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A publication of the Center for Leadership

Education in Maternal and Child Public Health

Winter 2009-2010

Early Childhood
Mental Health

Screening of Young Children

Evidence-based Practices
Early Childhood Family Education
Mental Health Disparities in Early Childhood
Early Childhood Interventions
Traumatized Young Children
Competency-based Training and Endorsement
Experts and Resources
Early Childhood
Mental Health

Winter 2009-2010

IN This Issue

A Public Health Approach to Early Family Home Visiting: A Public Health Center for Excellence in Children’s Mental
Childhood Mental Health: Balancing Mental Program to Promote Healthy Social- Health: Linking University and Community
Health Promotion and Treatment for Mental Emotional Development . . . . . . . . . . . . . . 19 Experts and Resources . . . . . . . . . . . . . . . 32
Health Problems . . . . . . . . . . . . . . . . . . . . . 2 Sharon Hesseltine, BSW Cari Michaels, MPH
Joän M. Patterson, PhD, LP Jill E. Simon, MSW, LICSW, IMH-E® (IV)
Culturally Sensitive, Relationship-
Early Experience and the Science of Brain Follow Along Program: An Early Childhood based Practice Promoting Infant Mental
Development . . . . . . . . . . . . . . . . . . . . . . . . 5 Intervention System at the Minnesota Health: Competency-Based Training and
Megan R. Gunnar, PhD, and the National Department of Health . . . . . . . . . . . . . . . 20 Endorsement . . . . . . . . . . . . . . . . . . . . . . . 33
Scientific Council on the Developing Child Andrea Mayfield Candace Kragthorpe, MSW, IMH-E® (IV)

Social-Emotional Developmental Part C IDEA, Early Intervention Services: Bringing Order to the Complexity of Early
Screening of Young Children . . . . . . . . . . . 7 Serving Children Under 3 Years with Mental Experience: The Role of Training in Infant
Troy Hanson, MD, and Joän Patterson, Health Concerns . . . . . . . . . . . . . . . . . . . . 21 Mental Health . . . . . . . . . . . . . . . . . . . . . . 34
PhD, LP Karen Adamson, RN, MPH Elizabeth A. Carlson, PhD, LP

Diagnosing Young Children with Mental Minnesota Head Start: Addressing Mental
Health Concerns . . . . . . . . . . . . . . . . . . . . 10 Health Needs Early . . . . . . . . . . . . . . . . . . 22
Catherine Wright, MS Gayle L. Kelly, MS

Early Childhood Mental Health Systems Promoting Infant Mental Health through
Development in Minnesota . . . . . . . . . . . . 11 Relationship-Based Interventions . . . . . . . 24
Catherine Wright, MS Martha Farrell Erickson, PhD

Evidence-based Practices in Early Childhood Promoting Early Childhood Mental Health

Mental Health . . . . . . . . . . . . . . . . . . . . . . 13 through Evidence-based Practice . . . . . . . 26
Glenace E. Edwall, PsyD, PhD, LP, MPP Gael Thompson, MSW, LICSW

Early Childhood Family Education (ECFE): Supporting the Mental Health Needs of
A Mental Health Promotion Program for Traumatized Young Children . . . . . . . . . . 28
Young Children and Families . . . . . . . . . . . 15 Abigail Gewirtz, PhD, LP
Lois Engstrom
Minnesota Early Childhood Comprehensive
Clinical and Public Health Perspectives on System (MECCS): Building the Infrastructure
Mental Health Disparities in Early to Meet Developmental Needs of Young
Childhood . . . . . . . . . . . . . . . . . . . . . . . . . 17 Children . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Andrea Aga Kelly Monson MAEd, CFLE

The Center for Leadership Education in Maternal and Child Healthy Generations is produced with support from the Maternal and Child Health Bureau,
Health Resources and Services Administration, U.S. Department of Health and Human
Public Health is committed to improving the health of children, women Services (grant numberT76-MC00005-55)
and families. Center faculty and staff offer a Master’s degree in Public Health The University of Minnesota is committed to the policy that all persons shall have equal
(including an online degree program), continuing professional education, and access to its programs, facilities, and employment without regard to race, color, creed,
consultation and technical assistance to community- based organizations and religion, national origin, sex, age, marital status, disability, public assistance status, veteran
status, or sexual orientation.
agencies. Center faculty are involved in intervention and etiologic research in
Contact: or (612) 626-8644
child health, adolescent health, family health, health disparities, reproductive
© 2009 by University of Minnesota Board of Regents. All rights reserved.
health, and women’s health. See our web site at
Graphic design/art direction: Carr Creatives
Letter from the Editors

In this issue of Healthy Generations, we focus on the mental health of young children, ages birth to five.
We are aware that this domain of early childhood has too often been overlooked—only recently drawing
considerable professional attention. Why this lack of attention? Perhaps too many have believed that young
children, especially infants, cannot experience mental health problems. Infants who cry inconsolably or
preschoolers who show excessive biting have often been viewed as “going through a stage” that they will
outgrow. This dismissive attitude fits the societal stereotype about mental health problems in general; that
is, the tendency to ignore such challenges because a parent or caregiver does not know what to do, or worse,
fears being blamed for their young child’s behavior. Dramatic advances in our understanding of early brain
development, the critical importance of social environments that stimulate and nurture, and the untoward
consequences when relationships to provide this care are absent or unpredictable have taught us that the
developmental trajectory towards positive mental health begins early. We now know what can and MUST be
done to ensure that ALL infants and young children receive what they need from their caregiving environments
to develop into happy, healthy children with positive mental well-being who grow into productive, contributing
members of our society.

We want to thank the many professionals who contributed to this volume and shared their expertise
about early childhood mental health. We are excited to see that public health thinking is being brought to
bear in assuring the mental health of our young children. To present a balanced perspective—promoting
positive mental health with attention to mental health problems—we invited articles that provide examples of
interventions that promote mental health, prevent problems in high-risk groups, as well as interventions that
treat diagnosed mental health disturbances—in all cases, emphasizing evidence-based practice. Other articles
in this volume highlight cutting edge issues related to early childhood mental health—screening and diagnostic
assessment, collaborative efforts to develop early childhood and mental health systems of care, and workforce
training initiatives in Minnesota.

We are keenly aware of the need for policies that provide public support for the programs and interventions
described in this issue, as well as policies that assure the social conditions that enable families and communities
to create nurturing, supportive contexts where children’s mental health can flourish.

We are pleased to showcase the wealth of information and strength of resources presented by our
professional colleagues in Minnesota. We are also very proud to share with our readers several articles written
by graduates of our Maternal and Child Health Program at the University of Minnesota, who are leaders in
this field. As we finalized this volume, we read, with sadness, that Norman Garmezy died on November 21,
2009. Dr. Garmezy, a Professor Emeritus of Psychology at the University of Minnesota, was considered the
“grandfather of resilience theory.” Among the many findings of Dr. Garmezy and his colleagues was that good
relationships with adults exert an effect that is as powerful—or even more powerful—than the mitigating
effects of adversity on child mental health. His work furthered our understanding of how children can flourish
in adverse environments and continues to stimulate researchers at the University of Minnesota and across the

As always, we welcome your feedback about this issue as well as topics for subsequent issues.

—Joän Patterson, PhD, LP, Julia Johnsen, MPH, and Wendy Hellerstdt, MPH, PhD

Winter 2009-2010 1
A Public Health Approach to
Early Childhood Mental Health
Balancing Mental Health Promotion and Treatment for Mental Health Problems Joän M. Patterson, PhD, LP

I nfants, toddlers, and preschoolers

can—and do—experience significant
mental health problems. Untreated,
these problems may adversely affect
multiple developmental domains, and
in turn, a child’s school performance,
social competence, and even adult
health. Furthermore, mental health
problems that emerge in early
childhood are not simply outgrown;
in many cases, they persist into
adolescence and adulthood due to
impairments embedded in early brain
structure that lead to heightened
physiological reactivity when exposed
to subsequent adversity (see Gunnar,
page 5).

"Parents and other regular Defining Early Childhood which is related to several challenges in
Mental Health conceptualizing and measuring mental
caregivers in children’s lives impairment in this age group:
In young children, mental health is often
are 'active ingredients' of equated with healthy social and emotional ■ First, given the rapid pace of
environmental influence during development, which is defined as “the development in the early years, there
is wide variation in what constitutes
the early childhood period. developing capacity of the young child to
normal social and emotional
experience, regulate, and express emotions;
Children grow and thrive in the form close and secure interpersonal development, making it difficult to
assign boundaries between normative
context of close and dependable relationships; and explore the environment
development and at risk, problematic,
and learn, in the context of a caregiving
relationships that provide environment that includes family, or clinically significant impairment;
love and nurturance, security, community, and cultural expectations ■ Second, a young child’s mental health
responsive interaction, and for young children.”1 Noteworthy in this can best be understood in terms of
definition is the emphasis on positive mental his/her primary relationships with
encouragement for exploration. health, which contrasts with the tendency caregiver(s) in the context of family,
Without at least one such to focus on mental health problems in older culture, and community; these
children, adolescents, and adults. contextual factors are not considered
relationship, development is in diagnostic schemes that are used for
disrupted and the consequences Assessing Prevalence of older children and adults; and
can be severe and long lasting.” Mental Health Problems ■ Third, there is not yet consensus on
— National Research Council and There are limited data for estimating the the diagnostic criteria for classifying
Institute of Medicine, page 7..4 number of young children who experience psychiatric impairment in young
serious mental health disturbances, children.2
2 Healthy Generations
However, awareness of social, emotional, young children at risk for mental health on optimizing positive mental health draws
and behavioral problems in young children problems include violence in the home or from recent psychological literature that
is increasing, as reflected in the growing neighborhood, intense marital discord, describes persons who are “flourishing” in
number of young children who are expelled parental substance abuse, and child abuse contrast to “languishing,”9 and from a recent
from preschool.3 A limited number of and neglect. The effects of these exposures Institute of Medicine report emphasizing
studies of psychiatric disorders (e.g., anxiety in infants and young children may “developmental competencies” in children.10
disorders, disruptive behavior disorder, manifest in behaviors such as excessive Emphasis on positive mental health is also
attention deficit/hyperactivity disorder, and and inconsolable crying; a heightened congruent with public health’s focus on
depression) have reported prevalence rates sensitivity to touch and cuddling; excessive health promotion (and disease prevention),
in preschool children ranging from 14% biting, kicking and hitting; inability to and infant/toddler mental health
to 26%, which are similar to rates reported focus on activities; flat affect (no emotive professionals emphasis on the promotion
for school-age children.2 Newer diagnostic expressions); and/or depression. of social and emotional competencies in
schemes, developed specifically for birth Poverty. Many of the aforementioned young children.
to three years (see page 10), emphasize risks are confounded by living in a Categories of interventions. In the
relationship disorders and stress-related family experiencing persistent poverty. Georgetown model, interventions are not
disorders resulting from exposure to Children from low-income families show restricted to preventing and treating mental
environmental stressors, but prevalence higher rates of emotional and behavior health problems, but include interventions
rates have not yet been reported. problems.6 Because children of color are to promote positive mental health as
disproportionately represented among well. Interventions are grouped into four
Determinants of Mental low-income families, they are reported domains:
Health in Young Children to experience poorer social-emotional ■ Promoting and optimizing positive
Determinants of mental health for the birth development. Poor, minority children also mental health in ALL children by
to 5-year-old population include biological, are more likely to be in the child welfare assuring that the determinants of
geographical, social, and economic factors system—another setting where higher rates positive mental health are present (e.g.,
associated with both positive mental health of social, emotional, and behavior problems Early Child and Family Education
and mental health problems. in young children are found.7 programs to support parents in how
The quality of early relationships is the However, when any of these determinants to engage in nurturing, consistent
most fundamental determinant of healthy are identified early, at-risk children and relationships with their babies—see
social-emotional development in infants their caregivers can receive interventions page 15);
and toddlers. A secure attachment to a and support that can buffer mental health ■ Preventing mental health problems in
primary caregiver has an enduring influence problems and lead to positive emotional young children, especially those known
on the mental health of young children. and social developmental outcomes. to be at risk due to exposure to any of the
Relationships with parents (and other determinants of mental health problems
caregivers) need to be nurturing, protective, A Framework to Guide (e.g., home visiting—see page 19);
consistent, and characterized by high Mental Health Interventions
sensitivity to infant cues. ■ Treating diagnosed mental health
Georgetown University, with support from problems as early as possible to
Biological factors within the infant, such as the Substance Abuse and Mental Health diminish or end the effects of the
a difficult temperament or premature birth Services Administration (SAMHSA), identified problem (e.g., the Incredible
and low birth weight, may pose a challenge recently released a monograph that draws Years program for young children with
to some parents’ abilities to respond on public health values, principles, and conduct disorders—see page 26); and
sensitively to infant cues and develop a functions to advance an intervention model
nurturing relationship. for children’s mental health.8 ■ Re/Claiming health for those children
who have been or continue to be
The mental health of parents and caregivers Differentiating positive mental health treated for mental health disorders
is another major determinant of infant from mental health problems. Unlike the so they can develop and experience
mental health because it influences the historical emphasis on preventing and mental well-being even in the context
caregivers’ capacity to be nurturing and treating mental health problems in children of managing their mental health
responsive to their infants and provide and adolescents, this new intervention problem.
adequate stimulation for learning. model proposes a balanced focus between
Untreated postpartum depression in positive mental health and mental health Nearly all of the interventions include a
mothers is a recognized risk factor affecting problems. Positive mental health is viewed focus on the quality of the young child’s
infants’ social-emotional development.4 along a continuum that is independent of early relationships with parents/caregivers.
Among child care workers, higher rates of the continuum of mental health problems.8 Viewing a child alone as the source of
depression have been reported compared to The absence of a mental health problem the problem, without considering his/
adults in the general population.5 does NOT indicate positive mental health, her relationships, can lead to ineffective
nor does having a diagnosable mental intervention practices. Although examples
Social environment. Other factors in the for each category of intervention are
social environment that can undermine illness prevent a child from experiencing
social-emotional well-being. The emphasis described throughout this issue, many fit
high quality early relationships and put Continued on page 4
Winter 2009-2010 3
Intervening Model for Children’s Mental Health6
Early Childhood Mental Health from page 3

more than one category. It is important

to remember, however, that assessing the
outcomes of an intervention requires a
shift in focus when selecting indicators for
positive mental health (e.g., social skills
or emotional regulation) versus mental
health problems (e.g., reduction in anxiety

A Mental Health Systems

Families are embedded in multiple systems
within their cultures and communities
that ideally are equipped to support them
in meeting their children’s emotional
needs by providing education and support
and by identifying social-emotional
problems in young children early through
screening in naturalistic settings (see page
7) which can be followed by diagnostic
assessment (see page 10) and treatment that between 80–90% of 3–5-year-olds 2. Egger HL, Angold A. Common emotional and
when needed. The mental health system with identified mental health needs did not behavioral disorders in preschool children: prevention,
nosology, and epidemiology. J Child Psychol Psychiatry
alone cannot accomplish this goal; it receive services.11 In Minnesota, inroads 2006; 47:313-337.
requires coordination with other systems— are being made to expand early childhood 3. Gilliam W. Prekindergarteners left behind: explusion
education, child care, nutritional programs, mental health training across the state (see rates in stae prekindergarten systems. New Have, CT:
and healthcare—to ensure that young Kragthorpe page 33 and Carlson page 34). Yale University Child Study Center, 2005.
children receive what they need to promote 4. National Research Council and Institute of Medicine.
positive mental health and to identify and There is a growing recognition that the From neurons to neighborhoods: the science of early
treat problems when they occur. Wright trajectory to success, both in school and childhood development. Shonkoff JP, Phillips DA
in later life, begins in the early years. What (editors). Washington DC: National Academy Press,
(page 11) describes the mental health 2000.
system in Minnesota and Monson (page 30) happens during the first three years of life
5. Whitebook M, Phillips D, Bellm D, et al. Two years
describes a comprehensive early childhood can lay the foundation for becoming a in early care and education: A community portrait of
system in Minnesota that includes mental productive, mentally healthy, contributing quality and workforce stability. Berkeley, CA: Center for

health as one of several domains that member of society, or it can lay the Study of Child Care Employment, U of CA at Berkeley,
intersect to ensure healthy development in foundation for intergenerational cycles of
abuse, neglect, violence, dysfunction, and 6. Duncan GJ, Brooks-Gunn J. Family poverty, welfare
young children. reform and child development. Child Dev 2000; 71:188-
mental illness. The burgeoning science 196.
Role of Public Policies of early brain development points to the 7. Burns B, Phillips S, Wagner H, et al. Mental health need
wisdom of investing resources “early” in a and access to mental health services by youths involved
in Assuring Early Childhood child’s developmental trajectory, beginning with child welfare. A national survey. J Am Acad Child
Mental Health in utero to eliminate toxic exposures that Adolesc Psychiatry 2004; 43:960-970.

compromise brain development, and 8. Miles J, Espiritu R, Horen N, Sebian J, Waetzig E. A

Awareness of the determinants of positive public health approach to children’s mental health: a
mental health and mental health problems then assuring the social conditions that conceptual framework. Washington DC: Georgetown
point to the importance of assuring the support and contribute to high quality University Center for Child and Human Development,
nurturing and responsive parent-infant National Technical Assistance Center for Children’s
social conditions that will contribute to the Mental Health, 2009.
ability of parents and families to engage in relationships.5,10 Meeting the mental health
9. Keyes C. Promoting and protecting mental health as
nurturing relationships with young children needs of all young children and families flourishing. Am Psychol 2007; 62(2):95-108.
and to provide adequate stimulation and through careful planning, integration
10. National Research Council and Institute of Medicine.
experiences for learning. It is the role of of services and supports, and the full Preventing mental, emotional and behavioral disorders
public policies to assure that those social participation of families, providers, and among young people: progress and possibilities.
other community members makes good Washington DC: National Academies Press, 2009.
conditions exist.
economic sense and helps assure good 11. New M, Razzino B, Lewin A, et al. Mental health
Training. As our awareness of the mental service use in a community Head Start population. Arch
outcomes for our children, their families,
health needs of young children has Pediatr Adolesc Med 2002; 156:721-727.
and our communities.
increased, we are confronted with the
dearth of clinicians who are trained to References Joän Patterson, PhD, LP, is an Associate Professor
screen, diagnose, and treat infants, toddlers 1. Zero to Three Infant Mental Health Steering Committee. in the Maternal and Child Health Program in
and preschool children with mental health Definition of infant mental health. Washington, D.C.: the School of Public Health at the University of
problems. In one study, it was estimated Zero To Three; 2001. Available from: http://www. Minnesota.
4 Healthy Generations
Early Experience and the
Science of Brain Development Megan R. Gunnar, PhD, and the National Scientific Council on the Developing Child

S cience tells us that what happens

in early childhood can enhance
or impair the health and productivity
of society. Research on the biology
of stress in early childhood shows
how major adversity, such as extreme
poverty, abuse, or neglect, can weaken
developing brain architecture and alter
the body’s immune system in ways that
risk the individual’s adult physical and
mental health. Science also shows that
providing stable, responsive, nurturing
relationships in the earliest years of
life can prevent or even reverse the
damaging effects of toxic stress, with
lifelong benefits for learning, behavior,
and health. This conclusion is based on
the following series of core principles
derived from decades of scientific

Brains Are Built Over Time Interactive Influences as expected, which can lead to disparities in
from the Bottom Up of Genes and Experience learning and behavior.

The construction of the brain’s architecture Shape the Developing Brain The Brain’s Capacity for
begins before birth and continues to be It is not just one’s genetic makeup, but Change Decreases with Age
refined into early adulthood. Brain systems how those genes get used, that determines
that perceive sensation (e.g., hearing, brain development. Once the child is born, The brain is most flexible, or “plastic,” early
touch) and simple actions develop first, experiences influence how genes are turned in life. As the maturing brain becomes
followed by systems that are involved in on and off and thus how they are used. more specialized to assume more complex
emotions, more complex actions, and One important example of this process is functions, it is less capable of reorganizing
early language. Later-developing systems the “serve and return” nature of children’s and adapting to new or unexpected
support increasingly complex thinking, relationships with adults. Young children challenges. For example, by the first year,
reasoning, planning, and self-control. As naturally reach out for interaction through the parts of the brain that differentiate
each brain system develops, it is built on top babbling, facial expressions, and gestures. sound are becoming specialized to the
of earlier-developing systems and can be Adults respond with the same kind of language the baby has been exposed to. At
only as good as the architecture on which vocalizing and gesturing back at them. In the same time, the brain is already starting
it is built. Early experiences affect whether the absence of such responses—or if the to lose the ability to recognize different
a child’s brain architecture will provide a responses are unreliable or inappropriate— sounds found in other languages. Although
sturdy or fragile foundation for all of the the child’s brain architecture does not form the “windows” for language learning and
learning and development that will follow. other skills remain open, these brain
Continued on page 6
Winter 2009-2010 5
Early Experience and the Science of Brain Development from page 5

circuits become increasingly difficult to alter

over time. Early plasticity means it is easier
and more effective to influence a baby’s
developing brain architecture than to rewire
parts of its circuitry in the adult years.

Cognitive, emotional, and social

capacities are inextricably intertwined
throughout the life course. The brain
is a highly integrated organ, and its
multiple functions operate in a richly
coordinated fashion. Emotional
well-being and social competence
provide a strong foundation for emerging
cognitive abilities, and together, they
are the bricks and mortar that are
prerequisites for success in school and
later in the workplace and community.

Chronic Stress Can Be Toxic

to Developing Brains
Learning how to cope with threat and
challenge is an important part of healthy
development. When we are threatened, our childhood, the greater the likelihood of includes extended family members, early
brains activate a variety of physiological developmental delays and other problems.) care and education providers, and members
responses, which together are called “stress Adults who had a greater number of of the community. Studies show that
biology.” When a young child is protected adverse experiences in early childhood are children who develop in a context of secure,
by supportive relationships with adults, she/ also more likely to have health problems, trusting relationships are better adjusted
he learns to cope with everyday challenges including alcoholism, depression, and heart when they get to school, do better in
and the child’s stress response systems disease. school, stay in school longer, become more
quickly return to baseline. Scientists call productive and healthier members of the
this positive stress. Tolerable stress occurs Early Intervention Can workforce as adults and are better equipped
when more serious difficulties, such as the Prevent the Consequences of to support the healthy development of the
loss of a loved one, a natural disaster, or a next generation. Numerous scientific studies
frightening injury, are buffered by caring
Early Toxic Stress
support the conclusion that providing
adults who help the child adapt, which Research shows that later interventions supportive, responsive relationships as early
mitigates potentially damaging biological are likely to be less successful—and in in life as possible enhances future prosperity
stress reactions. When strong, frequent, some cases ineffective. For example, when and can prevent or reverse the damaging
or prolonged adverse experiences such children who experienced extreme neglect effects of toxic stress.
as extreme poverty or repeated abuse were placed in the care of responsive and
This article is based on the collective work of the
are experienced without adult support supportive parents before age two, their IQs National Scientific Council on the Developing Child.
and intervention, stress becomes toxic increased more substantially and their brain Working papers with scientific citations for the research
as the biology of stress begins to damage activity and emotional relationships were studies referred to can be found at their website: http://
developing brain circuits. more likely to become normal than if they
were placed after the age of two. While there
Significant Early Adversity is no “magic age” for intervention, it is clear Megan R. Gunnar, PhD, is a Regents Professor and
that, in most cases, intervening as early as Distinguished McKnight University Professor in the
Can Lead to Lifelong Institute of Child Development at the University of
possible is significantly more effective than
Problems Minnesota. She is a member of the National Scientific
waiting. Council on the Developing Child.
Toxic stress in early life and common
precipitants of toxic stress—such as poverty, Stable, Caring Relationships
abuse or neglect, parental substance Are Essential for Healthy
abuse or mental illness, and exposure to
violence—can have a cumulative toll on
an individual’s physical and mental health. Children develop in an environment of
(The more adverse the experiences are in relationships that begins in the home and
6 Healthy Generations
Social-Emotional Developmental Screening
of Young Children
Troy Hanson, MD, and Joän Patterson, PhD, LP
The First Step in Identifying Mental Health Problems

S ocial and emotional developmental

screening is an essential component
in the early identification of mental
health problems in young children.
Ideally, screening occurs with ALL
children when there are no symptoms
present, long before an infant’s or young
child’s development and functioning are

Why Is Screening Important?

Problems or delays in early social-emotional
development represent the precursors of
what can become a maladaptive mental
health trajectory. Research in developmental
psychopathology draws attention to the
cascading effects of untreated problems that
often adversely affect realms of functioning
at a tremendous cost to the child, his/her
family, and society.
culturally sensitive for diverse populations,
It is estimated that one in three children
to label a child and it does not provide a including those for whom English is a
ages 3–5 years fail to meet age-appropriate
diagnosis. Rather, screening is the first step second language. Three screening tools that
social and emotional developmental
toward the possibility of a diagnosis. Ideally, meet these criteria are recommended by
milestones.1 Early identification of these
screening is done using a standardized the Minnesota Interagency Developmental
social-emotional problems and subsequent
tool to identify social-emotional concerns Screening Task Force2 (see the box).
diagnostic assessment can direct young
or problems. Most general developmental The Ages and Stages Questionnaire:
children and families toward effective,
screening tests that are designed to assess Social-Emotional (ASQ:SE)3 is the
evidence-based early interventions,
other domains—such as cognitive or motor social-emotional screening tool most widely
which provide an amazing opportunity to
development—do not adequately capture used by providers in multiple settings.
positively alter mental health trajectories
social and emotional development. Thus
and improve mental health outcomes
separate instruments have been designed Settings for Developmental
throughout the life course. If these delays
to identify children who are at risk of Screening
are not found early, a child misses the
social-emotional problems.
opportunity for early interventions. Early identification of social-emotional
Choosing a social-emotional screening delays or problems necessitates that
What Is Social-Emotional instrument. A screener, first of all, should screening occurs in settings regularly
Developmental Screening? be easy for a parent to complete in a short accessed by infants, young children, and
amount of time (30 minutes or less). It their families, and where such screening is
Social-emotional screening is designed should have norms for specific age groups perceived as appropriate and acceptable.
to identify children who should receive tested; demonstrate good reliability, validity,
more intensive assessment and diagnosis The primary health care setting is one of
sensitivity, and specificity; and have written
for potential delays in social-emotional those regularly accessed settings because 14
procedures for administration, scoring,
development. Screening should not be done health supervision visits are recommended
and interpretation. The screener should be
for children between birth and 5 years.4
Continued on page 8
Winter 2009-2010 7
Social-Emotional Developmental Screening of Young Children from page 7

Even with this relatively high number of

potential contacts with health professionals,
it is estimated that only 20–40% of “at-risk”
or “pre-impaired” children are appropriately
identified during this period of peak neural
plasticity or receptivity to change.1
Barriers to early identification in primary
care. There are many reasons why so
many young children “fall through the
cracks” and remain unidentified during
health supervision visits—but one of
the significant factors is failure to use a
standardized, validated screening tool.
Too many providers use their subjective
judgment about whether a young child
has social-emotional problems. When an
empirically validated social-emotional
developmental screening tool is
systematically employed, accurate detection
rates of social-emotional problems increase
to 70–80%.5
Many parents believe that their child cannot
have a mental health problem, or that he
or she will “outgrow” disruptive behavior
problems, extreme shyness or anxiety,
excessive irritability, difficulty in forming
friendships, and so on. These societal
attitudes are rooted in the stigma associated
Social-Emotional Development Screening Instruments with mental illness generally, as well as
a lack of mental health knowledge and
Ages and Stages Questionnaire– Brief Infant-Toddler Social Emotional awareness among some parents, child care
Social-Emotional (ASQ-SE)1 Assessment (BITSEA)3 professionals, and even health providers.
Parent report (5th grade reading level) Parent report (5th grade reading level) 7–10 The Centers for Disease Control and
Time: 10–15 minutes to complete; 1–3 minutes minutes to complete Prevention provide guidelines for health
to score Child ages: 12–36 months providers when interpreting screening
Child ages: 6, 12, 18, 24, 30, 36, 48 & 60 month Sensitivity: 80–99% Specificity: 80–89% results (see chart).6 Screening itself can be
intervals Available in English, Spanish an intervention when results are reviewed
Sensitivity: 71–85% Specificity: 90–98% Areas assessed: internalizing problems, with the parent/caregiver and strengths
Available in English, Spanish externalizing problems, disregulation, and as well as possible delays are discussed. In
Areas assessed: self-regulation, compliance, competence
addition, anticipatory guidance can alert
communication, adaptive functioning, autonomy,
affect, and interaction with people REFERENCES parents about what to watch for and do at
1. Beligere N, Bandepalli C, Helin R, et al. Parents report home to foster healthy development.
Pediatric Symptom Checklist (PSC)2 of social and emotional status of the premature infants.
Child care and early education settings
Ages and Stages Questionnaire (ASQ) on Social and
Parent report (5th grade reading level) Emotional (S/E) Assessment ASQ:SE. J Dev Behav are another regularly accessed setting used
Time: 2–12 minutes to complete Pediatr 2005; 26(6):472. by families of infants and young children.
Child ages: 4–16 years 2. Jellinek MS, Murphy JM, Little E, et al. Use of the Head Start and Early Head Start now
Sensitivity: 88–92% Specificity: 68–99% Pediatric Symptom Checklist to screen for psychosocial require screening for social-emotional
Available in English, Spanish, Chinese problems in pediatric primary care: a national feasibility
study. Arch Pediatr Adolesc Med 1999; 153:254-260. development. However, there is a need to
Area assessed: psychosocial dysfunction advocate for the integration of screening
3. Briggs-Gowan MJ, Carter AS, Irwin JR, et al. The Brief
Infant -Toddler Social and Emotional Assessment: into other child care and education settings.
screening for social-emotional problems and delays in In these settings, barriers to screening
competence. J Pediatr Psychol 2004; 29(2):143-55.
may include lack of training and expertise
in child development for some providers,
lack of access to early childhood mental
health consultants, and lack of resources to
implement screening.

8 Healthy Generations
Social and Emotional
Developmental Milestones

The Centers for Disease Control and

Prevention’s (CDC) Learn the Signs—Act Early
website provides an interactive opportunity for
parents and caregivers to learn about general
developmental changes to expect as their child
develops in the first 5 years. Some examples of
social and emotional developmental milestones
from the website include:

By the end of Three Months:

■ Begins to develop a social smile;
■ Enjoys playing with other people and may cry
when playing stops; and
■ Imitates some movements and facial

By the end of One Year:

■ Cries when mother or father leaves;
■ Enjoys imitating people in his play; and
■ Repeats sounds or gestures for attention.
By the end of Two Years:
■ Imitates behavior of others, especially adults
Other settings where screening occurs. As (S/E) Assessment ASQ:SE. J Dev Behav Pediatr 2005;
and older children;
described in other articles in this issue,
there are several additional settings where 4. Hagan JF, Shaw JS, Duncan PM, eds. Bright futures: ■ Demonstrates increasing independence; and
guidelines for health supervision of infants, children and
screening of infants and young children adolescents, 3rd edition. Elk Grove Village, IL: American ■ Begins to show defiant behavior.
regularly occurs: the Follow Along Program, Academy of Pediatrics, 2008.
home visiting, Early Childhood Family 5. Meisels SJ, Atkins-Burnett S. Developmental screening
By the end of Three Years:
Education, and child welfare visits. Early in early childhood: a guide (5th ed.). Washington, ■ Can take turns in games;
DC. National Association for the Education of Young
childhood screening is required for public Children, 2005. ■ Understands concept of “mine” and “his/hers;”
school entrance and is usually done at ages 3 and
6. Pediatric screening developmental flow chart. Available
to 4. Both observation and parent report are from:
required. htm#chart ■ Expresses a wide range of emotions.
Early childhood social and emotional By the end of Four Years:
developmental screening represents an Troy Hanson, MD, is a board-certified family medicine
■ Cooperates with other children;
important component of a public mental physician who works in several rural clinics and
health agenda and a necessary step toward emergency departments in Minnesota. Dr. Hanson is ■ Increasingly inventive in fantasy play; and
a graduate student in the MCH MPH program. He
improving the life course for mental health also completed the Infant Mental Health certificate ■ Negotiates solutions to conflicts.
and public health outcomes. It should remain program in the University of Minnesota’s Institute of
a priority for future public health efforts and Child Development. By the end of Five Years:
policy. ■ Wants to please friends;
Joän Patterson, PhD, LP, is an Associate Professor in
References the Maternal and Child Health Program in the School ■ Able to distinguish fantasy from reality; and
of Public Health at the University of Minnesota.
1. Shonkoff J, Phillips D. (Eds.). National Research ■ Sometimes demanding, sometimes eagerly
Council and Institute of Medicine. From neurons cooperative.
to neighborhoods: the science of early childhood
development. Washington, DC: National Academy Press, For more information about how the CDC is
2000. helping parents, educators, and caregivers to
2. Developmental and social-emotional screening of young recognize signs of healthy development of young
children in Minnesota. Developmental and social- children and provide care earlier for children with
emotional screening instruments. Minnesota Department developmental delays, please visit: http://www.cdc.
of Health. Available from:
3. Beligere N, Bandepalli C, Helin R, et al. Parents report of
social and emotional status of the premature infants. Ages
and Stages Questionnaire (ASQ) on Social and Emotional

Winter 2009-2010 9
Diagnosing Young Children
with Mental Health Concerns
Catherine Wright, MS

I f the result of social-emotional screening for an infant or young child is positive

(i.e., indicates mental health problems or concerns), the next step is an assessment
to determine if the child needs specialized services.

national organization, Zero to Three, in from multiple sources, including all

2005. The DC:0-3R manual is used to caregivers who engage regularly with the
provide developmentally appropriate child, and must include observations of
diagnostic assessments for children, birth the young child in multiple settings.1
to 4 years, with mental health conditions.
The diagnostic categories are research-based Minnesota’s Promotion
and were developed by medical and mental of the DC:0-3R
health professionals with expertise in infant
The Minnesota Department of Human
and early childhood mental health and
Services (DHS), Children’s Mental Health
developmental conditions.1,2 The DC:0-3R
Division, in partnership with local
diagnostic categories, based on early
communities, the Maternal and Child Health
childhood development research, are not
Assurance Unit at DHS, and the Minnesota
described in other diagnostic systems.
Department of Health have promoted
Diagnostic Assessment Key principles and assumptions the use of the DC:0-3R by providing free
An early childhood mental health diagnostic of the DC:0-3R include: trainings to mental health professionals
assessment is a formal process conducted ■ The developmental domains for infants across the state. Over 700 Minnesota mental
by a trained mental health professional that are inter-related and require the health professionals have been trained in
incorporates comprehensive information integration of professional perspectives the use of the DC:0-3R. The DHS Children’s
about the child’s developmental history, from mental health, rehabilitation Mental Health Division offers ongoing
current functioning (including strengths services, medical, and social service consultation for mental health professionals
and vulnerabilities), and family history. professionals. through a free monthly clinical consultation
It also includes observations of the child group staffed by a contracted national
■ Infants and young children develop in DC:0-3R trainer. For more information
interacting with his/her caregivers and with the context of relationships, culture, and
the mental health professional. The purpose about the DC:0-3R trainings offered
community. Their relationships with throughout Minnesota or the DC:0-3R
of diagnostic assessment is to determine their primary caregivers are paramount
if the child needs specialized services and monthly clinical consultation group, contact
to their development. Thus, clinicians Catherine Wright at catherine.wright@state.
more specifically, what treatment modalities must engage the children’s primary
might be useful for the child and family.
caregivers as partners in the assessment
Diagnostic assessment helps to inform process. The children’s relationships References
treatment; it is not a mechanism for labeling with their primary caregivers, their 1. Zero to Three. Overview: Diagnostic classification of the
children. Diagnostic assessment is ongoing, cultures, and their communities must mental health and developmental disorders of infancy
requiring periodic re-evaluation as the child be incorporated into the diagnostic
and early childhood: Revised. Unpublished paper, 2006.
enters different developmental stages and process. 2. Zero to Three. Diagnostic classification of mental health
experiences different life events.1 and developmental disorders of infancy and early
■ Infants and young children are unique childhood: Revised edition. Washington, DC: Zero to
Three Press, 2005.
DC:0-3R and their development, temperament,
and other differences affect the way they
The Diagnostic Classification of Mental experience various events. Catherine Wright, MS, is an Early Childhood Mental
Health and Developmental Disorders of Health Program Coordinator at the Minnesota
Infancy and Early Childhood: Revised ■ The diagnosis of young children is a Department of Human Services, Children’s Mental
Edition (DC:0-3R) was released by the process that must include information Health Division.

10 Healthy Generations
Early Childhood Mental Health Systems
Development in Minnesota
Catherine Wright, MS

F or the past six years, the Minnesota

Department of Human Services
(DHS) Children’s Mental Health
Division (CMHD) has been working
with community stakeholders across the
state to develop an early childhood (birth
to 5 years) mental health system of care.
Development of this system requires
integration across multiple sectors:
mental health, medical, early education,
Head Start, early intervention, child
welfare, and public health. Development
of this system has been informed by
parents to ensure that it is comprehensive,
flexibly designed, and inclusive of all
systems serving young children and their

Continuum of Care Child and Teen Check-Ups* conducted in new eligibility criteria allow children birth
medical clinics. The screening tools assist to 2 years with mental health conditions to
The Minnesota statewide early childhood
caregivers and medical professionals in receive the full early intervention services
mental health system includes four specific
identifying social-emotional concerns in offered through Part C.2
domains in the continuum of care:
young children. The Maternal and Child The CMHD also is working closely with
■ Prevention—services available to all Health Assurance Unit was also recently the Minnesota Head Start Association to
children; awarded the ABCD III grant from the promote the use of the Incredible Years3
■ Early intervention—services for Commonwealth Fund and the National curriculum, an evidence-based early
children who demonstrate undiagnosed Academy for State Health Policy (NASHP). intervention for children with potential
mental health concerns; This grant will assist medical clinics in behavioral concerns.
connecting with local early intervention
■ Intervention—services for children with services for children with identified mental Intervention. For the past six years, the
diagnosable mental health conditions; health and developmental concerns. CMHD, in partnership with the Minnesota
and Department of Health’s Minnesota Children
Early intervention. In 2006, the Minnesota with Special Health Needs (MCSHN)
■ Intensive intervention—intensive Department of Education, with support from
services for children with significant section, has been working with the national
state and local agency partners, changed organization, Zero to Three, to train and
diagnosable mental health conditions. the eligibility criteria for Part C of the mentor mental health professionals in the
Prevention. Through a Commonwealth Individuals with Disabilities Education Act use of the DC:0-3R, a developmentally
Grant, Assuring Better Child Development (IDEA) to include 13 early childhood mental appropriate mental health diagnostic tool
(ABCDII), the CMHD partnered with the health diagnoses listed in the DC:0-3R
DHS Maternal and Child Health Assurance (Diagnostic Classification of Mental Health *Child and Teen Checkups is Minnesota's name for Early
Unit to promote the use of standardized and Developmental Disorders of Infancy Periodic Screening, Diagnosis and Treatment (EPSDT),
mental health screening tools during and Early Childhood: Revised Edition).1 The which is required by Medicaid.
Continued on page 12
Winter 2009-2010 11
Early Childhood Mental Health Systems Development in Minnesota from page 11

for children ages birth to 4. Over 500 mental

health professionals have been trained in the
use of the tool.
In addition to diagnostic assessment
training, the CMHD is training mental
health professionals in the use of
evidence-based mental health treatments
for young children. Over 21 clinicians from
13 agencies have been trained in the use
of Parent Child Interaction Therapy,4 an
evidence-based treatment for young children
and their families who have experienced
trauma or are exhibiting other mental health
Intensive interventions. The CMHD has
been working closely with Minnesota Health
Care Plans and mental health practitioners
to provide an array of intensive interventions
for young children with significant mental
health conditions. These services include
mental health targeted case management,
day treatment, and therapeutic preschools.

The CMHD recently required all mental
health professionals who receive public 2. Minnesota Department of Health. Early childhood
intervention Part C. Available from: Minnesota Association of
reimbursement for services to birth Children’s Mental Health:
to 5-year-olds to use two evaluation
3. More information about the Incredible Years programs is From a parent support group to a
instruments: the Strengths and Difficulties available from: statewide advocacy organization
Questionnaire6 (an assessment tool for
4. Eyberg SM, Boggs SR, Algina J. Parent-child interaction
children ages 3 to 5) and the Early Childhood therapy: a psychosocial model for the treatment of
The Minnesota Association for Children’s Mental
Services Intensity Instrument7 (a functional young children with conduct problem behavior and their
families. Psychopharmacol Bull. 1995;31(1):83-91. Health (MACMH) was established in 1989 by a small
assessment tool for children ages birth to group of parents who shared the experience of
5). The State chose to evaluate state-funded 5. Minnesota Department of Human Services. Bulletin.
raising children with mental health disorders. Today
DHS requires standardized outcome measures and level
mental health services so that families and of care determinations for children’s mental health. April MACMH is a statewide education and advocacy
consumers would have information to 2009. Available from: organization. Its mission is “to promote the positive
better choose from the array of services and groups/publications/documents/pub/dhs16_144775.pdf mental health of all infants, children, adolescents, and
providers for their children.5 6. Goodman R. The Strengths and Difficulties their families” and is carried out through education,
Questionnaire: a research note. J Child Psychol advocacy, and an annual conference. MACMH has
Psychiatry 1997; 38:581-586. published curricula for parents, educators, and
Infrastructure Building
7. American Academy of Child and Adolescent Psychiatry, other practitioners and offers numerous trainings
Through the Governor’s Mental Work Group on Community-based Systems of Care. in Minnesota. Among MACMH’s resources are its
Health Initiative of 2007, the CMHD Early Childhood Service Intensity Instrument (ECSII). Guide to Early Childhood Mental Health, mental
2005. Available from:
has released 3 million dollars in direct PracticeInformation/Information_sheet_ECSII.pdf health factsheets (in English and Spanish), and a
service/infrastructure building grants for newsletter. Its Open-Up magazine is one component
early childhood mental health systems of a new arts-based community outreach initiative
Catherine Wright, MS, is an Early Childhood Mental that showcases the work of young people through
development across the state. In April 2009,
Health Program Coordinator for the Children’s Mental essays, poems, and visual arts to impart powerful
10 communities were awarded these grants Health Division at the Minnesota Department of messages about mental health.
to develop comprehensive services for Human Services.
children, birth to 5 years, employing the four According to MACMH, its annual conference is the
For more information about early childhood systems largest of its kind in the nation, offering parents,
categories of the continuum of care using the
development efforts in Minnesota, please contact caregivers, and professionals access to more than
state-required evaluation tools. 75 workshops of varying technical levels and
Catherine Wright at
REFERENCES nationally renowned keynote speakers. The 2010
1. Zero to Three. Diagnostic classification of mental health conference will take place April 25-27 at the Duluth
and developmental disorders of infancy and early Entertainment Convention Center.
childhood: Revised edition. Washington, DC: Zero to
Three Press, 2005.
For more information about MACMH go

12 Healthy Generations
Evidence-based Practices
in Early Childhood Mental Health
Glenace E. Edwall, PsyD, PhD, LP, MPP

E vidence-based practice (EBP)

in mental health is a relatively
new phenomenon, with virtually no
citations prior to 1995 in the published
literature. However, only a decade later,
PsycINFO contained 271 references to
EBPs for children and adults. There
are many recent review articles and
books about the emerging science of
determining what works, for whom,
and under what conditions.

What Is the Meaning of EBP? challenging questions are often raised about a rating based on the quality of research
EBPs. underlying a specific practice, as well as
The American Psychological Association
■ What “evidence” is required to establish notes the demographic and diagnostic
(APA) has provided leadership in defining
an EBP? Early EBPs emphasized what application of the practice, to the
and promulgating EBPs for children’s
is now referred to as a “gold standard” extent that this information is specified
mental health. In a 2008 task force report,
of evidence, including double-blind, in the practice’s research reports.
APA noted that the term EBP has come to
randomized trials with control groups, Evidence that is still needed in the
using competing interventions, early childhood domain is that from
■ A broader focus than evidence-based longitudinal interventions.
manualized practices, studies by more
treatment, which is limited to
than one group of researchers, and ■ Do EBPs privilege some values over
prevention or intervention programs
statistically and clinically significant others? EBPs are unapologetically
for which there is a strong scientific
differences in outcomes favoring the rooted in the tradition of scientific
practice in question..2 If we relied solely evidence derived from experimental
■ The quality, robustness, and/or on this standard, there would be very research. As the field has evolved,
scientific evidence about prevention, little “evidence” for effective practice. there has been increasing attention
treatment, access, engagement, and More recent approaches to EBPs have to contextual factors related to
retention of targeted client populations; included somewhat broader research evidence, including the importance
■ Incorporation of client characteristics criteria. For example, the National of individualized care, strengths- and
as well as clinical expertise; and Registry of Evidence-based Practices family-based care, and cultural
and Programs assigns ratings from competency.
■ A coherent body of scientific 1 to 4 on specific criteria: reliability
knowledge relevant to a range of ■ Do EBPs reinforce the “medical model”
and validity of measures, intervention of mental health? EBPs are certainly
service and clinician practices, which fidelity, missing data and attrition,
allows for prediction of the impact of rooted in health care, and particularly
potential confounding variables, and in evidence-based medicine. Compared
interventions.1 appropriateness of analysis.3 The with EBPs for adult care, EBPs for
database that Minnesota is using to children generally have a more
EBPs: Questions and Issues train providers, developed from the developmental and preventive focus.
Particularly as applied to early childhood work of Dr. Bruce Chorpita (University
mental health services, a number of of California–Los Angeles), also assigns
Continued on page 14
Winter 2009-2010 13
Evidence-Based Practices in Early Childhood Mental Health from page 13

■ Do EBPs work across different settings,

e.g., clinics, home visits, preschools?
The range of settings in which the
effectiveness of EBPs has been
demonstrated is constrained by the
published literature, but cross-setting
generalizability can sometimes be
extrapolated or tested in the next
iteration of a specific practice.
■ How do EBPs relate to an emphasis
on outcome measurement? The use
of EBPs is dependent upon, not a
replacement for, clear measurement of
outcomes. EBPs are generally defined
by efficacy—the ability to produce a
desired effect in a controlled context; but
effectiveness—the degree to which the
intervention produces the desired effect
in real-world, uncontrolled settings—
demands rigorous measurement.
■ How do EBPs relate to family
preferences and choice? Family
preference and choice have been
empirically demonstrated to have a clear interventions, including providing a
role in the engagement phase of mental clear focus on outcomes. Evidence-based practices make it ethically
health treatment. As more research
■ EBPs clarify clinicians’ case indefensible NOT to offer children and
establishes a wider range of alternatives
for the treatment of common children’s conceptualizations, particularly those families the best care available...The right
mental health problems, more choice emanating from theoretical perspectives. care has become the right thing to do.
among effective treatment modalities is ■ Adoption of EBPs creates the possibility
opened for families. of continuity and consistency of care absence of treatment resources (but no
■ Are EBPs used to restrict access to across providers. longer does), it is also no longer arguable
services? This has been a common fear that any service is as good as any other.
■ EBPs create a common language for
about EBPs, with limited examples, The right care has become the right thing
understanding interventions, much like
primarily in adult services. More to do.
prior work on screening (e.g., ASQ:SE)
common practice among states is to use and diagnosis (DC:0-3R). References
EBPs as part of quality improvement
■ EBPs create the basis for training in 1. American Psychological Association Task Force on
activities and provider training. This has Evidence-Based Practice for Children and Adolescents.
core elements of interventions, thus
been the case for the Children’s Mental Disseminating evidence-based practice for children
increasing the effectiveness of all and adolescents: a systems approach to enhancing care.
Health Division at the Minnesota
interventions for children. Washington, DC: American Psychological Association,
Department of Human Services (DHS). 2008. Available from:
■ Effectiveness and quality are linked to evidencerpt.pdf
■ What are the ethical considerations
better outcomes with lower resource use. 2. Chambless D, Hollon S. Defining empirically supportable
in implementing EBPs? Assuring therapies. J Consult Clin Psychol 1998; 66:7-18.
access to the highest quality of care ■ Rapid return to a typical developmental
3. National Registry of Evidence-Based Practices and
for all children, training, and adequate trajectory is particularly crucial for Programs. NREPP Review Criteria, 2007. Available from:
supervision are all hurdles that states young children to lessen the possibility
must plan for in implementing EBPs. of more complex problems or acquired
co-morbid conditions.
Glenace E. Edwall, PsyD, PhD, LP, MPP, is the
EBPs: Why and Why Now? ■ Pragmatically, EBP implementation is Director of the Children’s Mental Health Division at
The Children’s Mental Health Division increasingly a requirement of federal the Minnesota Department of Human Services.
of DHS is frequently asked why so much and private grant-making.
attention is given to implementing EBPs ■ The publication explosion around EBPs
for intervention in children’s mental health is making it ethically indefensible not
problems. The top answers are: to offer children and families the best
■ EBPs provide the best opportunity care available. Just as it once seemed
to maximize the effectiveness of logical not to screen for problems in the

14 Healthy Generations
Early Childhood Family Education (ECFE):
A Mental Health Promotion Program for Young Children and Families
Lois Engstrom

“I don’t have any friends.” “Nobody

likes me.” These words from
a 4-year-old bring into focus the
importance of addressing social-
emotional development during a child’s
early years. Until recently, this domain
of early development had received less
attention compared to motor, cognitive,
and language development. However,
social-emotional competence is equally
important and essential to children’s
well-being and success in school and in
later life.

Importance of Early statewide implementation through

Nearly all parents want to do the best Community Education in public school
Relationships they can for their children at home districts. Now ECFE is offered essentially by
In the now classic report from the Institute of and select high quality out-of-home all school districts, either independently or
Medicine, From Neurons to Neighborhoods; care environments. Many parents seek in cooperation with other districts.
the Science of Early Childhood Development,1 information and support in this endeavor
the authors highlight the importance of early In accordance with Minnesota statute
life experiences and the highly interactive 124D.13, all programs must provide:
for young children as well as support for
nature of genetics and environment. Early ■ Education to parents on the physical,
relationships are critical to the development mental and emotional development
of the infant brain and in turn, to the of their children and enhancing the
Minnesota Legislation
unfolding patterns of human development, skills of parents* in providing for their
including social-emotional competence. Supports ECFE children’s learning and development;
Parents, other caregivers, and teachers Minnesota is fortunate to have statutory ■ Structured learning activities requiring
need to provide the environments and provisions making Early Childhood Family interaction between children and their
interactions that enable children to learn to Education (ECFE) available to all parents to parents;
trust others, gain self-control, demonstrate support them as their children go through
age-appropriate levels of independence, various stages of development from birth ■ Structured learning activities for
and acquire the ability to take initiative and to kindergarten enrollment. ECFE began in children that promote children’s
assert themselves in socially acceptable ways. 1974 with six state-funded pilot programs development and positive interaction
administered by the Minnesota Council with peers, which are held while parents
Parents have a profound influence on the attend parent education classes;
early development of their children. Nearly on Quality Education, which coordinated
all parents want to do the best they can a variety of research and development ■ Information on related community
for their children at home and select high strategies funded by the legislature. The resources;
quality out-of-home care environments. number of pilots expanded gradually to 34 in
Early childhood teachers and specialists in 1983 when the Minnesota Legislature began *The phrase “or relatives” was added to the statute
to make the transition from grant-funded recently to include those who play a major parenting role
a variety of settings are trained to provide in the lives of the children involved.
the most effective learning environments pilots to a foundation aid formula and
Continued on page 16
Winter 2009-2010 15
Early Childhood Family Education from page 15 Cultural Adaptation of a Parent Education
Program for Somali Women
Nadifa Osman
■ Information, materials, and activities
that support the safety of children,
including prevention of child abuse and I am a Somali immigrant to the U.S. and have been the same information as the Family Services
neglect; and living in the Twin Cities for several years. I became parenting curriculum. The major difference was it
increasingly aware of the social isolation of many used citations from the Qura’n and sayings from
■ A community outreach plan to ensure other Somali women who had more recently Prophet Mohamed. I started using this book as a
participation by families who reflect the immigrated to Minnesota. Many of these women teaching tool and reference. It created a drastic
racial, cultural, and economic diversity were parenting children, some of whom were not change of attitude in these Muslim mothers and
of the school district. their own because their parents had been killed gave them great reassurance that the parenting
or lost in their flight from the war in Somalia. practices we were talking about totally fit with
ECFE Programs Are Tailored Many of these women had lost their partners their Islamic faith.
and their extended families. They appeared
to Parents’ Needs Meeting as a group of women with a shared
depressed, although the Somali culture does trauma experience who also wanted to be good
Parents and children attend ECFE programs not really recognize depression as an illness for parents, they found support and friendship from
together. Programs are usually free of charge. which medical help is available. I was concerned each other, which seemed to relieve some of
In addition to the program requirements about the health of these women and how their their depressive symptoms. The group quickly
above, school districts vary in the specific depressed mood was affecting their ability to be mushroomed into over 30 women and has
programs that are offered as they adapt good parents. continued to meet for several years. I have had
programs to the changing structure and In 2003, I brought six of these mothers together requests from other Somali women throughout
needs of families in their communities. For and started teaching them parenting skills using the Twin Cities to start a similar group for them.
example, some ECFE programs offer: a curriculum developed by Family Services Inc. It taught me the importance of honoring cultural
and Children’s Home Society. These agencies beliefs and practices and providing support to
■ Daytime, evening, and Saturday classes wanted me to modify the curriculum so it suffering women who desperately wanted to be
to accommodate parents’ schedules; would fit the cultural beliefs of East Africans. good mothers and protect their children from
I struggled a lot because many of the parents harm.
■ Family literacy programs; believed that I was introducing Western culture
■ Classes for specific affinity groups like and parenting practices and encouraging them REFERENCE
fathers, single parents, and parents of to neglect their own culture and parenting style. Beshir E, Beshi MR. Meeting the challenge of parenting in
infants; I searched for information about how Islam said the west: An Islamic perspective. Beltsville, MD: Amana
children were to be raised. I found a book called, Publications, 2000.
■ Home visits; Meeting the Challenge of Parenting in the West: An Nadifa Osman is a Minneapolis resident and
■ Classes at hospitals for parents of Islamic Perspective, written by a child psychologist Executive Director of a non-profit, Women of Africa
who raised four of her children in the western Resource and Development Association (WARDA).
newborns; and
world while adhering to her Muslim faith. What
■ Parenting education for court-ordered surprised me was that this book contained
Within a given community, ECFE
professionals collaborate and coordinate source of support and connectedness with
their efforts with other early education other parents and families who often become
programs like child care, crisis nurseries, long-time friends.
Head Start, early childhood special
education, interagency early intervention For more information about ECFE programs
services, and nurse home visiting. in your area, see
Benefits of ECFE Reference
Not only do parents and their children 1 Shankoff J, Phillips D. (Eds.) and the National Research
benefit directly from ECFE, but society Council and Institute of Medicine. From neurons
to neighborhoods: the science of early childhood
benefits too, because healthy and supported development. Washington, D.C.: National Academy Press,
families are better able to develop nurturing 2000.
relationships with their children that
contribute to their social and emotional Lois Engstrom is the Executive Director of the
competence. In this way, ECFE promotes Minnesota Association for Family and Early
positive mental health for children. One Education. She was statewide coordinator of ECFE
of the greatest testimonials to the value of at the Minnesota Department of Education from
ECFE is that so many parents report ECFE 1983-2003.
has helped them to understand and more
effectively meet their children’s needs, while
simultaneously providing them with a strong

16 Healthy Generations
Clinical and Public Health Perspectives on
Mental Health Disparities in Early Childhood
Andrea Aga

“H ealth disparities” refers to the greater incidence, prevalence, mortality, and

burden of disease among specific population groups—based on factors
such as race, ethnicity, socioeconomic status, disability, etc. In the U.S., health
disparities begin at very young ages (often in utero) and persist throughout the life
course. The disproportionate exposure of racial/ethnic minorities and low-income
families to high-risk, resource-poor environments may explain the disparities in
social-emotional problems among these young children, according to Dr. Charles
Oberg, a pediatrician and an Associate Professor in the Maternal and Child Health
Program in the School of Public Health at the University of Minnesota. There is
also an achievement gap between children from at-risk backgrounds and their
more advantaged peers—a gap that is apparent even among young children1,2 and
likely associated with disparate social-emotional development.

Environmental Exposures Family Economic Stress

Racial/ethnic minority children and When the families of young children
those from low-income families have undergo persistent financial strain, they are
disproportionate residential exposure to faced with a number of stressors in their
old housing, industrial waste, landfills, and daily lives—food insecurity, unemployment,
environmental pollutants, like lead.3 Lead homelessness, frequent moves, and unsafe
exposure comes primarily from lead-based neighborhoods. This kind of stress makes it To address this variability and ensure that
paint; toddlers ingest paint chips and dust difficult for parents and other caregivers to children receive high quality care, Dr. Oberg
through normal hand and mouth activity. develop nurturing, protective, and consistent suggests “improved consistency in training,
Lead is also in the soil of high-traffic and relationships with their infants and young more readily available assessments, and
industrial areas, thus affecting the play areas children. Such relationships are essential having referrals in place to help address the
of children who live in such areas. Early for the child’s development of secure needs that are identified.”
exposure to lead is associated with aggressive attachment, emotional regulation, and other Importance of provider training. While
behavior and poor intelligence testing. developmental milestones. the type of training providers receive has
Lead, mercury, dioxins, polychlorinated changed over time, more must be done to
biphenyl compounds (PCBs), and other Clinical Care for Stressed ensure that providers are able to competently
toxins also cross the placenta, affecting fetal Families address the social and emotional health
neural development.4,5 The mechanisms by needs of children. Dr. Oberg supports the
Disparities persist beyond children's
which specific deficits develop are not well idea of a medical home, an approach that
residential environment. In many clinical
understood.4,5 Among the many aims of grew from efforts to provide continuous
settings, there are variations in the services
the National Children’s Study (NCS) is to and comprehensive care for children with
provided for young children who experience
understand how environmental exposures special health care needs. This model
emotional and social developmental delays
may affect neurodevelopment, from fetal life allows the provider to link with the family,
or have mental health problems. While such
throughout young adulthood. Dr. Oberg is a school, and community to coordinate care
problems should be recognized during the
co-investigator and Dr. Wendy Hellerstedt, through multiple systems: health, education,
screening portion of well-child exams—
Director of the Center for Leadership and social services. Clinicians need more
which includes anticipatory guidance and
Education in Maternal and Child Public training and education to become familiar
listening to a family’s concerns—there are
Health, is the co-Principal Investigator of with the medical home model and skilled in
differences in the quality of care and the
the Ramsey Location for the NCS (www. implementing it.
amount of time devoted to such screening.
Continued on page 18
Winter 2009-2010 17
Early Childhood
Clinical and Public Health Perspectives on Mental Health Disparities in Early Childhood from page 17
Longitudinal Study:
Disparities in Early Child
Stigma and Lack and enhance the public health curriculum. Development
of Awareness of Resources On a broader level, Dr. Oberg states that
policy development is necessary to support
Families may not be aware that their young the economic well-being of families, given
In June 2009, Child Trends published an analysis
children have mental health problems about multiple potential risk factors for
the higher risk for mental health problems developmental disparities at 9 and 24 months of
or they may not be aware that resources among children in financially stressed age. Data were from a nationally representative
exist to address them. Consequently, Dr. families. sample of infants born in 2001, the Early Childhood
Oberg emphasizes the importance of early Longitudinal Study. The authors (Halle et al.)
childhood education programs because Dr. Oberg emphasizes that children,
examined three domains of development: cognitive,
they are encouraged to evaluate and including those from birth to 5 years,
general health, and social-emotional.
promote a child’s emotional and mental need good physical health and good social
and emotional health. Children must Some of the key findings of this report were:
health. High-quality programs also provide
an environment that is developmentally have adequate nutrition, quality housing, ■ Disparities in cognitive, social, behavioral, and
appropriate and emotionally safe, and parents with livable wages to eliminate health outcomes by family income were evident
financial stresses, and resources to address at 9 months and were even greater at 24
support coordination between social and months of age.
health care services. violence in the home. According to Dr.
Oberg, “intervention early on really does ■ Infants and toddlers from certain backgrounds
Some families, and some cultures, may pay off substantially as children enter into (i.e., racial/ethnic minority groups, whose home
stigmatize mental health or be reluctant to middle childhood, adolescence and young language was not English, and/or who had
seek services for other reasons. While stigma adulthood.” mothers with low maternal education) scored
exists, Dr. Oberg believes it has become less lower on cognitive assessments, had poorer
of a barrier for accessing mental health care For more information about the afore behavior ratings and were less likely to be in
for children. “What I’ve noticed when there mentioned certificate programs offered at the excellent or very good health than children not
is an issue facing the family in regards to the University of Minnesota, please visit: from such backgrounds.
social and emotional health of their infant, ■ Infant and Early Childhood Mental ■ The more sociodemographic risk factors a child
toddler, or child,” he said, “is that they are Health Certificate at the Center for Early had (e.g., low-income family, mother with low
reaching out, looking for services. I think Education and Development Program, education), the wider the disparities across
outcomes for 9- and 24- month-olds.
that speaks to an evolutionary change within
our society.” Due to this shift, Dr. Oberg certificateprograms/IECMH/default. The sociodemographic risks examined in this study
also believes mental health is going to be a html. Also see page 35. affect a significant number of infants and toddlers
in the US. For example, nearly half of all infants and
major focus for the next several decades in ■ Early Childhood Policy Certificate toddlers—approximately 1.5 million children—live
the medical, public health, and social service Program in the College of Education in families with incomes below 200% of poverty.
fields. and Human Development, www.cehd. The authors drew several policy implications from their analyses:
“What I’ve noticed when there is an issue html 1. Start Early. Meaningful differences in outcomes
facing the family in regards to the social were detected as early as 9 and 24 months.
They recommended high quality, comprehensive
and emotional health of their infant, References
and continuous interventions for children ages 0
toddler, or child, is that they are reaching 1. Hart B, Risley T. The early catastrophe: the 30 million to 3, as well as ages 3 to 5.
out, looking for services. I think that word gap by 3. Am Educator 2003; 27(1);4-9.
2. Target Low-income Children. Low income
speaks to an evolutionary change within 2. Halle T, Forry N, Hair E, et al. Disparities in early
was the most prevalent risk factor in the study.
learning and development: lessons from the Early
our society.” - Dr. Charles Oberg Childhood Longitudinal Study – Birth Cohort (ECLS-B). 3. Engage and Support Parents. Low maternal
Available from: education was a prevalent risk factor. The
authors suggested interventions that include
3. Powell DL, Stewart V. Children. The unwitting target of parental education about early childhood
Role of Public Health environmental injustices. Pediatr Clin North Am 2001;
development and those that support parental
Practitioners educational attainment and/or income
4. Schantz SL, Widholm JJ, Rice DC. Effects of PCB self-sufficiency.
Dr. Oberg believes public health practitioners exposure on neuropsychological function in children.
can be instrumental in addressing mental Environ Health Perspect 2003; 111(3):359-76. Available 4. Improve the Quality of Early Care Settings.
from: Most infants and toddlers (especially those
health disparities. Child social and emotional
health and development should be part 5. Patandin S, Lanting CI, Mulder PG, et al. Effects of from low-income families) are cared for in
environmental exposure to polychlorinated biphenyls home-based settings. High-quality early care and
of a public health graduate curriculum, and dioxins on cognitive abilities in Dutch children at 42 education may moderate the effects of stressful
he suggests. He points to two certificate months of age. J Pediatr 1999;134(1):33-41.
residential exposures and may promote safe,
programs available at the University supportive and stimulating environments for
of Minnesota—one in infant and early Andrea Aga is an MPH student in the Maternal and young children.
childhood mental health and another in Child Health Program at the University of Minnesota.
early childhood policy (see links, end of The full report is available at:
article). These certificates blend disciplines

18 Healthy Generations
Family Home Visiting
A Public Health Program to Promote Healthy Social-Emotional Development
Sharon Hesseltine, BSW
Jill E. Simon, MSW, LICSW, IMH-E® (IV)

M innesota family home visiting programs focus on preventing children’s

mental health problems by offering support directly to families in their
homes.1 Public health nurses or trained home visitors support parents of infants
and toddlers by providing information and guidance about child health and
development, promoting parenting skills, and enhancing parents’ ability to
engage in positive interactions with their children. During these visits, potential
threats to the emotional health of the child, including a parent’s mental health
problems, parent addictions, or family violence are identified and referrals to
needed resources are made.

Building a Supportive is presented through a series of home “stepping back” to consider the meaning of
Relationship visiting case scenarios. This method allows one’s professional and personal responses to
participants the opportunity to learn relationship interactions. The home visitor
Essential to the effectiveness of ongoing concepts by applying them to a home
home visits is having the family experience steps back to ponder her own reactions,
visiting situation and gain insight through wonder about the parent’s perspective,
a supportive and continuing relationship discussion with peers and trainers. In each
with a visitor. This relationship promotes and reflect on how she might best help the
scenario, participants are encouraged to parent discover her or his own solutions.
the parent’s capacity to care for the focus on how to use the visitor-parent
child in a manner that fosters healthy Likewise, the home visitor helps the parent
relationship as the primary vehicle to effect think about his or her thoughts and feelings,
attachment. Research shows that supportive change. Future training development will
relationships in the parent’s life have a consider the child’s experience, and identify
continue to promote the fundamental solutions that encompass both perspectives.
significant and long-term positive influence skills and theoretical underpinnings of
on the parent-child relationship. It is Essentially there is a parallel process; that
evidence-based home visiting practice and is, the home visitor relates to the parent in
well-documented that an infant’s healthy its relationship to infant mental health.
attachment is a major contributing factor a healthy respectful manner, which builds
in optimal social, emotional, and cognitive One of the tools that home visitors use is the parent’s capacity to develop a healthy
development of the child.2 the Parent-Child Interaction (PCI) Feeding relationship with his or her child. The goal
and Teaching Scales,3 which assess the of reflective practice is to gain a better
To enhance the capacity of family home quality of parent-child interaction and understanding of relationships—between
visitors in the work of relationship-building, communication behaviors. Results of this the parent and child, as well as between
the Minnesota Department of Health assessment can be used by home visitors the home visitor and parent—so that all
(MDH) provides training, technical to support parents’ learning about how to relationships support the healthy emotional
assistance, and consultation. respond to their infants’ cues, which is a development of the child.
critical component of sensitive caregiving. MDH offers a reflective practice consultant
Training Home visitors also receive training in to local public health departments to
A new family home visiting training motivational interviewing,4 which is a support and strengthen home visitors’
curriculum, “Promoting Relationships with collaborative, person-centered discussion to skills in using a reflective approach with
Relationships,” is available to public health elicit and strengthen parents’ motivation for families. The consultant facilitates reflective
home visitors in Minnesota. This training making healthy changes. practice case conferences and provides
addresses infant mental health, parent-child mentoring and reflective practice groups
attachment, and culturally responsive Reflective Practice for supervisors. Reflective supervision
practice. To emphasize the ongoing An essential component of most contributes to an understanding of home
development of relationship-building evidence-based home visiting models is the visitor boundaries and roles and clarifies
skills and knowledge, the course material use of reflective practice, which involves goals and areas of intervention.
Continued on page 27
Winter 2009-2010 19
Follow Along Program: An Early Childhood
Intervention System at the Minnesota Department of Health
Andrea Mayfield

F or infants and young children with developmental delays, early intervention is

important to improve health outcomes and address challenging behaviors in the
school and home environments. A major challenge in providing early intervention
services is the ability to accurately identify infants and young children with social,
emotional, and other developmental delays early in childhood. The Minnesota
Department of Health (MDH) Follow Along Program (FAP) provides periodic
monitoring and screening to help families and health care professionals determine if
infants are meeting expected developmental milestones.
activities to practice with their children. newborns to participate. Other referrals
When there are concerns about a child’s come from home visiting programs,
developmental progress, the public hospitals, physicians, and word of mouth.
health nurse contacts the child’s family to Enrollment in FAP varies throughout the
ensure they responded to the questions state. While 12% of children birth to 3
appropriately. If there are remaining years participated in FAP statewide in 2008,
Origins of the FAP concerns, the nurse discusses options for enrollment ranged from 4% in the metro
Lola Jahnke, a Public Health Social Work follow-up, including referral to a primary area to 29% in southwestern Minnesota
Specialist with the FAP, has seen the care physician, Part C of IDEA (Individuals where the program started first.
program grow from its infancy to statewide with Disabilities Education Act), an early
implementation. In the 1980s, Jahnke and intervention program for infants and Next Step after FAP
other service providers noticed that children toddlers, or other health and social service
programs. This process ensures that parents When a child reaches 36 months,
with developmental delays were not being participating families receive information
identified until they reached school age. receive support in learning about normal
child development and children with about the next step: Early Childhood
She explains, “at that point in time, there Screening. The state of Minnesota mandates
wasn’t much around for kids from birth to developmental delays are identified and
connected with intervention services early. that all children receive one screening
five.” A group of providers collaborated to (including social and emotional) prior to
find a “low-cost option” that would identify kindergarten. Results from these screening
and monitor the social and emotional
Funding for FAP
tests are reported to the Minnesota
development of young children. The FAP While FAP at the state level receives federal Department of Education (MDE) and
grew out of these meetings. funding, local county agencies throughout help determine if children are in need of
Minnesota support the cost of their FAPs special education. Together, these programs
From Screening and through a variety of sources. As these facilitate the timely identification of children
Monitoring to Referral programs have “no direct line of funding with developmental delays, promote early
through the MDH…they are given lots access to intervention services when
Families with children in the Program of flexibility in terms of how they run the
receive the Ages and Stages Questionnaire needed, and help to ensure that families are
program,” explains Jahnke. As a result, connected with a health care provider as
(ASQ) and ASQ:SE (social-emotional) counties use different recruitment strategies
when the child reaches 4, 8, 12, 16, 20, 24, children enter the school-age years.
and eligibility criteria. Some provide the
30, and 36 months of age. After the family program to all newborns, while others For more information about the Follow
completes the questionnaires, they are only offer the program to at-risk children. Along Program, please visit: http://www.
scored by public health staff at the local In counties that offer the program to all
county agency. Families with children who children, administrators obtain birth
are developmentally on-track are sent a letter certificate information from the local public Andrea Mayfield is an MPH student in the Maternal
informing them of the survey results along health department and invite parents of all and Child Health Program at the University of
with an activity sheet with age-appropriate Minnesota.

20 Healthy Generations
Part C IDEA, Early Intervention Services:
Serving Children Under 3 Years with Mental Health Concerns
Karen Adamson, RN, MPH

W hile all states provide early childhood intervention services for children
under 3 years of age who are experiencing developmental delays,
screening and services for social-emotional delays have lagged behind services
for other developmental delays in many states.1 In Hennepin County, Minnesota,
staff provide developmental and social-emotional screening for referred children
under age 3. These children are referred from families, pediatric providers,
hospitals, and other community sources when a delay is suspected. Screening
is done in the home using standardized tools by public health nurses and child
development specialists.

In 2008, Hennepin County early childhood “at risk” of developmental delay.1 intervention, but have very significant
staff administered nearly 500 mental needs as evidenced by their interactions
health screens using the Ages and Stages Interagency Coordination and behavior. It is for these children that
Questionnaire: Social Emotional (ASQ:SE).2 Part C legislation requires coordination Hennepin County social workers try to
In this sample of children with suspected among education, health, and social provide additional in-home services or
delays, 17% of the infants under 1 year service agencies in a state, with one agency referrals to early childhood mental health
scored in the “concerns” area and 40% of 1 designated as the lead. In Minnesota, professionals for therapeutic intervention.
to 3-year olds, had scores in the “concerns” education is the lead, and Interagency These services are provided through county
range.3 In Minneapolis, all children under Early Intervention Committees (IEIC) funds or third-party billing.
age 3 with scores indicating mental health have been formed throughout the state to
concerns are referred to IDEA Part C, enact this coordination function. School Services for Abused and
Part C of the Individuals with Disabilities districts are required to provide early Neglected Children
Education Act (IDEA) Early Intervention intervention services for eligible children The Child Abuse Prevention and Treatment
Services through the Minneapolis School in their districts. Because the needs of very Act (CAPTA)5 mandates social-emotional
District. young children are frequently complex and screening and, when warranted, referral
not directly observable in a public K–12 to Part C Early Intervention services.
What is IDEA and Part C? system, public health and social services are In 2008, child welfare staff in Hennepin
IDEA Part C is a federal program that important partners with education in finding County administered mental health screens
assists states in providing statewide early young children experiencing developmental to all children under age 5 who had been
intervention services for children, birth to delays. Screening is just the beginning. Part in foster care for at least 30 days. Many
3 years, with disabilities.4 Established in C Early Intervention Services require a full of these children have significant mental
1987 and reauthorized in 2004, all states evaluation for all children whose screens health conditions and require therapeutic
participate in the program, although there is indicate developmental delays, and services intervention in addition to services through
considerable variation in how developmental are provided at no cost to families through the local school district. Nationally,
delay is defined and how many children the school district. one-third of children ages 2 to 5 in child
are served. Services must be provided for welfare need mental health services and
those who are experiencing developmental Early Intervention Services related interventions.6
delays and for those who have a diagnosed for Social-Emotional Delays As we improve our ability to screen more
mental or physical condition that has a high
Determination of service need is based on young children in Hennepin County,
probability of resulting in a developmental
an education model. As we screen young Minnesota and other states, we realize that
delay. States may choose to serve children
children for mental health concerns, we find we need multiple resources to meet the
“at risk” of experiencing a substantial
that there are some children who do not mental health needs of very young children.
developmental delay, but currently, only
meet the eligibility criteria for educational In addition, there is a need to assist agencies
seven states and one territory include those
Continued on page 23
Winter 2009-2010 21
Minnesota Head Start:
Addressing Mental Health Needs Early
Gayle L. Kelly, MS

W hen a young child has a fever,

you call the doctor. Who do you
call when a baby is difficult to console
and cries incessantly; or a young child
expresses extreme anger and rage; or a
preschooler consistently bites and hits
other children? In 2004, Minnesota
Head Start staff and parents asked these
questions as part of a statewide initiative
to find better ways to support the social
and emotional well-being of young
children and their families. Increased
awareness of the frequency that children
in Head Start were showing challenging
behaviors led to an initiative to build
an improved system of mental health
promotion, prevention, and intervention
services within Early Head Start and
Head Start programs (collectively called
Head Start).

Head Start Goals with mental health professionals to offer Addressing Parent Education
consultation services for enrolled children Needs
Echoing the Zero to Three definition of
with social or emotional problems. Mental
infant mental health, Head Start’s goals are Parents look to Head Start to understand
health consultants can provide a range of
to ensure that all young children can form their children’s social and emotional
services including classroom observations,
strong attachments with their caregivers, development, and parent education is a
in-depth assessments of children, direct
regulate their emotions, and reach out and critical component of Head Start’s family
therapeutic services, training and/or support
explore their environment to learn.1 These development services. The Ages and Stages
for staff, and meetings with parents.
goals underlie all Head Start efforts to Questionnaire: Social-Emotional (ASQ:SE)3
provide early learning experiences for young The 2008 federal Program Information has been adopted by every Head Start
children. Report demonstrated that Minnesota Head program in Minnesota to screen children
Start staff sought consultation with mental and help initiate a dialogue with parents
Federal Requirements for health professionals related to the mental about their child’s development. ASQ:SE
Meeting Social-Emotional health problems of more than 2,100 enrolled is completed by parents within the first 45
children (or 13% of Minnesota’s Head Start days of their children entering Head Start,
enrollment).2 In-house professionals served and the results are reviewed with every
The federal Head Start Performance many additional children and families. parent. Parents whose children have a
Standards require programs to develop The number of children in Head Start positive screening result can request further
systems for screening, identifying, and with mental health concerns has grown assessment, and all parents have a variety
treating children with emotional difficulties. dramatically in the past 10 years. of options for further discussion with staff
They also require Head Start to contract
specialists or mental health professionals.
22 Healthy Generations
continued from page 21
Part C IDEA, Early Intervention Services

New parent education offerings like the programs indicate they now serve many that work with young children on a daily
Incredible Years Parenting Program (see children with mental health problems who basis, such as preschools and child care
page 26) are being offered in partnerships are waiting for evaluation by their local Part centers, to employ qualified professionals
between Head Start and community mental C or ECSE team or have not qualified for who are skilled in early childhood services.
health organizations throughout Minnesota. those education services. References
Changing role of mental health consultation. 1. Cooper J, Vick J. Promoting social-emotional wellbeing in
Mental Health Consultation Increasingly, Head Start programs are early intervention services. A fifty-state view. New York:
National Center for Children in Poverty, 2009. Available
In 2004, Minnesota Head Start programs partnering with community mental health from:
faced considerable challenges in finding organizations with expertise in early 2. Squires J, Bricker D, Twombly MS, Heo K. Identification
qualified mental health consultants with childhood, thereby bringing assessment and of social- emotional problems in young children using a
early childhood expertise. A partnership treatment services into Head Start settings. parent completed tool. Early Child Res Q 2001;16(4):405-
between the Minnesota Head Start 419.
Today, integrated service approaches are
Association and the Minnesota Department occurring with dramatic positive results 3. Hennepin County Human Services and Public Health.
2008 Annual Report: Early Childhood Public Health.
of Human Services (DHS), Division of for children and families. Examples of the Internal publication, available upon request.
Children’s Mental Health, has contributed evolving role of mental health consultants in 4. U.S. Department of Education. Individuals with
to significant progress in improving mental Head Start include: Disabilities Education Act. Available from: http://idea.
health supports for young children.
■ In the Duluth Head Start programs,
Building capacity through training. 5. Cutler C, Ward H, Yoon SY, et al. Children at risk in the
mental health consultants conduct child child welfare system: collaborations to promote school
In 2004, Head Start adopted a “grow observations, work closely with parents, readiness. University of Southern Maine: Muskie School
your own” approach by partnering with and work closely with classroom staff to of Public Service, April 2009. Available from: http://
mental health professionals. The Head
develop individualized strategies for all
Start program identified community children showing challenging behaviors. 6. Cooper J. Social and emotional development in early
childhood: what every policymaker should know. New
mental health professionals who lacked Reflective consultation is used to help York: National Center for Children in Poverty, 2009.
training and experience serving young staff recognize the difficulty in caring for Available from:
children, but were motivated and willing children with social-emotional issues.
to acquire additional competencies. The
■ Through the work of its consulting Karen Adamson, RN, MPH, is Program Manager for
DHS Division of Children’s Mental Health Children, Youth and Families at Hennepin County
psychologist, Parents in Community
began offering regional training grounded Human Services and Public Health (Minnesota) and
Action (PICA), Inc., the Head Start
in neurobehavioral scientific research and she is the current Chair of the Minnesota Department
provider in Hennepin County, has of Health MCH Advisory Task Force. Karen received
designed to develop trainee competencies in
developed a collaborative partnership her MPH in Maternal and Child Health from the
using state-of-the-art methods for screening,
with Family and Children’s Services University of Minnesota.
assessment, and intervention with children
to provide on-site play therapy
under the age of 5. Head Start programs
for identified children. PICA’s
in many communities provided financial
referral-to-follow up ratio is nearly
support to help their mental health partners
100%. Visit the Center for Leadership
participate in this training. They also made
their classrooms available as laboratories The Minnesota Head Start community Education in Maternal and
to help ground these professionals in the is redefining the roles of mental health Child Public Health ONLINE
language of early childhood development. consultants as an invaluable resource for the
well-being of children and families, as well
Referral for diagnostic assessment. Prior Join us in the blogosphere:
as staff. The first priority in comprehensive
to 2004, Minnesota Head Start programs
school readiness must be early learning
referred children with mental health Engage with MCH professionals discussing a broad
policies and funding streams that ensure
concerns almost exclusively to their local range of cutting-edge topics, including innovative
services to promote the social and emotional
educational agency for evaluation by Early MCH projects, emerging research, and important
well-being of children and their caregivers. policy efforts.
Childhood Special Education (ECSE) (or
for a child under 3 years, Part C Early References Tour our website:
Intervention). Very few children were given 1. Task Force on Infant Mental Health. Definition of infant Learn more about our academic training
a diagnosis related to their social-emotional mental health. Arlington, VA: Zero to Three, 2002. programs and continuing education workshops
Available from:
delay or disability and hence, were not and events, or check out the new videos and
eligible for ECSE or Part C services. Today, 2. Kuklinski W. Data from the 2008 Federal Head Start podcasts we have posted. The content is changing
Program Information Report for Minnesota. St. Paul,
more programs have access to mental health everyday—so be sure to bookmark us and check
MN: Minnesota Department of Education.
professionals who have been trained in back often!
3. Squires J, Bricker D, Twombly E. Ages and stages
developmentally appropriate mental health questionnaires: social-emotional (ASQ:SE): a parent- If you would like to be added to our mailing list
assessment techniques such as DC:0-3R completed, child-monitoring system for social-emotional to receive future volumes of Healthy Generations
behaviors. Baltimore: Brookes Publishing, 2009. please contact Jan Pearson at
and referrals are often made concurrently
to community mental health providers and
their local ECSE or Part C team. Head Start Gayle L. Kelly, MS, is Executive Director of the
Minnesota Head Start Association, Inc.

Winter 2009-2010 23
Promoting Infant Mental Health through
Relationship-based Interventions
Martha Farrell Erickson, PhD

T he STEEP™ program (Steps Toward

Effective, Enjoyable Parenting)
aims to promote healthy parenting and
prevent social-emotional problems
among babies in families facing
risk factors such as poverty, social
isolation, or a history of troubled
relationships. Attachment theory
provides a framework for the program,
and longitudinal research on factors
that underlie healthy parent-child
relationships informs the program’s
broad goals.1

STEEPTM Program Structure

Participants typically are recruited through
obstetric clinics during pregnancy. Bi-weekly
home visits, tailored to the needs and
strengths of each family, continue until the
child’s second birthday. Shortly after the
babies are born, mothers begin attending
bi-weekly group sessions. Reflecting the
relationship-based approach of STEEP™,
each group is led by the person who
conducts the home visits for those 8–10
Group sessions begin with mother-child
activities geared to the babies’ stage of mind, STEEP™ promotes sensitivity and
development. Then, following a casual addresses factors that can undermine The primary pathway to a
meal, mothers gather for “mom talk,” or sensitive care. A centerpiece of the program secure attachment and the
discussions focused on their own personal is Seeing Is Believing™, a video-recording
growth and life goals. Although group of parent-infant interaction for engaging foundation of infant mental
meetings are for mothers and babies, fathers parents in self-observation and discovery health is parental sensitivity to
and other family members are included in as they watch the video with their home
home visits and periodic family events. visitor.2 Through open-ended questions, baby’s cues and signals.
the facilitator encourages parents to focus
Grounded in Attachment on what their babies are telling them and and is a valuable aid when facilitators seek
Theory and Research to recognize their own skills in adapting to supervision or consultation. The video
their babies’ needs. Video-recording helps becomes a treasured keepsake for the family
The primary pathway to a secure and, according to many participants, is a
to keep the parent-child relationship at
attachment and the foundation of infant powerful incentive to participate in the
the center of the intervention, provides a
mental health is parental sensitivity to program.
permanent record for monitoring progress,
a baby’s cues and signals. With that in
24 Healthy Generations
Babies know what they experience—whether of drug abuse. STEEP™ helps parents with several special populations, including
mom and dad can be counted on to offer identify potential sources of support indigenous families, women who abused
comfort when they cry, play with them and develop the skills to use support substances during pregnancy, teen parents,
when they’re feeling sociable, and respect effectively. mothers who are depressed, families
their privacy when they’d rather sleep than ■ Looking back, moving forward. identified as abusive or neglectful, and
be tickled. Many factors underlie a parent’s Consistent with attachment theory families of preterm, medically fragile infants.
ability to sustain sensitive, responsive care. and research on intergenerational For further information about this work, or
Although each family has unique strengths transmission of parenting, an important to inquire about training for staff in your
and challenges, some major factors deserve part of STEEP™ is to help parents reflect organization, contact the author at mferick@
special attention in a program designed to on what they learned in their own early
promote sensitivity: relationships and how that influences References
■ Knowledge and understanding of child their responses to their children. Both 1. Egeland B, Erickson MF. Lessons from STEEP™: linking
development. Sensitive care is grounded in home visits and groups, STEEP™ theory, research and practice for the well-being of infants
in knowledge about child development creates a supportive environment in and parents. In Sameroff A, McDonough S, Rosenblum
K. editors. Treating parent-infant relationship problems:
and understanding of the developmental which parents reflect on their history, strategies for intervention. New York: Guilford, 2003, p.
meaning of key behaviors such as confront painful memories, and identify 213–242.
separation protest or toddler negativism. positive experiences to pass on to their 2. Erickson MF. Seeing is Believing™ Training DVD.
When parents lack that understanding, children. Understanding that no one is Minneapolis, MN: Irving B. Harris Training Center,
University of Minnesota, 2005.
they often hold unrealistic expectations a perfect parent, the focus is on leaving
and get caught in a cycle of frustration hurtful patterns behind and mustering 3. Erickson MF, Egeland B, Simon J, Rose T. STEEP™
Facilitator’s Guide. Minneapolis, MN: Irving B. Harris
and anger, attributing negative qualities all available resources to become a Training Center, University of Minnesota, 2002. .
to their child just because he or she is “good enough” parent. As described in
doing what children naturally do. the STEEP facilitators’ guide,3 group
activities give parents permission Martha Farrell Erickson, PhD, retired in 2008 from
■ Social support. For parents to respond her position as Director of the Irving B. Harris
sensitively to their children’s needs, their to begin looking back so they can Training Programs in the Center for Early Education
own needs must be addressed. Some move forward. Home visits afford an and Development in the College of Education and
parents are socially isolated; they lack opportunity for more personalized Human Development at the University of Minnesota.
supportive friends or family members, encouragement and support. She continues to consult and speak throughout the U.S.
and abroad on infant mental health, parenting, and
and/or lack the skills or confidence to evidence-based strategies for working with high-risk
access supportive resources. Barriers
Broad Dissemination
families. Dr. Erickson also appears regularly on TV
to getting support may include lack of and Adoption and radio in the Twin Cities and, with her daughter,
transportation and money. Sometimes Erin Garner (a MCH student in the Maternal and
Since the development and evaluation of
Child Health Program at the University of Minnesota),
parents are surrounded by family STEEP™ and Seeing Is Believing™ at the hosts the weekly talk show, Good Enough Moms™.
and friends who do not support good University of Minnesota, these programs
parenting and the best interest of the have been used in varied settings in North
child. This is dramatically evident, for America, Australia, and Europe. The
example, in families living in a culture approaches have been used effectively

Register Now! “Engaging Fathers: Strengthening Families”

Minnesota’s Birth-to-Three Conference
January 13-15, 2010, Arrowwood Resort, Alexandria, MN

The Center for Leadership Education in Maternal and Child Public Health is a co-sponsor of this event.

Winter 2009-2010 25
Promoting Early Childhood Mental Health
through Evidence-based Practice
Implementation of the Incredible Years in Ramsey County, Minnesota Gael Thompson, MSW, LICSW

I n 2004, the Amherst H. Wilder

Foundation introduced the Incredible
Years programs to the community.
This set of evidence-based programs is
designed to teach positive interaction
skills, social problem-solving strategies,
anger management, and appropriate
school behaviors to young children. The
programs also strengthen parent-child
relationships and help parents develop
positive behavior guidance strategies.

Mission of the Wilder

Wilder introduced the Incredible Years
programs as part of their 100-year history
of combining direct services, research,
and community development to address
the needs of the most vulnerable people in
Ramsey County, Minnesota. Through more
than 70 diverse programs and services,
Wilder works with thousands of individuals
every year to help them overcome barriers Photo used with permissioin of The Wilder Foundation Early Childhood Programs
to learning, address mental health needs, intervention corresponding to universal, the past five years, the Dina Dinosaur
live more independently, maintain selective, and indicated prevention curriculum has been implemented in
affordable housing, and engage in their programs, plus an additional treatment Wilder’s Child Development Center,
communities. program. an accredited full-day early child care
At Wilder, three of the Incredible Years and education program that works
The Continuum of Incredible with some of the most vulnerable
programs have been implemented and
Years Programs two additional programs were added in members in the community. In
The Incredible Years programs have November 2009: addition, Wilder trains and mentors
two foci: (1) comprehensive treatment other early childhood professionals
■ Dina Dinosaur is a classroom-based to use the Dina Dinosaur curriculum,
programs for young children with early prevention curriculum that
onset conduct problems, and (2) universal including those from Head Start, early
teaches social problem-solving and childhood special education, and
prevention programs to promote social self-regulation skills in order to prevent
competence and prevent young children community-based child care centers.
and reduce aggression at home and
from developing conduct problems in school (Level 2 of the intervention ■ Dina small group therapy program is
the first place. The curricula are designed pyramid). It is delivered in the a treatment program (Level 5 of the
for teachers, parents, and children. The classroom two to three times a week in pyramid) designed specifically for
development of materials was guided 15–20 minute circle time discussions young children who show high rates of
by developmental theory and fit into followed by small group activities. For aggression, defiance, and oppositional
an intervention pyramid with levels of or impulsive behaviors. It is delivered

26 Healthy Generations
in small group sessions for 20–22 weeks.
In addition to the weekly therapeutic
sessions for children, the BASIC Parent
Program is offered to parents so they
learn ways to foster healthy interactions
at home similar to what their children
are learning in the group.
■ Preschool BASIC parent program is
designed for parents of 3 to 6 year-olds.
It focuses on strengthening children’s
social skills, emotional regulation, and
school readiness skills. Parents are
taught how to encourage cooperative
behavior and how to use positive
discipline by establishing rules, routines,
and effective limit setting.
■ Parents and babies program is designed
for parents of infants (ages 0–12
months). The program focuses on
helping parents learn to observe and
read their babies’ cues and learn ways
to provide nurturing and responsive
care, including physical, tactile, and
visual stimulation as well as verbal
■ Parents and toddlers program is
designed for parents of 1 to 3 year-olds.
Parents learn how child-directed play National Award Recipient continued from page 19 Family Home Visiting
promotes positive relationships, how to On September 25, 2009, the Substance
use emotion coaching to build children’s Abuse and Mental Health Services
emotional vocabulary and encourage Administration announced that Wilder’s Visit
their expression of feelings, how to build Incredible Years Program was selected as one fhv/index.html for information about the
children’s self-esteem through praise of 27 nation-wide recipients of their 2009 family home visiting program and www.
and encouragement, and how to teach Science and Service Awards. These awards
age-appropriate self-care skills. recognize exemplary implementation of newsletter/documents/summer2009.pdf for
evidence-based interventions that have been information about reflective practice.
Program Outcomes shown to prevent and/or treat mental illness References
In 2009, Wilder Research completed an and substance abuse. 1. Powers S, Fenichel E. Home visiting: reaching babies
and families “where they live.” A report of the best
outcome report of data collected since For more information about the early available information from 20 years of research and
implementing the Incredible Years programs childhood programs offered at the practice on home visiting. Washington DC: Zero to
(2005–2009). Children showed statistically Wilder Foundation, go to www.wilder. Three, 1999.
significant improvements in all five org/432.0.html. For more information about 2. Zeanah CH, Zeanah PD. Towards a definition of infant
behavioral domains: emotional symptoms, the Incredible Years programs, please go to mental health. Zero to Three, 2001; 22(1):13-20.
conduct problems, hyperactivity-inattention, 3. Nursing Child Assessment Satellite Training (NCAST)
AVENUW. Available from:
peer problems, and pro-social behavior.
Parents and teachers reported that fewer 4. Miller W, Rollnick S. Motivational interviewing.
Gael Thompson, MSW, LICSW, is the Early Childhood preparing people for change, 2nd edition. New York:
children had difficulties with emotions, Intervention Program Coordinator at the Amherst H. Guilford, 2002..
concentration, behavior, or getting along Wilder Foundation Child Guidance Clinic, St. Paul,
with others at discharge compared to intake. MN.
Sharon Hesseltine, BSW, is a Child Development/
Parents who participated in the Preschool
Infant Mental Health Specialist in the Family and
BASIC Parent Program demonstrated Community Health Division of the Minnesota
significant improvement from intake to Department of Health
discharge in six of seven parenting skills
areas: appropriate discipline, harsh and Jill E. Simon, MSW, LICSW, IMH-E® (IV), is a
inconsistent discipline, positive verbal Reflective Practice Consultant in the Family and
Community Health Division at the Minnesota
discipline, praise and incentives, physical Department of Health.
discipline, and clear expectations.

Winter 2009-2010 27
Supporting the Mental Health Needs of
Traumatized Young Children
Abigail Gewirtz, PhD, LP

A 2009 study by the U.S.

Department of Justice indicates
that children (birth to 17 years)
experience astonishingly high rates
of traumatic events.* Over 60% of
children studied had experienced or
witnessed at least one violent incident
in the past year.1 The youngest
children—those ages birth to five—
were most vulnerable to abuse,
neglect, and exposure to domestic
violence. Such young children are the
most dependent on caregivers, and
cannot report on their own traumatic
experiences, complicating efforts to
gather prevalence data.1

Risks Associated with Trauma who are homeless—are most likely to be to live in communities (or on bases) with
single-mother families with several young better social supports and more resources.
Several subgroups of very young children
children. Children living in homeless
are at particularly high risk for exposure to
families are significantly more likely to Treatment for Traumatized
traumatic events. These are young children
have health and social-emotional problems Young Children
with backgrounds indicating high adversity
compared to poor children who have
or exposure to multiple stressful events, and What can be done to support young, highly
often the caregivers of these children also stressed families dealing with traumatic
have been exposed to significant trauma. Military families. Recent studies have shown experiences? Over the past several decades,
These childhood experiences include increased risk of maltreatment among effective programs have been developed
homelessness, having refugee parents who children in military families where a parent to both prevent and treat trauma-related
have fled war in their native countries, and has been deployed to Iraq or Afghanistan.4 problems in adults and children. SAMHSA’s
having mothers fleeing domestic violence. Parents remaining at home are challenged National Child Traumatic Stress Network
An additional group emerging as high-risk by the stressors associated with being a sole (NCTSN) is a nationwide network
includes children whose parent(s) have caregiver and having a deployed partner of Centers dedicated to developing,
been deployed to combat duty in Iraq or in an unsafe environment. Reunions can disseminating, and implementing best
Afghanistan. These "high-risk" families are also be stressful for all members of the practices in child trauma.5 The NCTSN’s
less likely to access mental health or related family. Some returning soldiers may have
services that might buffer poor parenting,2 posttraumatic stress disorder (PTSD), * Traumatic events include any event in which an
increasing both parenting and couple individual experiences actual or threatened death,
enhance social support, and increase child serious injury, the threat to physical integrity, or the life
and family functioning. challenges. In the military, supports for or integrity of a close associate. Examples include abuse,
active-duty service families are stronger than domestic violence, community violence, wars, natural
Homeless and poor families. Families
for families with caregivers serving in the disasters such as tornados or flooding, terrorism, or motor
living in poverty—particularly those vehicle or other accidents.
National Guard or Reserves; the former tend

28 Healthy Generations
goal is to increase access to high-quality care
for traumatized children and their families.
Parenting through change. Ambit Network Earn an Online MPH
is the NCTSN Center in Minnesota. A
community-University partnership based In Maternal and Child Health
at the University of Minnesota, Ambit
includes multiple child-serving systems
and agencies. Over the past four years,
Ambit (formerly known as the MN Child
Response Center) has trained hundreds of
practitioners in Minnesota to increase their
capacity to identify and provide services
for traumatized children and families. The
Center has focused on the implementation
of two types of interventions—treatment
for individual children and prevention to
support parenting in traumatized families.
A flexible program for working professionals who are
The latter, Parenting through Change concerned about vulnerable populations and want to
(PTC),6 is a 14-week group that enhances
critical elements of parenting that may acquire leadership skills for addressing the health needs
be adversely affected when families have of families, women, infants, children, and adolescents.
experienced traumatic events. PTC has been
implemented successfully in a shelter, at
several supportive housing agencies, and
at schools, in collaboration with several
non-profit agencies (the Family Housing
Fund and the Minneapolis Public Schools).
In partnership with the Center for Victims
of Torture and the East African Women’s
Center, a PTC group will begin with Somali
mothers in Minneapolis in late 2009. Also in
late 2009, a PTC group for returning military T o learn more: visit our Web site
parents will be led by Ambit Network staff in
partnership with the Minneapolis Veterans or email
Administration Medical Center.
or call (612) 626-8802
Trauma-focused cognitive behavioral
therapy. For traumatized children ages
three and older, trauma-focused cognitive
behavioral therapy (TF-CBT)7 is a treatment through Ambit Network, contact Ashley 6. Forgatch MS, Patterson GR, DeGarmo DS, Beldavs ZG.
shown to be effective in multiple settings. Wahl at 612-624-7722. Testing the Oregon delinquency model with 9-year
follow-up of the Oregon divorce sudy. Dev Psychopathol
Over the past three years, Ambit Network, in 2009; 21:637-660.
partnership with the Minnesota Department REFERENCES
7. Cohen J, Mannarino A, Deblinger E. Treating trauma and
of Human Service, Division of Children’s 1. Finkelhor D, Turner H, Ormrod R, Hamby S, Kracke traumatic grief in children and adolescents. New York:
K. Children’s exposure to violence: a comprehensive
Mental Health, has trained and provided Guildford Press, 2006,
national survey. Juvenile Justice Bulletin, Washington
technical assistance to almost 100 mental DC: Department of Justice, Office of Justice Programs,
health professionals across Minnesota to OJJDP Bulletin, 2009. Available from: http://www.ncjrs.
Abigail Gewirtz, PhD, LP, is an Assistant Professor
deliver TF-CBT. in the Department of Family Social Science and the
2. Gewirtz AH, Forgatch M, Wieling L. Parenting practices Institute of Child Development at the University of
Over the next three years, Ambit, in as potential mechanisms for child adjustment following
Minnesota, and Director of Ambit Network.
collaboration with Minnesota’s Department mass trauma. J Marital Fam Ther 2008; 34(2):177–192.
of Human Services, will expand its efforts to 3. Gewirtz AH, DeGarmo DS, Plowman E, August GJ.
develop a trauma-informed mental health Parenting, parental mental health, and child functioning
in families residing in supportive housing. Am J
system in Minnesota, to ensure that all Orthopsychiatry, in press.
children and families who have experienced
4. Gibbs DA, Martin SL, Kupper LL, Johnson RE. Child
traumatic events have access to the best maltreatment in enlisted soldiers’ families during
services available. combat-related deployments. JAMA 2007; 298:528-535.
5. National Child Traumatic Stress Network. Description,
For more information about the programs
resources and products. Available from:
for traumatized children and families offered

Winter 2009-2010 29
Minnesota Early Childhood Comprehensive System (MECCS):
Building the Infrastructure to Meet Developmental Needs of Young Children
Kelly Monson MAEd, CFLE

E xtensive research supports the

importance of a comprehensive
system of care and services for children
in order for them to be ready for
school.1,2 Many state efforts to improve
school readiness have focused on
strengthening early learning services
such as child care and preschool.
However, to be prepared for school and
the interaction of normal life situations,
how young children feel and behave is
just as important as what they know
and think. All of these competencies
are inextricably linked.

Moving from a Fragmented ■ Mental health and social-emotional adopt a model developed by the National
development; Childhood Systems Working Group1,3 that
to a Comprehensive System integrates the key systems necessary for early
■ Early child care and education;
In most states, policies and programs that childhood development: (1) health, mental
address the developmental needs of young ■ Parenting education; and health and nutrition; (2) early learning; (3)
children and their families are spread across ■ Family support. family support; and (4) special needs/early
government agencies, funded through intervention.1,3
The Minnesota Department of Health
different sources, and delivered through The five essential elements of ECCS
(MDH) has been an ECCS grantee since
multiple public and private providers in are represented by one or more of the
July 2003. The Minnesota Early Childhood
communities.1 This fragmentation is costly, four ovals in this systems model. While
Comprehensive System (MECCS) focuses
inefficient, and most importantly, results in individual programs within any of the ovals
on infrastructure and capacity building
many needs of young children going unmet. may demonstrate some positive impact
services and involves representatives of key
In an effort to encourage comprehensive upon children’s healthy development and
units within the state departments of health,
systems for young children 0–5 years and school readiness, they will not realize
education, and human services whose
their families, the Health Resources and their full potential without support from
work is directly related to the five critical
Services Administration initiated the State the programs in the other ovals.1 By
Early Childhood Comprehensive Systems adopting a systems model, mental health
(ECCS) grants in 2003. The purpose of
Adopting a Model was incorporated into early childhood
ECCS grants is to integrate early childhood systems-building in Minnesota. Ensuring
policies and programs, including funding for Systems Development
positive mental health requires that children
streams. The systems to be integrated include With this multi-sector partnership, have good self-esteem, adaptive skills, and
key public, private, state, and local agencies Minnesota adopted the goal of “families positive social behaviors with peers and
that address five critical components of early supported and children thriving, healthy, adults—and that any developmental delays
childhood: and ready for school in the context of of children are recognized and treated.1
■ Access to health insurance and medical culture and community.” In 2007, MECCS
homes; collaborated with Ready 4K, the state
recipient of a national Build grant,3 to

30 Healthy Generations
Key Indicators to Monitor identified and referred at early REFERENCES

an Early Childhood System childhood screening; 1. Bruner C. Connecting child health and school
readiness. Build Initiative and Child and Family Policy
In collaboration with the Wilder Foundation, ■ Number/percent of children being Center, February 2009. Available from: http://www.
Minnesota Build and MECCS identified 22 served through publicly funded mental
indicators of child and family well-being health services compared to estimated
need; 2. Shonkoff J, Phillips D. (Eds.). National Research
and systems quality that represent each Council and Institute of Medicine. From neurons
of the four ovals in the systems model.4 ■ Number of children ages 0–2 and 3–4 to neighborhoods: the science of early childhood
development. Washington, DC: National Academy Press,
Identification and ongoing measurement enrolled in quality early childhood 2000.
of indicators are critical because such data programs;
3. Build initiative: A project of the Early Childhood
allow the state partners to: ■ Participation rates in ECFE and other Funders’ Collaborative supporting state efforts to prepare
our youngest children for success. Available from: http://
■ Track trends in young child and family parent education and support models;
well-being over time; and
4. Moore C, Chase R, Waltz M, et al. Early childhood
■ Measure progress toward improving ■ Number/percent of children birth to 3 Minnesota Indicators and strategies for Minnesota’s early
childhood system, a joint report of Minnesota Build and
child outcomes; years who are served through Part C Minnesota Early Childhood Comprehensive Systems. St.
■ Improve programs for children and Early Intervention. Paul: Wilder Research, 2008. Available from: http://www.
families; Given the frequently voiced concern by both
■ Inform state and local planning and parents and professionals about the unmet
social-emotional needs of young children, Kelly Monson MA Ed, CFLE, is a State Early
policymaking; Childhood Systems Coordinator at the Minnesota
the infrastructure being developed through
■ Monitor the impact of investments and Department of Health, Community and Family
MECCS is an important step in the direction
policy choices; Health Division.
of filling this gap and improving the mental
■ Improve data quality and availability of health of all young children in Minnesota.
current and emerging indicators; and For more information about MECCS, visit
■ Expose and eliminate disparities by their website at:
income and race/ethnicity...4 divs/cfh/meccs/. For more information about
the BUILD initiative, visit their website at:
Some of the indicators selected that relate
specifically to young children’s mental health
■ Number/percent of children with
possible social-emotional problems

Winter 2009-2010 31
Center for Excellence in
Children’s Mental Health
Linking University and Community Experts and Resources Cari Michaels, MPH

T he Center for Excellence in Children’s Mental Health (CECMH) was established

in 2003 as part of the University of Minnesota President’s Initiative on Children,
Youth, and Families. Its mission is to promote the mental health of Minnesota
children, their families, and their communities by informing and integrating research,
training, practice, and policy. Toward that end, CECMH staff work with University
faculty, staff, and community members to improve children’s mental health in the state
of Minnesota.

Head Start Goals specific area and a collection of responses SPEAKERS' SERIES Center for Excellence
from providers and policymakers regarding
Since its inception, CECMH has displayed in Children’s Mental Health LESSONS
the practical application of that research. The
a strong commitment to strengthening from the FIELD 2009-2010:
first issue, “Attachment Relationships and
children’s mental health by promoting the Race, Culture and Children’s Mental Health
Adoption Outcomes,” and all subsequent
use of evidence in mental health practice
eReview issues are published on the CECMH
and policymaking. CECMH also works December 4, 2009, 9:00 a.m. – 12:30 p.m.
website (
with faculty members to promote publicly Historical Trauma, Microaggressions, and Identity: A
engaged research that is pertinent to the One of the most critical areas of CECMH Framework for Culturally Based Practice
needs of community members. work is to promote publically engaged Dr. Karina Walters
research by building partnerships between February 17, 2010, 9:00 a.m. – 12:30 p.m.
In order to engage a wide range of
research faculty and community members. Intersection of Culture and Children’s Mental Health
providers, parents and researchers in in Working with Immigrant & Refugee Families
CECMH staff bring University research
training events, CECMH sponsors an
expertise to bear on problems of significance March 18th, 2010, 9:00a.m. – 12:30 p.m.
annual Lessons from the Field seminar
to the community—facilitating the Promoting Child Well-being and Early Intervention
series that features local and national within a Cultural Context
community’s voice in guiding academic
speakers. Seminars are video-streamed Brenda Jones Harden, University of Maryland
research. One example of this work is the
live to over 30 sites in Minnesota where
CECMH’s active participation in a Cultural May 12, 2010, 1:30p.m. – 3:30 p.m.
participants view and listen to the speakers Title TBD
Providers Network of local clinicians
and participate in discussions. Each Lessons Alicia Lieberman, University of California – SF
that serves children of color. This diverse
from the Field series is organized around a
group of dedicated providers incorporates All sessions will be at the Coffman Theater, University
community-identified theme. Because of of Minnesota and broadcast to sites in Greater
research-based evidence into their work
CECMH’s strong interest in early childhood, Minnesota.
and develops new, culturally appropriate
the 2006–2008 seminars explored issues
interventions. Sponsors: Center for Excellence in Children’s
of attachment and its relationship to Mental Health in partnership with Center for
mental health, intervention, treatment CECMH is housed in the interdisciplinary Advanced Studies in Child Welfare (UMN) and Harris
methods, and intergenerational issues. The Children, Youth, and Family Consortium Programs (UMN).
2009–2010 series will focus on race, culture, (CYFC) at the University of Minnesota. For
Co-sponsors: Center for Leadership Education
and children’s mental health.This series is more information about CECMH and its in Maternal and Child Public Health (UMN), MN
co-sponsored by several partners, including projects, visit or call ADOPT, Office for Equity and Diversity (UMN),
the Center for Leadership Education in (612) 625-7849. Minnesota Community Foundation-Baby Project, and
Maternal and Child Public Health. Sheltering Arms Foundation.
CECMH also disseminates current, Cari Michaels, MPH, is the Associate Director of the
applicable, and accessible research to Center for Excellence in Children’s Mental Health at
the University of Minnesota.
providers and policymakers. CECMH
For more information, visit: http://www.cmh.
eReview is an online publication that features
a summary of published research in a
32 Healthy Generations
Culturally Sensitive, Relationship-based Practice
Promoting Infant Mental Health
Competency-based Training and Endorsement Candace Kragthorpe, MSW, IMH-E® (IV)

A ll providers and educators who

work with young children and their
families play critical roles in promoting
optimal mental health outcomes for
infants, toddlers, and preschoolers.
Roles may include health promotion
for all children, preventive intervention
in at-risk situations, early intervention
that addresses developmental concerns,
and intensive services and treatment
for children with serious emotional
disturbances. Best practices for this
population focus on supporting positive
relationships between parent, child,
and other caregivers in the context of a
family’s culture and community.

Training in Best Practices Professional competencies. MAIECMH outcomes, improved quality of services, and
works to advance standards in practice support for ethical practice and cultural
Infant and family professionals require among a range of professional disciplines competence.1
specialized professional development and working with infants, young children, and
consultation from infant mental health Endorsement. Professional competencies
their families. These standards are grounded are the framework for a professional
specialists to ensure service quality and in comprehensive professional competencies
effectiveness in addressing the diverse and endorsement program offered in Minnesota
based on infant mental health principles, as by MAIECMH, called Culturally Sensitive,
often complex needs of infants, young identified by the Michigan Association for
children, and families. Relationship-based Practice Promoting
Infant Mental Health (MI-AIMH). These Infant Mental Health. A number of states
The Minnesota Association for Infant principles include mutuality of caregiving across the country offer the endorsement
and Early Childhood Mental Health relationships and understanding and using program, developed and copyrighted by
(MAIECMH) is a statewide membership the rich histories, feelings, and behaviors MI-AIMH. Working with MI-AIMH,
organization whose mission is to promote that the child, parent/caregiver, and partner states, Minnesota organizations,
social and emotional development and provider/educator bring to these working and association members, MAIECMH is
mental health of children, from birth to 5 relationships. promoting and evaluating the application
years. Founded in 2007 and affiliated with Reflective practice. These principles of these competencies among a range of
the World Association for Infant Mental require that professionals actively engage practitioners, providers, and educators.
Health, MAIECMH operates as the infant in a reflective stance via supervision and
and early childhood division of MACMH The set of professional competencies can be
consultation. This reflective practice is used to:
(Minnesota Association for Children’s an integral component of interventions
Mental Health). The goals of MAIECMH provided along a continuum of care, from ■ Guide and encourage continuous
include education and advocacy to enhance promotion and prevention to intensive professional development and career
culturally sensitive interdisciplinary capacity treatment. Reflective supervision, provided planning;
to serve infants, young children, and their regularly, leads to improved family ■ Guide the development of pre-service
families. Continued on page 35
Winter 2009-2010 33
Bringing Order to the Complexity of Early
Experience The Role of Training in Infant Mental Health
Elizabeth A. Carlson, PhD, LP

E arly childhood is unique in the human life cycle for the rapidity and
complexity of developmental change and transformation.1 Typically, the
infant progresses from complete dependence upon the caregiver to a mobile,
cognitively sophisticated, self-regulating child who is capable of understanding
and participating actively in the social world.1,2 However, development in the early
years is paradoxical; it is both highly robust and highly vulnerable, with cascading
effects for later development.3

growth-promoting experiences in cognitive, and higher quality care and intervention

linguistic, social, and emotional domains.3 outcomes.3,4 Recent competency systems,5,6
While the majority of children experience including the Minnesota Association of
the benefits of both, significant numbers do Infant and Early Childhood Mental Health
not. (MAIECMH) endorsement process, provide
important guidelines for higher education
The Need for Training Specific institutions and other organizations in
to Infant Mental Health establishing effective training programs.
The many practitioners engaged in Competencies needed. Training itself is
addressing the needs of young children complex and involves a developmental
and their families often face a host of process including multiple levels of
challenges, including the need to move experience.7 Practitioners must acquire:
beyond their own professional training and ■ A knowledge base from which to
experience. Well-defined training within understand infants and toddlers, the
one age range (e.g., middle childhood, adults who care for them, and early
adolescence) or within one discipline (e.g., relationship development;
education, nursing, social work) often does
not equip providers to address the complex ■ Skills of observation, assessment, and
needs of the birth-to-three population intervention, and guidance in their
and their family life circumstances, such application; and
as family stressors, issues associated with ■ Opportunities for reflection with
poverty, and/or cultural diversity. Moreover, a training supervisor who is
domain-specific training may not prepare knowledgeable about early development
Conditions Necessary for professionals to work across disciplines nor and able to help sustain the work.
Infant Mental Health to develop a shared perspective or language Similar to processes of change or learning
about development and practice. As a result, in other domains, the professional
The well-being and well-becoming of young providers and interventionists report feeling development of skilled workers, teachers,
children (infant mental health) depend isolated, ineffective, and overwhelmed by the and interventionists in early childhood
upon two essential conditions: (1) stable and work.4 necessitates more than new information or a
loving relationships with a limited number
Ongoing evaluation research highlights new technique. It requires a transformation
of adults who provide responsive, regulatory
the need for a common understanding of or shift in understanding of the nature
experience, encouragement for exploration
early development and the social contexts of early experience and its role in later
and learning, and transmission of cultural
in which development unfolds, as well as functioning.
values; and (2) a safe and predictable
environment that provides a range of the association between specialized training

34 Healthy Generations
continued from page 33
Promoting Infant Mental Health

The comprehensive series of courses and and continuing education curricula;

experiences provides a background in early ■ Document and demonstrate to families,
development, experience in observation colleagues, employers, and funders a
and assessment, guidance in the application professional’s growing proficiency in
of developmental principles to prevention/ specialized knowledge and skills;
intervention, and reflective practice
regarding the experience of families ■ Enhance staff development activities;
that are served and the interveners who ■ Promote effective, culturally-sensitive
serve them. Informed by developmental program development;
research and theory, the training program
■ Inform policy development and systems
attends to principles and processes
enhancements; and
that underlie both typical and atypical
development in early childhood. From ■ Identify research agendas.
this framework, child behavior is viewed Endorsement for Culturally Sensitive,
as an adaptation constructed over time, a Relationship-based Practice Promoting Infant
product of regulatory history and current Mental Health is available to providers,
environmental challenges and supports. clinicians, and educators who work in a
Such a developmental perspective brings range of settings and disciplines at four
order to the complexity of early experience. professional levels spanning the continuum
Interdisciplinary training in development of care.2 Depending on the education and
facilitates communication and coordination experience of the professional, competencies
across domains, provides direction in include:
Professional Development practice, and instills hope in work with
children and families. 1. theoretical foundations
Program at the University
of Minnesota For more information about the Infant 2. law, regulation and policy

As one of a number of training programs and Early Childhood Mental Health 3. systems expertise
in the U.S., the University of Minnesota’s certificate program, contact Sara Zettervall 4. direct service, reflection and leadership
2-year post-baccalaureate Infant and (612-625-2252) or visit their website: skills and
Early Childhood Mental Health certificate
certificateprograms/IECMH/default.html 5. research and evaluation.
program provides a professional
development opportunity for early REFERENCES For more information
interventionists and an illustration or model
of a process-oriented approach to training.
1. Sroufe LA. (1996). Emotional development: the about endorsement:
organization of emotional life in the early years. New
The program is designed for front-line York: Cambridge University Press, 1996. Contact MAIECMH staff at 651-644-7333
service providers (e.g., public health nurses, 2. Zeanah CH (Ed.). Handbook of infant mental health, 3rd or 1-800-528-4511
edition. New York: Guilford Press, 2009.
early childhood and family educators, Continuing requirements for endorsement
child welfare workers, home visitors) and 3. Shonkoff J P, Phillips DA. From neurons to
include MAIECMH membership and 15
neighborhoods: the science of early childhood
credentialed mental health professionals development. Washington, D.C.: National Academy hours annually of related training approved
who wish to build their knowledge and skills Press, 2000. by MAIECMH. A central registry of
in early childhood mental health, dyadic or 4. Erickson MF, Kurz-Riemer K. Infants, toddlers, and endorsees and consultants is maintained at
triadic treatment, and reflective consultation. families: a framework for support and intervention. New
the MACMH office, 165 Western Avenue
York: Guilford Press, 1999.
The Institute of Child Development, the North, Suite 2, St. Paul, MN 55102
academic home of the program, offers 5. Korfmacher J, Hilado A. Creating a workforce in early
childhood mental health: defining the competent
graduate credits applicable to advanced specialist. Research Report from the Herr Research
degrees; alternatively, participants may Center for Children and Social Policy at Erikson 1. Lamb-Parker F, LeBuffe P. A strength-based, systemic
complete the program for professional Institute, 2008. Available from: mental health approach to support childen’s social and
hrc emotional development. Infants & Young Children
continuing education units. 2008;21(1):45-55.
6. Weatherston DJ, Dowler Moss B, Harris D. Building
capacity in the infant and family field through 2. MAIECMH Endorsement for Culturally Sensitive,
competency-based endorsement: three states’ Relationship-based Practice Promoting Infant Mental
experiences. Zero to Three 2006; 26(3):4-13. Health. Available from:
…the professional development of skilled maiecmhweb/2PageEndorsemntFlyer.pdf
workers, teachers, and interventionists in 7. Fraiberg S. Clinical studies in infant mental health. New
York: Basic Books, 1980.
early childhood requires a transformation
Candace Kragthorpe, MSW, IMH-E® (IV), is Director
or shift in understanding of the nature of the Minnesota Association for Infant and Early
Elizabeth A. Carlson, PhD, LP, is Director of the
of early experience and its role in later Harris Programs and is a Research Associate at
Childhood Mental Health (MAIECMH), a Division of
functioning. MACMH.
the Institute of Child Development, University of

Winter 2009-2010 35
Interested in Making a Difference?
Consider a Master’s in Public Health (MPH) degree in Maternal and Child Health (MCH)

F or Lauren Gilchrist, a typical day at work always has “an exciting element of
the unexpected.” Gilchrist is a health policy advisor for Minnesota Senator Al
Franken. As the nation is engaged in a debate about health care reform, it is not
surprising that Capitol Hill would provide a stimulating professional venue for
this recent MCH Master's of Public Health graduate.

“The hands-on experience and historical And I use that as a way to evaluate policy
perspective on policy as a strategy for public opportunities, and to frame ideas that we
health” that Gilchrist received through are thinking of putting forth or supporting
Jean Forster’s legislative advocacy classes ideas that other folks have put forth.”
gave her a way to pull all of her skills Gilchrist’s work with Senator Franken is
together. During her MCH training, she a good fit because the health of women
spent a semester working with the state and children throughout the life course
legislature at the Children’s Defense Fund are among his policy priorities. According
A native of Rochester, Minnesota, home of Minnesota. Through that experience she
of the world-renowned Mayo Clinic, to Gilchrist, “maternal and child health
realized that public policy work was a good issues are critically important when we are
Gilchrist grew up believing that people fit for her skills and personality.
“deserve a high standard of health care designing public health programs…and
and health status.” After graduating from After receiving her MPH in 2007, Gilchrist policy. Also, when we are looking at health
Wesleyan University, Gilchrist pursued this worked as the Outreach Director for the care reform, we want to make sure…that
view, working for several years in direct Deborah E. Powell Center for Women’s everything we do is in the best interest of
services with underserved communities. Health at the University of Minnesota, maternal and child health because we know
That experience gave Gilchrist perspective where she planned programs to promote that those investments have the greatest
about the day-to-day challenges confronting the health of women and girls. In 2008, pay-off in the long run.”
disenfranchised people. To Gilchrist, Gilchrist received a one-year Health Policy Gilchrist’s future goals in her position
“direct services were rarely getting to the Fellowship from the Association of Schools are “to pass national health care reform
root of problems…I felt like I was putting of Public Health. Her placement with the and make sure it is implemented in
band-aids on things instead of helping late Senator Ted Kennedy on the U.S. Senate a way that will be most beneficial to
problems be resolved or improved in a Committee for Health, Labor, Education, Minnesotans.” Additionally, Gilchrist
larger sense.” and Pensions helped her transition from hopes to “continue to make our country
designing public health programs and a more prevention-focused place,” so that
Gilchrist pursued a degree in public health working on state policy to working on
because she wanted to use research and discussions about health care reform are a
policy at the federal level. jumping-off point for a movement towards
policy as tools to make systemic changes to
improve people’s lives. Through the MCH After her Fellowship Gilchrist began work health promotion, health maintenance, and
Program at the University of Minnesota, with Minnesota Senator Al Franken. Her addressing barriers to optimal health at the
Gilchrist was able to take classes about position offers “a great opportunity… to be community level.
the health of children and families and tied to what is going on…in [Washington] Learn more about getting an MPH in
develop strong analytic and quantitative D.C…and at the same time…work on Maternal and Child Health, visit:
skills through the program’s epidemiology Minnesota issues.” Gilchrist spends her
time meeting with Minnesota constituents,
emphasis curriculum.
collaborating with other Senate offices, and html
Particularly influential in her current work drafting and evaluating original legislation email: Kathryn Schwartz,
as a policy advisor are the skills Gilchrist to develop and support policies that will
gained in epidemiology and program “enhance the health of Minnesotans.”
evaluation as a student in the MCH Gilchrist’s experiences as a Minnesotan, a
program. Her training in epidemiology gave public health professional, and a specialist
Gilchrist the “ability to look critically at in maternal and child health give her a
research” and assess its quality. The skills she unique perspective on health policy: “I look
developed in program evaluation help her at everything through a Minnesota lens,
to determine if a policy has accountability. a public health lens, and…an MCH lens.

36 Healthy Generations
Website Resources for Early Childhood Mental Health

In addition to the websites identified in this issue’s articles, the following list provides additional select web resources related to early childhood
mental health and social-emotional development.

American Academy of Pediatrics advocates at the federal and state National Center for Children in Poverty at Columbia University’s
level for children’s mental health as well as provides informational resources Mailman School of Public Health, conducts research on states’ efforts to
to parents and professionals about the behavioral and mental health of infants maximize polices to provide services that effectively promote social and
and young children. emotional development in early childhood, particularly for at-risk children.
Bright Futures is a national initiative that seeks to strengthen the
connection between state and local programs, health and service providers, National Early Childhood Technical Assistance Center (NECTAC)
and families through cross-agency training and distance-learning curricula is supported by the U.S. Department of Education’s Office of Special
related to children’s mental health. Education Programs to strengthen service systems to ensure that children with
disabilities (birth through 5 years) and their families receive and benefit from
Center for Early Education and Development (CEED) and the Irving high quality, culturally appropriate, and family-centered supports and services.
B. Harris Training Center for Infant and Toddler Development at the University
of Minnesota support the social-emotional development of young children
throughout Minnesota through applied research on infant mental health, Social and Emotional Development in Children and Adolescents–
trainings to help educators address challenging behaviors, and outreach to MCH Knowledge Path offers a selection of recent scientific research
promote quality early child care. about the promotion of healthy social and emotional development in young
children as well as tools for keeping up-to-date with new research. http://www.
Center on Social and Emotional Foundations of Early Learning
(CSEFEL) is a national resource center that provides training materials,
videos, and print resources to help early child care, health, and education Technical Assistance Center on Social Emotional Interventions
providers implement the Pyramid Model for Supporting Social Emotional (TACSEI) translates research on effective practices for improving the social
Competence in Infants and Young Children. and emotional health outcomes for young children into free products and
resources to help caregivers and service providers apply best practices in their
Georgetown University Center for Child and Human everyday work.
Development provides national technical assistance, trainings, and policy
resources, and conducts research and evaluation to address mental health Zero to Three provides resources for parents and professionals on
needs of young children. social-emotional development and mental health of young children as well as
information for policymakers and advocates on relevant public policy initiatives
Minnesota Association for Family and Early Education (MNAFEE) and advocacy opportunities.
is a membership organization that offers professional development meetings,
conferences, and networking opportunities to providers and coordinators of
early childhood education throughout Minnesota.

Winter 2009-2010 III

Center for Leadership Education in Nonprofit Org.
Maternal and Child Public Health U.S. Postage
School of Public Health PAID
Division of Epidemiology and Community Health Mpls., MN
University of Minnesota Permit No. 155
1300 So 2nd St Suite 300
Minneapolis, MN 55454

Save these dates

for upcoming conferences and events
December 2, 2009 January 13–15, 2010
National Children’s Study Speakers Series Strong Foundations Conference & MN Fatherhood Summit
Fatherhood in the 21st Century: From Pregnancy Planning to Engaging Fathers – Strengthening Families
Parenting Arrowwood Resort, Alexandria, MN
Robert “Clarence” Jones, MA; Community Outreach Director, Sponsors: Minnesota Departments of Health, Education and Human
Southside Community Health Services/Q Health Connections Services; MN Fathers and Families Network, CEED, Center for
3:00–4:30 p.m., FREE Leadership Education in Maternal and Child Public Health
Wilder Center, 451 Lexington Parkway North, St. Paul, MN Registration:
Sponsors: National Children’s Study, Center for Leadership Education
in Maternal and Child Public Health January 20, 2010
Registration: Laurie Ukestad, National Children’s Study Speakers Series
Fetal Origins of Adult Disease
December 4–6, 2009 Kristin Oehlke, MS, CGC; State Genomics Coordinator,
The National Federation of Families for Children’s Mental Minnesota Department of Health
Health Conference 3:00–4:00 p.m., FREE
Children’s Mental Health Matters Wilder Center, 451 Lexington Parkway North, St. Paul, MN
Washington, D.C Sponsors: National Children’s Study, Center for Leadership Education
Registration: in Maternal and Child Public Health
Registration: Laurie Ukestad,
December 4–6, 2009
National Training Institute: Zero to Three January 25–27, 2010
Dallas, TX Child Welfare League of America National Conference
Registration: Children 2010: Leading a New Era
Marriott Wardman Park Hotel, Washington, D.C.

March 6-10, 2010

Association of Maternal and Child Health Programs
Annual Conference
Washington, D.C.

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