Emotional & Behavioral Area of Emphasis
Within the Emotional and Behavioral Health Area of Emphasis, the Waisman Center works to promote healthy social and emotional development. We support positive behaviors for individuals with developmental disabilities and special health care needs, including co-occurring mental health conditions. Emotional health, expression of positive behaviors, and social skills are foundational to an individual's success, beginning in infancy and progressing across the lifespan. When not addressed, challenging behaviors such as aggression, destruction, or self-injury can result in a greater restriction of life opportunities.
Research and practice demonstrate that a blend of positive practices systematically implemented increases the success of individuals with developmental disabilities who are experiencing complex behavioral and mental health challenges. With proper support across settings, individuals who exhibit challenging behaviors can successfully live, be educated, work, and recreate in the community.
Areas of UCEDD activity focus are: infant and early childhood; family mental health and outreach; and consultation for challenging behaviors for people with developmental disabilities and special health care needs.
Challenges to Emotional and Behavioral Health
Identification and Intervention for Mental Health Needs. Identifying and accessing appropriate interventions at the earliest signs of mental health and behavioral challenges can be daunting for both families and the health and educational professionals providing supports to children, youth, and adults with these challenges. There is increased recognition of mental health disturbances in very young children including disturbances in mood; difficulties in regulation of feeding, sleep, or attention; sensory or relational difficulties; and withdrawn or aggressive behavior (Clark, 2010). For individuals with developmental disabilities and other special health care needs, the social and emotional needs associated with healthy development are often overlooked until these challenges escalate into behavior challenges.
How do we go about assuring that all providers and agencies have the proper screening tool and strategies as well as effective training protocols?
Relationship-Based Context for Intervention. All learning, behavior, and socialization occur in the context of relationships. The promotion of healthy social emotional development begins in infancy and continues throughout the lifespan. Early onset of severe and persistent emotional and behavioral issues in children with developmental disabilities can sometimes prevent the development of these important relationships. The development of strong and healthy relationships in early childhood lays the foundation for all later relationships. For adults, the therapeutic relationships across the various providers is a key component to a successful supported lifestyle.
How can family members and providers be educated and supported effectively and in a timely manner in order to establish and maintain these essentials emotional bonds?
Bias toward People with Disabilities. The belief that people with developmental disabilities and challenging behaviors cannot participate in community life with appropriate supports is a common occurrence. This notion is compounded by those who also have mental health issues. It is imperative that families recognize potential trajectories for their children within community life, regardless of the level of support that may be needed. Too often, professionals and community members prepare families for a more limited future based solely on a diagnosis and observable behaviors, rather than a combination of possibilities within the child, family, and community. For families with young children, this often begins in the early childhood years. Their children are not accepted into child care settings due to behavioral or other special needs, and these types of exclusions continue throughout the school years. For adults in supported living, "Severe Reputations" may emanate from past incidents that may have only occurred a few times and within the context of poorly-planned supported lifestyles.
How do we go about educating families, professionals as well as attitudes within communities to how people with disabilities and mental health challenges can thrive in the community, with proper support; and furthermore, how communities can be enriched though the participation of people with disabilities and mental health challenges?
Safety. Assuring safety for individuals with challenging behaviors, providers, and citizens is an essential component of a well-crafted community support plan. When safety issues are not properly addressed, children are at risk for out-of-home placement or segregated education. A growing number of preschoolers are expelled from child care settings each year due to challenging behaviors (Gilliam, 2005). Schools struggle with providing individualized special education in the least restrictive environment and recognizing parent and child rights while also looking out for the safety of all children. Children struggling with emotional regulation issues that are not addressed often continue to experience emotional volatility in adult years. Adults are at risk for arrest, unnecessary psychiatric stays, or institutionalization. In developing programs that assure safety, Community Support Teams sometimes need to incorporate more intensive strategies. These approaches sometimes need to also include what are termed Restrictive Measures. When developed properly and incorporated within positive behavioral supports, Restrictive Measures can protect individuals, providers, and the community from those low frequency and high intensity behaviors that may include aggression, destruction, or self-injury.
How do we assist these teams in considering whether to use restrictive measures, and if so, how they can be used for the purpose of safety and not as a form of punishment or potential abuse?
Education and Training of educational and healthcare professionals, including those in mental health fields, as well as direct support providers and families is a key component to successful school and community life for people with challenging behaviors. Many professionals earn their degrees and practice without specific knowledge of very young children or people with developmental disabilities who also have mental health and behavioral needs. Without appropriate training, disparities in access to appropriate services will continue throughout the lifespan. In the early childhood years, this means increasing the capacity of early care and educational providers from diverse programs (e.g., child care, Head Start, schools, Birth to 3, home visiting, family resource centers) to address the emotional and learning needs of all children. The challenge is to create a coordinated, cross-system professional development system that reaches all people who touch the lives of children. This cross-system attention to professional development is also necessary for professionals working with adults. In both early childhood and supported community programs for adults, direct care positions are typically under-funded, which results in low wages and leads to high turnover rates. Additionally, provider agencies often do not have access best practice training strategies related to challenging behaviors and/or do not have the resources to properly educate the direct providers.
How do we go about assuring that there are an adequate number of providers who are educated, adequately compensated supervised, and remain in their positions over time?
Specific Emotional and Behavioral Health-Related Activities at the Waisman Center
In order to address the Emotional and Behavioral Health area of emphasis, the Waisman Center is currently involved in the following activities.
Service to Individuals and Families
- Community TIES provides outreach behavioral consultation to individuals with DD, parents, provider agencies and schools. The Community TIES program has blended various approaches in establishing this style of positive behavioral supports that also promotes Community Inclusion. The approach subscribes to the belief that people with disabilities and challenging behaviors can thrive in the community with proper supports.
- TIES Clinic offers psychiatric consultation to patients with DD and co-occurring mental health issues
- Adaptations and Modifications Program offers environmental accommodations to living spaces that assure safety and promotes continued participation in community life.
- The Waisman Early Childhood Program provides an enriching environment that supports healthy social and emotional development in young children and supports young children with challenging behaviors in an inclusive early childhood environment.
- The Waisman Center Clinics offer assessments of social emotional development, parent child interactions, and challenging behaviors within interdisciplinary clinical evaluations. The clinics include highly qualified professionals (e.g., psychologists, developmental pediatricians, and speech and language therapists) who are able to conduct assessments and make recommendations for interventions to address social and behavioral challenges in children and youth with developmental disabilities and special health care needs.
Outreach Consultation on Challenging Behaviors
- The Community TIES Program offers field placements (one or two semesters) for UW Social Work and Rehabilitation Psychology Undergraduate and Masters students. Experiences focus on the development of consultation skills for providing positive behavior supports to address challenging behaviors.
- Community TIES also serves as a rotation site for UW Psychiatric Residents. In this experience, residents learn about behavioral and medical management of psychiatric disorders. http://www.waisman.wisc.edu/cedd/Student_Postdoc_Opportunities/field_experiences.php
Community Training and Technical Assistance
Infant, Early Childhood and Family Mental Health
- University of Wisconsin Infant, Early Childhood and Family Mental Health Certificate Program is a year-long program for a cohort of mental health, educational and other early childhood professionals seeking advanced knowledge and skills in addressing the social emotional and mental health needs of young children and their families. This UW-Madison Continuing Studies Certificate Program is a partnership between the Waisman Center and the Department of Psychiatry, University of Wisconsin School of Medicine and Public Health. The program begins in June 2010.
- Social Emotional Foundations in Early Learning (SEFL) is a statewide professional development initiative adapted for Wisconsin through a partnership with the national Center for Social Emotional Foundations in Early Learning http://www.vanderbilt.edu/csefel/ . Staff of the Early Childhood Professional Development Hub of the Waisman Center serve on the State Leadership team and are members of a cohort of approved SEFEL trainers. who provide training on social and emotional development in a variety of early childhood settings.
School Age Children/ Youth and Adults
- Training and Consultation is a comprehensive offering of seminars and trainings for caregivers, support brokers/case managers, consumers, families, program administrators/supervisors and anyone interested in learning more about related topics in the field of Developmental Disabilities. Training and Consultations has a series of seminars related to behavioral support.
- Behavioral Consultations are offered through Community TIES. Short term consultations for individual with DD and challenging behaviors for provider agencies, Family Care programs, families and schools across Wisconsin are provided
Advisory Group Membership
UCEDD staff and faculty serve on the following committees and boards relevant to this Area of Emphasis:
- State Leadership Team for the Social Emotional Foundations in Early Learning
- Participation on committees to provide direction and oversight for use of positive behavioral supports that also include Restrictive Measures
- Statewide for children receiving waiver services
- Family Care – Care Wisconsin
- Dane County Human Services children and adults
Researchers at the Waisman Center are studying a number of areas that are relevant to the field of Emotional and Behavioral Health across the lifespan. This includes a number of studies on the roles of relationships in early development, underlying brain mechanisms associated with emotional responses, and family stressors when faced with mental illness.
- Role of family relationships in the development of resilience in high risk infants, toddlers, and preschoolers. Julie Poehlman, PhD
- Relationship between early emotional experience and child psychopathology. Seth Pollak, PhD
- Underlying brain mechanisms associated with discrimination of facial expressions of emotions, facial recognition, and facial identification in individuals with autism, fragile X syndrome and Williams syndrome compared to typically developing individuals. Richard Davidson, PhD and Kim Dalton, PhD
- Challenges faced by families of persons with severe and persistent mental illness. Marsha Mailick, PhD and Jan Greenberg, PhD
Emotional & Behavioral Products
Infant, Early Childhood and Family Mental Health
- Zero to Three Organization
- Zeanah, C. H., Jr. (Ed.). (2009). Handbook of infant and mental health. (3rd edition). New York, NY: The Guilford Press.
- Landy, S. (2002). Pathways to Competence: Encouraging Healthy Social and Emotional Development in Young Children. Baltimore, MD: Paul H Brookes Publishing Co.