Mental Health

Family Connections: A Mental Health Consultation Model

Explore Family Connections, a preventive, system-wide mental health consultation and training approach to strengthen the capacity of Early Head Start and Head Start staff. Staff can use these resources to work with families dealing with parental depression and related adversities, with children in classrooms and in the home, and engage and support parents struggling with adversities. These materials were developed by the Family Connections Project at Boston Children’s Hospital.

Introduction to the Family Connection Materials
Why is depression a relevant topic for Early Head Start and Head Start?
How do these materials help build our capacity to engage all parents?
Why focus on supporting Early Head Start and Head Start staff?
How can supporting staff affect their work with parents?
A Description of the Family Connections Materials
The Family Connections Readiness Guide
A Guide to Using the Family Connections Materials: Lessons Learned
Short Papers for Staff
Short Papers for Parents
Training Modules
Additional Resources

Introduction to the Family Connection Materials

See PDF version of the Introduction to Family Connections Materials

The Family Connections team and our community partners have worked together to develop a preventive mental health consultation approach to strengthen the capacity of Early Head Start and Head Start staff in dealing with parental depression and related adversities. We do this work through direct consultation to staff, work with children in partnerships with staff in classrooms and in the home, and through a comprehensive program of engaging parents as individuals and through group work. Our partnerships with Early Head Start and Head Start programs have allowed us to acknowledge four key assumptions that have grounded all of our efforts:

  • Early Head Start and Head Start families and staff are often in chronically adverse situations, including poverty, exposure to violence, and social isolation.
  • Depression is a common response to such adversity.
  • These adversities and the resulting trauma and depression affect the ability of parents and staff to relate effectively with other adults, with their children or the children in their care, and with the community at large.
  • Staff, in working with families, also experience stress and adversity and need consistent self-care in order to be competent and confident in their work.

From the beginning, the goal of Family Connections has been to develop training approaches and consultation strategies that could be made available to Early Head Start and Head Start as well as home visitation, and both center-based and family early care programs. In that effort, our first objective was to develop the approach and then test it in several Early Head Start and Head Start programs in the greater Boston area over several years. In those partnerships, we provided trainings, mental health consultations, observations, classroom interventions, reflective practice, and ongoing supervision to the mental health consultants who collaborated with us in implementing the program. Since its inception in 2004, we have also had the privilege of extending the vision for preventive system-wide mental health consultation nationally to programs in a number of states and communities. The results of those experiences are captured here in the Second Edition of the Family Connections materials. These materials include information on depression and related adversities, detailed workshops, strategies for working effectively with children, families, and other staff, and a guide to assess a program's readiness to take full advantage of this resource.

Why is depression a relevant topic for Early Head Start and Head Start?

Members of the Early Head Start and the Head Start community recognize that they are responsible to be not only involved, but to be engaged with parents (PFCE Framework, 2011) in an ongoing way. Parent engagement in Head Start and Early Head Start is related to a wealth of positive outcomes for children, including improved early literacy, more positive social behavior, and fewer behavioral problems overall (FACES, 2000). While parent outreach is a foundation of the Early Head Start and Head Start professional's experience, trying to engage parents can be challenging under the best circumstances. One example of a factor that can provide such a challenge is parental depression, because the isolating effects of depression can prevent individuals from accessing the very resources that could ease their suffering. Recent research and public discussion have brought new attention to adult depression, its risk factors, and successes in treatment. A recent study found that 48 percent of Early Head Start mothers were found to be suffering from depression (ACF, 2002), bringing with it a heightened awareness to the relevance of the topic to the Head Start community.

When Head Start and Early Head Start staff learns about building relationships, engaging parents, understanding depression and related adversities, they are more likely to develop competent strategies for addressing the needs of families facing adversity. In so doing, staff strengthens their knowledge base in effective parent engagement. The first goal of the Family Connections model is to build capacity for reaching out to and actively working with depressed or anxious/traumatized parents within the Early Head Start or Head Start community, so that families they serve might benefit from the many resources these programs provide.

How do these materials help build our capacity to engage all parents?

The Family Connections training approach provides workshops designed to strengthen Head Start staff's knowledge base regarding the signs and symptoms of depression and other emotional issues, healthy social-emotional development, and the importance of perspective taking, self-care, and reflection. We have found that the combination of these topic areas provides a powerful foundation for understanding the effects of depression and emotional difficulties, the importance of nurturing resilience in ourselves and others, and the development of strategies for staff members to effectively engage families that are coping with the risk factors and experience of depression.

The materials are also designed to build on Head Start staff's skills by providing strategies and learning opportunities designed to do the following:

  • Practice of reflection and perspective taking as professional skills.
  • Positive engagement of all parents in order to reach those affected by depression, other emotional difficulties, and adversity.
  • Positive attachment with children as a foundation for the promotion of social-emotional growth and positive relationship building with parents. Children of depressed parents are at increased risk for language and cognitive problems, insecure attachments, difficulties with emotional regulation, social competence, and behavioral problems. Ongoing work with children struggling with behavioral issues, as well as with all of the children in a program, in partnership with program staff.
  • Active participation in effective information-sharing and communication practices.
  • Understanding of the crucial role each Head Start staff member plays in effective parent outreach and promotion of child emotional health and school readiness.

As you consider embracing this new direction, we encourage you to access the support of a mental health consultant who knows your program. Such a relationship can provide support during many aspects of this new initiative, from conducting a readiness assessment to planning specific new interventions, and can assist in understanding the training needs of the staff. In our experiences with our past and current mental health consultation partnerships, we have found mental health consultants to be key partners for the Head Start program in taking on the Family Connections mental health consultation and training approach.

Why focus on supporting Early Head Start and Head Start staff?

Our central goal is to maintain a focus on building capacity within one's program, leaving the professionals of that program better able to respond to the challenges they face in effectively engaging all the families they seek to serve.

Working with young children and their families is a highly demanding job. Staff working in an early childhood setting, serving families, negotiating the effects of poverty, community violence, social spending cuts, and a shortage of affordable housing are at risk of experiencing a significant degree of stress and professional "burn-out." Our approach acknowledges this stress openly, and as a result the promotion of mental health and emotional support for staff is presented as a priority.

We also acknowledge that a unique aspect of the culture of Head Start and Early Head Start is that many Head Start professionals were once Head Start parents. In other words, Head Start staff may be feeling the effects of the stress coming from their experience in the community as well as in the role of a professional trying to support other members of that community. Because of this unique characteristic of Head Start, the goal of engaging and supporting parents and the goal of providing support for staff are intertwined. Building confidence and competence in staff increases their well-being, promotes their professional growth, and elevates the capacity for the entire organization.

How can supporting staff affect their work with parents?

It is essential to provide good information about depression, related emotional difficulties, and resilience, and to support parents struggling with depression and related adversities. It is also important to keep in mind that information alone does not automatically lead to change in behavior or skill. Factual knowledge must be made personally relevant and meaningful for practitioners in order to change professional skills and behaviors. The content and progression of the Family Connections trainings for staff and parents focuses not only on important information and concrete skills, but also upon the personal meaning of the topics for the participants. Reflecting the philosophy that meaning provides the essential link between thought and action (Selman, 1997), all training efforts seek to encourage "meaning making" by:

  • Linking topics to practical knowledge identified as relevant by staff or parents
  • Engaging staff and parents in exercises that challenge them to connect training themes with the real-life situations they encounter in their work and home.
  • Incorporating practice of self-reflection and perspective taking into training experiences as important tools in ongoing personal and professional growth.
  • Advocating for other elements of engagement by supervisors and Workshop Leaders. For instance, classroom observation can provide opportunities for modeling the new child interaction skills described in training.
  • Encouraging an emphasis on self-care and the support of the ongoing mental health of the Head Start and Early Head Start staff.
  • Modeling active positive social-emotional practices with staff, parents and children on a regular and frequent basis.

Staff members are encouraged to reflect on their values, expectations, and attitudes about parenting, mental health, and depression in order to consider how those views affect their ability to build a supportive alliance with the families they serve. The emphasis on self-care has provided the opportunity to acknowledge the incidence of depression among Early Head Start and Head Start staff and how it can be a factor that may limit these professionals in fulfilling their responsibilities as well as their potential.

A Description of the Family Connections Materials

The Family Connections materials provide staff with information, learning opportunities, and a description of the crucial ways programs can better understand and respond to the needs of children and families. These resources are designed to promote the professional skills of Self-Reflection, Self-Care, and Perspective Taking.

The Family Connections Readiness Guide

This guide presents information and processes focused on assessing a program's level of "readiness" to engage in the kind of work involved in reaching out to families and children facing adversity. Every program is ready for some work in this regard. Rather than judge whether a program is or isn't ready, this guide provides a method for self-reflection designed to suggest levels of readiness and then recommends which of the Family Connections materials might be most effective according to the level.

A Guide to Using the Family Connections Materials: Lessons Learned

This section provides specific observations from long-term partnerships with Early Head Start and Head Start programs. The seven "lessons learned" offer insight on the most effective use of the Family Connections materials.

Short Papers for Staff

The short papers are designed to share information on topics that are central to understanding depression, resilience, and best practice in engaging parents facing adversities. They are intended to work as stand-alone handouts for parents and staff as well as materials used in training workshops and in parent groups. The following list includes the title and a short description of content for each short paper.

The Challenges and Benefits of Making Parent Connections

Includes strategies for effective parent outreach.

Better Parent Communication: What Do I Say When a Parent Tells Me Something Difficult?

Includes strategies for responding effectively to parents and the difficult topics they can bring to Head Start staff.

Better Communication with Children: Responding to Challenging Subjects

Includes strategies for responding effectively to children and the difficult topics they can bring to Head Start staff.

Parenting, Depression, and Hope: Reaching Out to Families Facing Adversity

It is important that early childhood professionals and parents recognize depression and understand ways to get treatment when needed. It is equally important to go beyond recognition and treatment and find ways to build other skills. Learn how to foster effective parenting and help parents build strengths and resilience in their families.

Fostering Resilience in Families Coping with Depression: Practical Ways Head Start Staff Can Help Families Build on Their Power to Cope

To recognize and identify strengths and resilience is crucial to the daily work of early childhood professionals. Head Start and child care staff can recognize and foster resilience at four levels. Explore this resource to learn about the four levels of resilience and how to apply them in your work.

Understanding Depression Across Cultures

Includes a discussion on the range of responses to mental health issues, including depression across cultures, and the importance of cultural sensitivity in mental health outreach.

Communicating Across Language and Culture: How Do I Reach Out to Parents Who Are Immigrants?

Includes a discussion of the unique challenges facing immigrant families and strategies for building ties with parents across language barriers.

Encouraging an Expressive Environment: Supportive Communication from the Inside Out

Includes a discussion concerning the benefits of having a program with an expressive environment and strategies for supporting such a program climate.

Self-Reflection and Shared Reflection as Professional Tools

Includes a discussion of the benefits of using self-reflection and shared reflection as tools that can enhance communication and service delivery.

Supportive Supervision: Promoting Staff and Family Growth Through Positive Relationships

Includes a discussion of how supervision can benefit from a relational approach that includes strategies for both the supervisor and supervisee in making supervision an effective professional experience.

Short Papers for Parents

Parenting Through Tough Times: Coping with Depression

Depression is an illness that can range from mild to severe. It can be very painful to live with depression. It causes people to withdraw from social contacts, from their children and families, and even from the help that could save them from years of suffering. Many people do not know how to recognize or talk about depression. However, it is one of the most common mental illnesses that caregivers and parents experience.

The Ability to Cope: Building Resilience in You and Your Child

It is possible to build family strengths even while living under stressful conditions or during difficult times. Fostering resilience in yourself and your child can help you both be stronger and more connected to others. Resilience is the ability to cope effectively with the stress caused by challenging situations. Explore strategies for building resilience in yourself and your child, which can also help you be more effective as a parent.

Self-Reflection in Parenting: Help for Getting Through Stressful Times

A discussion about the benefits of using self-reflection as a parent, especially when facing stressful times, as well as strategies for practicing self-reflection.

Training Modules

This section includes an extensive group of training materials organized into modules and infused with guidance for the person designated as the Workshop Leader. The modules themselves will contain directions for presenting the specific trainings in each group, the handout information required for those trainings, and the questionnaires designed to receive feedback on each training effort. See the Introduction to the Family Connections Training Modules for more information.

The modules include:

Module One

  • The Benefits and Challenges of Engaging Parents
  • Perspective Taking
  • What Is Depression? Part 1

Module Two

  • The Program Climate and You
  • Accentuate the Positive
  • What Is Depression? Part 2

Module Three

  • Supporting Social and Emotional Growth
  • Strategies for Talking to Children about Difficult Issues
  • Using Reading and Circle Time to Promote an Expressive Environment

Module Four

  • Better Communication
  • Developing a Resource and Referral Process
  • Getting the Most from Home Visits


In closing, we would like to emphasize the importance of conducting a careful assessment of the readiness of a program interested in getting the most from these materials, the availability of mental health consultation during the use of these materials, and ongoing training and support for those who will implement the program. At the same time, we recognize that different programs will use these materials in different ways and hope it is helpful to programs, staff, families, and children in dealing with the adversities faced by families with young children.

For more information about the family connections materials please visit:


Administration for Children and Families. (2002). Making a difference in the lives of children and families: The impacts of Early Head Start programs on infants and toddlers and their families. Washington, DC: U.S. Department of Health and Human Services.

United States Department of Health and Human Services. Administration for Children and Families (ACF). Office of Planning, Research, and Evaluation (OPRE). Head Start Family and Child Experiences Survey (FACES): 2000 Cohort [United States][Computer file]. ICPSR04149-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2008-09-10. doi:10.3886/ICPSR04149.

Selman, R.L. Watts, C.L., and Schultz, L.H. (Eds.) (1997). Fostering Friendship: Pair therapy for treatment and prevention. Aldine DeGruyter/Transaction Press.

Additional Resources

Beardslee, William. When a Parent is Depressed: How to Protect Your Children from the Effects of Depression in the Family. Boston: Little, Brown, and Company, 2003. Originally published in hardcover under the title When a Parent is Depressed: Protecting the Children and Strengthening the Family. Boston: Little, Brown, and Company, 2002.

Knitzer, Jane, Suzanne Theberge, and Kay Johnson. "Reducing Maternal Depression and Its Impact on Young Children: Toward a Responsive Early Childhood Policy Framework." Project Thrive Issue Brief No. 2. New York: Columbia University, National Center for Children in Poverty, 2008. [PDF, 261KB].

Center on the Developing Child at Harvard University. "Advancing the Scientific Foundations of Health, Learning, and Community Well-Being."


The Family Connections materials were developed under the Innovation and Improvement Project grant for U.S. Department of Health and Human Services, Administration for Children and Families, Office of Head Start (90YD01090) and by the Family Connections Project at Children's Hospital Boston through local partnerships with Action for Boston Community Development Inc., through generous gifts from the A.L. Mailman Family Foundation, Inc. & the Baer Foundation.

Last Updated: November 26, 2018