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Module 4
Understanding Challenges and Developing Strategies

GOAL 4
 Participants will identify critical issues and challenges in the consulting process and will develop strategies to address them.

OBJECTIVES

After completing Module 4, participants will be able to:

  • Identify their own specific challenges to early childhood mental health consultation from their perspective or role.
  • Identify several strategies for each challenge.

KEY CONCEPTS

  • Challenges are a natural part of any problem-solving effort including the consultative process.

  • Awareness of challenges is important; solutions and strategies need to be implemented to address these challenges.

  • Developing consensus and working with community partners are essential to meeting the challenges.

  • Strategies should be culturally sensitive and relevant to the settings.

BACKGROUND INFORMATION: A MINI-LECTURE

Early childhood mental health consultation enhances the well-being of children, families, and staff and program capacity. The consultant has the personal satisfaction of making a difference. However, developing an early childhood mental health consultation effort presents challenges. Some of these challenges include:

  • Difficulty in implementing the intervention plan

  • Organizational setting

  • Value conflicts

  • Racial, ethnic, cultural, and socioeconomic issues

  • Lack of mental health professionals with early childhood consultation experience

  • Funding

Use Overhead 1 and Handout 1: Common Challenges to share information from Section IV (pages 19–23) in Early Childhood Mental Health Consultation.

Challenges to implementing an intervention plan include ambiguity in the plan itself and lack of clarity about the consultative process; lack of awareness of work load or time demands on staff; complexity of the plan itself and difficulty in implementing it; and other entrenched habits.

Challenges in the organizational setting include overworked staff, high staff turnover and low morale, autocratic decision making, and inadequate resources. Consultants begin the process of consultation by defining the organizational structure, establishing the different roles and boundaries within the organization, and setting achievable goals and outcomes.

Challenges around values focus on moving away from the traditional approach of identifying an individual’s problems toward assuming a strengths-based approach and capitalizing on the strengths of both children and their families. It is essential for the mental health consultant to be aware of strengths as problems are being addressed.

Challenges around racial, ethnic, cultural, and socioeconomic issues may inhibit the success of the consultation. The consultant needs to be both culturally empathic and culturally knowledgeable. A consultant working in cross-cultural situations should be aware of cultural differences and address these differences openly and in a nonjudgmental manner with staff.

Challenge of lack of mental health professionals with early childhood experience, training, and consultation skills. It is sometimes difficult to identify mental health consultants who are knowledgeable about child development, family systems, child care issues, and early childhood education. Few higher education programs offer mental health training courses that teach students how to be consultants.

Challenges of funding is one of the most frequently cited barriers to mental health consultation. Obtaining funds for program consultation is even more challenging than paying for child-focused consultation in which Medicaid may provide some funds through its Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Some states and communities are recognizing the benefits of providing mental health services to young children and their families and are using creative approaches to plan, provide, and pay for these services.

ACTIVITY 4-1

IDENTIFYING MY OWN CHALLENGES (30 Minutes)

Purpose

In this activity, participants will identify challenges to mental health consultation in an early childhood setting and will identify their own system or program challenges and share them with others.

Preparation

ARRANGE FOR:
 Post-it notes, pens, easel and flip chart paper, and markers
DUPLICATE:

HANDOUT:
Handout 1: Common Challenges

OVERHEAD:
Overhead 1: Common Challenges
MAKE:

On 8 separate flip chart pages posted around the room, make headings for:

  • Difficulty in implementing the intervention plan

  • Organizational setting

  • Value conflicts

  • Racial, ethnic, cultural, and socioeconomic issues

  • Lack of mental health professionals with early childhood consultation experience

  • Funding

  • Other

Leading the Activity

1. Present information on Common Challenges to the large group.
2. Have participants count off by two and give each pair some Post-it notes and markers.
3.

Give the following instructions:

  • Based on Handout 1: Common Challenges, as well as what you know about early childhood mental health consultation, talk with your partner about what you think may be the challenges to mental health consultation as part of your own system or program.

  • Write at least 2 or 3 challenges on separate Post-it notes.
4. Have the participants read one challenge aloud and place all their Post-it notes under the appropriate headings on the flip chart paper around the room.

Summing Up

Using Overhead 1 point out the variety of challenges that may be related to the particular organizational and operational issues. Inquire about headings with no Post-it notes, and explore whether participants did not think about this category or whether it is not an issue or challenge.

ACTIVITY 4-2

PROBLEM-SOLVING STRATEGIES FOR THE CHALLENGE (40 Minutes)

Purpose

In this activity, participants will problem solve strategies to overcome challenges.

Preparation

ARRANGE FOR:
 Pens, Post-it notes, flip chart paper, and markers
DUPLICATE:

HANDOUT:
Worksheet 1: My Own Challenges

Leading the Activity

1. Acknowledge that challenges are normal and expected but that there may be specific interventions or strategies that we can do either immediately or long range that could be helpful to overcoming the challenges.
2. Describe a few helpful strategies either from the publication Early Childhood Mental Health Consultation or from your own experience. Emphasize that mental health consultation is a mutual problem-solving approach.
3.

Create small groups, one for each poster with Post-it notes indicating specific challenges.
4. Assign each group a flip chart poster.
5.

Give the following instructions:

  • Explain that each group is a mini-consultant team.

  • As a team, they will review the challenges listed on their flip chart poster and will discuss possible solutions to the barriers posted. Try to be as realistic as possible
6. As a team, identify possible solutions, and post them on the flip chart paper next to the relevant challenges. If time allows, invite each individual participant to wander around the room to each poster and add strategies where they can.
7. Finally, have all the participants walk around the room using their Worksheet 1: My Own Challenges to record the specific challenges and strategies they want to remember for their individual challenges.

Summing Up

Offer observations about the group process of teamwork in identifying specific strategies. Note that it is often helpful to engage others in a problem-solving process to generate a variety of ideas. However, another challenge is to make the strategies specific and doable and something that can really make a difference back home within the context of your own early childhood or mental health services program.

ACTIVITY 4-3

NEXT STEPS AND WHO DO I NEED (20 Minutes)

Purpose

In this activity, participants will prioritize challenges and strategies, delineate next steps, and think about who might be needed to accomplish the tasks.

Preparation

ARRANGE FOR:
 Pens
DUPLICATE:

HANDOUTS:
Planning Guide 1, 2, and 3 Worksheets
Worksheet 1: My Own Challenges
Handout 2: Financing Early Childhood Mental Health Consultation Services

Leading the Activity

1. Discuss the importance of formulating clear next steps for each strategy.
2. Encourage participants to spend some time reviewing their Planning Guide 1, 2, and 3 Worksheets from the three previous modules, in addition to the strategies they have learned from the flip charts.
3.

Explain that this is an opportunity to integrate the ideas and next steps that they noted throughout the training. Have people recognize that they may need others to help them implement a strategy.
4.

Give the following instructions:

  • Spend a few minutes alone and review your Worksheet 1: My Own Challenges and Planning Guides.

  • Select a strategy that you want to work on very soon after this training. Pick something doable.

  • Write your Next Steps.
5.

In the large group, ask for someone to share one priority—a challenge, a strategy to address the challenge, a next step or steps, and others they need to enlist in the effort.

Summing Up

Remind participants that they can use the planning sheets when they get back to their programs to further develop a plan for early childhood mental health consultation. Suggest that they can use a planning process similar to the one in which they just participated, pulling together a team of colleagues to complete the work. Distribute Handout 2: Financing Early Childhood Mental Health Consultation Services, acknowledging that financing is one of the most common challenges.

HANDOUT 4-1

Common Challenges

Challenges to implementing an intervention plan include ambiguity in the plan itself and lack of clarity about the consultative process; lack of awareness of work load or time demands on staff; complexity of the plan itself and difficulty in implementing it; and other entrenched habits.

Challenges in the organizational setting include overworked staff, high staff turnover and low morale, autocratic decision making, and inadequate resources. Consultants begin the process of consultation by defining the organizational structure, by establishing the different roles and boundaries within the organization, and by setting achievable goals and outcomes.

Challenges around values focus on moving away from the traditional approach of identifying an individual’s problems toward assuming a strengths-based approach and capitalizing on the strengths of both children and their families. It is essential for the mental health consultant to be aware of strengths as problems are being addressed.

Challenges around racial, ethnic, cultural, and socioeconomic issues may inhibit the success of the consultation. The consultant needs to be both culturally empathic and culturally knowledgeable. A consultant working in cross-cultural situations should be aware of cultural differences and address these differences openly and in a nonjudgmental manner with staff.

Challenge of lack of mental health professionals with early childhood experience, training, and consultation skills. It is sometimes difficult to identify mental health consultants who are knowledgeable about child development, family systems, child care issues, and early childhood education. Few higher education programs provide mental health training courses that teach students how to be consultants.

Challenges of funding is one of the most frequently cited barriers to mental health consultation. Obtaining funds for program consultation is even more challenging than paying for child-focused consultation in which Medicaid may provide some funds through its Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Some states and communities are recognizing the benefits of providing mental health services to young children and their families and are using creative approaches to plan, provide, and pay for these services.

HANDOUT 4-2

Financing Early Childhood Mental Health Consultation Services

  • A broad array of public and private entities provides early childhood services. Half of all preschool-aged children have a mother in the labor force. Children are cared for by their relatives, by their in-home sitter, in family day care homes, in public and private child care centers, in public preschool programs, and in private preschools.

  • A complex system exists for financing children’s mental health services. A variety of public agencies and programs provide for mental health services for young children, including child welfare and protective services, Part C early intervention systems, preschool special education programs, Medicaid, and Head Start. Foundations and private nonprofit groups also pay for services in communities.

  • Private health insurance plans typically pay for a narrow array of direct services provided. Our current health care financing systems fail to cover mental health services to the same extent as physical health services. Barriers often exist for providers seeking reimbursement for consultation services.

  • Major sources of funding do exist for early childhood mental health services, including some types of consultation:

    • Medicaid

    • Head Start and Early Head Start

    • Individuals with Disabilities Education Act (Part B, Section 619; and Part C)

    • Mental Health and Substance Abuse Block Grants

    • Child Care and Development Fund

    • Child Welfare funds (Title IV-E of the Social Security Act)

    • Maternal and Child Health Block Grant (Title V of the Social Security Act)

    • Temporary Assistance to Needy Families (TANF, replaced AFDC)

    • Housing and Urban Development

    • State and County Appropriations

    • Foundations (e.g., Annie E. Casey Foundation and Ounce of Prevention Fund)

    • Community Organizations (e.g., churches, Elks clubs, sororities, and Junior League)
WORKSHEET 1

MY OWN CHALLENGES

CHALLENGES
STRATEGIES
NEXT STEPS
WHO DO I NEED
 

1.

2.

3.

    
 

1.

2.

3.

    
 

1.

2.

3.

    
 

1.

2.

3.

    

Common Challenges

Challenges to implementing an intervention plan:

  • Ambiguity in the plan itself

  • Lack of clarity about the consultative process

  • Lack of awareness of work load or time demands on staff

  • Complexity of the plan and difficulty in implementing it

  • Other entrenched habits

Challenges in the organizational setting:

  • Overworked staff

  • High staff turnover

  • Low morale

  • Autocratic decision making

  • Inadequate resources

  • Beginning the process of consultation by defining the organizational structure, by establishing the different roles and boundaries within the organization, and by setting achievable goals and outcomes

Challenges around values:

  • Moving away from the traditional approach of identifying an individual’s problems

  • Moving toward assuming a strengths-based approach and capitalizing on the strengths of both children and their families as problems are being addressed

Challenges around racial, ethnic, cultural, and socioeconomic issues:

  • May inhibit the success of the consultation

  • Consultant is culturally empathic and culturally knowledgeable

  • Awareness of cultural differences

  • Willingness and ability to address these differences in an open and nonjudgmental manner

Challenge of lack of mental health professionals with early childhood experience, training, and consultation skills:

  • Difficult to identify consultants who are knowledgeable about child development, family systems, child care issues, and early childhood education

  • Few higher education programs offer courses that teach students how to be consultants

Challenges of funding:

  • Obtaining funds for program consultation

  • Available reimbursement for services through Medicaid and its Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program

  • Other creative approaches to plan, provide, and pay for these services

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