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Emergence of infant and early childhood mental health as a field ... EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF CARE ... Mental health consultation to early care ...

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infusing mental health services and supports in early childhood settings

Infusing Mental HealthServices and Supports in Early Childhood Settings

Deborah Perry, PhD

Georgetown University

Center for Child and Human Development

May 11, 2006

why now
  • Increased awareness of problems of young children
  • Brain development research
  • Increased use of psychotropic medications
  • Problems in child care and early education settings
  • Emergence of infant and early childhood mental health as a field
  • Importance of environment and relationships
  • Relationship between healthy social and emotional development and later school success
early childhood mental health
  • For young children, mental health is:
    • The social, emotional, and behavioral well-being of young children and their families.
    • The developing capacity to experience, regulate, and express emotion;
    • Form close, secure relationships;
    • Explore the environment and learn.

(Adapted from ZERO TO THREE)

estimated prevalence
Estimated Prevalence
  • No national epidemiological data
  • In studies of health care visits, rates of psychosocial problems=10-21%; externalizing problems=7-17%
  • In Head Start, externalizing problems=10-23%
  • 10-15% typical preschoolers have chronic mild/moderate behavior problems
  • No data for children under age of 2

Center for Evidence-Based Practice: Young Children with Challenging Behavior

school readiness skills
School Readiness Skills
  • Emotional self-regulation
  • Behavioral self-regulation
  • Empathy and perspective taking
  • Communicating needs, desires & interests in pro-social way
  • Understanding cause & effect sequences
  • Interest, motivation, persistence
  • Early Childhood Resource Center, RTI


Fosters the social and emotional well-being of infants toddlers, preschool-age children and their families

Services and Supports


Family Voice

Child and Family Centered

Relationship Based

Culturally Competent

Infused into Natural Settings and Services

Grounded in Developmental Knowledge

Supports for Parents and Families

Supports for Other Caregivers

Services for Children and Families

Building Blocks

Strategic Planning, Policies, and Procedures

Maximized and Flexible Funding

Interagency Partnerships

Prepared Workforce

Outcome Evaluation




Developed by Roxane Kaufmann, GUCCHD

the system of care concept and values
  • A philosophy or framework about the way services should be delivered to children and families based on core values and principles
  • Not a model or single definable thing –

It is a community specific design built within this framework; around local/state leadership, political context and funding; and to fit with other early childhood initiatives and partnerships

the pyramid
The Pyramid

Levels and Types of Intervention




  • Developmental and social-emotional screening in primary care and early care and education programs
  • High quality child care
  • High quality training on social-emotional development
  • Use of an evidence-based early childhood curriculum
  • Dissemination of information promoting healthy social-emotional development
  • Home visitation programs
  • Mental health consultation
  • Family mentors
  • Social skills curricula
  • Family supports
  • Caregiver supports
  • Intervention
  • On-site mental health consultation
  • Crisis teams
  • Wraparound services
  • Relationship-based therapy
  • Hotline for families
  • Behaviorally-based programs in a variety of settings
  • In-home treatment
ecmh system of care values and principles
Family Voice

Child and Family Centered

Relationships Based

Culturally Competent

Continuum of ECMH Services and Supports

Infused into Natural Settings and Services

Grounded in Developmental Knowledge




why culture matters
Why Culture Matters

Because it affects…

  • Attitudes and beliefs about mental health
  • Expression of symptoms
  • Coping strategies
  • Help-seeking behaviors
  • Utilization of services
  • Appropriateness of services and supports

Lazear, K., (2003). Primer Hands On

work force issues
Work Force Issues
  • Lack of trained personnel
  • Stigma
  • Barriers in communication between early childhood and mental health
  • Changing practices from reactivity to prevention
  • Lack of ongoing support to providers
work force issues1
Work Force Issues
  • Allocation of limited resources to multitude of needs
  • Limited access to higher education
  • High staff turnover
  • Need for evidence-based models and training approaches
core competencies
Core Competencies
  • Values/Beliefs
  • Knowledge of ECMH
    • Early childhood development
    • Importance of relationships
    • Risk/protective factors
  • Skills
florida imh levels of service
Florida IMH Levels of Service

Level 1 Services to strengthen caregiver skills and relationship with child

Level 2 Services for families and children with identified social risks, delays, special health needs, and disabilities

Level 3 Services to families of children diagnosed with serious emotional disorders or severe mental/ behavioral health problems

Source: Infant Mental Health Services for Young Children and Families. Florida State University, Center for Prevention and Early Intervention Policy. © 2000

implications for fl workforce
Building infrastructure to support training

Level 1: Target all child-serving staff in ECE, home visitors, schools, faith based, law enforcement, judicial systems

Level 2: families and professionals involved with Part B and C of IDEA, child protection, social workers, therapists, health care practitioners

Level 3: new university graduate programs to train clinicians in IMH psychotherapy

Implications for FL Workforce
merrill palmer institute
Merrill-Palmer Institute
  • Wayne State University in Detroit, MI
  • Graduate Certificate Program in Infant Mental Health
graduate certificate program in imh
Graduate Certificate Program in IMH
  • Intro to Infant Mental Health
  • Theory and Practice
  • Infant Mental Health
  • Psychology of Infant Behavior and Development
  • Assessment
  • Family study
  • Clinical Practicum
    • Supervised experience in assessment, observation, intervention

Early care and education professionals


Early Childhood Consultation Partnership

Mental health consultation to early care and education professionals

11 master’s level mental health professionals

Educating Practices in the Community

Health care practitioners

Kids Care Initiative

Systems-level training across multiple child-serving agencies

what is connecticut charts a course
What is Connecticut Charts-A-Course?

Connecticut Charts-a-Course (CCAC) is the statewide system of career development for early care & education, and school-age care.

who funds ccac
Who funds CCAC?

CCAC is funded by state quality enhancement funds for school readiness from Department of Social Services and Education.

Investments made from FY98-02:

  • Children’s Fund of Connecticut $340,000
  • Department of Social Services $3,755,000

CCAC is a special initiative of the Connecticut Community Colleges and is connected to the Chancellor’s Office.

what is the goal of ccac
What is the goal of CCAC?

To promote quality in early care & education by:

  • Supporting the career development of early care & education providers in all settings
  • Increasing the early care & education workforce capacity
  • Promoting early care & education as a viable career choice
  • Decreasing staff turnover
  • Supporting program improvement and quality initiatives
how does ccac support the early care education provider
How does CCAC support the early care & education provider?
  • Scholarships
  • Access to training
  • Career counseling
  • Certificate of recognition
  • Career ladder
what is the training program in child development
What is the Training Program in Child Development?
  • Quality education and training for early care & education providers
  • 180 hours of non-credit training delivered over four modules
  • Content is distributed through the Core Areas of Knowledge
10 years of success
10 years of success
  • 8,500 CCAC members
  • 2,500 scholarships
  • 5,000 training participants
  • 40% of CT CDAs are CCAC funded
  • 780 approved trainers
  • 230 career counseling sessions
  • 265 accredited centers
  • 12 colleges/universities in ECE articulation plan
  • Child Care Apprenticeship Program
highlights 1 98 6 02
Highlights 1/98 – 6/02
  • More than 5,000 participants to date
  • Over 213,000 hours of training delivered
  • 25 training organizations
  • Statewide accessibility – over 30 locations
  • All 180 hours of CCAC curriculum offered
  • 20% of training in Spanish
how was the outcome evaluation conducted
How was the outcome evaluation conducted?
  • Pre and post observation of participants in Modules I and II
    • Arnett
  • Interviews with participants who completed Module IV
  • Training is making a difference:

-child care providers consistently demonstrate positive changes related to the learning opportunities and environments they offer and the quality of their interactions with young children.

  • Largest increases in the areas of language and reasoning, program and interaction (ECERS, FDCRS, HOME)
  • Significant increases in providers’ responsiveness and decreases in harshness and detachment (ARNET)
ct kids care initiative
  • Institutes on competency based training to support implementation of systems of care
  • Five days of training for teams
  • Competency matrix addresses attitudes, knowledge and skills for community based care
  • Direct care, supervisor and management
  • Children w/ MH needs and families
  • Training of trainers model
core curriculum
Core Curriculum
  • Day 1: Systems of care 101
  • Day 2: Understanding the strengths and needs of children and their families
  • Day 3: Individualized strategies in response to the strengths and needs of children and families
  • Day 4: building equal partnerships with parents and children
  • Day 5: Interagency and community collaboration
training implementation goals
Training Implementation Goals
  • Provide strength based training that emphasizes individuals and families as partners in community-based planning and behavioral health care
  • Train 300 to 5000 individuals from diverse agencies (including all child welfare and public mental health staff), families, advocates, community providers, consumers
vermont system of care
CMHS grant to integrate mental health into child health, early care and education

Multi-faceted intervention: Prevention-treatment

ECMH competencies for providers, and training

4 DOMAINS: child, family, community and teamwork

VERMONT--System of Care
vermont competencies
Articulation of “Vermont Culture”

10 Guiding Principles

4 domains



Action/Learning Plan

Specific goals




Vermont Competencies
teamwork example
Teamwork (example)
  • I know about… I am able to do…
    • My own biases, values, strengths and vulnerabilities in forming relationships with families, children and other team members
      • Familiar with
      • Less familiar, like to learn more
      • We can identify someone within our community who is knowledgeable
      • This is a high priority for my learning
state and local responsibilities

Clear point of responsibility/accountability in Exec. Branch

Committee on interagency collaboration at senior level

Regular feedback from community and families

Policy shifts related to funding and HRD

State family organization/coalition


Local cross-system team responsible for planning, policy development, resource identification, training,monitoring

Strong family involvement on this management committee

Interagency review mechanism

System for referrals

Local family supports

State and Local Responsibilities
lessons learned in vermont
Lessons Learned in Vermont
  • You don’t build a freestanding mental health system of care for young children.
  • This is a cultural exchange process.
  • Intervention isn’t enough.
  • There are many new opportunities to blend funding.
  • There are too few staff trained in early childhood mental health. We must grow our own.
  • Two-year process to create the Knowledge and Practices document

Common Elements of Effective ECMH Systems

  • Involve different catalysts and different leadership
  • Involve partnerships and many stakeholders
  • Emphasize prevention and early intervention, not only “treatment”
  • Involve different entry points and build on existing early childhood programs
  • Develop creative fiscal strategies
  • Develop the workforce
  • Work toward policy and systems change
10 action steps
1. Raise awareness

2. Test new approaches

3. Develop cross training initiatives

4. Build collaborative approaches

5. Identify existing services/programs

6. Develop common service definitions

7. Involve families and child care community

8. Utilize existing data

9. Gather outcome data

10. Start Somewhere and Just do it

10 Action Steps