gratefully acknowledges support for this educational activity from

1
gratefully acknowledges support for this
educational activity from

• Improving Mental Health in Primary Care Through
  Access, Collaboration, and Training grant
  provided to the AAP through the Maternal and
  Child Health Bureau
• Child Care and Healthy Partnership grant provided
  to the AAP through the Child Care Bureau and the
  Maternal and Child Health Bureau
• Many colleagues

2
Partnering to Address Mental Health Concerns in
Early Education and Child Care

• Webinar brought to you by
• American Academy of Pediatrics
• March 23, 2009

3
Disclosures

• We have no relevant financial relationships with
  the manufacturer(s) of commercial product(s)
  and/or provider of commercial services discussed
  in this CME activity.
• We do not intend to discuss any unapproved/
  investigative use of a commercial product/device
  in our presentation.

4
Welcome!

• Marian Earls, MD, FAAP
• Guilford Child Health Inc
• Task Force on Mental Health Early Childhood
  Algorithm Team
• Section on Early Education Child Care
• Section on Developmental Behavioral Pediatrics

5
General Housekeeping Tips

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6
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7
Outline of Webinar

• Overview Health Professionals Involved in Early
  Education and Child Care Regarding Mental Health
  Concerns
• Bringing it All Together The Importance of the
  Medical Home
• Successful Start Rhode Islands Early Childhood
  Systems Plan
• Office of Head Start Early Childhood Development
  and Mental Health Concerns and the Role of
  Community Pediatric Clinicians
• Wrapping it Up How to Find and Connect with
  Local Health Consultants
• Question Answer Session

8
Overview Health Professionals Involved in Early
Education and Child Care Regarding Mental Health
Concerns

• Abbey Alkon, RN, PNP, PhD
• UCSF School of Nursing
• California Childcare Health Program
• www.ucsfchildcarehealth.org
• Section on Early Education Child Care

9
US Children in Child Care

• A majority of children less than 6 years old
  (60-70) spend time in out-of-home child care.
• Young childrens socio-emotional development is
  based on relationships.
• Early identification of mental/behavioral and
  physical health problems can help children get
  needed services and be ready for kindergarten

Center on the Developing Children Mental health
problems in early childhood can impair learning
and behavior for life. Working paper 6 2008
9
10
US Children in Child Care

• 12 million children more than 9 million
• are in licensed child care facilities.
• 105,444 child care centers.
• 213,966 family child care homes.
• 16,110 other licensed facilities.
• About 3 million children are cared for in
  unlicensed and unregulated care.

10
11
Background

• The most common health concerns for child care
  providers are
• Infectious diseases (for children lt 2 years of
  age)
• Challenging behaviors
• Expulsion rates in child care are higher than
  elementary school
• High child care staff turnover
• Children need to be physically and mentally
  healthy to be ready to enter kindergarten

11
12
Prevalence and Risk

• 13-23 of preschool children have mental health
  problems.
• Higher rate with the co-occurrence of other risk
  factors
• Less than 1 of preschool children receive mental
  health services.

12
Raver, etal. 2008. ECRQ. Per Yoshikawa and
Knitzer, 1977 Pottick Warner, 2002.
13
Social and Emotional Development in Young Children

• How they feel about themselves
• Confident, secure, eager to learn, proud of their
  culture versus always scared, afraid of being
  wrong
• How they behave
• Constantly fighting, easily upset, temper
  tantrums versus able to deal with conflict
• Withdrawn, shy
• Eating problems
• How they relate to others
• Especially people who matter to them (eg,
  parents, teachers, and friends)

13
National Center for Children in Poverty.
www.nccp.org/pub_rps05.html
14
Goals

• Promote healthy physical and emotional
  development.
• Identify early signs of emotional and/or
  behavioral difficulties.

14
15
Health ProfessionalsInvolved in Child Care

• Child Care Health Consultants (CCHC)
• Early Childhood Mental Health Consultants (ECMHC)
• Primary Care Clinician (PCC)

15
16
Communication and the Medical Home
Primary CareClinician
Child and Family
Early Childhood Mental Health Consultant
Child Care Health Consultant
17
Child Care Health Consultants

• A health professional who has interest in and
  experience with children, has knowledge of
  resources and regulations and is comfortable
  linking health resources with facilities that
  provide primarily education and social services
  
• Health Professionals nurses, physicians, health
  educators, social workers, etc
• Training National Training Institute
  (train-the-trainer program)
• Gold Standard National Health and Safety
  Performance Standards (Caring for Our Children)

Caring for Our Children National Health and
Safety Performance Standards Guidelines for
Out-of-Home Child Care, 2nd Edition, 2002.
17
18
Child Care Health Consultants Job Responsibilities

• Establish a trusting relationship
• Conduct baseline needs assessment
• Identify health problems to target for
  intervention
• Develop or update written health policies
• Provide workshops for child care providers and
  families
• Provide regular telephone or email advice
• Provide referrals to community services
• Review health records
• Develop care plans for children with special
  health care needs

18
19
Impact of Child Care Health Consultation

• National health and safety standards (CFOC)
• Increased and quality of written health and
  safety policies
• Medication administration, exclusion of ill
  children, care of mildly ill children, daily
  health check, emergency preparedness, and
  inclusion of children with special needs
• Improved health and safety practices
• consistent with CFOC
• Emergency preparedness
• Reduction in risk of SIDS

19
20
Impact of Child Care Health Consultation,
Continued

• Child Health Status
• Immunizations up-to-date
• Medical home
• Health care plan for children with special health
  care needs
• Health Insurance

The influence of child care health consultants in
promoting childrens health and Well-being A
report on selected resources. 2006.
http//hcccnsc.edc.org/resources/data/CC_lit_revi
ew_Screen_All.pdf
20
21
Early Childhood Mental Health Consultants

• Providers with mental health expertise and
  training on early care and education
• collaborate with administrators, staff and
  family members of children from birth through 6
  years of age participating in group care and
  early education settings
• Builds staff capacity
• To promote childrens social and emotional
  development
• To address challenging behaviors

Brennan, EM, Bradley JR, Allen MD, Perry DF.
(2008). The evidence base for mental health
consultation in early childhood settings
Research synthesis addressing staff and program
outcomes. Early Education and Development, 19(6)
982-1022.
21
22
Early Childhood Mental Health Consultants

• Types of Consultation
• Child- or Family-Centered Consultation
• Programmatic Consultation
• Focus on relationships
• Staff and consultant, child, parent

Cohen, E., and Kaufmann, R. Early Childhood
Mental Health Consultation. DHHS Pub. No.
CMHS-SVP0151. Rockville, MD Center for Mental
Health Services, Substance Abuse and Mental
Health Services Administration, 2005.
22
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Early Childhood Mental Health Consultants

• Knowledge of child development, normal growth and
  development, and ability to identify atypical
  behavior
• Understand concepts underlying young childrens
  socio-emotional development
• Observation, listening, interviewing, and
  assessment skills
• Understanding of cultural differences
• Ability to work with adults and knowledge of
  adult learning principles
• Ability to recognize the diverse perspectives of
  staff and to facilitate communication of these
  perspectives
• Knowledge of early childhood, child care, family
  support and early intervention systems, both
  public and private

Cohen, E., and Kaufmann, R. (2005).
23
24
Consult with Staff for Children Who May Not
Succeed in School Transition

• Engage in frequent fighting, shouting, or other
  aggressive behaviors
• Are unable to control impulsive behavior
• Are unable to pay attention to tasks or follow
  directions
• Engage in oppositional, noncompliant, even
  defiant behavior
• Are unable to cooperate with others
• Constantly seek attention from peers or teachers
• Ignore peers or teachers

Raver and Knitzer (2002) Ready to Enter What
research tells policymakers about strategies to
promote social and emotional school readiness
among three- and four-year-old children. National
Center for Children in Poverty.
24
25
Impact of Early Childhood Mental Health
Consultation

• Review of 26 studies from 1985-2008 of staff and
  program outcomes (not child level)
• Programs generally served urban, ethnically
  diverse children 2 to 5 years old
• Results
• Staff increased self-efficacy/confidence and
  competence in dealing with troubling or difficult
  behaviors
• Staff improved sensitivity and had lower
  job-stress
• Improved overall quality of child care program
• Reduced staff turnover

Brennan, EM, Bradley JR, Allen MD, Perry DF.
(2008).
25
26
Developmental Screening of Young Children

• Where?
• Primary care office
• Child care
• What screening instrument?
• PEDS www.pedstest.com
• ASQ, ASQ- SE www.pbrookes.com
• ABLE http//abletest.com
• Others
• How are results shared between PCC, child care
  provider, and child care consultants (CCHC,
  ECMHC)?

26
27
Primary Care Clinicians

• Primary care clinicians have a critical role to
  play in meeting childrens mental health needs.
  In fact, Massachusetts is now requiring, by court
  order, universal mental health screening by
  primary care clinicians for all children on
  Medicaid in that state.
• Provide guidance to families
• Help parents find high quality early care and
  education experiences for their children
• Complete health forms and care
• plans for children with special
• health care needs
• Communicate health issues and/or
• treatment raised in PCC office or
• child care program

Rosie D. Reforming the Mental Health System in
Massachusetts. Center for Public Representation
Web site. Available at http//www.rosied.org/Defa
ult.aspx?pageId67061. Accessed March 9, 2009
27
28
Primary Care Clinicians

• Provide health consultation services to child
  care programs
• Support child care in your local community to
  meet national standards for health and safety of
  child care for all young children.
• Advocate for quality child care
• State regulations to support health consultation

American Academy of Pediatrics. The
Pediatrician's Role in Promoting Health and
Safety in Child Care. Elk Grove Village, IL
American Academy of Pediatrics 200125-27
28
29
Bringing it All Together The Importance of the
Medical Home

• Jack Levine, MD, FAAP
• Section on Early Education Child Care
• Section on Developmental Behavioral Pediatrics

30
The Medical Home A Concept rather than a
Building

• Accessible
• Family-centered
• Continuous
• Comprehensive
• Coordinated
• Compassionate
• Culturally Effective

31
Successful Early Child Care
Informed, activated family
Integrated, supportive community
Community resources and agencies
Medical Home
Based on Wagner et al.
32
Integral Part of Community-based System

• Coordinates with community-based services
  designed to promote the healthy development and
  well being of children and their families
• Facilitates access to and collaborates with a
  broad range of specialty, ancillary and related
  community services

33
Communication and the Medical Home
Primary CareClinician
Child and Family
Early Childhood Mental Health Consultant
Child Care Health Consultant
34
Effective Communication Among Health
Professionals

• Primary Care Clinician Family Consultant
• Results of screening or initial evaluations
• Reason for referral to mental health consultant
• Share important medical information
• Collaborate and cooperate on care plan for
  children
• Medications
• Emergencies
• STAY INVOLVED!

35
Communication With Child Care Providers

• Written communication
• Clear language with no jargon
• Write-out care plan and instructions
• Appreciation for child care provider
• Know childrens behavior in group situations
• Experience with range of childrens behaviors

36
Successful Start Rhode Islands Early Childhood
Systems Plan

• Susan Dickstein, PhD
• Bradley/Hasbro Childrens Research Center
• Brown Medical School
• Director, Bradley Early Childhood Clinical
  Research Center

37
Successful StartRhode Islands Early Childhood
Systems Plan
Improved Outcomes for Children Families
through A More Effective Early Childhood System
38
Successful Start VISION To create a
comprehensive and coordinated early childhood
system that supports families and communities in
promoting positive early childhood development so
that all children enter school healthy and
ready to learn.
Successful Start MISSION To ensure that all young
children reach their full potential through a
system of services that promotes healthy
social-emotional development, quality early care
and education, coordinated medical homes, and
effective parent education and family support
services.
39
Critical Components of Early Childhood Systems
SOCIAL-EMOTIONAL COMPETENCE
Optimal Outcomes for Young Children and their
Families
MEDICAL HOMES
EARLY CARE EDUCATION
PARENT EDUCATION FAMILY SUPPORT
40
Critical Components of Early Childhood Systems
Programs
SOCIAL-EMOTIONAL COMPETENCE
CCSN Early Learning
Standards CCHC EHS/HS PEP/PBIS
Early Intervention Family Outreach
Strengthening Families Watch Me Grow
KIDSCONNECT Child Outreach Bright Stars
(QRiS) PPEP T.E.A.C.H. FCCP
IYS LAUNCH Nurse Family Partnership
EARLY CARE EDUCATION
MEDICAL HOMES
PARENT EDUCATION FAMILY SUPPORT
41
Mental health consultation to improve child care
contexts
Child Care Support Network Early
Childhood Mental Health Consultation
Funding provided byRI Dept of Human
Services,RI Dept of Health, and the RI Maternal
Child Health Bureau
42

• Child Social-Emotional Behavioral Functioning
• Social-Emotional Competence at School
• Behavior Regulation at School

• Classroom observation and feedback to staff
• Classroom Support
• Program support
• In-service training workshops of topics relevant
  to early childhood mental health

• Classroom Functioning
• CR Environment
• CR Atmosphere
• CR Quality
• CR Behavior Patterns
• Teacher Practices
• Teacher Strategies
• CR Map
• Parent Involvement
• Supervision practices

• School Success
• Decreased suspensions expulsions
• Decreased mobility

43
CCSN MHC ImplementationQuestions (Pilot Year 1)

• How Were Child Care Centers Enrolled?
• Who Participated?
• How Did Classroom Observations Inform ECMHC
  Activities?
• What ECMHC Activities were Implemented?A)
  Type?B) Amount?

44
How Were Child Care Centers Enrolled?

• Active Recruitment by RI Dept of Health
• Priority to centers serving children with DHS
  child care subsidies
• Eligible centers assigned to ECMHC for up to 12
  months
• ECMHC conducted on-site enrollment Interview
• Collaborative plan to determine needs of the
  center center point person for ECMHC schedule
  of consultation services, etc.
• Pre-ECMHC classroom observations scheduled
  staff questionnaires completed
• 2-session workshop training scheduled (based on
  CSEFEL principles)

45
2. CCSN MHC Pilot Yr 1 Who Participated?
46
How did Classrooms Observations Inform ECMHC
Activities?

• Classroom observations in every classroom by
  evaluation team using standardized tools
• Clinical feedback provided to ECMHCs
• ECMHC worked with program to incorporate feedback
  into consultation plan and ongoing consultation
  activities

47
What ECMHC Activities were Implemented?

• Classroom Support
• Consultation- classroom, child, or family
  concerns
• Classroom improvement plans
• Program enhancements for challenging behaviors
  and/or developmental concerns
• Communication with parents about child
  behavior/development
• Community-based referrals
• Program Support
• Case management reviews
• Reflective supervision practices
• Team building
• Workshop Trainings

48
Summary of Pilot Year 1 Direct ECMHC Activities

• Most (83) MHC activities were conducted at the
  classroom support level (ranging from 57-97)
• Some (11) MHC activities were conducted at the
  program level (ranging from 3-25)
• 5/6 programs participated in the 2-session
  workshop series

49
Engagement with ECMHC Activities

• On-site Consultation Average rating of
  satisfaction with MHC activities4.36 on scale
  from 1(low) to 5 (high)
• MHC Workshops 94 participants reported strong
  agreement with stated learning objectives (e.g.,
  I can describe how classroom environments support
  child development, etc.)

50
Evaluation Questions

• Were there pre-post ECMHC changes in
• classroom functioning?
• teacher practices?
• program supervisory practices?
• rate of expulsion from child care centers?

51
Classroom Functioning?

• Environment (space, care routines, interactions,
  activities, structure, parent involvement)
• Quality (general functioning)
• Atmosphere (child compliance, cooperation,
  interest, enthusiasm in classroom activities)
• Behavior Disruptions during routine daily
  transitions (very challenging in most child care
  settings)

52
Classroom Environment?

• Overall, ECERS/ITERS Total Scores showed
  statistically significant improvement from
  pre-ECMHC (mean3.67, SD.57) to post-MHC
  (mean4.08, SD.62)(scale 1inadequate,
  3minimal, 5 good, 7excellent)
• Classroom Quality?
• Classroom PIRS Total Scores showed small to
  moderate improvement (about 1/2 sd) from
  pre-ECMHC (mean3.31, SD.55) to post-ECMHC
  (mean3.06, SD.69)
• (lower scores are positive)

53
Classroom Atmosphere?

• Classroom Atmosphere Total Scores showed no
  substantive change from pre-ECMHC (mean3.13,
  SD.60) to post-ECMHC (mean3.20, SD.78)
• (lower scores indicate better child emotional
  adjustment in the classroom)
• Classroom Behavior Problems?
• Classroom Situations Scores showed overall
  decrease in frequency of behavior disruptions
  during classroom transitions from pre-ECMHC
  (about 7 transitions with moderate to severe
  behavior disruptions) to post-ECMHC (about 5
  transitions with moderate to severe behavior
  disruptions)

54
Teacher Practices?

• Self-reports by teachers generally showed small
  to moderate improvements in several areasa)
  Confidence (significant change)b) Use of
  Positive Strategies (.35 SD change)c) Use of
  Praise (.63 SD change)d) Effective Limit
  Setting (.50 SD change)

55
Program Supervision Practices?

• Average rating of teacher satisfaction with
  supervision received by program supervisors
  showed small to moderate improvement (about 1/3
  SD) from pre MHC (mean3.99, SD.77) to post MHC
  (mean4.23, SD.67)

56
Rate of expulsion from child care centers?

• People working in the fields of child care and
  early childhood education knew there was a
  problem when a number of children as young as 3
  were getting booted out of preschool because of
  disruptive behavior.
• K. Shaw (2003)

57
National Preschool Expulsion Rates(Gilliam, 2005)

• Average 3x higher than those of K-12.
• Overall, for every 1,000 children in pre-K, 6.7
  children are expelled.

58
Preventing Preschool Expulsion Mental Health
Consultation

• Access to early childhood mental health
  consultation is associated with lower rates of
  expulsion from pre-K
• On-site access to a psychologist or social worker
  expelled 5.7 children per 1,000
• Lack of access to early childhood mental health
  consultation expelled children at the highest
  rates of 10.8 per 1,000
• (Gilliam, 2005)

59
May Reduce Risk of Preschool Expulsion By

• Enhancing skills of early care and education
  providers in behavior and classroom management
• Increasing developmentally appropriate practices
  and expectations
• Reducing staff stress and turnover
• Reducing levels of problematic behavior in young
  children
• Enhancing early identification of problem
  behaviors
• Supporting the child care community, families,
  and children who are manifesting (or are at-risk
  for) problematic behaviors
• (Brennan, 2005 Perry, 2005)

60
Impact of ECMHC on Pre-K Expulsion Rate 6 CCSN
Pilot Year 1 MHC Centers?

• In year prior to ECMHC, these 6 pilot centers
  reported 4 expulsions 16 per 1000 2 ½x
  national average
• In year during ECMHC, these 6 centers reported 2
  expulsions 7.8 per 1000 closer to national
  average lower than the RI average
• Centers reported 50 fewer expulsions from pre-
  to post-ECMHC
• Promising!

61
How is the CCSN Mental Health Consultation
Program Sustained?

• Futures Directions of ECMHC in RI
• RI Association for Infant Mental Health (RIAIMH)
  to address workforce development issues in
  training front line professionals in principles
  of Early Childhood Mental Health and in
  establishing standards/credentialing for
  consultants
• Bright Stars (quality rating improvement
  standards for child care) to link with ECMHCs
• Project LAUNCH
• Workgroup Established for Integration and
  Financing for Childrens Developmental and Mental
  Health Services within Primary Care and Child
  Care Settings

62
RI LAUNCH Building on the Successful Start
Results-Based Framework
Inputs Resources Core Components
Infrastructure Change Outputs
Outcomes
Successful Start   Statewide Early Childhood
Systems Building     Infrastructure,
Organization, Partnerships     Early Childhood
Systems Plan     Implementation of Project
Strategic Plan Goals  

• Diminished Service Delivery Boundaries
• Organized Management Structure
• State, Academic, Community, Family
  Partnerships
• State Financing
• Third Party Financing

AllChildren Healthy Ready to Learn Early
childhood family services that promote healthy
early childhood physical, cognitive, and
emotional development

• Cross-Sector Goals
• Sector-Specific Goals
• Systems Capacity
• Quality of Services
• Service Integration
• State Community Policy Change
• Program Evaluation

Parent Education Family Support
Early Care Education
Medical Homes
Social-Emotional Development
63
LAUNCH SettingProvidence, RI

• Rhode Island is smallest state geographically,
  1.2 million residents
• Providence is capital city, population 173,600
  with 26,700 children 1-8 years
• Latino (Puerto Rican, Dominican) and African
  American most prominent racial-ethnic groups
  (approx 75 minority in Providence)
• 51 single parent 28 lt HS education 43 living
  in poverty

64
Goal 1 ECMHC in Primary Care Settings

• Integrate developmental and behavioral health
  screening in medical homes
• Locate mental health consultants in pediatrician
  offices where screening is implemented to
  establish follow up assessment and targeted
  intervention

65
Goal 2 Link Parent Support and Education in
Primary Care

• Assess parent and family functioning in primary
  care linked to developmental screening
• Implement empirically validated parenting
  intervention for targeted families (VIPP IYS)
• Identify third-party reimbursement mechanisms for
  empirically validated parenting interventions

66
Goal 3 Consultation in Child Care Settings

• Implement mental health consultation in child
  care integrated with developmental screening
• Implement empirically validated classroom
  behavior management training for staff in child
  care (IYS CBMS)
• Implement empirically validated parent training
  for targeted families (VIPP IYS)
• Identify third-party reimbursement mechanisms for
  child/family assessment and empirically validated
  parenting interventions

67
Challenges

• Minimize extent to which current programs work in
  silos
• Develop referral resources beyond consultation
  for identified children (0-8) and their families
• Develop sustainable funding mechanisms
• Establish standards/competencies for
  professionals in early childhood fields and for
  child care quality

68
Opportunities

• Training opportunity for early childhood
  professionals
• State government academic partnership
• Alignment with multiple state initiatives for
  improving childrens behavioral and physical
  health

69
For More Information

• Susan Dickstein, PhD
• 401-793-8731
• Susan_Dickstein_at_brown.edu
• Kristine Campagna, MEd
• 401/222-5927
• Kristine.Campagna_at_Health.ri.gov
• Special thanks to CCSN Early Childhood Mental
  Health Consultants at
• Bradley Early Childhood Clinical Research
  Center/Brown Medical School
• Providence Center Early Childhood Institute

70
Office of Head Start Early Childhood Development
and Mental Health Concerns and the Role of
Community Pediatric Clinicians

• Barry Marx, MD, FAAP
• Senior Medical Advisor, Office of Head Start

71
Office of Head StartMission Statement

• Head Start is a national program that promotes
  school readiness by enhancing the social and
  cognitive development of children through the
  provision of educational, health, nutritional,
  social and other services to enrolled children
  and families.

http//www.acf.hhs.gov/programs/ohs/about/index.ht
mlmission
72
Head Start - Early Childhood Development and
Health Services

• Head Starts commitment to wellness embraces a
  comprehensive vision of health for children,
  families, and staff. The objective of Child
  Health and Developmental Services is to ensure
  that, through collaboration among families,
  staff, and health professionals, all child health
  and developmental concerns are identified, and
  children and families are linked to an ongoing
  source of continuous, accessible care to meet
  their basic health needs.

73
Head Start Program Performance Standards

• 1304.24 Child mental health
• (a) Mental health services.
• (1) Grantee and delegate agencies must work
  collaboratively with parents (see 45 CFR
  1304.40(f) for issues related to parent
  education) by
• (i) Soliciting parental information,
  observations, and concerns about their child's
  mental health
• (ii) Sharing staff observations of their child
  and discussing and anticipating with parents
  their child's behavior and development, including
  separation and attachment issues
• (iii) Discussing and identifying with parents
  appropriate responses to their child's behaviors
  
• (iv) Discussing how to strengthen nurturing,
  supportive environments and relationships in the
  home and at the program
• (v) Helping parents to better understand mental
  health issues and
• (vi) Supporting parents' participation in any
  needed mental health interventions.

http//eclkc.ohs.acf.hhs.gov/hslc
74
Head Start Program Performance Standards

• 1304.24 Child mental health (cont.)
• (2) Grantee and delegate agencies must secure the
  services of mental health professionals on a
  schedule of sufficient frequency to enable the
  timely and effective identification of and
  intervention in family and staff concerns about a
  child's mental health and
• (3) Mental health program services must include a
  regular schedule of on-site mental health
  consultation involving the mental health
  professional, program staff, and parents on how
  to
• (i) Design and implement program practices
  responsive to the identified behavioral and
  mental health concerns of an individual child or
  group of children
• (ii) Promote children's mental wellness by
  providing group and individual staff and parent
  education on mental health issues
• (iii) Assist in providing special help for
  children with atypical behavior or development
  and
• (iv) Utilize other community mental health
  resources, as needed.

75
Head Start Program Performance Standards

• 1304.52 Human resources management
• (d) Qualifications of content area experts.
  Grantee and delegate agencies must hire staff or
  consultants who meet the qualifications listed
  below to provide content area expertise and
  oversight on an ongoing or regularly scheduled
  basis. Agencies must determine the appropriate
  staffing pattern necessary to provide these
  functions.
• (4) Mental health services must be supported by
  staff or consultants who are licensed or
  certified mental health professionals with
  experience and expertise in serving young
  children and their families.

76
Head Start Program Information Report (PIR)

• The PIR is an important source of comprehensive
  data on Head Start programs at the national,
  regional, and program level. It provides
  information about the number of children served,
  staffing, program services and activities, and
  other areas of importance to national
  policymaking. PIR information is also used by the
  Administration for Children and Families to
  respond to Congressional and public inquiries
  about the program. PIR information is essential
  for compiling the Biennial Report to Congress on
  the Status of Children in Head Start Programs, a
  report required under the Head Start Act.

77
Head Start Program Information Report 2006-2007
Data

• Total actual enrollment 1,061,275
• The total number of children with health
  insurance
• At enrollment 927,094
• At end of enrollment year 990,189
• Medical Home Number of children with an ongoing
  source of continuous, accessible care
• At enrollment 928,553
• At end of enrollment year 1,007,550

78
Head Start Program Information Report 2006-2007
Medical Services

• Number of children up-to-date on a schedule of
  age-appropriate preventive and primary health
  care, including all appropriate tests and
  physical examinations 954,277
• Of the children screened, the number diagnosed as
  needing medical treatment 186,957
• Of the children diagnosed, the number who
  received or are receiving medical treatment
  174,435

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Head Start Program Information Report 2006-2007
Screenings

• Screenings Developmental, sensory, behavioral
• Children who completed screenings for
  developmental, sensory and behavioral concerns
  941,484
• Of the children screened, the number identified
  as needing a follow-up assessment or formal
  evaluation 124,654

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Head Start Program Information Report 2006-2007
Mental Health (MH) Services

• Number of children for whom the MH
  professional(s) consulted with program staff
  about the childs behavior or mental health
  143,458
• Number for whom the MH professional provided 3 or
  more consultations with program staff during the
  operating period 47,384
• Children for whom the MH professional(s)
  consulted with the parent(s) / guardians(s) about
  their childs behavioral and/or mental health
  60,881
• Children for whom the MH professional(s) provided
  an individual mental health assessment 69,008
• Children for whom the MH professional facilitated
  a referral for mental health services 31,251

81
Head Start Program Information Report 2006-2007
Mental Health Services

• Mental Health Referrals
• Children referred for Mental Health Services
  outside of program 22,752
• Received Mental Health Services 16,765

82
Head Start Program Information Report 2006-2007
Family Services

• Family Services
• The number of families who received the following
  services during the operating period
• Emergency/crisis intervention (addressing
  immediate need for food, clothing or shelter)
  161,938
• Housing assistance (subsidies, utilities,
  repairs, etc.)116,997
• Transportation assistance (subsidizing public
  transportation, etc.) 105,377

83
Head Start Program Information Report 2006-2007
Family Services

• Family Services (cont.)
• Mental health services 123,800
• English as a second Language (ESL) training
  74,576
• Adult education (GED programs, college
• selection, etc.)136,401
• g. Job training 94,703
• Substance abuse prevention or treatment
• 51,729
• i. Child abuse and neglect services 103,346

84
Center on the Social and Emotional Foundations
for Early Learning (CSEFEL)

• National Consortium led by Vanderbilt University
  focuses on promoting the social emotional
  development and school readiness of young
  children birth to age five.
• Jointly funded by the Office of Head Start and
  the Child Care Bureau, ACF/HHS.

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CSEFEL

• Analyze and synthesize the research on the social
  emotional development of low-income children and
  translate the findings into materials that are
  practical and accessible.
• Engage in intensive T/TA to selected states,
  territories and/or tribal partners to foster
  professional development that sustains the use of
  effective practices at the local level.
• Disseminate evidence-based practices and
  materials via an interactive website.

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CSEFELGuiding Principles/Values

• Supporting young childrens social and emotional
  development to prevent challenging behaviors
• Individualizing interventions to meet childrens
  and families unique interests, strengths, and
  needs
• Promoting skill building with enough intensity to
  affect change
• Implementing strategies in the context of
  naturally occurring routines and environments
• Ensuring fidelity of use through a systematic
  change process and
• Modifying strategies to meet the cultural and
  linguistic diversity of families and children.

87
CSEFEL Pyramid ModelPromoting Social Emotional
Competence in Infants and Young Children
88
Collaboration To Address Childrens Mental Health
Needs in Head Start

• Head Start Mental Health Consultant (MHC) and/or
  staff refers to PCC for evaluation and/or
  treatment
• PCC communicates a behavioral/mental health plan
  of care to Head Start staff
• Head Start MHC and/or staff collaborate to assist
  family (eg, referrals, ongoing care plan) in
  additional ongoing needs
• PCC and Head Start staff share information about
  resources and service availability
• Health professionals (eg, PCC, MH Professionals)
  shape the programs delivery of health services
  through participation on the Head Start Health
  Services Advisory Committee

89
Head Start Health Services Advisory Committee

• The Head Start Program Performance Standards
  require that every Head Start program form and
  maintain a Health Services Advisory Committee
  (HSAC) to advise in the planning, operation, and
  evaluation of health services in Head Start and
  Early Head Start programs 45 CFR 1304.41(B).
  The HSAC links Head Start programs to essential
  persons, organizations, and resources within the
  community. The HSAC plays an important role in
  ensuring that Head Start children have medical
  and dental homes that will remain in place after
  they leave the program. The HSAC also plays an
  integral part in the development of health
  policies and procedures for Head Start programs.

90
Head Start Health Services Advisory Committee

• Participants on the HSAC may include, but are not
  limited to
• ?? Pediatricians
• ?? Nurses
• ?? Nurse practitioners
• ?? Dentists
• ?? Nutritionists
• ?? Mental health providers
• ?? Women, Infants, and Children
• (WIC) program staff
• ?? Medicaid and SCHIP staff
• ?? Head Start parents
• ?? Head Start staff

91

AAP Policy Statement

• Committee on Community Health Services
• The Pediatricians Role in Community Pediatrics
• Pediatrics 200511510921094
• http//aappolicy.aappublications.org/cgi/reprint/p
  ediatrics115/4/1092.pdf

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The Pediatrician's Role in Community Pediatrics
Recommendations

• Pediatricians should use community data
  (epidemiologic, demographic, and economic) to
  increase their understanding of the health and
  social risks on child outcomes and of the
  opportunities for successful collaboration with
  other child advocates.
• Pediatricians should work collaboratively with
  public health departments and colleagues in
  related professions to identify and decrease
  barriers to the health and well-being of children
  in the communities they serve.
• Pediatricians should become comfortable with an
  interdisciplinary collaborative approach and
  advocacy effort to child health. Pediatricians
  can play an important role in coordinating and
  focusing new and existing services to realize
  maximum benefit for all children.

93
The Pediatrician's Role in Community Pediatrics
Recommendations

• Pediatricians and other members of the community
  should interact and advocate to improve all
  settings and organizations in which children
  spend time (eg, child care facilities, schools,
  youth programs). School and community resources
  should be considered as assets in developing
  strategies for the problems that children will
  face now and throughout their lives.
• Pediatricians should nurture and advocate for
  neighborhood structures that support healthy
  families capable of promoting optimal health,
  safety, and development in their children.

94
The Pediatrician's Role in Community Pediatrics
Recommendations

• Pediatricians should advocate improving the
  effectiveness and efficiency of health care for
  all children, striving to ensure that every child
  in the community has a medical home.
• Pediatricians should educate themselves
  concerning the availability of community
  resources that affect the health and well-being
  of the children they serve.

95
Head Start and Community Pediatric Clinicians

• Head Start staff and programs serve children,
  families and communities in the greatest need.
  These same communities are served by dedicated
  clinicians who have chosen to devote their
  talent, skills, and caring to vulnerable
  populations. Limited resources are an operational
  reality of these service models. Head Start
  programs are designed to provide a support
  infrastructure to assist children and families in
  accessing and participating in ongoing
  comprehensive health care. Collaboration between
  Head Start programs and community providers of
  pediatric health care strengthens both systems of
  care, and enriches the lives of staff, children,
  families, and communities.

96
Additional Resources

• The Head Start Program Information Report (PIR)
  may be obtained by e-mail request to
  dstark_at_stria.org
• Further information about Center on the Social
  and Emotional Foundations for Early Learning
  (CSEFEL) may be found at http//www.vanderbilt.ed
  u/csefel/

97
Wrapping it Up How to Find and Connect with
Local Health Consultants

• Marian Earls, MD, FAAP
• Guilford Child Health Inc
• Task Force on Mental Health Early Childhood
  Algorithm Team
• Section on Early Education Child Care
• Section on Developmental Behavioral Pediatrics

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Find and Connect with your Local Health
Consultants

• Healthy Child Care Consultant Network Support
  Center (NSC) http//hcccnsc.edc.org/
• Registry of CCHCs
• State profiles (contact CCHC coordinator)
• Are you a CCHC?
• Add your name to the NSC registry!!!

99
Find and Connect with your Local Health
Consultants

• - National Training Institute for Child Care
  Health Consultants (train-the-trainer program)
  http//nti.unc.edu
• Contact NTI to find local CCHCs who have been
  trained by an NTI graduate
• - National Association of Child Care Resource
  Referral Agencies (NACCRRA) www.naccrra.org
• Enter zip code to find local CCRR
• This agency can help you connect with local
  ECMHCs
• - National Technical Assistance Center for
  Children's Mental Health
• Georgetown University Center for Child and Human
  Development
• Georgetown University
• http//gucchd.georgetown.edu/programs/ta_center/co
  ntact/contact.html

100
Question / Answer Session

• Please type in your questions in the chat log
  located on your control panel.
• The phone lines for the panel members will be
  open at this time.
• The moderator will select questions from the chat
  log and the panel members provide answers.

101
Thank You for Participating!

• This Webinar has been recorded
• and will be posted online, along with a complete
  resource list, at
• www.aap.org/mentalhealth
• www.healthychildcare.org