Health Manager Orientation Guide

Infant and Early Childhood Mental Health Consultation

Two women kneeling down to talk with a young boy.Infant and early childhood mental health consultation (IECMHC) is an effective and evidence-based strategy to promote infants' and young children's positive social and emotional development and behavioral health. IECMHC has been shown to be important in helping prevent, identify, and reduce the impact of mental health problems among infants, young children, and their families. In addition, it can reduce racial and ethnic, gender, language, or disability-based disparities in infant and young child outcomes. IECMH consultants work in and across systems with a community, program, and individual focus to support quality and equity in care.

IECMHC starts with the premise that all relationships in a child's life matter. It works to promote strong relationships and supportive environments for children, both of which are important for building healthy brains. It focuses on building the capacity of the adults in children's lives, so children are supported wherever they learn and grow. The partnership between a health manager and IECMHC is incredibly valuable in fostering mental health networks and practices in Head Start programs.

The Role of IECMH Consultants

IECMH consultants are highly trained, licensed, or license-eligible professionals with knowledge in childhood development, the effects of stress and trauma on families, and the impacts of adult mental illness on developing children.

The role of the IECMH consultant is to promote healthy growth in young children's social and emotional development by guiding and supporting mental health capacities of families, teachers, and others who care for young children. IECMH consultants help staff build strong relationships with the children and families they serve, but they do not themselves provide direct mental health intervention.

IECMH consultants need to be reflective and compassionate, listen for cultural differences, and work in partnership with staff, families, and children. They need to be able to share expertise with staff in a nonjudgmental way.

The Center of Excellence for Infant and Early Childhood Mental Health (CoE) has identified competencies that define the role of the IECMH consultant. For example, core competencies include:

  • Partners with staff, program, other setting, and systems leaders to build more equitable systems for infant and young children by:
    • Understanding the role and importance of ongoing personal transformation
    • Discussing explicit and implicit bias and intervening to address its behavioral manifestation
    • Increasing positive relationship between early childhood providers, infants, young children, and families with different abilities and from different racial/ethnic and language backgrounds
    • Continuously monitoring and using disaggregated data to identify and address disparities and advocating for and supporting the implementation of policies that support positive and equitable experiences for all infants and young children
  • Understands the multidisciplinary body of knowledge that informs consultation.
  • Appreciates and embraces multidisciplinary approaches to working with infants, young children, families, caregivers, and staff who work in programs or other settings serving infants, young children, and families, drawing on areas of study that include professional consultation, mental health, early education, early childhood development, infant and early childhood mental health, family and systems functioning, culture, race and equity and anti-racism approaches.

Services for Children, Families, Programs, and Staff

An IECMH consultant works with programs to set up a family-focused, culturally responsive atmosphere that promotes social and emotional development. A minimum of at least one hour of consultation a week per classroom is recommended by the CoE. Services are mainly indirect: The consultant works with adults to build skills through modeling and coaching, training, and advocacy. They can observe children (with the intent of providing recommendations and strategies to build adult capacity), consult with parents, and support staff in individual and group sessions to problem-solve situations.

Using the data collected through a community assessment and feedback of families and staff, a health manager, IECMH consultant, and other program staff are able to intentionally build a plan for what will be provided by the consultant.

Some specific examples of activities IECMH consultants provide include:

  • Co-develop behavior support plans for children showing challenging behavior at home, in the classroom, or in the community.
  • Offer group consultation to home visitors or preschool staff to help them talk through the mental health dimensions of the work they do with children and families.
  • Share tools and insights to address specific families' mental health needs and to refer them to outside mental health services when appropriate.
  • Support administrators with policy development (e.g., expulsion policy) and using evidence-based practices to support mental health.
  • Support staff wellness through check-ins, professional development, wellness activities, and wellness screenings and referral to outside mental health services and supports.

IECMH consultants should not do formal diagnostic evaluations; individual, family, or staff therapy; therapeutic play groups; or family support groups. These are all very important services that should be provided by a mental health professional who is not working for the program as an IECMH consultant. Programs should include providers of these services in their resource and referral guide.

Support and Oversight for the IECMH Consultant

Support and oversight of the IECMH consultant is an important part of effective mental health services, but program administrators often overlook this. It is especially important when a program partners with a IECMH consultant who is unfamiliar with Head Start, Early Head Start, or early childhood programs.

Because mental health systems and early childhood systems are so different, program administrators or a health manager can play a key role in supporting the consultant in their role. Support and supervision have three forms: administrative supervision, clinical and reflective supervision, and collegial support.

Administrative Supervision

Whether they are on staff or a contractor, consultants need direct supervision from an employee of the Head Start program. A program can decide who is the best person to supervise and have direct contact with this consultant. The IECMH consultant may report to the disabilities coordinator, the health manager, or another manager. This administrative supervisor gives information and support about the program's vision and strategic plan for mental health, policies and procedures, and program structure. The administrative supervisor could work closely with the consultant to set up important policies and procedures, such as the consultation referral process, the consultant's role in supporting staff wellness, and the activities that the consultant will do in the program. The administrative supervisor may also need to be a liaison between the consultant and the staff by introducing the consultant to staff and explaining how the consultant is valuable to the program.

The supervisor also collaborates with the consultant to review information and feedback about outcomes of, and satisfaction with, the consultation services. This might include making sure documentation is completed according to program procedures; making sure the consultation process follows program policies and procedures; and ensuring that the consultant completes contract expectations. The supervisor may also work with the consultant to review individual child data, collect parent or staff satisfaction surveys, and review program data on classroom suspension rates.

Clinical and Reflective Supervision

Supervision is very important for mental health professionals, so that they can reflect on their practice, discuss and problem-solve ethical issues, and develop their knowledge and skills. Consultants who work with Head Start programs should receive consistent, ongoing clinical and reflective supervision — regardless of whether the consultant is an employee of the program or a contractor. The CoE recommends a minimum of two hours per month of reflective supervision for practicing consultants. Reflective supervision helps the consultant further develop in their critical competencies and explore the emotional aspect of their relationships with parents, the children, and other staff including the supervisor.

Clinical supervision should be from mental health professionals who have an advanced degree and experience in mental health, are licensed in the state of practice, understand the role of the mental health professional in the Head Start program, and know community resources. Head Start administrators play a key role in making sure that IECMH consultants receive outside clinical and reflective supervision. Health managers can help to connect mental health professionals with supervisors found through local mental health agencies identified in the program's resource network.

Collegial Support

Collegial (peer) support is very important. However, many Head Start IECMH consultants, especially those serving rural areas, have never spoken to or met another colleague in the same role. Also, racially and ethnically diverse IECMH consultants may not easily find other consultants, mentors, and supervisors who share their racial and ethnic identities and life experiences. Health managers and other administrators may be able to help IECMH consultants connect with others working in the community, region, or state to share ideas, resources, tips, and strategies. Consultants who feel connected and supported are more likely to stay with a program.

Consider the following questions:

  • How can you work with your program leaders to make sure your consultant receives quality support and supervision?
  • Who is the administrative supervisor of your IECMH consultant now? How could administrative supervision be improved?
  • How often does the IECMH consultant receive clinical supervision or reflective supervision, and from whom? Does your consultant feel they are getting adequate and effective clinical or reflective supervision?
  • What opportunities does your IECMH consultant have to connect with other consultants? How could you support the consultant in developing these relationships?

Job Description

Head Start programs take different approaches to hiring IECMH consultants. Health managers may lead this effort or be part of a team that oversees the engagement and supervision of the consultant. The HSPPS offer programs considerable latitude in how they work with IECMH consultants and little specific guidance about who should be hired, what these consultants should do, and how to structure their work.

A program may hire a solo practitioner or contract with a local mental health agency; a Head Start program that contracts for IECMHC may need to solicit services through a Request for Proposal. Once a consultant or agency is selected, the Head Start program will need to write a contract or formal memorandum of agreement between the program and the consultant or agency that lists the range of services.

The minimum qualifications for an IECMH consultant to work in a Head Start program are licensure or certification as a mental health professional and a knowledge of and experience in serving young children and their families. The CoE recommends that qualifications include three or more years of post-master's experience working with young children and the capacity to work within the culture and system of the service community in which consultation is delivered.

Job descriptions and contracts are both essential documents for implementing, supporting, and evaluating the work of the IECMH consultant. Through the job description and the contract, the Head Start program conveys its vision of mental health services. The documents become a roadmap for the consultant to create and carry out IECMHC services that reflect this vision. They are also useful for communicating the roles and responsibilities of the IECMH consultant to program staff. The Head Start program can also use the job description or contract to evaluate how well the consultant is providing the types of services that the program intended.

Whether health managers are writing a contract or hiring a consultant directly, it's important to write a detailed job description. It should very clearly describe the job's responsibilities and the skills, knowledge, and abilities needed. Health managers can learn more about what makes a good job description in the CoE's Job Descriptions, Hiring, and Contracts tutorial.

Finding a Mental Health Provider for Children and Families in Your Early Head Start/Head Start Program offers more guidance in searching for a consultant. It also has questions to ask mental health professionals to decide if they are a good fit.

Developing and Carrying Out a Program-wide Vision for Effective Mental Health Consultation

Finding highly qualified mental health consultants is one part of effective mental health services. Other important factors are these, from What Works? A Study of Effective Early Childhood Mental Health Consultation Programs:

  • High-quality services
  • Solid program infrastructure (i.e., strong leadership, strategic partnerships)
  • Quality of the relationship between and among consultants and program staff
  • Readiness of the families and staff for consultation services (e.g., being open to gaining new skills and knowledge, opportunities for collaboration)

Tips and Strategies for IECMHC

  • Have reflective discussion with your management team about how to design mental health consultation services. It's important to identify what expertise you have in your program and where you need the support of a consultant.
  • Some questions to ask your management team:
    • Who in your program coordinates and oversees mental health to make sure the standards are being met?
    • Would your program contract with an IECMH consultant to meet all the mental health performances standards or only certain parts?
    • Who in the program could also offer mental health support?
    • Based your program's needs, is it important for your consultant to have more skills or experience working with a specific population or specialty area?
  • Ask these questions to decide if a potential IECMH consultant is a good fit for your program:
    • What type of education and licensure do you have?
    • How do you meet the diverse needs of the children, families, and staff concerning culture and language differences?
    • What training and experience do you have in supporting the needs of families with infants and young children?
    • What experience do you have working with children and families with low incomes?
    • How do you incorporate a trauma-informed approach in your work with children, families, and staff?
    • What is your experience working with families affected by substance use disorders?
    • What ideas do you have about supporting staff wellness in a program?
    • What is your experience working with programs affected by emergencies or crises (e.g., natural disaster or community violence)?
    • What is your approach to working with families?
    • Which evidence-based programs and services do you use in your work with families with infants and young children?