Implementing an early childhood mental health consultation pilot in Virginia: Tensions and implications for scale-up

• In Event: Looking out for teachers who are looking after our children: Examining teacher stressors and supports

Abstract

Early childhood mental health consultation (ECMHC) is a targeted prevention service that aims to build the capacity of early care and education (ECE) professionals to foster supportive environments that promote children’s social-emotional competence and well-being. Through a collaborative relationship, consultants with early childhood mental health expertise support ECE professionals to prevent and address concerns related to children’s social-emotional competence and mental health (Cohen & Kaufmann, 2005). Studies of ECMHC show that it is a promising approach to supporting ECE professionals and children (Albritton et al., 2019; Mathis et al., 2022); however, ECMHC is complex to implement, especially at scale.

Implementation of ECMHC involves the amount or dosage of consultation that is delivered to ECE professionals, the quality of consultation, the extent to which consultation matches participants’ needs and cultural backgrounds, and participants’ responsiveness to services (Durlak & DuPre, 2008). Implementation frameworks emphasize myriad factors that influence dosage, quality, alignment, and responsiveness (Domitrovich et al., 2008). Within the ECE system, factors include funding for ECMHC services, resources available to ECE professionals (e.g., planning time, staff coverage, access to professional development), the diverse characteristics and needs of the ECE workforce, and varying perceptions of what mental health consultation entails and implies. A key challenge to delivering ECMHC at scale is navigating these complex multi-level factors to maximize successful implementation and program benefits at scale.

The current study contributes to the literature by describing a pilot ECMHC program during its first year of implementation, with a focus on grappling with tensions that arose in the implementation process. In the 2021–2022 pilot year, ECMHC was offered as a free service to ECE programs in one large region of Virginia, with the goal of examining feasibility to scale statewide in future years. Consultation was implemented in 45 preschool classrooms across 30 programs. Implementation data were collected using consultation logs and participant surveys, as well as 8 focus groups with 20 participants (educators, parents, program directors).

We discuss four implementation tensions that arose when designing and rolling out this new ECMHC program. For each tension, we provide context from the larger literature on ECMHC, describe the decision points that were made for Virginia’s pilot ECMHC program, and present relevant implementation data to illustrate these tensions in practice (see Table 1 for examples from different data sources, which will be expanded upon in the presentation).

The first tension describes ideal plans versus reality of a new ECMHC roll-out. The second tension concerns how to support ECE professionals’ practice as it relates to children’s behavior, without contributing to a deficit view that children need to be “fixed.” The third tension raises how to allocate limited resources to ensure responsiveness to the varied needs and cultures of ECE professionals, children, and families. Finally, the fourth tension addresses systemic factors in the early childhood field that may undermine the implementation and effectiveness of ECMHC.

We will conclude with reflections on lessons learned that have implications for other ECMHC scale-up efforts.

Authors

• Ann Partee, University of Virginia - Charlottesville
  Presenting Author

• Pilar Alamos, University of Virginia - Charlottesville

• Marissa Ann Bivona, University of Virginia - Charlottesville

• Kelsey Ann Clayback, University of Virginia - Charlottesville

• Jason Downer, University of Virginia - Charlottesville

• Sasha Miller-Marshall, University of Virginia

• Kyra Parker, University of Virginia - Charlottesville

• Shubhi Sachdeva, University of Texas at Austin

• Amanda P Williford, University of Virginia - Charlottesville