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0000017a-15d9-d736-a57f-17ff8e2b0000Stories and conversations about disparities in health and nutrition in early childhood in N.H. Part of the NHPR News series The First Decade.View the entire series, or find stories by topic:Main Series PageHome & FamilyHealth & NutritionEducationPlayPolitics & Policy

Mental Health Initiatives Target New Hampshire's Youngest and Poorest

Isaias via Flickr CC

In 2000, a committee of researchers compiled nearly a century of knowledge on how children develop from birth to age five. The findings, published in a 600-page book titled From Neurons to Neighborhoods: The Science of Early Childhood Development, covered everything from the long-standing debate over “nature vs. nurture” to the latest breakthroughs in neuroscience.

If the massive effort could be summarized in one sentence, it would be this: What happens during the first months and years of a child’s life matters - a lot. Researchers know, for example, that middle- and upper-income children are more likely to have positive, nurturing relationships with the adults who care for them and, as a result, they do better in school, form healthier relationships and are less likely to suffer from mental illness.

Meanwhile, children who grow up poor are often subjected to abuse and neglect that creates unrelenting “toxic” stress that damages their developing brain, increasing the likelihood they will be diagnosed with developmental delays and emotional disorders.

Current data on the number of young children who need mental-health services in the Granite State is hard to come by. A 2009 estimate by the New Hampshire Association for Infant Mental Health put the figure at about 7,500, or about 10 percent of children under five.

But talk to any child-health advocate in New Hampshire and you’re likely to find yourself in a discussion about From Neurons to Neighborhoods. The study and subsequent research by Harvard’s Center for the Developing Child provide compelling evidence for the need to address the emotional wellbeing of infants and young children, especially the growing number whose circumstances and experiences put them at the greatest risk.

Kim Firth, program director at the New Hampshire Endowment for Health, says the explosion of data on early-childhood mental health has changed the way people look at the issue. “It’s usually talked about as a deficit or disorder,” she says. “But I would turn that on its head and say that early childhood mental health is really the social-emotional development of young kids. It’s just part of a developmental domain that is essential to kids succeeding in preschool, in kindergarten and in life.”

Over the past several years, as attention was focused on the collapse of New Hampshire’s adult mental-health system, advocates and community-health workers have launched programs aimed at young children and families in two of the state’s poorest areas.

In Manchester, where a quarter of children live in poverty, a federally-funded initiative called Project LAUNCH has expanded behavioral and mental-health services to children eight-years-old and younger. The project involves the Manchester Community Health Center, the Family Resource Center, Head Start and other local agencies.

Program Coordinator Lara Quiroga says many of the families targeted by the project are dealing with the stress associated with being poor. “It’s really hard to be there emotionally for your family when you’re working two or three jobs and you’re leaving your kids in child care or with family members or neighbors,” she says.

Katy Burchett is the director of behavioral health and family support programs at Child Health Services, which merged with the Manchester Community Health Center last year. Burchett says Manchester’s large refugee and immigrant population faces a number of barriers to mental-health care, including limited English-language skills and a lack of transportation and child care.

One potential solution is have bilingual child-development specialists conduct “brief, targeted interventions” during a primary care visit instead of scheduling an hour-long appointment they may not be able to keep. “A lot of the kids and families we work with are never going to easily navigate a community mental health setting,” Burchett says. “So trying to meet them in other places is one way to go.”

Now in its second year of operation, Project LAUNCH is also offering parent training classes at several locations in Manchester, as well as home visits to conduct needs assessments and provide other support.

“It’s not enough to give people information,” Quiroga says. “We’re inundated with information and we do a lot of nothing with it. It’s really important to teach people how to use that information.”

The project is also trying to address the shortage of licensed mental health workers by embedding so-called behavioral coaches at child-care centers. Quiroga says the goal is to teach providers how to work with children who have emotional and behavioral problems, which can lead to suspension and expulsion.

“It’s about prevention, making sure these behaviors never happen,” Quiroga says. “But it’s also about understanding what to do when you see these behaviors, because there are children who have had some really horrific experiences and it plays out in their behavior.”

Up north, in Coos County, a similar initiative is now in its sixth year, thanks to $5 million from the Neil and Louise Tillotson Fund of the New Hampshire Charitable Foundation.

The Coos Coalition for Young Children and Families is an alliance of local groups that have joined together to promote the physical, social and emotional development of infants and children up to age five. Charlie Cotton, director of the lead agency, Northern Human Services, says the county’s existing mental-health system worked almost exclusively with adolescents and teens. But when the Coalition’s members were asked for ideas, they unanimously agreed that they needed to develop ways to intervene with children as soon as possible.

“Our answer was, ‘We can’t wait until the house is on fire and then put out fires,” Cotton says. “We need to keep the house from getting on fire in the first place.”

Cotton says infants and young children have trouble accessing mental-health services care because they aren’t routinely screened by their primary-care providers. And while the state’s community mental health centers treated more than 12,000 children in 2013, very few were preschool children, who are difficult to evaluate and diagnose.

Moreover, he says, the state’s Medicaid program effectively prohibits mental-health services for very young children.

“You can only bill for these services if you meet the state’s eligibility criteria,” Cotton says, “and those criteria are very much a challenge if the kid is an infant, because how do you establish eligibility for a six-month-old who may need help? That’s something we’re struggling with.”

One of the Coalition’s major goals is to measure the development of the county’s roughly 1,600 young children using a screening tool called the Ages & Stages Questionnaire, which is designed to identify children who need more intensive evaluation. “

That gives you a score that tells you where the kid is relative to their healthy development,’ Cotton says. “At some point, 6 months or a year later, we take another score. What we’re trying to do is get a kid closer to where they should be in their developmental trajectory by offering additional support, primarily to the parent or the primary caregiver.”

The Coalition eventually hopes to create a “dashboard” of family and early childhood health and wellness, Cotton says. The tool would gather and report data on a variety of indicators, such as the number of kids living in poverty, their education level and the quality of childcare they receive. The dashboard would also give Coalition members and others a sense of whether its various initiatives are improving outcomes.

“It’s exciting,” he says. “I’m not saying we can’t use more resources. I’m not saying we’re not still swamped, because we are but we have a model that’s working, we have, blessedly, some long term support from the charitable foundation and we’re doing some really exciting stuff.”

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