Research, Policy, and Practice: The Challenge of Early Childhood Mental Health

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Research, Policy, and Practice The Challenge of
Early Childhood Mental Health

• Jane Knitzer, Ed.D.
• Director, National Center for Children in Poverty
• Mailman School of Public Health, Columbia
  University
• Systems of Care Institute, San Francisco
• June 24, 2004

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Four Questions

• What is early childhood mental health?
• What invest?
• What are early lessons from practice and policy
  initiatives?
• What are key policy challenges and
  opportunities?

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What is Early Childhood Mental Health (ECMH)

• ECMH is the development of age appropriate
  social,
• emotional and behavioral skills in infants,
  toddlers and
• preschoolers, especially re how they
• manage emotions (e.g.anger, frustration)
• relate to adults (parents, foster parents, child
  care teachers)
• relate to peers, and
• feel about themselves (curious, safe in exploring
  the world, etc.)

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Why Invest? Field Perspectives

• ECE concerns
• Too many children are bad, mad and sad and
  being kicked out of ece programs
• Dont know how to help children families
  affected by violence, maternal depression
  substance abuse
• Kindergarten/school concerns
• Too many children at risk of early school failure
  (cant follow directions, listen to teachers etc.
  
• Both
• Pressures (no naps or recess or testing)

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Why Invest? Research Perspectives

• Early emotional development matters
• Many risk factors are known AND the more risk
  factors the greater the odds of poor outcomes.
• Early learning involves both social,emotional,
  and cognitive development
• The early years are known windows of
  opportunities for early intervention for some
  disorders (e.g. conduct disorders).

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Why Invest Policy Perspectives

• Consistent with national policy goals
• New Freedom Commission Report
• Calls for public health/mh prevention,ei focus
• Goal I Educate America
• ALL children shall enter school ready to learn
  
• Serving Hard to Employ Parents
• Risk factors for parents are risk factors for
  young children

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Early Lessons ECMH Through a System Lens

• Focus is on prevention and early intervention
  risk reduction resilience promotion etc.)
• Many risks are known challenge, organizing
  interventions to address them
• Poverty and low-income status
• Parental psychosocial risk factors (depression,
  sa, dv especially) that affect the caregiving
  environment
• Environmental risk factors (lead)
• Chronic parental or child health problems or
  disabilities
• Poor quality non-family early care environments

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Early Lessons About ECMH Systems (cont)

• Joins developmental, clinical knowledge family
  systems knowledge
• Is, or should be a family affair
• Systemness takes from both public health and
  mental health
• Uses multiple words (S/E/B ECMH, etc.)

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Goals for Intentional ECMH/S/E/B Strategies

• Promote emotional health and school readiness in
  young children
• Help parents (foster parents, kinship relatives,
  etc.) be more effective nurturers and teachers
  (two-generational challenge)
• Expand the competencies of other adults ( child
  care providers, teachers) to promote s/e health
  and school readiness
• Ensure that young seriously troubled children and
  their families get help

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Examples of Types of Strategies

• Evidence-based population-based
  prevention/promotion
• Consultation strategies
• More intensive strategies in the context of ece
  settings (EHS)
• Strategies for young children with diagnoses
• Strategies for more burdened parents with young
  children.

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Building Systems Common Challenges

• Attitudes Language (they will outgrow it- for
  crazies, dont label, etc.)
• Understanding how the same and different from SOC
  
• Too narrow a view of school readiness and early
  child development
• Funding (p/c therapy at risk not SED using
  Medicaid EPSDT MH)
• Two-generational mh system challenges
  (adult/child)

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Building Systems Early Lessons

• Infusion of mh into ece. Build on what exists
• Developmental knowledge key
• Use multiple entry points
• Partnerships are key (ece, mh, dv, sa, mh(adult)
  and engage families
• Emphasize prevention and EI, but dont forget
  about more intensive treatment
• Do fiscal as well as programmatic planning
• START SOMEWHERE

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National Organizations with ECMH Resources and
Information

• The National Center for Children in
  Povertywww.nccp.org (esp Promoting Resilience
  Series)
• NCSEFL http//csefel.uiuc.edu/
• The Center for Evidence-Based Practices
  http//www.evidencebasedpractices.org/
• Georgetown University http//gucchd.georgetown.edu
  /cassp.html
• Portland Research and Training Center
  http//www.rtc.pdx.edu/
• Zero To Three www.zerotothree.org

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If you would like more information, contact
Jane Knitzer at jk340_at_columbia.edu Or visit the
NCCP web site www.nccp.org