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Welcome to the second edition of the Head Start Mental Health electronic newsletter. The newsletter highlights information available on-line through the Mental Health Tool Kit on the Head Start Information and Publication Center Web site (http://www.headstartinfo.org/infocenter/tkit_con.htm).
The Newsletter will periodically remind you of the Toolkit resources available on-line for T and TA providers, Head Start managers, staff, parents and consultants who have responsibilities related to mental health services in Early Head Start (EHS) and Head Start (HS). In the very near future, this newsletter will be on the Web in a downloadable format with an archive section of back issues and a search tool.
The Newsletter also will provide an introduction to new resources on child mental health, and will highlight new or unusual materials available from familiar sources.
In this issue:
This article describes a research project targeting the "early onset" conduct problems that are believed to be the precursors for academic and behavioral problems that lead to adult delinquency, violence, and substance abuse. This training program was originally designed for a clinical population but was adapted to serve as a prevention and early intervention program for at-risk Head Start children and families. The program consists of group-based training sessions for children, parents and teachers. Each group is shown videos presenting effective and ineffective ways of handling common problems. Some of the topics parents are taught are encouragement, praise, ignoring inappropriate behaviors, limit setting, natural and logical consequences, and time out. Topics for the children include school rules, doing your best in school, feelings, anger management, making friends, and teamwork. Topics for teachers include building positive relationships with students, building parent-teacher collaborations, encouraging parent participation, the importance of teacher praise and positive attention, using proactive strategies to prevent problems, limit setting, and time out. The study found that the entire culture of classes became focused on helping each child to succeed and make generalizations to real-life situations. Teachers used less harsh discipline and more praise than teachers in the control group. Parents trained in this model were found to decrease harsh and critical interactions and teachers reported an increase in the children's social competence. Most improvements were found to last past the year of the intervention.
To read more about this model, click http://www.rtc.pdx.edu/FPinPDF/fpSpr00.pdf. To read more extensively about the research underlying this model, click: http://www.apa.org/journals/ccp/ccp665715.html.
Q. Why did your program develop the early childhood behavioral specialist position?
A. Teachers in our Head Start classrooms were experiencing children's behaviors that are becoming more difficult and, at times, even violent. We have children who have severe temper tantrums, rage, and bite others. These are continuous problems that don't go away. Early Childhood educators do not receive the type of classes and resources, during their schooling, that prepare them to address these behaviors. We needed to explore ways to support staff who deal with children and families. Head Start values each child as an individual, and the development of self-esteem in the early years is what Head Start philosophy engages. This can make even a skilled teacher's job frustrating and almost impossible.
Q. What do you see as the reasons for the increase in unmanageable behaviors?
A. Children experience violence in the media, on the street, at home, in reality, all around. Some children deal with this as well as parental substance abuse, incarceration of a parent and other situations. We find that children exposed to violence are more likely to display violent, atypical behavior.
Q. Can you describe how you developed this model?
A. Our program was experiencing an increase in children's behavioral concerns and addressed this issue in a unique way. We studied the referrals made to the disabilities and mental health areas of the program for the prior two years. Sixty percent of all referrals made to these areas were behavior related. We employed a Licensed Clinical Social Worker (LCSW) and a Mental Health Assistant to support children, families and staff; but his model only addressed about 10 percent of the referrals. Because of the intensity of the intervention needed by the children, the percentage of children who actually received the service remained small. The timeliness from referral to intervention was also a problem. Sometimes, the parents weren't even brought into the center to discuss their children's difficulties. In addition, the mental health staff (LCSW and assistant) had no formal early childhood education and, therefore, were only performing triage and giving community referrals. This model did not seem to be meeting the needs of the classroom staff. The staff informed us by way of surveys and interviews with a consultant, that they needed someone who would respond rapidly, directly model how to intervene, help them develop behavior plans, and locate resources. They also wanted someone with experience in a preschool setting.
Q. How were you able to fund these positions?
A. The changes took place when the new performance standards were introduced. We saw there was an urgent need for support for the teachers. We decided we needed to reorganize the program and change some of the management positions in order to accommodate the mental health needs. We developed a position entitled Early Childhood Behavioral Specialist (ECBS). The ECBS was not trained in mental health, but had a very strong early childhood education background. A mental health consultant was brought in to do intensive training. The ECBSs (there were two hired for a program of 387 children) also attended training on the "Second Step" conflict resolution/anti-violence curriculum, as well as other training on children's behavioral issues.
Q. What does the ECBS do?
A. In the ECBS model, the specialists became the first to respond to referrals. They are reachable during working hours, by page or telephone, for behavioral emergencies. They perform triage over the phone and either personally go to the classroom or identify and send another person to help. The specialist meets with staff and families to develop behavior plans, and refer families/children to mental health professionals in the community who will be able to work with them while they are in our program and continue to follow them after they move on. They also maintain a database in order to provide informational handouts to parents and staff about specific behavior concerns.
Q. Why did you choose to hire teachers to fill the ECBS role?
A. We felt we needed someone with a really strong early childhood background. Because they know child development so well, for instance, they would know exactly what a 3-year-old should be doing and can identify a problem versus age appropriate behavior. Teachers are able to identify with the frustrations of other teachers. There is an easy rapport. They are able to model appropriate guidance in the classroom, review environments, and support the teachers' group management skills. They identify training needs for the staff in behavioral issues and plan for that training. They can also go into a classroom for consecutive days to help a staff member bring the classroom under control.
Q. What specialized training do the ECBSs have?
A. Our ECBSs have many years experience as classroom teachers and have developed a knowledge base in both mental health and education. They have learned about theories and interventions through extensive workshops and ongoing collaboration with our mental health personnel, who are available for regular consultation. It is important for them to have a grounding in the behavioral sciences and comfort with the social, emotional, cognitive, academic, language, sensory, motor and physical domains. For example, it is helpful to know about brain development and how certain brain-related difficulties impact on a child's behavior and learning potential. This allows the teachers to plan strategies that aim for that child's strengths.
Q. Can you tell me about a case?
A. One child recently came to our center with no background information. After a brief honeymoon in the classroom, the presenting problem from the teacher was that he was cursing at other children. We observed that he had very poor social skills, was easily overstimulated, had very poor impulse control and would become aggressive when his demands weren't met. We called in the grandparents and learned that his mother had substance abuse problems throughout her pregnancy with him. She was currently incarcerated. This particular boy was hitting and biting a lot. He would take a hard wooden spoon to strike other children. First, he was referred for play therapy and was able to be seen on-site twice a week. The therapist, teacher and grandparents worked together to develop a plan of action for him. An instructional aide was assigned to shadow him to support his developing self-control and was able to determine that the interventions were working.
Q. What have been some of the other positive effects of this model?
A. This model has just completed its third year and the number of referrals has drastically decreased. The model provides instant help for behavior problems in the classroom. They are able to intervene before the negative behavior escalates. The instructional aides in the classroom also provide support by shadowing the children and training them on positive interactions. They don't function as playmates; they stay in the background but are close by to help when necessary. This frees the teacher to interact with all of the children. It also helps them to avoid feeling burned out by the emotional demands of these children. The classroom staff feel that the Early Childhood Behavioral Specialists have been the greatest addition to the program in years.
This handout from the National Mental Health Association enumerates the differences between a child's physical and emotional needs. It emphasizes how good mental health allows children to think clearly, develop socially, and learn new skills. It provides tips to assist teachers and parents in the value of praise, setting realistic goals, honesty, avoiding sarcastic remarks and the need for encouragement. It also describes the value of play, offer suggestions on guidance and discipline and give some warning signs when a child may need professional assistance or an evaluation. Specific resources and Web sites with further information are given. To read more, click: http://www.nmha.org/infoctr/factsheets/72.cfm.
Proposal for RFA of Child Mental Health Diagnostic Measures
http://www.nimh.nih.gov/council/cncptstover2_501.cfm
This RFA is intended to improve the diagnosis
of mental disorders in children. It will encourage research establishing
the validity of state-of-the-art diagnostic instruments and screening
tools for assessing mental disorder and/or impaired functioning in children
and adolescents. Past work has established the reliability of these diagnostic
tools, but establishing their validity is even more vital in documenting
the prevalence and clustering of specific behaviors, syndromes, disorders,
and areas of functioning.
Proposal for RFA on "Research Units on Pediatric Psychopharmacology
and Psychosocial Interventions (RUPP-PI)"
http://www.nimh.nih.gov/council/cncptnorquist_501.cfm
The network of Research Units on Pediatric
Psychopharmacology (RUPPs) was started in 1996, with subsequent additions
in 1997, for a total of seven units currently active. Research has successfully
focused on short-term efficacy and safety studies of psychotropic medications
commonly used in children and adolescents with mental disorders.
The purpose of this RFA is to provide an opportunity to both existing RUPPs and other qualified institutions to compete for new research units. In addition, the research scope of the RUPP network will be expanded by adding psychosocial treatment research.
A list of organizations/Web sites offering a variety of information on child mental health.
World Association for Infant Mental Health
http://www.waimh.org/
The World Association for Infant Mental Health (WAIMH) is an interdisciplinary and international association that:
Michigan Association for Infant Mental Health
http://mi-aimh.msu.edu/intro/index.html
An affiliate of WAIMH, the Michigan Association for Infant Mental Health offers a variety of resources, including a lending library of videotapes on infant mental health, position papers, and the Infant Mental Health Journal, issued quarterly, which provides an interdisciplinary forum for publication of research findings, literature reviews, clinical techniques and case studies, prevention/intervention research, and book reviews related to the biological, social, emotional, and cognitive development of infants and their families in various ecological contexts.
National Technical Assistance Center for Children's Mental Health
Georgetown University Child Development Center
http://www.georgetown.edu/research/gucdc/
The National Technical Assistance Center
for Children's Mental Health (NTAC) is part of the Georgetown University
Child Development Center. Since 1984, NTAC has been serving as a national
resource center for policy and technical assistance to improve service
delivery and outcomes for children and adolescents with, or at risk of,
serious emotional disturbance and their families. The mission of the Georgetown
TA Center is to assist States and communities in building systems of care
that are child- and family-centered, culturally competent, coordinated
and community-based.
Special areas of emphasis and expertise include system planning, interagency coordination and collaboration across the major child-serving systems, financing, managed care, service development and integration, human resources development, family involvement, cultural competence and early childhood/early intervention.
UCLA/School Mental Health Project
Center for Mental Health in Schools
http://smhp.psych.ucla.edu
Resources available from the Center for
Mental Health in Schools at UCLA include hard copy and on-line resources,
quick find searches, quarterly newsletter and electronic monthly news
update. Web site features include resources materials, technical assistance,
consultation cadre, calendar of events, networking, and continuing education
units.
The National Institute of Mental Health (NIMH) is currently supporting several studies on Childhood Mental Illness. A list is available at: http://www.nimh.nih.gov/studies/index.cfm.
The following intramural studies are taking place on the National Institutes of Health (NIH) campus in Bethesda, Maryland:
NIMH Childhood-onset Schizophrenia Survey
https://silk.nih.gov/SLKSSL/nimh/index.htm
This is an on-line survey form that parents
can complete and submit to NIMH in order to facilitate evaluation of their
child's eligibility for participation in an NIMH study of childhood-onset
schizophrenia/psychotic disorders.
Bright Futures in Practice: Mental Health will be an innovative volume in the Bright Futures in Practice series, providing guidelines on mental health promotion and substance abuse prevention for infants, children, and adolescents. Under the leadership of chair Michael Jellinek, M.D., a multidisciplinary panel of experts will work toward consensus guidelines for mental health promotion and substance abuse prevention as integral parts of child health supervision. Bright Futures in Practice: Mental Health will be published fall 2001.
How will Bright Futures in Practice: Mental Health be used?
Bright Futures in Practice: Mental Health will be used to:
What makes Bright Futures in Practice: Mental Health unique?
How can I learn more about Bright Futures in Practice: Mental Health?
For more information, please contact: National Center for Education in Maternal and Child Health at: brightfutures@ncemch.org.
The National Center for Education in Maternal and Child Health (NCEMCH) maintains MCHLine, an on-line database containing information about publications and other materials in the Mary C. Egan Maternal and Child Health Library at NCEMCH. The Mary C. Egan Maternal and Child Health Library, part of the library system of Georgetown University, contains more than 20,000 volumes on a wide range of maternal and child health (MCH) topics. The complete MCHLine database is available at: http://www.ncemch.org/databases/MCHLineSearch.lasso.
Child Mental Health Bibliography
Adelman, H., & Taylor, L. (1999). Expanding policy leadership
for mental health in schools: Report from the mini-summit. Los Angeles,
CA: Center for Mental Health in Schools, 37 pp.
Contact: Center for Mental Health in Schools, University
of California at Los Angeles Box 951563, Los Angeles, CA 90095-1563; Telephone:
(310) 825-3634; Fax: (310) 206-8716; E-mail: smhp@ucla.edu; Web site:
http://smhp.psych.ucla.edu; Available
at no charge.
This report contains work done prior to and during the meeting, "Expanding Policy Leadership for Mental Health in Schools." The first section discusses key concerns for enhancing a policy focus relevant to mental health in schools. The second section describes recent policy activity with implications for mental health in schools. The third section explores the steps toward an expanded leadership cadre. Appendices list participants and discuss policy academies on systems of care for children at risk of emotional or behavioral disorders and their families, initiatives relevant to mental health in schools, and frameworks for policy analysis. A bibliography is included (funded by the Maternal and Child Health Bureau).
Hernandez, M., & Isaacs, M.R. (Eds.). (1998). Promoting cultural
competence in children's mental health services. Baltimore, MD: Paul
H. Brookes Publishing Company, 370 pp. (Systems of care for children's
mental health).
Contact: Paul H. Brookes Publishing Company, P.O. Box
10624 , Baltimore, MD 21285-0624; Telephone: (800) 638-3775; : (410) 337-9580;
Fax: (410) 337-8539; E-mail: custserv@pbrookes.com;
$32.95 includes shipping and handling. Document number: ISBN 1-55766-287-8.
This book defines cultural competence and outlines strategies for fostering it in a wide variety of mental health programs for children from birth to age 18 and their families. The book contains self-assessment tools, troubleshooting suggestions, planning assistance, methods for recruiting and retaining ethnically diverse staff, and tips on operating in a managed care environment. Section 1 focuses on the need to develop organizational infrastructures that support and further cultural competence. Section 2 reviews methods for incorporating cultural competence principles at the local community level. Section 3 is focused on special issues related to serving culturally diverse populations. Section 4 highlights the need to continue to research and evaluate the development of culturally competent services and systems. Advice on the impact of exposure to violence, substance abuse, and stress in immigrant and refugee populations is included.
Isaacs, M.R. (1998). Towards a culturally competent system of care,
Volume III: The state of the States: Responses to cultural competence
and diversity in child mental health. Washington, DC: National Technical
Assistance Center for Children's Mental Health, Center for Child Health
and Mental Health Policy, Georgetown University Child Development Center,
105 pp.
Contact: Mary Deacon, National Technical Assistance Center
for Children's Mental Health, 3307 M Street, N.W., Suite 401, Washington,
DC 20007-3935; Telephone: (202) 687-5000; Fax: (202) 687-1954; E-mail:
gucdc@gunet.georgetown.edu;
Web site: http://www.georgetown.edu/research/gucdc/cassp.html;
Price unknown.
This volume provides an overview of the status of cultural competence development and implementation within State and local child mental health systems over the period from 1991 to 1995. It reviews the types of activities and tasks that have been undertaken by State mental health agencies in order to address Federal funding mandates in the area of cultural competence, shifting demographics, and increasing concerns for more efficient and effective services from State legislators and taxpayers. The volume also attempts to address shifts that States have made within their policy and administrative structures, as well as those changes related to service delivery goals and outcomes.
Judge David L. Bazelon Center for Mental Health Law. (1999). Where
to turn: Confusion in Medicaid policies on screening children for mental
health needs. Washington, DC: Judge David L. Bazelon Center for Mental
Health Law, 18 pp.
Contact: Judge David L. Bazelon Center for Mental Health
Law, 1101 15th Street, N.W., Suite 1212, Washington, DC 20005-5002; Telephone:
(202) 467-5730; TDD: (202) 467-4232; Fax: (202) 223-0409; E-mail: hn1660@handsnet.org;
$12.90 plus shipping and handling. Document number: CM-2.
This report summarizes a study reviewing the policies in 29 States for screening of Medicaid-eligible children to determine whether they need mental health services. The report includes sections about EPSDT screening requirements, managed care and screening responsibilities, study findings, the effect of screening policies, policy implications and recommendations, family information, and the EPSDT treatment mandate. A table showing managed care responsibilities for screening State-by-State is included at the end.
Mental Health Foundation. (1999). Bright Futures: Promoting children
and young people's mental health. London, England: Mental Health
Foundation, 152 pp.
Contact: Mental Health Foundation, 20/21 Cornwall Terrace,
London, England NW1 4QL; Telephone: 0171-535-7400; E-mail: mhf@mentalhealth.org.uk;
Web site: http://www.mentalhealth.org.uk;
10 English pounds plus postage. Document number: ISBN 0-901944-66-1.
This report is about the mental and emotional well-being of children and young people in England, and makes the case that mental health, in its broadest sense, is a subject that needs wider recognition and more attention. The report includes sections about children's mental health, early intervention, mental health services for children and young people, and a look to the future.
Rogers, S. (1999). Do school-based mental health services make sense?
Washington, DC: Georgetown Public Policy Institute; Arlington, VA: National
Center for Education in Maternal and Child Health, 28 pp. (DC Family Policy
Seminar background briefing report).
Contact: Librarian, National Center for Education in
Maternal and Child Health, 2000 15th Street, North, Suite 701, Arlington,
VA 22201-2617; Telephone: (703) 524-7802; Fax: (703) 524-9335; E-mail:
info@ncemch.org; Web site: http://www.ncemch.org;
Available from the Web site at no charge.
This report summarizes the DC Family Policy Seminar on school-based mental health services. It discusses the costs of failing to detect and treat mental illness, factors to consider in program implementation, and several model programs that may assist District of Columbia officials and service providers if they choose to create additional school based programs. Appendices list local and national resources (funded by the Maternal and Child Health Bureau).
U.S. Center for Mental Health Services, Outcomes Roundtable for Children
and Families. (1998). Fitting the pieces together: Building outcome
accountability in child mental health and child welfare systems.
[Rockville, MD]: Outcomes Roundtable for Children and Families, U.S. Center
for Mental Health Services, 90 pp.
Contact: U.S. Center for Mental Health Services, Outcomes
Roundtable for Children and Families, 5600 Fishers Lane, Room 9-210, Rockville,
MD 20857; E-mail: info@samhsa.gov;
Web site: http://www.samhsa.gov; Price
unknown.
Links to complete publications on child mental health topics.
National Congress for Hispanic Mental Health—Proceedings
http://www.mentalhealth.org/cmhs/SpecialPopulations/HispMHCongress2000/proceedingsch3.htm
Relationships,
Resiliency and Readiness: Building a System of Early Care and Education
Mental Health Services: Conference Proceedings, April 2000
This publication is available through the
Web site of the National Resource Center for Health and Safety in Child
Care. It is found under the heading "Mental Health" at the following
location: http://nrc.uchsc.edu/RESOURCES/list.htm#M.
What are the Warning Signs of Mental Illness?
Available on the Web site of the American Psychiatric Association at the following location: http://www.psych.org/public_info/warnings.cfm.
The Role of Mental Health Professionals—How Child Abuse And Neglect Is Defined
Available on the Web site of the National Clearinghouse on Child Abuse and Neglect Information at the following location: http://nccanch.acf.hhs.gov/pubs/usermanuals/menthlth/menthlthd.cfm.
If you have a favorite mental health Web site that you would like us to consider including in the Head Start Mental Health Toolkit, please send it to us at: nanettel@headstartinfo.org.
For comments or questions or to subscribe, please contact us at: nanettel@headstartinfo.org.
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