nagle ecmh handouts - national conference of state ... · geoffrey nagle, phd, lcsw, mph ......

1

Geoffrey Nagle, PhD, LCSW, MPH

Tulane University

Institute of Infant and Early Childhood Mental Health

December 3, 2011

What is Early Childhood Mental Health?

ú  Yes, 16% of preschoolers have emotional or behavioral problems that get in the way of normal development   Anxiety disorders, disruptive behavior disorders,

depression, ADHD

Can young children have mental health problems?

Egger & Angold, 2006

2

§  Early childhood mental health problems can disrupt the child’s developing foundation of emotional and behavioral regulation skills, and are associated with long term emotional, academic, and relationship problems.

Briggs-Gowan & Carter, 2008; Briggs–Gowan et al., 2006

Can young children have mental health problems?

0%

5%

10%

15%

20%

AnyDisorder

AnxietyDisorder

Depression DBD ADHD

Ages 2-5 Ages 5-17

Egger & Angold, 2006

Rates of Preschool Mental Health Problems

3

Impact of Early Childhood Mental Health Problems

§  Child distress and suffering

§  Trouble with ú  Play ú  Peer interactions ú  Relationships ú  Learning

The Brain Changes its Structure and Function in Response to Experience §  Plasticity

ú  The brain is adaptable and can be influenced by positive experiences

ú  The brain in vulnerable and can be harmed by negative experiences

4

§  Excessive stresses stimulate the release of chemicals into the central nervous system that can disrupt the evolving architecture of the brain.

Toxic Stress

§  Disrupts brain architecture and leads to stress management systems that respond at relatively lower thresholds.

Toxic Stress

5

§  Strong and prolonged activation of the body’s stress management systems in the absence of the buffering protection of adult support.

Toxic Stress

§  Some causes ú  Extreme poverty

ú  Physical or emotional abuse

ú  Chronic neglect

ú  Severe maternal depression

ú  Substance abuse

ú  Family violence

Toxic Stress

6

The Body’s Response to Stress

§  Increase in heart rate

§  Increase in blood pressure

§  Increase in breathing rate

Cortisol §  Suppresses the immune system

§  Reduces number of cell connections

§  Impairs memory - shrinks hippocampus

§  Impairs selective attention

§  Impairs thinking

§  Creates anxious behavior

7

Cortisol

§  If exposed to chronic stress, then level of production of hormones becomes “normal”

§  Over arousal and tendency toward impulsive ú  Over active ú  Over reactive ú  More aggressive ú  Less attentive

Importance of Social-‐Emotional Development

§  James Heckman, Nobel Prize winning economist at the University of Chicago. ú  The benefits of investing in human capital.

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

8

§  Disparities in Early Learning and Development: Lessons from the Early Childhood Longitudinal Study – Birth Cohort (ECLS-B)

ú  Across Cognitive, Social, Behavioral, Health

ú  Gaps apparent at just nine months old

ú  Grow larger by 24 months


For Council of Chief State School Officers, by Child Trends, 2009

§  6 longitudinal studies show that attention problems at ages 5-6 predict school performance at the end of primary school (ages 11-12)

  –Duncan et al.

§  Pediatrics, June 2009 ú  Attention problems at age 6 significantly

predict academic achievement at age 17   –Breslau et al.


9

National Institute of Child Health and Human Development

§  Study of Early Child Care ú  Measured children’s experiences with

nonmaternal care and their developmental outcomes from birth.

ú  Diverse sample in 10 locations across the U.S.   1,364 children

Risk Factors

§  Lower socioeconomic group

§  Less maternal education

§  Reduced parental sensitivity

§  Harsh and punitive parenting

§  Depressive symptoms

§  Fewer child centered attitudes

10

0

1

2

3

4

5

6

7

2 3 4.5 5 7 9Age

Agr

essi

on S

core

Very Low Low Moderate/Declining Moderate HighNICHD Early Child Care Research Network (2004)

Trajectories of Aggression from 2-‐9 years

2.13

2.52

5.14

2.98

2.98

70%

30%

Relationships are the “Active Ingredients" of Early Experience

§  An infant experiences the world through their caregiving relationships.

§  Nurturing and responsive relationships build healthy brain architecture that provides a strong foundation for learning, behavior, and health.

11

Importance of Relationships

§  Quality of social and emotional development of children in the first few years of life ú  Capacity to experience, regulate and express

emotions ú  To form close and secure relationships ú  To explore the environment and learn

Benefits of Recognizing Early Childhood Mental Health Problems

§  Parents have concerns but access to professional service is delayed by years

§  Without early identification, we miss an opportunity to intervene early!

ú  Only 8% of children in need of receive treatment

12

§  As much as half of school failure may be due to gaps in learning and development before school entry.

§  High quality child care benefits child development while poor quality care can actually do harm.

Focus on Early Childhood Settings

Early Childhood Settings

§  Pre-k §  Child care §  Head Start §  Family Child Care Homes

13

§  Cognitive development

§  Classroom behavior

§  Attention

§  Social skills

§  Peer relations

High Quality Early Care is Critical

§  Harvard’s Center on the Developing Child ú  Mental Health Problems in Early Childhood Can

Impair Learning and Behavior for Life: Working Paper No. 6.

ú  Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9.

ú  Building the Brain’s “Air Traffic Control” System: How Early Experiences Shape the Development of Executive Function: Working Paper No. 11.

www.developingchild.harvard.edu


14

Quality Start: Louisiana’s Child Care Rating & Improvement

System

Intentional Focus on Early Childhood Mental Health

Points to Earn Stars

Total Number of Points

Star Rating

3-‐5

6-‐9

10-‐11

15

Integrating Social-‐Emotional Development in the Rating System

§  Environment Rating Scales ú  Social-Emotional Subscale

§  Mental Health Consultation

§  Social-Emotional Screening

Environment Rating Scales

Social-Emotional Subscale

16

Each ERS Scale Assesses

§  Space and Furnishings

§  Personal Care Routines

§  Activities

§  Listening & Talking/Language-Reasoning Skills

§  Interaction

§  Program Structure

Social-‐Emotional Subscale

§  ITERS-R ú  Listening and

Talking ú  Interaction ú  Program Structure

§  ECERS-R ú  Language-

Reasoning ú  Interaction ú  Program Structure

17

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, with no one classroom lower than 3.25 on the subscale

4

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

5 An average of 5 on the overall ERS, with no one classroom lower than 4 on the overall ERS

Program Standards -‐ Scores on the ERS (ITERS/ECERS)

Mental Health Consultation

18

Mental Health Consultants

§  12 full time equivalent consultants across state

§  All have master’s degree in a mental health field and hold a license

§  Primarily LCSW or LPC

§  12 total visits ú  One day every other week (day = 5-6 hours) ú  Centers with 8 or more classrooms receive weekly

visits with up to 24 total visits

§  All centers participating in the QRIS program are eligible

§  Centers serving children enrolled in CCAP, or in foster care, receive priority


19


§  Designed to support ALL children, teachers, and families involved in child care.

§  A combination model ú  Program ú  Child focused

Program Centered Components § Focus on relationships

§ Observes in classrooms

§ Meets with director

§ Meets individually with staff members

§ Provides 6 clock hours of training

§ Parent meetings/workshops are available

20

Child Centered Components

§  MHC available to complete a child-centered consultation when requested ú  Parent permission necessary ú  MHC can:

  Observe child in classroom   Interview parents/teachers/director   Make referrals when needed   Assist in designing behavior management

program for class and assist teacher in implementing

Consultant Supervision §  Consultants participate in

ú  Individual reflective supervision two times per month

ú  Group reflective supervision one time per month

§  Focus of supervision ú  Relationships with center staff ú  Avoiding the “expert stance”

21

Evaluation -‐ Teacher Self Report1

§  Teacher Self-Efficacy ú  Ability to make a difference in children’s lives ú  Increase at end of intervention •  Increase maintained after 6 months

§  Teacher Competence ú  Knowledge of, and ability to, support child

development ú  Increase at end of intervention •  Continued to increase after 6 months

•  Greater impact on younger and less experienced teachers

Evaluation -‐ CLASS Observations2

§  After 6 months §  Significant improvement in all 7 dimensions

Emo$onal Support

Posi$ve Climate Nega$ve Climate

Teacher Sensi$vity Regard for Student

Perspec$ve

Classroom Organiza$on

Behavior Management

Produc$vity Instruc$onal Learning

22

Social-‐Emotional Screening

Preparing to Screen

§  Who orders §  Who completes? (e.g., teacher; parent;

etc) §  Who scores §  Who discusses results with parents §  How to give feedback to parents §  How to follow up? (e.g., referrals, re-

screening, etc.) §  Social-Emotional Warm line information

23

Program Standards: Social-‐Emotional Development Screening

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 thereafter.

5 Same

Staff Qualifications: Social Emotional Screening Training

Points Criteria

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

4 Same

5 Same

24

Introduction to Social Emotional Screening Community Training

§  Rationale for universal screening ú  Importance of early detection ú  Identifying risk and protective factors ú  Outcomes for early treatment vs. later

treatment

§  Screening results are not a diagnostic indicator

Select Screens

§  Ages and Stages: Social Emotional (ASQ:SE)

§  Brief Infant Toddler Social Emotional Assessment (BITSEA)

§  Early Childhood Screening Assessment (ECSA)

§  Preschool Kindergarten Behavior Scale (PKBS)

§  Temperament and Atypical Behavior Scale (TABS)

25

Select Screens

6 – 11 months

12 – 17 months

18-‐35 months

36 – 60 months

ASQ: SE

BITSEA

ECSA

PKBS

TABS

Select Screens

Time to Administer

Format

Time to Score

ASQ: SE 10-‐15 minutes 3 point rating scale

1-‐3

minutes

BITSEA 7-‐10 minutes

3 point rating scale Some reverse scoring

ECSA 5-‐10 minutes 3 point rating scale

1-‐2

minutes

PKBS 8-‐12 minutes 4 point rating scale

TABS 10 minutes Yes/No 5 minutes

26

Select Screens Costs

ASQ: SE Approximately $200

BITSEA Approximately $100 +

ECSA Free

PKBS Approximately $100 +

TABS Approximately $85

Warm Line

§  Statewide 800 number

§  Leave a message

ú  Child care providers

ú  Parents

§  Will receive call back by the end of the next day

27

Evaluation Findings

§  Significant increase in positive attitudes towards mental health screening

§  Significant increase in perceived knowledge

Citations §  1Heller, 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.

§  2Heller, S. S., Rice, J., Boothe, A., Sidell, M., Vaughn, K., Keyes, A., & Nagle, G. (in press). Mental health consultation and teacher student interaction. Early Education and Development.

§  Heller, S. S., Boothe, A., Keyes, A., & Malik, N. (in press). Infant mental health consultation in early childhood classrooms. In S. J. Summers & R. Chazan-‐Cohen (Eds.), Essential Partners: Promoting Social Emotional Development Early Education Settings. Baltimore, MD: Brookes Publishing Co.

28

Citations §  Briggs-‐Gowan, M. J., & Carter, A. S. (2008). Social-‐emotional screening status in

early childhood predicts elementary school outcomes. Pediatrics, 121(5), 957-‐962. §  Briggs-‐Gowan, M. J., Carter, A. S., Bosson-‐Heenan, J., Guyer, A. E., & Horwitz, S. M.

(2006). Are infant-‐toddler social-‐emotional and behavioral problems transient? Journal of the American Academy of Child and Adolescent Psychiatry, 45(7), 849-‐858.

§  Breslau, J., Miller, E., Breslau, N., et al. (2009). The Impact of Early Behavior Disturbances on Academic Achievement in High School. Pediatrics, 123:1472-‐1476.

§  Duncan, G.J., Dowsett, C.J., Claessens, A., et al. (2007). School readiness and later achievement. Developmental Psychology, 43(6):1428–1446.

§  Egger, H.L., & Angold, A. (2006). Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology. Journal of Child Psychology and Psychiatry 47(3/4):313–337.

§  Halle, T., Forry, N., Hair, E., Perper, K., Wandner, L., Wessel, J., & Vick, J.(2009). Disparities in Early Learning and Development: Lessons from the Early Childhood Longitudinal Study – Birth Cohort (ECLS-‐B). Washington, DC: Child Trends.

§  Heckman, 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 physical aggression from toddlerhood to middle childhood: Predictors, correlates, and outcomes. Monographs of the Society for Research in Child Development, 278(69):4.

THANK YOU Contact Information: Geoffrey Nagle, PhD [email protected]

(504) 988-8241

nagle ecmh handouts - national conference of state ... · geoffrey nagle, phd, lcsw, mph ......

Documents