th i h fhe first three years of liiffe forever: building ... · last forever: building an ......

h i h f ifThe First Three Years of Life Last Forever: Building an gEarly Childhood System That S t E l Childh dSupports Early Childhood Mental Health

[Your Teacher’s Name]

[Y S h l]Geoffrey Nagle, PhD, LCSW, MPH

[Your School]Tulane UniversityInstitute of Infant and Early Childhood Mental Health

October 16, 2012

QRIS Focus on Social‐Emotional Development

Early Childhood Budget

Alternative FinancingS h l R di T C diSchool Readiness Tax Credits

Neglected Child

Courtesy of Dr. H.T. Chugani from the Children’s Hospital of Michigan, Wayne State University

Healthy Child

y g p g y y

Committee on Integratingthe Science of Early Childhoodthe Science of Early Childhood Development

Board on Children, Youth, and FamiliesInstitute of Medicine

National Research CouncilNational Research Council

Importance of the early yearsMi d t itiMissed opportunitiesThe right thing to doBrain development

Brain architectureBrain architectureToxic stressDisparities in developmentEconomic developmentEconomic developmentNational securityE i F iExecutive Function

Social and Emotional DevelopmentSocial and Emotional Development

Committee on Integratingthe Science of Early Childhoodthe Science of Early Childhood Development

Board on Children, Youth, and FamiliesInstitute of Medicine

National Research CouncilNational Research Council

Young children are capable of deep and lasting sadness, grief, and disorganizationlasting sadness, grief, and disorganization in response to trauma, loss, and early personal rejectionpersonal rejection.

Child distress and suffering

Trouble withlPlay

Peer interactionsRelationshipsLearning

James Heckman, Nobel Prize winning economist at the University of Chicago.economist at the University of Chicago.

The benefits of investing in human capital

While important, cognitive abilities alone are not as powerful as a package ofare not as powerful as a package of cognitive skills and social skills – defined as attentiveness perseverance impulseattentiveness, perseverance, impulse control, and sociability.  

Heckman (2011)Heckman (2011)

Study of Early Child CareMeasured children’s experiences withMeasured children s experiences with nonmaternal care and their developmental outcomes from birthoutcomes from birth.Diverse sample in 10 locations across the U SU.S.

1,364 children

6

7

4

5

on S

core

2

3

Agr

essi

o

0

1

2 3 4.5 5 7 9AgeVery Low Low Moderate/Declining Moderate High

NICHD Early Child Care Research Network (2004NICHD Early Child Care Research Network (2004))

Intentional Focus on Early Childhood Mental HealthMental Health

Total Number of Points

Star Rating

3‐5

6‐9

10‐11

Environment Rating Scales Social Emotional SubscaleSocial‐Emotional Subscale

Mental Health ConsultationMental Health Consultation

Social‐Emotional ScreeningSocial Emotional Screening

Social‐Emotional SubscaleSocial Emotional Subscale

Infant/Toddler Environment Rating Scale ‐Revised (ITERS‐R) – birth through 2½ years

E l Childh d E i R i S lEarly Childhood Environment Rating Scale ‐Revised (ECERS‐R) – 2½ years to 5 years

Harms, T., Cryer, D., & Clifford, R. M. (2006) Harms, T., Clifford, R. M., Cryer, D. (2005) , , , , y , ( )

Space and FurnishingsPersonal Care RoutinesPersonal Care RoutinesActivitiesListening & Talking/Language‐Reasoning SkillsInteractionInteractionProgram Structure

ITERS‐RListening and Talking

ECERS‐RLanguage‐ReasoningListening and Talking

InteractionProgram Structure

Language ReasoningInteractionProgram StructureProgram Structure Program Structure

Points Criteria

1 An average of 3.75 on the social‐emotional subscale, with no one classroom lower than 3 on the subscale

2

33

44

5

Points Criteria

1 An average of 3.75 on the social‐emotional subscale, with no one classroom lower than 3 on the subscale

2 An average of 4 on the social‐emotional subscale, with no one classroom lower than 3 on the subscale

3 An average of 4.25 on the social‐emotional subscale, 3 g 4 5 ,with no one classroom lower than 3.25 on the subscale

44

5

Points Criteria

1 An average of 3.75 on the social‐emotional subscale, with no one classroom lower than 3 on the subscale

2 An average of 4 on the social‐emotional subscale, with no one classroom lower than 3 on the subscale

3 An average of 4.25 on the social‐emotional subscale, 3 g 4 5 ,with no one classroom lower than 3.25 on the subscale

4 An average of 4.5 on the social‐emotional subscale, with 4 An average of 4.5 on the social emotional subscale, with no one classroom lower than 3.5 on the overall ERS

5

Points Criteria

1 An average of 3.75 on the social‐emotional subscale, with no one classroom lower than 3 on the subscale

2 An average of 4 on the social‐emotional subscale, with no one classroom lower than 3 on the subscale

3 An average of 4.25 on the social‐emotional subscale, 3 g 4 5 ,with no one classroom lower than 3.25 on the subscale

4 An average of 4.5 on the social‐emotional subscale, with 4 An average of 4.5 on the social emotional subscale, with no one classroom lower than 3.5 on the overall ERS

An a erage of   on the o erall ERS   ith no one 5 An average of 5 on the overall ERS, with no one classroom lower than 4 on the overall ERS

12 total visitsOne day every other week (day = 5‐6 hours)One day every other week (day = 5 6 hours)Centers with 8 or more classrooms receive weekly visits with up to 24 total visitsweekly visits with up to 24 total visits

All centers participating in the QRIS program are eligibleprogram are eligibleCenters serving children enrolled in CCAP, or in foster care, receive priority

Focus on relationshipsObserves in classroomsObserves in classroomsMeets with directorMeets individually with staff membersProvides 6 clock hours of trainingProvides 6 clock hours of trainingParent meetings/workshops are available

6 interactive didactic trainingsMost based on CSEFELMost based on CSEFEL

Teacher Self‐EfficacyAbility to make a difference in children’s livesIncrease at end of interventionIncrease at end of intervention

Increase maintained after 6 months

Teacher CompetenceTeacher CompetenceKnowledge of, and ability to, support child developmentdevelopmentIncrease at end of intervention

Continued to increase after 6 monthsContinued to increase after 6 monthsGreater impact on younger and less experienced teachers

Heller, S. et al. (2011) ( )

After 6 monthsSignificant improvement in all 7 areasSignificant improvement in all 7 areas

Emotional  Classroom Support

Positive Climate

Organization

Behavior ManagementNegative Climate

Teacher Sensitivity 

R d f St d t

Productivity

Instructional LearningRegard for Student 

Perspective

Heller, S. et al. (2012)

Points Criteria

4 Complete screening for social‐emotional development with instrument from recommended list for all children (0‐5 yrs.) within 45 calendar days of enrollment and annually thereafterof enrollment and annually thereafter.

5 Same

Points Criteria

3 Directors and lead teachers complete training in social‐emotional screening of children.

4 Same4

5 Same5

Rationale for universal screeningImportance of early detectionImportance of early detectionIdentifying risk and protective factorsOutcomes for early treatment vs laterOutcomes for early treatment vs. later treatment

S i lt t di tiScreening results are not a diagnostic indicator

Approved screening instrumentsAge rangesAge rangesCost of implementationPsychometric properties

Ages and Stages: Social Emotional (ASQ:SE)Brief Infant Toddler Social EmotionalBrief Infant Toddler Social Emotional Assessment (BITSEA)E l Childh d S i A (ECSA)Early Childhood Screening Assessment (ECSA)Preschool Kindergarten Behavior Scale (PKBS)Temperament and Atypical Behavior Scale (TABS)(TABS)

Statewide 800 numberLeave a messageLeave a message 

Child care providersPParents

Will receive call back by the end of the next day

Significant increase in positive attitudes towards mental health screeningtowards mental health screening

Si ifi i i i dSignificant increase in perceived knowledge

75

90

60

Centers

30

45

rcen

t of 

15

Pe

01 Star 2 Stars 3 Stars 4 Stars 5 Stars

Feb. 2009 Aug. 2010 Aug  2012g g

60%

40%

50%

20%

30%

10%

20%

0%0 Stars 1 Star 2 Stars 3 Stars 4 Stars

Nov. 2009 Nov. 2010 Aug  2012

The budget is the most significant POLICY DOCUMENT used in government planning.DOCUMENT used in government planning.

“The budget process is the spinal column of public policymaking.”public policymaking.

Nathan, R. P. Handbook for Appointed Officials in America’s Governments. Chapter 5, Page 42. Available at www.rockinst.org/pdf/government_reform/2009-handbook_for_appointed_officials_in_america%27s_governments.pdf

A cross‐system plan without a cross‐system budget is difficult to implement.budget is difficult to implement.

Looks at resources for children less than age 5Formatted by categoriesFormatted by categoriesIncludes 

d i tidescriptionsource of fundspopulation servedpopulation servedgeographic areas served

No right answersSimply shows the resources and programs in p y p gthe priority areas

Context?310 000 children under age 5 (7 2%)310,000 children under age 5 (7.2%)31% of children under age 5 live in poverty

DSS – Office of Family Support

State General Fund

Federal Funds Total Funds

DSS – Office of Family Support

State General Fund

Federal Funds Total Funds

Child CChild Care Assistance

Head Start Collaboration

Support E f tEnforcement

Totals

DSS – Office of Family Support

State General Fund

Federal Funds Total Funds

Child CChild Care Assistance

$7,500,000 $109,804,670 $117,304,670

Head Start $35 000 $175 000 $210 000

Collaboration$35,000 $175,000 $210,000

Support E f t

2,349,694 $22,031,073 $24,380,767Enforcement

, , $ , , $ , ,

Totals $9,884,694 $132,010,743 $141,895,437

Early Care and Education

State General Fund

Federal Funds Total Funds

Early Care and Education

State General Fund

Federal Funds Total Funds

Pre‐K

NSECDNSECD

Head Start

Child Care SubsidySubsidy

Totals

lFamily Support/Parenting Ed

State General Fund

Federal Funds Total Funds

Child Support Enforcement

Nurse Family Partnership

Child Protection

TANF CashTANF Cash Assistance

Totals

Access to Medical Care

State General Fund

Federal Funds Total Funds

Medicaid

CHIPCHIP

MCH

Immunization

Total

Mental Health/Social‐Emotional

State General Fund

Federal Funds Total Funds

Emotional

Early Childhood Supports andSupports and Services

PerinatalPerinatal Depression

Project LASTProject LAST

Total

FY 12 AppropriatedSGF IAT Fees Stat.

Dedications Federal TotalDedications

Access to Medical Care

Early Care and Education

Family Support and Parenting Education

Mental Health and Social-Emotional Development

EARLY CHILDHOOD SYTEM INTEGRATION BUDGET TOTALS

FY 12 AppropriatedSGF IAT Fees Stat.

Dedications Federal TotalDedications

Access to Medical Care

$240 017 765 $6 696 769 $1 453 550 $0 $616 902 589 $865 070 673$240,017,765 $6,696,769 $1,453,550 $0 $616,902,589 $865,070,673

Early Care and Education

Family Support and Parenting Education

Mental Health and Social-Emotional Development

EARLY CHILDHOOD SYTEM INTEGRATION BUDGET TOTALS

FY 12 AppropriatedSGF IAT Fees Stat.

Dedications Federal TotalDedications

Access to Medical Care

$240 017 765 $6 696 769 $1 453 550 $0 $616 902 589 $865 070 673$240,017,765 $6,696,769 $1,453,550 $0 $616,902,589 $865,070,673

Early Care and Education

$21 371 312 $70 509 597 $1 832 631 $8 987 900 $180 378 210 $283 079 650$21,371,312 $70,509,597 $1,832,631 $8,987,900 $180,378,210 $283,079,650

Family Support and Parenting Education

Mental Health and Social-Emotional Development

EARLY CHILDHOOD SYTEM INTEGRATION BUDGET TOTALS

FY 12 AppropriatedSGF IAT Fees Stat.

Dedications Federal TotalDedications

Access to Medical Care

$240 017 765 $6 696 769 $1 453 550 $0 $616 902 589 $865 070 673$240,017,765 $6,696,769 $1,453,550 $0 $616,902,589 $865,070,673

Early Care and Education

$21 371 312 $70 509 597 $1 832 631 $8 987 900 $180 378 210 $283 079 650$21,371,312 $70,509,597 $1,832,631 $8,987,900 $180,378,210 $283,079,650

Family Support and Parenting Education

$35 977 551 $10 887 865 $5 654 080 $93 000 $188 488 360 $241 100 856$35,977,551 $10,887,865 $5,654,080 $93,000 $188,488,360 $241,100,856

Mental Health and Social-Emotional Development

EARLY CHILDHOOD SYTEM INTEGRATION BUDGET TOTALS

FY 12 AppropriatedSGF IAT Fees Stat.

Dedications Federal TotalDedications

Access to Medical Care

$240 017 765 $6 696 769 $1 453 550 $0 $616 902 589 $865 070 673$240,017,765 $6,696,769 $1,453,550 $0 $616,902,589 $865,070,673

Early Care and Education

$21 371 312 $70 509 597 $1 832 631 $8 987 900 $180 378 210 $283 079 650$21,371,312 $70,509,597 $1,832,631 $8,987,900 $180,378,210 $283,079,650

Family Support and Parenting Education

$35 977 551 $10 887 865 $5 654 080 $93 000 $188 488 360 $241 100 856$35,977,551 $10,887,865 $5,654,080 $93,000 $188,488,360 $241,100,856

Mental Health and Social-Emotional Development

$1 031 606 $116 868 $0 $0 $6 382 944 $7 531 418$1,031,606 $116,868 $0 $0 $6,382,944 $7,531,418

EARLY CHILDHOOD SYTEM INTEGRATION BUDGET TOTALS

$298,398,234 $88,211,099 $9,940,261 $9,080,900 $992,152,103 $1,396,782,597

Changes from FY 11 to FY 12SGF IAT Fees Stat.

Dedications Federal TotalDedications

Access to Medical Care

$45 350 842 ($2 317 543) $129 764 $0 ($12 956 575) $30 206 488$45,350,842 ($2,317,543) $129,764 $0 ($12,956,575) $30,206,488

Early Care and Education

($479 839) $1 105 005 $182 ($4 510 251) $10 425 567 $6 540 664($479,839) $1,105,005 $182 ($4,510,251) $10,425,567 $6,540,664

Family Support and Parenting Education

$2 158 045 $2 087 849 ($47 493) $0 $5 762 732 $9 961 133$2,158,045 $2,087,849 ($47,493) $0 $5,762,732 $9,961,133

Mental Health and Social-Emotional Development

$195 635 ($89 342) $0 $0 $484 173 $590 466$195,635 ($89,342) $0 $0 $484,173 $590,466

EARLY CHILDHOOD SYTEM INTEGRATION BUDGET TOTALS

$47,224,684 $785,969 $82,453 ($4,510,251) $3,715,897 $47,298,751

Early Care and Education20.3% Family 

Support/Parenting Educationg Education

17.3%

Access to Medical Care61.9%

Early Care and Education20.3% Family 

Support/Parenting Education

Mental Health/Social‐E ti l D l tg Education

17.3%Emotional Development 

0.5%

Access to Medical Care61.9%

SGF IAT FeesStat. 

Federal TotalSGF IAT FeesDedications

Federal Total

Access to Medical Care

$240 017 765 $6 696 769 $1 453 550 $0 $616 902 589 $865 070 673$240,017,765 $6,696,769 $1,453,550 $0 $616,902,589 $865,070,673

Other38%

Medical62%

SGF IAT FeesStat. 

Federal TotalSGF IAT FeesDedications

Federal Total

Access to Medical Care

$240 017 765 $6 696 769 $1 453 550 $0 $616 902 589 $865 070 673$240,017,765 $6,696,769 $1,453,550 $0 $616,902,589 $865,070,673

Medicaid/LaMedicaid/LaCHIP 89%Other

38%Medical62%

Other  11%11%

SGF IAT FeesStat. 

Federal TotalSGF IAT FeesDedications

Federal Total

Early Care and Education

$21 371 312 $70 509 597 $1 832 631 $8 987 900 $180 378 210 $283 079 650$21,371,312 $70,509,597 $1,832,631 $8,987,900 $180,378,210 $283,079,650

SGFSGF

20%80%62%

SGF IAT FeesStat. 

Federal TotalSGF IAT FeesDedications

Federal Total

Family Support and Parenting Education

$35 977 551 $10 887 865 $5 654 080 $93 000 $188 488 360 $241 100 856$35,977,551 $10,887,865 $5,654,080 $93,000 $188,488,360 $241,100,856

83% 17%

SGF IAT FeesStat. 

Federal TotalSGF IAT FeesDedications

Federal Total

Family Support and Parenting Education

$35 977 551 $10 887 865 $5 654 080 $93 000 $188 488 360 $241 100 856$35,977,551 $10,887,865 $5,654,080 $93,000 $188,488,360 $241,100,856

Family

83% 17%

Family Support 95.6%

Parenting ED 4 4%4.4%

SGF IAT FeesStat. 

Federal TotalSGF IAT FeesDedications

Federal Total

Family Support and Parenting Education

$35 977 551 $10 887 865 $5 654 080 $93 000 $188 488 360 $241 100 856$35,977,551 $10,887,865 $5,654,080 $93,000 $188,488,360 $241,100,856

Child Welfare

F il

Welfare 22%

Family Support 73%

Parenting ED 4% 73%

SGF IAT FeesStat. 

Federal TotalSGF IAT FeesDedications

Federal Total

Mental Health and Social‐Emotional Development

$1 031 606 $116 868 $0 $0 $6 382 944 $7 531 418$1,031,606 $116,868 $0 $0 $6,382,944 $7,531,418

99.5% 0.5%

9 programs in this category81% is in just one program81% is in just one program

8.9%10%

8%

5.5%6%

2.2%2%

4%

0%

2%

0%of Total State Funds of Total Federal Funds of Total State Budget

10%

6.4%

8%

4%

6%

3.2%

2%

4%

0.7%

0%f T t l St t F d f T t l F d l F d f T t l St t B d tof Total State Funds of Total Federal Funds of Total State Budget

*estimate

Long Term Funding for Quality Child CareQuality Child Care

Package of 4 Tax Credits Credits to ProvidersCredits to ProvidersCredits to Directors and TeachersCredits to Business for Supporting Child CareCredits to Business for Supporting Child CareCredits to Parents/Consumers

Tax policies can support the ends we want to achieve…to achieve…

School ReadinessQ li Child CQuality Child Care

Providers receive a tax credit based on the number of children they serve in the Child Carenumber of children they serve in the Child Care Assistance Program (or in foster care)

Refundable credit

Both for‐profit and non‐profit centers are eligibleg

St R tiTax Credit 

Star Rating(per child in CCAP/foster care)

$1,500

$1,250

$1,000

$$750

1 St ( t ti i ti ) No credit1 Star (or not participating) No credit

If you serve 10 CCAP children and you are a 2 star center, then you receive a $7,500star center, then you receive a $7,500 refundable tax credit!

10 children x $ 750 (2 star center) = $ 7 50010 children x $   750 (2 star center) = $   7,50010 children x $1,000 (3 star center) = $10,00010 hild $1 250 (4 t t ) $12 50010 children x $1,250 (4 star center) = $12,50010 children x $1,500 (5 star center) = $15,000

Refundable credits

Based on the level of educationMust be working at a center participating in theMust be working at a center participating in the rating systemMust work there at least 6 monthsMust work there at least 6 monthsThe star rating of the center does not impact this creditcredit

Child Care Director and Teacher Qualification

Tax Credit Teacher Qualification

Level 4 $3,000

Level 3 $2,500

$Level 2 $2,000

Level 1 $1 500Level 1 $1,500

Employers receive a credit for “eligible child care expenses” based on the quality rating ofcare expenses based on the quality rating of the center

Refundable credits

St R tiTax Credit 

Star Rating(of eligible expenses)

20%

15%

10%

5%

1 St ( t ti i ti ) No credit1 Star (or not participating) No credit

Eligible ExpensesEmployers may claim a tax credit for up toEmployers may claim a tax credit for up to $5,000 in grants to child care resource and referral agenciesreferral agencies.

This credit is dollar for dollar$Maximum is $5,000

Builds on the existing state child care tax credit.tax credit.

Families are eligible for an increased gtax credit based upon the quality rating of the center.at g o t e ce te

St R tiIncrease to Existing        

Star Ratingg

Tax Credit

200%

150%

100%

50%

1 St ( t ti i ti ) No change1 Star (or not participating) No change

3 Years2008‐20102008 2010

$1,646,222

$871,281

$1,076,328

4,6594,6597,0327,032

10,03310,033

4,6594,659

2008 2009 2010

$4 911 742$4,911,742

$3,278,385

$1,631,129

257257468468

123123257257

2008 2009 2010

$4,568,410

$3,283,024

$1,499,402

2,3262,326

1,7371,737

871871

2008 2009 2010

13 09813,098

9401

5778

2008 2009 2010

$11 618 763

$8 268 077

$11,618,763

$8,268,077

41%41%

$4,150,548

99%99%99%99%

2008 2009 2010

THANK YOUGeoffrey Nagle, PhDgnagle@tulane.edu

(504) 988-8241

From neurons to neighborhoods : the science of early child development.  (2000).  Jack P. Shonkoff and Deborah A. Phillips, editors.  National Academy of Sciences.ed to s at o a cade y o Sc e cesHeckman, J.J. (Spring 2011).  The Economics of Inequality: The value of Early Childhood Education.  American Educator.NICHD Early Child Care Research Network.  (2004).  Trajectories of y ( ) jphysical aggression from toddlerhood to middle childhood: Predictors, correlates, and outcomes.  Monographs of the Society for Research in Child Development, 278(69):4.Heller S S Boothe A Keyes A Nagle G Sidell M & Rice JHeller, S. S., Boothe, A., Keyes, A., Nagle, G., Sidell, M., & Rice, J.  (2011).  Implementation of a mental health consultation model and its impact on early childhood teachers’ efficacy and competence.  Infant Mental Health Journal, 32(2), 143‐164., ( ),Heller, S. S., Rice, J., Boothe, A., Sidell, M., Vaughn, K., Keyes, A., & Nagle, G.  (2012).  Mental health consultation and teacher student interaction.  Early Education and Development, 23, 919‐944.

Harms, T., Clifford, R.M., Cryer, D. (2005).  Early Childhood Environment Rating Scale‐Revised Edition.  New York: Teachers College.  Harms, T., Cryer, D., & Clifford, R. M. (2006).  The Infant/Toddler Environment Rating Scale Revised Edition New York: TeachersEnvironment Rating Scale‐Revised Edition. New York: Teachers College Press. Early Childhood System Integration Budget available at:Early Childhood System Integration Budget available at:

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