Early Childhood Mental Health: What’s Happening in NH

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Early Childhood Mental Health Whats Happening
in NH
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Early Childhood Mental Health is

• The social/emotional well being of children aged
  birth to six years which promotes the capacity
  to
• Experience, manage and express emotions
• Develop and sustain stable relationships with
  others (adults and peers)
• Safely explore the environment and learn
• Demonstrate developmentally appropriate behavior

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Prevalence of Early Childhood Mental Health
Concerns

• 74,689 children under the age of 5 in NH
• 13.5 (10,218) live in poverty, (NCCIC, 2010)
• 912 cases of founded child abuse in 2007, a
  10.9increase over 2006
• In 2007, of 1,084 children not living with
  parents, 290 were under the age of 5,
  (Administration for Children and Families, 2009,
  www.cwla.org)

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Prevalence of Early Childhood Mental Health
concerns

• NH Center for Public Policy Studies (NHCPPC)
  estimated that 20 of NH children ages 5-15
  could have a mental health disorder
• 10-20 of preschool children experience-
  behavioral/mental health concerns, (Dunlap, 2006)
• This suggests that over 7,500 under age 5 are in
  need of mental health services, (NHAIMH, 2009)

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Prevalence of Early Childhood Mental Health
concerns (cont.)

• Of 173 families surveyed, 46.2 were worried that
  their child (under age 6) might have a social
  emotional or behavioral disorder, (NHAIMH
  2009,Mental Health Services for NHs Young
  Children and their families Planning to Improve
  Access and Outcomes)

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Prevalence of Early Childhood Mental Health
concerns (cont.)

• Nationally, the rate of child care/preschool
  expulsion due to challenging behavior of
  preschool age children is three times greater
  than for kindergarten and toddler (Gilliam,
  2005).
• NHAIMH 2001 Child Care Expulsion survey found
  that in a 15 month period, 53 of child care
  programs reported they had either expelled a
  child or enrolled a child that had been expelled
  elsewhere.

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Prevalence of Early Childhood Mental Health
concerns (cont.)

• Toxic stress is known to negatively impact brain
  development.
• Between 75 and 130 of every 1,000 children in the
  US under the age of 5 live in homes with 1 of 3
  common precipitants of toxic stress
  (maltreatment, parental substance abuse and
  maternal depression)
• www.developingchild.harvard.edu

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Where people go for help

• 80 of families report they first seek help from
  their medical provider when concerned about their
  childs mental health or behavior
• 72 of medical providers report they need more
  information regarding child development
• 80 report they need information and resources
  about behavior
• (NHAIMH, 2009)

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Some Risk Factors for Early Childhood Mental
Health Issues

• Toxic Stress
• Parents with significant mental health issues,
  (including depression, personality disorders,
  anxiety, PTSD, Bi-Polar, Schizophrenia)
• Current or history of abuse and neglect,
  homelessness, substance abuse, domestic violence
• High level of family stress, (chronic or multiple
  acute stressors)
• Child with developmental or medical issues,
  colic, challenging temperament, attachment
  concerns
• Parent-infant temperament mismatch

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Why early intervention is so important

• Well designed early childhood interventions have
  been found to generate a return to society
  ranging from 1.80 to 17.07 for each dollar
  spent on the program. Economics Nobel Laureate,
  James Heckman University of Chicago
• http//www.ideainfanttoddler.org/pdf/2008_Good_New
  s.pdf

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Why early intervention is so important

• Effective early childhood programs generate
  benefits to society that far exceed program
  costs. Investments in the earliest years of life
  show the greatest returns- 3.00-16.00 dollars
  per dollar invested through reduced crime,
  welfare, educational remediation, etc.
  www.developingchild.harvard.edu

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Home Visiting

• Home visiting influences maternal parenting
  practices, the quality of the childs home
  environment and childrens development. Greatest
  benefit for low-income first time adolescent
  mothers. (Howard, Brooks-Gunn, 2009)
• 15 year follow up from home visiting project in
  Elmira, NY, (David Olds), found 48 less
  incidents of abuse and neglect through age 15
  (Robert Wood Johnson Foundations, 2006)

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So, where are these children?

• Child care
• Medical Care Providers
• Home and community
• Schools (pre-school and kindergarten)

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and what are the services?

• Child Care
• Early Head Start
• Head Start
• Home Visiting Programs
• Early Supports and Services
• Special Education
• Watch Me Grow

• Child Protection
• Mental Health Services
• Community and Family Support Programs (Family
  Resource Centers)
• Other Community services

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Recommended Levels of Service

• 3 Tiered Approach
• Tier 1- safety, health, supportive and nurturing
  relationships for all
• Tier 2- Center-based care and education and
  Parent and Family Supports for families in
  poverty
• Tier 3- specialized support and clinical services
  for families most likely to experience toxic
  stress and or high risk in other ways.
• www.developingchild.harvard.edu

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In NH.

• General family support and parent education
• Child care site-focused support and education,
  (i.e. PTAN child care consultation)
• General child development support
• Child/family specific support/ intervention
  based on eligibility
• Enhanced services based on eligibility,
  diagnosis and/or finding of abuse or neglect (ie
  through ESS or Mental Health)

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State Supported Programs
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State Supported Programs cont.
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Numbers Served Costs
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Numbers Served Costs cont.
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Numbers Served Costs cont.
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Numbers Served Costs cont.
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Identified Gaps/Needs and Existing Promising
Practices

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Gaps and Needs

• Information, support and resources for primary
  care providers
• Support and consultation for childcare providers
• Professional training at all levels
• Earlier identification of social emotional needs
• Access to and availability of quality services
  across regions
• Clear eligibility criteria for community mental
  health services
• Expansion of evidence-based practices

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Information, Support and Resources for Primary
Care Providers

• Watch Me Grow
• ASQ-SE and other screening tools
• Developmental specialists and Mental Health
  Providers in primary care offices

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Support and Consultation for Childcare Providers

• PTAN and other existing child care consultation
  models
• The Head Start Early Childhood Mental Health
  Consultation Model
• NH Early Learning Guidelines
• Healthy Child Care NH
• Maine RELATE Model of Early Childhood
  Consultation
• NH Early Childhood and Family Mental Health
  Competencies

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Professional training at all levels

• Mental Health Expertise on Early Supports and
  Services Teams
• ECMH expertise in Community Mental Health
• Training in Child-Parent Psychotherapy
• NH Early Childhood and Family Mental Health
  Competencies

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Access and availability of quality services
across regions

• Evidence-based home visiting models (i.e.
  www.futureofchildren.org)
• Child care consultation and support
• Family Resource Center Programs
• Local ECMH grant funded programs
• Some community mental health expertise
• Child-Parent Psychotherapy consultation model

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Community Mental Health Services

• Some community mental health expertise
• Child-Parent Psychotherapy consultation model
• Preventative services
• Consistent eligibility evaluation criteria and
  process
• DC 0-3 for diagnosis

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One Last Thought.

• Promoting Early Childhood Mental Health requires
  an integrated comprehensive community-based
  system of care. So it is a really good thing
  that we are all here and working together. Our
  future is our children.