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AECCS Social-Emotional Workgroup

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Presentation on theme: "AECCS Social-Emotional Workgroup"— Presentation transcript:

1 Arkansas’ State Strategic Plan for Supporting Early Childhood Mental Health
AECCS Social-Emotional Workgroup Report to the AR Children’s Behavioral Health Care Commission April 17, 2014 Nikki Conners-Burrow Carol Amundson Lee

2 Purpose Review background/purpose of workgroup
Briefly review recent relevant science Evidence of need in Arkansas Overview of process to develop plan Overview of draft plan: broad goals and key strategies

3 AECCS SE Workgroup 1 of 5 workgroups for the Arkansas Early Childhood Comprehensive Systems Initiative funded by the Maternal-Child Health Bureau operates under DHS The past accomplishments include: contributions to the state Quality Rating Improvement System identifying a social-emotional screening tool for statewide used toolkit for addressing maternal depression development of graduate certificate program in ECMH

4 AECCS SE Workgroup This long lived committee was engaged in the earliest DHS DCCECE and DBHS early child mental health treatment and consultation efforts. Representatives have included DBHS Divisions, UAMS, ACH, Community Mental Health Centers, ADH, Head Start, Educational Cooperatives, Private Providers, Higher Education and more. A complete list of contributors to the strategic plan can be found within the plan on page 3

5 AECCS SE Workgroup Task for this : development of a state plan for supporting early childhood mental health Requested by DHS/DCCECE Utilizing a public health approach Cross-discipline, cross-agency, public/private

6 Public Health Model for Supporting Children’s Mental Health
4 categories. Two of the categories above the mid‐line, Promoting and Re/Claiming, optimize and measure positive mental health, while the two others, Preventing and Treating, reduce and measure mental health problems. The right two areas focus on Treating and Re/Claiming both focus on intervening with special consideration for an identified mental health problem. On the left side, Promoting and Preventing focus on interventions without consideration of an identified mental health problem. From: A Public Health Approach to Children's Mental Health: A Conceptual Framework

7 Infant & Early Childhood Mental Health
Synonymous with healthy social-emotional development Social development - communicating needs, getting along with others and making friends. Emotional development –able to be soothed when upset, recognizing feelings and expressing them appropriately. Supports the ability of the young child to learn and explore the world around them. We always like to define IMH and ECMHC, as they are less used in AR than elsewhere and can sort of conjure up weird pictures of babies on the psychiatrist couch Early childhood professionals often use the terns ‘early childhood mental health’ and positive ‘social and emotional development’ interchangeably. Social development involves skills like communicating needs, getting along with others and making friends. Emotional development involves skills like being able to be soothed when upset, recognizing feelings and expressing them appropriately, and beginning to understand that others have feelings too. When children experience healthy social and emotional development, they are able form All developmental domains are interrelated: Physical, Language, Social-Emotional, Cognitive Children with SE health are Able form satisfying relationships with others, play, communicate, learn and face challenges. Providing the foundation for school success and life-long learning.

8 Early Relationships Support or Undermine ECMH
Children develop in the context of relationships The brain is shaped by the experiences adults provide Nurturing caregiving supports brain development and is the foundation for lifelong mental health Serious problems in early relationships can have negative effects on the brain, developmental delays, problems in learning and mental health Next I want to share a little bit about what we know about what supports and undermines ECMH, a that science is really what provides the foundation for our recommendations in the strategic plan. Early relationships are at the foundation of early childhood mental health. Most experiences young children have are adult-dependent. Those experiences shape the way in which the brian is developed – for good or for bad. When children do not have a strong emotional tie to a caregiver, or that relationship has been disrupted or is characterized by abuse or neglect, children are at increased risk for social, emotional, and behavior problems. The loss or disruption of crucial early relationships can have negative effects on the developing brain, resulting in delays across all developmental domains (Dicker & Gordon, 2004). Children without healthy early relationships are at higher risk for delinquency, substance abuse, and depression later in life You’ll see then that supporting children’s early relationships is a theme that is woven throughout our plan. The architecture of the brain is composed of highly integrated sets of neural circuits (i.e., connections among brain cells) Genes determine when specific brain circuits are formed and indiv idual experiences then shape how that formation unfolds.

9 ECMH is Undermined by Early Adversity
Chronic adversity makes children most vulnerable Recurrent abuse, neglect Witnessing domestic violence Serious parental mental health or substance abuse problems Unresponsive or inconsistent caretaking Has effects on body and brain that carry into adulthood We know that serious problems in early relationships can be detrimental to ECMH, as can anything that places the child under chronic stress. It really is that ongoing or chronic nature of it that places children at highest risk. The ongoing abuse or neglect, the ongoing domestic violence in the home. Intensive poverty over a long period. Day after day in a chaotic and neglectful child care setting.

10 Early Adversity and Stress Response System
These adversities activate the biological stress response system Abnormal levels of stress hormones that can damage brain architecture Supportive relationships help child cope and bring hormones back into balance Undermines development of executive function skills – processes by which we learn Can alter immune function and inflammatory markers These experiences, especially without a safe and dependable relationship with a supportive adult who can help the child cope, can result in “toxic stress”. Toxic stress actually damages the developing brain. This damage ultimately affects a child’s cognitive functioning, ability to manage their emotions, and ability to develop social skills Without that adult support, chronic stress has the potential to cause lifelong harm. It is associated with many poor health outcomes - lifelong Cardiovascular disease, COPD, asthma, autoimmune diseases and depression

11 Problems in ECMH A significant proportion of young children (i.e., birth to 5 years) suffer from mental health problems. The symptoms may be more difficult to recognize in a young child but might include poor eye contact, excessive fussiness or little expression of emotion, inability to be soothed by caregiver, difficulty with bonding/attachment, and/or problems with feeding and sleeping. A toddler or preschooler might exhibit additional symptoms, such as tantrums, opposition/defiance, aggression, anxiety, social withdrawal or other depressive symptoms, and difficulty with empathy and learning right from wrong. In fact, the prevalence of such problems warranting a psychiatric diagnosis has been estimated to range from 15% to 25%, meaning that one in every five to ten children under 5 experience significant difficulties with behavior and emotional regulation. Studies of early childhood mental health problems reveal that 50% or more of these children will continue to have these difficulties in later childhood and adolescence (Campbell & Ewing, 1990; Campbell, Ewing, Breaux, & Szumowski, 1986). Adapted from Egger & Angold, 2006

12 Problems in ECMH in AR 16% of AR pre-k children screened have significant behavioral concerns High rates of ‘preschool expulsion’. Postpartum depression rate of 17.7% Large parts of the state with no quality-rated child care programs. Lack of mental health professionals trained to work with families of young children 4,614 victims of abuse or neglect aged 0-5 Arkansas is among a group of states with 4-7 expulsions per 1,000 preschoolers, a rate about three imes higher than the rate in Kindergarten through 12th grade large parts of the state with no quality-rated program - children in low quality care are more likely to have problems with behavior and to fall behind on school readiness indicators

13 Intervention for Vulnerable Children - Lessons from Evaluation Research
Improving outcomes involves enhancing the quality of a child’s environment and relationships. There are evidence based interventions that can be implemented across service sectors: mental health home visiting parenting education high quality child care The earlier the intervention the more cost-effective and efficient it is Young children need positive relationships, meaningful learning opportunities and safe environments. Many kinds of services can effectively promote positive relationships : mental health interventions home visiting parenting education high quality child care We know at least a couple of things about what works: Interventions much be matched to the severity of the problems and earlier is better. Serious parental problems that impact early relationships need more intensive intervention Mental health problems, domestic violence, substance abuse, frequent long separations Promoting healthy brain development from the beginning is easier than the intensive work required to repair damage As children age, their problematic behaviors frequently progress into more dangerous or costly behaviors

14 Intervening Early is Cost Effective
Studies of early childhood mental health problems reveal that 50% or more of these children will continue to have these difficulties in later childhood and adolescence. The costs of failing to intervene are high Lifetime costs of an untreated high risk child estimated at 2M School, social, legal, substance abuse, suicide, teenage pregnancy Given the societal problems we face that undermine ECMH, we are going to pay for those problems one way or another. Paying for prevention and early intervention is far cheaper than failing to intervene. Children with mental health problems are at greater risk for a variety of health and social problems as they reach adolescence and adulthood, such as substance abuse, risky sexual behavior, and criminality (Caspi, Moffitt, Newman, & Silva, 1996; Fergusson & Woodward, 2000; Molina & Pelham, 2003; Stevenson & Goodman, 2001). These problems are taxing on many social service systems, and particularly demanding of medical and law enforcement/criminal justice resources (Cohen, 1998; Leibson, Katusic, Barbaresi, Ransom, & O’Brien, 2001). For example, the lifetime cost of an untreated high-risk youth has been estimated at between $1.7 and $2.3 million (Cohen, 1998).

15 Process for Development of Plan
Recruitment of additional workgroup members for this purpose. Developed a shared understanding ECMH and supports for ECMH; Completed an environmental scan of existing programs that support ECMH in the state; Identified gaps and needs to be addressed; Identified 5 broad goals that focus on the gaps in existing programming in the state; Develop strategies under each goal; Distributed for comment. This is the last stop in that proces – we hope to gather and incorporate comments from this group here today.

16 How Should Plan Be Used? The plan is a guide for Arkansas’ public and private agencies and universities to support the development of a comprehensive system that supports early childhood mental health. Recommendations target interagency collaborations, education and training, infrastructure, and investments of time and resources. Broad goals are intended to be long-term. Specific strategies include short-term opportunities. We hope that this is a plan that can be picked up and responded to by all kinds of agencies, across disciplines, public-private. This is a plan for all of us. Includes both long-term goals and some short-term, what we think of as ‘low-hanging fruit’.

17 Five Overarching Goals
1. Families most at risk will be supported with services designed to keep families together. 2. Young children and their families will be fully represented in state cross-systems initiatives to support mental health. 3. Evidenced based screenings and referrals for social- emotional problems in young children and serious family risks will be expanded. 4. Early childhood mental health and early care and education providers will receive the supports necessary to improve child social-emotional outcomes. 5. Multiple public awareness efforts will focus on the mental health needs of young children.

18 Goal One - Families most at risk will be supported with services designed to keep families together.
Family support services must be embedded into settings where high risk families are identified. This will require: The expansion of accessible evidence-based/ promising parenting education and mental health interventions. These services must be made available in all settings that serve children considered to be at high risk.

19 Family-centered court systems supported, replicated
and expanded through the development and expansion of evidence-based, collaborative practices. Utilizing the existing AR Safe Babies Court Team resources to raise awareness of needs of young children; Expanding cross system partnerships between court systems and DHS divisions, in order to develop guiding policies and procedures for mental health and substance abuse providers working with identified families. Recommending: The replication the Court Team model

20 Goal Two: Young children and their families will be fully represented in state cross-systems initiatives to support mental health. Best practices for young children and their families will be identified and implemented across interdivisional and interagency efforts led by the Arkansas Department of Human Services. Recommending that this would best supported by: An identified staff member within DHS to work across divisions to support ECMH initiatives.

21 The availability of a full continuum of services must include:
Young children and their families will become a priority in our behavioral health system. Early childhood mental health and interventions are dependent on early relationships and parent/caregiver involvement. The availability of a full continuum of services must include: Promotion and prevention: e.g. parenting/caregiver education Early intervention and supportive services: e.g. social skills curriculum & classroom supports Treatment (e.g. mental health services such as parent-child interaction therapy, trauma focused cognitive behavioral therapy) The usage of evidenced based treatments for children 0-5 with their caregiver.

22 Guided by the following principles:
An emphasis on developmentally appropriate assessments. A focus on very young children - recognizing that evidence-based treatments are available to support high-risk parent-child dyad as early as infancy and continuing throughout early childhood. The understanding that young children are best served in their natural settings.

23 Supported by: State Child and Adolescent Service System Program (CASSP) council and local CASSP and Care Coordination Council teams increasing the engagement of young child serving entities and prioritize effective young child interventions. That young child who meets the current Multiple Agency Planning (MAP) and Wraparound criteria (e.g. serious diagnosis, multi-agency involvement) are able to access the full array of all appropriate services and supports. Data development through the DHS Division of Medical Services to track involvement of young children; The development of referral uniformity that addresses disparities through education and training.

24 Goal Three: Evidenced based screenings for social-emotional problems in young children and serious family risks will be expanded and referrals to appropriate services will be enhanced. Screen for family risk factors to identify children at high risk for early onset of social-emotional difficulties. Providers of services to pregnant women will screen to identify mothers at highest risks for problems in parenting. Screening for pregnant women and mothers of young children will include mental illness, substance abuse, domestic violence, catastrophic events, chronic illness and child welfare involvement. The use of established and successful AR screening tools will be encouraged in primary care, home visiting and early education settings.

25 Children with early emerging social emotional problems will be identified through the expansion of routine standardized screening. Routine screening with standardized questionnaires expanded in primary care, home visiting and early care and education. In coordination with DHS, monitoring systems will be developed to ensure that groups of children identified as being at high risk receive screening on a recommended schedule. Reimbursement incentives for screening and preventive services require development.

26 Goal Four: Early childhood mental health care providers and early care and education providers will receive the supports necessary to improve child social-emotional outcomes. Advocacy for the rollout of the Early Childhood Mental Health (ECMH) graduate certificate for behavioral Health providers to work with young children. Increasing the collaboration between Higher Education, behavioral health and early childhood education training programs to support current and future workforce development. Working with the State behavioral health licensing boards.  

27 The promotion of promising and evidence-based mental health services for young children and their families through investment in training and support. Through: DHS Divisional supported early childhood liaisons in local communities. Investing in training and evidenced based mental health treatments for young children and their families. Expanding the network of mental health professionals serving young children Identifying and supporting the professional training needs of public and private providers. Using tele-health for enhancing training and interventions.

28 Defining the appropriate role of mental health in the treatment of autism spectrum disorders and
resolution of inconsistencies between private insurance and Medicaid. Recommendation: To consider the successful approach used in the AR BEST program to disseminate the best practice of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).

29 Invest in training for early care and education providers to
Improve social-emotional outcomes by: Providing additional training and supports for early care and education providers targeting the improvement of child social-emotional outcomes. Adopting standardized Social-Emotional curriculums (ages 3-5) across providers. Expanding AR Early Childhood Mental Health Consultation services using the AR Project Play model, across the state. Developing protocols for increasing the coordination and communication across multiple systems including mental health, Part C, Part B and the Department of Education.

30 Goal Five: Public awareness of the mental health needs of young children will be increased.
An ECMH toolkit with simple targeted messages about early childhood mental health will be designed for use with varied audiences. Enhanced screening efforts will be accompanied with materials designed to facilitate the reduction of stigma related to screening. AR customized materials will target the general public as well as behavioral health professionals, physicians and other medical providers and educators.

31 Public awareness campaigns will promote the importance of early childhood mental health and simple ways to promote children’s social and emotional development. Requiring: Collaboration between DHS, ADH and AAIMH for development of media materials A “train the trainer” format to prepare for an expansion of state-wide advocates who will be available to use the toolkit in their community with diverse audiences

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