Janice L. Cooper, PhD Interim Director, NCCP

1. Intentional Policy-making to Support Young Children!Establishing Conditions for Optimum Child Development in the Early Years Janice L. Cooper, PhD Interim Director, NCCP Early Childhood Mental Health Blue Ribbon Policy Denver, CO | May 19, 2010

2. Who We Are • NCCP is the nation’s leading public policy center dedicated to the economic security, health, and well-being of America’s low-income children and families. • Part of Columbia University’s Mailman School of Public Health, NCCP promotes family-oriented solutions at the state and national levels. • Our ultimate goal: Improved outcomes for the next generation.

3. NCCP’s Early Childhood Team and FES Team that Contribute to Our ECMH Work • Sheila Smith, PhD, Director • Yumiko Aratani, PhD, Assoc. Research Scientist • Vanessa Wight, PhD, Demographer • David Seith, Research Analyst • Liz Isakson, MD • Louisa Higgins, MA, Project Thrive Coordinator • Will Schneider, Data Manager, ITO

4. Outline • Setting the Context • Why Social-emotional Development Matters? • What Do We Know about Systematic Efforts to Develop Policies that Facilitate S-E Development? • Recommendations

10. Research Also Shows that Exposure to Multiple Risks Matter • The more risk factors, in general, the worse the outcomes, regardless of what they are • Infants, toddlers and parents who face 4+ demographic risk factors in EHS benefit less than other children (impacted about 26% of the sample). • Multiple risks increase the odds of poor outcomes exponentially • Child with 1 risk factor has nearly 2 times • Child with 2 risk factors has nearly 3.3 times, • Child with 3 risk factors has over 4.5 times • Child with 4 risk factors has more than 15 times • Higher odds of experiencing poor health or developmental delays than a child with no risk factors

13. Young child poverty by percent of young children with 3 or more risk factors, 2008

14. Setting the Context Poverty rate rising • Overall poverty rate rose from 12.5% to 13.2%; the first statistically significant increase since 2004.   • Child poverty increased a full percentage point—rising from 18% to 19%. • Latest data show that 14.1 million children live in poverty. • Children of color living in poverty increased: • Asian-Pacific Islander (from 12.7% to 15.0%) • Hispanic heritage Latino (28.7% to 30.5%) • American-Indian children (25.7% to 31.3%)

17. KIDSCOUNT: Colorado’s Data Shows • Ranks in middle in child poverty • Experienced greatest 10 yr in US • Child poverty rate 10% to 15% over 10 yrs • Growth # children of first gen Americans above US • 230% growth vs 90% Sources: Kids Count 2010, Kaiser 2010

18. KIDSCOUNT: Your Own Data Shows • Too many uninsured children Poor Children <100% FPL • CO (30.6) vs. US (18.1) • Children as a percentage of the uninsured: • CO (21.2) vs. US (17)

19. NCCP’s Early Child Profile Shows that Colorado • Made several important recent decisions to put children first, even in these difficult times. A few examples: • Provides relative generous eligibility levels for public health insurance Medicaid, CHIP- 250% FPL (children 0-5 yrs.); temp. coverage for pregnant women up to 200% FPL • CO is one of the states that funds a pre-K/Head Start ($28.4 m in 2008), but from prior year • CO has implemented a statewide childcare Quality Rating Improvement System (QRIS) and a statewide home visiting program (NCCP new study stresses “I” in QRIS)

20. WHY SOCIAL-EMOTIONAL DEVELOPMENT MATTERS?

21. Poor Mental Health Outcomes Start Early Young Children with “challenging behaviors” and social- emotional problems: • Often fare poorly in achieving benchmarks for early school success • Are 3X more likely to be expelled from pre-school than children/youth K-12 • More likely to experience problems later such as conduct disorder, anti-social behaviors and serious mental health conditions

22. Modeling Policy Changes Colorado Simulator

23. Basic Budget Needs: Selected Localities

24. What does it take to make ends meet?

25. Social emotional development for young children • Far-reaching consequences and implications for the life-span of an individual and ultimately of a nation • Indicators of good social emotional development include: • positive peer relationships • positive child adult relationships • language development—expanding ability to use vocabulary including emotional vocabulary, and expanding ability to express needs and relationship with world and manage emotion.

26. Social emotional development for young children • Prenatally we can prepare for a child’s social emotional development: • good spacing between children • health before, during and after pregnancy can reduce the risks for conditions (including depression) • From birth we can provide parents with supports that: • they need to help children to develop relationships that are healthy • support their individual ways of learning, their efforts to learn new things and their ability to get along with their peers • prevents and treats maternal depression • support parents through effective parenting education, provide supports for positive alternatives to help parents parent!

27. Why NCCP interested in Social-Emotional Development in Early Childhood • Income matters • Early experiences and relationships have lasting consequences • Multiple risk factors increase the chances of harmful effects Key Take Home Messages from Child Development Research

28. Income Matters • Net of any other changes, increased income improves school readiness • Financial hardship reduces parents ability to invest in time and resources to promote positive outcomes • Financial stress has been linked to parenting, relationship challenges and poor mental health outcomes • Recent synthesis of literature on the impact of homelessness on child functioning found across studies poverty matters [1/2 homeless children 0-5]

29. CHILD MENTAL HEALTH

30. Children’s Mental Health Today Courtesy Bruner

31. Research Shows Vast Needs that Go Unmet • Social-emotional/behavioral problems common among young children • 9.5-14% problems impact learning, functioning, achievement • Family, Environmental and Neighborhood Risk Factors may Compound Vulnerability: • Family risks factors (eg poverty) increase odds of behavioral problems that impact development • 40% of 2 yos in ec settings experience poor/insecure attachments • Yet research shows that 50% of the impact of income could be mediated by strategies that focused on parenting

32. Research Suggests Disparities in Access for Young Children • Differences in access by race/ethnicity, age • Between 80-97% very young children do not get access to early childhood mental health services • Disproportional pre-school expulsions based on race/ethnicity • African-American preschoolers 3X White, 5X API

33. In Colorado, Office of Health Disparities’ 2009 Report on Racial & Ethnic Disparities showed

34. In Colorado, Office of Health Disparities’ 2009 Report on Racial & Ethnic Disparities showed

35. In Colorado, Office of Health Disparities’ 2009 Report on Racial & Ethnic Disparities showed

36. State of Services and Supports for Young Children • Difficult to Fund and Sustain in Many States: • Effective two generation strategies and those that build and support parent-child relationships • Strategies such as mental health consultation, social emotional learning • Standardized screening tools to ensure accurate identification • Social emotional learning in schools and child care settings

37. State of Services and Supports for Young Children • Inadequate Infrastructure Supports Hamper Progress: • Poor provider capacity • Shortage and competencies in early childhood development • Mental well-being of non-relative care givers • Inadequate appropriate developmental fit for some diagnostic procedures and failure to either fund based on risk or systematic adopt a cross-walk like DC 0-3R to maximize reimbursement for needed services • Few statewide training institutes to improve the quality of interventions across domains • Insufficient focus on outcomes for young children

38. The Core Findings Unclaimed Children: Early Childhood • 44 states reported one or more early childhood initiatives; 37 states CMHA funded early childhood mental health services directly. • In only half of these states is at least one initiative statewide. • Initiatives encompass early childhood specialists in CMHC’s (N=21); ECE mental health consultation programs (N=26); reimbursement for social & emotional screening tools; working with adult mental health (N=15).

39. Type of ECMH Initiatives* CMHA funds (N=51) *Includes infrastructure building related initiatives

40. Examples of Systematic Efforts to Develop Policies that Facilitate S-E Development in Early Intervention • Strengthening ECMH training for Part C providers. Eg: New Mexico and Kansas adopted the MI Association for Infant Mental Health Endorsement System. • Using a risk-assessment tool to determine eligibility for early intervention services. Eg: MA and KS include child and parental factors such as: parental behavioral health conditions, and lack of social supports • Requiring core competencies for EI specialists. Eg: In MA, knowledge of "how children learn through relationships" and skills in using strategies to "engage and support caregivers in positive interactions with their infants and toddlers that promote healthy social-emotional development.

41. Examples of Systematic Efforts to Develop Policies that Facilitate S-E Development • Strengthening early identification and treatment of maternal depression – • WIC screening in MD • IL leveraging funding incentives, validated tools • ECMH consultation statewide • IL – all child care programs reflective supervision- Erikson Inst. • MD using Georgetown model • CT - all child care programs reflective supervision, Yale • AZ including home visiting, reflective supervision, training attachment, trauma – quality monitoring

42. Examples of Systematic Efforts to Develop Policies that Facilitate S-E Development • Child screening validated tools and enhance rates use in PC settings • MN DOH instruments SE • MI • NC • Provider training and support PITC (Pgm Infant/Toddler Caregiver) • FL, IL, IN, IA, KS, MN, MS • ND, NM, TX, OH, OK, • SC, SD, WY

43. Recommendations for Policy Action • Fund effective two generation strategies and those that build and support parent-child relationships • Reimburse strategies such as validated assessments, mental health consultation, and social emotional learning • Infuse funding and support for young children in both education and human services’ strategic agenda • Address the pervasive shortage among mental health providers including those with expertise in early childhood • Require a focus to reduce based on age, race/enthicity and language related disparities including public reporting on outcomes

44. Recommendations for Policy Action • Address the need for effective parenting programs • Take to scale effective strategies to all young children and their parents • Require that agencies that touch children and families have a shared goal for social-emotional healthy children and are held accountable for meeting this goal. That means matching financing to support this goal. • Support efforts to reduce the impact of income on poor young child outcomes.

45. For More Information, Contact Janice Cooper jc90@columbia.edu Or Visit NCCP web site www.nccp.org SIGN UP FOR OUR UPDATES