Foundations of Child Mental Health



University of Southern California

Keck School of Medicine

Master of Public Health Program

PM 583: Foundations of Early Childhood Mental Health

Thursdays 9-12:30 p.m.

Instructors: Marie Kanne Poulsen, Ph.D.

4650 Sunset Blvd., Mailstop #53

Los Angeles, CA 90027

Phone: (323) 361-3819

E-mail: mpoulsen@chla.usc.edu

Karen Moran Finello, Ph.D.

155 N. Occidental Blvd, Ste 245

Los Angeles, CA 90026

Phone: (213) 383-5967

E-mail: kfinello@chla.usc.edu

Office Hours: 8-9 am Thursdays by appointment

Course Description:

In response to the serious crisis in mental health care for children, there is a growing movement in the United States and in other countries to treat infant and early childhood mental health as a primary issue in child health and welfare with a family-centered focus on early identification, preventive intervention and treatment. This course will provide a broad overview of major infant and early childhood mental health issues, relating to the status of child mental health and the importance of comprehensive systems of care for children that support resilience and respond to biological and psychosocial mental health risks. Specific topics will include: early brain development, biological and psychosocial risks that impact child mental health, developmental trajectories to mental health problems, and systems, programs and policies that support the mental health of young children.

Student Learning Objectives:

Upon completion of this course, students will be able to:

1. Describe the status of young child mental health and mental health services in the United States, and associated major public health issues.

2. Describe the variety of public programs and policies designed to support a range of early childhood mental health issues.

3. Discuss state, national and international policy issues related to early childhood mental health and development.

4. Define principles and standards of care that guide the development of mental health systems of care.

5. Differentiate the roles of public health specialists in developing policies, providing advocacy, conducting epidemiological studies, and influencing direct clinical services on behalf of young children and their families.

Evaluation Methods & Course Assignments:

Evaluations will be based on the following criteria:

1. Active class participation and discussion indicating that you have read and understand assigned materials. Course readings are listed by session on the Course Outline. You are expected to bring in a question or issue raised by the readings each week and be prepared to address it during class. (25% of your grade)

2. Research a state, national or international policy or public health topic impacting the development of very young children. Prepare a written analysis including an overview of the topic, historical perspectives on how the policy developed, and any recommendations for change on behalf of young children. This analysis should be approximately 3-4 pages (double spaced) in length. DUE DATE: 10/22/09 (25% of your grade).

3. Final Paper: Choose a topic requiring legislative action or international advocacy. Prepare a “white paper” or policy brief designed to influence federal or international policy in a specific public health area with implications for early childhood mental health. Complete the process required for legislative advocacy at the local, state, or federal level. You will be required to do an oral presentation of your work to the class at the final meeting. Please choose your topic by 10/1/09 at the latest, (topic must be cleared with course instructors first and duplicate topics will not be permitted). Paper is to be 10-15 double spaced pages maximum. DUE DATE: 12/3/09 (25% of your grade for written paper and 25% of your grade for oral presentation).

Grading will be as follows:

A = 93 - 100

B = 84 - 92

C = 75 - 83

D = 65 - 74

Students with Disabilities

Any student requesting academic accommodations based on a disability is required to register with Disability Services and Programs (DSP) each semester. A letter of verification for approved accommodations can be obtained from DSP. Please be certain the letter is delivered to us as early in the semester as possible. DSP is located on the University Park campus in STU 301 and is open from 8:30 AM – 5:00 PM, Monday through Friday. The phone number is: (213) 740-0776.

Course Outline:

* Starred Readings are required

8/27/09: Introduction, Historical Perspectives and Overview of Early Childhood Mental Health Issues (Poulsen)

❑ Introduction to course

❑ How does early childhood mental health fit into public health work

❑ Historical perspectives of child mental health in the United States

❑ Status of child & adolescent mental health

❑ Early childhood mental health: why now

❑ Defining early childhood mental health

❑ Early childhood mental health through interdisciplinary perspectives

❑ Mental health promotion, preventive intervention & treatment

Readings:

*National Research Council and Institute of Medicine. (2000). From Neurons to Neighborhoods: The Science of Early Child Development. Committee on Integrating the Science of Early Childhood Development. Washington, DC: National Academy Press, pp. 1-15.

Poulsen, M.K. (2002). Defining early childhood/family mental health. Cathie Wright Technical Assistance Center Updates. Volume 5 (3), pp. 1-9.

Zeanah, P., Stafford, B., Nagle, G., Rice. (2005). Addressing Social-Emotional Development and Infant Mental Health in Early Childhood Systems. Los Angeles, CA: National Center for Infant and Early Childhood Health Policy; Building State Early Childhood Comprehensive Systems Series, No.12., pp. 4- 10.

9/03/09: The Biological Context of Early Childhood Mental Health (Poulsen)

❑ Infant Brain Development

❑ Biological influences on early childhood mental health

o Prematurity

o Under-nutrition/iron deficient anemia

o Prenatal substance exposure

o Developmental disabilities

o Chronic illness

o Serious illness

❑ Programs and policies

o Medical home concept

o Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

o Federal Food Stamp Program (FSP)

Readings:

*Davies, D. (2004). Brain development. Child Development: A practitioner’s guide, 2nd Ed . New York: Guilford Press, pp. 39-60.

Meyers, A. & Chawla, N. (2000). Nutrition and the social, emotional, and cognitive development of infants and young children. Zero to Three Bulletin, 21(1) , 5-14.

Nix, C.M. & Ansermet, F. (2009). Prematurity, risk factors and protective factors. In C.H. Zeanah, Jr. (Ed.). Handbook of Infant Mental Health, 3rd Edition. New York: Guilford Press, pp 180-196.

Sheridan, M. & Nelson, C.H. (2009). Neurobiology of fetal and infant development: Implications for infant mental health. In C.H. Zeanah, Jr (Ed). Handbook of Infant Mental Health, 3rd Edition. New York: Guilford Press, pp 40-58.

9/10/09: Overview of Infant & Early Childhood Mental Health (Finello)

❑ Mental health risk & protective (resilience) factors in early childhood

❑ Development of attachment

❑ Markers of early childhood mental health

o Social-emotional development and school readiness

❑ Programs and policies addressing early childhood well-being

o Mental health services in early childhood

Readings:

*Davies, D. (2004). Risk and protective factors: The child, family & community contexts. Child Development: A practitioner’s guide, 2nd Ed. New York: Guilford, pp. 61-108.

Kaufmann, R., Perry, D.B. (2002). Promoting social-emotional development in young children: Promising approaches at the national, state and community levels. The Kauffman Early Education Exchange. Volume 1, pp. 80-96.

Zeanah, C. H. & Zeanah, P.D. (2009). The scope of infant mental health. In C.H. Zeanah, Jr (Ed). Handbook of Infant Mental Health, 3rd Edition. New York: Guilford Press pp.5-21.

9/17/09: The Parenting Context of Early Childhood Mental Health (Poulsen)

❑ Perinatal caregiver issues

o Perinatal substance abuse

o Maternal & paternal depression

o Unsupported single parenthood

o Teen parenthood

o Fathers

o Maternal mental illness

❑ Programs and Policies

o Family Leave Legislation

Readings:

*Wakschlag, L.S. & Hans, S.L. (2000). Early parenthood in context: Implications for development and intervention. In C..H. Zeanah, Jr. (Ed.). Handbook of Infant Mental Health, 2nd Edition. New York: Guilford.

Onunaku, N. (2005). Improving Maternal and Infant Mental Health: Focus on Maternal Depression. Los Angeles, CA: National Center for Infant and Early Childhood Health Policy at UCLA

Seifer, R. & Dickstein, S. (2000) Parental mental illness and infant development. In C.H. Zeanah, Jr. (Ed.). Handbook of Infant Mental Health, 2nd Edition. New York: Guilford.

9/24/09: Addressing Policy: State, National, and International Programs (Finello)

❑ Challenges and opportunities in mental health systems

❑ International approaches to early childhood mental health

❑ SAMHSA early childhood mental health systems of care

❑ State Initiatives: Florida, New Mexico, Arizona, Louisiana

❑ State, Federal and International Programs and Policies

o IDEA, Part B & Part C

o Head Start

o Child Care & Development Fund (CCDF)

o CAPTA

o Titles IV- & IV-E

o State Children’s Health Insurance Program (SCHIP)

o Early Periodic Screening, Diagnosis & Treatment (EPSDT)

o Medicaid

o Maternal & Child Health Programs

Readings:

* Zero To Three (2009). Early experiences matter: A guide to improved policies for infants and toddlers.

* Zero to Three Public Policy Information section.

Center on the Developing Child at Harvard University (2007). A science-based framework for early childhood policy: Using evidence to improve outcomes in learning, behavior, and health for vulnerable children.

Knitzer, J. (2001) Building Services and Systems to Support the Healthy Development of Young Children: An Action Guide for Policymakers. New York, NY: National Center for Children in Poverty, Columbia University, Mailman School of Public Health.

Zero to Three Policy Center (August, 2007). Tracking services for infants, toddlers & their families: A look at federal early childhood programs and the roles of state and local governments. Washington, D.C.: Zero to Three.

10/1/09: Research Issues & Advocacy (Finello)

❑ Epidemiological studies

❑ Community Based Participatory Research

❑ What do public health advocates do to influence policy

❑ Priority legislative areas for APHA

❑ Visiting legislators

❑ Influencing policies on behalf of young children and their families

Readings:

*Center on the Developing Child at Harvard University (August, 2007). A science-based framework for early childhood policy using evidence to improve outcomes in learning, behavior and health for vulnerable children.

Frank, John (2007). A beginner’s guide to judge research studies: Quick tips to sort the wheat from the chaff. Editorial in Medical Post.

Rappaport, Debbie M. (2007). Building relationships: Parallels between infant-toddler development and the public policy process. Washington, DC: Zero to Three Policy Center

Shonkoff, J.P. Lippitt, J.A. & Cavanaugh, D.A. (2000). Early childhood policy: Implications for infant mental health. In C.H. Zeanah, Jr. (Ed.) Handbook of Infant Mental Health, 2nd edition. New York, NY: Guilford Press, pp. 503-518.

10/08/09 Policy Week—no class meeting

10/15/09: Mental Health of Children in Kinship and Foster Care (Poulsen)

❑ Mental health needs of children in foster care

o Consequences of trauma and emotional neglect

o Consequences of separation and loss

Policies that support behavioral health needs of children and families involved in the child welfare system

o Family Preservation programs

Readings:

*Halfon. N., Zepeda, A. Inkelas, M. (2002). Mental Health Services for Children in Foster Care. (Policy Brief, No. 4). Los Angeles, CA: UCLA Center for Healthier Children, Families and Communities.

American Academy of Pediatrics, Committee on Early Childhood, Adoption and

Dependent Care. (2000). Developmental issues for young children in foster care. Pediatrics. Volume 106 (5), pp. 1145-1150.

Jones Harden, Brenda (2007). Infants in the Child Welfare System (Chapter 4: Foster Care of Infants.) Washington, DC: Zero to Three Press.

McCarthy, J., McCullough. (2003). Special considerations for children and families involved with the child welfare system. In A View from the Child Welfare System.

Washington DC: National Technical Assistance Center for Children’s Mental Health, pp. 9-30

Poulsen, M.K. (1995). Children at risk in out-of-home placement. In Smith, G.H., Coles, C.D., Poulsen, M.K,, Cole, C. Children, Families and Substance Abuse: Challenges for Changing Educational and Social Outcomes. Baltimore,MD: Paul H. Brookes Publishing Company.

Smyke, A.T. & Breidenstine, A.S. (2009). Foster care in early childhood. In Zeanah, C.H. Jr (Ed), Handbook of Infant Mental Health 3rd Edition. New York: Guilford Press, pp. 500-515.

10/22/09: Controversial policies impacting early childhood mental health (Finello)

❑ Psychotropic drugs in early childhood

❑ Controversial treatment strategies (autism)

❑ Feeding Practices & their impact on development

❑ Controversies regarding causes of problems (vaccines & autism)

❑ Measuring poverty—use of the federal poverty line

❑ Multiethnic placement of young children

❑ Programs & Policies

o Multiethnic Placement Act (1994)

o Adoptions & Safe Families Act (1997)

Readings: (different readings to be selected by teams who will lead the discussion around that issue)

Jenkins-Monroe, V. (2005). Developing reunification and adoption recommendations for substance-exposed infants and toddlers in foster care. In K. M. Finello (Ed.). Handbook of Training and Practice in Infant and Preschool Mental Health. San Francisco: Jossey Bass.

Gleason, M.M. (2009). Psychopharmacology in early childhood: Does it have a role? In Zeanah, C.H Jr. (Ed), Handbook of Infant Mental Health, 3rd Edition. New York: Guilford Press, pp. 516-530.

Jones Harden, Brenda (2007). Infants in the Child Welfare System (Chapter 5: Creating Permanency for Infants.) Washington, DC: Zero to Three Press.

Poverty in the United States-Wikipedia.

10/29/09: Environmental Context of Early Childhood Mental Health (Finello)

❑ Effects of poverty on the mental health of children

❑ Public health threats to mental health (lead, toxins)

❑ Culture and Ethnicity

❑ Programs and Policies

o TANF

o Social Services Block Grant (SSBG)

Readings:

*Knitzer, J. & Perry, D. (2009). Poverty and infant and toddler development: Facing the complex challenges. In C.H. Zeanah, Jr. (Ed.) Handbook of Infant Mental Health, 3rd edition. New York, NY: Guilford Press, pp. 135-152.

Barbarin, O.A. (2002). Culture and ethnicity in social, emotional and academic development. The Kauffman Early Education Exchange. Volume 1, pp. 8-29.

Devaney, B.L., Ellwood, M.R., Love, J.M. (1997). Programs that mitigate the effects of poverty on children. The Future of Children: Children and Poverty. Volume 7 (2), pp. 88-112.

Fenichel, E., Mann, T. (2001). Early Head Start for low-income families with infants and toddlers. The Future of Children: Caring for Infants and Toddlers. Volume 11 (1), pp: 135-141.

11/05/09: The Impact of Family and Community Violence on Early Childhood Mental

Health (Poulsen)

❑ Effects of violence on young child mental health

o domestic violence

o community violence

❑ Programs addressing exposure to violence

Readings:

* Schechter, D.S. & Willheim, E. (2009). The effects of violent experiences on infants and young children. In Zeanah, C.H. Jr. (Ed), Handbook of Infant Mental Health, 3rd Edition. New York: Guilford Press, pp. 197-213.

Kaufman, J., Henrich, C. (2000). Exposure to violence and early childhood trauma. In C.H. Zeanah, Ed. Handbook of Infant Mental Health, 2nd edition. New York, NY: Guilford Press.

Wolfe, D.A., Jaffe, P.G. (1999) Emerging strategies in the prevention of domestic violence. The Future of Children: Domestic Violence and Children. Volume 9. pp. 133-144.

11/12/09: Diagnosing Mental Health Disorders in Infancy and Early Childhood (Poulsen)

❑ Developmental psychopathology

❑ The stigma of mental health disorder

❑ Developmental trajectories to disorder

❑ Diagnosis of mental health in young children

❑ Diagnostic classification systems

❑ DSM IV

❑ DC:0-3

❑ ICD 9 codes

❑ Medical necessity

Readings:

*Poulsen, M.K., (2005). Diagnosis of mental health in young children. In K.M. Finello (Ed.),

The Handbook of Training and Practice in Infant and Preschool Mental Health. San Francisco, CA: Jossey-Bass.

Egger, H.L. & Angold, A. (2009). Classification of psychopathology in early childhood. In Zeanah, C.H. Jr. (Ed), Handbook of Infant Mental Health 3rd Edition. New York: Guilford Press, pp. 285-300.

Zero to Three. (2005). Diagnostic Classification:0-3 R. Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (Excerpts).

Washington, DC: Zero to Three.

11/19/09: Mental Health as a Primary Health Concern (Finello)

❑ Child mental health as a primary health concern

❑ Need for a comprehensive mental health system

❑ Principles to guide a mental health system of care

❑ Standards of care for mental health service delivery

❑ System of Care Issues

❑ Integrated approaches to early childhood mental health

Readings:

*Tolam, P.H., Dodge, K.A. (2005). Children’s mental health as a primary care concern.

American Psychologist. Volume 60 (6) pp. 601- 614.

Dossier, D.A., Handron, D., McCammon, S., & Powell, J.Y. (Eds) (2001) Child mental health: Exploring systems of care in the new millenium. The Haworth Press, Inc.

Huang, L. et al (2005). Transforming mental health care for children and families.

American Psychologist. Volume 60 (6) pp. 615- 627.

Zeanah, P., Stafford, B., Nagle, G., Rice. (2005) Addressing Social-Emotional Development and Infant Mental Health in Early Childhood Systems. Los Angeles, CA: National Center for Infant and Early Childhood Health Policy; Building State Early Childhood Comprehensive Systems Series, No.12, pp. 40-45

11/26/09: Thanksgiving Holiday

12/3/09: Class Presentations of Projects Demonstrating the Intersection of Public Health & Early Childhood Mental Health (All)

**Final Papers due at beginning of class

o Individual/Group Presentations

o Course Wrap Up

Useful Web Sites:

Center on Infant Mental Health & Development



National Center for Children in Poverty (NCCP)



Zero to Three: Infant Mental Health Resource Center



National Institute of Mental Health (NIMH)



Substance Abuse and Mental Health Services Administration (SAMHSA)



American Academy of Pediatrics (AAP)



Child Welfare League of America



World Health Association (WHO)



United Nations Children’s Fund



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