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Early Childhood Well Being (ECWB)

What if almost every young child referred for mental health services did not have a mental health problem? – It’s often about relationships.

Photo of Fred Cardenas
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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

I hear demons telling me to be “bad”. But I need my medicine to calm down. Mom has a new boyfriend, but that’s okay cause dad has a new girlfriend. No, I’m bad, I’m bad, I’m bad!! Adult - I wish you had known what had been going on in my life when I was 4 years old. Baby, pulling adult for attention, then quickly pushing away, then pulling in, then pushing away again…not knowing whether the adult can be trusted, or will leave baby alone again – working on a healthy attachment. Child in her 5th foster home placement. It's amazing & overwhelmingto consider that the statements above (except one) come from the experiences & words of 1-5 year old children. Children 0-6, regularly get referred to our mental health program, mostly from classroom settings. Behaviors exhibited are often related to the relationships & interactions that the child is experiencing, or not experiencing. Some children as young as 3, who have been diagnosed with a mental health problem often have not been appropriately assessed . As a 31 year old man recalls with his former preschool teacher - "I just wish you had known what had been going on in my life when I was 4." The program integrates various evidence-based practices: Parent Child Interaction Therapy strategies (parent follows child's lead and sets structure & clear expectations); 2nd Step Curriculum (social skills training curriculum); CLASS - assessment system focused on interactions between teachers and students; PBIS; Incredible Yrs

Which categories describe you? (the answer will not be public)

  • Hispanic, Latinx, or Spanish origin (for example: Mexican, Puerto Rican, Cuba, Salvadoran, Dominican, Colombian)

If you chose to self-identify your race, ethnicity, or origin, please share here: (the answer will not be public)

Mexican American

Website

https://www.family-service.org/early-childhood-well-being.html

Location: Where is your organization headquartered? [State]

  • Texas

Location: Where is your organization headquartered? [City]

San Antonio

Location: Where is your project primarily creating impact? [State]

  • Texas

Location: Where is your project primarily creating impact? [City]

All in Texas: San Antonio with some work in several small rural communities - Crystal City, Uvalde, La Pryor, Batesville.

Problem: What problem is this project trying to address?

ECWB was created in 2011 after years of recognition by Family Service Association of the link between many social problems & the roots often found in early childhood. Overwhelmed and confused parents, stressed teachers and medical professionals who want to provide relief often utilize traditional child mental health programs try to find a psychiatric diagnosis to find the solution. This program focuses on the context & relationships experienced by the child. Goal - prevention/early intervention - working directly w/parents, schools & community with true collaboration. Adolescent or adult mental health problems and often have their roots in early childhood and brain science has shown much can be done to maximize resilience starting in early childhood. High school drop out, adult mental health problems, or trauma responses can start with a fundamental resilient trajectory of healing
One in five children are affected by a mental health problem by the time they enter kindergarden. The statisic can be higher for children affected by multiple risk factors. One in five children are affected by a mental health problem by the time they enter kindergarden. The statisic can be higher for children affected by multiple risk factors.

The program is promoting a better understanding that child mental health - (mental well-being) exists within a context of family and community who interact with young children on a regular basis. There are lots of dynamics that contribute to adults who may prefer a traditional child mental health approach that "blames the victim", tries to identify "quick and easy" solutions (such as psychotropic medication or blaming teachers or parents), and has parents who may have difficulty accepting that a child may have a developmental delay or other special need (and not a mental health issue), or teachers who work within school and childcare systems that are inadequately prepared to effectively address mental health concerns in the child's natural environments.

The solutions include maximizing those psychosocial interventions that include the context directly (classrooms, parents, community) and "slow down" the process to ensure adequate assessment where the environment or context of the child is examined as closely as the child and his/her behavior. These psychosocial interventions include early childhood practitioners who can effectively implement evidence-based practices in partnership with parents and teachers who can impact the full context of the child using EBP's such as Parent Child Interaction Therapy, Incredible Years parenting programs, 2nd Step Social Skills Curriculum, and Positive Behavioral Intervention and Support .

To provide an example of program services, the following describes what one of the early childhood clinicians may experience in a typical day. They often start at a campus to observe a referred child and conclude their 1-2 hour visit with a consultation for the teacher with written recommendations (usually classroom or behavioral management strategies). They will visit several campuses in a day. After so many visits for a referred child, the clinician may develop a behavioral plan in collaboration with the teacher and we do follow up coaching and support for the teacher. Staff may hold off on full family integration (for classroom referrals until after 2-3 visits) as 50-80% of those referrals are due to classroom management problems and not a true mental health problems although they may be difficult to differentiate without those extensive observations. Clinicians do home visits after a few classroom observations to do a family assessment and then begin individualized parenting sessions (PCIT and Incredible Years strategies used) with an option of brief counseling for child, parents, or other family members. Most of the interventions are integrated into the classroom so lots of training, coaching and guidance is given to teachers. Staff may attend an IEP meeting (called ARD meetings in Texas) to help parents advocate for their child. All staff provide training related to early childhood mental health (program does an average of 1-2 training sessions per month with teachers and parents being the primary participants). Late afternoon, eves or Saturday mornings may include home visits.  Program staff are quite excited about a new project, Early Intervention Court (baby court) in which 0-3 year olds in the foster care system get the comprehensive services that may include foster parents, biological parents, other caregivers and the child. It is modeled after drug courts so parents get increased visits and expedited reunification based on progress.

ECWB is also working on the child advocacy and policy advocacy side of mental health working in partnership with many local and state advocacy agencies to help remove barriers to availability and access to developmentally appropriate early childhood mental health services.  The program has led the creation of a local chapter of an infant mental health association, has brought policy experts to train community members and leaders in policy advocacy, and helped to create opportunities for professionals to help educate and bring awareness to policy makers regarding early childhood mental health and related issues.

The latest part of the program now is collaborating with a local Federally Qualified Health Center to provide integrated healthcare where the center's child psychiatrists and pediatricians divert mental health referrals of young children to ECWB to provide those more developmentally appropriate psychosocial interventions.

All of this work includes advocating for teachers and families and educating them and learning from them to maximize the effectiveness of early childhood mental health services.

Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Children who are differently abled
  • Low-income communities
  • Other

Does your model work within any of the following sectors?

  • Childcare
  • Child and Family Services
  • Criminal Justice
  • Education
  • Mental Health
  • Other

If you chose "other," please share the sector you work within here:

Family advocacy and child policy advocacy

Year Founded

2011

Project Stage

  • Growth (the pilot has already launched and is starting to expand)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

A federally qualified health center recognized the importance of more appropriate early childhood mental health services for young children & now partner with the program to divert children from being inappropriately/prematurely diagnosed & medicated with psychotropic medications. The program is extending its home-based services (where the clinic could not do that) & integrates special education advocacy. Early childhood mental health training is provided to to 900 people anually. A local community college & a child advocacy agency have also partnered with the program to provide policy advocacy training for community leaders, teachers & other professionals to support their efforts to raise awareness with state/local policymakers.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

About 200-250 children are impacted annually directly with early childhood mental health consultation services in classrooms and homes. 900 training participants (most of who are teachers) then impact the 10-20 children in their classrooms. Surveys and pre-post comparisons have resulted in over 90% of children exhibiting behavioral improvements, over 85% of teachers and parents expressing gained confidence in addressing their children's/student's behaviors. And over 90% of training participants have learned something they can utilize in their work with children. Program services are bieng sought by many community entities and one goal of the program is to integrate this mental health approach in all elementary schools and into primary healthcare provider offices. Impact on policy to increase funding and access is an additional goal.

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $250k - $500k

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

Currently a local health foundation has committed ongoing support and new foundations are also now supporting efforts. The program has also contracted with school districts, head start, early head start to provide child mental health services. One of the challenges is that while the program avoids diagnosing unless necessary, most insurance billing in Texas requires a label or diagnosis of the child. We are working on the policy advocacy.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

There are 2-3 other programs in Texas also doing early childhood mental health consultation all at different stages of development. Our program has existed for 5 years and also now secured state funding with a Texas SAMHSA grant. Most of these funding efforts are short-term so we plan to continue to seek long-term funding and also work with policy advocacy to get insurance providers to allow billing for these services. It is verty difficult to access developmentaearly childhood mental health services in Texas as is in the rest of the country.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

The field needs to get away from child mental health practice as usual- labeling, diagnosing, medical model, sometimes influenced by business oriented forces (pharma) Mental health professionals must examine children's experiences and environments much more closely and the most effective intervention is likely to more intentionally engage teachers and parents more effectively vs. "blaming the victim". True prevention is the key - why just treat the 10 year old diagnosed with ADHD when we can effectively prevent that trajectory with the 4 year old in partnership with home, school & community.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Email
  • Other

Referral: If you discovered the Challenge thanks to an organization or person other than Ashoka, who was it? (the answer will not be public)

listserv from RWJ foundation.

Program Design Clarity

From an early childhood partner agency (over 10 partners/35 locations), a concerned teacher, parent or human service professional expresses concern over a child (ages 0-6) due to extremely aggressive, anxious, withdrawn or otherwise disruptive behavior. Concerned adult submits a referral - child is observed in his/her natural setting (school, home, childcare, etc). Child is assessed within the context of the natural environment. Behavioral specialist works closely with the adult providing weekly early childhood mental health consultation, on-location (home, classroom...), 80%+ kids improve.

Community Leadership

The program is developing an advisory council. It serves many Head Start programs which have parents and professionals who provide guidance and oversight over the programs operations including our progam mental wellness support/early childhood mental health consultation services. Special education advocacy is a big part of the work and this work entails being in tune with the desires of parents for their child and advocating WITH the parent.

Age of Children Impacted

  • Pregnancy - 0
  • 0-1.5
  • 1.5 -3
  • 3 - 5
  • 6 - 12

Spread Strategies

Training and community awareness presentations, partnerships throughout the state with statewide policy advocacy collaboration. Bringing evidence-based practices, training and resources to community partners and mentoring interns who then multiply program impact through their integration of developmentally appropriate early childhood mental health services into other systems. Policy advocacy extends reach to support child policy efforts.

Reflect on how your work helps children to thrive. How are you cultivating children’s sense of self, belonging, and purpose through your model?

Young children exhibiting agression become assertive and able to appropriately express their needs. Children with developmental delays receive appropriate intervention, referrals and advocacy to link to appropriate school and early intervention services. ATTACHMENT and relationships are a foundational focus of the program, with and between (children, caregivers, parents, famlies, policymakers/decisionmakers, mental health professionals.

Leadership Story

Nancy Hard, CEO for Family Service Association, and her executive team decided that with its over 100 year history (at that time in 2010) of providing human services to some of the neediest and most vulnerable populations, the roots and trajectory of many social ills addressed by Family Service Association over the years could be found in early childhood. Fred Cardenas was selected as manager and he brought extensive experience in child mental health, childcare, early childhood education, grantwriting, and program development and management to help initiate the program with 3 staff to now 15.

What awards or honors has the project received? (Optional)

The Program was Recognized as a Community Partner by RAISING TEXAS, a statewide effort supported by then Governor of Texas, Rick Perry. The Program which started with a grant from one local foundation and 3 staff, has now grown with contracts and other grants to have a team of 15 professionals.

Organization's Twitter Handle

@FamilyServiceSA

Organization’s Facebook Page (URL)

https://www.facebook.com/Family-Service-Association-of-San-Antonio-Inc-1165

Leader's LinkedIn Profile (URL)

https://www.linkedin.com/in/nancy-hard-24302012?au

Evaluation results

3 evaluations so far

1. Relevance: Does this project seem to help children (ages 0 to 12 years) develop a strong sense of self, belonging, and purpose?

5 - Yes, this is great! The project lays out a strong, compelling case for how its model nurtures children’s wellbeing. - 0%

4 - It seems like a good fit, and the model talks explicitly about children’s wellbeing. - 100%

3 - I think so. The project seems related to children’s wellbeing, but the logic is vague. - 0%

2 - Not sure. The project doesn’t have much to do with wellbeing, or it doesn’t give enough information. - 0%

1 - Nope, this project definitely doesn’t fit the challenge brief (e.g., It doesn’t help kids younger than 12, isn’t in the U.S., etc.) - 0%

2. Innovation: Does this project tackle children’s wellbeing from a new angle?

5 - I loved this! The project describes a novel model that addresses important cultural or systemic barriers. - 0%

4 - This is pretty cool. The project is addressing an important problem in a new or compelling way. - 33.3%

3 - I feel like there’s something there, but I want more details about what makes it distinctive. - 33.3%

2 - It’s a good project, but I’ve seen others like it before. - 33.3%

1 - It was confusing or hard to tell what it made it different. - 0%

3. Social Impact: What is this project’s potential for creating positive social impact?

5 - Lots of potential. This project is achieving impressive results, and it’s growing quickly. It could absolutely inspire changes in the ways we approach caring for kids nationally, across sectors (e.g. childcare, healthcare, education). - 0%

4 - Pretty good potential. This project demonstrates significant positive impact so far, and it could scale regionally or nationally one day and fundamentally change how a system operates (e.g. childcare, healthcare, education). - 33.3%

3 - Budding potential. This project is creating local impact, but it would take a few adjustments before it could scale. - 66.7%

2 - Some potential. This project demonstrates some initial positive impact, but it would require major changes before it could scale. - 0%

1 - Limited potential. This project has great intentions, but it looks like it does not include key drivers of a shift towards children’s wellbeing. - 0%

4. Overall, how do you feel about this idea?

5 - This idea rocked my world. It’s awesome! - 0%

4 - This idea seems really exciting. With a little more polishing, it’d be among my favorites. - 33.3%

3 - I think the idea is great, but it needs some work before it moves onto the next round. - 66.7%

2 - I liked it fine but preferred others. - 0%

1 - It didn’t make my heart beat faster. Needs significant revisions. - 0%

5. Offer some feedback. Where should this participant spend some time revising?

DEFINING THE PROBLEM. Make sure to articulate the root causes or main barriers of the social issue your project addresses. (Founding Story, Problem, Solution). - 0%

CLARITY OF MODEL. Make sure to mention (a.) the beneficiary, b) the main activities, and c) how those activities drive social impact. Keep it streamlined! - 50%

MARKETPLACE. Make sure to research other players in this space and articulate how this project is different. I didn’t get a complete sense of how this project compares to others. - 100%

IMPACT POTENTIAL. Make sure to use specific numbers to describe what your project has achieved so far! And consider how you might scale the model or its insights, through partnerships, trainings, or franchising. - 50%

WRITING STYLE. Try to stay concise and make it vivid. Avoid jargon. - 0%

Nothing stands out! I thought it was great. - 0%

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Attachments (3)

Early Childhood Well Being slide.pptx

One in five preschool children in the U.docx

QEC presentation desktop master.pptx

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Photo of Fred Cardenas
Team

Thank you very much for your interest and comments. Yes, parents and family play a crucial part in a child's social and emotional development and their mental well being. At the same time it's important to be cognizant that parents themselves often are dealing with their own stressors, traumas and other challenges that can contribute to their ability or challenge in parenting such as single parenthood, poverty, marital difficulties or their own trauma or mental health issues. So strategies and programs that address child mental health must be prepared to support and/or connect parents to resources so that the approach is comprehensive. Children get better within the context of family and their other environments. And yes, the earliest stages of life and development can provide a wonderful opportunity to help families help their children begin with the love, support, nurturing, education and resources needed to help them be successful with the support of community as well (schools, childcare, etc.). Parents are not to blame for their child's serious mental health problems but they are a crucial part of the context in which children can improve.

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