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Infusing Mental Health Into an Early Childhood
System of Care
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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, and express emotion
• Form close, secure relationships
• Explore the environment and learn
• Adapted from ZERO TO THREE

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Impact Prevalence
Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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• Campbell (1995) estimated that approximately
  10-15 of all typically developing preschool
  children have
• chronic mild to moderate levels of
• behavior problems.
• Children who are poor are much more likely to
  develop behavior problems with prevalence rates
  that approach 30 (Qi Kaiser, 2003).

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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• Children who are identified as hard to manage at
  ages 3 and 4 have a high probability (5050) of
  continuing to have difficulties into adolescence
  (Campbell Ewing, 1990 Egeland et al., 1990
  Fischer, Rolf, Hasazi, Cummings, 1984).

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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• Early Predictors
• Temperamental Difficulties
• Early Aggression
• Language Difficulties
• Noncompliance

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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• Family Factors
• Maternal Depression
• Harsh Parenting
• Stressful Family Life Events
• Low Social Support
• Family Instability

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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• Early appearing aggressive behaviors are the best
  predictor of juvenile gang membership
• and violence.
• (Reid, 1993)

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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• When aggressive and antisocial behavior has
  persisted to age 9, further intervention has a
  poor chance of success.
• (Dodge, 1993)

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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• Young Children with Challenging Behavior
• Are rejected by peers
• Receive less positive feedback
• Do worse in school
• Are less likely to be successful in
  kindergarten

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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• Of the young children who show early signs of
  problem behavior, it has been estimated that
  fewer than 10 receive services for these
  difficulties.
• (Kazdin Kendall, 1998)

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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• There are evidence-based practices that are
  effective in changing this developmental
  trajectorythe problem is not what to do, but
  rests in ensuring access to intervention and
  support

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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Risk and Protective factors

• Resilient children tend to have had environments
  that are supportive in critical ways and the
  capacity for resilience develops over time in the
  context of environmental support (Egeland,
  Carlson Sroufe,1993)

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Protective Factors

• Positive self-esteem
• Active style of responding to stress
• Ability to elicit positive attention form adults

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System of Care

• A philosophy or framework about the way services
  should be delivered to children and families
• Not a model or single definable thing-cannot be
  replicated in a community unless framework is
  understood and applied to that particular
  community
• Based on core values

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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
Services and Supports
VALUES Family Voice Child and Family
Centered Relationship Based Culturally
Competent Infused into Natural Settings and
Services Grounded in Developmental Knowledge
Supports for Parents and Families
Supports for Other Caregivers
Services for Children and Families
Building Blocks
Strategic Planning, Policies, and Procedures
Maximized and Flexible Funding
Prepared Workforce
Interagency Partnerships
Outcome Evaluation
Developed by Roxane Kaufmann, GUCCHD
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Values and Principles

• INFUSE Mental Health in early childhood natural
  settings where kids are

Supports for care givers, parents, services for
children and families

• USE PUBLIC HEALTH MODEL (intervention is not
  enough)

• Promotion - for healthy social emotional
  development of all kids and families
• Prevention - focus supports for at risk children
  and families
• Intervention - services to kids with diagnosis

• ACCEPT THAT THIS IS A CULTURAL EXCHANGE PROCESS

Engaging and involving families, caregivers,
early childhood providers, mental health
providers, and community at large.
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Top 10 Differences

• Partnerships look different
• Its important to use a developmental perspective
• Diagnostic issues are challenging
• Engaging families not typically part of a family
• Organization
• How do you make youth involvement meaningful?
• Service array presents unique challenges
• Workforce issues heightened in this population
• Funding sources are different
• Evaluation brings up more issues
• Its not a Mental Health System of Care

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Continuum of Mental Health Services and Supports

• Promotion
• Prevention
• Intervention

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Populations to be Targeted
Intervention Symptoms of Distress
Prevention individuals at risk
Promotion everyone
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Promotion

• Dissemination of information promoting healthy
  social-emotional development
• Developmental screening
• High quality child care
• Use of an evidence-based curriculum

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Prevention

• Home visiting
• Mental health consultation
• Family mentors
• Social skills curricula
• Family supports
• Caregiver supports

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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

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EARLY CHILDHOOD MENTAL HEALTH CONSULTATION
Definition A problem-solving and
capacitybuilding intervention implemented within
a collaborative relationship between a
professional consultant with mental health
expertise and one or more individuals with other
areas of expertise - primarily child care, child
development, and families or individuals with
child care responsibilities.
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TYPES OF MENTAL HEALTH CONSULTATION

• 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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TYPES OF MENTAL HEALTH CONSULTATION (continued)

• 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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Achieving System Reform Goals

• Work together
• Emphasize shared values
• Learn from differences
• Engage key stakeholders
• Focus on the philosophy and values

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Strategic Planning

• Why?

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• We know more now about the importance of early
  life experience than we ever have.
• We know more now about what works than we ever
  have.
• We know more about strengths of families
  than we ever have.
• We know more about the power of
  community than we ever have.
• The time to invest in the future is now.

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• The Department of Developmental and Mental Health
  Services applied for and received from the Center
  for Mental Health Services
• Services Initiative Grant
• 5.7 Million Dollars
• Five Years Duration

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STRATEGIC PLANNING

• Interagency Partnership

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Regional Planning Process

• Management team
• Priority needs and services
• Budgets
• Fiscal agent
• Local outcomes

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Vermont Early Childhood System Work Group
Children Families
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State Outreach Team

• Family members
• and
• Representatives from
• Agency of Human Services
• Department of Developmental and Mental Health
  Services
• Department of Health
• Department of Social Welfare, Social and
  Rehabilitation Services (child welfare)
• Department of Education

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Identified Local Values

• Input from community families
• Need for community forums and community needs
  survey
• Greater understanding of the culture of each
  others system
• Being child/family centered at all systems levels

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Identified Top 3 Community Survey and Forum
Priorities

• Parenting and child care training opportunities.
• Behavioral consultation in child care settings
  and school settings.
• In-home direct therapeutic and consultation
  services.

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Who participated?

• Family members
• Early childhood System of Care (including health)
• Systems of Care for Children with Emotional and
  Behavioral Challenges (school-ages)
• Other community agencies and leaders

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SERVICES AND SUPPORTS

• What?

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Regional Services 26 FTEs hired statewide















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DIFFERENT SERVICES

• Consultation without identified client
• Cross training of early childhood caregivers

DIFFERENT PLACES TO SERVE

• Childcare
• Parent Child Centers
• Pediatric practices

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PREPARED WORKFORCE

• HOW and WHO?

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Learning Team Commitments

• Operate as learning organization
• Strengthen existing skills, knowledge and systems
  of care
• Build competent workforce
• Strive for meaningful family participation
• Make community priorities our priorities
• Address needs of under-served families

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CUPS Learning Team Initiatives

• Coordinate with early childhood initiatives
• Provide philosophical leadership
• Identify core competencies
• Address local training priorities
• Conduct statewide learning series
• Collaborate with Family Consortium
• Facilitate network for reflective supervision
• Provide training scholarships
• Explore higher education and in-service training
  opportunities

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Early Childhood Mental Health Knowledge and
Practices Document Includes
A description of the field of early childhood
mental health.
A set of Guiding Principles underlying all
services, supports and practices in the field.
Core Competencies organize into four domains

Child
Family

Community
Interpersonal relationships and teamwork
A Personal or Team Summary
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CUPS HANDBOOKFINDING HELP WITH
SOCIAL-EMOTIONAL-BEHAVIORAL PROBLEMS FOR YOUNG
CHILDREN THEIR FAMILIES
TABLE OF CONTENTS
Introduction 1. Families in the 21st.
Century2. Assessment as Discovery3. Early
developmental delays and differences4. Teen
parenting5. Trauma to the child including
sexual and physical abuse6. Domestic violence
witnessed by the child7. Neglect of the
child8. Challenging behaviors 9. Parent
substance abuse and chemical addictions10. Parent
psychosocial/developmental challenges11. Environ
mental stressors   APPENDIX I Legal
Definitions APPENDIX II General Resources,
State-wide (Vermont) APPENDIX III General
Resources, National International
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Financing

• How?

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FINANCING

• How?
• Many new partners, many new opportunities to
  blend resources.
• Early Childhood providers fear of Medicaid and
  diagnosis.
• Use of V codes
• Use of treatment planning

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BIG QUESTIONS

• How to leverage Federal dollars for these
  services that dont identify a specific client?
• Promoting public health model.
• Consulting and providing Technical Assistance to
  early childhood providers.
• Screening all children for social and emotional
  issues.

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Special Program to be Conducted by Experts in
Mental Health

• Definition This special program will consist of
  Consultation Education with family and
  community-based groups to improve circumstances
  and environments for young children and their
  families. The consultation and education (e.g.,
  training) should aim to assist parents and
  community groups to use health care resources
  effectively and efficiently as they gain
  knowledge, attitudes and skill to enhance early
  identification, intervention, screening and
  referral for mental health Medicaid services for
  young children and their families.

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Evaluation

• 134 parents of children ages1 to 6 participated
  in the evaluation
• Significant positive changes were reported after
  six-months of services they appear to have been
  maintained after one year.
• Childrens emotional problems decreased.
• Parents stress was reduced.
• Parents were more satisfied with their
  childrens progress than before service.

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Key Findings

• Parents felt that services helped their family.
• Parents were satisfied with their childs
  progress.
• Children demonstrated improved social and
  emotional outcomes.

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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

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Core Elements of an Effective System-Building
Process

• A Core Leadership Group
• Evolving Leadership
• Effective Collaboration
• Partnership with Families and Youth
• Cultural Competence
• Connection to Neighborhood Resources and Natural
  Helpers
• Bottom Up and Top Down Approach
• Effective Communication
• Conflict Resolution, Mediation, and Team-Building
  Mechanisms
• A Positive Attitude

Pires, S. (2002).Building Systems of Care A
Primer. Washington, D.C. Human Service
Collaborative.
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Charlie Biss, DirectorChild, Adolescence
Family UnitPhone [phone]Fax (802)
652-2005e-mail cbiss_at_vdh.state.vt.us

• Division of Mental Health
• 108 Cherry Street
• PO Box 70
• Burlington, VT 05402-0070
• Website healthvermont.gov
• Click on mental health
• Click on mental health again to get to DMHS
• You will then click on research publications
• Once you get to publications, click on child
  adolescent
• Click on CUPs handbook OR
• Click on knowledge and practices to promote the
  emotional and social development of young children