Infant & Toddler Mental Health Assessment

1. Infant & Toddler Mental HealthAssessment Stacey Ryan, LCSW Angela M. Tomlin, Ph.D.

2. Objectives Participants will be able to • Discuss the scope of mental health problems in young children • Describe what IMH assessment and treatment is and is not • Explain the importance of social and emotional development to other developmental areas

3. Objectives • Select tools and methods for assessing child development, parent-child relationships, parent capacity for relationship, and family situations • Demonstrate beginning knowledge of infant-toddler mental health interventions

4. Is Infant &Toddler Mental Health Really a Problem? • Yes! • Young children do experience problems in social emotional competency and even psychopathology • We are better able to understand and measure these problems

5. Why we resist this… • We are too worried about cognitive skills (“ready to learn”) • Stigma associated with mental health issues • Myth of childhood • Our own discomfort with the idea

6. Prevalence • Best estimates of serious behavior concerns in children 2 to 3 years fall between 10 to 15% • Parent and pediatrician report behavior problems in 10% of 1 to 2 year olds

7. But won’t these problems go away? • No! • 37% of 18 mos with extreme behavior/emotional problems continue to have problems at 30 mos • Over ½ of 2-3 with psychiatric d/o still have symptoms 2 years out

8. Long Term Effects • Exposure to poor caregiving, abuse, or domestic violence can lead to developmental and mental health problems in young children • Babies, toddlers, and preschoolers can demonstrate depression, PTSD, and disruptive behaviors

9. The Science of Early Childhood Development • Babies brains are growing at a phenomenal rate • The infant brain is “experience expectant” • Both positive and negative experiences have significant and long lasting effects

10. The Science of Early Childhood Development • Experience, especially social experiences, change the way the brain is shaped and functions • Babies who experience or witness violence have behavioral and physiological changes

11. The Science of Early Childhood Development “Separation from parents, sometimes sudden and usually traumatic, coupled with the difficult experiences that have precipitated placement in foster care, can leave infants and toddlers impaired in their emotional, social, educational and physical development” (0-3, 2003)

12. So now we’re thinking… • OK, maybe babies and toddlers can have emotional concerns… • And maybe relationship is pretty important… • But there can’t be that many babies removed from their parents… • Can there?

13. Young Children in Foster Care • 25% of children in foster care are under 5 years old • 13% of those entering care are under 1 year • Infants are the faster growing population in foster care

14. Young Children in Foster Care • Once in foster care, babies stay longer than other children • They are more likely to be abused while in foster care or when returned to parents • Reunification of babies placed under 3 months is low

15. Young Children in Foster Care Of all the children who died from abuse and neglect,77% were under 4 years old.

16. MH Challenges in Young Children • Are real • Involve a substantial number of babies • Can be assessed and treated

17. What Infant & Toddler Mental Health is NOT • Babies on a couch • Talking therapy with toddlers • Seeing a child without parents • Bonding therapies • Developmental therapy

18. What Infant & Toddler Mental Health IS • Based on over 50 years of clinical practice • Informed by recent brain research findings • Outcome-based interventions • A way to understand children in their families

19. Areas to Consider When Assessing Young Children • Developmental Levels of Infant or Child • Quality of Important Relationships • Parent Status (Capacity for Relationship) • Family Situations

20. Infant & Child Development • A good working knowledge of typical development is needed when you assess young children • You can’t tell what is atypical if you don’t know what is typical

21. Infant & Child Development • Expected order of milestones is knownSkills are traditionally divided into 5 areasThere is much overlap between the areasUneven development across areas is concerning

22. Infant & Child Development Ways to learn about development • Have a great memory from college coursework • Get a child development text • Watch some babies • Review some developmental checklists online

23. Infant & Child Development • aap.org • http://thechp.syr.edu/Developmental_checklist.pdf

24. Infant & Child Development • Cognitive • Receptive, Expressive, and Pragmatic Communication • Fine & Gross Motor • Social-emotional and behavior • Adaptive Skills (Self Help)

25. Cognitive Skills • Thinking • Problem Solving • Memory • Attention • Imitation

26. Communication • Use of gestures and facial expressions • Understanding speech • Expressive language • Social or pragmatic aspects of communication

27. Fine & Gross Motor Skills • Use of hands and arms to manipulate objects • Balance • Strength and tone • Walking, running, jumping

28. Eye contact Social smile Relationships/attachment Regulation Sleep Feeding Aggression Compliance Social-emotional and behavior

29. Self-Help/Adaptive • Eating • Dressing • Participation in grooming • Toileting

30. Ways development can be atypical • Global delays in development • Inconsistent development • Atypical, unusual behaviors—red flags

31. Red Flags in 6 Month Olds: • Inability to Read Signals • Persistent Sleep Problems • Lack of Predictability • Failure to Imitate Sounds and Gestures • No Affect, Range of Feelings • Lack of Stranger Anxiety (8 months)

32. No Words Persistent Sleep Problems Withdrawn Excessive Rocking Prolonged Fears No Separation Distress Immobile, Low Activity No Social Engagement Predominant Anger and Outbursts Red Flags 12-18 Month Olds:

33. Eating Problems Non Speaking Extreme Shyness Lack Autonomy Failure in Gender Identification No Enjoyment in Play Poor Problem Solving Total Lack of Self Control Chaotic Behavior Red Flags in 18 Months to 3 Year olds

34. Collecting Information about Infant & Child Development • Existing records from previous assessments • Screening and referral • Single discipline developmental assessment • Multi or interdisciplinary team assessment

35. Existing records:Understanding test data • Screening or child find results • First Steps evaluation/Curriculum based assessment • Normed assessment methods/Clinic or school based

36. First Steps • Check with the SPOE for the county the child lived in before placement to see if there is a First Steps E & A • 1/800-441-STEP • http://www.in.gov/fssa/first_step/

37. Tools Used in First Steps • Goals of assessment in First Steps is to determine if eligible for program and to develop intervention plan • Curriculum-based tools are typically used

38. Tools Used in First Steps • HELP and AEPS are most common • Have an associated curriculum • Are basically a list of skills to be assessed and taught • Sometimes yield age equivalents

39. First Steps Documentation You Can Use • ED Team Report • Will indicate developmental levels in 5 areas of development • Will make recommendations for services • Individual Family Service Plan (IFSP) • Will explain services that the child will receive • Includes information about family routines and preferences

40. First Steps and CPS • Indiana now CAPTA compliant • In other states, the influx of referrals has been a problem for Part C • Some states are using screening tools, then full assessment if indicated • So far, we are not sure what First Steps will do with the evaluations in Indiana

41. Clinic & School Assessments Independent, clinic-based assessments may have been completed If child is 3 or near 3, a school assessment might be available School and clinic evaluations often include norm referenced tools

42. Clinic & School Assessments Cognitive • BSID-3 • DAS • SBIS-5 • MSID

43. Clinic & School Assessments Communication • Rosetti (Caregiver Report) • Preschool Language Scale-4 • Informal assessments • AAC

44. Clinic & School Assessments Adaptive Behavior VABS-2 SIB-R ABAS

45. Clinic & School Assessments Motor Assessments Peabody Developmental Motor Scales-2 VMI

46. Clinic & School Assessments Social-Emotional and Behavioral ITSEA BASC CBCL

47. Clinic & School Assessments Autism Assessments Developmental History ADOS Checklists (Gilliam, CARS, MCHAT)

48. What to do if… No previous developmental assessment?? • Conduct your own developmental assessment • Get full E & A thru First Steps • Screen and refer

49. Screening & Referral • Screening methods tell you if the child needs further assessment in a given developmental area • Many screening tools use caregiver report • Do not use social-emotional screener for CPS population

50. Suggested Developmental Screening Tools • Caregiver Report Methods • Ages & Stages Questionnaires • PEDS • DOCS • Direct Assessment of Child • Denver-II • Bayley Infant Developmental Screener • Batelle Developmental Inventory Screening Test