ࡱ> YTUE@ bjbj a!"???8"@A"B(>B"`B`BvBUDD4E$RѼ6ed3D"UDeded6`BvBKgigigiedP8`BvBgiedgi:gii0vB B K?f6la0JN]Eh]l""];E\ OfgiV\|;E;E;E66""48?i(""8Allegheny County Childrens Cabinet: Birth to Five Committee System of Early Care: Building Family-Centered Healthcare Partnerships and Supports for Young Children in Everyday Settings Position Statement, Proposed Model, and Workscope August, 2003 Interim Leadership Council Stephen J. Bagnato, 0-5 Co-Chair Walter Smith, 0-5 Co-Chair Rachel Anne Wilson, Childrens Cabinet Director Michele Meyers-Cepicka, Leadership Member Ray Firth, Leadership Member John Lovelace, Leadership Member Reggie Young, Leadership Member BACKGROUND On March 24, 2002, the Birth to Five Committee of the Allegheny County Childrens Cabinet, chaired by Walter Smith, Ph.D., issued its revised report entitled, System of Care for Families with Very Young Children. This report and the committee presented the philosophical framework that distinguishes the unique developmental and ecological aspects of early child development. These aspects dictate the special ways in which behavioral supports promote caregiver-child attachments, resiliency, positive social-emotional development, and early school success. It was determined that systems reform initiative was necessary to accomplish these important objectives. Moreover, the report profiled the barriers to systems reform, discussed special issues pertaining to supporting young children, and potential pilot projects to express the recommended approach. Three major perspectives were emphasized in the Birth to Five Committee report: The System of Care for Young Children should emphasize both early prevention and early intervention; The System of Care for young children needs to incorporate a variety of points of access, and ensure coordination, collaboration, and consistency across the diverse early childhood and human service agencies [the unsystem]; Adult-serving systems must assure that the needs of the young children of the adult parents and caregivers that they serve are met, and they need to collaborate with the child-serving agencies, seamlessly. INTERIM STEPS Since March 2002, The Birth to Five Committee has confederated with numerous new early childhood interest groups within Allegheny County, in addition to the traditional early childhood agencies within its membership. These partners have mutual interests to work as catalysts to design a system of care framework for young children and families. An environmental scan was conducted by the Directors office to survey the array of services and supports, including model demonstration research ventures that exist as exemplars for interagency collaboration for behavioral support. The work of each of these partners still focuses on their own particular objectives; however, their overarching philosophical and operational elements are now being incorporated within the goals, objectives, and strategies of the work plan for the Birth to Five Committee. This consensus strategy is being used to reduce redundancy and to maintain uniformity and continuity of vision among each of the special interest groups in the County. This plan is viewed as its first phase and will change organically as the intergroup collaborations proceed. A current membership list for the 0-5 committee is available from the Childrens Cabinet, Office of the Director. The confederation of new partners on the Committee since March 2002 is as follows: Infant Mental Health Initiative, Staunton Farms Foundation CCBHO/Sto-Rox System Mental Health Planning Group Service Pathways, Office of Child Development, Jewish Healthcare Foundation, Inc. Allegheny County Local Planning Group, Office of Child Development Early Childhood Initiative-Demonstration Project, Office of Child Development, Heinz Endowments Early Childhood Partnerships, HealthyCHILD, Childrens Hospital of Pittsburgh, The UCLID Center at the University of Pittsburgh The School Readiness Group The Center for the Social-Emotional Foundations of Early Learning- Commonwealth of Pennsylvania, Departments of Public Welfare and Education, Head Start Collaborative Office On November 14, 2002, the interim leadership council of the Birth to Five Committee (Stephen J. Bagnato, Co-Chair; Rachel Anne Wilson, Director of the Childrens Cabinet; Michelle Meyers-Cepicka; Ray Firth; and John Lovelace) met to begin the next steps of the Birth to Five Committee process: (1) to create a timeline and shared work scope for the Committee over the next 12 months; (2) to design a proposed Birth to Five system of early care model for behavioral and developmental support; and (3) to plan how to accumulate supporting evidence on the outcomes of the Birth to Five Committee approach and its elements as being implemented through natural experiments by partners across Allegheny County. Within these steps, the members discussed three categories of issues: Prevention [how to have flexible access to services and appropriate providers who will commit to a prevention continuum approach]; Engagement [how to gain the collaboration and trust of providers, agencies, and family members given the unsystem]; Linkages [how to link the unsystem together and, particularly the adult- with child-serving components to achieve holistic care]. NEXT STEPS Principles and Recommended Professional Practices Discussions and consensus sessions within the Birth to Five Committee between 2001 and 2002 and within the leadership council buttressed by reviews of systems reform and mental health research in early childhood have resulted in a shared perspective about the overarching principles and recommended professional best practices and structural elements underlying a system of early care reform initiative. The following overview of these 7 major principles, recommended practices, and systemic elements are outlined below: Early Identification for Flexible Access to Servicesuse of non-categorical or functional approach to early detection for services that is based on natural assessments by caregivers in everyday settings and based on a risk status model to define service eligibility rather than traditional medical/mental health diagnoses; Prevention-Intervention Continuum...commitment to an early intervention approach focused on preventing the development of maladaptive patterns of social-emotional and attachment or relationship behaviors within a continuum of comprehensive and increasingly intense service options; Family-Centered, Culturally-Competent Practicesa model and service approach that invites family participation in a co-equal manner of collaborative decision-making and which understands, and is committed to address cultural mores that will influence the family-professional partnership; Community-based, On-site Supports in Natural Settingscommitment to community-based delivery of services and supports through a graduated continuum of consultation, mentoring and direct service options that increase the competency of parents, caregivers, and early childhood providers to promote healthy social-emotional and behavioral skills; discourages the emphasis on traditional clinic-based, hospital-based, and agency-centered therapies delivered in decontextualized settings (except in circumstances in which crisis issues exist and the most intensive services are necessary); Care Coordination and Transagency Care Plan to Integrate Health and Education Supportsa strategy of super care coordination which understands, plans, and integrates behavioral health, physical health, and early care and education developmental services and supports to be delivered in the natural settings; a uniform integrated transagency care plan; Focus on Building the Behavioral Foundations of Resiliencyuse of intervention strategies that emphasize the healthy developmental foundations for attachment, resiliency, social skills, self-control behaviors, and the social-emotional precursors for early school success; Mentoring to Foster Uniform Competencies and Credentialing of Interdisciplinary Professionals Who Support Young Children and Familiescreation of a responsive and accessible system for professional development and mentoring which ensures that all professionals (including professionals in the adult-serving system) who work with young children and families will have the appropriate developmental perspective; will demonstrate the core body of knowledge; and will adhere to and use professionally sanctioned and evidence-based practices. The 0-5 Committee established three major goals to structure its work for the next two years and to produce this version of the Birth to Five Report for the Childrens Cabinet: Reach consensus among the broad early childhood community represented in the Cabinet on the principles, practices, and system reform elements that should underpin the proposed model for Allegheny County; Propose a comprehensive, coordinated system of early care transagency model for Allegheny County based on evidence-based features and imbedded within the DHS structure and purview; Establish a workplan that would initiate the model in Allegheny County; promote the use of best professional and evidence-based practices; consider approaches for marshalling political support for the model linked to emerging state and federal policy changes; and seek federal and other research funds to field-validate the model. A System of Early Care for Young Children in Allegheny County: Explication of the Model Much research, systems reform and policy development efforts underlie recommendations for tailoring an innovative system of early care which transforms and integrates healthcare and education to address the unique needs of families and their infants, toddlers, preschoolers, and early school-age children (0-8 years of age). The professional dimensions, structural elements, and operational features of an integrated and seamless early childhood system of care have been detailed in several recent publications (Knitzer, 2000ab; Hanson et.al., 2001; Kauffman Early Education Exchange, 2001; Bagnato, 1998; Bagnato, 2002; Stroul, 2002; Fox, Dunlap, Hemmeter, Joseph, Strain, 2003). Many researchers and policy makers specializing in early childhood agree on the central importance of the seven philosophical and best practice elements previously identified. Based upon this published evidence, the Birth to Five Committee of the Childrens Cabinet proposes a structural and operational model for Allegheny County which encompasses these features that have demonstrated varying degrees of efficacy; in the following sections, a schematic of the model is presented, an explanation of its proposed operation, a profile of how major elements of the model are operating currently in at least three County initiatives, and a phased approach for next steps that will include collating data on the impact and outcomes of the model in the County. Figure 1 illustrates in graphic form the content and operation of the system of early care model, whose operational features are referred to as developmental healthcare support alluding to the comprehensive nature of the array of behavioral and physical health, and developmental emphases. Each of the central operational features is detailed in the following sections. The Collaboration Leadership Team (COLT) The Collaborative Leadership Team (COLT) is an interagency oversight committee to be established by the Department of Human Services for Allegheny County and composed of the leaders/representatives of the primary early childhood intervention entities across the county. The COLT strives to coordinate and synchronize the unsystem through a partnership infrastructure which institutionalizes the collaboration among parents and behavioral health, physical health, other human services and education. In particular, the COLT works to integrate the collaboration among early intervention, early care and education (public and private), Head Start, and school transition programs. The major partners are identified as the Alliance for Infants and Toddlers, Inc; the Allegheny Intermediate Unit/Early Childhood and Family Support Services; Pittsburgh Public Schools-MOSAIC; PPS-Head Start; COTRAIC Head Start; PAEYC; Child Care Partnerships, DHS Behavioral Health, Allegheny County Department of Public Health, and one family representative from each of the major interagency partners with a goal of 51% representation by families on the COLT. At least one representative of the Family Leadership Council (to be newly instituted in the Childrens Cabinet Model) shall be appointed also. Family members at large may be appointed also by consensus of the COLT and in collaboration with the Family Leadership Council to achieve 51% family representation. Finally, the COLT model gains broadened scope with representation from an appropriate Adult Serving System member. Some additional members can be added to ensure breath and to plan for future needs such as school district representation for transition planning in view of the future possibility of Head Start/school district partnerships in both state and federal plans. The COLT attempts to have some form of overarching representation for all early childhood entities in the system of early care model. Conceivably, the COLT could form the future leadership council of the 0-5 Committee with the approval of the Childrens Cabinet Director. It is proposed that the COLT and the 0-5 Committee of the Childrens Cabinet with its larger membership will interface to ensure broad consideration of current and future needs in the field. The primary purpose of the COLT is to troubleshoot the operation of the model, reach consensus on operation and needed changes, and to empower staff to operate outside the box in a coordinated manner within a new interagency model that adheres to established principles for collaborative and coordinated care systems.  Integral to the COLT are two major systemic or interdepartmental linkages within DHS and the Cabinet: the Adult-Serving System representatives (to be designated) and a newly instituted Family Leadership Council. The Family Leadership Council, as part of the Youth and Family Support Entity defined in the Cabinets new model paper, shall have a strong, visible presence for all parents and families served by the system of early care model. This entity assures that parents, children and other family members will receive peer support through mentoring, support groups, advocating, and information services appropriate to families of young children. Emphasis will be placed on issues of positive parenting, attachment and school readiness. Parents teaching parents is proposed as one essential and proven methodology for the Council. Members of this entity, at the request of the family, are available for all meetings involving the child and family. Representatives will provide advocacy and technical assistance, in collaboration with and at the request of COLT member agencies, families and family groups, regarding family centered and inclusive practices, cultural competence and community-based principles. The Council is led and managed by parents and family members with experience in the early care, education and support of very young children. Care Coordination Agency The COLT oversees the administration and implementation of the system of early care by a care coordination group such as the Alliance for Infants and Toddlers, Inc. This administrative group will expand their care coordination activities to support families and children in the birth to 5 year, but optimally, 8 year age range. Links with the adult-serving system representatives will ensure a full continuum of care for parents, older caregivers and the children. The care coordinators must understand the diverse rules, regulations, recommended professional practices, and resources in Allegheny County which reflect on the specialization for infants and preschoolers using a family-centered approach, these include early intervention, early care and education, Head Start, school-age special education, mental health, and other policies and services. The focus must be broad, covering the needs of typically developing children with social behavioral concerns as well as the needs of children who are at developmental risk or who have developmental delays and disabilities. The care coordination agency will ensure that parents have a co-equal voice in decision-making about themselves and their children relying on proven helping methods in family-centered practices (Dunst, Trivette, & Deal, 1994). The care coordination agency will assist parents and early childhood programs to access the varied on-site supports available from members of the developmental healthcare support team. Developmental Healthcare Support Team: Generalist and Specialists The Developmental Healthcare Support Team is composed of five members: the parent or caregiver, the care coordinator, developmental healthcare consultant, developmental psychologist, and community health nurse. The parent-professional team comprises both generalist and specialist professional roles and activities with integral collaboration and consensus decision-making with the parents and/or caregivers. The Care Coordinator establishes the essential ongoing, trusting relationship with the family and functions as the familys advocate to ensure the most effective mix of interagency services and supports. The care coordinator ensures that the familys voice is co-equal and, therefore, integral to the collaborative process of decision-making and service delivery. The care coordinator and its umbrella care coordination agency provide the direct communication and liaison to the COLT. The Care Coordinator facilitates the collaborative activities of the interdisciplinary team of generalists and specialists. Parents/caregivers family members are key decision-makers and integral members of the team for their children. It is their concerns, priorities and strengths that are the basis for the development of services and supports offered in the system of early care. Services and supports are wrapped around the family respecting their values and culture as prevention and early intervention strategies are developed. In a system of early care that is family centered, culturally sensitive and strengths-based, families are supported to be equal partners on the Developmental Healthcare Support Team. Families are essential to continuity in care and offer a link with the natural settings of the childs early care and education program and the home. The Developmental Healthcare Consultant is the primary interventionist who partners with the care coordinator and the parents/caregivers, strives to address the needs of each family/child dyad and/or the needs of the early childhood providers who work with the child in early care and education settings. The developmental healthcare consultants role is to: provide overall environmental support in natural settings to the family and program staff; emphasize general ways to promote social-emotional and behavioral competencies; ways to modify the home or classroom/care environment to prevent behavior problems, and tactics to nurture healthy social-emotional and physical development. When parents provide consent and the child/family are qualified for more intensive supports and interventions, the Developmental Healthcare Consultants activities are augmented by partnerships with a Developmental Psychologist who will offer more intensive interventions through various modes: mentoring, modeling, individualized behavior plans, in-service training, and direct support to the child. The focus is always to assist the primary caregiver (parent and teacher) who is familiar and attached to the child to use strategies that promote success rather than relying on an unfamiliar specialist to intervene. The psychologist can also provide traditional supports such as credentialed authorization for educational and mental health diagnoses and wrap-around services. Another member of the team is the Community Health Nurse who can provide consultation and more intensive family and program supports regarding the care of children who have more chronic medical conditions that affect early learning, behavior, and adaptation in the home and the early care and education setting. Team Functioning and Methods The developmental healthcare support team functions as a mobile service delivery group composed of both generalists and specialists in early childhood. The main representative of the team is the Developmental Healthcare Consultant (BS or MS in early childhood education, psychology, or child development). This individual partners with the parent and the care coordinator to form the core of the team. Using primarily a consultative approach to provide support, the consultant provides approximately 80% of the needed support based on previous research data (Bagnato, 1999). The Developmental Psychologist (Ph.D. or equivalent in school, developmental, clinical, or community specialties) partners with the parents/caregivers and behavior health consultant to individualize interventions and supports for children and families with consent. Research outcomes indicate about 20% of the needed instances of behavioral support for the most challenging children are provided by the psychologist (Bagnato, 1999). The Community Health Nurse (RN or PNP) provides consultation and direct support needed to assist teachers and parents to cope with chronic illness and other medical issues that serve as barriers to the childs adaptation in early childhood settings (e.g., asthma, seizures, diabetes). Training for staff on universal health precautions and other general health promotion issues is also a primary responsibility of the nurse. The team ensures that a full array of on-site supports are available to parents and programs including: consultation regarding programmatic environmental modifications; mentoring; professional development in-service education; brief individual child interventions; collaboration in team decision-making; collaboration on writing individual behavioral resource plans; early screening and diagnostic assessment; family supports; and monitoring child progress and intervention impact and outcomes. The system of early care model uses an integrated document, temporarily referred to as the Integrated Developmental Healthcare Plan, as the vehicle to guide the process and content of collaborative parent-professional decision-making. The Integrated Developmental Healthcare Plan will serve the purpose of establishing coordinated goals and services across the interagency and interdisciplinary partners including education, health, mental/behavioral health, and family support. The efficacy of this vehicle as essential in promoting interagency collaboration has been researched by Salisbury etal, (in press). Based on evidence-based research in the Center for Social-Emotional Foundations of Early Learning (Fox, etal, 2003), we propose that the team members will use the continuum of prevention-intervention strategies illustrated in the Teaching Pyramid (see Figure 2). The pyramid focuses on a graduated sequence of four major categories of behavioral and developmental support strategies: (1) Training caregivers in basic positive strategies for developing adult-child attachments and in general use of best professional and evidence-based practices; (2) consultation regarding classroom and home environmental management and prevention techniques to manage challenging and unhealthy behaviors and to promote positive alternatives; (3) methods to teach specific social-emotional and self-regulatory skills; and (4) more intensive individualized interventions for children and families in the classroom and home. This would involve the design of the Integrated Developmental Healthcare Plan in the our proposed model. In all stages of the model, the team would use positive behavior support (PBS) strategies to foster social-emotional competencies and to reduce challenging and unhealthy behaviors. PBS has a proven evidence-base in early childhood intervention; the focus of PBS is to assist children to acquire new social and communication competencies, nurture their attachments and relationships with adults and peers, and to enable teachers and caregivers to consistently use techniques that build social and self-control behaviors.  We propose that the following outlined steps would direct the overall work activities of the developmental healthcare support team based on the model by Fox and colleagues (2003): Provide programmatic environmental consultation and mentoring in best practices and prevention and health promotion strategies to teachers, staff, and/or parent groups in-vivo in the early care and education and community settings for all children and families in a county area who may meet presumptive eligibility criteria for at-risk status and support; Determine child/family eligibility for at-risk status for system of early care services and supports through more flexible and inclusive criteria which adhere to developmentally-appropriate perspectives and practices; Provide, first, the same programmatic-level consultation on prevention and health promotion strategies using PBS for all children and families that meet individual eligibility criteria Develop, next, program-level consultation goal-plans to structure the work of the developmental healthcare consultant, care coordinator and teachers; Determine the need for intensive individualized positive behavior support in the classroom and home by specialists on the team through parent consent; Implement the Integrated Developmental Healthcare Plan and monitor impact and outcomes over a 1-2 month period; Determine need for more intensive interventions through diagnosis and referral to such programs as mental health wraparound services and early intervention. It is estimated that several developmental healthcare teams will need to be constituted by the Allegheny County Department of Human Services to ensure coverage across regions of the county. The generalist Developmental Healthcare Consultant represents perhaps the most important member of the team, but the least expensive. Several will be needed to provide sufficient coverage in the County. Mapping them to the regional areas of Allegheny Intermediate Units Early Childhood and Family Support Services-Head Start may be one possible organizational approach. These teams could then be matched with the existing care coordinators from the Alliance for Infants and Toddlers, Inc. Future research by the Birth to Five Committee can provide some estimate of the proper number of teams so that cost studies can be initiated. Allegheny County Outcome Data Supporting Elements of the SEC Model Over the past 2 years, longitudinal evaluations have been conducted in associated Head Start and early care and education programs in Allegheny County and the city of Pittsburgh on the progress of over 400 high-risk children, ages 3-6 years, in acquiring social-emotional competencies and self-control behaviors as precursors to early school success. All programs used a standards-oriented and curriculum-based model of providing instruction to children and also received prevention support from interagency partners who emphasized a continuum of classroom consultation to intervention services similar to that proposed in the system of early care model. The general outcomes of the evaluation show that the following results as illustrated in the figures below: All high-risk children demonstrated steady acquisition of social and self-control behaviors important for early school success when receiving combined instruction, prevention, and intervention supports. Children who met criteria for a mental health diagnosis in the County demonstrated a steep slope of progress in social and self-control behaviors when receiving support (through a combination of instruction, prevention, and intervention strategies) in their programs that eliminated delays in social skills and reduced levels of challenging and atypical behaviors which resulted in age-appropriate levels of functioning at entrance to kindergarten.  EMBED PowerPoint.Slide.8   EMBED PowerPoint.Slide.8  Overview of Published Research on Early Childhood and Systems Reform Efforts in Allegheny County The following section provides a snapshot of the research on five notable and published early childhood and systems reform efforts tailored for Allegheny County. The outcomes of these program evaluation research efforts offer data on the effectiveness of major elements of the proposed system of early care model. Full reports of these initiatives are available elsewhere. HealthyCHILD (Bagnato, 1994-1998; 2000; 2003): HealthyCHILD is a federally-funded, field-validated model demonstration program designed to document the effectiveness of a transagency model of delivering a full range of physical health, behavioral health, and developmental support services to families and preschool children with chronic medical conditions, challenging behaviors, and developmental delays/disabilities. The following aspects are central to the success of HealthyCHILD: Funded by the US Department of Education, Office of Special Education and Rehabilitative Services; Jewish Healthcare Foundation, Commonwealth of Pennsylvania, Department of Public Welfare and Child Care Resource Developers Transagency partnerships among Childrens Hospital of Pittsburgh, Pittsburgh Public Schools-MOSAIC, and diverse early care and education programs in the Pittsburgh region COLT interagency oversight and liaison group Mobile developmental healthcare team Individualized classroom and child resource plans Primary care physician liaison and sign-off Family-centered strategies On-site program services and support Experimental-control group design Significant comparative social-behavioral, programmatic, health, teacher-family satisfaction outcomes, and project goal-attainment statistics Application to early intervention, Head Start, and early care and education settings; Ongoing contractual partnerships with 8 different early childhood programs in PA and Northern Panhandle of West Virginia (1997-present) Service Pathways (Firth; Etheridge, et al, 2002): Service Pathways is an approach to identify young children with challenging behaviors in early care and education settings and to match on-site support to the children and programs through the Alliance for Infants and Toddlers, Inc. as the care coordination group in partnership with qualified consultants in the communities. Funded by the Jewish Healthcare Foundation of Pittsburgh Partnerships between the Alliance for Infants and Toddlers and the Office of Child Development, University of Pittsburgh Care coordination, parent-professional teamwork, and partnerships with local psychologists and early behavior specialists Reimbursements for services from County TANF funds Compiled status and outcome data on risk status of child using TABS assessments; response time of consultants and satisfaction data from parents. Community Connections for Families (CCF/SAMHSA, 2003): CCF is an organizational structure to provide a network of care for families and children with serious emotional disturbances in 5 Pittsburgh neighborhoods: East End, Hill District, McKeesport, Sto-Rox, and Wilkinsburg. CCF strives to overcome the fragmentation of services by offering a structure for service coordination and service integration. Community-based care model with service coordination Participates in national longitudinal evaluation of research outcomes Consumer satisfaction about interagency collaboration, advocacy, natural and community supports, and forming trusting relationships Decreased hospitalizations and residential treatment Increased availability of resources and support to families Decreases in family strain Increased school performance and reduced suspensions and absences Lower externalizing and internalizing behavior problems Higher cultural competence and satisfaction Early Childhood Initiative (ECI) (Heinz Endowments, Bagnato, 2002): The Early Childhood Initiative was a model systems reform initiative championed by the Heinz Endowments to establish high-quality early care and education programs for children in high-risk communities and to document the relationship among quality mentoring, quality teaching and care, and positive developmental, behavioral, family, community, and early school success outcomes for children. Funded by Heinz Endowments, RK Mellon and other entities Natural community experiment operating since 1998 Independent oversight and quality mentoring support Community-based management from public and private groups NAEYC standards to set quality benchmarks for teaching, management, and care Interagency partnerships for related support services Positive developmental, social behavioral, and early school success outcomes for 1350 high-risk children beyond maturational expectations and exceeding historical school data for nearly 200 children participating the longest Demonstrated effectiveness for all high-risk children including those with developmental delays (14%) and mental health (18%) diagnoses. Head Start Child Outcomes Research (AIU Early Childhood and Family Support Services; Pittsburgh Public Schools Head Start; CenClear Child Services): Through collaborations with the Early Childhood Partnerships program of Childrens Hospital and UCLID, Early Head Start and Head Start programs in Allegheny County, Pittsburgh City, Center and Clearfield Counties, and the Northern Panhandle of West Virginia, a type of behavioral epidemiological research is being conducted on the status and outcomes of children as they enter Head Start. Benefits from its supports are being documented. Funded by interagency contracts Collect data using teachers, parents, and team members in natural settings utilizing the Preschool and Kindergarten Behavior Scale (Merrell, 2002) and the Temperament and Atypical Behavior Scale (Bagnato, etal, 1999). Focus on social skills and self-control behaviors that are precursors to early school success Collected data on nearly 3000 children indicating serious risk-status rates of 25-30% (would qualify for a county mental health diagnosis) for children entering Head Start Demonstrated social behavior prevalence rates of about 25%-30% at entry into Head Start; significant improvements in social skills and self-control behaviors into the average range with combined Head Start classroom instruction and interagency mental health support to teachers, staff, parents, and children through a consultative and direct service continuum. Early Identification and Access to Services The issue of early detection for service eligibility represents, arguably, the most prominent difference between child and adult mental health services. Early childhood education epitomizes the prevention approach for fostering healthy social-emotional and behavioral development in young children and families. Early intervention, in its broadest context, is viewed universally as a way to provide at-risk children and families with early learning supports which have proven benefits in fostering resiliency through the building blocks for healthy social behavioral development. Denying access to such supports, denies these benefits for young children. Early detection is the gateway for intervening to prevent the development of maladaptive behaviors. Traditional assessment and measure practices in early childhood fail to have a solid evidence-base and are fail to accommodate early childhood behavioral styles; thus, the capabilities of young children with special needs is most often misrepresented (Neisworth & Bagnato, 2003). Within the early childhood fields, early detection is viewed as a process of determining strengths and needs so that supports for success can be optimized. Early detection eschews the psychopathological diagnostic model predominant in adult services (e.g., DSM IV) in favor of a more developmental and functional classification approach. This early identification identifies risk status without resorting to judgment-laden labels which have a long clinical and research history of serious errors for work with young children. Research evidence favors the latter functional model while no data support the former with young children. It is recommended that evidence-based research from the TRACE Center for Excellence in Early Childhood Assessment at Childrens Hospital and The UCID Center at the University of Pittsburgh be used to inform the early detection and early childhood assessment practices for the Birth to Five Committee of the Childrens Cabinet. TRACE is a national, multi-center, research collaborative funded for five years by the US Department of Education, Office of Special Education Programs, to conduct evidence-based research on the most efficacious models for child find, eligibility determination, referral, assessment, and monitoring within early childhood. TRACE and Office of Special Education Programs, will use this research to influence state and federal government policy regarding the process and outcomes of early intervention for young children at a developmental risk and with developmental delays/disabilities. The Pennsylvania satellite director for TRACE is Dr. Stephen Bagnato, Director of the Early Childhood Partnerships program of Childrens Hospital of Pittsburgh and The UCLID Center at the University of Pittsburgh. Principal Investigators and national collaborators are Drs. Carl Dunst, Carol Trivette, and Melissa Sheldon from North Carolina and Beverly Johnson from the Institute for Family Centered Care in Washington, DC. To be discussed more fully in later versions of this report, the Birth to Five Committee will begin to amass pilot data on the efficacy of the functional classification model employed across local and state programs for use in the proposed system of early care model. The functional classification model will have the following characteristics: Reliance on parent and professional assessors to collect natural data on childrens social-emotional and behavioral needs; Use of the Temperament and Atypical Behavior Scale (TABS) as a primary normative method to determine risk status for extremes in temperament and problems in self-regulatory behavior. Couple the TABS with the Diagnostic Classification System: 0-3 (National Center for Infants and Families, 1996) as an alternative to DSM IV in documenting the functional risk status of children with a regulatory disorder rather than a traditional form of psychopathology to determine eligibility for services. Collect ongoing, longitudinal data on children in early care and education settings with authentic observational scales which emphasize the healthy development of social-emotional competencies and self-control behaviors to document child progress and a reduced need for intensive services and supports. PROPOSED WORKPLAN AND TIMELINE The Birth to Five Committee plans to initiate a 24-month developmental work plan and timeline to formulate the phased iterations of a system of early care which will begin on September 2003 and conclude on September 2005. The matrix below summarizes this plan referred to hereafter as the Birth to Five Committee Work Scope. The complete plan of objectives and work activities attempts to integrate all the elements previously discussed regarding philosophy, professional best practices, system reform elements, and issues of prevention/identification, engagement, and linkages. The work of the Birth to Five Committee will be influenced and modified according to the activities of such state-level groups as the Center for Social Emotional Foundations of Early Learning (Center for Schools and Communities, 2002, Commowealth of Pennsylvania Departments of Education and Public Welfare), recommendations from the Governors Task Force on Early Care and Education, and the evidence-based research from the TRACE Center for Excellence in Early Childhood Assessment. WHAT?HOW?WHO?WHEN?PHASE 1: 2000-2003Compose initial 0-5 Committee Report Collaborative meetingsFull-group and leadershipMarch, 2002Complete 0-5 Committee model and workscopeCollaborative meetingsLeadership groupJuly 15, 2003Reach consensus on principles, practices and model system elements in the 0-5 plan2-meeting series of B5 Leadership Team Informational Meeting and discussionBirth to Five Leadership Team Full Birth to Five groupJuly 15, 2003 July 24, 2003Agree upon the primary local initiatives as system reform exemplarsConsensus meetingsBirth to Five Leadership TeamAugust 31, 2003Align system reform plan with other major local initiatives Meetings with representatives of initiativesECIDP; HealthyCHILD; Department of Human Services; ACLPG; Service PathwaysSeptember 5, 2003PHASE 2: 2003-2004Conduct ongoing meetings to: Activate COLT & model in local initiatives, prove its viability, & provide systemic product of 0-5 CommitteeCollaborative meetings with local ECE agencies representatives0-5 Leadership CouncilSeptember, 2003-2004Initiate process for creating a permanent 0-5 Committee structure within the Childrens Cabinet Collaborative meeting0-5 Interim Leadership CouncilDecember, 2003Reach consensus and conduct work on evaluation outcome data collection from local system reform exemplarsEvaluation data meetingBirth to Five Leadership Council and local exemplarsSeptember, 2003-September, 2004 Plan and conduct groundwork for systems reform with politicians linked with emerging state and federal ECE policy changes  Ongoing meetings 0-5 Leadership Council and partners September 2004Compose initial report on systems reform outcome dataWritten report, data analysis with case vignettesBirth to Five Leadership Team and Early Childhood Partnerships-SPECS evaluation consultant January 31, 2004Compose final report on system of early careWritten report with system-wide scaling guidelinesBirth to Five Leadership Team Input from Marc Cherna Presentation to the Childrens Cabinet MembersMay 31, 2004PHASE 3: 2004-2005Gain state and federal grant support to refine and field-validate the system of early care modelCollaborative meetings 0-5 Committee and Leadership with DHS and partnersSeptember, 2004 ongoing CONCLUSION Research on innovative practices in systems reform and interagency coordination in the human service fields (Salisbury, in press; Melaville & Blank, 1991) indicates clearly that 7 components are necessary for successful implementation of reform initiatives: Design of an integrated program plan for each child/family. Establish an integrated program planning process between parents/caregivers and professionals. Establish an integrated collaborative leadership oversight group. Ensure a state-local feedback loop for government and interagency. partners to address policy-linked challenges to implementation at regular intervals. Integrate collaboratively a technological computer or Web interface across the agencies to share client, program, and outcomes data. Provide opportunities for structured interdisciplinary cross-training and continuing education. Integrate ongoing impact evaluation into the systems reform effort for program quality improvements. The challenge of developing a successful system of early care reform model, let alone a Childrens Cabinet new model for all ages, depends on the extent to which the Committee can design and implement these seven elements for services in Allegheny County. The needs of vulnerable young children and their families to reach their potential for early school and life success depend on the attainment of this systems reform effort. As Gould (1981) assertedThere arefew injustices deeper than the denial of an opportunity to strive or ever hope by a limit imposed from without, but falsely identified as lying within (p. 28). REFERENCES American Psychological Association (1994). Comprehensive and coordinated psychological services for children: A call for service integration. Washington, DC: American Psychological Association, Task Force on Comprehensive and Coordinated Psychological Services for Children Ages 0-10. Bagnato, SJ, Neisworth, JT (1999). Collaboration and teamwork in assessment for early intervention. Child and Adolescent Psychiatric Clinics of North America, 8(2), 347-363. Bagnato, SJ (2002). Quality early learning-Key to school success. A first-phase 3-year program evaluation research report for Pittsburghs Early Childhood Initiative (ECI). Pittsburgh, PA: Early Childhood Partnerships, Childrens Hospital of Pittsburgh, The Heinz Endowments. Bagnato, SJ, etal (2002). Child developmental impact of Pittsburghs Early Childhood Initiative (ECI) in high-risk communities: First phase authentic evaluation research. Early Childhood Research Quarterly, 17(4), 559-580. Bagnato, SJ (1998). Efficacy of collaborative developmental healthcare support in inclusive early childhood programs via a mobile transagency team: Final research report for HealthyCHILD. Washington, DC: Childrens Hospital of Pittsburgh, US Department of Education, Office of Special Education and Rehabilitative Services, Grant # HO23D40013). Bagnato, SJ, Minzenberg, B, Blair, K, Fireman, K, McNally, R (2003). Developmental healthcare partnerships in inclusive early childhood settings: The HealthyCHILD Model. Infants and Young Children. Bagnato, SJ, Neisworth, JT, Salvia, J, Hunt, F (1999). Temperament and Atypical Behavior Scale (TABS): Early Childhood Indicators of Developmental Dysfunction. Baltimore, MD: Paul Brookes Publishing. Blair, K, Bagnato, SJ, Sart, Z, Slater, J (2002). Prevalence of social and self-control behavior problems in Head Start children (submitted manuscript for publication) Community Connections for Families (2003). Making waves: CCF Bi-Annual Report. Washington, DC: CCF and SAMHSA. Dunst, CJ, Trivette, CM, & Deal, AG (1994). Supporting and strengthening families: Methods, strategies, and practices. Cambridge, MA: Brookline Books. Etheridge, W, Nelkin, R, Townsend, M (2002). Are we leaving them behind: The case for helping childcare providers and parents address behavioral problems in very young children. Pittsburgh, PA: University of Pittsburgh, Office of Child Development, Jewish Healthcare Foundation Fox, L, Dunlap, G, Hemmeter, ML, Joseph, GE, Strain, PS (2003). The Teaching Pyramid: A model for supporting social competence and preventing challenging behavior in young children. Young Children, 58(4), 48-52. Gould, S. J. (1981). The mismeasure of man. New York: W.W. Norton & Co., Inc Hanson, L, Deere, K, Lee, C, Lewin, A, Seval, C (2001). Key principles in providing integrated behavioral health services for young children and their families: The Starting Early Starting Smart experience. Washington, DC: Casey Family Programs and the US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Kauffman Early Education Exchange (2001). Set for success: Building a strong foundation for school readiness based on the social-emotional development of young children. Kansas City, MO: The Ewing Marion Kauffman Foundation. Knitzer, J (2000). Using mental health strategies to move the early childhood agenda and promote school readiness. New York: Carnegie Corporation of New York and the National Center for Children in Poverty. Knitzer, J (2000). Early childhood mental health services: A policy and systems development perspective (416-438). In JP Shonkoff, SJ Meisels (Eds.). Handbook of early childhood intervention (Second edition). United Kingdom: The Press Syndicate of the University of Cambridge. Melaville, A, Blank, MJ (1991). What it takes: Structuring interagency partnerships to connect children and families with comprehensive services. Washington, DC: Education and Human Services Consortium. Neisworth, JT, Bagnato, SJ (2003). The mismeasure of young children: The authentic assessment alternative. Infants and Young Children. Salisbury, C (in press). Integrating education and human service program plans: A strategy to improve interagency planning and service delivery. Journal of Early Intervention. Shonkoff, JP, Phillips, JP (Eds.). (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press, National Research Council and Institute of Medicine. Stroul, BA (2002). Issue BriefSystem of care: A framework for system reform in childrens mental health. Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Childrens Mental Health, CMHS, SAMHSA. Most recent version: 10/03/2003 PAGE  PAGE 22  EMBED Word.Document.8 \s  ACEWYZ[tͻͪ{l]N{<+ hTaH5>*CJOJQJ^JaJ#hTaHhTaH>*CJOJQJ^JaJh4i>*CJOJQJ^JaJhx>*CJOJQJ^JaJhmK>*CJOJQJ^JaJ#hTaHhM>*CJOJQJ^JaJh;8>*CJOJQJ^JaJhTaHhTaH>*OJQJ^J!hTaHhM56>*OJQJ^J#hg7hM>*CJOJQJ^JaJ#hg7hTaH>*CJOJQJ^JaJhTaH56>*OJQJ^J#hTaH56>*CJOJQJ^JaJ&?@ABCYZ  ! 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