Focus on infant and child mental health
When a child’s needs are not met, consequences can last a lifetime
Teachers see it all too often: a young child melting down and reacting inappropriately — even violently — to everyday occurrences such as being told to put his or her toy away.
Some would see the episode as a result of the child making bad choices, and opt for punishment. Mental health specialists see it differently — as a matter of brain chemistry that requires outside intervention for the entire family.
As the long-lasting impact of a child’s early brain development is better understood, infant and child mental health, or how well a child develops socially and emotionally, is a topic getting more and more attention.
Research clearly shows that the greatest period of brain development in a person’s life happens in the first three years. Challenges such as substance abuse, difficult relationships or poverty can disrupt a parent’s ability to consistently nurture and respond to the child. If a child’s needs are not met during this time, the consequences can last a lifetime.
“The bodies of children with consistently unmet needs go into more of a survival mode, and it literally alters their brain chemistry,” explains Alison Hinson, Douglas Education Service District’s behavior services coordinator. “It is a full chemical and developmental change that happens in children. We can repair that, but it takes very specific strategies.”
There is now a large amount of evidence in the area of neuroplasticity, which shows that the brain is resilient and can actually rewire itself with the right kind of therapeutic interventions.
To understand the extent of the problem, developmental pediatrician Sherri Alderman points to the fact that almost half of babies born in Oregon qualify for Medicaid. “While poverty, in and of itself, does not absolutely determine early childhood outcomes, it is undeniably a major stressor for families,” says Alderman, who serves as president of the Oregon Infant Mental Health Association. “How we as a society support infants and toddlers living in poverty at a time when their brains are developing requires resources, policies, and opportunities for parents and caregivers.”
Impact on rural
Although the issue of infant and child mental health is a critical one for the entire population, rural areas in Oregon face special challenges. Geographic isolation makes convenient access to care much more difficult. “It’s not that people don’t want help,” Hinson says, “but it could be that they don’t have gas money, child care or the ability to take sick days.”
Rural areas typically have a higher rate of poverty and intergenerational trauma. There is often a lack of awareness about the complexities of the issue on both sides of the equation — primary care providers and the families.
“We sometimes see bias in rural areas on both sides,” Hinson explains. “At times there’s a lack of trust on the family side, especially when factoring in the stigma of mental illness.” On the flip side, the people doing the work, many of whom might be professionals from an urban area who might bring their own biases, may have a lack of understanding about the constraints families are facing and the choices families are making.
Rural communities also have strengths, Alderman points out. “The dedication and passion that rural citizens have for their communities builds greater capacity for serving families there.”
Dr. Ajit Jetmalani, director of the Division of Child and Adolescent Psychiatry at Oregon Health & Science University, says that the children’s mental health system has many serious challenges in Oregon. However, he says he’s encouraged by an expanded emphasis on supporting mental health in the primary care medical environment. “The premise is that if you intervene early at critical moments the impact is much broader,” he says.
OHSU, for example, has partnered with Oregon Pediatric Society and Oregon Council of Child and Adolescent Psychiatry to offer the Oregon Psychiatric Access Line about Kids. OPAL-K provides primary care providers in Oregon with free, same-day, child psychiatric phone consultation. That’s a boon to those outside the metro area, who make up about 25% of the calls, with the biggest users in Jackson and Deschutes counties.
Another initiative that holds great promise for rural areas, Jetmalani says, is a new program called ECHO, Expanding Community Health Outcomes. Funded by the Oregon Office of Rural Health, the program connects primary care providers with OHSU specialists for a live, weekly virtual classroom that provides case-based learning and lectures on common child mental-health challenges.
The importance of collaboration in the realm of infant and child mental health resonates with Hinson. As behavior services coordinator, she directs the ESD’s mental health and behavioral intervention programs, including Ready, Set, Learn (see below).
“The thing that works is relationship, the human connection,” she says. “The people with the greatest impact in this work all suffer from the same overwhelmed resources, lack of time, deficit of funding, at this go-go-go pace.”
And while the situation might be daunting, the successes are rewarding. “You get a referral from the school, and a child has to be tutored one day a week because he is so violent and disruptive. We come in, make a plan, work with the family, and the child creates new skills and new abilities,” Hinson says.
“Nothing makes me happier than when I walk into a classroom and someone says, which one are you working with? When someone can’t figure out who he is, we’ve done it right.”
Ready, Set, Learn
Three years ago, Douglas County school superintendents declared a crisis resulting from the lack of mental health services available to youth. Many children were coming to school with severe behavioral issues, and teachers and their districts were often at a loss in how to deal with it.
The process of designing a program to combat the issue began with facilitation, led by the Douglas Education Service District, to identify root causes and potential solutions. From there, the Douglas ESD took the lead role in designing the solution in collaboration with county school districts. The Ford Family Foundation contributed financial support.
The result was Ready, Set, Learn Behavior Intervention Program, available to area school districts through the Douglas ESD’s regional delivery model.
The program deploys a team of behavior specialists to work with families, students and schools. Students enrolled in the program generally spend two weeks to four months, receiving intensive services that help them learn to manage stress and frustration. They also acquire the skills they need to attend class. The Douglas ESD and districts share the costs.
In its first year, the Ready, Set, Learn Behavior Intervention Program enrolled 23 youth from ages 5-13. Forty-eight percent of participants at least doubled their time at school; 43% are maintaining success in their current placement; 21% were referred to a more intensive level of placement, such as behavior-based classrooms or day treatment programs.
Now in its second year, the program has served 24 students, with more referrals expected as the school year continues. It also has expanded to serving preschoolers who are demonstrating social-emotional-behavioral challenges which put their preschool placements at risk.
“Districts are very pleased with the program,” says Michael Lasher, Douglas ESD superintendent.