Early Childhood Mental Health Consultation Research Articles

Virtual robotic telepresence early childhood mental health consultation to childcare centers in the aftermath of COVID-19: training approaches and perceived acceptability and usefulness.

Childcare center closures during COVID-19 impacted education for approximately 40 million children nationwide. Unfortunately, COVID-19 restrictions significantly limited the extent that outside personnel could provide in-person support to educators, resulting in the need for innovative approaches to meet childcare centers' needs. A virtual robotic telepresence approach was applied to early childhood consultation models to promote child resilience while mitigating COVID-19 risks. The goal of this study was to examine how training influenced consultants' and childcare staff uptake of the virtual robotic telepresence consultation approach and their acceptance of this technology. Ten early childhood consultants received multimedia/simulation training and weekly communities of practice related to virtual telepresence robotic consultation. Telepresence robotic consultation equipment was deployed to 16 childcare centers in a diverse multilingual metropolitan area as a part of a larger randomized controlled trial. Consultants trained childcare staff (14 center directors and 58 teachers) on how to receive virtual telepresence robotic consultation. Demographic information and measures of technology acceptability and uptake were collected from childcare staff and consultants. A mixed methods approach was used including multilevel modeling and focus groups to examine consultation uptake, acceptability, barriers, and facilitators of virtual telepresence robotic consultation implementation. Consultants and childcare staff generally perceived the virtual telepresence consultation approach to be useful and easy to use. Consultant perceptions of the acceptability of technology did not change over time. Childcare staff, center, and consultant factors impacted the uptake of the virtual robotic telepresence consultation approach and childcare staff acceptance of the technology. Focus groups revealed that consultants believed that additional hands-on training with childcare staff would have benefited implementation and expressed a desire for a hybrid approach for consultation. Perceptions of telepresence robotic consultation acceptability are discussed, including future recommendations for training.

Child-focused infant and early childhood mental health consultation: Shifting adult attributions to reduce the risk for preschool expulsion.

Infant and early childhood mental health consultation (IECMHC) in early care and education (ECE) settings is a promising approach to support young children. Although research on the effects of IECMHC is encouraging, it is limited by the complexities of the systems in which IECMHC is implemented and the variability in IECMHC models. The current study aims to clearly articulate a statewide, child-focused, short-term IECMHC model, assess consultee satisfaction, examine the effects of consultation on children's functioning in the school and home settings, and evaluate changes in teacher perceptions associated with expulsion risk following consultation. In total, 268 children ages 1-5 (69% White, 75% male) and their family and school caregivers participated in consultation in a New England state, and 95 children and caregivers were included in an evaluation subsample. Of this subsample, teachers and ECE administrators, but not families, indicated significant improvement in children's functioning from referral to end of consultation. There was also a significant decrease in children's risk of expulsion, as measured by teachers' perceptions associated with expulsion decisions. This study contributes to the IECMHC literature by providing results specific to a child-focused model of consultation and highlighting the possible role of adult attributions for children in ECE.

1.48 Follow-up Success After Early Childhood Mental Health Consultation

1.48 Follow-up Success After Early Childhood Mental Health Consultation

Essential elements of infant and early childhood mental health consultation: Inside the black box of preschool expulsion prevention

Exclusionary discipline practices differentially harm young children of color. As early childhood education systems seek to close these gaps to ensure all young children have access to high quality early learning experiences, the field requires more evidence-based approaches that can be scaled and replicated. Infant and early childhood mental health consultation (IECMHC) has been associated with lower rates of preschool expulsion; but the field lacks clear guidance on the essential elements of high quality IECMHC. Without such guidance, researchers cannot build a credible evidence base for the causal link between IECMHC and exclusionary discipline. An interdisciplinary research team, with support from the national Center for Excellence in IECMHC, led a consensus-building process to identify the essential activities of IECMHC as implemented across settings. The three-stage Delphi Process resulted in a list of five essential elements and 26 activities that define IECMHC and make concrete its emphasis on relationships and equity. This greater clarity around the activities of IECMHC can help inform future research and evaluation, as well as workforce and professional development.

Implementation of an early childhood mental health consultation pilot in Virginia: Critical tensions and implications for scale-up

Early childhood mental health consultation (ECMHC) is a targeted prevention service that aims to build the capacity of early care and education (ECE) professionals and foster supportive environments that promote children’s social–emotional competence and improve mental health and well-being. A key challenge to delivering ECMHC at scale is navigating complex multi-level factors to maximize successful implementation and program benefits at scale. The current study describes the implementation tensions arising during the first year of a pilot ECMHC program conducted in partnership across multiple agencies and a state’s department of education. In the 2021–2022 pilot year, ECMHC was offered as a free service to ECE programs in one large region of Virginia, with the goal of examining feasibility to scale statewide in future years. Consultation was implemented in 45 preschool classrooms across 30 programs. Implementation data were collected using consultation logs and participant surveys, and 20 participants (educators, families, program directors) participated in focus groups. Three implementation tensions are highlighted in this paper: (1) ideal plans versus reality of a new ECMHC roll-out; (2) how to support ECE professionals’ practice as it relates to children’s behavior, without contributing to a deficit view that children need to be “fixed;” and (3) systemic factors in the early childhood field that undermine the implementation and effectiveness of ECMHC. For each tension, we provide context from the larger literature on ECMHC, describe relevant decision points from Virginia’s pilot ECMHC program, and present implementation data to illustrate these tensions in practice. We conclude with reflections on lessons learned that have implications for other ECMHC and SEL intervention scale-up efforts.

Designing a virtual mental health consultation program to support and strengthen childcare centers impacted by COVID-19: A randomized controlled trial protocol

BackgroundThe COVID-19 pandemic has had negative psychosocial impacts on young children; teachers in childcare centers continue to be overwhelmed by how to address the downstream psychological effects children are experiencing. This randomized controlled trial will study the role of a community-based, childcare center-support system in improving resilience and mitigating the long-term impacts of COVID-19 on children's development. MethodsThis study will be modeled on a successful Early Childhood Mental Health Consultation (ECMHC) intervention which utilizes mental health consultants to deliver a Jump Start+: COVID 19 Support (JS + CS) virtual toolkit to childcare centers in Miami-Dade County via a Kubi robot. The toolkit comprises four strength-based strategies likely to be effective in improving resiliency following disasters: Safety Planning, Effective Communication, Adult Self-Care, and Trauma-Informed Behavior Support. Our first aim will utilize a cluster randomized trial to examine the effectiveness of JS + CS on improving the psychosocial functioning of young children, as compared to an obesity prevention intervention control group. Children will be followed at 6, 12, 18, and 24 months. The second aim will examine the mechanisms that contribute to effective uptake by teachers of the JS + CS support strategies on child outcomes. The third aim will explore implementation barriers/facilitators as well as potential societal contextual factors (e.g., vaccine uptake) to help centers serving disproportionately affected minority communities recover from and prepare for future crises. ConclusionThis design will inform the refinement and scaling of JS + CS and generalize impacts to other childcare center interventions in the context of disasters.

Workforce Development Needs to Address Early Childhood Mental Health within the Childcare and Early School Years Setting

Supporting infant and early childhood mental health is a vital component of school readiness, but suspension or expulsion from early childhood educational settings can have a lasting impact on a child. The Pyramid Model for Social and Emotional Competence in Infants and Young Children (PM) framework and Infant and Early Childhood Mental Health Consultation (IECMHC) are two models to address preschool suspension and expulsion, while promoting young children’s healthy social emotional development. Both models require a qualified workforce. In Maryland, several initiatives are underway to address workforce development needs and to create pipelines of professionals trained in infant and early childhood mental health. These include statewide coordination of PM and IECMHC programming, the creation of new guidelines and pipelines for IECMHC service providers, workforce development, specific focus on equity within PM and IECMHC programs statewide, and an expansion of these efforts into early elementary school.

Strengthening Home Visitor Practice Through an Embedded Model of Infant and Early Childhood Mental Health Consultation.

Home visitors face the difficult task of engaging and supporting families who experience economic, social, and mental health challenges. Infant and Early Childhood Mental Health Consultation (IECMHC) is one strategy to improve early childhood professionals' abilities to promote maternal and children's mental health through relationship building and collaboration. To date, most of the evidence showing positive effects of IECMHC comes from evaluations conducted in center-based early childhood programs. Only a few have examined the implementation and outcomes of IECMHC in home visiting programs. Using a longitudinal, matched-comparison group design, a three-year pilot study of a cross-system, embedded model of IECMHC assessed implementation and outcomes for teachers and home visitors. Here, we focus on intervention effects on home visitor-family relationships based on an analysis of 42 recordings of home visits. We used the Home Visit Rating Scales Adapted & Extended to Excellence (HOVRS-A+ v.2.1; Roggman et al., in2010) and created another scale, the IECMHC scale, of items aligned with the expected outcomes of the model. Home visitors in the intervention group scored significantly higher on the HOVRS-A+ home visitor responsiveness to family scale over time than those in the comparison group. Additionally, scores of home visitors in the intervention group increased at a greater rate, on average, on the newly developed IECMHC scale than scores of home visitors in the comparison group. We conclude that the Illinois model of IECMHC successfully improved home visitors' responsiveness to families and improved the quality of home visits. Due to the small sample, we recommend further study of the model in home visiting and further development of the IECMHC scale as part of the HOVRS-A+ .

Building reflective capacity and improving well-being of early childhood professionals through an embedded cross-system model of infant early childhood mental health consultation.

Infant and Early Childhood Mental Health Consultation (IECMHC) aims to improve early childhood professionals' abilities to promote children's mental health through relationship building and collaboration. Using a longitudinal, matched-comparison group design, a 3-year pilot study of a cross-system, embedded model of IECMHC assessed teachers and home visitors in intervention and comparison programs in reflective capacity, burnout, and perceptions of children's behavior. A sample of 136 staff (n = 72 intervention group; n = 64 comparison group; 21% Black; 51% White; 28% Latina/Hispanic) participated in surveys over a 21-month implementation period. A subsample of staff (n = 26) participated in interviews that included a narrative measure of reflective capacity; and a smaller subsample of teachers only (n = 21) completed assessments of children. Staff in the intervention group significantly increased reflective capacity after 21 months. For the staff interview subsample, receiving the intervention predicted lower levels of burnout at 12-15 months post-baseline. Among teachers completing child assessments, those with higher reflective capacity rated children's behaviors more positively than teachers with lower reflective capacity. We conclude that this IECMHC model successfully improved reflective capacity in staff. Future research should investigate reflective capacity as a potential mechanism of change for IECMHC.

58.2 Perinatal and Early Childhood Consultation in Louisiana: Collaborating to Bridge Care Gaps

The objectives of this presentation are to describe 2 consultation programs in Louisiana—the Louisiana Mental Health Perinatal Partnership (LAMHPP), a statewide, telephone-based perinatal psychiatry access program, and the Tulane Early Childhood Collaborative (TECC), a regionally focused early childhood mental health consultation program—and to discuss opportunities and strategies for collaboration and integration across programs.

The Evidence Base for How and Why Infant and Early Childhood Mental Health Consultations Works

Infant and Early Childhood Mental Health Consultation (IECMHC) is an evidence-based service in which consultants build capacity for early childhood professionals and programs to promote the social-emotional development of infants and young children. This paper describes the current state of the evidence for IECMHC, mapping the evidence to a new theory of change from the Center of Excellence (CoE) for IECMHC. There is a substantial literature base regarding the effects of consultation on outcomes for infants and young children; yet the evidence for consultation’s specific mechanisms of change, moderators of impact, and reductions in disparities have been understudied. The authors identify gaps in the scholarly literature, articulate next steps for research, and conclude with a call to action for IECMHC researchers to expand rigorous studies to the range of settings in which IECMHC is implemented and to center social justice in the research questions, methods, and dissemination.

Infant and early childhood mental health consultation in a diverse metropolitan area.

IECMHC can and should be a vehicle that promotes greater equity in access to high quality relationships within an early classroom environment. It is important to consider consultation through a racial equity lens to ensure that it is integrated in all levels of work. The goal of the study was to replicate the results from other IECMHC programs with a diverse, largely Latinx, population. The Jump Start program was given the unique opportunity to adapt the Georgetown Framework of Infant and Early Childhood Mental Health Consultation to a multicultural population in Miami. A total of 88 early learning programs and 244 teachers participated. Services were provided in English, Spanish, and Creole at the program- and classroom-level. Pre- and post-data were collected at both levels. Significant improvements at the program- and classroom-level were found post-consultation. Consultants demonstrated fidelity to core program practices while providing culturally and linguistically competent service. The current study replicated findings regarding the effectiveness of IECMHC while expanding results to a diverse metropolitan community. Key features of program success may be attributed to the use of highly trained consultants, action planning, fidelity monitoring, and enrollment of programs that were ready and have a champion for IECMHC.

Using Early Childhood Mental Health Consultation to Facilitate the Social–Emotional Competence and School Readiness of Preschool Children in Marginalized Communities

Using Early Childhood Mental Health Consultation to Facilitate the Social–Emotional Competence and School Readiness of Preschool Children in Marginalized Communities

Maryland’s infant and early childhood mental health consultation equity efforts

ABSTRACT Infant and early childhood mental health consultation (IECMHC) is a national model with proven positive outcomes for children, teachers and classrooms, as well as effectively addressing racial inequity in preschool suspension and expulsion rates. This paper discusses recent efforts in the Maryland IECMHC program to deeply and systematically address equity and increase consultant capacity to understand and address racial inequity within early childhood settings.

Training Future School and Clinical Psychology Leaders in Consultation for Early Childhood Education Settings

ABSTRACT This paper describes how training school and clinical psychology graduate students in early childhood mental health consultation (ECMHC) has the potential to fill gaps in the ECMHC workforce, enhance the capacity of early care and education (ECE) providers to effectively support the mental health needs of children and families, and help ECE programs provide equitable services to children and families. We first present the need for explicit ECMHC training in school and clinical psychology doctoral programs, and how didactic coursework and practica could align with national competencies for high-quality ECMHC. We then illustrate how graduate programs might aspire to greater impact by 1) shifting to promotion and prevention, systems- and organizational-based practice orientations, and equity and cultural competence principles; and 2) leveraging ECE programming to infuse ECMHC practice. We conclude with a call to action for graduate programs to address this need for mental health professionals with specialized ECMHC competencies.

Infant and Early Childhood Mental Health Consultation in the Context of a Statewide Expulsion Prevention Initiative

ABSTRACT This paper focuses on outcomes for Infant and Early Childhood Mental Health Consultation (IECMHC) provided to early education teachers as part of a tiered statewide expulsion prevention initiative. In a sample of 360 children (83.3% male, 66.6% White, 88.1% with clinically elevated externalizing behavior at baseline) at risk for expulsion, outcomes from consultation are described, including expulsion outcomes and changes in child behavior. Multiple regression was used to explore the role of teacher engagement in the IECMHC process on child-level behavioral outcomes. Of the referred children receiving IECMHC, 3.9% were expelled. From pre- to posttest, teachers reported significant reductions in behavior concerns (both frequency and the perception of the behaviors as “problematic”) and expulsion risk (based on teacher perception of child behavior). Teacher engagement in the IECMHC process was a robust predictor of change in child outcomes, with greater engagement associated with improvements in child behavior problems and prosocial skills.

REACHING FOR RESILIENCE: NEW DATA ON OVERCOMING ADVERSITY IN YOUTH

Objectives: As appreciation for the role of adversity and trauma in the development of psychopathology has risen, so has the need to better understand resilience and how to enhance it. The goal of this session is to update attendees on new research in the area of resilience with an emphasis on the methods to increase it through interventions and education. Methods: New data from multiple study designs, settings, and ages will be presented. Samples used for this Symposium include: 1) high-risk newborns and toddlers, including a twin sample, many of whom were born into poverty and had histories of maltreatment and were followed prospectively;2) 39 classrooms of young children who received 0, 10, or 20 weeks of early childhood mental health consultation;3) a sample of 484 older adolescent college students who completed daily ratings of mental health and wellness prior to and during the COVID-19 pandemic using a smartphone app;and 4) another sample of 88 college students, some of whom were taught specific resilience skills in an undergraduate class. Results: Prospective data from the high-risk samples of newborns and toddlers reveal more favorable long-term outcomes for those at risk than are often assumed. Classroom mental health consultation was found to improve the classroom climate in young children, especially with longer intervention periods. For college students, those taught resilience skills showed improved coping skills, decreased stress, and a reduction in dysfunctional attitudes. In another college sample, specific personality traits, some of which had not been previously associated with resilience, were found to buffer against the negative impact of the COVID-19 pandemic. Conclusions: These presentations reveal a more hopeful picture for those who have experienced trauma and adversity than is sometimes assumed in discussions of toxic stress. Further, specific resilience-focused interventions can be successful at both the individual and group levels and across different ages. Data also suggest that some resilience factors should not be considered universal and may instead vary based upon the particular characteristics of the stressor itself. PRE, WL, SC

50.1 POLICY STRATEGIES AND LANDSCAPES TO ADVANCE INFANT AND EARLY CHILDHOOD MENTAL HEALTH CONSULTATION (IECMHC) IN PEDIATRICS

The objective of this presentation is to describe the policy and systems context of early childhood mental health consultation to primary care.

50.2 JUST SAY YES: SUPPORTING PEDIATRIC PRIMARY CARE’S ASSESSMENT AND TREATMENT OF EARLY CHILDHOOD MENTAL HEALTH CONCERNS

Pediatric primary care providers (PPCPs) are often the first point of contact for young children and their families when behavioral health concerns arise. Pediatric Mental Health Care Access (PMHCA) programs have been developed to support PPCPs in assessing and treating behavioral health concerns presenting in primary care. This presentation will discuss strategies developed by one PMHCA program, the Colorado Pediatric Psychiatry Consultation & Access Program (CoPPCAP), to support PPCPs in assessing and treating perinatal concerns and early childhood mental health concerns including a description of the model, current funding and policy successes, and the integration of the program within the public health system in Colorado. The development and outcomes of core components of CoPPCAP will be presented including the peer-to-peer consultation, support for finding resources, training on a “disruptive behavior action plan,” and education via Extension for Community Health Outcomes (ECHO) and learning collaboratives. This presentation will include active audience participation of polling questions and discussion to understand participants’ own work with primary care supporting early childhood mental health initiatives and models of funding. Data will be presented with respect to: the proportion of consultations for ages 0 to 6 years vs ages 7 to 12 years vs ages 13 to 18 years; types and outcomes of consultation for ages 0 to 6 years; PPCP practice change secondary to CoPPCAP; and outcomes of evaluation of our learning sessions. Participants will understand how CoPPCAP, a PMHCA program, has included early childhood mental health as a core component for consultation, teaching, and partnering with public health departments and state agencies. Ensuring enduring funding requires persistence and input from multiple stakeholders, and it must ensure return on investment. For true, successful prevention efforts through a population health model, early childhood mental health consultation must be provided where patients and their families are seeking help, the pediatric primary care setting. Programs such as CoPPCAP address the capacity for PPCPs to assess and treat the younger child in the primary care setting.

Suspension and expulsion in Colorado early care and education settings: Child, program, and community-level predictors.

Expulsion presents a significant risk in Early Care and Education (ECE) settings due to its association with early disadvantage and frequency of use. A statewide survey was conducted to characterize ECE suspension and expulsion (S/E) in Colorado. Child, program, and community-level factors were examined as predictors of S/E, alongside preventative intervention supports capable of reducing S/E. Six hundred and sixty three licensed child care programs participated in the survey, providing information on 19,848 enrolled children, 312 suspensions, and 74 expulsions. A series of multilevel hierarchical regressions were conducted, examining predictors for S/E. Children with IEPs/IFSPs were disproportionately suspended; 2-3-year-olds were disproportionately expelled; and boys, 5-6-year-olds, and children with disabilities were disproportionately suspended and expelled. Center-based programs, lower quality ratings, and "zero tolerance" policies predicted greater use of suspension. In contrast, school-district affiliation and knowledge of how to access infant and early childhood mental health consultation (IECMHC) decreased suspension. Lower levels of regional child poverty predicted higher use of expulsion. Affiliation with a school-district, IECMH consultant-led training, and use of quality coaches predicted decreased expulsion. This study identifies the need for ongoing protection for children with IEPs/ IFSPs and the preventative interventions that mitigate risk for S/E.