Mental Health Consultation in Early Childcare Settings: Outcomes from an Arkansas Pilot Project

1. Mental Health Consultation in Early Childcare Settings:Outcomes from an Arkansas Pilot Project

2. Today’s Presentation • ECMH Consultation • The need • What is it? • Overview of Arkansas pilot project • Evaluation Results • Lessons Learned • Future Plans

3. Overview of the Need • Difficulties related to social-emotional development are common in young children. • 7% to 20% of children meet criteria for Oppositional Defiant Disorder or conduct disorder. • Up to 35% in low-income families (Webster-Stratton & Hammond, 1998). • 13% of preschool children described by parents as difficult to control (Campbell, 1995).

4. Overview of the Need The Childcare Setting • For young children experiencing social-emotional problems, the childcare setting can make a difference • Teachers help set the stage for both learning and healthy social emotional development when…. • They have a warm relationship with the children And • Routines are consistent, rules are clear and children are taught expected behaviors in positive ways

5. Overview of the NeedPreschool Expulsion • While teachers can help, children with serious behavior problems present challenges • In Southern States: • 10.4% of pre-k teachers reported expelling at least one preschooler in the past 12 months • 19.9% of those teachers reported expelling more than one. From: Prekindergarteners Left Behind: Expulsion Rates in State Prekindergarten Systems. The Foundation for Child Development. New York, NY. May 2005

6. Overview of the NeedPreschool Expulsion • Rates were highest for older preschoolers and African-Americans. • Boys were over 4½ times more likely to be expelled than girls. • Rates were lowest in classrooms in public schools and highest in faith-based centers and for-profit child care. • Access to classroom-based mental health consultation made expulsion less likely.

7. EARLY CHILDHOOD MENTAL HEALTH CONSULTATION – WHAT IS IT? • Intended to promote healthy social and emotional development for young children in group care and early education settings • Based on a collaborative relationship between mental health and childcare professionals continued

8. EARLY CHILDHOOD MENTAL HEALTH CONSULTATION – WHAT IS IT? • There are two types of consultation: • Child Focused – To address needs of a specific child • Programmatic – To address issues within the childcare setting continued

9. WHAT IS IT? Child Focused Consultation • Teacher identifies a child they are concerned about • Mental health consultant observes/assesses the child and engages the parent • A plan is created to address the issues that contribute to the child’s social and emotional difficulties • Parent, teacher and consultant bring expertise and a unique perspective to the process

10. WHAT IS IT?Programmatic Consultation • Focuses on improving the overall quality of a childcare program by • Addressing structural issues that impact the climate of a classroom or • The teachers’ ability to build nurturing relationships with the children in their care

11. ECMH consultation is NOT • Direct therapeutic services for children or their families • Completing formal mental health diagnostic evaluations • Serving as a classroom or teacher aide • Acting as the sole expert

12. Arkansas Pilot Project Funded by: DHS/Division of Child Care and Early Childhood Education • Partners: • DHS/Division of Behavioral Health Services • Arkansas Head Start Collaboration Office • Grantees (selected through competitive process): • Ozark Guidance Center • Counseling Associates • Mid-South Health Systems • Evaluation - UAMS/Partners for Inclusive Communities

13. Pilot Project Goals: • Enhance the capacity of childcare centers/ teachers and parents to prevent and manage social-emotional problems in children. • Improve the outcomes of children enrolled in the collaborating childcare programs.

14. Teachers and Children Served • Each year more than 70 teachers have received consultation services. • Approx. 600 children screened per year • 9-12 centers involved each year • 1-2 centers dropped/added per year • Primarily Head Start or State-funded Pre-K • Included 3 developmental disability providers

15. Arkansas Pilot ProjectEvaluation Study • Evaluation plan designed with input from all partners • Data collection activities include: • Assessment of Child Behavior and Strengths • Assessment of Teacher Behavior and Classroom Management • Teacher Survey • Focus Groups with Teachers/Parents • Includes a comparison group

16. Outcomes- Teacher Satisfaction • Teachers are very satisfied with the consultation services. • 74% reported that they look to the mental health professional for help • 87% reported having a good relationship with the mental health professional • 76% reported having learned a new strategy from the mental health professional

17. Outcomes- Teacher Behavior • Research staff conducted structured classroom observations using the Arnett Caregiver Interaction Scale. • Teachers receiving the consultation services are more likely to exhibit behaviors supportive of healthy social- emotional development than teachers in the comparison group.

18. Outcomes- Teacher Behavior • By year 3, teachers receiving consultation were significantly: • More sensitive/positive • sensitive teachers have warm, high quality communication and are enthusiastic about children • Less permissive • permissive teachers avoid enforcing rule and disciplining children even when it seems necessary • Less detached • detached teachers avoid interacting with the children and do not appear interested in their activities

19. Outcomes- Teacher Behavior Within the treatment group… • teachers who received more consultation services were more likely to change their classroom behaviors

20. Outcomes- Child Behavior • Overall, 16% of children had seriously high levels of behavior problems. • As measured by teacher report on the Devereux Early Childhood Assessment (DECA) • Problems were more pervasive and severe in centers serving special needs children. • Almost half (46%) of children had seriously high levels of behavior problems.

21. Outcomes- Child Behavior • By the third year of the project, children at intervention sites had fewer behavior problems than children in the comparison sites.

22. Outcomes- Child Strengths • Protective factors help buffer against stress and help make children less vulnerable to social problems as they go through childhood. • By the third year of the project, children at intervention sites had more protective factors than children in the comparison sites.

23. Outcomes- Child Strengths • Children at intervention sites exhibited more: • Self Control • (ability to experience a range of feelings and express them in appropriate ways); • Initiative • (self-directed activities; ability to take appropriate actions to get his/her needs met); • Attachment • (ability to have a mutual, strong relationship between a child and significant adults).

24. Outcomes- Parents’ views • Results of focus groups suggest parents have positive view of the project • Parents reported: • Reduced stigma • because the Mental Health Professional was available at childcare center • Increased ease of working with the consultants • because of their first hand observations of the children • Willingness of the consultants to accommodate their schedule

25. Arkansas Pilot ProjectLessons Learned • ECMH consultation is an evolving field • The Arkansas pilot project is cutting edge • Our approach has evolved: • based on our lessons learned and • new guidelines and guidance from experts in the field

26. Lessons Learned:Clear Definitions Needed • Providers and Partners need a clear understanding of what mental health consultation is and is not • This differs depending on who is providing the services • Our definitions and scope of work evolved • Less focus on direct intervention; more focus on skill-building among childcare center staff

27. Lessons Learned:Specialized Knowledge is Necessary • Consultants Need Specialized Knowledge • Normal child growth and development • Atypical behavior • Basic concepts of social-emotional development • Family systems • Early childhood and early intervention systems • Child care quality standards • Adult learning principles • Often NOT Covered in Training Programs for Mental Health Professionals

28. Lessons Learned:Training is critical • Training has been critical to the success of the project • Both for Mental Health and Childcare Professionals • Arkansas needs a broader, ongoing process and curriculum for training consultants • Our trainings included Early Childhood Liaisons from all Community Mental Health Centers • Staff turnover requires that ongoing training be available

29. Lessons Learned:Developmental Disability Providers • Issues arising with Developmental Disability Providers are different • Setting/staffing patterns are different • Specialized knowledge related to specific disabilities is needed • The typical consultation model may need to be modified in these settings

30. Moving Forward • In the 2008-2009 school year, we engaged all new childcare partners • Primarily licensed, community based providers • Not Head Start or state-funded Pre-k • Want to determine if project has similar/better results with these childcare providers

31. A Parent’s Perspective In the words of a parent: “The effect [Mental Health Consultants] can have on every child, even if it’s not a large problem, it’s sometimes a life changing effect”

32. Contact Info and Acknowledgments Funding: Supported with quality dollars from the federal child care development fund Partners: Arkansas Head Start Collaboration Office For questions, contact Nikki Conners-Burrow at connersnicolaa@uams.edu or 501-682-9900