macma (3) cwright edits - Minnesota Association for Children`s

Minnesota Association of Children’s Mental Health
Conference 2010
Connecting the Very Young with Part C Early
Intervention: Roles for Minnesota’
Minnesota’s
Interagency Early Intervention Committees in
Infant
Mental Health
Catherine Wright, MS, Children’
Children’s Mental Health- Minnesota Department of Human
Services
Loraine Jensen, Part C Coordinator-Minnesota Department of Education
Shawn Holmes- Part C Planner- Minnesota Department of Health
Sue Benolken, State Interagency Facilitator-Minnesota Department of Human Services
Introductions

Discussion- name and role within your
agency
Agenda/Outcomes
Understand the needs of very young
children with social emotional and or
mental health concerns
 Understand how Part C/Help Me Grow
and Mental Health intersect
 What is your role in this Early Intervention
system

What is EI Mental Health


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Early Childhood Mental Health is referring to
children ages 0-5 and interwoven with a young
child’s development and overall health.
We know that much of the brain development
occurs before the age of three.
Early Intervention is the key to reverse the
effects of adverse early experiences.
http://developingchild.harvard.edu/initiatives/counci
l/
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How does Social Emotional
Development go Awry?

Exposure to trauma, significant loss with primary care givers.

Disruptions in relationships with primary care givers because of:
 Parental mental illness
 Substance abuse
 Domestic violence

Biological Reasons
 Genetic inheritance
 Exposure to injury, infection, toxicants, nutritional deficiencies (in-utero
or after)
 Difficult temperament
What Do We Know and Believe

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Social/Environmental Stressors
 Living in high risk neighborhoods
 Discrimination and racism
 Prolonged family stress due to death, divorce, extreme economic
hardship, etc.



Early experiences influence the developing brain.
Chronic stress can be toxic to developing brains.
Significant early adversity can lead to lifelong
problems.
Early intervention can prevent the consequences
of early adversity.
Stable, caring relationships are essential for
healthy development
Social emotional is a developmental domain
Intervention should be as early as possible.
From Neurons to Neighborhoods, 2000 and ACE study (ongoing)www.acestudy.org
Brain Research
 Early experiences determine whether a child’s
brain architecture will provide a strong or weak
foundation for all future learning, behavior, and
health
 Young children experience their world as an
environment of relationships, and these
relationships affect virtually all aspects of their
development.
 Young children are highly vulnerable emotionally
to the adverse influences of parental mental
health problems and family violence
 What happens in early childhood can matter for
a lifetime.
Human Brain Development
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
Family Centered/Driven processes that focus on the needs and priorities
outlined by the families and addressed yield better results

Early Intervention that is relationship based (child within the family
context, dyad, wholistic), developmentally focused and delivered within
natural environments and activities enhances results

Systems that can provide the right service at the right time in the right
amount are expected to have better outcomes

Young children need positive relationships, rich learning opportunities,
and safe environments, not quick fixes or magic bullets

Ensuring that children have positive experiences prior to entering school
is likely to lead to better outcomes than remediation programs at a later
age, and significant up-front costs can generate a strong return on
investment

Belief that a comprehensive, coordinated, interagency,
multidisciplinary system to be more effective and of higher
quality.

A family focused system that is accountable, easy to access
and is ready to provide needed services and supports,
improves outcomes of children with disabilities and their
families.

Child maltreatment results in a substantial risk to a child’s
development.
 The risk for developmental delays can last for several years
after maltreatment.
 Risk factors can result in academic difficulties as a child
enters school.
What Do We Know and Believe
Program strategies that:

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Facilitate friendships
and mutual support
Strengthen parenting
Respond to family crises
Link families to services
and opportunities
Facilitate children’s
social and emotional
development
Observe and respond
to early warning signs
of child abuse or neglect
Value and support parents
Build

Parental resilience

Social connections

Knowledge of parenting
and child development

Concrete support
in times of need

Social and emotional
competence of children
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Attention to Social Emotional/Mental
Health is Important
What do we mean when we say
infant mental health?
Definition- from Zero to Three:
“ Infant mental health is the developing capacity of
the child from birth to three to: experience,
regulate, and express emotions; form close and
secure interpersonal relationships; and explore
the environment and learn- all in the context of
family, community, and cultural expectations for
young children. Infant mental health is
synonymous with healthy social and emotional
development.” Zero to Three, 2001


Infants and toddlers are capable of deep and lasting sadness, grief, and
disorganization in response to trauma, loss and early rejection.

Additionally, biological conditions or neurological disorders can create
immediate social-emotional problems or subsequent risk for them. Early
childhood development research shows that babies:
 Four months or younger can experience depression
 As young as 6 months suffer from long term effects from witnessing
trauma
 As young as 1 month can sense whether or not a parent is depressed
or angry, and is affected by the parent’s mood. Many of these
children exhibit signs of traumatic stress, including withdrawn
behavior, fearfulness, anxiety, aggression, disorganization
 and sadness.
 Significant parental mental health problems, substance abuse, and
family violence impose heavy developmental burdens on young
children.
Mental Health and Early
Intervention Connections
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Who is Eligible for Early
Intervention/Help Me Grow
A child under 3 years of age who needs early
intervention services because the child:

Meets the criteria for any one of the thirteen special education
disability categories (categorical disability)
Evaluation Process for Determining
Eligibility

Review of the child’s current records related to health
status and medical history.

Evaluation of the child’s levels of functioning across five
developmental domains. (standard deviation 1.5 below mean in 1 or
OR

more areas)

Is experiencing a developmental delay that is demonstrated by
a score of 1.5 standard deviations or more below the mean as
measured by appropriate diagnostic instruments in 1 or more
of the areas of development



OR

Has a diagnosed physical or mental condition that has a high
probability of resulting in developmental delay


Cognitive development
Physical development
Communication development
Social or emotional development
Adaptive development
Assessment of the unique needs of the child in terms of
each of those developmental areas.
Eligibility Guidelines: http://www.health.state.mn.us/divs/fh/mcshn/ecipelig/
Eligibility Criteria (hand outs)

13 DC:0-3R diagnoses qualify children
ages 0-3 for Part C services
 What
is DC:0-3R
 What are the Diagnoses
 Who Can do the Diagnoses
What about EC Mental Health
Eligibility
CMH conditions that qualify a child for
Help Me Grow:
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Adjustment Disorders
Anxiety Disorders of Infancy and Childhood
Depression of Infancy and Early Childhood
Deprivation/Maltreatment Disorder
Disorders of Affect
Feeding Behavior Disorders
Mixed Disorder of Emotional Expressiveness
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What about EC Mental Health
Eligibility
CMH conditions that qualify a child for
Help Me Grow:

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Post-traumatic stress disorder (PTSD)
Prolonged Bereavement/Grief Disorder
Regulation Disorders of Sensory Processing
Sleep Behavior Disorder
Disorders of Relating and Communicating
Multisystem Developmental Disorder (MSDD)
Social Emotional Development Mental Health
Conditions and Early Intervention Eligibility


Categorical Disability (EBD)
Developmental Delay
 Diagnosed condition with a high probability of
resulting in developmental delay or
disorder(DC:0-3 selected conditions)
 1.5 Standard Deviation delay below the mean in
1 or more of 5 developmental domains
(communication, cognition, social/emotional,
adaptive, physical development)
 Informed Clinical Opinion
HOW Do You Get into Help Me
Grow
Questions
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
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Child may be screened for social emotional
concerns in primary care, Head Start, child
welfare, through Follow-Along Program or…
Children with elevated screening scores are
referred to Help Me Grow to receive a full
evaluation
If eligible and a mental health need has been
identified the Help Me Grow connects families
with Mental Health Professionals and engage in
joint planning to address needs
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How to refer a child to Part C services if
there are concerns with a child’s
development
 Call 1-866-693-GROW (4769) to be
directed to your Early Childhood Special
Education contact.

http://www.parentsknow.state.mn.us/parent
sknow/Newborn/HelpMeGrow_SpecialNee
ds/index.html?redirectNodeId=Newborn
1-866-693-GROW (4769)
www.mnparentsknow.info
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What might the parent/child
experience? (Birth to age 3)

Home visit
 Developmental
history
 Developmental screening
 Planning a comprehensive evaluation (if
necessary)
 Public Health nurse, social worker, ECSE staff
member
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What might the parent/child
experience? (Birth to age 3)

Comprehensive, multidisciplinary evaluation
 Cognition
 Self-help
 Language
 Motor
 Social
skills
 Family-directed
Assessment (optional for
family)

Completed within 45 days of referral
Payment for services
No cost to families for the following
services: evaluation, assessment, early
intervention services, service
coordination, and information and referral.
 Parents may have a cost associated with
the additional services
 Services must be described and delivered
via an Individualized Family Services Plan
(IFSP)

What do you get
Services for children between the ages of
0-3 with developmental delays and/or
disabilities.
 Help families find health, educational and
social services that promote child
development.
 Family-centered services provided in a
natural environment (home, day care,
community play grounds, shelter…

Services at no cost
Evaluation
 Assessment
 Early Intervention Instruction
 Information and referral
 Service coordination

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Other Possible Services
 audiology
 nursing

 nutrition
 physical
therapy
technology
 occupational therapy
 vision services
 Family education and counseling
 health services (during EI delivery)
 Respite services
 medical services (diagnosis and evaluation)
 transportation and related costs
 speech pathology
 psychological services
 assistive
Service Plans 0-2
Individualized Family Service Plan
Documents early intervention services
 Must include service coordination
 Major outcomes based on family priorities
 Functional—tied to routines in the home or
other natural environment
 Focus on building the capacity of the family
and other primary caregivers to enhance the
development of the child

Payment for IFSP services
Parental financial responsibility:
Parental fee structures already
permitted can be used
Parental responsibilities are clearly
described in the IFSP
Inability of a parent to pay for services
must not prohibit a child from receiving
needed services.
Individualized Family Service Plan
(IFSP)
A planning process and document
of the plan that results from:
 assessment evaluation
 family identification of their needs,
concerns and priorities (Family
Centered Practices)
That clearly specifies:
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Individualized Family Service
Plan (IFSP)
 Child’s
developmental status
 Outcomes to be achieved
 Specific services, along with the dates and
duration
 Payment arrangements
 Medical/other services needed
 Transition steps
 Signatures of parents, service coordinator, and
providers.
Individualized Family Service
Plan (IFSP)
And is:
Protected by: Procedural safegaurds and
dispute procedures
Coordinated by: an assigned Service
Coordinator
And has:
Services Delivered: in the home or other
natural environment (if not in a natural
environment-with justification)
IEIC Effort
Payment for IFSP services
If the activity is related to evaluation to
determine MH needs, Part C funds can be
used IF no other funding source is
available
 Part C funds can also be used to pay for
services where there is no other funding
source available

IEIC? Interagency Early Intervention Committee
 Outreach to Primary Referral Sources
 Work across agency to assure a coordinated,
comprehensive system
 Agreements, Payments, dispute resolution
 Special efforts to reach underserved populations
 Linguistically
diverse
 Homeless/Migrant
 Children
who are victims of substantiated cases of
abuse/neglect
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County and School Board
Responsibilities:
School
Responsibilities of county boards and
school boards
(IEICs)
board:
Joint responsibilities:
 coordinate, provide and pay for appropriate
services and to facilitate payment from
public and private sources
 coordinate early intervention services
 determine primary agency
 may develop interagency agreements to
establish agency responsibilities
 provide,
pay for and facilitate payment
for special education and related
services
County
board:
 provide,
pay for and facilitate payment
for noneducational services of social
work, psychology, transportation and
related costs, nursing, respite and
nutrition services
Your Role in the EI system

Discuss your roles within the Early
Intervention system
 Education
 Medical
(nurses, physician, mental health
professional)
 Child Care, Head Start, ECFE
 Social Services
 Public Health
 parent
 other
Your Role in EI

Parents
 Make
a referral- you know your child best, if you are
concerned, seek support!
 Let your child’s primary care provider (doctor) know
about your concerns- you can always request that
your physician regularly screen your child for
developmental and mental health concerns.
 Actively participate in your child’s plan development
and treatment.
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What is your role in EI

Education:
What is your role in EI

 Address
the social emotional developmental
issues, as a mental health concern raised
make sure you refer and connect with a
mental health professional
 Service coordinator coordinates evaluation
and facilitates the connections to resources
such as mental health
 Coordinate the part c resources
What is your role in EI

Public Health/ Child Protection/ other
County Services:
 In
the home- refer!!
 Help bridge the MH professional into the
home as you have a relationship
 Incorporate goals of the EI/MH plan into your
work with the family.
Mental Health Professional:
 Complete
a diagnostic assessment with child and
family
 Partner with appropriate agencies and child’s family to
develop a holistic treatment plan
 Provide appropriate treatment based on diagnostic
assessment
 Complete outcome measures to ensure effectiveness
of care
What is your role in EI

Early Head Start/ Early Childhood Family
Education/ Child Care
 Make
referrals when needed (if you are
screening, always offer parents a referral
when the screening indicates a concern)
 Team with EI, family and MH team members
to promote goals in setting, as the plan
indicates
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What is your Role in EI

Primary Care
 Screen
for developmental and mental health issues
regularly.
 Assist families in making referrals to EI when
concerns arise from the screenings.
 Report any changes in physical health status to EI
team.
 Team with parent, EI and MH team members to
coordinate care for children qualifying for EI/MH
services.
Resources

Reading/Resource List

Examples of Part C Eligibility for Early
Childhood Mental Health Conditions
Resources for
Developmental Red Flags
First Signs
http://www.firstsigns.org/
 CDC: Learn the Signs-Act Early
http://www.cdc.gov/ncbddd/actearly/index.html
 Parents Know
www.mnparentsknow.info
 Nichy
http://www.nichcy.org/Disabilities/Milestones/Pages/D
efault.aspx

Video Clips
Age Specific Showing Developmental Milestones
Newborn
2 Months
4 Months
6 Months
9 Months
1 Year
18 Months
2 Years
3 Years
4 Years
5 Years
http://mediamill.cla.umn.edu/mediamill/display/38631
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Questions
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