BUILDING SOCIAL EMOTIONAL HEALTH
A Foundation for Success: The Unique Role of the Child Health Consultant
GOALS
• To identify the unique roles and
opportunities for child care health
consultant to promote social
emotional health
• To understand the compelling case for
social emotional health promotion in
early childhood
• To identify concrete next steps and
tools to integrate into practice
The Foundation of a Successful Society is
Built in Early Childhood
Successful Parenting of Next Generation
Educational
Achievement
Economic
Productivity
Responsible
Citizenship
Lifelong
Health
3
Source: Center on the Developing Child at Harvard
University (2011).
INFANT MENTAL HEALTH
“The developing capacity of the children
from birth to 3 to experience, regulate,
and express emotions; form close and
secure interpersonal relationships; and
explore the environment and learn – all in
the context of family, community, and
cultural expectations for young children.”
Zero to Three, 2002
CHILD CARE HEALTH CONSULTANT
• Access to setting including providers
and parents
• Trusted
• There already…can you add this lens?
• Pair & Share: Can you share a moment
when you did or saw an opportunity to
address social emotional health?
700 New Neural Connections
Every Second
Image source: Conel, JL. The postnatal development of the human cerebral cortex. Cambridge, Mass: Harvard University Press, 1959
6
700 NEW NEURAL CONNECTIONS
EVERY SECOND
FOUNDATION FOR EXECUTIVE FUNCTION
SKILLS IS BUILD IN EARLY CHILDHOOD
• Self-Control – ability to filter thoughts
and impulses to resist temptations and
distractions
• Working Memory – ability to hold and
manipulate information in our heads
over short periods of time
• Mental Flexibility – adjusting to
changing demands, priorities, or
perspectives
CRITICAL FACTORS IN DEVELOPING A STRONG
FOUNDATION FOR EXECUTIVE FUNCTION SKILLS
• Children’s Relationships– consistent
reliable adults who support and protect
them, and model and engage them in
building executive function skills
• Activities – the opportunity to engage in
activities that reduce stress, foster social
connection, incorporate vigorous
physical activity, and increase the
complexity of skills at the right speed for
each child
• A safe and stable environment
WHAT’S THE BIG IDEA? WHY SO
IMPORTANT
• Scope of social emotional/ behavioral
issues
• Expulsion rates
• Teacher turnover
• Tools and techniques that work
• Impact on school success/ failure
• Lifelong health
BARRIERS TO EDUCATIONAL ACHIEVEMENT
EMERGE AT A VERY YOUNG AGE
Cumulative Vocabulary (Words)
1200
1000
College Educated
Parents
800
600
Working Class
Parents
Welfare
Parents
400
200
16 mos.
24 mos.
Child’s Age (Months)
36 mos.
CARING FOR OUR CHILDREN STANDARD 2.1.1.1
INTERACTIONS WITH INFANTS AND TODDLERS
• Caregivers/Teachers should provide
consistent , continuous and inviting
opportunities to talk, listen to and
otherwise interact with young infants
throughout the day (indoors and
outdoors) including feeding, changing,
playing with, and cuddling them
• **RICHNESS OF LANGUAGE
• The social and emotional
communications and the atmosphere
and essential
SERVE & RETURN BUILDS BRAINS & SKILLS
• Ongoing, reliable
interaction with
trusted adults is
essential for the
development of
healthy brain circuits
• Systems that support the quality of
relationships in early care settings,
communities, and homes help build brain
architecture
KEY FACTORS
• A language rich environment
• Warm, responsive interactions between
caregivers/ staff and children
• Video clip
examplehttp://csefel.vanderbilt.edu/resou
rces/inftodd/mod1/1-1.mpg
PAIR AND SHARE
• Example of when this went right or wrong
during your observation
• Strategies for promoting serve and return/
language rich interactions
EARLY CHILDHOOD STRESS INFLUENCES
DEVELOPMENTAL OUTCOMES
• Brief increases in heart rate, mild
elevations in stress hormone levels;
important to development in the
context of stable and supportive
relationships
• Serious and temporary, but impact
buffered by supportive
relationships and safe
environments
• Prolonged activation of stress
response systems in the absence
of protective relationships; disrupts
brain architecture, increases the
risk of stress-related physical and
mental illness
Harvard center on the Developing Child
Positive Stress
Response
Tolerable Stress
Response
Toxic Stress
Response
PREVELENCE OF ADVERSE CHILDHOOD
EXPERIENCES (ACE)
Girls
Boys
Total
(n=9,367)(n=7,970) (17,337)
13.1%
7.6%
10.6%
27.0%
29.9%
28.3%
24.7%
16.0%
20.7%
• Abuse
– Emotional
– Physical
– Sexual
• Household Dysfunction
– Mother Treated Violently
13.7%
– Household Substance Abuse 29.5%
– Household Mental Illness
23.3%
– Parental Separation or Divorce24.5%
– Incarcerated Household Member
4.7%
• Neglect *
– Emotional
16.7%
– Physical
9.2%
11.5%
23.8%
14.8%
21.8%
5.2%
12.7%
26.9%
19.4%
23.3%
4.1%
12.4%
10.7%
14.8%
9.9%
*Wave 2 data only (n=8,667)
Source: Kaiser ACE Study, 1 995-1997. Data from : www.cdc.gov/nccdphp/ace/demographics
Children with Developmental Delays
PREVELENCE OF
ADVERSE CHILDHOOD EXPERIENCES (ACE)
100%
80%
60%
40%
20%
Number of Risk Factors
Data Source: Barth, et al. (2008)
Graphic adapted from 2011, Center on the Developing Child at Harvard University
3:1 ODDS OF ADULT HEART DISEASE AFTER 7-8
ADVERSE CHILDHOOD EXPERIENCES
3.5
Odds Ratio
3
2.5
2
1.5
1
0.5
0
1
2
3
4
5,6
Adverse Experiences
7,8
UNDERSTANDING IMPACT OF ADVERSE
CHILDHOOD EXPERIENCES
Death
Early
Death
Disease &
Disability
Adoption of
Health-Risk Behaviors
Social, Emotional, and
Cognitive Impairment
Conception
Adverse Childhood Experiences
Freely reproducible slide from the Centers for Disease Control and Prevention.
RELATIONSHIPS BUFFER TOXIC STRESS
• Learning how to cope with
moderate, short-lived stress can
build a healthy stress response
system
• Toxic stress (when the body’s
stress response system is
activated excessively) can
weaken brain architecture
• Without caring adults to buffer children, toxic stress can
have long-term consequences for learning, behavior,
and
both physical and mental health
Harvard Center on The Developing Child
CFOC 2.1.2.1 PERSONAL CAREGIVER/TEACHER
RELATIONSHIPS FOR INFANTS AND TODDLERS
• Hold and comfort children who are upset
• Engage in frequent, multiple and rich social
interchanges such as smiling, talking, touching,
singing and eating
• Be play partners as well as protectors
• Be attuned to children’s feelings and reflect them
back
• Communicate consistently with parents/guardians
• Interact with children and develop relationship in
the context of everyday routines (diapering/feeding
etc.)
HELPING CAREGIVERS UNDERSTAND
TEMPERAMENT
•
•
•
•
•
•
•
•
•
Activity level – always active or generally still
Biological rhythms – predictability of hunger, sleep, elimination
Approach/withdrawal – response to new situations
Mood – tendency to react with positive or negative mood,
serious, fussy
Intensity of reaction – energy or strength of emotional reaction
Sensitivity – comfort with levels of sensory information; sound,
brightness of light, feel of clothing, new tastes
Adaptability – ease of managing transitions or changes
Distractibility – how easily a childʼs attention is pulled from an
activity
Persistence – how long child continues with an activity he/she
finds difficult
From csefel handout on temperament traits
ADDRESSSING CAREGIVER STRESS
•
•
•
•
•
Check in
Acknowledge
Empathize
Reframe
Commit to Plan
Video clip portraying caregiver perceptions:
http://csefel.vanderbilt.edu/resources/inftodd/mod1/1-4.mpg
STRATEGY FOR EARLY CHILDHOOD
SETTINGS AND PARENT EDUCATION
Read together every day (your)
Rhyme play and cuddle with your child every
Routines
Reward your child with praise for successes to
build self-esteem and promote positive
behavior
• Develop a strong and nurturing Relationship
with your child as the foundation for their
healthy development
•
•
•
•
PROGRAM SUPPORT FOR STRENGTHENING
RELATIONSHIPS
Adequate adult to child ratios
Small group sizes
One primary caregiver per child
Continuity of care; one caregiver over
time
• Time for parents/guardians to share
information
• Time for caregivers to get to know the
child through observation
•
•
•
•
The National Training Institute for Child Care Health Consultants
MAKE DAILY ROUTINES PREDICTABLE
• Post pictures or other visual cues about
what comes next.
• Alternate small and large group
activities, as well as quiet and highenergy activities.
• Allow clear choices between activities.
• Create rules and rituals that are easy to
follow.
The National Training Institute for Child Care Health Consultants
STRATEGIES TO SUPPORT ROUTINES FOR
INFANTS AND TODDLERS
• Use first/next or first/then words
• Display an item, such as a new toy, photo or
plant, that children and families can explore
together during arrival
• Sing or play lullabies
• Involve children in routines – for example,
invite toddlers to help pass items to the next
person during mealtimes
WHAT IS EMOTIONAL LITERACY?
• It is the capacity to:
– Identify, understand and express emotion in a
healthy way
– Recognize, label, and understand feelings in self
and others
Adapted from Craddling Literacy 2007
STRATEGIES TO DEVELOP EMOTIONAL
LITERACY IN INFANTS AND TODDLERS
• Use the adult/child relationship to expand
children’s awareness of emotions or feelings:
– Verbally acknowledge and label emotions
expressed by children in care
– Assist infants and toddlers with regulating their
emotions
– Talk about the fact that feelings can change
– Use questions about feelings to see if and how a
child responds
CSEFEL MODULE 2
STRATEGIES TO DEVELOP EMOTIONAL
LITERACY IN INFANTS AND TODDLERS
• Use enriching language tools:
– Choose books, music, finger plays with a rich
vocabulary of feeling words
– Use puppetry or felt board stories that retell
common social experiences and emphasize
feeling vocabulary and conflict resolution
– Read stories about characters that children
can identify with who express a range of
feelings
CSEFEL MODULE 2
SOCIAL EMOTIONAL HEALTH
PROMOTION: CURRICULUM
• Building Executive Function
• Building Health
DEVELOPMENT OF PLAY SKILLS FOR
INFANTS AND TODDLERS
(CSEFEL MODULE 2)
Age
Play
13 to 24 Months
• Enjoys play with objects
• Increased interest in watching other
children play (onlooker)
• Primarily plays alone (solitary)
• May offer toys to caregiver or other
children
• May choose independent play close to
other children (parallel) but not
interact with them
25-36 Months
• May play with other children but in an occasional or
limited way (associative)
• Some cooperation and talking with other children
• May take leader/follower roles in play
• Some pretend play
• Still plays alone frequently
• Interactive level moving toward (cooperative play)
SETTING UP THE ENVIRONMENT FOR
DEVELOPING PLAY AND FRIENDSHIP SKILLS
• Evaluate the physical space to ensure that there
is enough space for infants and adults to engage
in social activities
• Evaluate the physical environment for spaces for
two or more children to enjoy side-by side
activity and for adults to be close for supervision
• Evaluate the daily schedule for opportunities to
develop play skills each day
• Provide enough materials and equipment that
allow and encourage two or more children to
interact
PROMOTING THE DEVELOPMENT OF
FRIENDSHIP SKILLS
• Encourage toddlers to
help each other and do
routines together
• Provide positive verbal
support for play between
children
• Read books about
friends, playing together,
helping each other, etc.
• Practice turn-taking and
sharing
DEALING WITH CHALLENGING
BEHAVIOR
• Not addressing sufficiently here: a separate talk
• This Opens a dialogue and highlights promotion
• Many Resources for challenging behavior
– Including (identify/explore/action and care
plans/effective in class
interventions/supports/community resources and
referrals/communication with medical home)
• Other core area communication with parents: further
training
• This was meant to be an overview to promote
opportunities and a promotion approach….more to
follow
PAIR AND SHARE
• What is one thing you are going to do differently to
enhance your promotion of social emotional
health?
• What is a challenge that you would like to address
around promoting social emotional health?
• What is a next step in supporting your ability to
address the challenge? Action step
• What is a long term goal in promoting social
emotional health? And an action step to get there
WHAT NEXT?
•
•
•
•
Let’s build bridges!
Let’s build systems!
Common vision
Next steps
CHILDCARE HEALTH CONSULTANT
NETWORK BUILDING
• Bridges Between Health and Early Childhood
Systems (focus on childcare health
consultants as key stakeholder group/target
audience)
• Docs For Tots Plan to support ECCS/ Build
online Resource Center/Training/ Listserv/TA
• What are your thoughts? What would be
helpful?
TO BUILDING AND SHARING THE
PYRAMID!
CSEFEL A TREMENDOUS RESOURCE
• Explore website: make it a GO TO RESOURCE
• http://csefel.vanderbilt.edu
• Training Modules:
– http://csefel.vanderbilt.edu/resources/training_modu
les.html
• Unlimited practical caregiver resources/ classroom
tools/ Strategizing tools/ parent handouts
– http://csefel.vanderbilt.edu/resources/strategies.html
Thank you!
www.docfortots.org