University of Southern California
Keck School of Medicine
Master of Public Health Program
PM 583: Foundations of Early Childhood Mental Health
Thursdays 9-12:30 p.m.
Instructors: Marie Kanne Poulsen, Ph.D.
4650 Sunset Blvd., Mailstop #53
Los Angeles, CA 90027
Phone: (323) 361-3819
E-mail: mpoulsen@chla.usc.edu
Karen Moran Finello, Ph.D.
155 N. Occidental Blvd, Ste 245
Los Angeles, CA 90026
Phone: (213) 383-5967
E-mail: kfinello@chla.usc.edu
Office Hours: 8-9 am Thursdays by appointment
Course Description:
In response to the serious crisis in mental health care for children, there is a growing movement
in the United States and in other countries to treat infant and early childhood mental health as a
primary issue in child health and welfare with a family-centered focus on early identification,
preventive intervention and treatment. This course will provide a broad overview of major infant
and early childhood mental health issues, relating to the status of child mental health and the
importance of comprehensive systems of care for children that support resilience and respond to
biological and psychosocial mental health risks. Specific topics will include: early brain
development, biological and psychosocial risks that impact child mental health, developmental
trajectories to mental health problems, and systems, programs and policies that support the
mental health of young children.
Student Learning Objectives:
Upon completion of this course, students will be able to:
1. Describe the status of young child mental health and mental health services in the United
States, and associated major public health issues.
2. Describe the variety of public programs and policies designed to support a range of early
childhood mental health issues.
3. Discuss state, national and international policy issues related to early childhood mental
health and development.
4. Define principles and standards of care that guide the development of mental health
systems of care.
5. Differentiate the roles of public health specialists in developing policies, providing
advocacy, conducting epidemiological studies, and influencing direct clinical services on
behalf of young children and their families.
Evaluation Methods & Course Assignments:
Evaluations will be based on the following criteria:
1. Active class participation and discussion indicating that you have read and understand
assigned materials. Course readings are listed by session on the Course Outline. You are
expected to bring in a question or issue raised by the readings each week and be prepared
to address it during class. (25% of your grade)
2. Research a state, national or international policy or public health topic impacting the
development of very young children. Prepare a written analysis including an overview of
the topic, historical perspectives on how the policy developed, and any recommendations
for change on behalf of young children. This analysis should be approximately 3-4 pages
(double spaced) in length. DUE DATE: 10/22/09 (25% of your grade).
3. Final Paper: Choose a topic requiring legislative action or international advocacy.
Prepare a “white paper” or policy brief designed to influence federal or international
policy in a specific public health area with implications for early childhood mental health.
Complete the process required for legislative advocacy at the local, state, or federal level.
You will be required to do an oral presentation of your work to the class at the final
meeting. Please choose your topic by 10/1/09 at the latest, (topic must be cleared with
course instructors first and duplicate topics will not be permitted). Paper is to be 10-15
double spaced pages maximum. DUE DATE: 12/3/09 (25% of your grade for written
paper and 25% of your grade for oral presentation).
Grading will be as follows:
A = 93 - 100
B = 84 - 92
C = 75 - 83
D = 65 - 74
Students with Disabilities
Any student requesting academic accommodations based on a disability is required to register
with Disability Services and Programs (DSP) each semester. A letter of verification for
approved accommodations can be obtained from DSP. Please be certain the letter is delivered to
us as early in the semester as possible. DSP is located on the University Park campus in STU
301 and is open from 8:30 AM – 5:00 PM, Monday through Friday. The phone number is: (213)
740-0776.
Course Outline:
* Starred Readings are required
8/27/09: Introduction, Historical Perspectives and Overview of Early Childhood Mental
Health Issues (Poulsen)
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Introduction to course
How does early childhood mental health fit into public health work
Historical perspectives of child mental health in the United States
Status of child & adolescent mental health
Early childhood mental health: why now
Defining early childhood mental health
Early childhood mental health through interdisciplinary perspectives
Mental health promotion, preventive intervention & treatment
Readings:
*National Research Council and Institute of Medicine. (2000). From Neurons to Neighborhoods:
The Science of Early Child Development. Committee on Integrating the Science of Early
Childhood Development. Washington, DC: National Academy Press, pp. 1-15.
Poulsen, M.K. (2002). Defining early childhood/family mental health. Cathie Wright Technical
Assistance Center Updates. Volume 5 (3), pp. 1-9.
Zeanah, P., Stafford, B., Nagle, G., Rice. (2005). Addressing Social-Emotional Development
and Infant Mental Health in Early Childhood Systems. Los Angeles, CA: National Center for
Infant and Early Childhood Health Policy; Building State Early Childhood Comprehensive
Systems Series, No.12., pp. 4- 10.
9/03/09: The Biological Context of Early Childhood Mental Health (Poulsen)
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Infant Brain Development
Biological influences on early childhood mental health
o Prematurity
o Under-nutrition/iron deficient anemia
o Prenatal substance exposure
o Developmental disabilities
o Chronic illness
o Serious illness
Programs and policies
o Medical home concept
o Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
o Federal Food Stamp Program (FSP)
Readings:
*Davies, D. (2004). Brain development. Child Development: A practitioner’s guide, 2nd Ed .
New York: Guilford Press, pp. 39-60.
Meyers, A. & Chawla, N. (2000). Nutrition and the social, emotional, and cognitive
development of infants and young children. Zero to Three Bulletin, 21(1) , 5-14.
Nix, C.M. & Ansermet, F. (2009). Prematurity, risk factors and protective factors. In C.H.
Zeanah, Jr. (Ed.). Handbook of Infant Mental Health, 3rd Edition. New York: Guilford Press, pp
180-196.
Sheridan, M. & Nelson, C.H. (2009). Neurobiology of fetal and infant development:
Implications for infant mental health. In C.H. Zeanah, Jr (Ed). Handbook of Infant Mental
Health, 3rd Edition. New York: Guilford Press, pp 40-58.
9/10/09: Overview of Infant & Early Childhood Mental Health (Finello)
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Mental health risk & protective (resilience) factors in early childhood
Development of attachment
Markers of early childhood mental health
o Social-emotional development and school readiness
Programs and policies addressing early childhood well-being
o Mental health services in early childhood
Readings:
*Davies, D. (2004). Risk and protective factors: The child, family & community contexts. Child
Development: A practitioner’s guide, 2nd Ed. New York: Guilford, pp. 61-108.
Kaufmann, R., Perry, D.B. (2002). Promoting social-emotional development in young children:
Promising approaches at the national, state and community levels. The Kauffman Early
Education Exchange. Volume 1, pp. 80-96.
Zeanah, C. H. & Zeanah, P.D. (2009). The scope of infant mental health. In C.H. Zeanah, Jr
(Ed). Handbook of Infant Mental Health, 3rd Edition. New York: Guilford Press pp.5-21.
9/17/09: The Parenting Context of Early Childhood Mental Health (Poulsen)
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Perinatal caregiver issues
o Perinatal substance abuse
o Maternal & paternal depression
o Unsupported single parenthood
o Teen parenthood
o Fathers
o Maternal mental illness
Programs and Policies
o Family Leave Legislation
Readings:
*Wakschlag, L.S. & Hans, S.L. (2000). Early parenthood in context: Implications for
development and intervention. In C..H. Zeanah, Jr. (Ed.). Handbook of Infant Mental Health,
2nd Edition. New York: Guilford.
Onunaku, N. (2005). Improving Maternal and Infant Mental Health: Focus on Maternal
Depression. Los Angeles, CA: National Center for Infant and Early Childhood Health Policy at
UCLA
Seifer, R. & Dickstein, S. (2000) Parental mental illness and infant development. In C.H.
Zeanah, Jr. (Ed.). Handbook of Infant Mental Health, 2nd Edition. New York: Guilford.
9/24/09: Addressing Policy: State, National, and International Programs (Finello)
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Challenges and opportunities in mental health systems
International approaches to early childhood mental health
SAMHSA early childhood mental health systems of care
State Initiatives: Florida, New Mexico, Arizona, Louisiana
State, Federal and International Programs and Policies
o IDEA, Part B & Part C
o Head Start
o Child Care & Development Fund (CCDF)
o CAPTA
o Titles IV- & IV-E
o State Children’s Health Insurance Program (SCHIP)
o Early Periodic Screening, Diagnosis & Treatment (EPSDT)
o Medicaid
o Maternal & Child Health Programs
Readings:
* Zero To Three (2009). Early experiences matter: A guide to improved policies for infants and
toddlers. http://www.zerotothree.org/policyguide
* Zero to Three Public Policy Information section. http://www.zerotothree.org
Center on the Developing Child at Harvard University (2007). A science-based framework for
early childhood policy: Using evidence to improve outcomes in learning, behavior, and health
for vulnerable children. http://www.developingchild.harvard.edu
Knitzer, J. (2001) Building Services and Systems to Support the Healthy Development of Young
Children: An Action Guide for Policymakers. New York, NY: National Center for Children in
Poverty, Columbia University, Mailman School of Public Health.
Zero to Three Policy Center (August, 2007). Tracking services for infants, toddlers & their
families: A look at federal early childhood programs and the roles of state and local
governments. Washington, D.C.: Zero to Three.
10/1/09: Research Issues & Advocacy (Finello)
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Epidemiological studies
Community Based Participatory Research
What do public health advocates do to influence policy
Priority legislative areas for APHA
Visiting legislators
Influencing policies on behalf of young children and their families
Readings:
*Center on the Developing Child at Harvard University (August, 2007). A science-based
framework for early childhood policy using evidence to improve outcomes in learning, behavior
and health for vulnerable children. http://www.developingchild.harvard.edu
Frank, John (2007). A beginner’s guide to judge research studies: Quick tips to sort the wheat
from the chaff. Editorial in Medical Post.
Rappaport, Debbie M. (2007). Building relationships: Parallels between infant-toddler
development and the public policy process. Washington, DC: Zero to Three Policy Center
Shonkoff, J.P. Lippitt, J.A. & Cavanaugh, D.A. (2000). Early childhood policy: Implications
for infant mental health. In C.H. Zeanah, Jr. (Ed.) Handbook of Infant Mental Health, 2nd
edition. New York, NY: Guilford Press, pp. 503-518.
10/08/09 Policy Week—no class meeting
10/15/09:
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Mental Health of Children in Kinship and Foster Care (Poulsen)
Mental health needs of children in foster care
o Consequences of trauma and emotional neglect
o Consequences of separation and loss
Policies that support behavioral health needs of children and families involved in the
child welfare system
o Family Preservation programs
Readings:
*Halfon. N., Zepeda, A. Inkelas, M. (2002). Mental Health Services for Children in Foster Care.
(Policy Brief, No. 4). Los Angeles, CA: UCLA Center for Healthier Children, Families and
Communities.
American Academy of Pediatrics, Committee on Early Childhood, Adoption and
Dependent Care. (2000). Developmental issues for young children in foster care. Pediatrics.
Volume 106 (5), pp. 1145-1150.
Jones Harden, Brenda (2007). Infants in the Child Welfare System (Chapter 4: Foster Care of
Infants.) Washington, DC: Zero to Three Press.
McCarthy, J., McCullough. (2003). Special considerations for children and families involved
with the child welfare system. In A View from the Child Welfare System.
Washington DC: National Technical Assistance Center for Children’s Mental Health, pp. 9-30
Poulsen, M.K. (1995). Children at risk in out-of-home placement. In Smith, G.H., Coles, C.D.,
Poulsen, M.K,, Cole, C. Children, Families and Substance Abuse: Challenges for Changing
Educational and Social Outcomes. Baltimore,MD: Paul H. Brookes Publishing Company.
Smyke, A.T. & Breidenstine, A.S. (2009). Foster care in early childhood. In Zeanah, C.H. Jr
(Ed), Handbook of Infant Mental Health 3rd Edition. New York: Guilford Press, pp. 500-515.
10/22/09: Controversial policies impacting early childhood mental health (Finello)
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Psychotropic drugs in early childhood
Controversial treatment strategies (autism)
Feeding Practices & their impact on development
Controversies regarding causes of problems (vaccines & autism)
Measuring poverty—use of the federal poverty line
Multiethnic placement of young children
Programs & Policies
o Multiethnic Placement Act (1994)
o Adoptions & Safe Families Act (1997)
Readings: (different readings to be selected by teams who will lead the discussion around that
issue)
Jenkins-Monroe, V. (2005). Developing reunification and adoption recommendations for
substance-exposed infants and toddlers in foster care. In K. M. Finello (Ed.). Handbook of
Training and Practice in Infant and Preschool Mental Health. San Francisco: Jossey Bass.
Gleason, M.M. (2009). Psychopharmacology in early childhood: Does it have a role? In
Zeanah, C.H Jr. (Ed), Handbook of Infant Mental Health, 3rd Edition. New York: Guilford Press,
pp. 516-530.
Jones Harden, Brenda (2007). Infants in the Child Welfare System (Chapter 5: Creating
Permanency for Infants.) Washington, DC: Zero to Three Press.
Poverty in the United States-Wikipedia.
http://en.wikipedia.org/wiki/poverty_in_the_United_States
10/29/09: Environmental Context of Early Childhood Mental Health (Finello)
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Effects of poverty on the mental health of children
Public health threats to mental health (lead, toxins)
Culture and Ethnicity
Programs and Policies
o TANF
o Social Services Block Grant (SSBG)
Readings:
*Knitzer, J. & Perry, D. (2009). Poverty and infant and toddler development: Facing the
complex challenges. In C.H. Zeanah, Jr. (Ed.) Handbook of Infant Mental Health, 3rd edition.
New York, NY: Guilford Press, pp. 135-152.
Barbarin, O.A. (2002). Culture and ethnicity in social, emotional and academic development.
The Kauffman Early Education Exchange. Volume 1, pp. 8-29.
Devaney, B.L., Ellwood, M.R., Love, J.M. (1997). Programs that mitigate the effects of poverty
on children. The Future of Children: Children and Poverty. Volume 7 (2), pp. 88-112.
Fenichel, E., Mann, T. (2001). Early Head Start for low-income families with infants and
toddlers. The Future of Children: Caring for Infants and Toddlers. Volume 11 (1), pp: 135-141.
11/05/09: The Impact of Family and Community Violence on Early Childhood Mental
Health (Poulsen)
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Effects of violence on young child mental health
o domestic violence
o community violence
Programs addressing exposure to violence
Readings:
* Schechter, D.S. & Willheim, E. (2009). The effects of violent experiences on infants and young
children. In Zeanah, C.H. Jr. (Ed), Handbook of Infant Mental Health, 3rd Edition. New York:
Guilford Press, pp. 197-213.
Kaufman, J., Henrich, C. (2000). Exposure to violence and early childhood trauma. In C.H.
Zeanah, Ed. Handbook of Infant Mental Health, 2nd edition. New York, NY: Guilford Press.
Wolfe, D.A., Jaffe, P.G. (1999) Emerging strategies in the prevention of domestic violence. The
Future of Children: Domestic Violence and Children. Volume 9. pp. 133-144.
11/12/09: Diagnosing Mental Health Disorders in Infancy and Early Childhood (Poulsen)
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Developmental psychopathology
The stigma of mental health disorder
Developmental trajectories to disorder
Diagnosis of mental health in young children
Diagnostic classification systems
 DSM IV
 DC:0-3
 ICD 9 codes
Medical necessity
Readings:
*Poulsen, M.K., (2005). Diagnosis of mental health in young children. In K.M. Finello (Ed.),
The Handbook of Training and Practice in Infant and Preschool Mental Health. San Francisco,
CA: Jossey-Bass.
Egger, H.L. & Angold, A. (2009). Classification of psychopathology in early childhood. In
Zeanah, C.H. Jr. (Ed), Handbook of Infant Mental Health 3rd Edition. New York: Guilford Press,
pp. 285-300.
Zero to Three. (2005). Diagnostic Classification:0-3 R. Diagnostic Classification of Mental
Health and Developmental Disorders of Infancy and Early Childhood (Excerpts).
Washington, DC: Zero to Three.
11/19/09: Mental Health as a Primary Health Concern (Finello)
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Child mental health as a primary health concern
Need for a comprehensive mental health system
Principles to guide a mental health system of care
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Standards of care for mental health service delivery
System of Care Issues
Integrated approaches to early childhood mental health
Readings:
*Tolam, P.H., Dodge, K.A. (2005). Children’s mental health as a primary care concern.
American Psychologist. Volume 60 (6) pp. 601- 614.
Dossier, D.A., Handron, D., McCammon, S., & Powell, J.Y. (Eds) (2001) Child mental health:
Exploring systems of care in the new millenium. The Haworth Press, Inc.
Huang, L. et al (2005). Transforming mental health care for children and families.
American Psychologist. Volume 60 (6) pp. 615- 627.
Zeanah, P., Stafford, B., Nagle, G., Rice. (2005) Addressing Social-Emotional Development and
Infant Mental Health in Early Childhood Systems. Los Angeles, CA: National Center for Infant
and Early Childhood Health Policy; Building State Early Childhood Comprehensive Systems
Series, No.12, pp. 40-45
11/26/09:
Thanksgiving Holiday
12/3/09:
Class Presentations of Projects Demonstrating the Intersection of Public
Health & Early Childhood Mental Health (All)
**Final Papers due at beginning of class
o Individual/Group Presentations
o Course Wrap Up
Useful Web Sites:
Center on Infant Mental Health & Development
http://depts.washington.edu/chdd/ucedd/ucedd_infantmentalhealth.html
National Center for Children in Poverty (NCCP)
http://www.nccp.org
Zero to Three: Infant Mental Health Resource Center
http://www.zerotothree.org/imh/
National Institute of Mental Health (NIMH)
http://www.nimh.nih.gov/healthinformation/childmenu.cfm
Substance Abuse and Mental Health Services Administration (SAMHSA)
http://www.mentalhealth.samhsa.gov/topics/explore/children
American Academy of Pediatrics (AAP)
http://www.brightfutures.aap.org
Child Welfare League of America
http://www.cwla.org
World Health Association (WHO)
http://who.int
United Nations Children’s Fund
http://unicef.org