Early Childhood Mental Health Consultation (EC-MHC): An Oregon-Centered Approach to Inclusive Pre-K
The Early Childhood Mental Health Steering Committee, a partnership between BUILD, National Center on Children and Poverty, Children's Institute, and the Early Division in Oregon has been gathering detailed information on how other states have implemented ECMHC, keeping in mind amendments that are necessary to best address Oregonian’s early learning system needs. Four speakers, including representatives from Arizona, Arkansas, New York, and the Navajo Nations, shared what has worked well for them in developing and implementing a culturally sensitive state-wide ECMHC program. A diverse subset of Oregon’s early education stakeholders (147 individuals) such as early childcare providers and educators (e.g. from Head Start, Preschool Promise), staff from Child Care Resource and Referral (CCR&R), mental health consultants, child and family health care workers, and Early Learning Hub affiliates, etc., contributed oral and written feedback on these approaches including what might work well and considerations for what might require further amendment. Here, I present the emergent themes from the compiled feedback to inform relevant staff in efforts to establish a statewide system of ECMHC care in Oregon.
Definition: ECMHC provides access to a mental health consultant for early educators and teachers with children who are experiencing behavioral challenges in preschool. The consultation model consists of diagnosing the present challenge and providing students and teachers with appropriate intervention strategies to better integrate a child in the classroom. Three major themes emerged from surveying Oregon stakeholders; 1) the utilization of the triage approach, 2) ensuring a community-centered approach, and 3) retention and appropriate staffing across the state.
Utilizing a triage approach. Arkansas presented their use of a triage approach, a model that was well-received by Oregon stakeholders. The triage, or three-tier approach, includes a warmline that could take the form of a phone number and/or online query form and should be used as the first encounter when seeking support. Here, providers or parents can write or call in about a particular challenge and receive over the phone assistance to support a particular child’s needs. After a phone call, if the situation requires further assistance, tier 2 would involve a visit to the school, center, or an in-home visit (this is where the majority of cases fell in the case of Arkansas). Finally, if a child needs more formal, longer-term intervention, they would fall under tier 3 and receive the support he or she needs in the classroom, at home, or in a clinic. The goal of the three-tier service is to allocate appropriate resources and staff to what an individual child is going through and provide a consistent and aligned approach across the state. While this approach was widely applauded as an appropriate method to be implemented in Oregon, a few important questions were raised through feedback from Oregon stakeholders. This approach would require the necessary promotion of this resource to Oregonians statewide. This approach must also be incorporated into current systems that exist in particular regions in Oregon, for example, some districts may already have a mental health consultant. Here we are calling for meaningful collaboration and cohesion between the state-wide ECMHC program and existing community structures.
Ensuring a community-centered approach. The second theme to emerge was a focus on framing the ECMHC intervention as a bottom-up, rather than a top-down approach to mental health consultation. In order for a successful program in Oregon, an approach that incorporates the collection of ongoing feedback from community members will amend the three-tier approach to appropriately match particular regions in Oregon and create widespread positive and successful utilization of the services. For teachers and families to get the most of this service, it must be both inclusive and community-driven. Several feedback forms included the important consideration of how mental health consultation for young children should center around the entire community, rather than an individual child on his or her own. Further, the focus should emphasize bolstering the strengths of a community to support a child rather than the traditional approach of mental health deficit focus. Importantly, destigmatizing mental health disorders and creating safe support systems for all members of a particular community is necessary for the successful implementation of ECMHC. In Oregon specifically, this requires increased support with a particular focus on the historically vulnerable populations including BIPOC individuals, non-native English speakers, refugee status, and children with disabilities.
Retention and appropriate staffing. Finally, it is critical in adopting and developing a ECMHC model in Oregon, that the program is staffed appropriately. This includes recruiting a staff that is representative of the demographics in a particular location across the state. While this may be a challenge in the early stages of ECMHC implementation, systems for educating and retaining staff must be considered and set up for the future success of the program. For example, a sustainable system might include incentivizing higher education in under-represented populations in Oregon through scholarship opportunities, recruiting from out of state, and taking care to consider how to best support the staff when they are working in these potentially emotionally taxing positions. Ongoing training and support groups, appropriate benefits, such as time off, appropriate wages and compensation, and the opportunity for other work-related activities such as book clubs should be implemented to support staff’s hard work and prevent burnout and low retention in career positions. Staff should be equipped with trauma-informed strategies and culturally sensitive approaches, and importantly should be provided with mentorship to assist in particularly difficult situations that may come up in deciding appropriate mental health treatments.
A big question that continues to persist in Oregon’s early education stakeholder’s minds is how a program like this can be funded sustainably. The reason we have not seen a program such as ECMHC implemented in our state before is due to the major roadblocks of adequate funding to support a program long term, no clear education pipeline to equip the state with a staff of diverse social workers and mental health consultants, and no support for staff at all levels to prevent burnout and remain in a position where they can do their jobs appropriately. Acknowledging these barriers, there is no better time than the present to start looking toward other states and programs to adopt what has worked well, amend to Oregon’s specific needs, and ask questions of the community to tailor a program that will most efficiently and effectively improve the mental health and well-being of preschool age children.
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