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Training Goals

Introduction to Infant and Early Childhood Mental Health Division of Child and Family Services Early Childhood Mental Health Services. Training Goals. At the end of this training, you will be able to: Define infant mental health Recognize mental health issues of young children

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Training Goals

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  1. Introduction toInfant and Early ChildhoodMental HealthDivision of Child and Family ServicesEarly Childhood Mental Health Services

  2. Training Goals At the end of this training, you will be able to: • Define infant mental health • Recognize mental health issues of young children • Know how infant mental health issues are assessed and treated • Understand how to access services in your community to address mental health and developmental needs of young children

  3. Goal #1:Define infant mental health

  4. Definition of Infant Mental Health • Infancy is technically the period “without language”, which is the first year of life • Infant mental health covers a broader age range, and there is no universal definition • In Nevada, Early Childhood Mental Health Services serves children birth – seven years and their families

  5. Definition of Infant/ Early Childhood Mental Health The developing capacity to: • experience, regulate and express emotions, • form close and secure interpersonal relationships and • explore the environment and learn. www.zerotothree.org

  6. #1: Experience, Regulate andExpress Emotions • Initially infants depend on adults to regulate their interaction, attention, and behavior • Gradually the young child begins to regulate their emotions through self-monitoring, which increases over time

  7. The Developing Capacity to Regulate and Self-regulate Sameroff & Fiese, 2000

  8. Basics of State Regulation in Infancy Infant Behavioral States • Cry • Fuss • Alert • Waking Activity • Drowsy • Active Sleep • Quiet Sleep

  9. Over the first two years of life, the child learns to give cues, both potent and subtle, about his/her interest in any given moment in relating to others Developing Capacityto Give Clear Cues

  10. Potent Cues --Babbling, giggling --Face gazing+ --Smiling+ --Reaching toward caregiver --Smooth movements NCAST, Kathy Barnard Subtle Cues --Brow raising --Eyes wide & bright --Facial brightening --Hands open, fingers slightly flexed --Head raising --Stilling of body Engagement Cues

  11. Potent Cues --Back arching --Choking, coughing, spitting up --Crying, fussing, “No!” --Halt hand --Head shake --Major gaze aversion --Moving away Subtle Cues --Defensive posture --Dull expression --Grimaces, eye blinks --Frown --Hand behind head, to eye, ear, back of neck --Sobering --Yawns --Head lowering, minor gaze aversion Disengagement Cues

  12. #2: Form Close and SecureInterpersonal Relationships • Infants learn what people expect of them and what they can expect of other people • Nurturing, protective, stable, and consistent relationships are essential • The state of the adults’ emotional well being and life circumstances profoundly impact the quality of infant/caregiver relationships

  13. Attachment • Secure attachment is a loving emotional connection with caregiving adults who are part of the child’s daily life. • Attachment begins at birth and continues throughout life. • It is difficult to be separated from an important attachment figure. www,zerotothree.org

  14. Through this attachment, the child: • Learns to depend on people to meet his/her needs • Seeks comfort when distressed • Learns to express love/affection • Relies on the caregiver as a safe base from which to explore the environment • Develops in the areas of emotionality, social behavior, language and cognition

  15. Goodness of Fit • Each of us is born with temperamental characteristics that tends to persist lifelong • Caregivers and children who are temperamentally similar will have an easier time developing a good relationship than those who are temperamentally dissimilar

  16. Young children learn primarily through interactions with caregivers It is important for children to have time playing with their caregivers to maintain a good relationship and to help them with language and cognitive development #3: Explore the Environment and Learn

  17. Hierarchy of vulnerability: emotional development social development language development cognitive development motor development physical growth Development in Young ChildrenIs Vulnerable to Stress

  18. Infant Mental Health • Infant mental health is synonymous with healthy social and emotional development. • It occurs in the context of family, community and cultural expectations for the child. www.zerotothree.org

  19. Goal #2: Recognize mental health issues of young children

  20. Facts about Mental Health of Young Children • Young children are about as likely to have mental health issues as are older children and adults • In very young children, mental health issues are most often expressed as difficulties with eating, sleeping, and regulation of behavioral states

  21. As children become older, they increasingly express mental health issues as more recognizable difficulties with moods and behaviors • If mental health issues are left untreated, children often begin to show more general delays in the areas of social/emotional functioning, language, cognition and even motor and physical development

  22. How Do I Recognize the Need for Mental Health Treatment? • Issue is pervasive, meaning it occurs across settings • Issue is persistent, meaning it occurs more days than not for 2-4 weeks • Issue has a negative impact on a child’s daily functioning

  23. Overview of CommonMental Health Issues • Sleeping Disorders • Eating Disorders • Attention Deficit Hyperactivity Disorder (ADHD) • Post Traumatic Stress Disorder (PTSD) • Deprivation/Maltreatment Disorder (DMD), Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED). • Depression

  24. Sleep onset Night waking Night Terrors Nightmares Sleeping Disorders

  25. Typical Sleep Needs of Young Children

  26. Eating Disorders • Eating– to be diagnosed, must result in weight loss or inadequate weight gain • Difficulties of state regulation • Difficulties with caregiver relationship • Sensory issues with food textures • Problems associated with medical issues

  27. Symptoms of ADHD • Craving high-intensity sensory stimulation • High need for motor discharge: impulsive • High activity level • Seeking constant contact with people & objects • Recklessness

  28. True ADHD is believed to be present from birth, and to occur even in the absence of major environmental stressors. However, some of the symptoms of ADHD (high level of motor activity, lack of focused attention) can occur as part of an anxiety response to environmental stressors. Therefore it is important to see the child in a stable environment over a period of several months before making this diagnosis.

  29. An event involving actual or threatened death or serious injury or threat to the physical or psychological integrity of the child or another person. It may be a sudden & unexpected event (e.g. car wreck), a series of connected events (e.g. repeated domestic violence) or an enduring situation (e.g. chronic sexual abuse). from DC: 0-3R PTSD: Definition of Trauma

  30. Symptoms of PTSD • reliving the trauma, in children often through post-traumatic play • avoiding reminders of the trauma • intense emotional responses to reminders of the trauma • maintaining hypervigilance, startling easily • numbing of affect • difficulties falling and staying asleep, nightmares

  31. Many stressful events in children’s lives do not rise to the level of trauma, but may lead to a variety of other mental health issues, with symptoms that may appear similar in some respects to those of PTSD.

  32. Normal attachment during early childhood can be disrupted by specific conditions: Several changes of primary caregiver, such that the child can not develop a focused attachment Extreme caregiving by a consistent caregiver which does not result in the child learning to trust people DMD/RAD/DSED: Environment

  33. Sustained suspicion (DMD/RAD) Indiscriminant approaches/closeness (DMD/DSED) Mixture of previous two patterns (DMD) DMD/RAD/DSED: Relatedness Patterns

  34. Attachment Issues Can BeAssociated with Poor Outcomes • Increased risk of juvenile (and adult) justice involvement • Difficulties coping with stress • Increased risk of dangerous behaviors • Problematic peer relationships • Reduced likelihood of maintaining a stable, loving relationship with an adult partner • Poor parenting skills

  35. Symptoms of Depression • Change in mood– can be either depressed or irritable • Loss of interest in many activities • Persistent, at least some of the time uncoupled from sad/upsetting experiences • Pervasive across activities, settings or relationships • Symptoms cause child distress, impair functioning or impede development

  36. Goal #3:Know how infant mental health issues are assessed and treated

  37. Specific Issues to Referto Infant Mental Health • Difficulties with soothing and comforting • Persistent issues in the regulation of eating or sleep • Poor mood regulation • Difficulties with relatedness, including attachment issues • Trauma, especially loss of a primary caregiver • Behaviors that pose a danger to self or others

  38. Very young children can and do suffer from trauma, abuse, neglect, loss, stress and lack of opportunity When these issues are identified and treated early, outcomes are better than when services are delayed. Most young children who receive mental health services do not have the stigma of lifelong labels. Why Refer Young Children to Developmental and Mental Health Services

  39. How to Refer a Child for Services • In Nevada, Child and Family Teams (CFT’s) make decisions about what services a child needs. If you think a child in your care needs services, you must begin with your DFS caseworker, and ask for a CFT to discuss the need for services.

  40. Evaluation typically involvesseveral sessions • Parent interviews for family history • Direct observation & reports of family interaction/functioning • Direct observation & reports of child’s characteristics & development, including areas of concern • General assessment of child: ability to regulate mood and self-soothe, relatedness, sensory function, motor tone and motor planning

  41. DSM-V was not developed with particular attention to young children DC: 0-3R has been developed by Zero to Three as a developmentally sensitive alternative for young children Diagnosis of Young Children

  42. Infant Mental HealthSpecialists Provide: • Family therapy involving child and parent/caregiver • Developmental guidance • Advocacy for child & family • Early relationship assessment & support • Emotional support for caregivers • Connection to other resources

  43. Therapeutic Interventions • Help caregivers establish/maintain good schedules & routines • Improve attachment between child and caregiver • Promote caregiver’s realistic developmental expectations for child • Address family systems issues • Address caregiver mental health, substance abuse & domestic violence issues

  44. The Importance of a Family Approachto Treatment • Children learn in relationships • Relationships with caregivers are the most important relationships children have until their teenage years • Changes in the structure of the environment and the behavior of important caregivers toward the child contribute most to changes in the child’s behavior and/or mood

  45. Additional Therapeutic Services • Basic Skills Training (BST) • Psychosocial Rehabilitation (PSR) • Day Treatment and After School Services • Psychiatric Medications • Partial Hospitalization • Psychiatric Hospitalization

  46. Goal #4:Understand How to Access Services in the Community to Address Mental Health andDevelopmental Needsof Young Children

  47. Resources for Young Childrenin Clark County • Mental Health Services -- Early Childhood Mental Health, DCFS if fee-for-service Medicaid or uninsured 486-7764 -- Medicaid HMO’s and private insurance providers

  48. Services for children with developmental delays: --Nevada Early Intervention Services children birth to 36 months 486-7670 --CCSD Child Find children 33 months + 799-7463

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