Mental Health

Description of the video:

I'm so pleased to have Steve Viehweg with us and he and I, mostly Steve will be chatting and I might just chime in occasionally and ask some questions or comments as we go along. But as we think about infant toddler, mental health and it's all about relationships. One of the things that can throw off relationships is having expectations for young children that are too hard, right? Or not developmentally appropriate. And then what happens is we get frustrated. Kid gets frustrated because they can't do what it is that we're hoping that they'll do or we're expecting them to do. As we learn more about social emotional milestones, the goal here is to think about how can understanding these milestones help us to better form solid and secure relationships with these kiddos. Because that's what they need in order to be able to learn how to manage emotions and all the other things that we want them to be able to do at home and in school, et cetera. That was more than a sentence. Steve, I'll turn it over to you. I was going to say that was an amazing sentence, but well said, I love that you brought up how this all came about because we have a longstanding partnership anyway, Katie Heron and I, in this work, and we both have this burning desire to understand better mental health and what can we do as providers. Whatever role we play to better help those young kids that goes across things like not only service but even thinking bigger and widening our lens about what do we do programmatically? What do we do around training and understanding? What do we do about policy? How do we get folks that make decisions about where resources go to understand the complexity of this and to think about the youngest kids, and they need us to do that. We have to be a voice for the babies. That's something we always try to say, is that we invite you to be a voice for the babies if we don't know each other. I am Steve Viehweg. I have a lot of letters after my name. I do that on purpose for a couple of reasons. One is so that you know I'm a licensed clinical social worker, but I'm also endorsed as an infant early childhood mental health provider. And you too, likely, could get those letters after your name, if you don't have them already. And that's one of the other webinars that's coming up is to learn more about that. Learn how you too could get those letters and please check it out. The goal is that folks that have knowledge, experience, and understanding about early childhood social emotional development would embrace this competency driven endorsement so that you too could have letters after your name. But really the big reason is that we're trying to create a community of practice so that wherever there's a kid that needs help, we could identify them and get them connected to folks that have a clinical background when necessary, to help them out. The CDC has learned the science. I'm the Act Early Ambassador to Indiana. And that's another connection that Katie and I have, because she's now the Mental Health, I guess, Ambassador, we could call it. Katie as she'll introduce herself. But the CDC is interested in trying to get information out about early childhood development. We're going to focus on that today as Katie was inviting us to think about the developmental piece around this. And we acknowledge that the social emotional domain is the hardest one to describe, to understand, to assess, and to deal with. But we have some information that could help us standard in my day job. I work for the Indiana Lend, which is our Leadership Education and Neurodevelopmental Disabilities Training Program at the School of Medicine in Indianapolis. And I'm also the Associate Director of the Center for Translating Research to Practice. We do like to let you know you mentioned Angie Tomlin who's a coauthor with me in a book called Teching Tough Stuff. It's aimed at home visitors that support families. But really, it's a practical guide that can help anybody. And some of this material is in there, like understanding the behavioral pieces that might connect with development, invite you to look at, so that's who I am. And the question is, what about the other one? Katie? Who are you? Okay. I'll chime in quickly here. And I have your book on my shelf. By the way, I am the director of the Early Childhood Center at the Indiana Institute on Disability and Community. So I'm located at Iu Bloomington on campus. For the last year, I have been the CDCs Mental Health champion to Indiana. We have been looking at ways to connect these milestones with mental health. It was interesting looking at those social emotional milestones on these slides, and I'll ask when we get there, but it's interesting me, there isn't more emotional stuff on those milestones. Yeah, I don't know if you have thoughts on why that is and we can get there. But I thought I was really reflecting on that when I was looking at the definition of mental health and then looking at the milestones. I thought it seems like there was maybe a little disconnect there. And the other thing that we'll naturally observe, we'll just throw out before we get there, is that when you look at the other domains that sometimes I look at, maybe something in communication and go, doesn't that look like social emotional development for young kids? There's a lot of crossover. I think that's an important message, right? That it's messy and complicated. But we can use the evidence. The other thing we'll say about these milestones that we look at today is that they are evidence space. The CDCs only put out milestones that they could say comfortably, we have evidence that this really is the thing, and that most kids, 75% or more would have this skill, this activity, by that age. That also helps, I think, answer your questions like why are there more things? But we don't have evidence for them, But here's what we have evidence for. It's a high criterion to become a stone makes a lot of sense. We all have to work on this, right? We all have to work together to keep building the evidence space about what's behind this. Yeah, that's true, because mental health and early childhood, we're pulling pieces from a lot of different places to try to build that base. And it's not always there yet. That's me, we can keep going. Well, the other thing you said that was really key in the long introduction sentence was that's all about relationships. And that's a good place for us to start as we just reflect back on a definition of infant, early childhood mental health, which you can see coined by zero to three, The National Association of Zero to Three. If you haven't visited their website, go do it. Just type in zero to three.org and you'll get there. But look, this was in 2002 and has remained the go to definition because it's just good. When we talk about infant, early childhood mental health, we're talking about the child's developing capacity to do three things. One is to form close and secure interpersonal relationships. And you can think about how that happens, right? That's the babies are born experience expectant and they need adults to help them navigate the world that begins at birth. Is that connection with hopefully with a secure interpersonal relationship. Which by the way, is something we need throughout our lives to be able to do that. And second, to experience, regulate, and express emotions. When babies are born they're learning this skill and it comes with lots of practice. The adult caregivers help them understand and calm down and learn how to get needs met. But also like how to regulate, how do I do this in a way that's not so disruptive? Then third, to explore the environment and learn another skill that turns out to be really important for later on. All of that is within the context of family, community, and cultural expectations. The nuances of how that might work, I like to always throw in that I think all of us could share this idea with folks that do public policy, that make decisions about where dollars go. Because the work that you and I do in early childhood, it turns out, is very important for something you need later on. If you're in Indiana today and we may have folks from outside the state joining us, I don't know, but Indiana is a state that works. I saw it on the side of a building downtown. We value work and you think about what employers want. They want people who can do these things. They want them to be regulated, dependable to be able to solve problems, to interact with others, and to do what they're supposed to do. We are at the beginning of making that happen, we are today thinking about kids in the context of relationships and social emotional development. Another way to look at this and maybe more simplified way is comes from our colleagues, our friends in the infant early childhood mental health world at Fitzgerald. And Debbie Weatherston, some others. They say that this directs our attention to the well being of all infants and toddlers within the context of secure and nurturing relationships. Just think about that, but what happens and why relationships are important. And then the role that we all might play in supporting those caregivers in whatever way we can to build those connections with kids. You might have come to this today wondering, can babies and toddlers have mental health problems? And the answer is yes, they can. There is evidence that would say that kids even under the age of five, can experience what we might call grown up feelings like all those listed here. Extreme fear, grief, sadness, hopelessness, intense anger, even rage. Now, it might look different, right? So we have infants and early toddlers who aren't able to articulate these things using words. But there are ways that they can share some of their big emotions and you can imagine why kids might have these big emotions, right? It could be lots of reasons where there could be traumas or things that happen in their lives or things that interrupt their connections with adult caregivers. We just need to become better at knowing what to look for with those young kids and to try to understand, hence our conversation today. Trying to understand what this might look like, what does mental health look like? And young kids ways we might figure this out or begin to wonder it is if there are delays in development. I think this group is probably really good at observing young kids and being aware of when things are not on track. We might not always have the ways to explain what it is, but we have a sense, right, of when we're observing kids. We might also notice kids that are having trouble regulating in all the different ways. That might be whether it's through sleep or other behaviors or eating or the things that they're doing notice might have particular fears or they might be in emotional distress. Have you looked at kids? Sometimes and you can tell that they're not feeling comfortable. It's not comfortable for me to see that, but we might observe that and be aware there's a lot of talk about attachment, how kids connect with those adult caregivers. And there's a whole literature about attachment. Most kids have what they call a secure attachment, but sometimes they don't. They might have what's a disordered attachment? And there are some descriptions about how we might understand that and try to intervene and help kids get better attachment. And it could be for lots of reasons. Certainly we know about kids that have difficult behaviors, including aggression. And we can begin to wonder what's going on, and that's what we'll explore. What could be behind this, Maybe feeding or sleep problems, or even physical problems. They're growing, they're not growing in the right way. Lots for us to think about, but think about how some of these symptoms might in fact be related to mental health. The mental health and well being of kids. We could say that these problems can be serious chronic. We need intervention for them, but we can do that. We know that we could successfully treat these things and be able to help kids and families who might be having these challenges. You wonder how common is this? Well, the data would say the best estimates of serious behavior concerns in kids ages two to three might fall 10-15% That's enough kids that we should pay attention to that parents in pediatrician report says that behavior problems, there's 10% of one to two year olds. Even those really young kids, they're reporting behavior problems. We might flip it around and wonder like how many kids are being kicked out of preschool because they have behavior problems? Right? I'm not sure what the data would say about that. That's hard to collect, but our own experience might be it's too many. What could we do to help kids stay in the environments that they're in? Some more data, up to one in four kids under the age of five are at moderate to high risk for developmental, behavioral, or social emotional delays based on the National Survey of Children's Health. And these reports are like the incidence concerns of older kids. So it's similar, it's about the same. We should be paying attention to this and trying to understand when parents are reporting challenging behaviors. They're also sharing that there might be delays in social emotional competence. When we're listening to what they say, they report being worried about their kids behavior. And certainly they're telling us that the behaviors interfere with family activities. That's some clues for us that gets us to thinking about the developmental piece, about this. The CDC, the Centers for Disease Control, is they've been putting together for a long time now. They've had the materials out, they learn the science, act early materials. What prompted them as an agency to think about this was understanding that developmental disabilities are common and not usually identified before kids get to school. But the data would say that 1.6 kids between the ages of 3.17 ends up with the developmental disabilities. That's a lot of kids. What could we be doing ahead of time to better understand that? The latest data that just came out of the CDC through their Atom network, their autism and developmental disabilities monitoring network, says that 1.36 children age eight meet the criteria for having autism spectrum disorder very quickly. The way they figure that out is they have teams of researchers looking at medical charts, eight year olds, and seeing if kids meet the criteria based on what's documented there. That doesn't mean all those kids have that diagnosis, but it means a large number of kids would meet the criteria. We also know that early intervention ahead and ask you a question. Sure. Or maybe it's a it's a comment and a question. I'm looking at that list of ways behaviors that we might see when a kid might be struggling. You shared that list then you shared that slide. Yeah, that's the one. Yeah. I was thinking there's probably some things on that list that are going to be Really stand out to childcare providers or teachers as potentially disruptive in a classroom. Or we've got our externalizing behaviors that are, it's hard to ignore those. And then we've got our internalizing that are a little quieter. So I'm looking at that and then I'm listening to you talk about the kiddos that actually need clinical intervention or may have a disability or delay. I'm thinking about a teacher. A couple of preschool teachers I was talking to the other day that were saying that they have an inclusive classroom where they have kids with Ip's Right. So that are getting special education services. And then typical kids in their class and the behaviors of the typical kids were so challenging that they were having trouble serving and providing the specialized services that the kids with Ip's needed. So I guess I just wanted to point out that it's so interesting to think about all of the ways that it's important to identify when kids are struggling because it doesn't always reach the need for clinical intervention and it doesn't always become a disability. But if we identify when we see some of these behaviors, even in smaller doses or in certain situations, I think we're seeing it so much at lower levels that I don't know what my question is. I guess I just wanted to point out, it's not like we're only talking about the kids that get a diagnosis. We talk about this stuff. You're making me think about all the things that have happened. Let's talk about we had a pandemic, in case you didn't know, we're still all learning. Like what the impact of that was. I hear early care education providers talking about the kids that were in settings and then out because we were all at home and then came back. Or we have kids who were never in and now we're coming in. There's lots of things that could influence that. Then I think you're right, it's probably helpful for us to just step back and understand what's going on developmentally, for all kids to try to understand like what's behind the behavior, what's going on. Because there could be any number of things. It could be serious. It could be not so serious, but it's impacting my behavior. Now if I understand it, maybe we can find ways to help with that. I also was thinking about how people have been embracing self care, ideas like mindfulness and yoga. Or how all the meditation and applying that to very young children as another tool to help them with some self regulation. When those things occur, like when we're all getting out of control in our classroom. But we can learn as a group of kids like, well, when we get like this, we got to use our whatever skill to help us calm down instead of becoming a behavior problem. Sure, Yeah, I have good observation. Yeah. When we have Crystal and Nancy and Shannon come on June 15 to talk about some of the initiatives that Costal is doing. They're going to talk about how the call map is available and free to all childcare providers now as well as teachers. I hear a lot of providers saying that they're using it in their classroom. I think they're using it for themselves as well as using it in their classroom with these littlest learners learning to be calmed by music, mini meditations, things like that. When I've heard examples of when that's been introduced into classrooms, where when things get out of control, then the kids themselves go, okay everybody, we're getting a little bit, whatever the word is, it's time for us to use this skill so that we can calm down and they can do it themselves. And isn't that what we want? Right. And then built at home. Exactly. Yeah. Yeah. Somebody just commented in the chat that they worked in a school as a therapist and they had built in mindfulness into the school. And then I think this is interesting, they added one mindfulness session after a code red. If something stressful happened in the school, they worked in a procedure. They had a process where they were automatically going to take a few moments to calm down. I love that. That's a great idea. Yeah, this ties into this notion that earlier intervention is better, right? We're just throwing out lots of examples of when we notice things that need attention, then we should do it as early as possible and get whatever support services are necessary. But at the same time, it's never too late either. Like we don't have to say, oh, you missed that birth of three window or birth of five window. So there's no hope. I think we should always be trying to do but the earlier, the better. Hence these conversations. Now one aspect, how do we just look at development to better understand that? I don't think we have to sell you on the idea of early intervention. Everybody's here is like, yeah, let's do that. So let's focus now on looking at the CDC materials and understanding just how they set these up. And then we can play with some of the materials that they have to dig a little deeper. But the CDC put together these materials because there was a piece missing, they felt. That whole umbrella of understanding child development. And what do you do when there's a concern? They are on the end of keeping track or monitoring and looking at milestones which they would just define as things that kids do by certain ages. How they play or how they learn or how they speak or how they act, or how they move. The things that you and I see every day and looking at those milestones give us some clues about where kids are developmentally. Parents may need our help in understanding what those are. If any of us have kids or grand kids, we didn't just automatically know everything that kids are supposed to do, we might need a resource to help us. Cdc said, well, we'll put together materials that are aimed at parents. They're in parent friendly language, they're sensitive to the culture, and they're evidence based. They're written in accessible language and presented in ways that makes sense to people that everybody would have the ability to have some common language about what kids do at certain ages. But also understanding that kids develop at their own pace. And some are going to reach certain milestones earlier or others. This is not scientific in the sense that it's not a measurement. It's just a tool to help us begin to understand and communicate about it. And tracking again, go ahead. Yeah, my lens, I'm a parent of a child with a disability, and then I also have done a lot of work in this field, particularly in early intervention. And one of the things that I hear from parents when they have kiddos that do have delays over and over again, is that milestones can be a bummer. They can be sad because if you're so far behind, if your kiddo is so far delayed in a particular area, it can just be a sad conversation. I've heard a lot of really skilled professionals use them in lovely ways with kids that do have delays and disabilities around. Not so much focusing on how behind a child is, but talking about what's coming next and what did you just accomplish. It's this individualized thing. I love that you talk about how kids develop at their own pace. And then just thinking about how, beyond that the messaging works when kids are developing at their own pace, I think is really important. You'll see in the materials that the CDC is developed that alongside the milestones is a lovely list of activities, things that we could do to encourage development at that stage. You're right. If we can separate out the age piece, we have to start somewhere. Like if we're trying to identify where kids are and if there's a delay, then we start at age 30 months. And yet we could use this tool still in a sensitive way that's supportive, as you're saying, when we identify a problem. What I hope we all take away too is I hear a lot from providers that they're hesitant to talk about delays with families for lots of reasons. It may be that we're not diagnosticians, so we don't feel comfortable saying there's a concern. But I also understand, and I say again, we're all observers and how many of us are constantly watching kids wherever we are. And when there's something that doesn't seem right, we're right, that doesn't look right. And how do we know that? We know that because we have this experience. We have this knowledge. It's okay if we were to bring this up and support families. The other thing I would tell you is that in our research with these materials, is that families would say that they trust their early care education providers to tell them about what their kids are doing and when there's a problem more than they would their doctors. And why is that? Because as Katie said, it's all about relationships. We develop relationships, partnerships with families. They're expecting us to tell them. You could use these tools as a way to help build that language and that opportunity to talk about it in ways that makes sense. I think what you're saying is that when you have that relationship, it's much more likely to be strength based. Whereas in a pediatrician's office or something like that in 15 min, you may end up with this deficit based approach accidentally from any attempt to be mean, but just it's quick, it's straightforward. But when we build relationships, we really can use this tool in a strength based way. Well, think about the opportunity of partnering together. When we're looking at what kids are doing, we're understanding what's happening. Then we have that opportunity to go, oh, what do we do here? Here's what we're trying in the program, here's what you can try at home. And when there's a bigger question, then we can have that conversation about what do we do next? We screen, right? So if we're monitoring and keeping track when we have a question, then the next thing we might do is get more information. And that's exactly what Elmira says in the chat. She says that teachers also observe longer and have more take it away. That's a perfect segue. It is. We wanted to just set this out there, but today we're talking about monitoring and just understanding, develop, and keeping track of all of us do that. And we're looking at milestones, the things that kids do from birth to five. It just helps us look first, celebrate what kids are doing. So that's what we could use this with everybody. And then it helps us talk about progress with everybody that's involved. It helps us know what's next. Also helps us identify if there's any concerns. Materials we could use that we'll look at today are the free CDC materials. When there is a question, then we would talk about doing some screening. That is a more formalized tool. Again, it's not scientific, it's not a measurement to say you have a diagnosis or a delay. But what a screening tool will do is also looking at milestones, but in a more organized way, is going to tell us if things are okay or if we need to go to the next level and get a child and family connected for an assessment, that would be done by whatever provider. It could be a psychologist or a speech therapist or any of those folks that have their even more refined tools that could get to a diagnosis. You see we're not doing that. We're just talking about what kids do is on track. If it's not, we should get more information that would help us know how to support that child, where they are, and to keep them going. I hope you're taking away from this, that tracking is important, keeping track of what kids do. It gives us a chance to know where we are, catch early signs of development, et cetera. That gets us to a place like, let's play with this a little bit and we always like to start with when we talk about development, to know what are the five domains of development. Here's the quiz portion. Tell us what they are. You can unmute, you can go ahead and type it in the chat. I'll see how fast you could do that, but okay, social, emotional. Yeah, cognitive. Somebody that motor. In the chat I see physical, adaptive, problem solving. Someone said problem solving, Language and literacy. Fine motor. Oh my gosh. We got way more than the number you said. Well, let's talk about that, Katie, because they're using some words that might be in the same categories. Definitely. So what we're going to show you is what comes out of part C of Idea, the Individuals with Disability Education Act. So these are the five domains, here they are. And Elmira, you win the prize if there only were one to say social emotional first. And that's my bias, it might be Katie's bias. That one is what we should be putting at the top for lots of reasons. Not just because I'm a social worker, but because none of the other stuff happens. A child doesn't have a good connection with an adult. If they're not connecting, then they don't grow. Their brains don't grow, they don't grow physically, et cetera. Then the second one here is called communication, and that talks about both expressive and receptive. That's a second on my list because a lot of the issues we might identify that are behavioral might be related to communication. Right. When kids are having trouble with either understanding or expressing what they're looking for, then we had cognitive, some of you listed that as problem solving. Okay, that's fine. Adaptive is in here, I will say, is that the materials we look at today from the CDC and also like in the ages and stages screening tool leaves out that domain because like we've said earlier, there's so many crossovers for this young age group, it's not necessary to include that as a specific category to look for. Then the last one on our list here is physical, which by the way, includes both those motor things, the gross motor and the fine motor, but also a focus on nutrition, hearing, and vision as part of that physical domain. Now we have that background. The Cdc's milestones are available in lots of different ways. What we'll look at today are the check lists they have put together. And you can see in the middle here of this screen an example of your child at 15 months. What they've done is this is something that you can access online, you could print, you could use it a variety of ways. And it has just a few of the milestones from each of those four domains. And it's in a checkbox format. You could use this tool, talking with a family or a caregiver, and compare, does the child do this or not? Are all these milestones are the ones that have evidence? And the CDC would say that at least 75% of kids or more would have these milestones by this age. Then in a little bit down there, you can see that pink area are some open ended questions, and that's designed to get at the nuances of some of this. There's some questions where you could talk about just to get a better understanding of what the child does, what do they do together, et cetera, to have more conversation and a better understanding of where this is. Now I will say on the left, you can see that there's a picture of a phone. Because all of this that we're looking at is available on an app that's free and downloadable. But of course it's also available if you look at the right and a nice little print edition because some people like little booklet, they've made it available in lots of different ways. And see it's available in Espanol, all of this in Spanish and English. You can download it, get it, et cetera. Enough of that. We thought we would spend some time looking at some of the social emotional milestones in some of the areas. I pulled out the social emotional milestones from the 15 month checklist. Here's the five things that they show. By the way, if you look in the Or if you just do the check in the app. The question would ask you, is the child doing this? Yes, not yet or not sure. So that gives you that choice. Now, the beautiful thing is in the app, or if you go to the milestones and actions at the CDC website, is if you're not sure what these things are, then there's either a picture or a video clip and they're trying to get more video clips. What it looks like, here's what it looks like. If you go to the CDC website where the milestones and actions are. These checklists, here we are on the checklist page for 15 months. And we can scroll down, here's what most babies do by this age, social emotional milestone here. There's pictures for some of these. And then there's a video. You can just click on the video and it'll pull it up eventually. Now we're in super slow. Sorry about that. So it's just a short video clip that shows you what that looks like. Okay. Or there's a picture, you can see a picture of copies, other kids and what this looks like. So how did these sound to you? I mean, that was Katie's question. You're like, looking at these, do you have any comments about what these things look like? I think we have to know the parents that we're working with. So like for example, if we have parents who like to be perfect, having a list might be overwhelming and could be like, oh, my kid doesn't clap, but they do other things just knowing the parent and the kid. Yeah. Yeah. That's a piece of this, isn't it? Is. How do we use these tools in ways that are accessible to families based on what we know about them? Yeah, One of the things that I was thinking about when I was looking at this list and thinking about all of the times when I hear about challenging behavior right, with our little kids, is something like copying other children while playing. Right? Taking toys out of a container when another child does. If we had somebody who wasn't as familiar, a parent that was less familiar with developmental milestones, they might be really frustrated to watch a 15 month old child because maybe is playing with something and another one comes over and wants to do the same thing. That could look like trying to take away the toy, or not playing nicely, or not sharing. But we know that taking turns and sharing takes a lot of stuff that those 15 month olds don't have yet. But really what they're doing is showing you something that's developmentally appropriate, which is showing interest in a toy that another child has, and trying to do something similar. Thinking then about one, if we're always frustrated by that, even though it's typical that's getting in the way of the relationship, then also, what could we do instead then we don't want to sit there and ask them to take turns, right? Because they're not quite ready to do that in 15. Right. Could we provide two or multiples of things that the kids are interested in or what are the ways that we then handle that differently? Well, I was thinking about we pulled up the one here, that's 15 months, so think about how that's a one year old with a couple of months afterwards. Right. So what does that look like? And by the way, also the CDC, when they revised and updated all of the milestones, added a 15 month and a 30 month checklist that used to not be there, but there's enough of a difference between a 12 month old and an 18 month old to have a 15 month old check list. And it is interesting just to see what these things are. And I like what you were saying, Katie, about how we present, so how we understand it and translate this could be really important, right, about this child at this age. The other thing I was reflecting on is when we participated in the CDC and helping look at the one year old book that they created called Baby's Busy Day. We test drove it with groups of parents and have them read it and look at it. I remember the Spanish speaking families. A couple of them remarked that there was little note in there that says, shows imagination, and families, like one year olds are imaginative, had not thought about it that way. And what a delight to see them like. That's really cool that my one year old has an imagination. And this is what it looks like, right? To have a way to understand it. I think it is important for us to think about that. To look at what these are and how do we explain them. Which is why it's nice to have a picture or a video clip. To just talk about what it looks like and then how does it translate to what we're trying to do within our classroom. Always remembering that the pacing is different for individual kids. And then thinking about if you do have a kid with a delay or a disability, how they may be doing some of these things but in slightly different ways. You mentioned earlier, which I thought was such a good point that yeah, we're focusing on social emotional, but all these domains impact each other. When my child who had a disability was little, he couldn't walk until he was six and he didn't have a wheelchair until he was four. Imagine not being able to move, which is a primary way of imitating or interacting with other young people. And imagine the impact that might have. So if everyone is jumping and my son couldn't jump, how is he trying to do what you be like, what the other kids are doing? And are there ways of adapting that and recognizing the impulse though? It's just it's tricky and it's good to keep an open mind. I mean, these are super helpful. But also keeping an open mind, right? Yeah, right. Well, and keeping the lens wide because I think I appreciate that you brought up earlier like this is, this is good for everybody. I mean, everybody benefits parents, caregivers, teachers. He's interacting with the child to have a sense of like, well, what do kids typically do at this age, even if there's no delay? Because when we're learning about it, we can celebrate it. And it helps us to understand how could we include this child over here who's not moving, and why, why would we do that? Because it does relate to some of these other things. I think that's a good point. And you can see on this checklist that we're showing here, the language milestones And the cognitive milestones. I always admire looking at these and sometimes think like how does this not fit like a social emotional thing, because they tie together. Right? And that's a good point. Okay, let's see here. We pulled out a couple of the older ones now like to just take a speed through the 30 month and maybe the three year because probably more of the time that we're all experiencing questions about behavior is when kids are 22.5 Three is when we're seeing that. Here's the 30 month one. This was the new one that they added. Here's the social emotional milestones. You can see the difference here. In the 15 month, what did it say? Copies other children while playing, like taking toys out of the container. Here at 30 months is the milestone, says plays next to other children and sometimes plays with them. So what does that look like? Shows you what she can do by saying, look at me as a social emotional milestone. Follow simple routines when told, helping to pick up toys. And you say it's cleanup time again, we can go to the website and you can see what this page looks like. And by the way, this is designed. If you go to the website and Katie put in the chat with the Urls, but I always just put Cdc.gov slash act early and you'll get right there. That's what I can remember, Cdc.gov slash act early, then you can easily find the milestones. And by the way, there's also like a whole video library of all the pictures and the video clips that they've put together by age and domain. If you wanted to just go find that to show a family or a staff member what this stuff looks like, you could easily find it and download them and use them however you like. Here's at the 30 months, what your baby does by 30 months. And there's more videos here and they're trying to get more in there, but we could look at this video. This is their example of what it looks like for a child playing next to just doesn't exam. Again, I'm thinking about what this might look like in a classroom of this is 30 months. So 2.5 year olds. Yep. 2.5 year olds at 2.5 having everybody come to Circle Time to do ring around the Rosie or something. It might work for kids and it might not work for others. Or in that moment, some kids might want to do that with everybody and some kids might not want to engage and thinking about ways you can have some options for a child who doesn't feel like doing that particular game. Because at that age, sometimes they play with others and sometimes they may feel more like just being nearby or watching and thinking about that and then look at the language. Right. So as you mentioned earlier, are our expectations realistic? At 30 months, we're saying that kids, 75% or more kids would say about 50 words. So that's a fairly limited number of words around doing what you just suggested, right? Offering choices. And like the next activity, I might not have the ability to process all that right away. And then if I'm doing something I like and you're telling me to do something else. Might my behavior look like? I might not be able to say, you know what, I'm really enjoying this activity right now and I prefer to play a few more minutes, if you don't mind. Could we change your agenda? I can't do that at each start, but I might throw the toy at you because I'm mad because this is one way to let you know that I wanted to keep doing this. To keep it in perspective. Yeah. No, I think that's really important because again, if we think about all of this as the bottom line is we want kids to be successful. We want families and caregivers to feel like they're successful as well. So for example, if you need to transition activities and the kids enjoying themselves, you say, okay, go ahead and put away your toys, Come over to the carpet and sit quietly. Now, it says here follows simple routines. When and under cognitive, we can get to two steps. There you go. And what did I just say? I said toys. I counted three. Go to the carpet and sit quietly. Yeah. Those kids are going to forget to sit quietly or forget the carpet or go to the carpet first because they saw somebody else do it and forget about the toys. Right. We're already setting ourselves up to be frustrated if we don't have a sense of where we need to be with the milestones. Melissa's got a long comment and here about challenging piece of going to daycares where there's a wide variety of expectation in settings. It's hard for the little ones that we're working with is their developmental level doesn't always match the age, right? But they required to be separated based on age. That is an interesting question. They push for a circle time which includes a Bc's counting colors, et cetera, which may not always be a good match. You're right, those are things to think about. Using these tools might help us have some of those conversations at every level. Whether I'm the parent caregiver or whether I'm a teacher, maybe I'm asking those questions because I'm in that setting and wondering about this or wherever we might be able to have that. If you're a preschool director or childcare director, sometimes having these milestones available for children or for families can help you to explain why you might not be at Circle time for 10 min doing a Bc's for 2.5 year olds. Right? Because sometimes parents they'll see a very strict or regimented preschool or childcare and think, yes, they're getting ready for school. Excellent. Really, that's not a developmentally appropriate space. Right. It depends on the age of the child and what we're working on. Ideally, all spaces, even going into school through regular school, should be looking at the, looking at learning from the idea of offering options. It's called Universal design for learning, and it is the most accessible way for kids with disabilities, for kids without disabilities to acknowledge that kids learn differently and sometimes need options. But that's a whole other. So then six months later, here's three years. So look at the two that have evidence, right, for social emotional milestones. And it's the first one says calms down within 10 min after you leave her. Like at a childcare drop off at three years. We would expect that most kids would be able to calm down after 10 min when you leave them right now. Now that's interesting to me when I think about, you know, dropping off your kids and what that might be like even earlier. We're hoping by age one that I can do a quick drop off and not have the trauma that we think might happen. But this is a milestone that we don't expect until three. Then the other one is for social motions, notices, other kids, joins them to play. Just to take a quick look at what that might look like, you can see there's nothing yet for the calming down. That means they're working on it. They're working on getting these videos and pictures. But here's the video clip of noticing other kids and joining them to play. Maybe, there you go. So think about how you could use a video clip like that, right? To have a conversation either with a caregiver, a parent, or staff. And just what you could parse out from that. And sometimes I think about these videoclips could look at not only a social emotional, any of the other milestones and how they fit together about how these kids were communicating or how they were playing, or what they were doing. In addition to, in this example, what the social emotional milestone would be. And then let's do it this way, just so you can see comparison of one year later here. And the Cdc's materials will go at three years, then four years, then five years. There's a gap in there once we get going along. But they have several more under social emotional of what this looks like. Another. Other way you might use these. Sometimes I'll create questions with polls to say, when does a child pretend to be something else during play? And give people choices like is this a 30 month, is a three year, four year, five year. And then let them see, then show them the video clip. Then you can have very nice conversations about, well, why did we think about that? Well, it may be because most of the kids I'm working with already have that skill. That's my experience with my own children said that that was the case. But others may have different experiences. You can use it to have nice conversations and to get some insights and learning about how that looks. Here's the example. We'll go to the CDCs website. Again, you can see there are some of these videos, but now we're looking at a four year old. And here's what social emotional milestone might look like at age four. And you'll see that this is a little bit different from age three. Well, maybe you will. What are you going to do? You're going to put out the fire. We'll wait for ten fire a firefighter will. Yeah. Okay, so that gives you an example. And we might even just for a moment, flip down to what are the language communication milestones. And now there are fewer here in this one that have the evidence behind them. But says sentences with four or more words, that's something we'd expect at age four. The majority of kids would say sentence with four or more words. What does that look like? Something out. I hear a lot when we're talking about communication and when we're thinking. Talking also about challenging behaviors. That saying a sentence with four or more words, that's when we're in the frontal lobe, that's when we're calm and we're able to think, right? But sometimes if we're trying to negotiate about a toy or a child is tired or upset about something that can go away. Right? This context specific. And I think it's really important to remember because one of the things that can really challenge a relationship is if we try to reason with a kiddo who isn't in that part of their brain. If they're upset and they're in that more active emotional part of their brain, they just can't do some of those things in that moment. If we get frustrated and say, I know they're capable of saying these words and they're not, then are they being naughty or no, Or are we acknowledging that there could be trauma and other things going on and we have to let them calm down and regulate before we can see some of these things. That makes me think too about when there might be discrepancies between what kids are doing during the day and what they might be doing with us at home in the evening. Because I know my own kids, they were very attentive, very busy during the day, and then they would come home and they had used up all that energy I think, and so they weren't able to be in that space anymore, and they were more in the reactive space. When we would have the parent teacher conferences and they'd say, oh, they're so helpful. Like who are you talking about? But I think that might account for that. Right. They're tired and they don't have the same, it could look different. Yeah. That would be a really important conversation to know like, well, what are the things that work during the day that we might try at night and vice versa? What are they doing at home that might be important for you to know during the day when you're caring for them. And also just knowing that context of what's going on with that kiddo. Of course, that takes us to family engagement in all kinds of things, but I was just talking to a colleague who was sharing that some counties around Indiana have adopted a handle with care program. If you heard about this, where law enforcement is collaborating with schools to share, if a child has had an interaction, if let's say they had domestic violence in the home or something has happened where that child has come into contact with law enforcement, they will reach out to that kindergarten teacher or preschool teacher or whatever and say handle with care. They're not going to share details, they're not going to say what happened, they're going to write handle with care. That way we know that something possibly traumatic happened to that little kid and we can know what emotions we might be seeing and why we might be seeing bigger emotions or fewer of those milestones on a particular day. I've seen that also offered by teachers, just classroom by classroom, where they'll send home a little note to the mom saying, or dad, or grandma, or whoever, saying if something happens, if the kid just has a rough morning and is grumpy, just send me handle with care. You can put it in the folder. You can email me or text me and you don't have to tell me anything more than that. I'm going to know that something's going on. I love that. I just want to well, I hope what we're able to take away from this is based on this conversation or based on our skills and abilities going to be able to diagnose a social emotional issue. That isn't the goal of this conversation today. What we're hoping is that we can take away an appreciation for learning more about what is typical development, what are some clues then that would help us know when things are going awry. And then then another session we can spend more time learning about, well, what do you do then? Where do you refer to? Try to get more assessment or information about whether or not there is some social, emotional, mental health issue going on that we've not been able to address in the ways that we've been just throwing out and tossing around today that might need the support of some other provider. See, there's lots of opportunity here for us in the work that we do to better understand, and that's part of it, I think is seeking to understand what's going on with this particular child and then acting accordingly and doing it in ways that maybe match where they are developmentally. I do want to throw in just to note here that the CDC has other materials that are available that highlight all of these milestones and ideas about activities in some different ways. In addition to the checklists and the print materials and the app, they also have three books. So far, there's a book for one year old, two year old, three year old, They're very interactive. The pages of the book, it just lists what milestones being addressed and maybe a suggested activity. You could use all of these in lots of different ways. They have training on line called Watch Me, and it's aimed at early care education providers. It takes about an hour and you get credit for it. You can print off your certificate if you need that. Then the other list of things they have is something called fact sheets. This is just some helpful information, some aimed at parents like how do I help my kid or how do I talk to my Dr. there's a sheet there for you and me about how do we have difficult conversations, but all of this stuff is available on the website. What we're hoping you're taking away an appreciation that kids have mental health challenges. Yes, that understanding and keeping track of milestones is important, that we've got free resources to help us do this. And that understanding social emotional development in kids can be challenging, but it is possible. We've, I think talked about some practical ways to make that work, just in some conversation. Then we've raised a question that when it goes beyond this, that we need to get more information. That might be a screening or it might be getting connected to a mental health professional that can dig deeper into understanding what it might be. So, I'm aware that we are close to the time. There a slide with a Qr code, Steve? Yes, there is. To here. I just put the link in the chat and that you can fill out a super brief survey and then you'll get a certificate. You can also scan the Qr code with your phone and get to the same survey that way.

Description of the video:

I'm very pleased to turn everything over today to Crystal Robinson and Shannon Garrity who are here to talk about workforce Wellness. They have some exciting new initiatives. And as we've been pulling together all this data around mental health, one of the things that's been really, really cool is to see all the different ways that our systems are working to address these challenges. And so I'm going to turn it over to Crystal so that she can share some of the things they've been working on. Great. Thank you so much, Katy, for the opportunity to be here today and to talk about, as you said, some really exciting work that we have going on here in the state of Indiana. My name is Crystal Robinson. I have the pleasure of serving the state of Indiana as the director of childcare policy. And I'm just so thrilled to be with you again, I see some familiar names and faces in the chat, so I'm just very excited to be with you. And again, share this great work from not only the state, but our partners as well. A little bit about what our office really envisioned in terms of support as it relates to mental health and infant and early childhood mental health. Our vision is a multi pronged approach where we are supporting educators both in the classroom as well as their own mental health and well being. We're supporting children in the development of their mental health and ensuring that spaces are also safe for them, Not only just physically but emotionally as well. And then also thinking about how we support childcare programs in establishing policies that support the mental health and well being of not only their staff, but their children and families as well. So we recognize that these things have to work together in order to create the best environments possible for children, families, and childcare educators. Just a little bit about kind of our make up as it relates to licensed childcare programs. Here in the state of Indiana, we have over 4,100 childcare providers across the state. We also pride ourselves on having what we call a mixed delivery system. And what that means is that we support a number of different settings, whether that be licensed centers, licensed family childcare providers, ministries. We also engage with our local education agencies or schools to provide CDF vouchers for children across the state. But again, I think it's just important to know that this is the targeted program and workforce that we are hoping to support. We also have varying levels of quality across the state. You'll see here we have past equality, which is our quality rating and improvement system. It is a voluntary system that is encompassed by four levels. The first of those is just basic health and safety. The second is really thinking about learning environments and program policies. The third level focuses on curriculum and environment, and the fourth level is national accreditation. So you'll see here the breakdown of just over 4,100 programs and how they are ranked in terms of past quality level. The other thing I think it's important to share is a little bit of information about our childcare workforce in Indiana. Early on in the pandemic, the childcare workforce was deemed essential by the State. We also know that we have a very diverse group of educators. And when I say diversity, I'm thinking in a couple of different ways. The first of those is not only by culture but also by language. We know that Spanish is the second most common for our childcare educators. We also have a number of childcare providers who speak Burmese, amongst other languages as well. We also know that our providers vary in level of education. So some educators may have a high school diploma, some may have a number of different degrees, credentials, CDAs, et cetera. The other thing I think it's important to know is that our educators come from a number of different areas, whether that be rural, suburban, or urban, which can have an impact on the number of supports and services that they have available to them. We also know that childcare providers and childcare educators have a lack of access to health insurance, which can create a number of different problems. But today we're talking about wellness and not having access to time off when you're sick or that health insurance to be able to go to the Dr. when you're not feeling well can have a significant impact. We also know that our childcare providers do tend to experience low wages. According to some of our most recent studies, the average across the state and across all settings, which would encompass, as we talked about earlier, our ministries, family childcare homes, et cetera, is about a little over $12 an hour. We also know that many of our programs are very understaffed. I think that is across the board in education that everyone is facing a workforce shortage. But across the state, according to our most recent survey, we have over 2,400 open teaching positions across the state in childcare programs. And that's with about 60% of our childcare programs reporting those numbers. We also pay a lot of attention to what's happening on a national level. And very early on in the pandemic, there was a survey that went out to early educators in both licensed and non licensed settings. That I think was really staggering. And there's a couple of data points that I pulled from that study that I think just had a significant impact on me and my team as we were thinking about what providers were experiencing and how we might help. The first of those is that about 45% of early childhood professionals reported experiencing depression, which is significantly higher than a nationally representative sample. So you'll see we would be looking for somewhere around 30% but was significantly higher with early childhood professionals during the pandemic. We also saw that there was a significant increase in the number of professionals who were experiencing stress. And I don't think that's a surprise, right? Especially if you were engaged with childcare, working in a childcare program, Thinking about those very early days of the pandemic when there was just so much we didn't know. Elevated stress doesn't come as a surprise. But I think we all recognize that the stress and the mental health of the educator has a direct impact on the education that children are receiving in their care. We also engage with providers in several different ways. We have what are called regional advisory council meetings. We have licensing advisory groups. We also have providers that will pick up the phone or send us an e mail to let us know what's happening and what they're experiencing. What we heard when we put our ears to the ground was that providers were feeling very isolated. There was a lot of fear, again, going back to those very early days when there was so much we didn't know about how covid was transmitted or what kind of impact that might have. And also just changing expectations because we were learning so much. There was so much changing for childcare providers in a very short period of time. We also heard about that increase in stress. Just thinking about, you know, enhanced cleaning procedures, having to work so many more hours to make sure that everything was sanitized before they went home for the day. Just all of those things increasing the stress levels. And that's just the stress on the job, right? I think we all experienced levels of stress outside of that and within our personal lives, trying to keep ourselves safe. Trying to keep our families safe and make ends meet. We also saw that the availability of resources or unavailability of resources created a lot of stress as well. I think on a personal level, we all saw those empty store shelves with no toilet paper, no paper towel. Thinking about how are they going to get those things to meet the needs of the children in their care? How were they going to get the cleaning supplies? How are they going to get the mass? There was a lot of elevated stress in trying to secure those materials and those resources to keep the environment healthy and safe. We also saw a significant increase and continue to see an increase in challenging behaviors. Teachers are continuing to report to us that children are exhibiting behaviors that they've either never seen before or maybe just don't know how to mitigate. Just as a point of reference, since October of last year, we have had 83 referrals to our technical assistance provider, Spark Learning Lab. Who's with me today just related to I need help with challenging behaviors. I think that that is a significant increase from what we've seen historically. The other thing that we heard from providers is that they were just very tired. They were exhausted. This was a lot put on providers, especially when we had essential essential workers that needed to go to work. And so they were working extra hours working extra shifts just to be able to make sure they could keep kids healthy and safe so that families could go to work. We also heard just, I think, really devastating stories about how covid impacted providers, how it's impacted families. I will never forget, we were in an advisory council meeting and there was a provider who just said, I just need to get this off my chest. My assistant teacher died, Covid, and I have to figure out how I'm going to tell parents that I can't care for them on Monday because I don't have another teacher. And I get goosebumps when I think about just how absolutely devastating that is. But also realizing that that educator didn't even really have time to grieve the loss of a coworker. They immediately went to how is this going to impact my families? Unfortunately, we just heard several stories like that. And sorry, I get emotional when I talk about situations like that, but it really, I think, prompted us to know that we had to create some, a response to make sure that we were taking care of our educators, their mental health and their well being. With that, we have a couple of things that we're going to talk to you about today. Some different programs and initiatives that we have going on. The first of those is the Building Wellness Employee Assistance Program. We'll make sure that you get a copy of these slides, but there is a link at the bottom of the screen that will direct you to some more information on that. But the Employee Assistance Program, Building Wellness is available to all educators and their immediate family. Not necessarily the families attending the program. But if I were a childcare provider, my husband could access or my child could access this particular service. And this is an employee assistance program similar to what many other businesses offer. So folks are able to access short term mental health support. They can also get financial support, legal advice. I know I've had folks on my team reach out to get will set up or you talk about budgeting things along those lines. But there's a number of different supports and services that are available to them at no cost to them. So this is a cost that we are working with Spark Learning Lab to incur. So again, it is a free service. And what we also like to highlight is that it is a confidential service, so we don't get any kind of client level data Spark. Our partners do not get any kind of client level data. We just know how many times it's being accessed, what services they're accessing, and then just a little bit about what or why they're calling. But just very broad here. You can see here that in the last, just about a year, year ago we launched this program. Services have been accessed over 800 times. The most commonly used service is that mental health service. So getting connected to a counselor, to a therapist to talk through whatever situation you're experiencing. And within that, the primary issues that folks are reaching out to those mental health professionals for, are depression, anxiety, psychological issues, and stress. I do think it's also interesting to note that we are seeing a majority of our providers using the telephone and video service rather than going to any kind of face to face appointment. Not sure exactly why that is, but I think people are getting more comfortable with using technology and videos, but have definitely seen that that is the modality of choice for accessing these services. I did also want to share, we don't have a ton of information about the impact that this particular program has had, because as I mentioned, we don't get any kind of client level data. However, we were in a public meeting and we had a childcare director share this statement that's on the screen in front of you as a former director hearing her say that for the first time ever, she was able to say that there was a resource available for her staff that was going through a really hard time, was just incredibly moving and thinking about, you know, if you aren't able to offer health insurance, how are you supporting your staff in that way? And again, just being a supportive supervisor and making sure that your staff are taking the time to take care of themselves. But yeah, she was just so deeply moved to say that they were going through something very traumatic and may not have been able to afford or access mental health services if it weren't for this employee assistance program. So again, we don't have a ton of data or specific comments about the impact, but I think this just demonstrates that it's something that is so desperately needed and we've been glad to see that it's been appreciated by providers. The other thing that we started very early on, gosh, I think this was Shannon, you can correct me if I'm wrong, November of 2021, perhaps we launched Provider Support Groups. What we heard earlier on that I mentioned is that providers were feeling very isolated and very alone. And so we were able to start these provider support groups facilitated by an LCSW, completely confidential and just bringing folks together to talk about what they're seeing, what they're experiencing, and build some of those connections with other educators. We have gotten 100% positive feedback from providers they met for eight weeks. I don't want to steal Shannon's thunder here, but she was just telling me a story about how two educators who actually met in the provider support group just met face to face. And they actually went to their Mayor's office together to talk about the importance of early childhood education. And so I think that just says a lot about the impact of not only the group, but the relationships that people are building by getting so connected to other providers. And again, just trying to break down those walls so that they don't feel so isolated and what they're experiencing. We have had. My slide may have gotten a little cut off here, but we've had 145 people participate in these groups and they are from all sorts of settings. It is not just centers, not just ministries, not just homes. It is educators across the board. And we are going to be launching another round of our providers support groups here shortly. And we have over 100 providers registered. So the response to these groups has been tremendous. I remember when we launched the first one, I think it filled in less than 24 hours. The registration filled up. So we know that the need is there. We know that there's been value in those connections and looking forward to continuing these groups. I also want to share just a couple of testimonies that we got as we've been doing our evaluation on our mental health initiatives. This one really stuck out to me because if any of you have worked in childcare, early education, you know that finding peace during the day can be difficult to do. This individual just said that it gave her that sense of peace during the week and really helped her to feel less stressed at work, which is really the intent of these initiatives. And then this next one I think just says so much about how important human connection is and being able to connect with people that understand what you're experiencing, understand, understand you as an individual. And I just thought, you know, this person said being able to encourage each other so that we don't give up is invaluable. So just having that kind of social capital, those people in your corner to talk things through and just engage with when times get really tough. Just really excited to see these comments and the feedback from providers. So that's just a little bit about a couple of initiatives, and I'm actually going to pass it to my colleague Shannon Garrity, who works at our partner organization, Spark Learning Lab, to talk about some other really exciting initiatives we have going on. Thank you, Crystal. Yes, good afternoon, everyone. Shannon Gearty. I am the Deputy Director of Strategic Initiatives at Spark Early Learning. I have amazing team and have been leading the mental health, wellness and business supports that along with the office that we've been able to provide for all of our providers. Another one that we were able to provide is the calm app. And the Cam app actually came out of our provider support groups. And then I'm just going to add one thing about them. When we started in November 2021 with the provider support groups, we had one LCSW and now we have three that are working because the need was there and so many had registered and we wanted to make sure we met those needs. But one of our LCSW uses the app with her providers. And the providers kept talking about how useful it was. We were able to get to partnership with Cam to give access to our providers, all of our providers a year subscription. They have full access to this subscription. Not only is it helping the adult wellness, but we have heard a lot that it is helping at naptime. There are has sleep stories. Children fall asleep and they stay asleep. Crystal and I even put this together, we're getting a lot of testimonials about how peaceful nap time is. And we know that naptime can be very stressful, especially when you have children not sleeping better for the children and for the staff. One of the testimonials was from a provider who didn't even know how stressed they were until they started it and they started listening. We have had a very good engagement rate. We did just launch this this year. We are currently actually doing some informational sessions and having providers be able to engage with the Sparks staff to get signed up. They make sure that they have that full year subscription which is exciting because like Crystal said, we really want to make sure that we are providing that wellness holistically for the adults and any this is an easy one for them to have, not only for themselves in the classroom. Some of the ways that you can go on crystal, some of the things that no Krystal was saying, especially with Covid, is that we've been hearing a lot about. Increase in referrals and challenging behavior, suspension and expulsion. Lots of different challenges that the providers are having. In partnership with our office of Early Childhood, we launched a PD Needs survey. Were very excited to have over 1,200 providers fill out that survey last year. If you can go to the next slide, it talks a lot about that. We just wanted to ask questions when it's coming to that the need for suspension, I feel that suspension of children is an effective method of responding to challenging behavior. Luckily, we had a lot of providers stated they disagree and strongly agree. But we know that challenging behaviors have been on the rise. As Crystal said, we just wanted to gauge and think about the different ways that we could support with the goal is to never have any child suspended, but provide those supports that they need. Some other questions that we asked in ways that Spark has been supporting is building up our coaching. We were able to hire mental health and wellness coaches that have a very diverse background. We have a licensed social worker as a coach, behavioral health coach. We have five mental health and wellness coaches. We wanted to gauge how comfortable providers would be with having coach come in and give those. Our providers are already engaged with Spark through coaching, through helping them level up with past the quality that Crystal is talking about and just those overall just helping those providers get those support. They were very comfortable. It is interesting because this survey came out last year in our at our Regional Advisory Council meeting that we held in May 1 of our SBA's has been very much engaged with a mental health and wellness coach and actually gave her a shout out about how much support the program is getting, just having them in. Some of the things that our mental health and wellness coaches are doing is really looking at the environment. Is your environment set up to ease the stress level of you as the adult and the children? Is your circle time too long? Are you making children sit for too long of a time? How are your transitions just providing just that additional set of eyes to see how they could help improve in the classroom. Our mental health and wellness coaches are not consultants. They do not observe or diagnose children. Again, looking at those environmental factors that could play a role in having some challenging behavior. We also asked how they would like to engage with mental health and wellness coaching. As you can see, still more comfortable with Webinar and zoom again, this was last year now as everything is never going away, as people are more comfortable having that face to face, that modality has changed. And we do have coaches going into programs more and more, but we do a spark try to. We do use this information to make sure that we are meeting all providers where they need. We do have zoom options and they can just get on a call if they need to. A coach doesn't have to come in, but they still have access to a Spark coach via the telephone or zoom meeting peer to peer in those group cohorts. We do really want to meet all of our providers in whichever way they feel most comfortable engaging with coaching. We did ask a lot about developmental screening tools and talking about screening versus assessment. We are excited. One of the other things we were able to do is pilot with our CDC, the Science Act Early ambassador, who I think is on this call CV way, we were able to provide virtual trainings on learning the Science Act. Early then Spark partnered with Brooks Publishing. All of our mental health and wellness coaches are also trained, the trainers on ages and stages, Steve has been. Been amazing and been able to have lots of trainings for our providers, both in English and Spanish. Developmental screening, developmental screening milestones just really helping providers see what is developmentally appropriate behavior. But we did want to assess and get all the information from our providers of what tools they're used to using, how comfortable they are using these tools. Then just providing providers with the tools to talk to families about what is appropriate development. Having those resources for themselves and for families. To just make it easier to talk to families when some of these challenging behaviors may arise. Again, very much with the training and modality preferences. You can see how providers would like to engage with us. We really try to take this data reach all of these. Spark has not held a conference, but we do have some large group instructor led training, one on one, peer to peer. We are able to hit those marks to meet providers where they need. Then here are some of that data around our learning science at training from April 2022 to June 2023, 89 providers, 59 providers that have participated in the ASQ and the SQS. Three trainings and excuse me and receive it. That's one of the other exciting opportunities that we've had when providers sign up to participate in learn science actor training in the ASQ and SE trainings. When they've completed that they will receive a free kit are Q three and SQS kit in their program and then Spark staff and the coaches go out and can help them. Right? Because we all know sometimes when we go to a lot of trainings, you get all this information, then you get the things back to your facility, your home, and you're like, wait, what did they say? How do I use this? So we do have those coaches that can go back in and provide those supports for the staff. Then some other training opportunities that we've been able to provide to our trainers. You can go to the next slide is from some of our mental health and wellness specialists and I think Courtney is on here as well, that her team has developed trainings that they have been able to provide. They have done one on burnout in self care. They were chosen to present at the Indiana YC Conference with over 70 providers. That was very exciting. They have done and built some trainings around self regulation techniques to navigate difficult situations and diminishing mental health stigma. They have been virtual options so far. Four opportunities have been offered in 14 providers have engaged. Cone has a newer team, so we're excited to continue offering these trainings to our staff or to providers. Again, just getting those techniques, having that ability to meet, even if it is virtually with one another so they can form those relationships are very important. Some other opportunities that kids engaged with and are very excited about this Lay Shore partnership, January to May of this year, we offered 23 in person trainings. I will speak for Crystal and I, we held our breath to see how many people would come in person. Right, especially post pandemic. And we do a lot of surveys and hearing our providers, they said we want in person. And we were like, okay, we're going with it. We had over 1,000 providers engaged. We had an amazing opportunity to partner with Lake Shore to provide these training. Some of the topics included promoting positive behavior, social emotional environment, routines and relationships, and setting up a high quality environment. We had many different other topics, but Every participant that came to the training received $500 worth of material around the topic. Setting up a high quality environment. We set that up in several different auspices. Family child care homes, the ministries, the centers, our family care providers. They received $500 worth of materials. Again, we also didn't cap it. I was actually at the First Steps Conference last week and one of the providers from Clark Community Centers said that she went to four trainings, that's four trainings times that, 500 basically. But again, in our family, very high quality new materials that they can use. Again, coaches have been a lot of the ones that are going out and hosting them in person with the lake shore trainers. They can go in and they go in and work with providers to just help them intentionally use all of these materials. We have had a really great survey responses. 305 strongly agree that they increase their knowledge, that they're confident that they can take this into practice. When we're very excited, we're taking the month of June off. But to be able to provide more trainings for from July to the end of September of 2023, With the incentive still being able to offer that incentive, we're adding things still around the pyramid model. We've added some DB trainings, we've added some science and math. We weren't sure how this would go. We really focused in and honed in using our survey data, using what we've collected to pick the topics. It did go so well that now we can hone in and make that more holistic and well rounded. There's some math and there's outdoor learning. We know that sometimes we don't have a lot of outdoor materials or if you have a limited budget, you're not spending it on that. We've been able to offer outdoor and they give $500 worth of outdoor materials. We're very excited about that opportunity that so many people come. Crystal and I were just in a meeting earlier and somebody was like, thank you for having these training. We're very excited that that was be hold your breath and hopefully they come and they really did. They showed out for this one. Shannon, if I can just add, Trainings were also offered in Spanish. Only some opportunities across the state for our Spanish speaking providers. I will tell you, I think those sold out the quickest. Right. The turnout has just been so amazing from our Spanish speaking community for these particular trainings, and that's also been incredibly great to see that response across the state. Yes. Thank you. Crystal, I had that one and it slipped. And we've also doubled our Spanish trainings for this next round because the response has been so great. We want to make sure that we are honoring that. Definitely. Thank you for adding that. Also, let's talk about infant, early childhood mental health consultation, Spark With Kids, Count Therapy. We're very excited. They are a local pediatric therapy service, providing and offering ABA therapy, speech therapy, occupational therapy, physical therapy, diagnostic testing, and mental health services in three counties in central Indiana. We really wanted to partner with them and have our providers engage with KC T just to see and really understand all the supports there. The first cohort had 18 participants. When a program enrolls, they have the opportunity for one or more staff to attend 12 weeks of virtual learning cohorts. Then they also have access to in person consultation. So one of the consultants came out to the centers, right, And worked with the providers and the teachers. We know how important this is, but we also knew that providers were a little hesitant about this. We really wanted providers to have this interaction with its Count therapy and really understand and learn about infant and child mental health. The impact of trauma and attachment supporting emotional regulation. You know, we really wanted our providers to have this training opportunity. Virtual weekly office hours Were there too. If different providers wanted to talk specifically, not in a group setting, about what was happening in their center, they could always schedule virtual hours with one of the KC T staff to get that additional support. Again, having that on site consultation and education was key. We want providers to really understand that, that there are so many supports for them, right, That they don't have to do this alone. This more intensive on site consultation is amazing for them. And then all of these projects have been intentionally designed to be iterative. And we're learning by doing that is really important, um, for us. Then you can move to the next slide, Crystal. These are the three different groups that we've had. I think it's important to know just for the providers, but how many children were impacted by providers participating in this consultation opportunity? Just learning and growing understanding, all of the things I listed below before about trauma. We have had a lot of people impacted right now with this opportunity and we're excited here some testimonials from our providers. Again, it's very helpful to learn other techniques and strategies that I was unaware of. Just building the confidence, then having the knowledge to evaluate our early learners progression and offer accurate reassurance of suggestions to parents. Montgomery. Montgomery, I always mess it up. I was going to say, Crystal, you have it on hand. Thank you. All right. I was going to actually type it in the chat, but it is Montgomery Hendricks. Boone Boon. Marian. Bartholomew. Yes. Thank you. And if I could just add here. I mean, I know anyone who has worked with kids has probably had to have a conversation with a family around some sort of developmental concern. And that is never an easy conversation to have. I think it's what's been really great about all of these different initiatives with developmental screeners, with the consultation. Really just empowering educators to gather the data and to have those conversations in a very kind and caring way with families. Again, I know that can always be the scariest thing. I know my little brother has special needs and when he was diagnosed, it was very, very hard for my family, and I know the start of that process can feel overwhelming, and as a parent it can just feel so scary. And being able to, again, empower educators to have those conversations in kind and caring ways has, I think, made all the difference. And that's really what I think these two testimonials speak to. Yes. Do you want to take this slide? Yeah, happy to. Yeah. I would be remiss if I did not mention our longstanding partnership with the great folks over at infancy onward, which is under Mental Health America of Indiana. We have provided support for infant and early childhood mental health endorsement, as well as support for their staff in being able to do community outreach and really get into communities and talk about the importance of infant and early childhood mental health. I just want to do a quick plug if you are interested in getting endorsed. There are several different categories and focuses that you can become endorsed in. Tell you that I have gone through the process and am a family associate and I can just tell you that the team at infancy onward made the process very straightforward, very easy to navigate. I put it off for years because I thought it was going to be very scary and it wasn't. And I can say that wholeheartedly and the team over there will do everything they can to make the process as smooth as possible. But again, just would encourage anyone, if you've thought about it, reach out to infancy onward and consider getting your endorsement. I think endorsement does a lot of different things. It not only helps us to professionalize our field and professionalize infant and early childhood mental health. Consultation and services, but also helps us to spread the word. Right, I've got my credentials and my e mail signature, and people will ask me, what's that about? And it's a really great conversation starter to talk about the importance of infant and early childhood mental health. So would encourage everyone to consider that if you're interested. And so I would just add to that one of the exciting pieces with the provider support groups for providers is that Spark staff, all the coaches, all of our coaches are actually also going through their own support groups and reflective supervision. So they are getting their endorsement as well. Right? And so again, to Crystal's point, helping and knowing that our coaches are going through it too to show the importance to providers that it really is something beneficial to have sparking at the office. We really want to make sure our providers know that we're along with them and doing that same work with them and making sure that we have those credentials and not promoting something that we wouldn't do ourselves thing. That's really important. Yeah, that's a really good point. It's hard for me to say, oh yeah, go get this endorsement. But I've never done it right. I think it is important to be able to speak to what the process is firsthand. And again, I can tell you not just because Ni Lu over at infancy onward, she is such an amazing support and just such a cheerleader for everyone as you go through the process. Again, I would encourage you to reach out to them. I would do a quick plug for their conference, but it actually just happened last week in partnership with our friends from Indiana University and First Steps Early Intervention Services. But they host a wonderful conference every year. And we are so glad to provide their support in working through that particular conference. But it was a great time. And yeah, if you haven't been to the early intervention conference, would definitely add to your list of conferences to attend. So a couple of other things that are coming down the pipeline. We are working very diligently with our partners at Spark Learning Lab and across our system to launch our infinite early childhood mental health consultation statewide. So that is a big undertaking. Very grateful for Shannon and her team that are leading this work with the office. But our plan at the time is for this to launch October 1 statewide, moving from that five county pilot to be able to offer this across the state because we know it's needed and we know that it has a significant impact. Similarly, we'll be working to offer the statewide mental health and wellness coaching and then also trying to increase the opportunities for training, whether that be asynchronous trainings that live on our learning management system, face to face trainings or live webinars. Really thinking through what that all will look like October 1, But again, some very exciting things coming from our office and from Spark Learning Lab. With that, I do want to pause just in the event that there are any questions about the supports services, things we've been hearing. Things you've been hearing are things you've been feeling in the last few years that we'd love to talk to you about. And just hear if you've experienced an you've had any interaction with these services and what your experience has been. But again, we would just really appreciate everyone's help in getting the word out that these supports and services are available because we know that they're needed and the folks that are accessing the services are having a really great experience. But I'll pause there. If there's any questions, you can either drop them in the chat or, Katie, don't kill me. But maybe they can come off mute too. Is that possible? Absolutely. They should be able to unmute themselves. If they'd like to speak up and ask a question, Great. While we're waiting for folks to process. That was a lot of information and it was all so good. I have a question. As you're working to put together this mental health consultation statewide, do you have a feel yet what that would look like? I liked that Shannon started to talk a little bit about what mental health consultation looks like in a classroom or in a center, because I think sometimes we use that word and we're not totally sure what it means. If one of you might want to speak a little bit more to what that might look like just in general terms even. I think that might be helpful. Yeah, Shannon, I can start with some of the high level thought behind it and then if you want to fill in details behind me, I would love that because you're more entrenched in this than I am, but I think our overall vision is looking at consultation in a couple of different ways. Right. I think overall, we are hoping that this consultation will be a really proactive measure for educators. And thinking about how am I really focusing on my interactions? How am I setting up my environment to support the mental health and wellness of the children in my classroom. Right? It could also be proactive in working with the program director to look at those program policies, to say, how am I setting up my staff for maintaining their own mental health and wellness, right? Are they getting a lunch break or are they working through nap time? Like I think all of those questions. So it's kind of multifaceted. But then we are trying to think through what that kind of reactive role of consultation is as well. Because I think, you know, we have seen this increase in challenging behaviors. But we also recognize that not every challenging behavior is a mental health concern or a mental health issue. And so how do we make sure that we are getting educators, getting children connected to the right people? Whether that is a consultant, early childhood mental health consultant, or that could be a quality coach that we have that supports other forms of technical assistance. And so I think, you know, we're making a lot of progress. We're also getting some technical assistance, 0-3 on the development of our model. We don't want to do this in isolation, we want to learn from the experts. And so I think we still have some outstanding questions that we'll be working through here in the coming months. But I would say it is kind of that balance of proactive, reactive. And then how are we also leveraging the other supports and services that we have in tandem with consultation and Shannon? I don't know if you want to fill in any details or things I missed, but no. Yeah, I would just add on the upcoming. So right now we are still continuing to work with K CT. We're not doing the cohort model A and we've actually added Columbus into that Columbus, Indiana. We're working with CT to just do consultation. We've built a referral form. And then in partnership with Crystal and Team, What does an intake form look like if providers didn't want to go to that 12 week cohort? But they just want consultation, they can reach out and fill out a referral form that goes straight to CT. They will do that intake form and an assessment. And we're trying to gather that data as well right now to see if if providers will really engage with that. We will be sending out communication around that as that is going to be rolling out and go till the end of September. And I think we're going to take a lot of valuable lessons from that as well, Right. In how we try to build our system. Yeah, I would agree with Crystal, we are definitely leveraging our national and other state partners are able to meet with other states in a group to get in. We know that other, for example, Colorado is a lot farther down the road. They've been doing this for ten years and so we have access. Crystal and our team, we have access to them so we can say, what are your lessons learned? What worked for you? What would you say is how did you get started? That has been exciting. It has been very nice to have those supports, so we're not doing it by ourselves Again, K, I think just making sure our providers are comfortable, right? We just want to really make sure any time, especially we've done informational sessions at Spark, but we really have our partners at KC T do informational sessions so providers can come and see them, they can meet them before they even engage, right? So they can just talk to them and ask questions to get comfortable with that, right? Because we're all protective of the things that we have. And why are they coming in? What do they want? We just want to make it everyone understands that this is really just to support you holistically as the adult, your families, and all the children. Super cool. Thank you. One thing that I realized we probably should have mentioned is that all of these initiatives that we have talked about today, we have been engaged in a very intense evaluation process with not Katie's department, but another department within IU has been working alongside us to collect data to help give us the information they've been doing focus groups. That's how we were able to get some of these testimonies. Really working with folks that have engaged with these services to help us know what's what's making the difference and what's not. Because that has helped us iterate over the last year and a half after these have been implemented or two years these have been implemented, so that we can make sure that our supports and services are meeting the needs of providers. Again, the EAP piece gets tricky. We are mostly monitoring the data about utilization there since we don't have the client level data. But everything else we've been able to evaluate pretty intensively and then again, use that feedback to iterate and change as we go. Awesome, thank you. I'm not seeing questions in the chat. Did anyone want to come off Mike and ask a question? Amazing. I think you covered it. You hit the sweet spot. You gave everybody all the information. This was great for me to see all of these initiatives in one place bundled. The way that you just shared them is so impressive and so exciting. I mean, I think it's easy as an entire state to forget about early childhood mental health and to see the amount of work that you all are putting into not only supporting early childhood mental health and behaviors that we may be seeing and kiddos that are struggling and need to be identified. But also supporting the providers that are working with those kids. Because we know the definition of early childhood mental health is strong, secure relationships with adults and we need to support our adults if they're going to be able to forge those relationships with the kiddos. Super exciting. Thank you so much for sharing. Is it okay if I put a PDF of the slides into the chat or would you like to share those with me separately or Oh, you're welcome to share the slides and just say that if anybody has questions or wants to give feedback, my e mail address is up on the screen. I also put Shannon's here to sorry Shannon. I probably should have asked you about that, but put our e mail addresses here so if you would like some more information or again, we'd like to talk things through, just know I always, if my physical and virtual door is always open and would love to engage and learn and listen with you. And I would just like to reiterate that this will continue to be a priority for the state of Indiana And it has truly been such an honor to do this work alongside all of our partners. Not just Spark Learning Lab, but also with Indiana University and the team there too. So we're just so grateful to do this work and to do it with so many amazing organizations.

Description of the video:

All right, well then I think we're going to go ahead and get started and be mindful of everyone's time. Thank you for joining us and giving us your lunch hour today if you're lucky enough to get an hour lunch. I know many of us work in fields where you grab lunch when you can. Some of you might be in your car right now. This is the fourth in a series on early childhood mental health that we've been doing over the course of last month. Of this month, we've pulled together some data, Indiana data on early childhood mental health that was shared in the first webinar. Then we had a webinar with Steve Wig where we talked about social emotional milestones and connecting those milestones. Childhood mental health. We then had some folks from the Office of Early Childhood, Out of School Learning, Crystal Robinson and Shannon Garrity come and talk about some of the initiatives that they've been doing around supporting the mental health of the child care workforce. Now we're wrapping up with sharing some information and an exciting panel with you all today From infancy onward. One of the things I've known about infancy onward for years. And one of the things that I'm excited to hear today is that we're going to hear not only about what they do in the endorsement that they offer, which is great information for I'm sure everyone who's joining us and beyond. But we're also going to get to hear from some folks who are using the endorsement. They have the endorsement. They're doing the work in a bunch of different ways. We're going to get to hear how being part of that community has informed their work and enriched their work with no further ado other than to let you know that there will be a very brief survey and a certificate available at the end. If you need that, just hang on and we'll put a link in the chat. I'm going to turn it over to nil with infancy onward to get us started, and then we'll introduce our panel in a little bit. Thank you very much, Katie. Hi, everyone. My name is Nil Peri Bores, and I am the director of endorsement. At Infancy onward, we are Indiana Statewide Infant and Early Childhood Mental Health Association. We are a subsidiary program of Mental Health America of Indiana, and then a member association of the International Alliance for the Advancement of Infant Mental Health. Okay, a little bit about what infant and early childhood mental health is. We're really talking about the developing capacity of a child ages 06. To express emotions, to have secure relationships, and to explore and environment infant in early childhood mental health, or CMH, as I'll refer to it as, professionals believe that the relationship between the caregiver and the child is key to a healthy development in the children. The experiences and actions of the caregiver, as well as the infant's own characteristics and responses and the surrounding environment that the child is in a supports that mental health of the young child. This is a great resource to share with families who may not know what infant mental health is. A lot of times mental health is associated with just therapeutic approaches. What we're really talking about is promoting healthy habits early on. And ideally prevention early on as well as early intervention and treatment. To this breaks it down into the three main areas that we're covering. Which is the brain development, supporting that throughout the first six years. Helping them manage their own emotions and avoiding toxic stress. As well as developing that secure relationship with their caregivers. And caregivers don't just need to be the parents. It can be anyone who is there to support the child and their needs in those early years. If you're looking for resources, I highly recommend for families, looking for resources for families. I highly recommend going to our website, Infancy Onward.org and looking at our IECMH resources. There's a variety of different topics available there that you can refer families to if they're ever needing support on the mental health needs of their young child. For you as professionals, what we offer is a endorsement, which is a professional development credential for anyone who works with or on behalf of children ages zero to six. We have two types of endorsement. We have the infant endorsement, which covers ages zero to three, and then the Early childhood endorsement, which covers ages three to six. The endorsement comes from that international alliance that I mentioned. There are 35 US states that carry the endorsement, including Indiana as well as Western Ireland and Australia. Basically, the thought is that if you were to get endorsed in any of these green areas and We don't want you to move away from Indiana, we want to keep you. But if you happen to move states or countries even and go to one of these areas, you would be able to carry that endorsement with you. It's a career long professional development credential. It follows you, not just your job. This is the breakdown of the different categories of endorsement. Really what I want you to look at is the scopes of work that we're talking about. I touched on these, but we're looking at either promoting healthy mental health in the early years, we're looking at early intervention or prevention. We're looking at that same topic on a macro level. Basically looking at reflective supervision for a professional, which I'll get into a little bit as well. Then of course, we have the clinical intervention and treatment side of things as well. We also have categories that are specific for policymakers, leaders in research, and faculty and clinicians. There's really a category for anyone. If you have a minimum of two years experience or related degree, then you qualify for the endorsement. You don't have to have all of these things when you initially apply. You can earn them throughout your entire process. Many of the trainings that you all are doing, such as this one or the other that you attended as part of the series, can count towards your endorsement as long as they align with a competency area. The Alliance has developed several competency areas for each category of endorsement that relates to the specific category. If you meet those competency areas in a variety of different ways, whether that's through training, whether that's through references or education, then you can count that towards your endorsement. I'll go back for a second. As part of what I mentioned earlier is there's a big piece called reflective supervision and consultation that we offer actually at infancy onward, at no cost to our members who are working towards endorsement. Reflective supervision and consultation is a space in which providers come together to discuss their own emotional content of the work you process, your own emotions. You have a space where you can talk about difficult cases, you can talk about challenges that have arisen in your work, and get advice from others in the field who really understand your perspective and where you're coming from. What's great about the groups that we offer is they are with an outside consultant who in their virtual, so we can reach everyone across the state. And then you get different perspectives from a variety of different backgrounds of people. It's not just your colleagues that you work with day to day and who see the same things. You can get different perspectives of people who are maybe in a child care setting or First Steps or in a clinical setting. You get different perspectives that can really enrich your own personal work. As I mentioned, we do have those groups available for our members. If you decide to go for endorsement, you want to participate in reflective supervision or you're in a category that requires it, we do offer that available to our membership. I will say one of the biggest things that we hear from people is that their favorite part of the entire endorsement process is reflective supervision and consultation. Just because they really get to connect with others in the community who understand their own perspectives and where they're coming from. Then they can also process their own emotions in a safe place. It really helps support burnout and employee retention as well. Part of our endorses benefits are that you get to be part of a registry that is available on our website. The registry shows where everyone is endorsed across the state. It includes everyone's name listed out along with their category of endorsement. Now this is really a place that's to support the professionals in the field as opposed to like a referral system for families. It's more of a referral system for providers. It's a resource for professionals in the field. Cmh endorses can get recognition for work they got for getting on this registry. They can also connect with one another to network and receive mentorship from one another, as well as building a community of practice. Then a benefit for employers is that if someone applies and says that they have the endorsement, they can come to this registry and verify that they are indeed endorsed in Indiana. Our registry is available online. If you do decide to get the endorsement, you will be part of that registry as long as you maintain your active endorsement. I didn't mentioned this earlier, but as part of our endorsement, there's those initial requirements. And then each year from then on out, we have renewal requirements. Which is a much smaller chunk of training hours and reflective hours. 15 training hours annually and 12 hours of reflective supervision or consultation. That just shows that you're really staying on top of the topics of IEC MH each year. As we know, it's an ever evolving field. Another part of our benefits on our website is that we do have trainings available that either we host or that we share within our community, usually at zero to no cost or to low cost. And then we also have a listing of some self paced trainings that you can take on your own on time. These trainings can support the endorsement process as well as building your own knowledge in the field. Then we do have, as I mentioned, the resources for families, professionals. Anyone who wants to know more about the topic of IECMH, they can go to our resources tab and go to IECMH resources. There's some books that are available in there. We have a resource guide, there's little handouts, infographics, there's a little bit of everything. If you do a quick find search for a topic that you're looking for, I'm to find it. If not, you can always reach out to me or my colleagues at info at infancy onward.org Maybe someone can throw that in the chat if you're looking for something specific, we're always here to support you and your families as best as we can. That's a little bit about what we do here. I will open it up for any questions people may have. Then if you're interested in endorsement, you can e mail endorsement at infancy onward.org Or if you're just in general interested about what we do here, you can e mail info at infancy onward.org I'm going to go to the chat if I can find it. There we go. Yeah, I've been putting in links for you, Nils, you've been talking the infographic is in there. We've got links to various things that you mentioned. If I missed anything, feel free to add it in as we talk here. Absolutely. Thank you so much. Thank you for sharing a little bit more about the endorsement. I know that one of the things that I've always wondered about is just hearing all the different ways that the endorsement can be used. We're going to transition if folks don't have questions and I'm not seeing any questions at the moment, We're going to transition into talking with the folks that have joined us today. And I'm going to let them introduce themselves and then we'll ask them some questions. If you have questions, then you can throw those into the chat and we'll just have a little bit of a conversation about how these folks use the endorsement in their real day to day lives. I'm going to go based on my zoom screen. Amy, if you don't mind introducing yourself, sharing what your role is, we'll just start with that. Yes. Hello. As Haiti said, my name is Amy Marine. I have worked in the field of early childhood education for over 18 years. I started out as a preschool teacher for a summer internship, and then I went on to teach kindergarten for a small private ministry. I've also worked with in the two classroom, as well as supervised for infant classrooms two. I've been a pastor, advancement coach, and community and family engagement specialist. Hello, And I am, pardon me, currently, I'm a Family Engagement Specialist with the Childcare Resource and Referral network. Thank you. Amy, I was going to see if I could put the link and Well, if you want to put the link in while other folks are introducing themselves, feel free as a resource. Janet, you next step on my screen. Hello, I'm Janet Ballard. I have been in the field for 30 years now, One capacity or another. I was a long time provider with First Steps. I left First Steps and developed our Monroe Counties Early Head Start program and was there for about four years before coming to IU. And I've just recently, within the past year, started seeing some first step is just to figure out how the FDR BI the family guided routines based intervention and how that works. I do carry a small, very small caseload of first step kids. That's me. Thanks Janet. And we've got Mandy with us. Hi everybody. I'm Mandy Nard. I am a licensed clinical social worker. I'm also endorsed as an clinical mentor through infancy onward. I do a lot of different things with this work. My full time job is I manage the Brown County Centerstone office. I've been with Centerstone for 17 years and my passion is really in children's mental health, and particularly in infant toddler mental health. Through that work, I do a lot of advocacy for early childhood mental health through Centerstone. I also work as a consultant providing reflective supervision through infancy onward and Spark. And I also run provider support groups for daycare directors, primarily through Spark. I think that's Wear a lot of different hats. Yeah. Okay. Well, thank you. We've got folks today who have been working with families and children for a long time. I guess my first question for you all is, how does the endorsement influence the way you do your work or how is the endorsement impacted the way you do your work? And I'll let whoever wants to start jump in. I think for me, the endorsement really helped connect me to a network of people and information that really understood the importance of infant toddler, early childhood mental health, preschool mental health. And I was able to learn and grow early on in my career. I got my MSW in 2010. I believe I was endorsed. I began the cohort shortly after that and then became endorsed I think in maybe 2012 in that time frame. It was just incredible the amount of resources that were at my fingertips that I was able to use and then apply in the field. Since then, I've had the opportunity to take child parent psychotherapy training now. Being able to understand how to support families that have experienced trauma. And work with them in the context of community mental health. To really help address not just the child but the full family system. I'm going to help them heal from and move forward through trauma. I think that's one of the more powerful that I use endorsement. And then of course, in leadership supporting others to at this point in my career, I think that's a big part of how I use endorsement in my work is being able to support others in their direct care and direct provision of care through whether they be a daycare director or a therapist, or a coach for me. One of the things that we do with childcare resource and referral is we help families locate childcare in their area as well as help them with individualized support if it's needed. Being endorsed has just helped me continue learning about infant mental health. As well as just the overall social and emotional learning that takes place with these young ones. And being able to provide advice and just ongoing support for families when they reach out and ask for it. It's been helpful. I love that that's available along with childcare, resource and referral because I feel like sometimes a family might think they just need a childcare. But there's so much that goes into making that choice that does involve mental health of the whole family and mental health of the child and social emotional needs. And I love that. That's all interconnected for you. What about you? I got my endorsement maybe a year ago. I have the Infant Family Associate one because at that time I wasn't seeing any first step kids. Now that I have been seeing some kids, we're seeing a lot of infants and toddlers that are coming out of being born secluded from family members because of Covid going in and looking at getting to know the family, getting to know what their experiences are. Are there any stressors in there? Those are all kinds of things I want to find out as I get to know the family. Really focus on social, emotional. We talk about emotions with the infants and toddlers. Especially the toddlers just really working with the family of how to have that great attachment with their child and how to work through some of those emotions that toddlers sometimes have. Yeah, I think that's why I like having all of you here in the different roles. Because, I mean, Mandy, hearing her background, you might assume that you're going to be addressing social emotional needs because you're working in a clinical setting with families and children. But you know, Amy doing childcare, resource referral, family navigation, that might not be in the forefront of everyone's mind going into that kind of a role. And same with first steps, to be honest, because first steps, if you're going in because a kiddo isn't walking yet, you might not, as a provider, necessarily, be thinking about how to support that family child connection, or how to support that family. To talk about emotions like that might not be the IFSP goal, and yet it's the foundational stuff that has to happen. If we don't have those secure relationships in place, then how much progress are we going to make on language and development and all the other things that first steps might be working on. I like how it's integrated into lots of different roles. Is infant mental health, or early childhood mental health something that you talk about explicitly with families? Or how does, what would you want families to know about you having the endorsement or the way that that influences your work? You can always go first. Amy, I can't ever tell if you're going for the button or not. It's hard to tell. I would say what I'd like families to know about the endorsement is that when they identify people that are endorsed to some degree, you have to know those people are passionate, committed, and have specialized training and experience with this population. That's really bottom line. Especially I'm just thinking in the context, even where we're at as a society with employment. Everyone on this call, I'm sure, recognizes that there's a struggle with keeping fully staffed no matter where you are. And I think the endorsement is like it's something, It's not easy. I mean, it's not hard. I don't want to discourage you from it, but it does take effort, intention, and commitment to working with this population. If you identify somebody who is endorsed, you know they care and they have more information and more experience than most likely other people that may be in the field as well. With my work, I often just highlight how important those early relationships are in the young child's life. And how those relationships, they form the foundation of a child's overall healthy development. That families are not alone and that they have support should they need it. And they can reach out, we can connect them to certain resources if it's needed, or try to help them one on one. But yeah, just really trying to help families understand all the learning, honestly that takes place that we all know from birth page three, even birth page five. Yeah. I would say that I haven't honestly shared that I have this endorsement with my families. I've never really even thought about doing that. I do see the value and now sharing that information as I work with some of the different families that I work with. But I think that they can tell that I've had some extra trainings, extra things because of the information I share with them about the importance of those relationships. And not only with the family, but with other people in the child's life that just help support that, that good, positive social emotional development. Yeah. Whether you use the term mental health or you share the exact thing or whether it's more just that you have that perspective of looking at the whole child, the whole family. I think sometimes when we come in for one thing like, okay, I'm here to help you find a child care, or I'm here to help with this developmental trajectory. It's family doesn't always know that you're available to help the whole family. And that's really what we know works, even just sharing that. Because I think when we say mental health, especially early childhood mental health, I don't think it's intuitive what we mean always by that. In fact, some families might get a little scared by that term, because maybe that means we're talking about their child having depression, or schizophrenia, or some big scary label. When really what we're talking about is, as Amy said, this important early relationships and safety, and security, and managing emotions and all of that. Somebody, I think it might have been Amy mentioned that also. Gives her a perspective on what resources might be needed or making sure that she guides families to resources. Are there particular useful programs or resources that you've found that are good for families or good for these folks? I imagine that who we have here, I know some of the names are First Steps names, and I think in the past webinars in this series we've had childcare folks as well. Are there good resources that these folks ought to know about that relate to this topic that you'd like to share? I know we have struggles in this area. I know we have weight lists. I know we have challenges. But knowing that we're going in and talking to about a third of our families with young children that have mental health struggles, knowing that it's common, and knowing that we're seeing children, as Janet mentioned, coming out of covid with behaviors that are maybe more different than what we've seen before. What are some things you might want to share about good resources? Something that I know we share at different family events or community events. Anywhere that families may be, we share the CDC milestone moments, either those books or passing out what's it called, the CDC Milestone Tracking App flyer. Really highlighting on that that if all they have to do is put in their child's birthday and then do an overall assessment for their child, then it gives them tips and tricks to do activities to do with their children to help them reach the next milestone. That's something that we alas highlight at different events, and honestly most families, they haven't heard of this. I feel like that's a great outreach opportunity to share about that important milestone tracking, as well as we've referred families to First Steps or back to their pediatrician if they have concerns trying to think what else. We also have lots of recorded webinars on our website too. When it comes to child development, different topics, whether that be challenging behaviors is one that gets viewed a lot on how to help with challenging behaviors. But we have different webinar topics on our website that we point families to as well, if they are interested. I would agree with Amy that the CDC app has been a big help for families, just to keep track, look for things, just fun activities that they can do at home that maybe they didn't think, maybe it wasn't needed just to help enhance what's their development. And I know that one's a big one, depending on the Indiana family to family is another one that I like to tell families about. Especially if I've worked with a couple families that have a new diagnosis of autism for their child. And just helping them navigate what's available out there to help support the family. Then just really talking to the families that every behavior is a form of communication. And trying to figure that piece out of some of those challenging behaviors. For some families, they think the behaviors to get their attention about something, or they're deliberately doing this and having them step back a little bit and try to figure out what that behavior truly means is another easy way to have those conversations with families, childcare providers too, I think, figure out what those behaviors mean. When I was thinking about your original question. I had thought about like I don't know if this is what would be helpful to everyone, but I thought of Nurse Family Partnership. That's something that I think is an incredible program. They really want to start working with mothers when they're pregnant and they'll follow them. They're two old, the child is two years old. I've just seen incredible work being done through Nurse Family Partnership, and I'm pretty sure every county has a program. It's either through goodwill or through I think. So that's something to just look into. They do provide nursing, but they also do so much more. It's not just nursing. And they do focus on that attachment. And they can connect families to outside resources as well if it's beyond what they can do. In the context of Nurse Family Partnership, I also thought about Healthy Families. That's another program that I think is a great program to refer to. You have to refer when the baby is under 75 days old, I think. And I believe they follow them along through age five, or until age five, I can't remember. But those are two things. Then. When Amy was talking about the app, this is a little bit different, but it is something that I have found to be really useful. But the call map. That I think a lot of childcare providers should have access to now through Spark has really, it's been transformative in my life. I love it and with my own children. But I also have heard so many daycare directors implementing it related to sleep stories to help with nap time. And they also have meditation and relaxation activities. There's also stuff you can do for your own personal professional development. We know adult regulation is really critical to a child's health and well being. For parents and for providers. It's something to check out. Yeah, I see the question in there about Nurse Family Partnership. I don't know if did you put a link in there? I did put a link in there. Yeah. The link for a Nurse Family Partnership is in there. I do not know if their website is up to date, but if it is, it looks like they're serving 39 counties right now. It may not be everywhere yet. I know it started as a pilot and has consistently expanded with more money. But again, this is a 2022 profile that I'm looking at, and it's showing counties in Central and South East portion of the state and then north of Indianapolis, and then a little bit up towards the border with Illinois and Michigan, but there are some gaps as well. But it's a fantastic program if it's available in your area. I'll put this in there too just because this is a nice quick look. Yeah, I can pull the link, Shannon I can pull the links out of here and put them in an e mail. I can do that. Yeah. What I love about all the resources you all just shared because we're trying to put everything into the chat that you all are talking about, is that none of these are clinical resources, right? I mean, we know that 1016, 15% of kids might need clinical services when we talk about young children. And that's a significant number, but clearly it's not most kids. What you all shared when you were talking about healthful resources are things that are going to support the whole family to be healthy and function well, right? You're talking about calming things, things around regulation. When we talk about the calm app and chance talking about getting out of the community and connecting with the community and thinking about connecting parent to parent support. And Amy, you're talking about U, you know, links to supporting the good connections with childcare, but also other things around parenting and just feeling confident as parents and we shared home visiting. Anyway, I guess my point is it's really important to widen our definition of what, when we talk about mental health. We're really talking about because it's more than just finding a community mental health center. Sometimes that is exactly what we need is an opening at a community mental health center. So let me not minimize that, but for 85% of our families with young children, these are the other resources that are so important. I want to emphasize, because I'm not sure if I did it earlier, that we welcome questions from the chat. If folks have things that they're wondering about or would really like me to ask, I am going through a list of things that I thought would be good to ask about, but we welcome you all to participate as well. Or if you have a resource that hasn't been mentioned that you think is super helpful, then throw that in the chat too, and let's crowdsource this. One of the things, and I'm going to tell you I'm a little off script here you guys. But I did warn you that I'm a little chaotic that way. We mentioned reflective supervision earlier. Nil mentioned it in her presentation. Mandy, you mentioned that you have done it, Amy and Janet. I don't know if you all have had experience doing it, but I'm curious. Can you talk to me a little bit about what that's like for someone in this field to go through and what you see as some of the benefits. I'll go ahead and share that reflective supervision has been very helpful, very beneficial for many reasons. But it's a nice group we meet virtually. It's a great place for like minded individuals that come from various children's services, different avenues of working with children. It's great to come together and share what's going on, get other people's ideas. It's a nice place to get. I don't have an answer prepared for this now. My words are all jumbled. But it's nice to have a place to come and share what's going on. Share what's going on with your heart when you're dealing with, or you're going through a certain situation with a family, something that may be heavy. It is wonderful to be able to share that with other people and have them how they would handle the situation. Just grow in that experience as how you handled the situation. Like you may not be thinking it was the best way to handle or something like that. But it's great also to get built up by these people in your group. It's been very helpful. I really enjoyed having a reflective supervision group. I have not done reflective supervision with this endorsement primarily because when I first got this endorsement I wasn't seeing any children or families but heads up nil. It is something that I want to move up to the next level and start doing that reflective supervision. I feel like with First Steps folks who do work, often quite separately from one another in the field. I have heard from others who have done it because we have quite a few first steps folks who have gone through that process, that it is just nice to be able to come together and connect with other people who are doing the same work. It's just like when you come to a conference and you suddenly you see, oh my God, there's hundreds and hundreds of people who do what I do every day and understand the frustrations and the fact that I'm meeting in my car right now wi I'm listening to this webinar. I think that's a nice connecting point for folks. And Mandy, I know you lead the group. You're a guru in this area, an expert in this area, I should say. I don't know, I get nervous with those words, but I do think it's great to have a confidential space where you're meeting with the same people. You do build relationships over the course of sometimes years, depending on which group, what group you're in, and if it continues to work out with your schedule and with what you need for your professional development. But you established routines, rituals, you get support, you become uplifted. It's a space that I think is really different from traditional workspace supervision. I provide lots of different types of supervision, administra, clinical, and reflective. We all have key performance indicators. No matter where you work, you've got a key performance indicator. I'm pretty sure it's nice to not be talking about just all of that stuff. That is your normal workflow and step back. We always begin our reflective supervision with a brief meditation and a check in. And it allows you to slow down, breathe, pause, and actually be present in what we all know to be like super, super fast paced, really demanding work. That's why I love it for me. I received my own reflective supervision too. And then I also provide it. Now, one of the key words I feel like is regulation. We, we want our kiddos to be able to self regulate eventually. I think we're all still working on that. So it's a goal, but co regulation, this idea that adults need to be calm so that children can be calm. To reflect that in the way that we're engaging with our peers Makes so much sense to me to have a moment to calm before you start to have a moment to share what you're feeling. I think that we have to all be regulated as professionals when we go into homes that may be at various states of regulation. That makes tons of sense to me. Yeah, I know at center we've done a lot of coaching. Coaching is really different from reflective supervision. Coaching is very structured. You have a goal and you all agree on that goal. And then you observe something and you discuss it and you problem solve, and then you create an action plan. The reflective supervision is really that opportunity that a lot of times folks don't get to. Boy, that was hard, what was that about? And being able to talk about it and just come up with new insights because your peers are present and listening to you. Anyway, I think that's a great part of infancy onward and the endorsement process that maybe not everybody knows that is open to you. If you go through the process. I'm, I don't see questions in the chat, although people are welcome, people can mute too if you don't feel like typing. You're eating a sandwich in the car and you just want to mute real quick and ask something. We're fine with that. But while I'm waiting, I will ask another question. Janet, you mentioned that how different Things are after Covid and how you feel that seeing families is different, that families are dealing with different things. I guess I'm just curious. In this day and time with all of you working with families in the different ways that you do, what are you seeing? What are the pressing needs of families right now? I can start off if you want, when we're talking about families with very young children or infants. The first thing that popped into my mind truly is infant daycare. I do think everywhere I, once children turn to, it seems so much easier to find child care. But quality infant daycare is tough. I think beyond that basic need, I guess I still come back to though we have so many families that need that sense of community. Was it Janet that said that? I think being able to connect with those, whether that be physically or whether that be in life stage and experience or whatever other ways people interconnect. Just sense of community is important for young families. I also think it's really important right now to focus on basic needs being met. Like housing, do they have access to safe, consistent housing, food? I think that that is more of an issue than what people may realize. Sometimes that's my thoughts. I would agree with the community piece, some of the families that I'm seeing understand the importance of young kids being together. And what they can learn from each other, good or bad. They do learn from each other the importance of that socialization that can really help build a good foundation for them. Really talking to them about finding a place in the community. And I know everybody's community is different, but here in Bloomington we have the warehouse, which is literally a big old warehouse that they have converted into different areas for different age kids. I know they do have like a toddler area. I know a lot of families, they don't already know about it. I always tell them about that. It's a great way to get the kids out, get active, get him around other kids, Maybe you could meet other parents there. Going to libraries and doing those type of things are also a great way to take advantage of some of the community things that they do. Really, if they don't know about some of the community places to go, I really try to talk to them about that. I have a mom that she has, one that has just been diagnosed with autism, and the younger one is on the wait list to be tested for autism. She's dealing with a lot, and there's a lot of times that when I come and if Dad's home, she has to get out of there. She's a stay at home mom. Dad works long hours and she's always very apologetic when she has to flee when I get there. But the next is that I try to reassure her that that's perfectly fine. She needs to take time for herself. Letting parents know the importance of taking time for themselves, I think is another important thing that families need to realize that helps with that regulation. I was just going to emphasize that, yes, we need more infant toddler care in Indiana. We need more high quality care in Indiana when it comes to childcare. When families can't find childcare, when they can't work, then they can't afford to meet those basic needs that they have. It puts a strain on the families, which then affects the whole family's health and well being. And that's why it's so important for communities to embrace the need for early childhood in each community. Try to build up the seats that are needed in each county. So many of those things are connected. Absolutely. Yeah, I know that when we pulled together this data to look at the state of early childhood mental health, a lot of the things that we pulled together were things like housing, stability, and availability of childcare. Because like you said, I think it's something like 70% of Indiana families have all the adults in the household working, which means that childcare is an absolute necessity for those families. And if you can't find it, then you either go with substandard care, right? So something that's not ideal. And then again, if we're concerned about relationships, it's likely that substandard care is going to have a lot of babies with not a lot of connection or not the best connection, et cetera. And then, or you've got families that aren't earning enough money and then the stressors that accompany low income. We know that we've got about a third of families where the adults in the household talking about their own mental health struggles. And about half of those families are not receiving services or support the adults. I know we're talking about early childhood, but really if we're not treating the adults, we know that there is then a result impact on the relationship between the adult and child overall. Yeah. Those are all incredibly important things. One of the newer resources is 988. Have any of you all had a connection with that? That's something that Indiana has decided to fund. I know that over the next few years it will become more and more, I guess, integrated into current systems and more advanced in terms of what it's offering. But it is currently available. My understanding is it is for adults who are experiencing a mental health crisis or need support around substance abuse. I don't know if anyone has used it yet, but I'll put it, I am familiar with 98 and it's not just adults, it actually is for any age, it's a crisis talk or text line. You can actually text 988, really all 988 and it's 24 hours a day right now, it's absolutely a talk text line. And they can help with, again, family crisis, parenting escalation struggles, stressed out parents could call that and do call that already. Eventually, it's going to take time. The States talked about how 911 didn't just suddenly appear, developed over years, and that's where they're at with 988. This is just launching. But eventually they are going to be able to also connect straight away to mobile crisis units. They're already starting to do that in some areas, but if it's not able to be resolved by talk text, they can connect to a team that can either then meet with them virtually or actually be dispatched to their house. Physically, you'll have a therapist or a counselor that would be able to come out of the house and help with whatever situation is going on. It is mental health, stress, substance use, but you don't have to be 18 to call it. Can be a child to be able to call it if it is life threatening. If somebody has a gun, what if there's concern someone has overdosed? You still need to call 911988. Can dispatch ambulance and law enforcement to if they need to, but it's better not to say you don't want to waste a single second or minute. I would just call 911 if it was that level of a crisis. But otherwise, it's a great resource. I'm so glad you said that. I can't believe I didn't think to mention that. I thank you for the additional information. I think one of the things I hear is that sometimes professionals, like we want to have the perfect resource for a family. We're hesitant sometimes to talk about stuff like, oh, you seem to be struggling, how are things going? Because what if they tell us that they really are struggling and then we don't know what to do? Then like we've opened this can of worms. And now what do we offer them? I think even though we may not have the perfect thing to offer them, because it's not our job to solve every problem, we can still be an empathetic listener and be aware of what's happening in a family without solving the problem. On the other hand, 988 or something like that is something that we can have in our back pocket and offer as are a lot of these resources that we've put in the chat. So that was a what have I not hit on? All this has been good, but what else have I asked that you might want to share or nil? Do you have anything that you would want to ask? Share, bring you into I'd just say we're always thinking about the families which is our job to, but also make sure that you're thinking about yourself and your colleagues because that work could not be done without you. That's where infant really comes into place, is to support you and your needs. And then embedding that parallel process. The more you can take care of yourself and your needs, the better you can take care of the families supporting them. Teaching them how to then take care of the babies and the young ones. That's our goal. With consultation with trainings, with resources is really embedding that parallel process and all of the work that we do. I saw a great quote from, and I don't know who it's from, but saying that it's unrealistic sometimes when we are parents and helper, we're in a helping profession to always put yourself first. But you can remember yourself always, even if in the moment you have to just do something, even though you don't want to because you're there and it has to happen. I know as parents we know what that feels like to always remember yourself and then take time. Whenever that time is to do that, it's a good reminder.