What Works: Using Evidence and Practice-Based Interventions to Support Social Emotional Health

1. What Works: Using Evidence and Practice-Based Interventions to Support Social Emotional Health Neal M. Horen, Ph.D. National Center on Health National Head Start Association 39th Annual Conference April 18, 2012

2. The Head Start Act • Comprehensive health, educational, nutritional, social, and other services needed to aid participating children in attaining their full potential, and to prepare children to succeed in school

3. Healthy ChildrenReady To Learn • In a comparison of school readiness outcomes for Head Start children and eligible children on the wait list • The Head Start children scored significantly better in School Readiness measures • Parent reports of health outcomes also showed significant differences between the 2 groups with the Head Start families group reporting more healthy responses1

4. ACE Study: Major Findings Increases in ACE score associated with increased risk for the following health problems: • Alcoholism and alcohol abuse • Chronic obstructive pulmonary disease (COPD) • Depression • Fetal death • Health-related quality of life • Illicit drug use • Ischemic heart disease (IHD) • Liver disease • Risk for intimate partner violence • Multiple sexual partners • Sexually transmitted diseases (STDs) • Smoking • Suicide attempts • Unintended pregnancies

5. FACES data • Parents • Majority of parents do not report depressive symptoms • About 40% report some symptoms, 19% report moderate symptoms • Staff • Majority of HS teachers do not report depressive symptoms, about 1/3 report some symptoms • 16% report moderate to severe symptoms

6. Surgeon General’s Visionfor Children’s Mental Health Prevention • Project Head Start • Carolina Abecedarian Project • Infant Health and Development Program • Elmira Prenatal/Early Infancy Project • Primary Mental Health Project • Other Prevention Programs and Strategies

7. Head Start Performance StandardsEarly Childhood Health and Development Services 1304.20 Child Health and Development 1304.21 Education and Early Childhood Development 1304.22 Child Health and Safety 1304.23 Child Nutrition 1304.24 Child Mental Health

8. 1304.21(c)(1)(iii-vii) • Integrates all educational aspects of the health, nutrition, and mental health services into program activities; • Ensures that the program environment helps children develop emotional security and facility in social relationships; • Enhances each child's understanding of self as an individual and as a member of a group; • Provides each child with opportunities for success to help develop feelings of competence, self-esteem, and positive attitudes toward learning; and( • Provides individual and small group experiences both indoors and outdoors.

9. Head Start Performance StandardsMental Health 1304.24 (a) (1) Work Collaboratively with Parents 1304.24 (a) (2) Must Secure the Services of Mental Health Professionals. to enable the timely and effective identification and intervention in family and staff concerns about a child’s mental health 1304.24 (a) (3) must include a regular schedule of on-site mental health consultation

10. Where and When Do You Integrate Social Emotional Well Being into Your Work?

11. Teachable Momentsfor Social Emotional Well Being Activities • Art Activities • Behavior Management • Blocks and Table Toys • Circle Time • Clean Up Time • Cooking • Dramatic Play • Field Trips • Home Visits • Large Motor Play • Meals • Music and Movement • Outside Time • Parent Meetings • Quiet/Nap Time • Sensory Play Materials • Staff Training • Transitions

12. Work Collaboratively with Parents • The Head Start Parent, Family, and Community Engagement Framework • Children will: • Engage and maintain positive adult-child relationships and interactions • Engage and maintain positive peer relationships and interactions • Display levels of attention, emotional regulation, and behavior in the classroom that are appropriate to the situation and supports available • Learn and internalize classroom rules, routines and directions • Develop and display a sense of self, confidence in their abilities and a strong identity that is rooted in their family and culture. -NCQTL

13. Culture • "Each baby is born into a unique family that has its own culture and history, its own strengths and its own way of coping with stress and adversity." Parlakian & Seibel, 2002

14. My Culture • Small group activity

15. Supporting Resilience • Help build a positive vision of future. • Affirm your support. • Help the family develop a plan to reduce effects of external stressors. • Evaluate which stressors are producing the most disruption of family interaction and routines. • Facilitate identification of resources and strategies to reduce the impact of stressors. • Identify family and other natural supports.

16. CSEFEL Pyramid Model Goal: To Strengthen the Capacity of Head Start and Child Care to Promote the Social and Emotional Foundations of Early Learning

17. Communication • Strong, clear communication strengthens partnerships. How we communicate with families both verbally and non-verbally sets a tone for how partnerships develop.

18. 1304.24 (a) (3) • Mental Health Consultation

19. ECMH Consultation • Indirect mental health intervention for infants, toddlers and preschoolers • Focused on young children in ECE settings and their caregivers • Collaboration between a professional consultant with mental health expertise and consultees 10

20. Types of ECMHC • Child/family-centered consultation: Focuses on a particular child with challenging behavior and/or the family of that child • Programmatic consultation: Focuses on a general program or classroom issue that impacts the mental health of staff, children and/or families Cohen & Kaufmann, 2000 11

21. Common Goals of ECMH Consultation • Reduce the impact of mental health problems among young children in ECE settings • Build the capacity of ECE staff, programs, and families to promote young children’s healthy social/emotional development and address challenging or troubling behaviors 12

22. What ECMHC “Isn’t” • Formal diagnostic evaluations • Therapeutic play groups • Individual therapy • Family therapy • Staff therapy • Family support groups

23. CSEFEL Pyramid Model: Promoting Social Emotional Competence in Infants and Young Children Intensive Intervention  Systematic approaches have preventive and remedial effects on social emotional develop- ment. Targeted Social Emotional Supports  • Supportive, responsive relationships among adults and children are necessary for promoting social emotional development • High quality environments promote positive outcomes for all young children Nurturing and Responsive Relationships AND High Quality Environments

24. Breaking it Down: Nurturing Relationship “an enduring emotional bond to one or two specific people in whose presence I feel safe to explore new activities, ideas, feelings, and to whom I want to return when stressed.”

25. http://ecmhc.org/temperament/index.html

26. http://ecmhc.org/baby_books.html

27. High Quality Supportive Environments

28. What Would You See Happening? Talk at your tables and come up with one or two examples of what “Quality Supportive Environments” look like- put your post it on the flip chart

29. CECMHC Resources for Quality Supportive Environments • Infant Family Posters • Infant Staff Posters • Toddler Family Posters • Toddler Staff Posters • Preschool Posters

30. Putting it Into Practice Where do you see these tools fitting into your training and coaching work?

31. Targeted and Intensive Supports

32. CECMHC Resources for Targeted and Intensive Intervention

33. Let’s Observe- Michael a Toddler

34. Walking Through the Process

35. Let’s Reflect for Michael

36. What Does Social Emotional Development Look Like As Children Enter School? • A sense of confidence and competence • Ability to develop good relationships with peers and adults/make friends • Ability to persist at tasks • Ability to follow directions • Ability to identify, understand, and communicate own feelings/emotions • Ability to constructively manage emotions • Development of empathy • What happens when children don’t have these skills?

37. Emotional Literacy …the ability to identify, understand, and express emotions in a healthy way

38. 38

39. “If a child doesn’t know how to read, we teach.” “If a child doesn’t know how to swim, we teach.” “If a child doesn’t know how to multiply, we teach.” “If a child doesn’t know how to drive, we teach.” “If a child doesn’t know how to behave, we……..... ……….teach?………punish?” “Why can’t we finish the last sentence as automatically as we do the others?” – Tom Herner (NASDE President ) Counterpoint 1998, p.2

40. So. . .How do we teach it? • What are you doing now?

41. Use Songs and GamesSample Song • If you are happy and you know it…add new verses to teach feelings • If you’re sadand you know it, cry a tear.”boohoo” • If you’re mad and you know it, use your words “I’m mad” • If you’re scared and you know it ask for help, “help me” • If you’re happy and you know it, hug your dad • If you’re tired and you know it, give a yawn. Jim Gill “I’m So Happy I Could Growl” 41

42. How Schedules and Routines Support Social and Emotional Development • Schedules and Routines: • are an important part of each day • meet children’s basic needs • provide opportunities for learning and development • provide predictability, help infants and toddlers learn what to expect (from people and the environment) • help children develop a sense of security and control • support competence and confidence

43. How to Structure Schedules and Routines to Support SE Development and Prevent Challenging Behavior • Schedules • Have a consistent schedule • Minimize transitions • Prepare children when there will be a change • Use visual cues if children need them • Create opportunities for “playing” with your child

44. How to Structure Schedules and Routines to Support SE Development and Prevent Challenging Behavior • Routines • Structure routines so they have a beginning, middle, and end • Make them fun!!!!!!!!!!! • Teach children the expectations of the routine • Use visual cues if needed • Involve children in daily routines such as preparing a meal or provide them with something to do • Use routine activities to strengthen relationship with your child • Use routine activities to teach new skills • Prepare children for transitions

45. Wash hands First Then Snack

46. Visual Schedules 46

47. STOP

49. 1. Turn on water. 2. Wet hands. 49 3. Get soap. 4. Rinse hands.

50. 5. Turn off water. 6. Dry hands. 50 7. Throw away towel. 8. Go play.