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| Table of Contents Introduction
| Mending the Safety Net | National
Blueprint Nurtures Children's Mental Health | Pre-teens
tell Parents What They Really Want | One
Mother's Story of Mental Illness | The
Myth of The Bad Kid | Young Children It’s
More than an Office Visit The Need for Early Intervention “One in ten American children suffers from some sort of mental health problem, but only 20 percent of those are being treated for it,” wrote Surgeon General Dr. David Satcher in his recent report to the nation. “We need a system in place that helps us recognize problems early….the burden of suffering experienced by children with mental health needs and their families has created a health crisis in this country.” In our existing human service systems we see children in need. And we see them right away, from the first months of life. Doctors and nurses see them in the hospital, primary care offices and clinics. Human service workers see them in social services offices, early intervention and outreach programs. Teachers see them in early education programs and later at public school. Social workers and psychologists see them at clinics, often referred by community-based programs. We see these children. We reach out to them. And we do help in many ways. Yet, we have not fully interrupted the patterns of trouble and suffering. We are isolated, operating with pockets of money in unwieldy systems that have yet to build enough bridges to span their differences. And, we are waiting too long. If we see a child in need at two, three, or four years old, why wait? When we wait, we see children grow up with bigger troubles. The Field of Infant Mental Health A shining light of the late twentieth century has been the development of the field of infant mental health. Rooted in the work of great thinkers such as Anna Freud, John Bowlby, D.W. Winnicot, Selma Fraiberg and many others, this new field has arisen to address early intervention from a mental health and community perspective for children from birth through the early years. From 1977 to 1983, the National Institute of Mental Health sponsored a pilot project, “Clinical Infant Development Program.” Developed by Dr. Stanley Greenspan in the Washington D.C. area, this pilot program is now part of a non-profit organization which provides a continuum of services, ongoing research findings, and a model for other programs across the nation. The program is developed for high-risk, hard-to-reach families with infants. By intervening with a level of support that genuinely meets the level of need, this program helps very young children and families to really change for the better. Key elements of the program include:
The primary assumptions underlying the program are that the very young child exists in the context of other family members and that she grows along multiple lines of development. A comprehensive model becomes the basis for actions—one that emphasizes relationship-based interventions over time. A host of other initiatives have sprung up in this emerging field. The Zero to Three/National Center for Clinical Infant Programs, in conjunction with a distinguished national task force, has issued a diagnostic classification system for children 0 to 3 years old. The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (1994) seeks to address the need for a systematic, developmentally-based approach to the classification of mental health and developmental difficulties in the first four years of life. It is used in conjunction with the DSM-IV. In 1993, Head Start jumped into a new initiative—Early Head Start. Nationally serving 33,000 pregnant women and children ages 0-3 years old, Early Head Start is also conducting an intensive research effort in ten regions nationwide to identify and assess key elements for successful early intervention for low-income parents and their very young children. The Portage Project of Portage, Wisconsin, is a leader in the field of early intervention for families of children with disabilities. Their work draws heavily on the principles of infant mental health, focusing on family guided interventions and parent-child interactions as a vehicle for change and growth. Emmy Werner, Michael Rutter and others who have been investigating the characteristics of resilient children over the last 20 years have influenced the field of infant mental health. They have identified protective factors which off-set or balance the effects of risk and adversity on children. Protective factors include three categories: 1. A supportive family environment 2. Community support systems 3. Child attributes Programs designed to strengthen protective factors in young children are showing promise in reducing subsequent negative outcomes. What’s Happening Locally? At least 10% of our 372 enrolled children, ages 0-5, experience significant emotional or behavioral difficulties in any given program year in our local Head Start/Early Head Start program in Washington County. Most often they are not eligible for placement in special preschool services since these are generally accessed based on language or cognitive delays. These children may need short-term interventions or longer-term work with their parents. Families who attempt to make use of mental health outpatient services often report problems in accessing them due to long waiting lists for appointments, inadequate transportation, discomforts with the formalities of the clinic setting and paying for services. At Washington County Head Start/Early Head Start we have successfully created and funded a continuum of on-site mental health services that combine counseling and intervention for a child and family within the familiar setting of a child’s home and school. Since 1990, Dr. Patrick Cavanagh has served as consulting psychologist to our program, providing invaluable assistance to children and families both directly and in consultation with staff. Dr. Cavanaugh also consults weekly with Warren County Head Start. In 1997, we created a modest collaboration with Caleo Counseling Services to serve children by enrolling them at Caleo and serving them at our Head Start sites and in their homes. Since 1998, we have moved to full funding through the Department of Health and Human Services, adding two full-time professional level positions so that we can directly offer mental health services on-site at no cost to families. This is a fairly unique achievement from a Head Start perspective and probably will be replicated or adapted for use elsewhere over time. Currently, we are serving 40 children and their families on a weekly basis. We offer consultation with parents at center and home visits, classroom observation and assessment, play sessions, parent and child work, and collaboration with school districts and mental health services as children make the transition to public schools. We consult regularly with staff using a reflective practice model within an interdisciplinary approach. There is much more work to do. We look to the future with confidence and great commitment to helping young children and their families in the early years of life. Kathy Flanagan, MA Early Childhood Education, MSW, CSW, is the Mental Health Coordinator at Washington County Head Start/Early Head Start and Child Care Programs. She can be reached at kflan@washcohn.org, (518) 746-9066, 18 River Street, Hudson Falls, NY 12839.
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