Integrating Early Childhood Social Emotional Development into Early Childhood Systems

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Integrating Early Childhood Social Emotional
Development into Early Childhood Systems

• Deborah F. Perry, PhD
• Georgetown University
• Center for Child Human Development
• August 2010

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Overview

• Define early childhood social emotional
  development
• Explore the role of early brain development on
  trajectories of development
• Describe policy implications for Part C systems

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The Context

• Young children are
• Being kicked out of child care settings
• Showing the impacts of maternal depression
• Dealing with multiple family risks (parental
  substance abuse, domestic violence and mental
  illness)

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School Readiness Skills
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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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Social Emotional Development

• Inter-relatedness of domains
• Intimately tied to caregivers mental health
• Core tasks
• Attachment
• Behavior
• Competence

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Neurons to Neighborhoods
virtually every aspect of early human
development, from the brains evolving circuitry
to the childs capacity for empathy is affected
by the environments and experiences that are
encountered in a cumulative fashion, beginning in
the prenatal period and extending throughout the
early childhood years.
Shonkoff and Phillips, 2000
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Role of Early Experience

• Connections between neurons are strengthened
  through repeated exposure/use
• Connections that are not used often are pruned
  away
• Environmental influences shape the architecture
  of the brain

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Quality and Quantity of Experiences

• Frequent, regular, predictable
• Occur in the context of warm, supportive
  relationships
• Are associated with positive emotions
• Involve several senses
• Are responsive to the childs interests or
  initiative
• Early Childhood Resource Center, RTI

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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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Experience and Regulate Emotions

• INFANT Behaviors
• Smiling
• Cooing and Babbling
• Fussing when hungry or tired
• Kicking legs when excited
• Quieting when held by a familiar adult

• TODDLER Behaviors
• Laughing
• Goes to familiar adult for comforting
• Able to move from one activity to the next
• Growing ability to focus
• Calms with help from a familiar caregiver

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Form Secure Relationships

• INFANT Behaviors
• Smile at and back to a familiar caregiver
• Anticipates being held
• Likes to look at and be near familiar caregiver
• Shows preference for parent or caregivers face
  and voice
• Stretches arms up to be held

• TODDLER Behaviors
• Explores but checks in with familiar caregiver
• Shows affection for familiar caregivers
• Responds to his/her name
• Makes needs known to a familiar caregiver

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Explore and Learn

• INFANT Behaviors
• Reaches for and grasps things
• Enjoys simple games like peek-a-boo
• Imitates others actions
• Smiles or plays with self in the mirror

• TODDLER Behaviors
• Keeps looking for a toy
• Tries new things
• Shows interest in other people
• Imitates others actions

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Goodness of Fit

• Extent to which the temperament of the child is
  compatible with the environment, expectations and
  demands

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Adversity in Early Childhood Can Have
Long-Lasting Consequences
Adverse Childhood Experiences Study (ACES) has
documented the long term effects of earlier
exposure to significant stressors Explains the
link between early childhood brain development
and long term health and mental health outcomes
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Adverse Childhood Experiences Are Common

Household dysfunction
Substance abuse 27 Parental sep/divorce
23 Mental illness 17 Battered
mother 13 Criminal behavior
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Abuse Psychological
11 Physical 28 Sexual 21
Neglect Emotional
15 Physical
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Adverse Childhood Events and Adult Depression
Odds Ratio
Adverse Events
Chapman et al, 2004
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Adverse Childhood Events and Adult Substance Abuse


Self-Report Alcoholism
Self-Report Illicit Drug Use
Dube et al, 2002
Dube et al, 2005
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Adverse Childhood Events and Adult Ischemic Heart
Disease
Odds Ratio
Adverse Events
Dong et al, 2004
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Levels of Stress

• Positive Stress normative, helps in development
• Tolerable Stress outside the normal range, one
  time events, buffered by caregivers
• Toxic Stress prolonged activation of the stress
  response system, in absence of buffering adult

Harvard Center for the Developing Child
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Emotional Stimulus
HPA Pathway Control
Amygdala
Hippocampus
Hypothalamus PVN
Cortisol
Cortisol
CRH
PIT
ACTH
Adrenal Cortex
Charles Zeanah PPT
LeDoux, Synaptic Self
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Interaction of the Brain and Immune System
CRF
Hypothalamus
Cortisol
Locus Ceruleus
CRH
Adrenal Gland
ACTH
Pituitary Gland
Vagus
Cortisol
Cytokines
Sympathetic Nervous system
Immune Cells
Nerve
Immune Organs
Charles Zeanah PPT
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Impact of Stress on
Development
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How depression affects development

• Specific aspects of parenting behavior
• Maternal responsivity
• Maternal sensitivity
• Emotional availability
• Negative mood (intrusive/hostile)
• Inconsistency in discipline
• Modeling negative affect
• Inability to assist with emotional regulation

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Consequences of Maternal Depression

• Mothers well-being
• Decreased Maternal Self-Efficacy
• Fathers well-being
• Increased depression marital stress
• Increased concern of infants
• Infant development
• Emotion dysregulation
• Cognitive and language delays
• Increased risk for psychopathology
• Mother-infant interaction
• Mothers understimulating or overstimulating
• Infants Less responsive, more gaze avoidant,
  more distress

Field, 1997 Milgrom McCloud, 1996 OHara, 1994
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Challenges Opportunities

• Address the mental health needs of young children
  and their caregivers in context of their network
  of services and supports

• Integrate the best available science on what
  works for preventing and treating mental health
  needs of young children and their families

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Challenges to Integration of ECMH into EC
Systems-Building

• Need to address complex, multi-factorial problems
  that evolve over time and across settings
• Focus on caregivers (parents and child care
  providers)
• Lack of fit between increasing specialization
  real needs of young children their caregivers
• Requires integration adaptation of
  evidence-based practices (EBP)

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An Early Childhood Systems Framework
Developed by Roxane Kaufmann, GUCCHD design by
Lucia Foley, Hampshire Educational Collaborative
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System of Care Values/Principles

• Infused Into Natural Settings and Services
• Stand-alone early childhood mental health systems
  wont work
• Grounded in Developmental Knowledge
• Lifespan approach, different approaches needed
  for infants, toddlers, preschoolers
• Risk Resilience
• Building family and community assets

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Need for Focus on Relationship-Based Strategies

• Dyadic interventions
• Two-generation models
• Family systems framework
• Relationships between MH and other service
  systems
• Relationships with stakeholders in systems
  building

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Best Scientific Evidence

• Growing number of evidence-based prevention and
  treatment models
• Developed through rigorous scientific experiments
• Need for adaptation for local context, but with
  eye to fidelity
• Difficulties in bringing these to scale
• How to value practice-based evidence and
  family wisdom

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Pyramid Model
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Promotion

• Developmental and social-emotional screening in
  primary care and early care and education
  programs
• High quality training on social-emotional
  development for Part C providers and child care
  community
• Dissemination of information promoting healthy
  social-emotional development

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Prevention

• Screening for caregiver depression
• Mental health consultation in child care and
  integration of MH into Part C systems
• Social skills curricula (i.e., Second Step)

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Intervention

• Positive Behavioral Support
• Intensive mental health consultation in homes and
  child care settings to support children with
  IFSPs
• Relationship-based therapy (e.g., PCIT)
• In-home treatment for children with mental health
  diagnoses and depressed caregivers

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Moving Forward

• Consider how current eligibility criteria and
  procedures for Part C reflect the fundamentals of
  early childhood social-emotional development
• Broaden networks of providers who are screening
  families (caregivers and children) for
  social-emotional risks
• Establish cross-sector competencies for all
  providers working with young children and
  families
• Support integration of mental health consultants
  in Part C systems