Implementing Evidence-Based Strategies in a Countywide Mental Health Consultation Program for Head Start: Preliminary Findings.

Introduction: A disparity exists between need for, and delivery of, preventative mental health treatment. This disparity is especially prevalent among children that experience socioeconomic disadvantage. Head Start is a national, federally-funded preschool program that serves socioeconomically disadvantaged families. This paper presents initial outcomes of a mental health consultation program delivered through a partnership between a countywide Head Start program and an academic-medical center team of clinical researchers. This program utilizes strategies from Teacher-Child Interaction Therapy (TCIT), an evidence-based practice for impacting young children’s socioemotional competence through improving early teacher-child relationships and enhancing teachers’ behavior management techniques.

Methods: Teachers were trained in TCIT skills in large groups prior to the school year. Two doctoral-level psychologists oversaw the mental health consultation program, with direct services delivered by clinical psychology predoctoral interns. Two interns at a time served as consultants on 6-month rotations. The first team of two consultants completed initial observations of teachers’ skills after the large group trainings. These same two consultants provided classroom modeling and coaching of TCIT skills to 55 classrooms in 13 schools. Then, two new consultants completed mid-year assessments. Each of the four clinical psychology predoctoral interns had extensive training in behavior management techniques and received additional training in live observational coding of TCIT skills prior to conducting observations.

Results: During the time period between the initial and the mid-year observations, the mental health consultants delivered a total of 74 classroom interventions in which they modeled the use of TCIT skills and 44 classroom interventions in which they coached teachers on the use of TCIT skills.Results from analyses using multilevel modeling indicated that teachers improved in use of multiple observed TCIT skills between the initial and mid-year assessment (i.e., increased frequency of labeled praises, reflections, behavioral descriptions, and commands that were complied with; decreased frequency of commands that children did not have an opportunity to comply with). Additionally, teachers who received consultation in the form of coaching, as opposed to modeling, exhibited greater gains in some of these TCIT skills.

Conclusion: Evidence-based practices can be implemented in mental health consultation programs to Head Start and lead to observed improvements in teachers’ behavior management skills. Implications of findings related to integrating preventative mental health services into programs that serve large systems of young children will be discussed.