socioemotionalweek 8

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Sc-e Deee E Cdd

What Every Policymaker Should Know

Janice L. Cooper August 2009Rachel Masi

Jessica Vick


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National Center for Children in Poverty Social-emotional Development in Early Childhood 3

Sc-e Deee E CddWhat Every Policymaker Should Know

Janic L. Cpr | Racl Mai | Jica Vic At 2009

Te early years o lie present a unique opportunityto lay the oundation or healthy development. It isa time o great growth and o vulnerability. Researchon early childhood has underscored the impact othe rst ve years o a childs lie on his/her social-emotional development. Negative early experiencescan impair childrens mental health and eect theircognitive, behavioral, social-emotional development.2

The infant is embedded in relationships

with others who provide the nutrition for

both physical and psychological growth.1

te needs f yug Cde

__________

* Young children are dened as birth through age 5 or the purpose o this brie unless otherwise noted.

Social-emotional problems among youngchildren* are common.

Between 9.5 and 14.2 percent o children betweenbirth and ve years old experience social-emotional problems that negatively impact theirunctioning, development and school-readiness.3

Approximately 9 percent o children who receivespecialty mental health services in the UnitedStates are younger than 6 years old.4

Boys show a greater prevalence o behavior prob-lems than girls.5

Some young children have more severe mentalhealth disorders.6

Mntal halth dsods n young chldn

Dsod Pvalnc

Anxiety Disorders 1 to 11%

Simple Phobias 1 to 11%

Oppositional Defant Disorder 1 to 26%

Conduct Disorder 1 to 5%

Attention Defcit/Hyperactivity Disorder 1 to 7%

Prevalence rates of behavioral problems in pediatricprimary care sample of preschool children by ageand by gender (N=3,860)

0 3 6 9 12 15

5 years

4 years

3 years

2 years

Age

0 3 6 9 12 15

Girls

Boys

Gender

10.0%

13.2%

7.3%

4.7%

6.6%

10.0%

Source: Lavigne, J.; Gibbons, R.; Christofel, K. K.; Arend, R.; Rosenbaum, D.; Binns, H. et al. 1996.Prevalence Rates and Correlates of Psychiatric Disorders among Preschool Children.Journal of theAmerican Academy of Child and Adolescent Psychiatry35: 204-214.


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F d Ee rsk Fcs

Specic amily and environmental actorscan make a child more vulnerable to social,emotional and behavioral problems.

Neighborhood characteristics and amily incomecan be risk actors that impact young childrenssocial-emotional health and development.

Young children in low-income neighborhoodsare more likely to experience behavioral prob-lems than children living in moderate or auentneighborhoods.7

Young children rom households with lower levelso amily income are more likely to experiencebehavioral problems that negatively impact their

development.8

Research suggests that up to 50 percent o theimpact o income on childrens development can bemediated by interventions that target parenting.9

Parents and caregivers play an important rolein supporting childrens healthy development.Research shows that amily risk actors, particularlymaternal risk actors such as substance use, mentalhealth conditions and domestic violence exposure,can impact parents ability to support childrens

development, and may contribute to behavioralproblems among young children as early as age 3.10

Young children with these amily risks actorshave been ound to be two to three times morelikely than children without these amily riskactors to experience problems with aggression(19% vs. 7%) anxiety and depression (27% vs. 9%)and hyperactivity (19% vs. 7%).11

Attachment is an important marker or social-emotional development. Poor attachment, especiallymaternal attachment, can negatively impact chil-drens social-emotional health, and development.

Almost two-hs o two-year-olds in early careand learning settings had insecure attachmentrelationships with their mothers. In particular,research shows that Arican-American and Latinoyoung children experience lower levels o secureattachment than Asian-American and Whitechildren.12

Children o parents with mental illness are at agreater risk or psychosocial problems.

More than two-thirds o adults with mental illnessare parents.13

Between 30 and 50 percent o children withparents who are mentally ill have a psychiatricdiagnosis, compared to 20 percent o children inthe general population.14

Children o parents with a mental illness may alsoshow higher rates o diculties with regulatingtheir emotions, relationship problems and devel-opmental delays.15

Even the mental health problems o non-relativecaregivers aect the quality o childrens early expe-riences in their care.

Adults who work in childcare centers have higherrates o depression than ound in the general popu-lation.16 Caregivers who report depressive symp-toms are more likely to be detached, insensitiveand interact less with children in their care thannon-amilial caregivers who are not depressed.17


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te re f Fse Ce d Cd Wefe

Young children in child welare settings havegreater need and are less likely to receiveservices.

Tirty-eight percent o children in oster careare younger than age 6.18 Children, ages two- tove-years-old, in child welare (including thosein oster care) have a greater proportion o social,

emotional, and behavioral problems than childrenin the general population, and within child welare,compared to older children, young children are lesslikely to receive mental health services.19

One-third o children ages 2 to 5 in childwelare need mental health services and relatedinterventions.20

rce d Ec me

Young children o color are more likely toexperience key risk actors.

Young children o color are more likely to experi-ence actors that put them at risk or poor social,emotional, and behavioral development. Tese chil-dren are also over-represented in child welare, andmake up the largest proportion o children expelledrom preschool and in specialty mental health care.

Among young children victimized in 2007, 49percent were children o color (Arican-American 21%, Latino 22%, Asian-Pacic Islanders 1%,Multi-racial 3% and American Indian/AlaskaNatives 1%).21

Arican-Americans are overrepresented in thepopulation o maltreated children age 0 to 5(21% vs. 14% in the general population).22

Forty percent o the preschoolers in specialtymental health services are children o color

(Arican-American 24.8% and Latino 13.6%).

23

In early care and learning settings, Arican-American young children are between three andve times more likely to be expelled than theirpeers.24

Arican-American children are 8.5 times morelikely to have a parent incarcerated than whitechildren (overall nearly 25 percent o childrenunder age 5 had an incarcerated parent).25

Percentage of children in foster care by age, FY 2006

0 5,000 10,000 15,000 20,000 25,000 30,000 35,000

6 years

5 years

4 years

3 years

2 years

1 year

Less than1 year

Age

Source: Childrens Bureau, Administration on Children, Youth and Families, Administration for Children and Families, U.S. Department of Health and Human Services.2008. Adoption and Foster Care Analysis and Reporting System. Ithaca, NY: Cornell University, National Data Archive on Child Abuse and Neglect.

14 years to

20 years of age35%

7 years to13 years of age

29%

Less than 1 year

to 6 years of age38%

Children under 6 in foster care, FY 2006

21,574

23,021

24,384

26,966

30,367

34,344

30,418


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te Fue f Cue Sece Dee d Su Sses

Despite research that supports identication, earlyintervention and treatment, many young childrendo not receive screening, services, or supports.

Inadequate screening prevents recognition osocial, emotional, and behavioral problems.

Less than one percent o young children withemotional behavioral problems are identied.26

Nearly 55 percent o amily practitioners andpediatricians report that they did not use a stan-dardized tool to screen or developmental delaysduring routine well-child visits or two-yearolds.27

Nearly two to three times more preschool agechildren exhibit symptoms o trauma-relatedimpairment than are diagnosed.28

Only 11 percent o young children who receiveservices and supports under Individuals withDisabilities Act (IDEA) Part B are 3 to 5 yearsold.29 O those, only one to three percent arechildren with emotional disturbance. By age nine,however, the proportion o children as receivingservices or emotional disturbance increasessignicantly (5-15%).30

Only our percent o young children receivingearly intervention (EI) services through IDEAPart C are identied as having social-emotionalproblems by EI providers. Yet, parents o up to 25percent o children receiving EI services reportedthat their children were over anxious, hyperactive,exhibited signs o depression and/or problemswith social interactions.31

More than 30 percent o parents o childrenreceiving EI services report problems managingtheir childrens behaviors.32

Lack o access to treatment

Studies show that many young children with identi-ed needs and their parents do not receive services.

Between 80 and 97 percent o children ages 3 to5 with identied behavioral health needs did notreceive services.33

Even in structured early learning settings such asHead Start 80 percent o parents needing mentalhealth services did not receive them.34

More vulnerable young children in child welareace obstacles accessing services.

Children ages birth to ve in child welare are

more likely to have developmental delays thanschool-aged children despite higher rates o devel-opmental delays. 35

Compared to school-age children, young chil-dren in child welare (0-5 years) are less likelyto receive services (35% vs. 13%). Very youngchildren (0 to 2 years) are the least likely group toreceive developmental services.36

Children ages 6 to 10 years old were our timesmore likely to access developmental services thanchildren birth to two years old.37


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pcce Bes Due medcd d oe Se pces

Te policy and practice environments oryoung children oen ail to incorporateevidence rom research about efectivestrategies.

Despite research that validates the importance oscreening:

orty percent o state Medicaid agencies do notpermit reimbursement or the use o standardizedscreening tools to identiy emotional behavioralproblems in very young children;38

only 11 percent o pediatricians and eight percento amily practitioners report that reimbursementor developmental screenings during well-child

visits was sucient. When reimbursement is avail-able, it rarely covers the cost o screening;39 and

eighty percent o primary care physicians and 96percent o pediatricians do not ormally screen ormaternal depression, in spite o its proven impacton caring or young children.40

Even proven programs like Early Periodic ScreeningDiagnostic and reatment (EPSD) and the EarlyIntervention Program or Inants and oddlerswith Disabilities o Te Individuals with DisabilitiesEducation Act (IDEA-Part C) with the core philos-ophy o timely screenings and treatment or youngchildren have been inadequate, plagued by meagerresources and weak enorcement. Specically:

y-ve percent o states recommend or requirebehavioral health screening tools or compo-nents in their EPSD programs, but in only 33percent o these states were these screening toolsstandardized;41

only 10 states meet the national benchmark that80 percent o children on Medicaid receive an

annual health screening under EPSD;42

andewer than 15 percent o state Medicaid agen-

cies reimburse pediatricians or screening ormaternal depression.43

Barriers for Parents with Mental Illness

Few state mental health authorities (SMHAs) reportpolicies that improve systems ability to identiy

adults with mental illness as parents and provide thetypes o supports they need to enhance parentingskills.44 Specically, o SMHAs reporting on adultswith mental illness served in their systems:45

only 23 percent report that they routinely iden-tiy them as parents;

only 21 percent report that they ormally assesstheir parenting skills; and

only 23 percent report that they provideservices and supports that also ocus on theirparenting skills.

Barriers to Treatment by Medicaid andOther Policies

Tirty-one percent o state Medicaid agenciesdo not permit reimbursement or some types otreatment o children at-risk or social-emotionaldelay.46

Forty-our percent o state Medicaid agenciesdo not permit reimbursement or non-physicianproviders with early childhood expertise.47

Seventy-two percent o state Medicaid agenciesreport that they permit reimbursement or treat-ment o maternal depression only i the motheris Medicaid eligible, regardless o the childsMedicaid eligibility.48

Only our states use the Diagnostic Classicationo Mental Health and Development Disorders oInancy and Early Childhood (DC:0-3R), a clas-sication o mental health and related disorders inchildren birth to age 3, with Medicaid support.49

Only hal o state Medicaid agencies permit treat-

ment reimbursement without diagnosis or youngchildren.50

Only eight states include at-risk children in thedenition o eligibility or IDEA Part C.51

wenty-seven states have no written policies toguide reerrals or inants and children who areat-risk in terms o social-emotional develop-ment, but not eligible or Part C.52


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Fewer than hal o the states report undingspecic early childhood related services. See tablebelow.53

Num o stats undng aly chldhood svcsy svc typ

Svc typ Num o stats

Mental health services 22

Screening 18

Mental health consultation 15

Treatment 21

Family treatment 19

Parent depression 8

Practice barriers are caused by stigma andlack o knowledge.

Parents o children with social, emotional andbehavioral problems were less likely to discussthese problems with a health care proessionalthan parents o children with other developmentalproblems (20% vs. 80%).54

When these parents did report problems totheir health care providers, they were still lesslikely to access needed services than parents ochildren with other developmental problems(38% vs. 91%).55

Practice barriers are caused by low providercondence and competency.

Many primary care physicians report that theylack the condence to manage children identiedwith developmental delay (29 percent o pediatri-cians and 54 percent o amily practitioners).56

Currently access to services that lead topositive outcomes or young children arehampered by multiple actors.

Diagnosis-ocused eligibility criteria ignore theresearch on the strong association between riskand poor child outcomes.

Decision-makers ignore the importance o assessingchildrens development within the context o theirhome and early care and learning environments.

Eligibility criteria or assessing developmentaldelays currently miss many children at risk oremotional problems.

rained providers are oen unavailable.

Tere are restrictions on unding services indiverse service settings, and amily ocused strate-gies are lacking.

Children with greatest needs may be stigmatized.

Serviceslack amily, developmentally appropriateand culturally competent ocus.

te adese ic f Ue needs yug Cde

Early childhood problems can impair earlyschool success.

Young children with multiple risk actors aremore likely to are poorly in achieving bench-marks or early school success.57

Expulsion rates or young children in preschoolare three times higher than children and youth inK-12 grade.58

Among young children, 4-year-olds expulsionrates were 50 percent greater than or three yearolds.59

Boys were our times more likely to be expelledthan girls.60

Early childhood problems can afectadolescent behavior and mental health.

Behavioral problems among young children areoen predictive o later conduct problems, anti-social behaviors, delinquency and serious mental

health problems.61


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receds f pckes

Policy action is needed to improve the social-emotional development and mental health or

young children and their amilies.

Promote quality child care settings that supportsocial-emotional development and the mentalhealth o young children. Preschools with accessto mental health consultation have lower expul-sion rates.62

Prevent severe emotional and behavioralproblems among young children by using childor amily risk-actors to determine service/supports eligibility and access. Begin byensuring that young children who are at-risk areeligible or IDEA-Part C.

Address the lack o trained providers in health,mental health and early care and educationsettings.

Pediatricians and other providers trained inidentication and management o emotionaland behavior problems were more likely toaccurately identiy young children with behav-ioral problems.63

Brie primary care provider training thatocused on communication skills, amilyengagement and child behavior and develop-

ment was associated with reduction in parentalsymptoms and increases in child unctioningamong Latino and Arican-American children.64

raining programs ocused on the helpingteachers to promote childrens positive social-emotional competence are associated with chil-drens increased social skills and a reduction inproblem behaviors.65

Require the use o standardized tools whenscreening young children and their parents. Astate that required the use o a standardized devel-

opmental tool improved screening rates by over50 percent.66

Implement the use o the DC-03R as a toolor reimbursement or screening and servicesor Medicaid and other third-party payers.Communities and states that use developmentally

appropriate diagnostic classication tools like theDC-03R provide appropriate scal supports orearly childhood social-emotional development-related interventions.67

Support and und the use o developmentallyappropriate screening and assessment o very

young children. Comprehensive assessmentswere associated with signicant increases in thenumber o young children identied and appro-priately served.68

Require and und the consistent and appro-

priate application o efective interventionstrategies or young children and their amilies.Use o empirically supported interventions led topositive social, emotional and behavioral healthoutcomes or young children and their amilies.69

Establish and put into practice policies toidentiy parents with mental illness who have

young children, and provide parenting supportsand treatment as needed. Screening or parentaldepression can help reduce its negative impact onyoung children.70

Ensure that home visiting programs can addressthe needs o children and their amilies withsocial-emotional and behavioral problems. Aneective home visiting program that embeds anevidence-based intervention or parents withdepression has demonstrated improved outcomesor children and their parents.71

Create mechanisms, including throughMedicaid to support development and reim-bursement or onsite mental health consulta-tion in early care and learning settings. Mental

health consultation is associated with signicantlyewer preschool expulsions.72


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mg Fwd

An agenda or social-emotional development inyoung children requires:

access to services based on risk actors;

a comprehensive set o screening, assessment andtreatment and support services;

use o eective research inormed strategiesdesigned to address the child, his/her amily andtheir environment;

a bold training and human resource develop-ment initiative that will equip providers or youngchildren across all settings with the appropriateknowledge and skills to meet the needs o youngchildren; and

unding fexibility that supports eective amilyocused approaches to the delivery o servicesand supports.

Te principles o strong eective public policiesmust support: a public health ramework; a devel-opmentally appropriate ocus; amily-based strate-gies; and services and supports in multiple settingsincluding the home and early care and learningsettings.

Empirically supported strategies exist to address

the social-emotional needs of young children.

Te box on page 11 outlines selected strategies romprevention to treatment.


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instumnt/intvnton Ag Dscpton

evdnc-asd pvnton statgs

Tpl P Pantng Pogama Birth to 12years

It is multilevel evidence-based parenting and amily support strategy,which helps increase the knowledge, skills and confdence o parents. It isa multilevel program that aims at preventing severe behavioral, emotional

and developmental problems in children.73

Level 1: provides parents with inormation about parenting

Level 2: primary health care intervention providing guidance to parentso children with mild behavior difculties

Level 3: primary care intervention or parents o children with mild tomoderate behavior difculties and provides parents with skills training

Level 4: intensive group or sel help parenting program or parents ochildren with more severe behavior difculties

Level 5: advanced behavioral amily intervention program or amilieswhere other sources o amily distress increase parenting challenges

PATHS PschoolPromoting alternative thinkingstrategies

Birth to 5years

It is school-based preventive interventions or preschool children.74

PATHS:

enhances childrens social-emotional development, while reducingaggression and other behavioral problems.

presents skills concepts through direct instruction, modeling, story-telling, role playing, writing, signing, drawing, science and math andother activities that promote school readiness.

can be adapted to meet the need o individual classrooms.

evdnc-asd aly cognton and dntfcaton statgs

Ags & Stags Se 6 months to60 months The questionnaire is completed by a parent/caregiver and scored by aproessional. ASQ-SE is a comprehensive screening tool or children ages6 months to 60 months to assess a childs social-emotional development.75

iTSeA

Inant Toddler Social-Emotional Assessment

12 months to36 months

A tool used to assess children in our domains: externalizing, internal-izing, dis-regulation and competence to identiy developmental delays.76

PeC-AS

Preschool Early ChildhoodFunctional Assessment Scale

4 to 7 years A multidimensional measure that is used to assess psychosocialunctioning.77

DeCA

Devereux Early ChildhoodAssessment

2 to 5 years Used to assess with-in child protective actors. It evaluates the requency

o positive behaviors exhibited by children. DECA identifes children whoare low on the protective actors, generates classroom profles o all chil-dren and screens children who maybe exhibiting behavioral concerns.78

a. Prevention and intervention strategy


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instumnt/intvnton Ag Dscpton

evdnc-asd ntvnton statgs

Mntal Halth Consultatona Birth to 5years

An intervention strategy associated with reduction in the likelihood ochildren being excluded rom child care settings.79 Encompasses:80

a partnership between a mental health clinician with early childhooddevelopment expertise, parents and child care providers; and

mental health clinician available to consult with child care programs,sta and parents to provide strategies to oster positive learning,healthy development and social-emotional well-being.

Had Stat- reDi

(Research-based,Developmentally-inormed)Intervention

Preschool agechildren

An intervention designed to be integrated into the existing ramework oHead Start programs. REDI promotes school readiness by targeting social-emotional skills and language/emergent literacy skills.81

Provides teachers with brie lessons, hands on extension activities andtraining in specifc instructional strategies to target social-emotional andcognitive skills.

Uses Promoting Alternative Thinking Strategies (PATHS) Curriculum topromote social-emotional skills.

Focuses on vocabulary, syntax, phonological awareness and printawareness to promote language/emergent literacy skills.

incdl Yasa 4 to 8years A curriculum-based parenting and psychosocial intervention programdesigned to promote sel competence, reduce, prevent and treat aggres-sion and conduct related behaviors.82 Focuses on:

parent and teacher training and child training programs; and

eective prevention intervention with children, parents and teachers inHead Start.

PCiT

Parent-Child InteractionTherapy

2 to 12 yearsc An evidence-supported treatment or young children with conduct disorderand other externalizing behaviors. 83 The treatment ocuses on improvingparent child interactions and teaches parents how to change parent childinteraction patterns. Parents are taught specifc skills to enhance pro-socialskills and reduce negative behaviors.

The treatment ocuses on two interactions:

child directed interactions (CDI) parents engaging their child in a playsituation

parent directed interactions (PDI) more clinical sessions, in whichparents learn to use specifc behavior management techniques as theyplay with their child.

MDT-PSMulti-dimensional TreatmentFoster Care or Preschoolers

3 to 6 yearold children inoster care

Delivered through a treatment team, the program emphasizes the use oconcrete encouragement or pro-social behavior, consistent, non-abusive limit-setting to address disruptive behavior and close supervision o the child.84

Foster parents receive training and ongoing consultation/support romprogramming sta.

Children receive individual skills training and therapeutic playgroup.

Birth parents (or other permanent placement resources) receive amilytherapy.

a. Prevention and intervention strategy

b. Best practice

c. Adapted or children who experience physical abuse ages 4-12


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Edes

1. Samero, A. J.; Fiese, B. H. 2000. Models o Developmentand Developmental Risk. In C. Zeanah (Ed.), Handbook onInant Mental Health (pp. 3-19). New York, NY: Guilord Press.

2. Shonko, J.; Phillips, D. A.; Council, N. R. (Eds.). 2000.

From Neurons to Neighborhoods: Te Science o Early ChildhoodDevelopment. Washington, DC: National Academy Press.

3.Brauner, C.B.; Stephens, B. C. 2006. Estimating the Prevalenceo Early Childhood Serious Emotional/Behavioral Disorder:Challenges and Recommendations. Public Health Reports 121:303-310.

4. Warner, L. A.; Pottick, K. 2006. Functional ImpairmentAmong Preschoolers using Mental Health Services. Child andYouth Services Review 28: 473-486.

5. Lavigne, J.; Gibbons, R.; Christoel, K. K.; Arend, R.;Rosenbaum, D.; Binns, H. et al. 1996. Prevalence Rates andCorrelates o Psychiatric Disorders among Preschool Children.Journal o the American Academy o Child and Adolescent

Psychiatry 35: 204-214.6. McDonnell, M.; Gold, C. 2003. Prevalence oPsychopathology in Preschool-age Children.Journal o Childand Adolescent Psychiatric Nursing16: 141-154.

7. Duncan, G. J.; Brooks-Gunn, J.; Klebanov, P. K. 1994.Economic Deprivation and Early Childhood Development.Child Development65: 296-318.

8. Knapp, P. E.; Ammen, S.; Arstein-Kerslake, C.; Poulsen, M.K.; Mastergeorge, A. 2007. Feasibility o Expanding Services orVery Young Children in the Public Mental Setting.Journal othe American Academy o Child and Adolescent Psychiatry 46(2):152-161.

9. Duncan, G. J.; Brooks-Gunn, J. 2000. Family Poverty, Welare

Reorm, and Child Development. Child Development71:188-196.

10. Whitaker, R. C.; Orzol, S. M.; Kahn, R. S. 2006. MaternalMental Health, Substance Use and Domestic Violence in theYear Aer Delivery and Subsequent Behavior Problems inChildren at Age 3 Years.Archives o General Psychiatry 63:551-560.

11. Ibid.

12. Cherno, J. J.; Flanagan, K. D.; McPhee, C.; Park, J. 2007.Preschool: First fndings rom the Tird Follow-up o the EarlyChildhood Longitudinal Study, Birth Cohort (ECLS-B) (No.NCED 2008-025). Washington, DC: National Center orEducational Statistics, Institute o Education Sciences, U.S.Department o Education.

13. Nicholson, J.; Biebel, K.; Katz-Levy, K.; Williams, V. F. 2004.Te Prevalence o Parenthood in Adults with Mental Illness:Implications or State and Federal Policymakers, Programs andProviders. In R. Manderscheid & M. Henderson (Eds.),MentalHealth, United States, 2002. Rockville, MD: Substance Abuseand Mental Health Services Administration.

14. Hammen, C. 2003. Risk and Protective Factors orChildren o Depressed Parents. In S. S. Luthar (Ed.), Resilienceand Vulnerability: Adaptation in the Context o ChildhoodAdversities. New York, NY: Cambridge University Press.

Nicholson, J.; Biebel, K.; Hiden, B.; Henry, A.; Steir, L. 2001.Critical Issues o Parents with Mental Illness and their Families.Rockville, MD: Center or Mental Health Research, SubstanceAbuse and Mental Health Services Administration.

15. See Hammen in endnote 14.16. Whitebook, M.; Phillips, D.; Bellm, D.; Crowell, N.;Almaraz, M.; Jo, J. Y. 2004. wo Years in Early Care andEducation: A Community Portrait o Quality and WorkorceStability. Berkeley, CA: Center or the Study o Child CareEmployment, University o Caliornia at Berkeley.

17. Ibid.

Hamre, B. K.; Pianta, R. C. 2004. Sel-Reported Depressionin Nonamilial Caregivers: Prevalence and Associations withCaregiver Behavior in Child-care Settings. Early ChildhoodResearch Quarterly 19(2): 297-318.

18. Childrens Bureau, Administration on Children, Youthand Families, Administration or Children and Families, U.S.

Department o Health and Human Services. 2008.Adoptionand Foster Care Analysis and Reporting System. Ithaca, NY:Cornell University, National Data Archive on Child Abuse andNeglect.

19. Burns, B.; Phillips, S.; Wagner, H.; Barth, R.; Kolko, D.;Campbell, Y.; et al. 2004. Mental Health Need and Access toMental Health Services by Youths Involved With Child Welare:A National Survey.Journal o the American Academy o Childand Adolescent Psychiatry 43(8): 960-970.

Leslie, Laurel K.; Hurlburt, Michael S.; James, Sigrid; Landsverk,John; Slymen, Donald J.; Zhang, Jinjin. 2005. RelationshipBetween Entry into Child Welare and Mental Health ServiceUse. Psychiatric Services 56(8): 981-987.

20. See Burns in endnote 19.21. National Child Abuse and Neglect Data System Child File,FFY. 2006. Based on NCCP Analysis on unduplicated cases.Cornell University, National Data Archive on Child Abuse andNeglect: Ithaca, NY.

22. Ibid.

23. See endnote 4.

24. Gilliam, W. S. 2005. Prekindergarteners Le Behind:Expulsion Rates in State Prekindergarten Systems. RetrievedFebruary 11, 2006, rom http://www.cd-us.org/PDFs/NationalPreKExpulsionPaper03.02_new.pd.

25. Wildeman, C. 2007. Parental Imprisonment, the PrisonBoom and the Concentration o Childhood Disadvantage.Retrieved February 11, 2008, rom http://paa2007.princeton.edu/download.aspx?submissionId=7180

Mumola, C. 2000. Incarcerated parents and their children (No.NCJ 182335). Washington, DC: U.S. Department o Justice,Oce o Justice Programs.

26. Conroy, M. 2004. Early Identication, Prevention andEarly Intervention or Young Children at Risk or Emotional,Behavioral Disorders: Issues, rends, and a Call to Action.Behavioral Disorders 29(3): 224-236.


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27. Sices, L.; Feudtner, C.; McLaughin, J.; Drotar, D.; Williams,M. 2003. How Do Primary Care Physicians Identiy YoungChildren with Developmental Delays? A National Survey.Developmental and Behavioral Pediatric, 24(6): 409-417.

28. Scheeringa, M. S.; Zeanah, C. H.; Myers, L.; Putnam, F. W.2005. Predictive Validity in a Prospective Follow-up o PSD inPreschool Children.Journal o the American Academy o Childand Adolescent Psychiatry 44(9): 899-906.

29. Oce o Special Education. 2007. able 1-1. Children andstudents served under IDEA, Part B, by age group and state:Fall 2006 IDEA Part B Child Count. Retrieved February 11,2008, rom http://www.ideadata.org/arc_toc7.asp.

30. Oce o Special Education. 2007. able 1-7. Children andstudents served under IDEA, Part B, in the U.S. and outlyingareas, by age and disability category: Fall 2006 IDEA Part BChild Count. Retrieved February 11, 2007, rom http://www.ideadata.org/arc_toc7.asp.

31. Hebbeler, K.; Spiker, D.; Bailery, D.; Scarborough, A.; Mallik,S.; Simeonsson, 34R.; et al. 2007. Early Intervention or Inantsand oddlers with Disabilities and their Families: Participants,Services and Outcomes. Menlo Park, CA: SRI International.

32. Ibid.

33. New, M.; Razzino, B.; Lewin, A.; Schlump, K.; Joseph, J.2002. Mental Health Service use in a Community Head StartPopulation.Archives o Pediatrics & Adolescent Medicine 156:721-727.

Kataoka, S.; Zhang, L.; & Wells, K. 2002. Unmet Need orMental Health Care among U.S. Children: Variation byEthnicity and Insurance Status.American Journal o Psychiatry159: 1548-1555.

34. Razzino, Brian E.; New, Michelle; Lewin, Amy; Joseph,Jill. 2004. Need or and Use o Mental Health Services AmongParents o Children in the Head Start Program. PsychiatricServices 55(5): 583-586.

35. Zimmer, M. H.; Panko, L. M. 2006. Developmental Statusand Service use among Children in the Child Welare System:A National Survey.Archives o Pediatrics & Adolescent Medicine160: 183-188.

36. Ibid.

37. Ibid.

38. Rosenthal, J.; Kaye, N. 2005. State Approaches to PromotingYoung Childrens Healthy Development: A Survey o Medicaid,and Maternal and Child Health, and Mental Health Agencies.Portland, ME: National Academy or State Health Policy.

39. See endnote 27.

40. Olson, A. L.; Kemper, K. J.; Kelleher, K. J.; Hammond,

C. S.; Zuckerman, B. S.; Dietrich, A. J. 2002. Primary CarePediatricians Roles and Perceived Responsibilities in theIdentication and Management o Maternal Depression.Pediatrics 110(6): 1169-1176.

41. Semansky, R. M.; Koyanagi, C.; Vandivort-Warren, R. 2003.Behavioral Health Screening Policies in Medicaid ProgramsNationwide. Psychiatric Services 54(5): 736-730.

42. National Center or Children in Poverty. 2009. Improving theOdds or Young Children, State Proles. Retrieved on April 3,2009 rom http://www.nccp.org/proles/early_childhood.html.

43. See endnote 38.

44. Biebel, K.; Nicholson, J.; Geller, J.; Fisher, W. 2006. ANational Survey o State Mental Health Authorities Programsand Policies or Clients Who are Parents: A Decade Later.Psychiatric Quarterly 77(2): 119-128.

45. Ibid.

46. See endnote 38.

47. Ibid.

48. See endnote 38.

49. Stebbins, H.; Knitzer, J. 2007. United States Health andNutrition: State Choices to Promote Quality. Improve the Odds:State Early Childhood Proles. Retrieved September 27, 2007rom http://www.nccp.org/publications/pd/text_725.pd.

50. Cooper, J.; Aratani, Y.; Knitzer, J.; Douglass-Hall, A.; Masi,R.; Banghart, P.; et al. 2008. Unclaimed Children Revisited, Testatus o childrens mental health policy in the United States. NewYork, NY: Columbia University, National Center or Childrenin Poverty.

51. U.S. Department o Education. 2007. Inants and oddlers

Receiving Early Intervention Services in Accordance with Part C.(No. OMB #1820-0557). Washington, DC: U.S. Department oEducation, Oce o Special Education Programs, Data AnalysisSystem (DANS).

52. National Center or Children in Poverty (in press). StateReport on Part C Screening and Services. New York, NY:Columbia University, National Center or Children in Poverty.

53. See endnote 50.

54. Horowitz, S. M.; Kelleher, K. J.; Stein, R. K.; Storer-Isser,A.; Youngstrum, E. A.; Park, E. R.; et al. 2007. Barriers to theIdentication and Management o Psychosocial Problems inChildren and Maternal Depression. Pediatrics 119: e208-e219.

55. Ibid.

56. See endnote 27.

57. United States Department o Education National Centeror Educational Statistics. 2001. Entering Kindergarten: APortrait o American Children When they Begin School: Findingsrom the Condition o Education 2000 (No. NCES 2001-035).Washington, DC: U.S. Government Printing Oce.

58. See endnote 24.

59. Ibid.

60. Ibid.

61. Caspi, A.; Henry, B.; McGee, R.; Mott, .; Silva, P. 1995.emperamental Origins o Child and Adolescent BehaviorProblems: From Age Tree to Age Fieen. Child Development

66: 55-68.White, J.; Mott, .; Earls, F.; Robins, L.; Silva, P. 1990. HowEarly Can We ell? Predictors o Childhood Conduct Disorderand Adolescent Delinquency. Criminology 28: 507-533.

62. See endnote 24.

63. Lea, P.; Owens, P.; Leventhal, J. M.; Forsyth, B. W. C.;Vaden-Kiernan, M.; Epstein, L. D.; et al. 2004. Pediatriciansraining and Identication and Management o PsychosocialProblems. Clinical Pediatrics 43(4): 355-365.


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65. Bierman, K. L.; Domitrovich, C. E.; Nix, R. L.; Gest, S. G.;Welsh, J. A.; Greenberg, M. .; Blair, C.; Nelson, K. E.; Gill,S. 2008. Promoting Academic and Social-Emotional SchoolReadiness: Te Head Start REDI Program. Child Development

79: 1802-1817.

66. Earls, M.; Shackleord Hay, S. 2006. Setting the Stage orSuccess: Implementation o Developmental and BehavioralScreening and Surveillance in Primary Care Practice-the NorthCarolina Assuring Better Child Health and Development(ABCD) Project. Pediatrics 118(1): e183-e188.

67. Knapp, P. E.; Ammen, S.; Arstein-Kerslake, C.; Poulsen, M.K.; Mastergeorge, A. 2007. Feasibility o Expanding Services orVery Young Children in the Public Mental Setting.Journal othe American Academy o Child and Adolescent Psychiatry 46(2):152-161.

68. See endnote 16.

69. Masten, A. S.; Powell, J. L. 2003. A Resilience Framework orResearch, Policy, and Practice. In S. S. Luthar (Ed.), Resilienceand Vulnerability: Adaptation in the Context o Childhood

Adversities. New York, NY: Cambridge University Press.

70. Knitzer, J.; Teberge, S.; Johnson, K. 2008. ReducingMaternal Depression and its Impact on Young Children toward aResponsive Early Childhood Policy Framework. New York, NY:Columbia University, National Center or Children in Poverty.

71. Ammerman, R. .; Putnam, F. W.; Altaye, M.; Chen, L.;Holleb, L. J.; Stevens, J.; et al. 2009. Changes in DepressiveSymptoms in First ime Mothers in Home Visitation. ChildAbuse & Neglect33: 127-138.

72. See endnote 24.

73. riple-P America 2009. Retrieved March 27, 2009 romwww.triplep-america.com.

74. PAHS Preschool. Facts and Frequently Asked Questions.Retrieved July 27, 2009 rom http://www.channing-bete.com/prevention-programs/paths-preschool/acts-and-aqs.php.

75. Ages and Stages Questionnaires. 2009.ASQ, What is ASQ.Retrieved March 27, 2009 romhttp://www.agesandstages.com/asq/asqse.html.

76. Pearsons.2009. Inant and oddler Social EmotionalAssessment. Retrieved March 27, 2009 rom http://pear-sonassess.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=015-8007-387.

77. Hodges, K. 2003. Preschool and Early Childhood FunctionalAssessment Scale (Pecas). In Caas Manual or rainingCoordinators, Clinical Clinical Administrators, and DataManagers (2nd ed.). Ann Arbor, MI.

78. Devereux Early Childhood Initiative. 2009. Inant & oddlerAssessment. Retrieved March 27, 2009 rom http://www.devereux.org/site/PageServer?pagename=deci_it_assessment.

79. See endnote 24.

80. Johnston, K.; Brinamen, C. 2005. Integrating and AdaptingInant Mental Health Principles in the raining o Consultantsto Childcare. Inants & Young Children 18(4): 269-281.

81. Bierman, K.; Domitrovich, C.; Nix, S.; Scott, G.; Welsh, J.;Greenberg, M.; et al. 2007. Promoting Academic and Social-

Emotional School Readiness: Te Head Start REDI Program.Child Development, Provisionally accepted.

Bierman, K.; Nix, R.; Greenberg. M.; Blair, C.; Domotrovich, C.2008. Executive Functions and School Readiness Intervention:Impact, Moderation and Mediation in the Head Start REDIprogram. Development and Psychopathology.

82. Webster-Stratton, C.; Reid, M. J.; Hammond, M. 2001.Preventing Conduct Problems, Promoting Social Competence:A Parent and eacher raining Partnership in Head Start.Journal o Clinical Child Psychology 30(3): 283-302.

83. Parent Child Interaction Terapy. 2009. What is PCI?Retrieved on March 27, 2009 rom http://pcit.phhp.uf.edu/.

84. Multidimensional reatment Foster Care. 2009.

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