Early Childhood Mental Health: What’s Happening in NH

Early Childhood Mental Health:

What’s Happening in NH

Early Childhood Mental Health is…

The social/emotional well being of children aged birth to six years which promotes the capacity to:

Experience, manage and express emotionsDevelop and sustain stable relationships with others (adults and peers)Safely explore the environment and learnDemonstrate developmentally appropriate behavior

Prevalence of Early Childhood Mental Health Concerns

74,689 children under the age of 5 in NH13.5% (10,218) live in poverty, (NCCIC, 2010)912 cases of founded child abuse in 2007, a 10.9%increase over 2006In 2007, of 1,084 children not living with parents, 290 were under the age of 5, (Administration for Children and Families, 2009, www.cwla.org)

Prevalence of Early Childhood Mental Health concerns

NH Center for Public Policy Studies (NHCPPC) estimated that 20% of NH children ages 5-15 could have a mental health disorder10-20% of preschool children experience- behavioral/mental health concerns, (Dunlap, 2006)This suggests that over 7,500 under age 5 are in need of mental health services, (NHAIMH, 2009)

Prevalence of Early Childhood Mental Health concerns (cont.)

Of 173 families surveyed, 46.2% were worried that their child (under age 6) might have a social emotional or behavioral disorder, (NHAIMH 2009,Mental Health Services for NH’s Young Children and their families: Planning to Improve Access and Outcomes)


Nationally, the rate of child care/preschool expulsion due to challenging behavior of preschool age children is three times greater than for kindergarten and toddler (Gilliam, 2005).NHAIMH 2001 Child Care Expulsion survey found that in a 15 month period, 53% of child care programs reported they had either expelled a child or enrolled a child that had been expelled elsewhere.


Toxic stress is known to negatively impact brain development. Between 75 and 130 of every 1,000 children in the US under the age of 5 live in homes with 1 of 3 common precipitants of toxic stress (maltreatment, parental substance abuse and maternal depression) www.developingchild.harvard.edu

Where people go for help

80% of families report they first seek help from their medical provider when concerned about their child’s mental health or behavior72% of medical providers report they need more information regarding child development80% report they need information and resources about behavior

(NHAIMH, 2009)

Some Risk Factors for Early Childhood Mental Health Issues

Toxic StressParents with significant mental health issues, (including depression, personality disorders, anxiety, PTSD, Bi-Polar, Schizophrenia) Current or history of abuse and neglect, homelessness, substance abuse, domestic violenceHigh level of family stress, (chronic or multiple acute stressors)Child with developmental or medical issues, colic, challenging temperament, attachment concernsParent-infant temperament mismatch

Why early intervention is so important

“Well designed early childhood interventions have been found to generate a return to society ranging from $1.80 to $17.07 for each dollar spent on the program.” Economics Nobel Laureate, James Heckman University of Chicagohttp://www.ideainfanttoddler.org/pdf/2008_Good_News.pdf

Why early intervention is so important

“Effective early childhood programs generate benefits to society that far exceed program costs. Investments in the earliest years of life show the greatest returns- $3.00-$16.00 dollars per dollar invested through reduced crime, welfare, educational remediation, etc. www.developingchild.harvard.edu

Home Visiting

“Home visiting influences maternal parenting practices, the quality of the child’s home environment and children’s development…. Greatest benefit for low-income first time adolescent mothers.” (Howard, Brooks-Gunn, 2009)15 year follow up from home visiting project in Elmira, NY, (David Olds), found 48% less incidents of abuse and neglect through age 15 (Robert Wood Johnson Foundations, 2006)

So, where are these children?

Child care Medical Care ProvidersHome and communitySchools (pre-school and kindergarten)

…and what are the services?

Child Care Early Head StartHead StartHome Visiting ProgramsEarly Supports and ServicesSpecial EducationWatch Me Grow

Child ProtectionMental Health ServicesCommunity and Family Support Programs (Family Resource Centers)Other Community services

Recommended Levels of Service

3 Tiered Approach3 Tiered Approach Tier 1- safety, health, supportive and nurturing relationships for allTier 2- Center-based care and education and Parent and Family Supports for families in povertyTier 3- specialized support and clinical services for families most likely to experience toxic stress and or high risk in other ways.

www.developingchild.harvard.edu

In NH….

General family support and parent educationChild care site-focused support and education, (i.e. PTAN child care consultation)General child development supportChild/family specific support/ intervention based on eligibilityEnhanced services based on eligibility, diagnosis and/or finding of abuse or neglect; (ie through ESS or Mental Health)

State Supported Programs

Program Age Eligibility Criteria Services Provided

Early Head Start

0-3 Income based Home visiting, parent education and support, screening, mental health consultation, center-based socialization

Head Start

3-5 Income based Educational, center-based, parent education and support (in group), screening, enriched child care, mental health consultation

Early SupportsAnd Services

0-3 33% developmental delayAtypical social emotional Development, Established Condition, or meets “At Risk” criteria

Assessment, Parent education and support, Developmental therapy and support (includes behavioral and counseling), and case management

Home Visiting NH

Preg.-1

Medicaid eligible Parent education and support (improved birth outcomes, child development, family planning, smoking cessation, impact of substance use)

Child Care

0-6 Income based for subsidy Child careChild care subsidy to eligible Child Care consultation (PTAN)

State Supported Programs cont.

Program Age

Eligibility Criteria Services Provided

Preschool Special Education

3-5 Educational disability, including Emotionally Disturbed

Assessment, Educational therapies and support

Division of Children Youth and Families

0-6 Finding of Abuse or Neglect

Case management, child care, parent education, support, remediation services, placement as needed, referral and funding for assessment, parent education, support, therapies

Community Mental Health

?-6 Determination of SED or at Risk of SED and DX by DSM IV R

Varies by region- assessment, emergency services, psychiatric evaluation, some family tx, some play tx some Child-Parent Psychotherapy, some parent education and support

Watch Me Grow

0-6 None Community based screening (development, some Autism, some social emotional)

Community 0-6 None Recreation, community resources, private therapies

Program NumbersServed

Costs

Early Head Start

318 $3,656414, average cost per child, $11,498

Head Start

1,146 $11,471,019 avg. cost per child, $7,933

Early SupportsAnd Services

3598 in 20094.04% (1,744/43,201) of the NH general population

$2,950 per child annually

Numbers Served & Costs


Costs

Home Visiting NH

900 families in SFY 2010 $3,175 - $4,398 per child pregnancy – birth (Health Metrics, 2004)

Child Care December 2010 child care scholarship served 4,376 children under 6.5 years old.1,108 were under 18 months old1,200 were 18 to 35 months old1,758 were 36 to 79 months old

December cost per child for children 1-79 months was $371.80. The total cost for the month for children 1-79 months was $1,623,361.74* Fasting growing group in child care- children under the age of one.

Numbers Served & Costs cont.


Costs

Preschool Special Ed 3 yo- 867, (55 ASD, 0 ED)4 yo 1120, (64 ASD, 3 ED)5 yo 1105, (88 ASD,3 ED) (Dec.1, 09)

Unknown

DCYFComprehensive Child & Family Support

2008 Founded Cases

0-3yo 308 (24% of all)

4-7yo 241 (23% of all)

Unknown

Community Mental Health

Unknown Unknown




Costs

Watch Me Grow 178 Approx $25,000

Community unknown unknown

Identified Gaps/Needs and Existing Promising Practices

Gaps and Needs

Information, support and resources for primary care providersSupport and consultation for childcare providersProfessional training at all levelsEarlier identification of social emotional needsAccess to and availability of quality services across regionsClear eligibility criteria for community mental health servicesExpansion of evidence-based practices

Information, Support and Resources for Primary Care Providers

Watch Me Grow ASQ-SE and other screening toolsDevelopmental specialists and Mental Health Providers in primary care offices

Support and Consultation for Childcare Providers

PTAN and other existing child care consultation modelsThe Head Start Early Childhood Mental Health Consultation ModelNH Early Learning GuidelinesHealthy Child Care NHMaine RELATE Model of Early Childhood ConsultationNH Early Childhood and Family Mental Health Competencies

Professional training at all levels

Mental Health Expertise on Early Supports and Services TeamsECMH expertise in Community Mental HealthTraining in Child-Parent Psychotherapy NH Early Childhood and Family Mental Health Competencies

Access and availability of quality services across regions

Evidence-based home visiting models (i.e. www.futureofchildren.org)Child care consultation and supportFamily Resource Center ProgramsLocal ECMH grant funded programs Some community mental health expertiseChild-Parent Psychotherapy consultation model

Community Mental Health Services

Some community mental health expertiseChild-Parent Psychotherapy consultation modelPreventative servicesConsistent eligibility evaluation criteria and processDC 0-3 for diagnosis

One Last Thought….

Promoting Early Childhood Mental Health requires an integrated comprehensive community-based system of care. So… it is a really good thing that we are all here and working together. Our future is our children.

Documents

Early Childhood Mental Health: What’s Happening in NH