Chandler_Masters_Paper_Final_11.9.17.pdf

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Abstract

Background

Growing literature on the emotional development of young children suggests that social-emotional health in young children is a strong predictor of success in adulthood. The North Carolina Infant Mental Health Association (NCIMHA) is committed to developing a workforce that is trained in positive social-emotional development of children ages 0-5.

Methods

Inspired by stakeholder input, and an infant mental health summit, the author, the summit convening team, and NCIMHA’s Workforce Development Project Steering Committee conducted a survey of early childhood workforce professionals to assess professional development needs in June of 2017.

Results

252 respondents completed the survey. Face-to-face continuing education or in-service training was ranked as the most effective form of training (55% of respondents), followed by bachelor’s degree programs (22%). Online continuing education or in-service training was most frequently ranked the second (33%) most effective form of training. Respondents discussed a need for more variety in the geographic location of training (17%), more online training options (16%), and more face-to-face training options (13%). 14% of respondents said that reducing the cost of trainings would make them more accessible.

Implications for Practice

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Acknowledgements

Thank you to Melissa Johnson, Gene Perotta, and the Board of the North Carolina Infant

Mental Health Association for allowing me to pursue this work and for your continued feedback

and support. My time spent on this work was financially supported by the gifts of Sarah Taylor

Morrow and her family.

I owe many thanks to my advisor, Dr. Meghan Shanahan, for her invaluable guidance,

insights, and feedback. Thank you, also, to Tom Vitaglione, a long-time leader and champion of

child health in North Carolina, who provided substantive feedback on this paper.

Finally, I would like to express graditude towards my family and friends for their

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Table of Contents

INTRODUCTION ... 1

The Ecological Environment and Threat of Toxic Stress ... 2

North Carolina Children: Risk in Numbers ... 3

North Carolina’s Efforts to Address Social-Emotional Development ... 4

Workforce Development ... 7

METHODS ... 10

RESULTS ... 11

DISCUSSION AND RECOMMENDATIONS ... 15

LIMITATIONS ... 17

Summary of Key Recommendations ... 19

CONCLUSION ... 19

APPENDIX A:NCIMHACORE COMPETENCIES ... 23

Table of Figures Figure 1. Key Players involved in training and workforce development, service systems, and resources related to NC early childhood programs... 6

Figure 2. Ranking of top three most effective modes of training on early childhood social-emotional health and development. ... 14

Table of Tables Table 1. Respondent Roles and Disciplines ... 11

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Introduction

From the moment children enter the world, they are taking in their surroundings and

developing into a thinking, contributing member of society. As children leave the womb and

enter the hands of a healthcare provider, their vital signs are monitored and a series of physical

health checks ensue. Over the next several months and years, children will see a pediatrician

for regular check-ups, vaccinations, and coughs, and their physical health will be closely

monitored. Parents will share stories of sleepless nights and of the tears that come with ear

infections and stuffy noses. But will they have the same conversations about their child’s

mental health? Chances are, probably not. Mental health is less readily apparent and is

stigmatized so that it is rarely addressed until there is a problem. Furthermore, current

professional training systems have neglected to adequately prepare providers and educators to

support the social-emotional health and development of young children (Meyers, 2007).

Early childhood mental health involves the social and emotional development of a child

from birth to age five.This period encompasses critical neurologic development central to

vision, hearing, language, and a significant portion of higher level cognitive functioning

(National Scientific Council on the Developing Child, 2008). This development is the foundation

of physical health and development throughout the life course, as well as mental, social, and

emotional health. Growing literature on the social-emotional development of young children,

including research out of the Harvard Center for the Developing Child, the Adverse Childhood

Experiences Study, and a 2015 Robert Wood Johnson Foundation study on social competence in

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success in adulthood (Felitti et al., 1998; Jones, Greenberg, & Crowley, 2015; Shonkoff et al.,

2012).

The Ecological Environment and Threat of Toxic Stress

A child’s ecological environment, consisting of concentric layers of relations and

interactions, mediates his/her developmental trajectory (Bronfenbrenner, 1994). Consider a

scenario with an individual child at the center, where his/her behaviors are informed by

personality, instincts, temperament, and lessons from past interactions. That child is then in a

relationship with parent(s) or caregiver(s), siblings, and other prominent figures in his/her life,

such as teachers or healthcare providers. Those who are in a relationship with the child are also

in relationships with one another, building a social network surrounding the child. These

relationships and interactions are informed by community factors, such as poverty, violence,

food security, and employment opportunities, as well as societal factors, including rule of law

and social norms. In conjunction with natural environmental factors, these community and

society level factors trickle back down to influence the child’s social network and the child’s

social-emotional development.

Optimal social-emotional health in early childhood is promoted through positive

parenting and age-appropriate stimulation, and can be disrupted by a variety of adverse

experiences, such as poverty, abuse, parental incarceration, and parental depression (National

Scientific Council on the Developing Child, 2008). Disruption and adversity during the formative

first five years of life can critically impact a child’s later social-emotional and cognitive

development, as well as increase his/her susceptibility to chronic disease and mental illness

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frequent, or strong stimulation of the stress response system, can occur in a child when

adversity or danger is experienced without the presence of a supportive caregiver (Center on

the Developing Child, 2013).

Toxic stress can disrupt brain development, negatively impact other organ systems, and

increase the risk of serious mental and physical health problems in childhood and throughout

the life course (Center on the Developing Child, 2013; McEwen, 2000). Early trauma and toxic

stress, in particular, can impact developmental pathways and impede opportunities for

resilience. Supportive adults are critical for a child’s ability to overcome the impact of toxic

stress. In fact, when relationships with adults, whether they are parents, other family members,

teachers, or healthcare professionals, are supportive and responsive to a child’s needs, they can

buffer a child from experiencing the effects of toxic stress. In order for adults to best support

the children they interact with, they first must understand the social-emotional needs of a

developing child.

North Carolina Children: Risk in Numbers

In 2014, North Carolina (NC) was home to 729,638 children ages 0-5. Of those children,

169,000 (24%), were living at or below 100% of the federal poverty level. In 2012 only 352,523

children under age 6 (54%) received a developmental screening.1_{In the same year, only 17% of}

children ages 0-3 were living in households who had received a new parent home visit following

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well-their birth2_{, and 5.4% of children ages 0-3 were receiving early intervention services. However,}

19% of all children ages 2-17 in 2012 reported at least one emotional, behavioral, or

developmental condition (KIDS COUNT Data Center, 2017).

North Carolina provides a number of early childhood services to help meet the needs of

at risk children and children who have received cognitive or behavioral diagnoses. In the

2014-2015 fiscal year, 339,413 unduplicated children ages 0-5, about 46% of all children in this age

range, were enrolled in programs monitored by the NC Early Childhood Integrated Data System

(NC ECIDS). These programs include Child Protective Services, Exceptional Children Services

through local school systems (IDEA Part B), Food and Nutrition Services, Infant Toddler Services

(IDEA Part C), NC Pre-K, and Subsidized Child Care Assistance (North Carolina Early Childhood

Integrated Data System, 2017). These numbers provide a snapshot of the number of children in

NC, particularly those at risk for suboptimal social-emotional development on the basis of the

previously identified social determinants, and the potential impact that a deeper understanding

of early childhood social emotional health could have on the NC community.

North Carolina’s Efforts to Address Social-Emotional Development

The 2012 North Carolina Institute of Medicine (NCIOM) report, “Growing Up Well:

Supporting Children’s Social-Emotional Development and Mental Health in North Carolina,” was

produced at the request of the North Carolina General Assembly to assess the adequacy to

2_{Home visiting programs are designed to bring a trained professional, such as a nurse or social worker,}

into the home of new parents to identify and mitigate challenges related to being a new parent and providing care for infants. Home visiting programs are associated with a reduced risk of child abuse and neglect, emergency room visits for accidents and poisonings, and developmental and behavioral

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North Carolina’s current mental, social, and emotional health services available to meet the

needs of young children and their families. The report made a series of 12 recommendations

addressing needs and challenges, including issues of system coordination and integration, a lack

of awareness and understanding of the importance of young children’s social-emotional and

mental health, a need for effective, evidence-based treatment and interventions during the

prenatal and early childhood periods, and the importance of a well-prepared early childhood

workforce (North Carolina Institute of Medicine, 2013).

The North Carolina Infant Mental Health Association (NCIMHA), which is committed to

developing a workforce that is trained in positive social-emotional development of children

ages 0-5, has led NC’s efforts in addressing these recommendations. In response to the

“Growing Up Well” report, NCIMHA identified a long-term goal of building capacity to provide

sufficient resources for North Carolina children birth to age five and their families to receive

support for social-emotional development. Successfully and sustainably building this capacity

requires buy-in from key players on three primary levels: training and workforce development,

service systems, and resource providers (Figure 1). These key players were identified based on

engagement, mission, role, or previously expressed support for issues related to early

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Figure 1. Key Players involved in training and workforce development, service systems, and resources related to NC early childhood programs.

In order to achieve this goal, NC needs to address gaps within each of these three branches

(workforce development, service systems, and resources). This needs assessment will focus

specifically on the training needs to ensure a workforce that is able to support the positive

social-emotional development of children and their families, including the establishment of a

system of early childhood mental health competencies for early childhood workforce

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Workforce Development

Growing importance has been placed on improving the workforce development

standards for professionals working with children ages 0-5 and their families around the United

States, with particular emphasis on infant mental health and social-emotional development

(Mendez, Simpson, Alter, & Meyers, 2015; ZERO TO THREE, 2016). In response, states have

begun introducing social-emotional competencies through credentialing and certificate

programs as a means of ensuring that professionals are equipped to meet the social-emotional

and health needs of their youngest clients. In 2010, North Carolina initiated a process of

building a cadre of trainers through the Center on the Social Emotional Foundations for Early

Learning (CSEFEL) out of Vanderbilt University (North Carolina CSEFEL Pyramid Model

Partnership State Update, 2010).

The first step in establishing this system was to look to other models to identify

competencies that should be prioritized in North Carolina. Michigan has served as a leader in

the establishment of competency systems addressing social-emotional health throughout the

United States. In the 1990’s, Michigan began identifying key infant mental health principles and

essentials for quality practice. By 2016, 23 states, as well as several large organizations and two

countries, adopted Michigan’s early childhood competency system and Michigan has partnered

with states to establish credentialing systems that meet individual state needs (ZERO TO THREE,

2016). In North Carolina, the Alamance Alliance for Children and Families in Alamance County,

NC, had already begun this work thanks to a SAMHSA grant and was able to provide funding for

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competencies that the Alamance Alliance had previously adopted and plan for pilot testing of

new curriculum in North Carolina pre-service educational programs.

In March 2015, the NCIMHA Workforce Development Committee conducted a series of

formative focus groups and interviews with child care providers, early childhood educators,

therapeutic and clinical child welfare specialists, and healthcare providers. Participants were

asked about their perceived benefits and challenges to implementing an early childhood

social-emotional competency system in North Carolina. Findings from these focus groups indicated

that key stakeholders thought that implementing a cross-disciplinary set of core competencies

would have a positive impact on the service system and the quality of care provided to children.

Foreseen challenges included the logistics of the system structure, funding, buy-in from the

relevant key players, the nature of professional silos, and access to training opportunities

(North Carolina Infant Mental Health Association, 2016).

Ultimately, NCIMHA adapted and adopted eight competencies that are critical to the

provision of high-quality care for young children: Parenting, Caregiving, Family Functioning and

Parent-Child Relationships; Child Development: Infant, Toddler, and Preschool Age Children;

Biological and Psychosocial Factors Impacting Outcome; Risk and Resilience; Observation,

Screening, and Assessment; Diagnosis and Intervention; Interdisciplinary/Multidisciplinary

Collaboration; and Ethics. These competencies apply to a wide variety of professionals, so

NCIMHA developed three levels of specific definitions and training recommendations based on

the level of education required to enter a professional field and the amount of autonomy a

professional has when working with children and their families (Appendix A). There is currently

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is difficult to know what competencies professionals have been trained on and what they have

not been exposed to (North Carolina Infant Mental Health Association, 2016). In addition, there

are no current data on the number of professionals that comprise the NC early childhood

workforce, so it is challenging to predict the cost or capacity needed to implement the

proposed competency system.

In May 2017, the North Carolina ZERO TO THREE TA grant team, led by Communicy Care

of North Carolina’s Director of Pediatric Programs, Marian Earls, MD, MTS, FAAP, hosted a

summit addressing the social-emotional health of NC’s children. Summit attendees included

direct service providers, administrators from state offices, philanthropic organizations, early

childhood intervention programs, and advocates. Participants worked in four breakout groups,

one of which was designated to discuss workforce development needs in North Carolina. The

Workforce Development group identified a need to better understand where and how

professionals working in early childhood settings have received training on early childhood

social-emotional health and development, how professionals prefer to receive training, and the

obstacles they face in accessing training as the first step in strengthening workforce

development in North Carolina. Inspired by stakeholder input, and an early childhood mental

health summit, the author, the summit convening team, and members of NCIMHA’s Workforce

Development Project Steering Committee conducted a survey of early childhood workforce

professionals to assess their professional development needs in June of 2017. The aim of this

study is to describe the professional development needs of early childhood workforce members

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Methods

The study sample was recruited through email invitations that were sent to people who

attended the NC ZERO TO THREE Summit, and people who were on listservs associated with

NCIMHA, NC Child First, the early intervention system (CDSA), or NC Smart Start. The email

invitation indicated that the survey should be completed by professionals who provide services

for children birth through age five in North Carolina and included an anonymous link that was

forwarded to contacts by the initial recipients. As such, a response rate cannot be calculated.

The survey consisted of eight questions regarding respondents’ field of work, and

professional training experiences related to early childhood social-emotional development.

Beyond the types of training respondents received, the Workforce Development committee

was interested in what respondents perceived as the most effective forms of training.

Respondents were asked to rank the top three of the types of professional development that

they had experienced based on training effectiveness. Respondents provided open-ended

answers to questions asking about what they or their colleagues would need to feel confident

providing services that address the social-emotional needs of children 0-5, what would make

training on 0-5 social-emotional health more accessible or efficient, what obstacles they face in

accessing training on addressing the social-emotional needs of children 0-5.

Data were collected through Qualtrics online surveying software and analyzed using

Microsoft Excel. Open-ended responses were thematically coded and grouped by conceptual

similarities. Quantitative analysis consisted of descriptive statistics.. The survey and analysis

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board member, as NCIMHA is an independent non-profit orgaizaitonsn and does not have its

own IRB.

Results

A total of 252 respondents completed the survey. Thirty-four percent (n=85) of

respondents work in a direct service provider role, while 27% (n=69) work in an administrative

role and 24% (n=61) work in a supervisory role. Twenty-three percent (n=59) of respondents

selected more than one response option for this question. 38% (n=97) of respondents said that

their work most closely aligned with the field of early childhood development, and 22% (n=56)

said their work most closely aligns with the field of social work (Table 1).

Table 1. Respondent Roles and Disciplines

Respondent Role (N=250) n (%)

Direct Service Provider 83 (32.94)

Administrator 69 (27.38)

Supervisor 61 (24.21)

Community Advocate 31 (12.30)

Consultant 25 (9.92)

Trainer 23 (9.13)

Higher Education Professional 13 (5.16)

Other* 40 (15.87)

Respondent Discipline (N=252) n (%)

Early Childhood Development 97 (38.49)

Social Work 56 (22.22)

Service Coordination 20 (7.94)

Psychology 15 (5.95)

Public Health 15 (5.95)

Nursing 14 (5.56)

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Speech Therapy 2 (0.79)

Other 19 (7.34)

*17 of the 40 respondents who selected Other in response to their professional role provided an open-ended response. Of these 17 responses there was a wide range of titles. 23 of the respondents who selected other did not define their role.

Respondents were asked to identify the modes in which they have received professional

development training on early childhood social emotional development up to the present point

in their career (Table 2). Nearly three-quarters (74%, n=186) of participants had received

face-to-face continuing education or in-service training. Half of respondents (50%, n=125) had

received online continuing education or in-service training, and a third of participants (33%,

n=82) had received training through a learning collaborative. Twenty percent (n=51) had

experienced collegial support in learning about early childhood social-emotional health and

development, 15% (n=38) received clinical supervision, and 12% (n=30) received information

through early childhood mental health consultations. Participants also reported receiving

training on early childhood social-emotional health and development through pre-service

academic degree programs, including bachelor’s degrees (37%, n=94), master’s degrees (29%,

n=72), doctoral degrees (5%, n=13), associate’s degrees (5%, n=13) and professional degrees

(4%, n=9). (Figure 2).

Table 2: Modes of Professional Development

Mode (N=242) n (%)

Face-to-face continuing education or

in-service training 186 (73.81)

Online continuing education or in-service

training 125 (49.60)

Bachelor’s degree program 94 (37.30)

Learning collaborative 82 (32.54)

Master’s degree program 72 (28.57)

Collegial support 51 (20.24)

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Early childhood mental health consultation 30 (11.90)

Doctoral degree program 13 (5.16)

Associate’s degree program 13 (5.16)

Professional degree program 9 (3.57)

Of the participants who reported that they had received each form of training,

face-to-face continuing education or in-service training stands out as the most effective form of

training, ranked first by 55% (n=103) of respondents, followed by bachelor’s degree programs

(22%, n=21). Online continuing education or in-service training was most frequently ranked the

second (33%, n=41) and third (24%, n=30) most effective form of training. Over a third (34%,

n=35) of respondents who had received face-to-face continuing education or in-service training

ranked it as the second most effective form of training. Other forms of training that were

consistently ranked in the top three forms of effective training were bachelor’s degree

programs (1: 22%, n=21; 2: 17%, n=16; 3: 15%, n=14), master’s degree programs (1: 21%, n=15;

2: 19%, n=14; 3: 17%, n=12), and learning collaboratives (1: 15%, n=12; 2: 26%, n=21; 3: 24%,

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Figure 2. Ranking of top three most effective modes of training on early childhood social-emotional health and development.

The primary need for respondents to feel confident providing services that address the

social-emotional needs of children 0-5 is general training (33%, n=53). Another 19% (n=31) said

that they needed training specifically on typical social-emotional development and mental

health indicators, and 15% (n=24) requested in-service training or continuing education.

Additional needs identified include ongoing mentorship, coaching or supervision (15%, n=21), a

review of current literature and best practices (10%, n=16), and referral resources (9%, n=15).

When asked about what could make training more accessible or efficient, respondents

discussed a need for more variety in the geographic location of training (17%, n=27), more

online training options (16%, n=25), and more face-to-face training options (13%, n=20). 14%

(n=21) of respondents said that reducing the cost of trainings would make them more

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0-5 social-emotional health and development identified by respondents. Respondents most

frequently perceived cost (28%, n=45) and time (26%, n=41) as obstacles to accessing training.

28% (n=45) of respondents identified a lack of training options as an obstacle, and more than

half (n=25) of these respondents discussed a lack of training options in their geographic vicinity.

7% (n=12) of respondents said that the need to travel to trainings in other parts of the state is

an obstacle to accessing trainings. A few respondents (5%, n=8) said that they were not aware

of the training that are offered and where they would find a listing of trainings.

Discussion and Recommendations

The NCIMHA Workforce Development Survey was designed to improve the association’s

understanding of training needs perceived by the workforce who interfaces with children 0-5

years of age and their families on a regular basis. The needs identified by respondents were

similar to the needs that had been previously perceived by the NCIMHA Workforce

Development Committee and provided a new depth and context to these needs and how they

can begin to be addressed.

Recommendation 1. Training on 0-5 social-emotional health and development should

continue to be incorporated into pre-service associate's, bachelor’s, and master’s degree

programs. NCIMHA previously conducted a crosswalk of NC college and university degree

programs in which curricula were identified as appropriate to include competencies on early

childhood social-emotional health and development. With support from NCIMHA’s early

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program and UNC Greensboro (UNCG) is incorporating the competencies in their Human

Development and Family Studies Bachelor’s degree courses. Additionally, UNCG is partnering

with Alamance Community Collee to integrate the competencies into several of their Associate

degree programs. Providing pre-service training on early childhood social-emotional health

and development would better assure that professionals are entering the workforce having

already gained substantial knowledge for an entry level workforce position. Incorporating

training into pre-service learning would reduce the cost and amount of time required for

in-service training.

Recommendation 2. In-service training modules should also be developed to address

the needs of professionals currently in the workforce. While survey responses most frequently

indicated that face-to-face training is the most effective form of in-service training or

continuing education, respondents said that online trainings would make training more

accessible. Online training eliminates some of the barriers respondents and their colleagues

face in actually attending trainings. Webinar style online trainings with interactive features may

be a means of bridging the gap between accessibility and effectiveness. Research has shown

that online learning can be just as effective as in-person classroom learning if critical

components that assure interaction and some degree of personalization are included in online

learning modules (Swan, 2003). One respondent suggested a flipped classroom experience, in

which learning could begin online and then training participants could practice applying

knowledge and skills in face-to-face sessions. Respondents suggested that face-to-face trainings

should be held in a variety of locations around the state to improve accessibility for

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model may be an effective mode of reaching professionals working with young children across

the state (Orfaly et al., 2005).

Recommendation 3. NCIMHA should facilitate, encourage, and connect the

coordination of training to advance knowledge and practice around the eight social-emotional

competencies for professionals in North Carolina. Respondents’ lack of awareness of training

options suggest that it would be beneficial to develop a reference resource, such as a webpage

on the NCIMHA website, that can serve as a central portal for professionals to access

information on trainings and other professionals in their area. This would be an essential early

step in the establishment of a certificate or program around the 0-5 social-emotional

competencies. Professionals must know where and how to access trainings if they are to be

advised or required. Including information on trained professionals who are competent in 0-5

social-emotional health and development in an online hub would improve the ability of

professionals to confidently make referrals for their clients. Funding to provide the necessary

resources to create and maintain such a site is a necessary component of this recommendation.

Limitations

The results of this survey should be considered in light of a few limitations. The survey

was distributed to a convenience sample of early childhood professionals who were previously

involved in work through NCIMHA, NC Child First, the ZERO TO THREE Infant Mental Health

Summit, ABCD, the NC Partnership for Children, and other early childhood organizations,

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survey to contacts within their organizations, so we cannot know how many individuals

received the survey to calculate a response rate. There is a population of early childhood

professionals, including preschool teachers, whose highest degree of education is an associate’s

degree who appear to be underrepresented in this survey sample. We do not know if the

primary needs, obstacles, and effective forms of training would have differed for this

population. Finally, this survey did not ask respondents for demographic data, such as age, race,

ethnicity, or income, so we do not know how representative this sample is of the early

childhood professional population.

Despite these limitations, this survey provides insight into the needs of professionals

working in early childhood to adequately provide services that support infants’ and young

children’s social-emotional health and development. To the best of our knowledge, this

information had not been captured in a survey previously, and the survey results will help to

inform future efforts to improve training on the social-emotional competencies. This baseline

assessment aids the NCIMHA Workforce Development Committee in identifying necessary

steps in working towards a certificate or credentialing program around the defined early

childhood-social emotional competencies, including the establishment of an online

infrastructure where information on offered trainings can be shared. NCIMHA should continue

to assess the needs of the workforce, with an aim to reach early childhood professionals who

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Summary of Key Recommendations

• Incorporate early childhood social emotional competencies into pre-service educational

and training programs.

• Develop complementary online and in-person training modules on 0-5 social-emotional

development and mental health indicators, the 8 social-emotional competencies,

integration of competencies into practice.

• Build capacity to develop an on online hub for resources around early childhood

social-emotional competencies. This should include training opportunities, professionals with

expertise in early childhood, and resources for providers and clients.

• Include demographic items, including, race, ethnicity, socio-economic status on future

iterations of the NCIMHA Workforce Development survey. Inclusion of these items will

help to assess and promote equity in the reach of the survey and in training needs and

obstacles.

Conclusion

The NCIMHA Workforce Development Survey provided crucial information surrounding

the workforce development needs, obstacles, and potential solutions to training needs for

North Carolina’s early childhood workforce. The results suggest that a series of in-person and

online trainings on the early childhood social-emotional competencies should be developed and

implemented across North Carolina, and made as low-cost as possible. Degree programs in

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development. Finally, NCIMHA should take steps to evaluate the possibility of establishing an

online hub for experts, resources, and training opportunities. Action based on these

recommendations would advance North Carolina’s ability to improve infant mental health care

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Appendix A: NCIMHA Core Competencies

Early Childhood Social-Emotional Competencies

Provider Categories

Foundation Professionals (Core Provider Category 1): This category includes any person working with young children and their families, such as individuals providing child care, Head Start, or home health services.

Intermediate Professionals (Core Provider Category 2): This category includes providers who work with children and families in a non-clinical setting or in a supportive role, such as child care supervisors, directors, registered nurses, or educators.

Advanced and Specialist Professionals (Core Provider Category 3): This category includes

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Knowledge Domains

The NCIMHA early childhood social-emotional knowledge domains are:

A. Parenting, Caregiving, Family Functioning and Parent-Child Relationships

B. Child Development: Infant, Toddler and Preschool Age Children

C. Biological and Psychosocial Factors Impacting Outcomes

D. Risk and Resilience

E. Observation, Screening, and Assessment

F. Diagnosis and Intervention

G. Interdisciplinary/Multidisciplinary Collaboration

H. Ethics

It is recognized that professionals from a wide range of disciplines, educational backgrounds, and roles will seek to develop proficiencies associated with these competencies. All professionals are not

expected to acquire competencies in all Categories or in all Domains. Organizations will need to identify applicable competencies relevant to the role(s) of their staff and mission of their organization.

Organization directors are encouraged to adopt these competencies for all staff working with children and families within their organization. Supervisors are encouraged to utilize these competencies in planning annual training for their units and in setting annual training goals with individual staff.

A workforce development staff planning tool is included in this document for use by supervisors. Training resources, including web-based and face-to-face, have been identified, by domain, to assist supervisors in planning with staff.

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Knowledge area Category 1 Category 2 Category 3

Any person working with young children and Bachelor degree or equivalent; providers who Master’s degree; provider is a licensed mental health

their families work with children and families in a non- therapist

clinical setting or in a supportive role

A. Parenting, Caregiving, Understands the importance of Understands issues related to transition to

Family Functioning and parent/caregiver availability. parenthood, issues of being a new parent

Parent-Child Relationships particularly for young adults

• Range of family structure Demonstrates an understanding of healthy Understands the infant/young child’s use of the Demonstrates an understanding of different patterns • Pregnancy and childbirth attachment after birth and the importance of parent as a secure base for explorations of the of parent-infant interaction and attachment and their • Postpartum period the postpartum period on the newborn. environment and under conditions of stress impact on child outcomes.

• Attachment issues • Parenting as a

developmental process

Understands the role of caregivers as models Demonstrates an understanding of family and • Family dynamics

for the development of behavior in young parenting function as a lifelong developmental • Family expectation

children (e.g. coping, anger management). process beginning before conception. regarding child

development • Providing

family-sensitive services

Adjusts daily routine based on the child’s Understands and utilizes the concept of Remediates the potential problem in the developing • Cultural issues in

temperament and understands and responds “goodness of fit” between the parent and child parent-child relationship brought about by a parenting and family

to baby cues. (temperament, etc.) in observing and temperament mismatch of parent and child.

development

supporting parent child interaction. • Goodness of fit between

parents and young children

Supports the unique parent-child relationship. Uses a variety of techniques to facilitate and Demonstrates knowledge of family dynamic (systems, • Importance of

reinforce positive parent-infant interaction and relationships) and family composition including relationships to

enhances parents’ capacity to be responsive relationships with caregiver, sibling, and extended development

and sensitive to their baby/child. family. Transitions

Family systems

Respects the parent’s relationship with child as Uses interviews with parents/caregivers to Establishes and maintains a therapeutic alliance with

primary. listen carefully, obtain information, and begin parent/caregiver.

to develop trust.

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Knowledge area

Category 1 Category 2 Category 3

Any person working with young Bachelor degree or equivalent; providers who work Master’s degree; provider is a licensed mental

children and their families with children and families in a non-clinical setting or in health therapist

a supportive role

A. Parenting, Caregiving, Demonstrates awareness of Demonstrates sensitivity to professional role as a Understands the concepts of transference and

counter-Family Functioning and boundaries in working with collaborating partner with the family and advocates for transference and how they may impact the ongoing

Parent-Child families. parents while maintaining boundaries and fostering treatment

Relationships independence.

Demonstrates awareness of the potential negative impact

Continued of multiple separations and/or multiple family

placements on early development.

Demonstrates awareness of and able to competently engage with a wide range of family structures, family dynamics and cultural influences on family functioning.

Demonstrates awareness of Utilizes diverse cultural belief about development in Understands the impact of the client’s culture, values, and cultural issues that impact family understanding parent-child interaction and family education on their own behavior and reaction to the

interactions, relationships, and expectations. therapist.

parenting.

Understands that parent behavior may be the result of Demonstrates reflective insight into personal relationship how the parents were treated by their parents history and dynamics, and understands importance of (empathize with parent history). one’s own awareness in context of therapeutic

relationships with families.

Understands strategies for facilitating change and growth processes in families with significant problems in relationships — at the representational, dyadic and systemic levels.

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Knowledge area

children and their families with children and families in a non-clinical setting or health therapist

in a supportive role

B. Child Development: Demonstrates an understanding of the Demonstrates an understanding of the construct of Demonstrates an understanding of normative dyadic

Infant, Toddler and importance of healthy relationships for attachment and attachment behavior. emotional development and the implications for atypical

Preschool Age children healthy development. dyadic emotional development (parent-child).

• Typical development in infancy, toddler and/or preschool

periods Demonstrates an understanding of Recognizes difference in processing sensory inputs. Demonstrates an understanding of the importance of

• Milestones of typical development including: development of self-regulation, early childhood social

development language, motor, sensory, adaptive self- relationships, communication and representational skills,

• Peer relationships help, cognition, and social & emotional and executive function abilities for school readiness.

• Expectations of (including capacity to play and interact

children in groups with others). • Cultural variations in

development and

family expectations Recognizes and respects how different Demonstrates an understanding of the impact of Demonstrates an understanding of social-emotional

settings where children spend time environment on behavior at all stages of development and the role of peer and group interactions as

including child care, play groups, and development. it relates to child behavior and can utilize a range of

home may affect children’s behavior. strategies for promoting optimal interactions.

Accurately interprets information from direct and reported

information, observations and assessments in a range of

settings to identify capacities and strengths, as well as

developmental delays and/or emotional disturbances in

infants and young children served.

Uses collaborative approaches to explore appropriate family

expectations and provides developmental guidance in

achieving strategies that support those expectations.

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Knowledge area

children and their families with children and families in a non-clinical setting or health therapist

in a supportive role

C. Biological and Utilizes basic knowledge of brain Demonstrates an understanding of the impact of in Accurately interprets the bi-directional nature of biological

Psychosocial Factors development. utero toxins on later development such as alcohol, and psychosocial circumstances that influence infant brain

Impacting Outcomes nicotine, and prescription and non-prescription development, parent-child relationships and the regulation

• Temperament medications. of emotions and behavior, including genetics, low birth

• Prenatal Environment weight, under-nutrition, substance exposure, disability and

• Family Stress _{the impact of family discord and trauma.}

• Regulatory and _{Demonstrates awareness of regulatory} _{Demonstrates an understanding of the impacts of} sensory issues _{challenges, including sleep/wake} _{regulatory challenges (e.g., colic, disruptions in}

• Brain research _{patterns; feeding.} _{feeding and sleeping) on attachment and parental}

• Neuro- _{ability to respond and sense of competence.}

developmental issues _{Can implement supportive behavioral techniques for} _{Demonstrates an understanding about intervention}

• Prematurity and low _{problems in sleeping, eating, and self-control (e.g.} _{strategies for infants with regulatory challenges and/or}

pre-birth weight _{charting, positive reinforcement).} _{term infants.}

• Child abuse _{Demonstrates an understanding of} _{Demonstrates an understanding of the impact of} _{Can identify and address family and child health factors,} • Child neglect _{nutritional needs and methods of} _{chronic poor nutrition on development.} _{including nutrition, and their role in child and family} • Nutrition

feeding at different stages of outcomes from preconception onward.

• Poverty _development.

• Trauma

• Community issues

• School and Demonstrates an understanding of when Demonstrates an understanding of the concept that

community services and how challenging behaviors interfere prolonged/ chronic stress in the infant/child/ parent or dyad

• Impact of such with healthy development. affects all domains of development and may lead to

factors upon subsequent interference with brain development and

development and emotional regulation.

relationships Demonstrates awareness of the kinds of Recognizes the importance of trauma-informed assessments

traumatic experiences to which young and interventions

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Any person working with young Bachelor degree or equivalent; providers who work with Master’s degree; provider is a licensed mental health

children and their families children and families in a non-clinical setting or in a therapist

supportive role

C. Biological and Demonstrates an understanding that Demonstrates an understanding of the importance of Identifies/describes key signs, symptoms, impact and

Psychosocial Factors trauma places children’s attachments, screening for traumatic life experiences manifestations of trauma, disrupted attachment, and

Impacting Outcomes self-regulatory capacities, and childhood adversity in children and in adults.

Continued cognitive development at risk

Demonstrates an understanding that the domains and stages Explains the relationship between trauma, adversity of normal childhood development (brain, social, emotional, and disrupted attachment in the child/caregiver cognitive, and physical) can be affected by trauma, abuse, relationship.

adversity and stress.

Demonstrates an understanding of how behaviors, including Explains how behaviors, including those that appear to those that appear to be problems or symptoms often reflect be problems or symptoms often reflect trauma-related trauma-related coping skills individuals need to protect coping skills individuals need to protect themselves and

themselves and survive. survive.

Assists parents/caregivers of children who have been Describes the multi-generational nature of trauma and exposed to trauma and childhood adversity to recognize and childhood adversity.

address their own risk for secondary/vicarious trauma and possible unresolved trauma in their own lives.

Demonstrates sensitivity to children’s parents/caregivers Defines re-traumatization and identify ways that who often have unaddressed trauma issues that can impact children and their families can be re-traumatized/ their ability to help their children. triggered by the systems and services designed to help

them.

Describes local resources for trauma specific treatment and Defines trauma informed and trauma specific care, trauma informed services for children and their families. including knowing the key elements of a trauma

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Knowledge area

Any person working with young Bachelor degree or equivalent; providers who Master’s degree; provider is a licensed mental health therapist

children and their families work with children and families in a non-clinical

setting or in a supportive role

D. Risk and Resilience Demonstrates knowledge of the Demonstrates a theoretical understanding of the Applies concepts of resilience to guide treatment planning

• Atypical development effects of risk factors such as genetics, cumulative risk factors that affect family well- assessment and interventions with children and families. • Maternal depression medical complications, being and parent-child relationships for infants

• Parental substance prematurity/low birth weight, and young children and their families and abuse substance exposure and teratogens, communities stemming from a variety of sources. • Teenage parenting and the impact of familial, cultural,

• “Ghosts” in the nursery social, physical and/or economic • Chronic physical illness factors including poverty, abuse and • Chronic mental illness _{neglect on development and}

in parent _{relationships.}

• Developmental _{Demonstrates an understanding that} _{Demonstrates a theoretical understanding of the} Disabilities _{practices should be responsive to} _{resilience factors that allow infants, toddlers and} • Protective factors that _{developmental protective factors and} _{preschoolers to positively adapt despite}

promote resilience _{risk factors.} _{significant life adversities.}

• Family Violence

Demonstrates the ability to select

• Foster Care _{strategies/interventions based on parent}

• Promoting resilience in _{concerns, priorities and resources, including}

children and families _{consideration for culture, language and}

• Developmental _education.

disabilities

Demonstrates knowledge of the impact of Demonstrates the ability to identify and address parent-family familial, economic or social factors on difficulties that negatively impact the parent-child relationship relationships and social-emotional development. and infant or child’s social-emotional development.

Educates parents/caregivers about risk and protective factors associated with

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Knowledge area

E. Observation, Screening Creates environments that are safe,

and Assessment comfortable, and welcoming for all

• Development of children, families, and staff observational skills with

infants and young Demonstrates an understanding of Demonstrated familiarity with the various tools Demonstrates an understanding of the relevance of both children how and when to refer for and the appropriate use of each tool. population and clinic prevalence for diagnosis.

• Use of observational (screening and/or) evaluation. information

• Use of screening tools Uses screening tools. Demonstrates an understanding of assessment as intervention.

• When to make referrals for more

comprehensive Conducts trauma-informed screening and

assessments including obtaining appropriate assessment

client and family histories to determine exposure • How to make a referral,

to trauma/childhood adversity and risk and including following

protective factors associated with through or assisting

trauma/childhood adversity. family with initial

contacts Demonstrates an understanding of the role of Selects and uses screening and assessment practices appropriate

• Interviewing different professionals in making appropriate to pregnant and postpartum parents, including screening for

referrals. depression.

• Introduction to major assessment

instruments and Successfully uses a wide range of Observes, in multiple settings (including the Demonstrates an understanding of how to use various strategies in various settings to home), the parent’s emotional states and their observation, screening and assessment tools/processes for the processes

reach and engage families. responses to the infant/young child. individual infant, young child and family.

Observes, in multiple settings (including the Incorporates observations of the infant and young child in home), the child’s emotional states and his/her multiple settings including play, child-parent interactions, early

response to the parent. care and education settings and home into every assessment of

the child.

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Knowledge area Category 1 Bachelor degree or equivalent; providers whoCategory 2 Category 3

Any person working with young _{work with children and families in a non-clinical} _{Master’s degree; provider is a licensed mental health therapist}

children and their families _{setting or in a supportive role}

F. Diagnosis and Observes the infant/young child’s Notices and can describe the parent’s behavior to Demonstrates an understanding of and ability to integrate a

Intervention behavior, ability to soothe, self- soothe, regulate, and redirect the infant/young multidimensional assessment of an infant or young child, utilizing

regulation, and sensitivities. child. information from other providers and caregivers as appropriate,

inclusive of health, physical, social, emotional, psychological and • Diagnostic systems for Recognizes, in the home, threats to the_{infant/young child’s physical and emotional well-} _{cultural aspects from a developmental and relational perspective.}

infants, toddlers and _being.

young children

Can, through observation and interview, recognize challenges to adults functioning as parents, including signs of substance abuse, developmental delay, mental illness, etc., and provide appropriate referrals and interventions.

Allows parent to express core relational conflicts in an accepting and nonjudgmental manner.

Uses and scores the results of standardized Knows the criteria necessary for formal diagnoses of disorders in observation/parent report instruments (e.g. Ages mental health and uses clinical tools appropriately (e.g. numbers and Stages, PEDS, etc.). of symptoms, age of onset, duration, impairment).

Demonstrates knowledge of the distinctions Knows about the symptoms of infant/child disorders in DSM-V; among difference, delay and disorder and makes knows about the disorders of infancy/ toddlerhood a set forth in appropriate referral for each. DC-03 and the implications of differential diagnosis for treatment;

and knows the extent to which the DC-03 disorders have counterparts in DSM-V and ICD-10

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Any person working with young Bachelor degree or equivalent; providers who work with Master’s degree; provider is a licensed mental

children and their families children and families in a non-clinical setting or in a supportive health therapist

role

F. Diagnosis and Relates and interacts comfortably Knows how to implement dyadic therapeutic techniques as

Intervention with infants/young children. described in the infant mental health literature.

Continued Knows how to help parents Can be empathic and sympathetic while not over identifying with Organizes, synthesizes, and interprets information

identify goals and activities that the parents. from all sources and communicates the need and

contribute to pleasurable strength of the infant/young child to parents to

interaction with the infant/young facilitate their understanding and cooperation in

Linking assessment and child. treatment.

Demonstrates technique for Promotes parental competence in areas such as resolving and Provides intervention that recognizes the concept of diagnosis to _{soothing, limit setting, and} _{forestalling crises and solving family conflicts.} _{resistance to engage, to take advantage of services,}

intervention _{protection and can discuss the} _{etc., and seeks to overcome resistance in}

Development of _{meaning of these with parents.} _{a therapeutic manner}

intervention goals

Is persistent in monitoring the progress of the service plan. Monitors progress and problems in whatever therapeutic techniques are being implemented by written notes and/or records.

Understands the implication of co-morbidity for treatment planning.

Recognizes intervention must be developed immediately following recognition of a child’s developmental risk in order to minimize the likelihood of failure to progress.

Integrates information and formulates plans together with the Demonstrates an ability to modulate intervention family using an approach that facilitates and supports change style and strategies in response to specific strengths

and vulnerabilities of each infant, child and family. Facilitates referrals and access to trauma informed and trauma

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Any person working with young Bachelor degree or equivalent; providers who work with Master’s degree; provider is a licensed

children and their families children and families in a non-clinical setting or in a mental health therapist

supportive role

F. Diagnosis and Provides emotional support in times of

Intervention stress.

Continued Provides both positive and negativefeedback in a sensitive and effective

manner.

Effective Can be empathic and sympathetic while

keeping appropriate boundaries with communication with _parents.

caregivers and others _{Assists parents in identifying community resources for}

Concrete assistance _{services that parents identify as important.}

Community resources

Provides resources for related services such as primary care, Demonstrates an understanding of and is able to

Developmental _{child welfare, mental health or social services and provides} _{address the importance and need for concrete}

guidance _{guidance regarding child’s development.} _{assistance, developmental guidance, crisis}

Behavioral support _{management and advocacy in therapeutic and}

Interaction guidance _{developmental work with families of infants and}

Working with _toddlers.

challenging families _{Demonstrates an understanding of evidence}

Conflict resolution _{based/ promising practices that support ECMH and}

Strategies to promote _{social-emotional competency, e.g., TF-CBT and the}

infant-family and early _{Incredible Years.}

childhood mental

Selects and implements evidence-supported

health _{relationship-based intervention strategies that are}

Strategies for _{appropriate to support and promote the infant or}

preventive _{young child’s strengths and needs.}

intervention _{Demonstrates an ability to consider culture and}

addressing social- _{context as well as risk factors in planning}

emotional-behavioral _{assessment and interventions.}

vulnerabilities

Demonstrates familiarity with frequently-used psychotropic Is knowledgeable about potential side effects of Intervention strategies

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Any person working with young Bachelor degree or equivalent; providers who Master’s degree; provider is a licensed mental health

children and their families work with children and families in a non-clinical therapist

F. Diagnosis and Demonstrates an understanding of the cognitions and beliefs

Intervention of some clients which are no longer supportive and seeks to

change them in a non-threatening manner (i.e. using a

Continued Motivational Interviewing approach).

Intervention strategies Implements “packaged” parent training

Use of self in provision programs.

of services Demonstrates ability to teach children and parent/caregivers

Developing reflective techniques, including relaxation calming, soothing, and

practice grounding themselves and/or their children.

Ensures that families are primary members of the Individual Family Service Plan/Individual

Education Plan or Child and Family teams.

Demonstrates an understanding of limits and Demonstrates knowledge of the limits of one’s own boundaries of practice and makes appropriate discipline’s scope of practice and the need for referral for

referrals issues beyond one’s own discipline’s expertise.

Demonstrates an understanding of and utilizes Suggests, demonstrates and coaches families on strategies to the principles of reflective practice. nurture a child’s development across all domains, including

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Knowledge area

G. Interdisciplinary/ Demonstrates knowledge about Completes the referral process in a Demonstrates knowledge of the existence of a wide variety of

Multidisciplinary resources in the community. knowledgeable, professional and timely manner. resources and systems providing services to young children &

Collaboration families.

• Understanding the roles of other professionals in

Works as a member of a team: Shares own reports and interprets reports from Demonstrates the importance of sensitive, respectful and working with young

practices openness to new other professionals in such a way as to facilitate effective communication with other providers of services to the children and families

information, ability to communicate parental understanding and cooperation. child and family. • Respecting boundaries of

clearly one’s own position and value, practice

ability to hold multiple viewpoints and • Community resources

reflect upon them. • Working together with

other professionals to

create an integrated plan Demonstrates an ability to assemble an

• Collaborating to interagency and interdisciplinary team in which

prioritize child and team and family members exchange information

family needs and learn from one another.

Works as a team leader when appropriate, or can co-team lead, when necessary, with another professional.

Demonstrates an ability to integrate multiple sources of information into a cohesive, family friendly report.

Coordinates early intervention services across a variety of agencies.

Facilitates relationships, communication and Demonstrates awareness that relationships with other providers collaboration among family and all other team will have an effect on their relationships with the child and

members. family.

Respects and incorporates information and feedback from other team members.

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H. Ethics Demonstrates self-awareness and the Demonstrates a clear understanding of scope of

• Ethics of scope of ability to reflect on one’s impact on areas of personal competency as determined by

practice families and vice versa. training and experience, and seeks consultation

• Working ethically in when questions arise.

family settings Demonstrates knowledge of Demonstrates an understanding of when Demonstrates a clear understanding of scope of practice as applicable state and agency particular problems manifested by the child defined by license, certification, and/or position/role, and regulations with respect to such issues require services outside of their competence. seeks consultation when questions arise.

as eligibility for services, confidentiality, documentation, reporting of child abuse, and others that may arise.

Works within the regulation and code Demonstrates respect for boundaries of practice. of ethics of their profession. Maintains appropriate boundaries with families

and other professionals.

Demonstrates an understanding of the Uses regularly scheduled time for supervision Makes effective use of reflective practice facilitation, mentoring, impact of his/her own cultural and (reflective supervision, etc.), recognizes his/her coaching, and/or supervision.

educational background and values on own limitations, and seeks support & supervision

the client. as needed.

Recognizes and supports the cultural Recognizes the significance of socio-cultural and beliefs and values of families. political contexts of children from diverse