Research-based policies, practices and programs

Agencies providing early intervention, mental health, early learning, and child protection services can collaborate to build a statewide, comprehensive framework for children’s social-emotional health. This integrated system for children should include smooth transitions as children age and specific professional development for all providers who work with children.

Zero to Three¹ and the Center for the Study of Social Policy (CSSP)² have created frameworks that include promotion, prevention, and intervention.

A comprehensive framework for promoting all young children’s social-emotional health and development could include:

• Social marketing around the importance of supporting children’s social-emotional health and development, aimed at parents and the broader public

• Using technology to answer parents’ questions about their children’s behavior or development

• Screening for social-emotional development at all well-child visits

• Integrating social-emotional learning principles and practice into existing programs. For example, training early childhood teachers on infant and young child mental health competencies

• Universal home visiting services offered at birth

Prevention aspects of a policy framework would focus on children living in families where there are risks that are known to result in delays, challenges, or impairments, like high levels of family stress, parent substance abuse or mental illness, or child neglect or abuse. Prevention activities could include:

• Early identification of social-emotional problems through expanded behavioral health screenings using specified, validated screening tools, and including training for medical professionals
• Embedding mental health professionals in child care and early education settings to help teachers and parents address early behavioral issues
• Providing self-help groups and other informal supports for parents worried that they might abuse their young children
• Providing early identification and access to early intervention and treatment services for young children in the child welfare system
• Targeting home visiting services to families experiencing trauma and toxic stress

Intervention practices for children with identified social-emotional concerns could include:

• Ensuring access to early intervention services
• Providing specialized treatment to address parental mental health or substance use disorders and trauma from domestic violence
• Providing specialized treatment programs to improve parent-child interactions
• Targeting home visiting services specifically to very high-risk families or those engaged with the child welfare or adult mental health systems
• Providing high quality special education services in public schools

A comprehensive framework should also address infrastructure issues, including systemic challenges (e.g., payment for services), administrative policies, data capacity and workforce development. For example:

• Training early childhood providers in how to integrate services that families need (like child care subsidies and transportation), provide trauma-informed care, and authentically engage families.
• Broadening Medicaid coverage to provide prevention and treatment services for families with young children who experience behavioral or social-emotional challenges
• Sharing data across sectors, like between schools and health and human service agencies

High levels of parent stress can increase the risk of child maltreatment, including harsh discipline practices and low levels of parent warmth and nurturing behavior.¹ Parent stress is linked to the challenges of living in poverty without the benefits of supportive services, including housing and mental health treatment.²

Investing resources in meeting young families’ income, housing, child care, workforce, and mental health needs (particularly postpartum depression) can support children’s healthy social-emotional development and parents’ ability to function. The state and localities can maximize enrollment of eligible parents and families in these programs and services.

Critical family support practices include:

• Integrating and bundling work supports to provide modest improvements across many aspects of a family’s life, including:
  • Improving parents’ education levels
  • Improving parental health and mental health
  • Raising family incomes
  • Reducing family stress

•  
• Streamlining application processes and ensuring more eligible families are enrolled in family supports, including:³
  • Implementing a “no wrong door” policy, so that any community or state agency provider can determine a family’s eligibility for services and supports
  • Allowing families to complete one application to receive access to all benefits they are eligible for⁴, e.g., Medicaid, the Children’s Health Insurance Program (NC Health Choice), SNAP (food assistance), and other types of federal assistance.  
  • Reviewing internal and interagency rules and application procedures to simplify and streamline application processes

• Embedding trauma-informed practice as part of all state and local agencies and programs serving families who have experienced chronic adversity and toxic stress, including the health, education and child welfare systems.

Maintain North Carolina’s high rates of health insurance for children. Ensure continuation of low-income children’s access to screening, diagnosis, and treatment through Medicaid under the Early and Periodic Screening, Diagnostic and Treatment program (EPSDT).

One in three US children receives health care services through Medicaid or the Children’s Health Insurance Program (CHIP).¹ Access to health care for children covered by Medicaid and CHIP is significantly better than for uninsured children. Children covered by Medicaid have a similar rate of access to that of children covered by private insurance.² In 2015, 96 percent of children in North Carolina were insured, with more than 40 percent of children insured through Medicaid and Health Choice (North Carolina’s CHIP). Investment in Medicaid maintains North Carolina’s high rates of insured children and ensures their access to medically-necessary services.³

Young children learn best by playing and through hands-on learning. However, over the past few decades, preschools and kindergarten classrooms have shifted away from play towards textbooks and teacher instruction.¹ This shift has been supported by parents trying to give their children a strong academic start² and by educators seeking to address the nation’s long-standing academic achievement gap.³ The North Carolina Foundations for Early Learning and Development (Foundations) provides guidance on the importance of play. This resource could be used to train teachers of young children, develop curricula, and create shared goals across early education and kindergarten programs to re-focus on play and hands-on learning.⁴ The Foundations (PDF) are a set of developmental standards that describe children’s learning and development from birth to age five.⁵ Foundations recommend goals for play and learning, including:

• Curiosity, Information-Seeking, and Eagerness: Children show curiosity and express interest in the world around them [and] actively seek to understand the world around them.
• Play and Imagination: Children engage in increasingly complex play [and] demonstrate creativity, imagination, and inventiveness.
• Risk-Taking, Problem-Solving, and Flexibility: Children are willing to try new and challenging experiences [and] use a variety of strategies to solve problems.
• Attentiveness, Effort, and Persistence: Children demonstrate initiative, maintain attentiveness, and focus [and] persist at challenging activities.⁶

Another resource, the North Carolina Emotional and Social Development Early Learning Standards, presents a learning framework organized around three domains of emotional and social learning from birth to five years:  

• Developing a sense of self
• Developing a sense of self with others
• Learning about feelings.⁷

North Carolina has been very successful in providing screening and referrals for developmental delays and services. Lessons learned from this success can help build a system for universal social-emotional health screening, referral and treatment.

The Pyramid Model for Promoting the Social and Emotional Development of Infants and Young Children is a tiered framework of evidence‐based interventions that promote young children’s social-emotional and behavioral development.¹

• Tier I is universal promotion of children’s social-emotional health. Programming for Tier I is based on what is needed to build strong nurturing interpersonal relationships and environments.
• Tier II is targeted prevention of impaired social skill development and lack of emotional regulation. Some children require more systematic and intentional instruction to learn appropriate expression of their emotions, cooperation and problem-solving.² Tier II includes guidance, coaching and support for family members and teachers to improve children’s social and emotional skills.
• Tier III consists of highly targeted interventions. They are intensive and individualized, and designed from Positive Behavior Intervention and Support (PBIS) practices. PBIS can be implemented across environments and by caregivers. Within the context of the Pyramid Model, PBIS involves the following practices:
  • Convening a team, including the family and teacher or other caregivers, to create and implement a child’s intervention plan
  • Conducting a functional assessment to identify factors related to the child’s behavior
  • Identifying strategies designed to address factors that trigger the child’s behaviors
  • Implementing replacement skills as alternatives to the challenging behaviors and strategies to ensure that the challenging behavior is not reinforced³

PBIS in North Carolina. From 2008 through 2011, North Carolina participated in a multi-state initiative to implement the Pyramid Model. Training was provided to practitioners and administrators from Smart Start, Head Start, Early Head Start, Migrant Head Start, Early Interventionists, and Child Care specialists. The work and resources of this team continue to be available online.⁴ Currently, the national Technical Assistance Center for Social Emotional Intervention (TACSEI), funded through the US Department of Education’s Office of Special Education Programs, offers technical assistance to states on the Pyramid Model to improve the early care and education workforce and support young child social-emotional development.⁵

As reported by the North Carolina Department of Public Instruction, schools implementing PBIS experienced:

• More instructional time
• Improved staff and student attendance
• Increased student proficiency in math and reading
• Increased parent participation and partnership
• Improved community involvement and support
• Decreased staff turnover⁶

North Carolina Healthy Social Behaviors in Child Care Center Settings initiative. This project, based on the Pyramid Model, addresses behavioral issues with a goal of reducing the expulsion rate of NC child care centers. It offers services to child care center teachers and administrators designed to identify, prevent and modify challenging behaviors.⁷ Healthy Social Behavior Specialists serve all 100 counties in North Carolina. A Project Manager, employed by Child Care Resources Inc., provides guidance and oversight of the project. More than 4,000 child care centers have been served since the project began in 2005.

The Healthy Social Behaviors project is being expanded to provide more Pyramid Model training to cross-sector early childhood professionals, help create course content to embed social-emotional development theory and practice in college coursework, and expand training for program administrators and child care center owners on North Carolina’s new policy on suspensions and expulsions in licensed child care settings.

Advocacy services for domestic violence victims that address issues around family supports, mental health services, legal services, benefits, housing, finances and health care decrease the risk of re-abuse and increase women’s well-being, which protects children’s social-emotional health.¹

Children’s social-emotional health is impacted by the violence they are exposed to in their communities. The following chart provides evidence-informed practices for reducing community violence, along with an indication of the strength of the evidence and the level of impact.¹