Strong Foundations: Minnesota’s Birth to Three Institute for Healthy Development

The Center for Leadership Education in Maternal and Child Public Health, the Center for Early Education and Development, the Minnesota Department of Health, the Minnesota Department of Human Services and the Minnesota Department of Education are excited to sponsor Strong Foundations: Minnesota’s Birth to Three Institute for Healthy Development.

The purpose of this institute is to strengthen the knowledge, skills, strategies, and alliances of those who work with expectant families, infants, toddlers, parents and communities to build a strong foundation for healthy development.

When: May 30-31, 2012

Where: Earle Brown Heritage Center, 6155 Earle Brown Drive, Minneapolis, MN

Cost: $195; $165/students. Limited scholarships are available.

Register at: http://www.cehd.umn.edu/CEED/conferences/strongfoundations/default.html

Keynote Speakers include:

• Sondra Samuels, Northside Achievement Zone (NAZ) President and Chief Executive Officer

Cradle to College is the cornerstone of the work of the Northside Achievement Zone (NAZ). Focusing on the importance of community leadership and family engagement, as well as starting early (prenatally), Sondra asserts that taking a life course perspective will positively impact the achievement of all children.

• Sasha Silveanu, Washington State Family Policy Council, Policy Analyst and Story Tracker

A Powerful Framework will share examples of how communities in Washington State have applied a science-based framework to fuel practice and policy changes. Sasha and her colleagues’ work include strengthening foundations for positive early childhood development; responding to ACEs with innovation and informed care; making accommodations for people, including parents and their children, with high ACEs; and improving response to ACEs focused on resilience and positive adaptation. She will share examples from–but not limited to–the education, social work, child care, mental health, home-visiting, and public health sectors.

Contact hours and graduate credits are available (graduate students only).

Healthy Homes: Lead Poisoning

Keeping the home healthy: an environmental health issue. But should it also be a concern for MCH? Where children spend time eating, drinking, playing, doing homework and sleeping, should the MCH field focus on how living spaces may influence health? Many of the hazards that affect a child’s life course may originate in the home setting. However, should the government regulate private residencies; are they overstepping their boundaries into this sphere, or is this a case to protect a special vulnerable population?

Despite these concerns, public health officials are working to ensure children live fulfilling lives. A MCH campaign in St. Louis is working to prevent lead exposure in children. Researchers there began the Heavy Metal Project, offering low-income pregnant women free home inspections and screening. Moreover, if researchers found lead, they cleaned and covered old paint and replaced windows. Here, the project aimed to prevent newborns from being exposed to lead in the first place.

Was the program effective?

Compared to babies whose homes were not cleaned, babies who lived in homes researchers intervened in had lower blood lead levels. Visit the study’s methodologies and results at: http://www.ajog.org/article/S0002-9378%2812%2900002-6/fulltext.

Why is this significant?

Lead exposure has been shown to be related to brain damage, leading to lower IQ, behavioral problems and learning disabilities, as well as cardiovascular and immune system troubles later in life. Despite the fact that campaigns have been working for decades to remove lead pain from housing, about 250,000 children each year are diagnosed with lead levels higher than the recommended 10 micrograms. According to the Centers for Disease Control and Prevention (CDC), 24 million homes in the U.S. are still thought to have paint with lead.

In January 2012, the Advisory Committee on Childhood Lead Poisoning Prevention released recommendations to decrease the limit of how much lead exposure is considered dangerous. This was cut in half for children ages 5 and younger, from 10 micrograms to 5, doubling the number of children considered in danger of high levels.

Despite this, Congress has slashed funding for the CDC’s lead prevention grant program from $30 million to $2 million (that’s 94 %!). More and more children are now screened after age 5 for lead positioning; this is in contrast to families receiving home inspections before exposure occurs.

What factors influence this environmental MCH problem?

• Social determinants related to substandard housing
  • Socioeconomic status
  • Education
  • Race/ethnicity

• Children can also be exposed to lead via:
  • Tap water
  • Older toys
  • Jewelry
  • Soil around houses

For more information

Visit the CDC’s Healthy Homes and lead information website at http://www.cdc.gov/HealthyHomes/index.html and http://www.cdc.gov/nceh/lead/ respectively.

MCH Call to Action: Child Abuse

Child abuse and maltreatment is a silent and hidden morbidity and mortality issue today. A new report has shed light on this taboo subject, the dramatic statistics we have compared to other countries and the difference domestically between states.

Currently, the child maltreatment death rate is 11 times higher than Italy’s and 3 times higher than Canada’s. In the past 10 years, more than 20,000 children have died because of household abuse. Texas has a child abuse death rate of 4.05/100,000, 4 times higher than New Hampshire and Vermont.

So why these rates, why these disparities?

Many believe the answer is in our child protection service (CPS) workforce. Employees are overworked and the system is slow and ineffective. But as the investigation explains, these critics forget the fact that these services were made to protect children after abuse, not prevent them from being harmed in the first place.

Prevention: the key public health value. Child abuse must be seen as an issue in which the public health field can intervene, even more specifically with a Maternal and Child Health focus. What can MCH leaders focus on to help this phenomenon from continuing to escalate? What are areas with low child maltreatment rates doing that work?

1. The United States has a weak public system— our home visiting programs could be expanded, and until the Affordable Care Act goes fully into effect, we have no universal health care. Texas has low taxes, and high numbers of keeping families together. Compared to other countries, the U.S. has low taxes. Children are more likely to be uninsured, incarcerated, to not finish high school, and to die from abuse if public service programs do not have funding.
2. Child abuse has been found to be interlinked with these factors affecting families, including poverty and teenage pregnancy. When families do not have resources, education, training, or an understanding, children are at greater risk. High stress is also associated with these factors.
3. Education and training of adults who work with children. Diagnosis is difficult when injuries are internal, thus it is important for workers to understand the risks of abuse. This includes pediatricians, social workers, teachers, and counselors.
4. Cutting budgets has been the major focus of 2011, and more states are reducing prevention effort funding. Legislatures are not educated on the consequences of abuse, including the future costs to states in working down-stream. If you work with families early on, it is possible to reduce child abuse and neglect, affecting the life course. States with low child abuse rates invest in working up-stream.

We cannot lobby legislatures to increase funding if we do not have the general public behind us. As MCH leaders, we must work to reverse child abuse as a taboo and silent topic. Media campaigns, outreach, and education must be expanded. In the 20^th century, breast cancer was unmentionable, and now there is a month dedicated to battling it. Spread the word-here is the link to the BBC report: http://www.bbc.co.uk/news/world-us-canada-15288865.

New resource on childhood mental health

The National Technical Assistance Center for Children’s Mental Health has issued a new reference for public health professionals who work in childhood mental health.

Free to download here, “A Public Health Approach to Children’s Mental Health”  offers a comprehensive public health approach to children’s mental health. The guide links environmental supports, services, and interventions across child-serving systems; identifies shared language and definitions that can form a platform for communication between multiple child-serving sectors; and provides numerous examples of interventions and policies that show tremendous promise for child mental health services.

The last chapter provides community leaders with a number of strategies that put the public mental health intervention framework into action.

For more information on the guide, click here: http://gucchdtacenter.georgetown.edu/public_health.html.

For more on early childhood mental health, see our winter 2009 Healthy Generations, Early Childhood Mental Health, available here: http://www.epi.umn.edu/mch/index.php/Page/View/Resources

*NEW* Healthy Generations: Early Childhood Mental Health

Hot off the presses! http://www.epi.umn.edu/mch/index.php/Page/View/Resources.

The Center for Leadership Education in Maternal and Child Public Health at the University of Minnesota is very pleased to announce the release of the winter 2010 issue of Healthy Generations.  Each Healthy Generations focuses on a significant MCH topic and includes articles written by leaders in the field. The winter 2009-2010 issue looks at the complex issue of Early Childhood Mental Health.  You can download a copy of this and past issues at http://www.epi.umn.edu/mch/index.php/Page/View/Resources.  If you would like to request (free) copies for yourself or your organization, please send an email to Jan Pearson at pears014@umn.edu.    If you are not on our mailing list, and would like to be added, please send a request to mch@umn.edu.

Letter from the Editors

In this issue of Healthy Generations, we focus on the mental health of young children, ages birth to five. We are aware that this domain of early childhood has too often been overlooked—only recently drawing considerable professional attention. Why this lack of attention? Perhaps too many have believed that young children, especially infants, cannot experience mental health problems. Infants who cry inconsolably or preschoolers who show excessive biting have often been viewed as “going through a stage” that they will outgrow. This dismissive attitude fits the societal stereotype about mental health problems in general; that is, the tendency to ignore such challenges because a parent or caregiver does not know what to do, or worse, fears being blamed for their young child’s behavior. Dramatic advances in our understanding of early brain development, the critical importance of social environments that stimulate and nurture, and the untoward consequences when relationships to provide this care are absent or unpredictable have taught us that the developmental trajectory towards positive mental health begins early. We now know what can and MUST be done to ensure that ALL infants and young children receive what they need from their caregiving environments to develop into happy, healthy children with positive mental well-being who grow into productive, contributing members of our society.

We want to thank the many professionals who contributed to this volume and shared their expertise about early childhood mental health. We are excited to see that public health thinking is being brought to bear in assuring the mental health of our young children. To present a balanced perspective—promoting positive mental health with attention to mental health problems—we invited articles that provide examples of interventions that promote mental health,  prevent problems in high-risk groups, as well as interventions that treat diagnosed mental health disturbances—in all cases, emphasizing evidence-based practice. Other articles in this volume highlight cutting edge issues related to early childhood mental health—screening and diagnostic assessment, collaborative efforts to develop early childhood and mental health systems of care, and workforce training initiatives in Minnesota.

We are pleased to showcase the wealth of information and strength of resources presented by our professional colleagues in Minnesota. We are also very proud to share with our readers several articles written by graduates in maternal and child public health at the University of Minnesota, who are leaders in this field. As we finalized this volume, we read, with sadness, that Norman Garmezy died on November 21, 2009.  Dr. Garmezy, a Professor Emeritus of Psychology at the University of Minnesota, was considered the “godfather of resilience theory.” Among the many findings of Dr. Garmezy and his colleagues was that good relationships with adults exert an effect that is as powerful – or even more powerful  – than the mitigating effects of adversity on child mental health. His work furthered our understanding of how children can flourish in adverse environments  and continues to stimulate researchers at the University of Minnesota and across the globe.

As always, we welcome your feedback about this issue as well as topics for subsequent issues.

Joän Patterson, PhD, LP,  Julia Johnsen, MPH, and Wendy Hellerstedt, MPH, PhD