Infusing Mental Health Into an Early Childhood System of Care

Image of a crisis clinic about to go over a cliff

Early Childhood Mental Health

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

Values and Principles• INFUSE Mental Health in early childhood natural settings –

“where kids are”Supports for care givers, parents, services for children and families

• USE PUBLIC HEALTH MODEL (intervention is not enough) Promotion - for healthy social emotional development of all kids

and families Prevention - focus supports for at risk children and families Intervention - services to kids with diagnosis

• ACCEPT THAT THIS IS A CULTURAL EXCHANGE PROCESS

Engaging and involving families, caregivers, early childhood providers, mental health providers, and community at large.

Strategic Planning

Why?

Mental Health Issues for Young Children and Their Families in Vermont, 1996What kind of mental health issues do you experience or encounter among the families and young children whom you serve?Parents of Young Children:

DepressionSubstance abuseDomestic violence

Young Children:Behavioral and emotional challenges

We know more now about the importance of early life experience than we ever have.

We know more now about what works than we ever have.

We know more about strengths of families than we ever have.

We know more about the power of community than we ever have.

The time to invest in the future is now.

"Face to face with the second step"

Image of an animal climbing up stairs

The Department of Developmental and Mental Health Services applied for and received from the Center for Mental Health Services

Services Initiative Grant $5.7 Million Dollars Five Years Duration

STRATEGIC PLANNING

Interagency Partnership

Children &

Families

Agency of Human Services Central Office

• Head Start – State Collaboration• Success By Six Regional Planning• Parent-Child Centers• Domestic Violence Network

Child Welfare Department

• Protective Services & Family Support Child Care

• Child Care Subsides & Fee Scales

Health Department

• Healthy Babies

• Women, Infants, Children (WIC)

• Family, Infant, Toddler (FIT) (Part C)

• Alcohol & Drug Abuse Programs

Education Department

• Early Education Initiative

• Early Essential Education

Private

• Child Care Centers

• Day Care Homes

Vermont Early Childhood System & Work Group

An Invitation to Promote Children’s Upstream Services (CUPS)

Regional Planning Process

Management team

Priority needs and services

Budgets

Fiscal agent

Local outcomes

Who participated?

Family members

Early childhood System of Care (including

health)

Systems of Care for Children with Emotional

and Behavioral Challenges (school-ages)

Other community agencies and leaders

Identified Top 3 Community Survey and Forum Priorities

Parenting and child care training opportunities. Behavioral consultation in child care settings and

school settings. In-home direct therapeutic and consultation

services.

State Outreach Team

Family members

and Representatives from:

• Agency of Human Services• Department of Developmental and Mental Health Services• Department of Health• Department of Social Welfare, Social and Rehabilitation

Services (child welfare) • Department of Education

Never, ever, think outside the box

Mice in a maze

SERVICES AND SUPPORTS

What?

Cartoon saying “Only I can prevent forest fires? Don’t you think I should share some of the responsibility?”

Regional Services: 26 FTE’s hired statewide Outreach, information and referralInteragency training and technical assistanceConsultation to early childhood care and education, primary care providers

Direct interventionCrisis outreachObservations, assessments and referralsCase management and service coordinationCollaborative treatment planningIntensive home-based servicesRespite careIntensive childcare-based services

DIFFERENT SERVICES Consultation without identified client Cross training of early childhood caregivers

DIFFERENT PLACES TO SERVE Childcare Parent Child Centers Pediatric practices

PREPARED WORKFORCE

HOW and WHO?

Learning Team Commitments Operate as “learning organization”

Strengthen existing skills, knowledge and

systems of care

Build competent workforce

Strive for meaningful family participation

Make community priorities our priorities

Address needs of under-served families

CUPS Learning Team Initiatives

Coordinate with early childhood initiatives Provide philosophical leadership Identify core competencies Address local training priorities Conduct statewide learning series Collaborate with Family Consortium Facilitate network for reflective supervision Provide training scholarships Explore higher education and in-service training opportunities

Early Childhood Mental Health Knowledge and PracticesKnowledge and Practices

Document Includes

A description of the field of early childhood mental health.

A set of Guiding Principles underlying all services, supports and practices in the field.

Core Competencies organize into four domainsChildFamilyCommunityInterpersonal relationships and teamworkA Personal or Team Summary

CUPS HANDBOOK:FINDING HELP WITH SOCIAL-EMOTIONAL-BEHAVIORAL PROBLEMS FOR YOUNG CHILDREN & THEIR FAMILIES

TABLE OF CONTENTS• Introduction

1. Families in the 21st. Century2. Assessment as Discovery3. Early developmental delays and differences4. Teen parenting5. Trauma to the child including sexual and physical abuse6. Domestic violence witnessed by the child7. Neglect of the child8. Challenging behaviors

9. Parent substance abuse and chemical addictions10. Parent psychosocial/developmental challenges11. Environmental stressors  

APPENDIX I: Legal DefinitionsAPPENDIX II: General Resources, State-wide (Vermont)APPENDIX III: General Resources, National &

International

Financing

How?

Early Childhood Mental Health Service: Financing Map

Organizational Chart detailing General Funding Streams and Flow of

Funds at the Federal, State, City and County levels.

BIG QUESTIONS

How to leverage Federal dollars for these services that don’t identify a specific client?

Promoting public health model. Consulting and providing Technical

Assistance to early childhood providers. Screening all children for social and

emotional issues.

FINANCING

How? Many new partners, many new opportunities

to blend resources. Early Childhood providers fear of Medicaid

and diagnosis. Use of “V” codes Use of treatment planning

Evaluation 134 parents of children ages1 to 6

participated in the evaluation

Significant positive changes were reported after six-months of services; they appear to have been maintained after one year.

Children’s emotional problems decreased. Parent’s stress was reduced. Parent’s were more satisfied with their

children’s progress than before service.

Key Findings Parents felt that services helped their family. Parents were satisfied with their child’s

progress. Children demonstrated improved social and

emotional outcomes.

Billy’s story

Risk and Protective factors

Resilient children tend to have had environments that are supportive in critical ways and the capacity for resilience develops over time in the context of environmental support (Egeland, Carlson & Sroufe,1993)

Protective Factors

Positive self-esteem Active style of responding to stress Ability to elicit positive attention form adults

Services and Supports

Prepared Workforce

Interagency Partnerships

Maximized and Flexible

Funding

Building Blocks

Promotion Prevention Intervention

Supports for Parents and

Families

Supports for Other

Caregivers

Services for Children and

Families

Outcome Evaluation

Strategic Planning, Policies, and Procedures

Developed by Roxane Kaufmann, GUCCHD

EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF CAREFosters the social and emotional well-being of infants toddlers, preschool-age children and their families

VALUES Family Voice Child and Family

Centered Relationship Based Culturally Competent Infused into Natural

Settings and Services Grounded in

Developmental Knowledge

Promotion

Dissemination of information promoting healthy social-emotional development

Developmental screening

High quality child care Use of an evidence-

based curriculum

Prevention

Home visiting 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

Hotlines for families

Behaviorally-based programs provided in a

variety of settings

In-home treatment

Achieving System Reform Goals

Work together

Emphasize shared values

Learn from differences

Engage key stakeholders

Focus on the philosophy and values

Charlie Biss, DirectorChild, Adolescence & Family Unit

Phone: (802) 652-200Fax: (802) 652-2005

e-mail: cbiss@vdh.state.vt.usDivision of Mental Health108 Cherry StreetPO Box 70Burlington, VT 05402-0070

Website: http://www.HealthyVermonters.info• Click on mental health• Click on mental health again to get to DMHS• You will then click on research publications• Once you get to publications, click on child & adolescent• Click on CUPs handbook• Then click on knowledge and practices