Introduction

Early Head Start/Head Start (EHS/HS) programs are required to provide a broad spectrum of mental health services. The services include mental health promotion, prevention, early identification of mental health concerns, and referrals for treatment of children and families. It is estimated that 9 percent to 14 percent of young children from birth to age 5 years experience social and emotional problems that negatively affect their functioning and development (Whitaker, Orzol, and Kahn, 2006). In addition, risk factors such as substance use, mental illness, and domestic violence can affect families' ability to support children's social and emotional development and may contribute to behavioral problems in young children (Brauner and Stephens, 2006). At times, referrals outside of the EHS/HS program are necessary to address the mental health needs of children and their families, when those needs exceed the scope of services offered by the EHS/HS program.

There are more than 40 Head Start performance standards that relate to child and adult mental health. Several of these are highlighted in this brief. Program staff members are required to work collaboratively with families to ensure access to any needed mental health interventions (see Figure 1). This brief is designed to: (1) provide guidance to EHS/HS program staff in identifying mental health providers who best meet a family's needs, culture, and personality, and (2) offer ideas to overcome access barriers.

What Education, Skills, and Attributes Should a Mental Health Provider Have?

Mental health providers should have the licensure, education, experience, and attributes that support high quality services.

Education

Typically, a mental health provider has a minimum of a master's degree in a human services field with licensure or certification from an accredited state board. Common types of mental health professionals include marriage and family therapists, social workers, psychiatrists, and psychologists. Figure 2 describes the level of education and licensure each type of mental health provider requires.

Experience

Services for children and families are likely to be more successful when a mental health provider is experienced in treating the specific challenges the family is facing. Often, a mental health provider has a special area of focus, such as depression, childhood trauma, or substance abuse. Experienced providers have seen the problems faced repeatedly by children and families, which can broaden their view and give them added insight.

Important to early child and family work is the mental health providers' experience with and ability to:

• Conduct and interpret mental health screening and assessments for very young children
• Facilitate a family-centered approach to services
• Use evidence-based practices
• Have knowledge of and sensitivity to the first language of families
• Use treatment methods that reflect the culture-specific values and treatment needs of clients (Center for Substance Abuse Prevention, 1994)

Attributes

Mental health providers are typically required to have training in ethical conduct covering topics such as tolerance, integrity, boundaries, and self-awareness (American Psychological Association, 2002). Yet, a mental health professional's "way of being" can greatly affect the success of a child and family's experience with therapeutic work. Figure 3 provides examples of questions to ask to learn more about a potential provider. Important attributes to look for in any mental health provider include:

• Strong communication skills with the ability to listen and
  engage in shared decision‐making
• A strength-based perspective that supports a family's sense
  of hope
• Flexibility to adjust one's schedule and expectations to the
  needs of the family
• Dependability—showing up on time and regularly
• Open-mindedness—accepting where families are in the
  process

Approach/Orientation

Another important component to consider when looking for mental health providers is their approach to mental health work (often referred to as their "orientation"). Mental health providers have very different approaches to their work based on their training and experience. Some therapists adopt a particular approach to their work that may be informed by a specific theoretical perspective and others use a more eclectic approach—drawing from multiple theories and orientations. Some therapists might provide their clients with guidance on how to change specific behaviors that are problematic while others may focus more on the quality of the relationships that a parent or child has with other family members. Knowing what a family expects or is most comfortable with before a referral can assist program staff in linking a family to the right mental health provider. For example, one family may prefer a therapist with a more behavioral approach who might suggest specific strategies. Another family may be more comfortable with a therapist who spends more time listening, reflecting, and asking questions about their relationships.

How Do EHS/HS Programs Overcome Barriers to Accessing a Qualified Mental Health Provider?

Accessing mental health providers with all of the skills, attributes, and experience needed for every child and family is a challenge in some communities. Common challenges programs face are finding mental health providers that speak the families' native languages and/or come from the same racial/ethnic group, have the expertise and knowledge of early child development, and provide services that are easily accessible. These challenges can cause delays in getting children and families the help they need. Ideas to consider in overcoming these barriers are shared below.

Knowing Where to Find Mental Health Providers in the Community

• Each EHS/HS program is required to have on-site mental health consultation involving a mental health professional (1304.24). These individual(s) can often be a great resource in helping program staff find mental health providers for families within the community.
• EHS/HS program staff can look to local, state, and national organizations and contacts to assist in finding a mental health provider including:
  • Local community mental health center(s) or agencies
  • The state children's mental health director
  • The liaison to the state chapter of licensed psychologists
  • The (Individuals With Disabilities Act [IDEA]) Part C or 619 coordinator
  • Department leaders at university schools of social work, child psychiatry, psychology, and special education
  • National Association for Social Workers
  • American Psychological Association
• Have a mental health provider from the community on the policy council or health advisory committee that can get to know the needs of children and families in your program. This can help them to provide more intentional linkages to outside resources.
• Consider forming a mental health services advisory committee—as part of your health advisory committee or as a stand-alone group—if there are sufficient numbers of providers in your community.
• Visit the Substance Abuse and Mental Health Services Administration link that can help identify local providers by zip code and type of provider (Substance Abuse and Mental Health Services Administration):
  http://www.samhsa.gov/treatment/

Families Have Challenges Accessing Mental Health Services

• Ask mental health providers if they are willing to work with children and/or families at the EHS/HS program.
• Ask the mental health provider, local mental health agency, or state department of mental health about home-based mental health service options for families.
• Work with local business partners to get stipends for gas and/or bus tokens.
• Find out about other community intervention programs that may be serving large numbers of families to avoid duplication of efforts. Offer to host intervention groups at the EHS/HS program.
• Assist the family in obtaining any insurance that they may be eligible for, such as state Medicaid/SCHIP.
• Identify any grant-funded services that may offer low cost or reduced fees for treatment services.

Finding Providers Who Understand and Meet the Diversity and Specialized Needs of Families

• Be open to working with mental health interns who meet the diversity of families and are being supervised by a licensed professional.
• Work with other partner agencies to support a mental health provider to get specialized training in child, family, and early childhood topics. For example:
  • Invite mental health providers to EHS/HS program trainings on curriculum, child development, etc.
  • Blend funds with other partners (e.g., Part C, Department of Human Services, etc.) to fund a mental health provider to go to specialized trainings at conferences and other state or national events to increase their knowledge base.
  • Link a mental health provider with the EHS/HS mental health professional/consultant for shadowing.
• Involve a mental health provider in EHS/HS program work groups to learn more about the children and families served.
• Use technology to link with state mental health experts from hospitals, universities, and state agencies to provide webinars and videoconferencing to staff and families.
• Ask mental health providers to host regular in-services with families to get better acquainted with their needs and experiences.
• Link family mentors with mental health providers to provide translation and peer-to-peer support.

Conclusions

Linking families to mental health providers who can best support their needs is a critical activity in EHS/HS. Finding ways to overcome barriers in finding mental health providers can help children and families obtain needed mental health services. Early access to these services helps children and families to be better prepared for school and life.

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060–1073.

Brauner, C.B., & Stephens, B.C. (2006). Estimating the prevalence of early childhood serious emotional/behavioral disorder: challenges and recommendations. Public Health Reports, 121, 303–310.

Center for Substance Abuse Prevention. (1994). Following Specific Guidelines Will Help You Assess Cultural Competence in Program Design, Application, and Management. Rockville, MD: Substance Abuse and Mental Services Administration.

Substance Abuse and Mental Health Services Administration website. Retrieved from: http://www.samhsa.gov/treatment/

Whitaker, R.C., Orzol, S.M., & Kahn, R.S. (2006). Maternal mental health, substance use and domestic violence in the year after delivery and subsequent behavior problems in children at age 3 years. Archives of General Psychiatry, 63, 551–560.