CI Joins Amicus Brief in Supreme Court DACA Case

by Helen Shum | Oct 10, 2019 | Federal Policy, Health and Development, Policy Trends

Children’s Institute has joined health experts and advocates from across the country to fight Trump administration efforts to end the Deferred Action for Childhood Arrivals (DACA) program.

In an amicus brief filed last Friday, 36 organizations and leaders, including the American Academy of Pediatrics and the American Professional Society on the Abuse of Children have asked the court to consider that a reversal of DACA protections would cause developmental, psychological, and economic harm to at least 250,000 children in the U.S.

Oregon is home to one of the largest populations of DACA recipients in the country, with 9,910 DACA residents and 5,500 children of DACA recipients.

The brief states in part, “The imminent threat of losing DACA protection places children at risk of losing parental nurturance, as well as losing income, food security, housing, access to health care, educational opportunities, and the sense of safety and security that is the foundation of healthy child development.”

Oral arguments in the case—one of three DACA-related cases that the Supreme Court will review this fall—are scheduled for November 12. All are challenges to the legality of attempts to end the DACA program.

The DACA program began in 2012, under President Barack Obama. DACA recipients, also known as Dreamers, are children of undocumented immigrants brought to the United States as minors. DACA allows recipients to work in the U.S. and protects them from deportation in renewable two-year increments.

Research has shown that DACA has increased the wage and employment status of DACA-eligible immigrants, improved the mental health outcomes for DACA participants and their children, and reduced the numbers of households living in poverty.

Immigrant children in Oregon and elsewhere, raised under the threat of separation, detention, or deportation of their parents and family members, lack the safe and stable care environments that we know are critical to healthy development and learning.

Understanding that the hearts and minds of our children hold the greatest promise for our nation’s future demands that we protect DACA policies which keep families together, effectively and appropriately prioritizing the needs of our youngest.

– from the amicus brief, Children’s Institute

Read the full text of the amicus brief and the appendix here.

5 Things to Know About Infant and Early Childhood Mental Health

by Helen Shum | Sep 19, 2019 | Health and Development, Health and Kindergarten Readiness, Parents and Families

Advocates for children’s mental health envision a comprehensive network of supports for children and families that begins with mothers at the prenatal stage and continues throughout an individual’s lifetime. That’s reflective of continuing research which demonstrates that children who enjoy good health—including mental health—are better prepared for school and life.

Yet, general understanding of infant and early childhood health is still at an emergent stage. That’s partly because diagnostic classification of mental health and developmental disorders in children under 5 did not exist until 1996. While treatment and payment protocols have been established in Oregon since then, more work is needed to integrate infant and early childhood mental health into the larger array of available services and supports for families and children.

Here are five answers to questions about infant and early childhood mental health in Oregon:

What does mental health in an infant or toddler look like?

Social and emotional health in the youngest children develops within safe, stable, and attached relationships with caregivers. Children who have positive and engaging interactions in their earliest years are more likely to enjoy good physical and mental health over their lifetimes. They are also better able to experience, regulate, and manage their emotions—key skills for later school readiness.

What types of mental health issues and disorders do young children suffer from?

Children who suffer from abuse, neglect or trauma—especially those facing additional barriers such as living in poverty—are more susceptible to mental health issues, including attachment and emotional regulation disorders and other developmental or psychological disorders.

Laurie Theodorou, Early Childhood Mental Health Specialist at the Oregon Health Authority (OHA), says very young children can also suffer from the same disorders that affect older children.

“Depression and anxiety can be seen even at the pre-verbal level. Though they can be harder to diagnose, young children respond well to therapy that includes their parent,” she said.

She’s also careful to note that mental health issues and disorders are not limited to situations related to maltreatment. “It’s important to de-stigmatize mental health and mental health treatment… Parents can be doing everything right and still need additional help for their child’s social emotional or behavioral problems.”

How are infant and early childhood mental health issues treated?

Proper screening and assessment are key to identifying and treating young children who are at risk for or suffering from mental health issues or disorders.

Treatment for mental health issues and disorders can be provided in a variety of home and clinical settings. Evidence-based treatments are family-centered and use attachment-focused approaches, including infant-parent psychotherapy, Parent Child Interaction Therapy, and psychoeducation.

Source: The Oregon Children’s System Advisory Council (CSAC) 2015; Early Childhood Workgroup. Adapted from TACSEI, www.challengingbehavior.org and http://csefel.vanderbilt.edu/ April 2015

What policy strategies can help improve outcomes for young children?

Researchers Joy D. Osofsky of Louisiana State University, and Alicia F. Lieberman of the University of California, San Francisco, recommend four actions to improve awareness and action on early childhood mental health issues:

Expand early screening for infants and toddlers to detect mental health issues.
Train professionals in mental health, pediatrics, early childhood education, child welfare, and other related professions to recognize risk factors; and ensure that undergraduate, graduate, and continuing professional education include content on infant mental health.
Integrate infant mental health consultations into programs for parents, child care, early education, well-child health services, and home-based services.
Address insurance and Medicaid payment policies to provide coverage for prevention and treatment of mental health issues for infants and toddlers.

How is Oregon working to improve public policy and practice for infant and early childhood mental health?

Oregon’s efforts to build a system of care for infant and early childhood mental health have been steadily building. For example, Oregon’s adoption of developmental screening as an incentive metric for Coordinated Care Organizations has increased the numbers of children identified for further assessment. The creation of a diagnostic crosswalk—a guide that aligns multiple diagnostic classification manuals—has also made it easier for providers to be reimbursed for mental health treatment.

More recent and upcoming developments include the planned roll-out of universally offered, voluntary home visiting in Oregon, and Project Nurture, an integrated model of maternity care and addiction treatment for pregnant women with substance use disorders.

A number of workforce-related efforts have strengthened the existing network of support for Oregon’s youngest children. OHA and the Oregon Infant Mental Health Association have partnered to offer an infant and early childhood mental health endorsement for early care and education and mental health professionals. An infant/toddler mental health graduate certification is available at Portland State University and the school has also introduced a new, two-year scholarship program to study rural infant mental health with funding from The Ford Family Foundation.

Raise Up Oregon, the state’s early learning systems plan, and the passage of the Student Success Act also promise to bring more attention and resources to the ultimate goal: a network of support for all children beginning at the prenatal stage which sets children up for future academic and lifetime success.

Who’s in Charge of Student Success? In Yoncalla, It’s Everyone

by Helen Shum | Sep 5, 2019 | Community Engagement, Parents and Families, Successful Students

It’s a gorgeous summer evening in Yoncalla, Oregon and community members are gathered on the high school football field to kick-off the start of the school year with a celebratory barbecue. A band is playing, children are running at full speed in no particular direction, and the sun is just low enough in the sky to force a squint from those soaking up a stunning panoramic view of the surrounding valley.

A young girl has just sprung out from a nearby photo booth—converted from an old VW bus and hired just for this occasion. Souvenir photo strip in hand, she’s bounced over to ask for an autograph from a local celebrity—new elementary school principal, Don Hakala.

While school principals don’t often claim the mantle of rock star, improving education for the kids of Yoncalla has been taking center stage, with demonstrated progress over the last seven years that continues to build the case for community-driven, collaborative initiatives like Early Works.

A Maverick Streak

As picturesque as Yoncalla is, this small town of just over 1,000 people in North Douglas county struggles with challenges facing many rural Oregon communities; high unemployment and poverty rates, inadequate access to health care and limited access to high-quality early care and education programs.

It’s also a place of deep history, with an electorate that’s not afraid to show off a maverick streak now and again. In 1920, two months after women gained the vote, Yoncalla made national headlines for electing an all-female city council. Last year, Yoncalla voters elected a teenage mayor, 18-year-old Ben Simons.

So perhaps it’s not surprising that Yoncalla, with its demonstrated openness to new ideas and tight-knit community, might actually be a great place to nurture and support educational innovation for its youngest citizens.

A Collective Effort

At the local community center, more than 70 people stand shoulder-to-shoulder preparing to introduce themselves at the annual Early Works and Yoncalla School District retreat, a gathering to help prepare for the upcoming school year. Classroom teachers and school administrators are here, of course. But so are parents, school kitchen and custodial staff, and a representative from the local breastfeeding support group.

There are school board members, instructional assistants, and representatives from the newly opened health clinic in Drain. In fact, there are so many people that organizers have to pull out extra chairs from a back room to squeeze in among the tables.

Over the next few hours, these community members and partners are engaged in a sort of educational barn raising—reviewing data, brainstorming ideas on how to overcome health-related barriers to school attendance, and discussing how to improve teacher-parent engagement in upper grades.

Christy Cox, senior program officer for The Ford Family Foundation is excited by what she sees as the growth and transformation of the project. “As the kids and families involved with Early Works move into the elementary, middle, and high school grades, they are bringing the values and guiding principles of Early Works with them.”

Cox notes that while Early Works was originally focused on children ages 0 to 8, the leadership of Yoncalla Superintendent Brian Berry, teacher Jerry Fauci, and others have expanded the vision to a broader community of staff, parents, and community partners. This expanded effort now includes support for kids from prenatal to grade 12.

“It’s so gratifying to see how far we’ve come, ” said Erin Helgren, Children’s Institute’s Early Works site liaison. “And it inspires us to continue to work, improve, and do more.”

A Focus on Attendance and Engagement

Data presented by researchers at Portland State University shows solid progress on family engagement and attendance in Yoncalla over the last five years:

The percentage of families reporting that they feel connected to the Yoncalla community has more than doubled among students in preschool through sixth grade.
The percentage of families who feel welcome at the school is also climbing, as are increases in the frequency of parent-teacher communication.
The percentage of regular attenders has steadily increased for K–12 students, bucking a statewide downward trend.
Though regular attendance among Yoncalla kindergarteners is still lower than the state average, the gap has narrowed by 14 percentage points since 2014–2015. Among preschool students, the percentage of regular attenders has increased 21 percent in the last three years.

PSU/Yoncalla Retreat Slides

Meet the Community

A community-wide responsiblity to Yoncalla’s children means everyone has a role to play in education.

Don Hakala, Yoncalla Elementary Principal and friend

Kim Gandy and Kendra Bickham, Umpqua Community Health Center

Melissa Peterson and Gail Jones, Yoncalla Elementary School Kitchen

Pam Ciullo, Sixth Grade Teacher

Madison Kokos, Parent

Alauna Bowen, Kindergarten Teacher

Yoncalla School Board Members

Sheryl and Richard Braun, Longtime Residents

Children’s Institute Staff

CCO Health Innovations Support Early Learning Goals

by Helen Shum | Aug 2, 2019 | Parents and Families, Health and Development, Health and Kindergarten Readiness

Oregon’s creation of Coordinated Care Organizations (CCOs) in 2012 served as a landmark accomplishment in the ongoing effort to better meet the health needs of children and families who qualify for the Oregon Health Plan (Medicaid). By integrating and coordinating health care across multiple areas of a person’s health, CCOs seek to improve patient health while controlling costs.

A greater focus on the connection between early health and school readiness has also been an important part of CCO work. Across the state, CCOs are partnering with educators, social service providers, and other child and school advocates to introduce new ways to meet early health goals. In doing so, they also hope to positively impact academic and lifetime outcomes.

Health and Early Learning Connections

At a recent “Innovation Café” organized by the Oregon Health Authority (OHA), CCOs from across the state gathered to share and discuss efforts they have made to address the health needs of their members.

Café participants highlighted work at multiple levels—from on-the-ground, practical supports for families to provider-focused improvements and systems-level coordination.

HEALTH & EARLY LEARNING INITIATIVES ACROSS THE STATE

Click on the markers below for more detail

In Eastern Oregon, a group effort from health, early learning, and school and district staff helped bring oral health services into early grade classrooms. Children now have easier access to dental screenings, fluoride varnish, and sealants to support dental health.
In the mid-valley, a continuation of work begun by the Oregon Pediatric Improvement Partnership (OPIP) has led to improvements in the referral process thanks to the combined efforts of two pediatric clinics, Willamette ESD, and the Marion and Polk Early Learning Hub.
A statewide effort to improve care for young children with special health needs aims for a more coordinated approach to care. Public health nurses convene care planning teams that include medicine, education, behavioral health, and other community-based providers.

Rural Health Clinic Opens to Meet Community Demand

As locally-governed organizations, CCOs also have a fundamental responsibility to their communities. When the results of a 2017 Community Health Survey in North Douglas county showed that the most pressing concern of residents was access to health care, Children’s Institute and others worked to bring a new health clinic to the area.

“Families and community members expressed to us that they really wanted a consistent health care provider—someone to build a relationship with,” said Erin Helgren, CI’s Early Works liaison in Yoncalla.

The Umpqua Community Health Center North County opened its doors in mid-July, offering primary care for children and adults. The community has also identified after school appointments, weekend services, addressing transportation barriers, and pharmacology services as future priorities

Incentives Drive Improvement, Innovation

One of the ways that CCOs foster innovation in their work is through the OHA’s unique Quality Incentive Program. CCOs receive bonus payments based on their ability to improve their performance on a defined set of measurements. Through incentive metrics, Oregon has greatly improved its developmental screening rate for children under 3 and reduced avoidable emergency room visits, for example. More Oregonians are also reporting that they are in better health.

These bonus payments can be used in a variety of ways, including to address social determinants of health. Since environmental factors like poverty, trauma, or chronic stress can negatively impact physical health, CCOs recognize that a more holistic approach is needed in order to improve the long-term health and wellness of their members.

CI’s Continuing Work

In May, the work of Children’s Institute and others culminated in Oregon’s Metric and Scoring Committee endorsing a new set of proposed incentive metrics that address kindergarten readiness. That work is now moving into an implementation phase that will involve developing new metrics to track follow-up to developmental screening and CCO efforts to support social-emotional health. Children’s Institute, OPIP, and the OHA will be engaging system leaders, community partners, and families in these efforts, and working to tackle policy and capacity barriers at the same time.

Supporting children’s healthy development is a key part of an ongoing strategy to improve academic and life outcomes. As Oregon’s CCOs have demonstrated through the incentive metric program and related innovations, entire communities stand to benefit.

“If we’re going to make a difference in changing outcomes for kids, it truly does take multiple programs and sectors coming together with a common goal and working together in new ways. These are some great examples of what can be accomplished through collaboration,” says Elena Rivera, senior health policy advisor at Children’s Institute.

Review the full report from OHA’s Innovation Cafe

Making Progress for All Learners through LEAP

by Helen Shum | Jul 25, 2019 | EI/ECSE, Featured Programs

The LEAP program at Cherry Park Elementary in Southeast Portland is one of a handful of inclusive preschool programs in Oregon. Originally designed to support children with autism spectrum disorder (ASD), the evidence-based model has been so effective that Principal Kate Barker has expanded it to upper grade levels.

LEAP (an acronym for Learning Experiences–an Alternative Program for Preschoolers and Parents) was created at the University of Colorado Denver in 1981 and aims to educate children with ASD alongside their typically developing peers. Programs like LEAP take a comprehensive, integrated approach to educating children in the early years, based on a growing body of research that supports inclusive education practices for children with disabilities.

Inclusion is Key

Very simply, LEAP proponents and researchers have found that children with ASD learn better alongside their typically developing peers, especially in the development of social and communication skills. A unique component of LEAP is that it trains typically developing peers to act as facilitators, or interventionists, in the classroom. Research shows that typically developing children also benefit from the program, showing higher levels of social competence compared to their same-age peers.

As Barker tells it, “This model works for all children and in all my many years of education, this is the most powerful model I have seen for young learners, including children with non-ASD disabilities and English language learners.”

Peer-to-Peer Learning

It’s story time in Max Striplin’s preschool class and students are holding pictures that correspond to the book they are reading. When a girl named Olivia sees her picture come up in the book, she stands up and places her picture on a Velcro story board.

A few pages later, JJ’s picture comes up. Olivia knows that JJ experiences autism, and may not be able to complete the same task independently.

Olivia approaches JJ and uses a visual cue card to let him know it is his turn. When he doesn’t stand up, she gently touches his elbow and lifts his arm toward the story board.

Peer-to-peer learning is a key component of the LEAP model

The subtle physical prompt combined with the visual materials help JJ to stand up and put his picture on the story board.

The students cheer for JJ and Striplin praises Olivia for being “a great helper and friend.”

“If we didn’t have LEAP … we would not have the same level of success mainstreaming children with disabilities in our school. We are sending children up through the grades who, before LEAP, would almost certainly have been placed in self-contained classrooms,“ said Striplin.

An example of visual materials used in the classroom

LEAP at Cherry Park

Cherry Park students speak 26 different home languages, with 75 percent of families living below the poverty line, and 13 percent of students receiving special education.

The school now operates four LEAP preschool classrooms. Each class cohort is comprised of 12 “typical peers” and five special education students. Children attend school for half a day, four days a week. (Wednesdays are reserved for meetings and home visits.) Other than a $20 supply fee, the program is free and offers transportation.

Teachers have training in early childhood special education and work with two assistants. Students have access to services from a physical therapist, speech therapist, behavior coach, occupational therapist, and mental health and other support specialists throughout the week.

Multiple Benefits Drive Expansion

Early literacy assessments from 2018 showed that all students who participated in the preschool at Cherry Park hit grade-level benchmarks by the end of kindergarten. At the end of 2019, all but one child reached grade-level benchmarks. Additionally, the school has seen a sharp reduction in behavioral referrals since LEAP was introduced—from 40 down to just six this past school year.

Barker has been so impressed by the outcomes that she now dedicates K–5 general funding and professional learning time to bring LEAP strategies into kindergarten and upper grade classes.

Soobin Oh, senior early education advisor for Children’s Institute notes that in adapting LEAP strategies up to later grades, Barker and her staff are addressing instructional alignment through inclusion. That novel approach is of particular interest to him and CI as we launch Early School Success—a new initiative that seeks to improve early grades instructional alignment through district and community-wide approaches.

Funding Considerations

Inclusive programs like LEAP can offer services for special education students in a more cost-efficient manner than one-on-one instruction because the approach improves child outcomes across multiple areas of development.

The ability of administrators to creatively braid multiple sources of funding, as Barker does, is also notable as Oregon struggles to meet the educational needs of children with disabilities. A lawsuit filed in January by Disability Rights Oregon and others cite disparities in instructional time and other supports for children with disabilities, including ASD.

Starting next year, Oregon will invest more in services for young children with diagnosed disabilities and delays. The Early Childhood Coalition (ECC) and others helped ensure the Student Success Act included full funding for Early Intervention and Early Childhood Special Education. The ECC pointed to research that showed earlier intervention resulted in special education cost savings down the road. Only 13 of 198 school districts in the state graduated 81 percent or more of high school students with special needs in 2018.