Community Projects

Creating Cycles of Hope

Funded by United Way of the Columbia-Willamette, this project is developing interventions to break the intergenerational transmittion of adverse childhood experiences that contribute to poor social-emotional development of children. The social-emotional health of our children may be the most important protective factor we can offer them, and yet, services that address these needs are often woefully inadequate.

According to a 2004 report by the Governor’s Mental Health Task Force, 12% of Oregon’s 250,000 children under the age of 5 show some sign of emotional distress.  That figure jumps to 22% among children who are high-risk and eligible for Medicaid.  Seven percent (17,500) of young children have identified mental health needs serious enough to require clinical intervention, and 16% of Oregon’s children entering kindergarten are reported as lacking the social and emotional skills necessary to learn. These numbers are disturbing enough on their own, but they become truly frightening when the long-term effects of such problems are considered.  Several studies have shown that the social, emotional, and behavioral health of young children predicts their academic performance in first grade—even more so than their cognitive skills or family backgrounds.

The effects of early emotional disturbances or trauma do not stop at school. Felitti and Anda report that adverse childhood experiences are far more common than acknowledged, and have a tremendous impact on adult health a half-century later.  Their compelling results led them to conclude that “adverse childhood experiences are common, destructive, and have an effect that often lasts for a lifetime.  They are the most important determinant of the health and well-being of our nation.”

Children who suffer from adverse childhood experiences or emotional difficulties grow up to become parents who suffer from these same difficulties.  Social, emotional, or behavioral problems—especially when combined with intergenerational risk factors such as poverty, lack of education, exposure to abuse, lack of parental support, and limited access to healthcare—result in multiple generations being negatively affected.  New research is showing that interventions that involve caregivers and children and that address these social-emotional issues in caregivers can provide a defense against these risk factors in their children.  In fact Lieberman et al, in a 2005 study examining the effects of nurturing early experiences on adult parenting and attachment, concluded that “early benevolent experiences with caregivers can work as protective forces even in the face of overwhelming trauma.”

But where do families turn for help?  Family pediatricians are often the first step, but it is well-established that most pediatricians have neither the time nor the training to address parents’ concerns about behavior, much less provide developmental and/or psychosocial screening and monitoring.  In addition, the medical community alone cannot provide the necessary comprehensive system of care required for successful early childhood mental health preventative care.  Zeanah et al. (2005) note that building social and emotional health in young children must include working with the child and family from multiple perspectives: biological, developmental, environmental, and relational.  Professionals and agencies from numerous disciplines must collaborate to provide what Zeanah et al. recommend:  a system of care for early childhood mental health that incorporates and links assessment, educational services, intervention services, and care coordination.

To create this holistic approach, this project weaves together a variety of disciplines: preventative health, behavioral health, child and adult mental health, parenting, housing, child care, and early education to wrap comprehensive supports around families to improve early childhood outcomes, which will, in turn, create healthy parents later in life.

The project is accomplishing significant work on both the individual and systemic level.  The services increase parents’ skills in providing their children with the loving, nurturing care that creates a secure attachment between parent and child - the foundation for healthy social-emotional development.  An array of services ia provided offering broad-based parenting and child care provider supports and education to all participants; on-site behavioral pediatric screening, monitoring, and case management to most of the population; and intensive parent-child group therapy through Circle of Security (COS), an emerging evidence-based practice model, to a select group of parents ready for this intervention. A community based Health Promoter creates linkages between all the services and the families, increasing their ability to be successful.  Self-care workshops are also made available at CPAH and Letty Owings residential site as a way to nurture parents and provide them incentives to participate improving both the mental health status of the parent and the child.  When necessary, families can be referred for more intensive adult mental health treatment through community providers.

On  a systemic level the project works to remove barriers, cross-pollinate the disciplines involved through both formal and informal training, and is responsible for bringing a very exciting and promising early childhood mental health intervention, COS, to Oregon. Circle of Security is traversing the globe as an intervention to help parents raise their children with love, warmth, and emotional intelligence. This innovative approach has created a readily accessible and engaging approach to help parents to connect with their infants and toddlers in ways that break the old, destructive patterns of parenting that so often have been learned through parents’ own difficult childhood experiences. Cited from England to India, COS offers new hope for making the hard-earned wisdom of attachment research available to clinicians, helping parents heal old wounds and building new options for the next generation. 

Having a developmental Behavioral Pediatrician on site at the Letty Owings Center and CPAH will afford parents and child care providers easy access to a health practitioner when issues or concern arise.  In NWECI’s pilot work creating community health linkages, we found often that the presenting issue may be a less concerning health issue, but that once the relationship is formed, more intimidating social-emotional concerns that were lurking in the background are brought forward.  While the project does not provide primary care, it does greatly increase access to care by first getting parents, many of whom may be wary of systems or authority, comfortable accessing care and then connecting them with community providers through special advocacy when necessary.  Once a relationship is established, the Pediatric Practitioner will be available to do behavioral screening, monitoring, and case management for roughly 3-4 families every other week at each residential site.

Elon Ellis Literacy Outreach Project

The Elon Ellis Literacy Outreach Project is a three-year project conducted in collaboration with Portland State University, Peninsula Children’s Center, Peninsula Elementary School and one other Elementary School in the Portland District.   The project focuses on lower-income, culturally diverse Portland communities.  Up to180 first and second grade children who are at risk for literacy failure receive intensive literacy intervention provided by speech-language pathologists with expertise in reading disorders.  Evening parent educational sessions are offered to as many as 360 family members with the goal of increasing their skills in promoting their children’s literacy at home. 

Peninsula Children's Center

The Hearing & Speech Institute and NWECI are please to partner, along with Morrison Center, in the North Portland Early Childhood Partnership at Peninsula Children's Center. The partnership increases resource access for more than 30 families in Peninsula's Infant-Toddler program to the following services:

• All day, quality, developmentally appropriate early child care and education;
• Health screenings, including mental health, hearing and speech, and dental, with diagnosis and referrals;
• Home visits;
• Family advocacy services, e.g., referrals and assistance with navigating the other agencies and programs available for assistance;
• Specific individual case management;
• Access to on-site, free classes and programs, e.g., health and fitness classes;
• Developmental tracking and assessment;
• Family/caregiver involvement.

Funded by United Way of the Columbia-Willamette, the Portland Children's Investment Fund and the Northwest Health Foundation, this is a three year project sponsored by Peninsula Children's Center.

Oregon State Incentive Grant (SIG)

The State of Oregon is implementing a State Incentive Grant (SIG) to develop the system of early childhood behavioral health and substance abuse prevention and treatment services in communities around the state.  The Oregon SIG project will fund four pilot sites to participate in these system development efforts.

As part of planning for the Oregon SIG project, the SIG Advisory Committee requested technical assistance and consultation from the Northwest Early Childhood Institute’s (NWECI) Scientific Affairs Committee. The NWECI SIG workgroup developed a report on its findings. To view the report with Adobe Acrobat Reader, click here: NWECI SIG Report.

Tillamook Local Prevention Initiatives

Marion County Local Initiatives

Behavioral Health Screen Tool

Prevention and early intervention services for young children need an objective measure of developmental/psychosocial health and a method of monitoring both developmental progression and the results of intervention efforts. Early identification of developmental, behavioral and emotional disturbances in infancy and early childhood has been hampered by subjective parent-report instruments, insufficient time for professional assessment and inadequate data bases of normative early childhood psychosocial and behavioral patterns.

The recent works of Stanley Greenspan, MD, Serena Weider, PhD and Georgia DiGangi, OTR, PhD have focused on the DIR (developmentally based, individual differences, relationships) model of the functional emotional and behavioral patterns in early childhood as observed by the interactive capacity of the child and his caregivers and as first described by the FEAS (Functional Emotional Assessment Scale). Working from this model with other developmental and psychosocial screening/assessment instruments, we have developed a preliminary screening tool scored from a 10 minute video segment of child-parent play.

Expected developmental interactive capacities are observed and measured for children of targeted ages of 6 months to 4 years. Preliminary efforts with this tool suggest its value for monitoring the developmental and behavioral/emotional health of the early years, and in detection of such conditions as maternal depression, autism spectrum disorders, developmental delays, relational disturbances and early behavioral manifestations of what may be precursors for childhood mental health disorders. Standardization, validity and reliability efforts of this new objective screening tool are in process.

Projects:
Cycles of Hope
Literacy in the Schools
Peninsula Children's Center
Oregon State Incentive Grant (SIG)
Tillamook Local Prevention Initiatives
Marion County Initiatives
Behavioral health Screen