Presentation on theme: "A Presentation at NASP, 2011 Conference"— Presentation transcript:
1A Presentation at NASP, 2011 Conference Implementing Early Childhood Mental Health Consultation in Urban Childcare CentersA Presentation at NASP, 2011 ConferenceSan Francisco, CATuesday, February 22, 2011Shannon Sweitzer, Ph.D., PCOM School PsychologyAnnemarie Clarke, Ph.D., SPIN, Inc.Behavioral & Developmental Services
2Goals for TodayEstablish the rationale for ECMH Consultation within Early Care and Education ProgramsLink ECMH outcomes to academic achievementReview projects/programs implemented within Philadelphia, PADiscuss future of this work in ECE programs
3Why Early Childhood Mental Health? 10 – 15% of all typically developing preschool children will have chronic mild to moderate levels of behavior problemsThink “PBS”/”SWEBS” Models from School-Age ProgrammingChildren who are poor or developing atypically are more likely to develop behavior problems at a rate approaching 30% ( Campbell, 2002; Qi & Kaiser, 2003).
4Risk Factors and Outcomes Adverse Childhood Experiences StudyAs 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, incarceratedhousehold member, Abuse (emotional,physical, sexual), & neglect (emotionalor physical).Living at or below the poverty level is associated with higher prevalence of risk factors to emotional health & well being & diminished protective factors.
5Philadelphia’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%
6Philadelphia’s Children Availability of behavioral health treatment for young children in Southeastern PA continues to be a problemLack of child psychiatrists and other behavioral health professionals with particular expertise in early childhoodLack of available intervention and treatment optionsAccording 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)
7Pennsylvania’s Response Instituted Office of Child Development and Early Learning (OCDEL) to connect all early childhood-serving systemsDeveloped both Infant-Toddler and Pre-K Standards to be implemented in all early care and education (ECE) programsStrong focus on social-emotional/behavioral standardsHired state-wide ECMH Consultants to begin to address issuesImplemented “Keystone Stars Program” with a focus on continuous quality improvement for all ECE providersUse of both ITERS (Infant Toddler Environmental Rating Scale) and ECERS (Early Childhood Environmental Rating Scale) to support strengthening programming at Tier 1 Level
8Pennsylvania’s Response Used ARRA funds ( ) to support the implementation of an ECE PBS program state-wideImplemented with consulting teams at a county level in limited number of ECE centersExternal “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
9Pennsylvania’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
11WHY? 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).
12WHY? 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
13WHY? Linking Emotional Health & Academics Teachers and challenging behaviors:Professionals within early childhood programs have historically received little training in behavior support/managementNationwide 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
15What’s Happening?Varied……Somewhat fragmented…… Integration is emerging gradually…..Statewide ECMH workgroup and Philadelphia’s Blue Ribbon Commission on Children’s Behavioral Health provided backdropVariety of smaller/larger projects funded through assorted stakeholders with similar goals but different approaches
16SPIN’s ECMH Grant ( )Funded under a grant from The Pew Charitable TrustsParalleled the framework of the CSEFEL Pyramid Model, however, it provided a more intensive site-wide approach to ECMH consultationMajor goal was “capacity building” to increase professionals trained to work in this areaFive (5) sites per year received at least 8 hours of ECMH consultation services per weekEach consultant provided three tiers of service based on components of Incredible Years curriculum (Webster-Stratton)
17SPIN’s ECMH Grant ( )Incredible Years Curriculum (Webster-Stratton)Multi-pronged approach:Direct social skills instruction for children through “circle time” activitiesConsultation and training on issues related to social-emotional development to teachers and directorsParent training programALSO: 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.
18Annual Timeline of Service Provision August/September: Centers enrolled in grantSeptember/October: Observations, initial data collection, information provided to teachers and parents regarding programNovember-May: Dinosaur School Runs; curriculum focuses on: feelings; problem solving skills; anger management; friendship skillsJanuary: Mock Dinosaur School “assembly” for parents to solicit participation in Parenting GroupsJanuary-May: Parenting Group runsOngoing: 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
19Children’s Program Also called Dinosaur School Emotional literacy Perspective takingFriendship skillsAnger managementInterpersonal problem-solving
20Teacher Program of IY Skills include: Effective use of teacher coaching skillsAttention, praise and encouragementUse of incentives for difficult behavior problemsProactive teaching strategiesHow to manage inappropriate classroom behaviors with discipline hierarchiesThe importance of building positive relationships with studentsHow to teach empathy, social skills and problem-solving in the classroom.
21Parenting Program of IY Skills include:How to play with childrenEffective praise and use of incentivesEstablishing predictable routines and rules Promoting responsibilityEffective limit-settingStrategies to manage misbehaviorTeaching children to problem solve.
22Research 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 populationsParent: Beauchaine, et al., 2005; Reid, et al., 2003; Scott, 2001; Taylor, Schmidt, Pepler, & Hodgins, 1998; Webster-Stratton, 1992 ; Webster-Stratton, et al., 2004Teacher: Webster-Stratton & Reid, 1999; Webster-Stratton et al., 2004Child: Webster-Stratton, 2004 ; Webster-Stratton & Hammond, 1997Above studies described at
23Results Year Children Teachers Parent Group Individual 1 210 26 30 2 225247411332013140
24Results: 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 behavior79% decreased use of inappropriate behavioral strategies62% increased their skill for setting limits
25Results: Parents Years 2 & 3 77% report increase in their use of positive parenting practices with their children69% report increase in their overall positive attitude toward their relationship with their children85% reported a decrease in negative attitude toward their children58% reported a decrease in the use of harsh parenting practices65% reported being more consistent in parenting
26Results: ChildrenChildren 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.
27Challenges Student Transiency Parents preferred drop-in consultation approach rather than parent groupThis is similar to a direction that is emerging where BH services are structured within other primary servicesTeacher Turnover
28Other ActivitiesCurrently at least 2 additional grants focusing on ECMH funded through The Pew Charitable TrustsCity’s Mayor’s Early Childhood Advisory Committee Exploring additional avenues to address social-behavioral/emotional development through pilot programsState is exploring methods for continuing PBS work done for past two years under ARRA grant project; future uncertain at this dateRetracted social service funds will likely impede the speed of progress of this work
29Areas 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 interactionsCreate a less expensive, more teacher-friendly social-emotional preschool curriculumEstablish 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
30For more information…. Shannon Sweitzer, Ph.D. ShannonSw@pcom.edu Annemarie Clarke, Ph.D.