Selection of interventions. The ultimate decision on which intervention strategy to select must rest with staff. Skilled consultants work with staff members to select interventions that are both effective and doable. In the early stages of strategy selection, the consultant can discuss with early childhood staff the types of interventions that they have found to be successful in the past that would be appropriate to implement in the current situation.

Effective consultation requires the intervention selected to fit within the staff’s workload capability. In determining the amount of work involved, consultants and staff must consider the following:

• time needed to design, implement, and monitor the intervention;
  
  
• time needed to learn the intervention;
  
  
• appropriateness of the intervention to the program philosophy;
  
  
• impact on the family and the immediate and larger environment;
  
  
• length of time that the intervention is expected to be in place before the natural environment or the staff member assumes maintenance of the change; and
  
  
• expected results of the intervention.

Another important consideration in selecting an intervention is cultural competence. Consultants’ expertise must include sensitivity to the staff’s and families’ beliefs about the causes of a problem, and the consultant must try to match treatment rationales to these beliefs. For example, one aspect of the Navajo culture is a holistic approach to mental health wellness. Families may view developmental problems as a result of disharmony within that natural system. Within the Navajo belief system, interventions must be geared to regaining harmony through traditional means rather than through mainstream interventions. Mental health consultants to early childhood programs that serve special populations are more likely to guide the program to success if they acknowledge and respect these beliefs when they design interventions.

Implementation of the plan. To facilitate the successful implementation of the plan in the early childhood environment, it is important that the consultant consider the staff’s level of understanding and skills.

Other factors to be taken into account during the implementation of the plan include:

• arranging opportunities for frequent contact between staff and the consultant,
  
  
• providing support to build the staff’s capacity to confront similar problems in the future,
  
  
• considering cultural issues as the plan is implemented, and
  
  
• noting any observations that will be helpful later in evaluating the consultation.

Entry. Entry refers to the consultant’s introduction into an early childhood program (for example, Head Start, early intervention, or family support). The process, which usually begins with a preliminary exploration of the match between program needs and the consultant’s skills, takes various forms, depending on whether the consultant has been engaged by invitation or secured for the program by an administrator or a monitoring or accrediting agency. During one or more early meetings, the consultant and staff members exchange information. Topics may include basic descriptive information about the program, perceived staff needs, specific precipitating issues (if any), desired outcomes, information on the consultant’s skills and working style, and a description of how the consultation might proceed. Fees and time frames also may be discussed.

The entry process involves the formal introduction of the consultant and staff to each other. It often is a good strategy to introduce the consultant during a staff meeting, when he can describe his role and the services to be provided and can answer staff members’ questions. This introduction is particularly important for external consultants.

Some agencies use internal consultants who are members of the organization to which they consult; typically, these internal consultants enjoy established relationships of trust with their service-provider colleagues. Internal consultants must take care to avoid ignoring entry issues, because moving immediately into problem-solving aspects of the consultation can lead to later misunderstandings. It is important for an internal consultant to delineate her role and relationship to the administration (for example, the information that will be shared and the confidentiality of her evaluation of staff performance) at the start of each new consultation.

Contracting. When the consultant and official representatives of the organization reach consensus about the consultant’s usefulness to the organization, they move into contracting. Contracting in this context refers to negotiation and agreement between the consultant and the organization regarding the nature of the consultation and the financial arrangements. Although contracting may not involve a formal written contract, particularly when internal consultants are involved, the outcome of the activity is the same as that of negotiating a written contract—clear understanding and agreement by both parties of the responsibilities of each.

Many potential problems about role, termination, method of intervention, and focus of the consultation can be prevented by creating a clearly written letter of agreement between the contracting parties. In addition, documenting understandings is critically important later in assessing the success of the consulting process.

The consultant’s and staff’s expectations must be aired, agreed on, and documented during the early stages of consultation. These initial agreements often are renegotiated and updated as the consultation progresses, but the expectations developed in the initial stages usually provide a strong framework for the process. Examples of topics to explore during the contracting stage (in no particular order) follow. (The consultant and staff may discuss some of these topics during the entry stage.)

• goals or intended outcomes of consultation,
  
  
• possibility of change in goals and outcomes as consultation proceeds,
  
  
• confidentiality of service and the limits of this confidentiality,
  
  
• time frames,
  
  
• expectations of staff members,
  
  
• times when the consultant will be available,
  
  
• possibility of contract renegotiation if change is needed,
  
  
• consultation fee and duration of consultation,
  
  
• consultant’s access to sources and types of information within the organization,
  
  
• person to whom the consultant is responsible,
  
  
• role of families,
  
  
• steps to take if the consultant is concerned about the teacher or another staff member, and
  
  
• steps to take if staff have concerns about the consultant.
  

Evaluation. The evaluation stage of consultation consists of a series of ongoing consultant-staff interviews to address key issues. The consultant and the staff member meet to determine the following:

• degree of goal attainment,
  
  
• nature of consultant-staff relationship,
  
  
• effectiveness of implementation of the plan, and
  
  
• next steps for the consultation process (continuation, renegotiation, or termination).

Data for making these determinations include primarily observations that begin during the assessment stage and continue throughout the consultation process. During the assessment stage, it is critical to determine who will do the evaluation, who will receive the evaluation, and how to measure the changes.

Two types of evaluation are important in consultation: formative and summative. Formative evaluation occurs during implementation of the plan; summative evaluation occurs after completion of the consultation.

• Formative evaluation constitutes a continuous feedback loop that includes all key players, such as families, staff, the consultant, and administrators. They determine how well an intervention strategy is working and whether or not adjustments must be made. One possible outcome of formative evaluation is that the family, the consultant, and the staff member decide that the interventions developed must be reworked, and they return to the strategy-selection stage. Or, a staff member might decide that the original conceptualization of the problem was incorrect, so the consultant and staff might return to the problem-definition stage.
  
• Summative evaluation is generally a more formal process. Although summative evaluation can provide corrective feedback, most frequently it is used to assess overall effectiveness. Summative evaluation often is undertaken to communicate results to funders, policy makers, and other decision makers. But staff also are interested in the effectiveness of consultation relative to the skills and attitudes of individual staff members and the operation of the overall organization, the cost benefits of consultation, and the satisfaction of staff members and families.

Programs may resist evaluating the consultant-recommended interventions because of the added cost or the difficulty of the evaluation, or both. All parties will gain valuable information, however, by planning for evaluation early in the consultation process; by addressing issues of interest to the consultant, the staff member, and program management; and by defining the goals of consultation in a precise manner to allow measurement (Alkon, Ramler, & MacLennan, 2003).

An example of a summative evaluation is provided by the Miriam and Peter Haas Fund Early Childhood Mental Health Initiative. This initiative assessed the effect of mental health consultation and services on 25 early childhood classrooms in San Francisco serving low-income children ages 2 to 5. The goal of the evaluation was to determine whether and how mental health consultation and services impact child care quality and teachers’ self-efficacy and sense of confidence in their ability to manage children with behavioral and emotional difficulties. Selected findings of this evaluation include the following:

• Teacher self-efficacy showed a significant improvement. After a minimum of 1 year of intervention, teachers were far more hopeful about the future of the children in their care and more confident about their ability to make a positive difference.
  
  
• Both teachers and directors saw improvement in teachers’ understanding of child development and teachers’ ability to manage difficult behavior.
  
  
• Child care staff felt that the consultation resulted in a center environment that can better include parents as partners.
  
  
• Mental health consultation did not have a significant impact on the global quality of centers, as measured by the Early Childhood Environment Rating Scale.
  
  
• Mental health consultation did not have an impact on teacher-child interactions in the domains of sensitivity, harshness, or detachment, as measured by the Arnett Caregiver Interaction Scale.
  
  
• Teachers interviewed in focus groups after working with the mental health consultant for a year felt they had a greater capacity for empathy with children, were more curious about the meaning of difficult behavior, and took on more responsibility for changes in the classroom. These teachers also thought they had gained skills in observation and assessment (James Bowman Associates, 1992).

Termination. Termination of the consultation generally occurs when staff and the consultant agree that the problem that prompted consultation has been resolved, but earlier termination is also an option. The issue of when to terminate the consultation should be addressed early in the consultation.