Improving Early Childhood Mental Health in Maryland: Getting to Results

1. Improving Early Childhood Mental Health in Maryland: Getting to Results Development of Young Children with Disabilities#872.514 (61) Al Zachik Adapted by Carol Ann Heath

2. Child Find • Required by the Individuals with Disabilities Education Act to engage in child find • Includes screening by providers from such disciplines as pediatricians, public health nurses, and day care providers

3. Screening • Clinical interviews • Home observations • Rating scales

4. Screening for Social Emotion Problems • “Social competence is one of the most important accomplishments during early childhood. Social development begins during the first years of life and, along with caregiver attachments, is one of two main developmental tasks for that period” (p. 273) Michnowicz, McConnell, Petersen & Odon (1995). Social goals and objectives of preschool IEP’s: A content analysis. Journal of Early Intervention 19(4). 273-282)

5. Research • Identifying behaviors in very young children that are linked to future conduct disorders, aggression, antisocial personality disorders, and delinquency.

6. Assessing Social Emotional Skills • Difficult and challenging • Based on sampling of social emotional behavior and behavioral states • Assess adaptive behaviors • Observe play skills • Cultural diversity and changing demographics of US add to the challenge

7. Issues • Lack of tools contribute to avoidance of assessing young children • Use of assessments that have not been validated for use with infants, toddlers, or preschoolers • Use screening instruments to make decisions beyond the scope of the assessment tool

8. Areas of Importance • Stages of development by age • Development domains: motor, verbal/language, attachment, social skills • Social emotional- attachment- Importance of human contact

9. Early Mental Health: A Key to School Readiness • Many young children are not developing the emotional skills that they will need to succeed in school and be productive members of society (Knitzer, Building Services & Systems) • Brain research:Ever increasing knowledge of the development and plasticity of the young human brain continues to inform the field of early childhood mental health

10. Treatment • Therapy • Individual • Parent • Parent/child • Medication

11. Improving Early Childhood Mental Health: Getting to Results 1.How are we doing with respect to the mental health of children in Maryland? What additional data do we need to answer this question? 2. What are the causes and forces at work that explain our current situation with respect to children’s mental health?

12. Improving Early Childhood Mental Health: Getting to Results 3.What will it take to improve the current status of children’s mental health? A. Who are the partners who have a role to play? B. What has worked elsewhere? C. What are no-cost or low-cost strategies? 4.What will be the cost if we do nothing – the “cost of bad outcomes”?

13. Improving Early Childhood Mental Health: Getting to Results 5.What is the State’s strategy – our action plan – to improve the mental health of children in Maryland?

14. 1.How are we doing with respect to the mental health of children in Maryland? “The burden of suffering experienced by children with mental health needs and their families has created a health crisis in this country.” David Satcher M.D., Ph.D. Report of the Surgeon General’s Conference on Children’s Mental Health: National Action AgendaSeptember 2000

15. What does a “mental health problem” mean? • Problem serious enough to impair child’s functioning in their normal environment • Difficulty with relationships and attachment • Aggressive, out of control, severe oppositional behavior • Quiet, withdrawn, not interacting • Can affect eating, sleeping, level of activity, ability to be soothed

16. 1.How are we doing with respect to the mental health of children in Maryland? • “In the United States, one in ten children and adolescents suffer from mental illness severe enough to cause some level of impairment.” (Surgeon General’s Report) • In any given year, it is estimated that only about 20% of these children in need receive specialty mental health services. (Surgeon General’s Report) • Research shows that increasing numbers of infants, toddlers, and preschool children experience or are at risk for mental illness

17. Maryland Population 0-5 Year Olds • 427,000 total population • 40,000 estimate with mental health need based on national prevalence rate

18. Maryland Model for School Readiness - MSDE • Work Sampling System Kindergarten Checklist Data 2000 • Social and Personal Domain • Full readiness = 48.3% • Approaching readiness = 41.7% • Developing readiness = 10%

19. Maryland Public Mental Health System Data • FY 2002 projections: • 40% of recipients served are children and adolescents Total number of children 0-5: 4,000* Total expenditure (0-5): $4,000,000 * based on claims data

20. Maryland Head Start Data • Head Start enrollment =10,390 • Referred for mental health treatment = 693 • Received mental health treatment = 609

21. Infants and Toddlers Program • 4.900 children being seen in December 2000 • 225 in family counseling • 70 seeing a psychologist • 75 seeing a social worker

22. Child Care Providers • Maryland Committee for Children: Resource and Referral Centers

23. Family Support Centers • Friends of the Family

24. Children in Foster Care • 4500 entries into foster care statewide • 3200 entries into foster care Baltimore City • All Baltimore City children taken into custody by DSS get a mental health screen • 25% needed mental health follow up

25. Private Insurance Funded Care • Pediatricians, Nurse Practitioners • Mental Health Professionals

26. 2. What are the causes and forces at work that explain our current situation with respect to children’s mental health? Risk Factors Evidence suggests that the more risk factors young children experience, the greater the probability that their emotional and cognitive development will be compromised

27. Risk Factors • Substance abuse in parents (prenatal effects) • Poverty • Mental illness in parents • Teenage parents • Family and community violence • Child abuse and neglect

28. Risk Factors • These are complex social phenomena • Require an integrated, multi-system approach

29. GAPS About 140 federal programs and tax provisions are directed at or include children and their families, however fewer than 10% of these initiatives are intended for infants and preschoolers (Richardson & House, 1999 in Funding Early Childhood, p6)

30. GAPS • Funding • Uninsured • Insurance • Private insurance lacks full array of mental health services • Parity between mental health and physical health

31. GAPS • Service Availability • Full array of services and location • Providers • Inadequate number • Quality of service

32. 3. What will it take to improve the current status of children’s mental health? A. Who are the partners who have a role to play? • Parents, families, caregivers • Advocates • Early Childhood providers • Family/Adult service providers • State and local child and family serving agencies: DHR, MSDE, DHMH (MHA, ADAA, DDA, Maternal and Child Health), OCYF, DJJ, LMB, CSA • Legislators

33. Additional Partners • Child, adolescent and adult mental health providers • Substance abuse professionals • Pediatricians and other health professionals • Faith Community • Community Service Organizations

34. 3. What will it take to improve the current status of children’s mental health? B. What has worked elsewhere? • Working with families and caregivers • Promoting early childhood mental health (prevention) • Integrating mental health services into existing early childhood programs • Developing a full array of community based early childhood mental health services • Training early childhood providers in mental health • Training more early childhood mental health professionals

35. 3. What will it take to improve the current status of children’s mental health? C. What are no-cost or low-cost strategies? • Look at better ways to allocate what we already have in place (funding, services, training initiatives) • Working better together

36. 4.What will be the cost if we do nothing – the “cost of bad outcomes”? • Loss of an individual child • Greater likelihood that the overall societal cost will be much higher as some of these children move into higher end services in the foster care, juvenile justice, residential treatment center, special education and ultimately corresponding adult systems of care

37. 5.What is the State’s strategy – our action plan – to improve the mental health of children in Maryland? • There are many separate programs in Maryland that impact outcome • We need a more coherent strategy • But we are moving on it

38. Early Childhood Mental Health Steering Committee • Subcommittee of Subcabinet for Children, Youth and Families • Co-chairs • Albert Zachik, M.D. (DHMH/MHA) • Carol Ann Baglin, Ed.D. (MSDE) • Multiple stakeholders including families, state and local child serving agencies, early childhood providers, advocates

39. Emerging Strategy • Broad support for families and caregivers • Pre-natal care for all mothers • Drug treatment for parents • Violence prevention

40. Emerging Strategy • Social and emotional health promotion • Integrate mental health consultation into all existing early childhood programs in Maryland to support prevention and triage for mental health need • Train early childhood professionals to recognize and manage less severe mental health need

41. Emerging Strategy • Develop a full system and array of early childhood mental health services throughout the state to receive those children who have more severe mental health need • Services need to be child centered, family focused, culturally competent, and community based

42. Emerging Strategy • Work with Maryland colleges and universities to increase training for early childhood mental health professionals • Training needs to include working in an integrated system of care • Scholarship incentives

43. 6.What can the government do? • Promote Children’s Mental Health • Parity legislation • Require all insurance plans to have a broad array of services for children and adolescents at risk for or with mental health needs • Encourage all state agencies with involvement with children to collaborate • Remove barriers to action

44. The Importance of Tracking Child Outcomes • Work with families to assess the individual outcomes for their children and the overall outcomes of the initiative and individual programs

45. Sources: • Albert Zachik, M.D. Director Office of Child and Adolescent Services State of Maryland Department of Health and Mental Hygiene Mental Hygiene Administration • Yockelson, S. J. (1998). Identification of infants and young children with social- emotional problems. Infants & Young Children, 10(3), 10-18.