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