CT Infant Mental Health Association

1. CT Infant Mental Health Association

2. CT INFANT MENTAL HEALTH ASSOCIATION Screening for Emotional and Behavioral Challenges in Young Children April 30, 2007

3. Screens for Emotional and Behavioral Challenges in Young Children • BITSEA - Brief Infant-Toddler Social-Emotional Assessment • Ages and Stages: Social-Emotional • DECA - Devereux Early Childhood Assessment • Parent Questionnaire: Screen for Environmental Risk

4. Why Is Screening Important? • Identify children at the earliest possible time so that intervention may be provided • May be conducted in multiple environments: • Pediatric health care • Early care and education • Home visiting programs • Family resource and support centers • Provides an opportunity to start a very important conversation with a parent or caregiver

5. Ecological Approach Must look broadly at: • Child – health and development • Relationship between child and parents, as well as other important caregivers • Challenges in the environment which impact the child’s development

6. PARENTAL CHALLENGES RELATIONSHIPS CHILD: HEALTH AND DEVELOPMENT Ecological Approach COMMUNITY

7. Emotional and Behavioral Problems Do Not Just Go Away! • Emotional or behavioral problems at age 3 years 60% psychiatric diagnosis by kindergarten or 1st grade.

8. If We Do Not Act Now • Need for special education • Serious emotional disturbance • Substance abuse • Teen pregnancy • School drop-out • Violence in home and community • Crime and incarceration • Unemployment • Abuse and neglect • Poverty

9. Parent Questionnaire:Screening for Environmental Risk Darcy Lowell, M.D. Director, Child FIRST April 30, 2007

10. Parent Questionnaire:Screen for Environmental Risk • This is a screening measure to begin to assess risk in the caregiving environment • Goal: Identify those environments with challenges which interfere with a parent’s ability to nurture and support a child’s development, and intervene to prevent later morbidity.

11. Characteristics of theParent Questionnaire • Filled out by parent or caregiver • Takes approximately 2-3 minutes to complete • Available in English and Spanish • Developed by Child FIRST through grants from SAMHSA and Robert Wood Johnson Foundation • Soon to be validated

12. Why Is Environmental Risk Important? • First three years of life, 80-90% of brain growth is completed. • Quality of nurturing environment is an essential determinant of brain architecture. • Stresses and challenges are mediated through the caregiver-child relationship.

13. Examples • Children who are not touched or played with have brains 20-30% smaller on MRI • 40% of infants of depressed mothers have decreased brain activity • Repetition of traumatic or stressful experiences leads to hard wiring of neuronal pathways for fear, anxiety, and hypervigilance

14. Relationship between Risk and Serious Emotional Disturbance • Cumulative level of risk is directly related to incidence of emotional disturbance: < 2 risks associated with a 7% incidence of behavioral problems > 8 risks associated with a 40% incidence of behavioral problems

15. Experience with the Parent Questionnaire • Bridgeport PCC: 45% + for risk • Bridgeport ECC: 35% + for risk • In Bridgeport: Of those children who were high risk, 70% screened positive for emotional concerns

16. Examples of Environmental Risks • Parental mental health issues • Substance abuse • Domestic and community violence • Teen and single parenthood • Isolation and lack of social supports • Lack of education and illiteracy • Unemployment • Homelessness, housing instability and inadequacy • Health and dental issues • Poor quality child care • Lack of basic needs: food, clothing, heat, furniture • Lack of books and toys • Incarceration

17. How Can We Increase Parents’ Capacity to Nurture and Support Their Children’s Development? • Increase parental knowledge of child development and the critical importance of their role. • Address the challenges in the nurturing environment which prevents parents from focusing time and attention on their children. • Impact the parents’ psychological status

18. Parent Questionnaire - Scoring • Questions in risk categories are numbered from 1 through 12. • Each numbered group of questions receives a maximum of 1 point. • Scoring: • “Yes” in any sub-question receives 1 point • Exceptions: # 3 and # 7 are reverse scored: For #3: “No” in all 3 sub-questions gives 1 point For # 7: “No” gives 1 point • Starred * items are automatic positives

19. Parent Questionnaire:Scoring Example 1. I am worried about my child’s development…………...YES NO He/she is not learning as fast as I expected………….. YES NO 2. I am worried about my child’s behavior…………… YES NO I am worried that my child is not happy …….………… YES NO 3. I am employed or in an education/training program…. YES NO My child’s other parent is employed or in an education/training program……………………………... YES NO I have completed high school or have a GED………… YES NO 4. I feel very worried, stressed or sad a lot of time………..YES NO Sometimes I feel that life is just too hard to continue….YES NO Any Yes = 1 Any Yes = 1 3 Nos = 1 * Any Yes = 1

20. Parent Questionnaire: Positive Screen • 3 or more points • Yes in any one of the “red flag” questions is an automatic positive: • # 4 – depression • # 8 – domestic violence • # 10 – substance abuse • Any clinical concern, regardless of number of points

21. Start a Conversation • Purpose of screening is to be able to start a conversation with a parent which enables you to understand the challenges in the child’s environment. • Remember, a parent may give a “no” answer even if a problem exists. • A parent may attribute a problem he/she has to the other parent only. • Questions may be misunderstood or answers may reflect normal developmental challenges. Follow-up is essential.

22. And now meet Marla and Louis