Mental Health in Early Head Start and Head Start

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Mental Health in Early Head Start and Head Start

• Amy Hunter, LICSW
• Early Head Start National Resource Center,
• ZERO TO THREE
• ahunter_at_acf.hhs.gov
• 202.205.7329

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Whats Happening in Mental Health

• Definition, needs and standards
• PIR data
• PRISM core question and protocol
• MH projects and resources, CSEFEL, HS Bulletin,
  MH Work Zone, Federal TA Early Childhood
  Collaboration

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Definition of Mental Health

• The successful performance of mental function,
  resulting in
• productive activities,
• fulfilling relationships,
• ability to adapt to change and to cope with
  adversity
• Mental health is the springboard of thinking and
  communication skills, learning, emotional growth,
  resilience, and self-esteem.
• (Report of the Surgeon General. 1999)

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Early Childhood Mental Health Is

• The developing capacity to experience, regulate
  and express emotions
• Form close and secure interpersonal relationships
• Explore the environment and learn
• In the context of family, community and cultural
  expectations for young children
• Adapted from Zero to Three

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Framework of EHS, HS Mental Health Services

• Promotion
• Prevention
• Early Intervention
• Treatment
• Services to children, families, and staff

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Head Start Program Performance Standards

• In 1995 Performance Standards were updated to
  include a more specific emphasis on fully
  integrating mental health services into the
  regular operating routine with references to
  mental health consultation.

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Revised Head Start Program Performance Standards

• Over 40 Head Start Performance Standards related
  to mental health
• Most prominent in Child Mental Health 45 CFR
  1304.24

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Many Mental Health Standards Woven In

• Education and early child development
• Family partnerships
• Community partnerships
• Management systems and procedures
• Human resource management
• Disabilities services

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The Need is Great Prevalence Data

• Conservative estimate 20 of youth need mental
  health intervention
• Some approximations reach 38 (Committee on
  School Health, 2004 Goodman et al., 1997
  Marsh 2004)
• Prevalence numbers do not include at risk

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The Need is Great Data and Statistics

• Preschool children are 3 times more likely to be
  expelled than children in grades K-12.
• (Gilliam, 2005)

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The Need is Great Data and Statistics

• Children who are poor are much more likely to
  develop behavior problems with prevalence rates
  that approach 30 (Qi Kaiser, 2003)
• Teachers report that challenging behavior affects
  overall job satisfaction. (Joseph, Strain,
  Skinner, 2003)
• Of the young people who show early signs of
  problem behavior less than 10 receive services
  for these difficulties. (Kazdin Kendall, 1998)

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The Need is Great Data and Statistics

• Early appearing behavior problems in a childs
  preschool career are the single best predictor of
  delinquency in adolescence, school dropout, gang
  membership, adult incarceration, and early death
  (Loeber Farrington, 1988 Reid, 1993).
• The correlation between preschool-age aggression
  and aggression at age 10 is higher than that for
  IQ. (Kazdin, 1995)

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Research of Depression in Early Head Start
Families

• Nearly half of mothers (48) were depressed at
  enrollment
• 33 of mothers were depressed when child was 1
  year old 33 when child was 3 years old
• 18 of fathers were depressed when child was 2
  years old 16 when child was 3 years old

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Mental Health Professionals Services for
Children (2004-05 PIR)

• STAFF CONSULTATIONS
• Consultations with staff about a child
• 13.04 of enrolled (all HS and EHS)
• Of above, 3 or more staff consultations made
• - 32.86 of staff consults
• -

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Mental Health ProfessionalsServices for
Children (2004-05 PIR)

• PARENT CONSULTATIONS
• Consultations with parents about a child
• 5.2 of enrolled
• Of above, 3 or more consults provided
• 44.2 of parent consults

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Child Mental Health Services Outside Referrals
(2004-05 PIR)

• Children referred for services (outside of
  program)
• 21,852 children
• - 2.07 of enrolled
• Of above, those referred who received external
  mental health services
• 15,935 children
• - 72.92 of those referred

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MH Consult Time Varies Greatly (from 2003 PIR
data)
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Why Focus on Mental Health?

• Multiple data sources suggest many programs
  struggle with meeting the many mental health
  Performance Standards
• Children, families, and staff may not be
  receiving needed or adequate services in the area
  of mental health
• Mental well-being is a foundation for childrens
  school success
• Mental health findings occur infrequently in Head
  Start Review Reports

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MH CORE Question

• How does the grantee implement a comprehensive
  system of mental health prevention and
  intervention to children and families including
  providing mental health awareness and education
  to staff?

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Mental Health Services Protocol 5 Main Ideas

• 1. Program Planning and Management for Quality
  Mental Health Service
• 1a. Coordination with Community Mental Health
  Resources
• 2. Early Identification of Childrens Mental
  Health Needs
• 3. Parent Involvement in Childrens Mental Health

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Mental Health Services Protocol 5 Main Ideas

• 4. Mental Health Education and Intervention for
  Parents
• 5. Special Help for Childrens Individualized
  Mental Health Needs

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Protocol Area 1 Program Planning and Management
for Quality Mental Health Services

• How does the grantee ensure that
• the service of a mental health professional (or
  professionals) is on a regular schedule of
  sufficient frequency to ensure the timely and
  effective identification of and intervention in
  family and staff concerns about a child?

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Protocol Area 2 Early Identification of
Childrens Mental Health Needs

• How does the grantee ensure that each child
  receives an appropriate and timely (within 45
  days of the childs entry into the program)
  screening to identify, using multiple sources of
  information, and address any behavioral, social,
  emotional concerns? 1304.20(b)(1)-(3)

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Protocol Area 3 Parent Involvement in
Childrens Mental Health

• How does the grantee ensure that the staff works
  with parents to discuss and identify appropriate
  responses to their childrens behavior including
  how to strengthen nurturing, supportive
  environments and relationships in the home and at
  the program?

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Protocol Area 4 Mental Health Education and
Intervention for Parents

• How does the grantee ensure that parents receive
  mental health education on issues that place
  families at risk (including for pregnant women,
  education and referrals if needed for maternal
  depression and substance abuse) and other
  appropriate intervention, including opportunities
  to participate in counseling programs?

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Bad newswere all out of our minds. Youre
going to have to be the lone healthy person in
this family.
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Protocol Area 5 Special Help for Childrens
Individualized Mental Health Needs

• How does the grantee ensure that parents, program
  staff and the mental health professional design
  and implement program practices that are
  responsive to the identified behavioral and
  mental health concerns of an individual or group
  of children including providing special help
  children with atypical behavior?

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Center for Social Emotional Foundations of Early
Learning (CSEFEL)

• Five-year project designed to strengthen the
  capacity of Head Start and child care programs to
  improve the social and emotional outcomes of
  young children.
• Evidence-based practices for promoting children's
  social and emotional development and preventing
  challenging behaviors.
• Training Modules, What Works Briefs, State
  Strategic Plans, Partners in Excellence, Primary
  Partners

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Early Childhood Comprehensive Systems Grants
(ECCS)/ MCHB funded

• support States to plan, develop and implement
  collaborations and partnerships to support
  families and communities in their development of
  children who are healthy and ready to learn.
• 23 States who are implementing, 27 who are
  planning, and three brand new planning grants.
• must involve a broad range of public and private
  early childhood agencies, parents and communities
  who share the goal of promoting the health and
  well-being of children from ages 0 to 5
• must address the key components of health and the
  medical home, early care and education, mental
  health, and social-emotional development, family
  support and parenting education.

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Other Resources

• Federal Early Childhood Mental Health TA
  Collaboration
• Head Start Bulletin, Mental Health Issue
• Mental Health Work Zone