Early Childhood System of Care Community of Practice Call
6/30/06, 2:30 ET

Update on MCH Early Childhood Comprehensive Systems (ECCS) grants: Opportunities for Collaboration

Purpose of this call:
Presenters on the June 30 call reviewed the Federal Maternal and Child Health Bureau’s Early Childhood Comprehensive System (ECCS) Grants, as well as current efforts in Kentucky, a grantee State, to look at well-being of children’s and families’ health across systems.

Powerpoints and Presentation Materials:
Download the following PowerPoint slides and presentation materials:

• Project THRIVE at NCCP
• PowerPoint: Collaborative Early Childhood Mental Health Efforts in Kentucky
• Kentucky’s Early Childhood Initiative Summary
• HOW WE GOT FROM THERE TO HERE ….. System of Care Movement
• Early Childhood Mental Health Guidelines and Expectations

Discussion and Questions:
Following presentations, participants asked presenters about strategies and lessons-learned from Kentucky’s “Kids Now” project and other States’ experiences in implementing Early Childhood Initiatives.

1. Q. Where does screening for at-risk children come into your joint planning process?

A. In general, one of the challenges is thinking about all the various ways that screening is going on, including through mental health initiatives, pediatric primary care, Part C of IDEA, etc. We are trying to think across those systems to develop a more uniform system, including a set of principals for screening. In addition, we need to consider how front-line screening systems differ from a more in-depth assessment. And of course another key issue is how services are provided after needs are identified; often follow-up is even more fragmented than the screening process itself.

2. Q. So there really isn’t a front line screening tool?

A. I think there are more and more tools available; there is not one recommended screening tool. Some States have agreed on a screening tool; Minnesota, for example, is using the “Ages and Stages” tool across multiple agencies. Other States and communities are using a variety of screening instruments. I think some of the key issues are: a) who is gathering information; b) how information is shared; and c) what kind of follow up is available. This has to be an inter-agency process.

Note: For more information on “Ages and Stages” screening tool, take a look the TA Partnership’s list of common screening tools at: http://www.tapartnership.org/advisors/mental_health/resources/ScreenListv3.pdf

3. Q. What has your experience been with overcoming financing challenges in Kentucky?

A. We are still struggling with financial challenges. Our funds are even more limited for the upcoming fiscal year. Our question has always been how we will pay for consultation and education when we run out of grant funds. There are also financial issues concerning covering services for children who don’t have Medicaid, or whose families have private insurance but co-pay rates that are not conducive to families seeking services. These are common issues. In addition, our State Medicaid system is about to go through changes, but it is not clear what those changes will be. From the public health side, one thing that we’ve done is send money to Regional Mental Health Centers. Mental Health Specialists are allowed to spend 50% of their time doing direct case work, which is billable; this helps sustainability. You need to build in billable time in order to stretch grant dollars, so make sure that billable time is allowable within grant mandates.

Also both our early childhood mental health and home visiting programs have done a lot of thinking around Medicaid.

4. Q. Can you expand on your relationship with Part C of IDEA?

A. The Kids Now summary notes that some money does go from the Kids Now project into the First Steps Early Intervention program that serves children from birth to three years of age. Part of that money goes to identifying children with social and emotional issues. Training for providers is provided to mental health centers through a contract with the University of Kentucky. This training is actually provided Statewide and is open to any mental health professional that serves children birth through five years of age.

Note: For information and summary of changes to Part C of IDEA since July, 2005, visit: http://www.ed.gov/policy/speced/guid/idea/tb-partc-opt.pdf

5. Q. Are Healthy Start consultants and Early Childhood Mental Health Specialists trained together or separately? In general, how much do they work together?

A. Healthy Start consultants and Early Childhood Mental Health Specialists do a lot of co-training. This co-training is one of the few free trainings that are available. Co-training consists of basic socio-emotional wellness. Early Childhood Mental Health specialists created Tip Sheets for Healthy Start consultants to help them deal with immediate problems until clinicians arrive. Healthy Start consultants also partake in a National Model Training; they receive specific training on socio-emotional wellness as well as a training specific to the “DECA” (Devereux Early Childhood Assessment-Screening) tool. We also hosted another training for the Mental Health folks on the DECA Clinical (DECA-C) version.

6. Q. Is the relationship between children ages three to five and Early Intervention services as positive as the relationship between Early Intervention and ages zero to three? How do you address parental issues? Children age three to five seem much more challenging to work with around socio-emotional issues, particularly in regards to needs for family specialists.

A. Our version of early intervention for ages three to five is located in a pre-school program. When a school system or school opts to be part of the Kids NOW initiative, there is a time commitment involved. Schools are required to send a team, usually consisting of the principal, a counselor, a teacher, and a parent; that’s our way of dealing with the three-to-five population. If serious issues are identified through any of our service providers, referrals can be made to Kentucky Impact Program. Same with parent issues; parents can be referred back to their general practitioner if it’s an issue that can be addressed at that level, or on to receive mental health services. We do have some home visiting programs both through Health and Mental Health. For maternal depression, we are planning to put a piece in our Statewide mental health conference that addresses maternal depression. We are just building that piece.

One of our strategies in Project THRIVE is to have a policy roundtable with practitioners and State leaders as well as experts. Last week our policy roundtable focused on reducing maternal depression and we tried to bring people from both family and practitioner sides to find out what States are doing. Currently we are preparing an issue brief on maternal depression to come out in the fall.

6. Q. Can Early Childhood Mental Health Specialists only see DSM-IV diagnosed children?

A. Yes, but Kentucky is working to use the DC 0-3 R diagnoses as well as DSM-IV. Diagnoses that we typically use that are not DSM-IV are Youth Adjustment Disorders or V-Codes for short-term interventions.

Note: For information on the DC 0-3 R (Diagnostic Classification for children ages zero to three), take a look at notes from June 1 Early Childhood Community of Practice Call at http://www.tapartnership.org/Earlychildhood/DC0-3_Call.asp

7. Q. Do you find that it is a challenge to match DSM-IV diagnoses with results from the DECA?

A. That hasn’t been a problem that specialists have discussed, but we don’t really know the answer to this question.

8. Q. Where can I find information on some of the training modules you mentioned, such as the Greenspan training?

A. Greenspan training is the training developed by Stanley Greenspan. It includes a four-day, in-person training.

Note: For information on Greenspan trainings, including audio tapes from past trainings, visit Stanley Greenspan’s Web site at: http://www.stanleygreenspan.com/

10. Q. Where can I find information on screening and assessment tools for the zero to five population?

A. Florida has compiled a resource guide of screening and assessment tools for children ages birth to three years old. This resource guide profiles 17 instruments including two screeners, nine assessment tools, and 6 multi-function assessment tools; you can find this guide at: http://www.floridajobs.org/earlylearning/documents/resource.pdf

You can also find more information on important criteria for early screening and assessment at the National Academy for State Health Policy Web site, under the Assuring Better Child Health Development (ABCD II) initiative. To view this information, visit: http://www.nashp.org/_catdisp_page.cfm?LID=F4134DA0-737D-4F0B-8AC67E95A8C3035D

11. Q. Where can I find references and research on prevalence rates of mental health disorders for the zero to five population? I need this information in order to help policy makers and legislators understand and recognize the need for mental health and socio-emotional services for this population.

A. Take a look at the Zero to Three Web site; under the legislative and policy section there are articles with the latest prevalence rates. UCLA also has information on prevalence rates, but this information may be a little dated (from the 1990s). The National Survey of Children’s Health just came out in the June issue of Pediatrics; one of the things this survey looks at is Children’s Mental Health.

Note: Zero to Three is a Washington, D.C.-based organization for infants and toddlers formed by academics and clinicians. The Zero to Three Web site is located at: http://www.zerotothree.org.