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 2012: Includes results of 2010-2011 evaluation of ECMH consultation project, progress on Parent-Child Interaction Therapy in Pennsylvania, and highlights of county work on ECMH initiatives.
March 2011: Includes information about Parent-Child Interaction Therapy expansion in Pennsylvania, 2011 National Children’s Mental Health Awareness Day, updates on various ECMH initiatives, and several new resources for ECMH practitioners. Please print and distribute freely.
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.
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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Pennsylvania’s Early Childhood
Mental Health Consultation Project
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.
NEW! "We are Pennsylvania's Future" video from Pennsylvania’s Promise for Children shares from the children's perspective how investments in quality early education build a brighter future for Pennsylvania's families, businesses and communities.
NEW! Video about Early Childhood Mental Health Consultation, from the University of Pittsburgh's Office of Child Development
Research information from the Office of Child Development and Early Learning: OCDEL works with many partners to create opportunities for the commonwealth’s children. Parents, schools, child care, early intervention, Head Start, libraries, community organizations and other stakeholders have joined with the Office of Child Development and Early Learning to provide high quality early childhood programs and effective prevention strategies to mitigate challenges faced by families that affect school readiness and academic success.
Research Brief, February 2013; shows significant evidence suggesting that technical assistance is effective in helping facilities advance STAR levels and improve the quality of their programs.
Early Childhood Mental Health Consultation Reports
- Early Childhood Mental Health Consultation Program Report, 2008-2009 (full report)
- Early Childhood Mental Health Consultation Annual Report; July 1, 2008 - June 30, 2009 (two-page summary suitable for printing and distribution)
- Early Childhood Mental Health Consultation Annual Report: July 1, 2009 - June 30, 2010
- Early Childhood Mental Health Consultation Project Annual Report, July 1, 2011 - June 30, 2012 (two-page summary suitable for printing and distribution)
- Early Childhood Mental Health Consultation Annual Report, July 1, 2011-June 30, 2012 (full report)
Resources on Early Childhood Mental Health Consultation
- Markers That Matter: Success Indicators in Early Learning and Education, July 2013: Report developed by FSG with support from the W.K. Kellogg Foundation distills a set of 48 early childhood indicators that reflect healthy development of young children.
- Video about Early Childhood Mental Health Consultation, from the University of Pittsburgh's Office of Child Development
- Center on Effective Early Childhood Mental Health Consultation, Georgetown University Center for Child and Human Development. Includes a Best Practice Tutorial Series for early childhood mental health consultants.
- 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.
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).
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.
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.
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.
Evaluation Report Released on Early Childhood Mental Health Consultation
Evaluation of the Infant/Toddler Systems Building Initiative: Final Report for the Early Childhood Mental Health Consultation Program, June 2006-June 2008
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Parent Child Interaction Therapy (PCIT)
In 2010, the Department of Public Welfare received a two-year grant from The Heinz Endowments to assist with the goal of implementing Parent-Child Interaction Therapy in Pennsylvania and issued a Request for Applications to all licensed mental health agencies in the commonwealth. Eight providers from across the state received grant assistance to receive training in PCIT. Parent-Child Interaction Therapy (PCIT) is an evidence-based mental health intervention that has been shown to decrease child behavior problems, improve the parent-child relationship, decrease parental stress while increasing their sense of control, and decrease the re-occurrence of or prevent child abuse. Implementing this intervention will help increase the capacity of Pennsylvania providers to serve very young children. PCIT has been demonstrated to have positive outcomes with many children and families and is listed in the National Registry of Evidence-based Programs and Practices.
University of Pittsburgh Receives Grant; PCIT to Expand in Pennsylvania
In 2012, the University of Pittsburgh received a five-year grant for $3.3 million from the National Institute of Mental Health called “A Statewide Trial to Compare Three Training Models for Implementing an Evidence-Based Treatment (EBT).” The EBT that will be used in the statewide trial is Parent-Child Interaction Therapy (PCIT), comparing three training models for that treatment modality. The grant project is known as “PCIT Across PA: Healthier Kids Happier Families.”
The grant will help us understand what training methods are most effective for implementing an evidence-based treatment like PCIT. It will also help to build workforce capacity and significantly expand access to PCIT services in Pennsylvania for children ages 2½-7. Seventy-two additional licensed outpatient mental health providers will be chosen to participate in the grant project. The grant will cover the cost of training four clinicians from each agency and some site preparation costs. In addition to expanding PCIT across Pennsylvania, the grant provides an opportunity for the state to help inform PCIT International about the efficacy of various training models since currently the answer is not known to the question of which training method is most effective.
Training in Berks and Erie Counties is currently in progress; agencies in Allegheny, Bedford/Somerset, Bucks, Carbon/Monroe/Pike, Chester, Clearfield/Jefferson, Cumberland, Franklin/Fulton, Huntingdon/Mifflin/Juniata, Lackawanna/Susquehanna, Luzerne/Wyoming, Northumberland and Schuylkill Counties will begin in September 2013. An informational meeting with several other counties was held in early July. PCIT across PA staff at the University of Pittsburgh are continuing to get the word out to more counties and providers about the opportunity to be involved in this grant project and receive free training in PCIT. By the end of the grant, the goal is for all 67 counties in Pennsylvania to have received training.
For more information about the grant, contact Dr. Amy Herschell, principal investigator, University of Pittsburgh School of Medicine.
Map and list of PCIT providers in Pennsylvania, as of August 2013. (This document shows the growth in the number of counties and providers offering PCIT from 2011 to the present.)
More information about how PCIT is being implemented in Pennsylvania is in an expanded edition of the December 2012 edition of the PA CASSP Newsletter.
Policy Clarification for Parent-Child Interaction Therapy programs regarding the use of seclusion and restraint
The OMHSAS Bulletin, “The Use of Seclusion and Restraint in Mental Health Facilities and Programs” (02-01, issued 4/8/01), applies to a wide range of mental health facilities and programs, including psychiatric Outpatient clinics. The bulletin prohibits the use of seclusion, except in psychiatric hospitals, and identifies the rationale for use of manual restraint to be in response to an emergency safety situation, “only after appropriate less restrictive behavioral techniques have been tried…”
Parent-Child Interaction Therapy (PCIT), an evidence-based practice for young children (2.5-7 years) with severe behavioral challenges and their families, has procedures that may involve a parent picking up and moving a child, and also may involve the use of a room for the child that is separate from the therapy room, referred to as a time-out room, a time-out space, and a safe space. Are these practices, understood within the context of PCIT as an integrated treatment for the above target population, compatible with the bulletin and with other bulletins related to the use of seclusion and restraint?
Guidelines for PCIT Time-Out Rooms used within Pennsylvania Outpatient Clinics (examples of acceptable and unacceptable practices)
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
- A Call to Action on Behalf of Maltreated Infants and Toddlers, published by the American Humane Association, Center for the Study of Social Policy, the Child Welfare League of America, Children’s Defense Fund, and Zero to Three, 2011
- A Developmental Approach to Child Welfare Services for Infants, Toddlers and Their Families, a self-assessment tool for states and counties administering child welfare services. From Zero to Three, May 2012.
- Act Early Campaign, Centers for Disease Control: FREE materials for parents, healthcare providers, and childcare providers; printed with English on one side and Spanish on the other.
- 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)
- Attachment: What Works? a brief from the Center for the Social and Emotional Foundations for Early Learning, February 2011
- Backpack Connection Series: from the Technical Assistance Center on Social Emotional Intervention, handouts to send home in each child’s backpack when a new stratgey or skill is introduced; helps teachers and parents/caregivers work together to help young children develop social emotional skills
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.
- Building Strong Systems of Support for Young Children’s Mental Health: Key Strategies for States and a Planning Tool, June 2011. Published by the National Center for Children in Poverty.
- 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 email@example.com 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.
- Connecting Neurons, Concepts, and People: Brain Development and Its Implications, by Ross Thompson, Jr., National Institute for Early Education Research, Rutgers University, 2008.
- 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.
- Devereux Early Childhood Initiative: Creates working partnerships among early childhood educators, mental health professionals, and families to promote young children's social and emotional development, foster resilience, and build the skills for school success.
- Early Childhood Education as an Essential Component of Economic Development, University of Massachusetts Political Economy Research Institute, January 2013.
- 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.
- The First Eight Years: Giving Kids a Foundation for Lifetime Success; Policy Report from Kids Count, Annie E. Casey Foundation
- 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.
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.
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.
- Infant Mental Health and Its Impact on the Family Relationship: Webinar series from Allegheny County’s “Helping Families Raise Healthy Children” Robert Wood Johnson grant project.
- Infant Early Learning GPS (Guiding Parents Smoothly), a program of Pennsylvania’s Promise for Children. Helps families set the right course for their children’s success in kindergarten and beyond. Great for anyone who has a baby in their life—grandparents, aunts, uncles, friends and neighbors.
- Multiplying Connections: Based in Philadelphia, Multiplying Connections seeks to create more and higher quality connections between young children and caring adults. Focused on enhancing the efforts of the public system professionals entrusted with nurturing, protecting, and supporting children, and collaborates with Philadelphia’s Department of Public Health, Division of Maternal, Child and Family Health; Department of Behavioral Health, Children’s Services; Department of Human Services; and the School District of Philadelphia’s Early Childhood Division
- National Council on the Developing Child, Harvard University: multi-disciplinary collaboration of scientists and scholars from universities across the United States and Canada designed to bring the science of early childhood and early brain development to bear on public policy decision-making. Publishes a series of reports and working papers, including:
- Parent Engagement from Preschool Through Grade 3: A Guide for Policymakers, from the National Center for Children in Poverty, September 2013. Features how Pennsylvania uses Early Childhood State Advisory Councils to develop and disseminate parent education materials
- Preventing the Use of Restraint and Seclusion with Young Children: The Role of Effective, Positive Practices, Issue brief from the Technical Assistance Center for Social Emotional Intervention, February 2011
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.
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.
It Together: Providing Mental Health Services in Early Intervention,
by S. Burns, V. Stagg, and B. Brennermon. Published in 1999 as
a CASSP Monograph.
- Racial Gaps in Early Childhood: Socio-emotional Health, Developmental, and Educational Outcomes Among African-American Boys, National Center for Children in Poverty, May 2011
- 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.
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.
- Resources for Early Childhood Practitioners: “How to Choose a Social-Emotional Curriculum” and “When to Seek Outside Help for Children’s Problem Behavior.” From the Center for the Social and Emotional Foundations of 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.
- SERIES: An Integrated Approach to Supporting Child Development, from the PolicyLab at The Children’s Hospital of Philadelphia, Summer 2012. Highlights recent work related to developmental screenings for young children. Research found that although although developmental screening of children in primary care settings has increased, many children with identified developmental needs are never linked to appropriate services.
- Sesame Street Toolkits for Parent: Have you ever wished that your child came with an instruction manual? Sesame Street Tool Kits are the next best things. They provide opportunities to build closeness and confidence, make learning fun, and keep your child's world safe and secure
sesamestreet.org—toolkits for parents
- Supporting Infants, Toddlers and Families Impacted by Caregiver Mental Health Problems, Substance Abuse, and Trauma: A Community Action Guide, 2012. From SAMHSA. Using a case study approach, presents resources service providers, advocates, and practitioners can use to better understand and engage the community in responding to children whose caregivers are negatively impacted by mental illness, substance abuse, or trauma.
- State-level Indicators for Social-emotional Development: Building Better Systems, National Center for Children in Poverty, February 2011
- Text4baby: Free mobile information service designed to promote maternal and child health, from the National Healthy Mothers, Healthy Babies Coalition. Provides pregnant women and new mothers with information to help them care for themselves and give their babies the best possible start in life. Women who sign up by texting BABY to 51141 (or BEBE in Spanish) will receive free text messages each week.
- The Incredible Years: Research-based, proven effective programs for reducing children's aggression and behavior problems and increasing social competence at home and at school.
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.
- Understanding Parents’ Perspectives on the Transition to Kindergarten: What Early Childhood Settings and Schools Can Do for At-Risk Families, Best Practices in Mental Health, Vol. 7, No. 1, January 2011.
Is Infant Mental Health?
- When Families Grieve, resources for helping children and families deal with grief, from Sesame Street Workshop
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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.
Factsheet from Strengthening Families Pennsylvania
Strengthening Families Pennsylvania website
Preventing Child Maltreatment and Promoting Well-Being: A Network for Action 2012 Resource Guide, developed to support service providers in their work with parents, caregivers, and their children to prevent child abuse and neglect and promote child and family well-being. Resources are in both English and Spanish.
Parent Leadership and the Five Protective Factors; An Idea Book for Successful Program Integration, December 2012
Core Meanings of the Strengthening Families Protective Factors
Briefs on Five Protective Factors
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