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The Core Story 1 - Child development is the foundation of prosperous communities

Promoting Community Systems of Care to Foster Young Children’s Social and Emotional Development May 22, 2014. The Core Story 1 - Child development is the foundation of prosperous communities 2 - Brains are built over time, from the bottom up (skill begets skill)

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The Core Story 1 - Child development is the foundation of prosperous communities

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  1. Promoting Community Systems of Care to Foster Young Children’s Social and Emotional DevelopmentMay 22, 2014

  2. The Core Story 1 - Child development is the foundation of prosperous communities 2 - Brains are built over time, from the bottom up (skill begets skill) 3 - Genes and experiences together build brains (serve and return relationships) 4 - Cognitive, social and emotion development are inextricably intertwined 5 - Toxic stress damages brain architecture 6 - Resilience is not an internal character strength, but rather is built through combined impact of genes and experiences of a child 7 - For many functions, the brain’s capacity for change decreases over time (cost-effectiveness factor) - but not all P.Levitt, 2013

  3. The Challenge • Social and emotional development is foundational, and impacted by internal and external forces • Early traumatic experiences are common • In Wisconsin (2010) • 4,839 child victims of maltreatment • Represents 3.7 children per 1,000 children in the State WI Department of Children and Families, Wisconsin Child Abuse and Neglect Report, 2011

  4. The Challenge: Child Maltreatment U.S. Dept. Health and Human Services, 2010

  5. The Challenge: Childhood Mental Illness • >14 million children and adolescents in the US (1 in 5) with a diagnosable mental health disorder • Only 20-25% of affected children receive treatment or support US DHHS Surgeon General’s Report (1999); AACAP Committee on Health care Access and Economics, Pediatrics (2009) reference

  6. Community System of Care • What is a community system of care? • Members • Families • Professionals

  7. Today’s Goals • Consider what it means as a community to work together on fostering young children’s social and emotional development • Develop an ongoing base for growth in this area

  8. Learning Objectives • Learn about the importance of monitoring young children’s social and emotional development • Discuss impact of toxic stress on children’s development, and the role of trauma-informed care in mitigating the effects of trauma and toxic stress in children

  9. Learning Objectives • Identify resources available to support professionals in promoting • Social and emotional development in all children • The early identification of those with behavioral health needs • Effective intervention and care coordination for those with established mental health challenges

  10. Learning Objectives • Prioritize professional self-care and colleague support • Identify other community members working to support children and define concrete strategies to connect with one another to develop community systems of care

  11. Guiding Principles • Child and family focus • Healing occurs in supportive relationships • Professionals must care for themselves and support one another in order to care for others • Shared responsibility across professionals sectors is essential • Children receive support according to their level of need, as offered by a spectrum of care within the community

  12. Spectrum of Care: Pyramid Model for Supporting Social Emotional Competence in Infants and Young Children

  13. Spectrum of Care: Pyramid Model for Supporting Social Emotional Competence in Infants and Young Children Intensive Intervention Targeted Social and Emotional Supports Early Identification of Children with Social and Emotional Challenges Social and Emotional Development Promotion for All Children

  14. For Consideration • Where are you in the spectrum of care? • Who are your community partners in the other parts of this spectrum? • How successful are your efforts to connect with other community partners on this spectrum? • How might this connection be improved?

  15. What is Social and Emotional Development? From a working definition developed by Zero To Three : National Center for Infants, Toddler and Families – Infant Mental Health Task Force The developing capacity of a young child to: • Experience, regulate and express emotion • Form close and secure interpersonal relationships • Explore the environment and learn All within the context of family, community and cultural expectations for young children

  16. Infant and Early Childhood Mental Health Develops through relationships with parents and other caregivers. • Is fostered through nurturing and supportive relationships. • Teaches the child that she/he has an impact on her/his environment.

  17. Relationships are the Basis of a Child's Stress Response System Calm High Arousal Adapted from B. Perry, MD, PhD. (2009)

  18. Relationships are the Basis of a Child's Stress Response System Calm High Arousal Adapted from B. Perry, MD, PhD. (2009)

  19. “There is no such thing as a baby, there is a baby and someone else…” -D.W. Winnicott

  20. Think of a child you know who is socially/emotionally skilled. What does that look like? Think of a child who struggles and is hard to reach. What does that look like? Social and Emotional Skills

  21. Social Emotional Competence • Trust • Self-Confidence • Motivation • Persistence • Self-Control

  22. Stress Impacts Social and Emotional Development

  23. Stress Responses in Childhood AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013

  24. Three Levels of Stress Positive Brief increases in heart rate, mild elevations in stress hormone levels. Tolerable Serious, temporary stress responses, buffered by supportive relationships. Toxic Prolonged activation of stress response systems in the absence of protective relationships.

  25. Some Stressors in Childhood AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013

  26. Other Factors Influencing Stress AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013

  27. Traumatic Alterations • Experience • Epigenetic modifications • Changes in brain structure and function • Behavioral attempts to cope • May be maladaptive in other contexts AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013

  28. Epigenetic Changes • Alterations in the way the genetic program is read • Can cause structural changes in developing brain • Can influence the stress response

  29. Disruptions in Brain Architecture with Toxic Stress 3 important brain structures: Amgydala Hippocampus Frontal cortex Prefrontal Cortex

  30. The Impact of Early Adversity on Children's Development

  31. Disrupted Brain Architecture Can Influence Behavior Behavior changes seen in young children Additional behavior changes seen in older children, adolescents and young adults

  32. Maladaptive Behavior Can Be Misleading • Potential misdiagnoses • ADHD • ODD • Bipolar Behavior worked previously, continues to result in some gain

  33. Adverse Childhood Events (ACEs) • ACEs (before age of 18) • Physical abuse • Emotional abuse • Sexual abuse • Alcohol and/or drug abuser in household • Incarcerated family member • Household member chronically depressed, mentally ill, institutionalized or suicidal • Violence between adults in the home • Parental separation or divorce • Original study (1995-97) • WI Behavioral Risk Factor Survey (2010)

  34. http://www.cdc.gov/ace/

  35. Significant Adversity Impairs Development in the First 3 Years Barth 2008, Center on the Developing Child at Harvard University

  36. Rate of ACEs by disability status, WI adults ages 18-64, 2010-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

  37. ACEs and Life Course Theory

  38. And Now Some Good News… • Identifying toxic stress and social and emotional development concerns, and • Referring children and families to supports and services have the potential to positively impact the child’s life-long health and prosperity AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013

  39. Spectrum of Care Resources: Workforce Resources

  40. Resources to support effective workforce development • Wisconsin Alliance for Infant Mental Health • Infant, Early Childhood and Family Mental Health Certificate Program • YoungStar • Supporting Families Together Association • AAP and WiAAP resources • Trauma-informed care • General development promotion • Self- and colleague-care reflective supervision

  41. WI Alliance for Infant Mental Health • To stay connected with other early childhood professionals and to find out more about professional development opportunities, visit us at: www.wiaimh.org.

  42. UW Infant, Early Childhood and Family Mental Health Certificate Program Applications are currently being accepted for this interdisciplinary academic program: http://infantfamilymentalhealth.psychiatry.wisc.edu/

  43. YoungStar http://dcf.wisconsin.gov/youngstar/default.htm

  44. Supporting Families Together Association https://supportingfamiliestogether.org/ Offers training and technical assistance support to Child Care Resource and Referral Centers, Family Resource Centers throughout the State

  45. Birth to 5: Watch Me Thrive Resources for • Early Intervention Service and Early Childhood Special • Education Providers • Families • Primary Care Providers • Communities • Child Welfare • Home Visitors • Behavioral Health Providers • Housing and Homeless Shelter Providers • Parents http://www.acf.hhs.gov/programs/ecd/watch-me-thrive

  46. WIAAP Mental Health Webinar Series Collaboration between Wisconsin Chapter of American Academy of Pediatrics & Wisconsin Council of Child and Adolescent Psychiatry https://www.wiaap.org/wiaap-foundation/wacpp/

  47. AAP Mental Health Toolkit • Focus Areas • Community resources • Health care financing • Support for children and families • Clinical information systems/delivery system redesign • Decision support for clinicians

  48. AAP Trauma Guide Helping Foster and Adoptive Families Cope With Trauma Webinar (58 min) Helping Foster and Adoptive Families Cope With Trauma: A Guide for Pediatricians (20 p) Coding Tips (2 p)Visit Discharge and Referral Summary for Family (1p) Parenting After Trauma: Understanding Your Child’s Needs (4 p) • http://www.aap.org/traumaguide

  49. Role of Trauma Informed Care When faced with challenging behavior, professionals think, “What might have happened to this child?” rather than “What’s wrong with this child?”

  50. Wisconsin Trauma-Informed Care Resources Resources on Trauma Informed Care, as well as active listserv http://www.dhs.wisconsin.gov/tic/ WI ACE and Trauma Workgroup - Children’s Trust Fund http://wichildrenstrustfund.org/index.php?section=adverse-childhood

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