New Pediatric Sub-Specialty Board Approved for Certification of Pediatricians with Expertise in the Management of Victims of Child Maltreatment

It has been well demonstrated that maltreatment in the earliest years of life can lead to life- long behavioral and health problems (Sameroff, 1998). In November of 2009, approximately 200 doctors will sit for a board examination offered for the first time by the American Board of Pediatrics. The Board Exam will be for candidates in the field of child abuse pediatrics- a specialty involving not only caring for child maltreatment victims but also working with law enforcement and caseworkers and testifying in court cases. The acceptance of child abuse pediatrics as a medical concentration is expected to lead to an established system of accreditation for the estimated 25 child maltreatment fellowship programs in the U.S. for which there are presently no nationally agreed upon standards.

Administrators expect the changes to result in more specialists who can teach in medical universities, conduct research and serve as a resource for the general medical community. Additionally, practitioners also hope the increased acceptance of the concentration will generate higher reimbursements from insurance organizations and government health care programs- a benefit for hospitals that usually lose money on their child maltreatment teams because of the time devoted to these complicated cases (Hollingsworth, 2009).

The need for the maltreatment focus area is clear: research has regularly indicated that many medical professionals lack the knowledge to effectively handle these demanding cases. A recent study published in Pediatrics suggests that current standards of child maltreatment instruction are insufficient (Hollingsworth, 2009).

Even medical professionals who are not certified in child abuse pediatrics should focus on preventing child abuse and neglect: it is an integral component of accomplishing their responsibility of ensuring children’s health and welfare. Young children who are abused or chronically neglected have increased risks for social-emotional, behavioral and cognitive delays. Too often, by the time a child is determined to be a maltreatment victim, these problems have already begun to develop (Hawley, 2000). In 2008, children under six were the victims in nearly half of all investigations of abuse or neglect in Shelby County (TN DCS, 2008).

General principles that all who are involved in child care should become aware of include the following (Dubowitz, 2002):

1. Risk factors for abuse and neglect (such as parental substance abuse and maternal depression) need to be recognized and confronted. Caregivers at risk for abuse and/or neglect usually need mental health and social supports, and providers should expedite referrals.

2. Recognition and identification of a parent’s strengths and resources is vital to understanding the circumstances and preparing an appropriate response.

3. Child and family intentions/goals should be defined, clarified and integrated into the overall health care plan. For instance, a mother’s desire for her toddler to respect rather than fear her assists in the introduction of effective discipline approaches.

4. Acceptance of unconventional and informal assistance (i.e., friends, family, faith community) can be supported. For example, doctors can promote a grandmother’s engagement in child rearing by asking her to attend office visits.

For more information on the well-being of children in Memphis and Shelby County, visit The Urban Child Institute at http://www.theurbanchildinstitute.org.

References
Dubowitz, H. (2002, June). Preventing child neglect and physical abuse: A role for pediatricians.
Pediatrics In Review, 23(6), 191-196.

Hawley, T. (2000). Starting smart: How early experiences affect brain development. Zero To Three/The Ounce of Prevention Fund. Washington, DC.

Hollingsworth, H. (2009, August 18). New specialty spurs hope for helping abused kids. Associated Press: Yahoo News. Retrieved on August 24, 2009 from
http://news.yahoo.com/s/ap/20090818/ap_on_he_me/us_child_abuse_pediatrics.

Sameroff, A.J. (1998). Environmental risk factors in infancy. Pediatrics, 102, 1287-1292.

Tennessee Department of Children’s Services. CPS/Custody Data. Nashville, TN.

Exposure to Multiple Risk Factors in Early Childhood Impairs Children’s Brain Development

30 years ago, a group of researchers created a longitudinal study of children called the Rochester Longitudinal Study (RLS) to examine the influence of exposure to multiple known risk factors on children’s cognitive and social/emotional development. The study examined the social/emotional and cognitive development of children at birth, 4 months, 12 months, 30 months and again at 48 months of age. Interestingly, the researchers reexamined the children in the study when they were 13 and 18 years old.

In addition to tests of the children’s social/emotional and cognitive development, the researchers also gathered evidence on the children’s exposure to known risk factors that influence development, including socio-economic status, mother’s physical and mental health status, parent’s education, marital status, family size, stressful life events and occupations. They hypothesized that exposure to multiple risk factors would impair children’s social/emotional and cognitive development in their earliest years and as they grew up. Their formal list of risk factors included:

- Having a mother who sought treatment for mental illness on more than one occasion;

- Having a mother with a high level of anxiety;

- Having a small amount of spontaneous interaction between parent and child;

- Having parents in a semi or unskilled occupation;

- Having parents who lacked a high school education;

- Being a minority;

- Having a parent with rigid beliefs about child development;

- Having a single mother;

- Being exposed to a large number of stressful life events; and

- Being in a family with 4 or more children

Each child in the study was assigned a risk score based on the number of identified risk factors at birth. They also updated the child’s risk score at each visit. As they hypothesized, children with only one or no risk factors did not suffer social/emotional or cognitive delays over the course of their earliest years. Unfortunately, children exposed to two or more risk factors in early childhood did have diminished cognitive and social/emotional development. In fact, the more risk factors a child was exposed to in early life, the larger their developmental deficits. On average, exposure to each additional risk factor in early childhood lowered a child’s IQ at age 4 by 4 points. So a child in the study who was exposed to 5 risk factors during early childhood, on average, had an IQ that was 20 points lower than a child who was exposed to one or no risk factors (Sameroff, 1998).

Disturbingly, the researchers also found that a child’s exposure to risk factors was consistent over the course of their childhoods. Very few children in the study who were at risk, by exposure to multiple risk factors, lost their exposure as they grew up. Additionally, the prolonged exposure to risk factors continued to have a negative effect on cognitive and social/emotional development. At 4 years of age, 22% of the children exposed to 4 or more risk factors had an IQ below 85. By the time the children were re-tested at 13, 46% of them had an IQ below 85 (Sameroff, 1998).

We have no way of knowing if the results of the Rochester Longitudinal Study would hold true for children growing up in Memphis. However, we do know that many children growing up in Memphis are exposed to many of their identified risk factors on a daily basis. While poverty is often identified as a serious risk factor for cognitive and social/emotional delays, we often do not examine what it means to live in poverty.

Fundamentally, poverty is an umbrella term, describing the multiplicity of psychosocial
and bio-ecological risks children growing up in poverty are likely to encounter, such as
family turmoil or instability, less responsive parenting, less access to educational
stimulation at home or in school, increased exposure to dangerous neighborhoods, and
environmental pollution (Evans, 2004).

In other words, children growing up in poverty are regularly exposed to multiple risk factors which work together to undermine their foundational cognitive, social/emotional and physical development. Beyond being troubling, the RLS’s findings have important implications for the way that we seek to improve children’s developmental and long term outcomes. Most importantly, they imply that it is not enough to meet one identified need here and there. Our approach must be holistic and seek to provide protective factors which insulate children from the range of risk factors that interact to undermine their development.

Sources

Evans, G. (2004). The environment of childhood poverty. American Psychologist, 59, 77–92.

National Scientific Council on the Developing Child, Young Children Develop in an Environment of Relationships. (2004). Working Paper No. 1. Retrieved [August 21, 2009] from www.developingchild.net/pubs/wp/environment_of_relationships.pdf

Sameroff, Arnold J. (1998). Environmental Risk Factors in Infancy. Pediatrics, 102, 1287-1292. Accessed August 20, 2009 <http://www.pediatrics.org/cgi/content/full/102/5/SE1/1287>

Two U.S. Health Organizations Collaborate To Improve Breastfeeding Rates

Last week, administrators from the U.S. Office of Women’s Health and the Centers for Disease Control and Prevention met at the CDC Headquarters in Georgia to learn from breastfeeding specialists about improving child and maternal health through breastfeeding initiatives. By mid-2010, the agencies aim to disseminate a “Call To Action”- a government plan that promotes distinct procedures and operations to address what is being called an essential public health concern.

“Helping women breastfeed is a no-brainer in the health and well-being of mother and baby,” said Sheela R. Geraghty, medical director of the Center for Breastfeeding Medicine at Cincinnati Children’s Hospital Medical Center. “It’s a completely cost-effective mechanism to improve health in the U.S. And, it’s an economic benefit, with less formula costs, less bottles.” (Gardner, 2009, p.1)

Improving breastfeeding rates can be difficult. Many hospitals separate mothers and infants immediately after birth. Furthermore, the majority of women who are of childbearing age are employed at least part-time, and many employers require mothers to return to work as early as six to eight weeks after childbirth. Employed mothers can utilize breast pumps to extract and store breastmilk for their infants while they are at work; however, breast pumps are expensive and many people do not have a private place to pump while on the job. Across the country, mothers in lower socioeconomic categories do not breastfeed as often as mothers with greater access to financial resources (Gardner, 2009).

Providers and policymakers should work to overcome these obstacles: the benefits of breastfeeding are expansive and research-supported. Breast-fed babies have a lower risk for obesity, asthma, diabetes and sudden infant death syndrome (Gardner, 2009). Breastfeeding enhances the cognitive development of young children and their intellectual and scholastic ability in later life. Breastmilk contains high amounts of important fats, such as DHA and ARA. These are very important components of brain structures, and research has shown that breastfed infants have higher concentration of these essential fats in their brain and blood than do formula fed babies (BPNI, 2005).

Fast Facts:

1. In Tennessee, breastfeeding prevalence rates vary significantly by socioeconomic status.

Percentage of TN children (0-5) having ever been breastfeed by socioeconomic status (National Survey of Children’s Health, 2007) :

Children living below 100% of the federal poverty line: 49.4%
Children living at 100% to 199% of the federal poverty line: 57.9%
Children living at 200% to 399% of the federal poverty line: 71.4%
Children living at or above 400% of the federal poverty line: 78%

2. About half of residents in Memphis/Shelby County believe mothers should stop breastfeeding completely at some point when their baby is between 0 and 11 months of age (MidSouth Social Survery, 2008). Meanwhile, The American Academy of Pediatrics suggests that there is no upper limit for breastfeeding duration- Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child.

3. Tennessee code Ann. 50-1-305 (1999) requires employers to provide daily break time for a mother to express breast milk for her infant child, as well as make a reasonable effort to provide a private location, other than a toilet stall, in close proximity to the workplace for this activity. In 2008, only one in five Shelby County respondents were aware of this law’s existence.

Local Resources

La Leche League (LLL) is an international, nonprofit, nonsectarian organization dedicated to providing education, information, support and encouragement to women who want to breastfeed. All breastfeeding mothers and mothers-to-be interested in breastfeeding are welcome to contact LLL of Memphis for breastfeeding help or information. For more information, please visit http://www.llleus.org/web/MemphisTn.html.

Baptist Memorial Hospital for Women’s Breastfeeding Resource Center is staffed by certified lactation consultants who have more than 20 years of experience with mothers and newborns. Staff is available to assist new moms with their breastfeeding questions through one-on-one consultation sessions. For more information, call (901) 227-9620.

References

Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health, Data Resource Center for Child and Adolescent Health website. Retrieved [08/17/09] from
www.nschdata.org

Gardner, A. (August 13, 2009). It’s time for more moms to breastfeed, U.S. officials say. HealthDay Reporter.
http://news.yahoo.com/s/hsn/20090814/hl_hsn/itstimeformoremomstobreastfeedusofficialssay

Breastfeeding and brain development (Cognitive development): Information sheet- 9. (2005,
February). IBFAN Asia Pacific/Breastfeeding Promotion Network of India (BPNI).

Breastfeeding laws. (2009, May). National Conference of State Legislatures: Maternal and Child
Health Overview. U.S. Department of Health and Human Services. Washington, D.C.: Author.

Breastfeeding and the use of human milk. Pediatrics, 115(2), 496-506.

Providing Universal Healthcare Access for Children (0-18): Children’s Health Initiatives

Why is health care access important during the first 36 months of life? The American Academy of Pediatrics and the Centers for Disease Control state that children need to be immunized against 15 different diseases during this period. Additionally, 9 of these vaccines are administered in multiple doses during this time period (CDC, 2009). Pediatricians are also an important source of early detection for developmental delays including cognitive, social/emotional and physical delays. Early Intervention Services can effectively remediate many types of developmental delays and have a demonstrated cost benefit of $13 in public savings for every $1 invested (Glascoe & Shapiro, 2007).

There is also a demonstrated connection between having insurance and consistent health care access. Uninsured children do receive health care services, but often they do not receive all of the care that they need when it is needed. This can be very expensive for them and the healthcare system since paying for chronic pre-existing conditions is significantly more expensive than providing preventive care (Stoll and Thorpe, 2005).

So who currently pays for care for uninsured children? A 2005 Families USA report revealed that roughly 1/3^rd is paid by uninsured children’s families, 1/3^rd is paid for through a combination of existing government programs and the final third is passed on to privately insured individuals and families in the form of higher health insurance premiums. The report estimated that the average privately insured family in Tennessee will be paying just over $1,299 extra in health insurance premiums each year by 2010 to cover the cost of providing health care for uninsured individuals (Stoll and Thorpe, 2005).

Increasingly, children whose families earn too much to qualify for publicly funded health insurance programs (Medicaid and SCHIP) lack insurance. California responded to this reality by creating the Children’s Health Initiative (CHI). The first Children’s Health Initiative was created in 2001 in Santa Clara County. Currently there are Children’s Health Initiatives in 30 counties and during their 8 years of existence, they have helped provide health insurance to 88,000 uninsured children (California Children’s Health Initiatives, 2009).

Children’s Health Initiatives work by enrolling eligible children in Medi-Cal, California’s Medicaid program, and Healthy Families, their SCHIP program. Children who are ineligible for either program are enrolled in locally funded and non-profit programs. The Initiative is primarily funded through the Foundation community of California, including the David and Lucille Packard Foundation, the California Endowment and the Tides Center. The programs which provide health insurance for children who do not qualify for Medi-Cal or Healthy Families include:

- Healthy Kids, a locally operated insurance program that does not have income eligibility limits. Families pay low premiums and co-pays for health, dental and vision coverage.

- CalKids, a non-profit program for children ages 2 through 18 whose families earn below 250% FPL, regardless of immigration status;

- Kaiser Permanente Child Health Plan, a state level program that provides low cost care for all children who do not qualify for state plans, regardless of family income.

There are also two federal and state funded programs that provide care for children with identified disabilities or medically necessary care.

To date, the CHI has demonstrated improved access to dental and medical care services, reduced child hospitalizations and improved health care status for many children statewide who would have lacked coverage otherwise (Cousineau et al, 2007; Howell and Trenholm, 2007; Phipps et al, 2008).

Sources

California Children’s Health Initiative (2009). History. Altadena, CA: The Tides Center. Accessed August 14, 2009. < http://www.cchi4kids.org/history.php>

California Children’s Health Initiative (2009). Vision and Mission. Altadena, CA: The Tides Center. Accessed August 14, 2009. < http://www.cchi4kids.org/vision&mission.php>

California Children’s Health Initiative (2009). Partners. Altadena, CA: The Tides Center. Accessed August 14, 2009. <>

Centers for Disease Control and Prevention (2009). Recommend Immunization Schedule for Persons Aged 0 through 6 Years. Washington D.C.: Author. Accessed August 14, 2009. <>

Cousineau, Michael R., Gregory D. Stevens and Trevor A. Pickering (December 2007). Children’s Health Initiatives Have Helped Prevent Over 1,000 Unnecessary Child Hospitalizations Annually. University of Southern California: Center for Community Health Studies. Accessed August 14, 2009. <>

Glascoe, F.P. & Shapiro, H.L.(2007). Introduction to developmental and behavioral screening.
Developmental Behavioral Pediatrics Online, www.dbpeds.org

Howell, Embry and Christopher Trenholm (March 2007). Santa Clara County Children’s Health Initiative Improves Children’s Health. Los Altos, CA: David and Lucille Packard Foundation. Accessed August 14, 2009. <>

Phipps, Kathy, Joel Diringer, T. Em Arpawong, Chris Feifer, Michael R. Cousineau, and Gregory D. Stevens (July 2008). Dental Utilization in California’s Children’s Health Initiatives’ Healthy Kids Programs. University of Southern California: Center for Community Health Studies. Accessed August 14, 2009. <>

Stoll, Kathleen and Kenneth Thorpe (June 2005). Paying a Premium: The Added Cost of Care for the Uninsured. Washington, D.C.: Families USA. Accessed August 14, 2009. <>

Tennessee Ranks Near Bottom In Child Well-Being: Child Poverty Especially High In Urban Shelby County

Last month, the Annie E. Casey Foundation published the 10th annual KIDS COUNT Databook, showcasing the welfare of our nation’s children on a state-by-state basis and grading states on 10 measures of child welfare*. According to the report, Tennessee has lots of room for improvement when it comes to children’s issues- our state ranks 46th nationally.

According to Linda O’Neal, Executive Director of the Tennessee Commission on Children and Youth, the majority of the factors examined by the Annie E. Casey Foundation are related to poverty. The percentage of Tennessee children residing in impoverished households in 2007 was 23 percent, up from 20 percent in 2000. “Tennessee and other Southern states have been plagued by a history of poverty, unemployment and low-paying jobs that worsen dropout rates, teen birth rates and other metrics the study considers” O’Neal suggested (Carey, The Tennessean, p.1).

Economic hardship is especially prevalent in our community. In Shelby County (2007), about 30 percent of children live in poverty, with half of these living in extreme poverty (approximately $10,000 in annual income for a family of four). Poverty is on the rise in the city of Memphis- from 2003 to 2007, the percentage of children in poverty rose from 35 to 42 percent (The Urban Child Institute [TUCI], 2009).

For our youngest citizens, residing in poverty is more than economic disadvantage- science suggests that poverty negatively impacts cognitive and social-emotional growth. Children raised in impoverished households lack access to critical resources needed for intellectual development, including high quality child care, medical care and reliable transportation.

How can we make sure that our infants and toddlers have a healthy start in life and guarantee that local families have access to the supports that will help them meet their young children’s basic needs?

Policy Suggestions (Zero To Three, 2009):
- Actualize family-friendly welfare-to-work programs that support the developmental requirements of very young children.
- Extend tax protocols for low-income families, including the Child Tax Credit and the Earned Income Tax Credit.

For more information on the well-being of children in Memphis and Shelby County, visit The Urban Child Institute at http://www.theurbanchildinstitute.org.

References

The Annie E. Casey Foundation. (2009). 2009 Kids Count DataBook. Baltimore, MD: The Annie E. Casey Foundation.

Carey, C. (2009, July 29). Tennessee is 46th in caring for kids: State worsens in poverty but
improves dropout rates. http://www.tennessean.com/article/20090729/NEWS01/907290393/Tennessee+is+46th+in+caring+for+kids

DiLauro, E. (2009). Getting back to basics: Building the foundation for infants, toddlers, and their families. Washington, DC: ZERO TO THREE Policy Center.

The Urban Child Institute. (2009). The State of Children in Memphis and Shelby County: DataBook. Memphis, TN: The Urban Child Institute.

*For a complete listing of variables examined by the Annie E. Casey Foundation, please visit http://www.aecf.org/.

Educare: An Early Child Care and Education Model that Bridges the Gap Between “What We Know” and “What We Do”

“Educare seeks to take the nation’s best early childhood research from the lab to the street” (Buffett Early Childhood Fund, 2009, 2).

Educare is a model for providing comprehensive full day, full year early child care and education services to at-risk families. Specifically, the program works with parents and children who are transitioning from welfare (Temporary Aid to Needy Families, or TANF) to work. The Educare Program model was designed by the Ounce of Prevention Fund and the first Educare center was opened in 2000 in Chicago. There are currently 9 Educare centers in the U.S. with another 3 in development.

In order to create an Educare center, local philanthropic and advocacy partners work together to obtain public dollars for Early Head Start, Head Start and child care. The funding is then combined to create a unified funding stream to provide comprehensive services for children from birth through age 5. Once a blended funding stream is established for the support of the center, local partners supply private dollars to design and build an Educare center and hire the support staff to run the programs.

Each Educare center is designed to serve between 140 and 200 at-risk children. Each classroom is led by a teacher with a Bachelor’s degree, and is also staffed by an assistant with an Associate’s degree along with a community volunteer. Each center has a supervisor with a Master’s degree in early childhood development. In addition to teaching staff, each center employs social workers to assist families in obtaining needed wrap around services, including health care. The program utilizes the most successful elements from nationally proven early childhood models such as Perry Pre-School and the Abecedarian project to design and implement their curriculum.

Providing services through an Educare Center begins with pre-natal care for children’s mothers. a third of the space at budget of each Educare Center is devoted to education and support to help parents establish strong relationships with their children and to help them balance the demands of work and family life. Parents are also expected to take an active role in the day to day operations and governance of the Educare center. Each Center is required to hire a Ph.D. level evaluator who regularly sends data on the center’s outcomes to the University of North Carolina where it is used to analyze how effectively services are being provided and children’s outcomes are being improved (Buffett Early Childhood Fund, 2009).

How large is the need for early care and education services among at-risk families in Memphis?

Currently, about 7,949 (30% of the eligible population) at-risk children (0-5) are being served by DHS child care funds. 95 (2% of the eligible population) children between birth and age 3 are served by Early Head Start; 2,296 (22% of eligible children) are served by Head Start and an additional 2,540 (24% of eligible children) are served by public pre-kindergarten (CUCP, 2009). All of these programs currently only reachat-risk families and their children. Additionally, with the exception of DHS child care, none of these programs provides full day, full year child care options. It is difficult to provide a complete estimate of eligible children who are not receiving services because there is overlap in the populations of children receiving different publicly funded care. For instance, many of the children who are participating in Early Head Start, Head Start, and public pre-K are also receiving before and after care from DHS funded child care providers. There are also many children in the population of families who are legally eligible for DHS child care, but only when there are funds available to cover them.

What would it mean to take the Educare model to scale in Shelby County?
In order to provide full day, full year care using the Educare model, we would need about 100 centers to provide care for all the children who are considered at-risk by virtue of their families being TANF recipients or transitioning off of TANF (CUCP estimate, 2009). From the ground up, the cost of an Educare center is daunting. The most inexpensive center in their system was created for $4 million dollars (Buffett, 2009). However, there is some potential for obtaining new funding dollars for an initiative of this type. Last month, the House of Representatives created the Early Learning Challenge Fund to provide a billion dollars a year for the next 8 years in order to provide grant money for states to undertake one or more of the following activities:

• Undertake activities to develop the components of an early learning system;

• Undertake such activities that will allow the state to become eligible and competitive for a Quality Pathways Grant;

• Prioritize the activities that improve the quality of early learning programs serving low income children.

The grants are designed to be dispersed for up to 3 years. In order to obtain funding, states must provide matching funds in each program year (Pre-K Now, July 2009). The grant funding is large enough that if we could coalesce public will around providing comprehensive full day, full year care for at-risk children in the city and convince the private foundation and business communities to provide matching funds to obtain the grants, we could obtain the funding to build an Educare system in Memphis. The most positive potential benefit is that we could have a vast improvement in the quality of early care and education services for at-risk children that could fundamentally improve our children’s brain development, school preparation and life successes.

Sources

Buffett Early Childhood Fund (2009). Educare. Omaha, NE: Author. Accessed 6th August, 2009. http://buffettearlychildhoodfund.org/downloads/EDUCARE.pdf

Center for Urban Child Policy (July 2009). Early Childhood Comprehensive Systems: Setting Our Children – And Our City – On a Path to Success. Memphis: The Urban Child Institute. http://www.theurbanchildinstitute.org/Download.php?fileId=4a672cd7c4e4c5.32385947

Pre-K Now (July 2009). Memorandum: Early Learning Challenge Fund. Washington D.C.: Author. Accessed 6th August, 2009. http://www.preknow.org/documents/ELCF_Post_Mark-up_Memo_7-24-09.pdf

The DC: 0-3: Enabling Healthcare Practitioners to Diagnose and Treat Infant Mental Health Disorders

Infants and toddlers establish their social/emotional foundational skills during their earliest years through interacting with their adult caregivers. Child development workers and psychiatrists refer to infant and toddler social/emotional development as infant mental health (Cohen et al, 2005). When a child’s earliest experiences are marked by poverty, family violence, child abuse and maternal depression, the physical regions of their brains that allow them to learn do not develop properly (National Scientific Council on the Developing Child, December 2008). Luckily, it is possible to assess and treat children’s mental health disorders early on in their lives so that they have the social/emotional skills they need before they enter kindergarten.

Babies need at least one stable adult relationship in order to develop the ability to form relationships with others and have the confidence to explore the world around them and learn. Adults also support babies in their social/emotional development by modeling and teaching them how to understand and manage their emotions, thoughts and actions. Developing social/emotional skills is necessary for a child’s successful transition into school because children are not capable of developing their cognitive skills in kindergarten if they do not know how to successfully engage in relationships and learning from the first day of school forward (Cohen et al, 2005).

The DC: 0-3 is the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. It was developed to supplement the DSM: V since many young children’s mental health disorders are not diagnosable using traditional instruments that focus on assessing the mental health of the individual. As one of the DC:0-3’s authors explains, “We say that much of the burden of mental and developmental disorder during infancy is primarily a disorder of the caregiver environment; it cannot even be described outside the context of the caregiving environment (Jancin 2001)”. In other words, the mental health of infants and toddlers is dependent upon and mediated through their relationships with their caregivers.

There are many children in Memphis who are at-risk for poor social/emotional development in their earliest years because of their exposure to poverty, family and neighborhood violence and child abuse. Currently, 47% of children in the city under 5 are growing up in poverty (ACS, 2007). One study of children in Early Head Start revealed that nearly half (48%) of the children participating had mothers who reported enough depressive symptoms to be considered clinically depressed (EHS Evaluation and Research Project, 2003). If these numbers hold true for Memphis, we would estimate that roughly a quarter of the children in the city under 5 have a mother suffering from clinical depression. Every year, roughly one third of the children who are victims of child abuse and neglect in Shelby County are between birth and age 3 (DCS Foster Care Data, 2008).

The key to effectively improving children’s social/emotional development in Memphis is to begin to identify young children who have mental health disorders and treat them before they enter kindergarten. Increasing the number of children who are assessed using the DC: 0-3 for disorders could improve our ability to target interventions to children and families who would benefit from them. These types of services could be targeted to the at-risk population via established DHS child care providers, Early Head Start and Head Start providers since they already care for the children who have the greatest exposure to risk factors.

Children’s social/emotional development could also be improved by increased screening and treatment for maternal depression. Many women seek mental health care services form their primary physician and so physicians need to be trained to perform maternal depression screenings. Physicians also need access to information on treatment programs for mothers who are depressed and reimbursement for screening and diagnosis.

In Illinois, multiple state agencies have worked together to create a funding stream for physicians to screen, diagnose and refer mothers for treatment for maternal depression. They have also provided training to physicians and access to psychiatrists to provide consultation on maternal depression for physicians as they see patients (Onunaku, July 2005). With these measures in place, depressed mothers have more resources for diagnosis and treatment. Effective treatment of depression enables mothers to provide nurturing, responsive care that supports their children social/emotional development.

In Shelby County, black churches have partnered with the mental health care system to create Emotional Fitness Centers. Through this partnership, peer advocates are being trained to do initial mental health screenings and then refer parishioners in need of care on to the mental health care system. Thus far, the program is being piloted in 6 Memphis churches with a budget of $250,000. They have a goal of serving 3,000 clients in their first several months of existence (Powers 2008). Hopefully, the Emotional Fitness Centers will provide more avenues for screening, diagnosis and treatment for mothers and children struggling with depression and other issues that hamper children’s social/emotional development.

Sources

American Factfinder (2007). Table B17001. POVERTY STATUS IN THE PAST 12 MONTHS BY SEX BY AGE. Washington D.C.: U.S. Census Bureau.

Cohen, Julie, Ngozi Onunaku, Steffanie Clothier and Julie Poppe (September 2005). Helping Young Children Succeed: Strategies to Promote Early Childhood Social and Emotional Development. Washington D.C.: Zero to Three and the National Conference of State Legislatures. Accessed 29th July 2009.

Early Head Start Evaluation and Research Project (January 2003). Research to Practice: Depression in the Lives of Early Head Start Families. Washington D.C.: U.S. Department of Health and Human Services, Administration for Children and Families.

National Scientific Council on the Developing Child (December 2008). Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life: Working Paper #6. Accessed 29th July 2009.

Jancin, Bruce (November 2001). "DC 0-3 Enhances Diagnosis of Mental Illness in Children: The Central Importance of the Parent-Child Relationship Needs to Be Recognized," Clinical Psychiatry News. Accessed May 21, 2009

Onunaku, Ngozi (July 2005). Improving Maternal and Infant Mental Health: Focus on Maternal Depression. Washington D.C.: Zero to Three. Accessed July 29, 2009.

Powers, Mary (13th March, 2008). "Six Churches Tapped for Emotional Fitness Campaign," The Commercial Appeal. Accessed 30 July, 2009. <http://www.commercialappeal.com/news/2008/mar/13/six-churches-tapped-for-emotional-fitness/>

Tennessee Department of Children's Services (2008). Child Abuse Data for Shelby County 2008. Available from TN: DCS. Estimates are the work of the author.