Project Description:
The goal of the Stein Tikun Olam Early Connections Program is to develop and implement a universal, preventative model of relationship-based, trauma-informed, culturally sensitive infant-family mental health screening and services that will reach every infant and young child (ages birth through 3 years) receiving medical care at CHLA and expand prenatal/perinatal mental health services. Further, the program will build an interdisciplinary workforce of health and behavioral health professionals trained to meet the unique mental health needs of infants and support attachment relationships. Finally, we will develop sustainable models of care and disseminate our model to other children's hospitals to promote adoption of a universal prevention model nationally and internationally. Overall, we aim to advance health equity, promote early relational health, and mitigate adverse childhood experiences to positively impact long-term health and wellness.
Target population and need:
Universal Infant Mental Health Screening and Intervention:
The target population for universal screening and intervention includes all infants and young children (0-3) and their families who receive medical care at CHLA through either outpatient clinics or inpatient settings, potentially experiencing high levels of pediatric medical traumatic stress. As a safety-net hospital in a diverse urban setting, many families at CHLA face psychosocial stressors that complicate their medical care and increase the risk for mental health challenges. These stressors include difficulty accessing basic nutritional, transportation and housing needs; exposure to community and interpersonal violence; and experiences of racism and other systemic stressors. Across the 5-year project, we will offer infant mental health screening and intervention for families while their child is receiving medical care. Annually, CHLA serves approximately 30,000 children aged 0-3 in the outpatient setting and 5,000 children aged 0-3 in the inpatient setting.
By partnering with medical teams throughout the hospital, we will provide screening and intervention at a time when a family is receiving essential healthcare for their child, which will decrease stigma and barriers to mental health screening, increase access for infant mental health intervention, and promote health equity through a universal approach. A universal approach is also necessary because children 0-3 and their families are under-referred for behavioral health support due to a lack of awareness of infant mental health needs and principles. Early screening provides opportunities for prevention and early intervention that ameliorate the impact of potentially traumatic experiences and mitigate the need for more intensive services later in childhood. Given the importance of relationships and early life experiences on brain development and the potential negative impact of early traumatic experiences on a range of long-term outcomes, we are focusing on a universal, population-based approach. We know that many CHLA children and their families are at increased risk for medical traumatic stress following a chronic medical diagnosis, while others may be seen for a less severe acute illness and may benefit from typical developmental guidance such as support for sleep, feeding, fussiness, and regulation. Many families at CHLA face challenges to infant-parent bonding and attachment due to the medical and psychosocial circumstances impacting them early in life.
Workforce Training, Development and Wellness:
The target population for training and wellness includes CHLA staff and community members; each group will receive training tailored to their needs, roles, and prior experience.
- We propose to train the 7,000 staff and faculty across disciplines at CHLA regarding core infant mental health principles, grounded in support for parent-infant attachment and culturally responsive, family-centered care. Every CHLA staff member, from receptionists to nurses, plays an important role in supporting infant mental health principles throughout the institution. The training will initially be disseminated in discipline-specific departmental team meetings and then integrated into new employee orientation. Some CHLA teams—particularly those who provide medical care to large numbers of infants and toddlers—will benefit from additional training in infant mental health tailored to their specific population and the disciplines of their staff.
- The Infant Mental Health Training Academy:
This small cohort of interdisciplinary providers, selected annually based upon application, will have the opportunity to complete a certificate program in infant mental health. The goal of the academy will be to develop interdisciplinary infant mental health champions across CHLA to train and lead subsequent infant mental health related initiatives in their respective spheres of influence.
- CHLA Pediatric Care Network:
We will develop an Infant and Early Childhood Mental Health Toolkit and training curriculum for the over 250 community pediatricians who are part of the CHLA Pediatric Care Network. Through this training, the community pediatricians affiliated with CHLA will be better able to appropriately screen, identify, intervene, and make referrals for infant mental health needs within the context of the care they provide during their pediatric appointments with infants and young children.
The program will be guided by close collaboration with an Early Connections Family Advisory Council made up of family members whose children receive(d) medical care at CHLA during the 0 - 3 age period. Our aim is to incorporate input from FAC members to ensure family voices are considered in all aspects of the program, to help us develop strategies for reaching diverse populations in culturally sensitive ways, and to ensure that our program evaluation incorporates outcomes of most importance to families. FAC members will provide input about our parent education materials, choice of interventions, marketing materials, approaches to dissemination, and more.
Evaluation and Dissemination:
We will partner with a consultant who has expertise in program evaluation and research to develop and implement a comprehensive program evaluation for Early Connections. This will include setting up systems to track the number of children screened, screening results, proportion of children needing which type of intervention, interventions delivered and outcomes from those interventions, training delivery and outcomes, and revenue collected through insurance billing. Additional research about the needs of young children and their families and responses to interventions will be made possible by the extensive database developed through the program.
Keyword(s):
Child Maltreatment, Clinical Care, Developmental Disabilities, Early Childhood – Developmental Health (including developmental screening), Early Childhood – General, Health Equity, Maternal Health – Maternal Depression, Maternal Health – General, Early Childhood – Newborn Screening, Maternal Health – Perinatal/Postpartum Care, Preventive Services, Social Determinants of Health, Children, Adolescents, and Young Adults with Special Health Care Needs, Maternal mental health; infant-family mental health; children with special
Target Audience:
Students/Trainees (long or intermediate trainees), Professionals and Para-Professionals, Family Members/Caregivers, Children/Adolescents with Disabilities/SHCN, Legislators/Policy Makers, General Public
Unserved or Under-served Populations:
Racial or Ethnic Minorities, Disadvantaged Circumstances, Limited English, Specific Groups
