Moving from Whether Early Childhood Mental Health Consultation Works to Why, How and For Whom

• In Event: Bridging Policy, Practice, and Research for Infant and Early Childhood Mental Health Consultation

Abstract

The evidence base for Infant and Early Childhood Mental Health Consultation (IECMHC) has grown since the publication of two review papers more than a decade ago (Brennan et al., 2008; Perry et al., 2010). Of note, much of the published literature continues to focus on IECMHC in early care and education settings, even as IEMCHC is being implemented in home visiting, early intervention and other early childhood systems. As a result, the outcomes that have been studied remain largely unchanged. At the same time, the scientific community has moved away from simply documenting main effects to more explicit testing of how and for whom interventions work. These latter questions are especially important as the field elevates questions of racial and gender inequities in out-of-school-discipline--especially expulsion that policy makers must address. To guide the development of progressive social policy, the next generation of research in IECMHC must be driven by a more fully articulated theory of change.

In this presentation, researchers will present an IECMHC theory of change that can be applied to multiple early childhood sectors (see Figure 1). Integrating research and clinical insights, the theory of change defines the most influential factors in the process and outcomes of IECMHC. The theory of change articulates how constructs measured at the individual (i.e., consultant and consultee) level affect the formation of a clinically significant consultative alliance, which in turn influence decisions about the activities of consultation, which then have direct and indirect impacts on consultees, programs, children, and families. Concurrently, the authors conducted a systematic review of all IECMHC research published in the peer-reviewed literature. Findings from each study (n=23) were then mapped to the theory of change to elucidate the pathways that are well-established; future directions for the measurement of causal constructs, mediators and moderators are also highlighted.

The vast majority of published IECMHC studies demonstrated positive effects on child outcomes as well as teacher outcomes. Specifically, many articles demonstrate reductions in child externalizing behavior (e.g., Gilliam et al., 2016; Upshur et al., 2009) and improvement in social-emotional skills (e.g., Crusto et al., 2013). For teachers, the evidence is strong for the impact of IECMHC on gains in teacher knowledge, self-efficacy, and more positive interactions with students (Conners-Burrow et al., 2012; Heller et al., 2011). What is less well-documented is the extent to which IECMHC results in reductions in inequities in expulsion for boys and children of color, as theorized (Albritton et al., 2019). Future research should focus on the development of well-validated measures for emerging constructs such as the “consultative alliance,” “reflective supervision” as well as investigate causal claims and test theorized mediational pathways. Moderation analyses should explore the differential impact of IECMHC on direct and indirect outcomes. Most importantly, policy makers need actionable information about the role that IECMHC can have on reducing the long-standing inequities that have been documented for young children of color as well as mental health disparities in maternal mental health.

Authors

• Annie Davis Schoch, Georgetown University
  Presenting Author

• Deborah Perry, Georgetown University
  Non-Presenting Author

• Kaela Tidus, University of Virginia - Charlottesville
  Non-Presenting Author