Early Childhood Community of Practice

Early Childhood Questions and Answers

Q: Do you know about other federal agencies with early childhood programs that I can contact as resources?

A: (From Gail Ritchie, SAMHSA/CMHS)

Health Resources and Services Administration (HRSA), Maternal and Child Bureau is sponsoring an interesting live web cast on February 1 at 1:00 PM EST.
Spending Smarter: How State Early Childhood Comprehensive Systems (SECCS) Grantees Can Maximize Existing Funding Streams to Promote Social-Emotional Health for School Readiness

Dr. Phyllis Stubs of HRSA will be presenting. She is Chief of the Infant and Child Health Branch. To learn more and register, visit http://www.mchcom.com/liveWebcastDetail.asp?leid=229

For information about the SECCS grants contact Mr. Joseph Zogby, MSW at joseph.zogby@hrsa.hhs.gov 301.443.4393.
SAMHSA/CMHS/Division of Prevention Traumatic Stress and Special Programs: I would also like to offer time during a conference call with your grantees to talk to them about several of our Prevention and Early Intervention Grantees who focused on young children. Two grantees in particular concentrated on mental health consultation with child care providers, and others worked with parents and their babies. I can connect them with specific current and former grantees, but think it best for me to give them an overview so they can be efficient about whom they call.

***

Q: Do you have information on any published or current longitudinal studies in early childhood mental health outcomes, Best Practices, etc?

A: (From Gail Ritchie, SAMHSA/CMHS)

National Center for Children in Poverty, Mailman School of Public Health, Columbia University, NY, NY. www.nccp.org
They are an excellent resource for timely academic papers on key issues related to young children’s mental health. Dr. Jane Knitzer is the Executive Director and a well-known expert.
Deborah Weatherston, PhD, is widely published and has a distinguished career in training many infant mental health specialists at the Merrill-Palmer Institute, at Wayne State University. She is currently Executive Director of the Michigan Association for Infant Mental Health. Email: aa2233@wayne.edu. She can help grantees think through issues of training and supervision.
SAMHSA/CMHS/Division of Prevention Traumatic Stress and Special Programs: My division has good news. In February 2006 we will be printing the first two volumes in a new monograph series called “Promotion of Mental Health and the Prevention of Mental and Behavioral Disorders.” Your grantees will be pleased to learn that the first two are on early childhood mental health consultation. Both were co-authored by Roxane Kaufmann. Volume 1 is written for the early childhood community to help child care providers use mental health consultation. We define the concept of mental health for young children, and take them step by step through the process of “hiring” a mental health consultant. Volume 2 is a training curriculum to be used by a trainer to teach early childhood clients about how to use the first volume. We really hope that Volume 1 does not sit on a shelf, but is actually used.
Zero to Three, Washington, D.C., www.zerotothree.org
They are one of the leading organizations for infants and toddlers formed by academics and clinicians many year ago. They developed their own DSM for kids from birth to three. They have a yearly world-class training institute that would probably be of interest to your grantees. I was a presenter last year and was able to visit a few other workshops and found them to be first rate.

(Note from Ken Martinez: We will be partnering with Zero to Three in future activities.)

***

Q: How are children on the autism spectrum incorporated into other existing programs?

A: (From Diane Sondheimer) If you are interested in learning more about co-occurring autism and mental health disorders please feel free to call Myra Alfreds from Westchester County at 914-995-5250. They are the only SOC site we know of that is actively trying to work out the infrastructure issues in order to serve these children, both younger and older. For example, “who pays for what” is an interesting issue because you are dealing with 2 categories of funding (DD and MH). In some states, like N.Y., children under the age of 3 who are diagnosed with autism are entitled to intensive services (up to 20 hours/week through Early Intervention which is how NYS uses EPSDT Title XIX funds). Children with autism also qualify for services under the MR/DD Home & Community Based Services Waiver (Medicaid). This entitles them to care coordination and a range of services, driven by parent choice. However, we have found that the MR/DD Waiver does not have the intensity of services that children need who have both developmental disabilities and SED. In those cases, where there is also an Axis I diagnosis, the children's mental health system will often provide the intensive case management and, when it works, access MR/DD waiver services (a local model).

In NY, the bulk of services are provided through school districts. Interestingly enough, Myra’s Advisory Committee met recently (also the Governing Body for the grant). An Asst. Commissioner of State Education came to the meeting who indicated that he was looking to address the statewide increase in out-of-state school placements. They may form an alliance with him to create a single point of entry led by education in collaboration with mental health and cross system partners. He specifically said that State Ed. has added more local residential beds, specifically for kids with developmental disabilities and emotional disturbances, one of Westchester County’s most challenging and growing populations. Funding is through education (for education costs) and social services (for care - 80% of costs). He plans to be pro-active around the Coordinated Children's Services Legislation which is due to sunset in 2007 and includes all system partners on the state and local levels, including OMRDD, State Education and MH. CCSI is their "interagency team."

Questions for Sarah Hoover of Project Bloom:

Q: As you think back to when you started out, what are some lessons learned? What are some pitfalls to avoid?

Halfway into the project, decided to use Wraparound, but didn’t do an in depth analysis of some of the planning processes in which children and families are already involved – Should have done that first rather than just jumping in to using Wraparound.

Q: How did you get training for the DC 0-3?

Dr. Robert Harmon was based at the University of Colorado Health Sciences Center, where Project BLOOM is managed, and did a training and a “train the trainers” (Dr. Harmon had been working on the DC 0-3 and DC 0-3R, but he recently passed away.)

Q: Who did you train, and how did you recruit that audience?

There was an introductory training and an advanced training. The intro training was for anyone who was interested; the advanced training was only for clinicians. Recruitment was done through our four BLOOM communities and the University network.

Q: Did Bloom do any workforce development?

Yes, focused on 2 areas: pre-service and in-service training
Created a steering committee around professional development focused on higher education competencies for social/emotional development
BLOOM project director co-chairs a professional development task force in partnership with our State Early Childhood Systems initiative that later led to the development of an early childhood professional development office.
Created a training matrix that included available training opportunities and described how social and emotional competencies relate to these.

Q: For local evaluation data, does that information go into the ICN site or do you have separate databases?

Right now, Project Bloom is entering data once into ORC Macro’s database and they also have their own data that they are tracking.
Bloom has developed a separate web-based database for their local evaluation. A lot of that data is not included in what the National Evaluation needs; other data is included. They still use Macro’s identification numbers for the local data so that they can hopefully one day not have to enter the data twice. Bloom is working with Macro on this issue right now on this; they would like to enter the data once and have it available for local communities as well as Macro.

Q: How did you integrate screening outcomes in local evaluation process?

Used Bloom funds to support Ages and Stages SE in certain settings à Evaluated how the tool has been used and the outcomes. Using screening tools in primary care settings is a challenge because reimbursement is so low through Medicaid.

Q: How did your site work with the local schools?

It was difficult to engage schools. Schools had issues with very early intervention; they thought it would over-identify kids for special education. à Bloom gave schools information/research on the benefits of early intervention (it took two years to work through some of the issues).

Q: Can you talk about how you selected the 4 communities and what the interest was across the state in participating in the program?

Colorado had legislation passed several years ago that established pilot sites to increase the quality of early care and education. They looked at communities that had these pilots and had some sort of collaborative—but that also had some challenges. As we were developing the proposal to SAMHSA, communities applied to be BLOOM communities through a brief application process.

Q: Can you speak about Project Bloom's governing council?

At the local community level: local governance teams (one per each of the 4 communities).
At the State level: leadership team (staff, partners, etc).
There is also a policy council (legislature, agency heads, advocacy organizations, family, youth, etc)

Questions for Charlie Biss of Vermont CUPS:

Q: Were there any lessons learned about sustainability that we should be thinking about in Year 1?

A: We needed to develop a partnership with our Medicaid agency from day one. CUPS would never have been able to sustain if we had not made connections with Medicaid at the beginning. An example of a strategy is using V Codes as a method of billing for payment.

Q: Is there a conflict in serving children who are also enrolled in Part C of IDEA?

A: There were no problems working with children in Part C—in fact, CUPS had a great partnership with Part C and there were many benefits to working with them. For example, we learned very quickly that speech and language difficulties were usually good predictors of later disorders.

Q: Have you been able to do any longitudinal studies of kids enrolled in project?

A: No, this is one of the most frustrating things. It would allow us to get additional leverage and support.

Q: Can you describe your social marketing efforts?

A: Social marketing efforts began in early discussions of how we were going to open up our grant. We learned that just getting family involvement in early childhood area was easier if we went to where parents and children were, such as child care settings, Headstart, etc. Marketing efforts tried to de-stigmatize mental health. We did not use words “mental health” at first—we said “social and emotional development” to avoid stigma. We consulted in places where there were no identified children, but where children and caregivers were located. This way, we were not identifying a specific child, but the health of all children.

Q: Are there resources to support longitudinal studies of CUPS or other SOCs?

A: CUPS does not have a longitudinal study. There may be NIH grants that may fund longitudinal studies.

Q: How did you pay for consultation services? Did you use the grant?

A: The money we had for services for the grant, we were able to double statewide. We tried to talk to the early childhood community (state and local) about using Medicaid where they could use it and reinvesting the rest into other services. Reinvestment dollars went toward consultation services.

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	Early Childhood Questions and Answers Q: Do you know about other federal agencies with early childhood programs that I can contact as resources? A: (From Gail Ritchie, SAMHSA/CMHS) Health Resources and Services Administration (HRSA), Maternal and Child Bureau is sponsoring an interesting live web cast on February 1 at 1:00 PM EST. Spending Smarter: How State Early Childhood Comprehensive Systems (SECCS) Grantees Can Maximize Existing Funding Streams to Promote Social-Emotional Health for School Readiness Dr. Phyllis Stubs of HRSA will be presenting. She is Chief of the Infant and Child Health Branch. To learn more and register, visit http://www.mchcom.com/liveWebcastDetail.asp?leid=229 For information about the SECCS grants contact Mr. Joseph Zogby, MSW at joseph.zogby@hrsa.hhs.gov 301.443.4393. SAMHSA/CMHS/Division of Prevention Traumatic Stress and Special Programs: I would also like to offer time during a conference call with your grantees to talk to them about several of our Prevention and Early Intervention Grantees who focused on young children. Two grantees in particular concentrated on mental health consultation with child care providers, and others worked with parents and their babies. I can connect them with specific current and former grantees, but think it best for me to give them an overview so they can be efficient about whom they call. * Q: Do you have information on any published or current longitudinal studies in early childhood mental health outcomes, Best Practices, etc? A: (From Gail Ritchie, SAMHSA/CMHS) National Center for Children in Poverty, Mailman School of Public Health, Columbia University, NY, NY. www.nccp.org They are an excellent resource for timely academic papers on key issues related to young children’s mental health. Dr. Jane Knitzer is the Executive Director and a well-known expert. Deborah Weatherston, PhD, is widely published and has a distinguished career in training many infant mental health specialists at the Merrill-Palmer Institute, at Wayne State University. She is currently Executive Director of the Michigan Association for Infant Mental Health. Email: aa2233@wayne.edu. She can help grantees think through issues of training and supervision. SAMHSA/CMHS/Division of Prevention Traumatic Stress and Special Programs: My division has good news. In February 2006 we will be printing the first two volumes in a new monograph series called “Promotion of Mental Health and the Prevention of Mental and Behavioral Disorders.” Your grantees will be pleased to learn that the first two are on early childhood mental health consultation. Both were co-authored by Roxane Kaufmann. Volume 1 is written for the early childhood community to help child care providers use mental health consultation. We define the concept of mental health for young children, and take them step by step through the process of “hiring” a mental health consultant. Volume 2 is a training curriculum to be used by a trainer to teach early childhood clients about how to use the first volume. We really hope that Volume 1 does not sit on a shelf, but is actually used. Zero to Three, Washington, D.C., www.zerotothree.org They are one of the leading organizations for infants and toddlers formed by academics and clinicians many year ago. They developed their own DSM for kids from birth to three. They have a yearly world-class training institute that would probably be of interest to your grantees. I was a presenter last year and was able to visit a few other workshops and found them to be first rate. (Note from Ken Martinez: We will be partnering with Zero to Three in future activities.) * Q: How are children on the autism spectrum incorporated into other existing programs? A: (From Diane Sondheimer) If you are interested in learning more about co-occurring autism and mental health disorders please feel free to call Myra Alfreds from Westchester County at 914-995-5250. They are the only SOC site we know of that is actively trying to work out the infrastructure issues in order to serve these children, both younger and older. For example, “who pays for what” is an interesting issue because you are dealing with 2 categories of funding (DD and MH). In some states, like N.Y., children under the age of 3 who are diagnosed with autism are entitled to intensive services (up to 20 hours/week through Early Intervention which is how NYS uses EPSDT Title XIX funds). Children with autism also qualify for services under the MR/DD Home & Community Based Services Waiver (Medicaid). This entitles them to care coordination and a range of services, driven by parent choice. However, we have found that the MR/DD Waiver does not have the intensity of services that children need who have both developmental disabilities and SED. In those cases, where there is also an Axis I diagnosis, the children's mental health system will often provide the intensive case management and, when it works, access MR/DD waiver services (a local model). In NY, the bulk of services are provided through school districts. Interestingly enough, Myra’s Advisory Committee met recently (also the Governing Body for the grant). An Asst. Commissioner of State Education came to the meeting who indicated that he was looking to address the statewide increase in out-of-state school placements. They may form an alliance with him to create a single point of entry led by education in collaboration with mental health and cross system partners. He specifically said that State Ed. has added more local residential beds, specifically for kids with developmental disabilities and emotional disturbances, one of Westchester County’s most challenging and growing populations. Funding is through education (for education costs) and social services (for care - 80% of costs). He plans to be pro-active around the Coordinated Children's Services Legislation which is due to sunset in 2007 and includes all system partners on the state and local levels, including OMRDD, State Education and MH. CCSI is their "interagency team." Questions for Sarah Hoover of Project Bloom: Q: As you think back to when you started out, what are some lessons learned? What are some pitfalls to avoid? Halfway into the project, decided to use Wraparound, but didn’t do an in depth analysis of some of the planning processes in which children and families are already involved – Should have done that first rather than just jumping in to using Wraparound. Q: How did you get training for the DC 0-3? Dr. Robert Harmon was based at the University of Colorado Health Sciences Center, where Project BLOOM is managed, and did a training and a “train the trainers” (Dr. Harmon had been working on the DC 0-3 and DC 0-3R, but he recently passed away.) Q: Who did you train, and how did you recruit that audience? There was an introductory training and an advanced training. The intro training was for anyone who was interested; the advanced training was only for clinicians. Recruitment was done through our four BLOOM communities and the University network. Q: Did Bloom do any workforce development? Yes, focused on 2 areas: pre-service and in-service training Created a steering committee around professional development focused on higher education competencies for social/emotional development BLOOM project director co-chairs a professional development task force in partnership with our State Early Childhood Systems initiative that later led to the development of an early childhood professional development office. Created a training matrix that included available training opportunities and described how social and emotional competencies relate to these. Q: For local evaluation data, does that information go into the ICN site or do you have separate databases? Right now, Project Bloom is entering data once into ORC Macro’s database and they also have their own data that they are tracking. Bloom has developed a separate web-based database for their local evaluation. A lot of that data is not included in what the National Evaluation needs; other data is included. They still use Macro’s identification numbers for the local data so that they can hopefully one day not have to enter the data twice. Bloom is working with Macro on this issue right now on this; they would like to enter the data once and have it available for local communities as well as Macro. Q: How did you integrate screening outcomes in local evaluation process? Used Bloom funds to support Ages and Stages SE in certain settings à Evaluated how the tool has been used and the outcomes. Using screening tools in primary care settings is a challenge because reimbursement is so low through Medicaid. Q: How did your site work with the local schools? It was difficult to engage schools. Schools had issues with very early intervention; they thought it would over-identify kids for special education. à Bloom gave schools information/research on the benefits of early intervention (it took two years to work through some of the issues). Q: Can you talk about how you selected the 4 communities and what the interest was across the state in participating in the program? Colorado had legislation passed several years ago that established pilot sites to increase the quality of early care and education. They looked at communities that had these pilots and had some sort of collaborative—but that also had some challenges. As we were developing the proposal to SAMHSA, communities applied to be BLOOM communities through a brief application process. Q: Can you speak about Project Bloom's governing council? At the local community level: local governance teams (one per each of the 4 communities). At the State level: leadership team (staff, partners, etc). There is also a policy council (legislature, agency heads, advocacy organizations, family, youth, etc) Questions for Charlie Biss of Vermont CUPS: Q: Were there any lessons learned about sustainability that we should be thinking about in Year 1? A: We needed to develop a partnership with our Medicaid agency from day one. CUPS would never have been able to sustain if we had not made connections with Medicaid at the beginning. An example of a strategy is using V Codes as a method of billing for payment. Q: Is there a conflict in serving children who are also enrolled in Part C of IDEA? A: There were no problems working with children in Part C—in fact, CUPS had a great partnership with Part C and there were many benefits to working with them. For example, we learned very quickly that speech and language difficulties were usually good predictors of later disorders. Q: Have you been able to do any longitudinal studies of kids enrolled in project? A: No, this is one of the most frustrating things. It would allow us to get additional leverage and support. Q: Can you describe your social marketing efforts? A: Social marketing efforts began in early discussions of how we were going to open up our grant. We learned that just getting family involvement in early childhood area was easier if we went to where parents and children were, such as child care settings, Headstart, etc. Marketing efforts tried to de-stigmatize mental health. We did not use words “mental health” at first—we said “social and emotional development” to avoid stigma. We consulted in places where there were no identified children, but where children and caregivers were located. This way, we were not identifying a specific child, but the health of all children. Q: Are there resources to support longitudinal studies of CUPS or other SOCs? A: CUPS does not have a longitudinal study. There may be NIH grants that may fund longitudinal studies. Q: How did you pay for consultation services? Did you use the grant? A: The money we had for services for the grant, we were able to double statewide. We tried to talk to the early childhood community (state and local) about using Medicaid where they could use it and reinvesting the rest into other services. Reinvestment dollars went toward consultation services.	General Questions: Do you know about other federal agencies with early childhood programs that I can contact as resources? Do you have information on any published or current longitudinal studies in early childhood mental health outcomes, Best Practices, etc? How are children on the autism spectrum incorporated into other existing programs? Questions for Sarah Hoover of Project Bloom: As you think back to when you started out, what are some lessons learned? What are some pitfalls to avoid? How did you get training for the DC 0-3? Who did you train, and how did you recruit that audience? Did Bloom do any workforce development? For local evaluation data, does that information go into the ICN site or do you have separate databases? How did you integrate screening outcomes in local evaluation process? How did your site work with the local schools? Can you talk about how you selected the 4 communities and what the interest was across the state in participating in the program? Can you speak about Project Bloom's governing council? Questions for Charlie Biss of Vermont CUPS: Were there any lessons learned about sustainability that we should be thinking about in Year 1? Is there a conflict in serving children who are also enrolled in Part C of IDEA? Have you been able to do any longitudinal studies of kids enrolled in project? Can you describe your social marketing efforts? Are there resources to support longitudinal studies of CUPS or other SOCs? How did you pay for consultation services? Did you use the grant?

Technical Assistance Partnership for Child and Family Mental Health