This Web site is a component of the SAMHSA Health Information Network
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This Web site is a component of the SAMHSA Health Information Network |
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This Web site is a component of the SAMHSA Health Information Network. |
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MODULE
1
|
| GOAL
1 |
Participants will describe the value of mental health consultation and its definition in supporting young children and their families. |
OBJECTIVES
After completing Module
1, participants will be able to:
KEY CONCEPTS
BACKGROUND INFORMATION: A MINI-LECTURE
Promoting healthy development
and the future well-being of infants, toddlers, and preschool children is a
vital public health issue. This issue has important implications for families,
businesses, private philanthropy, and government. Fostering mental health in
the early childhood years is a special opportunity to prepare a child for school
and life and, when possible, to avoid future developmental and emotional problems.
Early childhood providers have a particular opportunity to provide mental health
support in a wide variety of settings. These are child care providers, early
childhood educators, and early intervention specialists for children with special
needs (including mental health service providers).
Early childhood service providers report increasing numbers of children under
stress for whom violence, abuse, parental substance exposure, losses due to
incarceration or death, or residing with multiple caregivers or in foster homes
has had an impact. Challenging behaviors increase with the complexity of the
difficulties that families and communities confront. Teachers and parents of
infants and young children need support to respond to these challenging behaviors
and to promote healthy development. Directors, administrators, and providers
of early childhood programs must 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.
Recent neurobiological research has produced a solid basis for introducing an
early childhood mental health perspective into programs and systems that serve
young children and their families. The way in which the brain develops during
the early years of life, and the role nurturing relationships play, is crucial
in young children’s social and emotional development. This information
has influenced the understanding of early childhood mental health. This information
is also influencing the perspective and practices of child care and other early
childhood-focused programs. The mental health perspective focuses on enhancing
the well-being of all children, minimizing or avoiding behavioral problems in
children under stress. Programs that emphasize the mental health of children
and families reflect this mental health perspective and include preventive intervention
activities.
For more background information, see pages vii–ix in Volume 1, Early
Childhood Mental Health Consultation. Use Handout 1: Children’s Mental
Health in America to reinforce information about children’s mental
health.
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ACTIVITY
1-1
|
VALUES
CLARIFICATION (30 Minutes)
PERSONAL
REFLECTION (Optional) (20 Minutes)
PURPOSE
This activity will help
participants reflect on their own values and assumptions about early childhood
mental health. Discussion will identify current trends that focus our attention
on early childhood mental health and that clarify the underpinning values of
the mental health perspective in early childhood.
PREPARATION
| ARRANGE
FOR: |
Easel, chart paper, markers, and masking tape |
| DUPLICATE: |
HANDOUTS: |
| MAKE: | Line of tape on the wall, with ends marked “1” and “10” and midpoint marked “5”. |
Leading the Activity
| 1. | Remind participants to use Planning Guide 1 for note taking. |
| 2. | Introduce the activity and review its purpose with the participants. Emphasize that understanding the underpinning values provides the foundation necessary for defining early childhood mental health consultation. |
| 3. | Note that this exercise will use statements that take an extreme point of view to illustrate the diversity of perspectives toward mental health. |
| 4. | Ask 8 volunteers to stand under the line of tape on the wall. Explain that you will be asking them to take on the identity of particular groups, such as parents, child care workers, and others. Define their job as representing a particular group’s beliefs or assumptions. Tell them that you will be reading some provocative statements about early childhood mental health. After each statement, you want them to stand at the point on the line that represents a particular group’s beliefs or assumptions. Explain that the line represents a scale of 1–10, with 1 being strongly disagree and 10 being strongly agree. |
| 5. | Ask the rest of the participants to observe where members of the group stand on the Agree-Disagree scale. Encourage them to notice the different perspectives of each group as they shift on the scale. |
| 6. | Read
3–5 of the statements below. When you read each statement, pose the
following: |
Therefore, you will
pose each statement 4 times. Statements:
|
|
| 7. | Invite the group to describe beliefs and values that they have noted from the activity. Facilitate the discussion. Refer to Handout 1: Children’s Mental Health in America and the mini-lecture to support the need to focus attention on mental health services to young children. Emphasize that we each have our own perspective and values about early childhood mental health. |
| 8. | Distribute
and review Handout 2: Values Inherent in the Mental Health Perspective
that reflects the underpinning framework for early childhood mental health
services and supports (see Discussion Guide and Summing Up below). |
OPTIONAL ACTIVITY
On a more personal level,
ask each participant to take a moment to reflect on the discussion thus far.
Use the following questions as a guide:
Discussion Guide
Use the following points
to guide the large-group discussion:
SUMMING UP
Summarize some key points
of the activity and the discussion. Lay out the challenges that face the participants
(whatever their role—administrators, service providers, and others—see
page ix in the publication Early Childhood Mental Health Consultation)—and
the need for creative ways to support young children and families and respond
to mental health developmental needs. Review the mental health perspectives
and values, point by point, using Handout 2: Values Inherent in the Mental
Health Perspective, and emphasize that the training they have begun will
help them think more completely and creatively about the potential for early
childhood mental health consultation.
|
ACTIVITY
1-2
|
DEFINING MENTAL HEALTH CONSULTATION (40 Minutes)
PURPOSE
In this activity, participants
will define two types of mental health consultation: Child- and Family-Centered
Consultation and Programmatic Consultation. Participants will understand each
type and be able to differentiate between consultation and other problem-solving
and capacity-building interventions.
PREPARATION
| ARRANGE
FOR: |
Easel,
chart paper, markers, and masking tape Tables in rounds of 4–6 Overhead projector and screen |
| DUPLICATE: |
HANDOUTS: OVERHEADS:
|
| MAKE: | Fold
the 6 vignettes on card stock in half so that the heading Scene 1: Take
1 appears on the outside. Seal the folded cards with a replaceable sticker
or tape at the bottom. Have enough copies to give 1 vignette to each group. |
Leading the Activity
| 1. | Introduce the activity and review its purpose with the participants. Explain that the focus of this activity is to help participants learn about mental health consultation as a problem-solving and capacity-building intervention implemented within a collaborative relationship between a professional mental health consultant and early childhood service providers. | ||||||||||||||
| 2. |
Mini-Lecture: Review the definition
of mental health consultation. Clarify the term “capacity building”
as any interaction or activity that improves the ability of staff, families,
programs, and systems to prevent, identify, treat, and reduce the impact
of mental health problems among children from birth to age 6 and their
families. Present information about the two types of mental health consultation.
Define Child- and Family-Centered Consultation and Programmatic Consultation,
giving examples (pages 5–9 in Early Childhood Mental
Health Consultation). Highlight the differences. Then, continue to
discuss other problem-solving, capacity-building activities including
teaching and training, clinical supervision, and psychotherapy, being
clear about the differences (pages 4 and 5 in Early Childhood
Mental Health Consultation). Use Overhead 1: Definition of Mental
Health Consultation and Overhead 2: Other Capacity-Building Interventions
and their corresponding Handout 3 and Handout 4 with the same titles
to share this information. Part 1:
Part 2:
|
Discussion Guide
When presenting the definitions
of the types of mental health consultation, be sure to emphasize the capacity-building
and problem-solving aspects of this collaborative relationship. Use the following
points to guide the large-group discussion:
The consultant is not there
to “fix the child” but to work with staff members. Both programmatic
and child- and family-centered consultation assist staff in understanding and
incorporating the mental health perspective into their work and enhance their
own roles, skills, and experience.
Hint: The following
list identifies each vignette and the primary type of consultation:
Scene 2: Ms. Jones—Programmatic
Scene 3: Dr. Pryor—Programmatic
Scene 4: Mr. Adams—Child
and Family Centered
Scene 5: Dr. Gregory—Child
and Family Centered
Summing Up
In bringing the discussion
to a close, inform the participants that they now know the basic definition
of mental health consultation and the two primary types within an early childhood
service setting. Summarize the definition of each type and use an example from
one of the scenarios to illustrate each type of mental health consultation.
The process for deciding what type of mental health consultation might be most
useful may have been reflected in some of their small-group discussions and
fits with the steps of the problem-solving and capacity-building process. The
collaborative relationships between staff and consultants and a continuous communication
feedback loop are critical to supporting this interactive process.
The interactive process
between staff and consultants is most effective when it occurs on a regular
schedule. The program director, the childhood staff, and the mental health consultant
must value and build in adequate time and other supports for team meetings,
problem solving, discussing observations, expressing concerns, and planning
and evaluating strategies. Distribute Handout 7: Reminders About Communication.
 |
PLANNING
GUIDE 1: |
WHILE THE INFORMATION IS STILL FRESH, JOT DOWN SOME NOTES AND IDEAS TO TAKE BACK HOME AS NEXT STEPS IN PLANNING FOR MENTAL HEALTH CONSULTATION:
Good Information:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Great Ideas:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Next Steps Back Home:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
HANDOUT
1-1
Children’s
Mental Health in America
THE NEED
FOR EARLY CHILDHOOD MENTAL HEALTH CONSULTATION
Never before have we
known so much about how infants and young children learn, think, and act.
The earliest interventions are important because:
Developmental psychopathology
arises from the complex interplay of child characteristics, family characteristics,
and community-level factors. Although biological factors are implicated
in some conditions (e.g., autism and Attention-Deficit/Hyperactivity Disorder),
psychosocial factors present significant risks for many conditions. The most
prevalent psychosocial risk factors are:
Seventy percent of children
with mental health problems are not receiving needed services. (U.S. Department
of Health and Human Services, 1999; Yoshikawa & Knitzar, 1997). Barriers
include:
Effective prevention
and intervention programs are available. Targeting high-risk families when
children are younger yields larger savings and generates better development
outcomes, for example:
References:
Karoly, L. A., Greenwood,
P. W., & Everingham, S. S., et al. (1998). Investing in our children:
What we know and don’t know about the costs and benefits of early childhood
interventions. Santa Monica, CA: RAND Corporation.
Kaufmann, R., & Wischman, A. L. (1999). Communities supporting the mental
health of young children and their families. In Roberts, R., & Magrab, P.
Where children live: Solutions for serving young children and their families.
Stamford, CT: Ablex Publishing Corporation.
Shonkoff, J. P., & Phillips, D. A. (2000). From neurons to neighborhoods:
The science of early childhood development. Washington, DC: National Academy
Press.
U.S. Department of Health and Human Services. (1999). Mental health: A report
of the surgeon general. Rockville, MD: Author.
U.S. Public Health Services. Report of the surgeon general’s conference
on children’s mental health: Developing a national action agenda. Washington,
DC: Author.
Yoshikawa, H., & Knitzer, J. (1997). Lessons from the field: Head Start
mental health strategies to meet changing needs. New York: National Center
for Children in Poverty and American Orthopsychiatric Association.
Values Inherent
in the Mental Health Perspective*
*These values were developed by a group of mental health experts at a roundtable convened by Georgetown Child Development Center (now known as the Georgetown University Center for Child and Human Development) for SAMHSA.
Definition
of Mental Health Consultation
MENTAL HEALTH CONSULTATION
A problem-solving and capacity-building
intervention implemented within a collaborative relationship between a professional
consultant with mental health expertise and one or more individuals with other
areas of expertise or parenting responsibilities.
CHILD- AND FAMILY-CENTERED CONSULTATION
PROGRAMMATIC CONSULTATION
Other Capacity-Building
Interventions
TEACHING AND TRAINING
A teacher or trainer uses
a didactic, expert approach toward their students and chooses the content and
format of information to be conveyed. By contrast, a mental health consultant
to an early childhood program provides information on topics specifically requested
by program staff. Teaching is commonly used as a tool in the consultative process,
but much of that teaching is informal and involves various forms of modeling,
rather than presentations in a typical classroom format.
CLINICAL SUPERVISION
Both clinical supervisors
and mental health consultants help program staff improve their skills to understand
and accomplish their work, and to crease their capacity to master future problems.
A supervisory relationship implies administrative and legal accountability of
staff members for following the supervisor’s recommendations, but in a
consulting relationship, staff take responsibility for deciding whether or not
to implement the consultant’s recommendations.
PSYCHOTHERAPY
In therapy, as in consultation,
a client seeks assistance (or treatment) to solve a problem. Both therapeutic
and consultative relationships are characterized by genuineness and trust, and
the goal of each is to foster understanding in the client. Therapists focus
completely on personal, psychological problems. Consultants may look at the
factors in a staff member’s experience that contribute to his subjective
perception of the situation. Sometimes, consultants may suggest that a staff
member seek therapeutic services; at other times, the actual consultation can
have coincidental therapeutic results. But consultation mainly focuses on improving
the effectiveness of the individual staff member in her work with the child
and family.
A variety of factors
enter into choosing the best intervention to address a particular issue.
Among them are:
Scenes 1–6:
Takes 1 and 2
SEE FOLLOWING PAGES FOR ALL SCENES.
 |
Dr.
Stuart was scheduled to observe Sandra in her classroom. When he discovered
that she was no longer in the program, he realized that she was the fourth
child to leave suddenly. The school is located near a public housing development
that is being relocated. Neither the program director nor staff, families,
or children have addressed this issue.
WHAT'S YOUR TAKE ON THIS SCENE? |
 |
SCENE 1 Dr. Stuart convened a meeting for staff to discuss separation and loss. Together, they designed a way to talk about “goodbyes and missing friends” with children in the classroom. The program director asked Dr. Stuart to come to the next family meeting to share ways to prepare children for moving to new homes and child care programs. As a consultant to the program and as someone only a step removed from the classroom experience and community events, Dr. Stuart was able to observe the situation from a different perspective. He helped program staff and families recognize how changes in the community can impact children and their families—one at a time or as a large group. He also helped them develop specific preventive intervention approaches and strategies to deal with a community issue that had an impact on all children and families—those who were moving and those who remained behind. |
 |
One morning as children were arriving at the Head Start program, a young man shot a father who had just dropped off his child. Although no one else was hurt, some children and staff had witnessed the event. The teachers and staff immediately implemented their emergency procedures, and the program director secured the building. Everyone was very anxious and upset. The director called the police.
|
|
SCENE 2 Once the director was sure that all children and teachers were in the classroom, secure in the building, and police on their way, her own anxiety level guided her to contact the program’s mental health consultant. Ms. Jones assured the director that she had taken all the appropriate immediate steps. The consultant then helped to calm the director and agreed to come to the school immediately. Ms. Jones arrived within a half-hour and met with the director. Ms. Jones worked with the director to develop a crisis intervention plan. Ms. Jones went into each classroom to talk directly with staff and children. She knew that this kind of trauma affects individuals differently and is best resolved over time. Parent and staff support groups were initiated to process fears about safety and reactions to the event. Through the use of conversation, dramatic play, books, and storytelling, children were encouraged to share their feelings and fears. By offering immediate and longer term support, the consultant was able to help everyone deal with this trauma. |
 |
Mr.
Neil, the three-year-olds’ classroom teacher, seemed to be avoiding
the mental health consultant, Dr. Pryor. On consultation days, he often
scheduled special activities or outings. He was very verbal in his belief
that “consultants” look for only what’s wrong with children.
Although he sometimes described his own concern about some children in
his class, he strongly believed that they would grow out of most of their
problems. WHAT'S YOUR TAKE ON THIS SCENE? |
|
SCENE 3 Dr. Pryor arranged a meeting with Mr. Neil at a time that was convenient to the teacher. During the meeting, he asked Mr. Neil to share his observations about the strengths and interests of the children in his classroom. After acknowledging that Mr. Neil’s observations were very astute, Dr. Pryor shared that he also looked for the strengths in children and families. They found a common understanding of the roles that growth and development play in helping children learn new skills to manage their own emotions and behavior. Together, they explored the many ways that Dr. Pryor could be useful to Mr. Neil, the children, and their families. A clear understanding of expectations, communication, and professional respect is essential to building rapport between the teacher and the mental health professional, which is in the best interest of children and families. |
 |
Mary,
the toddler classroom teacher at the Flower Street Child Care Center,
has been increasingly concerned about Robert. He has always been shy and
withdrawn, but during the last 3 months—ever since he moved to his
new class—he has had difficulty during naptime. He often cries, revealing
his own distress as well as disturbing other children. He stops crying
when Mary is by his side but starts up again the minute she leaves. She
also noted that he has not been eating much lately. WHAT'S YOUR TAKE ON THIS SCENE? |
|
SCENE 4 Mary approached Mr. Adams, the consultant, to discuss her concerns about Robert’s change in behavior. To assess Robert’s abilities, limitations, vulnerabilities, and strengths, the consultant visited the center and observed him at various times during the course of a day. He also assessed the quality of the interactions in the classroom—those involving Robert as well as the other children. The consultant met with Robert’s parents and discovered that because of a new work schedule, there were frequent disruptions in their family schedule. The consultant shared this information with staff to increase their understanding of Robert’s behavior. With the consultant’s assistance, staff developed new strategies to help Robert develop a sense of predictability, including consistent contact with one staff member, transition to nap time, and a routine and “rules” under which Robert would be given the same toy or book before he went to sleep. By observing and encouraging communication between staff and parents, Mr. Adams helped Robert’s caregivers implement strategies to help him adjust to change. |
 |
A
16-year-old
mother, Wanda, complained to the teacher that Juanita, her 18 month old,
was a stubborn, “bad” little girl who did not listen to her.
Wanda expressed frustration and anger, saying that she is afraid that
she might lose control one day. She went on to say that she has tried
talking to her, threatening to put her to bed, and taking away toys. Nothing
seems to make a difference in Juanita’s willful behavior. WHAT'S YOUR TAKE ON THIS SCENE? |
|
SCENE 5 The teacher suggested that Wanda speak with Dr. Gregory, the mental health consultant, about her frustration and concerns for Juanita. They arranged a home visit where Dr. Gregory could observe Juanita at play and mealtime. After they met, Dr. Gregory helped Wanda to better understand typical 18-month-old behavior. He also helped her structure their daily routine, set reasonable limits, and build in time for Wanda and Juanita to play together. By joining with Wanda in her concerns about her daughter, by offering support, and by increasing her understanding of her daughter’s development, Dr. Gregory was able to help Wanda find new strategies to feel more in control and to enjoy her daughter and their relationship. |
 |
Gabrielle, a 4-year-old girl who was small for her age, had a sad, solemn expression during much of the school year. She did not willingly participate in group activities or play with other children. Instead, she chose to look at books or stare into space, holding a favorite stuffed animal. She also seemed tired a lot of the time.
WHAT'S YOUR TAKE ON THIS SCENE? |
|
SCENE 6 The mental health consultant, Ms. Raven, noticed Gabrielle’s lack of affect and asked to meet with her teacher and parents. She shared her observations and asked whether these were consistent with the observations at home and school. Ms. Raven also then recommended that Gabrielle see her pediatrician to rule out any health problems. At a follow-up meeting, after the doctor found no health problems, Ms. Raven designed a sequenced plan to engage Gabrielle in classroom activities. She suggested that the teacher pair Gabrielle with another gentle child around a preferred activity, as a place to start. They agreed that the teacher would regularly observe Gabrielle for any progress and report back to Ms. Raven and Gabrielle’s parents. Through the consultation process, the teachers and parents were coached to observe, offer specific support, and follow up with one another to monitor Gabrielle’s mood and progress. |
Steps in Problem
Solving and Capacity Building
ASSESSMENT
SELECTION OF INTERVENTIONS
IMPLEMENTATION OF THE PLAN
Reminders About
Communication
IN MY PROGRAM:
MENTAL HEALTH CONSULTATION
A problem-solving and capacity-building
intervention implemented within a collaborative relationship between a professional
consultant with mental health expertise and one or more individuals with other
areas of expertise or parenting responsibilities.
CHILD- AND FAMILY-CENTERED CONSULTATION
PROGRAMMATIC CONSULTATION
TEACHING AND TRAINING
A traditional teacher or
trainer chooses the content and format of the information to be conveyed. By
contrast, a mental health consultant to an early childhood program provides
information on topics specifically requested by program staff. Teaching is commonly
used as a tool in the consultative process, but much of that teaching is informal
and involves various forms of modeling, rather than presentations in a typical
classroom format.
CLINICAL SUPERVISION
Both clinical supervisors
and mental health consultants help program staff improve their skills to understand
and accomplish their work and to increase their capacity to master future problems.
A supervisory relationship implies administrative and legal accountability of
staff members for following the supervisor’s recommendations, but in a
consulting relationship, staff take responsibility for deciding whether or not
to implement the consultant’s recommendations.
PSYCHOTHERAPY
In therapy, as in consultation,
a client seeks assistance (or treatment) to solve a problem. Both therapeutic
and consultative relationships are characterized by genuineness and trust, and
the goal of each is to foster understanding in the client. Therapists focus
completely on personal, psychological problems. Consultants may look at the
factors in a staff member’s experience that contribute to her subjective
perception of the situation. Sometimes, consultants may suggest that a staff
member seek therapeutic services; at other times, the actual consultation can
have coincidental therapeutic results. But consultation is mainly focused on
improving the effectiveness of the individual staff member in his work.
ASSESSMENT
SELECTION OF INTERVENTIONS
IMPLEMENTATION OF THE PLAN
|
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