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Great Start Result:
Infants, young children and their families are socially and emotionally healthy.
Similar to physical development, a young child’s social and emotional capacity expands rapidly in the early years—or doesn’t. During this time relationships with parents and other caregivers create the framework for positive and negative social and emotional patterns affecting behavior and self-concept that can persist into adulthood. The way children feel about themselves and respond to their social world is as critical to their success in school and in life as their capacity to think.
The capacities to get along with other children, behave in class, and follow directions were characteristics considered essential or very important in children starting school, according to over 80 percent of kindergarten teachers in a national survey.1 Less than one-third of these teachers cited the ability to count to 20 or recite the letters of the alphabet as being essential or very important.
Young children who experience sensitive, consistent, responsive, and nurturing care generally develop a sense of security and a deep emotional bond with their primary caregivers. This relationship results from many interactions, particularly those in response to the needs of the infant. Young children who do not develop this attachment can experience delayed development, a lack of curiosity or interest in their world, and later on little or no empathy for the feelings of others.
PREVALENCE AND CAUSES OF SOCIAL-EMOTIONAL PROBLEMS AMONG YOUNG CHILDREN
Results from multiple studies estimate that approximately 10 percent of young children suffer from emotional and behavioral challenges that impair their ability to learn, with the incidence among economically disadvantaged young children two or three times as high as their more affluent peers.2 More than one in every four kindergarteners in one urban school district (25%) showed problematic behaviors, and one in every six (16%) first graders in another district with a high proportion of low-income children were held back in their grade, mainly due to behavior issues.3
The social and emotional health of young children can be compromised by inconsistent or unstable care. Such situations can stem from several factors, including economic stress and parental depression. Other environmental issues include homelessness and family divorce, or trauma from other events such as violence or natural disaster. Promoting economic security and access to basic supports for families with young children, enabling parents to focus on nurtur- ing, are critical.
Children in low-income families are not only likely to be deprived materially but also emotionally as parents struggle with unpredictable work schedules, limited and continually shifting access to poor-quality child care, an inability to leave work to take the child to the doctor during regular office hours, and a lack of health insurance and sick or vacation days. When parents are too burdened by these stresses to their own physical and mental health, they often cannot meet the routine needs of their children for nurturing and stimulation and other common supports critical to a child’s growth and development.
Maternal depression can have a severe impact on both mother and child. National studies suggest roughly 1 in 10 new mothers suffers from post-partum depression in the months after delivery. The effects of substantial hormonal shifts and physical changes compounded by exhaustion and other stressors overwhelm their capacity to care for themselves and their infant. Multiple studies have documented that the rate of maternal depression among low-income women (40%) is double that of their higher-income peers. Research studies have shown that maternal depression can affect the cognition and behaviors of children even in their infancy. The interdependence of emotion, capacity to learn, and acceptable behavior is particularly intense in the early years, and positive or negative experiences can dramatically affect later performance in school and in other settings.
Although depression is a treatable condition, most low-income mothers do not have access to treatment. Michigan does provide Medicaid-funded home-based infant mental health services serving the parent and infant/toddler together when either the low-income parent or the infant/toddler reaches the diagnostic criteria for severity.4 Medicaid recipients with less severe conditions receive a maximum of 20 outpatient visits at managed care facilities, but this treatment protocol is not considered appropriate for parent-child issues.5
Few statistical indicators are available to report on the social-emotional health of young children in Michigan and its communities. The rate of young children served by the community mental health services provides some measure of those who gain access to the system, as do the rates of those who receive special education services due to emotional impairment and those who spend time in foster care due to abuse or neglect.
A TOTAL OF 6,630 YOUNG CHILDREN AGES 0-5 LIVED IN OUT-OF-HOME CARE IN 2007
Almost nine of every 1,000 young children ages 0–5 in Michigan lived in a foster home in 2007 because it had been determined that they were not safe from abuse or neglect in their own homes with their parents or guardians.
Children are removed from their homes when Child Protective Services workers of the Department of Human Services (DHS) determine through a risk assessment process that the abuse or neglect is likely to continue. These children suffer several levels of loss—their sense of security, the physical space they knew as “home,” and regular contact with the significant adults in their lives. While most of these children will eventually return to their birth families, this out-of-home experience has been shown to have a lasting impact on the child. Federal requirements now specify that children in foster care must receive an assessment soon after entering care, and there is a pilot effort in Michigan to provide infant mental health assessment and intervention for infants/toddlers under the jurisdiction of the courts. Efforts are also underway to develop specialized foster homes for infants and toddlers.
Increased prevention efforts focused on improving the economic conditions for families, providing family support and parent education, and expanding access to quality early care and education could dramatically improve the lives of families with young children. Young children are especially vulnerable to abuse and neglect because of their near total dependency; it is also a period when their social and emotional environment has the most profound impact.
Across Michigan counties the rate of young children living in foster care varies considerably—from two of every 1,000 young children in Livingston County to 27 in Crawford County. In two-thirds of the 63 counties for which a change in the rate could be calculated, the rate climbed between 2003 and 2007. While the overall state rate rose only slightly (5%), in 10 counties the rate essentially doubled and almost tripled in another two—Crawford and Arenac counties.
MENTAL HEALTH SERVICES FOR YOUNG CHILDREN AND THEIR FAMILIES IN MICHIGAN
In response to the court’s ruling in a recent Children’s Rights lawsuit about conditions for foster children in Michigan, the DHS will begin to screen all foster children for mental health needs within 30 days of their entry into the system In fall 2008 it piloted in two communities the use of standardized, validated, reliable screening tools appropriate for a child's age to determine which children need to be referred for a more comprehensive mental health assessment.6 There is still some concern about where all of those needing treatment will be served, as the state’s currently operating mental health system serves only the children with the highest needs.
FEW YOUNG CHILDREN IN MICHIGAN RECEIVE MENTAL HEALTH SERVICES
National data show that most mental health services to preschoolers ages 0–5 are primarily funded by Medicaid. In Michigan nearly 1,800 Medicaid-enrolled children under the age of 3 received mental health services in 2007, up slightly from the two previous years when 1,600 received such services. This number represents less than 1 percent of children in that age group, well below the estimated need.
Older preschool children were more likely to receive services. In 2005 almost 4,800 children ages 4–6 in Michigan—just over 1 percent—were served through the public mental health system. According to national researchers, preschoolers receiving mental health services were likely to have been referred by parents or other caretakers because of aggression or other behavioral problems.7
MICHIGAN IS DEVELOPING SOME PROGRAM AND POLICY RESPONSES TO IMPROVE THE SOCIAL-EMOTIONAL WELL-BEING OF ITS YOUNG CHILDREN
Michigan children from birth to five years who experience behavioral problems in child care settings eligible for the state child care subsidy may be able to get assistance through the Child Care Expulsion Prevention (CCEP) project.8 This comprehensive program is staffed by early childhood mental health consultants who support parents and child care providers in nurturing the social and emotional development of children in their care, increase access to mental health and other services for children and their families, and promote retention or appropriate relocation of children in child care settings.
CCEP project consultants team with parents and providers to assess a child’s situation and then develop and implement individualized positive child guidance plans, based on the child’s social-emotional needs in the context of the child care and home environments. The program is currently available in 31 counties.
Several initiatives, such as the use of screening tools, in public health programs or physicans’ offices, for early identification of children with social-emotional needs are being piloted in Michigan. The next step is to assure that pregnant women and children identified by screening instruments are referred routinely for more in-depth assessment and treatment in an expanded system that provides the appropriate interventions as early as possible. In addition, all those in child-serving systems, especially child care providers and health professionals, should be trained in ways to improve supports and interactions with young children and their families in a concentrated effort to enhance the social and emotional well-being of the next generation.
MICHIGAN IS DEVELOPING SOME PROGRAM AND POLICY RESPONSES TO IMPROVE THE SOCIAL-EMOTIONAL WELL-BEING OF ITS YOUNG CHILDREN.
1 National Survey of Kindergarten Teachers (2004) conducted by Mason-Dixon Polling and Research, Inc. and commissioned by Fight Crime: Invest in Kids. (Findings released August 11, 2004).
2 Jane Knitzer. Building Services and Systems to Support the Healthy Emotional Development of Young Children—An Action Guide for Policymakers. New York, New York: National Center for Children in Poverty, Mailman School of Public Health, Columbia University.
4 Maternal eligibility for Medicaid is based on pregnancy (through one month after delivery) with income below 185 percent of the federal poverty level. Unless eligible through a disabling condition, non-elderly adults qualify for Medicaid at income below 60 percent of the poverty level (under $10,200 for a single parent with two children).
5 Home-based services are considered the most effective format for addressing parent-child issues.
6 The pilot project uses the Ages and Stages Questionnaires: Social Emotional (ASQ:SE) to screen children under the age of six.
7 K.J. Pottick et al. “More than 115,000 Disadvantaged Preschoolers Receive Mental Health Services.” Latest Findings in Children’s Mental Health. Rutgers University. Vol. 1 (2). Fall 2002.
8 These settings include licensed centers and group homes, registered family homes, homes of DHS-enrolled relative care providers, and homes of families employing DHS-enrolled day care aides
9 These settings include licensed centers and group homes, registered family homes, homes of DHS-enrolled relative care providers, and homes of families employing DHS-enrolled day care aides.