Objectives

RECOGNIZING AND ADDRESSING MENTAL HEALTH ISSUES IN THE EI

SETTING

ANGELA WASHINGTON, MA LPCDIRECTOR OF CHILDREN SERVICES

ARC OF WALKER COUNTY

LEANN OLIVER, MA LPCPARENT

EARLY INTERVENTION / PRESCHOOL CONFERENCENOVEMBER 2010

Objectives1. Recognize common behavioral/

mental issues in children2. Identify and differentiate between

behavioral concerns and true developmental delays

3. Recognize and understand the impact of familial mental health on children

4. Identify and understand how to respond to common behavioral issues and when to refer.

Infant-Toddler BehaviorTemper

Tantrums

Aggression

Attachment

Sleep Disturbanc

e

Anxiety

Non-complianc

e

Typical vs. Atypical

• duration• Intensity• Time of day• Setting

Temper Tantrums

• triggers• Impulsive• Anger vs.

Communication

Aggression

Typical vs. Atypical

• triggers• Setting• Physical reactionsAnxiety

• interaction• Family vs. public• Age of onset• Child history

Attachment

Typical vs. Atypical

• triggers• Setting – time of day• Setting

limits/boundaries

Non-Complianc

e

• Age• Frequency/external

factors• Duration of sleep

problems

Sleep Disturbanc

e

Is this behavior normal?Conversation/observation is key in

determining if behavior is typical or atypical. Here are a few things to observe:

Duration – is the behavior lasting for long periods of time i.e. greater than 15-30 minutes

Does behavior occur in a variety of settings?

Is the child able to “self-calm”? Do triggers appear to be present? Is the behavior easily explained? Are there recent changes in the family?

Atypical BehaviorWhat do we do now?

You determine the behavior present is not typical, what do you do now?

Have a caring, supportive conversation with the family.

Discuss with the family their concerns and ways you can help

Assist the family in getting everyone “on board” with interventions

Depending on the concern, refer to outside professionals

**Interventions need to be addressed on IFSP**

Behavior and the IFSP“Matthew”

Matthew is a two year old boy who was initially referred to EI for speech concerns. At your last visit Mom tells the EI provider that Matthew’s temper tantrums are worse. Through conversation you learn that Matthew is having approximately 5-6 tantrums a day lasting 30 minutes or longer. Tantrums occur at home, the store etc. Along with his tantrums he is becoming aggressive. Mom has difficulty cooking dinner, shopping ,etc due to his increased tantrums.

Do we address this concern on the IFSP?YES!!

MatthewWhat does his IFSP look like? What are his

outcomes? Who will provide the service?

Outcomes need to be specific and functional for the family

Procedures need to be specific for the family

Services may need to be addressed as a non-EI service

Familial Mental Health Depression Anxiety Personality Disorders Substance Abuse Major Mental Health

Disorder

Maternal DepressionEffects on Infants and Toddlers

Slow to respond to overtures for verbal or physical interactions by their children

Make critical comments Have difficulty in encouraging the child’s

speech/language facility. Have difficulty asserting authority and setting limits

which would help the child learn to regulate his or her own behavior.

Talk less to their infants Do use lilt and exaggeration that are typical of non-

depressed mothers Less aware and responsive to their infant’s cues Have difficulty in providing appropriate stimulations.

Maternal Depression and EI(or family depression)

“Grace”Nine month-old “Grace” is listless. Referral

information indicates she is not sitting up or pulling to a stand.

What type of evaluations would you recommend based on this information?

Typically this information would lend to PT evaluation…here is more information before we refer.

“Grace”Nine month-old “Grace” is listless. Referral

information indicates she is not sitting up or pulling to a stand.

Grace’s mother has frequent crying spells and spends little time with her infant. Left alone in her crib for long periods of time. Grace is unresponsive, difficult to arouse and looks downcast.

Does this information change or alter our referral in any way?

“Grace” PT evaluation would be beneficial and

necessary, however should not stand alone. Conversation with Mom and possible referral is vital.

Routine Based Assessment is key in determining other causes to a child’s delay.

When we evaluate the child, we need to look at the family as a whole

Maternal DepressionMaternal Depression has been shown to be

associated with the following: Increase in behavior problems Social-Emotional maladjustment Deficits in Cognitive functioning Difficulty with attachmentResearch has shown that if attachment is

secure, the young child is more likely to successfully negotiate developmental tasks.

Talking with the FamilyDo’s and Don’ts

Listen to the family – a good Routine Based Assessment will lead to discussion and help identify the parents concerns and possible behavior problems

Focus on the issue – not the person. The child or parent is not “bad” – the behavior or behavior pattern is of concern.

Be open and honest - ignoring issues will only lead to them becoming worse.

We have tried everything…when to refer

Traditional behavioral interventions are not working

Behavioral disruptions are occur in a variety of settings i.e. home, church, daycare etc.

A person is at risk of harming themselves or someone else

Suicidal ideations

Referral SourcesBehavior Problems in Children Licensed Counselor/Play Therapist who specializes in

children Psychologist/Psychiatrist Local Mental Health CenterFamilial Mental Health Problems Licensed Counselor/Psychologist Substance Abuse Counselor/Group Local Mental Health Center Name/Number of local Crisis Line

Summary Behavior problems are common in

toddlers Evaluate behavior to determine if it is

typical or atypical Familial mental health is important, and

left untreated directly affects the child Many behavior problems can be

addressed on the IFSP, however it is important to know when to refer

Questions?

Thank you!!!

Have a wonderful day!

Angela Washington, MA LPCDirector of Children Services

Arc of Walker County [email protected]

LeAnn Oliver, MA LPCDirector Family Options/Parent

[email protected]