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ABOUT IMPAQ INTERNATIONALWith research studies, program evaluations, implementation assistance, surveys and data collection, technical solutions, and communications strategies, IMPAQ helps governments, businesses, foundations, non-profits, and universities evaluate and enhance their programs and policies.

IMPAQ International evaluates and enhances public programs and policy.

ISSUE BRIEF AUTHORSSarah Nadiv

ISSUE BRIEFT H R E E M O D E L S F O R P R O V I D I N G

E A R LY C H I L D H O O D M E N TA L H E A LT H C O N S U LTAT I O N( E C M H C )

OVERVIEWIn a time when pre-kindergarten access is growing and states are grappling with suspension and expulsion policies many teachers and early care and education providers are searching for support in addressing child challenging behavior in the classroom. Early Childhood Mental Health Consultation (ECMHC) is a promising strategy for building providers’ skills and reducing problematic behavior in young children in early care and education settings. However, for many funders, policy makers, providers, and recipients of Early Childhood Mental Health Consultation it can be confusing to understand the different models of ECMHC and which one is the best fit for them. The following brief describes three models of providing ECMHC.

ECMHC can lead to improvements in child social and emotional skills, reduce child challenging behaviors, changes in teacher attitudes and behaviors, and reduced expulsions.

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WHAT IS EARLY CHILDHOOD MENTAL HEALTH CONSULTATION?

Early Childhood Mental Health Consultation (ECMHC) is a promising strategy for building providers’ skills and reducing problematic behavior in young children in early care and education settings including Head Start. Gilliam (2005) reported that pre-kindergarten programs that had on-site mental health consultants had lower rates of expulsion than those without access to this service. In addition, two systematic reviews of more than 30 evaluations of ECMHC conducted across the country showed evidence that these programs can lead to improvements in children’s behaviors, changes in teacher attitudes and behaviors, and reduced expulsions (Brennan, et al., 2008; Perry et al., 2010).

ECMHC involves providing an early childhood consultant on-site to work in concert with teachers, and often the family (Cohen & Kaufmann, 2000; Donohue, Falk, & Provet, 2000; Johnston & Brinamen, 2006). ECMHC aims to build the capacity of staff, families, programs, and systems to prevent, identify, treat, and reduce the impact of mental health problems among children from birth to age six and their families (Cohen & Kaufmann, 2000). It involves a collaborative relationship between a professional consultant with mental health expertise and one or more individuals with expertise in infant and early childhood education.

This strategy provides an opportunity for Early Childhood Education (ECE) providers to receive one-on-one coaching and mentoring that can either target the child and/or family or focus on an entire program or classroom. In the former, referred to as child- and family-focused consultation, the consultant works with the provider and a child and/or family to address the specific behaviors of concern in an individual child or family. In contrast, program-focused consultation is intended to both improve the overall quality of the classroom environment, as well as to provide strategies to build staff capacity to address problematic behaviors or system problems that may be affecting one or more of the children, families, and/or staff.

On-Cal l Model of Consultat ion

ECMHC can be further defined by the amount of time a consultant works with one particular site/program. In an on-call model, consultants are asked by a family, teacher or administrator to work with a child, provider, or program on a case-by-case basis. This work can be child- and family-focused or program-focused. While often times these cases are initiated around a specific child with challenging behavior, any teacher or administrator can initiate a case for

program-focused consultation. In Maryland, on-call cases tend to last an average of 6 months but can vary greatly depending on the complexity of the case.

Embedded Model of Consultat ion

By contrast, the embedded model of ECMHC requires a consultant to be on-site at a particular program for a pre-determined period of time. This model is typically used by Head Start centers or other programs where a large proportion of the students are vulnerable due to risk factors such as poverty, community violence, trauma, involvement in child welfare, homelessness, and other adverse conditions. This model usually has components that support individual children and families, teachers and classrooms, and the program as a whole. While both the on-call model and embedded model of ECMHC are relationship-based, the embedded model may allow a consultant to work more effectively with populations that are more vulnerable, since more time is spent on-site building the crucial foundational relationships with children, parents, teachers, and administrators.

Blended Model of Consultat ion

In recent years, many ECMHC providers are beginning to explore a blended model in which a consultant’s caseload is comprised of both embedded and on-call cases. For example, a blended consultant maybe embedded in several early care and education programs, for example spending a day a week in a particular setting, while concurrently having several on-call cases. This model raises issues related to frequency and dosage of consultation for both the embedded and on-call cases; but it could be a viable option for some jurisdictions or programs.

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Brennan, E., Bradley, J., Allen, M.D., Perry, D.F. (2008). The evidence base for mental health consultation in early childhood settings: research synthesis addressing staff and program outcomes. Early Education and Development, 19(6): 982-1022.

Cohen, E., & Kaufmann, R. (2000). Early childhood mental health consultation. Washington, DC: Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration and the Georgetown University Child Development Center.

Donohue, P., Falk, B., & Provet, A. G. (2000). Mental health consultation in early childhood. Baltimore, MD: Brookes.

Gilliam, W. S. (2005). Prekindergarteners Left Behind: Expulsion Rates in State Prekindergarten Programs. New Haven, CT: Yale University Child Study Center, Development of the Preschool Mental Health Climate Scale Walter S. Gilliam March 14, 2008, unpublished manuscript, Yale University.

Johnston, K.,&Brinamen, C. (2006). Mental health consultation in child care: Transforming relationships among directors, staff, and families. Washington, DC: Zero to Three.

Perry, D.F. (December 2005). Results of the Early Childhood Mental Health Pilot Sites: A Report to the MD State Legislature. Washington DC: Georgetown University, Center for Child and Human Development.

Perry, D.F., Allen, M.D., Brennan, E., Bradley, J. (2010). Establishing the evidence base for early childhood mental health consultation: a research synthesis of child outcomes. Early Education and Development, 21: 795-824.

Perry, D.F., Dunne, M.C., O’Neill, L. and Campbell, D. (2008). Reducing the risk for preschool expulsion: mental health consultation for young children with challenging behaviors. Journal of Child and Family Studies, 17: 44-54.

On-Call Embedded Blended

BENEFITS

Allows consultants to respond to the needs of individual programs, teachers, and children.

Tend to be briefer cases (on average 6 months), meaning more cases could be seen in a year.

Allows consultants to build relationships with programs and teachers sooner.

Consultants are more likely to be readily available to support programs, teachers, and families in crisis.More likely to provide programmatic and whole school/program-wide supports.

Allows consultants to be embedded in a few programs while still having room on their caseloads for “on-call” referrals.

Fosters sustainability of a feasible approach to ECMHC in this jurisdiction.

Strengths from both the embedded and on-call approaches are realized.

Efficiency resulting from the prioritization of targeted interventions both on the classroom-wide and individual level.

CHALLENGES

Tend to be more child focused at referral time, which may make it hard to conduct program-wide work.

Can be hard to determine the best caseload, since cases will vary in complexity and duration.

Can be difficult to serve a large caseload of child specific cases due to more programmatic work.

Can be hard to balance the needs of multiple programs.

Can be arduous to find the “perfect” balance of time spent on-site and time spent addressing “on call” cases.

Could contribute to consultants feeling “stretched too thin” along with the creation of a “Student Wait-List for “on call cases”

EMBEDDED MODEL OF CONSULTATION

REFERENCES

SARAH NADIV

Ms. Nadiv strives to have research drive policy and practice and as such, she has extensive experience with community-based participatory research and utilization-focused evaluation. She uses qualitative, quantitative, and mixed-methods approaches. In addition, she has created a number of data sharing systems, which track individual child data for longitudinal research purposes. She has developed both in-person and online professional development modules for practitioners, policymakers, and families. Ms. Nadiv has provided clinical services to children and families in outpatient mental health clinics and Head Start.

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