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What
is Early Childhood Mental Health?
As attention to early childhood mental health has increased,
some people question the use of the term “mental health”
in connection with young children, given the stigma still associated
with mental illness. Can infants, toddlers, and pre-schoolers
even be mentally ill and, secondly, even if they can, why would
we want to attach such a label to a child that might stick with
him or her for a long time and negatively affect the way others
respond to the child? Why call it early childhood mental health?
To begin with, mental illness and mental health are not the same
thing, even though they are often closely connected because, for
example, agencies that treat mental illness often have the words
“mental health” in their names. But one term focuses
on a problem (illness), while the other focuses on something positive
(health). When we talk about “early childhood mental health,”
we are not primarily talking about bipolar disorder, major depression,
or even oppositional defiant disorder or conduct disorder, even
though it is possible that some of the young children served by
early childhood mental health initiatives will develop those illnesses.
Rather, we are referring to the positive results of intervening
early before problems develop into something more serious. Simply
put, early childhood mental health is the same as healthy social
and emotional development in young children, encompassing things
like learning to express and regulate emotions, forming close
and secure personal relationships, and exploring and learning
about their environment (paraphrased from the definition
developed by Zero to Three’s Infant Mental Health Task Force
and used by Pennsylvania’s Infant-Toddler Mental Health
Project.) So why don’t we call it “early childhood
social and emotional development?” Besides that being quite
a mouthful, the language of mental health is important not only
for its educational value in combating stigma against mental health
problems, but also for its implicit reminder that if we don’t
do our job with prevention with young children, their problems
may require more serious interventions later in life. We truly
do want them to develop good “mental health” in the
most positive sense of that term.
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Periodic Updates on Early Childhood Mental Health Initiatives in Pennsylvania
April 2010: Includes information about the Early Childhood Mental Health Consultation Project, the Advisory Committee recommendations, and other initiatives; also features a rationale for investing in early childhood mental health. Please print and distribute as you like.
June 2009: Includes data from Early Childhood Mental Health Consultation Project, information about various workforce development efforts, and a tribute to the late Jane Knitzer. Feel free to print and distribute.
November 2008: Contains a report of the new Early Childhood Mental Health Advisory Committee, along with updates on initiatives in workforce development.
May 2008: Contains information about the December 2007 Infant-Toddler Mental Health Symposium and brief summaries of other ECMH-related initiatives. For a fuller report of the symposium, check the Briefing Report.
- Briefing
Report from Pennsylvania’s Infant-Toddler Mental Health
Symposium, December 2007
These updates are designed to be printed and distributed to anyone who is interested.
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Early Childhood Mental Health Advisory
Committee Update
Advisory Committee Continues Work on Recommendation Action Plans
Since the September 1, 2009 meeting of the Early Childhood Mental Health Advisory Committee when the committee presented its recommendations to Estelle Richman, Secretary of Public Welfare, workgroup members have developed action plans for implementing the recommendations. The committee anticipates providing an update on progress to current Acting DPW Secretary Harriet Dichter at the next meeting on June 1, 2010.
Recommendations of the Pennsylvania ECMH Advisory Committee
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Pennsylvania’s Early Childhood
Mental Health Consultation Project
The Office
of Child Development and Early Learning and the Office of
Mental Health and Substance Abuse Services are partnering to promote
healthy social and emotional development in young children. The
two offices have combined resources to establish an Early Childhood
Mental Health Consultation Project to serve infants and toddlers
birth to age three in early care and learning centers. Originally
funded by grants and operating in three regions of the state,
the Early Childhood Mental Health Consultation Project expanded
statewide. There are Early Childhood
Mental Health consultants in each of the six
regional Keys that serve early learning programs in Pennsylvania.
The consultants help staff at early care and learning centers
by observing children and program practices, developing goals
and strategies to enhance the practitioners’ capacity to
encourage positive relationships, creating a learning environment
that promotes positive behaviors, and addressing the needs of
children who are experiencing behavioral challenges. As a resource
to the Early Childhood Mental Health Consultants, a child psychiatrist
is available for clinical consultation. In addition, collaboration
between county children’s mental health systems and the
consultants is encouraged when young children need to be referred
to the mental health system.
Early Childhood Mental Health Consultation Reports
Resources on Early Childhood Mental Health Consultation
- National Center for Effective Mental Health Consultation
- Integrating Early Childhood Mental Health Consultation with the Pyramid Model, Policy Brief by Deborah F. Perry and Roxane Kaufmann, November 2009. Published by the Technical Assistance Center on Social Emotional Intervention.
- Characteristics
of Effective Mental Health Consultation in Early Childhood Settings:
Multilevel Analysis of a National Survey, by B. Green, M. Everhart,
L. Gordon, and M. G. Gettman. Published in 2006 in Topics in Early
Childhood Special Education (Vol. 26, No. 3, pp. 142-152).
- Early
Childhood Mental Health Consultation, by E. Cohen and R. Kaufmann.
Volume 1 of 2005 series on Promotion of Mental Health and Prevention
of Mental Health and Behavioral Disorders, published by the Substance
Abuse and Mental Health Services Administration.
- Early
Childhood Mental Health Consultation: A Developing Profession,
by M. Allen, E. Brennan, B. Green, K. Hepburn & R. Kaufmann.
Published in the Winter 2008 edition of Focal Point, a publication
of the Research and Training Center in Family Support and Children’s
Mental Health, Portland State University.
- Early
Childhood Mental Health Consultation: An Evaluation Tool Kit,
by K. Hepburn, et al. Published in 2007 by the National Technical
Assistance Center at Georgetown University, and the Research and
Training Center in Family Support and Children’s Mental
Health at Portland State University.
- What Works? A Study of Effective Early Childhood Mental Health Consultation Programs, August 2009; published by the Georgetown University Center for Child and Human Development.
- Research Synthesis: Early Childhood Mental Health Consultation; published by the Center on the Social and Emotional Foundations for Early Learning
- Improving the Development of Pennsylvania Infants and Toddlers, prepared by the Infant-Toddler Systems Committee of the Pennsylvania Early Learning Council. Describes the “scientific and economic basis for investing in babies and toddlers” and makes recommendations for intervening early for infants and toddlers at risk of developmental problems.
What Works? A Webinar Series on Effective Early Childhood Mental Health Consultation
This eight-part series kicks off on April 28, 2010, and continues monthly through December. Registration is currently closed, but the audio and presentation materials will posted on the ECMHC webinar series web site.
Evaluation Report Released on Early Childhood Mental Health Consultation
Since 2006, Early Childhood Mental Health Consultants, located in the six regions of the Pennsylvania Key, have helped staff at early care and learning facilities address the needs of young children who are experiencing emotional and behavioral challenges. The University of Pittsburgh Office of Child Development recently released their evaluation report of the first two years of the Early Childhood Mental Health Consultation Project. Here are few of the findings:
- Over the course of the two-year pilot, the seven-member team served 226 children and 133 early learning programs.
- ECMH consultants referred 58% of their cases to other support services, most frequently to early intervention, but also to STARS technical assistance, children's mental health agencies, and other supports (pediatricians, etc.).
- The program received high praise from early care and education practitioners; on-site assistance was viewed as the most valued and helpful aspect of the program.
- Stakeholders felt that the project made valuable contributions to the state's early childhood mental health system: increased awareness of children's mental health issues; increased knowledge of services, supports and child development; and increased access to educational materials, referrals, support services, training and collaboration.
- There is still much work to be done: families need information, education and support, and practitioners and administrators need more resources, training and networking opportunities.
- The evaluators recommend that the project develop a detailed plan to identify goals, core program activities and program outcomes.
Finally, the ECMH consultants made several specific suggestions:
- Consultation services to young children through age 5 years,
- Additional training for early care and education staff on mental health and family issues,
- Expanded education for legislators on the importance of social emotional development in young children,
- Directed outreach and marketing of the project to families especially in rural counties,
- A continuing education system and professional development opportunities for early care and education staff focusing on social emotional development, and
- Support for ECMH staff that includes regularly scheduled reflective supervision, and expansion of consultants’ role to include systems building.
The Department of Public Welfare recently issued a news release about the evaluation report which includes a link to the full report.
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Focus on Early Childhood Mental Health - Handouts
One of the resources the Early Childhood Mental Health Consultation Project is providing to Keystone STARS early care and learning facilities across the commonwealth is a series of brief reader-friendly discussions of various topics of concern to parents of young children and early learning practitioners, called "Focus on Early Childhood Mental Health." A new topic is explored each month and can be used in facility newsletters or as handouts for parents.
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Additional Resources on Early Childhood Mental Health
Strengthening Families Through Early Care and Education
Pennsylvania is one of 17 state affiliates of the Strengthening Families National Network and is working to implement the Strengthening Families approach in early childhood programs.
Strengthening Families is a project of the Center for the Study of Social Policy and emphasizes five protective factors that not only reduce the incidence of child abuse and neglect but also encourage healthy social and emotional development. These protective factors are:
- Parental resilience: the ability of parents to cope with challenges
- Social connections: friends, family members, neighbors and other community members who provide emotional support and assistance to parents
- Knowledge of parenting and child development: accurate information about child development and how to appropriately discipline young children
- Concrete support in times of need: financial, formal and informal supports
- Children’s emotional and social competence: child’s ability to interact positively with others and communicate emotions effectively.
Early childhood programs can use an online self-assessment tool to help them begin to build the protective with families.
- Addressing the Mental Health Needs of Young Children and Their Families. Substance Abuse and Mental Health Services Administration, May 2010 (released for National Children’s Mental Health Awareness Day)
- Building
Blocks to a Healthy Future. This resource from SAMHSA for
parents, caregivers, and teachers of children aged three to six
provides lots of great tips, materials, and ideas for spending
time with their children and learning together.
- Child, Family and Community Core Competencies: Competencies
for Infant-Toddler and Early Childhood Mental Health Professionals,
by M. Hansen, C. Anderson, S. Peters, M. Lindblad-Goldberg &
D. Marsh. Published in 1999 by the former PA CASSP Training and
Technical Assistance Institute. Contact hsb5@psu.edu for a copy.
- Colorado Center for Social Emotional Competence and Inclusion: promotes the social and emotional development and inclusion of all children, birth through five, using the Pyramid Model, SpecialQuest approach, and other related evidenced-based practices.
- Crisis in the Kindergarten: Why Children Need to Play in School, by Edward Miller and Joan Almon. Published in 2009 by the Alliance for Childhood. New research shows that in many kindergartens there is no time for play as hours are spent each day instructing and testing children in literacy and math. As play time decreases, emotional and behavioral problems are increasing.
- Early Childhood Interventions: Proven Results, Future Promise, by Lynn A. Karoly, M. Rebecca Kilburn, and Jill S. Cannon. The Rand Corporation, 2005.
- Early Childhood Community of Practice, part of the Technical Assistance Partnership for Child and Family Mental Health. Provides an opportunity for discussion, collaboration, and the exchange of ideas and resources related to young children ages 0-8 who have mental health challenges and are currently being served by system of care communities.
- Evidence-Based Social-Emotional Curricula and Intervention Packages for Children 0-5 Years and Their Families, by Diane Powell and Glen Dunlap. Published in 2009 by the Technical Assistance Center on Social Emotional Intervention for Young Children. Part of the “Roadmap to Effective Interventions Practices” Series.
- Healthy Beginnings, Healthy Futures: A Judges’ Guide, 2009; published by the American Bar Association’s Center on Children and the Law in collaboration with the National Council of Juvenile and Family Court Judges and the Zero to Three National Policy Center; addresses the wide array of health needs of very young children in the child welfare system.
- Helping
Young Children Succeed: Strategies to Promote Early Childhood
Social and Emotional Development, by J. Choen, N. Onunaku,
S. Clothier & J. Poppe. Published in 2005 by the National
Conference of State Legislators and Zero to Three.
- Improving
maternal and infant mental health: Focus on maternal depression,
by N. Onunaku. Published in 2005 by Zero to Three: National Center
for Infants, Toddlers and Families.
- InBrief Series and Presentations from the National Symposium on Early Childhood Science and Policy, published by the Center on the Developing Child at Harvard University.
- Promising
Practices in Early Childhood Mental Health, by J. Simpson,
P. Jivanjee, N. Koroloff & M. Garcia. Volume III in the 2001
Series on Promising Practices in Children’s Mental Health,
published by the Substance Abuse and Mental Health Services Administration.
- Promoting Young Children’s Health and Development: Taking Stock of State Policy, by Will Schneider, Sheila Smith, Dionna Walters and Janice L. Cooper. National Center for Children in Poverty, May 2010.
- Program-Wide
Positive Behavior Support: Supporting Young Children’s
Social-Emotional Development and Addressing Challenging Behavior,
by L. Fox, S. Jack & L. Broyles. Published in 2005 by the
University of South Florida’s Mental Health Institute.
- Putting
It Together: Providing Mental Health Services in Early Intervention,
by S. Burns, V. Stagg, and B. Brennermon. Published in 1999 as
a CASSP Monograph.
- Webinar on Recognition and Response: Findings from the First Implementation Study. Recognition and Response is a model for pre-kindergarten children based on Response to Intervention (RTI) which is designed to provide high quality instruction and targeted interventions that are matched to children’s learning needs.
- Reducing
maternal depression and its impact on children: Toward a responsive
early childhood policy framework, by J. Knitzer, S. Theberge,
S. & K. Johnson. Published in 2008 by the National Center
for Children in Poverty at Columbia University.
- Research Synthesis: Infant Mental Health and Early Care and Education Providers; published by the Center on the Emotional and Social Foundations for Early Learning.
- Screening for Social Emotional Concerns: Consideration in the Selection of Instruments. J. Henderson and P. Strain, January 2009. This "Roadmap to Effective Intervention Practices," published by the Technical Assistance Center on Social Emotional Intervention for Young Children, provides an overview of various screening instruments and helps administrators and teachers decide which ones are best for their programs.
- The
Social and Emotional Development of Young Children, March
2008 edition of the PA?CASSP?Newsletter, published by the Office
of Mental Health and Substance Abuse Services, Bureau of Children’s
Behavioral Health Services.
- What
Is Infant Mental Health?
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Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders Action Plan
The Pennsylvania Fetal Alcohol Spectrum Disorders Action Plan 2008 from the Department of Health “is intended to provide a plan of action to address the very serious issue of birth defects caused by prenatal alcohol exposure. With a prevalence rate estimated at 1 in 100 live births for a spectrum of disorders which are 100 preventable, it is vital for the commonwealth to take steps toward prevention and intervention of FASD.”
The plan was developed by a state task force that included parents, advocates, physicians, researchers, service providers, nurses and government policy makers. It lists goals and objectives in five major areas:
- Awareness: Increase awareness of FASD and its symptoms.
- Data: Collect, interpret, and disseminate information on FASD.
- Education: Increase the knowledge of FASD within the professional community and the general population.
- Funding: Ensure adequate funding for prevention as well as services for diagnosis and intervention for children, adults and families affected by FASD.
- System: Align and improve systems of care by making FASD a statewide priority.
According to the National Organization on Fetal Alcohol Syndrome, alcohol use during pregnancy is the leading preventable cause of mental retardation and birth defects in the United States, and affects about 40,000 babies each year—more than spina bifida, Downs Syndrome and muscular dystrophy combined. Effects of FASD include growth deficits, mental retardation, physical defects, behavior problems, attention and memory problems, difficulties with motor skills and poor judgment. Additional descriptions and diagnostic labels for children and adolescents with FASD include oppositional defiant disorder, obsessive compulsive disorder, depression, conduct disorder, attention deficit hyperactivity disorder, attachment disorder, sleep disorders, extreme aggressiveness, extreme impulsivity and learning disability. The Centers for Disease Control asserts that there is no cure for FASD, but if children are identified early and receive appropriate services, they can be helped.
For additional information about FASD and two Pennsylvania family stories, check out the June 2006 edition of the PA CASSP Newsletter, “Focus on Fetal Alcohol Spectrum Disorder.”
Resources on FASD
The Maternal and Child Health (MCH) Library at Georgetown University has key resources on Fetal Alcohol Spectrum Disorders (FASDs), including web sites; fact sheets and brochures; screening, diagnosis, surveillance, intervention, and training tools; prevention-education materials (in both English and other languages); and other materials.
From Minnesota:
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