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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
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QRIS Focus on Social‐Emotional Development
Early Childhood Budget
Alternative FinancingS h l R di T C diSchool Readiness Tax Credits
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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
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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
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Importance of the early yearsMi d t itiMissed opportunitiesThe right thing to doBrain development
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Brain architectureBrain architectureToxic stressDisparities in developmentEconomic developmentEconomic developmentNational securityE i F iExecutive Function
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Social and Emotional DevelopmentSocial and Emotional Development
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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
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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.
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Child distress and suffering
Trouble withlPlay
Peer interactionsRelationshipsLearning
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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)
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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
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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))
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Intentional Focus on Early Childhood Mental HealthMental Health
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Total Number of Points
Star Rating
3‐5
6‐9
10‐11
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Environment Rating Scales Social Emotional SubscaleSocial‐Emotional Subscale
Mental Health ConsultationMental Health Consultation
Social‐Emotional ScreeningSocial Emotional Screening
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Social‐Emotional SubscaleSocial Emotional Subscale
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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 , ( )
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Space and FurnishingsPersonal Care RoutinesPersonal Care RoutinesActivitiesListening & Talking/Language‐Reasoning SkillsInteractionInteractionProgram Structure
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ITERS‐RListening and Talking
ECERS‐RLanguage‐ReasoningListening and Talking
InteractionProgram Structure
Language ReasoningInteractionProgram StructureProgram Structure Program Structure
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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
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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
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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
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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
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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
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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
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6 interactive didactic trainingsMost based on CSEFELMost based on CSEFEL
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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) ( )
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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)
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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
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Points Criteria
3 Directors and lead teachers complete training in social‐emotional screening of children.
4 Same4
5 Same5
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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
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Approved screening instrumentsAge rangesAge rangesCost of implementationPsychometric properties
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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)
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Statewide 800 numberLeave a messageLeave a message
Child care providersPParents
Will receive call back by the end of the next day
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Significant increase in positive attitudes towards mental health screeningtowards mental health screening
Si ifi i i i dSignificant increase in perceived knowledge
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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
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60%
40%
50%
20%
30%
10%
20%
0%0 Stars 1 Star 2 Stars 3 Stars 4 Stars
Nov. 2009 Nov. 2010 Aug 2012
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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
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A cross‐system plan without a cross‐system budget is difficult to implement.budget is difficult to implement.
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Looks at resources for children less than age 5Formatted by categoriesFormatted by categoriesIncludes
d i tidescriptionsource of fundspopulation servedpopulation servedgeographic areas served
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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
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DSS – Office of Family Support
State General Fund
Federal Funds Total Funds
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DSS – Office of Family Support
State General Fund
Federal Funds Total Funds
Child CChild Care Assistance
Head Start Collaboration
Support E f tEnforcement
Totals
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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
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Early Care and Education
State General Fund
Federal Funds Total Funds
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Early Care and Education
State General Fund
Federal Funds Total Funds
Pre‐K
NSECDNSECD
Head Start
Child Care SubsidySubsidy
Totals
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lFamily Support/Parenting Ed
State General Fund
Federal Funds Total Funds
Child Support Enforcement
Nurse Family Partnership
Child Protection
TANF CashTANF Cash Assistance
Totals
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Access to Medical Care
State General Fund
Federal Funds Total Funds
Medicaid
CHIPCHIP
MCH
Immunization
Total
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Mental Health/Social‐Emotional
State General Fund
Federal Funds Total Funds
Emotional
Early Childhood Supports andSupports and Services
PerinatalPerinatal Depression
Project LASTProject LAST
Total
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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
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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
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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
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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
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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
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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
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Early Care and Education20.3% Family
Support/Parenting Educationg Education
17.3%
Access to Medical Care61.9%
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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%
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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%
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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%
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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%
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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%
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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%
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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%
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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%
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9 programs in this category81% is in just one program81% is in just one program
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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
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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
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Long Term Funding for Quality Child CareQuality Child Care
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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
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Tax policies can support the ends we want to achieve…to achieve…
School ReadinessQ li Child CQuality Child Care
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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3 Years2008‐20102008 2010
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$1,646,222
$871,281
$1,076,328
4,6594,6597,0327,032
10,03310,033
4,6594,659
2008 2009 2010
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$4 911 742$4,911,742
$3,278,385
$1,631,129
257257468468
123123257257
2008 2009 2010
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$4,568,410
$3,283,024
$1,499,402
2,3262,326
1,7371,737
871871
2008 2009 2010
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13 09813,098
9401
5778
2008 2009 2010
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$11 618 763
$8 268 077
$11,618,763
$8,268,077
41%41%
$4,150,548
99%99%99%99%
2008 2009 2010
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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.
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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:
http://www.doa.louisiana.gov/opb/pub/FY12_ECSIB_at_Appropriated as of 07‐01‐2011.pdfpp p _ _ _ p