MENTAL HEALTH, PREVENTION,

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MENTAL HEALTH, PREVENTION, DISABILITIES IN
YOUNG CHILDREN FAMILIES
Catherine Ayoub, Ed.D Harvard University With
contributions from the Early Head Start Research
Consortium, the Family Connection Project,
Childrens Hospital Boston
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Mental Health Children with Disabilities

• The aim of early childhood mental health is to
  improve social emotional well being of young
  children families by strengthening
  relationships with caregivers promoting
  age-appropriate social emotional skills.
• Associations between
• Developmental disabilities environmental
  stress is a mental health double jeopardy
• Maternal depression childs self-regulation
• Maternal depression reduced services for
  child

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Rates of Depression in Early Head Start Families

• 48 of mothers pregnant or with infants
• 33 of mothers of 14 month old children
• 33 of mothers of 36 month old children
• 12 of mothers were chronically depressed
• 18 of fathers of 24 month old children
• 16 of fathers of 36 month old children

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Depression Complications Treatment

• 24-40 of Americans with mood disorders also
  have substance abuse disorders.
• In the United States, only one-third of people
  with depression receive treatment.
• In the EHS sample 23 of families at exit
  indicated that they had received mental health
  services      

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Impact of Depression on Infants Toddlers

• Poorer child functioning social cognitive
• Increased aggression
• Increased negative parenting
• Increased parenting stress
• Increased family conflict

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Impact of Depression on Infants Toddlers

• Difficulty with nurturing parent-child
  relationships (Belle, 1982)
• Increased harsh parenting (Downey Coyle, 1990)
• Increased negative parenting (EHS)
• Increased parenting stress (EHS)
• Increased family conflict (EHS)

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For whom does Early Head Start work
best? (Roggman, et. al., 2001)

• Parents with moderate risk for depression.
• The most consistent program impacts were for
  the group at moderate risk of depression
• Parents who were engaged in the EHS program.
• Parents who were at moderate risk for depression
  AND were engaged in the program showed the
  greatest gains for themselves and their
  children.

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Interventions General Principles

• Earlier is better.
• Engagement is key.
• Combination interventions matched to individuals
  have best results.
• Exogenous Endogenous depression are different.
• Depression is a highly treatable illness.
• Psychotherapy and medication have been shown to
  be effective treatments.

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The Family Connections Approach

• Emphasize the positive ways that all parents can
  enhance their parenting their interactions with
  Head Start
• Foster engagement with Head Start among depressed
  parents
• Incorporate a program for getting appropriate
  treatment
• Enhance parents childrens classroom
  interactions through consultation, teaching and
  support for Head Start staff.

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Figure 1 The Family Connection Pyramid
Clinical Intervention Identification and
treatment of depression and parenting
difficulties/ disconnections extended
outreach and crisis services
Targeted Prevention (At Risk Parents/Children)
Enriched prevention programming, mental health
outreach, social and academic skill building,
networks to specialized services in mental
health, substance abuse, marital counseling
Universal Prevention (All Children and Families)
Education on depression parenting education
focused upon relationship-building in families
classroom-based enrichment activities to support
social and academic development community
networks to connect families to supportive
prevention services
Community and Systems Development (All Head
Start Staff) Education on depression and mental
health classroom consultation parenting support
skill development community connections to
enrichment and family nurturing programs
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Family Connection Partnership

• Training support for staff
• Partnerships for referral networking
• Consultation/intervention in the classroom
• Stress support groups for parents
• Expanded home visitation consultation
• Preventive relational friendship building for
  children

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Family Connection Partnership

• Training support for staff
• Example sessions that relate to mental health
  with an emphasis on depression

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Fostering Relationships

• Staff consultation
• Parent groups individual support for service
  acquisition
• Home visitation consultation support for
  depressed parents using the child connection
• Building childhood friendships through classroom
  and pair interventions

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Present Future Resources

• Manual for addressing depression as a family
  issues in Early Head Start and Head Start
  settings
• Guide to therapeutic pair play
• Community resource and network guides
• Training about Depression series

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References

• Beardslee, W.R. (2002). Out of the darkened
  room When a parent is depressed. Protecting the
  children and strengthening the family. Boston
  Little, Brown.
• Knitzer, J. (2000). Early childhood mental
  health services. J. Shonkoff S. Meisels (eds).
  Handbook of Early Intervention, 2nd Edition.
  Cambridge University Press, 416-438.
• Podorefsky, D., MacDonald-Dowdell, M.
  Beardslee, W.R. (2001). Adaptation of preventive
  interventions for a low-income, culturally
  diverse community. Journal of the American
  Academy of Child and Adolescent Psychology, 40,
  879-886.
• Rogmann, L., Boyce, L., Hart, L., Robinson, J.,
  Ayoub, C., Pan, B., Peterson, C., Love, J., Ispa,
  J., Greene, B., Schochet, P. Vogel, C. (2002).
  Depression and Engagement as Factors Affecting
  Impacts of the Early Head Start Program. World
  Association of Infant Mental Health, Amsterdam,
  Netherlands.