Early Intervention

What’s needed:

Increase the awareness of physicians and other care providers of the importance of this for healthy family functioning
Change funding mechanisms to make this viable
Increase availability of referral resources
Integrate credentialing to insure the provision of quality services

By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States.

from the Child Trends articles (cited below):

Many negative mental health issues, if addressed early, could be averted. For example, every year more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most under-diagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development. Pediatric practices, as medical homes, can establish a system to implement postpartum depression screening and to identify and use community resources for the treatment and referral of the depressed mother and support for the mother-child (dyad) relationship

Integration of Pediatrics with Mental Health Care

DOCS for TOTS- Pediatric Practice Transformation

A pediatrician-led nonprofit based on Long Island, NY that's focused on improving outcomes for children prenatally through age 5 by fostering practice transformation and systems change.

American Academy of Pediatrics:

Bright Futures

The primary goal of Bright Futures implementation is to support primary care practices (medical homes) in providing well-child and adolescent care according to Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. Settings for Bright Futures implementation include private practices, hospital-based or hospital-affiliated clinics, resident continuity clinics, school-based health centers, public health clinics, community health centers, Indian Health Service clinics, and other primary care facilities.

Addressing Social Health and Early Childhood Wellness Initiative (ASHEW)

Zero to Three:

Healthy Steps- Partnering with Pediatrics

Almost all families take their babies to see a pediatric primary care provider. New parents and caregivers attend 12-13 well-child visits in a child’s first three years—that’s at least 12 opportunities to change a child’s future.

We achieve improved outcomes for young children and families by bringing together the expertise of a child development expert, the HealthySteps Specialist, and the pediatric primary care provider.

Center for the Study of Social Policy:

DULCE

- an innovative approach based in the pediatric care setting that proactively addresses social determinants of health, promotes the healthy development of infants, and provides support to their parents, all during the precious and critical first six months of life. DULCE does this by introducing a Family Specialist trained in child development, relational practice, and concrete support problem solving into the pediatric care team. Family Specialists attend well-child visits with families and providers. They get to know the families, provide peer support, and then work with the DULCE Interdisciplinary Team to connect families with resources and support.

The Pediatric Integrated Care Resource Center (PIC-RC)

- designed to promote the integration of medical and behavioral/mental health services for children, adolescents, and their families by providing ready access to needed resources to interested professionals in different disciplines who are working in a variety of settings.

Integrated Behavioral Health Care as a means of addressing common behavioral health concerns within pediatric primary care

Integrating Child Psychology Services in Primary Care

American Psychological Association

Five-Year Outcomes of Behavioral Health Integration in Pediatric Primary Care

Pediatric Mental Health Integration Program- Weill Cornell Medicine

Integrating Behavioral Health and Primary Care Increases Access and Equity

Pediatric Integrated Primary Care- Meghan McAuliffe Lines, Ph.D.

Screening Resources

Good policy recommendations for screening in these articles from Child Trends:

Childhood adversity screenings are just one part of an effective policy response to childhood trauma

Adverse childhood experiences are different than child trauma, and it’s critical to understand why

The following sites are from the Center for the Study of Social Policy:

Pediatrics Supporting Parents:

Enhancing standards of care in pediatric well-child visits

Advancing Early Relational Health

Transforming child health care and early childhood system building

Fostering Social and Emotional Health through Pediatric Primary Care: Common Threads to Transform Everyday Practice and Systems

The following are from the National Institute for Children’s Health Quality:

Five ways Pediatrics can support social-emotional development

Pediatricians partnering with parents to promote social and emotional development.

Following articles are from the American Academy of Pediatrics:

Early Relational Health Implementation Guide

Promoting Optimal Development: Screening for Behavioral and Emotional Problems

Clinical Report—Incorporating Recognition and

Management of Perinatal and Postpartum Depression

Into Pediatric Practice

Perinatal Depression

NIMH

Early Intervention Resources

Nurture Connection- a movement to promote Early Relational Health

Early relational health: Innovations in child health for promotion, screening, and research- David W Willis J Mark Eddy

The Paradigm Shift to Early Relational Health: A Network Movement

Zero to Three

From Center for Early Childhood Mental Health Consultation; Georgetown University- focused on Head Start but with useful information and tutorials for parents and caregivers

An early intervention to promote maternal sensitivity in the perinatal period for women with psychosocial vulnerabilities: study protocol of a randomized controlled trial

Prenatal representations predicting parent-child relationship in transition to parenthood: Risk and family dynamic considerations

Parental Reflective Functioning: An approach to enhancing parent-child relationships in pediatric primary care

Beyond the ACE score: Examining relationships between timing of developmental adversity, relational health and developmental outcomes in children

Links Among High EPDS Scores, State of Mind Regarding Attachment, and Symptoms of Personality Disorder

Howard Steele

Foundations for Infant/Toddler Social Emotional Health and Development: Online Course for Parents and Families

The effects of parental rearing styles and early maladaptive schemas in the development of personality: a systematic review

Early maladaptive schemas as predictors of maternal bonding to the unborn child

Parental Reflective Functioning: An approach to enhancing parent-child relationships in pediatric primary care

The Multiple Determinants of Maternal Parenting Stress 12 Months After Birth: The Contribution of Antenatal Attachment Style, Adverse Childhood Experiences, and Infant Temperament

The child as held in the mind of the mother: The influence of prenatal maternal representations on parenting behaviors

Maternal parenting predicts infant biobehavioral regulation among women with a history of childhood maltreatment

Development of a prenatal program for adults with personal histories of childhood abuse or neglect: a Delphi consensus consultation study.

An early intervention to promote maternal sensitivity in the perinatal period for women with psychosocial vulnerabilities: study protocol of a randomized controlled trial

The prenatal parental reflective functioning questionnaire: Exploring factor structure and construct validity of a new measure in the finn brain birth cohort pilot study