Promoting Healthy Social and Emotional Development in Young Children: Policy Challenges and Opportunities

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Promoting Healthy Social and EmotionalDevelopment
in Young Children Policy Challenges and
Opportunities

• Jane Knitzer, Ed.D.
• Project THRIVE and
• National Center for Children in Poverty
• March 7, 2005
• AMCHP Annual Conference

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Setting the Context About The National Center
for Children in Poverty (NCCP)

• NCCP
• Promotes the economic security, health and
  well-being of Americas low-income families
• Is university-based (Mailman School of Public
  Health, Columbia University
• Advances family-oriented policy solutions and the
  strategic use of public resources
• Hosts Project THRIVE Policy analysis center for
  ECCS grantees
• Provides Other Resources 50 state data tools
  Child Care and Early Education Research
  Connections Family Resource Simulator

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Overview

• What is healthy social-emotional development?
• What is a public health policy framework to
  support healthy S-E development?
• What are key policy building blocks?
• How have some states responded?
• What are special challenges opportunities?

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What is Healthy Social, Emotional Development in
Young Children?

• The age-appropriate ability for infants, toddlers
  and preschoolers to
• Manage emotions (anger, frustration)
• Relate to adults (parents, child care teachers)
• Relate to peers and
• Feel good about themselves (engaging with
  learning, curious, safe in approaching new tasks

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Its not one size fits all

• Early detection and prompt interventions can
  improve outcomes (i.e., shift the odds) for
  both children living in high-risk environments
  and those with biologically based disabilities.
  (IOM)
• Interventions tailored to specific needs are more
  effective than services that provide generic
  advice and support. (IOM)
• Pediatric child development, universal preschool,
  and services to promote healthy mental
  development are complementary. All are needed.

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A Continuum of Services

• Promotion

All kids
Prevention
Intervention
Increasing cost per child Increasing intensity of
need Decreasing numbers of children
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What is A Policy Framework to Support Healthy S-E
Development?

• A system of supports for young children, their
  families and other caregivers to promote
  age-appropriate social and emotional development
  especially for children whose development is
  compromised by poverty and other risk factors.
• A public health approach to mental health that
• Strengthens parental and other caregivers ability
  to promote young childrens healthy s-e
  development
• Addresses prevention, early intervention
  treatment

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Policy Framework System Goals

• Common cross-system goals
• Promote early learning healthy behaviors
• Foster skills in other caregivers
• Reverse a poor s-e developmental trajectory
• Remove parental barriers and risks to effective
  parenting
• Ensure that children with disorders get help

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Policy Grounded in Research and Best Practices

• Lessons from research
• Lessons from other states
• Cross-system fiscal and program analysis and
  planning
• Intentional, research-informed intervention
  strategies

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Policy Building Blocks Examples of Prevention
Strategies

• Screening (EPSDT linked, Devereux parents)
• Developmental services
• Anticipatory guidance for parents
• Community, state-level child development
  cross-training for staff working directly with
  young children and families (e.g. Touch Points)
• Classroom-based curricula (e.g. Tools of the
  Mind)
• Culturally appropriate parenting programs /
  relationship-based programs (Reach Out Read
  Baby Fast Incredible Years)

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Policy Building Blocks Examples of Early
Intervention Strategies

• Use ECMH Consultation
• Embed child, staff and/or family focused
  interventions in pediatric and ece settings
• Target high risk children
• Maximize available federal funding
• Develop common definitions of risk and criteria
  for eligibility across systems

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Policy Building Blocks Examples of Treatment
Strategies

• Parent-child therapies
• Specialized family-driven interventions (Early
  Childhood Centers, Cleveland)
• Classroom-based consultation
• Treatment programs in courts, shelters foster
  families (MTFC-P Miami-Dade, trauma linked
  screening and treatment)
• Family supports such as wraparound case
  management)

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Policy Building Blocks Examples of
Infrastructure Building

• Cross-system planning capacity
• ECCS approaches
• Common-cross-system tools
• outcome measures, screening tools, definitions of
  risk, eligibility criteria, billing codes
• Best policy and fiscal practices to support
• Cross-training
• MH Consultation
• Family-focused treatment

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Policy Building Blocks Examples of Best Fiscal
Policy Practices

• Pay pediatric providers for developmental
  screening and services
• Pay for family-focused treatment
• Offer cross-training on child health
  development
• Pay for screening for parental depression
• Pay for child health mental health consultants

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State Strategies in Action

• Louisiana
• In 6 of 64 parishes community-based,
  interdisciplinary assessment, training
  re-training funded with state dollars
• Maryland
• Statewide needs assessment ( 2002), Established
  consultation projects. In Eastern Shore 25 of
  children served had been in 3 or more child care
  settings. In Baltimore, implemented in child
  care, Head Start and family child care homes
  target, children at risk of removal. 84 not
  removed

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State Strategies in Action (Cont)

• Kentucky Early Childhood Mental Health Program
• Provides ECMH consultation thru14 early childhood
  specialists across state Uses Devereaux Early
  Childhood Assessment (DECA) for screening in ECE
  settings Funded with tobacco settlement
  dollarsTrains existing and new providers.
• Connecticut
• Provides ECMH consultation through partnership
  with Behavioral Managed Care organization
  Evaluation in process Involves full assessment
  of child and settings

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ECCS Needs and Objectives

• Increase partnership with primary health care
• Create incentives for screening
• Improve Medicaid screening, referrals, and
  billing
• Increase priority of young children in mental
  health
• Create data systems that can track risk and need
• Go from pilot projects to statewide
  programs/systems
• Increase capacity through training of providers
• Use common screening tools
• Develop common, shared referral mechanisms
• Use family resource centers and home visiting for
  family support

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Some Challenges

• Tough and uncertain federal context
• Multiple consultants to child care
• Identifying and using evidence-based practices
• Making fiscal policies fit with best practice
• e.g. paying for screening for moms, for
  relationship-based treatment
• e.g. overcoming mental health/physical health
  barrier
• Increasing work force capacity
• Investing in research

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Some Opportunities

• Growth in state budgets
• Push for school success by grade 3
• Reduced child care churning
• Increased recognition of the importance of
  healthy social-emotional development
• Increase interest among state policy makers

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Recent NCCP Publications www.nccp.org

• Resources to Promote S/E Heath and School
  Readiness A Community Guide
• Spending Smarter (and Project THRIVE Issue Brief
  1)
• Pathways to Early School Success Helping the
  Most Vulnerable Infants, Toddlers Families

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Questions?
Questions?
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Questions?
Thank you!