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Presenters :. Deana Buck , Program Group Leader Partnership for People with Disabilities, VCU Ashley Everette , Early Childhood Mental Health Consultant ChildSavers Mickie McInnis Include Me, Early Childhood Program Consultant Kathleen Lynch , Senior Research Associate

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Deana Buck, Program Group Leader

Partnership for People with Disabilities, VCU

Ashley Everette, Early Childhood Mental Health Consultant


Mickie McInnis

Include Me, Early Childhood Program Consultant

Kathleen Lynch, Senior Research Associate

Partnership for People with Disabilities, VCU

Background and need for project

Background and Need for Project

  • Project Hugs – one of 6 Social-Emotional Pilot projects funded by VDSS

  • Administered by ChildSavers

  • Overall goals:

    • Improve child care provider access to resources

    • Increate capacity and competence of child care providers to address social, emotional, and behavioral needs of infants and toddlers

Background and need for project1

Background and Need for Project

  • Caregivers of infants and toddlers wanted training and support

  • Some infants and toddlers needed support to address challenging behaviors and mental health needs

  • Agencies/providers had history of collaboration

    • ChildSavers

    • United Way of Greater Richmond and Petersburg

    • Partnership for People with Disabilities

    • City of Richmond, EC Initiative

Early childhoo d mental health consultation

Early Childhood Mental Health Consultation

Ashley Everette, M.A.

Early Childhood Mental Health Consultant


The case for mental health consultation in early childhood settings

The Case for Mental Health Consultation in Early Childhood Settings

  • Young children are being expelled from child care at 3 times the rate of children expelled from K-12. (Gilliam, 2005)

  • Child care providers continue to list coping with challenging behaviors as their number one need for additional training and support (Center for Evidence-Based Practices, 2005).

    Greater Richmond Area

  • In the greater Richmond area, few services existed to support the mental health of infants and toddlers.

  • 2010 needs assessment indicated that approximately 20-25% of child care programs responding had children ages birth to 3 who left care because of difficult behaviors .

What is early childhood mental health consultation

What is Early Childhood Mental Health Consultation?

  • Problem-solving and capacity-building intervention implemented within early childhood settings.

  • Collaborative and reflective relationship with ECE staff and family members.

  • Promotes social and emotional development and seeks to reduce challenging behaviors

  • Relationship based

    • Always supporting the adult-child relationships vs. focusing solely on the child

Help us grow strong hugs early childhood mental health consultation 2010 project implementation

Help Us Grow Strong (HUGS) Early Childhood Mental Health Consultation 2010 Project Implementation

  • ChildSavers served as lead agency

  • 2 Mental health consultants (MHC) hired with Master’s level degrees in mental health related field.

    • Contracted Doug Davies, LCSW, Project HUGS expert consultant on early ECMHC

      Service Implementation:

  • Children 0-36 months exhibiting behavioral concerns in early child care settings;

  • Free consultation services to ECE providers and parents/caregivers.

  • Child care centers and home-based setting located in Richmond City and designated zip codes within Henrico and Chesterfield County.

Mh consultant training and support

MH Consultant Training and Support

  • Specialized training in Infant Mental Health

    • Dr. Doug Davies, Project HUGS expert consultant on early ECMHC

    • Quarterly Onsite visits and training, and monthly phone consultations .

    • Specialized training in Infant mental health made available to other Richmond area clinicians, specialists, and mentors.

  • Ongoing support

    • Weekly Clinical Supervision

Hugs goals

HUGS Goals

To build the capacity of families and ECE staff to successfully nurture the social-emotional development of all children in their care, including those exhibiting challenging behaviors, to prevent expulsion as well as prevent, identify, and reduce the impact of mental health problems among children and their families.

Hugs approach to service delivery

HUGS Approach to Service Delivery

  • Embrace values that support relationship-building and high-quality service provision:

    • Collaborative

    • Family-Centered

    • Culturally Competent

    • Strengths-based

  • Individualize services/strategies

  • Promote consistency across home and classroom settings

  • Utilize hands-on, practical materials

Service array

Service Array

  • Child-Focused Consultation

    Focuses on a particular child with challenging behavior.

  • Program Consultation

    Focuses on enhancing the overall quality of an ECE program and/or assist the program in solving a specific issue that affects the mental health of more than one child, staff member, and/or family.

    Providing both types of consultation helps to ensure that services address the mental health needs of all children in an ECE program.

Hugs consultation process

HUGS Consultation Process

  • Referral and Intake

  • Observation and Assessment

  • Meetings with team to develop Behavior Support Plan

  • Support to family and child care providers to implement plan

  • Referrals to outside services as needed

  • Conclusion of services

*On average, services are provided for 3-6 months depending on the needs of the child and caregivers. The frequency of visits decreases as progress is noted.

Referral intake

Referral & Intake

Who can refer children to HUGS ?

  • Child care providers

  • Parents/Guardians

  • Community agencies

    • ChildSavers

    • Early Intervention

    • VSQI Star Mentors

      Intake Process

  • Child must meet age and locality requirements

  • Parental/Guardian consent form

  • Parental Rights and Responsibilities

  • Child care center must sign Partnership Agreement

Why are children referred for hugs services

Why are children referred for HUGS Services?

Children are referred for many reasons but most often for:

  • Aggression

  • Impulsivity

  • Non-compliance

  • Defiance

  • Tantrums 76% of referrals are boys

  • Destruction of property

  • Developmental Concerns

  • Communication challenges

Observation and assessment

Observation and Assessment

Goal: Understand what the child is trying to communicate and to identify possible underlying reasons for challenging behavior

  • Information Gathering & Data Collection

    • Interviews with family and child care staff

    • Classroom observations

    • Home observations

    • Functional assessments

  • Standardized screening &Assessment tools:

    • ASQ-3 & ASQ: SE

    • DECA

Assessment areas of exploration

Assessment : Areas of Exploration

  • Child’s experience with comfort trust, and interest in connect

  • Level of Developmental Mastery

    • What are the child’s areas of strengths? What developmental tasks challenge her?

      • Attention

      • Communication

      • Emotional Regulation, self-soothing

      • Impulse Control and Problem Solving

      • Flexibility

Areas of exploration cont

Areas of Exploration, Cont.

  • Constitutional Factors

    • Temperament

    • Language and Information Processing

  • Relational History

  • Family Functioning

  • Cultural Factors at home and school

  • Significant History

    • Trauma, Adoption, Attachment styles

  • Sleeping, Eating, Toileting behaviors

  • Gross and Fine motor Control

  • Trigger for Problematic Behavior

  • Early Care and Education Environment

  • Programmatic issues

Behavior support plan and support

Behavior Support Plan and Support

  • Collaborative process

  • Reflect on information gathered to created sound strategies that support child at home and school.

  • Goal Development

  • Agreed upon strategies to be implemented at home and school


  • Weekly-Biweekly support provided to family and providers until goals are met.

What strategies do consultants help caregivers to use

What Strategies do Consultants help caregivers to Use?

Affect Regulation Strategies

Tucker the Turtle Technique

Sensory activities as soothers

Sand table, water play, play dough, “Relaxation in a bottle” stress balls

Use books to discuss feelings

Calm down basket

Yoga and Relaxation techniques

deep breathing , blowing bubbles & Pinwheels

Stress Balls

Calm Down Basket



  • Problem Solving

  • Modeling

  • Scripted Stories

  • Puppets

  • Individualizing Visuals

  • Positive Guidance-Feedback

  • Environmental Supports

  • Calming places and spaces: “Safe place”,

  • “Pillow house”, “Cozy area”, “peaceful

  • corner”

  • Utilizing feeling charts

  • Building Emotional literacy

    • - Naming , acknowledging, and validating feelings

Scripted Stories

Safe Place or Cozy area

Individualized Visual supports

Diy sensory toys

DIY Sensory Toys

Water Beads

Hugs accomplishments

HUGS Accomplishments

Since, April 2010:

  • 62 infants, toddlers, and preschoolers have received individual services

  • 71 families of young children received consultation services

  • 160 early childhood providers received specialized early childhood consultation supports.

  • 30 child care centers received consultation services on individual children

*Only 1 child has been expelled

due to behavior

Lessons learned

Lessons Learned

  • Implement a strong service initiation process

    • Clarifying expectations

  • Need for ECMHC services for children 3-5years.

  • Services were most effective when families actively participated in services.

Childsavers early childhood mental health consultation model 2012

ChildSavers Early Childhood Mental Health Consultation Model 2012

  • ChildSavers, Richmond, VA, committed to maintaining ECMHC services.

  • Provide child-centered mental health consultation

  • Expanded catchment area: Richmond City, all of Henrico and Chesterfield County

  • Expanded age range: 0-5years

  • Family Involvement is a requirement

  • Written agreements between HUGS and child care center or home provider

    • ECMHC Partnership Agreement

Csefel training and mentoring

CSEFEL Training and Mentoring

Mickie McInnis

Early Childhood Program Consultant

Partnership for People with Disabilities

Virginia Commonwealth University

Cesfel training

CESFEL Training

  • Schedule & Participant Selection

  • Modules 1, 2

  • Participant Incentives

  • Module 3

Cesfel program mentoring

CESFEL Program Mentoring

  • Resources and Plan (See Handout)

  • Training

Cesfel training and mentoring

CESFEL Training and Mentoring



Project evaluation

Project Evaluation

Kathleen Bodisch Lynch

Partnership for People with Disabilities

Virginia Commonwealth University

Project hugs intended outcomes

Project HUGS Intended Outcomes



Project hugs intended outcomes1

Project HUGS Intended Outcomes



Project hugs wiki

Project HUGS Wiki

Evaluation results

Evaluation Results

Outcome 1:

Improved access of child care providers to community resources

Strengthening existing resources

Strengthening Existing Resources

Greater access to resources

Greater Access to Resources

ECMHC Consultation

Mental health clinicians group

Mental Health Clinicians Group

MH Clinicians Ratings of Increased Knowledge


Subcommittee of Statewide

Infant/Toddler MH Endorsement Committee

Evaluation results1

Evaluation Results

Outcome 2:

Increased capacity of child care providers to recognize and address the social-emotional and behavioral development of infants and toddlers

Consultation to child care centers

Consultation to Child Care Centers

Positive Feedback


In their own words

~ In Their Own Words ~

“I learned a great deal of information, and our student has shown GREAT improvement, and this program was extremely helpful to the parent.”

Consultation to child care centers1

Consultation to Child Care Centers

Child Outcomes


Consultation to child care centers2

Consultation to Child Care Centers

Relationships with



Consultation to parents

Consultation to Parents



In their own words1

~ In Their Own Words ~

“I was not sure [my children] needed a mental health person, but I think we all did....HUGS also is now helping me look at what child care should be…so I can keep [my children] safe and smart.”

Csefel training

CSEFEL Training

Csefel training1

CSEFEL Training

Positive Feedback


In their own words2

~ In Their Own Words ~

“I have lots of up-and-coming 2 year olds that tantrum out...I plan on using new techniques to calm and make children understand.”

Csefel mentoring

CSEFEL Mentoring



In their own words3

~ In Their Own Words ~

“I was shown a way to get my kids more involved by having fun along with learning; how to help them to socialize; how to listen to them more.”

Contact information

Contact Information

  • Deana

  • Ashley

  • Mickie

  • Kathleen



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