Effective Models for Mental Health Consultation in Early Childhood Settings Beth Green, Ph.D. NPC Research, Inc. & Research and Training Center for Family Support and Children’s Mental Health Portland State University

June 2003 Building on Family Strengths Annual Conference 2 Why Do Early Childhood Programs Need to Provide Mental Health Services? Increasing prevalence of behavioral and emotional problems in children under 5: Behavioral and emotional problems among preschool children challenge families and teachers –Shifts focus in classroom from support to behavioral control –Aggressive behavior = exclusive practice

June 2003 Building on Family Strengths Annual Conference 3 A Paradigm Shift in Providing Mental Health Services in Early Childhood Settings Piotrkowski, Collins, Knitzer, and Robinson (1994): –Shift away from problem-focused, therapeutic treatment of individual children –Shift towards holistic, integrated, prevention-oriented mental health services Revised Head Start performance standards

June 2003 Building on Family Strengths Annual Conference 4 Early Childhood Mental Health Consultation: What Does it Look Like? Child-centered consultation: Traditional, problem-focused approach Program-centered consultation: Supports programs and staff more generally to implement prevention and early intervention for all children

June 2003 Building on Family Strengths Annual Conference 5 What are Consultants in Head Start Programs Doing? In 1994, Piotrkowski found that 18% of Head Start program directors knew about and were implementing some kinds of program-level consultation In 2003, we conducted a survey of 79 Head Start programs, including over 800 staff, directors, and consultants. Found that 60% of program directors reported at least some use of program-centered consulting strategies: However, only 7% did this frequently

June 2003 Building on Family Strengths Annual Conference 6 What are Consultants in Head Start Programs Doing? Piotrkowski found that 19% of programs had an on-staff mental health professional, compared to 21% in 2003 In 2003, programs reported spending about 2% of their budget on mental health services In 2003, programs reported about 1 1/2 hours of consultation per year, per child

June 2003 Building on Family Strengths Annual Conference 7 Integration Makes a Difference Qualitative research suggested that integration of the MHC is important, even given limited resources –Available –Approachable –Part of the “team” Looked at programs in our survey who rated the consultant(s) as either very integrated or less integrated.

June 2003 Building on Family Strengths Annual Conference 8 Mental Health Program Structure No differences in terms of: –Hours of consultation per child –% of budget spent on MH services –% reporting use of in-kind for MH services –% of children needing MH services –Size or other demographic characteristics Integrated programs were higher in: –Frequency of MHC activities, both types –Use of other funding streams for MH services (37% vs. 27%) –Rates of using a salaried MHC (24% vs. 16%) –Rates of having a written mission statement (78% vs 85%)

June 2003 Building on Family Strengths Annual Conference 9 Program Outcomes: Staff Practices Staff from integrated programs reported significantly higher levels of: –Prevention-focused approaches –Strengths-based services –Parent involvement in services –Culturally competent services There were no differences in terms of: –Desire for therapeutic classrooms –Perceptions that some children would be better served outside of Head Start

June 2003 Building on Family Strengths Annual Conference 10 Program Outcomes: Overall Program Functioning Staff from integrated programs reported significantly: –Smoother classroom transitions –Higher levels of support to staff –More confidence in effectively managing classrooms –Less need for improvement in mental health component –Shorter times between referral and assessment

June 2003 Building on Family Strengths Annual Conference 11 Child Behavior Outcomes Staff from integrated programs reported that their mental health services were significantly more helpful in: –Supporting positive behavior –Reducing internalizing behavior –Reducing externalizing behavior

June 2003 Building on Family Strengths Annual Conference 12 What Supports Integrated Models of Consultation? Require a broad range of types of consultation activities, and involve the consultant frequently Have consultants who are available and responsive to staff Strong leadership support for mental health Written mission statements Level of integration was not related to consultant characteristics: –Education –Time with program –Organizational position