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MODULE 2
The Effective Mental Health Consultant

OBJECTIVES

After completing Module 2, participants will be able to:

• Identify expert knowledge and skills of an effective early childhood mental health consultant.
  
  
• Define roles and responsibilities that a mental health consultant may have in an early childhood mental health consultation model.
  
  
• Describe the administrative process for mental health consultation.
  

KEY CONCEPTS

• Early childhood mental health consultants working with infants, young children, and families are licensed or certified within their state.
  
  
• Effective early childhood mental health consultants have particular skills and expertise relevant to working with young children, parents, families, and program staff.
  
  
• Specialized knowledge, expertise, or experience in certain content areas depends on the community and families served by the program and the consultant.
  
  
• A consultant has interpersonal skills that move staff and families to action. These skills are critical for working within a program and for building alliances with families.
  
  
• A match between the early childhood program and the mental health consultant in philosophy, values, and approach is critical to a successful consulting relationship and partnership.
  
  
• The roles and responsibilities of the early childhood mental health consultant are determined by the match between the program’s needs and the consultant’s skills.
  
  
• The administrative processes for mental health consultation include selection of a consultant to match program needs and approach as well as entry, contracting, termination, and evaluation processes.
  

BACKGROUND INFORMATION: A MINI-LECTURE

Although States license diverse types of professionals as mental health providers, the most commonly licensed specialties are child psychiatry, psychology, clinical social work, marriage and family therapy, counseling, and psychiatric nursing. Mental health consultants who interact with staff, families, and young children should be State-licensed or certified mental health professionals.

The licensed or certified professional as the mental health consultant brings skills, experience, and areas of expertise to individual families, staff, and the program setting. Early childhood programs face the challenges of (1) knowing what a consultation has to offer, (2) knowing what they want from a consultant, (3) determining what philosophy and approach match their needs, and (4) determining how they can use the consultant’s services effectively. Programs also face the challenge of accessing resources and making changes within their own program to design and implement a consultation model. Mental health providers have their own challenges in determining the best way to apply their clinical skills in the context of an early childhood setting and ways to provide services in a consultant role.

IMAGINE AND CREATE… (30 Minutes)

PURPOSE

In this activity, participants will begin to identify desirable qualities and traits of an early childhood mental health consultant.

PREPARATION

Leading the Activity

Summing Up

Summarize some key points of participants as they are added to the illustration of the mental health consultant. List some qualities or traits emphasizing the ones that were repeated as perhaps the most valued. Emphasize that programs should seek individuals with these traits as they contract with a mental health consultant. Using Overheads 1: Consultant Skills and Areas of Expertise and 2: Consultant Roles and Responsibilities and the corresponding Handouts 1 and 2, review desirable skills and attributes for consultants as well as real knowledge, skills, roles, responsibilities, and activities for the consultant within the context of an early childhood setting. Reflect on examples under each type of consultation from Module 1. For example:

• Scene 1 with Dr. Stuart required a consultant who had knowledge of child development and specifically grief and loss; possessed good communication, facilitation, and group work skills; and could observe classroom interaction, meet with staff, and offer therapeutic group work in the classroom environment.
  
  
• Scene 6 with Ms. Raven required a consultant who had knowledge of child development; possessed good observation skills; could take a holistic approach to behavioral concerns; and could engage staff and parents in a team approach to intervention that involved systematic support and follow-up.
  

Suggest that the group keep these ideas in mind for the next activity. It is important, however, to realize that no consultant will possess all the skills and attributes mentioned. They will need to consider their program’s philosophy, set priorities for their needs, and consider training options for consultants to obtain the best possible results from mental health consultation.

WANTED: THE PERFECT MENTAL HEALTH CONSULTANT (60 Minutes)

PURPOSE

In this activity, participants will focus on understanding the importance of a philosophical match between an early childhood services program and the mental health consultant. This activity will help participants understand the important aspects of philosophy and approach, program needs, and a consultant’s expert knowledge and skills in defining the roles and responsibilities of a mental health consultant in an early childhood mental health consultation model.

PREPARATION

Leading the Activity

For Example:

• If the philosophy is that behavioral management is the basis for early childhood mental health intervention, the consultant should have behavior management skills.
  
  
• If the philosophy is that teamwork is key to a supportive environment for children, the consultant should have expertise in organizational dynamics and team building.
  

Summing Up

Emphasize the following points:

• Statements on the cards represent beliefs and philosophies with which mental health and early childhood providers struggle everyday.
  
  
• Each early childhood program and mental health consultant comes with his own philosophy and approach to early childhood mental health services.
  
  
• Reaching team or program consensus on a mental health philosophy or approach can be challenging but is essential.
  
  
• Choosing a philosophy that is too narrow can limit the range and scope of services available to children, families, and staff.
  
  
• A program’s philosophy and approach will greatly influence the match between the program and the consultant, as well as the preferred knowledge, skills, roles, and responsibilities of the consultant.
  
  
• Certain core knowledge and skills are essential for early childhood mental health consultants. Other areas of content expertise may be desirable, depending on the needs of the early childhood program or the community they serve. Remind participants to write notes, ideas, and next steps on their Planning Guide 2.
  

ENGAGING THE MENTAL HEALTH CONSULTANT (20 Minutes)

PURPOSE

In this activity, participants will learn the essential administrative process for engaging a mental health consultant. The steps in the process represent the way that consultation “unfolds” within an agency or service setting. The administrative process may be unique in each particular setting but comprises key elements or “pieces of the puzzle.”

PREPARATION

Leading the Activity

Discussion Guide

Use the following points to guide the large-group discussion:

• In discussing the entry stage of the consultant into the program, emphasize the importance of matching the consultant to the program. Remind the group that in addition to matching qualifications, skills, and experience to program needs, it is important to match the philosophy or approach. Other considerations include race, class, language, and other program or consultant attributes. Exploring shared or varying beliefs and values around mental health, young children, and support to families is a critical part of building trust and beginning a collaborative relationship. Briefly refer to the “values exercise” in Activity 1-1. Emphasize that once this common ground is established, the group can discuss the roles and responsibilities more specifically. Distribute Handout 5: Interviewing and Reaching Agreement.
  
  
• In discussing the contracting stage of the collaboration, remind participants that this is the stage when the consultant and the agency negotiate and reach agreement on roles, responsibilities, activities, scope of work, and financial arrangements. Review the specific topics that should be covered during this phase of the collaboration, using Handout 5: Interviewing and Reaching Agreement. Remind participants that a written contract representing a clear understanding and agreement by both parties and the responsibilities of each party is recommended.
  
  
• In discussing the evaluation stage of the collaboration, review the two types of evaluation: formative and summative:
  

Formative:

• “Nuts and bolts”
  
  
• “What we are doing”
  
  
• “Describing our activity”
  

Summative:

• “What happened”
  
  
• “Did we make a difference?”
  
  
• “Did we change any behavior? policy? procedure?”
  

Remind participants that evaluation assists programs in making decisions by answering such key questions as, “How is consultation being used?”, “Is this consultation helpful and useful?”, “How is consultation making a difference and for whom?”, and “What aspects of consultation do we want to do differently?”

• In discussing the termination stage of the collaboration, remind participants that termination should be part of the early discussion with the potential consultant. Termination may be either based on the consultant’s success in building the skills and capacity of staff to work effectively on their own or related to dissatisfaction with the consultant’s services, job performance difficulties, or other violations of the contractual terms. Point out that the process for termination should be clear, should include appropriate staff, and should be binding for both parties.
  

Summing Up

Summarize the key points of the activity and the discussion, reviewing the pieces of the puzzle. Remind the participants that this session has described the process of engaging a mental health consultant and the relevant administrative structures. These administrative structures provide the framework for the consultative relationship. Encourage participants to take a few minutes to jot down some notes, ideas, and next steps back home on their Planning Guide 2 for this module.

PLANNING GUIDE 2: Ideas to Take Home

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 2-1
Consultant Skills and Areas of Expertise

STATE LICENSURE OR CERTIFICATION REQUIREMENTS

KNOWLEDGE

• Child developmental milestones
  
  
• Normal growth and development of young children
  
  
• Atypical behavior in infants, toddlers, and preschoolers
  
  
• Underlying concepts of socio-emotional development such as attachment, separation, and relationship development
  
  
• Basic medical and genetics information
  
  
• Understanding of cultural differences (cultural competence)
  
  
• Treatment alternatives, including behavioral intervention
  
  
• Family systems
  
  
• Early childhood, child care, family support, and early intervention systems, both public and private
  
  
• Adult learning principles
  

SKILLS AND EXPERIENCE

• Ability to integrate mental health activities and philosophies into group settings
  
  
• Observation, listening, interviewing, and assessment
  
  
• Ability to work with adults
  
  
• Sensitivity to community’s attitudes and strengths
  
  
• Cultural competence
  
  
• Ability to recognize diverse perspectives of program staff and families
  
  
• Communication facilitation
  
  
• Interventions, including behavioral interventions, working with families, and other treatments
  

SPECIALIZED EXPERTISE

• Separation and loss
  
  
• Substance abuse
  
  
• Maternal depression
  
  
• Adolescent mothers
  
  
• Abuse and neglect issues
  
  
• Childhood mental health disorders
  
  
• Issues related to prematurity and low birth-weight infants
  
  
• Failure-to-thrive infants
  
  
• Children with aggressive behavior
  
  
• Learning disabilities and speech and language difficulties
  
  
• Infants, toddlers, and preschoolers with developmental disabilities
  
  
• Working with fathers
  

HANDOUT 2-2
Consultant Roles and Responsibilities

• Help staff in a collaborative manner to understand and problem solve when faced with challenging child behaviors, both in and out of the classroom
  
  
• Provide a receptive atmosphere to explore cultural differences and workplace conflicts
  
  
• Overcome resistance to mental health services by being a regular, reassuring presence at the classroom, program, or agency
  
  
• Provide staff with specialized workshops, training, support groups, and team-building exercises
  
  
• Offer a mental health and wellness perspective to participants in case discussion meetings
  
  
• Support staff in discussing their own stressors, concerns, and personal problems and the ways in which these factors affect their work
  
  
• Provide immediate and follow-up crisis intervention when crises occur
  
  
• Consult closely with parents and families (e.g., through workshops, crisis intervention, family therapy, and parent groups)
  
  
• Refer a child or families for follow-up or more intensive services

HANDOUT 2-4
Administrative Process for Engaging a Consultant

Explore match between program needs and consultant skills Exchange information Define goals of consultation Delineate role and relationship to administration Identify continuous feedback loop Introduce formally to staff Provide orientation to staff about roles and responsibilities

Define nature of consultation Reach consensus about consultant’s roles and responsibilities Negotiate agreement between consultant and organization Agree on financial arrangements Reach clear understanding and agree on contractual terms Document agreement

Revisit goals of consultation Match evaluation strategies to goals and community Use continuous feedback loop including all key players (Formative) Assess overall effectiveness and performance (Summative) Communicate results

Observe staff’s autonomous skill application Withdraw consultant’s active support Validate success and problem resolution Discuss impending departure

HANDOUT 2-5
Interviewing and Reaching Agreement

• Do the consultants have the skills to meet the needs of your agency?
  
  
• Is their general philosophy of service consistent with your program philosophy?
  
  
• Do they have a background in, and experience working with, children from birth to 5 or with expectant mothers? Was it a supervised internship? Was it paid employment?
  
  
• Do they have an educational background in normal development (especially courses in child development), developmental problems, and psychopathology (such as abnormal psychology and abnormal behavior)?
  
  
• Do they have the skills to identify developmental problems, emotional and mental disorders, or family problems?
  
  
• Are they as adept in identifying strengths as they are in identifying needs?
  
  
• Are they comfortable with a “wellness approach” that focuses on preventing problems or addressing minor problems before they get out of hand?
  
  
• Are they willing to learn from parents?
  
  
• Are they willing to learn from children?
  
  
• Are they willing to learn from staff?
  
  
• Are they aware of and sensitive to cultural differences, including low-income, racial, and ethnic factors?
  
  
• Do they possess language skills that match those of the community?
  
  
• Do they have good interpersonal skills?
  
  
• How comfortable are you with the individuals in general? Do they seem as if they can get along well with staff and with parents?
  

NEGOTIATION CONSIDERATIONS

• Be clear about job expectations:
  
  
  • How many hours a week are expected?
    
    
  • What are the job responsibilities?
    
    
  • Does the work include parent meetings, consultation with staff, observation, direct interaction with children, or other responsibilities?
    
    
  • What documentation is required?
    
    
  • What other meetings might be required?
    
    
• Ensure that the consultants understand the chain of authority within your agency. Clarify how the consultants will be introduced to staff and expected to interact with them.
  
  
• Also ensure that the consultants understand the agency policies that would impact their work within the agency and with staff, children, and families.
  
  
• Try to have the consultants on site frequently so that parents and staff are familiar and comfortable with them.
  
  
• Will the professional provide the services directly or will a supervisee actually deliver the services? If a supervisee delivers the services, describe the nature and frequency of the supervision. Will the nature and frequency of supervision be adequate to ensure good quality services?
  
  
• How much travel is involved? Consultants, like employees, typically pay for their travel to the worksite. However, some consultants may want to get paid for travel between worksites on the same day.
  
  
• Are expenses (travel, photocopying, and others) involved? If so, are they reimbursed?
  
  
• How will the consultants be paid? What are the customary rates for the professionals with whom you are negotiating and what is the flexibility?

STATE LICENSURE OR CERTIFICATION REQUIREMENTS

KNOWLEDGE

• Child developmental milestones
  
  
• Normal growth and development of young children
  
  
• Atypical behavior in infants, toddlers, and preschoolers
  
  
• Underlying concepts of socio-emotional development such as attachment, separation, and relationship development
  
  
• Basic medical and genetics information
  
  
• Understanding of cultural differences (cultural competence)
  
  
• Treatment alternatives, including behavioral intervention
  
  
• Family systems
  
  
• Early childhood, child care, family support, and early intervention systems, both public and private
  
  
• Adult learning principles
  

SKILLS AND EXPERIENCE

• Ability to integrate mental health activities and philosophies into group settings
  
  
• Observation, listening, interviewing, and assessment
  
  
• Ability to work with adults
  
  
• Sensitivity to community’s attitudes and strengths
  
  
• Cultural competence
  
  
• Ability to recognize diverse perspectives of program staff and families
  
  
• Communication facilitation
  
  
• Interventions, including behavioral interventions, working with families, and other treatments

SPECIALIZED EXPERTISE

• Separation and loss
  
  
• Substance abuse
  
  
• Maternal depression
  
  
• Adolescent mothers
  
  
• Abuse and neglect issues
  
  
• Childhood mental health disorders
  
  
• Issues related to prematurity and low birth-weight infants
  
  
• Failure-to-thrive infants
  
  
• Children with aggressive behavior
  
  
• Learning disabilities and speech and language difficulties
  
  
• Infants, toddlers, and preschoolers with developmental
  
  
• Working with fathers
  

• Help staff in a collaborative manner to understand and problem solve when faced with challenging child behaviors, both in and out of the classroom
  
  
• Provide a receptive atmosphere to explore cultural differences and workplace conflicts
  
  
• Overcome resistance to mental health services by being a regular, reassuring presence at the classroom, program, or agency
  
  
• Provide staff with specialized workshops, training, support groups, and team-building exercises
  
  
• Offer a mental health and wellness perspective to participants in case discussion meetings
  
  
• Support staff in discussing their own stressors, concerns, and personal problems and the ways in which these factors affect their work
  
  
• Provide immediate and follow-up crisis intervention when crises occur
  
  
• Consult closely with parents and families (e.g., through workshops, crisis intervention, family therapy, and parent groups)
  
  
• Refer a child or families for follow-up or more intensive services
  

W A N T E D
The Perfect Mental Health Consultant