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Wheeler’s Infant and Early Childhood Mental Health (IECMH) Program will provide outreach, prevention, screening, early intervention, outpatient and in-home services for children birth to age 12, who are at risk for, show early signs of, or have been diagnosed with a mental illness or Neonatal Abstinence Syndrome (NAS) and their families. The program will also enhance the early childhood workforce through training on NAS, toxic stress, and trauma. Wheeler will provide the IECMH program at its 43 Woodland Street, Hartford, CT site and in the community. Hartford has one of the nation’s highest childhood poverty rates (33.4%) and has identified gaps in services in developmental screenings and mental health services for children. Between 2012 and 2017 Hartford had more accidental drug overdoses than any other city in CT. Children born with NAS or who live with adults with substance abuse disorders are particularly vulnerable to developing mental health problems. Wheeler’s IECMH program will provide: (a) developmental screening of newborns and children by a Healthy Steps Specialist to ensure early detection and linkage to support services; (b) developmental supports in the home for children birth to five by Wheeler’s Parent Connections Developmental Specialists; (c) evidence-based, trauma-focused specialized intervention and treatment services for infants and children with behavioral health needs and their families utilizing the in-home Child First-NAS model for children birth to six and the Attachment Regulation and Competency (ARC) intervention model for children seven to 12; (d) community outreach to promote the importance of child development screening and healthy family relationships; and (e) workforce training on NAS for all CT Child First teams and on ARC for clinicians serving children and families throughout the state. The program will also provide funding for professionals to obtain CT Association of Infant Mental Health endorsements. The IECMH program will improve developmental and mental health outcomes for children birth to age 12 diagnosed with NAS and other developmental challenges through evidence-based, trauma-focused home visiting services; increase parent knowledge of child development, health literacy and access to community resources through outreach, developmental screenings, and in-home developmental support; and increase the number of providers with the skills and knowledge to support children and families. The IECMH program will serve 654 children and their families in year 1, and 626 children and their families per year in years 2-5 for a total of 3,158 children and families during the 5-year grant period. A total of 230 professionals will receive workforce development over the 5-year grant period.

Easterseals Michigan (ESM) is a leading provider of behavioral health services with a long history of supporting vulnerable children and families in Michigan. ESM will implement a comprehensive infant and early childhood mental health program for children, ages 0 to 6 years, who have experienced chronic stress or trauma. The program will include prevention, screening, early intervention and treatment services for children and their parents/caregivers. We will implement this program in four Michigan counties: Genesee, Kent, Macomb and Oakland. The target population is a diverse tapestry of racial and ethnic groups. The four targeted counties also include a mix of urban and rural areas. Many of the individuals served will come from lower socio-economic backgrounds; however, chronic stress and trauma can occur at any socio-economic level. Infants and children identified for the program may exhibit attachment issues, behavior challenges, or social-emotional developmental delays due to exposure to chronic stress or trauma. Infants and children who experience chronic stress or trauma are four times more likely to develop a mental health disorder by the time they reach adulthood than those who have not experienced childhood trauma. Without any intervention or treatment, these children are also at a higher long-term risk for major health concerns, such as smoking, alcoholism and chronic disease in their adult years. ESM’s proposed program will intervene with children and families to create more positive outcomes utilizing a culturally-sensitive, family-centered and multidisciplinary approach. It includes a variety of evidence-based treatment modalities such as infant mental health, intergenerational trauma treatment, child-parent psychotherapy and trauma-focused cognitive behavioral therapy. The project goals are to: improve the early identification of children who may already be experiencing delays in social-emotional development due to exposure to chronic stress or trauma; increase capacity for prevention and early intervention services by implementing mental health consultation for eight partner sites; provide comprehensive multidisciplinary assessments and develop early intervention and treatment recommendations; develop a comprehensive array of treatment services by providing training for mental health professionals on two evidenced-based practices; and demonstrate the efficacy of ESM’s program through data collection of both quantitative and qualitative measures. The program will serve 800 children over a five-year period. This is broken down as follows: 60 children in the first year, 100 children in the second year, 180 children in the third year, 210 children in the fourth year and 250 children in the fifth year. In addition, we will enhance the workforce by providing training for 12 professionals on the Inter-generational Trauma Treatment Model and 8 professionals on the Child-Parent Psychotherapy model. ESM will also build infant and child mental health knowledge and expertise within community agencies by providing a mental health consultation program.

In response to higher levels of underserved, minority populations than State averages, higher percentages of children in poverty, higher levels of uninsured households, higher mental health professional shortages, and documented involvement with Department of Child and Family Services, Preferred Family Healthcare’s (PFH) proposed Arkansas Infant Child Youth Wellness Initiative (AWI) project will serve, infants, children, and youth aged 0-12 years who experience or at risk for serious emotional disturbance (SED), and/or other mental illness and co-occurring disorders, as defined by the state Division of Outpatient Behavioral Health Services in two regions in Arkansas, which includes 6 counties in Northwest Arkansas and 4 counties in North Central Arkansas, at 9 performance sites. AWI will establish, enhance, and increase a wraparound continuum of treatment and support services to respond to the growing need for increased opportunities for access to mental health treatment for infants /young children through the following goals and objectives: Goal 1: Increase the number of individuals in mental health and related workforce trained in Play Therapy, Child-Parent Relationship Therapy, CBT/TF-CBT for youth aged 0-12 years: Obj. 1.1-24 individuals from mental health and related workforce will be trained in Theraplay; Obj. 1.2-20 individuals from mental health and related workforce will be trained in CPRT; Obj. 1.3-50 individuals from mental health and related workforce will be trained in DC: 0-5 by Zero to Three; Obj. 1.4-24 individuals from mental health and related workforce will be trained in CBT/ TF-CBT; Obj. 1.5-36 teachers and clinicians working in school-based settings will be trained in Sunshine Circles; Obj. 1.6-100% of partners will be given professional development opportunities in trauma-informed care; Goal 2: Increase number of youth and families receiving evidence-based mental health services; Obj. 2.1-365 infant-children-youth and family members screened for mental health or related intervention(s); Obj. 2.2-365 individuals will be referred to mental health or related services; Obj. 2.3-123 individuals in year 1 and 183 individuals annually (years 2-5) will receive evidence-based mental health or related services through AWI; Goal 3: Children and caregivers served through AWI will experience improved global functioning: Obj. 3.1-100% of infants and children assessed will be screened for developmental delay, intellectual and learning disabilities, referral to appropriate services; Obj. 3.2-75% of children served will experience reductions in externalizing behavior concerns such as aggression and hyperactive behavior from baseline to 6 months; Obj. 3.3-50% of children served will experience improved social-emotional skills and functioning from baseline to 6-months; Obj. 3.4-50% of children served will experience improved developmental and language functioning from baseline to 6-months; Obj. 3.5-100% of parents/caregivers will be instructed in appropriate parenting and/or caregiver techniques learned to improve responsiveness, nurturing, and positive discipline from baseline to 6-months.Goal 4: Providers trained/served will demonstrate improved competencies in mental health service provision through AWI; Obj. 4.1-100% of trained clinicians will take lessons learned and implement practice modifications as a result of training and/or mental health consultation to carry out continuous quality improvement.

The population of focus for the proposed project are high-risk term and pre-term infants that have been cared for at Children’s of Mississippi and in the Neonatal Intensive Care Unit (NICU) at the University of Mississippi Medical Center (UMMC). High-risk term and pre-term infants are at substantial risk for mental health problems and are overrepresented in families that reside in poor, rural, and medically under-served communities. Our proposal focuses upon these infants, their caregivers, and the systems of care that follow them to school age and beyond. While increased risk factors for impairments in health and mental health in NICU graduates are well recognized, families and our communities in Mississippi often lack a network of supports in which healthy development, including mental health development, can be optimized. The over-arching goal of the Mississippi Behavioral Health in Infants and Preschoolers (MS-Be HIP) program is ensure that Mississippi’s high-risk term and pre-term infants and families have access to a continuum of mental health services, including promotion, prevention, assessment, early intervention, and treatment services beginning at UMMC’s NICU services, extending to the NICU follow up clinic and to the communities where families reside. Utilizing both face-to-face and telehealth modalities, the MS-Be HIP program will develop and expand NICU mental health care for high-risk infants and children and carry forward mental health screenings and services to the NICU follow up clinic. The continuum of care for infant and early childhood mental health will be extended further into communities through the linkages with empirically validated interventions that support positive caregiving, specifically Parent-Child Interaction Therapy (PCIT), Caregiver-Adult Relationship Enhancement (CARE), and Teacher-Child Interaction Therapy (TCIT). Thus, the proposed program’ reach will increase statewide capacity to deliver evidenced-based services to children in their communities and schools. We have commitments from the Mississippi Departments of Mental Health and Health substantiating the development of the proposed continuum of care, encompassing children from birth through 12 years of age. We will conduct maternal/infant screenings (Annually 500; 5-Year: 2500) and infant developmental evaluations (250; 1250), provide intervention to children using PCIT (100; 500), provide promotion and prevention trainings using CARE and TCIT (75; 375), train community providers in PCIT (2-3; 8-12), and conduct trainings/didactics in early childhood for Neonatology Fellows (5-10; 25-50) and community providers to meet our objectives. We will create a 1-2 year postdoctoral psychology fellowship to further training. Overall, this proposal fills critical gaps in our mental health workforce and system of care. The proposed program is synergistic with recent workforce development grants at UMMC, but does not duplicate efforts. The commitment of state agencies provides high level oversight and coordination, ensuring cooperation among existing services and agencies. It ensures the valuable data obtained will result in sustainable statewide infant/child mental health care capacity.

The purpose of the South Dakota Early Childhood Mental Health Collaborative is to ensure that low-income children, ages 0-5 and their caregivers, in rural areas of South Dakota have increased access to mental health services including prevention, early identification, early intervention and treatment activities. The adversity faced by children in low-income environments is widely studied with attention to exposure to numerous risk-factors and greater frequency of the development of behavioral and emotional difficulties. The geographic catchment area of this Project is 14 counties in Eastern South Dakota, 10 of these counties are designated as mental health shortage areas and 13 have medically underserved communities. Nationally it is estimated that 9.5-14.2% of children from birth to five experience an emotional or behavioral disturbance. Translated to the catchment area, approximately 2,754 to 4,117 children from birth to 5 are at risk for developing an emotional or behavioral disturbance. Early symptoms of developmental disorders and mental illness can appear in infancy and toddlerhood and left untreated, these symptoms can seriously impact a child's cognitive, social, and emotional development and impair their lifelong well-being. For this Project, the population of focus will be accessed through two South Dakota organizations: 1) Southeastern Behavioral Healthcare (SEBH), a community mental health agency serving Sioux Falls and surrounding communities, and 2) Inter-Lakes Community Action Partnership (ICAP) Head Start which serves the 14 counties in the catchment. ICAP Head Start and Early Head Start is a federally funded program that currently serves 390 children ages 0-5, of which at least 90% are at, or below, 100% of the federal poverty line. At SEBH, 71% of clients served have an annual household income of less than $15,000 per year. The Project has 3 specific goals: 1) Increase developmental screening, mental health referrals, and access to evidence-based social-emotional learning curriculum for ICAP Head Start Children; 2) Increase knowledge, skills and attitudes of early childhood mental health workforce in South Dakota to serve children ages 0-5, diagnosed with or at-risk for developing an emotional disturbance, and their caregivers; 3) Increase access to evidence-based therapeutic interventions in South Dakota for children diagnosed with, or at-risk for developing a severe emotional disturbance, and their caregivers. The Project’s measurable objectives incorporate strategies to increase developmental screening for Head Start children and implementation of evidenced-based social emotional learning curriculum. Measurable objectives also include increased work-force training and delivery of evidenced-based therapeutic interventions such as Child-Centered Play therapy and Theraplay, for low-income children and caregivers. An estimate 270 children and 220 professionals will be served annually; and an unduplicated 825 children and 500 professionals project-wide.

Founded in 1977, El Centro de Amistad provides mental health care for those in the San Fernando Valley most likely to experience difficulty in accessing mental health services. This project will serve infants and children from ages 0 to 12 who are at risk for, show early signs of, or have been diagnosed with a mental illness, including a serious emotional disturbance, as well as their caregivers. Our project will focus on low-income children, particularly those from Spanish-speaking households. The project will improve outcomes fro these children by developing, maintaining, or enhancing infant and early childhood mental health promotion, intervention and treatment services; providing multi-generational services for their caregivers; and developing the workforce by training educators, clinicians, and other community agencies that serve this population. The proposed project have two goals: 1) Improve outcomes fro low-income infants and children, particularly those who have experienced trauma, and who are at significant risk of developing, showing early signs of, or having been diagnosed with, a mental illness through screening, early intervention, and caregiver support; and 2) Increase the capacity of educators, clinicians, schools, and community agencies to understand and address early social and emotional development and trauma's impact on development, The project's measurable objectives are: 1. By the time services are terminated, 90% of children who participate in services until a planned discharge will demonstrate an increase in verbal communication skills and a decrease in disruptive behavior. 2.By the time services are terminated, 90% of caregivers who participate in services until a planned discharge will have learned at least 3 new skills to effectively parent their child. 3. By the time services are terminated, 90% of caregivers who participate in services until a planned discharge will have identified at least 3 key ideas of positive and nurturing discipline. 4. Within 12 months of receiving the grant award, ECDA will train a minimum of 50 ECDA staff on topics related to early social and emotional development, trauma's impact on development, and early childhood social, emotional, and mental health disorders. 5. By the end of the five year project, ECDA staff will have conducted trainings for 800 early childhood and elementary educators and 800 mental health clinicians on early social and emotional development, developmental milestones, and trauma's impact on development. 6. By the end of the five year project, ECDA staff will have increased 60 consulting entities' understanding of early social and emotional development, developmental milestones, and childhood trauma's impact on development. Unduplicated numbers served: a. 3 Child Therapists will each serve 20 clients annually, providing services once weekly for 60 minutes, for a total of 60 clients served annually and 300 clients served over a five year period. b. Child Therapists will also provide services to client caregivers as necessary, for a total of 40 to 80 caregivers served annually and 200 to 400 over a five year period. c. ECDA staff will conduct 4 complete trainings for mental health clinicians annually. Trainings will be offered as a three part series one module each month. 40 clinicians will participate in each training, for a total of 160 clinicians a year and 800 over five years. d. ECDA staff will conduct 4 complete trainings for early childhood and elementary educators per year, with 40 educators participating per training. The training component will serve 160 educators annually and 800 educators over 5 years. e. ECDA staff will provide 60 minutes per week of consulting services for one agency per month, for a total of 12 agencies served per year and 60 agencies over 5 years.

The Gardner Family Care Corporation’s Project Prevent will provide access to quality home-based, infant and early childhood behavioral health, case management and parental mentoring services to 820 children during a five-year period, 180 annually. Project Prevent will train 320 professionals in evidence based practices, symptoms of child emotional distress, and indicators of familial substance abuse - expanding the knowledge of the local child-serving workforce. The children and their families targeted for Project Prevent services are not eligible for publicly funded services due to restrictions based on income and MediCal/Medicaid defined medical necessity. They will be referred from programs serving children for whom credible allegations of neglect and abuse have been verified, or be the children of unemployed parents with co-occurring mental health and substance abuse histories. Most will be of Hispanic, European, or Vietnamese heritage. Participants will be children and families no longer eligible for services from Gardner programs serving children about whom credible allegations of having been abused or neglected have been received, or the children of parents with dual diagnoses of substance abuse and mental illness, and child-patients of seven community health clinics. Additionally, referrals will be sought from a network of 22 First 5 Family Resource Centers, opening new avenues to treatment throughout Santa Clara County. Project Prevent will additionally expand the capacity of approximately 320 professionals of the local behavioral health and child-serving workforce by providing training in evidence-based practices, basic identification skills of symptoms of early childhood mental and emotional distress, plus the impact of familial substance abuse in child development. All of the Project Prevent team members will advance their knowledge of early childhood mental health evidence-based practices, receiving 80 hours of training in the first months of the grant period and an additional 150 hours annually. Project Prevent will assess for poor mental health or indicators of the child living in an environment at high risk of mental and emotional distress, plus develop service plans specifically to address the assessment results and the family’s desired outcomes. Project Prevent will use evidence-based practices and curricula in home-based treatment. The identified evidence-based practices cover a spectrum of focused treatments and parental skill building. They will lessen the severity of symptoms, prevent regression and be placed into more intensive services, and to increase child safety and positive parenting skills. Tele-monitoring will ease the families into self-direction and self-confidence in positive parenting their child. Data collection and analysis will be rigorous for continuous quality improvement of the service delivery, accurate and relevant data for funders, local child-serving agencies, and the Gardner leadership. Objective, reliable data also forms the foundation of sustainability – demonstrating to internal and County-wide funders the impact of the services, the testing of pilot forms of service delivery (tele-monitoring) and the results of workforce training.

Infancy and Early Childhood Mental Health Consortium: Building and Sustaining a Regional and National Workforce for Immediate and Long-Term Impact. The Infancy and Early Childhood Mental Health Consortium (I/ECMHC) will provide and ensure access to culturally- and developmentally-appropriate mental health promotion, prevention, early intervention, and treatment services to infants and young children in rural northern California. Workforce development strategies will be disseminated to three states with similar underserved rural populations: New Mexico, Michigan, and Minnesota. Families in rural areas experience extensive challenges associated with mental health and behavioral problems in young children, including higher than average child maltreatment and special education rates, parental substance use, exposure to domestic violence, and family poverty. The detrimental impact of risk factors is compounded by extensive service gaps and lack of access to services due to geographic and resource barriers that make it difficult to attract, train and sustain a qualified workforce. I/ECMHC will increase the number of infants and young children receiving services and improve outcomes by 20% each year for a total increase of 100% over the grant period. Outcomes will be achieved by providing services and implementing county-level trainings and case-focused mental health consultation on evidence-based/informed practices reaching up to 360 providers per year, for a total of 1800 providers over the grant period. Trainings will consist of culturally and linguistically appropriate services (CLAS) in promotion, prevention, early intervention and treatment for providers in home visiting, childcare and early childhood education, primary care, mental health, and child welfare systems to enhance skills in screening, early identification, assessment, consultation, preventive intervention, and specialized treatment. I/ECMHC will work collaboratively with Northern California Partners and State Partners in New Mexico, Michigan, and Minnesota to determine best trainings for child and family providers across service sectors. Service agencies will be invited to join the I/ECMHC after attending trainings to contribute to evaluation efforts, create a referral network and workforce tracking system, and build sustainable workforce development plans. I/ECMHC is a collaborative of three leading programs in infant and early childhood treatment, consultation, training, and dissemination with 40 years of experience in developing and implementing widely-used evidence-based/informed services for infants and young children. The UCSF Child Trauma Research Program, UCSF Infant-Parent Program, and Early Intervention Services at UCSF Benioff Children’s Hospital Oakland are among the longest standing infant and early childhood clinical and training programs in the country. The I/ECMHC’s combined expertise makes available a uniquely powerful range of services, consultation and training to provide and ensure access to a full continuum of evidence-based/informed practices for infants and young children.

A partnership led by the Mental Health Center of Denver (MHCD) proposes Right Start for Colorado (RS-CO) to improve outcomes for families and children ages 0-5 who are at risk for, or show signs of mental illness. RS-CO will develop a home-based, high-intensity infant/early childhood mental health (I/ECMH) program in Denver, and improve the Colorado workforce through training and support for clinicians and others who work with young children statewide. For over 20 years, Colorado and Denver have built a strong and sustainable infrastructure to support I/ECMH through policy advances, private and state funding, workforce development and innovative programming. This proposal seeks to build on this enviable foundation by expanding services and fostering sustainability through statewide workforce development strategies. MHCD has a well-developed service array for infants, young children and families, including robust mental health promotion and prevention services and strong I/ECMH outpatient care. However, because the program serves large numbers of children of color and those who have been exposed to trauma, a higher level of intensive, culturally competent treatment is an ongoing need. Grant funding would expand access to a minimum of 30 children and families annually (150 over five years) by developing intensive, home-based care using evidence-based interventions. Thus, MHCD could offer a full continuum of I/ECMH services to metro Denver families. A second aim of the RS-CO project is to address the statewide shortage of mental health clinicians with I/ECMH expertise by creating communities of practice that would support and sustain high quality service delivery throughout Colorado. This will include competency-based training and consultation, using the evidence-based Project Echo telehealth platform, to a total of 12 trainees and 30 practicing clinicians across the state. The Colorado Association for Infant Mental Health and Colorado Behavioral Healthcare Council will be key partners in this effort. Finally, the project intends to deliver training to a minimum of 525 providers who interact with young children and families (e.g., child welfare workers, educators, pediatricians) through a series of lunch and learn presentations and a web-based hub for ongoing education and support. The goal is to increase knowledge of and expertise in dealing with I/ECMH issues, and help providers recognize when a referral to I/ECMH services is indicated. Our partners in this effort will include the Colorado Office of Early Childhood, the Denver Department of Human Services, and the Denver Early Childhood Council. RS-CO’s expected outcomes are increased numbers of children and families receiving intensive, evidence-based services and numbers of mental health and related providers trained in the specified mental health practices/activities. Child/family-related outcomes include increased social-emotional skills and developmental and language functioning, decreased behavior problems, and improved caregiver practices and caregiver-child interventions. Improved provider knowledge and enhanced practice skills are among the workforce-related outcomes.

CHRIS 180 proposes to build capacity to identify, refer, and serve infants and children with serious emotional disturbances (SED). It will provide training and technical assistance to partners throughout the Atlanta area to help them identify and refer children with SED and their families. It will add two treatment teams trained in evidence-based practices to provide intensive, individualized services and treatment to eligible children and their families/caregivers. Project Name: Enhanced Services and Training for Atlanta-Area Children with SED Population to Be Served: The project will target children who are 0-12 years old, who are at risk for, show early signs of, or have been diagnosed with a mental illness including SED. CHRIS 180’s project will specifically focus on infants and children with signs of SED who 1) have a suspected or confirmed addiction, 2) are exposed to violence, 3) have a suspected or confirmed attachment disorder, and/or 4) have an open child protective services case. CHRIS 180 will also provide wraparound services and treatment to the children’s parents, caregivers, and foster families. The project will target children in Fulton, DeKalb, and Gwinnett counties in the Atlanta, Georgia area. CHRIS 180’s clientele is 57% male, 42% female, and 1% transgender or gender non-conforming. Nearly 75% are Black/African-American, 19% are white, 3.5% are bi/multi-racial, and 2.6% are Hispanic/Latino. Nearly all (91%) of clients are low-income. Strategies/Interventions: CHRIS 180 will hire two treatment teams to provide comprehensive services to children and their caregivers. It will use Matrix Model, trauma-informed/responsive services, Cognitive Behavioral Therapy, Motivational Interviewing, High-fidelity Wraparound, and Systematic Training for Effective Parenting, and train its clinical and direct service staff in two new evidence-based practices, Child Parent Psychotherapy and Circle of Security. Staff will provide services at CHRIS 180, partner sites, schools, and through home visits. It will seek to develop community capacity to identify, refer, and respond to children with SED by providing intensive training and ongoing technical assistance to area service providers. Project Goals and Measurable Objectives: CHRIS 180’s goals are to: Build capacity to serve 600 youth 0-12 and their family members annually; Provide and ensure access to culturally- and developmentally-appropriate mental health promotion, prevention, early intervention, and treatment services for 600 youth 0-12 and their family members; Increase participants’ access, engagement, and retention in treatment such that 100% of participants will have access to services and 80% of the participants will be engaged in/complete at least one treatment goal; and 85% of the engaged families will show improvement in family functioning and parenting skills. Number of People to Be Served: CHRIS 180 will train 1,450 people (1,000 year 1, 300 year 2, and 50/year thereafter) and provide assessments, treatment, and services to 600 unduplicated children (50 year 1, 100 year 2, and 150 in years 3-5) and their parents/caregivers during the project period.