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Illinois Strategies
IECMH Consultation in ECE and Home Visiting: Illinois Model for Infant and Early Childhood Mental Health Consultation

The aim of the Illinois Model for Infant and Early Childhood Mental Health (IECMH) Consultation, which was developed by the Illinois Children’s Mental Health Partnership through their Mental Health Consultation Initiative, is to provide a comprehensive approach to IECMH consultation for consultants working in a variety of early childhood education and care (ECEC) settings, including child care, prekindergarten, Head Start, and home visiting programs. The Illinois Model for Infant and Early Childhood Mental Health Consultation guide describes features of the model, including its definition of IECMH consultation, the role of the consultants and their competencies, consultation components and activities, and workforce qualifications and development. Underlying the model is an assumption that the ongoing, job-embedded professional development provided by consultation is critical to developing and maintaining the IECMH capacity of the ECEC workforce. Individuals in diverse positions, including state agency leaders, advocates, and early childhood service providers, helped design the model and informed it with a range of perspectives.

The original model and guide were developed in 2016, and findings from an extensive pilot evaluation were published in 2021 (see Monitoring and Evaluation section of this profile for more information on the evaluation). Implementation of the model is now led by a state leadership team in the Governor’s Office of Early Childhood Development (GOECD), and this team will oversee revisions to the model in 2021 to incorporate lessons and findings from the evaluation, including specific guidance around dosage.  Dosage is ultimately determined by consultants in conjunction with ECEC program leadership and reflects program size and needs. However, the model’s approach to IECMH consultation as a capacity-building prevention/promotion service assumes the consultant will work with a program for at least two years (with the exception of special situations). Typically, the intensity and frequency of consultation services will be greatest initially and decrease over the course of consultation as goals are met.

The model requires consultants to have a minimum of a master’s degree in mental health, such as social work, counseling, psychology, family and marriage therapy, psychiatry, or in either child development (specifically early childhood) or nursing with additional education in mental health. It also requires at least five years of experience in areas related to infant and early childhood development and mental health; consultants should also possess a demonstrated ability to engage in reflective practice and adopt a consultative stance.

To deliver consultation using the model, consultants must participate in preservice training and ongoing supports. Originally the preservice training consisted of an in-person three-day orientation, with a one-day in-person follow-up and a one-day online follow-up. Since COVID, the orientation is delivered as 18 hours of interactive virtual training in a series of two- and three-hour sessions. This format is likely to continue post-COVID as most consultants are independent contractors and the shorter sessions fit better with their work schedules. The orientation and other professional development services are delivered by the Illinois Network of Child Care Resource and Referral Agencies (INCCRRA).

The orientation sessions cover: a close examination of consultation and the role of consultants; infant-early childhood mental health; community engagement; reflective consultation; observation, screening, assessment, and strategizing with consultees about effective supports for children and families; co-facilitation of groups; Facilitating Attuned Interactions (FAN) training; and diversity, equity, and inclusion. Participants also receive an introductory training on the Pyramid Model to understand where IECMH consultation fits on the Pyramid as a support. Participants take a self-report skills assessment prior to the orientation and receive individualized support afterwards based on areas identified in the assessment that need strengthening. This individualized support consists of a report prepared by INCCRRA for the consultant with information on online resources, books, and in-person trainings related to the identified areas. Required ongoing supports for all consultants include reflective supervision and participation in reflective learning groups, as well as online training modules launching in 2021 that will align with the orientation topics and cover their content in greater depth. Consultants also attend an annual statewide two-day retreat. GOECD and INCCRRA will offer statewide quarterly calls with consultants to provide information on professional development opportunities and any changes or developments within the model.

All consultants who participate in the orientation can be included in the statewide IECMH consultant database that will launch in spring 2021. The database includes a wide range of information, some of which will be available on the front end for public use and some of which will be for back-end use by the leadership team and model administrators. Front-end, publicly available information includes: consultants’ professional experience and qualifications; language(s) spoken; demographic information; service delivery area; a personal statement; and ECEC program experience (e.g., child care, Head Start, home visiting). Users will be able to filter results by consultants’ service delivery area, language(s) spoken, and ECEC program experience. The public database will serve as a resource for programs to locate and contract with consultants, as well as a tool to educate programs on what to look for in effective consultation. Back-end information, provided by consultants, includes: completed trainings; participation in ongoing supports such as reflective learning groups, reflective supervision, and online training modules; and information about the consultation services they deliver to programs.

Consultants trained on the model meet the requirements established for consultation by each ECEC system, allowing individual consultants to work with programs in more than one sector, either concurrently or sequentially. Since 2018, 159 consultants have been trained on the model, with the intention to have 300 by 2023. The aim is to have consultation available for all systems serving children birth to age five in the state by 2025. Assumptions about consultant workloads (such as a ratio of 18 programs per consultant) and program demand (each program will receive services from a consultant) have generated an estimate of approximately 600 consultants needed to serve all ECEC settings, though this estimate may overstate actual demand. While attracting professionals who meet the education and experience requirements has not, overall, been difficult initially, some rural parts of the state have faced challenges.

A committee within the Illinois Mental Health Consultation leadership team is working to address diversity and equity concerns to ensure all children have access to IECMH consultation regardless of setting. One challenge the committee aims to address is the difficulty faced by some ECEC programs, especially among child care providers with fewer resources and staff, in arranging staff coverage for some of the consultation services specified in the model, such as reflective consultation with staff and program administrators and providing trainings to staff. The leadership team is also engaging in efforts to recruit a more diverse consultant workforce to better reflect the communities in which they work.

Financing

Funding for the training, ongoing supports, and database is currently divided between the federal Preschool Development Grant Birth through Five (PDG B-5) and private foundations. The PDG B-5 funding will last through 2022 and the Illinois Mental Health Consultation leadership team is seeking sustainable sources of state funding. The Governor’s Illinois Commission on Equitable Early Childhood Education and Care Funding is studying these funding challenges in order to make recommendations concerning funding goals and mechanisms, and to advise the governor in planning and implementing these recommendations. Funding during the initial five-year period encompassing the model development, pilot and evaluation, and initial work developing the training orientation and database came from private funders.

Funding for the IECMH consultation services comes from the systems whose programs receive the funding.  The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program covers costs for IECMH consultation in home visiting in Illinois. Consultation for child care programs is available through the state’s Caregiver Connections program, which is funded by the federal Child Care and Development Fund. Programs receiving state preschool funds can include funding for consultation in their grant proposal to the state as an allowable expense, a practice encouraged by the State Board of Education. These programs then contract directly with consultants to deliver consultation services. Head Start programs, which have funding in their grants for IECMH consultation, similarly contract directly with consultants.

Monitoring and Evaluation

A pilot of the model, including a formal evaluation, was led by the Illinois Children’s Mental Health Partnership, which convened a 40-person leadership team with representatives from all sectors served by the consultants as well as funders and evaluators. Twenty-three sites participated in the pilot (fifteen sites received the Illinois Model and the remaining sites were in the control group). The groups included child care, state-funded preschool, Head Start, and home visiting programs in urban, mid-size city, and rural settings. Most of ECE settings have a mix of child care, state preschool, and Head Start services and funding. Eight comparison sites with similar demographics serve as a control group. The leadership team worked to identify and recruit the sites and the 14 consultants who were trained on the model to serve them. In only one instance did a consultant have a preexisting relationship with a site. A final report with outcomes data was published in 2021.

The evaluation collected data from program directors, early childhood education and care (ECEC) providers, and consultants through parent, consultant, and ECEC provider surveys, child and classroom observations, and videos of home visits. Data will be used to examine the fidelity of the model’s implementation and impacts on: consultant-provider relationships and provider knowledge, stress, and well-being; provider-child interaction quality; and parent-child relationships and child social-emotional outcomes (e.g., reductions in challenging behavior).  Early findings on implementation showed that the model was delivered with fidelity. Most of the consultation requests in ECE settings were related to a particular child, and the greatest amount of consultant time was spent on reflective professional development with staff, which provides opportunities for safe discussions about concerns and staff responses to program conditions, families, and children’s behavior that will allow the planning and delivery of supportive strategies to address children’s needs. Other consultation activities include: conducting observations, screenings, and assessments; co-facilitation of discussion groups for staff; and providing trainings to providers (e.g., on topics such as intimate partner violence, substance use, attachment, postpartum depression, trauma, and safe sleep).

At the same time the pilot and evaluation were underway, the leadership team began to develop the statewide consultation database. When determining the range and depth of data that the database should collect, it looked at the data collection process used by the evaluation and ongoing lessons learned as the pilot moved forward. The statewide database will be used to conduct ongoing monitoring of IEMCH consultation statewide, as well as support ECE sites in finding a consultant. This will include analyses showing where and what type of consultation services are being delivered.

Special thanks to the following individuals for providing information for and reviewing this profile: Colette Lueck, former Director, Illinois Mental Health Consultation Initiative; Christine Brambila, IECMHC Coordinator, and Lori Orr, Director of Workforce Policy, Illinois Governor’s Office of Early Childhood Development; Amanda Walsh, Director, Katelyn Kanwischer, Director of Early Childhood Initiatives, and Julianna McHale, Program Coordinator, Illinois Children’s Mental Health Partnership.

Last updated February 2021

IECMH in Part C Early Intervention: Social-Emotional Consultants

The Child & Family Connections (CFC) system in Illinois is responsible for responding to referrals to the state’s early intervention (EI) system and providing service coordination. Among other services, the state’s 25 CFCs receive referrals; provide information to families; coordinate evaluations, assessments, and IFSP development; and facilitate provision of EI and non-EI services for families.

The state’s EI program has a social-emotional (SE) component, described in the state’s Child & Family Connections Procedure Manual. Each CFC has an SE consultant, either full-time or part-time, who is responsible for ensuring that certain SE supports are delivered. The SE consultant is required to have a master’s degree in child development, special education, psychology, social work, counseling, or a related field; knowledge and training in infant development and IECMH (including the DC:0-5), reflective supervision, and consultation; supervised clinical experience with children and families; and experience providing EI services (though SE consultants do not provide direct services to families). The SE supports provided by the state’s EI program and the CFCs include:

  1. Relationship-based training in EI offered by the Illinois Early Intervention Training Program, including sessions on topics related to social-emotional development and building relationships with families. CFC program managers, service coordinators, SE consultants, and EI providers are required to complete relationship-based training.
  2. Reflective consultation for the CFC program manager provided by the SE consultant, which helps program managers address the challenges they face in their work and strengthen their ability to provide reflective supervision to other CFC staff, including service coordinators and parent liaisons.
  3. Integrated assessment and intervention planning, in which the SE consultant works with service coordinators on interpreting findings from interviews, screenings, and assessments to inform the development of an Individual Family Service Plan.
  4. Case consultation, provided by the SE consultant, who holds small group sessions with CFC staff, and in some cases with EI providers, to help consider the child’s SE development, the family’s experiences and needs, and staff and provider experiences working with the family.
  5. Facilitation of the SE consultants’ peer support activities, which include regular meetings with other consultants to discuss best practices in EI and appropriate supports and referrals.
  6. Parent-to-parent mini-grants, administered by CFC program managers and parent liaisons, to expand support for families, including through parent newsletters, parent support meetings, and parent seminars.
  7. Reflective supervision for CFC staff, such as service coordinators and parent liaisons, individually or in groups, provided by the CFC program manager and supervised by the SE consultant.
  8. EI provider workgroups, in which the SE consultant and CFC program manager offer trainings, case consultation, and informal peer consultation to EI providers.

The SE consultant works with CFC management and staff to determine the amounts of each type of support to be delivered by the CFCs. In practice, case consultation and supporting reflective practice have been a large part of the SE consultants’ workload. During the pandemic, SE consultants’ efforts have focused on helping CFC staff and EI providers address issues related to COVID-19, including their own and EI families’ mental health and other challenges resulting from the pandemic.

Financing

SE consultants are salaried employees of CFCs, which receive funding to provide services (including SE-related supports) through state contracts based on their caseload size. Caseload size determines whether there is funding for a full-time or part-time SE consultant. The funding for CFCs that covers SE consultant and related services comes from a state appropriation.

Monitoring and Evaluation

An evaluation was conducted by the Erikson Institute on a pilot initiative that served as the basis for the current SE consultants. The pilot had 10 core elements, including training for SE consultants on supporting parent-child and EI provider-family relationships, reflective supervision and case consultation for service coordinators, and social-emotional screening and integrated assessment and intervention planning for children. Based on pre- to post-pilot data from participant questionnaires, the evaluation found perceived benefits and reported changes in practice from reflective supervision, case consultation, and social-emotional screening. Participants also increased their knowledge of infant-toddler social-emotional development in eight assessed areas, such as signs of a healthy parent-child relationship, and reported increases in skills and use of relationship-based practices, such as initiating discussions with parents about relationship and behavioral concerns.

Monitoring data related to the SE component are not collected at the state level. However, the Erikson Institute has proposed follow-up research to further investigate the implementation and outcomes of the SE component.

Special thanks to Ann Freiburg, Part C Coordinator, Bureau of Early Intervention, Illinois Department of Human Services, for providing information for this profile.

Last updated February 2021