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1
Geoffrey Nagle, PhD, LCSW, MPH Tulane University
Institute of Infant and Early Childhood Mental Health September 20, 2011
BUILDING AN EARLY CHILDHOOD SYSTEM:
A STATE EXAMPLE FROM LOUISIANA
Outline
§ Early Childhood Budget
§ QRIS – Focus on Social-Emotional Development
§ School Readiness Tax Credits
Early Childhood System Integration Budget
Basic Assumption (1)
§ The budget is the most significant POLICY DOCUMENT used in government planning.
§ “The budget process is the spinal column of public policymaking.”
Nathan, R. P. Handbook for Appointed Officials in America’s Governments. Chapter 5, Page 42. Available at www.rockinst.org/pdf/government_reform/2009-handbook_for_appointed_officials_in_america%27s_governments.pdf
Basic Assumption (2)
§ A cross-system plan without a cross-system budget is difficult to implement.
Early Childhood System Integration Budget
§ Looks at resources for children less than age 5 ú Formatted by categories ú Includes
description source of funds population served geographic areas served
2
ECSIB
§ No right answers ú Simply shows the resources and programs in
the priority areas
§ Context? ú 310,000 children under age 5 (7.2%) ú 30% of children under age 5 live in poverty
Typical Children’s Budget
DSS – Office of Family Support
State
General Fund
Federal Funds
Total
Funds
Child Care Assistance
$7,500,000 $109,804,670 $117,304,670
Head Start Collaboration
$35,000 $175,000 $210,000
Support Enforcement
2,349,694 $22,031,073 $24,380,767
Totals $9,884,694 $132,010,743 $141,895,437
EARLY CHILDHOOD SYTEM INTEGRATION BUDGET
FY 12 Appropriated SGF IAT Fees Stat.
Dedications Federal Total
Access to Medical Care
$240,017,765 $6,696,769 $1,453,550 $0 $616,902,589 $865,070,673
Early Care and Education
$22,871,312 $70,509,597 $1,832,631 $8,987,900 $180,378,210 $284,579,650
Family Support and Parenting Education
$35,977,551 $10,887,865 $5,654,080 $93,000 $188,488,360 $241,100,856
Mental Health and Social-Emotional Development
$1,031,606 $116,868 $0 $0 $6,382,944 $7,531,418
EARLY CHILDHOOD SYTEM INTEGRATION BUDGET TOTALS
$299,898,234 $88,211,099 $9,940,261 $9,080,900 $992,152,103 $1,398,282,597
Changes from FY 11 to FY 12 SGF IAT Fees Stat.
Dedications Federal Total
Access to Medical Care
$45,350,842 ($2,317,543) $129,764 $0 ($12,956,575) $30,206,488
Early Care and Education
$1,020,161 $1,105,005 $182 ($4,510,251) $10,425,567 $8,040,664
Family Support and Parenting Education
$2,158,045 $2,087,849 ($47,493) $0 $5,762,732 $9,961,133
Mental Health and Social-Emotional Development
$195,635 ($89,342) $0 $0 $484,173 $590,466
EARLY CHILDHOOD SYTEM INTEGRATION BUDGET TOTALS
$48,724,684 $785,969 $82,453 (4,510,251) $3,715,897 $48,798,751
EARLY CHILDHOOD SYTEM INTEGRATION BUDGET
Early Childhood System Integration Budget
Access to Medical Care
61.9%
Early Care and Education
20.4%
Family Support/Parenting Education
17.2%
Mental Health/Social-Emotional Development 0.5%
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SGF IAT Fees Stat. Dedications Federal Total
Access to Medical Care
$240,017,765 $6,696,769 $1,453,550 $0 $616,902,589 $865,070,673
EARLY CHILDHOOD SYTEM INTEGRATION BUDGET
Medical 62%
Other 38%
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Access to Medical Care
§ Overall increase of $30 million (3.7%) ú $50 million SGF and -$12 million federal
Due to increase in participation and FMAP change
ú New initiative – Birth Outcomes Project ú 10 programs in this category
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SGF IAT Fees Stat. Dedications Federal Total
Early Care and Education $22,871,312 $70,509,597 $1,832,631 $8,987,900 $180,378,210 $284,579,650
EARLY CHILDHOOD SYTEM INTEGRATION BUDGET
62% ECE 20% 80%
SGF IAT Fees Stat. Dedications Federal Total
Family Support and Parenting Education
$35,977,551 $10,887,865 $5,654,080 $93,000 $188,488,360 $241,100,856
EARLY CHILDHOOD SYTEM INTEGRATION BUDGET
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FS/PE 17%
83%
SGF IAT Fees Stat. Dedications Federal Total
Family Support and Parenting Education
$35,977,551 $10,887,865 $5,654,080 $93,000 $188,488,360 $241,100,856
EARLY CHILDHOOD SYTEM INTEGRATION BUDGET
72.9%
4.4%
22.4%
Fam Support Parenting Ed Child Welfare
SGF IAT Fees Stat. Dedications Federal Total
Mental Health and Social-Emotional Development
$1,031,606 $116,868 $0 $0 $6,382,944 $7,531,418
EARLY CHILDHOOD SYTEM INTEGRATION BUDGET
99.5% 0.5%
Mental Health and Social-‐Emotional Development
§ 9 programs in this category ú 81% is in just one program
4
2.28%
9.83%
5.60%
0%
2%
4%
6%
8%
10%
12%
of Total State Funds of Total Federal Funds of Total State Budget
ECSIB as a Percentage of Total State Budget (FY 12 Appropriated – Act 12)
0.63%
9.05%
3.29%
0%
2%
4%
6%
8%
10%
12%
of Total State Funds of Total Federal Funds of Total State Budget
ECSIB as a Percentage of Total State Budget (FY 12 as Appropriated) – Excluding Medicaid
www.brightstartla.org Quality Rating and Improvement System
Intentional Focus on Early Childhood Mental Health
Points to Earn Stars
Total Number of Points
Star Rating
3-‐5
6-‐9
10-‐11
Integrating Social-‐Emotional Development in the Rating System
§ Environment Rating Scales ú Social-Emotional Subscale
§ Mental Health Consultation
§ Social-Emotional Screening
5
Environment Rating Scales
Social-Emotional Subscale
Environment Rating Scales
Harms, T., Cryer, D., & Clifford, R. M. (2006).
Harms, T., Clifford, R.M., Cryer, D. (2005).
Infant/Toddler Environment Rating Scale - Revised (ITERS-R) – birth through 2½ years
Early Childhood Environment Rating Scale - Revised (ECERS-R) – 2½ years to 5 years
Harms, T., Cryer, D., & Clifford, R. M. (2006) Harms, T., Clifford, R. M., Cryer, D. (2005)
Each ERS Scale Assesses
§ Space and Furnishings
§ Personal Care Routines
§ Activities
§ Listening & Talking/Language-Reasoning Skills
§ Interaction
§ Program Structure
Social-‐Emotional Subscale
§ ITERS-R ú Listening and
Talking ú Interaction ú Program Structure
§ ECERS-R ú Language-
Reasoning ú Interaction ú Program Structure
Points Criteria
1 An average of 3.75 on the social-‐emotional subscale, with no one classroom lower than 3 on the subscale
2 An average of 4 on the social-‐emotional subscale, with no one classroom lower than 3 on the subscale
3 An average of 4.25 on the social-‐emotional subscale, with no one classroom lower than 3.25 on the subscale
4
An average of 4.5 on the social-‐emotional subscale, with no one classroom lower than 3.5 on the overall ERS
5 An average of 5 on the overall ERS, with no one classroom lower than 4 on the overall ERS
Program Standards -‐ Scores on the ERS (ITERS/ECERS)
Mental Health Consultation
6
Mental Health Consultants
§ 12 full time equivalent consultants across state
§ All have master’s degree in a mental health field and hold a license
§ Primarily LCSW or LPC
§ 12 total visits ú One day every other week (day = 5-6 hours) ú Centers with 8 or more classrooms receive weekly
visits with up to 24 total visits
§ All centers participating in the QRIS program are eligible
§ Centers serving children enrolled in CCAP, or in foster care, receive priority
Mental Health Consultation
Mental Health Consultation
§ Designed to support ALL children, teachers, and families involved in child care.
§ A combination model ú Program ú Child focused
A Combination Model of MHC
§ 3 types of MHC ú Program Centered
designed to improve experience of all individuals involved with center
ú Child Centered designed to assess and make recommendations
about particular children
ú Combination Model uses aspects of both models to assist center and
individuals within center
Program Centered Components § Focus on relationships
§ Observes in classrooms
§ Meets with director
§ Meets individually with staff members
§ Provides 6 clock hours of training
§ Parent meetings/workshops are available
Child Centered Components
§ MHC available to complete a child-centered consultation when requested ú Parent permission necessary ú MHC can:
Observe child in classroom Interview parents/teachers/director Make referrals when needed Assist in designing behavior management
program for class and assist teacher in implementing
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Consultant Training
§ Pre-Service Training ú Full training on all aspects of MHC
model 6 interactive didactic trainings (most based on CSEFEL) 2 community trainings
ú Shadow consultants in field ú Infant Mental Health training 60 hours of class time in person or via
videoconferencing
Consultant Supervision § Consultants participate in
ú Individual reflective supervision two times per month
ú Group reflective supervision one time per month
§ Focus of supervision ú Relationships with center staff ú Avoiding the “expert stance”
Evaluation -‐ Teacher Self Report
§ Teacher Self-Efficacy ú Ability to make a difference in children’s lives ú Increase at end of intervention • Increase maintained after 6 months
§ Teacher Competence ú Knowledge of, and ability to, support child
development ú Increase at end of intervention • Continued to increase after 6 months
• Greater impact on younger and less experienced teachers
Evaluation -‐ CLASS Observations
§ After 6 months § Significant improvement in all 7 areas
Emo$onal Support
Posi$ve Climate Nega$ve Climate
Teacher Sensi$vity Regard for Student
Perspec$ve
Classroom Organiza$on
Behavior Management
Produc$vity Instruc$onal Learning
Social-‐Emotional Screening
Program Standards: Social-‐Emotional Development Screening
Points Criteria
4 Complete screening for social-‐emotional development with instrument from recommended list for all children (0-‐5 yrs.) within 45 calendar days of enrollment and annually thereafter.
5 Same
8
Staff Qualifications: Social Emotional Screening Training
Points Criteria
3 Directors and lead teachers complete training in social-‐emotional screening of children.
4 Same
5 Same
Introduction to Social Emotional Screening Community Training
§ Rationale for universal screening ú Importance of early detection ú Identifying risk and protective factors ú Outcomes for early treatment vs. later
treatment
§ Screening results are not a diagnostic indicator
Selection of Screening Instrument
§ Approved screening instruments
§ Age ranges
§ Cost of implementation
§ Psychometric properties
Select Screens
§ Ages and Stages: Social Emotional (ASQ:SE)
§ Brief Infant Toddler Social Emotional Assessment (BITSEA)
§ Early Childhood Screening Assessment (ECSA)
§ Preschool Kindergarten Behavior Scale (PKBS)
§ Temperament and Atypical Behavior Scale (TABS)
Select Screens
6 – 11 months
12 – 17 months
18-‐35 months
36 – 60 months
ASQ: SE u u u u
BITSEA u u
ECSA u u
PKBS u
TABS u u
Select Screens
Time to Administer
Format
Time to Score
ASQ: SE 10-‐15 minutes 3 point rating scale
1-‐3
minutes
BITSEA 7-‐10 minutes
3 point rating scale Some reverse scoring
ECSA 5-‐10 minutes 3 point rating scale
1-‐2
minutes
PKBS 8-‐12 minutes 4 point rating scale
TABS 10 minutes Yes/No 5 minutes
9
Select Screens Costs
ASQ: SE Approximately $200
BITSEA Approximately $100 +
ECSA Free
PKBS Approximately $100 +
TABS Approximately $85
Warm Line
§ Statewide 800 number
§ Leave a message
ú Child care providers
ú Parents
§ Will receive call back by the end of the next day
Evaluation Findings
§ Significant increase in positive attitudes towards mental health screening
§ Significant increase in perceived knowledge
School Readiness Tax Credits
Long Term and Sustainable Funding
School Readiness Tax Credits
§ Package of 4 Tax Credits ú Credits to Providers
ú Credits to Directors and Teachers
ú Credits to Business for Supporting Child Care
ú Credits to Parents/Consumers
TAX CREDITS TO CHILD CARE PROVIDERS
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Tax Credits to Providers
§ Providers receive a tax credit based on the number of children they serve in the Child Care Assistance Program (or in foster care)
§ Refundable credit
§ Both for-profit and non-profit centers are eligible
Tax Credits to Providers
Star Rating Tax Credit
(per child in CCAP/foster care)
$1,500
$1,250
$1,000
$750
1 Star (or not participating) No credit
Tax Credits to Providers
§ If you serve 10 CCAP children and you are a 2 star center, then you receive a $7,500 refundable tax credit! ú 10 children x $ 750 (2 star center) = $7,500
ú 10 children x $1,000 (3 star center) = $10,000
ú 10 children x $1,250 (4 star center) = $12,500
ú 10 children x $1,500 (5 star center) = $15,000
TAX CREDITS TO TEACHERS AND DIRECTORS
Tax Credits to Directors and Teachers
§ Refundable credits
§ Based on the level of education ú Must be working at a center participating in
the rating system ú Must work there at least 6 months ú The star rating of the center does not
impact this credit
Tax Credits to Directors and Teachers
Child Care Director and Teacher Qualification Tax Credit
Level 4 $3,000
Level 3 $2,500
Level 2 $2,000
Level 1 $1,500
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TAX CREDITS TO EMPLOYERS/BUSINESSES
Tax Credits to Business
§ Employers receive a credit for “eligible child care expenses” based on the quality rating of the center
§ Refundable credits
Tax Credits to Business
Star Rating Tax Credit
20% of eligible expenses
15%
10%
5%
1 Star (or not participating)
No credit
Tax Credits to Business
§ Eligible Expenses Employers may claim a tax credit for up to $5,000 in grants to child care resource and referral agencies. ú This credit is dollar for dollar. ú Maximum is $5,000
TAX CREDITS TO PARENTS/CONSUMER
Tax Credits to Parents
§ Builds on the existing state child care tax credit.
§ Families are eligible for an increased tax credit based upon the quality rating of the center.
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Tax Credits to Parents
Star Rating Increase to Existing State Tax Credit
200%
150%
100%
50%
1 Star (or not participating) No Change
SRTC IMPACT
3 Years 2008-2010
Tax Credits to Parents
4710
7075
9489
2008 2009 2010
Column1
Tax Credits to Parents
$949,970
$1,316,299
$1,618,936
2008 2009 2010
Column1
Tax Credits to Providers
121
249
387
2008 2009 2010
Column1
Tax Credits to Providers
$1,618,129
$3,189,635 $3,363,992
2008 2009 2010
Column1
13
Tax Credits to Teachers
869
1696
2147
2008 2009 2010
Column1
Tax Credits to Teachers
$1,496,402
$3,205,500
$4,148,250
2008 2009 2010
Column1
Tax Credits to Businesses
$144,014
$609,668
$357,041
2008 2009 2010
Column1
Total Impact
5867
9393
12,266
2008 2009 2010
Column1
Total Impact
$4,208,515
$8,321,102
$9,488,219
2008 2009 2010
Column1
Citations § Heller, S. S., Boothe, A., Keyes, A., Nagle, G., Sidell, M., &
Rice, J. (2011). Implementation of a mental health consultation model and its impact on early childhood teachers’ efficacy and competence. Infant Mental Health Journal, 32(2), 143-‐164.
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