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Effective Models for Mental Health Consultation in Early Childhood Settings

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 green@npcresearch.com.

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Effective Models for Mental Health Consultation in Early Childhood Settings

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  1. 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 green@npcresearch.com

  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 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 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 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 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 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. 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%) 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 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 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 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 leadershipsupport for mental health • Written mission statements • Level of integration was not related to consultant characteristics: • Education • Time with program • Organizational position Building on Family Strengths Annual Conference

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