janice l. cooper, phd interim director, nccp
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Intentional Policy-making to Support Young Children ! Establishing Conditions for Optimum Child Development in the Early Years. Janice L. Cooper, PhD Interim Director, NCCP. Early Childhood Mental Health Blue Ribbon Policy Denver, CO | May 19, 2010. Who We Are. - PowerPoint PPT PresentationTRANSCRIPT
Intentional Policy-making to Support Young Children!
Establishing Conditions for Optimum Child Development in
the Early Years
Janice L. Cooper, PhDInterim Director, NCCP
Early Childhood Mental Health Blue Ribbon Policy
Denver, CO | May 19, 2010
www.nccp.org
Who We Are
NCCP is the nation’s leading public policy center dedicated to the economic security, health, and well-being of America’s low-income children and families.
Part of Columbia University’s Mailman School of Public Health, NCCP promotes family-oriented solutions at the state and national levels.
Our ultimate goal: Improved outcomes for the next generation.
www.nccp.org
NCCP’s Early Childhood Team and FES Team that Contribute to Our ECMH Work
Sheila Smith, PhD, Director Yumiko Aratani, PhD, Assoc. Research
Scientist Vanessa Wight, PhD, Demographer David Seith, Research Analyst Liz Isakson, MD Louisa Higgins, MA, Project Thrive
Coordinator Will Schneider, Data Manager, ITO
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Outline
Setting the Context Why Social-emotional Development Matters? What Do We Know about Systematic Efforts to
Develop Policies that Facilitate S-E Development?
Recommendations
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Research Also Shows that Exposure to Multiple Risks Matter
The more risk factors, in general, the worse the outcomes, regardless of what they are Infants, toddlers and parents who face 4+ demographic
risk factors in EHS benefit less than other children (impacted about 26% of the sample).
Multiple risks increase the odds of poor outcomes exponentially Child with 1 risk factor has nearly 2 times Child with 2 risk factors has nearly 3.3 times, Child with 3 risk factors has over 4.5 times Child with 4 risk factors has more than 15 times Higher odds of experiencing poor health or
developmental delays than a child with no risk factors
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Young child poverty by percent of young children with 3 or more risk factors,
2008
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Setting the ContextPoverty rate rising Overall poverty rate rose from 12.5% to 13.2%;
the first statistically significant increase since 2004.
Child poverty increased a full percentage point—rising from 18% to 19%.
Latest data show that 14.1 million children live in poverty.
Children of color living in poverty increased: Asian-Pacific Islander (from 12.7% to 15.0%) Hispanic heritage Latino (28.7% to 30.5%) American-Indian children (25.7% to 31.3%)
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KIDSCOUNT: Colorado’s Data Shows
Ranks in middle in child
poverty Experienced greatest
10 yr in US Child poverty rate 10% to 15% over 10 yrs
Growth # children of first gen Americans above US 230% growth vs 90%
Sources: Kids Count 2010, Kaiser 2010
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KIDSCOUNT: Your Own Data Shows Too many uninsured
childrenPoor Children <100% FPL
CO (30.6) vs. US (18.1)
Children as a percentage of the uninsured: CO (21.2) vs. US (17)
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NCCP’s Early Child Profile Shows that Colorado Made several important recent decisions to put children
first, even in these difficult times. A few examples: Provides relative generous eligibility levels for public
health insurance Medicaid, CHIP- 250% FPL (children 0-5 yrs.); temp. coverage for pregnant women up to 200% FPL
CO is one of the states that funds a pre-K/Head Start ($28.4 m in 2008), but from prior year
CO has implemented a statewide childcare Quality Rating Improvement System (QRIS) and a statewide home visiting program (NCCP new study stresses “I” in QRIS)
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WHY SOCIAL-EMOTIONAL DEVELOPMENT MATTERS?
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Poor Mental Health Outcomes Start Early
Young Children with “challenging behaviors” andsocial- emotional problems: Often fare poorly in achieving benchmarks for
early school success Are 3X more likely to be expelled from pre-
school than children/youth K-12 More likely to experience problems later such
as conduct disorder, anti-social behaviors and serious mental health conditions
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Colorado Simulator
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Basic Budget Needs: Selected Localities
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What does it take to make ends meet?
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Social emotional development for young children Far-reaching consequences and implications for the
life-span of an individual and ultimately of a nation Indicators of good social emotional development
include:
positive peer relationships positive child adult relationships language development—expanding ability to use
vocabulary including emotional vocabulary, and expanding ability to express needs and relationship with world and manage emotion.
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Social emotional development for young children Prenatally we can prepare for a child’s social emotional
development: good spacing between children health before, during and after pregnancy can reduce the risks for
conditions (including depression)
From birth we can provide parents with supports that: they need to help children to develop relationships that are healthy support their individual ways of learning, their efforts to learn new
things and their ability to get along with their peers prevents and treats maternal depression support parents through effective parenting education, provide
supports for positive alternatives to help parents parent!
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Why NCCP interested in Social-Emotional Development in Early Childhood
1. Income matters 2. Early experiences and relationships have
lasting consequences3. Multiple risk factors increase the chances
of harmful effects
Key Take Home Messages from Child Development Research
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Income Matters Net of any other changes, increased income
improves school readiness Financial hardship reduces parents ability to invest
in time and resources to promote positive outcomes Financial stress has been linked to parenting,
relationship challenges and poor mental health outcomes
Recent synthesis of literature on the impact of homelessness on child functioning found across studies poverty matters [1/2 homeless children 0-5]
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CHILD MENTAL HEALTH
Children’s Mental Health Today Courtesy Bruner
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Research Shows Vast Needs that Go Unmet Social-emotional/behavioral problems common among
young children 9.5-14% problems impact learning, functioning, achievement
Family, Environmental and Neighborhood Risk Factors may Compound Vulnerability: Family risks factors (eg poverty) increase odds of behavioral
problems that impact development 40% of 2 yos in ec settings experience poor/insecure attachments
Yet research shows that 50% of the impact of income could be mediated by strategies that focused on parenting
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Research Suggests Disparities in Access for Young Children
Differences in access by race/ethnicity, age Between 80-97% very young children do not get
access to early childhood mental health services Disproportional pre-school expulsions based on
race/ethnicity African-American preschoolers 3X White, 5X API
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In Colorado, Office of Health Disparities’ 2009 Report on Racial & Ethnic Disparities showed
American-Indian/Alaska Native
Rest of State
Unemployment
11% 6%
Smoking 30% 19%Obesity 27% 18%
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In Colorado, Office of Health Disparities’ 2009 Report on Racial & Ethnic Disparities showed
African-American
Rest of State
Unemployment 10% 6%Child Poverty 33% 15%Prenatal Stressors (3+) 44% 27%Infant Mortality (per 1K live births) 17% 6%Perinatal Mortality (per 100K fetuses) 12% 4%
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In Colorado, Office of Health Disparities’ 2009 Report on Racial & Ethnic Disparities showed
Hispanic/Latino
Rest of State
Not graduate HS 43% 25%Child Poverty 30% 15%Unmet child dental health needs
15% 8%
Lack of Adult Health Insurance
40% 17%
Obesity 24% 14%
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State of Services and Supports for Young Children Difficult to Fund and Sustain in Many States:
Effective two generation strategies and those that build and support parent-child relationships
Strategies such as mental health consultation, social emotional learning
Standardized screening tools to ensure accurate identification
Social emotional learning in schools and child care settings
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State of Services and Supports for Young Children Inadequate Infrastructure Supports Hamper Progress:
Poor provider capacity Shortage and competencies in early childhood development Mental well-being of non-relative care givers Inadequate appropriate developmental fit for some
diagnostic procedures and failure to either fund based on risk or systematic adopt a cross-walk like DC 0-3R to maximize reimbursement for needed services
Few statewide training institutes to improve the quality of interventions across domains
Insufficient focus on outcomes for young children
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The Core Findings Unclaimed Children: Early Childhood
44 states reported one or more early childhood initiatives; 37 states CMHA funded early childhood mental health services directly.
In only half of these states is at least one initiative statewide.
Initiatives encompass early childhood specialists in CMHC’s (N=21); ECE mental health consultation programs (N=26); reimbursement for social & emotional screening tools; working with adult mental health (N=15).
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Type of ECMH Initiatives* CMHA funds (N=51)
*Includes infrastructure building related initiatives
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Examples of Systematic Efforts to Develop Policies that Facilitate S-E Development in Early Intervention Strengthening ECMH training for Part C providers.
Eg: New Mexico and Kansas adopted the MI Association for Infant Mental Health Endorsement System.
Using a risk-assessment tool to determine eligibility for early intervention services.
Eg: MA and KS include child and parental factors such as: parental behavioral health conditions, and lack of social supports
Requiring core competencies for EI specialists. Eg: In MA, knowledge of "how children learn through relationships" and
skills in using strategies to "engage and support caregivers in positive interactions with their infants and toddlers that promote healthy social-emotional development.
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Examples of Systematic Efforts to Develop Policies that Facilitate S-E Development
Strengthening early identification and treatment of maternal depression – WIC screening in MD IL leveraging funding incentives, validated tools
ECMH consultation statewide IL – all child care programs reflective supervision-
Erikson Inst. MD using Georgetown model CT - all child care programs reflective supervision, Yale AZ including home visiting, reflective supervision,
training attachment, trauma – quality monitoring
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Examples of Systematic Efforts to Develop Policies that Facilitate S-E Development
Child screening validated tools and enhance rates use in PC settings MN DOH instruments SE MI NC
Provider training and support PITC (Pgm Infant/Toddler Caregiver) FL, IL, IN, IA, KS, MN, MS ND, NM, TX, OH, OK, SC, SD, WY
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Recommendations for Policy Action Fund effective two generation strategies and those that
build and support parent-child relationships Reimburse strategies such as validated assessments,
mental health consultation, and social emotional learning Infuse funding and support for young children in both
education and human services’ strategic agenda Address the pervasive shortage among mental health
providers including those with expertise in early childhood Require a focus to reduce based on age, race/enthicity and
language related disparities including public reporting on outcomes
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Recommendations for Policy Action Address the need for effective parenting
programs Take to scale effective strategies to all young
children and their parents Require that agencies that touch children and
families have a shared goal for social-emotional healthy children and are held accountable for meeting this goal. That means matching financing to support this goal.
Support efforts to reduce the impact of income on poor young child outcomes.
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For More Information, ContactJanice Cooper
Or Visit NCCP web sitewww.nccp.org
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