Healthy Beginnings A Collaborative Infant Mental Health Intervention in a Public Health Clinic.
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Transcript of Healthy Beginnings A Collaborative Infant Mental Health Intervention in a Public Health Clinic.
Healthy BeginningsHealthy Beginnings
A Collaborative Infant Mental A Collaborative Infant Mental Health Intervention in a Public Health Intervention in a Public
Health ClinicHealth Clinic
What Is an Infant Mental Health What Is an Infant Mental Health Intervention?Intervention?
Focuses on infants and children 0-5 years Focuses on infants and children 0-5 years of ageof age
Seeks to optimize social and emotional Seeks to optimize social and emotional development of young childrendevelopment of young children
Is a multi-disciplinary approach involving Is a multi-disciplinary approach involving psychiatry, psychology, social work, and psychiatry, psychology, social work, and pediatricspediatrics
2000 MCH Needs Assessment 2000 MCH Needs Assessment #1 Priority = Mental Health Access#1 Priority = Mental Health Access
Age (years)Age (years) Rate per 100,000Rate per 100,000
1-41-4 1010
5-145-14 1414
15-2415-24 211211
25-3425-34 287287
Homicide Rates – New Orleans
Healthy People 2010 goal < 7.2.
Age (years)Age (years) Rate per 100,000Rate per 100,000
15-2415-24 9393
Suicide Rates – New OrleansSuicide Rates – New Orleans
Healthy People 2010 goal = 9.6
2000 MCH Needs Assessment #1 Priority = Mental Health Access
2000 MCH Needs Assessment2000 MCH Needs Assessment
Suicide and Homicide rates far exceed Suicide and Homicide rates far exceed 2010 goal2010 goal
Community surveys list substance abuse Community surveys list substance abuse and homicide as primary concernsand homicide as primary concerns
Mental health access to services ranked Mental health access to services ranked #1 priority#1 priority
Must begin in infancy to prevent Must begin in infancy to prevent adolescent problemsadolescent problems
CollaboratorsCollaborators
Tulane Child Psychiatry DepartmentTulane Child Psychiatry Department
Children’s Bureau Children’s Bureau
LA Office of Public HealthLA Office of Public Health
Region I Office of Mental HealthRegion I Office of Mental Health
Institute for Mental HygieneInstitute for Mental Hygiene
New Orleans Health DepartmentNew Orleans Health Department
Collaborator RolesCollaborator Roles
Tulane Child Psychiatry:Tulane Child Psychiatry: – provides: provides:
two part-time supervising psychologiststwo part-time supervising psychologistspsychiatry fellow psychiatry fellow senior psychiatry faculty supervisionsenior psychiatry faculty supervisionone full-time clinic psychologist one full-time clinic psychologist
(program director)(program director)
– administers the HB grant from IMH administers the HB grant from IMH
Collaborator RolesCollaborator Roles
Children’s Bureau:Children’s Bureau: providesprovides two social workers two social workers and one case managerand one case manager
LA Office of Public Health:LA Office of Public Health: funds Children’s funds Children’s Bureau social workers and NOHD MCH nurse Bureau social workers and NOHD MCH nurse coordinatorcoordinator
Region I Office of Mental Health:Region I Office of Mental Health: provides half provides half time social workertime social worker
Collaborator RolesCollaborator Roles
Institute for Mental Hygiene: Institute for Mental Hygiene: provides funding provides funding through $125,000 grant to Tulanethrough $125,000 grant to Tulane
New Orleans Health Department:New Orleans Health Department: – provides:provides:
primary care (EPSDT) and WIC servicesprimary care (EPSDT) and WIC services
referrals to Healthy Beginnings Programreferrals to Healthy Beginnings Program
nursing and clerical supportnursing and clerical support
physical space in Mary Buck Clinic (paid by grant)physical space in Mary Buck Clinic (paid by grant)
GovernanceGovernance
MOAMOA written with help of facilitator and signed in written with help of facilitator and signed in fall of 2001fall of 2001
Operations Committee:Operations Committee: senior representation senior representation for each organization; meets quarterlyfor each organization; meets quarterly
Evaluation Committee:Evaluation Committee: oversees research, oversees research, data management, and program outcomesdata management, and program outcomes
Clinic Coordinating Committee:Clinic Coordinating Committee: oversees oversees clinic policies, forms, referrals, and feedback to clinic policies, forms, referrals, and feedback to providersproviders
Clinic OperationsClinic Operations
Children with risks identified are invited to Children with risks identified are invited to schedule an appointment with a HB social schedule an appointment with a HB social workerworkerAn assessment is conducted over several visits An assessment is conducted over several visits and immediate and long-term treatment goals and immediate and long-term treatment goals are formulated with the caretakerare formulated with the caretakerA home visit is conducted as part of the A home visit is conducted as part of the assessmentassessmentFamily is given choice of clinic or home for future Family is given choice of clinic or home for future sessionssessions
Clinic OperationsClinic Operations
All assessment data is entered into the All assessment data is entered into the databasedatabase
A caseworker links family with needed A caseworker links family with needed community social services community social services
Interdisciplinary case conferences are held Interdisciplinary case conferences are held weekly with clinic and HB staffweekly with clinic and HB staff
Families are followed until goals are met Families are followed until goals are met or family is lost to follow-upor family is lost to follow-up
Achievements in First Two YearsAchievements in First Two Years
A 30 hour training was held for 3 clinic A 30 hour training was held for 3 clinic physicians and 33 nurses in identifying physicians and 33 nurses in identifying infant mental health problemsinfant mental health problems
Facility was renovated to accommodate Facility was renovated to accommodate HB staff using grant fundsHB staff using grant funds
Achievements in First Two YearsAchievements in First Two Years
Undoing Racism workshop heldUndoing Racism workshop held
Over 143 children were served; 33 are still Over 143 children were served; 33 are still active active
Assessment process was shortenedAssessment process was shortened
Collaborator relationships continue to Collaborator relationships continue to developdevelop
Demographics of Population Demographics of Population ServedServed
66% males; 34% females66% males; 34% females
Average age 24 monthsAverage age 24 months
Average income below $10,000 Average income below $10,000
93% African American, 4.8% Caucasian, 93% African American, 4.8% Caucasian, 1.6% Hispanic, .8% Pakistani Indian1.6% Hispanic, .8% Pakistani Indian
Referral ConcernsReferral Concerns
Physical aggressionPhysical aggression
Temper tantrumsTemper tantrums
HyperactivityHyperactivity
InattentionInattention
Developmental Developmental DelaysDelays
Anxiety disordersAnxiety disorders
Feeding disordersFeeding disorders
Adjustment problemsAdjustment problems
Withdrawn behaviorsWithdrawn behaviors
Childhood depressionChildhood depression
Maternal depression Maternal depression (approximately 50%)(approximately 50%)
Domestic violenceDomestic violence
Physical abusePhysical abuse
Parenting concernsParenting concerns
Assessment ToolsAssessment Tools
Achenbach Child Behavior Checklist Achenbach Child Behavior Checklist (CBCL) Ages 1 1/2 - 5(CBCL) Ages 1 1/2 - 5
Infant Toddler Social Emotional Infant Toddler Social Emotional Assessment (ITSEA) Competence ScaleAssessment (ITSEA) Competence Scale
Disturbances of Attachment Interview Disturbances of Attachment Interview (DAI)(DAI)
Parent-Child InteractionParent-Child Interaction
AssessmentAssessment Tools ToolsBeck Depression Inventory (BDI-II)Beck Depression Inventory (BDI-II)
Parent Perception Interview Parent Perception Interview
Partner Violence Inventory (PVI)Partner Violence Inventory (PVI)
Omitted:Omitted:
HOME inventoryHOME inventory
VinelandVineland
Maternal Self-Efficacy ScaleMaternal Self-Efficacy Scale
Lessons LearnedLessons Learned
Early mental health intervention is possible Early mental health intervention is possible in a public health clinic with limited fundingin a public health clinic with limited funding
Collaborative efforts can bring cost-Collaborative efforts can bring cost-effective, state of the art interventionseffective, state of the art interventions
Communication between collaborators is Communication between collaborators is key; cultural, professional, and institutional key; cultural, professional, and institutional barriers need to be expected and barriers need to be expected and addressedaddressed
Key PlayersKey Players• Tulane: Paula Zeanah, PhD, MSNTulane: Paula Zeanah, PhD, MSN
Julie Larrieu,PhDJulie Larrieu,PhD
Shana Bellow, PhDShana Bellow, PhD
• NOHD: Susan Berry, MD, MPHDonna Malus, RN, BSNPat Delaune, RNMary Burns, RN
Key PlayersKey Players
• OMH: Guilda Butler, LCSWOMH: Guilda Butler, LCSW• Children’s Bureau: Ron McClain, Children’s Bureau: Ron McClain,
LCSW, Letia Bailey, LCSWLCSW, Letia Bailey, LCSW• OPH: Stacia Loveall, MSW, MPHOPH: Stacia Loveall, MSW, MPH