Overview
The Administration on Children, Youth and Families (ACYF) and the National Institute of Mental Health (NIMH) awarded five research grants in 1997 as the core component of a new young children's mental health research initiative designed to develop and test applications of theory-based research or state-of-the-art techniques for the prevention, identification and/or treatment of children's mental health disorders within a Head Start context. The goal was to create the Head Start Mental Health Research Consortium of researchers (these five new research grants, as well as other researchers who were doing similar work in this area) with an emphasis on advancing our current level of understanding and improving the provision of high quality, comprehensive, developmentally appropriate prevention and intervention services to young low-income children, families and staff, served by Head Start programs across the country.
The project period was 9/28/97-9/29/01.
Purpose and Background
The purpose of this, ACYF/NIMH young children's mental health research initiative was to fund a consortium of research projects that would develop and/or test applications of theory-based research or state-of-the-art techniques for the prevention, identification and/or treatment of children's mental health disorders within a Head Start context. The goal was to create a consortium of researchers focused on advancing our current level of understanding and improving the provision of high quality, comprehensive, developmentally appropriate prevention and intervention services to young low-income children, families and staff, served by Head Start programs across the country.
Along with pediatric primary health care providers, Head Start, as a comprehensive service delivery program, served as one of the earliest mechanisms for identification and intervention with a vulnerable population of low-income children and their families. Mental health was defined broadly as "promoting the healthy emotional development of children, supporting family strengths, identifying early signs of emotional and behavioral difficulties, and assisting families with special needs" (Yoshikawa and Knitzer, 1997). This definition incorporated a balanced emphasis that includes prevention as a key cornerstone of early intervention efforts, but also allowed for the appropriate early identification and treatment of children at-risk for, or manifesting emotional and/or behavioral difficulties. While the primary focus was on the child, this ecological approach acknowledges the importance of addressing the mental health needs of the parents and staff, as well.
There were a number of key gaps in the extant knowledge base that call for additional research in this area. First, there was the need to improve the understanding of the prevalence of mental health problems in this low-income population of young children, especially in comparison to the rates of identification of disabilities in Head Start programs. According to the Head Start Information Report (PIR) for the academic year 1995-1996, 107,791 children in Head Start were diagnosed with disabilities (the Head Start categories of disabilities include mental health problems), 13% of the total number of children (742,509) enrolled. There were concerns about the accuracy of these diagnoses, in comparison with prevalence rates in other studies. The percentage of children identified in Head Start with emotional/behavioral disorders (.7 percent) was in stark contrast to the 11-23 percent estimates of behavior problems in preschool age children in other studies (Earls, 1980). In contrast, speech and language impairments were by far the most prevalent disability identified, representing 66% of the disabilities diagnosed and 9.5% of all children served by Head Start.
There also was the need to better understand the trajectories of social and emotional development in very young, low-income children, including risk and protective factors. This was especially crucial given dramatic increases in the frequency, intensity and severity of exposure to risk factors (e.g., community violence, substance abuse, physical and sexual abuse, etc.) for young children growing up in poverty.
From a systems of care perspective, Head Start programs needed to be organized, both internally and within the context of the larger network of other community service providers, in ways that would lead to efficient, accurate, and high quality screening, assessment, intervention and/or referral, as necessary. The proactive universal screening of all enrolled children, required by Head Start Performance Standards, was one of the best mechanisms for ensuring the earliest detection of difficulties.
However, the effectiveness of such an approach undoubtedly was a function of certain key programmatic indicators of quality mental health service provision, such as the use of on-site mental health professionals (versus outside mental health professionals and/or consultants), high ratios of mental health professional staff to children served, adequate educational/professional training of mental health staff, and strong, established collaborative relationships with relevant community mental health providers. It also depended on the ability of Head Start programs and community service providers to involve families and staff in development of services that are appropriate and acceptable.
In addition to Head Start's primary role as a national program of comprehensive services for young low-income children and their families, it also served as a national laboratory, which develops, demonstrates, and tests best practices based on scientifically sound research and encourages and supports both new research and the methods for conducting research. This Head Start/early childhood mental health research initiative built upon a number of recent efforts, including: (1) the Task Force on Head Start and Mental Health supported by the American Orthopsychiatric Association; (2) the recently-completed Descriptive Study of the Head Start Health Component, which included an examination of mental health issues for a nationally-representative sample of Head Start programs and the families served; (3) the recently published Head Start Program Performance Standards, which stress collaborative relationships between programs and parents to share concerns about their children's mental health, identify appropriate responses to children's behavior, help parents to understand mental health issues, and create supportive environments and relationships in their homes and at Head Start; and (4) the recently completed study, Lessons from the Field: Head Start Mental Health Strategies to Meet Changing Needs (Yoshikawa and Knitzer, 1997), on the mental health service delivery systems of care in 73 Head Start programs across the country.
Membership in this consortium of research projects focused on Head Start mental health efforts were included, but not necessarily be limited to, investigators funded under this initiative and similar research projects currently supported by ACYF and/or NIMH. A Steering Committee was formed consisting of principal investigators from each of the participating projects, as well as representatives from ACYF and NIMH. The ACYF and NIMH Federal Project Officers served as the co-chairpersons for the Steering Committee. The Steering Committee advised ACYF and NIMH on the design, implementation, and management of the cross-cutting research activities (e.g., common assessment approaches and intervention activities) which were implemented by the participating projects. It also provided a forum for the discussion of issues raised by the Consortium members, ACYF and NIMH.
ACYF/NIMH Team
Michael L. Lopez, Ph.D.
Lead Senior Social Science Research Analyst
Child Outcomes Research and Evaluation (CORE), OPRE
Administration for Children and Families, DHHS
330 C Street, SW, Room 2128
Washington DC, 20447
Kimberly Hoagwood, Ph.D.
Chief, Child & Adolescent Services Research Program
National Institute of Mental Health
6001 Executive Blvd, Room 7131, MSC 9630
Rockville, MD 20852
Phone: (301) 443-3364
Email: khoagwoo@nih.gov
Cheryl A. Boyce, Ph.D.
Psychologist
Developmental Psychopathology Research Branch
Division of Mental Disorders
Behavioral Research, and AIDS
National Institute of Mental Health
5600 Fishers Lane, Room 18C-17
Rockville, MD 20857
Phone: (301) 443-0848
Email: cboyce@nih.gov
Rhonda Boyd, Ph.D.
Society for Research on Child Development Research Fellow
Child Outcomes Research and Evaluation (CORE), OPRE&
National Institute of Mental Health
Administration for Children and Families, DHHS
330 C Street, SW, Room 2119
Phone: (ACYF): (202) 205-8272
VoicEmail: (ACYF): (202) 205-5417
Phone (NIMH): (301) 443-2638
Email: rboyd@acf.hhs.gov