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5/26/16 1 2 | © 2015 This presentation will take approximately one hour to complete. VIEWING TIME 3 | © 2015 This presentation is designed for primary care physicians. Other health care professionals working with patients and their families may also find this program of interest. TARGET AUDIENCE 4 | © 2015 It is the policy of Children’s Hospitals and Clinics of Minnesota to ensure balance, independence, objectivity and scientific rigor in all its educational programs. Our faculty have been asked to disclose to our program audience any real or apparent conflicts of interest related to the content of their presentations. They have also been requested to let you know when any products mentioned in their presentations are not labeled for the use under discussion or are still under investigation. FACULTY DISCLOSURE 5 | © 2015 Katy Schalla Lesiak, MSN/MPH, APRN; Catherine Wright, PsyD, MS, LPCC; and Dr. Julie Rabb, Psy.D. have disclosed no actual or apparent conflict of interest in relation to this educational activity. During this educational activity they will not be discussing the off-label use of commercial or investigational products not approved by the FDA. SPEAKER FACULTY DISCLOSURE Early Childhood Adversity and Toxic Stress: Practical tools for the primary care clinician Grand Rounds May 19, 2016 Katy Schalla Lesiak, MSN/MPH, APRN Catherine Wright, PsyD, MS, LPCC Dr. Julie Rabb, Psy.D.

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5/26/16  

1  

2 | © 2015

• This presentation will take approximately one hour to complete.

VIEWING TIME

3 | © 2015

• This presentation is designed for primary care physicians.

• Other health care professionals working with patients and their families may also find this program of interest.

TARGET AUDIENCE

4 | © 2015

• It is the policy of Children’s Hospitals and Clinics of Minnesota to ensure balance, independence, objectivity and scientific rigor in all its educational programs. Our faculty have been asked to disclose to our program audience any real or apparent conflicts of interest related to the content of their presentations.

• They have also been requested to let you know when any products mentioned in their presentations are not labeled for the use under discussion or are still under investigation.

 

 

FACULTY DISCLOSURE

5 | © 2015

• Katy Schalla Lesiak, MSN/MPH, APRN; Catherine Wright, PsyD, MS, LPCC; and Dr. Julie Rabb, Psy.D. have disclosed no actual or apparent conflict of interest in relation to this educational activity.

• During this educational activity they will not be discussing the off-label use of commercial or investigational products not approved by the FDA.

 

 

SPEAKER FACULTY DISCLOSURE

Early Childhood Adversity and Toxic Stress: Practical tools for the primary care clinician

Grand Rounds May 19, 2016 Katy Schalla Lesiak, MSN/MPH, APRN Catherine Wright, PsyD, MS, LPCC Dr. Julie Rabb, Psy.D.  

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7 | © 2015

After completing this course, you will be able to:

1.  Identify actions to take in a primary care setting to

promote healthy social-emotional development and

identify concerns that need more attention

2.  Identify resources for referral, using a family-

centered approach

3.  Recognize the benefit and availability of early

childhood mental health services within Children’s

and throughout Minnesota

Objectives

8 | © 2015

Children’s Disclaimers •  Children's makes no representations or warranties about the accuracy, reliability,

or completeness of the content. Content is provided "as is" and is for informational use only. It is not a substitute for professional medical advice, diagnosis, or treatment. Children’s disclaims all warranties, express or implied, statutory or otherwise, including without limitation the implied warranties of merchantability, non-infringement of third parties’ rights, and fitness for a particular purpose.

•  This content was developed for use in Children’s patient care environment and may not be suitable for use in other patient care environments. Children’s does not endorse, certify, or assess third parties’ competency. You hold all responsibility for your use or nonuse of the content. Children’s shall not be liable for claims, losses, or damages arising from or related to any use or misuse of the content.

•  Please ask if you have any questions about these disclaimers.

9 | © 2015

Children’s Confidentiality Protections •  This content and its related discussions are privileged and confidential under

Minnesota’s peer review statute (Minn. Stat. § 145.61 et. seq.). Do not disclose unless appropriately authorized. Notwithstanding the foregoing, content may be subject to copyright or trademark law; use of such information requires Children’s permission.

•  This content may include patient protected health information. You agree to comply with all applicable state and federal laws protecting patient privacy and security including the Minnesota Health Records Act and the Health Insurance Portability and Accountability Act and its implementing regulations as amended from time to time.

•  Please ask if you have any questions about these confidentiality protections.

10 | © 2015

•  Children’s Hospitals and Clinics of Minnesota is accredited by the Minnesota Medical Association to provide continuing medical education for physicians.

•  Children’s Hospitals and Clinics of Minnesota designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™

•  Physicians should only claim credit commensurate with the extent of their participation in the activity.

•  Children’s Hospitals and Clinics of Minnesota takes responsibility for the content, quality and scientific interest of these activities.

 

 

Accreditation

11 | © 2015

• It is the policy of Children’s Medical Education program that we cannot offer to retain CME records for physicians attending or viewing the online CME activity. 

• The Minnesota Medical Association designates that physicians are responsible for maintaining their own CME records.

 

 

Retention of CME Records

12 | © 2015

• To receive CME credit, you must view the entire program. When the program is completed, click the Post Test button on the interface to access the Post Test.

•  You must successfully pass the Post Test to receive CME credit.

 

 

Receiving CME Credit

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Early  Childhood  Adversity    and  Toxic  Stress:    

Prac%cal  tools  for  the  primary  care  clinician  

Katy  Schalla  Lesiak,  MSN/MPH,  APRN    Minnesota  Department  of  Health  Catherine  Wright,  PsyD,  MS,  LPCC    

Minnesota  Department  of  Human  Services    

Children’s  of  Minnesota  Grand  Rounds  5/19/2016  

Disclosure

• We  have  no  disclosures  to  provide.  

Objec=ves

ParNcipants  will  be  able  to…  1.  IdenNfy  acNons  to  take  in  their  seSng  to  promote  

healthy  social-­‐emoNonal  development  and  idenNfy  concerns  that  need  more  aUenNon  

2.  IdenNfy  resources  for  referral,  using  a  family-­‐centered  approach  

3.  Recognize  the  benefit  and  availability  of  early  childhood  mental  health  services  within  Children’s  and  throughout  Minnesota  

Social-­‐emo=onal  development    (Infant  and  early  childhood  mental  health)

The  developing  capacity  of  the  child  to    •  Experience,  regulate  and  express  emoNons  •  Form  close  and  secure  interpersonal  relaNonships  •  Explore  the  environment  and  learn  

…all  in  the  context  of  family,  community  and  culture  www.zerotothree.org    

What  is  early  childhood  mental  health?

• Refers  to  children  birth  to  five  years  •  Interwoven  with  young  child’s  development  and  overall  health  

•  Early  intervenNon  is  the  key  to  reverse  the  effects  of  adverse  early  experiences  hUp://developingchild.harvard.edu/iniNaNves/council/    

Promo=ng  healthy  social-­‐emo=onal  development  in  primary  care • Recognize  parent/primary  caregiver  as  the  infant’s  most  important  partner  in  healthy  development  

• Model  and  encourage  reciprocal  communicaNon  (serve  and  return)  and  responsive  parenNng  

•  Talk,  read,  play  with  your  baby  • Promote  posiNve  parenNng    

www.cdc.gov/ncbddd/childdevelopment/posiNveparenNng/index.html    

• Provide  anNcipatory  guidance  about  development  • Provide  standardized  screening  to  idenNfy  and  address  concerns  early  

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Strengthening  Families  www.cssp.org/reform/strengtheningfamilies/about  

ProtecNve  factors  for  healthy  development  • Parental  resilience  •  Social  connecNons  • Knowledge  of  parenNng  and  child  development  • Concrete  support  in  Nmes  of  need  •  Social  and  emoNonal  competence  of  children  

What  can  nega=vely  impact  development? •  Exposure  to  trauma,  significant  loss  with  primary  care  givers  

•  DisrupNons  in  relaNonships  with  primary  care  givers  because  of  parental  mental  illness,  substance  abuse,  domesNc  violence  

•  Biological  Reasons  •  GeneNc  inheritance;  exposure  to  injury,  infecNon,  toxicants,  nutriNonal  deficiencies  (in-­‐utero  or  ader)  

•  Social/Environmental  Stressors  •  Living  in  high  risk  neighborhoods;  discriminaNon  and  racism;  prolonged  family  stress  due  to  death,  divorce,  extreme  economic  hardship,  etc.  

Ø Neurons  to  Neighborhoods,  2000    Ø ACE  study  (ongoing)-­‐  www.acestudy.org  

ADVERSE  CHILDHOOD  EXPERIENCES  (ACE)  STUDY

http://www.cdc.gov/ace/index.htm

22

ACEs  in  Minnesota  (BRFSS  2011)

23

Minnesotans  with  more  ACEs  are  more  likely  to  have  poor  health  

Toxic  stress

• What  is  it?  •  Excessive  or  prolonged  acNvaNon  of  the  physiologic  stress  response  systems    

•  Without  buffering  protecNve  relaNonships  •  In  contrast  to  posiNve  or  tolerable  stress  

• Why  does  it  maUer?  •  Long-­‐term  effect  on  brain  development,  learning,  behavior,  physical  &  mental  health  

•  Short-­‐term  vs.  chronic  stress  responses  Ø AAP  (2011).  Early  childhood  adversity,  toxic  stress  and  the  role  of  the  pediatrician:  TranslaNng  Developmental  Science  into  Lifelong  Health.  Pediatrics.  

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Bo[om  line

• ACEs  and  toxic  stress  impact  young  children  &  families.  

•  Child  brain  development  •  Health,  developmental,  educaNonal  outcomes  •  ParenNng  

• We  can  do  something  about  it.  •  Understand  the  impact,  share  info  with  families  (and  policy  makers  and  public)  

•  Help  prevent  ACEs  and  toxic  stress  •  IdenNfy  concerns  early  •  Provide  support,  intervenNon,  and  referral  that  makes  a  difference  

Screening

Screening  in  primary  care

•  Adverse  Childhood  Experiences?  •  Screen  children  or  parents  or  both?  •  What’s  missing?  Homelessness,  racism,  poverty  •  Dr.  Nadine  Burke  Harris  www.centerforyouthwellness.org    

•  Trauma?  •  Has  your  child  ever  experienced  anything  extremely  stressful  or  traumaNc  in  the  past  year?  

•  If  so,  what  was  it?    When  did  it  happen?  Did  you  get  any  support?      •  Would  you  like  some  support,  I  can  connect  you  with  a  colleague  (friend)  who  can  support  both  you  and  your  child  around  this  stressor.    

•  Social-­‐emoNonal  development  •  Evidence-­‐based,  validated/standardized  screening  tools  available  

•  Recommended  for  Child  and  Teen  Checkups  

Why  standardized  screening  makes  a  difference • When  depending  on  clinical  judgment  only,  medical  professionals  under-­‐idenNfy  social-­‐emoNonal  issues  in  young  children  80%  of  Nme  

Ø Lavigne  et  al  (1993).  Behavioral  and  emoNonal  problems  among  preschool  children  in  pediatric  primary  care:  Prevalence  and  pediatricians’  recogniNon.  Pediatrics.  

• When  clinics  screen  with  parent-­‐report  tools  are  used,  children  are  twice  as  to  receive  needed  mental  health  or  early  intervenNon  services  

Ø Bethell  et  al  (2011).  Rates  of  parent-­‐centered  developmental  screening:  DispariNes  and  links  to  services  access.  Pediatrics.  

Social-­‐emo=onal  screening

•  General  developmental  screening  tools  (such  as  PEDS  or  ASQ-­‐3)  do  not  adequately  screen  for  broader  social-­‐emoNonal  development  

•  Recommended  tools  are  available  here:  www.health.state.mn.us/divs/cl/topic/devscreening/instruments.cfm    

•  Ages  and  Stages  QuesNonnaires:  Social-­‐EmoNonal  (ASQ:SE  or  ASQ:SE-­‐2)  are  commonly  used  in  clinic,  Head  Start,  school,  public  health  and  other  seSngs  in  Minnesota  and  naNonwide  

•  Parent  report  –  assesses  SE  development  &  parent  concerns  •  Strong  psychometric  properNes  

ASQ:SE  psychometric  proper=es

ASQ-­‐SE  Sensi+vity  .71-­‐.85  Specificity  .90-­‐.98  Reliability    

Internal  consistency  .82  Test-­‐retest  .94  

Validity  .90-­‐.94    

ASQ:SE-­‐2  Sensi+vity  .78  -­‐  .84    Specificity  .76  -­‐  .98    Reliability    

Internal  consistency  .84  Test-­‐retest  .89    

Validity  77  -­‐  89%    

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Features  of  ASQ:SE  Ques=onnaire

• WriUen  at  a  4th  to  6th  grade  reading  level  • QuesNons  target  both:  

•  Competence  and  problem  behaviors    •  Externalizing  and  internalizing  behaviors    

•  Includes  open-­‐ended  quesNons    •  Related  to  eaNng,  sleeping,  and  toileNng  •  "Is  there  anything  that  worries  you  about  your  baby?  If  so,  please  explain."  

•  "What  things  do  you  enjoy  most  about  your  baby?”    

• ASQ:SE-­‐2  adds  auNsm-­‐specific  quesNons  ASQ-­‐3™  and  ASQ:SE  Training  Materials  by  Jane  Squires,  Jane  Farrell,  JanNna  Clifford,  Suzanne  Yockelson,  Elizabeth  Twombly,  and  LaWanda  PoUer    Copyright  ©  2013  by  Paul  H.  Brookes  Publishing  Co.,  Inc.  All  rights  reserved.  www.agesandstages.com  

Coding  Update

• Refer  to  MHCP  Provider  Manual,  C&TC  SecNon  www.dhs.state.mn.us/dhs16_150092    

• Bill  the  developmental  and/or  mental  health  screening  on  the  same  claim  as  other  C&TC  services.    

•  For  screening  with  a  standardized  instrument,  use  CPT  codes:  

•  Developmental:  96110    •  Social-­‐emoNonal  or  mental  health:  96127  •  AuNsm  spectrum  disorder:  96110  and  modifier  U1  • Maternal  depression  screening  with  Edinburgh,  PHQ-­‐9  or  BDI:  99420  with  modifier  UC  

What  is  happening  at  the  State  level  in  Minnesota? MN  Department  of  EducaNon  –  Early  Learning  Services  MN  Department  of  Health  –  Maternal  Child  Health  &  CYSHN  MN  Department  of  Human  Services  –  Children’s  Mental  Health  

Awareness  of  impact  of  trauma,  ACEs,  toxic  stress  on  child  development

• CollaboraNon  across  agencies  • CollaboraNon  with  professional  academies,  health  systems,  University  of  Minnesota,  and  others  

•  Statewide  training  and  support  •  Trauma-­‐informed  care  •  DC  0-­‐3  Revised  diagnosNc  manual  •  Social-­‐emoNonal  development:  promoNon,  early  idenNficaNon,  referral  

Support  of  statewide  screening  systems

• Minnesota  Interagency  Developmental  Screening  Task  Force  

•  Review  and  recommendaNon  of  screening  instruments  •  Resources  for  choosing  an  instrument,  referral  

•  Statewide  training  and  technical  assistance  •  Electronic  screening  pilot  (ASQ-­‐3  and  ASQ:SE)  

•  MulNple  languages,  audio  versions,  app-­‐based  •  CommunicaNon  and  coordinaNon  across  sectors  

 

Support  of  statewide  referral  systems

•  Expanding  Minnesota’s  Help  Me  Grow  system  •  Current  HMG  connects  children  0-­‐5  to  Early  Childhood  Special  EducaNon  evaluaNon  at  local  school  district  

•  Expanded  HMG  will:  •  Connect  families  to  full  range  of  exisNng  community  supports  for  health  development  (public  health,  mental  health,  etc.)  

•  Provide  short-­‐term  care  coordinaNon  and  tracking  of  access  to  referral;  document  gaps  and  barriers    

• Developing  the  Early  Childhood  Mental  Health  workforce  

•  Grants,  training  and  support  for  evidence-­‐based  early  childhood  mental  health  intervenNons  

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Training  MH  clinicians  on  appropriate  methods  for  diagnosis  of  young  children

•  Since  2004,  CMH  division  has  trained  1000  mental  health  professionals  in  the  use  of  the  DC:0-­‐3R  

•  Developmentally  appropriate  diagnosNc  process  for  children  ages  0-­‐4  years  

•  CMH  provides  ongoing  mentoring  support  to  clinicians  on  the  use  of  DC:0-­‐3R  through  a  monthly  case  consultaNon.    

•  CMH  partnered  with  the  Minnesota  Department  of  Health  to  idenNfy  clinicians  able  to  diagnosis  and  treat  young  children  based  on  our  list  of  1000      

•  Over  350  clinicians  across  the  state  will  see  children  under  5  

Early  Childhood  Mental  Health  clinicians  are  trained  in  evidence-­‐based  treatments:

• Parent  Child  InteracNon  Therapy  (PCIT)  Ages  3  –  7  years    

•  Trauma  Informed-­‐  Child  Parent  Psychotherapy  (TI-­‐CPP)  Ages  birth  –  6  years    

• AUachment  Bio-­‐behavioral  Catch-­‐up  (ABC)    Ages  6  months  –  3  years  

Referrals  to  EC  MH  (all  ages,  0-­‐5)

0%  

5%  

10%  

15%  

20%  

25%  

30%  

Family   County   Other   MH  Provider  

Head  Start  

Primary  Care  

EC  Teacher  

Special  Ed   Public  Health  Nurse  

2011   2014  

*Each of the following sources accounted for 1% or less of the referrals: IEIC, ECFE, Home Visitor, Rehabilitation, Crisis, County

What  does  our  data  say?  Type  of  diagnos=c  assessment:  DC:03  and  DSM

18.7% 15.9% 9.7%

5.0% 3.0%

76.0% 79.2% 85.8%

91.1% 92.6%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

100.0%

2011 2012 2013 2014 2015

DSM DC:03R

Diagnosis     Frequency Percent (%) 1   Adjustment disorder 778 17.9 2   Regulation Disorders of Sensory Processing 682 15.7 3   Anxiety Disorders 639 14.7 4   No DA information identified (code missing) 401 9.2 5   Posttraumatic Stress Disorder 347 8.0 6   Other Disorders of Childhood 182 4.2 7   Disruptive Behavior Disorders 174 4.0 8   Deprivation/Maltreatment Disorder 147 3.4 9   No Diagnosis Identified (code incorrect) 133 3.1 10   Other Disorders 112 2.6 11   Mixed Disorder of Emotional Expressiveness 94 2.2 12   Pervasive Developmental Disorder 88 2.0 13   Sensory Stimulation-Seeking 83 1.9 14   Disorder of Relating and Communicating 54 1.2 15   Anxiety Disorder NOS 52 1.2 16   Hypersensitive Type A: Negative Defiant 45 1.0 17   Disorders of Affect 34 0.8 18   Diagnosis on Axis I Deferred 27 0.6 19   Hypersensitive Type A: Fearful 25 0.6 20   Multisystem Developmental Disorder 23 0.5

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Numbers  of  Clients  receiving  Evidence-­‐Based  Prac=ces

Sum Column N % All evidence-based practices 714 21.9% Family Attachment Bio-behavioral Catch-up (ABC) 13 0.4% Family Child-Parent Psychotherapy (CPP) 308 9.4% Family Parent Child Interaction Therapy (PCIT) 234 7.2% Other EBPs (Incredible Years, TF-CBT, MN MAP) 159

Clinical  and  ancillary  services

•  Services  Received  By  ECMH  children  (any  Nme  in  SFY)  •  93%  Clinical    •  78%  Ancillary  (includes  transportaNon,  travel,  interprétaNon,  etc.)  •  70%  CoordinaNon  (Support)  (includes  phone  and  face-­‐to-­‐face  care  coordinaNon,  psychiatric  consultaNon,  and  teacher  consultaNons  

•  No  difference  in  clinical  or  ancillary  uNlizaNon  by  age  •  Support  services(Care  CoordinaNon)  

•  Median  2  meeNngs  per  child  total  SFY  •  Average  3.8  meeNngs  per  child    •  Children  who  received  support  services  tended  to  have  more  clinical  meeNngs  on  average  (17.8  mtgs  support  vs.  8.7  meets  no  support)  

•  Children  who  had  received  MH  services  previously  were  more  likely  to  get  support  services.    

Clinical  Services:  Loca=on  of  Service  Delivery

14%

39% 5%

39%

3%

Location of Service Delivery

Child Care/Head Start/School Site

Child's Home

Primary Care Office

Mental Health Clinic

Other

Policy  Alignment:  Psychiatric  Consulta=on  to  Primary  Care  Providers

As  stated  in  the  Provider  Manual:  hUp://www.dhs.state.mn.us/dhs16_138238  •  ConsultaNon  includes  communicaNon  between  a  consulNng  professional  and  a  primary  care  provider  for  the  purpose  of  medical  management,  behavioral  health  care  and  treatment  of  a  recipient.    

•  A  psychologist,  independent  clinical  social  worker  and  marriage  and  family  therapists  may  provide  consultaNon  about  alternaNves  to  medicaNon,  medicaNon  combined  with  psychosocial  treatments  and  potenNal  results  of  medicaNon  usage.    

•  The  provider  may  conduct  the  consultaNon  without  the  recipient  present.    

Policy  Alignment  con=nued

Specific  Medicaid/Mental  Health  Rules  that  support  young  children  include:  •  9505.0372  Covered  Services  

•  Subpart  1.  C.  (1)  for  children  under  the  age  of  5:  •  (a)  uNlizaNon  of  the  DC:0-­‐3R  diagnosNc  system  for  young  children  

•  Subpart  6.  D.  A:  mulN  family  therapy  group  •  If  the  client  is  excluded,  the  mental  health  professional  or  pracNNoner  must  document  the  reason  for  and  the  length  of  Nme  of  the  exclusion.  

Policy  Alignment  Con=nued

Subpart  5.  C.    Medical  assistance  covers  diagnosNc  assessment,  explanaNon  of  findings  and  psychotherapy  performed  by  a  mental  health  pracNNoner  working  as  a  clinical  trainee  when:  

1)  the  mental  health  pracNNoner  is:  a)  Complying  with  board  requirements  for  licensure  b)  A  student  in  a  bona  fide  field  placement  or  internships  under  

a  program  leading  to  the  compleNon  of  the  requirements  for  licensure  as  a  mental  health  professional    

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Policy  Alignment  Con=nued:    

2013  Changes  to  Minnesota  Statutes/  benefits  in  the  process  of  being  created:  •  256b.0625  Subd.  62:  Mental  health  clinical  care  consultaNon.  

•  Allowing  a  treaNng  mental  health  professional  or  clinical  trainee  to  bill  Medicaid  for  providing  consultaNon  to  another  professional  about  a  child’s  clinical  needs.      

•  Example:  Talking  with  a  child’s  childcare  teacher,  primary  care  physician,  public  health  nurse  to  ensure  mental  health  and  other  services  are  aligned.  

•  This  benefit  is  for  children  ages  birth  to  21  with  complex  and  chronic  condiNons,  including  early  childhood  mental  health  condiNons.      

•  The  State  Plan  Amendment  to  the  Center  for  Medicaid  Services  and  our  legislature  have  approved  this  benefit.    It  is  available  as  of  January  1,  2015.  

Policy  Alignment  Con=nued:

Changes  to  Minnesota  Statutes/  benefits  in  process:  256B.0946  INTENSIVE  TREATMENT  IN  FOSTER  CARE-­‐  •  Providing  holisNc  therapeuNc  services  to  a  child  in  foster  care  (wrapping  clinical,  mental  health  services  around  the  biological  and  foster  family)  in  order  to  reduce  disrupNons  in  placement  and  reduce  negaNve  outcomes  on  children.  

•  Services  include  helping  children  get  an  intensive  clinical  mental  health  service  while  sNll  meeNng  (respecNng)  their  permanency  needs  and  rights    

•  Use  current  systems  to  increase  access  for  children  who  need  an  intense  level  of  mental  health  service  

•  Create  more  flexible,  coordinated  service  delivery  among  all  child’s  team  members  (parents,  foster  parents  and  professionals)  

•  Strengthen  treatment  and  permanency  planning  with  consultaNon,  psychoeducaNon  and  therapy  services  to  support  successful  out-­‐of-­‐home  placements    

•  Promote  evidence  based  pracNces  and  outcome  measures  to  improve  results  for  children  in  foster  care    

Contact  us  with  other  ques=ons:

Katy  Schalla  Lesiak,  MSN/MPH,  APRN-­‐CPNP  Child  and  Teen  Checkups  (C&TC),  Early  Childhood  Comprehensive  Systems  Coordinator  Maternal  Child  health  Minnesota  Department  of  Health  [email protected]    Catherine  Wright,  PsyD,  MS,  LPCC  Early  Childhood  Mental  Health  System  Coordinator,    Children’s  Mental  Health  Minnesota  Department  of  Human  Services  [email protected]  

What’s  happening  at  Children’s  Hospitals  and  Clinics  of  Minnesota? Julie  Rabb,  PsyD,  LP  Clinical  Psychologist  –  Psychological  Services  Children’s  Hospitals  and  Clinics  of  Minnesota    [email protected]    

Children’s  Early  Childhood  Ini=a=ves

1.  Mosaic  in  Primary  Care  -­‐  Teaming  with  medical  providers    -­‐  Universal  screening    -­‐  Brief  in-­‐clinic  intervenNons    -­‐  Consistent  follow-­‐up    

2.  Research    -­‐  Toxic  Stress  and  Health    -­‐  Partnership  with  Harvard  Center  for  the  Developing  

Child  and  the  University  of  MN    

Children’s  Early  Childhood  Ini=a=ves,  con=nued 3.  Psychology  Services    

-­‐  Partnership  with  Children’s  Hospital  AssociaNon    -­‐  Increased  capacity  for  services  0-­‐6  -­‐  Two  generaNon  model  for  intervenNons  

4.  Group  Pilot    -­‐  Parents  with  children  0-­‐3    -­‐  Special  Medical  Needs    -­‐  AUachment  and  development  

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Early  Childhood  Mental  Health  clinicians  are  trained  in  evidence-­‐based  treatments:

• Parent  Child  InteracNon  Therapy  (PCIT)  Ages  3  –  7  years    

•  Trauma  Informed-­‐  Child  Parent  Psychotherapy  (TI-­‐CPP)  Ages  birth  –  6  years    

• AUachment  Bio-­‐behavioral  Catch-­‐up  (ABC)    Ages  6  months  –  3  years  

Children’s  Early  Childhood  Ini=a=ves,  con=nued 3.  Psychology  Services    

-­‐  Partnership  with  Children’s  Hospital  AssociaNon    -­‐  Increased  capacity  for  services  0-­‐6  -­‐  Two  generaNon  model  for  intervenNons  

4.  Group  Pilot    -­‐  Parents  with  children  0-­‐3    -­‐  Special  Medical  Needs    -­‐  AUachment  and  development  

Children’s  Ini=a=ves  -­‐  Contact

 Dr.  Julie  Rabb,  Psy.D.    Psychology  Services    

St.  Paul  651-­‐220-­‐6815  

[email protected]    

Top  3  take  away  points:

1.  Early  childhood  social-­‐emoNonal  and  brain  development  maUers,  and  toxic  stress  and  ACEs  impact  that  development.  

2.  There’s  something  we  can  do:  •  Advocate  and  educate  •  Support  parents/caregivers  as  babies’  most  important  developmental  partner  

•  Screen,  idenNfy  concerns  early,  refer  to  appropriate  resources  

•  Collaborate  within  and  outside  of  your  seSng  for  systems  improvements  

3.  Resources  are  available  and  emerging  over  Nme.  

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