Oh, The Places We Will Go: Advancing Early Childhood Mental Health Interventions

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Oh, The Places We Will Go Advancing Early
Childhood Mental Health Interventions

• Barbara Parks, LICSW
• Shana Bellow, Ph.D.
• JWan Griffin, LICSW
• DC Department of Behavioral Health

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Goals and Objectives

• 1) List examples of two best practice models of
  early childhood mental health interventions.
• 2) Identify 3 positive social-emotional outcomes
  as a result of the implementation of two early
  childhood mental health interventions.

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Could someone help me with these? Im late for
math class.
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Risk Factors in Early Childhood (Candeleria,2009)

• Individual Genetics, developmental delays,
  temperament, physical illness
• Family Overt family conflict, abuse/neglect,
  alcoholism, family mental health history.

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Risk Factors Continued

• Environment Access to firearms, substances,
  poverty, lack of support network
• Community Socio-economic disadvantage,
  homelessness, disaster, discrimination

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Risk and Resiliency

• Cumulative simultaneous risk factors increase
  the chances of poor developmental outcomes.

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Early Intervention What happens when you dont
intervene early

• Academic- retention, expulsion
• Social-Emotional- behavioral problems, affect
  regulation
• Familial- high levels of stress, out of home
  placements, abuse/neglect
• Interpersonal-low self-esteem, isolation,
  depression, substance abuse, criminality.

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Social Emotional Health and School Readiness
What, how, and how much a child learns in school
will depend in large part on the social emotional
competence they have developed as preschoolers
Children who do not begin kindergarten socially
and emotionally competent are often not
successful in the early years of school and can
be plagued by behavioral, emotional, academic
and social development problems that follow them
into adulthood (Peth-Pierce, 2000).
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Pre-School Expulsion research

• Of 4,000 classrooms studied nationally, 10.4 had
  expulsions within the last year. (Gilliam, 2008)
• Boys were more than 4.5x more likely to be
  expelled than girls. Rates were highest for older
  pre-schoolers and African-Americans.
• 6.7 per 1,000 pre-schoolers were expelled.
• Overall rate of Pre-K expulsions was more than
  three times greater than the national rate of
  expulsion in grades K-12.

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A Promising Alternative

• Early Childhood Mental Health Consultation
• 50 reduction in expulsion rates in classrooms
  that have access to an early childhood mental
  health consultant (Gilliam, 2008)

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Definition of Early Childhood Mental Health
Consultation
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. (Cohen Kaufmann, 2000)
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Video of Healthy Futures Program

• Media Version

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What Works? Georgetown University, Center for
Child and Human Development
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DC Healthy Futures Model

• Quality Services Frequency and Caseload
• Clinician embedded in centers 1 to ½ day per week
• Each consultant provides early childhood mental
  health consultation to 6-7 Centers each week
• Relationship with centers starts with a Center
  Director guided needs assessment and
  implementation plan

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HEALTHY FUTURES Model

• Licensed MH clinician with early childhood
  experience
• Trained in ECMHC through University of Maryland
  and Georgetown University

• Provision of early childhood mental health
  consultation to 6-7 Centers
• Spend one day or half day per week at each center

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Quality Services
Programmatic Consultation

• Formal and Informal Classroom observation
• Development of Classroom Plans
• Prevention and Early Intervention Activities
• Modeling and Coaching

• Support and Guidance around Social Emotional
  Screening
• Promote Team Building and Communication
• Staff Training A Z
• Classroom Set-up and Environment

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Quality Services Child and Family Centered
Consultation

• Social Emotional Screening and Assessment
• Developing and Monitoring Individual Intervention
  Plans
• Promotion of Early Childhood Mental Health
• Community Referrals

• Child observations
• Home Visits
• Parent and Staff Training and Skills Workshops
• Classroom and family consultation regarding
  challenging behaviors

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Activity Measurement Tool(s)
Frequency and intensity of consultation service Consultation log
Impact of consultation on the social-emotional quality of CDCs Goal Achievement Scale (GAS) Job Stress Index Teacher Survey
Satisfaction of ECMHC services Year End Directors Survey
Social-emotional climate of classrooms Pre-School Mental Health Climate Survey (Year 1) CLASS (Year 2) Arnett Caregiver Interaction Scales (Year 3)
Child specific consultation outcomes Devereux Early Childhood Assessment
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Expulsion data

• Every year, Healthy Futures consultants serve
  child development programs that enroll more than
  1,200 children under 5.
• Healthy Futures expulsion rates have averaged 3.3
  per 1300 across all 3 years of operation (well
  below national average of 6.7)
• In Year 4 Healthy Futures centers had 0 expulsions

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Summary of Outcomes Pre and Post Years 1 - 4
Classroom Environment Teacher Skill and Knowledge Childrens Behaviors
Improved child interactions with staff and peers Increased teacher ability to manage challenging behaviors Improved social emotional development
Reduced Punitive Behaviors from staff Improved staff awareness of potential classroom challenges and ability to avert problems Increased protective factors attachment, initiative, and self regulation
Improved Emotional Support and Engagement from staff Improved comfort in referring and knowledge of behavioral health referral resources Significant reduction in parent and teacher report of behavioral concerns
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Classroom Climate Year 3
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GAS Year 1 Change in Teacher Behaviors (Director
Report)
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DECA Year 4 Child Social Emotional Improvements
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DECA Year 4 Decrease in Behavioral Concerns
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PRIMARY PROJECT - A school-based
Intervention
J'Wan Griffin, LICSW, School Primary
Project Program Manager Department of Behavioral
Health, School Mental Health Program, Washington,
DC
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What is Primary Project?

• an evidence-based, early intervention/prevention
  program
• developed over 50 years ago by the Childrens
  Institute, Rochester, New York
• adopted by Department of Behavioral Health in
  2008
• for children pre-kindergarten through 3rd-grade
  identified as having mild problems with
  social-emotional adjustment in the classroom,
  i.e., shy and withdrawn, have limited or poor eye
  contact, have limited self-confidence, are
  slightly overactive or distractible, may display
  mild aggression, at times

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What is Primary Project? (continued)

• Five (5) Components
• 1) screening for early identification and
  intervention
• 2) intervention - one-to-one, non-directive
  (child-led) play sessions with a trained
  paraprofessional
• 3) collaboration with a mental health
  professional to enhance the continuum of mental
  health service provision
• 4) ongoing supervision, training, and program
  evaluation and
• 5) integration into the school community

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Determining Eligibility The Teacher-Child
Rating Scale (T-CRS)

• the T-CRS is a valid measure
• consists of 32 questions completed by the teacher
• reflects the teachers perception of each
  childs classroom performance in the following
  domains
• task orientation
• behavior control
• assertiveness
• peer social skills
• not time-consuming takes less than 5 minutes
• Assessment Report generates immediately

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Primary Project Screening
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The Intervention

• a play room or area consisting of a special
  arrangement of expressive toys, i.e., playdoh,
  dolls, cars, trucks, crayons, markers, puppets,
  etc.
• the play session is one-to-one, and,
  non-directive (child-led)
• conducted by a Child Associate, trained
  paraprofessional who uses specific communication
  techniques during the play session in interaction
  with the child
• 15 or 20-minute play sessions are conducted
  weekly for 8 to 15 weeks
• The child controls the play session and can play
  with whatever they want 3 rules apply during the
  play session (the Child Associate explains the
  rules to each student before play sessions
  begin)
• 1) you cannot harm yourself
• 2) you cannot harm the Child Associate and
• 3) you cannot destroy the toys

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Ive learned that people will forget what you
said, people will forget what you did, but people
will never forget how you made them feel.

• Maya Angelou (1928-2014)
• Quoted in the local Express newspaper on May 29,
  2014

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The Child-Child Associate Interaction

• The child-Child Associate relationship during
  play sessions has a total interaction time of
  only 4-8 hours during the school year
• Yet, the relationship has a powerful IMPACT on
  the childs social-emotional development, i.e.,
  decrease in shy and/or withdrawn behaviors,
  increase in verbal responses, improved
  decision-making, heightened self-confidence, etc.
• Enhances school-related competencies in four (4)
  domains, i.e., task orientation, behavior
  control, assertiveness, and, peer social skills

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Benefits of Primary Project

• Its an evidence-based program
• Provides early
• 1) detection of adjustment problems in young
  children
• 2) identification of need for mental health
  intervention
• 3) intervention to minimize/eliminate adjustment
  problems
• Promotes pro-social behaviors, i.e.,
  self-regulation, decision-making, positive
  self-esteem, improved self-confidence, etc.
• Improves school readiness and enhances
  school-related competencies
• Observable changes at school and home are
  reported by school staff, clinicians, Child
  Associates, and, parents/guardians
• The program enhances the DBH continuum of
  school-based mental health services for children
• School-based intervention occurs during the
  school day

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SY2013-14 Teacher-Child Rating Scale Results
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SY2013-14 Associate-Child Rating Scale Results
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Primary Project Screening Results
(2008-2013)
Students SY2008- 2009 SY2009-2010 SY2010-2011 SY2011-2012 SY2012-2013 SY2013-2014
screened 991 1435 835 1445 2664 3031
positive for Primary Project 355 (36) 522 (36) 323 (39) 497 (34) 579 (22) 567 (19)
of participants 164 329 206 269 328 247
positive - HF/SMHP service 65 (7) 99 (7) 105 (13) 354 (24) 785 (29) 868 (29)
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Presenter Contact Information

• Barbara Parks barbara.parks_at_dc.gov
• Shana Bellow shana.bellow_at_dc.gov
• JWan Griffin jwan.griffin_at_dc.gov