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Gratefully acknowledges support for this educational activity from

gratefully acknowledges support for this educational activity from…

  • Improving Mental Health in Primary Care Through Access, Collaboration, and Training grant provided to the AAP through the Maternal and Child Health Bureau

  • Child Care and Healthy Partnership grant provided to the AAP through the Child Care Bureau and the Maternal and Child Health Bureau

  • Many colleagues


Partnering to address mental health concerns in early education and child care

Partnering to Address Mental Health Concerns in Early Education and Child Care

Webinar brought to you by:

American Academy of Pediatrics

March 23, 2009


Disclosures

Disclosures

  • We have no relevant financial relationships with the manufacturer(s) of commercial product(s) and/or provider of commercial services discussed in this CME activity.

  • We do not intend to discuss any unapproved/ investigative use of a commercial product/device in our presentation.


Welcome

Welcome!

Marian Earls, MD, FAAP

Guilford Child Health Inc

Task Force on Mental Health

Section on Early Education & Child Care

Section on Developmental & Behavioral Pediatrics


Gotowebinar attendee interface

GoToWebinar Attendee Interface

1. Viewer Window

2. Control Panel


General housekeeping tips

General Housekeeping Tips

  • All participants will be automatically muted throughout the presentation

  • At any time throughout the presentation, all participants are encouraged to ask questions using the question dialogue box I just showed you

  • During the Q & A period at the end of the presentation, I will recite questions and funnel the questions to the appropriate speaker to answer

  • Should you have any technical assistance questions during the event, please call 1-800-263-6317


Outline of webinar

Outline of Webinar

  • Overview: Health Professionals Involved in Early Education and Child Care Regarding Mental Health Concerns

  • Bringing it All Together: The Importance of the Medical Home

  • Successful Start: Rhode Island’s Early Childhood Systems Plan

  • Office of Head Start: Early Childhood Development and Mental Health Concerns and the Role of Community Pediatric Clinicians

  • Wrapping it Up: How to Find and Connect with Local Health Consultants

  • Question & Answer Session


Gratefully acknowledges support for this educational activity from

Overview: Health Professionals Involved in Early Education and Child Care Regarding Mental Health Concerns

Abbey Alkon, RN, PNP, PhD

UCSF School of Nursing

California Childcare Health Program

www.ucsfchildcarehealth.org

Section on Early Education & Child Care


Us children in child care

US Children in Child Care

A majority of children less than 6 years old (60-70%) spend time in out-of-home child care.

Young children’s socio-emotional development is based on relationships.

Early identification of mental/behavioral and physical health problems can help children get needed services and be ready for kindergarten

Center on the Developing Children; Mental health problems in early childhood can impair learning and behavior for life. Working paper #6; 2008

9


Us children in child care1

US Children in Child Care

12 million children: more than 9 million

are in licensed child care facilities.

105,444 child care centers.

213,966 family child care homes.

16,110 other licensed facilities.

About 3 million children are cared for in unlicensed and unregulated care.

10


Background

Background

The most common health concerns for child care providers are:

Infectious diseases (for children < 2 years of age)

Challenging behaviors

Expulsion rates in child care are higher than elementary school

High child care staff turnover

Children need to be physically and mentally healthy to be ready to enter kindergarten

11


Prevalence and risk

Prevalence and Risk

  • 13%-23% of preschool children have mental health problems.

    • Higher rate with the co-occurrence of other risk factors

  • Less than 1% of preschool children receive mental health services.

12

Raver, etal. 2008. ECRQ. Per Yoshikawa and Knitzer, 1977; Pottick & Warner, 2002.


Social and emotional development in young children

Social and Emotional Development in Young Children

How they feel about themselves

Confident, secure,, eager to learn, proud of their culture versus always scared, afraid of being wrong

How they behave

Constantly fighting, easily upset, temper tantrums versus able to deal with conflict

Withdrawn, shy

Eating problems

How they relate to others

Especially people who matter to them, e.g., parents, teachers, and friends

National Center for Children in Poverty. www.nccp.org/pub_rps05.html

13


Goals

Goals

14

Promote healthy physical and emotional development.

Identify early signs of emotional and/or behavioral difficulties.


Health professionals involved in child care

Health ProfessionalsInvolved in Child Care

Child Care Health Consultants (CCHC)

Early Childhood Mental Health Consultants (ECMHC)

Primary Care Clinician (PCC)

15


Gratefully acknowledges support for this educational activity from

Communication and the Medical Home

Primary CareClinician

Childand Family

Early Childhood Mental Health Consultant

Child Care Health Consultant


Child care health consultants

Child Care Health Consultants

“A health professional who has interest in and experience with children, has knowledge of resources and regulations and is comfortable linking health resources with facilities that provide primarily education and social services”

Health Professionals: nurses, physicians, health educators, social workers, etc

Training: National Training Institute (train-the-trainer program)

Gold Standard: National Health and Safety Performance Standards (Caring for Our Children)

Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care, 2nd Edition, 2002.

17


Child care health consultants job responsibilities

Child Care Health Consultants Job Responsibilities

Establish a trusting relationship

Conduct baseline needs assessment

Identify health problems to target for intervention

Develop or update written health policies

Provide workshops for child care providers and families

Provide regular telephone or email advice

Provide referrals to community services

Review health records

Develop care plans for children with special health care needs

18


Impact of child care health consultation

Impact of Child Care Health Consultation

National health and safety standards (CFOC)

Increased # and quality of written health and safety policies

Medication administration, exclusion of ill children, care of mildly ill children, daily health check, emergency preparedness, and inclusion of children with special needs

Improved health and safety practices

consistent with CFOC

Emergency preparedness

Reduction in risk of SIDS

19


Impact of child care health consultation continued

Impact of Child Care Health Consultation, Continued

Child Health Status

Immunizations up-to-date

Medical home

Health care plan for children with special health care needs

Health Insurance

The influence of child care health consultants in promoting children’s health and

Well-being: A report on selected resources. 2006.

http://hcccnsc.edc.org/resources/data/CC_lit_review_Screen_All.pdf

20


Early childhood mental health consultants

Early Childhood Mental Health Consultants

Providers with mental health expertise and training on early care and education

“…collaborate with administrators, staff and family members of children from birth through 6 years of age participating in group care and early education settings…”

Builds staff capacity

To promote children’s social and emotional development

To address challenging behaviors

Brennan, EM, Bradley JR, Allen MD, Perry DF. (2008). The evidence base for mental health consultation in early childhood settings: Research synthesis addressing staff and program outcomes. Early Education and Development, 19(6): 982-1022.

21


Early childhood mental health consultants1

Early Childhood Mental Health Consultants

Types of Consultation

Child- or Family-Centered Consultation

Programmatic Consultation

Focus on relationships

Staff and consultant, child, parent

Cohen, E., and Kaufmann, R. Early Childhood Mental Health Consultation. DHHS Pub. No. CMHS-SVP0151. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.

22


Early childhood mental health consultants2

Knowledge of child development, normal growth and development, and ability to identify atypical behavior

Understand concepts underlying young children’s socio-emotional development

Observation, listening, interviewing, and assessment skills

Understanding of cultural differences

Ability to work with adults and knowledge of adult learning principles

Ability to recognize the diverse perspectives of staff and to facilitate communication of these perspectives

Knowledge of early childhood, child care, family support and early intervention systems, both public and private

Early Childhood Mental Health Consultants

Cohen, E., and Kaufmann, R. (2005).

23


Consult with staff for children who may not succeed in school transition

Consult with Staff for Children Who May Not Succeed in School Transition

Engage in frequent fighting, shouting, or other aggressive behaviors

Are unable to control impulsive behavior

Are unable to pay attention to tasks or follow directions

Engage in oppositional, noncompliant, even defiant behavior

Are unable to cooperate with others

Constantly seek attention from peers or teachers

Ignore peers or teachers

Raver and Knitzer (2002) Ready to Enter: What research tells policymakers about strategies to promote social and emotional school readiness among three- and four-year-old children. National Center for Children in Poverty.

24


Impact of early childhood mental health consultation

Impact of Early Childhood Mental Health Consultation

Review of 26 studies from 1985-2008 of staff and program outcomes (not child level)

Programs generally served urban, ethnically diverse children 2 to 5 years old

Results:

Staff increased self-efficacy/confidence and competence in dealing with troubling or difficult behaviors

Staff improved sensitivity and had lower job-stress

Improved overall quality of child care program

Reduced staff turnover

Brennan, EM, Bradley JR, Allen MD, Perry DF. (2008).

25


Developmental screening of young children

Developmental Screening of Young Children

Where?

Primary care office

Child care

What screening instrument?

PEDS; www.pedstest.com

ASQ, ASQ- SE; www.pbrookes.com

ABLE; http://abletest.com

Others

How are results shared between PCC, child care provider, and child care consultants (CCHC, ECMHC)?

26


Primary care clinicians

Primary Care Clinicians

Rosie D. Reforming the Mental Health System in Massachusetts. Center for Public Representation Web site. Available at: http://www.rosied.org/Default.aspx?pageId=67061. Accessed March 9, 2009

27

  • Primary care clinicians have a critical role to play in meeting children’s mental health needs. In fact, Massachusetts is now requiring, by court order, universal mental health screening by primary care clinicians for all children on Medicaid in that state.

  • Provide guidance to families

    • Help parents find high quality early care and education experiences for their children

    • Complete health forms and care

      plans for children with special

      health care needs

    • Communicate health issues and/or

      treatment raised in PCC office or

      child care program


Primary care clinicians1

Primary Care Clinicians

Provide health consultation services to child care programs

Support child care in your local community to meet national standards for health and safety of child care for all young children.

Advocate for quality child care

State regulations to support health consultation

American Academy of Pediatrics. The Pediatrician's Role in Promoting Health and Safety in Child Care. Elk Grove Village, IL: American Academy of Pediatrics;

2001:25-27

28


Bringing it all together the importance of the medical home

Bringing it All Together: The Importance of the Medical Home

Jack Levine, MD, FAAP

Section on Early Education & Child Care

Section on Developmental & Behavioral Pediatrics


The medical home a concept rather than a building

The Medical Home: A Concept rather than a Building

Accessible

Family-centered

Continuous

Comprehensive

Coordinated

Compassionate

Culturally Effective


Successful early child care

Successful Early Child Care

Informed, activated family

Integrated, supportive community

Community resources and agencies

Medical Home

Based on Wagner et al.


Integral part of community based system

Integral Part of Community-based System

Coordinates with community-based services designed to promote the healthy development and well being of children and their families

Facilitates access to and collaborates with a broad range of specialty, ancillary and related community services


Gratefully acknowledges support for this educational activity from

Communication and the Medical Home

Primary CareClinician

Childand Family

Early Childhood Mental Health Consultant

Child Care Health Consultant


Effective communication among health professionals

Effective Communication Among Health Professionals

  • Primary Care Clinician – Family – Consultant

  • Results of screening or initial evaluations

  • Reason for referral to mental health consultant

  • Share important medical information

  • Collaborate and cooperate on care plan for children

    • Medications

    • Emergencies

  • STAY INVOLVED!


  • Communication with child care providers

    Communication With Child Care Providers

    • Written communication

      • Clear language with no jargon

      • Write-out care plan and instructions

    • Appreciation for child care provider

      • Know children’s behavior in group situations

      • Experience with range of children’s behaviors


    Successful start rhode island s early childhood systems plan

    Successful Start: Rhode Island’s Early Childhood Systems Plan

    Susan Dickstein, PhD

    Bradley/Hasbro Children’s Research Center

    Brown Medical School


    Successful start rhode island s early childhood systems plan1

    Successful StartRhode Island’s Early Childhood Systems Plan

    Improved Outcomes for Children & Families

    through

    A More Effective Early Childhood System


    Gratefully acknowledges support for this educational activity from

    Successful Start VISION

    To create a comprehensive and coordinated early childhood system that supports families and communities in promoting positive early childhood development so that allchildrenenterschoolhealthyandreadytolearn.

    Successful Start MISSION

    To ensure that all young children reach their full potential through a system of services that promotes healthy social-emotionaldevelopment, quality earlycareandeducation, coordinated medicalhomes, and effective parenteducationandfamilysupport services.


    Gratefully acknowledges support for this educational activity from

    Critical Components of

    Early Childhood Systems

    SOCIAL-EMOTIONAL COMPETENCE

    Optimal Outcomes for Young Children and their Families

    MEDICAL HOMES

    EARLY CARE & EDUCATION

    PARENT EDUCATION & FAMILY SUPPORT


    Gratefully acknowledges support for this educational activity from

    Critical Components of Early Childhood Systems: Programs

    SOCIAL-EMOTIONAL COMPETENCE

    CCSN Early Learning Standards

    CCHC EHS/HS

    PEP/PBIS Early Intervention

    Family Outreach Strengthening Families

    Watch Me Grow KIDSCONNECT

    Child Outreach Bright Stars (QRiS)

    PPEP T.E.A.C.H.

    FCCP IYS

    LAUNCH Nurse Family Partnership

    MEDICAL HOMES

    EARLY CARE & EDUCATION

    PARENT EDUCATION & FAMILY SUPPORT


    Mental health consultation to improve child care contexts

    Mental health consultation to improve child care contexts

    Child Care Support Network

    Early Childhood

    Mental Health Consultation

    Funding provided by:RI Dept of Human Services,RI Dept of Health, and the

    RI Maternal & Child Health Bureau


    Gratefully acknowledges support for this educational activity from

    CCSN-Supported Activities

    Classroom Outcomes

    Child Outcomes

    • Child Social-Emotional Behavioral Functioning

    • Social-Emotional Competence at School

    • Behavior Regulation at School

    Classroom observation and feedback to staff

    Classroom Support

    Program support

    In-service training workshops of topics relevant to early childhood mental health

    • Classroom Functioning

    • CR Environment

    • CR Atmosphere

    • CR Quality

    • CR Behavior Patterns

    • Teacher Practices

    • Teacher Strategies

    • CR Map

    • Parent Involvement

    • Supervision practices

    • School Success:

    • Decreased suspensions & expulsions

    • Decreased mobility


    Ccsn mhc implementation questions pilot year 1

    CCSN MHC ImplementationQuestions (Pilot Year 1)

    • How Were Child Care Centers Enrolled?

    • Who Participated?

    • How Did Classroom Observations Inform ECMHC Activities?

    • What ECMHC Activities were Implemented?A) Type?B) Amount?


    How were child care centers enrolled

    How Were Child Care Centers Enrolled?

    • Active Recruitment by RI Dept of Health

    • Priority to centers serving children with DHS child care subsidies

    • Eligible centers assigned to ECMHC for up to 12 months

    • ECMHC conducted on-site enrollment Interview

    • Collaborative plan to determine needs of the center; center “point person” for ECMHC; schedule of consultation services, etc.

    • Pre-ECMHC classroom observations scheduled & staff questionnaires completed

    • 2-session workshop training scheduled (based on CSEFEL principles)


    Gratefully acknowledges support for this educational activity from

    Age range (months)

    # classrooms

    # children

    # staff

    Center 1

    0-60+

    5

    50

    10

    Center 2

    0-60+

    4

    47

    11

    Center 3

    36-60

    1

    25

    6

    Center 4

    0-36

    4

    27

    10

    Center 5

    0-36

    7

    84

    29

    Center 6

    36-60+

    2

    45

    14

    TOTALS

    23

    278

    80

    2. CCSN MHC Pilot Yr 1: Who Participated?


    How did classrooms observations inform ecmhc activities

    How did Classrooms Observations Inform ECMHC Activities?

    • Classroom observations in every classroom by evaluation team using standardized tools

    • Clinical feedback provided to ECMHCs

    • ECMHC worked with program to incorporate feedback into consultation plan and ongoing consultation activities


    What ecmhc activities were implemented

    What ECMHC Activities were Implemented?

    Classroom Support

    • Consultation- classroom, child, or family concerns

    • Classroom improvement plans

    • Program enhancements for challenging behaviors and/or developmental concerns

    • Communication with parents about child behavior/development

    • Community-based referrals

      Program Support

    • Case management reviews

    • Reflective supervision practices

    • Team building

    • Workshop Trainings


    Summary of pilot year 1 direct ecmhc activities

    Summary of Pilot Year 1 Direct ECMHC Activities

    • Most (83%) MHC activities were conducted at the classroom support level (ranging from 57-97%)

    • Some (11%) MHC activities were conducted at the program level (ranging from 3-25%)

    • 5/6 programs participated in the 2-session workshop series


    Engagement with ecmhc activities

    Engagement with ECMHC Activities

    • On-site Consultation: Average rating of satisfaction with MHC activities=4.36 on scale from 1(low) to 5 (high)

    • MHC Workshops: 94% participants reported strong agreement with stated learning objectives (e.g., I can describe how classroom environments support child development, etc.)


    Evaluation questions

    Evaluation Questions

    Were there pre-post ECMHC changes in:

    • classroom functioning?

    • teacher practices?

    • program supervisory practices?

    • rate of expulsion from child care centers?


    Classroom functioning

    Classroom Functioning?

    • Environment (space, care routines, interactions, activities, structure, parent involvement)

    • Quality (general functioning)

    • Atmosphere (child compliance, cooperation, interest, enthusiasm in classroom activities)

    • Behavior Disruptions during routine daily transitions (very challenging in most child care settings)


    Classroom environment

    Classroom Environment?

    Overall, ECERS/ITERS Total Scores* showed statistically significant improvement from pre-ECMHC (mean=3.67, sd=.57) to post-MHC (mean=4.08, sd=.62)*(scale: 1=inadequate, 3=minimal, 5= good, 7=excellent)

    Classroom Quality?

    Classroom PIRS Total Scores* showed small to moderate improvement (about 1/2 sd) from pre-ECMHC (mean=3.31, sd=.55) to post-ECMHC (mean=3.06, sd=.69)

    * (lower scores are positive)


    Classroom atmosphere

    Classroom Atmosphere?

    Classroom Atmosphere Total Scores* showed no substantive change from pre-ECMHC (mean=3.13, sd=.60) to post-ECMHC (mean=3.20, sd=.78)

    (*lower scores indicate better child emotional adjustment in the classroom)

    Classroom Behavior Problems?

    Classroom Situations Scores showed overall decrease in frequency of behavior disruptions during classroom transitions from pre-ECMHC (about 7 transitions with moderate to severe behavior disruptions) to post-ECMHC (about 5 transitions with moderate to severe behavior disruptions)


    Teacher practices

    Teacher Practices?

    • Self-reports by teachers generally showed small to moderate improvements in several areas:a) Confidence (significant change)b) Use of Positive Strategies (.35 sd change)c) Use of Praise (.63 sd change)d) Effective Limit Setting (.50 sd change)


    Program supervision practices

    Program Supervision Practices?

    Average rating of teacher satisfaction with supervision received by program supervisors showed small to moderate improvement (about 1/3 sd) from pre MHC (mean=3.99, sd=.77) to post MHC (mean=4.23, sd=.67)


    Rate of expulsion from child care centers

    Rate of expulsion from child care centers?

    “People working in the fields of child care and early childhood education knew there was a problem when a number of children as young as 3 were getting booted out of preschool because of disruptive behavior”.

    K. Shaw (2003)


    National preschool expulsion rates gilliam 2005

    National Preschool Expulsion Rates(Gilliam, 2005)

    • Average 3x higher than those of K-12.

    • Overall, for every 1,000 children in pre-K, 6.7 children are expelled.


    Preventing preschool expulsion mental health consultation

    Preventing Preschool Expulsion: Mental Health Consultation

    • Access to early childhood mental health consultation is associated with lower rates of expulsion from pre-K

    • On-site access to a psychologist or social worker expelled 5.7 children per 1,000

    • Lack of access to early childhood mental health consultation expelled children at the highest rates of 10.8 per 1,000

      (Gilliam, 2005)


    May reduce risk of preschool expulsion by

    May Reduce Risk of Preschool Expulsion By:

    • Enhancing skills of early care and education providers in behavior and classroom management;

    • Increasing developmentally appropriate practices and expectations;

    • Reducing staff stress and turnover;

    • Reducing levels of problematic behavior in young children;

    • Enhancing early identification of problem behaviors;

    • Supporting the child care community, families, and children who are manifesting (or are at-risk for) problematic behaviors

      (Brennan, 2005; Perry, 2005)


    Impact of ecmhc on pre k expulsion rate 6 ccsn pilot year 1 mhc centers

    Impact of ECMHC on Pre-K Expulsion Rate: 6 CCSN Pilot Year 1 MHC Centers?

    • In year prior to ECMHC, these 6 pilot centers reported 4 expulsions = 16 per 1000 = 2 ½x national average

    • In year during ECMHC, these 6 centers reported 2 expulsions = 7.8 per 1000 =closer to national average & lower than the RI average

    • Centers reported 50% fewer expulsions from pre- to post-ECMHC

    • …Promising!


    How is the ccsn mental health consultation program sustained

    How is the CCSN Mental Health Consultation Program Sustained?

    Futures Directions of ECMHC in RI:

    • RI Association for Infant Mental Health (RIAIMH) to address workforce development issues in training front line professionals in principles of Early Childhood Mental Health; and in establishing standards/credentialing for consultants

    • Bright Stars (quality rating improvement standards for child care) to link with ECMHCs

    • Project LAUNCH

    • Workgroup Established for Integration and Financing for Children’s Developmental and Mental Health Services within Primary Care and Child Care Settings


    Gratefully acknowledges support for this educational activity from

    RI LAUNCH: Building on the Successful Start Results-Based Framework

    Inputs & Resources Core Components Infrastructure Change Outputs Outcomes

    Successful Start

    Statewide

    Early Childhood Systems Building

    ·  Infrastructure, Organization, & Partnerships

    ·  Early Childhood Systems Plan

    ·  Implementation of Project & Strategic Plan Goals

    • Diminished Service Delivery Boundaries

    • Organized Management Structure

    • State, Academic, Community, Family Partnerships

    • State Financing

    • Third Party Financing

    • Cross-Sector Goals

    • Sector-Specific Goals

    • Systems Capacity

    • Quality of Services

    • Service Integration

    • State & Community Policy Change

    • Program Evaluation

    AllChildren Healthy &Ready to LearnEarly childhood & family services that promote healthy early childhood physical, cognitive, and emotional development

    Parent Education & Family Support

    Early Care & Education

    Medical Homes

    Social-Emotional Development


    Launch setting providence ri

    LAUNCH Setting:Providence, RI

    • Rhode Island is smallest state geographically, 1.2 million residents

    • Providence is capital city, population 173,600 with 26,700 children 1-8 years

    • Latino (Puerto Rican, Dominican) and African American most prominent racial-ethnic groups (approx 75% minority in Providence)

    • 51% single parent; 28% < HS education; 43% living in poverty


    Goal 1 ecmhc in primary care settings

    Goal 1: ECMHC in Primary Care Settings

    • Integrate developmental and behavioral health screening in medical homes

    • Locate mental health consultants in pediatrician offices where screening is implemented to establish follow up; assessment; and targeted intervention


    Goal 2 link parent support and education in primary care

    Goal 2: Link Parent Support and Education in Primary Care

    • Assess parent and family functioning in primary care linked to developmental screening

    • Implement empirically validated parenting intervention for targeted families (VIPP; IYS)

    • Identify third-party reimbursement mechanisms for empirically validated parenting interventions


    Goal 3 consultation in child care settings

    Goal 3: Consultation in Child Care Settings

    • Implement mental health consultation in child care; integrated with developmental screening

    • Implement empirically validated classroom behavior management training for staff in child care (IYS CBMS)

    • Implement empirically validated parent training for targeted families (VIPP; IYS)

    • Identify third-party reimbursement mechanisms for child/family assessment and empirically validated parenting interventions


    Challenges

    Challenges

    • Minimize extent to which current programs work in silos

    • Develop referral resources beyond consultation for identified children (0-8) and their families

    • Develop sustainable funding mechanisms

    • Establish standards/competencies for professionals in early childhood fields; and for child care quality


    Opportunities

    Opportunities

    • Training opportunity for early childhood professionals

    • State government – academic partnership

    • Alignment with multiple state initiatives for improving children’s behavioral and physical health


    For more information

    For More Information

    Susan Dickstein, PhD

    401-793-8731

    [email protected]

    Kristine Campagna, MEd

    401/222-5927

    [email protected]

    Special thanks to CCSN Early Childhood Mental Health Consultants at:

    Bradley Early Childhood Clinical Research Center/Brown Medical School

    Providence Center Early Childhood Institute


    Gratefully acknowledges support for this educational activity from

    Office of Head Start: Early Childhood Development and Mental Health Concerns and the Role of Community Pediatric Clinicians

    Barry Marx, MD, FAAP

    Senior Medical Advisor, Office of Head Start


    Office of head start mission statement

    Office of Head StartMission Statement

    “To promote school readiness by enhancing the social and cognitive development of children through the provision of educational, health, nutritional, social and other services to enrolled children and families.”


    Early childhood development health services

    Early Childhood Development & Health Services

    Commitment to Wellness

    To ensure a comprehensive vision of health for children, families, and staff.

    Objective

    To ensure that, through collaboration among families, staff, and health professionals, all child health and developmental concerns are identified, and children and families are linked to an ongoing source of continuous, accessible care to meet their basic health needs.


    Head start performance standards

    Head Start Performance Standards

    Child mental health services

    • Collaborative relationship between agencies and families

    • Secure necessary mental health services

    • Regular schedule of on-site mental health consultation involving the mental health professional, program staff, and parents

      Human resources management

    • Staff consultants must meet standards for qualified candidacy

    • Mental health consultants must be licensed or certified mental health professionals with relevant experience


    Head start information report

    Head Start Information Report*

    • Total actual enrollment: 1,061,275

    • Health insurance:

      • At enrollment: 927,094

      • At end of enrollment year: 990,189

    • Medical Home:

      • At enrollment: 928,553

      • At end of enrollment year: 1,007,550

        * From 2006-2007


    Head start information report medical services

    Head Start Information Report Medical Services

    • Up-to-date on a schedule of age-appropriate preventive and primary health care, including all appropriate tests and physical examinations: 954,277

    • Diagnosed as needing medical treatment (of the children screened): 186,957

    • Received or are receiving medical treatment (of the children diagnosed): 174,435


    Head start program information report screening

    Head Start Program Information Report: Screening

    Screening – Developmental, sensory, behavioral

    • Completed screening for developmental, sensory and behavioral concerns: 941,484

    • Identified as needing a follow-up assessment or formal evaluation: 124,654


    Head start program information report mental health mh services

    Head Start Program Information Report: Mental Health (MH) Services

    Mental health professional…

    Consulted with program staff about the child’s behavior or mental health: 143,458

    • Provided 3 or more consultations with program staff during the operating period: 47,384

    • Consulted with the parent(s) / guardians(s) about their child’s behavioral and/or mental health: 60,881

    • Provided an individual mental health assessment: 69,008

    • Facilitated a referral for mental health services: 31,251


    Head start program information report mental health mh services1

    Head Start Program Information Report: Mental Health (MH) Services

    Children who were…

    • Referred for MH services outside of program: 22,752

    • Received MH services: 16,765


    Collaboration to address children s mental health needs in head start

    Collaboration To Address Children’s Mental Health Needs in Head Start

    • Head Start Mental Health Consultant (MHC) and/or staff refers to PCC for evaluation and/or treatment

    • PCC communicates a behavioral/mental health plan of care to Head Start staff

    • Head Start MHC and/or staff collaborate to assist family (eg, referrals, ongoing care plan) in additional ongoing needs

    • PCC and Head Start staff share information about resources and service availability

    • Health professionals (eg, PCC, MH Professionals) shape the programs’ delivery of health services through participation on the Head Start Health Services Advisory Committee


    Head start health services advisory committee

    Head Start Health Services Advisory Committee

    • Links Head Start programs to essential persons, organizations, and resources within the community

    • Plays an important role in ensuring that Head Start children have medical and dental homes that will remain in place after they leave the program

    • Plays an integral part in the development of health policies and procedures for Head Start programs


    Head start health services advisory committee1

    Head Start Health Services Advisory Committee

    Participants on the HSAC may include, but are not limited to:

    􀁺 Pediatricians

    􀁺 Nurses

    􀁺 Nurse practitioners

    􀁺 Dentists

    􀁺 Nutritionists

    􀁺 Mental health providers

    􀁺 Women, Infants, and Children

    (WIC) program staff

    􀁺 Medicaid and SCHIP staff

    􀁺 Head Start parents

    􀁺 Head Start staff


    Head start and community pediatric clinicians

    Head Start and Community Pediatric Clinicians

    • Head Start staff and programs serve children, families and communities in the greatest need.

    • Collaboration between Head Start programs and community providers of pediatric health care strengthens both systems of care, and enriches the lives of staff, children, families, and communities.


    For more information1

    For more information

    Barry Marx, MD, FAAP

    Senior Medical Advisor

    Office of Head Start

    [email protected]

    Office of Head Start Web site

    http://www.acf.hhs.gov/programs/ohs/about/index.html#mission

    Head Start Program Performance Standardshttp://eclkc.ohs.acf.hhs.gov/hslc

    Committee on Community Health Services

    The Pediatrician’s Role in Community Pediatrics

    Pediatrics 2005;115:1092–1094

    http://aappolicy.aappublications.org/cgi/reprint/pediatrics;115/4/1092.pdf


    Wrapping it up how to find and connect with local health consultants

    Wrapping it Up: How to Find and Connect with Local Health Consultants

    Marian Earls, MD, FAAP

    Guilford Child Health Inc

    Task Force on Mental Health

    Section on Early Education & Child Care

    Section on Developmental & Behavioral Pediatrics


    Find and connect with your local health consultants

    Find and Connect with your Local Health Consultants

    Healthy Child Care Consultant Network Support Center (NSC) http://hcccnsc.edc.org/

    • Registry of CCHCs

    • State profiles (contact CCHC coordinator)

      Are you a CCHC?

      Add your name to the NSC registry!!!


    Find and connect with your local health consultants1

    Find and Connect with your Local Health Consultants

    - National Training Institute for Child Care Health Consultants (train-the-trainer program) http://nti.unc.edu

    • Contact NTI to find local CCHCs who have been trained by an NTI graduate

      - National Association of Child Care Resource & Referral Agencies (NACCRRA) www.naccrra.org

    • Enter zip code to find local CCR&R

    • This agency can help you connect with local ECMHCs

      - National Technical Assistance Center for Children's Mental Health

      Georgetown University Center for Child and Human Development

      Georgetown University

      http://gucchd.georgetown.edu/programs/ta_center/contact/contact.html


    Question answer session

    Question / Answer Session

    • Please type in your questions in the chat log located on your control panel.

    • The phone lines for the panel members will be open at this time.

    • The moderator will select questions from the chat log and the panel members provide answers.


    Thank you for participating

    Thank You for Participating!

    This Webinar has been recorded

    and will be posted online, along with a complete resource list, at:

    www.aap.org/mentalhealth

    www.healthychildcare.org


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