Mental Health

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Mental Health

• Impacts on Child Development
• Jacqui Van Horn, MPH, IMH-E
• jacquivanhorn_at_comcast.net

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(No Transcript)
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Co-creating Mental Health
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Early Childhood Mental Health

• Begins before birth
• Inextricably connected to
• The health (physical, mental, spiritual) of the
  parents
• All other areas of health and development
• Is formative and provides the basic structure
  within which all development unfolds throughout
  our lives.

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Across the Lifespan . . .

• Human relationships, and the effects of
  relationships on relationships, are the building
  blocks of healthy development.
• From the moment of conception to the finality of
  death, intimate and caring relationships are the
  fundamental mediators of successful human
  adaptation.
• (From Neurons to Neighborhoods, p. 27)

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Mentally healthy people . . .

• Experience, express, respond to and manage a full
  range of emotions in ways that support their
  ability to function across contexts and settings
• Their own emotions and
• The emotions of others.
• Successfully engage in a range of relationships
  with others within a range of social contexts.
• Can recognize and repair disruptions in
  relationships.

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Irreducible Needs

• Ongoing, nurturing relationships
• Physical protection, safety and regulation
• Experiences that are developmentally appropriate
  and tailored to individual differences
• Limit setting, structure and expectations
• Stable, supportive communities and cultural
  continuity
• 
  (Brazelton Greenspan, 2000)

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Needs Vulnerabilities

• Ongoing, nurturing relationships
• Physical protection, safety and regulation
• Experiences that are developmentally appropriate
  and tailored to individual differences
• Limit setting, structure and expectations
• Stable, supportive communities and cultural
  continuity
• (Brazelton Greenspan, 2000)

• Chronic stress
• Emotionally unavailable caregivers
• Maltreatment
• Foster Care
• Homelessness
• Domestic Violence
• Drug and alcohol exposure

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Development is Impacted

• Brain development is impacted by stress.
• Babies experience (and remember) stress when
• Their signals are not responded to sensitively
• Their attachment figure does not help them feel
  safe and cared for
• Their attachment figure is not physically or
  emotionally available to them

National Clearinghouse on Child Abuse and Neglect
Information
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Healthy Child Neglected Child Both
size and functioning of the brain are impacted.
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Development is Impacted

• The brain organizes itself to support survival in
  either a positive environment OR a negative
  environment.
• The early organizational structures continue to
  influence behavior and development over time.

National Clearinghouse on Child Abuse and Neglect
Information
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Impacts of Trauma

• Structural changes occur to the brain
• Less brain mass
• Less brain tissue connecting the hemispheres
• Neuronal pathways become over-sensitized
• Areas of the brain involved with fear/anxiety
  responses can become over-developed other areas
  are then under-developed
• When the brains resources are focused on
  survival, other aspects of development suffer
  the child has fewer resources available for
  learning.
• These physiological changes are associated with
  changes in cognitive functioning

National Clearinghouse on Child Abuse and Neglect
Information
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Many Wake Up! Calls

• High rates of maltreated infants, toddlers and
  young children present with significant physical,
  cognitive, social-emotional, relational and
  psychological problems.
• Most children placed in foster care have a
  history of severe neglect or abuse and have
  experienced significant stress during critical
  periods of early brain development.
• Shaw,
  E. and Goode, S. (2008)

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Many Wake Up! Calls

• Young children in foster care have higher rates
  of chronic health conditions and special needs
  than national estimates for children living at
  home.
• Very young children exposed to domestic violence
  may experience extreme stress that can have a
  potentially serious impact on brain development.
• Homeless children are twice as likely to
  experience learning disabilities and three times
  as likely to experience an emotional disturbance
  as other children. Shaw, E. and
  Goode, S. (2008)

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Stay Awake!
Approximately 10-15 of all typically
developing preschool children have chronic
mild to moderate levels of behavior problems.
Children who are poor are much more likely to
develop behavior problems with prevalence rates
that approach 30. Children who are identified
as hard to manage at ages 3 and 4 have a high
probability of continuing to have difficulties
into adolescence.
Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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Still Awake?

• Behavior problems in a childs preschool career
  are the single best predictor of delinquency in
  adolescence, gang membership, and adult
  incarceration.
• If challenging behaviors are not altered by the
  end of the third grade, it appears that they
  should be treated as a chronic condition
  hopefully kept somewhat in check by continuing
  and ever more costly intervention.

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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Looking Ahead

• Children who grow into adolescence with
  challenging behaviors are likely to drop out of
  school, be arrested, abuse drugs and alcohol,
  have marginalized adult lives, and die young.
• There is evidence to show that young children
  with challenging behavior are more likely to
  experience
• early and persistent peer rejection
• mostly punitive contacts with teachers
• family interaction patterns that are unpleasant
  for all participants
• school failure
• high risk of fatal accidents, substance abuse,
  divorce, unemployment, psychiatric illness, and
  early death

Center for Evidence Based Practice Young
Children with Challenging Behavior
www.challengingbehavior.org
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Looking Back

Felitti VJ, Anda RF, Nordenberg D, Williamson DF,
Spitz AM, Edwards V, Koss MP, et al JS. The
relationship of adult health status to childhood
abuse and household dysfunction. American
Journal of Preventive Medicine. 199814245-258.
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Adverse Childhood Experiences

•  Emotional Abuse
•  Physical Abuse
•  Sexual Abuse
• Emotional Neglect
•  Physical Neglect
• Mother Treated Violently
•  Household Substance Abuse
•  Household Mental Illness
•  Parental Separation or Divorce
•  Incarcerated Household Member

http//www.cdc.gov/nccdphp/ace/findings.htm
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ACE Study Basics

• The ACE Study is the largest study of its kind
  ever conducted (more than 17,000 study
  participants) and the range of adverse childhood
  experiences and health related outcomes studied
  was unprecedented.
• An unexpectedly high number of adults who came to
  the Department of Preventive Medicine for
  comprehensive medical screening had experienced
  significant abuse or household dysfunction during
  their childhoods (only 1/3 reported no ACEs).

http//www.cdc.gov/nccdphp/ace/findings.htm
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ACE Study Findings

• ACEs were not only unexpectedly common, but their
  effects were found to be cumulative.
• As the ACE score increased the chances of being a
  user of street drugs, tobacco or having problems
  with alcohol abuse increased in a stepwise
  fashion.
• As the ACE score increased the number of risk
  factors for the leading causes of death increased.

http//www.cdc.gov/nccdphp/ace/findings.htm
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ACE Scores have demonstrated

• As the number of ACE increase, the risk for the
  following health problems increases in a strong
  and graded fashion
• alcoholism and alcohol abuse
• chronic obstructive pulmonary disease (COPD)
• depression
• fetal death
• health-related quality of life
• illicit drug use
• ischemic heart disease (IHD)
• liver disease
• risk for intimate partner violence
• multiple sexual partners
• sexually transmitted diseases (STDs)
• smoking
• suicide attempts
• unintended pregnancies

http//www.cdc.gov/nccdphp/ace/findings.htm
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• Those with an ACE score of 4 or more were
• Twice as likely to be smokers,
• 12 times more likely to have attempted suicide,
• 7 times more likely to be alcoholic, and
• 10 times more likely to have injected street
  drugs.
• (compared to score of 0)
• The behaviors such as alcohol or drug abuse,
  smoking, or sexual promiscuity are likely the
  result of the effects of ACEs on childhood
  development, which we now know to be
  neurodevelopmental in nature.

http//www.cdc.gov/nccdphp/ace/findings.htm
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• Adverse childhood experiences would typically go
  undetected because of shame, secrecy and social
  taboo.

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The fallout from various forms of child abuse
household dysfunction is monumental,

• costing Americans untold sums of money because
  of the health risks such as the use of street
  drugs, tobacco, alcohol, overeating and sexual
  promiscuity. Not the least of these high-ticket
  medical costs is due to cardiovascular disease,
  cancer, AIDS and other sexually transmitted
  diseases, unwanted often-high-risk pregnancies,
  chronic obstructive pulmonary disease, and a
  legacy of self-perpetuating child abuse.

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Early Childhood Mental Health
Promotion
Preventive Intervention
Treatment
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ECMH Promotion

• A population-based strategy that highlights the
  necessity for predictable, nurturing, sensitive
  caregiver-child interactions
• Public Awareness
• Universal screening systems that
• Systematically address all developmental issues,
  including social and emotional development and
• Are conducted in collaboration with parents and
  other primary caregivers and seen as informative
  and supportive and
• Result in appropriate supports, referrals and
  interventions.

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Opportunities to Promote Nurturing Interactions

• Well Child Visits
• WIC
• Early Care and Education Settings
• Child Care
• Early Head Start Head Start
• Universal Home Visiting Services
• IDEA, Part C Programs
• Others?!

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Pitfalls of Developmental Screening

• Waiting until a problem is observable
• Ignoring screening results
• Relying on informal methods
• Using a measure that is not suitable
• Assuming services are limited or nonexistent
• www.dbpeds.org/articles/detail.cfm?TextID5

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For More Information

• Facts about Developmental Screening Tools
• http//www.cdc.gov/ncbddd/child/tools.htm
• Developmental screening and assessment
  instruments with an emphasis on social and
  emotional development for young children ages
  birth through five.
• www.nectac.org/pdfs/pubs/screening.pdf
• Early Identification/Developmental
  Screeninghttp//www.aap.org/healthtopics/early.cf
  m
• Pediatric Developmental Screening Understanding
  and Selecting Screening Instruments
  http//www.commonwealthfund.org/publications/publi
  cations_show.htm?doc_id614864

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Screen . . . and then what?

• Identify community resources
• Identify service accessibility and availability
  challenges
• Collaborate . . . start with what is work
  toward good enough . . . (for now) and
  collaborate to achieve a high quality system of
  caring for all children and families.

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Supporting Mental Health to Positively Impact
Child Development
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jacquivanhorn_at_comcast.net