Integrating Early Childhood Integrating Early Childhood Social Emotional Development Social Emotional Development into Early Childhood Systemsinto Early Childhood Systems

Deborah F. Perry, PhDDeborah F. Perry, PhDGeorgetown UniversityGeorgetown University

Center for Child & Human DevelopmentCenter for Child & Human DevelopmentAugust 2010August 2010

OverviewOverview

Define early childhood social emotional Define early childhood social emotional developmentdevelopment

Explore the role of early brain Explore the role of early brain development on trajectories of development on trajectories of developmentdevelopment

Describe policy implications for Part C Describe policy implications for Part C systemssystems

The Context The Context Young children are: Young children are: – Being kicked out of child care settingsBeing kicked out of child care settings– Showing the impacts of maternal depressionShowing the impacts of maternal depression– Dealing with multiple family risks (parental Dealing with multiple family risks (parental

substance abuse, domestic violence and substance abuse, domestic violence and mental illness)mental illness)

School Readiness SkillsSchool Readiness Skills

Estimated PrevalenceEstimated PrevalenceNo national epidemiological data No national epidemiological data Early Childhood Longitudinal Study: 10% Early Childhood Longitudinal Study: 10% of all kindergarten children show of all kindergarten children show problematic behaviorproblematic behaviorRates are two to three times as high in Rates are two to three times as high in low-income samples low-income samples Clinical level problems are lower (4-10%)Clinical level problems are lower (4-10%)

Social Emotional DevelopmentSocial Emotional Development

Inter-relatedness of Inter-relatedness of domainsdomains

Intimately tied to Intimately tied to caregivers’ mental caregivers’ mental healthhealth

Core tasks:Core tasks:– AttachmentAttachment– BehaviorBehavior– CompetenceCompetence

Neurons to NeighborhoodsNeurons to Neighborhoods

Shonkoff and Phillips, 2000

…virtually every aspect of early human development, from the brain’s evolving circuitry to the child’s capacity for empathy is affected by the environments and experiences that are encountered in a cumulative fashion, beginning in the prenatal period and extending throughout the early childhood years.”

Role of Early ExperienceRole of Early ExperienceConnections between neurons are Connections between neurons are strengthened through repeated strengthened through repeated exposure/useexposure/use

Connections that are not used often are Connections that are not used often are pruned awaypruned away

Environmental influences shape the Environmental influences shape the architecture of the brainarchitecture of the brain

Quality and Quantity of Quality and Quantity of ExperiencesExperiences

Frequent, regular, predictableFrequent, regular, predictableOccur in the context of warm, supportive Occur in the context of warm, supportive relationshipsrelationshipsAre associated with positive emotionsAre associated with positive emotionsInvolve several sensesInvolve several sensesAre responsive to the child’s interests or Are responsive to the child’s interests or initiativeinitiativeEarly Childhood Resource Center, RTIEarly Childhood Resource Center, RTI

Early Childhood Mental HealthEarly Childhood Mental HealthThe social, emotional and The social, emotional and behavioral well-being of behavioral well-being of young children and their young children and their familiesfamiliesThe developing capacity The developing capacity to experience, regulate, to experience, regulate, express emotionexpress emotionForm close, secure Form close, secure relationshipsrelationshipsExplore the environment Explore the environment and learnand learn

Adapted from ZERO TO THREEAdapted from ZERO TO THREE

Experience and Regulate Emotions

INFANT Behaviors: Smiling Cooing and Babbling Fussing when hungry or tired Kicking legs when excited Quieting when held by a familiar adult

TODDLER Behaviors: Laughing Goes to familiar adult for comforting Able to move from one activity to the next Growing ability to focus Calms with help from a familiar caregiver

Form Secure Relationships

INFANT Behaviors: Smile at and back to a familiar caregiver Anticipates being held Likes to look at and be near familiar caregiver Shows preference for parent or caregivers face and voice Stretches arms up to be held

TODDLER Behaviors: Explores but checks in with familiar caregiver Shows affection for familiar caregivers Responds to his/her name Makes needs known to a familiar caregiver

Explore and Learn

INFANT Behaviors: Reaches for and grasps things Enjoys simple games like peek-a-boo Imitates others actions Smiles or plays with self in the mirror

TODDLER Behaviors: Keeps looking for a toy Tries new things Shows interest in other people Imitates others actions

Goodness of FitGoodness of Fit

Extent to Extent to which the which the temperament temperament of the child is of the child is compatible compatible with the with the environment, environment, expectations expectations and demands and demands

Adversity in Early Childhood Can Have Long-Lasting Consequences

Adverse Childhood Experiences Study (ACES) has documented the long term effects of earlier exposure to significant stressors

Explains the link between early childhood brain development and long term health and mental health outcomes

Adverse Childhood Experiences Are Common Substance abuse 27%

Parental sep/divorce 23%Mental illness 17%Battered mother 13%Criminal behavior 6%

Household dysfunction:

Abuse: Psychological 11% Physical 28% Sexual 21%

Neglect: Emotional 15% Physical 10%

Adverse Childhood Adverse Childhood Events and Adult Events and Adult

DepressionDepression

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

0

1

2

3

4

5+

Odd

s R

atio

Adverse EventsChapman et al, 2004

Adverse Childhood Events and Adult Substance Abuse

0

2

4

6

8

10

12

14

16

0 1 2 3 4+

0

5

10

15

20

25

30

35

40

0 1 2 3 4 5+

%

Self-Report: Alcoholism Self-Report: Illicit Drug UseDube et al, 2002 Dube et al, 2005

%

Adverse Childhood Events and Adverse Childhood Events and Adult Ischemic Heart DiseaseAdult Ischemic Heart Disease

0

0.5

1

1.5

2

2.5

3

3.5

0

1

2

3

4

5,6

7,8

Dong et al, 2004 Adverse Events

Odd

s R

atio

Levels of StressLevels of Stress

Positive Stress: normative, helps in Positive Stress: normative, helps in developmentdevelopment

Tolerable Stress: outside the normal Tolerable Stress: outside the normal range, one time events, buffered by range, one time events, buffered by caregiverscaregivers

Toxic Stress: prolonged activation of the Toxic Stress: prolonged activation of the stress response system, in absence of stress response system, in absence of buffering adultbuffering adult

Harvard Center for the Developing Child

EmotionalStimulus

PIT

Cortisol CortisolCRH

Amygdala Hippocampus

AdrenalCortex

HypothalamusPVN

LeDoux, Synaptic Self

HPA Pathway Control

ACTH

Charles Zeanah PPT

Interaction of the Brain and Immune System

Hypothalamus

PituitaryGland

Immune Organs

Locus Ceruleus

CRF

ACTH

Cortisol

Co

rtis

ol

Cytokines SympatheticNervous system

Vag

us

Ner

ve

Adrenal Gland

Immune Cells

CRH

Charles Zeanah PPT

Impact of Stress on Development

How depression affects How depression affects developmentdevelopment

Specific aspects of parenting behavior:Specific aspects of parenting behavior:– Maternal responsivityMaternal responsivity– Maternal sensitivityMaternal sensitivity– Emotional availabilityEmotional availability– Negative mood (intrusive/hostile)Negative mood (intrusive/hostile)– Inconsistency in disciplineInconsistency in discipline– Modeling negative affectModeling negative affect– Inability to assist with emotional regulationInability to assist with emotional regulation

Consequences of Maternal Consequences of Maternal DepressionDepression

Mothers’ well-beingMothers’ well-being– Decreased Maternal Self-EfficacyDecreased Maternal Self-Efficacy

Fathers’ well-beingFathers’ well-being– Increased depression & marital stressIncreased depression & marital stress– Increased concern of infants Increased concern of infants

Infant developmentInfant development– Emotion dysregulationEmotion dysregulation– Cognitive and language delaysCognitive and language delays– Increased risk for psychopathologyIncreased risk for psychopathology

Mother-infant interactionMother-infant interaction– Mothers: understimulating or Mothers: understimulating or overstimulatingoverstimulating– Infants: Infants: Less responsive, more gaze avoidant, more Less responsive, more gaze avoidant, more

distressdistress

Field, 1997; Milgrom & McCloud, 1996; O’Hara, 1994

Challenges & OpportunitiesChallenges & Opportunities

Address the mental Address the mental health needs of young health needs of young children and their children and their caregivers in context caregivers in context of their network of of their network of services and supportsservices and supports

Integrate the best Integrate the best available science on available science on what works for what works for preventing and preventing and treating mental health treating mental health needs of young needs of young children and their children and their families families

Challenges to Integration of ECMH Challenges to Integration of ECMH into EC Systems-Buildinginto EC Systems-Building

Need to address complex, multi-factorial problems Need to address complex, multi-factorial problems that evolve over time and across settingsthat evolve over time and across settings– Focus on caregivers (parents and child care Focus on caregivers (parents and child care

providers)providers)

Lack of fit between increasing specialization & Lack of fit between increasing specialization & real needs of young children & their caregiversreal needs of young children & their caregivers

Requires integration & adaptation of evidence-Requires integration & adaptation of evidence-based practices (EBP)based practices (EBP)

An Early ChildhoodAn Early Childhood Systems’ Framework Systems’ Framework

Developed by Roxane Kaufmann, GUCCHD; design by: Lucia Foley, Hampshire Educational Collaborative

System of Care Values/PrinciplesSystem of Care Values/Principles

Infused Into Natural Settings and ServicesInfused Into Natural Settings and Services– Stand-alone early childhood mental health Stand-alone early childhood mental health

systems won’t worksystems won’t work

Grounded in Developmental KnowledgeGrounded in Developmental Knowledge– Lifespan approach, different approaches Lifespan approach, different approaches

needed for infants, toddlers, preschoolersneeded for infants, toddlers, preschoolers

Risk & ResilienceRisk & Resilience– Building family and community assetsBuilding family and community assets

Need for Focus on Relationship-Need for Focus on Relationship-Based StrategiesBased Strategies

Dyadic interventionsDyadic interventions

Two-generation modelsTwo-generation models

Family systems frameworkFamily systems framework

Relationships between MH and other Relationships between MH and other service systemsservice systems

Relationships with stakeholders in Relationships with stakeholders in systems buildingsystems building

Best Scientific EvidenceBest Scientific Evidence

Growing number of evidence-based Growing number of evidence-based prevention and treatment models prevention and treatment models – Developed through rigorous scientific Developed through rigorous scientific

experimentsexperiments– Need for adaptation for local context, but with Need for adaptation for local context, but with

eye to fidelityeye to fidelity– Difficulties in bringing these to scaleDifficulties in bringing these to scale

How to value “practice-based evidence” How to value “practice-based evidence” and “family wisdom”and “family wisdom”

Pyramid ModelPyramid Model

PromotionPromotion

Developmental and social-emotional screening Developmental and social-emotional screening in primary care and early care and education in primary care and early care and education programsprograms

High quality training on social-emotional High quality training on social-emotional development for Part C providers and child development for Part C providers and child care communitycare community

Dissemination of information promoting Dissemination of information promoting healthy social-emotional developmenthealthy social-emotional development

PreventionPrevention

Screening for caregiver depressionScreening for caregiver depression

Mental health consultation in child care Mental health consultation in child care and integration of MH into Part C systemsand integration of MH into Part C systems

Social skills curricula (i.e., Second Step)Social skills curricula (i.e., Second Step)

InterventionIntervention

Positive Behavioral SupportPositive Behavioral Support

Intensive mental health consultation in homes Intensive mental health consultation in homes and child care settings to support children with and child care settings to support children with IFSPsIFSPs

Relationship-based therapy (e.g., PCIT)Relationship-based therapy (e.g., PCIT)

In-home treatment for children with mental In-home treatment for children with mental health diagnoses and depressed caregivershealth diagnoses and depressed caregivers

Moving ForwardMoving Forward

Consider how current eligibility criteria and Consider how current eligibility criteria and procedures for Part C reflect the fundamentals of procedures for Part C reflect the fundamentals of early childhood social-emotional developmentearly childhood social-emotional developmentBroaden networks of providers who are Broaden networks of providers who are screening families (caregivers and children) for screening families (caregivers and children) for social-emotional riskssocial-emotional risksEstablish cross-sector competencies for all Establish cross-sector competencies for all providers working with young children and providers working with young children and familiesfamiliesSupport integration of mental health consultants Support integration of mental health consultants in Part C systems in Part C systems