Jane Knitzer Ed'D

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Investing Smart in Infant and Early Childhood
Mental Health

• Jane Knitzer Ed.D
• National Center for Children in Poverty
• Michigan Great Start November 14, 2007

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National Center for Children in Poverty

• Our Mission
• To promote the security, health, and well-being
  of Americas low-income children and families.
• Our Foci
• Improved family economic security
• Healthy, nurturing families
• Young children succeeding in school
• Our Approach
• Use research to promote improved policies and
  fiscal practices

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Outline for Todays Talk

• What is Infant and Early Childhood Mental Health
• Why Invest
• What to Invest In
• Building a System Challenges and Opportunities
• Moving Forward Toward A Great Start Agenda

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Defining Healthy Social and Emotional
Development

• Age-appropriate social, emotional and behavioral
  capacity (particularly related to school
  readiness) includes the ability to
• Manage emotions (e.g. anger, frustration)
• Relate to adults (parents, teachers, foster
  parents) and peers
• Feel good about themselves (curious, safe in
  exploring the world, approach learning eagerly
  etc.)

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Setting the Context The Big Picture

• The Challenge Ensuring that young low-income
  children have the physical, cognitive and social
  and emotional skills to succeed in the early
  school years
• What Can Help? The Big Picture
• Family Economic Security
• High quality early care and learning programs
• Family support
• Intentional strategies to promote social and
  emotional health and reduce behavioral risks

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• Why invest?

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The Message from Developmental Research Brain
Science is Clear

• Early relationships set the stage for healthy
  brain development.
• Healthy brain development sets the stage for
  successful early learning and necessary social
  and emotional skills
• Successful early learning (aka school readiness
  and transition) sets the stage for of later
  success in school.
• Early cognitive learning is intertwined with
  social and emotional learning and functioning and
  can help reduce the achievement gap

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Major Risk Factors for Poor Social and Emotional
Development are Known

• The more demographic and psychosocial risk
  factors the less likely positive social and
  emotional outcomes.
• Special risks include Extreme poverty (incomes
  under 10,000 a year for a family of four)
  concentrated community poverty multiple
  demographic risks
• Psychosocial parental adversities that are
  barriers to effective parenting including
• Depression 40 prevalence rates (EHS) substance
  abuse 10 domestic violence, prior, concurrent
  trauma
• Poor quality child care and early learning

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Social and Emotional Problems in Young Children
are Widespread

• No national epidemiological data, but
• 10 of all kindergarten children show problematic
  behavior (ECLS)
• Rates are two or three times as high in
  low-income samples
• Clinical level problems are lower but still
  significant (17 across diagnostic categories)
• Young children are being kicked out of child care
  settings particularly children of color.

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Therefore Social and Emotional Problems Among
Young Children

• Are real.
• The Institute of Medicine reported that Young
  children are capable of deep and lasting sadness,
  grief, and disorganization in response to trauma,
  loss, and early personal rejection.
• Matter now and in the future.
• Social and emotional problems can seriously
  compromise early child development and have
  lasting negative impact.
• Are associated with poverty.
• More exposures to poor parenting skills,
  inadequate child care, toxic substances, deprived
  play environments, etc.
• Have cumulative impact.
• Research suggests that negative experiences, and
  chronic stressors may affect a young child's
  developing brain (NICHD and NIMH)
• The combination of biological and psychosocial
  risks have a compound effect. (IOM)
• Can be addressed and ameliorated, but not with
  traditional mental health paradigms ( pull out
  therapy focused on the child)

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Goals and Assumptions of Infant and Early
Childhood Mental Health

• Goals
• Promote early school success
• Build capacity in early childhood work
• Promote effective parenting, particularly in
  high-risk families
• Deliver family-focused (parent-child) mental
  health services
• Core Assumptions Challenges traditional paradigm
  
• The best way to help young children is to help
  parents and other adults who are closest to them.
  
• Use a public health approach, not a traditional
  mental health paradigm
• Go across systems where families are
• Acknowledge that young children can have serious
  problems

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A Public Health Mental Health Framework for
Infant and Early Childhood Mental Health

• Promotion

All kids
Prevention
Intervention
Increasing intensity of need Decreasing numbers
of children
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What Can Help Promotion

• Basic high quality child development programs
  (EHS, serving about 3000 infants and toddlers in
  Michigan)
• Anticipatory guidance and support for parenting
  through the health care systems (mh consultants,
  Healthy Steps)
• Community-based promotion strategies like Touch
  Points
• Research-informed parenting programs through WIC,
  TANF
• WHAT FITS IN MICHIGAN? IS IT STATEWIDE?

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What Can Help Prevention

• Targeted to young children and families already
  showing risk (BUT not necessarily through direct
  services). Types include
• Social and emotional curricula for children (
  Tools of the Mind) and parents (Incredible Years)
  
• Interventions embedded in early childhood
  programs Family Connections (Beardslee)
• Facilitated social support for families (Baby
  FAST)
• Early childhood mental health consultation (3
  stories)
• Child Care Expulsion Project (Also CT, Colorado,
  Maryland)
• Uses ecological analysis of the childs
  environment and support systems
• WHAT FITS IN MICHIGAN? IS IT STATEWIDE?

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Early Childhood Mental Health Consultation cont

• Findings from evaluations of mental health
  consultation and case management strategies for
  0-5 preschool programs show
• Language improvement
• Reductions in developmental delays
• Decreases in aggression (or less increase than in
  controls)
• Decreases in expulsion
• (From Gilliam, Starting Early Starting Smart
  Perry)
• Michigans program reports similar impacts needs
  to be statewide, still in only 31/83 counties

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Workforce Challenges Opportunities

• Challenges
• Identify, recruit train early childhood mental
  health consultants and therapists
• Address cultural diversity, language challenges
• Embed more appropriate training for early
  childhood teachers
• Opportunities
• Build statewide training networks, using common
  curricula, peer supports, blended funding (IN,
  KY, MN, UT)
• Specialized Institutes (MA, SF re trauma)
• Embed requirements in credentials and
  professional development for ECE teachers
• Threats to success
• Poorly trained ECMH consultants
• Generic interventions that wont make a
  difference

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Examples of MH Consultation Strategies

• Illinois - Reimbursement for maternal depression,
  funds for ECMH child care consultation for all
  early childhood settings, and screening in
  primary care initiative.
• Ohio - started with a pilot mh consultation
  program did statewide training, appropriated
  funds for grants to counties, now serving 6500
  children. Even more in Cleveland.
• Kentucky KIDS NOW cross system initiative
  includes mental health consultants as resources
  to child care health consultants. Also have home
  visiting and medical home initiative.
• Connecticut - multi-disciplinary health
  consultation model, screening and follow-up
  emphasis, parents connect through Help Me Grow
  warm-line.

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Helping Higher Risk Young Children and Families

• Mental Health Consultation to DV Shelters,
• Evidence-based parent-child therapy (e.g. PCIT)
• Wrap around services
• Infant toddler mental health strategies
• Treatment for maternal depression linked to
  strengthening parent-child relationships and if
  necessary, early intervention (Every Child
  Counts)
• Child Welfare Incredible Years PCIT, Home Start
  
• ALL TRAUMA INFORMED STRATEGIES (Cooper, NCCP)
• EARLY CHILHDOOD SYSTEMS OF CARE

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The Role of Screening

• Too many children have undetected conditions.
• Screening is essential for early identification
  of risks and conditions.
• The screening process helps families and
  providers talk about concerns.
• Screening is the gateway to eligibility for many
  intervention services.
• Increasing attention to screening moms for
  conditions/risks that impair parenting, esp.
  depression

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Screening in Action Across Systems

• FOR CHILDREN
• Pediatricians
• ASQ/SE Early Childhood Programs
• Part C ( In Michigan, pilot with Part C, DECA IT)
  
• Child Welfare ?in Michigan ( 6400 young children
  in care)
• FOR MOMS
• Pediatricians (using standardized screens) and
  other health providers ( Chicago)
• CHALLENGES
• Payment (ABCD finds codes are not the problem for
  children)
• After screening, what (Help Me Grow)

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Principles for Developing Supports and
Infrastructure

• Grounded in developmental knowledge
• Relationship-based and family-centered
• Infused into and delivered in early childhood
  services (NOT office based)
• Attentive to community norms, cultures
• Use multiple entry points, (TANF, WIC)
• Family-focused for higher risk families
• Evaluated with measures that are both
  developmentally policy relevant

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Challenges Opportunities

• What to call it (destigmatizing mental health)
  
• How to measure and monitor impact
• Ensuring a trained work force
• Implementing research-informed practices ( Weisz)
• Paying for children w/o diagnoses (build on
  existing legislation for at risk infants in
  Michigan other model F4L)
• Avoiding unintended consequences
• Rush to the clinical model
• Not using a pre-birth to five framework
• Ignoring young children not in center-based
  programs
• Opportunities GREAT START Develop a three year
  plan to go statewide

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Opportunity Great Start

• Great Start Priority All early childhood
  practitioners and setting support healthy social
  and emotional development
• Strategically strengthen cross training for all
  early childhood providers (map through
  collaboratives) include ccrrs
• Continue to grow screening across settings
• Expand promotion programs like Touch Points

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Great Start Great Opportunity

• Great Start Priority Build a Statewide System
• Prevention Policy implications
• Take CCEP STATEWIDE (cost 3 million)
• Other Expand consultation to pediatricians,
  home-visitors and child welfare OVER TIME
• Early Intervention
• Ensure every cmhc has a specialist in b-5
• Expand the at-risk fund for infants and toddlers
  to preschoolers
• Develop a strategic partnership with child
  welfare to respond to the 6400 young children in
  placement (Fisher) and implement evidence-based
  parent-training for children not in placement
  (PCIT, Incredible Years)

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For More Information, Contact Dr. Jane Knitzer
jk340_at_columbia.edu Or Visit NCCP web
site www.nccp.org SIGN UP FOR OUR UPDATES See
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