Promoting Community Systems of Care to
Foster Young Children’s Social and
Emotional Development
May 22, 2014
The Core Story
1 - Child development is the foundation of prosperous
communities
2 - Brains are built over time, from the bottom up (skill begets skill)
3 - Genes and experiences together build brains (serve and return
relationships)
4 - Cognitive, social and emotion development are inextricably
intertwined
5 - Toxic stress damages brain architecture
6 - Resilience is not an internal character strength, but rather is
built through combined impact of genes and experiences of a
child
7 - For many functions, the brain’s capacity for change decreases
over time (cost-effectiveness factor) - but not all
P.Levitt, 2013
The Challenge
• Social and emotional development is
foundational, and impacted by internal and
external forces
• Early traumatic experiences are common
– In Wisconsin (2010)
• 4,839 child victims of maltreatment
• Represents 3.7 children per 1,000 children in
the State
WI Department of Children and Families, Wisconsin Child Abuse and
Neglect Report, 2011
The Challenge: Child Maltreatment
U.S. Dept. Health and Human Services, 2010
The Challenge: Childhood Mental Illness
• >14 million children and adolescents in the
US (1 in 5) with a diagnosable mental health
disorder
• Only 20-25% of affected children receive
treatment or support
US DHHS Surgeon General’s Report (1999);
AACAP Committee on Health care Access and Economics, Pediatrics
(2009)
Community System of Care
• What is a community system of care?
• Members
– Families
– Professionals
Today’s Goals
• Consider what it means as a community to
work together on fostering young
children’s social and emotional
development
• Develop an ongoing base for growth in
this area
Learning Objectives
• Learn about the importance of monitoring
young children’s social and emotional
development
• Discuss impact of toxic stress on children’s
development, and the role of traumainformed care in mitigating the effects of
trauma and toxic stress in children
Learning Objectives
• Identify resources available to support
professionals in promoting
– Social and emotional development in all children
– The early identification of those with behavioral
health needs
– Effective intervention and care coordination for
those with established mental health challenges
Learning Objectives
• Prioritize professional self-care and colleague
support
• Identify other community members working to
support children and define concrete strategies
to connect with one another to develop community
systems of care
Guiding Principles
• Child and family focus
• Healing occurs in supportive
relationships
• Professionals must care for themselves and support one
another in order to care for others
• Shared responsibility across professionals sectors is essential
• Children receive support according to their level of need, as
offered by a spectrum of care within the community
Spectrum of Care:
Pyramid Model for Supporting Social Emotional
Competence in Infants and Young Children
Spectrum of Care:
Pyramid Model for Supporting Social Emotional
Competence in Infants and Young Children
Intensive Intervention
Targeted Social and Emotional Supports
Early Identification of Children with
Social and Emotional Challenges
Social and Emotional Development Promotion
for All Children
For Consideration
• Where are you in the spectrum of care?
• Who are your community partners in the
other parts of this spectrum?
• How successful are your efforts to
connect with other community partners
on this spectrum?
• How might this connection be improved?
What is Social and Emotional Development?
The developing capacity of a young child to:
• Experience, regulate and express emotion
• Form close and secure interpersonal relationships
• Explore the environment and learn
All within the context of family, community and
cultural expectations for young children
From a working definition developed by Zero To
Three : National Center for Infants, Toddler and
Families – Infant Mental Health Task Force
Infant and Early Childhood Mental Health
Develops through relationships with parents
and other caregivers.
– Is fostered through nurturing and
supportive relationships.
– Teaches the child that she/he has an
impact on her/his environment.
Calm
High Arousal
Relationships are the Basis of a
Child's Stress Response System
Adapted from B. Perry, MD, PhD. (2009)
Calm
High Arousal
Relationships are the Basis of a
Child's Stress Response System
Adapted from B. Perry, MD, PhD. (2009)
“There is no such thing as a baby,
there is a baby and someone else…”
-D.W. Winnicott
Social and Emotional Skills
Think of a child you know who is
socially/emotionally skilled.
What does that look like?
Think of a child who struggles and is
hard to reach.
What does that look like?
Social Emotional Competence
•
•
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Trust
Self-Confidence
Motivation
Persistence
Self-Control
Stress Impacts Social and
Emotional Development
Stress Responses in Childhood
Stress
Positive
Response
Tolerable
Toxic
Duration
Brief
Sustained
Sustained
Severity
Mild/moderate
Moderate/severe
Severe
Social-emotional
buffering
Sufficient
Sufficient
Insufficient
Long-term effect Return to
on stress
baseline
response system
Return to
baseline
Changes to
baseline
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Three Levels of Stress
Positive
Brief increases in heart rate, mild elevations in stress
hormone levels.
Tolerable
Serious, temporary stress responses, buffered by
supportive relationships.
Toxic
Prolonged activation of stress response systems in the
absence of protective relationships.
Some Stressors in Childhood
Child Stressors
Family Stressors
Abuse, neglect, chronic fear state
Parental dysfunction:
•Substance abuse
•Domestic violence
•Mental illness
Other traumas
•Natural disasters
•Accidents and illness
•Exposure to violence
Divorce/single parenting
Disabilities/chronic disease
Poverty
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Other Factors Influencing Stress
Sources of Resilience
Temperament
Social-emotional supports
Learned social-emotional skills
Caregiver response
Other Vulnerabilities
Temperament
Delays in development
Limited social-emotional supports
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Traumatic Alterations
• Experience
• Epigenetic modifications
• Changes in brain structure
and function
• Behavioral attempts to cope
– May be maladaptive in other contexts
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Epigenetic Changes
• Alterations in the way the genetic program
is read
• Can cause structural changes in
developing brain
• Can influence the stress response
Disruptions in Brain Architecture
with Toxic Stress
3 important brain structures:
Amgydala
Hippocampus
Frontal cortex
Prefrontal Cortex
The Impact of Early Adversity
on Children's Development
Disrupted Brain Architecture
Can Influence Behavior
Behavior changes seen in young children
Additional behavior changes seen in older
children, adolescents and young adults
Maladaptive Behavior Can Be
Misleading
• Potential misdiagnoses
– ADHD
– ODD
– Bipolar
Behavior worked previously, continues to result
in some gain
Adverse Childhood Events (ACEs)
• ACEs (before age of 18)
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Physical abuse
Emotional abuse
Sexual abuse
Alcohol and/or drug abuser in household
Incarcerated family member
Household member chronically depressed, mentally ill,
institutionalized or suicidal
– Violence between adults in the home
– Parental separation or divorce
– Original study (1995-97)
– WI Behavioral Risk Factor Survey (2010)
http://www.cdc.gov/ace/
Significant Adversity Impairs
Development in the First 3 Years
Barth 2008, Center on the Developing Child at Harvard University
Rate of ACEs by disability status, WI adults ages
18-64, 2010-2011
50%
No disability
45%
Disability
40%
35%
30%
25%
20%
15%
10%
5%
0%
14%
29%
Four or more ACEs
Source: Wisconsin Department of Health Services, Behavioral Risk
Factor Survey (BRFS); 2008-2011 land-line only dataset.
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ACEs and Life Course Theory
And Now Some Good News…
• Identifying toxic stress and
social and emotional
development concerns, and
• Referring children and families
to supports and services have
the potential to positively
impact the child’s life-long
health and prosperity
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Spectrum of Care Resources:
Workforce Resources
Resources to support effective
workforce development
• Wisconsin Alliance for Infant Mental Health
• Infant, Early Childhood and Family Mental
Health Certificate Program
• YoungStar
• Supporting Families Together Association
• AAP and WiAAP resources
• Trauma-informed care
• General development promotion
• Self- and colleague-care reflective
supervision
WI Alliance for Infant Mental Health
• To stay connected with other early childhood
professionals and to find out more about
professional development opportunities, visit
us at: www.wiaimh.org.
UW Infant, Early Childhood and Family
Mental Health Certificate Program
Applications are currently being accepted for
this interdisciplinary academic program:
http://infantfamilymentalhealth.psychiatry.wisc.edu/
YoungStar
http://dcf.wisconsin.gov/youngstar/default.htm
Supporting Families Together
Association
https://supportingfamiliestogether.org/
Offers training and technical assistance
support to Child Care Resource and
Referral Centers, Family Resource
Centers throughout the State
Birth to 5: Watch Me Thrive
Resources for
– Early Intervention Service and Early Childhood Special
– Education Providers
– Families
– Primary Care Providers
– Communities
– Child Welfare
– Home Visitors
– Behavioral Health Providers
– Housing and Homeless Shelter Providers
– Parents
http://www.acf.hhs.gov/programs/ecd/watch-me-thrive
WIAAP Mental Health Webinar
Series
Collaboration between Wisconsin Chapter of
American Academy of Pediatrics & Wisconsin
Council of Child and Adolescent Psychiatry
https://www.wiaap.org/wiaap-foundation/wacpp/
AAP Mental Health Toolkit
• Focus Areas
– Community resources
– Health care financing
– Support for children and families
– Clinical information systems/delivery system
redesign
– Decision support for clinicians
AAP Trauma Guide
Helping Foster and Adoptive Families Cope With Trauma Webinar (58
min)
Helping Foster and Adoptive Families Cope With Trauma: A Guide for
Pediatricians (20 p)
Coding Tips (2 p)
Visit Discharge and Referral Summary for Family (1p)
Parenting After Trauma: Understanding Your Child’s Needs (4 p)
•
http://www.aap.org/traumaguide
Role of Trauma Informed Care
When faced with challenging behavior,
professionals think,
“What might have happened to this child?”
rather than “What’s wrong with this child?”
Wisconsin Trauma-Informed
Care Resources
Resources on Trauma Informed Care, as
well as active listserv
http://www.dhs.wisconsin.gov/tic/
WI ACE and Trauma
Workgroup - Children’s Trust Fund
http://wichildrenstrustfund.org/index.php?
section=adverse-childhood
WI Trauma Project
• Introduce evidence-based trauma
screening, assessment and treatment
• Train parents and agency social workers
on childhood trauma
• Create a more trauma-informed &
responsive system of care
• Track outcomes
• Sustain changes
National Child Traumatic Stress
Network (NCTSN)
The NCTSN Mission
To raise the standard of care and improve
access to services for traumatized
children, their families and communities
throughout the United States
http://www.nctsn.org/
Importance of Self-Care and
Colleague Support Among
Professionals
“…We are stewards not just of those who
allow us into their lives but of our own
capacity to be helpful...”
Conte, JR. (2009). Foreword. In L. Van Dernoot Lipsky, Trauma
stewardship. An everyday guide to caring for self while caring for others.
Reflective
Supervision & Consultation
• Core elements:
– Supervisor/consultant is not the expert, but a
collaborative partner.
– Shared exploration of the parallel process.
– Professional and personal development within
one’s discipline through attending to
emotional content.
• Reflective supervision/ consultation vs.
administrative supervision or clinical
supervision/ consultation
Social and Emotional Development
Promotion for All Children
Resources to support all children’s
social and emotional development
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Parenting support
Reach Out and Read
Learn the signs. Act early.
2-1-1 and MCH Hotlines
Early learning standards
Pyramid model and resources
Stewards for Children
Parenting Support
• Evidence-based home visiting models
• Family Resource Centers
• Parents Interacting with Infants (PIWI)
groups
• La Leche Leagues
• Fatherhood Initiative
Reach Out and Read
• http://www.reachoutandread.org/
CDC Resources
Learn the Signs. Act Early.
Milestone and Disability Specific Fact Sheets
http://www.actearly.wisc.edu/
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2-1-1 and MCH Hotlines
• 2-1-1
Community-based health and human services
information and resources
Call 2-1-1 or visit http://www.211wisconsin.org/
Twenty-four hours/day, 7 days/week
• Public Health Information & Referral
Services For Women, Children & Families
Maternal and Child Health Hotline
1-800-722-2295 http://www.mch-hotlines.org/
Twenty-four hours/day, 7 days/week
WI Model Early Learning
Standards
• Educate and provide guidance for families,
educators/caregivers, administrators and policymakers
regarding developmental expectations for children
birth to first grade.
• Provide a framework for making local decisions
regarding learning expectations for children birth to 1st
grade in public school, Head Start, preschool,
childcare settings and home.
• For trainings in WMELS
http://www.collaboratingpartners.com/wmels-trainingopportunities.php
Pyramid Model and Resources
http://www.collaboratingpartners.com/
Stewards of Children
• Workshop designed to educate adults on how to
prevent, recognize and react responsibly to the reality
of child sexual abuse
• Curriculum created by Darkness to Light and
implemented by the Awareness to Action partners
statewide
• Stewards of Children is an evidence-informed
prevention solution that increases knowledge,
improves attitudes, and changes child protective
behaviors
Early Identification of Children with
Social and Emotional Challenges
Resources to support the early
identification of children with delays
• AAP Guidelines
• Easter Seals’ Make the First Five Count
Campaign
• Primary Care Clinician Practice Education
• UW Extension ASQ and ASQ:SE Training
Importance of Monitoring
• Social-emotional screening
– SE screening status in early childhood
predicts elementary school outcomes
• American Academy of Pediatrics’
recommendations
– Routine developmental screening
– Pediatric mental health screening
(Briggs-Gowan, 2008; AAP Council on Children With Disabilities, 2006;
AAP Task Force on Mental Health, 2010)
Screen to Intervene
Early identification of needs and timely
referral to appropriate supports
increases the likelihood of child
reaching full developmental potential
Easter Seals’ Make the First Five
Count Campaign
• Offer free, online ASQ-3 questionnaires
to families of children under 5
• Results are emailed to parents within 2
weeks
http://www.easterseals.com/mtffc/asq/
Primary Care Practice Education
Available Presentations
 Developmental Screening within Well-Child Care
 Pediatric Mental Health Screening Tools
 Pediatric Mental Health Community Resources
 Maximizing Reimbursement for Behavioral Health
Provision in Primary Care
Wisconsin Statewide Medical Home Initiative
www.wismhi.org
ASQ and ASQ:SE Training
• For home visitors and family support professionals
(UW-Milwaukee through the Child Welfare Training
Partnership)
http://www4.uwm.edu/mcwp/programs/home-visitingtraining.cfm
• For early care and education providers
(Milwaukee County Cooperative Extension)
http://milwaukee.uwex.edu/family-living/upcomingtrainings/
Targeted Social and Emotional
Supports
Resources to support children in need of
targeted social emotional supports
• Birth to 3 Programs
• Home Visiting Programs
• Regional Centers for Children and Youth
with Special Health Care Needs
Wisconsin Birth to 3 Program
• The Birth to 3 Program supports families
of children with developmental delays or
disabilities under the age of three
• http://www.dhs.wisconsin.gov/children/birt
hto3/
Home Visiting Programs
• Home visitors are nurses, social workers, or early childhood
specialists, who support families regularly in their homes
• Home visit activities
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Assist with accessing quality prenatal care
Conduct screenings and assessments
Provide health education
Connect family to community resources
Offer strategies for parents to support their child’s development physically,
socially, and emotionally
• Together, home visitors and families come up with a set of
goals and activities that they work on
Evidence-Based Intervention
Makes a Difference
• Evidence-based parenting
interventions
– Assist parents in having better
relationships with their children
– Reduce child behavior problems
– Examples
Listening as an Active
Intervention
Regional Centers for Children and
Youth with Special Health Care Needs
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Northern Regional Center
Phone: 866-640-4106
Northeast Regional Center
Phone: 877-568-5205
Southeast Regional Center
Phone: 800-234-KIDS (5437)
Southern Regional Center
Phone: 800-532-3321
Western Regional Center
Phone: 800-400-3678
Intensive Interventions
Resources to support children in
need of intensive intervention
• Child Parent Psychotherapy
• Trauma-Focused Cognitive Behavioral
Therapy
• Child Psychiatry Consultation Program for
Primary Care Clinicians
Child Parent Psychotherapy
• Evidence-based way of working with very
young children (0-3) exposed to trauma
and their families
• Training available for selected clinicians
through the Wisconsin Early Childhood
Comprehensive Systems grant
• http://nrepp.samhsa.gov/ViewIntervention.aspx?id=194
Trauma-Focused Cognitive
Behavioral Therapy (CBT)
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Evidence-based trauma treatment
Effective in reducing PTSD symptoms
Attachment-based
Short-term with a distinct beginning, middle
and end
• Skill-building and desensitization through
gradual exposure
• Healing through meaning making and
relationship
Coming Soon… Child Psychiatry
Consultation Program
• Call-in line for primary care clinicians to
support them in caring for children with
mental health needs
• Staffed by child and adolescent
psychiatrists
• Support available Monday-Friday, during
office hours
• Pilot program beginning January 2015
Strategies for Growing
Community Systems of Care
Collective impact to reach ultimate goal:
Expedited and enhanced care for children
and families to promote optimal
outcomes
Successful Regional Examples
Small group discussion
• Medical Home
• Evidence-based Interventions
– Child-Parent Psychotherapy
– Trauma-Focused CBT
– Parenting Interventions
• Parent Engagement and Support
• Early Childhood Councils
• Supporting Your Staff
Report Out
Next Steps
• Available opportunities
– CPP training
– ECCS Pilot Community
– Exploring resources
– Continuing collaboration
Thank you for your attention •
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Collaboration and support provided by
Wisconsin Alliance for Infant Mental Health
Wisconsin Children and Youth with Special Health Care Needs
Program
Wisconsin Department of Children and Families
Wisconsin Division of Public Health
Wisconsin Early Childhood Comprehensive Systems Project
Wisconsin Project LAUNCH
Wisconsin Statewide Medical Home Initiative
Children’s Hospital of Wisconsin