CMHCs have divided the duties across 2 staff
• Specialist serves as regional point person on
  ECMH issues

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Questions
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For more information, contact

• Mary Beth Jackson
• 502-564-3756 ext. 3765
• Marybeth.Jackson_at_ky.gov

• Beth Armstrong
• 502-564-4456 ext. 4513
• Beth.Armstrong_at_ky.gov