How to Reach the City’s Youngest: Experts Weigh In

INFANT MENTAL HEALTH experts warn that the best way to address the city’s stark shortage in mental health services for young children is not simply to create more treatment slots. rather, attention has to be paid to placing these programs where families can find and use them. “We believe in a co-location model, where you put what we do in other systems,” explains Joaniko Kohchi, child development specialist at the Early Childhood Center of the Albert Einstein College of Medicine in the Bronx. Kohchi and her colleagues would like to see infant mental health services in places where parents with young children already go: pediatric clinics, child care centers, high school-based nurseries, family Court, foster care agencies, even in home-visiting pro-grams. “if a parent is already stressed, the chances of you getting to a clinic once every week is not realistic,” says Susan Chinitz, director of the Early Childhood Center.

As reported in a 2000 report of the Surgeon general’s Conference on Children’s Mental health, one study found that only about 41 percent of children referred by a pediatric provider for outside mental health services actually made it to intake. Putting mental health professionals where parents already are makes services easier for families to use while reducing the stigma often associated with mental health treatment, says Bonnie Cohen, director of university Settlement’s butterflies Program. This also a-lows infant mental health specialists to educate other types of professionals, like child care workers, about the often overlooked social-emotional side of infant and toddler development.

A 2012 Citizens’ Committee for Children analysis found that in the Bronx, Staten island, and Brooklyn, mental health treatment slots exist for only about 1 percent of the children ages 0-to-4 who need them. once a child turns 5, however, options for receiving help increase. Many more clinics accept children 5 and older, and with kids entering kindergarten at this age, it is far easier for professionals to identify who needs support and to provide help at school. Mental health specialists say that waiting until age 5 wastes valuable time as well as a key opportunity to help children at an age when their brains are developing most rapidly. (See “The Science of Trauma.”)

“In some ways, it’s discriminatory to only start services at school age,” says Chinitz. “Why wouldn't there be services for every age?”

A few New York City initiatives are already structured this way

• Therapists in the Butterflies Program at University Settlement work with the children, teachers, and families enrolled in university Settlement’s EarlyLearn program. One full-time therapist and one part-time therapist screen nearly 350 children under age 5 each year for social and emotional issues, support and train EarlyLearn staff, and provide therapy for children and families who need more intensive help. Many of the children they work with are Chinese-American and have recently been reunited with their parents in New York after spending earlier years with grandparents in China. Butterflies therapists help them reconnect with their parents and adjust to their new homes and country.

• The foster care agency Forestdale’s Attachment and Biobehavioral Catch-Up program works with babies between 6 and 24 months and their caregiver’s right in their homes. The highly-structured, 10-week program aims to increase attachment between children and caregivers. Forestdale’s version of the model typically works with babies in foster care and their foster parents, as well as with parents and children who have recently begun living together again after involvement in foster care. “These mothers have been brought to the attention of child welfare and feel like they’ve done something terrible and that they aren't a good mother,” says Anstiss Agnew, Forestdale’s executive director. “The model is meant to reassure and teach at the same time.”

• Recognizing that pediatricians are the only professionals to regularly see most babies, the Children’s Hospital at Montefior in the Bronx pairs an infant mental health clinician with pediatricians. At the hospital’s children’s clinic, this psychologist or licensed social worker—who has the more parent-friendly, less stigmatizing title healthy Steps Specialist—works alongside pediatricians to help ensure that young patients and their parents get appropriate mental health screening, referrals and treatment along with their physical checkups and vaccines. The infant and toddler specialist also trains pediatricians and medical students, helping to make them more comfortable in talking with patients about issues like post-partum depression, trauma and substance abuse.

• The Family Court in the Bronx has partnered with early childhood specialists at the Early Childhood Center, who provide treatment to parents of young children involved in family Court while sharing their expertise with judges and other court officials. The Jewish board of family and Children’s Services’ institute for infants, Children & families is planning a similar program for Manhattan family Court, which will be funded by the state’s office of Children and family Services.

• The Riverdale Mental Health Association (RMHA) provides mental health treatment along with services like work readiness training and job placement. Chances for Children, which works to strengthen relationships and attachment between parents and their young children, is based at RMHA and trains the association’s clinicians on how to work with the families of young children who have experienced trauma, stress and attachment difficulties.