A Thorough Assessment For Young Children Can Identify Problems Earlier

As more children are being diagnosed with severe emotional disturbance and developmental disabilities, the mental health system continues to struggle in detecting signs and symptoms during early childhood.  That said, during the past several decades, science has concluded that birth through early childhood is the most influential stage in human development.  Yet, the necessary resources hasn't been put into early childhood assessment.  

 

Traditionally, for persons with mental illness and severe emotional disturbance, public mental health has resigned to spending the majority of its funding on adolescents and adults.  Primarily due to the level of need.  It tends to be a reactive system of treatment, as opposed to proactive, i.e. prevention.  However, with certain trends (i.e. increase in autism, depression, learning disabilities, sensory issues, etc.) the need for prevention is becoming stronger and more important. 

Historically, community mental health has provided limited services to children ages 0-5.  Through the years, families have come to depend on other systems.  That being said, as prevention has become more popular for early childhood so has Infant Mental Health Services and other programs that are grant funded such as Childcare Expulsion Prevention.

Even though the Michigan mental health system is beginning to put additional focus on early childhood treatment and prevention, its evolutionary development has many short comings.  One being a lack of thoroughness in the evaluation and assessment process. 

Community mental health has traditionally had the “intake” as a single point of entry.  Once eligibility is determined, the second step in the system is the face-to-face assessment.  Both the intake and assessment are typically completed by a master’s level social worker.  From the assessment comes a diagnosis and level of care assignment.  Children ages 0-3 are assigned to Infant Mental Services and those that are older to traditional home-based treatment or outpatient therapy.

Once children are engaged in the community mental health system, they most likely are assigned a social worker.  Issues with young children can be far too complicated for a single discipline to determine all of the needs.  However, families depend on this system because there’s a desperate lack of integrated effort among different disciplines to provide analysis and information.  Thus, children are at risk of problems not being discovered, determined too late, or not addressed appropriately.

In an attempt to better evaluate and determine treatment needs, Shiawassee County Community Mental Health is conducting a pilot project and offering a multidisciplinary assessment to children ages 0-5.  This assessment includes:

§  Biopsychosocial (Psychologist)

§  Behavior (Board Certified Behavioral Analyst)

§  Nursing (Registered Nurse)

§  Sensory (Occupational Therapist)

§  Psychiatry (Psychiatrist) –assuming age appropriate

After the intake is complete, an appointment is scheduled for the child and parents so the psychologist can complete the Biopsychosocial assessment.  Once it’s completed, and the psychologist has determined that the child should be enrolled in services, the multidisciplinary assessment and its purpose is presented.  If the parents agree, the psychologist then becomes the "primary service provider" on a temporary basis.   

An interim service plan is developed, copy provided to the parents, and the other assessments are scheduled to occur as soon as possible.  Prior to other assessments taking place, the primary service provider is responsible for obtaining and compiling all appropriate medical and developmental information from the pediatrician and other service providers (including early childhood services, i.e. Early On, and intermediate school district). 

Records obtained from outside sources need to be accessible to the multidisciplinary assessment team.  One of the key pieces of information gained from the multidisciplinary assessment is the child’s medical history.  It is imperative that the multidisciplinary team, in collaboration with the child's pediatrician, rule out potential physical problems causing the child’s symptomology.  Children, many times, present with mental health symptoms that turn out to be physical in nature.  The responsibility of the nurse is to closely audit the medical information and determine physical issues that potentially need to be addressed. 

Once all of the assessments are complete, the multidisciplinary team meets to discuss findings and recommendations.  After consultation among team members is complete, a meeting is scheduled with the parents to review the team’s recommendations.   If the child is involved in early childhood services (i.e. Early On, ISD) it is imperative that this provider also participate in the team process.  Based on assessment findings and recommendations, the parents and team members determine an ongoing plan of care and a permanent primary service provider is assigned, and referrals are made to additional resources, if appropriate.

it is our belief that through this multidisciplinary assessment, problems can be identifed earlier.  Once they are, it is our hope that they can be more effectively treated.