Heed misbehavior’s warnings

By Robert Landauer – editorial columnist for The Oregonian, part of the series – “Rescuing the mentally ill,” March 23, 2000. Not available elsewhere online.

Parents leaving hospitals with newborns get less support than new-car owners leaving auto showrooms.

Manuals and toll-free telephone lines aid owners when cars malfunction. But many parents don’t know where to turn when relationships with infants or toddlers turn unworkably rough.

What begins as a family issue often grows into a community problem. Research from many fields — including insights into brain development from developmental biology and neurochemistry– confirms that these early interactions can affect how the child functions socially throughout life.

“Like a weed, the longer (antisocial behavior) grows, the stronger it gets, the harder it is to kill,” clinical psychologist Patti Chamberlain told an Oregon Department of Corrections seminar on Feb. 29. She and colleagues at the Oregon Social Learning Center in Eugene are pioneers in prevention and treatment research in children with mental illnesses and behavioral disorders.

One thing stands out in her remarks: The earlier the intervention, the fewer the barriers that are likely to trip up rehabilitation and recovery.

A 1999 Rand report, “Investing in Our Children: What We Know and Don’t Know About the Costs and Benefits of Early Childhood Interventions,” agrees. It concludes that good treatment programs that begin early can improve children’s emotional development, educational outcomes, job success and economic self-sufficiency. They can reduce substance abuse, criminal activity and child abuse. And their savings can cover their costs.

Every carefully targeted dollar spent now saves $2 to $4 later, says Mary Mertz, assistant supervisor of the Portland Early Intervention Program. It assesses 1,000 children up to age 5 each year. Ten percent have mental -health issues. But funding for treatment slots is slipping — down from 50 to 25 preschoolers — even as more children are identified as eligible for treatment.

A perverse pattern becomes clear. It starts with a lack of training to help parents develop nurturing relationships with their children. It continues by failing to help parents understand what kinds of behavior ought to signal them to look for help and where to find it.

Then, when preschool caregivers experience similar problems, many are unequipped to cope. Their remedy of last resort: Drop-kick troublemakers out of their program.

The pattern of neglecting early intervention continues when children get to school. Counselors and nurses, trained to spot children who should be referred for mental -health diagnosis and treatment, have been getting cut left and right, says Tina Garcia, Oregon’s associate superintendent of student services.

Ten years ago, for example, all of Portland’s elementary schools had a full-time child development specialist. Now, following budget cuts, one-third have no such help, and another one-third have only part-time help.

The disregard continues with adolescents even though many serious mental illnesses first become evident in teen-age years. Eighteen percent of visits to school-based health centers in Oregon produce mental -health diagnoses. The Legislature and local school districts fund only 44 of the centers statewide even though demand indicates twice as many would open almost instantly if funding were available.

What should be done in Multnomah County to help troubled children?

First, intervene early. With infants and toddlers this is likely to be significantly effective, take less time and have fewer lingering complications than help that is delayed, researchers agree.

Second, take mental-health services to places that care for children — homes, nursery schools and child-care settings of all types, Head Start programs — instead of waiting for advanced-stage problems to be referred.

Third, use mental-health workers to teach caregivers to cope with the behavior issues they face. This capacity-building is essential because public budgets ration mental -health professionals and because child-care workers need more training than all but a few employers can afford. Supporting those who care for numerous children five days a week could become the county’s most effective mental -health strategy.

Fourth, enlist financial support so that private-sector mental -health professionals can reach out further to help parents, caregivers and teachers respond effectively to children’s behavior. One example: The Coalition for Children and Families of the Oregon Psychoanalytic Foundation will open a line this month in Portland to assist a limited number of family child-care providers who don’t know where to turn for referrals or when to refer.

Putting all these efforts together would signal that we mean to pay as much attention to our young children as to our new cars.