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Minnesota Association of Children’s Mental Health Conference 2010

Connecting the Very Young with Part C EarlyConnecting the Very Young with Part C EarlyIntervention: Roles for MinnesotaIntervention: Roles for Minnesota’’ssInteragency Early Intervention Committees inInteragency Early Intervention Committees inInfant Infant Mental HealthMental Health

Catherine Wright, MS, ChildrenCatherine Wright, MS, Children’’s Mental Health- Minnesota Department of Humans Mental Health- Minnesota Department of HumanServicesServicesLoraine Jensen, Part C Coordinator-Minnesota Department of EducationLoraine Jensen, Part C Coordinator-Minnesota Department of EducationShawn Holmes- Part C Planner- Minnesota Department of HealthShawn Holmes- Part C Planner- Minnesota Department of HealthSue Benolken, State Interagency Facilitator-Minnesota Department of Human ServicesSue Benolken, State Interagency Facilitator-Minnesota Department of Human Services

Agenda/Outcomes

Understand the needs of very youngchildren with social emotional and ormental health concerns

Understand how Part C/Help Me Growand Mental Health intersect

What is your role in this Early Interventionsystem

IntroductionsIntroductions

Discussion- name and role within yourDiscussion- name and role within youragencyagency

What is EI Mental Health

Early Childhood Mental Health is referring tochildren ages 0-5 and interwoven with a youngchild’s development and overall health.

We know that much of the brain developmentoccurs before the age of three.

Early Intervention is the key to reverse theeffects of adverse early experiences.

http://developingchild.harvard.edu/initiatives/council/

How does Social EmotionalDevelopment go Awry?

Exposure to trauma, significant loss with primary care givers.

Disruptions in relationships with primary care givers because of: Parental mental illness Substance abuse Domestic violence

Biological Reasons Genetic inheritance Exposure to injury, infection, toxicants, nutritional deficiencies (in-utero

or after) Difficult temperament

Social/Environmental Stressors Living in high risk neighborhoods Discrimination and racism Prolonged family stress due to death, divorce, extreme economic

hardship, etc.

From Neurons to Neighborhoods, 2000 and ACE study (ongoing)-www.acestudy.org

What Do We Know and Believe Early experiences influence the developing brain. Chronic stress can be toxic to developing brains. Significant early adversity can lead to lifelong

problems. Early intervention can prevent the consequences

of early adversity. Stable, caring relationships are essential for

healthy development Social emotional is a developmental domain Intervention should be as early as possible.

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Brain ResearchEarly experiences determine whether a child’s

brain architecture will provide a strong or weakfoundation for all future learning, behavior, andhealth

Young children experience their world as anenvironment of relationships, and theserelationships affect virtually all aspects of theirdevelopment.

Young children are highly vulnerable emotionallyto the adverse influences of parental mentalhealth problems and family violence

What happens in early childhood can matter fora lifetime.

Human Brain Development

Family Centered/Driven processes that focus on the needs and prioritiesoutlined by the families and addressed yield better results

Early Intervention that is relationship based (child within the familycontext, dyad, wholistic), developmentally focused and delivered withinnatural environments and activities enhances results

Systems that can provide the right service at the right time in the rightamount are expected to have better outcomes

Young children need positive relationships, rich learning opportunities,and safe environments, not quick fixes or magic bullets

Ensuring that children have positive experiences prior to entering schoolis likely to lead to better outcomes than remediation programs at a laterage, and significant up-front costs can generate a strong return oninvestment

Belief that a comprehensive, coordinated, interagency,multidisciplinary system to be more effective and of higherquality.

A family focused system that is accountable, easy to accessand is ready to provide needed services and supports,improves outcomes of children with disabilities and theirfamilies.

Child maltreatment results in a substantial risk to a child’sdevelopment. The risk for developmental delays can last for several years

after maltreatment. Risk factors can result in academic difficulties as a child

enters school.

What Do We Know and BelieveProgram strategies that: Facilitate friendships

and mutual support Strengthen parenting Respond to family crises Link families to services

and opportunities Facilitate children’s

social and emotionaldevelopment

Observe and respondto early warning signsof child abuse or neglect

Value and support parents

Build Parental resilience

Social connections

Knowledge of parentingand child development

Concrete supportin times of need

Social and emotional competence of children

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Attention to Social Emotional/MentalHealth is Important

Infants and toddlers are capable of deep and lasting sadness, grief, anddisorganization in response to trauma, loss and early rejection.

Additionally, biological conditions or neurological disorders can createimmediate social-emotional problems or subsequent risk for them. Earlychildhood development research shows that babies: Four months or younger can experience depression As young as 6 months suffer from long term effects from witnessing

trauma As young as 1 month can sense whether or not a parent is depressed

or angry, and is affected by the parent’s mood. Many of thesechildren exhibit signs of traumatic stress, including withdrawnbehavior, fearfulness, anxiety, aggression, disorganization

and sadness. Significant parental mental health problems, substance abuse, and

family violence impose heavy developmental burdens on youngchildren.

What do we mean when we sayinfant mental health?

Definition- from Zero to Three:“ Infant mental health is the developing capacity of

the child from birth to three to: experience,regulate, and express emotions; form close andsecure interpersonal relationships; and explorethe environment and learn- all in the context offamily, community, and cultural expectations foryoung children. Infant mental health issynonymous with healthy social and emotionaldevelopment.” Zero to Three, 2001

Mental Health and EarlyIntervention Connections

Who is Eligible for EarlyIntervention/Help Me Grow

A child under 3 years of age who needs earlyintervention services because the child:

Meets the criteria for any one of the thirteen special educationdisability categories (categorical disability)

OR

Is experiencing a developmental delay that is demonstrated bya score of 1.5 standard deviations or more below the mean asmeasured by appropriate diagnostic instruments in 1 or moreof the areas of development

OR

Has a diagnosed physical or mental condition that has a highprobability of resulting in developmental delay

Evaluation Process for DeterminingEligibility Review of the child’s current records related to health

status and medical history.

Evaluation of the child’s levels of functioning across fivedevelopmental domains. (standard deviation 1.5 below mean in 1 ormore areas) Cognitive development Physical development Communication development Social or emotional development Adaptive development

Assessment of the unique needs of the child in terms ofeach of those developmental areas.

Eligibility Guidelines: http://www.health.state.mn.us/divs/fh/mcshn/ecipelig/

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Eligibility Criteria (hand outs)

13 DC:0-3R diagnoses qualify childrenages 0-3 for Part C servicesWhat is DC:0-3RWhat are the DiagnosesWho Can do the Diagnoses

What about EC Mental HealthEligibilityCMH conditions that qualify a child for

Help Me Grow: Adjustment Disorders Anxiety Disorders of Infancy and Childhood Depression of Infancy and Early Childhood Deprivation/Maltreatment Disorder Disorders of Affect Feeding Behavior Disorders Mixed Disorder of Emotional Expressiveness

What about EC Mental HealthEligibilityCMH conditions that qualify a child for

Help Me Grow: Post-traumatic stress disorder (PTSD) Prolonged Bereavement/Grief Disorder Regulation Disorders of Sensory Processing Sleep Behavior Disorder Disorders of Relating and Communicating Multisystem Developmental Disorder (MSDD)

Social Emotional Development Mental HealthConditions and Early Intervention Eligibility Categorical Disability (EBD) Developmental Delay

Diagnosed condition with a high probability ofresulting in developmental delay ordisorder(DC:0-3 selected conditions)

1.5 Standard Deviation delay below the mean in1 or more of 5 developmental domains(communication, cognition, social/emotional,adaptive, physical development)

Informed Clinical Opinion

Questions HOW Do You Get into Help MeGrow

Child may be screened for social emotionalconcerns in primary care, Head Start, childwelfare, through Follow-Along Program or…

Children with elevated screening scores arereferred to Help Me Grow to receive a fullevaluation

If eligible and a mental health need has beenidentified the Help Me Grow connects familieswith Mental Health Professionals and engage injoint planning to address needs

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Call 1-866-693-GROW (4769) to bedirected to your Early Childhood SpecialEducation contact.

http://www.parentsknow.state.mn.us/parentsknow/Newborn/HelpMeGrow_SpecialNeeds/index.html?redirectNodeId=Newborn

How to refer a child to Part C services ifthere are concerns with a child’sdevelopment

1-866-693-GROW (4769)www.mnparentsknow.info

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What might the parent/childWhat might the parent/childexperience? (Birth to age 3)experience? (Birth to age 3)

Home visitDevelopmental historyDevelopmental screeningPlanning a comprehensive evaluation (if

necessary)Public Health nurse, social worker, ECSE staff

member

What might the parent/childWhat might the parent/childexperience? (Birth to age 3)experience? (Birth to age 3)

Comprehensive, multidisciplinary evaluationCognitionSelf-helpLanguageMotorSocial skillsFamily-directed Assessment (optional for

family) Completed within 45 days of referral

What do you get Services for children between the ages of

0-3 with developmental delays and/ordisabilities.

Help families find health, educational andsocial services that promote childdevelopment.

Family-centered services provided in anatural environment (home, day care,community play grounds, shelter…

Payment for services

No cost to families for the followingservices: evaluation, assessment, earlyintervention services, servicecoordination, and information and referral.

Parents may have a cost associated withthe additional services

Services must be described and deliveredvia an Individualized Family Services Plan(IFSP)

Services at no cost Evaluation Assessment Early Intervention Instruction Information and referral Service coordination

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Other Possible Services audiology nursing nutrition physical therapy assistive technology occupational therapy vision services Family education and counseling health services (during EI delivery) Respite services medical services (diagnosis and evaluation) transportation and related costs speech pathology psychological services

Payment for IFSP services Parental financial responsibility:

Parental fee structures alreadypermitted can be used

Parental responsibilities are clearlydescribed in the IFSP

Inability of a parent to pay for servicesmust not prohibit a child from receivingneeded services.

Service Plans 0-2Service Plans 0-2Individualized Family Service PlanIndividualized Family Service Plan

Documents early intervention services Must include service coordination Major outcomes based on family priorities Functional—tied to routines in the home or

other natural environment Focus on building the capacity of the family

and other primary caregivers to enhance thedevelopment of the child

Individualized Family Service Plan(IFSP)

A planning process and documentof the plan that results from:

assessment evaluation family identification of their needs,

concerns and priorities (FamilyCentered Practices)

That clearly specifies:

Individualized Family ServicePlan (IFSP)

Child’s developmental statusOutcomes to be achievedSpecific services, along with the dates and

durationPayment arrangementsMedical/other services neededTransition stepsSignatures of parents, service coordinator, and

providers.

Individualized Family ServicePlan (IFSP)

And is:Protected by: Procedural safegaurds and

dispute proceduresCoordinated by: an assigned Service

CoordinatorAnd has:Services Delivered: in the home or other

natural environment (if not in a naturalenvironment-with justification)

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Payment for IFSP services

If the activity is related to evaluation todetermine MH needs, Part C funds can beused IF no other funding source isavailable

Part C funds can also be used to pay forservices where there is no other fundingsource available

IEIC EffortIEIC Effort

IEIC? Interagency Early Intervention Committee Outreach to Primary Referral Sources Work across agency to assure a coordinated,

comprehensive system Agreements, Payments, dispute resolution Special efforts to reach underserved populations

Linguistically diverse Homeless/Migrant Children who are victims of substantiated cases of

abuse/neglect

County and School BoardResponsibilities:

School board:provide, pay for and facilitate paymentfor special education and relatedservices

County board:provide, pay for and facilitate paymentfor noneducational services of socialwork, psychology, transportation andrelated costs, nursing, respite andnutrition services

Responsibilities of county boards andschool boards

(IEICs)Joint responsibilities:

coordinate, provide and pay for appropriateservices and to facilitate payment frompublic and private sources

coordinate early intervention services determine primary agency may develop interagency agreements to

establish agency responsibilities

Your Role in the EI system Discuss your roles within the Early

Intervention systemEducationMedical (nurses, physician, mental health

professional)Child Care, Head Start, ECFESocial ServicesPublic Healthparentother

Your Role in EI

Parents Make a referral- you know your child best, if you are

concerned, seek support! Let your child’s primary care provider (doctor) know

about your concerns- you can always request thatyour physician regularly screen your child fordevelopmental and mental health concerns.

Actively participate in your child’s plan developmentand treatment.

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What is your role in EI Education:

Address the social emotional developmentalissues, as a mental health concern raisedmake sure you refer and connect with amental health professional

Service coordinator coordinates evaluationand facilitates the connections to resourcessuch as mental health

Coordinate the part c resources

What is your role in EI

Mental Health Professional: Complete a diagnostic assessment with child and

family Partner with appropriate agencies and child’s family to

develop a holistic treatment plan Provide appropriate treatment based on diagnostic

assessment Complete outcome measures to ensure effectiveness

of care

What is your role in EI

Public Health/ Child Protection/ otherCounty Services: In the home- refer!!Help bridge the MH professional into the

home as you have a relationship Incorporate goals of the EI/MH plan into your

work with the family.

What is your role in EI

Early Head Start/ Early Childhood FamilyEducation/ Child CareMake referrals when needed (if you are

screening, always offer parents a referralwhen the screening indicates a concern)

Team with EI, family and MH team membersto promote goals in setting, as the planindicates

What is your Role in EI

Primary Care Screen for developmental and mental health issues

regularly. Assist families in making referrals to EI when

concerns arise from the screenings. Report any changes in physical health status to EI

team. Team with parent, EI and MH team members to

coordinate care for children qualifying for EI/MHservices.

ResourcesResources

Reading/Resource ListReading/Resource List

Examples of Part C Eligibility for EarlyExamples of Part C Eligibility for EarlyChildhood Mental Health ConditionsChildhood Mental Health Conditions

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Resources forDevelopmental Red Flags First Signshttp://www.firstsigns.org/ CDC: Learn the Signs-Act Earlyhttp://www.cdc.gov/ncbddd/actearly/index.html Parents Knowwww.mnparentsknow.info Nichyhttp://www.nichcy.org/Disabilities/Milestones/Pages/D

efault.aspx

Video ClipsVideo Clips

Age Specific Showing Developmental Milestones

Newborn 18 Months2 Months 2 Years4 Months 3 Years6 Months 4 Years9 Months 5 Years1 Year

http://mediamill.cla.umn.edu/mediamill/display/38631

Questions