Poster #63 - Infant and Early Childhood Mental Health Consultation: Pursuing Consultant Fidelity and Flexibility

• In Event: Poster Session 20

Abstract

Introduction
-Infant and Early Childhood Mental Health Consultation (IECMHC) is an evidence based service in which a mental health professional partners with the adults in young children’s lives to promote social emotional development.
-While there is ample evidence for the positive outcomes of IECMHC, less is known about the mechanisms of change, such as the specific activities that potentiate IECMHC’s impact (Tidus et al., 2022). In non-manualized practices like IECMHC, it is important to assess fidelity while also allowing for flexibility based on the consultees’ needs (Harn et al., 2013). Using a components based strategy that allows for adaptability, while adhering to the core components, can be an effective implementation strategy (Forehand et al., 2010).
-Additionally, little is known about how a consultant’s background affects their implementation of IECMHC. Understanding the interventionists themselves and how they implement IECMHC and who is more comfortable with being more flexible in their implementation which can provide guidance on how to create a fidelity measure (Kaufmann et al., 2012). This poster will share results of a secondary data analysis that sought to understand the effect of consultant characteristics in the identification of the essential elements and activities of IECMHC across settings.

Methods
-In this Delphi study, three iterative rounds of surveys were used to reach consensus among panelists. The panel was composed of 30 experts with lived experience as IECMH consultants from various settings (e.g., early childhood education, early intervention).
-The first survey utilized a series of open-ended questions, the results of which were analyzed qualitatively. Subsequent surveys posed questions to assess consensus. This process yielded a list of the essential elements and activities.

Results
-After Survey 2, all 5 elements met criteria for group consensus and only 4 of the 27 activities did not meet this standard and were reconceptualized in survey 3. Of those 4 activities, 3 of them were edited and reached consensus in round 3, while the 4th was dropped. The final elements and their corresponding activities can be found in Table 1.
-Some characteristics of the consultants’ backgrounds, such as geographic area or settings served, yielded little differences in the consensus levels compared to the sample as a whole.
-Interestingly, those with more years of experience in the IECMHC field (e.g, program manager) and more years as an IECMHC consultant rated more activities as being not as essential than lesser experienced consultants (Table 2).

Discussion and Implications
-The list of essential elements and activities could lead to the development of a fidelity measure that can be used across the various settings in which IECMHC is implemented to lead to efficacious implementation.
-Consultants with more experience seemed to argue for more flexibility within fidelity to the IECMHC model than newer consultants. This is in alignment more broadly with the tension between fidelity and flexibility that is well documented in the implementation science literature (Aboud et al., 2018).

Authors

• Kaela Tidus, University of Virginia - Charlottesville
  Presenting Author

• Annie Davis Schoch, Georgetown University

• Evandra Catherine, Arizona State University

• Frances Duran

• Lauren Rabinovitz, Georgetown University

• Deborah Perry, Georgetown University