University Place

Prenatal to Five Summit

– My name is Janean Dilworth-Bart. I am the chair of the Prenatal to Five initiative and the chair of the Department of Human Development and Family Studies in the School of Human Ecology. It is my pleasure to welcome each of you to this summit, an unprecedented one-day gathering of scholars, practitioners, early childhood professionals and community members representing 50 counties. I want to be sure to show you the counties. [audience laughs] 50 counties and seven tribal nations. Also represented are over 100 agencies and a dozen institutes of higher learning. Through our work, each of us is focused on one question. How can we ensure better outcomes for our children, for all children? To paraphrase Angela Davis, we are not accepting things we cannot change. We are changing things we cannot accept. [audience applauds]

What each of you, through your work, is dedicated to changing, to improving, is the health and wellbeing of all children and families who live in Wisconsin and in our tribal nations. Together, we will create an agenda full of possibility for children, families and communities and the hope for a healthy tomorrow. Today, we will work through the barriers that stand in the way of healthy pregnancy and birth. Today, we will uncover the thorny issues that prevent children from being ready to thrive in school on that very first day of kindergarten. Today, we will talk honestly about what works or what doesn’t work in our urban, rural and indigenous communities. I also want to express my personal gratitude and the gratitude of the Prenatal to Five planning committee to each of you for being here today. There’s an enormous amount of expertise in this room. All of you here, and others not here, could provide amazing examples and insights. We hope as our network continues, there will be more sharing from individuals and groups who are passionate about the work they’re doing.

We are very, very grateful to those who worked hard to present the examples we’ll hear today. Now I’d like to draw your attention to the child resilience systems model in your handout and on the screen. Center for Child and Family Wellbeing Director, Julie Poehlmann-Tynan developed this model based on the resilience literature and your responses to our fall survey. We have organized the talks according to this model and will refer to it throughout the day. In the center, each color represents an important domain of child development, like emotional wellbeing, language development and physical health. In the circle surrounding those domains, young children’s key contexts are represented, including families and early childcare setting. In the outer ring, policies, programs and practices from the wider society are depicted. All of these contexts influence infants and young children as they develop. Our work almost always spans more than one of the domains depicted here. This model provides a useful heuristic as we start to drill down into the issues and provides us an opportunity to expand our thinking to include innovative ideas that cross domains. We’ll begin with physical health and then travel around the circle counterclockwise.

– Good morning. I’m starting the physical health section, which are gonna talk about the critical role of women’s health before, during and after pregnancy. My name is Debbie Ehrenthal. I’m an internist in the School of Medicine and Public Health and I’ve worked clinically and in research and women’s health and maternal and child health through my career. So this is the famous Time cover that helps reinforce the critical importance of the prenatal period for so many different reasons. We know that birth weight and gestational age are tied to later health of kids as adults and their educational attainment. There’s strong evidence that low birth weight is tied to future adult health and cardiovascular disease and diabetes and we also know, as was earlier mentioned, the importance of adverse childhood experiences and how they carry forward and impact health.

But children begin their lives with tremendous disparities and here in Wisconsin, as in the U.S., African American families bear an undue burden of low birth weight and infant mortality and here we see babies are twice as likely to be born low birthweight if their mom was African American. So what drives these disparities? This population health framework, developed here at UW by Pat Remington and David Kindig, does a wonderful job depicting the various contributions to health. It’s not just health behaviors and it’s not only healthcare that contributes to health and it’s critical that we remember the importance of the social determinants of health, here a portion to about 50% of health and that’s certainly true in perinatal outcomes. So, what do we know about the health of women in Wisconsin? We have data from a CDC surveillance system, pregnancy risk assessment and monitoring system that’s administered here to the population in Wisconsin and helps us understand these various contributors. Here, we see racial disparities in prenatal care here in Wisconsin. Even though we don’t have disparities in insurance, we still have access issues here and we see that African American moms are much more likely to report inadequate prenatal care. We also have information for moms who had their babies about their household income and here we see extraordinary differences in resources available to moms with young children. This figure shows that more than 50% of African American moms report a household income of less than $10,000 a year. And then finally, we have information of women’s lives and experiences.

This figure shows the stresses that women report during pregnancy and again, we know the critical importance of stress in driving adverse outcomes during pregnancy, specifically prematurity. So we know, based on all of this information from national data, from local data, and from the voices of woman having babies here in Wisconsin that we have tremendous differences and experiences during pregnancy and even prior to that and they come together in a way that has an impact on a child’s health from the start. These are some preliminary data that are as yet unpublished from a project we’re doing to try to understand what the drivers of kindergarten reading readiness is, which is the “five” end of Prenatal to Five. These are results of kindergarten reading screeners administered to all children who entered kindergarten in the public school system in Wisconsin and here we see that simply birth weight is a huge predictor of kids’ readiness for reading and here we see that babies born low birthweight are substantially more likely to be in the lowest decile at entering school. So they’re starting, bearing the burden of the adverse health outcomes of the pregnancy and their health at birth. So what kind of strategies do we have that we know work to help support moms before pregnancy, during pregnancy and in early childhood? Healthcare has no silver bullet here. There is no intervention that we know that will always prevent prematurity, but healthcare strategies are important and we saw the issues that we have here in Wisconsin just accessing care, but healthcare begins before pregnancy. Preconception care and access to family planning is critical to help women optimally time their pregnancies for health reasons and others. We have new models of prenatal care, including centering pregnancy, that work to provide improved education and also social support to women during pregnancy.

There’s a national movement and a large initiative here trying to improve quality of healthcare through quality improvement strategies. We also have prematurity prevention strategies that are developed within the basic sciences community that are delivered by obstetricians that we need to ensure women have access to. And the healthcare system beginning to really recognize the critical role of social determinants and economic issues are now incorporating the recognition of that into the way they provide care and some of the screening and connection to resources that are being done. But there are other strategies as well. Public health and social services strategies are really critical and that includes things like health insurance, WIC, safe sleep campaigns to prevent crib death, early home visiting programs, many of which begin during pregnancy and work with families and support access to resources, decreased stress and help provide education that will enable them to carry pregnancies to term and parent. Smoking cessation, back to basics. Smoking is really common during pregnancy, much more than it should be and we need to continue our efforts to address smoking. And then finally, care coordination. We talked about all these different programs, but it’s very difficult to coordinate and we’re not sure that folks are getting access to programs that will be of impact.

And then finally, we can’t forget economic supports. Poverty has a terrible impact on health and there’s an emerging accumulating and strengthening evidence that strategies such as earned income tax credit, unconditional cash support and even minimum wage impacts prematurity. So what are some research opportunities that we have here in Wisconsin to ensure that we are doing the best we can to support birth outcomes? Well, we need to be asking are Wisconsin strategies effective? Are we using evidence-based approaches and are they equitable, so do they work? Do they reach the intended population? Do some groups benefit more than others? And are the benefits durable? Do they last beyond pregnancy? So some main takeaways, then, is that women’s health impacts infant health, which impacts their health over their lifetime. We have challenges to equity in Wisconsin. There are racial disparities in prematurity and low birthweight that are persistent. We have concentrated poverty and racial segregation that impedes access to healthy communities and healthcare. And effective healthcare, public health and economic strategies to reduce prematurity require greater investment and evaluation to ensure they’re effective. So thank you so much for the invitation to present and I’m gonna let the next speaker begin. [audience applauds]

– I’m Evelyn Cruz and I’ll speaking a little about Health Equity and Title V Block Grant. I have about 16 years of working on equal opportunities and addressing inequity. And I am the Maternal and Child Health Equity Consultant, working in the Family Health section. One of the things that I want to say in following some of the important points that Debbie made is that the maternal and child health grant incorporates a life course approach. We work with partners at the local, at the state and at the national level to address social determinants of health. What I would like to highlight here is the process that we use in the maternal and child health grant, looking for feedback from our stakeholders to identify unmet and emerging needs across the life course. One of the areas that I would like to highlight and speak very briefly about is the health equity area. And the social determinants of health is one of the cross-cutting areas that we work in the life course. These are our program priorities for this five-year grant that we are on and that work on health equity really seeks to increase community engagement and leadership in order for us to be informed about what is really important and needed at the community level. These are our national performance measures, how those priorities translate into national performance measure or state performance measures, which is the case of the health equity initiative that we currently have.

And I would like to spend a couple minutes here, speaking a little bit about the Collaborative Improvement and Innovation Network topics that we have been working on in Wisconsin. The COIN, as is the short for this initiative, is a national initiative to increase innovation and learning, increasing opportunities for reducing birth inequities. One of the points of this… These are the three priorities that Wisconsin is working on and I’m working more specifically with the social determinants of health. We work, in the social determinants of health, one of the projects that we worked on was to address earned income tax credit, homestead and child tax credit. We work with a home visiting program to increase opportunities to share information about these tax opportunities with the population impacted by home visiting. We also work with the justice system reform advocates. A lot of the work in the social determinants of health is really social justice work, so we work with the justice system reform partners to increase opportunities for communicating and collecting stories that provide a link between justice reform and birth outcomes. And lastly, the initiative that we’re currently working on is a self-assessment of our state health department family health section working on our capacity to implement and address health equity initiatives.

This is the framework that we are using in order to understand and infuse health equity across all of our performance measure and all of our maternal and child health initiatives. This is very complementary because it includes the county health ranking model that Debbie showed earlier. What it does is also illustrates other opportunities to address other power structures such as social cohesion and capital, socioeconomic decision and material conditions. It also aligns a little bit better some of the isms like racism and also illustrates the political context, which is usually in the background, but we don’t speak very much of in the consequences that it has for health outcomes. This self-assessment that we’re using, which is based on this framework also is helping us understand what are the foundational practices that we need in order to infuse health equity and what those critical competencies that our workforce needs. For us, in the maternal and child health unit, we are addressing social determinants of health as a primary approach to achieving health equity. Health equity is both a process and an outcome. It really provides a path and a final destination. It’s really important to ensure that we are working with partners impacted by these issues, that we’re working across and within government agencies, in academia, businesses and the general public. Thank you. [audience applauds]

– So this is a reminder of the framework we’re working with this morning and I’m gonna be speaking to this particular pie slice, safety and material wellbeing. And the topic that I’m addressing today is poverty and child maltreatment. I’m gonna talk a bit about what we know about the relationship between poverty and maltreatment and what kinds of things we can do to address it. And, I’m Kristen Slack. I’m a professor in the School of Social Work and most of the work that I’m talking about today has been done in partnership with Lonnie Berger, another professor in the School of Social Work, who’s also the Director of the Institute for Research on Poverty, and close partnerships over the last 15 years with the Wisconsin Child Abuse and Neglect Prevention Board and the Wisconsin Department of Children and Families. So, this is a quote from the National Alliance of Children’s Trust Funds that I am framing my talk around. “There is a thin line between parental neglect of children “and societal neglect of families.” There’s three points I wanna start out by making. The first is that child maltreatment really is a phenomenon of child neglect.

That’s become more and more true over the last 10 to 15 years. Nearly 3/4 of the reports to child protection systems are related to neglect allegations and over 60% of them are related only to neglect allegations. Neglect is the form of maltreatment that’s most correlated with poverty and that’s true in numerous studies across multiple decades and it’s also the form of maltreatment that the youngest children experience most often. But when I talk about this topic, I always show this slide because I want to be very, very clear that I am not saying that most families in poverty maltreat their children; that is not the case. The vast majority of families who struggle with poverty do not maltreat their children, but when you look at it from the lens of the child protection system or even many child maltreatment prevention programs, the majority of families that touch those systems and programs are experiencing poverty or have recently experienced poverty. So there is something about the experience of poverty that elevates the risk of child maltreatment and involvement with child protection systems. How might this relationship emerge? There is some evidence that the experience of poverty and economic hardship, particularly deep poverty, can have a direct impact on child abuse and neglect risk and part of that is because when you are unable to provide even the minimally sufficient basic needs to children, it creates a situation where there’s a safety risk. A very common pathway linking these two constructs, though, is an indirect pathway, where poverty and economic hardship elevate stress in a family and that can impact families in numerous ways through parenting interactions, through the home environment and the quality and safety in that environment, through the mental health and wellbeing of the parents and caregivers. But there are two other important ways that this relationship between poverty and maltreatment can emerge.

One has to do with this sideways bar here, interface with child maltreatment reporters. I’m very careful when I talk about this topic to distinguish between child maltreatment as a phenomenon and involvement with child protection systems as a phenomenon. They are not one and the same. They have some overlapping predictors, but the kinds of things that predict maltreatment or are associated with maltreatment are not necessarily identical with the things that predict getting noticed and reported for child maltreatment. So it’s important to understand that for families struggling with poverty, there may be a surveillance effect that puts them at greater risk of being noticed and reported for maltreatment. There are also caregiver characteristics that may explain both the risk of poverty and economic stress as well as the risk of child maltreatment and that is often something we’re trying to explain away in the research that we do. But what I’m mostly focusing on today is that there are structural and systemic characteristics that lead to poverty and economic hardship for families and those are things we can change and address. They also may be related to how families interact with various systems and get noticed and reported for maltreatment. So what do we know about this relationship? A lot of what we know is descriptive and correlational, but in recent years, we are learning from more rigorous research studies that are able to identify and isolate the causal impact of poverty or the flip of that, the causal impact of economic support on preventing maltreatment.

We know that low income families are overrepresented in CPS systems and in out of home care populations. There’s been four U.S. national incidence studies of child maltreatment that were authorized by the federal government under the Child Abuse Prevention and Treatment Act in the mid 1970’s and all four of those studies have shown a strong inverse relationship between income and all forms of child maltreatment that is particularly strong for neglect. We know from the extent literature that child maltreatment report rates are greatest in communities with high poverty rates and high unemployment rates. There’s some evidence from the great recession linking increased economic hardship to increases in child maltreatment in the U.S. Receipt of public assistance and loss of welfare benefits through sanctions are predictive of CPS involvement and there’s evidence that providing economic support to low-income families reduces the likelihood of CPS involvement. Despite all of this research linking poverty and maltreatment, the central focus of most of our child maltreatment prevention programming is on parenting. So there’s parent support groups, there’s parenting classes, play groups, home visiting, respite care. All of these are very critical components of our prevention network and most have, or many have, an evidence base behind them. But what I’m here to say is that the economic safety net for children and families is a prevention tool for maltreatment and that is not always an idea that’s systematically integrated into our prevention efforts.

If families could easily access benefits for which they’re eligible and also get help accessing those benefits ’cause these are complicated systems with confusing rules and not always a welcome front door, economic hardships may decline and that has a preventive effect on child maltreatment. Families identified as at risk for child maltreatment, I believe should also receive prioritized assistance in these various systems for accessing benefits they’re entitled to receive. I often use this phrase “poverty informed” practice when I’m talking to the prevention community ’cause prevention programs deal with these issues. They do deal with these issues of economic stress and poverty, but what I’m here advocating for are systematic interventions to address poverty as part of our prevention array of services. A recognition that the U.S. economic safety net is very complex, disjoined and it changes over time as your children’s ages change, as your family’s structure change, as your employment situation changes and families need help navigating this. It’s also really important to identify families for whom interventions to address poverty and economic stress are the primary solution for interrupting maltreatment risk. We don’t wanna see families in child protection systems if all they need is help with their economic stressors. Poverty informed practice can take many shapes and forms. These are just a few ideas of how they can be implemented.

I think it’s important to acknowledge with families that economic hardships can affect parenting and relationships in the home. To listen for sources of economic stress and when you identify them, consider how they translate into a risk for safety for children. Probe about the degree of control a caregiver has over these kinds of hardships and understand the benefit systems that families are trying to access, all in an effort to make poverty-informed decisions and advocacy efforts on behalf of families. The main takeaway I want to just leave you with is that the economic support systems and all its various components can prevent child maltreatment and so I think it’s really important when we change policies and programs on the economic safety net side to consider very carefully how that will affect the risk for maltreatment among low-income families and other families as well. We need to view our social safety net as a necessary and integrated component of child maltreatment prevention efforts. Thank you. [audience applauds]

– Good morning everyone. My name is Joshua Mersky and I am an Associate Professor in the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee. The title of my presentation today is Embedding Home Visiting in a System of Care: A Population Health Approach. I don’t think I could’ve been set up better today than to have Kristy go before me and I think a number of the themes that she highlighted will come out in my talk. In addition, I’d like to acknowledge some of my colleagues, a couple of whom are here with me today. Dr. James Topitzes, who is also with me at the Helen Bader School of Social Welfare and in the Institute of Child and Family Well-being at the University of Wisconsin-Milwaukee. And I’d also like to acknowledge Jeff Langlieb as well as Margaret Gesner from Central Racine County Health Department. I’m gonna be talking about a really exciting project, something that I’m excited about today and we’ll get to that in just a moment. My objective first is to talk about home visiting services. Home visiting has been invoked multiple times already this morning. I want to talk a little bit about the basic question, why. Why home visiting? First of all, it’s a flexible mechanism of service delivery.

You can do a lot of things if you serve families in their home. It’s really good for families as well ’cause it’s very convenient to be served in their home. They’re also advantageous because these services are often directed to families who have the greatest needs in our society. These are often directed toward families who are economically disadvantaged, typically, women who are pregnant or who have young children, so they serve families who are vulnerable at a particularly vulnerable time in the life course, in a sensitive period in the life course. And we also know that these programs, another reason why home visiting is important, we know that they work. We know that when they’re delivered with fidelity and as evidence-based programs, we also know that they have the potential to effectuate change in a number of domains that we consider to be important, many of which we’ve talked about already today. Maternal and infant health, positive parenting practices, whether we’re talking about something like child abuse and neglect that Kristy just talked about or even more broadly, thinking about attachment processes and positive sensitive warm parenting processes. In addition, they have been shown to promote child development as well as school readiness. So these are really important programs within our society.

Another reason why we wanna focus on home visiting is because the federal government has invested a significant amount of money, based in part on the evidence to date. Since 2011, the federal government has invested over $2.5 billion through the MIECHV program, the Maternal, Infant & Early Childhood Home Visiting Program and Wisconsin has received over $45 million through that mechanism to support its Family Foundations Home Visiting Program, FFHV. The FFHV program is a partnership between the Department of Children and Families and the Department of Health Services and it primarily serves economically disadvantaged families throughout the state of Wisconsin. 98.3% are at or below 200% of the poverty line, well over 70% are actually below the federal poverty line. Now, these programs are wonderful. They have a lot of great potential to improve outcomes for children and families. There’s a challenge, though, and I want to acknowledge all the great work that my partners at the Department of Children and Families and the Department of Health Services have done to help build a really robust infrastructure for long term home visiting services. All of the Family Foundations Programs that are supported here in Wisconsin, like the Nurse Family Partnership Program, like Healthy Families America, they’re all designed to begin prenatally and serve families for a long period of time, up until children are two or three years of age and that’s a wonderful approach. That being said, we have a population health challenge here.

Because of their cost, because of the duration of these services, they’re very difficult to scale up and to serve lots and lots of people and so if your goal is to prevent child maltreatment or reduce the rate of child maltreatment in society, you’re up against the numbers game and how is it that we can take this model or this approach to serving families and get it to more people? Just to illustrate what I’m talking about here, I want to highlight the number of families that have been served by the Family Foundation’s Home Visiting Program over the last three years. You can see that roughly 1,900 families have enrolled over the last three years. That’s roughly about 630 per year. At this projected rate, we’ll serve roughly 10,000 families over the next 17 years and yet right now, we know that from ages birth through 17, there are over half a million children ages birth through 17 who are either poor or near poor. So what this tells me is we have a wonderful mechanism of service delivery that can produce lots of positive outcomes for children and families, but we’re only scratching the surface. We’re only beginning to understand the potential of what this mechanism of service delivery can achieve and until we take a more population health approach to couple with that long-term home-visiting approach, we may not be able to move the needle on some of these population health outcomes. So there’s a particular model, one particular solution and there are many solutions you’ll hear about today. There’s one particular model that I’d like to highlight. It’s called Family Connects, formerly known as Durham Connects.

This was developed by Dr. Ken Dodge at Duke University. The philosophy of this program is sort of a balance between equity and equality. It recognizes that most families with newborns need some support. As a parent myself, I can remember it very well, but that some parents need more support than others. And so they developed this low cost, brief, universal home visiting program that costs roughly $700 per family on average and they reach all families that give birth within a particular catchment area and they offer them home visiting services and all families are eligible to receive at least one visit, but then it’s a triage model and those families that have greater needs receive more services than families that have less needs. What are the basic services provided? Families that agree to participate, and roughly 80% of families that are offered a home visit agree to one, what do they begin with? First of all, assessment. A basic assessment within the home. It’s actually a fairly lengthy assessment of the family’s needs and strengths. They use that process, not just to gather data on people, but to actually start a conversation with them, to dialogue with them and to help the family make connections between their needs and the potential solutions to those needs.

And so they engage in anticipatory and supportive guidance and then what they do is they link families to services within their communities. Before the program even begins, the model dictates that you have to engage in a really robust community scan and community service linkage process. The model emphasizes linking families, not just with pamphlets, not just with handouts, but with actually warm referrals, where the home visitor then ensures that those families actually get connected to a live person on the other end. Now, there’s good evidence to support this model. There’s a randomized controlled trial that demonstrated that the model produced a range of significant benefits, including reduced emergency infant care, including increased father involvement, improved maternal mental health, et cetera. Based solely on the findings for reduced emergency care, this model returned on investment three dollars for every dollar that was spent on it. So it’s not only effective, but also cost effective. Now, what we’re doing in this particular project that I’d like to highlight called Family Connects Racine County is we’re gonna replicate that model here in Wisconsin, in Racine County and we’re gonna innovate a little bit within that framework. We’re gonna pair a trauma screening, brief intervention, and referral to treatment protocol, T-SBIRT protocol.

This protocol is exactly what it says. It is gonna try to attempt to address some of the trauma and exposure and symptoms that many of the families that we interface with experience and that help to explain a lot of why they’re at risk for poor outcomes. This model is based on the well known SBIRT protocol that is a gold standard for treating alcohol use disorders. In this case, we’re overlaying this model, which was developed by Dr. Topitzes. We’re overlaying that framework with trauma and what does it do? First off, we screen for trauma, trauma exposure. We also screen for trauma symptomatology, right, and then we engage in some brief motivational interviewing and then refer the families to treatment if they need mental health treatment within the community. We already have three different mental health service providers in the Racine community that have signed on a memorandum of understanding with us for this project. So the question is why address trauma? Why are we importing this model within the Family Connects model? Well, first of all, trauma’s really prevalent. This is data from the Family Foundations home visiting program.

This is over 1,500 women that have received services. We’ve talked about ACEs already this morning. Look at the rates of ACEs in this population. Almost 40% reported that they have been physically abused, 50% reported that they grew up in a household where substance abuse occurred and almost 38% reported they grew up in a household with an incarcerated household member. Those rates are astronomical. The incarceration rate is over seven times the rate that was found in the original ACE study. So not only are ACEs prevalent, but we also know that they’re consequential and that’s why we want to address them within this framework and so what we’re gonna be doing is partnering with Ascension All Saints Hospital in Racine County to reach roughly about 1,500 families per year, potentially. Roughly 60% of them are Medicaid or Badger Care eligible, so they’re majority economically disadvantaged and ultimately, what we want to be able to do is scale this up even further in the coming years so that we can reach the entire county, serving 2,400 families per year. Now if that wasn’t bold enough, if that wasn’t ambitious enough, we’re also in the process of developing a new initiative in Racine.

It’s a community-wide initiative to create a trauma-informed systems of care and this initiative is being backed by the county executive of Racine County, Jonathan Delagrave who has recently announced in his state of the county speech. And Family Connects is gonna serve as an initial cornerstone of this community-wide initiative to develop a trauma-informed system of care. And the goal is, of course, to promote population health and well-being across the life course, but we’re gonna be starting, again from prenatal to five and why are we gonna be starting prenatal to five? Well, you already know the reasons for this. But here’s the punchline. It’s because it makes sense. It makes sense in terms of its effectiveness. We know that early childhood interventions work. We know that they’re not only effective, but they’re also cost effective and so, we’re looking forward to telling you more about this initiative in the not too distant future. Thank you. [audience applauds]

– All right, re-centering us here. And today I am going to speak about the purple piece of pie and live there for the next couple of minutes, which is talking about learning and development. Specifically, I want to focus on what’s happening with our kids every day of the year, where they’re living their lives, where they are experiencing learning and development and that’s in childcare and so I want to speak with you today about what is required to have quality childcare, which is taking care of the teachers that are educating our youngest children. My name’s Ruth Schmidt and I am the Executive Director of Wisconsin Early Childhood Association. Today, I want to focus on three things. I want to talk about where our children, primarily age birth to five, are living their lives. Who are they spending time with and who’s educating them. And why, if we don’t pay attention to these two things, we’re gonna face a real crisis in childcare in the state of Wisconsin and we’re experiencing that nationally also. And so I’m gonna present some compelling data to you, primarily to point to the struggle that we face to provide our youngest children with, getting back to our purple pie, optimal learning and development. I want to work from the premise that teacher well-being drives high quality learning and development for children.

So if we’re looking for optimal learning and development, we really need to focus on the teachers that are providing the care and education. UNICEF has done some studies and releases some important data that I think we need to pay attention to. In looking at the 29 wealthiest countries in the world, the United States ranks 26th in overall child well-being. We rank 22nd in childcare quality and we rank 16th in childcare affordability. I don’t know about you, but I think this is stunning data and I think it pushes us to wonder why haven’t we, as a nation, figured out how to change the trajectory that we’re on and what this data says about us. So, originally, it was gonna be seven a.m. and I was gonna ask do you know where Wisconsin’s children are, but right now, it’s about 10:20. [audience laughs] And so I want to talk about where are our kids and who are our kids, all right? And what we know is that in Wisconsin, there are close to 440,000 children age four and under and almost 75% of them are getting some sort of care and education regularly outside of the home and so what does that look like? Where are those kids? So we know that about 51,000 of them participate in four-year-old kindergarten programs through our school districts. We have four-year-old kindergarten in probably 95% or better of school districts in Wisconsin, which is wonderful. We know that between 16 and 17,000 of them are in Head Start a great opportunity for low-income children.

And then we know that there’s this population of about 260,000 of them that are in child care. That’s a big number; I want us to think about that, 260,000 kids are spending up to 50 hours a week in their waking hours, primarily, some of them nap, but a lot of them, it’s 50 hours of waking time that they’re spending in child care and who are the people who are educating those kids? So, there’s a workforce of about 22,000 people in Wisconsin that are educating our youngest children. My association, Wisconsin Early Childhood Association, worked with COWS to release this study in 2016 that looks at the child care workforce in Wisconsin. What we find is that over half of them have an Associate’s degree or better, which exceeds the overall workforce in Wisconsin by about 12%. So about 40% of the overall workforce in Wisconsin has an Associate’s degree and people who are working with our littlest kids, over half of them do. However, when we pair education with compensation, what we find is that early childhood educators with an Associate’s degree in Wisconsin are making $10 an hour and you compare this to overall people with an Associate’s degree in Wisconsin who are making about $18 an hour. $10 an hour is just under $21,000 a year, that the majority of our childcare teachers, our early childhood educators are living on. Very close to the poverty rate if you have a family. We also know that in Wisconsin, 36% of them have some source of public assistance that they rely on on a regular basis.

If you also look at when you get early childhood educators with a Bachelor’s degree, which is about 22% of them, they’re making a whopping $12 an hour compared to $22 an hour for the overall workforce in Wisconsin. So you take education and you take really cruddy wages and you pair those, what do you end up with? You end up with a system in Wisconsin where we have an excess of a 35% turnover rate for all early childhood educators in the state, so this group of 22,000 people that are educating our youngest kids. Now I don’t know about you, but when my children were very, very young, I relied on the relationship that they developed with their early childhood educator, the attachment that they formed with that individual, to keep them safe, to make sure they felt safe, nurtured, formed that critical relationship that kids need for all early learning and development, really laying that social and emotional framework of what kids need and what we’re finding is, we have this incredible churning that’s happening in childcare and that stresses children. It creates a sense of loss. It impacts teaching practices. It hurts child outcomes and all of these issues just boil up to the surface. And so what we know is that teacher well-being, optimally would mean fair compensation and access to ongoing professional development and education. We know that a skilled early childhood education staff have the incentive to stay and commit to providing stimulating, supportive environments for children. But the challenge before us is to focus on this issue of equity and access and think about the question of how can we as a society, as a state, develop the economic will and the political will to ensure that children get the education they need because they have teachers who are adequately compensated and educated to stay in this field. [audience applauds]

Thanks for that. [audience laughs] And now I just want us really quickly to look at where is our money going in the state of Wisconsin? So if we look at investment of our dollars into educating our kids, we know that the average child in the K-12 system in Wisconsin is funded about slightly over $12,000 a year. The average child in four-year-old kindergarten and four-year-old kindergarten is part year, part day, is funded at about $5,700 per year. The average child in Head Start, we’re funding through state, federal, local initiatives, to the tune of about $8,000 a year. And child care? When we look at all the dollars, all public dollars coming into the child care system is about $750 per child. So we have this dramatic disparity happening with where we’re investing our dollars into educating our youngest kids. As Josh had pointed out early, Dr. James Heckman at the University of Chicago, Nobel Prize winning economist, has said that investing in early childhood education is probably the absolute best thing we as a country could do with a return on investment of seven to $17 for every dollar that we invest in our kids. And so throughout the day today, I hope that we can take the time to talk about what strong policies would look like and what a strong public investment would look like into improving our system of early childhood education so that our children do have optimal learning and development when they’re living in that purple piece of pie. So, thank you. [audience applauds]

– My name is Nar Doumbya. I am currently the Professional Development Coordinator at Wisconsin Early Childhood Association and I’m gonna be talking about relationship and identity. And I am a Professional Development Specialist and Coordinator at Wisconsin Early Childhood Association. And I’m super excited to be here today because these are hands down some of my favorite topics. How to enhance relationships with children and families and how to support cultural identity and I’m specifically interested in the idea of cross culture teaching. How can we support children and really support their development and their growth, regardless of what culture, identity, or community they come from. So, relationship, I believe, is one of those things everything starts with good, solid relationships and when we look at child development, we know from years of research that children learn in the context of healthy, happy relationship and some of you might be tempted to say we do not need research to tell us that because we have been in early childhood classrooms and we see that, for infants and toddlers first of all, when you walk in the classroom, the relationship is the curriculum. We’re nurturing children, we’re responding to their needs, and we’re there available to create this sense of trust and security that enables them to venture and learn. And with preschool children, the relationship that we learn, that we develop with them informs the curriculum, whether we’re making decision in planning or instruction, it’s all about relationships.

So relationships do matter and when it comes to culture, the relationship is even more crucial because when we look at children in families, usually what we see about the culture is that overt aspect. Their behaviors, what they wear, what they eat, but what we don’t see, that we can only access through relationships, is the deep culture that life experiences, religion, thoughts and perspectives and this really helps us understand children. This helps us know how to plan for them in an equitable way because when we know the parents’ goal for their children, when we know their strength, when we know their challenges, that’s what we can use to provide an equitable environment. So relationships are really not just to be nice and warm and friendly, but they have to be deep because they do serve a purpose in supporting children’s healthy development. What we do at our work at Wisconsin Early Childhood Association, we’re really into this concept of supporting cultural identity and also how do we do that because a lot of the time we go in a classroom and it gets simplified, it gets really lost. So first of all, we come to the premise that children’s cultural identity have many facets and then we have to pay close attention to all of those. We have to support that developmental niche and we’ve heard from many speakers today how supporting families really enhance child development with all its aspects. So we know that the developmental niche greatly impacts children and how they view themselves because the parents’ belief, their attitudes, everything about the family really impact how they view child rearing practices. So we have to know the families to know what those child rearing practices are and its significant others in children’s life.

We all have a responsibility as teachers, as administrators, to make sure our environment are sending the right messages to children. And it is children’s life experiences. A child that’s born in an affluent family might have a different perspective from a child that’s born in stressful environment. So it is also the children’s cognitive development. When I’m having these conversations about race and social identity with children, I want to make sure that they are developmentally appropriate and it is the larger society and we usually see a lot of negative attitude and stereotypes when it comes to children of color and minority children and it is our role for teachers to really step back and say what is the message that these children are receiving outside and how can we support an accurate understanding of the events that are going on and support them really have a good sense of self. And I want to finally talk about this cross-cultural teaching and we know from research that I don’t need to be African American to be effective with African American children and we also know that children form attachment with people from different cultures and different races. So what we know from effective cross-cultural teaching and this comes from the research of Noguera and Blankstein and they tell us that it is really those teachers that spend time in critical reflection to really think about what they bring in the classroom, as far as their own culture. How they communicate with children, how they communicate with families and it is also those teachers that are aware of their biases and willing to unlearn them and when we’re talking about biases, we’re also focusing on implicit biases because those are very pervasive but yet you can unlearn them. So it is those teachers that really make a difference in teaching children from other cultures.

And of course we know with the content knowledge, we have to know child development, we have to know developmentally appropriate practices. We know cultural competence and I always use the term competence lightly because I know the culture’s very dynamic and we have to always be open to learning and growing and relevant learning materials. And in our agency, we have courage to explore, which really highlights the best of relevant learning environments and materials because when you go in an early childhood classroom, more often than not, relevant learning material equates how many pictures of minority children do I have? How many bilingual books do I have? Even though they’re usually a translation of Goldilocks and the Three Bears. Or how many cultural nights do I have during the year? But we want relevant learning materials to go beyond that. Are we telling children about their stories? Are we telling them about their cultures? Are we telling them about topics and perspectives that really matter to them? Are we telling them about the story about the great people in their culture that are making a difference in their lives and in the lives of others in the community? So we really want to go deep involving learning materials and then also having conversations with children about ways, about social identity because at the end of the day, those are the things that matter. When I walk in the classroom, I don’t necessarily look at a picture of an African American female to say, “oh, I’m comfortable.” It is what the teacher does and says that make me comfortable. So really, we try to go beyond that and we always say that cultural responsive teaching circles back to relationships, that idea of understanding children’s deep culture because it’s that comprehension of the challenges that the children bring in the classroom that will help us create equitable learning environment and it is also circling back to relationship because when we have partnership rooted in respect and trust with the families, that’s when they can open their cultures to us. So that’s it for me. I want to thank everybody for having me. [audience applauds]

– [speaking in foreign language] You guys feel like it’s stretching out? My back was hurting me. [audience laughs] Long morning, but very, very important morning and I wanted to thank for the invitation to speak. I am not a professional speaker, but because of the situations that I am living with, the families that I am helping or trying to help, I think, as a good social worker and advocate, I should be here and talking to you all. [audience applauds]

Thank you. So, my name is Fabiola Hamdan. I am originally from La Paz, Bolivia. I been living in Madison, Wisconsin for the past 37 years and this, a month or so ago, I went back to Bolivia after 27 years, taking my 18 year old for the first time and I am still in a bubble right now because I really learned that I really, very much acculturated to this country and to Madison, which I love and so I just wanted to share that with you. Yay! [audience laughs] So, I am a Community Social Worker. I work with a program called Joining Forces for Families. For those of you that don’t know, this program is out of the Department of Human Services.

What do we do? Connect families with resources and we have something that’s called open door policy, so I go to my office and the door is open and whoever comes through that door with whatever needs they have, I try to help. Also, it’s non-mandated, which is wonderful because I think one of the reasons that I wanted to become a social worker was that I want to impact or help somebody to change without really having to deal with courts or people coming to see us and saying okay, I’m gonna tell you what you need to hear so you can help me and then once that help is done, go back to square one. I’m gonna talk a little bit about the Formando Lazos Platicas workshops, the facilitated dialogue model that many of you probably hear. I like what you said about cultural competence. How many times do we have to hear that and we read in books and things like that, so for lack of a better term, I think I wanted to tell you that I think no matter how much we read, no matter how much we think we know about to be competent in a specific culture, I feel that we’re not gonna be completely culturally competent in anything because it’s a developing process, exactly what you had explained and I think, for me, what I wanted to tell you is that I wanted to share with you my experience as a community social worker. Not as a Latina because the Latino population, we come in all kinds of different forms, shapes, educational backgrounds, so on, right? So, really to tell you my experience and not generalize all Latinos because we’re not the same and that’s why I like this picture because you can see all kinds. You know, this is a family and you see different colors, shapes and all of that. And this audience, I see a lot of people that I have learned a lot from you and I don’t have to lecture you in cultural competence and all of you know that the Latino population is growing rapidly. In Wisconsin, it’s not an exception and we have a lot of needs and I think we have huge gaps of services.

I’m gonna skip to that one, otherwise, my five minutes are gonna be done. One thing that I learned doing this job is that you have to work outside of the box and do and initiate and create some different type of programs and not do the same old, same old because sometimes it doesn’t work. Many of us know that. So let me tell you a little bit about this Madre de Esperanza, Mother there is Hope, campaign that in 2008, the Perinatal Foundation, the Latino Children’s Families Council and the Latino Health Council came together because there was a grant for $15,000 and the Perinatal Foundation came to us and said hey, how can you use this money and how can we help and we haven’t really heard about the postpartum depression in the Latinas and I myself was like, okay, right. I was intrigued about that because at that time, I already had my first child, but how do we do? How do we talk about it and there was not much research. We looked and looked and there was not much out there about postpartum depression with Latina women. So what we tried to do… So then, we were eating in a restaurant and we saw the waiter in this Mexican restaurant. We talked to her about…

She was expecting a baby and if she knew anything about postpartum depression and so on and she was like, “What’s that? No.” Anyway, so trying to figure out how are we gonna do this campaign. First of all, if you do a campaign and you said hey, there is a problem here and how are we going to tackle this problem, but at the same time, you have to have resources, right? And that time, no resources were available as well, so we created a soap opera or radio novella, very common in Latin American countries, where we had a family, a fictitious family that was a young couple with two kids going through these changes with the wife. The wife didn’t want to breast feed… We just kinda got the point about postpartum depression and what things we experienced. We put it in a novella, radio novella and five episodes. First episode, the husband will come and say, “Hey, how come you’re not changed? Look at the house, it’s a mess. You’re not feeding the babies” and all of that. The mother-in-law, and this had to be culturally competent, so the mother-in-law came along and is like, “Is she going crazy? What’s happening?” [audience laughs] Sister-in-law will come, she will be like, oh I heard that something about postpartum depression and maybe we can attend to whatever meeting. So it was a soap opera.

You know how that goes. And then the baby crying and all that. So, we put that in the first two episodes and we are airing this in a radio station, La Movida, which is the Spanish speaking radio station here in Madison. And then, so… At the same time, we’re talking about, with experts about the science of postpartum depression and what some people experience and so on, so forth. So it’s educating. At the same time that we’re airing this, we had talked to the breeding hospitals here in Madison and said how can we help and reach out to Latina women that are having babies and maybe are experiencing these symptoms, but they don’t know. So, somebody came up with the idea of creating a CD. So we did a CD with some songs and then at the end, at this time, we already talked to other agencies that will provide services and resources for women experiencing this.

So we had the resources, we had the CD and we’re airing the radio novella and at the end of every episode, we’ll say if you know of somebody having these type of issues call to this number or do this, so that was really, really great. As everything else in this life, it ended because we didn’t have enough money and we were very low in resources. So, basically, I think with this, we did a very nice campaign. I shared this with you because I know here in this room, maybe there is something or some agency or somebody that could do this type of campaign, this type of assistance. Remember, somebody said give me the babies before they are born and then we have to start there, right? So I will be more than happy to share more information about this initiative that we did and it was really great. Now, the part that I was talking about, barriers, access to services and we are hearing already, how difficult it is to access good services, quality child care, so on, so forth. Now you have to put another barrier amongst the other barriers when you are an immigrant that don’t have documentation and you don’t have the ability to apply to different programs that exist. Let me tell you something, about a year, well, sometime ago, I think couple people already heard this story. I was going to a presentation and I was in the interstate, driving and then practicing my presentation and then suddenly, I realized that I changed purses and that my driver’s license was in my other purse.

That moment, I freaked out. I was like, “Oh, my God, my driver’s license. Now the police is gonna stop me.” All this stuff that comes to your mind and you don’t realize because it’s given that we have a driver’s license, we are documented and you don’t think about those things. So when I was driving, I slowed down right away. I was looking everywhere. Forget my presentation because I was thinking I’m gonna get stopped and of course, you know, they’re gonna give me a ticket and I’m practicing what I’m gonna tell the police. So unreal, right? Of course, I went home, tell my husband and we laugh about, like, I was really panicking, but I tell you this because it is real. To live in the shadows and to wake up in the morning and have the first thing in your mind about what’s gonna happen if I get picked up by the police and then immigration and all of that. So I think, especially nowadays in this anti-immigrant political climate that we are living, not only Latinos, but all immigrants that do not have papers, have to…

It’s really… It’s hard for me to even explain with words. I have lots of stories. My recent one, this dad had immigration appointment in Milwaukee as every month because he’s fixing his immigration documentation. He took his nine year old to the office and said, “Son, I’m gonna go inside. “if I don’t come back in about an hour and a half, “you know, you’re gonna call mom because they may detain me.” Nine year old. What’s happening with this kid, right? It’s all, “Oh, my God, my dad’s gonna get detained.” So a lot of this trauma that we’re creating on top of all the other traumas that we have is really, really sad. I could talk a whole day about this, but I wanted to just share that with you and things about isolation, lack of access, we’re gonna hear about quality child care, housing. You know how housing is, right, especially here in Madison, really hard.

I have families that are doubling up, tripling up and I have a mom that had a baby and had to take the two daughters with her to the hospital because she wasn’t gonna leave them at home with other roommates, they were males. So there are lots, lots of stories that I can tell you and as I said, I can stay here forever. Learning about Latino cultural values and behaviors improve the health and wellbeing for children and families. And this is really true. I think for all of us, you’re in government, service providers, really this is the time that I encourage you to learn a little bit about this very broken immigration system we have. It’s gonna impact a lot of families, our immigrant families because right now, our families are not… Even the food pantries, Latino families are not attending because sometimes they ask for ID or Social Security cards. So it’s impacting already and then how about domestic abuse, child abuse, all of that. Do you think that people are gonna come and report those things? People are really afraid and it’s real and I think it is very important for us, especially if we are service providers, to learn about some immigration laws. What is the bow wow, what are DACA, what are all these– This is stuff that’s happening. It’s super important to do that. I skipped a lot of my information because it’s only five minutes, but I wanted to thank you and [speaking in foreign language] [audience applauds]

– Okay, the title of my slide is actually called “Mental Health – It’s Not One Journey” and I titled it, “It’s Not One Journey,” because even though people may have similar diagnoses, mental illness actually impacts everyone and all families in a different way. So no one journey is the same. So I just wanted to be mindful of that. And my name is Corinda Rainey-Moore and I work for Wisconsin Council on Children and Families and prior to that, I worked at Journey Mental Health Center for 21 years, so I worked in mental health as a total for 27 years. And what I want people to know about mental illness is that it is a health condition and most people treat it as if it’s different than any other health disease, but it’s really not. It’s very much similar to other diseases. It is a brain disorder and so when you look at the brain, you can tell by how the brain is shaped and formed whether or not somebody has mental health issues.

And I put this slide up here is because just like cancer, there’s many different types of cancer. There are many different types of mental illness and so Bipolar Disorder, PTSD, Major Depression, Schizoaffective Disorder, Anxiety Disorder, eating disorder, OCD and what people don’t know is that when you see people who come into the ER, a lot of times they’re coming into the ER because they’re having anxiety disorder and they come in because they think they’re having a heart attack or they’re experiencing chest pain, which anxiety disorder actually is a tightening of the chest for a lot of people and they feel like they can’t breathe, but that is one of the major reasons why people are entering the ER’s. And so there are many variations in how depression appears for people. It doesn’t appear not just one way and when we look at some of the ways that trauma impacts people and you heard earlier, people talk about the impact of housing, poverty, lack of transportation, lack of access to treatment, those are all risk factors for major depression and we’re seeing an increase in suicide because of it and also when you think about the race equity report, the race equity report talked about many of these disparities that we talk about as preceptors for mental health issues, so when you think about that… that third grade, they’re saying that they can tell whether kids are going to prison or not and we know that people who are in prison or in jail have a high risk of getting mental health issues as well. So what I want people to know is that statistics tells us that one in four people will be affected by mental illness so when you think about yourselves and the number of people in this room or even counting off the people at the table with you, one in four people, one of you will have some type of mental health issue, whether it’s depression, whether it’s schizophrenia, whether it’s bipolar disorder and what we know is one in five families are gonna be affected by mental illness and what that means for our youth is that there are 20 million youth in this country that are affected by mental illness and what we know is that suicide in the age of 14 to 25 is the highest form of death for people in that age range. We also know that approximately 15% of students age 14 and older who are living with mental illness drop out of high school, so we talk about lack of education, there’s that risk factor once again. We know that this is the highest dropout rate for any disability, so when you think about all the disabilities that’s out there, people with mental illness has the highest dropout rates. So youth with unidentified and untreated mental disorders also end up in jail and prisons and we talk about access to mental health so part of why people don’t seek access to mental health is primarily because of stigma and you tie stigma with race, you get a double whammy.

And when people say there’s no stigma, stigma has been decreasing, well, it’s true. Stigma has been decreasing, but I can guarantee you stigma still exists today and one of the reasons I’ll tell you is I’ll give you an example. I was walking into Journey Mental Health Center one day. On West Washington Avenue, there’s a gas station across the street from Journey. One of the members of the community saw me walking into Journey Mental Health Center. She didn’t know that I worked there. So when I saw her the very next day, I didn’t even know she had seen me walk into the building, but when I saw her the very next day, she walked up to me and what she said was, “I saw you walking into that building “and what I wanna know is are you one of them?” And my mouth did exactly what your mouth did. My mouth actually dropped open, because when people see you walking into UW-Hospital or Meriter, they don’t say anything about, “Are you one of them?” or “Do you work there?” And I just couldn’t believe that that was a person that was in the community that actually had asked me and when I went home, I was talking to my husband about it and he was like “Well, what did you say?” I said, well my mouth was so frozen that I couldn’t even speak because I just couldn’t believe that that person had the audacity to ask me that and it just so happens that I was an employee there, but imagine what I would’ve felt like had I not been an employee there and had I not been walking in there for services. And then Madison is a very small community, so what I often say is when the guy talked earlier about home access and home care, I did work in the community and I did a lot of work with people in the community and when we have these social work standards that says how you’re supposed to act as a professional, Well, for people of color like me, when you’re working in the field, that doesn’t work.

And it doesn’t work because you’re gonna know somebody who has mental illness, whether you see them at an event or a family function. And you’re just gonna see somebody who you know that’s in the field, but it’s also when we talk about mental illness, one of the things that I often say too is it’s also the choice of language that we use and our choices affect how we treat people. So when we talk about stigma, stigma is also the language that we use, so for me, it’s really coming from a strength-based approach, acknowledging people’s strengths rather than their weaknesses and calling people, not by their diseases. If they have a mental health issue, we have a tendency to call them by their disease, which means that we take away all of the person’s identity because people are more than just their diagnoses and when you see somebody with cancer, we don’t say that that’s all of somebody with cancer is. We expect that those are people with hopes and dreams, just like everybody else and people with mental illness are no different. The other thing that I would say is that as we think about suicide prevention, especially, particularly in communities of color, we don’t want to acknowledge that they exist, but they do exist. I remember when I was doing my first prenotation around suicide, one of the persons that I know very closely said, “Well, why are you talking about suicide? It doesn’t happen in our community.” And what I said to her is that suicide is real and it’s happening with our youth and more and more of our youth are coming to the ER, like I said earlier, with suicide on their minds and they’re starting younger, even at the age of 12 and 14, we’re starting to see children who are affected by mental illness and what I said to her when she asked me that, I said, well, remember, you may not know this, but where do you think this guy that was going to your high school, where do you think he ended up? Because what happened was the guy broke up with his girlfriend– his girlfriend broke up with him. So, he went home and actually shot himself as his brother was walking through the door. So when we think about trauma, so not only did that affect that life, but think about the brother who got there a little too late to save his brother.

And I said, well, where do you think that guy went? And she was like I don’t know. I said, yeah, because he committed suicide and you didn’t know that because we don’t talk about it and this community, we don’t hear about African Americans who commit suicide in the communities, but when those incidents happen in McFarland and those are all white students, we did hear about them. They were on the news. They were in the newspaper. But when that incident happened with that young African American boy, it wasn’t talked about at all. So, she didn’t even know where he disappeared to, because he wasn’t at school the next day or any other day since then. So it is something, for me, that we need to talk about. So when I say where do we go from here? One is we know that education is a game changer for people. So we have to do a better job of educating our youth, not just about the things that they need in order to thrive in our communities, but we also need to do a better job of educating them about their illnesses and educating their families. We have to treat the whole family.

If somebody has cancer, we offer support to the whole family but oftentimes, we don’t offer support to the whole family if they’re affected by mental illness. We want to treat the person, but not the whole family. So we have to use education as a game changer, not just because it changes people’s trajectory, but it also puts people on the path to actually having a quality of life that we all want. We also have to see that treatment and recovery are possible and there are different methods and mechanisms for treatment and sometimes it includes medications and sometimes it may not, but we have to treat the whole person and not just that illness. We also have to know and recognize that help is available and help comes in all forms. One of the things that I say to my clients is that you might see me as an African American, but oftentimes, there’s not gonna be somebody who looks like me when you come into the office and that is because there’s not a lot of us who work in the field that look like me and just because they may not look me don’t mean that they don’t have the skills and the tools to be able to treat you. So be willing to actually give people a chance, regardless of what they look like. Now, if they prove you wrong, that’s one thing, but at least be willing to give people a chance and sometimes you have to train people into how you want them to work with you. We also have to dispense our judgment about what that looks like and we have to dispense our judgments about mental illness.

We also have to suspend our judgment because sometimes, we often blame people when they come to us for services for why they drop out of services. And sometimes it’s for their own reasons, but sometimes it is some of the behaviors that we are displaying to them that makes them feel that we’re not welcoming to who they are as a person and to their culture and to their language. As I said earlier, we also need to change how we talk about people. We need to talk about people from a strength-based approach and know that they’re more than just their illness, that there is a person behind that. Oftentimes what I do so that I create the environment where people recognize people for more than their illness is that I oftentimes create spaces where those people are at the table to talk about their illnesses, to talk about what kind of treatments they want, to talk about what’s gonna make their lives better, but to also give them the space where they can share their other talents that they have because people with mental health issues have hopes and dreams and goals just like everybody else. They’re no different than any one of us and all of them would like to be able to thrive and contribute to our community, if given the opportunity. So thank you. [audience applauds]

– Okay, we’ll be continuing the topic of mental health and emotions. I will be speaking about addressing postpartum depression and supporting mother-infant relationships in Wisconsin home visiting programs. I’m Jen Perfetti and I’m the Clinical and Professional Development Coordinator at the Parent-Infant and Family Mental Health Programs in the Department of Psychiatry in the UW School of Medicine and Public Health. To truly impact equity and access to mental health services, we need to challenge our traditional approaches and create opportunities for interdisciplinary collaboration. The project that I have helped develop integrates mental health into home visiting and impacts family wellbeing and extends to prevention for infants impacted by maternal depression and anxiety, trauma and poverty. Prevalence rates for postpartum depression range from eight to 15% in the general population and are as high as 54% for women living in poverty. These are the women that are served by the Department of Children and Families, Family Foundation’s home visiting programs that we have partnered with on this project. Postpartum depression has also been associated with difficulties in sensitive and responsive care and can impact infant-child development, attachment security and emotion regulation. That’s where the two- generation approach comes in. The opportunity to impact women’s wellbeing in the postpartum period and also offer preventative intervention for their infants and young children. Home visitors have consistently identified responding to mental health issues as their greatest professional development need, which leads to challenges in feeling effective in their services, to burnout and to turnover.

Our project is framed by the concept of parallel process. Parallel process holds that all layers of a system have influence on and impact on each other. How we hold and support one layer of a system impacts all of the parallel layers and there’s opportunity to affect change at each of these levels. So if we look at this model here, the supervisor can hold the home visitor in mind and support her in feeling overwhelmed in the face of family’s mental health challenges. The home visitor can then hold the mother in mind, who can then better hold her baby in mind and all these systems are held and supported by the mental health consultant, who can bring knowledge and skills, reflection and support that touches every layer of that system. We utilize the mother-infant therapy group that was developed by Dr. Roseanne Clark with an evidence-based model during the perinatal period, rather than just focusing on the depression or anxiety itself. It’s a three-layered group. We’ve got a mother’s therapy group, which focuses on reducing social isolation and providing social support, increasing interpersonal strategies and coping tools, examining one’s history of being parented and also holds a trauma-informed framework, utilizing regulation and body-based approaches, such as stress reduction, mindfulness and yoga. Meanwhile, the infants are in a developmental therapy group, receiving one-on-one responsive care giving, where they’re supported in developmental play and emotion regulation and following those, the moms and babies come together for the dyadic therapy group, where they’re each supported by their home visitor in promoting sensitivity and responsiveness to infant’s cues, following their baby’s lead and increasing moments of shared enjoyment and connection.

As we’re moving outward in the circles of parallel process, let’s remember that part of our call to action was home visitors feeling overwhelmed in the face of families’ mental health needs. So we really needed to build in those supports and layers of support for the home visitors. We have utilized professional development training, but also ongoing side by side supportive practice for home visitors, which includes two hours of weekly reflective consultation, dyadic supervision sessions that are video-based and help look at supporting the home visitor’s direct skills in supporting mother-baby interactions and relationships and a food and nurturing and a lot of valuing for the important and hard work that they do. We also have built in that layer of addressing integrating supervisors and also helping to bridge with community mental health providers in their own community and those help contribute to sustainability, so that a program can gradually work towards offering this group independently. So, what have we been finding? So far, our preliminary findings show that we are able to impact home visitor’s knowledge and skills in maternal mental health, infant mental health and postpartum depression, as well as their direct skills supporting mothers, infants and dyadic pairs. We also have shown a reduction in postpartum depression over the course of group, as measured by the Beck Depression Inventory and that’s significant here, particularly ’cause this group was initially created to be run specifically by mental health clinicians and this is a partnership where we’ve got some mental health clinicians in the room and many home visitors in the room doing that support, and so the question of can we help reduce depression using a teaming approach is really a piece of what we’re looking at. Most importantly, the qualitative feedback that we get from mothers and from home visitors who tell us things like– home visitors share things like, “I learned how the mother’s experience of being parented and past trauma can affect her mental health and her relationships, especially with her children. I learned strategies to help moms reflect on their experience of being parented, make sense of their past and envision how they want things to be different with their children.” And moms who tell us things like, “I loved coming to talk with people who have gone through things like me. I feel more secure with myself as a person, individual, partner, and mother.” That’s what we’re going for.

So in summary, this university-state-community partnership is informing practice and policy regarding what best supports home visitors who then support families struggling with mental health and trauma histories as they seek to support their own wellbeing and healthy development of their infants and young children. Access is enhanced as women experience meaningful relationships that recognize and meet their needs and are then more willing to reach out to supportive services in the community. As infants experience responsive caregiving and strengthened attachment relationships, the likelihood of increased regulation capacities may promote a stronger foundation for school readiness that will contribute to resilience and equity. Thank you. [audience applauds]