Transcript early childhood mental health consultation and incredible years

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