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PowerPoint Presentation
Presenters:Deana Buck, Program Group LeaderPartnership for People with Disabilities, VCU
Ashley Everette, Early Childhood Mental Health ConsultantChildSavers
Mickie McInnisInclude Me, Early Childhood Program Consultant
Kathleen Lynch, Senior Research AssociatePartnership for People with Disabilities, VCU
Background and Need for ProjectProject Hugs one of 6 Social-Emotional Pilot projects funded by VDSSAdministered by ChildSaversOverall goals:Improve child care provider access to resourcesIncreate capacity and competence of child care providers to address social, emotional, and behavioral needs of infants and toddlers
Background and Need for ProjectCaregivers of infants and toddlers wanted training and support Some infants and toddlers needed support to address challenging behaviors and mental health needsAgencies/providers had history of collaboration ChildSaversUnited Way of Greater Richmond and PetersburgPartnership for People with DisabilitiesCity of Richmond, EC InitiativeEarly Childhood Mental Health ConsultationAshley Everette, M.A.Early Childhood Mental Health ConsultantChildSavers6The Case for Mental Health Consultation in Early Childhood Settings Young children are being expelled from child care at 3 times the rate of children expelled from K-12. (Gilliam, 2005)
Child care providers continue to list coping with challenging behaviors as their number one need for additional training and support (Center for Evidence-Based Practices, 2005).
Greater Richmond Area In the greater Richmond area, few services existed to support the mental health of infants and toddlers.2010 needs assessment indicated that approximately 20-25% of child care programs responding had children ages birth to 3 who left care because of difficult behaviors .
When Kindergarten teachers report that children are not entering school ready to learn, they are most often referring to deficits in social and emotional skills.
Assistance with childrens challenging behaviors is he greatest need identified by preschool educators, who often have had little training in behavior management or ways to promote social and emotional competence.
This lack of knowledge and skills is idenfied as the greatest challenge to effective practice. 7What is Early Childhood Mental Health Consultation? Problem-solving and capacity-building intervention implemented within early childhood settings.Collaborative and reflective relationship with ECE staff and family members. Promotes social and emotional development and seeks to reduce challenging behaviors Relationship basedAlways supporting the adult-child relationships vs. focusing solely on the child
Early Childhood Mental Health Consultation has become a common approach to delivering mental health services and supports for young children, families, and child care providers.
A problem-solving and capacity-building intervention implemented within a collaborative relationship between a professional consultant with mental health expertise and one or more caregivers, typically an early care and education provider and/or family member. Early childhood mental health consultation aims to build the capacity of staff, families, programs, and systems to prevent, identify, treat and reduce the impact of mental health problems among children from birth to age 6 and their families.
The consultant works with family and caregivers, strengthening their capacity to reflect, problem solve, and change practices that will help them be effective in their roles.
Consultation begins with developing positive relationships with staff by BEING empathetic, respectful, reflective, consistent, and a good listener.
Assumptions: All learning takes place in the context of relationships and is strongly impacted by the quality of these relationshipsAll behavior has meaning.
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Help Us Grow Strong (HUGS) Early Childhood Mental Health Consultation 2010 Project Implementation
ChildSavers served as lead agency2 Mental health consultants (MHC) hired with Masters level degrees in mental health related field.Contracted Doug Davies, LCSW, Project HUGS expert consultant on early ECMHC
Service Implementation: Children 0-36 months exhibiting behavioral concerns in early child care settings; Free consultation services to ECE providers and parents/caregivers. Child care centers and home-based setting located in Richmond City and designated zip codes within Henrico and Chesterfield County.
ChildSavers mission is to provide comprehensive mental health and early childhood development services that holistically embrace the needs of children and those who care for and educate them.
9MH Consultant Training and Support Specialized training in Infant Mental HealthDr. Doug Davies, Project HUGS expert consultant on early ECMHC Quarterly Onsite visits and training, and monthly phone consultations .Specialized training in Infant mental health made available to other Richmond area clinicians, specialists, and mentors.
Ongoing support Weekly Clinical Supervision Training included: Cultivate the consultative stance Consultative process Early childhood development from a transactional approach Adapting clinical interventions to serve consultative role
10HUGS GoalsTo build the capacity of families and ECE staff to successfully nurture the social-emotional development of all children in their care, including those exhibiting challenging behaviors, to prevent expulsion as well as prevent, identify, and reduce the impact of mental health problems among children and their families.
HUGS Approach to Service Delivery Embrace values that support relationship-building and high-quality service provision: CollaborativeFamily-CenteredCulturally Competent Strengths-based
Individualize services/strategies
Promote consistency across home and classroom settings
Utilize hands-on, practical materials
12Service Array Child-Focused ConsultationFocuses on a particular child with challenging behavior.
Program Consultation Focuses on enhancing the overall quality of an ECE program and/or assist the program in solving a specific issue that affects the mental health of more than one child, staff member, and/or family.
Providing both types of consultation helps to ensure that services address the mental health needs of all children in an ECE program.
HUGS Consultation Process Referral and Intake Observation and Assessment Meetings with team to develop Behavior Support Plan Support to family and child care providers to implement plan Referrals to outside services as neededConclusion of services
*On average, services are provided for 3-6 months depending on the needs of the child and caregivers. The frequency of visits decreases as progress is noted.Referral & Intake
Who can refer children to HUGS ?Child care providersParents/GuardiansCommunity agencies ChildSavers Early Intervention VSQI Star Mentors
Intake Process Child must meet age and locality requirements Parental/Guardian consent formParental Rights and Responsibilities Child care center must sign Partnership Agreement
Why are children referred for HUGS Services? Children are referred for many reasons but most often for: AggressionImpulsivity Non-compliance Defiance Tantrums 76% of referrals are boys Destruction of property Developmental Concerns Communication challenges
Observation and Assessment Goal: Understand what the child is trying to communicate and to identify possible underlying reasons for challenging behavior Information Gathering & Data CollectionInterviews with family and child care staff Classroom observations Home observations Functional assessments
Standardized screening &Assessment tools: ASQ-3 & ASQ: SEDECA
Running record form of observation: Important qualities being: Accuracy ( occuring across a variety of days and weeks, routines and settings), Objectivity, Completeness (includes antecedencts, the behavior itself and then consequences of the behavior). 17Assessment : Areas of Exploration Childs experience with comfort trust, and interest in connect Level of Developmental Mastery What are the childs areas of strengths? What developmental tasks challenge her? AttentionCommunication Emotional Regulation, self-soothing Impulse Control and Problem Solving Flexibility
Experience of Comfort, Trust, and Interest in Connection
How does this child relate to/connect with others? Is he comfortable, trusting, and relaxed in hisrelationships?
Does he experience trust and safety in connection?Does he have a basic comfort level in engaging with others and an ease with the back andforth of relational exchange?Does he show interest in and empathy for others?Does he turn to others when he needs help or comfort?
Level of Basic Developmental Mastery
What are this childs areas of strength? What developmental tasks challenge her?
ATTENTION: Does she show a growing ability to harness and sustain attention?COMMUNICATION: Does she have a facility for and comfort in communicating taking in, processing, and relaying information, both verbally and non-verbally?BODY STATE REGULATION: Does she show an increasing ability to tolerate andmanage a range of sensory experience? Can she modulate her energy in a way that seemsappropriate for her age to shift from one level of energy to another and then to remainthere comfortably for a period of time?EMOTIONAL REGULATION AND SELF-SOOTHING: Does she show a growingability to regulate feelings, to manage frustration, and to calm down after an upset?IMPULSE CONTROL AND PROBLEM-SOLVING: Is she showing an increasing abilityto control her impulses? Can she find ways to engage in problem-solving rather thanremain unhappily stuck in a set of difficult, painful feelings when things aren't going theway she'd like them to?FLEXIBILITY AND TRACK-CHANGING: Does she show an increasing ability to beflexible, to share space and ideas, and to shift agendas when the situation requires her todo so?
Level of Basic Developmental Mastery
What are this childs areas of strength? What developmental tasks challenge her?
ATTENTION: Does she show a growing ability to harness and sustain attention?COMMUNICATION: Does she have a facility for and comfort in communicating taking in, processing, and relaying information, both verbally and non-verbally?BODY STATE REGULATION: Does she show an increasing ability to tolerate andmanage a range of sensory experience? Can she modulate her energy in a way that seemsappropriate for her age to shift from one level of energy to another and then to remainthere comfortably for a period of time?EMOTIONAL REGULATION AND SELF-SOOTHING: Does she show a growingability to regulate feelings, to manage frustration, and to calm down after an upset?IMPULSE CONTROL AND PROBLEM-SOLVING: Is she showing an increasing abilityto control her impulses? Can she find ways to engage in problem-solving rather thanremain unhappily stuck in a set of difficult, painful feelings when things aren't going theway she'd like them to?FLEXIBILITY AND TRACK-CHANGING: Does she show an increasing ability to beflexible, to share space and ideas, and to shift agendas when the situation requires her todo so?
18Areas of Exploration, Cont. Constitutional Factors Temperament Language and Information ProcessingRelational History Family FunctioningCultural Factors at home and school Significant HistoryTrauma, Adoption, Attachment styles
Sleeping, Eating, Toileting behaviors Gross and Fine motor Control Trigger for Problematic Behavior Early Care and Education Environment Programmatic issues
Relational History: How does the child connect with others? How do others feels when they connect with her?19Behavior Support Plan and Support Collaborative process Reflect on information gathered to created sound strategies that support child at home and school. Goal Development Agreed upon strategies to be implemented at home and school Support Weekly-Biweekly support provided to family and providers until goals are met. At the end of a BSP meeting MHC makes it clear:-It will take time for the strategies identified in the plan to work. There are no instant fixes - The plan is a flexible document and may need to be revised more than once, Until we get it right -The challenging behavior may get worse before it gets better -Continuity and consistency are key elements in implementing the BSP. 20What Strategies do Consultants help caregivers to Use? Affect Regulation StrategiesTucker the Turtle Technique Sensory activities as soothers Sand table, water play, play dough, Relaxation in a bottle stress ballsUse books to discuss feelings Calm down basket Yoga and Relaxation techniques deep breathing , blowing bubbles & Pinwheels
Stress Balls
Calm Down Basket Strategies
Safe Place or Cozy area
Scripted Stories
Individualized Visual supports Problem Solving ModelingScripted Stories Puppets Individualizing VisualsPositive Guidance-Feedback Environmental Supports Calming places and spaces: Safe place, Pillow house, Cozy area, peaceful cornerUtilizing feeling charts Building Emotional literacy- Naming , acknowledging, and validating feelings
DIY Sensory Toys
Water Beads
HUGS Accomplishments Since, April 2010: 62 infants, toddlers, and preschoolers have received individual services 71 families of young children received consultation services160 early childhood providers received specialized early childhood consultation supports. 30 child care centers received consultation services on individual children
*Only 1 child has been expelled due to behavior Lessons Learned Implement a strong service initiation process Clarifying expectations Need for ECMHC services for children 3-5years.Services were most effective when families actively participated in services. ChildSavers Early Childhood Mental Health Consultation Model 2012ChildSavers, Richmond, VA, committed to maintaining ECMHC services. Provide child-centered mental health consultation Expanded catchment area: Richmond City, all of Henrico and Chesterfield County Expanded age range: 0-5years Family Involvement is a requirement Written agreements between HUGS and child care center or home provider ECMHC Partnership Agreement
CSEFEL Training and MentoringMickie McInnisEarly Childhood Program ConsultantPartnership for People with DisabilitiesVirginia Commonwealth University27CESFEL TrainingSchedule & Participant SelectionModules 1, 2Participant IncentivesModule 3
CESFEL Program MentoringResources and Plan (See Handout)Training
CESFEL Training and MentoringLessons Learned
Project EvaluationKathleen Bodisch LynchPartnership for People with DisabilitiesVirginia Commonwealth UniversityThe evaluation for Project HUGS was provided through a contract with the Partnership for People with Disabilities at Virginia Commonwealth University.31Project HUGS Intended OutcomesImprovedAccess
Project HUGS activities were guided by two high-level intended outcomes. The first high-level outcome was to improve access of child care providers to community resources to support the healthy social, emotional, and behavioral development of infants and toddlers.32Project HUGS Intended OutcomesIncreasedCapacity
The second high level outcome was to increase the capacity of child care providers to recognize and address the social-emotional and behavioral development of infants and toddlers.
The evaluation methods that were used were geared towards gathering evidence of the extent to which the activities conducted by project staff and partners resulted in these two intended outcomes.33Project HUGS Wiki
Since this was a collaborative project, with several community partners, we created an online space that was a central repository for all project documents, such as the work plan, logic model, and resources about infant/toddler mental health. This was a private work space accessible only to the project staff and partners.
Partners were asked to report their progress towards accomplishing tasks they had agreed to be responsible for, through an online Monthly Reporting Form, which they accessed by clicking on the green button.34Evaluation Results Outcome 1: Improved access of child care providers to community resourcesWe do not have time to report the results of all of the evaluation activities that were completed. I will focus on some of the highlights.
Outcome 1 centered on increasing child care providers access to community resources by expanding the network of professionals with the knowledge and skills available to support child care providers when they needed help dealing with children who had social-emotional developmental issues.
35Strengthening Existing ResourcesProject HUGS strengthened existing resources by providing professional development to 21 existing infant/toddler mental health professionals. An expert in early childhood mental health consultation provided the training and support.
Through follow-up evaluations, these early childhood professionals reported that they gained knowledge and skills related to supporting childrens social-emotional development, applied what they learned on the job, and shared what they learned with others.36Greater Access to Resources
ECMHC ConsultationWith their awareness of infant/toddler mental health issues raised, these trained early childhood specialists made referrals to Project HUGS for mental health consultation services (12 respondents made 22 referrals).37Mental Health Clinicians GroupMH Clinicians Ratings of Increased KnowledgeSustainability:Subcommittee of Statewide Infant/Toddler MH Endorsement CommitteeAnother activity designed to improve access to resources involved working with existing mental health clinicians in the region.
The goal was to identify 5 mental health clinicians from the Richmond metropolitan area who would make a commitment to increase their knowledge of specialized infant and toddler mental health, to increase local capacity to provide such services to the community; 15 clinicians agreed, participated in monthly meetings, and a 3-day training on Why Diagnose Young Children.
In rating the effectiveness of the training, the MH clinicians agreed or strongly agreed that they had accomplished their learning objectives 97% of the time. They reported they made gains in awareness, knowledge, and understanding of the assessment and diagnosis process for infants and toddlers.
This component of the project has been maintained after the end of project funding because it has been established as a subcommittee of the statewide Infant/Toddler Mental Health Endorsement Committee.38Evaluation Results Outcome 2: Increased capacity of child care providers to recognize and address the social-emotional and behavioral development of infants and toddlersMajor activities related to this outcome included providing training and mentoring on social/emotional development and assessment, as well as onsite and telephone early childhood mental health consultation services and support to child care providers at centers and family day homes, as described by Ashley and Mickie.39Consultation to Child Care CentersPositive Feedback
98%41 individuals provided evaluations; this included 25 teachers and other child care providers, 14 Center directors, and 2 home providers. There was a high degree of consistency across all the evaluations received, with 96% of ratings across 9 items and all respondents being positive, and 98% of the respondents (all but one) saying they would recommend ECMHC services to others.
Providers said they received useful information; helpful, practical recommendations; gained knowledge about child development and a better understanding of what children need from a child care program.40~ In Their Own Words ~I learned a great deal of information, and our student has shown GREAT improvement, and this program was extremely helpful to the parent.
41Consultation to Child Care CentersChild Outcomes
90%90% of those receiving ECMHC services reported that the consultation helped them keep the child who was having difficulty in their programs.42Consultation to Child Care CentersRelationships with Families
83%83% of recipients of ECMHC services said the consultation helped them in their relationship with the childs family (even though that was not the primary purpose of the consultation).43Consultation to ParentsOutcomes
100%Satisfaction surveys were mailed out to all families whose children received services through Project HUGS. Surveys were anonymous, and 14 were returned. 100% of the families who returned surveys reported that ECMHC services helped their child, helped the family members better understand their childs behavior, and made them feel supported.44~ In Their Own Words ~I was not sure [my children] needed a mental health person, but I think we all did....HUGS also is now helping me look at what child care should beso I can keep [my children] safe and smart.
45CSEFEL Training
As Mickie described earlier, a series of eight sessions of training on CSEFEL Modules 1, 2, & 3 were offered to community-based child care providers from centers and family day homes in the Project HUGS targeted service area. 46CSEFEL Training
100%Positive FeedbackAcross 8 sessions of CSEFEL training, 282 evaluations were completed by child care providers, center directors, family day care providers, and other child care professionals, with a 100% return rate. Of these, 100% of participants said both that they had learned new information about childrens social-emotional development, and that the information would be useful to them in their jobs. 47~ In Their Own Words ~I have lots of up-and-coming 2 year olds that tantrum out...I plan on using new techniques to calm and make children understand.
48CSEFEL MentoringOutcomes
100%14 child care providers who had completed CSEFEL training received 3 hours of onsite, individualized mentoring services. 100% reported that mentoring helped them learn more about how to support childrens social-emotional development, that they were given ideas for ways to improve the classroom environment, and that they would recommend mentoring to other child care providers. The child care providers reported that having the mentor come into their program and work with them on improving the classroom environment, such as helping them to create and set up centers, was particularly valuable. Providers also commented that they learned how to listen to children more and communicate with them better.49~ In Their Own Words ~I was shown a way to get my kids more involved by having fun along with learning; how to help them to socialize; how to listen to them more.
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Contact InformationDeana [email protected] [email protected] [email protected] [email protected]
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