Cori Hill Partnership for People with Disabilities Virginia Commonwealth University

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Infant Mental Health IS Social Emotional Development: An Overview of Virginias Early Childhood Mental Health Initiative

Cori HillPartnership for People with DisabilitiesVirginia Commonwealth UniversityEarly Intervention Training Specialist

Bonnie GrifaInfant & Toddler Connection of VirginiaVirginia Department of Behavioral Health & Developmental ServicesProgram Specialist

This slide is up as participants enter session and when session starts while each presenter introduces themselves.

PLEASE NOTE: All slides are 1 mouse click to view slide unless otherwise stated in the notes section for a slide.1What Is Early Childhood Mental Health?

Opening Activity: 15 minutes

ASK: What is Early Childhood Mental Health?

At tables, ask participants to identify a writer and a presenter.

Use a fun technique to identify such as Who is the person who drove the furthest? Congratulations, youve already worked hard so you get to pick the writer and presenter for your table.

Ask each table to write down on scrap paper key words or phrases for what they think of when they hear the term infant mental health

Using flip chart, record responses generated from each table.

Summarize with an emphasis that ICMH is Social Emotional development.

Some key points to bring up if the participants do not:

Capacity to experience, regulate and express emotions;

Form close and secure interpersonal relationships;

Explore the environment and learn.

Synonymous with healthy social and emotional development

Reflects both the social emotional capacity and the primary relationships in children birth to age five

Because young childrens social experiences and opportunities to explore the world depend on the love & care they receive, the child AND the childs relationships are central to infant mental health.

It is essential to ensure that 1st relationships are trusting and caring, as early relationships provide an important foundation for later development.

Move to next slide after group activity is completed2What Does It Look Like?

Ask What does it look like?

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ASK: What do you think of when you see this picture?

Have participants call out their answers.

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ASK: What do you think of when you see this photo?

Have participants call out their answers.

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5

ASK: What do you see in this picture?

ASK: How many of you have seen this child before? What can you do? What DO you do?

Share briefly a personal experience about a tantruming toddler with the audience.

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6Why is Early ChildhoodMental Health So Important?

Healthy Social Emotional Development is Essential for Success in School and Life

The 1st years of life provide the basis for childrens mental health and social emotional development

Social development includes the ability to form healthy relationships with others;

Knowledge of social rules and expectations;

Emotional development includes experiencing feelings about self and others including positive and negative emotions as well as the ability to control and regulate feelings within the context of ones culture

Synonymous with:

Self worthSelf confidenceSelf regulation

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7What Is Known From Science?

Evidence based research is providing information and data that is driving the growth and expansion in the field of infant-child mental health.

From the earliest ages, early relationships are critical. Strong, responsive relationships have permanent effects on brain development, physical health, and mental health.

In the early stages of child development, social emotional and physical health go hand in hand.

Responsive providers/caregivers can improve the effects of varying conditions such as prematurity or poverty.

Intervention CAN be effective and recovery is possible.

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8What Are the Barriers for Families and Practitioners?

Unfortunately, there are still many barriers for families and practitioners when seeking support for infant-child mental health issues:

For some there is still stigma associated with mental health conditions;

There might be lack of extended family support or the idea that he/she could be better if only he/she tried harder.

MH concerns often have significant impact on family finances; caregivers with MH concerns may have trouble maintaining steady employment;

Nationwide, there is a lack of providers who are skilled to support children with MH concerns.

Sometimes there is lack of awareness that young children can even HAVE MH concerns and the early years are a critical period for the onset of mental health disorders:

Very young children are being expelled from childcare and preschool for behavior problems;

Infants are the fastest growing and single largest cohort in foster care; The extent of unmet need is not known.

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9 Is This An Issue For ALL Systems?ASK: Is this an issue for ALL systems?

ABSOLUTELY!!! This is truly an issue for ALL providers and systems. We need to collaborate with our partners (mention examples below) to build a cohesive system in each community:

Child CareHealth Care and Public HealthPart C Early InterventionChild WelfareEducationJuvenile JusticeMental HealthHead Start/Early Head Start

ASK: Do any of you have good examples of collaboration with agencies to support early childhood mental health?

Provide an example of your own, if necessary, to get the conversation started.

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10Why Invest In ECMH?

As we think about our partners and building a cohesive system, there are a few points that we can all agree to:

Infants cant wait;

2. Science supports our concern;

3. Social and emotional development is strongly linked to success in school (and beyond);

4. Barriers exist for families and providers

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11Why Is This Initiative So Important In Virginia?

Refer participants to Hand-Out : National and Virginia Data

Ask participants to take a look at the data. Give them time to read/review statistics.

ASK: What do you see when you look at these statistics about our very youngest children in Virginia?

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12What Can We Do?

ASK: So what can we do?

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A System of Early Childhood Mental Health . . . The Building Blocks PolicyPublic Awareness PracticeProfessional Development

There are 4 critical components or building blocks that are necessary to establish and build a mental health system focused on early childhood mental health according to Zero to Three, a national technical assistance organization:

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Policy-There has to be strong public policy to support this work. Much of the work in this field is still in its infancy. We all need to pay careful attention to public policy, legislative action and advocacy efforts to support this work.

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2. Public Awareness- Since this IS a relatively new field, we need to expand our public awareness efforts. We need to share information about child engagement, child participation and interaction, and the concept that even the youngest children are social beings.

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3. Practice-We need to strive toward mental wellness for all while preventing mental health issues whenever possible. When issues do arise for a child, we need responsive, effective intervention or treatment.

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4. Professional Development- Just as you are here today learning about infant mental health, ALL providers who work with young children and families need to be educated about this content.

Ask: Do you have ideas how YOU or your agency can assist with any of these components?

Consider some options that we can all do to improve early childhood mental health:

State and community strategic plans can guide our work. By developing goals, holding certain people accountable, etc, it enhances the capacity to build the system.

Get the word out on early indicators and screen as many children as possible. Ask: How many of you are seeing all of the public awareness occurring with autism? That is a prime example of sharing info about early indicators, benefits to screening, etc.

Dont reinvent the wheel. Collaborate. Pull resources and infuse infant & child mental health into all early childhood activities.

Continue seeking professional development. Take an online course, read a journal article, mentor with someone with infant mental health expertise.

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CHANGE PRESENTERS

14Improving Early Childhood Mental Health: What Is being done in Virginia?

ASK: So what is being done at the State level in Virginia?

Move to next slide15POLICYInfant & Child Mental Health Committee of Virginia (ICMHC)

Formed the Infant & Child Mental Health Committee of Virginia about 5 years ago;

Started as a sub-committee of the Head Start State Collaboration Advisory Committee;

Now recognized as the state level committee to address infant and child mental health in Virginia under Virginias Plan for Smart Beginnings, the state strategic plan for children birth to five, under Goal 4 (health);

The Infant & Child Mental Health Committee of Virginia:

Multi-agency, multidisciplinary, meets quarterly;

Have over 40 agencies/programs and parents represented;

Compiled a State by State Analysis of Early Childhood MH Initiatives;

Developed Virginias ECMH Mission and Goals;

Translated this into an Action Plan which is reviewed/revised/updated annually;

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16 POLICY

A major goal in our Action Plan was to establish a relationship with a professional organization focused on infant/child MH;

Currently in the process of expanding Virginias affiliate of the World Association of Infant Mental Health;

Officers elected in March 2011;

By-Laws revised and approved;

Quarterly meeting schedule established;

Membership application:(See hand-out)VAIMH membership: $25WAIMH membership $75Do not have to join the WAIMH to join the VAIMH

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17PRACTICE Adoption of the Pyramid Model (CSEFEL/TACSEI)

Refer to Hand-Out: The Pyramid Model

After researching several options, the Committee recommended that Virginia adopt the CSEFEL Pyramid Model:

It is a conceptual framework of evidence-based practices developed by the Center on the Social Emotional Foundations of Early Learning (CSEFEL) and supported by the Technical Assistance Center for Social Emotional Intervention (TACSEI).

They are both national technical assistance providers focused on social emotional development and assisting providers in supporting childrens healthy social-emotional development.

There are 9 Primary Partners of CSEFEL and TACSEI: (Pick a few to mention based on your audience)

Division for Early Childhood of the Council for Exceptional Children (DEC)IDEA Infant and Toddler Coordinators Association (ITCA)National Association for the Education of Young Children (NAEYC)National Association of State Directors of Special Education (NASDSE)National Association of State Mental Health Program Directors (NASMHPD)National Head Start Association (NHSA)Parent Advocacy Coalition for Educational Rights (PACER)National Association for Bilingual Education (NABE)National Association of Child Care Resource and Referral Agencies (NACCRRA)

The Pyramid Model focuses on:

Promotion of universal supports for all children; (Base);Prevention through targeted SE strategies to prevent problems; (Middle);Intervention for those children needing individualized help and referral to qualified mental health professionals. (Top)

It is based on a public health approach;Idea is that anyone working with children birth to five is trained to support children at all levels of the pyramid; At the base of the pyramid, providers learn and utilize techniques for ALL children to prevent social-emotional issues and support healthy social emotional development; At the middle of the pyramid, providers learn and utilize techniques to help children who may be at risk for social-emotional issues or are beginning to show early signs of a possible problem; fewer children are identified at this level than at the base of the pyramid (as you go up the Pyramid, fewer children should be identified at that level); At the top of the pyramid, providers learn and utilize techniques for a small number of children that are either diagnosed with a mental health issue or are demonstrating severe behavior or social-emotional issues. These are children who are also linked with a professional mental health provider.

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18PRACTICEEstablished Link between CSEFEL and

CSEFEL is assisting us with developing materials and training for VA using the Pyramid Model and the CSEFEL materials;

A Faculty Institute was held in February where a CSEFEL National Consultant worked with the professors from Virginia Community Colleges and Universities that train students for a degree in Early Childhood Special Education.

The participants learned how to infuse their university or college curriculum with the CSEFEL materials and Pyramid model framework.

Plan to do this type of training with the Universities and Community Colleges that train students in other related degrees such as Social Work, Early Childhood Education, PT, OT, Speech etc.

In addition:

Our first Train the Trainer event is being planned for late summer/early fall by 2 CSEFEL National Trainers.

Purpose is to train early childhood professionals on the Pyramid model and the CSEFEL materials.

Goal is to have trained professionals in every region of the state that can train others in their region.

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19PRACTICEEstablished Mental HealthEndorsement System

Refer to Hand-Out: VAIMH Endorsement Levels of Competency

Purchased a license agreement with Michigan using American Recovery & Reinvestment Act (ARRA) funding from the Part C Early Intervention program Infant & Toddler Connection of Virginia to use Michigans competency & endorsement system and materials in Virginia.

VA is now a part of a network of 14 states who have done this. A person endorsed in any of these states is recognized as being endorsed in any of these states (Reciprocity);

We participate in monthly calls and an annual conference with the other 14 states as well as with Michigan.

Able to learn from the other states since they are further along than we are with their endorsement so we are able to benefit from their lessons learned and experience.

Michigans materials includes a set of competencies for each level of the endorsement. This enables Virginia to ensure that anyone endorsed in Virginia at each of the 4 levels has the necessary knowledge, skills and abilities for that level to work with children birth to three in supporting their social-emotional needs.

1st VA endorsement cohort of eight candidates was identified on 3/29/11 with plans to begin the endorsement process with Michigan in April;

Anticipate 1-2 years to complete the endorsement process depending on where each candidate is with demonstrating the required competencies in their portfolio.

This 1st co-hort will work with Michigan to receive their endorsement and will then serve as our seed to grow the endorsement in Virginia;

They will mentor future endorsement candidates and assist us in effectively implementing the endorsement in Virginia;

One of the key requirements for those being endorsed at levels III and IV is reflective supervision.

We have identified a national expert in reflective supervision to do this for the first cohort.

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20PRACTICE Endorsement Levels I. Infant Family Associate II. Infant Family Specialist III. Infant Mental Health Specialist IV. Infant Mental Health Mentor (Clinical, Policy or Research/Faculty)

You will see on the Hand-Out that there are 4 levels to the endorsement.

The hand out explains the competency requirements to be successfully endorsed at each level including:

Education; Work experience; In-service training; Membership in an IMH association; Reflective supervision, if applicable;References; Written exam, Levels II & IV;

The professional portfolio requirements;

A signed Code of Ethics and Endorsement Agreement;As well as the costs associated with the endorsement process.

Examples of who might apply and at which level:Level I- Daycare, childcare or preschool worker;

Level II- Early Head Start home visitor, Part C Service Coordinator, NICU nurse, parent educator, CPS worker etc.

Level III- Therapist, supervisor, clinical nurse practitioner, early intervention specialist, or a mental health clinician.

Level IV- 0-3 administrator, researcher, faculty member, policy specialist or physician.

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21PRACTICEDeveloped ECMH Provider Survey

The ICMHC developed and distributed a Mental Health Provider Survey to Private Mental Health providers last April through July (2010) and will be doing this again in the very near future. Survey results will help us:

Identify:Existing behavioral health/MH providers in VA;

Support existing providers through technical assistance and training.

Assist:In building MH provider capacity in VA to serve this age group;

In advocating for necessary funding to support an effective early childhood mental health system in VA.

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22PROFESSIONAL DEVELOPMENTCreated a State Level Early Childhood Mental Health Coordinator Position

The ICMHC of Virginia created a State level ECMH Coordinator position:

Funded collaboratively by 3 state agencies (VDOE, VDSS, DBHDS Part C Early Intervention);

To be housed at DBHDS, Office of Child and Family Services;

To facilitate Train the trainer sessions across the state to develop a cadre of trainers skilled in the CSEFEL/TACSEI Pyramid Model that can train anyone working with children birth to five at the local level in supporting childrens social emotional development at all levels of the Pyramid as well as ensure that there is training available to assist our endorsement candidates, especially those at Levels III & IV in meeting the competencies needed for to be successfully endorsed;

To serve as contact for the VA Endorsement, VAIMH and other ECMH projects.

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23PROFESSIONAL DEVELOPMENTHelped in the Development of Online Training Modules

The ICMHC of VA helped in the development of online training modules on SE development.

The Modules are:

Based on CSEFEL materials and include an overview of the Pyramid Model;

Written by a CSEFEL Master Trainer;

Currently in final draft and review;

To be posted on the Early Intervention Professional Development website @www.eipd.vcu.edu

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24PROFESSIONAL DEVELOPMENTHelped Revise Virginias Competencies for Early Childhood Professionals

We are currently in the process of infusing the Competencies for Early Childhood Professionals document developed through the Virginia Early Childhood Development Alignment Project under the Office of Early Childhood Development with the social emotional competency language from Michigans Competency and Endorsement system adopted by Virginia.

Competencies related to supporting all childrens social emotional development needed to be strengthened. It is currently being revised to add other information as well and we were able to assist in doing this for social emotional development.

We are excited about this as it helps us to align the competency and endorsement system we are implementing from Michigan with Virginias Competencies for Early Childhood Professionals. This is a very important infrastructure step in building the early childhood mental health system in Virginia.25 PUBLIC AWARENESS

Please refer to the yellow hand-out: Infant & Child Mental Health Committee of Virginia Status Report

State Kick Off Event held last October in Richmond to announce the ECMH initiative happening in VA;

Established an online location for our materials, meeting summaries, training announcements etc. Refer them to the link at the bottom of the hand-out;

In the process of establishing a website for VAIMH which will eventually be the one location to go to for any information related to training, the endorsement, purchasing a copy of the competencies, meeting schedules, agendas and summaries etc.

Beginning to do presentations statewide.

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26WHATS NEXT?Survey Community Services Boards

To administer the ECMH Provider Survey to Community Services Boards in VA and do another round with private mental health providers within the next 4-6 weeks;

Will use the Survey respondents contact information to develop a data base for notifying mental health providers of ongoing professional development opportunities.

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27WHATS NEXT?Meet with DMAS

Once the endorsement is in place and the ECMH Coordinator is hired and initial training events are in place, plan to meet with DMAS to discuss the potential of Medicaid funding the work of endorsed ECMH Consultants available to anyone working with this age population in Virginia including daycares, preschools, Head Start, physicians and other health providers, early intervention providers, mental health providers etc.

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28WHATS NEXT?Strengthen Linkages with Early Childhood Partners

To ensure Virginia has a statewide, consistent & coordinated ECMH System, we must work collaboratively with all early childhood programs and providers.

We continue to work toward strengthening linkages with:

DBHDS, Office of Child and Family Services VDSS Social Emotional Pilot Communities Smart Beginnings Community Coalitions Home Visiting Consortium Infant Toddler Specialist Network Head Start/EHS Mental Health Coordinators Virginia Cross Sector Professional Development

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29WHATS NEXT?Identify Ongoing Funding To Sustain Our Efforts

Much of the funding we have been able to use so far has come from American Recovery and Reinvestment Act (ARRA) which will disappear very soon.

We need to identify all potential funding sources and work collaboratively with those sources to establish ongoing funding for these and future efforts to support an effective early childhood mental health system in Virginia.

The ECMH Coordinator position is currently funded for 2 years for example. We need to identify ongoing funding to support this position long-term.

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30WHAT CAN YOU DO?Help Support Our Efforts

We need your support. You can help us by doing the following:

Participate in training events sponsored by VAIMH or authorize staff you supervise to do this;

Join the VAIMH-it is open to anyone in Virginia that works with children birth to five, not just mental health professionals;

Become endorsed in Virginia-Or support staff you supervise to do this-one of the levels is sure to fit your or their education and experience ;

Complete the Provider Survey if you are a provider of mental health services to young children OR forward it to any mental health providers in your community;

Help us spread the word of what we are trying to do;

Help us identify potential funding sources;

Coordinate your early childhood mental health efforts with ours;

Provide us with your feedback and input;

Identify parents in your program to serve on the Infant & Child Mental Health Committee of Virginia or to join the VAIMH (This is an ongoing need).

Help us collect data and evaluate our efforts.

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31 Questions?

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Want contact information to be showing while questions are being answered32Contact Information:Cori Hill, Co-FacilitatorInfant & Child Mental Health Committee of [email protected]

Bonnie Grifa, VAIMH President, Co-FacilitatorInfant & Child Mental Health Committee of [email protected]

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Thank you for this opportunity to share what we are working on at the state level to support what you do each and everyday with the children and families you work with!33