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This Web site is a component of the SAMHSA Health Information Network. |
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Early Childhood Mental Health ConsultationPromotion
of Mental Health and Prevention of Mental and Behavioral Disorders
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| Charles
G. Curie, M.A., A.C.S.W. Administrator Substance Abuse and Mental Health Services Administration |
A.
Kathryn Power, M.Ed. Director Center for Mental Health Services |
Introduction
Background
Organization of This Monograph
Section I – Mental Health Perspective
Values Inherent in the Mental Health Perspective
Section II – Definition and Description of Types
of Mental Health Consultation
Definition and Types of Mental Health Consultation
Types of Early Childhood Mental Health Consultation
Section III – Essential Features of Early Childhood
Mental Health Consultation
Collaborative Relationships
Problem-Solving and Capacity-Building Goals
Issue Specificity and Time Limitation
Skills of Consultants
Section IV – Challenges and Strategies in the Consulting
Process
Difficulties in Implementing the Intervention
Plan
Organizational Setting
Value Conflicts
Racial, Ethnic, Cultural, and Socio-Economic Issues
Lack of Mental Health Professionals With Early Childhood
Consultation Experience
Funding
Section V – Conclusions and Recommendations for Action
Administrators of Community-Based Programs
Policy Makers and Funders
Educational Institutions
Consultants
Section
VI – Selected Resources
Appendixes
A. Selected Programs
Daycare Consultants, Infant-Parent Program
Developmental Training and Support Program,
Ounce of Prevention Fund
Day Care Plus, a Positive Education Program
Kidscope
B. Assessment in Child- and Family-Centered Consultation
C. Assessment in Program Consultation
D. List of Contributors
References
The vital public health issue of promoting healthy development and the future well-being of infants, toddlers, and preschool children has important implications for families, businesses, private philanthropy, and government. Investment in fostering mental health in the early childhood years presents a special opportunity to open a door to a child’s future; to lessen and, when possible, avoid future developmental and emotional problems; and to prepare a child for school and life.
This monograph had its genesis at the May 1998 “Roundtable on Mental Health Consultation Approaches for Programs/Systems Working with Infants, Toddlers, and Preschoolers, and Their Families.” Its goal was to exchange information. The then Georgetown University Child Development Center convened this meeting at the request of and with funding by the Substance Abuse and Mental Health Services (SAMHSA), Center for Mental Health Services (CMHS). The center collaborated with the CMHS Prevention Initiatives Priority and Program Development Branch to conduct the meeting.
Since then, the fields of prevention science and child development have made enormous strides, yet child care providers who could benefit from these advances are often unaware of them. Mental health clinicians, trained to work with infants, toddlers, preschool children, and their families, are in a unique position to help their colleagues in the early childhood community use the latest research in their work with children, especially those with challenging behaviors.
Therefore, SAMHSA’s CMHS is launching a series on the Promotion of Mental Health and Prevention of Behavioral and Mental Disorders. This series will have six monographs, and each topic conveys the work of national experts in the fields of prevention science and child development. The series comprises the following monographs:
This monograph, Volume 1, Early Childhood Mental Health Consultation, addresses young children’s mental health by providing a blueprint for child care providers to use when hiring a mental health consultant. This first monograph serves the following purposes:
The target audience includes early childhood program administrators, supervisors, directors of child care programs, foundations, training organizations, educational institutions, parents, families, and mental health professionals and consultants.
The second monograph, Volume 2, A Training Guide for the Early Childhood Services Community, is a companion piece to this monograph. It offers a guide for trainers to use when teaching the early childhood community how to use the blueprint.
Brain research conducted
over the past decade demonstrates that the way individuals function in their
preschool years through adolescence hinges—to a significant extent—on
their experiences before age 3 (Carnegie Corporation of New York, 1994). These
findings are bolstered by evidence of the long-term effects of comprehensive
early childhood programs. These effects include improved educational outcomes,
reduced levels of criminal activity, and increased economic self-sufficiency—initially
for the parent and later for the child—through greater labor force participation,
higher income, and lower welfare use (Gomby, Behrman, Larner, Lewit, & Stevenson,
1995).
Ideally, a child spends the years between birth and age 6 in close relationships
with adult caregivers who offer nurturing love, protection, guidance, stimulation,
and support. However, patterns of contact between American children and their
adult caregivers have changed significantly during the last couple of decades.
More and more infants, toddlers, and preschoolers spend 8 to 10 hours each day
in some type of early childhood setting. Seventy-five percent of mothers with
children under age 6 and 59 percent of mothers with children under age 3 are
in the work force. As a result, about 12 million children under age 6 require
some type of child care.
Child care, early childhood
education, and early intervention programs for children with special needs are
provided in a wide variety of settings. These settings include centers operated
on both a for-profit and a not-for-profit basis, such as family child care homes,
public and private nursery schools, prekindergartens, and home-visiting programs.
The quality of these arrangements varies dramatically. Some factors related
to quality of care are regulated by government (for example, child and staff
ratio, group size, physical facility features, and minimum caregiver training).
But other critical components are more subjective, and their quality cannot
be easily regulated. Examples of these components include the nature and frequency
of caregiver-child interactions, teaching and learning styles, and sensitivity
of programs to the cultures, languages, and preferences of the children and
families they serve.
Early childhood providers report that they see increasing numbers of children
with special needs (who may or may not meet eligibility criteria under the Individuals
with Disabilities Education Act [IDEA], Part B or Part C). Violence, abuse,
prenatal substance exposure, losses due to incarceration or death, or residing
with multiple caregivers or in foster homes often has significantly affected
the lives of children who display severe behavioral and emotional problems (Sameroff
& Fiese, 2000). The literature suggests that children who struggle with
behavioral and emotional problems at this young age have a 50 percent chance
of continuing to struggle into adolescence and adulthood.
The range of challenging behaviors that children demonstrate seems to increase
with the complexity of the difficulties that families and communities confront
(such as crime, substance abuse, depression, and domestic violence). However,
the skills and the resources that families and caregivers need to cope with
and manage their children’s behaviors often have not met that rising challenge.
Caregivers often experience stress and burnout as they deal with many of the
same issues (such as poverty, crime, and low wages) as the families of the children
they serve ((Bowdish, 1998). Salaries for early childhood caregivers are notoriously
low, and caregivers typically work under stressful circumstances. These factors
often lead to high staff turnover and low morale, conditions that can seriously
compromise providing stable, high-quality, and family-centered early childhood
services to children and their families.
Most important, the negative developmental paths predicted for these children
and their families are not improving. Child care programs are expelling increasing
numbers of “problem children” in a cycle of disruptive transitions
that interfere with the children’s critical need for stability. The State
of Michigan Department of Community Health conducted a series of surveys to
assess the prevalence of preschool-age children expelled from child care settings
and to determine strategies for retaining them. One survey reported that during
1 year, nearly 2 percent of the children in a single Michigan county had been
expelled. It is not surprising that parents whose children have been expelled
from child care frequently withhold pertinent information from subsequent potential
providers. They do so because they fear rejection, given their desperate need
for reliable child care arrangements. But withholding information offers little
or no chance for staff of these programs to care successfully for the children
(Tableman, 1998; for more information, contact Betty Tableman, University Outreach
and Engagement, Michigan State University, East Lansing, MI, 48824).
Despite this bleak picture, positive research findings indicate that prevention and intervention efforts to address mental health problems in early childhood may reduce significant personal and social difficulties in later childhood, adolescence, and adulthood. The earlier the intervention begins, the better the prognosis. Early childhood providers have indicated that the most helpful types of assistance to support them in caring for children with challenging behaviors are:
Directors and administrators
of early childhood programs are being challenged to consider and offer creative
ways to build their staff’s capacity to address the mental health concerns
of children and families living with many risks and stressors. They understand
that there are no “quick fixes” and that their objective requires
attention, time, and resources. However, providing staff support and mental
health skill development pays off in “better problem solving skills, greater
staff confidence in coping with difficult situations, a wider range of concrete
strategies to help children and families, and the provision of a safety valve
which enables staff to share their frustrations and to celebrate the victories
of their work” (Yoshikawa & Knitzer, 1997).
The Head Start program proactively emphasizes the mental health approach to
working with staff, children, and families (Green, Simpson, Everhart, Vale,
& Gettman, 2004). Head Start’s recently published performance standards
stress collaborative relationships between programs and parents to share concerns
about children’s mental health, to identify appropriate responses to children’s
behavior, and to help parents understand mental health issues and create supportive
environments and relationships in their homes. The performance standards also
require that local Head Start programs have mental health professionals on staff
and that on-site mental health consultation be available to staff at work.
ORGANIZATION OF THIS MONOGRAPH
This monograph is presented in six sections and five appendixes:
| I. |
Mental Health Perspective. Describes the early childhood mental health perspective and why it is essential to respond effectively to the social, emotional, cognitive, and behavioral needs of young children and their families |
| II. | Definition and Types of Mental Health Consultation. Defines early childhood mental health consultation and contrasts it with other problem-solving, capacity-building techniques and with direct mental health services that enhance the well-being of young children, their families, and other caregivers in child care settings. Using an example, this section describes two major types of mental health consultation: child- and family-centered consultation and programmatic consultation |
| III. | Essential Features of Early Childhood Mental Health Consultation. Describes the main features of effective early childhood mental health consultation, including the following: (1) collaborative relationships, (2) problem-solving and capacity-building goals, (3) issue specificity and time limitation, and (4) skills of consultants |
| IV. | Challenges
and Strategies in the Consulting Process. Discusses critical challenges
facing early childhood mental health consultation, as well as strategies
to surmount some barriers |
| V. | Conclusions and Recommendations for Action. Presents recommendations to program directors, policy makers, educational institutions, and consultants for integrating mental health consultation into early childhood programs |
| VI. | Selected Resources. Presents resources that support programs in implementing early childhood mental health strategies |
| A. |
Selected Programs. Summarizes several early childhood programs that have incorporated mental health consultation as part of the continuum of support provided to staff and families |
| B. | Assessment in Child- and Family-Centered Consultation. Presents lists of questions for consultants and staff to consider for case-based consultation |
| C. | Assessment in Program Consultation. Presents lists of questions for consultants and staff to consider for program-based consultation |
| D. | List of Contributors. Presents a list of professionals whose support and participation were invaluable and essential to the preparation of this monograph |
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