Early Childhood Mental Health: What’s Happening in NH

1. Early Childhood Mental Health: What’s Happening in NH

2. Early Childhood Mental Health is… The social/emotional well being of children aged birth to six years which promotes the capacity to: • Experience, manage and express emotions • Develop and sustain stable relationships with others (adults and peers) • Safely explore the environment and learn • Demonstrate developmentally appropriate behavior

3. Prevalence of Early Childhood Mental Health Concerns • 74,689 children under the age of 5 in NH • 13.5% (10,218) live in poverty, (NCCIC, 2010) • 912 cases of founded child abuse in 2007, a 10.9%increase over 2006 • In 2007, of 1,084 children not living with parents, 290 were under the age of 5, (Administration for Children and Families, 2009, www.cwla.org)

4. Prevalence of Early Childhood Mental Health concerns • NH Center for Public Policy Studies (NHCPPC) estimated that 20% of NH children ages 5-15 could have a mental health disorder • 10-20% of preschool children experience- behavioral/mental health concerns, (Dunlap, 2006) • This suggests that over 7,500 under age 5 are in need of mental health services, (NHAIMH, 2009)

5. Prevalence of Early Childhood Mental Health concerns (cont.) • Of 173 families surveyed, 46.2% were worried that their child (under age 6) might have a social emotional or behavioral disorder, (NHAIMH 2009,Mental Health Services for NH’s Young Children and their families: Planning to Improve Access and Outcomes)

6. Nationally, the rate of child care/preschool expulsion due to challenging behavior of preschool age children is three times greater than for kindergarten and toddler (Gilliam, 2005). NHAIMH 2001 Child Care Expulsion survey found that in a 15 month period, 53% of child care programs reported they had either expelled a child or enrolled a child that had been expelled elsewhere. Prevalence of Early Childhood Mental Health concerns (cont.)

7. Prevalence of Early Childhood Mental Health concerns (cont.) • Toxic stress is known to negatively impact brain development. • Between 75 and 130 of every 1,000 children in the US under the age of 5 live in homes with 1 of 3 common precipitants of toxic stress (maltreatment, parental substance abuse and maternal depression) www.developingchild.harvard.edu

9. Where people go for help • 80% of families report they first seek help from their medical provider when concerned about their child’s mental health or behavior • 72% of medical providers report they need more information regarding child development • 80% report they need information and resources about behavior (NHAIMH, 2009)

10. Some Risk Factors for Early Childhood Mental Health Issues • Toxic Stress • Parents with significant mental health issues, (including depression, personality disorders, anxiety, PTSD, Bi-Polar, Schizophrenia) • Current or history of abuse and neglect, homelessness, substance abuse, domestic violence • High level of family stress, (chronic or multiple acute stressors) • Child with developmental or medical issues, colic, challenging temperament, attachment concerns • Parent-infant temperament mismatch

12. Why early intervention is so important “Well designed early childhood interventions have been found to generate a return to society ranging from $1.80 to $17.07 for each dollar spent on the program.” Economics Nobel Laureate, James Heckman University of Chicago • http://www.ideainfanttoddler.org/pdf/2008_Good_News.pdf

13. Why early intervention is so important • “Effective early childhood programs generate benefits to society that far exceed program costs. Investments in the earliest years of life show the greatest returns- $3.00-$16.00 dollars per dollar invested through reduced crime, welfare, educational remediation, etc. www.developingchild.harvard.edu

14. Home Visiting • “Home visiting influences maternal parenting practices, the quality of the child’s home environment and children’s development…. Greatest benefit for low-income first time adolescent mothers.” (Howard, Brooks-Gunn, 2009) • 15 year follow up from home visiting project in Elmira, NY, (David Olds), found 48% less incidents of abuse and neglect through age 15 (Robert Wood Johnson Foundations, 2006)

15. So, where are these children? • Child care • Medical Care Providers • Home and community • Schools (pre-school and kindergarten)

16. Child Care Early Head Start Head Start Home Visiting Programs Early Supports and Services Special Education Watch Me Grow Child Protection Mental Health Services Community and Family Support Programs (Family Resource Centers) Other Community services …and what are the services?

17. Recommended Levels of Service 3 Tiered Approach • Tier 1- safety, health, supportive and nurturing relationships for all • Tier 2- Center-based care and education and Parent and Family Supports for families in poverty • Tier 3- specialized support and clinical services for families most likely to experience toxic stress and or high risk in other ways. www.developingchild.harvard.edu

18. In NH…. • General family support and parent education • Child care site-focused support and education, (i.e. PTAN child care consultation) • General child development support • Child/family specific support/ intervention based on eligibility • Enhanced services based on eligibility, diagnosis and/or finding of abuse or neglect; (ie through ESS or Mental Health)

20. State Supported Programs

21. State Supported Programs cont.

22. Numbers Served & Costs

23. Numbers Served & Costs cont.

24. Numbers Served & Costs cont.

25. Numbers Served & Costs cont.

26. Identified Gaps/Needs and Existing Promising Practices

27. Gaps and Needs • Information, support and resources for primary care providers • Support and consultation for childcare providers • Professional training at all levels • Earlier identification of social emotional needs • Access to and availability of quality services across regions • Clear eligibility criteria for community mental health services • Expansion of evidence-based practices

28. Information, Support and Resources for Primary Care Providers • Watch Me Grow • ASQ-SE and other screening tools • Developmental specialists and Mental Health Providers in primary care offices

29. Support and Consultation for Childcare Providers • PTAN and other existing child care consultation models • The Head Start Early Childhood Mental Health Consultation Model • NH Early Learning Guidelines • Healthy Child Care NH • Maine RELATE Model of Early Childhood Consultation • NH Early Childhood and Family Mental Health Competencies

30. Professional training at all levels • Mental Health Expertise on Early Supports and Services Teams • ECMH expertise in Community Mental Health • Training in Child-Parent Psychotherapy • NH Early Childhood and Family Mental Health Competencies

31. Access and availability of quality services across regions • Evidence-based home visiting models (i.e. www.futureofchildren.org) • Child care consultation and support • Family Resource Center Programs • Local ECMH grant funded programs • Some community mental health expertise • Child-Parent Psychotherapy consultation model

32. Community Mental Health Services • Some community mental health expertise • Child-Parent Psychotherapy consultation model • Preventative services • Consistent eligibility evaluation criteria and process • DC 0-3 for diagnosis

33. One Last Thought…. • Promoting Early Childhood Mental Health requires an integrated comprehensive community-based system of care. So… it is a really good thing that we are all here and working together. Our future is our children.