Post on 17-Dec-2015
BUILDING SOCIAL EMOTIONAL HEALTHA Foundation for Success: The Unique Role of the Child Health Consultant
GOALS
• To identify the unique roles and opportunities for child care health consultant to promote social emotional health
• To understand the compelling case for social emotional health promotion in early childhood
• To identify concrete next steps and tools to integrate into practice
The Foundation of a Successful Society is Built in Early Childhood
HEALTHY CHILD DEVELOPMENT
Educational Achievement
Economic Productivity
Responsible Citizenship
Lifelong Health
Strong Communities Healthy EconomySuccessful Parenting of Next Generation
Source: Center on the Developing Child at Harvard University (2011).
3
INFANT MENTAL HEALTH
“The developing capacity of the children from birth to 3 to experience, regulate, and express emotions; form close and secure interpersonal relationships; and explore the environment and learn – all in the context of family, community, and cultural expectations for young children.”
Zero to Three, 2002
CHILD CARE HEALTH CONSULTANT
• Access to setting including providers and parents
• Trusted• There already…can you add this
lens?• Pair & Share: Can you share a
moment when you did or saw an opportunity to address social emotional health?
700 New Neural Connections Every Second
Image source: Conel, JL. The postnatal development of the human cerebral cortex. Cambridge, Mass: Harvard University Press, 1959 6
FOUNDATION FOR EXECUTIVE FUNCTION SKILLS IS BUILD IN EARLY CHILDHOOD
• Self-Control – ability to filter thoughts and impulses to resist temptations and distractions
• Working Memory – ability to hold and manipulate information in our heads over short periods of time
• Mental Flexibility – adjusting to changing demands, priorities, or perspectives
CRITICAL FACTORS IN DEVELOPING A STRONG FOUNDATION FOR EXECUTIVE FUNCTION
SKILLS
• Children’s Relationships– consistent reliable adults who support and protect them, and model and engage them in building executive function skills
• Activities – the opportunity to engage in activities that reduce stress, foster social connection, incorporate vigorous physical activity, and increase the complexity of skills at the right speed for each child
• A safe and stable environment
WHAT’S THE BIG IDEA? WHY SO IMPORTANT
• Scope of social emotional/ behavioral issues
• Expulsion rates• Teacher turnover• Tools and techniques that work• Impact on school success/ failure• Lifelong health
BARRIERS TO EDUCATIONAL ACHIEVEMENT EMERGE AT A VERY YOUNG AGE
16 mos. 24 mos. 36 mos.
Cu
mu
lati
ve V
ocab
ula
ry (
Word
s)
College Educated Parents
Working Class Parents
Welfare Parents
Child’s Age (Months)
200
600
1200
400
800
1000
CARING FOR OUR CHILDREN STANDARD 2.1.1.1INTERACTIONS WITH INFANTS AND TODDLERS
• Caregivers/Teachers should provide consistent , continuous and inviting opportunities to talk, listen to and otherwise interact with young infants throughout the day (indoors and outdoors) including feeding, changing, playing with, and cuddling them
• **RICHNESS OF LANGUAGE • The social and emotional
communications and the atmosphere and essential
SERVE & RETURN BUILDS BRAINS & SKILLS
• Ongoing, reliable interaction with trusted adults is essential for the development of healthy brain circuits
• Systems that support the quality of relationships in early care settings, communities, and homes help build brain architecture
KEY FACTORS
• A language rich environment• Warm, responsive interactions
between caregivers/ staff and children
• Video clip examplehttp://csefel.vanderbilt.edu/resources/inftodd/mod1/1-1.mpg
PAIR AND SHARE
• Example of when this went right or wrong during your observation
• Strategies for promoting serve and return/ language rich interactions
EARLY CHILDHOOD STRESS INFLUENCES DEVELOPMENTAL OUTCOMES
• Brief increases in heart rate, mild elevations in stress hormone levels; important to development in the context of stable and supportive relationships
• Serious and temporary, but impact buffered by supportive relationships and safe environments
• Prolonged activation of stress response systems in the absence of protective relationships; disrupts brain architecture, increases the risk of stress-related physical and mental illness
Positive Stress Response
Tolerable Stress Response
Toxic Stress Response
Harvard center on the Developing Child
PREVELENCE OF ADVERSE CHILDHOOD EXPERIENCES (ACE)
Girls BoysTotal• Abuse (n=9,367)(n=7,970) (17,337)
– Emotional 13.1% 7.6% 10.6%– Physical 27.0%29.9%28.3%– Sexual 24.7%16.0%20.7%
• Household Dysfunction– Mother Treated Violently13.7%11.5%12.7%– Household Substance Abuse 29.5%23.8% 26.9%– Household Mental Illness23.3%14.8%19.4%– Parental Separation or Divorce24.5%21.8% 23.3%– Incarcerated Household Member 5.2% 4.1%
4.7%• Neglect *
– Emotional 16.7%12.4%14.8%– Physical 9.2%10.7% 9.9%
*Wave 2 data only (n=8,667)
Source: Kaiser ACE Study, 1 995-1997. Data from : www.cdc.gov/nccdphp/ace/demographics
PREVELENCE OF ADVERSE CHILDHOOD EXPERIENCES
(ACE)
Number of Risk Factors Data Source: Barth, et al. (2008)
Child
ren
with
Dev
elop
men
tal D
elay
s
20%
40%
60%
80%
100%
Graphic adapted from 2011, Center on the Developing Child at Harvard University
3:1 ODDS OF ADULT HEART DISEASE AFTER 7-8 ADVERSE CHILDHOOD
EXPERIENCES
Adverse Experiences
Odd
s Ra
tio
0 1 2 3 4 5,6 7,80 1 2 3 4 5,6 7,8
0.5
1
1.5
2
2.5
3
3.5
UNDERSTANDING IMPACT OF ADVERSE CHILDHOOD EXPERIENCES
Death
Conception Adverse Childhood Experiences
Social, Emotional, and
Cognitive Impairment
Adoption of
Health-Risk Behaviors
Disease &Disability
Freely reproducible slide from the Centers for Disease Control and Prevention.
Early Death
RELATIONSHIPS BUFFER TOXIC STRESS
• Learning how to cope with moderate, short-lived stress can build a healthy stress response system
• Toxic stress (when the body’s stress response system is activated excessively) can weaken brain architecture• Without caring adults to buffer children, toxic stress can have long-term consequences for learning, behavior, and both physical and mental health
Harvard Center on The Developing Child
CFOC 2.1.2.1 PERSONAL CAREGIVER/TEACHER RELATIONSHIPS FOR INFANTS AND TODDLERS
• Hold and comfort children who are upset• Engage in frequent, multiple and rich social
interchanges such as smiling, talking, touching, singing and eating
• Be play partners as well as protectors• Be attuned to children’s feelings and reflect
them back• Communicate consistently with
parents/guardians• Interact with children and develop
relationship in the context of everyday routines (diapering/feeding etc.)
HELPING CAREGIVERS UNDERSTAND TEMPERAMENT
• Activity level – always active or generally still• Biological rhythms – predictability of hunger, sleep,
elimination • Approach/withdrawal – response to new situations• Mood – tendency to react with positive or negative mood,
serious, fussy• Intensity of reaction – energy or strength of emotional
reaction• Sensitivity – comfort with levels of sensory information;
sound, brightness of light, feel of clothing, new tastes• Adaptability – ease of managing transitions or changes• Distractibility – how easily a childʼs attention is pulled
from an activity • Persistence – how long child continues with an activity
he/she finds difficultFrom csefel handout on temperament traits
ADDRESSSING CAREGIVER STRESS
• Check in• Acknowledge• Empathize• Reframe• Commit to Plan
Video clip portraying caregiver perceptions:http://csefel.vanderbilt.edu/resources/inftodd/mod1/1-4.mpg
STRATEGY FOR EARLY CHILDHOOD SETTINGS AND PARENT EDUCATION
• Read together every day (your)• Rhyme play and cuddle with your child every• Routines• Reward your child with praise for successes
to build self-esteem and promote positive behavior
• Develop a strong and nurturing Relationship with your child as the foundation for their healthy development
PROGRAM SUPPORT FOR STRENGTHENING RELATIONSHIPS
• Adequate adult to child ratios• Small group sizes• One primary caregiver per child• Continuity of care; one caregiver
over time• Time for parents/guardians to
share information • Time for caregivers to get to know
the child through observation
The National Training Institute for Child Care Health Consultants
MAKE DAILY ROUTINES PREDICTABLE
• Post pictures or other visual cues about what comes next.
• Alternate small and large group activities, as well as quiet and high-energy activities.
• Allow clear choices between activities.
• Create rules and rituals that are easy to follow.
The National Training Institute for Child Care Health Consultants
STRATEGIES TO SUPPORT ROUTINES FOR INFANTS AND TODDLERS
• Use first/next or first/then words• Display an item, such as a new toy,
photo or plant, that children and families can explore together during arrival
• Sing or play lullabies • Involve children in routines – for
example, invite toddlers to help pass items to the next person during mealtimes
WHAT IS EMOTIONAL LITERACY?
• It is the capacity to:– Identify, understand and express emotion
in a healthy way– Recognize, label, and understand feelings
in self and others
Adapted from Craddling Literacy 2007
STRATEGIES TO DEVELOP EMOTIONAL LITERACY IN INFANTS AND TODDLERS
• Use the adult/child relationship to expand children’s awareness of emotions or feelings:– Verbally acknowledge and label emotions
expressed by children in care– Assist infants and toddlers with
regulating their emotions– Talk about the fact that feelings can
change– Use questions about feelings to see if and
how a child respondsCSEFEL MODULE 2
STRATEGIES TO DEVELOP EMOTIONAL LITERACY IN INFANTS AND TODDLERS
• Use enriching language tools:– Choose books, music, finger plays with
a rich vocabulary of feeling words– Use puppetry or felt board stories that
retell common social experiences and emphasize feeling vocabulary and conflict resolution
– Read stories about characters that children can identify with who express a range of feelings
CSEFEL MODULE 2
DEVELOPMENT OF PLAY SKILLS FOR INFANTS AND TODDLERS
(CSEFEL MODULE 2)
Age Play
13 to 24 Months • Enjoys play with objects• Increased interest in watching other children play (onlooker)• Primarily plays alone (solitary)• May offer toys to caregiver or other children• May choose independent play close to other children (parallel) but not interact with them
25-36 Months • May play with other children but in an occasional or limited way (associative)
• Some cooperation and talking with other children• May take leader/follower roles in play• Some pretend play• Still plays alone frequently• Interactive level moving toward (cooperative play)
SETTING UP THE ENVIRONMENT FOR DEVELOPING PLAY AND FRIENDSHIP
SKILLS• Evaluate the physical space to ensure
that there is enough space for infants and adults to engage in social activities
• Evaluate the physical environment for spaces for two or more children to enjoy side-by side activity and for adults to be close for supervision
• Evaluate the daily schedule for opportunities to develop play skills each day
• Provide enough materials and equipment that allow and encourage two or more children to interact
PROMOTING THE DEVELOPMENT OF FRIENDSHIP SKILLS
• Encourage toddlers to help each other and do routines together
• Provide positive verbal support for play between children
• Read books about friends, playing together, helping each other, etc.
• Practice turn-taking and sharing
DEALING WITH CHALLENGING BEHAVIOR
• Not addressing sufficiently here: a separate talk• This Opens a dialogue and highlights promotion• Many Resources for challenging behavior
– Including (identify/explore/action and care plans/effective in class interventions/supports/community resources and referrals/communication with medical home)
• Other core area communication with parents: further training
• This was meant to be an overview to promote opportunities and a promotion approach….more to follow
PAIR AND SHARE
• What is one thing you are going to do differently to enhance your promotion of social emotional health?
• What is a challenge that you would like to address around promoting social emotional health?
• What is a next step in supporting your ability to address the challenge? Action step
• What is a long term goal in promoting social emotional health? And an action step to get there
CHILDCARE HEALTH CONSULTANT NETWORK
BUILDING
• Bridges Between Health and Early Childhood Systems (focus on childcare health consultants as key stakeholder group/target audience)
• Docs For Tots Plan to support ECCS/ Build online Resource Center/Training/ Listserv/TA
• What are your thoughts? What would be helpful?
CSEFEL A TREMENDOUS RESOURCE
• Explore website: make it a GO TO RESOURCE• http://csefel.vanderbilt.edu• Training Modules:
– http://csefel.vanderbilt.edu/resources/training_modules.html
• Unlimited practical caregiver resources/ classroom tools/ Strategizing tools/ parent handouts– http://csefel.vanderbilt.edu/resources/strateg
ies.html