early childhood mental health consultation and incredible years an 8 year project implementation at...
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EARLY CHILDHOOD EARLY CHILDHOOD MENTAL HEALTH MENTAL HEALTH CONSULTATION CONSULTATION
AND AND INCREDIBLE YEARSINCREDIBLE YEARS
An 8 year project implementation at An 8 year project implementation at
Morrison Child and Family Services Morrison Child and Family Services
Portland, OregonPortland, Oregon
ECMHC & Incredible Years ECMHC & Incredible Years Portland, OregonPortland, Oregon
Kathryn Falkenstern, MSW, LCSWKathryn Falkenstern, MSW, LCSW Clinical SupervisorClinical Supervisor
Morrison Child and Family ServicesMorrison Child and Family Services 15 sites located in Portland, Oregon. 15 sites located in Portland, Oregon. Provides a comprehensive range of community Provides a comprehensive range of community
mental health, substance abuse, juvenile justice, mental health, substance abuse, juvenile justice, and prevention services to more than 5,000 and prevention services to more than 5,000 children and their families.children and their families.
Programs include outpatient counseling, early Programs include outpatient counseling, early childhood mental health consultation, parent childhood mental health consultation, parent education, home and school-based programs, education, home and school-based programs, and foster care, residential, and day treatment.and foster care, residential, and day treatment.
AgendaAgenda
Introduction of the ECMHC and IY Introduction of the ECMHC and IY Project in Portland, ORProject in Portland, OR
The Incredible Years ObjectivesThe Incredible Years Objectives Project Design Project Design Advantages of addition IY to ECMHC Advantages of addition IY to ECMHC
servicesservices Implementation “Lessons Learned”Implementation “Lessons Learned” EvaluationEvaluation
3 year grant from The Substance Abuse and 3 year grant from The Substance Abuse and Mental Health Services Administration Mental Health Services Administration (SAMHSA) (SAMHSA) Received by Multnomah County Behavioral Health. Received by Multnomah County Behavioral Health. Morrison implemented the service component of the Morrison implemented the service component of the
grant.grant.
Funded:Funded: Early Childhood Mental Health Consultation (ECMHC) Early Childhood Mental Health Consultation (ECMHC) Incredible Years Parent Groups at childcare Incredible Years Parent Groups at childcare
programs. programs. This project ran from 2002 – 2005. This project ran from 2002 – 2005.
2002 Initial 2002 Initial ImplementationImplementation
Team: Team: 2 members at 1.75 FTE with one part-time 2 members at 1.75 FTE with one part-time
support person. support person. .3 of supervisor’s time. .3 of supervisor’s time.
ImplementationImplementation Two staff as well as the Supervisor and Two staff as well as the Supervisor and
Director of Outpatient programs were trained Director of Outpatient programs were trained in The Incredible Years Parent Program.in The Incredible Years Parent Program.
ECMHC offered to four childcare sites.ECMHC offered to four childcare sites. IY parent groups offered at the rate of about IY parent groups offered at the rate of about
6 per year, two at a time. 6 per year, two at a time.
2002 Initial 2002 Initial ImplementationImplementation
2003 Sustainable Funding: 2003 Sustainable Funding: The Portland Children’s Investment The Portland Children’s Investment
FundFund 2000, Dan Saltzman, Portland City 2000, Dan Saltzman, Portland City
Commissioner, developed The Portland Commissioner, developed The Portland Children’s Investment Fund .Children’s Investment Fund .
2001, Portland voters passed levy with 53% 2001, Portland voters passed levy with 53% approval and renewed in 2009 with 73% approval and renewed in 2009 with 73% support. Pooled approximately 10 million support. Pooled approximately 10 million dollars per year at a cost of about $60 per year dollars per year at a cost of about $60 per year for the average Portland homeowner.for the average Portland homeowner.
Funding supported 66 different programs for Funding supported 66 different programs for children in 4 categories: children in 4 categories: Early childhood health and education Early childhood health and education After-school and mentoring programsAfter-school and mentoring programs Child abuse prevention & interventionChild abuse prevention & intervention Support for children in foster care. Support for children in foster care.
2003 Sustainable Funding: 2003 Sustainable Funding: The Portland Children’s Investment The Portland Children’s Investment
FundFund Levy: Levy:
operated with a 5% administrative capoperated with a 5% administrative cap required agencies to invest in proven required agencies to invest in proven
programs and track and report outcomes programs and track and report outcomes via yearly audit. via yearly audit.
For more information on The Portland For more information on The Portland Children’s Levy:Children’s Levy: www.portlandchildrenslevy.org http://bayopliskonesansrenmenyoplis.org/docs/
TheChildrensTrustBook.pdf
The Incredible YearsThe Incredible Years
Parent, child and teacher training Parent, child and teacher training programsprograms
Goals: Goals: to prevent, reduce, & treat aggression to prevent, reduce, & treat aggression
and behavior problems in young children.and behavior problems in young children. Promote social, emotional, and academic Promote social, emotional, and academic
competencecompetence
www.incredibleyears.comwww.incredibleyears.com
Incredible Years Parenting Incredible Years Parenting Series:Series:
Methods & ProcessesMethods & Processes Relationship: “collaborative process”Relationship: “collaborative process” Culturally sensitiveCulturally sensitive Video modeling/DVDsVideo modeling/DVDs Role play practice & rehearsalRole play practice & rehearsal Home assignmentsHome assignments Group supportGroup support
Project Design:Project Design:ECMHC Integrating ECMHC Integrating
Evidenced Based Parent Evidenced Based Parent Groups Groups
ECMHC Components:ECMHC Components:
Child and family specific consultationChild and family specific consultation Child observations/screeningsChild observations/screenings Parent/teacher coachingParent/teacher coaching Evidenced Based Groups:Evidenced Based Groups:
Primarily IY Parent Group (Basic preschool series)Primarily IY Parent Group (Basic preschool series) Also, offer the Advanced Parent Series; Infant Also, offer the Advanced Parent Series; Infant
Group Group Incredible Years Dinosaur SchoolIncredible Years Dinosaur School CBT based parent stress/mood mgt classesCBT based parent stress/mood mgt classes
Project Design…continued
Program Level Consultation Adapted from Incredible Years principles
Social/Emotional Circle-time activity with puppets teaching :
Self-regulation skills Friendship skills Emotional literacy Problem solving
Utilized IY training to design classroom strategies
Staff trainings
Special PopulationsSpecial Populations
Work with or assist with referrals for any Work with or assist with referrals for any family in our designated childcare centers.family in our designated childcare centers.
Work towards maintaining a child in the Work towards maintaining a child in the normative settings through both ECMHC and normative settings through both ECMHC and Incredible Years offerings.Incredible Years offerings.
Offer a limited number of Dinosaur School Offer a limited number of Dinosaur School pull out groups for “top of the pyramid” pull out groups for “top of the pyramid” children.children.
Offer IY groups with translation and/or led by Offer IY groups with translation and/or led by bi-lingual staff.bi-lingual staff.
Mental Health Staff Mental Health Staff training and credentialstraining and credentials
5.5 FTE (7 staff members) of master’s 5.5 FTE (7 staff members) of master’s level mental health staff with Early level mental health staff with Early Childhood experience/training.Childhood experience/training. 5 of 7 are licensed mental health 5 of 7 are licensed mental health
professionals.professionals. All are trained in IY Basic, Advanced, and All are trained in IY Basic, Advanced, and
Dinosaur School.Dinosaur School. 5 of 7 have achieved certification in IY.5 of 7 have achieved certification in IY. One person is a mentor/trainer, and may One person is a mentor/trainer, and may
train others within our agency. train others within our agency.
Role of the Mental Role of the Mental Health StaffHealth Staff
Each Staff member is assigned to Each Staff member is assigned to one or more early childhood one or more early childhood care/education sites.care/education sites.
Each Consultant position includes Each Consultant position includes the role of evidenced based group the role of evidenced based group leader.leader.
Team Approach to Team Approach to ConsultationConsultation
Consultant Staff:Consultant Staff:
Plan and co-lead groups togetherPlan and co-lead groups together Collaborate in recruitment efforts for groupsCollaborate in recruitment efforts for groups Substitute in groups when a regular leader is Substitute in groups when a regular leader is
absent absent Form a “learning environment” of sharing ideas Form a “learning environment” of sharing ideas
and mentoring newer consultantsand mentoring newer consultants Provide peer supportProvide peer support
ECMHC RoleECMHC Role
Initial role Initial role Establishing relationships within the Establishing relationships within the
childcare center with administrators, childcare center with administrators, teachers/childcare staff, and families.teachers/childcare staff, and families.
Begin initial ECMHC roles, such as Begin initial ECMHC roles, such as child observations, teacher support.child observations, teacher support.
Promote upcoming Incredible Years Promote upcoming Incredible Years Parent Groups at all levels with the ECE Parent Groups at all levels with the ECE site.site.
Forming the IY Parent Forming the IY Parent Group:Group:
Think RelationshipThink Relationship Recruitment Strategies:Recruitment Strategies:
Relationship with Childcare Center Staff Relationship with Childcare Center Staff
Flyers :Flyers : Used only in conjunction with other more Used only in conjunction with other more
dynamic forms of recruitment.dynamic forms of recruitment. Don’t over rely on flyers as a recruitment Don’t over rely on flyers as a recruitment
strategystrategy
Forming the IY Parent Forming the IY Parent Group:Group:
Think RelationshipThink Relationship Recruitment Strategies:Recruitment Strategies:
Direct Recruitment with Parents:Direct Recruitment with Parents: ““Juice and Cookies” recruitment:Juice and Cookies” recruitment:
Consultant meets and talks one-on-one with Consultant meets and talks one-on-one with parents about the group at drop of or pick up parents about the group at drop of or pick up time at the childcare center.time at the childcare center. . .
““LET US MAKE YOU DINNER AND WATCH LET US MAKE YOU DINNER AND WATCH THE KIDS…. while you connect with other THE KIDS…. while you connect with other parents and enhance your parenting skills…”parents and enhance your parenting skills…”
Promotion at other childcare center events:Promotion at other childcare center events: Parent NightsParent Nights Holiday PartiesHoliday Parties
Forming the Group…Forming the Group…continued:continued:
Indirect RecruitmentIndirect Recruitment Promotion with teachers/childcare staff who Promotion with teachers/childcare staff who
encourage parents to attendencourage parents to attend Works best after the IY Program has been Works best after the IY Program has been
established in the center and teachers have established in the center and teachers have confidence in it.confidence in it.
Use of incentives to reward teachers for Use of incentives to reward teachers for their efforts at promotion.their efforts at promotion.
Coordinated RecruitmentCoordinated Recruitment Consultant and Teacher collaborate to Consultant and Teacher collaborate to
approach selected families who may approach selected families who may particularly benefit from the group. particularly benefit from the group.
Decreasing Barriers to Decreasing Barriers to AttendanceAttendance
AllAll parents at the center are invited to parents at the center are invited to attend…not just parents identified as attend…not just parents identified as needing parenting help.needing parenting help.
The IY group is held at the childcare The IY group is held at the childcare centercenter decreases transportation issuesdecreases transportation issues decreases stigmadecreases stigma
Dinner offeredDinner offered ChildcareChildcare Transportation supportsTransportation supports
Groups Offered YearlyGroups Offered Yearly
Team offers each year:Team offers each year: 10 Incredible Years Parent Groups10 Incredible Years Parent Groups 2 Dinosaur School Groups2 Dinosaur School Groups 4 Parent Stress/Mood Mgt Prevention 4 Parent Stress/Mood Mgt Prevention
Groups based on CBT principles.Groups based on CBT principles.
Advantages of combining Advantages of combining ECMHC with Incredible ECMHC with Incredible
YearsYears Enhances the Consultants visibility Enhances the Consultants visibility
and role within the ECE centerand role within the ECE center Extends what the Consultant can Extends what the Consultant can
offer to familiesoffer to families Builds rapport with parents at the Builds rapport with parents at the
centercenter Increases practical offerings to ECE Increases practical offerings to ECE
program staffprogram staff
Implementation Lessons Implementation Lessons LearnedLearned
Hiring the right staff is criticalHiring the right staff is critical Clear job descriptionsClear job descriptions Skills in community based jobsSkills in community based jobs Flexible, team-oriented Flexible, team-oriented
BudgetBudget Identify all the related costs to offering a Identify all the related costs to offering a
group in a community childcare centergroup in a community childcare center Maintain fidelity of the IY modelMaintain fidelity of the IY model
Encourage certificationEncourage certification Utilize consultationUtilize consultation
Take on group recruitment challengesTake on group recruitment challenges Be thorough, patient, and creative Be thorough, patient, and creative
EvaluationEvaluation of IY Groupsof IY Groups
IY Group EvaluationIY Group Evaluation Pre/post tests:Pre/post tests:
DECA - parent and teacher/childcare staffDECA - parent and teacher/childcare staff ECBI - parentECBI - parent SESBI - teacherSESBI - teacher
Parent Satisfaction SurveyParent Satisfaction Survey ECMHC EvaluationECMHC Evaluation
Retrospective Preschool Teacher Retrospective Preschool Teacher SurveySurvey
Satisfaction SurveySatisfaction Survey
IY Parent Outcomes - DECA
151 DECAs collected Findings:
Statistically significant change on 3 of 4 subscales (“protective factors; self-control; “initiative.”) p<.001.
Statistically significant change on the “Behavioral Concerns” scale. P<.001
ECBI Parent ECBI Parent
30 35 40 45 50 55 60 65
Intensity*
Problem*
Pre
Post
*p<.001
Parent SatisfactionParent Satisfaction
228 surveys collected from IY Parent 228 surveys collected from IY Parent GroupsGroups
Findings: Findings: 99% would recommend the program99% would recommend the program
98% reported overall satisfaction with 98% reported overall satisfaction with
the programthe program 91% were confident they could manage 91% were confident they could manage
child behavior problems on their own.child behavior problems on their own.
Retrospective Preschool Retrospective Preschool Teacher Survey Teacher Survey n=57n=57
1 2 3 4 5
* Sense of accomplishment working with child
* Sense of accomplishment working with parent
* Handle my classroom well
* Skills to reach challenging children
* Can respond effectively to disruptive child
* Can respond effectively to sad child
* Can identify child needing further assessment
* Know who to talk to when child needs support
*Can manage the stresses of being a preschoolteacher
Before
Now
*p<.001 Strongly disagree Strongly Agree