Healthy Beginnings

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Healthy Beginnings

• A Collaborative Infant Mental Health Intervention
  in a Public Health Clinic

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What Is an Infant Mental Health Intervention?

• Focuses on infants and children 0-5 years of age
• Seeks to optimize social and emotional
  development of young children
• Is a multi-disciplinary approach involving
  psychiatry, psychology, social work, and
  pediatrics

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2000 MCH Needs Assessment 1 Priority Mental
Health Access
Homicide Rates New Orleans
Age (years) Rate per 100,000
1-4 10
5-14 14
15-24 211
25-34 287
Healthy People 2010 goal lt 7.2.
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2000 MCH Needs Assessment 1 Priority Mental
Health Access
Suicide Rates New Orleans
Age (years) Rate per 100,000
15-24 93
Healthy People 2010 goal 9.6
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2000 MCH Needs Assessment

• Suicide and Homicide rates far exceed 2010 goal
• Community surveys list substance abuse and
  homicide as primary concerns
• Mental health access to services ranked 1
  priority
• Must begin in infancy to prevent adolescent
  problems

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Collaborators

• Tulane Child Psychiatry Department
• Childrens Bureau
• LA Office of Public Health
• Region I Office of Mental Health
• Institute for Mental Hygiene
• New Orleans Health Department

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Collaborator Roles

• Tulane Child Psychiatry
• provides
• two part-time supervising psychologists
• psychiatry fellow
• senior psychiatry faculty supervision
• one full-time clinic psychologist
• (program director)
• administers the HB grant from IMH

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Collaborator Roles

• Childrens Bureau provides two social workers
  and one case manager
• LA Office of Public Health funds Childrens
  Bureau social workers and NOHD MCH nurse
  coordinator
• Region I Office of Mental Health provides half
  time social worker

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Collaborator Roles

• Institute for Mental Hygiene provides funding
  through 125,000 grant to Tulane
• New Orleans Health Department
• provides
• primary care (EPSDT) and WIC services
• referrals to Healthy Beginnings Program
• nursing and clerical support
• physical space in Mary Buck Clinic (paid by
  grant)

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Governance

• MOA written with help of facilitator and signed
  in fall of 2001
• Operations Committee senior representation for
  each organization meets quarterly
• Evaluation Committee oversees research, data
  management, and program outcomes
• Clinic Coordinating Committee oversees clinic
  policies, forms, referrals, and feedback to
  providers

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Clinic Operations

• Children with risks identified are invited to
  schedule an appointment with a HB social worker
• An assessment is conducted over several visits
  and immediate and long-term treatment goals are
  formulated with the caretaker
• A home visit is conducted as part of the
  assessment
• Family is given choice of clinic or home for
  future sessions

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Clinic Operations

• All assessment data is entered into the database
• A caseworker links family with needed community
  social services
• Interdisciplinary case conferences are held
  weekly with clinic and HB staff
• Families are followed until goals are met or
  family is lost to follow-up

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Achievements in First Two Years

• A 30 hour training was held for 3 clinic
  physicians and 33 nurses in identifying infant
  mental health problems
• Facility was renovated to accommodate HB staff
  using grant funds

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Achievements in First Two Years

• Undoing Racism workshop held
• Over 143 children were served 33 are still
  active
• Assessment process was shortened
• Collaborator relationships continue to develop

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Demographics of Population Served

• 66 males 34 females
• Average age 24 months
• Average income below 10,000
• 93 African American, 4.8 Caucasian, 1.6
  Hispanic, .8 Pakistani Indian

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Referral Concerns

• Physical aggression
• Temper tantrums
• Hyperactivity
• Inattention
• Developmental Delays
• Anxiety disorders
• Feeding disorders

• Adjustment problems
• Withdrawn behaviors
• Childhood depression
• Maternal depression (approximately 50)
• Domestic violence
• Physical abuse
• Parenting concerns

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Assessment Tools

• Achenbach Child Behavior Checklist (CBCL) Ages 1
  1/2 - 5
• Infant Toddler Social Emotional Assessment
  (ITSEA) Competence Scale
• Disturbances of Attachment Interview (DAI)
• Parent-Child Interaction

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Assessment Tools

• Beck Depression Inventory (BDI-II)
• Parent Perception Interview
• Partner Violence Inventory (PVI)
• Omitted
• HOME inventory
• Vineland
• Maternal Self-Efficacy Scale

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Lessons Learned

• Early mental health intervention is possible in a
  public health clinic with limited funding
• Collaborative efforts can bring cost-effective,
  state of the art interventions
• Communication between collaborators is key
  cultural, professional, and institutional
  barriers need to be expected and addressed

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Key Players

• Tulane Paula Zeanah, PhD, MSN
• Julie Larrieu,PhD
• Shana Bellow, PhD

• NOHD Susan Berry, MD, MPH
• Donna Malus, RN, BSN
• Pat Delaune, RN
• Mary Burns, RN

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Key Players

• OMH Guilda Butler, LCSW
• Childrens Bureau Ron McClain, LCSW, Letia
  Bailey, LCSW
• OPH Stacia Loveall, MSW, MPH