Infant and Early Childhood Mental Health Consultation in Early Care and Education Programs

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Introduction

IECMH consultation is “a prevention-based service that pairs a mental health consultant with families and adults who work with infants and young children in the different settings where they learn and grow, such as child care, preschool, and their home. The aim is to build adults’ capacity to strengthen and support the healthy social and emotional development of children…. Mental health consultation equips caregivers to facilitate children’s healthy growth and development.”[1] In ECE settings, IECMH consultation programs display great variation across a range of program features, such as type of ECE setting served, duration and frequency of services delivered, program service model or approach, and consultant qualifications and training.[2]

While IECMH consultation in ECE is most frequently delivered in center-based settings such as prekindergarten programs, child care centers, and Head Start, it is also offered in home-based settings such as licensed family child care providers and to informal family, friend, and neighbor caregivers.[3] Consultants may work in a setting for one to six hours per week and from six weeks up to 12 months or longer.[4] Though IECMH consultants focus their support on professionals working in ECE settings, the target of the consultation may be a particular child or family, the entire classroom, or the ECE program as a whole.[5] Consultation services vary in their adherence to formal models. They may align with or incorporate existing approaches, such as the Pyramid Model or Facilitating Attuned Interactions, or they may follow a formal manual developed by the consultation program.[6]

For pre-service qualifications, consultation programs commonly require consultants to be licensed master’s-level mental health clinicians with experience working in the early childhood field, though some allow bachelor’s-level professionals, and others require consultants to have an infant-early childhood mental health endorsement.[7] Newly-hired consultants typically receive preservice training on the specific consultation model or practices delivered by the program, and then participate in ongoing supports such as reflective supervision and additional trainings.[8] Efforts have been made to define the specific skills and abilities that characterize the competent IECMH consultant.[9]

Federal interest in IECMH consultation has been driven by national data—supported by state-level research—revealing high rates of expulsion in ECE settings, particularly among boys and children of color.[10] In 2014 the U.S. Departments of Education (ED) and Health and Human Services (HHS) issued a joint policy statement on expulsion and suspension in ECE settings. It identifies IECMH consultation as a strategy to prevent expulsion and suspension by helping teachers address the child behavior problems frequently cited as their cause.[11] In 2015, to further support the awareness and adoption of IECMH consultation, HHS launched the national Center of Excellence for Infant and Early Childhood Mental Health Consultation, renewing it in 2019. Other federal initiatives have provided funds to states to develop IECMH consultation programs and fund services, including Race to the Top-Early Learning Challenge, Preschool Development Grant Birth through Five, and Project LAUNCH.[12] In addition to these federal grant projects and initiatives, common federal sources of ongoing funding for IECMH consultation services include the Child Care and Development Fund and Head Start/Early Head Start. Another major source of funding for ongoing services is state general funds.[13]

While there are no comprehensive national data on the number of children served by IECMH consultation, a 2018 national scan that included responses from 21 state children’s mental health directors found that in 11 states IECMH consultation was available statewide and in nine it was available in some areas.[14]

State Profiles that Infant and Early Childhood Mental Health Consultation in Early Care and Education Programs
Research Support for Infant and Early Childhood Mental Health Consultation in Early Care and Education Programs

Years of research on IECMH consultation in ECE settings have shown its effectiveness as an approach to improving teacher attitudes and knowledge, overall classroom quality, teacher-child interactions, expulsion outcomes, and child social-emotional development and behavior outcomes. In 2020, the Center of Excellence for Infant and Early Childhood Mental Health Consultation published a comprehensive synthesis of the research evidence for IECMH consultation, with an accompanying annotated bibliography of all known, published studies on IECMH consultation.[15] A number of additional literature reviews have synthesized the research across a broad range of outcomes.[16]

The evidence summary below focuses on studies that present findings about child social-emotional and behavioral outcomes of IECMH consultation programs conducted in ECE settings. When possible, links to descriptions of the models are provided. Studies of IECMH consultation as a standalone intervention are grouped separately from those in which consultation was combined with other supports, and within these categories studies with experimental or quasi-experimental designs are listed first.

IECMH Consultation in ECE as a Standalone Intervention

Experimental and Quasi-experimental Designs

Kids Connect provides child-focused and programmatic IECMH consultation to licensed ECE settings, including child care centers and homes, preschools, and Head Start, in Boulder and Broomfield Counties, Colorado. Master’s-level consultants deliver programmatic consultation for 16-20 hours per week to center-based programs and four hours per week to home-based programs for up to two years. State mental health administrative data include mental health provider assessments of overall symptom severity, recovery, and functioning at admission and discharge for all clients in the public mental health system, which includes children receiving Kids Connect child-focused consultation. Administrative data from 2007 and 2008 for Kids Connect children and a matched comparison group of children receiving therapy at publicly-funded mental health clinics elsewhere in the state showed that while both groups improved after receiving services, Kids Connect children showed substantially greater improvement.[17] Additionally, Kids Connect evaluation data from teachers and parents have shown improvements in pre- to post-reports of behavioral concerns.[18]

In Connecticut’s statewide Early Childhood Consultation Partnership (ECCP), master’s-level consultants deliver the program’s manualized classroom- and child-focused IECMH consultation to ECE programs for four to six hours per week for eight to 12 weeks. A study that randomly assigned classrooms to ECCP or a control group found that among 144 target children whose challenging behaviors most concerned the teacher (two per classroom), teacher reports of externalizing and total behavior problems showed significantly greater improvement among ECCP children.[19] Another randomized, controlled trial similarly found that among 176 target children, teacher reports of externalizing and total behavior problems showed significantly greater improvement among ECCP children.[20] A third randomized, controlled trial focusing on toddlers in infant/toddler classrooms found that among 58 randomly-selected peers of the target children, teacher reports of social competence and resiliency skills were significantly greater in ECCP classrooms.[21]

In Massachusetts, Together for Kids (TFK)provides child- and family-focused, classroom, and programmatic IECMH consultation to child care centers in the Worcester area. Master’s-level consultants delivered predominantly classroom-level and program-level services, along with some child- and family-focused consultation, in each child care center for 16-20 hours a week. At-risk children were identified through screening and received 4-6 months of child- and family-focused consultation, averaging around 24 hours of services during that time. A three-year evaluation in five child care centers included 136 children with externalizing behavior problems; 47 received child-focused services and 89 served as a control group because they were waitlisted or did not enroll in consultation. Analyses of a matched group of 19 intervention and 19 control children showed significantly greater spring to fall improvements in teacher-assessed aggressive and maladaptive behavior and growth in adaptive behavior for intervention children. [22]

In Michigan, 16 Childcare Expulsion Prevention Program (CCEP) projects provided IECMH consultation to children from birth to age five in a range of ECE settings in 31 of 83 counties in the state. Master’s-level and IECMH-endorsed consultants delivered child-focused and programmatic consultation, typically for 1-3 hours per week for 3-6 months. An evaluation of CCEP included a quasi-experimental study that compared outcomes of 86 children who received CCEP services with those of 86 children who lived in counties without CCEP and who were reported by parents as having challenging behavior in child care. Parent reports showed greater improvements in hyperactivity, attention problems, and social skills for CCEP children than for comparison children. Provider reports showed greater improvements in hyperactivity for CCEP children than for comparison children.[23] Information about MI’s current IECMC program can be found here .

The Learning to Objectively Observe Kids (LOOK) model of consultation involves online modules, child-focused consultation strategies developed through analysis of classroom observations, and consultant-guided video review of teacher practices and strategies. An evaluation of LOOK randomly assigned 45 Head Start teachers to intervention and control groups. For 132 target children who had been screened for behavior problems at the beginning of the year, the study found that intervention group children had significantly greater improvements than control group children in teacher ratings of inattentive task engagement, peer interactions, and peer disruption.[24]

Non-experimental Designs

Smart Support is an IECMH consultation program serving licensed center-based, regulated home-based, and home visiting programs in Arizona. Consultants are license-eligible, master’s-level professionals who undergo a yearlong training program focused on the Pyramid Model and FAN (Facilitating Attuned INteractions), and receive weekly in-person supervision. Consultation in ECE settings, which can focus on a child, classroom, or program, typically consists of 2-3 hours per week and lasts for a year (see PRiSM profile on Smart Support for more information). A four-year study of Smart Support collected baseline, 6-month, and 12-month data on 411 ECE programs, 799 ECE teachers, 1,028 focus children, and 105 consultants, through questionnaires, observations, and surveys. Significant improvements were found across the 12 months, with the most pronounced positive change in the first six months, for the following outcomes: teacher perceptions of teacher-child relationships; teacher reports of child self-regulation, attachment, and initiative; teacher reports of children’s risk of expulsion; and teacher attributions of individual children and her relationship with each child.

In Arkansas, Project PLAY (Positive Learning for Arkansas’ Youngest) offers child-focused IECMH consultation services as the highest tier in a system of behavioral supports for ECE programs in the state. In cases where concerning behaviors are extremely severe or there is a history of trauma or multisystem involvement, consultation services are offered weekly for three months. Consultants are licensed mental health professionals who receive extensive additional training and support to achieve state certification as an Early Childhood Mental Health Consultant to Child Care (see PRiSM profile on Arkansas for more information). Annual evaluation reports that examine teacher reports of children’s behavior pre- and post-consultation have found significant decreases in children’s disruptive behaviors, hyperactivity, and conduct problems, increases in prosocial behaviors, and decreases in the extent to which the disruptive behaviors were problematic for the teacher.[25] An earlier evaluation of Project PLAY’s pilot predecessor found significant positive effects for teacher reports of children’s attachment and decreases in behavior problems in 14 intervention sites compared to four control sites.[26]

A pilot IECMH program in Alameda County, California, developed and implemented standards of practice for agencies delivering IECMH consultation services in the county. Implementation of the standards was supported through intensive training and technical assistance for consultants. Reports from teachers receiving consultation for 21 focus children found significant improvements in attachment, regulation, and initiative from baseline to six months.[27]

The Early Childhood Mental Health Consultation Initiative in San Francisco, California, provides funding to agencies to deliver IECMH consultation services, which include child-focused and programmatic consultation, to ECE and other settings in the city. An evaluation of the initiative found significant improvements in teacher reports of social development and problem behaviors among children receiving services.[28]

The Classroom Consultation for Early Childhood Educators Program (CCP) pilot offered IECMH consultation to 15 ECE classrooms participating in Child First in Bridgeport, Connecticut (see PRiSM profile on Child First). In cohorts of four to six classrooms over the course of six months, a master’s-level IECMH consultant helped teachers use classroom- and child-specific strategies and provided both short-term and intensive parent support. An evaluation found that among children with lower resilience and/or greater behavioral concerns initially, teacher and parent reports of children’s initiative, self-control, attachment, and behavioral concerns showed significant improvements from pre- to post-consultation.[29]

In Washington, DC, the Healthy Futures program offers consultation to community-based child development centers (CDCs). Licensed mental health professionals visit 6-7 centers weekly and offer both programmatic and child-focused consultation, as determined in collaboration with CDC leadership. Consultants receive formal training on consultation, along with ongoing reflective supervision. Annual evaluations conducted in the program’s third through fifth years found in that teacher reports at baseline and 3-4 months for children receiving child-specific consultation showed significant improvements in children’s behavioral development in areas such as attachment, self-regulation, initiative, and behavior problems. [30]

A local community mental health center in rural southwest Kansas offered IECMH consultation services to a variety of ECE settings. Mental health consultants offered predominantly programmatic consultation in weekly or biweekly sessions of 20 minutes to an hour until the provider’s needs were addressed. Over 20 weeks, 10 home-based and 19 center-based providers reported significant improvements in children’s prosocial behavior and resilience.[31]

Currently, the Maryland Early Childhood Mental Health Consultation Project funds IECMH consultation programs across its 12 child care licensing regions. Evaluations have been conducted for individual consultation programs and for the state as a whole. In an evaluation of the IECMH consultation program in Anne Arundel County, two master’s-level consultants delivered consultation in five to 10 sessions of 1.5-2 hours to child care providers who identified a child with problem behaviors.[32] Following these sessions, the consultants produced a report with strategies for addressing the child’s specific issues, and the child was followed for another month. On-site training on how to cope with challenging behavior was also offered to child care staff. Child care teacher reports of problem behaviors and social skills at referral and discharge for 64 children revealed significant improvements. An evaluation of two pilot IECMH programs in Baltimore (Early Intervention Project (EIP)) and a five-county region (Project Right Steps) examined child care teacher reports of children’s problem behaviors and social skills at referral and discharge.[33] Both models offered programmatic and child-focused consultation, and Project Right Steps included home visits. The majority of children in both programs showed decreases in problem behavior and increases in social skills. A broader evaluation examined all 11 pilot consultation programs (including EIP and Project Right Steps), which served the state’s 24 counties. While each program employed a different approach to consultation, the evaluation examined child care teacher and parent reports of behavior and social-emotional functioning among children receiving child-focused consultation. Significant increases in protective factors, which include attachment, self-control and initiative, and decreases in challenging behaviors were reported by teachers for 55 children and by parents for 33 children. [34]

The statewide Pennsylvania Early Childhood Mental Health Consultation Project offers IECMH to ECE programs participating in the state’s quality rating and improvement system, with a focus on child-focused consultation. Programmatic consultation, in the form of program-wide IECMH training, may be added as needed. The master’s-level consultants deliver customized services based on the Pyramid Model. Annual evaluation reports have shown significant improvements in children’s behavior based on teacher report of children’s strengths and difficulties before and following consultation focused on 178 children in 2013-2014 and 238 children in 2014-2015.[35]

A pilot IECMH consultation program in Washington state served three counties, with each county developing its own consultation model. Child-focused consultation was the most frequent type of consultation activity in each model, with programmatic and family-centered consultation also delivered. In surveys completed after receiving consultation, 61 child providers reported significant improvements in children’s problem behaviors and social-emotional development. While 40 percent of program directors reported expelling a child in the year prior to the receipt of consultation services, only 20 percent reported expelling a child since receiving the consultation services.[36]

In the Training Opportunities for Tots and Staff (TOTS) program, two master’s-level consultants provided center-based child care programs with weekly child-focused consultation followed by monthly monitoring sessions after children met behavior goals. An evaluation of TOTS based on pre- and post-consultation teacher reports for 33 children found significant improvements in positive behaviors and behavior problems. [37]

IECMH Consultation in ECE in Combination with Other Supports

Experimental and Quasi-experimental Designs

The Chicago School Readiness Project was implemented in Head Start programs in Chicago, Illinois, and involved intensive teacher training in behavior management using an adaptation of the Incredible Years Teacher Training Program, along with IECMH consultation that consisted of 20 weeks of weekly follow-up coaching and stress reduction workshops for teachers and 10 weeks of child-focused consultation for three to five children in each classroom. Head Start programs were randomly assigned to receive the services or to serve as control sites, with two classrooms selected in each program. Analyses of teacher ratings and observational measures of child behavior found significant positive intervention effects on children’s internalizing and externalizing behavior problems.[38]

In North Carolina, Project Mastery delivered IECMH consultation to Head Start using a model based on The Incredible Years (IY) curriculum. Head Start centers were assigned to receive consultation or serve as a comparison group. Children in both groups were screened with a behavior rating scale, and children at intervention centers who screened positive received child-focused consultation. Two graduate students received training in IY and delivered weekly classroom- and child-focused consultation to teachers for at least four months. Parent and teacher questionnaires for 59 intervention and 37 comparison children–completed at baseline, at the end of the project, and one-year post-treatment–showed a significantly larger percentage of intervention children improved in their behavior compared to the comparison group. Teacher ratings indicated that disruptive behaviors among intervention children were stable whereas these behaviors increased for comparison group children.[39]

Non-experimental Designs

In northern New Jersey, consultation was offered to all three- and four-year-old children and teachers in four urban preschools. Three consultants spent two days per week in each preschool, offering a curriculum (Second Step) to all children, consultation to teachers, and play therapy to children identified as needing additional supports. As part of a three-year evaluation, teachers and clinicians completed assessments of children’s social-emotional competencies at the beginning and end of the school year, with pre- and post-assessment data available for 268 children who had received one year of services and 66 children who had received two years. Significant improvements were reported in social skills and problem behaviors after one year, with additional gains for children receiving a second year of services. The 35 children who received play therapy in addition to the curriculum also showed significant improvements in reported social skills and problem behaviors. [40]

In Rochester, New York, the Behavioral Supports for Children (BSC) project offered Behavioral Health Consultation (BHC), along with Pyramid Model training, universal social-emotional (SE) screening, and a SE curriculum, to 25 classrooms in six child care centers. BHC consultants delivered programmatic consultation (supporting implementation of the Pyramid Model, SE curriculum, and SE screening) and child-focused consultation to teachers and parents, typically visiting each center once a week. Teacher reports of children’s initiative, self-regulation, attachment, and behavioral concerns showed significant improvements for the 21 children who had received individualized consultation and who had pre- and post-scores. Teacher reports of children’s social-emotional competencies showed significant improvements for the 299 children in classrooms receiving programmatic consultation who had pre- and post-scores. [41]

Last updated February 2021

References

[1] Center of Excellence for Infant and Early Childhood Mental Health Consultation. (n. d.). About infant and early childhood mental health consultation. https://www.samhsa.gov/sites/default/files/programs_campaigns/IECMHC/about-infant-and-early-childhood-mental-health-consultation.pdf

[2] Caputo, M. (2016). Early childhood mental health consultation: Policies and practices to foster the social-emotional development of young children. Zero to Three. https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children

[3] Caputo, M. (2016). Early childhood mental health consultation: Policies and practices to foster the social-emotional development of young children. Zero to Three. https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children

Le, L. T., Lavin, K., Aquino, A. K., Shivers, E. M., Perry, D. F., & Horen, N. M. (2018). What’s working?: A study of the intersection of family, friend, and neighbor networks and early childhood mental health consultation. Georgetown University, Center for Child and Human Development. https://gucchd.georgetown.edu/products/ECMHCWorkingStudy_Report_F.pdf

[4] Caputo, M. (2016). Early childhood mental health consultation: Policies and practices to foster the social-emotional development of young children. Zero to Three. https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children

Le, L. T., Lavin, K., Aquino, A. K., Shivers, E. M., Perry, D. F., & Horen, N. M. (2018). What’s working?: A study of the intersection of family, friend, and neighbor networks and early childhood mental health consultation. Georgetown University, Center for Child and Human Development. https://gucchd.georgetown.edu/products/ECMHCWorkingStudy_Report_F.pdf

[5] Center of Excellence for Infant and Early Childhood Mental Health Consultation. (n. d.). Types of consultation services. https://www.samhsa.gov/sites/default/files/programs_campaigns/IECMHC/types-consultation-services.pdf

[6] Caputo, M. (2016). Early childhood mental health consultation: Policies and practices to foster the social-emotional development of young children. Zero to Three. https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children

Duran, F., Hepburn, K., Irvine, M., Kaufmann, R., Anthony, B., Horen, N., & Perry, D. (2009). What works?: A study of effective early childhood mental health consultation programs. Georgetown University, Center for Child and Human Development. https://gucchd.georgetown.edu/products/ECMHCStudy_Report.pdf

Hunter, A., Davis, A., Perry, D. F., & Jones, W. (2016). The Georgetown manual for school-based early childhood mental health consultation services. Georgetown University, Center for Child and Human Development. https://www.iecmhc.org/documents/FCC_Manual_2020_Proof2.pdf

[7] Caputo, M. (2016). Early childhood mental health consultation: Policies and practices to foster the social-emotional development of young children. Zero to Three. https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children

Duran, F., Hepburn, K., Irvine, M., Kaufmann, R., Anthony, B., Horen, N., & Perry, D. (2009). What works?: A study of effective early childhood mental health consultation programs. Georgetown University, Center for Child and Human Development. https://gucchd.georgetown.edu/products/ECMHCStudy_Report.pdf

[8]Caputo, M. (2016). Early childhood mental health consultation: Policies and practices to foster the social-emotional development of young children. Zero to Three. https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children

Duran, F., Hepburn, K., Irvine, M., Kaufmann, R., Anthony, B., Horen, N., & Perry, D. (2009). What works?: A study of effective early childhood mental health consultation programs. Georgetown University, Center for Child and Human Development. https://gucchd.georgetown.edu/products/ECMHCStudy_Report.pdf

[9] Center of Excellence for Infant & Early Childhood Mental Health Consultation. (n.d.). Center of Excellence for Infant and Early Childhood Mental Health Consultation competencies. http://www.iecmhc.org/documents/IECMHC-competencies.pdf

[10] Ferguson, D. (2015). Preventing preschool expulsion. Child Care & Early Education Research Connections. https://www.researchconnections.org/childcare/resources/29763/pdf

Gilliam, W. S. (2005). Prekindergarteners left behind: Expulsion rates in state prekindergarten programs. Foundation for Child Development. https://www.fcd-us.org/prekindergartners-left-behind-expulsion-rates-in-state-prekindergarten-programs/

U.S. Department of Education, Office for Civil Rights. (2014). Civil Rights Data Collection: Data snapshot: Early childhood education (Issue Brief No. 2). https://www2.ed.gov/about/offices/list/ocr/docs/crdc-early-learning-snapshot.pdf

[11] U.S. Department of Health and Human Services., & U.S. Department of Education. (n.d.). Policy statement on expulsion and suspension policies in early childhood settings. https://www2.ed.gov/policy/gen/guid/school-discipline/policy-statement-ece-expulsions-suspensions.pdf

[12] Center of Excellence for Infant & Early Childhood Mental Health Consultation. (n.d.). Center of Excellence for Infant and Early Childhood Mental Health Consultation financing guide for IECMHC. https://www.samhsa.gov/sites/default/files/programs_campaigns/IECMHC/financing-guidance-infant-early-child-mental-health-consult.pdf

Le, L. T., Lavin, K., Aquino, A. K., Shivers, E. M., Perry, D. F., & Horen, N. M. (2018). What’s working?: A study of the intersection of family, friend, and neighbor networks and early childhood mental health consultation. Georgetown University, Center for Child and Human Development. https://gucchd.georgetown.edu/products/ECMHCWorkingStudy_Report_F.pdf

[13] Caputo, M. (2016). Early childhood mental health consultation: Policies and practices to foster the social-emotional development of young children. Zero to Three. https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children

Center of Excellence for Infant & Early Childhood Mental Health Consultation. (n.d.). Center of Excellence for Infant and Early Childhood Mental Health Consultation financing guide for IECMHC. https://www.samhsa.gov/sites/default/files/programs_campaigns/IECMHC/financing-guidance-infant-early-child-mental-health-consult.pdf

Le, L. T., Lavin, K., Aquino, A. K., Shivers, E. M., Perry, D. F., & Horen, N. M. (2018). What’s working?: A study of the intersection of family, friend, and neighbor networks and early childhood mental health consultation. Georgetown University, Center for Child and Human Development. https://gucchd.georgetown.edu/products/ECMHCWorkingStudy_Report_F.pdf

[14] Le, L. T., Lavin, K., Aquino, A. K., Shivers, E. M., Perry, D. F., & Horen, N. M. (2018). What’s working?: A study of the intersection of family, friend, and neighbor networks and early childhood mental health consultation. Georgetown University, Center for Child and Human Development. https://gucchd.georgetown.edu/products/ECMHCWorkingStudy_Report_F.pdf

[15] Davis, A., Perry, D., F., & Tildus, K. (2020). Annotated bibliography: The evidence base for infant and early childhood mental health consultation (IECMHC). Center of Excellence for Infant & Early Childhood Mental Health Consultation. https://www.iecmhc.org/wp-content/uploads/2020/12/CoE-Annotated-Bibliography.pdf

Davis, A., Perry, D. F., & Tidus, K. (2020). Status of the evidence for infant and early childhood mental health consultation. Center of Excellence for Infant & Early Childhood Mental Health Consultation. https://www.iecmhc.org/wp-content/uploads/2020/12/CoE-Evidence-Synthesis.pdf

[16] Albritton, K., Mathews, R., E., & Anhalt, K. (2019) Systematic review of early childhood mental health consultation: Implications for improving preschool discipline disproportionality. Journal of Educational and Psychological Consultation, 29(4), 444-472. https://doi.org/10.1080/10474412.2018.1541413

Brennan, E. M., Bradley, J. R., Allen, M., & Perry, D. F. (2008). The evidence base for mental health consultation in early childhood settings: Research synthesis addressing staff and program outcomes. Early Education and Development, 19(6), 982-1022. https://doi.org/10.1080/10409280801975834

Perry, D. F., Allen, M., Brennan, E. M., & Bradley, J. R. (2010). The evidence base for mental health consultation in early childhood settings: A research synthesis addressing children’s behavioral outcomes. Early Education and Development, 21(6), 795-824. https://doi.org/10.1080/10409280903475444

[17] Heilbrunn, J. Z. (n.d.). The cost of failure revisited: Kid Connects mental health consultation as a cost savings investment strategy. The Partnership for Families & Children. https://web.archive.org/web/20170321005904/http://kidconnects.org/uploads/Kid_Connects_Cost_Study.pdf

[18] Described in Duran, F., Hepburn, K., Irvine, M., Kaufmann, R., Anthony, B., Horen, N., & Perry, D. (2009). What works?: A study of effective early childhood mental health consultation programs. Georgetown University, Center for Child and Human Development. https://gucchd.georgetown.edu/products/ECMHCStudy_Report.pdf

[19] Gilliam, W. S. (2007). Early Childhood Consultation Partnership: Results of a random-controlled evaluation: Final report and executive summary. http://www.chdi.org/files/3814/1202/7645/evaluation_of_cts_early_childhood_consultation_partnership.pdf

[20] Gilliam, W. S., Maupin, A. N., & Reyes, C. R. (2016). Early childhood mental health consultation: Results of a statewide random-controlled evaluation. Journal of the American Academy of Child & Adolescent Psychiatry, 55(9), 754-761. https://doi.org/10.1016/j.jaac.2016.06.006

[21] Gilliam, W. S. (2014). Early Childhood Consultation Partnership: Results across three statewide random-controlled evaluations: Final report with executive summary. https://web.archive.org/web/20160221204137/https:/hechingerreport.org/static/eccp2014report.pdf

[22] Upshur, C. C., Wenz-Gross, M., & Reed, G. (2009). A pilot study of early childhood mental health consultation for children with behavioral problems in preschool. Early Childhood Research Quarterly, 24(1), 29-45. https://doi.org/10.1016/j.ecresq.2008.12.002

[23] Van Egeren, L. A., Kirk, R., Brophy-Herb, H., Carlson, J. S., Tableman, B., & Bender, S. L. (2011). An interdisciplinary evaluation report of Michigan’s Childcare Expulsion Prevention (CCEP) initiative. Michigan State University. https://cerc.msu.edu/upload/documents/FINAL_COMPLETE_CCEP_REPORT_V2_2011-03-16.pdf

[24] Downer, J. T., Williford, A. P., Bulotsky-Shearer, R. J., Vitiello, V. E., Bouza, J., Reilly, S., & Lhospital, A. (2018). Using data-driven, video-based early childhood consultation with teachers to reduce children’s challenging behaviors and improve engagement in preschool classrooms. School Mental Health, 10(3), 226-242. https://doi.org/10.1007/s12310-017-9237-0

[25] Conners-Edge, N., & Kyzer, A. (n.d.). Project PLAY: Annual evaluation report FY18-19. University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine. https://familymedicine.uams.edu/wp-content/uploads/sites/57/2019/09/Annual-Evaluation-Report-FY18-19.pdf

Conners Edge, N. A., Kyzer, A., Abney, A., Freshwater, A., Sutton, M., & Whitman, K. (2020). Evaluation of a statewide initiative to reduce expulsion of young children. Infant Mental Health Journal, 1-16. https://doi.org/10.1002/imhj.21894

(n.d.). Project PLAY: Annual report FY17-18. University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine. https://familymedicine.uams.edu/wp-content/uploads/sites/57/2019/05/Annual-Evaluation-Report-FY18.pdf

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[26] Conners-Burrow, N. A., Whiteside-Mansell, L., McKelvey, L., Virmani, E., & Sockwell, L. (2012). Improved classroom quality and child behavior in an Arkansas early childhood mental health consultation pilot project. Infant Mental Health Journal, 33(3), 256-264. https://doi.org/10.1002/imhj.21335

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