“More Support, Understanding, and Listening”: An Evaluation of a New Model of Mental Health Consultation

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

Abstract

Infant and early childhood mental health consultation (IECMHC) is a promising approach to help staff manage challenging behaviors in children and families and reduce staff stress and burnout. This presentation describes findings from a study of an intensive, cross-system model of IECMHC designed to enhance the reflective capacity, knowledge, and skills of early childhood staff and administrators. The consultation model was delivered to staff in child care, pre-K, and home visiting programs for approximately 10 hours/month for 15 months, followed by 6 months of intermittent support.

The study used a quasi-experimental, comparison group design involving 16 intervention programs and 8 matched comparison programs in urban and rural areas. The evaluation sought to understand the impact of IECMHC on staff in center-based and home-based early childhood programs. We also examined organizational factors that affected implementation and potential impacts of the intervention on families and children. Methods included staff surveys, classroom and home visit observations, and qualitative interviews before, during, and after consultation. Surveys included assessments of reflective capacity, burnout, depression, self-efficacy, and supervisory relationships. We measured classroom mental health climate and home visitor practice through observations. Teacher perception of children’s behavior was measured in classrooms as well.

Mental health consultation had a positive effect on several outcomes. Staff in the intervention programs demonstrated greater reflective capacity over time than staff in comparison programs. In classrooms where teachers were receiving mental health consultation, we found improvements in behavior management through setting and modeling clear and consistent rules and positive behavior strategies. The intervention also had a significant effect on equity in classrooms, as teachers who received mental health consultation were more likely to attend to children equitably and provide appropriate individualized support. Higher levels of teacher reflective capacity predicted reduced burnout and reduced teacher stress associated with child behavior, while teacher depression predicted greater behavioral concerns for children in their classrooms. Home visit observations revealed that the intervention had a positive effect on home visitor responsiveness to families and facilitation of parent-child interactions. We also found improvements in staff practice and interactions with supervisors, families, and children for both teachers and home visitors. Qualitative data suggested that staff receiving consultation began to use a trauma-informed lens in their work with children and families to develop strategies—such as “observe, monitor, and document”—to improve their practice and decrease challenging child behavior. Consultants also worked with staff to address interpersonal issues and bolster team dynamics and relationships.

Organizational factors, including programs’ readiness and capacity to incorporate consultation, affected implementation. Despite variations in implementation, all of the consultants were able to implement activities that were aligned with the model expectations, for example, those that emphasized developing teachers’ and supervisors’ ability to process program issues and child behavior problems with a reflective, trauma-informed lens. Results provide valuable lessons for incorporating IECMHC into programs across EC settings to support staff and build their capacities, strengthening the early childhood workforce to better meet the needs of families and children and combat inequities in early care and education.

Authors

• Julie Spielberger, Chapin Hall
  Presenting Author

• Tiffany Burkhardt, Chapin Hall at the University of Chicago
  Non-Presenting Author

• Carolyn Winje, Chapin Hall at the University of Chicago
  Non-Presenting Author

• Anna Herriott, Chapin Hall at the University of Chicago
  Non-Presenting Author