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

1. 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

2. Setting the Context: About The National Center for Children in Poverty (NCCP) • NCCP • Promotes the economic security, health and well-being of America’s 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

3. 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?

4. 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

5. 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.

6. A Continuum of Services Promotion All kids Prevention Intervention Increasing cost per child Increasing intensity of need Decreasing numbers ofchildren

7. 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 children’s healthy s-e development • Addresses prevention, early intervention & treatment

8. 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

9. 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

10. 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)

11. 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

12. 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)

13. 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

14. 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

15. 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

16. State Strategies in Action (Con’t) • 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 dollars;Trains 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

17. 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

18. 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

19. 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

20. 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

21. Questions? Questions?

22. Questions? Thank you!