Consultores de salud mental: Abordar el trauma y la recuperación

(En inglés)

Mental Health Consultants: Addressing Trauma and Recovery

Dr. Sangeeta Parikshak: Good afternoon, everybody. This is Sangeeta Parikshak from the Office of Head Start. I'm the behavioral health lead, and I've been leading the Head Start Heals campaign. We are in our second week of the campaign. This is our third very well-attended webinar. We have almost 2,000 people on right now. We are doing our best through the Head Start Heals campaign to really address all of the questions that you have related to trauma, related to mental health.

And so, today we thought that we would do a Q&A session for you all on mental health consultation addressing trauma and recovery. You know, we've been hearing for a long time now, that people have a lot of kind of basic questions about mental health consultation, particularly when the new Head Start Program Performance Standards came out a few years back.

We got some more questions about really understanding the role of mental health consultation. And now that we are in a time of uncertainty around the coronavirus, we have been getting even additional questions about how can we use mental health during this time. So, we thought that we would bring in one of our favorite people, Neal Horen.

He is from the National Center on Early Childhood Health and Wellness. He directs the Early Childhood Division over at Georgetown University, and is an expert in all things mental health consultation related. So, we're really happy to have him on with us today, and he's also just a fun person. So, we're hoping to make this discussion enjoyable for you all. I wanted to do some housekeeping before we get started.

So, if you're looking for any of our slides after today, you can download them during our presentation today in the event resources. This is not exactly an office hours type thing, but we do want you to be able to ask questions and we have some questions already prepared – kind of common questions that we hear from the field, but if you do have any questions for us, please go ahead and put them in the questions box.

We already see a few coming in. I want to make sure, I think a couple of people are saying it's hard to hear me, so I'm going to speak up a little bit. Yeah, but we do have a few questions coming in and we're going to do our best to answer as many as we can. We're also compiling questions throughout our campaign so that we can host additional office hours for you and answer anything that is unanswered or just needs more clarification. So, please go ahead and put in the questions box.

Let us know, you know, where you're coming from. I see we have a lot of teachers on, some education managers, mental health consultants So, you know, please keep that coming in. We love to see who is actually on and interested in this topic. And also, just let us know what you're hoping to learn from us today. So, we hope we can give you as much – as much information as we can. So with that, here's a slide of commonly asked questions. So, these are things that we've just been hearing over many, many years about – some basics around mental health consultation. So, I thought I would start with the first one, provide a little bit of an answer, and then Neal can jump in and help me out with some of these.

So, the first one that we hear all the time is, "What is the difference between a mental health consultant and a therapist, and how should we use each?" And, you know, many of you know that mental health consultation is something that has been in the Head Start Program Performance Standards for a long time, and the reason that we put specifically mental health consultation as having a mental health consultant is that that person is really there, they are a prevention-based tool.

So, they're really not to work directly with the child necessarily like a therapist would, but to really work with the adults in a child's life. You know, Head Start is so unique in that we're getting, babies, right? We're able to work with these infants and these young children and really be in a place to prevent a lot of difficult things from happening in the future. And so, a mental health consultant is really there to help with the parents, help the staff in a program to support healthy social emotional development early on.

Whereas a therapist is someone that really is more intervention-based, you know, they work often directly with the child and the parent together. Not to say that that's not important, but I think it's important to distinguish when we say that you need a mental health consultant in your program who that person is. And Neal, can you add a little bit more for us for that question?

Dr. Neal Horen: Sure. Understanding the pressure, you put on me when you say, "Neal is fun" and it's a trauma webinar type thing, but sure I'll give it a shot. Yeah. I mean, I think this is all great. It's a great starting point, I think because I think that, for folks, when they think about mental health, they oftentimes think about therapy. They think about, "Where do we make a referral?" And there is certainly a place for that in our work. And I think it's, quite honestly, it's actually where a mental health consultant can also be helpful in making – in helping you make an appropriate referral.

But I think it's important for folks to understand that when we think about mental health, particularly in our Head Start work, even around issues of trauma and resilience and recovery, it's important to think about a continuum, it's important to think about what are we doing to promote mental health for all children and their families? What are we doing to prevent mental health issues from becoming, things that get in the way, and what are we doing when we actually need to intervene or do treatment?

And I think that in all of those spaces on the continuum, there's a role for a mental health consultant. And quite honestly, if you think about a sort of a public health approach in general, maybe 3 to 5% of children overall might need some really significant treatment-level kind of intervention. Whereas the majority of children, oftentimes, benefit from sort of the same old, same old. When we think about the kinds of curricula that we're using to address social emotional development, there are oftentimes things about routines and structure and being responsive caregivers in our Head Start work, that's promoted in terms of mental health, and it may not feel like it's mental health, but it is.

The therapist isn't going to do that. A therapist, as you pointed out, Sangeeta, is really going to zero in on the specific child and their family and what's going on, and that is very appropriate when necessary. And for some children and families who have experienced trauma, that is what's necessary.

For many children and their families, there are things that a mental health consultant can be doing in that day-to-day operations of our Head Start and Early Head Start work. There really are the kinds of things that help that child and their family develop the kinds of skills that we want them to have, and it's not focused on a particular issue that's been raised. It's really about their general social emotional development.

Dr. Parikshak: Yeah, and as you're talking, you know, I'm thinking that, what I think would be ideal, and I think we want to be as aspirational as possible, is we want a mental health consultant who is really embedded in the program. Like, I think about a therapist and like you're saying, it's somebody who's coming into the child or family's life because there's a problem. But ideally, we would have a mental health consultant who is embedded in the program, who's made relationships with families and with staff already, understand circumstances around it, and may understand that there might not be a particular diagnosis going on with the child.

We may not need to pull the child out of the program because we're not meeting their needs because there's something wrong with them, right? But it's more that that consultant is so well embedded that they understand, "Oh, I actually know that something happened at home with this child. I know that there's a way we can maybe change a little bit of the classroom structure and that will really help the child a lot as well." And so, I think we can think about this person as kind of, you know, an important part of the staff and not necessarily somebody that comes in and out once in a while. Do you think that's fair, Neal?

Dr. Horen: Yeah, no, I think it's great, Sangeeta, and the one thing that I'd add to that, and maybe the whole call is just going to be us adding points to each other's points, and that'll be fun. But you know, if it was up to me, every single Head Start program would have a 40-hour-a-week mental health consultant embedded in their program. It's not up to me cause I'm not in charge of budgets and all those other sorts of things, but there's real value in, and having as much access to, a mental health consultant who's really there to support the adults in their work.

And so, the more that that mental health consultant is there, the more that they're figuring out what each of the people need in order to support each of the children. Having a mental health consultant show up once every six months and do some observations doesn't really afford the same sort of support that you can get when that person is embedded in the program, knows the children, the classrooms, the directors, knows the home visitors and early, you know, those kinds of consultants have a much better sense of what is necessary to do that support.

But again, that's in a fantasy world. It's aspirational, but it is the kind of thing that hopefully people are thinking about is, "How do we have a mental health consultant who's helping us develop the skills: teachers, coordinators, home visitors, so that, that we know how to address social emotional development as effectively as possible?"

Dr. Parikshak: Yeah, and I think, a question came in; it's not so much a question, but a reflection. But, Paige Evans, I believe is her name, but she basically summed it up really well. She said, "See if I understand what was said about this, but the difference is that a mental health consultant is used for prevention and geared to work with adults, and a therapist is really the person who's there for intervention and working more with the child and family." So, I feel like, Neal, you did your job. Thank you so much.

Dr. Horen: That was great.

Dr. Parikshak: It was clarified very well. I know.

Dr. Horen: Yeah, the winner of the first – if this was like a real, like Head Start event, we would have a raffle at some point and, Paige, you would win the first raffle. Congratulations.

[Laughter]

Dr. Parikshak: So, next – next question. I think this ties in really well to kind of what the mental health consultant does and why we need someone who's well qualified. "Does the mental health consultant need to be licensed?" And we have in the performance standards, we – we have very specifically that mental health consultants are licensed or certified mental health professionals.

And we're saying that because we want somebody who is skilled and knowledgeable about mental health, right? Somebody who has been through the training, who understands the difference between, kind of, going in and giving a diagnosis and being a consultant. But I wondered, Neal, if you could talk a little bit more to that, particularly around the certified piece, because I think that can be a little confusing, the way that it's written.

Dr. Horen: Sure. So, you know, right now there is not a – sort of a national certification program for mental health consultants, although we, I will tell you we are working on that, and when I say "we" there, one of the sister technical assistance centers that exists, if you don't know, is the Center of Excellence on Infant and Early Childhood Mental Health Consultation. So, it's a center that is completely dedicated to the issues around mental health consultation, and one of the things that the center has really been thinking about is, "How do we get this to be as much a professionalized field as we can?"

And there are certainly, there's lots of good research out there and data. So, while there's not a certificate, I can tell you that in some states, mental health consultants have to have like the endorsements that some of you are familiar with, from the Alliance for the Advancement of Infant Mental Health, and there are any number of ways in which to ensure that the person that you're having as a mental health consultant is qualified.

And so, I – we as a center would tell you that the best outcomes seem to be happening in places where there's a master's level, license – or license-eligible – mental health person serving as a mental health consultant. Again, I'm realistic that that's not always the possibility in every single part of this country. In our Head Start world, it is a bit aspirational, but I, you know, I said this to Sangeeta, and I say this all the time, I think that at Head Start folks should be really good consumers of mental health and just because somebody has a mental health degree – and they gave one to me, so, you should keep that in mind – but just because somebody has a degree doesn't mean that they're qualified to be a mental health consultant in Head Start or Early Head Start.

I would really, really promote all of you thinking carefully about what is the person doing? What they're doing is they're forming relationships. One of the questions we saw was about, "What if the teachers don't listen?" Well good for the teachers. Maybe, they're not a good consultant, but others – other times it may be something else, but it's about that relationship. Hiring a really skilled, qualified mental health consultant. I think that the program performance standards have come a long way and Sangeeta's been a part of that, and also, Head Start's really thought carefully about this in a really nice way to keep pushing us as a group, our Head Start world, to think about, "If we could get somebody to be our mental health consultant, what would that person be doing?"

They'd be developing relationships with all the adults. They'd be identifying where the needs are, and through that relationship, working to enhance everybody's skills. Oftentimes, having a license in mental health, having that degree can be really helpful signs that the person has those qualifications.

Dr. Parikshak: That's helpful, and I know there's some specific questions coming in about what counts exactly as licensed or not licensed. I think that, you know, because the performance standards are so specific on the person having to have a license, unfortunately, if you did have a license and you don't have one right now, you would not qualify to be a mental health consultant.

But you know, the folks that are asking that question, you know, I would encourage you try to get your hours and get your license if you're interested in doing that. And we know that sometimes it can feel like a technicality, but we just want to make sure that we hold the bar as high as possible for mental health in Head Start because it is just so important. And I think, Neal, you've really, you've talked a lot about how to find the right mental health consultants for our program. Is there anything else that you wanted to add about that piece?

Dr. Horen: Sure. So, one thing that I would add is that – that on the center on mental health consultation, and actually in partnership with Sangeeta and other folks at the Office of Head Start and ACF, but with other federal agencies, we've developed a set of competencies for mental health consultants that are available for you to look at.

And again, if you could find somebody who meets all of those, you should scoop that person up. But you really should be thinking about what do we need a person to do in our program and what are the competencies that we really want to look at? And, I know at the end, I believe Sangeeta and I have listed resources, including the website for that center. But we did that first through the Office of Head Start, we developed a set of competencies for mental health consultants that are actually available on the ECLKC.

We've updated them. But I think that that's one of the things in terms of finding the right mental health consultant is first identifying what is it that you want that consultant to do. So, keeping in mind that there are different types of consultation. So, there's child center consultation where the issue might be that there's a child who is having difficulty or teachers having difficulty with – with a child, and the consultant comes in and works with the teacher on what are some strategies that might help here. There's a classroom-based – or program-based – where you're sort of working across an entire classroom, across an entire program, working with all the home visitors.

So, you have to think about what is it that we want the consultant to do in order to know how to find the right person. So, if somebody is really skilled at working with children, it doesn't actually mean that they're going to be really skilled at working with adults. So, really starting to think about those competencies, and what is it that, in your context, in your program, you're looking for: Somebody who understands the culture of your community and the culture of your program, and understands how you all approach social emotional development that you, you know, I think about programs that I've visited all across the country and think about how important it is that the consultant understands the families and their experience, the children and their experience, the staff and their experience.

Finding the right consultant is not simply a matter of going to find somebody who is certified or licensed. That's the program performance, Aaron, you have to do it. It's really been starting to say, "And what does that mean for us, for our program?" So, if I'm doing this in Salinas, Canton, you know, Salinas, KS, and I'm doing this, and in Bozeman, MT; I'm doing this in Puerto Rico, those consultants, hopefully, are going to be different because the needs may be different. The cultural aspects are different. All of that should factor in along with the set of competencies and ultimately meeting the program performance standards.

Dr. Parikshak: Right, and I was looking at some of the questions coming in and people were asking about, you know, psychology interns who are working towards their license. And, you know, I think the most important thing to think about is, "Will the person that you bring on be ... Are they already, like Neal said, part of your community, will they stay on?"

I think sometimes the hardest thing is if you have a mental health consultant who's there for a couple of months and then they're gone, and then you have to kind of reestablish that relationship. You know, you often don't have a whole lot of control over that, but for the person that asked that question, if you have somebody who's in there working towards their license, who's under somebody who's already licensed, then you can have that person stay.

If they're committed to staying, then I would encourage you to get that person onboard and – and – and they will get their license and hopefully stay on for a long time. I just think that – that the key piece is really getting somebody in who – who is going to be kind of like your lifeline, someone you can count on.

We say in the performance standards about securing mental health consultation on a schedule that ensures timely partnership with staff and families. So, we don't want someone who's not going to be available for you, you know, except for like once every three months, right? So, that's just something I think to think about too, when you're thinking about who that right fit would be for you. And I say all of this knowing that sometimes it's just very hard to find somebody. But if you do have a couple of options, these are some ways that you can try to think about who to bring on. OK.

Well, why don't we move on to talking a little bit about the parent piece here, because I know that there's – there's been a few questions coming in related to parents and the one that we hear the most in our office is, "Parents that I work with do not want to engage with our mental health consultant. And what should I do?" When we revised the performance standards, what we really wanted to emphasize was that mental health was integrated as one of the many comprehensive services provided through a Head Start program, not just kind of an add on.

So, what that means is that at every level in the program, people are onboard that mental health is something that we take very seriously here. And it is oftentimes very much synonymous with a child's social emotional development. So, I think when you're working with parents, you know, we have a lot of resources and other things around having difficult conversations with parents. But I, you know, I do think that we need to call the mental health consultant what that person is.

Say that it is somebody there who is there to work with the adults for all of the children. It's not about, you know, singling out that one child and saying, "Oh, now we're going to bring the mental health consultant in." If the parent has never heard that mental health is part of the comprehensive services and the fabric of Head Start, then it's going to be a shock to them. They're going to feel like they're being singled out.

And so, I just think that we need to be as preventative as possible around making parents feel that there's something wrong with their child by making it clear at intake when you first meet a parent, if you're working with them for the first time to let them know we provide all of these services and mental health is one of them. What do you think Neal?

Dr. Horen: Well, I think you're brilliant in every response you've had, because I have to say that each half hour of our call, but I also think that was a really good response because I think the way you started, Sangeeta, was really important, which is, let's call this what it is; it's mental health consultation. It's not mental illness consultation; it's mental health consultation. We're trying to figure out how do we support mental health, good social emotional development. I think when I hear this about parents as if there's one group of folks and we just say, "Parents don't this or parents this,"

I just want to be clear: everybody does things, right? 'Cause a lot of the questions in here are about teachers don't want to listen to the consultant, those kinds of things. So, I think the starting point where you were, Sangeeta, around how do we have parents sort of onboard is we probably start from the beginning. How does our, you know, our parents, our family council, how are they involved in the hiring process?

How are we sort of involving their perspective on what a mental health consultant should bring to the table as opposed to saying, "Well, it doesn't matter you guys, we... You are just part of our program?" Right, yeah, you're the major part of our program; so, having some say in the job description, having some say in the hiring has a very palpable difference, then, "Well you just," ... Hold on, my family likes to throw things during the call. It's like a Greek wedding here.

It's really cool. So, I do think that from the beginning, and from the beginning also in August when we come back and we're doing in-service and we're doing orientation with families, we're having our mental health consultant there. It's another sort of argument around why having an embedded mental health consultant rather than somebody who shows up once in a while really helps. Because then when you say to a family this is our mental health consultant., this is what this person does, this is what they don't do, this is how they help us and really explain the role of the mental health consultant.

It's vastly different than, you know, six months into the year we're like, "We have some concerns about your child. You need to talk to the mental health consultant." I don't know why I use that voice, Sangeeta, but it seems like you would. And so, I think that when we incorporate the mental health consultant as just another part of our program, no different than the disabilities coordinator, the ed coordinator, our nutrition folks, our bus, truck, we're all part of the same program.

And I think that that's how when we talk to parents if they don't want to engage, it's a relationship issue. And so, I think about a really good mental health consultant is really good at developing relationships and OK, without forcing it. This is not, "You have to talk to the mental health consultant or Johnny's in big trouble," it's, "This is a person who is here to support."

So, when we have conversations and everybody feels like we're on equal footing, right? That's a big part of being a mental health consultant is avoiding the position of expert. It's that we're in this together. It's collaborative problem-solving. That has a very different feel than the secret mental health consultant who no one knows who just shows up and has a meeting with a parent when there's trouble or that kind of thing.

Dr. Parikshak: Yeah, and I would also add that, you know, if you're having trouble like getting the parent to agree to talk with the mental health consultant, think about the people in the program that the parent most connects with and bring that person in with the mental health consultant. So if, you know, it's a teacher in the classroom or say it's a family service worker, or disability services coordinator, it doesn't, there's no right or wrong person that connects with that family, right? But you want to make the family feel as comfortable as possible.

So, bring that person in that they have the relationship with, and then bring the mental health consultant in together and make it that kind of approach, versus the other one with the scary voice that Neal was talking about because I don't want that. And I think also, you know, there's a question that came in about, "How you can help assist a parent that doesn't believe that their child may be experiencing some sort of mental illness?" I think that the way that you talk about a child's development with the parent is really important.

So, you think about the Head Start Early Learning Outcomes Framework, right? You think about it as like an academic tool, but there is a whole section on social and emotional development in the ELOF. And so, if you can sit down and talk with the parent about all the different domains where the child is progressing and evolving, and then you can get to the social emotional section and say, "And there's places where they could probably do better, and these are the things that we're concerned about."

I think that kind of feel might go over better with a parent than saying, "We're worried that your child has a mental illness." That – that terminology, the thought of a diagnosis can be really scary for, you know ... I was – I remember working in a clinic where I had to, basically, my job was telling a parent whether or not their child had autism, and it was really just, I felt so badly because every time I had to give the diagnosis, the parent was just really beside themselves. They were upset because they were thinking about all the different ways that their life was going to change. And I think it's the same thing with a child with challenging behavior. You know, giving a diagnosis or talking about ADHD or anything like that, it can be really overwhelming to a parent, particularly the families that we work with that may be struggling in other parts of their life.

Dr. Horen: Hey Sangeeta, this is Neal. This is Neal. I realize it's probably just me and you who are on the phone, but I'm going to identify myself. Anyway, this is Neal. So, Jody asked a really interesting question, around, "Do you recommend obtaining parental consent if a mental health consultant is going to complete a child-specific observation?" I'm going to take a shot, if that's OK, and – and say, let's sort of broadly, because I think Jody is, it – it sort of goes to the heart of this. I think parents should be involved from the beginning. I think having a parent understand why you might want to do an observation, what the observation is.

You know, it's sorta like when we take our 4 year old for her well-child checkup. One of the things I love about the pediatrician is, and the nurses, that they're explaining things. I don't know if my daughter really needs to understand the exact injection she's going to get when she gets her shot, but I think the idea that we're going to explain everything is important, and I think when we work with families, if we're really truly going to have a good working relationship, we're going to be straightforward from the beginning.

Here's what a mental health consultant is and is not; this isn't therapy. This isn't treatment. This is somebody who's here to try and do promotive preventive sorts of things, as we started out this call. And I think that when we are sort of upfront and honest and say to parents, "We're going to do this step if that's OK with you.

Here's what we're going to do after." I mean, this is why as a mental, I was a mental health consultant in Head Start, if I was going to do an observation, I would call the parent, I would say, or I meet with them and I'd say, "Here's what I'm thinking. I know this may not feel like the great, the best thing, but if it's OK with you, I'm going to go in that – in that classroom. I'm going to do an observation, are going to be up to 30, 40, you know, I explained what I was going to do and as soon as I'm done, I'm going to try and get in touch with you and I'm going to tell you what I saw and then we're going to talk about, so what does that mean?

We're going to talk about it with the staff, and if that's OK with you." And if you do that, it certainly feels very different than, "What do you mean, somebody watched my child today and thinks that there's something going on?" So, I think that it's, you know, the truth is, in all of this work, and I'm talking to thousands of Head Start people, you know, this – it's all about relationships and mental health consultation is all about relationships. I know that because Trista in Montana has said, "Preach," five times during this call, she just told me, so I must be saying something OK.

But this is about that relationship. So, asking for consent seems like a really good idea in just the whole sort of range of things at the mental health consultant can do.

Dr. Parikshak: Right, and you know, I also do want to say, you know, we've been talking about mental health consultants and therapists as kind of a different ends of the spectrum, but I do want to say that, you know, and you can read this in the performance standards too, that there is a place where, you know, mental health consultants, they are equipped to be able to talk to parents about the possibility that a child may need a diagnosis, and why that might be an OK thing because you could get children services that they can't otherwise get without a diagnosis. So, they're actually in a place to be able to explain better why a child may need a little bit more help and how to get them the help that they need.

And so, sometimes you can use the mental health consultant to work directly with the family to help connect them to those outside interventions. And we know, we have also heard that there are programs that have a mental health consultant onsite and also, a clinic, kind of an in-house clinic as well to refer children to. And you know, those also tend to work really well in the sense that then everybody is onboard that mental health is a big part of the program.

And I understand that there's a lot of budgetary restrictions and other things that people say, "We can't necessarily achieve that gold standard, but it's something to think about. You know, there is a lot of quality funding coming in related to trauma-informed care, and there is some money coming in, too, I think related to the coronavirus, but particularly the quality funding is a place that you can think about, "Does my program need some extra behavioral health support? Do they need, in addition to consultation, do they need some more people on site to do some specific interventions, and can we use some of this money coming in for that?"

So, it's kind of a unique time to start thinking about bringing more of your leadership onboard with mental health and why it's important. And there was one question that came in, Neal, that I thought was really interesting. I'm going to take a little bit of a stab, but see if you have anything else to add, around suggestions for how to get your leadership team onboard.

So, they may be OK with having a mental health consultant there to support families and children, but maybe they're not willing to engage with the mental health consultant. And I was just thinking, when you mentioned, you know, that you were a mental health consultant in a Head Start, I was just reflecting on my experience as a mental health consultant, as well, in a Head Start program.

And I remember sort of feeling, you know, I was one of those people who was a psychology intern, didn't quite have my license yet, and I was trying to get the leadership onboard with my presence and why it was important for them to connect with me, and what ended up helping me was I brought in some of the parents that I was working with to meet with the leadership team, so that they could hear directly from the parents why it was so important for them to kind of engage, more collectively with everybody in the program.

Why was it important for the director to have consultation time? Why was important for the bus driver to have consultation time? To make it more of a fabric of the program? So, I think, you know, like Neal was saying, you need to work with the parents from the beginning. The family-centered approach, the relationship piece is so important. When your parents are advocating for the work that the mental health consultant is doing with your leadership, they can really go a long way.

Dr. Horen: OK. Yeah. I think the other - the other piece of all that is, and certainly I know we're going to, you know, we're focused here on trauma, and so when I think about trauma and disaster and pandemics and things like this, that wellness piece is a huge component that a mental health consultant can bring to the table. And what I've experienced over the last 20 years in the Head Start world is that oftentimes our leadership are the ones who immediately are getting back in after dealing with trauma.

And not taking care of themselves because they're trying to take care of their staff; they're trying to take care of children and families. You know, they're good leaders, and what oftentimes gets sacrificed is their own wellness and being open to the idea that a mental health consultant is there not to try and do therapy with you as a leader, but to really support you so you can support others.

It's the whole, put your oxygen mask on before helping others put their masks on. I think that leadership can be involved in that conversation about what is the true role of this mental health consultant and what does it mean to do to support staff? Leadership are part of the staff, and over and over again, I try and remind leaders that you're not going to be able – you're going to get burned out, too, if you don't sort of allow yourself to be seen as part of the whole picture here. And mental health consultants can be of great support.

And, I know on the ECLKC we have, on the mental health consultation tool, we have some great videos of directors of programs. I think one of them was a child care, if I remember, I can't remember now, but one was Head Start, and the director talks really nicely about how much support the director got from the mental health consultant about their job, about what they were doing, about their role. So, I think there's a great place for this, and I think much like our conversation about how do we have parents who don't seem as interested or invested or how do we get teachers that don't seem as interested invested? It's all the same as all about those relationships.

Dr. Parikshak: You know, Neal, when you didn't answer for a few – for a few seconds, I thought I had rendered you speechless, but thank you for that. That's the ...

Dr. Horen: We both know that’s impossible – that is impossible.

[Laughter]

Dr. Parikshak: So, like you said, we're talking about trauma here. So, we have a question about, "How can I utilize a mental health consultant to help with implementing a trauma-informed approach specifically?" And I know that there was a question that came in about, "Should a mental health consultant provide training to staff and parents with challenging and aggressive behaviors?"

So, you know, when we think about the four R's of implementing a trauma-informed approach, I do think there is a place for a mental health consultant to provide training, right Neal? For staff and parents around the behaviors. But I think if we want it to be more tailored to a trauma-informed approach, it might also be useful for a mental health consultant to help with training around the signs and symptoms of trauma and that these different types of behaviors could be identified.

Dr. Horen: Yeah, I would say that if the mental health consultant is only doing training, you're not utilizing them as effectively as possible. If they're doing training as a part of the overall approach of supporting social emotional development, supporting mental health, I think that there's a real place, particularly around trauma, I think that's a great example of, part of the title is mental health consultant, right? Mental health. They have some expertise in these kinds of things like trauma and training about recognizing signs and symptoms. Knowing how to use some of the promotive preventive pieces of our Head Start work is exactly what can be done in a training.

So, I think there's some real value in that. I just want to make sure it's not just training and training only.

Dr. Parikshak: And then we have there, "What can mental health consultants be doing now and how can they help us prepare when we go back?" And I think those questions also, there was a couple that came up and I think, Neal, you're a little bit more equipped to answer this question than I am. I'm going to let you take the first step.

Dr. Horen: Sure. So, I think that one of the things that mental health consultants can do is, if you think about sort of the lane, if this is a highway, this is one of the ways we've been talking about this. If there's a highway, the lane that mental health consultants sort of drive in is the lane of, we are here to support the adults in the Head Start program who are supporting children and their families.

At this point, I think it might be, let's widen the lane a little bit. Let's get onto the other part of the highway – the mental health highway – which is, maybe we don't work directly with families on a typical basis because we are trying to support the staff as they develop the skills to work with children and families.

But right now, maybe that is the time – this is the time. And one of the things that's happening on the, our other center, the center of excellence on mental health consultation, infant early childhood mental health consultation is, we, I'm hoping this week, I don't want to make promises 'cause there's thousands of people and we're like, "Why did that guy say that it'd be there?" But we're hoping this week – we've been doing interviews with state leaders across the country, leaders in mental health consultation programs to hear how they pivoted in this time, and amongst those, I'll give you a nice sneak preview, and then you won't have to listen to them, but, among them are, they have their mental health consultants sort of taking calls, and taking calls from – from staff, but from parents as well, very directly and trying to help as much as possible.

It is challenging, but I think that there are things that mental health consultants can bring to the table now. And I don't know about all of you, but I spend most of my time on these Zoom or some, it's not a shameless plug for Zoom, you can go to whatever you want, but on these online things, doing trainings or whatever it is, there's an opportunity for your mental health consultant to be providing resources and supports for what is a really trying time for everybody. But I imagine for our Head Start folks even more trying.

That trying to figure out how to keep going, how to support the children and families in our programs, how to support ourselves. Mental health consultants can be of great value right now, and also, to prepare, as eventually we will go back. I don't know what it's going to look like and it may look different for each of us, but eventually we're going to go back and what are the kinds of things that we should be thinking about as children come back, as they are separated from their families that they've been spending 24/7 with in many cases, as teachers come back who have been with their own families? How do we – how does a mental health consultant maybe help us think about preparing to come back? So, I think that there's things that they can do now and things that they can do to help us prepare.

Dr. Parikshak: Yeah. I'd be curious to know if anyone's mental health consultant is actually is getting on calls with parents now. You know, we know that there's been a lot of – an uptake in telemedicine for behavioral health providers, so if you aren't sure if your mental health consultant is doing that, you know, maybe you could reach out and see if they can – they can start working with families now, before we go back.

I have heard about home visitors, obviously doing some Zoom calls, and I did hear a couple of anecdotes about home visitors and mental health consultants partnering up on these calls together. So, in thinking about, you know, like we were saying earlier, who has the best relationship with whatever individual family you're thinking about at the time, you may want to get that person and the mental health consultant together to talk with the families and see how they're – how they're doing, and get them ready to come back and meet with them – meet with the mental health consultant in-person, and hopefully later on.

Dr. Horen: Yeah. Sangeeta, I know, my friend, Eylea, in Puerto Rico asked this question about teleconsultation and there's been a number of folks who've put in the Q&A that is what they are doing. That is certainly what we're hearing from other folks across the country, who are providing mental health consultation, not just in Head Start, but in – in other settings, like in early care and child care, into home visiting programs, to child welfare. Whatever sorts of venues they're providing in, they are doing teleconsultation sessions. And one of the things that I want to make sure that we say before we hop off. I know we're not hopping off right now, but I want to make sure I don't forget, is ...

Dr. Parikshak: OK, I got scared, I was like where are you going?

Dr. Horen: No, no, I've got stuff; I've got an obstacle course set up downstairs for my 4 year old. I've tried to go on a walk at some point. So, no. I know that for some this feels like, "What is going on? What are we supposed to do? What should our consultant do?" We don't know ... It's also an opportunity. I think it's a real opportunity, particularly around mental health consultation for folks to see the real value of mental health consultants and the consultation field in general. And I would really push for folks to say, "Boy, in this time of trauma, and this is a time for some people of trauma.

What a great asset it is that our mental health consultant was here." I've seen this other – after other disasters, in my work in Head Start, that a really good mental health consultant supported everybody as they were thinking about how they're dealing with it, as they were coming back. I think this is an opportunity for mental health consultants to really show what value they have, and that can range from, "Can they do trainings for us right now," to how can they help the parents who are trying to, you know, many of us are trying to pretend that we're teachers.

Not all of you who have written in here, "I'm a teacher," but people like me who, like, have no clue, but I think this is an opportunity for us to see the real value of mental health consultation and to really push then in our Head Start program, we value it and it is critical for families. Again, those questions about families feeling, you're feeling like families may not want to engage with the mental health consultant. I wonder if their experience during this time may change that opinion because they have actually gotten some helpful support from your mental health consultants. So, I'd encourage you to see it as an opportunity as well.

Dr. Parikshak: Hmm. I saw a lot of people write in that their mental health consultant is working directly with families right now, and I think that's wonderful. I know that there were some questions around Zoom not being HIPAA compliant and wondering what Head Start recommends using. I mean, we don't have formal guidance around, you know, the telemedicine aspect of it, but I do know that mental health providers should be getting that information as far as what is compliant and not.

I know there's been some apps that have been recently updated to be HIPAA compliant. But, I don't have a direct formal guidance on that. Neal, I'm not sure if you know if there's anything specifically that you've heard of that you’re using for that.

Dr. Horen: That's why I, that's why I said, like, I'm not promoting any particular platform, and I can tell you, like in my clinical practice here at Georgetown, we go back and forth. Every day we get an email like, "Yeah, you should do ... Don't use that, use this. Don't use ..." So, I think that you all should figure out what works for you, and obviously it is critical to be thinking about confidentiality and all that kind of good stuff. But I think my point was a broader point about how we can support families and staff.

Dr. Parikshak: Got it, and I really wanted to address a question that came in. Just going back to kind of the broader discussion we've sort of been having about stigma around mental health and mental health consultation. You know, somebody said that their administration prefers to use the term behavior health consultants instead of mental health, you know? And we're wondering if it adds to the stigma around it?

You know, I don't worry so much, Neal, and I'm not sure how you feel about this, but I don't – I don't worry so much about using the term behavioral health consultant. I just want to make sure that families and staff that are utilizing the consultant understand that it's not just for kids with challenging behaviors, that behavioral health is kind of a general, broader term that encompasses, you know, mental health, substance use, those types of topics, and then I think it's fine. I think it's more about people understanding what, why that person is there more than what the title is.

Dr. Horen: I'm a licensed psychologist. I can no longer be embarrassed that I'm a mental health person, but again, and I think that whatever people want to call it, as long as you said, Sangeeta, as long as we're clear what it is, and I think when we start to be like, "No, no, no, they're not going to do this, they're going to ..." and we're not being direct, that's what makes it more challenging for people to sort of accept what it is. Because when you start to figure out that mental health is not some ...

You're not having 2 year olds, [Inaudible], you're not having 2 year olds and you know, sitting on a couch talking about their dreams. Like, that's not what this is. Mental health is, it's what happens ... I see it every day when somebody says to my daughter, when we're outside, at least six feet apart, not really coming close to people. When somebody says, "Wow, Isabella, you're getting so fast." That's mental health. That person's not a mental health consultant, but that's mental health, and if we start to think about mental health walking around, we think about mental health is just part of – of health.

And somebody in the comments, today said this like, "Let’s be clear, like if we were talking about any other part of health, everybody would be fine." If you want to call it something else, call it something else, but just do what it is, which is supporting that child's social emotional development and supporting the staff so they can support it and supporting families so they can support it. And if you want to call it behavioral health, if you want to call it family support, whatever you call it is OK.

But ultimately what you're trying to do is you're trying to address social emotional development. I'm just trying to get another preach out of my friend Trista. But I think it's OK, and that is certainly something that at a sort of across the country, people do at times feel like if we – if we call it mental health, it may be off-putting to folks, and, I think that's OK. And particularly if you know your community – if you know your community, and that's a phrase that’s not going to lend itself to people feeling like we can develop relationships, then you should think about that.

Dr. Parikshak: So, now we have about eight minutes left. I wondered if we wanted to take another question or two, Neal. I was looking at one around, you know, looks like this person is a mental health consultant who works with nine different counties and would like to outreach to families, but is trying to figure out where to focus their efforts on.

You know, should they focus their efforts on people they already have relationships with or people that may have other concerns? It's interesting cause you know, we had this discussion in our office just the other day around where should we be directing staff to focus their efforts on, you know, there's only so many Zoom calls you can do in a day or whatever platform you want to use. And you know, the conclusion that we came to was that it's really dependent, obviously, on what you know about each of the families.

Like if you haven't had a lot of contact with the family, but the program, certain staff are worried about certain families, I think it's important to do some outreach and maybe some triage around that. You know, whoever has the best relationship with that family, call that family up to find out what's going on, and if they need a referral to the mental health consultant, then they should do that.

I think it's important to have communication with other staff members if you're a mental health consultant, to see what they're thinking and how they want to be handling the different issues that may be arising in the program. So, that was one of the things that we would discuss. And I don't know, Neal, if you have any other thoughts on that question.

Dr. Horen: Yeah, I mean, I do think it's – it's challenging because the truth is you could focus anywhere. I don't think that saying to families that you have a long-standing relationship with, "Well, I can't really do anything right now. I've got to go do other things," is not going to be helpful. But I do think Sangeeta's point around, it doesn't always have to be that the mental health consultant is the person.

It could be that there's somebody who's helping those relationships, who's helping sort of prioritize, because, for some, I saw a great, I'm sure many of you have seen this sort of graphic around, sort of different zones that people are in currently, sort of a "fear zone" where you're worried about, and you're on information overload and you have 700 rolls of toilet paper versus a "learning zone" where you're seeing this as an opportunity to learn a little bit more.

Or, maybe even a "growth zone." And I think all the families in Head Start are in a similar place. There are going to be some families who are really going to have some difficulty and are struggling and they're going to be some families who are in a good learning zone and actually figuring out some really good things about their relationships with their children and about their education and their academic skills and things like that.

And folks in the growth zone. And I think kind of just sort of get a sense of what are sort of the immediate, high – high need kinds of things. And if you have an existing relationship with families, you probably already have a sense of how those families are doing currently in some way, shape, or form. You've done some sort of check in and have that and know that there are some that if you, for some reason had to go do one other thing, go work with one other family that you've not worked with before, but that family would be OK if it was two weeks instead of a week in which you had some touch base.

I do think it's a challenge. You know, I don't have an answer that's like, "Yeah, that's simple, you just make a list and you put three people on this and three people ..." You have to sort of figure out, how do we take our resources and use them as effectively as possible? And as, Sangeeta, as you said, how do we rely on the relationships that exist that maybe the disability coordinator's a great relationship with this family and can sort of just check in and then that coordinator checks in with the mental health consultant to say, "I think they're OK. Here's what I heard. What do you think?" And then you make some decisions.

Dr. Parikshak: Thank you for that, Neal, and speaking of resources. I know we only have a few more minutes left. So, we got to as many questions as we could today. And like I said, we're compiling all of the questions through the Head Start Heals campaign, and we'll – we'll host some more kind of discussions like this, in the next month – next month, or two.

So, we have some resources here for you, and again, you can download these slides, at the bottom of your page there. But here's some resources on mental health consultation. We have this mental health consultation tool. It's an online course that was developed by the National Center on Early Childhood Health and Wellness, as well as this. We have a family connection, mental health consultation model. I really like all of these resources.

I think they're great. I think often they've gotten lost on the ECLKC, so we haven't been able to highlight them as well as we'd like, but we really, I would encourage you to go and look here. Also, Neal mentioned the Center of Excellence for Infant and Early Childhood Mental Health consultation, a great, sister national center that is really focused directly on mental health consultation.

So, I would encourage you to go there as well. We also would be remiss if we didn't have any resources on self-care. We didn't get to take a lot of time to talk about self-care today because we really wanted to focus on the topics. But, really encourage you to go to some of these links to look at mindfulness practices. We have the stress and relaxation posters that people really like. I have a few posted around my desk at work, and I brought a couple home with me as well, just to help remind me of the things that we can do throughout the day to relax. So, I would encourage you to go there as well.

And we are just, you know, throughout this campaign, we want to let people know about the different national hotlines that are out there, particularly during the current pandemic. We are concerned, as you know, about uptakes in domestic violence, child abuse, and neglect, and so, we wanted to make sure that you all have all of these different support lines that you can give to your families, and staff as well. So, we have some on substance use as well, but are down here at the bottom. And then we would encourage you also to join our MyPeers community if you haven't already.

We have one on mental health. We can have lots of this similar types of discussions that we've had here today. If you're looking for information specifically on opioid misuse and substance use disorder, we have a form for that, as well as one on staff wellness. And then, as I mentioned, this is the second week of the Head Start Heals campaign, and coming soon, April 30, we're going to have a webinar on trauma-informed care in Migrant and Seasonal Head Start.

So, look for an e-blast that's going out about that. We are going to also have some focused webinars and discussions around trauma and adult mental health, specifically. We're going to be partnering with our National Center on Parent, Family, and Community Engagement for those. And then, next week we're going to be pushing out some resources on trauma-informed care in classroom settings, particularly around addressing challenging behaviors.

And then in a few more weeks, we'll be hearing from our National Center for Pyramid Model Innovations, which is out of the Office of Special Education Programs, and they will be talking more about trauma-informed care in classroom settings. So, I encourage you to stay tuned for all of the great Head Start Heals campaign events that we have coming up. Thank you so much for joining us. Thank you to Neal, and yes, we will be in touch soon. Have a great rest of your day everybody.

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