Together for Kids: First Year Report: A Project of Community Healthlink, Inc.

The Together for Kids (TFK) project grew out of two years of work of over 30 childcare, health care, child welfare, and social service agencies concerned about early childhood mental health issues. These concerned constituents, like others across the country, were responding to an increase in the incidence of young children exhibiting challenging behaviors that were resulting in disrupted early childhood classrooms and children being expelled from programs (Grannon et al, 1999; Swanson, 2001). The importance of addressing the needs of these children at an early stage has been emphasized by a broad array of mental health and childcare professionals. Without appropriate services, these children end up with impaired ability to interact appropriately with family and peers; create family stress; become stigmatized as problem children; fail to develop school readiness skills and behaviors; cause disruptions to other children’s learning, socialization and safety; and contribute to burn out and turnover of preschool teachers (Grannan et al 1999; Shonkoff & Phillips, 2000). The TFK Coalition collected information from the research literature and from local day care centers about the extent of children at risk in the Worcester area. They found that 3.1% of children in four local day care centers, enrolling over 300 preschool children, were so disruptive they were expelled or would have been if the parents did not voluntarily withdraw them, with an additional 14% identified as at risk of expulsion. They also anecdotally connected the increasing difficulty in managing classrooms with high staff turnover, ranging up to 46% in one year. At the same time, only one Center reported access to early childhood mental health services. Based on this information, the TFK Coalition began to develop an intervention model. The specific focus of the project is on challenging behaviors of preschool children (ages 3 and up) enrolled in childcare centers

Together for Kids: Three-Year Project Report: A Project Administered by Community Healthlink, Inc.

The Together for Kids (TFK) project, funded by The Health Foundation of Central Massachusetts and the United Way of Central Massachusetts, has been the result of the dedicated work of over 30 childcare, health care, child welfare and social service agencies concerned about early childhood mental health issues. These concerned constituents formed a coalition to address the increasing incidence of young children exhibiting challenging behaviors in preschool classrooms, as reflected nationally with current estimates ranging from 7% to 25% (Raver & Knitzer, 2002; Webster-Stratton & Hammond, 1997). These challenging behaviors typically include biting, hitting, throwing things, defying adults, or becoming withdrawn and unable to interact with others, and result in disrupted early childhood classrooms and children being expelled from programs (Grannan et al, 1999; Swanson, 2001). The problem of preschool expulsions has received national attention in recent years, and in fact a very recent national study confirmed that more children are being expelled from preschool than for all other grades (Gilliam, 2005). In Worcester, Massachusetts, there was also a concern about the growing number of public school special education students with diagnoses of emotional impairment or behavioral disorders in the early grades. The first year of the project intervention began as a Pilot to implement a mental health consultation model in two preschools and a Head Start Program, and to use two additional centers as comparison sites. In Year 2, these two additional centers that served as comparison centers during the Pilot phase also received the intervention. The results of the Years 1 and 2 showed behavioral improvement in children receiving the consultation services, as well as suggestive evidence for broader classroom positive effects. In Year 3, some modifications to the model were implemented. Families were allowed to continue with services when necessary beyond the 3 to 6 month intensive intervention. A Family Liaison was also added to the model to facilitate family engagement in the child care programs. The basic model of services, however, remained the same over the three years. This report is a summary of the results of the project, combing data from all three years to increase sample size and provide additional statistical power and confidence. We have determined there is sound evidence for clinical benefits of the TFK mental health consultation model, and the next step will be to sustain the model in child care programs using public resources. Thus, going forward, adaptations to the model will focus on how to establish universal screening and consultation for preschool families, using a ratio of one FTE clinician to 200 preschool children. Future evaluation activities will focus on sustainability issues, and documenting service delivery approaches for a generalizable model

Together for Kids: Second Year Report : A Project of Community Healthlink, Inc.

The Together for Kids (TFK) project, now beginning its third implementation year, grew out of two years of work of over 30 childcare, health care, child welfare and social service agencies concerned about early childhood mental health issues. These concerned constituents, like others across the country, were responding to an increase in the incidence of young children exhibiting challenging behaviors that were resulting in disrupted early childhood classrooms and children being expelled from programs (Grannan et al, 1999; Swanson, 2001). Locally, there was also a concern about the growing number of public school special education students with diagnoses of emotional impairment/behaviorally disordered in the early grades. The importance of addressing the needs of these children at an early stage has been emphasized by a broad array of mental health and childcare professionals. Without appropriate services, these children end up with impaired ability to interact appropriately with family and peers; create family stress; become stigmatized as problem children; fail to develop school readiness skills and behaviors; cause disruptions to other children’s learning, socialization and safety; and contribute to burn out and turnover of preschool teachers (Grannan et al 1999; Shonkoff & Phillips, 2000). The TFK Coalition collected information from the research literature and from local day care centers about the extent of children at risk in the Worcester area. They found that 3.1% of children in four local day care centers, enrolling over 300 preschool children, were so disruptive they were expelled or would have been if the parents did not voluntarily withdraw them, with an additional 14% identified as at risk of expulsion. Based on this information, the TFK Coalition developed an intervention model that focused specifically on challenging behaviors of preschool children (ages 3 and up) enrolled in childcare centers. The first year of the project was used as a Pilot year to implement the mental health consultation model in two preschool in Worcester and a Head Start Program in South County. Results of the evaluation of this Pilot phase were encouraging and supported the initiation of an implementation phase in Year Two. This implementation phase involved providing the mental health consultation model in two additional centers that served as comparison centers during the Pilot phase. These two sites were brought on as New Intervention Sites in January 2004. This report focuses on the evaluation of the implementation phase, including the original Pilot Sites, the South County Sites and the two New Intervention Sites, as well as summarizing the findings from both of the years of intervention

Implementing the Massachusetts Child Trauma Project (MCTP) to Improve Services for Children with Complex Trauma in Child Welfare: Phase I Needs and Readiness Assessment

MCTP seeks to improve placement stability and outcomes for children with complex trauma in the care of the Massachusetts Department of Children and Families (DCF) by creating a sustainable capacity for providing evidence-based trauma interventions within provider agencies, and trauma-informed practices within DCF

Pathways to Kindergarten Readiness: The Roles of Second Step Early Learning Curriculum and Social Emotional, Executive Functioning, Preschool Academic and Task Behavior Skills

Efforts to improve the achievement gap between low-income children and their more affluent peers has led to the development of classroom interventions and curricula to increase executive functioning (EF) and social-emotional skills (SE), thought to be foundational for learning. The Second Step Early Learning (SSEL) curriculum is a commercially available curriculum designed to improve school readiness by building EF and SE skills. However, although widely used, it has not been widely studied. Modeling SSEL’s underlying theory of change, structural equation modeling (SEM) was used to longitudinally examine the effects of the curriculum on low-income preschool children’s kindergarten school readiness through the hypothesized mediating role of EF and SE skills in improving pre-academic skills and task behavior in preschool. In a cluster randomized trial, 972 children attending 63 preschool classrooms within 13 low-income Head Start or community preschools were individually tested at the beginning (T1) and end of preschool (T2, n = 836) and followed into kindergarten. Children’s average age at T1 was 53 months, with 51% male, 42% Anglo-American, 26% African–American, and 40% Hispanic-American. Children’s EF, social skills, pre-literacy/language, and pre-math skills were assessed by trained child assessors blind to study conditions at T1 and T2. Assessors also rated children’s task behavior in the testing situation at T1 and T2. School records of children’s kindergarten screening scores were obtained on 345 children at T3. It was expected that SSEL would have both direct and indirect effects on kindergarten readiness through improvements in children’s SE and EF skills preschool academic skills and on-task behavior. We found no direct effects of SSEL on either pre-academic or on-task behavior outcomes in preschool, nor on later kindergarten readiness. However, SSEL significantly increased EF, and as expected by SSEL’s theory of change, growth in EF predicted gains in both pre-academics (particularly pre-math), and on-task behavior in preschool. End-of-year pre-academic skills and on task behavior in turn predicted better kindergarten readiness. Further, SE (although not impacted by SSEL) had direct and indirect effects on kindergarten readiness. Thus, overall, our findings largely support SSEL’s theory of change, particularly in relation to EF

Massachusetts Child Psychiatry Access Project (MCPAP) University of Massachusetts (UMass) Parent Satisfaction Study

Objective: To evaluate parents’ experience with Massachusetts Child Psychiatry Access Project (MCPAP), a Consultation Liaison model, aimed at improving access to child psychiatry for primary care (consultations to primary care providers are done either by phone contact and/or by a direct evaluation of the child by a MCPAP clinician). Methods: IRB approved Parent Satisfaction Questionnaire (PSQ) sent to families referred to the MCPAP between 2/2008-8/2008, identified using the University of Massachusetts Medical Center (UMMHC) database. Results: 360 initial and 348 follow up PSQ were mailed, and 158 PSQ returned, defining a response rate of 46.2%. 78.9% of parents agreed or strongly agreed that the services provided were offered in a timely manner. 74.9% of parents agreed or strongly agreed with the statement that their child’s issues were understood. 50% agreed or strongly agreed that their child’s situation improved following their contact with the services. 74.2% agreed or strongly agreed that the quality of the service they received was satisfying. 69% agreed or strongly agreed that the service met their family’s need. 58.6% of parents agreed or strongly agreed that the service helped them deal with their issues more effectively. 67.3% agreed or strongly agreed that they were better satisfied with the service compared to previous contact with mental health providers for their child. Conclusions: PSQ suggest high satisfaction rates with MCPAP. Notable are the high rates of parents reporting they felt prepared, heard and understood. Parents were also highly satisfied with the face to face contact they had with MCPAP clinician, when that contact had occurred. Parents reported being less satisfied with regards to follow up appointments in the community and reaching their goals for their child. The results show high parental satisfaction with MCPAP evaluation process, but also highlight the need for appropriate mental health follow up in the community in order to help children and families reach their goals. Presented at the American Academy of Child & Adolescent Psychiatry (AACAP) Annual Meeting, October 29, 2009

Helping Children Through Evidence-based Trauma Treatments, Initial Findings from the Massachusetts Child Trauma Project (MCTP)

Background-The Massachusetts Child Trauma Project (MCTP) is a statewide collaboration to implement improvements to the Massachusetts child welfare system in order to increase access to trauma services for children within the system. Purpose-This analysis compares PTSD symptoms and other behavioral and functional impairments at baseline and at 6-month follow-up/discharge among children enrolled in MCTP. Methods-The 166 clinicians trained in MCTP were required to enroll 2-3 children in the care of DCF into the evaluation process. Descriptive statistics were performed on the 300 children enrolled at baseline, as of Fall 2013. Paired t-tests were performed on the 73 children who had follow-up data to assess longitudinal differences in symptoms, behaviors, impairments, and functioning. Results-The baseline results indicate that children enrolled in MCTP present with clinical levels of symptoms of PTSD and behavioral/functional impairment. There were statistically significant decreases in PTSD severity (p=0.005), according to the UCLA PTSD Index Child/Adolescent Version. Additionally, internalizing behaviors, such as anxiety and/or depression, decreased (p=0.05), as assessed by the Child Behavior Checklist. However, the UCLA PTSD Index Parent Version and the externalizing measure of the Child Behavior Checklist showed symptom reduction, but were not statistically significant. Clinician reported progress, ascertained by the Child and Adolescent Needs and Strengths (CANS), showed mixed findings. Conclusion-While there was no comparison group, these results suggest that the trauma treatments provided by MCTP trained mental health providers is reducing symptamotolgy and improving functioning among children in DCF care who experienced trauma. Baseline findings indicate that most children present with symptoms in the clinical range of PTSD and other trauma-related impairments, while longitudinal results show that these children are experiencing symptom reduction, and improved functioning, suggesting that the trainings that MCTP has provided have been effective

The University of Massachusetts Medical School Child Trauma Training Center (UMMS-CTTC) [English and Spanish versions]

A Spanish translation of this publication is available to download under Additional Files below. The UMMS Child Trauma Training Center mission is to improve the identification of trauma and increase trauma-sensitive care and access to evidence-based trauma-focused treatment for at-risk and underserved populations in Central and Western Massachusetts, including court-involved youth and military families, ages 6 to 18 years

You Want Us to Do What? How to Conduct Community-engaged Research Studies from the Perspective of the Community Organizations: Evidence from the Kidsteps II Study

Voices of community partners can help guide future community engaged research partnerships. Drs. Upshur and Wenz-Gross have been working with a Worcester community coalition for almost 15 years to create, document and research issues of at risk preschool children. Their first work, funded by the Health Foundation of Central Massachusetts, developed and tested a model of early childhood mental health consultation to child care programs. This led to testing of a primary prevention curriculum funded by the National Institute of Mental Health, and subsequently to a large randomized intervention study funded by the US Department of Education. Community partners will describe their experiences in this community driven research

Importance of social support in the adjustment of children with learning problems

This study examined the social networks, social supports, friendships, and adjustment of 106 4th-, 5th- and 6th-grade children. Forty children were receiving special education services for learning problems 66 were in general education. Results showed that children with and without learning problems did not differ on the size or composition of their social networks nor on the negative features of their friendships (conflict, competition). However, children with learning problems used their network differently for support. They turned to the family less for problem-solving support and to peers less for all types of support than children without learning problems. Results are discussed in terms of the implications for children with learning problems as they enter adolescence