1. A Presentation at NASP, 2011 Conference
Implementing Early Childhood Mental Health Consultation in Urban Childcare Centers
A Presentation at NASP, 2011 Conference
San Francisco, CA
Tuesday, February 22, 2011
Shannon Sweitzer, Ph.D., PCOM School Psychology
Annemarie Clarke, Ph.D., SPIN, Inc.
Behavioral & Developmental Services

2. Goals for Today
Establish the rationale for ECMH Consultation within Early Care and Education Programs
Link ECMH outcomes to academic achievement
Review projects/programs implemented within Philadelphia, PA
Discuss future of this work in ECE programs

3. Why Early Childhood Mental Health?
10 – 15% of all typically developing preschool children will have chronic mild to moderate levels of behavior problems
Think “PBS”/”SWEBS” Models from School-Age Programming
Children who are poor or developing atypically are more likely to develop behavior problems at a rate approaching 30% ( Campbell, 2002; Qi & Kaiser, 2003).

4. Risk Factors and Outcomes
Adverse Childhood Experiences Study
As the number of ACES increases, so does the risk of disease, victimization, unhealthy behaviors, impairment, disability, and premature death.
Substance Abuse, one or no parents,
mental illness, mother treated violently,
criminal behavior, incarcerated
household member, Abuse (emotional,
physical, sexual), & neglect (emotional
or physical).
Living at or below the poverty level is associated with higher prevalence of risk factors to emotional health & well being & diminished protective factors.

5. Philadelphia’s Children
Philadelphia recently named as the poorest of America’s largest cities……
Approximately 26% of the city’s families with children under 18 years of age live at or below the federally established poverty level (US Census, 2000)
Among those same households with children under 5 years of age, the figure jumps to over 31%
When single parent households alone are analyzed, the number of children under 18 living at or below poverty jumps to nearly 41% (US Census, 2000)
Among those same households with children under 5 years of age, the figure jumps to over 47%

6. Philadelphia’s Children
Availability of behavioral health treatment for young children in Southeastern PA continues to be a problem
Lack of child psychiatrists and other behavioral health professionals with particular expertise in early childhood
Lack of available intervention and treatment options
According to a report by Public Citizens for Children and Youth (PCCY, 2008), there are approximately 128,000 children and adolescents with mild to severe behavioral health problems in Philadelphia, yet only 22.8% (22,900 children) of them receive behavioral health services.
48% of local early care and education programs reported removing, suspending, or expelling at least one child over the past year as a result of behavioral concerns (PCCY, 2008)

7. Pennsylvania’s Response
Instituted Office of Child Development and Early Learning (OCDEL) to connect all early childhood-serving systems
Developed both Infant-Toddler and Pre-K Standards to be implemented in all early care and education (ECE) programs
Strong focus on social-emotional/behavioral standards
Hired state-wide ECMH Consultants to begin to address issues
Implemented “Keystone Stars Program” with a focus on continuous quality improvement for all ECE providers
Use of both ITERS (Infant Toddler Environmental Rating Scale) and ECERS (Early Childhood Environmental Rating Scale) to support strengthening programming at Tier 1 Level

8. Pennsylvania’s Response
Used ARRA funds ( ) to support the implementation of an ECE PBS program state-wide
Implemented with consulting teams at a county level in limited number of ECE centers
External “coaching team” collaborated with each center’s “core team” to gather child- and classroom-specific data, monitor behavioral incidents, provide professional development re: behavior management, and improve internal capacity

9. Pennsylvania’s Response Cont.
AARA funds cont:
Built on the platform of Vanderbilt University’s Center for Social-Emotional Foundations of Early Learning (CSEFEL)
Emphasis is on ECMH Consultation and skill transfer to the internal teams at participating sites to facilitate sustainability beyond grant

10. CSEFEL Framework

11. WHY? Linking Emotional Health & Academics
Social emotional difficulties negatively impact school readiness and academic achievement in urban youth (Fantuzzo, 2007; Philadelphia Citizens for Children and Youth, 2006).
Difficulties demonstrated across other domains impacts a child’s ability to develop typical peer relationships and behave in ways conducive to learning (Pianta, Nimetz, & Bennett, 1997; Vaughn, Hogan, Lancelotta, & Shapiro, 1992).

12. WHY? Linking Emotional Health & Academics
Ratings of first graders on items describing a cheerful, outgoing temperament predicted adult educational attainment better than preschool or first grade achievement scores (Entwistle et al.,2005)
Children with consistently high levels of aggression from ages 2 -9 were more likely than other children to have achievement problems in third grade (NICHD, 2004)
On-grade achievement in third grade is strong predictor of high-school graduation

13. WHY? Linking Emotional Health & Academics
Teachers and challenging behaviors:
Professionals within early childhood programs have historically received little training in behavior support/management
Nationwide survey of teachers across all grade levels indicated that teachers feel a strong need for additional training and support in classroom management (Coalition for Psychology in the Schools and Education, 2006).
Leads to stress, burnout, and turnover

14. Other Philadelphia/Pennsylvania Initiatives

15. What’s Happening?
Varied……Somewhat fragmented…… Integration is emerging gradually…..
Statewide ECMH workgroup and Philadelphia’s Blue Ribbon Commission on Children’s Behavioral Health provided backdrop
Variety of smaller/larger projects funded through assorted stakeholders with similar goals but different approaches

16. SPIN’s ECMH Grant ( )
Funded under a grant from The Pew Charitable Trusts
Paralleled the framework of the CSEFEL Pyramid Model, however, it provided a more intensive site-wide approach to ECMH consultation
Major goal was “capacity building” to increase professionals trained to work in this area
Five (5) sites per year received at least 8 hours of ECMH consultation services per week
Each consultant provided three tiers of service based on components of Incredible Years curriculum (Webster-Stratton)

17. SPIN’s ECMH Grant ( )
Incredible Years Curriculum (Webster-Stratton)
Multi-pronged approach:
Direct social skills instruction for children through “circle time” activities
Consultation and training on issues related to social-emotional development to teachers and directors
Parent training program
ALSO: offered an option for one-on-one intensive intervention (therapy/clinical services) for children/families requiring more intensive support or unable to attend parenting group.

18. Annual Timeline of Service Provision
August/September: Centers enrolled in grant
September/October: Observations, initial data collection, information provided to teachers and parents regarding program
November-May: Dinosaur School Runs; curriculum focuses on: feelings; problem solving skills; anger management; friendship skills
January: Mock Dinosaur School “assembly” for parents to solicit participation in Parenting Groups
January-May: Parenting Group runs
Ongoing: Teacher and Director consultations on variety of topics related to childhood development, collaborating with parents, child-specific or classroom management PBS strategies; classroom modeling; individual therapy with parents

19. Children’s Program Also called Dinosaur School Emotional literacy
Perspective taking
Friendship skills
Anger management
Interpersonal problem-solving

20. Teacher Program of IY Skills include:
Effective use of teacher coaching skills
Attention, praise and encouragement
Use of incentives for difficult behavior problems
Proactive teaching strategies
How to manage inappropriate classroom behaviors with discipline hierarchies
The importance of building positive relationships with students
How to teach empathy, social skills and problem-solving in the classroom.

21. Parenting Program of IY
Skills include:
How to play with children
Effective praise and use of incentives
Establishing predictable routines and rules Promoting responsibility
Effective limit-setting
Strategies to manage misbehavior
Teaching children to problem solve.

22. Research Supporting the IY Curriculum
Studies by both Carolyn Webster Stratton (author) as well as independent evaluators support the curriculum as effective in the prevention of and intervention with children within clinical populations, as well as within general populations
Parent: Beauchaine, et al., 2005; Reid, et al., 2003; Scott, 2001; Taylor, Schmidt, Pepler, & Hodgins, 1998; Webster-Stratton, 1992 ; Webster-Stratton, et al., 2004
Teacher: Webster-Stratton & Reid, 1999; Webster-Stratton et al., 2004
Child: Webster-Stratton, 2004 ; Webster-Stratton & Hammond, 1997
Above studies described at

23. Results Year Children Teachers Parent Group Individual 1 210 26 30 22
252 47 41 13 3
201 31 40

24. Results: Teachers Years 2 & 3:
79% increased or stayed the same in their ability to use positive approaches in relating to parents if young children regarding their challenging behaviors.
67% teachers demonstrated an increased use of both proactive strategies and praise and incentives to support appropriate behavior
79% decreased use of inappropriate behavioral strategies
62% increased their skill for setting limits

25. Results: Parents Years 2 & 3
77% report increase in their use of positive parenting practices with their children
69% report increase in their overall positive attitude toward their relationship with their children
85% reported a decrease in negative attitude toward their children
58% reported a decrease in the use of harsh parenting practices
65% reported being more consistent in parenting

26. Results: Children
Children demonstrated improved social skills and self regulation behaviors evidenced by qualitative reports from teachers and parents.
Beneficial to measure child progress through a more defined process, such as behavior rating scales over time.

27. Challenges Student Transiency
Parents preferred drop-in consultation approach rather than parent group
This is similar to a direction that is emerging where BH services are structured within other primary services
Teacher Turnover

28. Other Activities
Currently at least 2 additional grants focusing on ECMH funded through The Pew Charitable Trusts
City’s Mayor’s Early Childhood Advisory Committee Exploring additional avenues to address social-behavioral/emotional development through pilot programs
State is exploring methods for continuing PBS work done for past two years under ARRA grant project; future uncertain at this date
Retracted social service funds will likely impede the speed of progress of this work

29. Areas for Future Development – School Psychology’s Role
Develop a formal observation system to measure a classroom’s climate as well as the quality of teacher-child interactions
Create a less expensive, more teacher-friendly social-emotional preschool curriculum
Establish prevention and intervention programs for families within visible, easily accessible, and frequently utilized centers (e.g. child care centers or primary care offices).
This will likely emerge through healthcare reform initiatives that seek to embed/marry primary care medicine and behavioral health services

30. For more information…. Shannon Sweitzer, Ph.D. ShannonSw@pcom.edu
Annemarie Clarke, Ph.D.