Early Childhood Mental Health Needs Assessment

Transcription

Early Childhood
Mental Health Needs
Assessment
Yolo County
June 2008
First 5 Yolo Early Childhood Mental Health Needs Assessment
ACKNOWLEDGEMENTS
First 5 Yolo would like to extend thanks to everyone who participated in the Early Childhood
Mental Health Needs Assessment. We are grateful to all of the mental health and health care
providers, teachers, childcare providers and administrators that participated in the surveys and
focus group. We are also very appreciative of the parents who shared their experiences and
insights with us. We thank the parents, teachers and childcare providers who took the time to
conduct the TABS screening on children.
In addition, we would like to especially thank the people who contributed their expertise and
assistance in shaping the project and interpreting the findings: Lynn Arner, Joan Beesley, Diane
Casey, Jim Coulter, Diana Hansen, Lewis Oleson, Michael Rahilly, Dr. Kevin Rosi, Anne Bolden
Schultze, Roseanne Testerman, Professor Ross Thompson, Pauline Wooliever and Oscar Wright.
Finally, we would like to express our appreciation to the Quality Subcommittee of the Yolo
County Children’s Health Initiative who identified mental health as a priority need for the
children of Yolo County and recommended undertaking an early childhood mental health needs
assessment for Yolo County.
This Early Childhood Mental Health Needs Assessment was conducted by Kathleen Bowers, The
Bowers Group.
TABLE OF CONTENTS
EXECUTIVE SUMMARY ............................................................................ 2
BACKGROUND ........................................................................................ 6
METHODS ............................................................................................... 7
FINDINGS ................................................................................................ 8
COMMUNITY ASSETS .............................................................................. 19
RECOMMENDATIONS ............................................................................. 29
APPENDICES............................................................................................ 32
EXECUTIVE SUMMARY
First 5 Yolo will assist our community to raise children who are healthy and ready to learn. We
will assure that our resources are effectively used and all community voices heard.
- First 5 Yolo Mission Statement
PURPOSE OF THIS REPORT
First 5 Yolo commissioned this Early Childhood Mental Health Needs Assessment in response to
a great deal of anecdotal information from early childhood educators, physicians, childcare
providers, parents, and other community members, regarding the challenges faced in both
attempting to identify early mental health issues in young children as well as accessing mental
health services for young children 0 to 5 years old. This report takes a systemic, data driven
approach in assessing Yolo County’s needs for early childhood mental health services as well as
mapping mental health assets within the county.
DEFINING INFANT AND EARLY CHILDHOOD MENTAL HEALTH
For the purposes of this study, early childhood mental health is the capacity of the young child
to “experience, regulate, and express emotions; form close and secure interpersonal
relationships; and explore the environment and learn.”1 For very young children, the terms
“emotional development” or “social and emotional development” are roughly analogous to the
term “mental health.” Social-emotional development is an essential component of optimal
child development and school readiness.
In addition, a systems perspective defines early childhood mental health as a set of strategies
that promote the emotional well-being of all young children; help families address any barriers
that they face to ensuring their young children’s emotional development; expand competencies
of caregivers and providers to promote the well-being of young children and families; and
ensure that young children who are experiencing clearly atypical emotional and behavioral
development and their families have access to needed services and support.2
Both perspectives, that of the individual child’s social-emotional development, and early mental
health issues within the context of systems, are used as a framework for assessing early
childhood mental health in Yolo County.
METHODS
In order to assess and describe the current landscape of mental health services for young
children in Yolo County, estimate the number of children 0-5 who might be in need of mental
health services, and identify gaps in services, the following activities were conducted:
1
Zero to Three, DC: 0-3R.
“Social and Emotional Health in Early Childhood: Building Bridges Between Services and Systems.” Perry,
Kaufman, and Knitzer (2007).
2
2
•
Interviews of 41 key informants, including researchers, directors and clinical directors of
community-based organizations, and Yolo County mental health practitioners in both
public service and private practice;
•
Surveys, including 69 Yolo County mental health providers, nine physicians, and 44
parents;
•
A focus group of Yolo County early childhood mental health experts;
•
A mental health screening of 276 two year-old and three year-old Yolo County children;
•
Literature and data review.
LIMITATIONS: This needs assessment focused primarily on the public and private mental health
services available to young children. It does not fully examine the mental health services within
educational or other settings that are not focused primarily on mental health.
KEY FINDINGS
1.
Key informants3 report that Yolo County’s greatest needs related to early childhood
mental health are in the areas of public awareness, prevention and early intervention.
2.
There is a shortage of practitioners with expertise in early childhood mental health.
3.
Assets for mental health services for young children in Yolo County include:
•
Limited public mental health services for young children through Yolo County
Department of Alcohol, Drug and Mental Health and its contracting agencies;
Yolo County Office of Education; the five school districts’ special education
departments. Mental health screening and limited mental health services for
children with severe physical disability and/or developmental delays (e.g., Downs
syndrome) are provided by Alta California Regional Center.
•
Private mental health services provided by 12 agencies and 55+ solo
practitioners who see Yolo County children (although some, such as the UC Davis
MIND Institute, are physically located outside Yolo County).
•
Parent education and support services that support the parent-child relationship.
4.
In a screening of 276 2 and 3 year olds throughout Yolo County, approximately 30%
were found to have indicators of possible atypical behavior. An additional 13% of
children were found to be at risk of atypical behavior.
5.
Very few children under 6 years old across all income groups receive mental health
services in Yolo County.
RECOMMENDATIONS
Key findings support the notion that young children and their families in Yolo County would
benefit greatly from the development of a coordinated system of care that offers a continuum
3
Mental Health Provider Survey, key informant interviews
3
of mental health services from promotion to prevention to intervention.
Suggestions on where to begin include the following:
1.
EXPAND PUBLIC AWARENESS
The goals of raising public awareness include reducing general stigma associated with early
childhood mental health. Additionally, all parents and family members, as well as professional
caregivers, early childhood educators, and mental health and medical care providers would
benefit from greater understanding of early childhood mental health. Another important area
to address is language and cultural issues.
2.
FOCUS ON PROMOTION, PREVENTION AND EARLY INTERVENTION STRATEGIES
Promotion activities target all young children and their families, are designed to promote
healthy social emotional development, and include approaches aimed at improving parenting
knowledge and skills, child development, and social-emotional health. Promotion services can
take many forms, such as parent support groups, home visiting to newborns, parent education
programs focusing on social-emotional development, high-quality childcare and preschool,
social-emotional screening as part of well-child check-ups, and breastfeeding support. These
services can take place in many settings, including homes, early care and education settings,
primary care provider offices, and other community environments. Social and emotional
components may be integrated into existing services.
Prevention strategies are targeted to specific populations considered to be at-risk because of
environmental or biological factors, and are available prior to diagnosable symptoms. These
types of services can be integrated into programs that serve at risk families and children.
Intervention services target children with identified social-emotional delays. They can be
provided in a variety of settings, and are designed to provide support to children who display
atypical psychosocial development.
Prevention and early intervention strategies should be relationship-based, developmentallybased, address the parent-child dyad or triad, support the parent’s mental health needs, and
build on the strengths of the family.
Focusing on promotion, prevention and early intervention represents a fundamental shift from
targeted investment in children with the most severe needs to an approach that is strengthsbased, developmentally based, and relationship-based.
3.
ENCOURAGE/SUPPORT WORKFORCE DEVELOPMENT
The field of early childhood mental health is new and rapidly evolving. Providing early
intervention services will require addressing workforce shortages. There is a need to promote
specialized infant and early childhood mental health training. Early childhood mental health
specialists include professionals with wide-ranging backgrounds: psychiatrists, psychologists,
other clinicians, therapists, social workers, and educators. Some specialize in particular
approaches and modalities as well as particular developmental stages within the 0-5 age range.
4
A workforce development strategy should take this into account.
PUBLIC HEALTH MODAL FOR EARLY CHILDHOOD MENTAL HEALTH SERVICES
Below is a conceptual model that is helpful in illustrating some of the key findings and
recommendations of the Yolo Early Childhood Mental Health Needs Assessment4.
Early intervention
Prevention /
Early intervention
Public awareness /
Prevention
INDIVIDUAL
Assessment / Therapy + all below
SELECTIVE
Curricula components /
New parent support model
/
Consultancy model + all below
Public education & anti-stigma
campaign / Training /
UNIVERSAL
Promotion activities target all young children and their families (Universal). These activities are
designed to raise awareness, reduce stigma, improve parenting knowledge and skills and
promote social-emotional health of all children. The vast majority of children and families
require only universal interventions and/or promotion services and supports.
A smaller subset of children and families with identified risk factors, such as poverty, poor
quality early care and learning experiences, parental risks and behaviors (e.g. lack of education,
poor parental health, untreated parental trauma, negative parenting) and children with serious
diagnosable emotional and behavior problems could benefit from prevention and early
intervention services (Selective). A much smaller percentage of the population is likely to need
additional targeted mental health services (Individual). These strategies are designed to assist
and support children who have significant social-emotional delays in development.
Key informants consistently suggested that the greatest need in Yolo County is for promotion,
prevention and early intervention early childhood mental health services.
4
Social and Emotional Health in Early Childhood: Building Bridges Between Services and Systems, 2007.
5
BACKGROUND
Early childhood mental health is the capacity of the young child to experience and regulate
emotions, have secure relationships, and is critical to healthy development. Early childhood
mental health cannot be separated from brain development. Children are born with roughly
100 billion neurons, and few additional neurons will be produced for the rest of their lives. At
birth, the connections between these neurons are tentative. As the child grows, experiences
the world, and establishes relationships with others, these connections are modified and
“hardwired,” and these hardwired connections are responsible for all of a child’s major
cognitive and emotional functioning. By age three, roughly 85% of the brain’s core structure is
formed.
In recent years, brain development studies and attachment theory have had important
influences on the domain of infant and early childhood mental health. Many of the newer
diagnostic tools, evidence-based practices, and treatment modalities are strengths-based and
developmentally-based. As such, they measure individual competencies and deficits against the
typical social-emotional development of infants, toddlers, and preschoolers, and then work
with both parent and child to help move the child toward the level of competency that is typical
for his/her developmental stage.
Many of these newer approaches strongly focus on the child’s first relationships, particularly
the parent-child dyad or triad. Treatment modalities sometimes focus on parent behavior as
much as on child behavior. These newer approaches diverge significantly from the pathologyfocused foundations of adult mental health care and from earlier approaches to early childhood
mental health. All major models place some focus on behavioral patterns.
The field of early childhood mental health is relatively new, and rapidly evolving. Currently,
those who are trained in the latest early childhood mental health modalities and methods come
from not only the domain of psychiatry and psychology, but also early childhood education and
early childhood development, medicine, and elsewhere.
The following research-based statements represent some of the central tenets of the early
childhood mental health field:
6
•
Warm, loving relationships (“attachments”) with caring adults have a tangible and longterm influence on children’s lives, contributing to optimal social, emotional, and
cognitive development for infants and toddlers (Zeanah & Doyle Zeanah).
•
“Emotional well-being, social competence, and emerging cognitive abilities are highly
inter-related, and together they are the bricks and mortar that comprise the foundation
for human development” (Emde & Robinson 2000).
•
Responsive care-giving can mediate the effects of some risk factors and chronic health
conditions, e.g., prematurity and poverty (Zero to Three).
•
Healthy social emotional development is strongly linked to success in elementary
school. Healthy social and emotional development provides a necessary foundation for
literacy, language, and number skills. A child who is not secure in relating to others,
doesn’t trust adults, is not motivated to learn, or who cannot calm himself, or be calmed
enough to tune into teaching, will not benefit from early educational experiences. The
emotional, social and behavioral competence of young children is a strong predictor of
academic performance in elementary school (Zero to Three).
•
In general, the earlier the intervention, the briefer and more effective it will be (key
informant survey, Mental Health Provider Survey, Zero to Three, National Center for
Children in Poverty).
METHODS
In order to assess and describe the current landscape of mental health services for young
children in Yolo County, estimate the number of children 0-5 who might benefit from early
childhood mental health services, and identify gaps in services, the following research activities
were conducted:
•
Interviews of 41 key informants, including researchers, directors and clinical directors of
community-based organizations, and Yolo County mental health practitioners in both
public service and private practice;
•
Surveys, including 69 Yolo County mental health providers, nine physicians, and 44
parents (surveys were conducted online, using the Survey Monkey tool);
•
A focus group of Yolo County early childhood mental health experts;
•
A mental health screening of 276 two year-old and three year-old Yolo County 0-5yo
children;
•
Literature and data review.
LIMITATIONS: This needs assessment focuses primarily on the public and private mental health
services available to young children. It does not fully examine the mental health services within
educational or other settings that are not focused primarily on mental health.
7
FINDINGS
TABS Screening in Yolo County
The estimated prevalence rates of children who are at risk for mental health disorders and
those who are exhibiting emotional and behavioral disorders varies across studies. Some
national studies indicate that one in five children may have a diagnosable disorder (Department
of Health & Human Services). A Surgeon General’s 1999 report indicates that 9 – 13% of all US
children have a serious, diagnosable emotional or behavioral disturbance resulting in
substantial–to-extreme impairment (Friedman). The percentage of preschool children who
meet the criteria for a clinical diagnosis of oppositional defiant disorder (ODD) ranges from 7 –
25% in the United States, depending on the population surveyed (Webster-Stratton, 1997).
In order to estimate the number of children 0-5 years old in Yolo County who might benefit
from preventive and/or early mental health services, a sample of 276 two year-old and three
year-old Yolo County children were screened in November – December 2007 using the
Temperament Behavior Scale (TABS) Screener. The TABS is a multi-component, and Atypical
norm-referenced screening tool for infants and young children ages 11 – 71 months. The TABS
Screener is designed for general screening programs as well as for individual administration.
The TABS Screener is not designed to be used alone in determining whether or not a particular
child is in need of services but to identify children who exhibit indicators of atypical
development or who are at risk of atypical development. It is recommended that identified
children be followed up with the full TABS assessment tool. If those results are also positive,
children should be referred to a mental health care professional for additional assessment and
treatment.
Two hundred and seventy-six children across Yolo County were screened by either their early
education or care provider or parent. Nineteen child care providers and preschool teachers,
and 80 parents completed this simple 15 item screening tool designed for rapid identification of
children who are likely to have or be at risk for atypical development, including behaviors
related to autism spectrum disorders, ADHD, dysregulation, attachment deficits, neurological
damage, or other brain development / mental health deficits. Of the 276 children screened, 239
were completed in English and 37 were completed in Spanish. Children were screened in Davis
(20), Woodland (109), Esparto (18), Knight’s Landing (17), West Sacramento (157), and other
outlying areas (15).
The TABS Screener consists of fifteen simple statements that scorers check off if it accurately
describes the particular child being assessed. Raw TABS scores are displayed in the graph
below. The largest score category is “0.” A “0” means that there is no indication of atypical
development or risk for atypical development. Scores of “1” and higher are increasingly
significant markers of atypical development or risk for atypical development. These indications
of possible atypical development may be tied to autism spectrum disorders, ADHD,
dysregulation, attachment deficits, neurological damage, or other brain development / mental
health deficits.
8
Among the children screened, 29% were assessed as exhibiting behavioral tendencies that
indicate they may already have some atypical development of temperament and self-regulation
(scores of 4 and greater). An additional 13% of children were found to have a likely risk for
atypical development (scores of 2 and 3). (See graph below.)
The TABS Screener addresses four types of risk factors tied to behavioral.
9
Detached: Exemplified by behavior that is withdrawn, aloof, self-absorbed, difficult to
engage, and disconnected from everyday routines involving adults or other children.
This behavior can be manifested in a variety of activities and contexts. Infants and young
children with a detached style may look through or past people, tune out, lose contact
with what is going on, often just stare into space, or act like others are not there.
Commonly associated with autism spectrum disorder (ASD).
Hyper-sensitive / active: Exemplified by behavior that is over-reactive to even slight
environmental stimulation as well as impulsive, highly active, negative, and defiant. This
behavior can be manifested in a variety of activities and contexts. Indicators include
difficult to soothe when upset, crying, frequently irritable, touchy, or fussy, too grabby,
impulsive, or destructive. Commonly associated with attention-deficit / hyperactivity
disorder (ADHD).
Under-reactive: Exemplified by child being truly unresponsive and requiring intense
environmental stimulation to elicit a response. Associated with limited awareness, low
alertness, passivity, and lethargy – and differs from a detached style that actively avoids
engagement. May show no surprise at new events, not be upset when a favorite toy is
taken away, not react to sounds, rarely smile, giggle, or laugh at funny things.
Commonly associated with severe neurodevelopmental problems (i.e., problems
presumed to have primarily a neural basis, such as problems related to brain injury and
more subtle neurological impairment).
Dysregulated: Exemplified by difficulty controlling or modulating neurophysiological
behavior (e.g., sleeping, crying, self-comforting) and oral-motor control (e.g., jitteriness
and hypersensitivity to physical contact.)
Among the children screened, hyper-sensitivity / hyperactivity and under-reactivity related
items were the most frequently reported. (See graph below.)
Factor 1
Factor 2
Factor 3
Factor 4
The Modified Desired Results Developmental Profile, Revised (MDRDP-R) 2007 findings for 152
10
Yolo County children ages 4 years old to pre-k also correlate well with the findings of the TABS
screening. The TABS screening suggests that 29% of Yolo County children in the 2 – 3 year age
range are likely to have atypical development of temperament and self-regulation.
The MDRDP-R shows that 23 to 49 percent of children aged 4 – pre-k fall short of the
benchmark on individual measures of social-emotional skills regarded as necessary components
for school readiness, such as:
•
•
•
•
•
•
•
•
•
Seeks adult help when appropriate;
Seeks adult help after trying to resolve conflict/problem on his/her own;
Negotiates with peers to resolve social conflicts with adult guidance;
Expresses empathy or caring for others;
Participates in cooperative group efforts;
Exhibits impulse control and self-regulation;
Follow rules when participating in routine activities;
Comforts self and controls the expression of emotion with adult guidance;
Understands and follow rules in different settings.
There were roughly 15,330 children aged 0-5 living in Yolo County in 2007 (US Census, 2007).
Both TABS and MDRDP found that a significant percentage of children assessed were reported
to show signs of atypical social-emotional development or to have deficits in areas of socialemotional functioning considered necessary to school readiness, thus there could be as many
as 4,450 children in Yolo County for whom a full assessment would be appropriate.
Retrospective Survey of Parents who have sought or received mental health
services for their children
We also wanted to learn about the experience of parents who do seek and obtain mental
health services, many of whom have children with severe needs. We surveyed parents who had
received mental health services to learn about their experiences during the time their child was
0-5 years old. This survey was distributed through Warmline, Alcohol, Drug and Mental Health
ADMH, the special day class at Korematsu Elementary School, Alphabet Soup, a Davis special
education elementary school parent group, and Horizon School at Whitehead Elementary
School. A total of 42 Yolo County parents participated in this retrospective survey. Seventy-five
percent of these parents reported on their child(ren) who were 6 years old and up at the time
of the survey, and 12% reported on their child(ren) who were 0-5 years old at the time of the
survey (12% declined to state).
Among Yolo County parents participating in this survey, all of whom have sought or received
mental health services for their children, 72% report that they first noticed problems during the
period at which their child was age 0-5. (See chart below.)
11
Note: While we attempted to include parents who had sought but not received services, the
majority of parents who responded to the survey participated through the service delivery
system.
KEY INFORMANT INTERVIEWS AND PROVIDER SURVEYS
Mental health provider survey respondents and interviewees provided information on what
they regarded as the greatest needs in regard to early childhood mental health in Yolo County.
The items mentioned most frequently were:
•
•
•
public awareness
prevention and early intervention
access to mental health service providers
Also mentioned frequently was the need for early childhood mental health training for those
working with young children and the need for more trained service providers.
The areas identified most often by survey respondents were prevention and early intervention
(82%), followed by earliest possible intervention (74%) and more support and education for
parents (71%). In comparison, relatively fewer mental health providers (37%) saw a need for an
increase in, or changes to, trauma-related services.
12
1. There is an acute need for greater public awareness
Key informants indicated that some sort of public awareness effort is
needed to make parents aware of the importance of supporting their
child’s healthy social and emotional development, what they can do to
support it, and where to access services that will help them in doing so.
Experts also consistently point to the need for public awareness
initiatives (ZERO TO THREE, National Conference of State Legislatures).
Key informants also point out that even people who are generally
knowledgeable about young children tend not to be educated about
mental health needs. They further report that, despite the successfulness
of emerging evidence-based prevention and early intervention strategies,
and despite the large percentage of children who exhibit atypical
behavioral tendencies, there is a critical problem in connecting children
to services. Moreover, children with mild to moderate social and
emotional deficits go largely undetected by parents, care providers,
doctors, and teachers until they are well into elementary school. By this
point, the child may have more pronounced difficulties, and require
lengthier and more intensive services.
Parents may be completely unaware of the possibility of having someone
help them address behavioral concerns for their young child(ren). A case
in point comes from the Yolo County Children’s Alliance, which conducts
phone surveys to follow up on health care utilization of the 56 0-5 year
old Yolo County children the agency has enrolled in health insurance
since January 2007. By December 2007, 21 families had been surveyed by
the organization, and have been asked the following: “This insurance
entitles your child/children to behavioral health care. Has your child seen
a counselor, therapist or doctor for behavioral health concerns?”
According to YCCA staff, the most frequent response from parents has
been, “What is behavioral health?” Once informed as to the meaning,
YCCA has discovered that, to date, only one family has raised a behavioral
health issue with a counselor, therapist or doctor.
Unless a parent, care provider, or doctor suspects a mental health need,
children in need will not be referred for assessment. Few parents, care
providers, and doctors are trained to recognize the difference between
typical and atypical behavior in young children. This situation is further
exacerbated by the fact that many parents, care providers, and doctors
often do not know which agencies provide assessment and therapeutic
services. Furthermore, public programs are mandated to serve children
who either present a very severe need or whose mental health needs are
secondary to severe developmental delays or physical disability. Private
mental health providers trained to work with this age group are also
13
“The very concept of early
childhood mental health is so
little understood.”
key informant interview
“Nearly everyone who works
with young children, from
parents to preschool teachers,
needs to learn about the
importance of promoting
healthy social-emotional
development.”
key informant interview
“The problem is not ‘bad kids’ or
‘bad parents’ as is sometimes
thought. Research shows that
early childhood is not this
carefree, evanescent time of life
that we adults sometimes make
it out to be… young children have
deep, vulnerable emotional lives
and are capable of very serious
emotional problems that, left
unaddressed, can lead to a
lifetime of impairment and
increasingly serious mental
health issues. It’s a matter of
providing assistance and support
to promote healthy development
at these very early stages.”
- key informant interview
extremely hard to find.
“I'm not sure parents understand
that they can get services through
the county for their very young
children, nor do they realize or
recognize there's a problem until
their child is older than 5 years.”
Mental Health Provider Survey
2. There is a great need for more mental health prevention
and early intervention services
What is Prevention? Prevention is defined as any service that comes
before a formal diagnosis is made. For many reasons, very few children
0-5 years old have been diagnosed. Parents may not realize that there is a
problem, or what supports exist. Doctors may hesitate in diagnosing
children so young. Parents may be frustrated in failed attempts to locate
early childhood mental health specialists. The lack of available and/or
publicized early childhood mental health specialists may also result in
parents being unaware that such a specialty exists.
“Sometimes a family tries several
avenues to get answers about
whether their child’s issues are
developmental delays or mental
health issues. During this
sometimes lengthy process of
searching for help, their child is
getting older and his problems
are getting worse.”
- key informant interviews
Among Yolo County early childhood mental health experts surveyed, 82%
identified “prevention and early intervention” as an area in great need of
attention. This was identified as one of the greatest needs in the county
by more mental health providers than any other need.
The need for early intervention: A large and growing body of research
substantiates that the earlier the interventions take place, the faster,
easier, more successful, and less costly the intervention will be (DeGangi,
Greenspan, et al, 1996) (Cicchetti, Rogosch, Toth, 2006) (Santos metaanalysis, 2005).
While atypical behaviors in infants and young children sometimes signal
transitory problems, there is mounting evidence for the importance of
early intervention to ensure that early behavioral issues do not become
increasingly problematic. One key informant indicated that “children with
early behavior disturbances often get on a developmental trajectory of
increasing and more severe problem behavior, and do not get off easily.”
This statement from a local early childhood mental health expert is
corroborated by many studies, as evidenced by:
14
•
The correlation between preschool-age aggression and aggression
at age 10 is higher than that for IQ (Kazdin, 1995).
•
Children identified as “hard to manage” at ages three and four
have a high probability (50:50) of continuing to have difficulties
into adolescence. (Campbell & Ewing, 1990. Edgeland et al, 1990.
Fischer, Rolf, et al, 1984).
•
Because young children’s brains are still forming, “The basic
principles of neuroscience tell us that providing the right
conditions for healthy development in early childhood is likely to
The greatest need is for “programs
to help the parents work better
with their children.”
- parent survey
“Mental health care services for
young children should be family
focused, including the parentchild relationship, and parentparent relationship (and
extended family, if available).
Within the family relationships,
family stressors, communication
and interaction patterns, and
family coping skills and resources
can be assessed to find the
strengths in each family. These
services would include an
educational component so that
families are fully informed about
child and family development.”
- Mental Health Provider
Survey
be more effective than treating problems at a later age… Once a
circuit is ‘wired,’ it stabilizes with age, making it increasingly
difficult to alter function to change.” (Science-Based Framework
for Early Childhood Policy, Center for the Developing Child,
Harvard)
Results from the TABS screening of children conducted in Yolo County
indicate that as many as 29 percent of young children in Yolo County
might benefit from further screening, and prevention and early
intervention services.
An overarching theme among mental health providers surveyed and
interviewed was that early childhood mental health services should be
relationship-based, address the parent-child dyad as well as supporting
the parent’s mental health needs, and be developmentally-based. Other
goals mentioned are home-based services and de-stigmatizing services.
The focus may be on the parent-child relationship for several reasons.
First, bonding and attachment are central to infant / early childhood
mental health. Secondly, even in the absence of attachment issues,
positive changes to parents’ skills can directly influence the child’s mental
health status.
Access to Care: Access to public and private mental health care services
was identified as a problem in Yolo County, and it is particularly true for
young children, as evidenced by the following:
15
•
The Federal Health Resources and Services Administration has
designated all of Yolo County as a Health Professional Shortage
Area (HPSA) for mental health services.
•
The Yolo County Alcohol, Drug and Mental Health Services
(ADMH) Mental Health Services Act Community Services and
Support Plan of January 2006 states that “it is clear that children 0
– 17 are underserved” in our county. The Community Services and
Support Plan further reports that for children 0-17yo, 27% are
fully served, 73% are underserved, and disparities exist for
Latino/Latinas.
•
The Community Needs Assessment 2004: Maternal, Child and
Adolescent Health published by Yolo County Health Department’s
Maternal, Child and Adolescent Health Program (MCAH) cites a
lack of availability of mental health services as a prominent
concern and gap in health access throughout the county. In this
report, county residents and physicians expressed concerns that
mental health care services for children are lacking or difficult to
access. Many of the other problem areas identified in the MCAH
report, including substance abuse, child abuse, obesity, and
“Excellence means universal
check-in screenings, both
prenatal and at birth to assess
for risk, with follow-up in the
form of free developmental
services for at least the first
year, to which any family can
self-refer.”
-Mental Health Provider
Survey
“The barriers that families face
are: a lack of a formal system,
lack of home base services, too
fragmented services.”
- Mental Health Provider
Survey
health access, are clearly stated to have mental health
implications, and “underscore the link between physical health
and mental health.”
The overwhelming majority of public mental health resources for Yolo
County children 0-5 years old are restricted to those whose problems are
comprised of the most persistent, serious mental illnesses, or whose
mental health deficits are secondary to trauma (such as sexual abuse,
child abuse, witness to a violent crime, serious neglect), or are secondary
to a serious developmental delay or physical disability (such as mental
retardation, Down Syndrome, Cerebral Palsy). Providers who are
accessed via private pay or private insurance, and who have infant / early
childhood mental health training are hard to find.
Yolo County Alcohol Drug and Mental Health (ADMH) staff, as well as
staff from agencies who refer to ADMH, indicate that the county’s
program priority is providing services to only those with the most
persistent, serious mental illnesses. Staff report that, in the case of young
children, this means that children must meet very high or multiple
criteria. Staff also report that “programs are impacted.” However, they
also report that there is space and equipment available to expand
capacity. What is lacking is allocated funds and a pool of therapists with
the early childhood mental health training desired.
Yolo County Office of Education (YCOE) is charged with serving children 03 with developmental delays or developmental concerns in the areas of
motor and fine motor skills, communication, self-help / adaptive, and
social emotional development. However, in practice, children with either
physical or global development delays (such as “mental retardation” and
autism) may receive services from both Yolo County Office of Education
First Steps Program as well as from Alta California Regional Center’s Early
Intervention Program (referred to as Alta Regional). Although criteria
differ slightly, the two agencies do case management together, and work
in close collaboration with each other, but children whose primary needs
are social-emotional rarely, if ever, receive services. Alta Regional staff
report that they do provide mental health services, but only for children
whose social and emotional deficits are secondary to a physical disability
or pervasive developmental delay.
Yolo County Office of Education and the county’s five school districts also
provide some mental health related services for children aged 3 – 5
within the context of educational programs. At this point, criteria are
related to disabilities that impede a child’s ability to benefit from
educational offerings. According to key informant reports, the schools
typically do not provide Individual Education Programs (IEPs) on the basis
of mental health (social and emotional) deficits, with the exception of
16
“One two year old boy
had obtained services
through the YCOE First
Steps Infant Program for
a few months – but when
he began to improve,
they dis-enrolled him.
Everyone agreed that he
still needs mental health
services. But it was
decided that his
remaining problems are
more of an emotional
nature than a
developmental delay so
he no longer meets the
Infant Program’s criteria
for eligibility. Now the
mental health services he
had (because of the cooccurring developmental
delay) are no longer
available to him.”
-Source: key
informant interview
autistic spectrum disorders, which may be considered a mental health
and/or developmental delay diagnosis, and very rare diagnoses of
emotionally disturbed (ED). In practice, however, children with socialemotional deficits sometimes enter into special education services
through another identified disability such as communication (speech and
language). Yolo County Office of Education staff report that this is due to
the fact that “it is easier to identify and measure physical disabilities than
emotional disabilities.”
These priorities and mandates of public agencies leave very few public
mental health “slots” countywide for those children who exhibit mild or
moderate social-emotional deficits.
For Yolo County’s low income families, access to mental health services is
complicated by factors of eligibility and severity of diagnosis as barriers to
care. According to California Datebook, 13.8% of Yolo County children live
below the poverty level. These children depend on the county system of
care for mental health services. Children below 300% of poverty who are
enrolled in Healthy Families, Yolo Healthy Kids, or the Kaiser Child Health
Plan experience barriers to accessing mental health services due to lack
of knowledge about benefit package, a shortage of providers in the
provider network, language and cultural barriers, and stigma associated
with mental health issues.
For moderate income families, lack of adequate health insurance
coverage creates additional barriers to access. Moderate-income families
may be without health insurance and ineligible for public insurance
programs. And when they do have insurance, it may not include mental
health benefits. The Yolo County Alcohol, Drug and Mental Health
Department, Mental Health Services Act Community Services and
Support Plan (January 2006) states that “children from low-income [and
moderate-income] families who are not eligible for Medi-Cal are more
likely to be uninsured and, therefore, their medical and mental health
needs are more likely to be undetected and untreated.” When families
do have insurance that includes mental health benefits, low provider
reimbursement rates result in very small provider networks and often
providers limit the number of clients paid for with insurance that they
will see. Even if providers accept insurance, typical office visit co-pays for
mental health services are approximately 40% of provider fees.
Yolo County physicians surveyed concur that access to mental health
services for young children is a problem. They pointed out the following
access issues:
•
17
insufficient number of providers who are comfortable working
with very young children;
“Parents who have private
insurance have an even
harder time getting mental
health services than those
with Medi-Cal.”
•
inadequate funding for mental health services for children of all
ages;
•
limited access to child psychiatrists at ADMH;
•
Complicated referral system;
•
Inadequate parenting support for uninsured and underinsured;
•
Cultural barriers to seeking mental health services.
3. There is a great need for provider training
There is little information on the number of local people trained and
available to work in the field of early childhood mental health. However,
there is evidence that there is an acute workforce shortage. Experts from
Yolo County ADMH, UC Davis, Napa Parent Child Fellowship Program, and
the American Academy for Child and Adolescent Psychiatry, all report
that there is an extreme national and regional shortage of child
psychiatrists and child therapists, and that for the 0-5 age group, this
shortage is even greater.
The field of early childhood mental health is so new and so rapidly
evolving that there are no standards for training. Early childhood mental
health is a specialty area, yet there is no infant or early childhood mental
health licensure, certification, or set of training standards at this time.
The limited pool of individuals with specialized early childhood mental
health training is distributed among medical, psychiatry, therapy,
educational, and childcare settings. Training is critical to even the most
basic assessment of typical versus atypical behavior (i.e., what constitutes
a cause for concern in regard to early childhood mental health).
While more research is required to determine the factors that are
generally considered to be measures of adequate training in this field, an
overarching theme among mental health providers surveyed and
interviewed was that early childhood mental health services should be
relationship-based, addressing the parent-child dyad as well as
supporting the parent’s mental health needs, and developmentallybased.
18
“For 90% of child psychiatric
disorders, the first treatment
choice is therapy. There are
not enough therapists trained
in the modalities we need. All
the kids we see need this. We
are pulling in people to do
child work who are not
trained. This means that we
are not able to provide the
most effective treatments.”
- key informant interview,
referring to ADMH
“Mental health services for all
children need to be provided by
experts in children's mental
health.”
COMMUNITY ASSETS
At this early stage of the development of the field of early childhood mental health, those who
have early childhood mental health training are found among a wide variety of credentialed
and non-credentialed professions. This is reflected in the composition of our survey
respondents (see graph below). Respondents listed the following credentials and degrees: MFT,
MSW, LCSW, PhD, CADC (certified alcohol and drug counselor), ASW, MS, MA, RAS (registered
addiction specialist), RN, and Psychologist. (Key informant interviews included people with all of
the above credentials as well as MD, Child Psychiatry.) A common theme among key
informants (mental health provider survey respondents and interviewees) was that, since the
field of early childhood mental health is so new, the kind and degree of training among
providers varies widely, and yet this is a critical element in choosing a provider to work with.
Among mental health practitioners surveyed, 59% reported that they work with Davis children,
and 70% report working with Woodland children. Mental health related care providers
surveyed reported that there are more private-pay early childhood mental health services
available in Davis than anywhere else in Yolo County, and that there are more public early
childhood mental health services available in Woodland than anywhere else in Yolo County.
Survey respondents came from a variety of mental health settings, including classroom and
daycare settings, nonprofits, in-home services, private-office therapy, government agency
settings, medical settings, and more. (See graph below for detail.)
Among public-service practitioner survey respondents, 12 work in Woodland and 1 in Davis.
Among private-practice survey respondents were 17 private practitioners in Davis and 1 in
Sacramento (who works with Yolo County children 0-5yo). These practitioners include
19
therapists, and other professionals with early childhood development or early childhood
education backgrounds. (See graph above for detail.) Some respondents serve in capacities
other than directly providing services (38), such as program administration.
Of 69 survey respondents (Mental Health Provider Survey), 40 told us about the children for
whom they or their employers provide mental health services. They report working with more
children on the older end of the 0-5 age range than with younger children, on average. (See
graph below.)
PUBLIC MENTAL HEALTH SERVICES: In Yolo County, public mental health services for children 05 years old come from three main sources:
1.
Yolo County Department of Alcohol, Drug and Mental Health and its contracting
agencies (Yolo Family Services Agency, Yolo Family Resource Center, Families First,
and Sexual Assault and Domestic Violence Center)
2.
Yolo County Office of Education; the five school districts and the programs
administered by them: Woodland Joint Unified School District, Washington Unified
School District, Esparto Unified School District, Winters Joint Unified School District,
Davis Joint Unified School District
3.
Alta California Regional Center
Public service strategies include home visits (Alta California Regional Center, First Steps
program of Yolo County Office of Education, Yolo Family Resource Center), child and parentchild therapy (Alta California Regional Center; Yolo County Alcohol, Drug and Mental Health;
Yolo Crisis Nursery; Yolo Family Service Agency; Sexual Assault and Domestic Violence Center),
and public school based services.
Fewer than 1% of ADMH clients are 0-5 years old. The total number of 0-5 year old children
seen by ADMH and all contracted agencies during the most recent fiscal year is 82.
20
ADMH services are only available to children enrolled in full-scope Medi-Cal, and the child’s
presenting mental health issue must be serious enough that treatment be a “medical necessity”
under Medi-Cal guidelines. “Medical necessity” refers to a service that is “reasonable and
necessary to protect life, to prevent significant illness or significant disability, or to alleviate
severe pain.”5 This means that the child must score high enough on a list of weighted factors
that include CPS involvement, sexual abuse, physical abuse, having witnessed domestic
violence, severe neglect, having been removed from the home by child welfare services, having
been expelled from preschool or child care three times or more, and exhibiting behavioral
“outbursts.”
ADMH has been overburdened and understaffed for several years. The focus is on providing
services for the most acute and chronic mentally ill patients. One exception is that MHSA
funding has been allocated to a pilot program in Esparto for young children and their families.
Families First and CommuniCare staff report that referrals to ADMH have not been successful in
getting access to treatment. ADMH staff reports that programs are impacted. An ADMH
psychiatrist adds that, due to a shortage of trained therapists, ADMH is not able to provide “the
treatment of first choice.”
Alta California Regional Center and Yolo County Office of Education collaborate to provide
services to children 0-3 years old with serious developmental delays (e.g., Down Syndrome and
mental retardation) and serious physical disabilities. In order to qualify, children must have
significant developmental delays in one or more areas. While “social and emotional delays” are
included in the list of delays covered, according to staff, very few if any children in this age
group are served for needs that are primarily social-emotional (i.e., mental health). Alta staff
report, “Mental health is not part of what we do.” An exception is autism, which is a much
more pervasive developmental delay and mental health that includes social-emotional deficits.
An Individualized Family Service Plan (IFSP) documents and guides the early intervention
process for children with disabilities and their families. The IFSP is the vehicle through which
effective early intervention is implemented in accordance with Part C of the Individuals with
Disabilities Education Act (IDEA). It contains information about the services necessary to
facilitate a child's development and enhance the family's capacity to facilitate the child's
development. Through the IFSP process, family members and service providers work as a team
to plan, implement, and evaluate services tailored to the family's unique concerns, priorities,
and resources. The IFSP often takes an interagency approach, involving representatives of
several agencies to provide resources the child and family. Yolo County Office of Education First
Steps staff report that caseloads are very high, and that the interagency approach sometimes
results in an unintended duplication of some services while other services are not provided.
Services available through the IFSP are usually provided in the child’s home. Changes in the
federal Individuals with Disabilities Education Act (IDEA), however, state that services are to be
provided in the child’s “natural environment,” which can include a child care setting, preschool
or other community setting.
At age 3, the IFSP is replaced with an Individualized Education Plan (IEP), and services are
provided by YCOE and the school district. While the IFSP approaches the disability from a more
global perspective, an IEP is tied to education. Key informants (Mental Health Providers Survey
5
Cal. Wel. & Inst. Code § 14059.5 (2001)
21
respondents and key informant interview participants) report that, in practice, the criteria for
IEPs are set so high (a 50% delay in one area or two 25% delays) that many children who are
struggling do not receive an IEP until well into elementary school. Key informants within this
special education system report that although one of the criteria for getting special education
services is a social-emotional deficit, in practice, this is very rarely applied to children 3-5 years
old. Autistic spectrum disorders are an exception, and include more global functioning deficits
beyond mental health.
Some parents surveyed mentioned difficulties in making the transition from the IFSP to IEP.
“Once a child ages out of the Early Start/Infant Programs at age 3 and services go from a
developmental to educational approach, many services are dropped.” (Source: parent survey)
AB 3632 delegates responsibility for providing mental health services for special education
students to county mental health departments (CMHs) when consistent with their statutory
obligations. This means that CMHs are responsible for mental health services that are necessary
for the child to benefit from special education [Cal. Gov. Code Sec. 7572(d)] and beyond the
capacity of the school’s counseling and guidance services to meet the child’s needs. [Cal. Gov.
Code Sec. 7576(d), Cal. Ed. Code Sec. 56363.] However, any mental health services necessary
for a child to benefit from special education, that is, necessary for a child to make progress
toward his or her IEP goals, are the responsibility of the child’s education agency. A diagnosis
does not automatically qualify a child yet it may be required for qualifying.
County mental health is not held responsible until the school demonstrates that its attempts to
provide counseling have been inappropriate or unsuccessful, that “the school has provided
counseling, psychological, or guidance services to the pupil under its service structure, and the
IEP team has determined that the services do not meet the pupil’s educational needs; or, in
cases where these services are clearly inappropriate, the IEP team has documented which of
these services were considered and why they were determined to be inappropriate.” [Cal. Gov.
Code Sec. 7576(b); 2 C.C.R. Sec. 60040.] These systems are not designed for early intervention.
In the first semester of the 2007-08 school year, there were 177 discrete special education
services of any kind provided to children 3-5 years old in Yolo County. (This count is of services,
not children. One child may receive several services.) Of these, no services were provided in the
emotionally disturbed category, and 43 services were provided in the autism category (which is
a more pervasive disability, yet includes social –emotional development). In a count of children
rather than services, seven children 0-5 years old are reported to have received stand-alone
behavior intervention services during this period (Source: Yolo County SELPA: Special Education
Enrollment Data Report, 2007-08). This does not include special day classes. Children with
social-emotional deficits may also have received other kinds of special education services under
other qualifying criteria.
This study does not aim to comprehensively discuss all of the mental health related
components within all five school districts in the county, which have begun to administer some
of the early childhood services previously administered by the Yolo County Office of Education,
and that process is ongoing.
District administered programs available to children under 6 years old include Horizon School at
22
Whitehead Elementary School in Woodland which provides an alternative educational setting
for elementary school aged children, including five year-olds, identified as severely emotionally
disturbed (SED). While this potentially includes kindergarteners, there are currently no children
under 7 years old in this program.
Programs also include a special day class at Korematsu Elementary School in Davis. Students
served in the preschool qualify for special day school due to speech and language criteria,
developmental delays, on the autism spectrum, orthopedic disabilities, or a multitude of other
disabilities due to developmental issues. Children cannot qualify for special education for
social-emotional reasons, unless there is very severe Emotional Disability (SED), and young
children typically are not diagnosed with SED. Korematsu Elementary School’s program
includes an autism clinic operated by Yolo County Office of Education.
Head Start is also administered by the Yolo County Office of Education, and offers socialemotional screening to all children enrolled in its programs. Children identified as having
deficits are referred to agencies in the community. Head Start provides a family support
worker and mental health consultant, and parents receive information through monthly
meetings and paid parent conferences.
Safe Schools - Healthy Students provides screening and treatment offerings to families
throughout the Woodland Joint Unified School District, and is currently reviewing screening
tools and planning to begin mental health screening by early 2008. While the public schools will
serve as a referral network for this program, it is still uncertain how parents of 0-5yo children
will learn about and connect with this program in order to obtain mental health screenings
and/or services.
23
Early Childhood Mental Health Services provided by public agencies and community based
organizations
Note: This does not include the entire spectrum of early childhood programs that foster social and emotional
health, nor programs that target family members.
PROVIDER
Rural Innovations in
Social Economics, Inc.
(RISE)
Yolo Crisis Nursery
NUMBER OF CHILDREN
0-5yo RECEIVING MH
SERVICES
7/yr
(some are duplicated in
the ADMH # above
and/or YFSA # below)
N/A
(200/yr receive some
kind of service)
Yolo Family Service
Agency (YFSA)
28/yr
(some are duplicated in
the ADMH # above)
Yolo Family Resource
Center (YFRC)
N/A
Sexual Assault &
Domestic Violence
Center (SADVC)
N/A
Safe Schools - Healthy
Students
expecting to
concurrently serve 100
children 0-18yo,
mostly school-aged
Alta Regional Center
N/A
(zero for children
whose primary need is
mental health related)
Alcohol, Drug and
Mental Health Dept
(ADMH)
24
82/yr
(includes those seen by
contracting agencies)
SERVICES INFORMATION
Children receive therapy services from two clinicians, one
provided by Yolo Family Service Agency (YFSA) and the other
provided by Yolo County Dept. of Alcohol, Drug & Mental
Health (ADMH). The RISE model is a seamless service delivery
system that includes a center-based childcare and parent
education. Other services for young children include a daycare
program that emphasizes parenting skills and early learning.
Services include therapy (including PCIT and Family Life Skills
Training), as well as free child care (designed for families in
crisis, but also accept non-crisis child care placements) and
other non-related services.
Children (0-5) represent 4% of YFSA clients. Services include
PCIT, Sand Tray, Play Therapy, Holding Therapy, Group-play
Therapy, “Bubble Space,” EMDR, and parenting classes.
YFRC provides services through the Child Welfare Services
Differential Response Program, Safe Schools/Healthy
Students, Alcohol, ADMH, and Head Start. YFRC also provides
counseling to preschool children, including those in State
Preschool. Services include case management (housing,
clothing, childcare, basic needs), therapy, and home visits.
Services focused on domestic violence, including children who
are witness to domestic violence. Funded by State Office of
Emergency Services, Health Dept (Maternal and Child Health)
fund for domestic violence, victim-witness funds.
Most targeted children are school aged, and are referred by
school nurses, psychologists, teachers, and administrators.
The program’s counseling center is under development, and is
scheduled to open in early 2008.A clinical supervisor, three
clinicians, and a case manager from Yolo Family Resource
Center (YFRC) will staff the counseling center.
Alta Regional provides services to children 0-3yo with severe
developmental delays (Down Syndrome, Mental Retardation,
etc.) and severe physical disabilities (Cerebral Palsy, etc.).
Children whose primary needs are mental health related are
not accepted into this program.
Children 0-5yo represent 1% of ADMH clients. Of this small
group, 56% receive services in Woodland, 17% in West
Sacramento, and 15% in Davis.
First Steps Infant
Program of Yolo
County Office of
Education
case load of 70
(zero for children
whose primary need is
mental health related)
UC Davis
MIND Institute
N/A
school districts
N/A
First Steps collaborates with Alta California Regional Center in
providing therapeutic and wrap-around services to children 03yo with severe developmental delays (Down Syndrome,
mental retardation, etc.) and severe physical disabilities
(Cerebral Palsy, etc.). Children whose primary needs are
mental health related are not accepted into this program.
Serves children via referral from UC Davis Medical Group
primary care physician. Or may be included in a databank for
inclusion in clinical trials. Treatment oversight (with outside
referral for ongoing services) for diagnoses which include
autistic spectrum disorders, ADHD, developmental delays, and
neurological issues such as seizure disorders.
All five Yolo County school districts provide psychological
assessments for children 3 – 5yo. Special day classes and other
services vary by school district.
Note: N/A indicates this information was not available at the time of this report.
PRIVATE-PRACTICE MENTAL HEALTH SERVICES: This needs assessment has identified roughly
55 mental health service providers in private practice who work directly with Yolo County
children 0-5yo. Of those, 18 participated in a survey and eight participated in a focus group or
interview. This included four practitioners with PhDs, five MFTs, four LCSWs, and four with
other master’s-level degrees. Seventeen of the providers in private practice see children in
Davis, and one in Sacramento sees children living in West Sacramento.
A survey of 36 Yolo County pediatricians and family physicians who treat children 0-5yo was
conducted. Nine physicians responded to this survey, one of whom reported that s/he provides
services related to mental health, and that same physician alone reported having some infant /
early childhood mental health training.
Among surveyed mental health providers in private practice, practitioners working in education
settings work directly with many more children each month (an average of 59 per month) than
those whose practices revolve around office visits (an average of 3.5 per month). Those who
work in educational settings are also more likely to provide child care provider and preschool
teacher trainings, to teach parenting classes, and to provide prevention and early intervention
services.
Of the mental health providers surveyed, 30 indicated that they obtain clients through referrals.
Among this group, 22 said that they receive referrals from teachers and school administrators,
20 receive referrals from other mental health care providers, and 17 receive referrals from
pediatricians and family physicians.
25
Referral Sources for Mental Health Providers
(n=30)
Other Mental Health Practitioners
67%
Pediatricians and Family Practice
Physicians
57%
Teachers / School Administrators
Department of Social Services
Child Protective Services
73%
23%
47%
Many providers in private practice either see mostly older children or see mostly children with
severe needs.
While providers report a significant need for early childhood mental health services, they also
cite poor public awareness as a reason that explains why there is a disproportionately small
demand in the private sector for these services. It is also difficult to attract new workers
because there is no infrastructure in place to connect children needing these services with
those who provide services.
Key informants and parents surveyed report that the greatest difficulties surrounding the
existing mental health services in the private sector are:
•
Locating practitioners;
•
Obtaining and using insurance for access to practitioners trained in early childhood
mental health;
•
Being able to afford the cost of private-practice early childhood mental health
services.
PROMOTION AND PREVENTION SERVICES: Assets also include individuals, organizations, and
programs that provide services that promote, prevent, and/or advocate for the positive mental
health of children 0-5 years old and their families. These include:
• Parenting classes, workshops, and other educational opportunities
• Supports for parents’ own mental health
• Programs that support the healthy development of young children
• Home visitation programs
• Workforce development for child care providers and preschool teachers to train in
regard to healthy early childhood social and emotional development, recognizing
the difference between typical and atypical behavior, and how/when to refer
children for mental health services
26
Yolo County assets that fit this broader definition include:
• Child welfare services
• Warmline
• NAMI (National Alliance on Mental Illness)
• United Advocates for Children
• Yolo Crisis Nursery
• Parent and provider coaching and consulting services from Early Years Parent and
Caregiver Consulting and other private consultants
• Parent education and support services (see table below)
• Early Childhood programs
Yolo County parent education and support programs.
PROGRAM NAME
PROVIDER
FREQUENCY
COSTS
DESCRIPTION
Meet Other New
Parents
UC Davis Family
Connection
Program
8-week
sessions, yearround
$90 per
session
An environment for new parents to
meet each other, ask experts questions
about infant development, see babies
explore.
Parenting Support
Group
Yolo Family
Resource Center
weekly
sessions
Free
Father/Grandfather
Connections
UC Davis Family
Connection
Program
8-week
sessions, yearround
$90 per
session
Parenting the Toddler
Child Care
Services
Resource &
Referral Network
4-week series
Free
weekly
sessions
Free
Parents Together
27
Child Care
Services
Resource &
Referral Network
Discussion of family, parenting issues,
children, communication, and other
problems or concerns.
An opportunity for infants, toddlers,
fathers and grandfathers to connect
with each other in a fun and supportive
environment.
A discussion of the challenges of raising
a toddler, including the word "No!" and
insights into who toddlers are and
what motivates them. Covers
communication, development,
nutrition, positive discipline,
friendships.
A group for parents of infants with
questions, concerns, or issues that they
would like to share and discuss with
other parents of young children.
Workshop designed for parents and
educators of children from birth to
3yo. Baby Signs reduces frustration and
builds trust, allows babies to share
their worlds, strengthens the parent or
caregiver/infant bond, and promotes
positive emotional development.
Baby Signs
Baby Signs
by Erin Panelli
day-long
workshops
Parenting in Recovery
CommuniCare
Health Centers
12weekly
sessions
Free.
Parenting the
Preschooler
Child Care
Services
Resource &
Referral
4-week series
Free
Various
Families First
varies
Free
Various
Mother & Baby
Source
varies
Varying
fees.
Varies.
$10/year
Videos and books on parenting and
child development topics, as well as
toys. For care providers as well as
parents.
Toy and Resource
Library
28
City of Davis
Childcare
Services
Resource &
Referral
ongoing
$50
Classes cover parent behaviors as well
as baby behaviors and needs.
Discussion of the challenges of raising a
preschooler.
Varies.
RECOMMENDATIONS
Key findings support the notion that young children and their families in Yolo County would
benefit greatly from the development of a coordinated system of care that offers a continuum
of mental health services from promotion to prevention to intervention. Key informants
consistently stated that the emphasis should be on prevention and early intervention services.
Suggestions on where to begin include the following:
1.
EXPAND PUBLIC AWARENESS
Improving public awareness begins the process of education for all. This critical step lays a
foundation for the development and utilization of early childhood mental health services within
the community. The National Conference of State Legislatures’ research and policy report,
Helping Young Children Succeed: Strategies to Promote Early Childhood Social and Emotional
Development concluded that “public awareness is critical to the improved well-being of young
children because parents and caregivers can gain greater skill in understanding the
developmental needs and stages in children’s lives and how to support them,” (ZERO TO THREE,
2005).
A well-coordinated public awareness campaign could take many forms, and would serve to
inform everyone from parents and family members to caregivers and medical and educational
professionals about the basics of early childhood mental health. Issues for a public awareness
campaign to address include: discrepancies between the common perceptions of early
childhood social and emotional development and what is known from research, stigma, and
language and cultural barriers. A public awareness campaign could include the following:
•
Provide information about social-emotional development in the context of care
giving relationships to all parents, health care providers, child care providers, early
educators, etc. as part of public awareness efforts;
•
Disseminate information about the early foundations of school readiness to parents
of young children, and talking to them about how these apply to their children;
•
Routinely talking about social and emotional milestones as part of developmental
anticipatory guidance at home visits, well-child visits, and other standard
interactions with parents and caregivers of young children;
•
Integrate infant/early childhood mental health concepts into trainings for personnel
working with young children and their families.
The goals of raising public awareness would be to reduce general stigma associated with
early childhood mental health. Additionally, all parents and family members, as well as
professional caregivers, early childhood educators, and mental health and medical care
providers would benefit from greater understanding of early childhood mental health.
2.
FOCUS ON PROMOTION, PREVENTION AND EARLY INTERVENTION STRATEGIES
A key recommendation of interviewees, as well as by national experts, is to focus on prevention
29
and early intervention. This represents a fundamental shift from focus primarily being on
children with the greatest needs to an approach that is strengths-based, developmentally
based, and relationship-based.
Promotion activities target all young children and their families, are designed to promote
healthy social emotional development. They include approaches aimed at improving parenting
knowledge and skills, child development, and social-emotional health. Promotion also involves
assisting parents/caregivers to understand and respond sensitively to the cues the child gives,
supporting families as they increase their coping skills and build resilience in their children.
Promotion services can take many forms, such as parent support groups, home visiting to
newborns, parent education programs focusing on social-emotional development, high-quality
childcare and preschool, social-emotional screening as part of well-child check-ups, and
breastfeeding support. These services can take place in many settings, including homes, early
care and education settings, primary care provider offices, and other community environments.
Social and emotional components may be integrated into existing services.
Prevention strategies are targeted to specific populations considered to be at-risk because of
various factors such an environmental or biological, and are available prior to diagnosable
symptoms. These types of services can be integrated into programs that serve at risk families
and children.
Prevention services could take many forms, for example: home visiting, curricula, parent
support groups, parent coaching, screening and assessment of social and emotional
development as part of routine care provided to children (early learning sites, health care,
home visiting programs, etc.). In group settings, the same prevention services can support the
healthy development of well-functioning children while beginning to address the needs of
children with deficits of social and emotional functioning. Prevention components may be
integrated into existing services and existing programs. In the context of school readiness,
several social-emotional skills have been identified that enable children to learn and be
successful in school and later in life. These include: confidence, curiosity, intentionality, selfcontrol, relatedness, capacity to communicate, and cooperativeness.
Early intervention services can also be provided in a variety of settings, and are designed to
provide support to children who display atypical psychosocial development. Prevention and
early intervention strategies would involve consulting with parents, through relationship-based
practices, in order to promote the parent-child relationship.
Providing prevention and early intervention services through child care centers and preschools
may be particularly effective. Caregivers are invested in solving the issues of problem behavior.
One possibility would be to integrate mental health consultation into existing programs. For
example, a consultancy strategy would utilize the existing early childhood mental health trained
workforce to serve as consultants to preschools and child care centers. The advantage of this
model is that it maximizes the existing pool of early childhood mental health specialists. Once
connected with the families through the child care or preschool, the specialist can determine
which children need follow-up, and then work with them and their families more closely.
Prevention and early intervention services would also include working with community mental
30
health and public health providers, when there is concern about maternal depression, parental
substance abuse and other family mental health disorders. It would also entail assisting eligible
children to access mental health providers for appropriate diagnostic and treatment services
within the context of their family. Early intervention involves maintaining a collaborative
relationship between parents/caregivers, early intervention team members and mental health
professionals to assure coordinated intervention efforts. Prevention/early intervention could be
effectively introduced at the earliest possible moment for maximum effectiveness – for
example, in obstetrical settings or in conjunction with well-baby visits.
Prevention and early intervention strategies should be relationship-based, developmentallybased, address the parent-child dyad or triad, support the parent’s mental health needs, and
build on the strengths of the family. Focusing on prevention and early intervention represents
a fundamental shift from targeted investment in children with the most severe needs to an
approach that is strengths-based, developmentally based, and relationship-based.
3.
ENCOURAGE/SUPPORT WORKFORCE DEVELOPMENT:
Providing early intervention services will require addressing workforce shortages. This field is
new and rapidly evolving. There is a need to promote specialized infant and early childhood
mental health training. Early childhood mental health specialists include professionals with
wide-ranging backgrounds: psychiatrists, psychologists, other clinicians, therapists, social
workers, and educators. Some specialize in particular approaches and modalities as well as
particular developmental stages within the 0-5 age range. A workforce development strategy
must take this into account.
A workforce development strategy needs to be well-matched to the long-range infrastructure
and service delivery model. Questions to be addressed: What kind and education-level of early
childhood mental health specialists do we need? To be paid how? To work in what settings?
This might consist of basic early childhood mental health training for early childhood educators
and caregivers already working in the field. Another option would be to provide early childhood
mental health training for clinicians.
Cultural competency is an important consideration in regard to not only service delivery but
also to workforce development.
CONCLUSION:
First 5 Yolo commissioned this Early Childhood Mental Health Needs Assessment in an effort to
begin to identify the current system of care that exists for young children and their families who
might be in need of mental health services. By using a variety of methods, we hoped to gain an
understanding of the current early childhood mental health landscape in Yolo County, as well as
identify gaps in services. Findings from this needs assessment were used in First 5 Yolo’s
strategic planning process, which resulted in the Integrated Family Support Initiative. Social
Emotional Health is one of four priority areas funded under this Initiative.
31
APPENDIX A: Study Participants
Study Conducted by:
Kathleen Bowers, The Bowers Group / Davis Consultant Network
Michael Mellison, The Bowers Group: Data collection and analysis
Lynn DeLapp, Davis Consultant Network: Key Informant Interviews
Francesca Wright, Davis Consultant Network: Key Informant Interview
Pablo Stansbery, Davis Consultant Network: Technical assistance
Assistance
Lynn Arner MS, Child Development Consultant: Early Years
Michael Rahilly PhD, Mental Health Specialist, Placer County Office of Education, Private-Practice
Therapist
Ross Thompson, Professor of Psychology, UC Davis
Key Informants (Mental Health Provider Survey and Key Informant Interviews)
Dr. Virginia Anthony, American Academy for Child and Adolescent Psychiatry
Lynn Arner, MS, Child Development Consultant
Jan Babb, Maternal, Child and Adolescent Health Director, Yolo County Health Department
Kathleen Baxter, MFT
Robin Bent, Yolo County Office of Education
Deborah Born, Services Coordinator, Alta Regional Center
Dr. Kristie Brandt, Co-Director, Napa Infant-Parent Mental Health Fellowship Program
Mark Bryan, Department of Alcohol, Drug and Mental Health (ADMH)
Carly Carstrida, Horizon School at Brighton Elementary School
Dr. Constance J Caldwell, MD, Yolo County Health Dept
Diane Casey, Inclusion and Family Resource Specialist, Warmline Family Resource Center
Grace Chen, MFTI, SJUSD
Kayce L. Cline
Susan Contreras, MSW, Yolo County ADMH
Jim Coulter, Director, Special Education Division, Yolo County Office of Education
32
Gretchen Cyprin, Alta California Regional Center
Mark Diel, Executive Director, Children’s Health Initiative, Napa County
Josie Enriquez, Yolo Family Resource Center
Michelle Foucheaux, Executive Director, Sexual Assault and Domestic Violence Center
Sara Gavin, MFTI, CommuniCare Health Centers / John H. Jones
Camille Giometti May, Assistant Superintendent / Yolo County SELPA Director, YCOE
Linda Glick, Infant Development Specialist (Teacher), YCOE First Steps Infant Program
Margaret Greenough, MFT, M.Ed, CAMFT, AAMFT
Kathleen Grey, MA, Child Development Consultant: Early Years, Parents Together Facilitator
Linda Guttierez, Executive Director, Safe Schools – Healthy Students Program of WJUSD
Etelberto Guzman, Yolo Family Resource Center
Margie L. Hackett, MFT, The Counseling Associates
Diana Hansen, MFT, Private practice supervisor for MFT students’ clinical hours in EC mental health
Prof. Robin Hansen, UC Davis M.I.N.D. Institute
Lynn Haskell , Behavioral Health Specialist, Butte County Department of Behavioral Health
Laura Heintz, Executive Director, Families First
Linda Hendricks, MFT, MFCC
Sandy Heringer, CommuniCare Health Centers
Kim Herkert, MFT
Kalista Hickman, MFT, Kaiser Permanente
Christina Hill-Coillot, LCSW, Deputy Director of Clinical Programs, Yolo County ADMH
Teena Hosey, LCSW
Milton Kalish, LCSW
Dr. David Katz, MD, CommuniCare Health Centers
Patricia A. Kelly, Sacramento County Department of Mental Health
Katy King Goldberg, Health Access Outreach Coordinator, Yolo Children's Alliance
Karina Knight, MFT
Tamiko Kwak, Resource and Referral Coordinator, Child Care Services, Resource and Referral
Dee Langley, CADC I, CommuniCare Health Centers
Karen Larsen, MFT, Substance Abuse Treatment Program Director, CommuniCare Health Centers
33
Dannelle Larsen-Rife, PhD, Family Connection Program
Mary M Lattimore, MFT, Winding Way Therapists
Joyce Lee , Parent and Provider Consultant
Christina Andrade-Lemus, CommuniCare Health Centers / John H Jones
Julia Levine, PhD
Dr. Edwin Lichwa, MD, CCHC
Sara Lindsey, MFT
Sue Lomax, MA, Ed, CommuniCare Health Centers
Alison Loscotoff, MSW, CommuniCare Health Centers
Lana Magness, MA, City of Davis Child Care Ser.
Monique Marin, Clinician, Yolo County Department of Alcohol Drug and Mental Health (ADMH)
Nancy Mercer, PhD
Mosey Meszaros, Yolo County Office of Education, First Steps Infant Program
Mary Meux, MD, CommuniCare Health Centers
Michael Minnick, MPPA, CommuniCare Health Centers
Hector Molina, PPS, WJUSD
Mara Newbart, LCSW
Antonia Oakley, UC Davis Family Connection Program
Dr. John Oberholtzer, MD, Sutter West Medical Group
Lewis Oleson, LCSW, MS Clinical Child Psychology, Yolo County ADMH
Patricia Osuna, LCSW, Supervisor, Woodland Outpatient Clinic, Yolo County ADMH
Dr. Yvonne S. Otani, MD, Kaiser Permanente
Carolyn Pierson, MA, Health Administration, Executive Director, Yolo Family Resource Center
Holly Pong, PhD, CommuniCare Health Centers
Jan Poole, Intake Coordinator, Yolo County Office of Education First Steps Program, YES Team Director
Dr. Yelena Popova, MD, Molina Medical Group
Michael Rahilly, PhD, Private-Practice Therapist
Cheryl Reilly, MFTI, Yolo County Department of Alcohol, Drug and Mental Health (ADMH)
Dr. Michael Reinhart, MD, Sutter West Medical Group
Dr. Gary Roberts, MD, CommuniCare Health Centers
Jim Rodgers, Executive Director, Yolo Family Services Agency (YFSA)
34
Oralia Rodriguez, Coordinator, R.I.S.E. (Rural Innovations in Social Economics Inc.)
Vivienne Roseby, PhD
Dr. David Rue, MD (Psychiatry), Sutter Center for Psychiatry
Susana Russ, Clinical Director, Yolo Family Services Agency (YFSA)
Linda Ryan, MFT, CommuniCare Health Centers
Anne Schultze, Mental Health Specialist, Yolo County Office of Education, Head Start / Early Head Start
Mickey Senescall, CADC II, CommuniCare Health Centers
Chris Shellhammer, MFT, Yolo Family Service Agency
Cyndi C. Smit, MFT, Yolo County Alcohol, Drug, and Mental Health
Kathleen Stutz, IMF, MFT, Youth and Family Services
Martha E. Tamayo, Migrant Head Start
Stewart Teal, MD (Psychiatry), Yolo County Department of Alcohol, Drug and Mental Health
Kathryn Tessmer, MFT
Roseanne Testerman, MFT, Woodland Healthcare
Judy Tischer, Clinical Director, Sexual Assault and Domestic Violence Center (SADVC)
Ross Thompson, Professor of Psychology, UC Davis
Robbie Townsley, Resource and Referral Supervisor, Childcare Services
Dolores Turner, MSW, Mercy Hospice
Rossana Vigil, Resource and Referral Coordinator, Child Care Services Resource and Referral
Karleen Watson, MFT, CommuniCare Health Centers
Jay Weatherbie, CommuniCare Health Centers
Cathie M. Wicks, Executive Director, R.I.S.E. (Rural Innovations in Social Economics Inc.)
Judith Ann Wilkin, PhD, MFT, RN
Pauline Wooliever, MS, Child Development Consultant: Early Years
Oscar Wright, Executive Director, United Advocates for Children
TABS Screening Participants
Elaine Barratt, Administrator, International Parent / Child Learning Center, Davis
Joy McMillister, Administrator, Holy Rosary Preschool, Woodland
Maxine Pounds, Executive Director, Storybook Cottage, West Sacramento
Cathy Wicks, Executive Director, RISE, Esparto
35
Renee Andreotti, Lead Teacher, Discovery Preschool, Youth and Teen Services, West Sacramento
Anne Shultze, Mental Health Specialist, Yolo County Office of Education Head Start / Early Head
Start
Antonieta Licea, Owner, Licea's Day Care, Woodland
Dave Bakay, Family Day Care, Davis
Dee Chang, Family Child Care, Davis
Cindy Cole, Pumpkin Vine Day Care, Woodland
Joy Escalante, Family Day Care, Esparto
Eliana Guerrero, Itsy Bitsy Preschool, West Sacramento
Lila Lemenager, Woodland Preschool, Woodland
Patricia Morales-Orozco, In Home Day Care, Woodland
Clare Purtill, Children's Center, Grafton Elementary School, Knight’s Landing
Johana Scott, Davis Joint Unified School District (DJUSD), Davis
Nazarene Schetab, Head Start, Yolo County Office of Education, West Sacramento
Kathy Torres-Lopez, Migrant Even Start, throughout Yolo County
Kirsten Truitt, Alphabet Soup, Woodland
36
Appendix B
Cited Works and Additional Resources
Bruner, C, J Goldberg, and V Kot. The ABC's of Early Childhood: Trends, Information, and
Evidence for Use in Developing an Early Childhood System of Care and Education. 1999.
Campbell, S B., and L J. Ewing. "Follow-Up of Hard-to-Manage Preschoolers: Adjustment at
Age 9 and Predictors of Continuing Symptoms." Journal of Child Psychology and
Psychiatry
(1990).
Center for Evidence-Based Practice: Young Children with Challenging Behavior.
<http://challengingbehavior.fmhi.usf.edu/>
Cohen, Julie, Ngozi Onunaku, Steffanie Clothier, and Julie Poppe. Helping Young Children
Succeed:
Strategies to Promote Early Childhood Social and Emotional Development. National
Conference of State Legislatures. www.zerotothree.org, 2005. 1-20.
<http://www.zerotothree.org/site/DocServer/helping_young_children_succeed_
final.pdf?docID=1725&AddInterest=1157>.
Cooper, Janice L., Rachel Masi, Sarah Dababnah, Yumiko Aratani, and Jane Knitzer.
Strengthening Policies to Support Children, Youth, and Families Who Experience
Trauma. National Center for Children in Poverty, Columbia University, Mailman School
of Public Health. Columbia University, 2007. 1-102.
<http://www.nccp.org/publications/pdf/text_737.pdf>.
Cooper, Ph.D., Janice L. "Financing Mental Health for Children, Youth and Their Families."
10.10.07. APA Congressional Briefing on Children’s Mental Health. Columbia University,
2007 1-3.
Degangi, G A., and S I. Greenspan. "The Effectiveness of Short-Term Interventions in Treatment
of Inattention and Irritability in Toddlers." JDLD 1 (1997): 277-298.
Egeland, Byron, Mark Kalkoske, Natan Gottesman, and Martha F. Erickson. "Preschool Behavior
Problems: Stability and Factors Accounting for Change." Journal of Child Psychology and
Psychiatry 31.6 (1990): 891-909.
Emde, R N., and J Robinson. "Guiding Principles for a Theory of Early Intervention: a
Developmental-Psychoanalytic Perspective." Handbook of Early Childhood Intervention.
Wiley, 2000.
Fischer, Mariellen, Jon E. Rolf, Joseph E. Hasazi, and Lucinda Cummings. "Follow-Up of a
Preschool Epidemiological Sample: Cross-Age Continuities and Predictions of Later
Adjustment with Internalizing and Externalizing Dimensions of Behavior." Child
Development 55.1 (1984): 137-150.
Fox, Lisa, and Barbara J. Smith. POLICY BRIEF: Promoting Social, Emotional and Behavioral
37
Outcomes of Young Children Served Under IDEA. Center on the Social and Emotional
Foundations for Early Learning & Center for Evidence-Based Practice: Young Children
with Challenging Behavior. www.challengingbehavior.com, 2007. 1-2.
<http://www.nectac.org/~pdfs/calls/2007/challengingbehavior/2-smith619policybrief.pdf>.
Fox, Lisa, Glen Dunlap, Mary Louise Hemmeter, Gail E. Joseph, and Phillip S. Strain. "The
Teaching Pyramid: a Model for Supporting Social Competence and Preventing
Challenging Behavior in Young Children." National Association for the Education of
Young Children (2003): 1-4.
<http://challengingbehavior.fmhi.usf.edu/handouts/yc_article.pdf>.
Fox, Ph.D., Lisa. Recommended Practices: Program Practices for Promoting the Social
Development of Young Children and Addressing Challenging Behavior. Center for
Evidence Based Practice: Young Children with Challenging Behavior.
www.challengingbehavior.org, 2005. 1-3.
<http://challengingbehavior.fmhi.usf.edu/handouts/ProgramPractices.pdf>.
Greenspan, Stanley, and Nancy T. Greenspan. First Feelings: Milestones in the Emotional
Development of Your Infant and Child From Birth to Age 4. Viking P, 1987.
Johnson, Kay, Jane Knitzer, and Roxanne Kaufmann. Promoting the Emotional Well-Being of
Children and Families, Policy Paper No. 4, Making Dollars Follow Sense: Financing Early
Childhood Mental Health Services to Promote Healthy Social and Emotional
Development in Young Children. National Center for Children in Poverty, Columbia
University, Mailman School of Public Health. Columbia University, 2002. 1-32.
Kazdin, A. E. "Risk Factors, Onset, and Course of Dysfunction." Conduct Disorders in Childhood
and Adolescence (2nd Edition). Thousand Oaks, CA: Sage Publications, 1995. 50-74.
Kazdin, A. E. "Risk Factors, Onset, and Course of Dysfunction." Conduct Disorders in Childhood
and Adolescence (2nd Edition). Thousand Oaks, CA: Sage Publications, 1995. 50-74.
Knitzer, Jane, and Jill Lefkowitz. Helping the Most Vulnerable Infants, Toddlers, and Their
Families. National Center for Children in Poverty, Columbia University, Mailman School
of Public Health. Columbia University, 2006. 1-38.
Knitzer, Jane. Promoting the Emotional Well-Being of Children and Families, Policy Paper No. 1,
Building Services and Systems to Support the Healthy Emotional Development of Young
Children—an Action Guide for Policymakers. National Center for Children in Poverty,
Columbia University, Mailman School of Public Health. Columbia University, 2002. 1-30.
30 Jan. 2008 <http://www.nccp.org/publications/pdf/text_369.pdf>.
Masi, Rachel, and Janice Cooper, comps. Children’S Mental Health: Facts for Policymakers.
National Center for Children in Poverty, Columbia University, Mailman School of Public
Health. Columbia University, 2006. 1-4.
38
Maughan, A, D Ciechetti, S L. Toth, and F A. Rogosch. "Early-Occurring Maternal Depression and
Maternal Sensitivity in Predicting Young Children's Emotional Regulation and
Socioemotional Difficulties." Journal of Abnormal Child Psychology 35.5 (2006): 685703.
National Institute of Mental Health. 28 Jan. 2008 <http://www.nimh.nih.gov/>.
Perry, Deborah F.., Kaufman, Roxane K., and Knitzer, Jane. Social and Emotional Health in Early
Childhood: Building Bridges Between Services & Systems. Paul H. Brookes Publishing Co.,
(2007).
Poverty and Brain Development in Early Childhood. National Center for Children in Poverty,
Columbia University, Mailman School of Public Health. Columbia University, 1999. 1-2.
Promoting the Social, Emotional and Behavioral Development and Outcomes of Young Children.
2007. <http://breeze.unc.edu/challengingbehavior>.
Promoting the Social, Emotional and Behavioral Development and Outcomes of Young Children.
2007. <http://breeze.unc.edu/challengingbehavior>.
Raver, C. Cybele, and Jane Knitzer. Promoting the Emotional Well-Being of Children and
Families, Policy Paper No. 3, Ready to Enter: What Research Tells Policymakers About
Strategies to Promote Social and Emotional School Readiness Among Three- and FourYear-Old Children. National Center for Children in Poverty, Columbia University,
Mailman School of Public Health. Columbia University, 2002. 1-24.
Santos, R. "Research on Home Visiting: Implications for Early Childhood Development (ECD)
Policy and Practice Across Canada." Encyclopedia on Early Childhood Development
(2005): 1-9. <http://www.child-encyclopedia.com/documents/SantosANGps.pdf>.
A Science-Based Framework for Early Childhood Policy. Center for the Developing Child,
Harvard University.
<http://www.developingchild.harvard.edu/content/publications.html>.
Shonkoff, M.D., Jack P., comp. Science-Based Framework for Early Childhood Policy. 07 Aug.
2007. Center for the Developing Child, Harvard University.
<http://www.developingchild.harvard.edu/content/publications.html>.
United States. Surgeon General. Department of Health and Human Services. U.S. Public Health
Service, Report of the Surgeon General’s Conference on Children’s Mental Health: a
National Action Agenda. Washington DC, 2000.
US Department of Health & Human Services. <http://www.hhs.gov/>.
Webster-Stratton, C, and M Hammond. Journal of Consulting and Clinical Psychology 65.1
(1997): 93-109. <www.myweb.brooklyn.liu.edu>.
When the Bough Breaks. Dir. Neil Docherty. Videocassette. Film Makers Library, Inc., 1992.
Zeanah, C H., and Doyle Zeanah. "Towards a Definition of Infant / early childhood mental
39
health." Zero to Three 22.1 (2001): 13-20.
<http://www.nhchc.org/Network/HealingHands/2005/June2005HealingHands.pdf>.
ZERO TO THREE web site <http://www.zerotothree.org>.
ZERO TO THREE. Diagnostic Classification of Mental Health and Developmental Disorders of
Infancy and Early Childhood, Revised (DC:0-3R). Zero to Three, Revised Edition, 2005. 175.
ZERO TO THREE, with National Conference of State Legislatures. Helping Young Children
Succeed: Strategies to Promote Early Childhood Social and Emotional Development, 2005.
40
APPENDIX C: Temperament and Atypical Behavior Scale
TABS Indicators
The following fifteen items list some of the most frequent problems in temperament and selfregulation that parents and professionals observe in young children. Read each numbered item
and check NO if the behavior is not a problem. Check YES if the behavior is a problem.
NO
1.
Emotions don’t match what’s going on
2.
Gets angry too easily
3.
Too easily frustrated
4.
Has wild temper tantrums
5.
Frequently irritable, touch, or fussy
6.
Can’t comfort self when upset
7.
Doesn’t pay attention to sights and sounds
8.
Seems to look through or past people
9.
Resists looking you in the eye
10.
Too grabby; impulsive
11.
Moods and wants are too hard to figure out
12.
Seems to be in own world
13.
Tunes out, loses contact with what is going on
14.
Overexcited in crowded places
15.
Wanders around without purpose
41
YES
Appendix D: Parent Survey
1.
How old is your child today?
2.
Where did you live during your child’s first five years?
3.
Please tell us what prompted you to try to get assessment or services for your child
(open-ended).
4.
At what aged did you first notice behavior issues or problems?
5.
When you first tried to get services for your child, was he/she 5 years old or
younger?
6.
Have you received all the services you have tried to get for your child?
7.
Please tell us about any problems you’ve experienced in trying to get services (openended).
8.
In what context(s) have you received services for your child?
a.
b.
c.
d.
e.
f.
In-home visitation
assistance in daycare setting
therapists office
nonprofit agency setting
government agency setting
in another setting (please specify)
9.
How did you locate services (open-ended)?
10.
Please tell us how satisfied or dissatisfied you’ve been with the services you’ve received.
What has helped you most? What’s missing? (open-ended)
11.
Please tell us what you think are the most pressing needs in Yolo County related to
support for children’s social/emotional development (open-ended).
12.
Is there anything else you’d like to tell us (open-ended)?
42
Appendix E: Mental Health Provider and Physician Survey
1.
What ages do you work with?
a.
b.
c.
d.
e.
f.
g.
h.
birth to 2 years old
3 to 5 years old
6 to 12 years old
teens
transition aged youth
young adults
adults
parents and children together
2.
Please estimate how many children 0-5 you see each month.
3.
Please tell us where your patients live. (please check all that apply)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
4.
Capay Valley
Davis
Dunnigan
Esparto
Sacramento
Vacaville
West Sacramento
Winters
Woodland
Other
How can clients access your services? (please check all that apply)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
I am able to accept Medi-Cal
I am able to accept EPSDT
I am able to accept Kaiser
I am able to accept Magellan (Western Health Advantage)
I am able to accept HealthNet
I am able to accept United Behavioral Health
I am able to accept Blue Cross/Blue Shield
I am able to accept AETNA
I accept private-pay clients
My employer pays me to provide services
Grant funds cover the cost of my services
I am able to accept other HMOs, carve-outs, public insurance, and/or employer
provided benefits (list below)
5.
Please list specific mental health related trainings you’ve received that have helped you
in your work with children aged 0-5.
6.
Do you provide direct mental health services to children aged 0-5?
7.
How many times per month would you estimate that you refer a child aged 0-5 for
43
mental health services?
1-3
4-6
7-9
10-15
16-20
21-30
31 or more
8.
Please provide us with the names of people to whom you refer children 0-5 for mental
health services.
9.
Do we have your permission to include you as a mental health services provider in an
upcoming First 5 Yolo Mental Health Practitioners Resource Directory?
10.
What information about you would you like included in the First 5 Yolo Mental Health
Practitioners Resource Directory?
11.
Which issues do you feel are in need of attention in regard to mental health services for
young children (0-5 years old) in Yolo County. Please rank as follows: 1) there is a huge
need for this; 2) there is a significant need for this; 3) there is some need for this; 4)
there is no real need for this; 5) I don’t know enough to rank this.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
More support for parents to promote positive mental health development in
infants and young children.
More attention to prevention.
More attention to identification of children who need help.
Earlier intervention than what now exists.
Increase in or changes to existing trauma, addition-related, domestic violence,
and abuse related services.
Better referral networks and/or collaboration among schools, doctors, mental
health agencies and mental health providers.
More training for doctors to help them identify and refer children who need
help.
More training for educators to help them identify and refer children who need
help.
More mental health practitioners available to meet the need.
More up-to-date models for mental health services to infants and very young
children.
12.
Please tell us more about what you see in regard to greatest need (open-ended).
13.
Please tell us about any barriers families may face in getting mental health services for
children aged 0-5 in Yolo County (open-ended).
14.
What do excellent mental health care services for young children look like? Please
describe some of what you regard as the most important components/features (open-
44
ended).
15.
45
Are there any promising practices for early childhood mental health services that you’d
like to tell us about?
Appendix F: Community-Based Mental Health Organization Key Informant Interview
1.
How many children aged 0-5/families did you serve last year?
•
Among these children, how many were initially the primary client?
•
What percentage of your total clientele does this represent?
2.
How do you adjust your services or process to address the needs of families of different
ethnicities? What are the issues, solutions?
3.
What are the primary presenting issues/needs/diagnoses that you see for children 0-5?
4.
What services do you provide for children 0-5 and their families (be specific)?
5.
How are children and families referred to you? From whom? Could you provide us with
any data on referral sources?
6.
What barriers do families face in obtaining mental health services for children 0-5?
7.
How are services paid for? What issues are involved with each funding stream?
•
•
•
•
•
Medi-Cal?
Other public agency funding?
Private insurance?
Foundation grants?
Other – fee for service, sliding scale?
8.
Do you integrate your services with other service providers? In what ways?
9.
What data do you have on outcomes for children 0-5? Could you share this data with
us?
10.
What gaps in services for children 0-5 in Yolo County do you see that are not currently
being addressed? Are there services/assets that are underutilized? (Why?)
11.
Are there any services for young children that you would like to provide but don’t?
12.
What promising practices do you currently use? Are there others that you would like to
implement?
13.
Anything you’d like to add? Any materials or practices you’d like to share?
46

Early Childhood Mental Health Needs Assessment

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