National Center for Effective Mental Halth Consultation
   

Selecting the Appropriate Service/Strategy

While there is likely more than one service or strategy that will be appropriate for any given situation, it is important for consultants to use a thoughtful decision-making process. This process may vary slightly depending on whether the focus is on providing child/family-centered consultation or programmatic consultation; however, as previously noted, consultants frequently apply both types of consultation in addressing a single situation. The steps below outline a service/strategy selection process that a consultant might use to deliver high-quality services in HS/EHS settings.

  • Information gathering. Regardless of whether providing child/family-centered or programmatic consultation, it is important to first gather information about the issue(s) at hand from multiple sources. When the issue involves a particular child, information gathering would ideally include classroom and home observations at different times of day as well as conversations with parents, teachers and other individuals who might be able to shed light on the issue, such as HS/EHS service area managers. For any type of consultation, it is also important to get a sense of what strategies might be appropriate (e.g., suitable for the situation and feasible to implement) from the consultee(s)' perspective. This requires that consultants familiarize themselves with consultees' personalities, cultures, strengths, needs and available resources (e.g., financial, transportation). It is worth noting that although information gathering is listed as the first step in this process, it should be an ongoing activity that continues to guide service delivery over time.Setting the Strategy
  • Initial strategy brainstorming. After the initial information gathering phase, consultants should reflect on what they have learned and then draw on their knowledge of best practices in early childhood mental health to identify potential services or strategies to explore with the service planning team, including family members. Some key questions consultants might ask themselves to guide this initial, internal brainstorming process include:
    • What is/are the main issue(s) that need to be addressed? For example:
      1. Johnny is having separation anxiety.
      2. Teachers are uncomfortable discussing concerns about children's mental health with parents.
    • What is/are the underlying issue(s) resulting in the current situation? For example:
      1. Johnny's parents recently got divorced.
      2. Teachers expressed uncertainty about typical vs. atypical social and emotional development in young children and fear about how parents will react.
    • Have I previously encountered a similar situation and, if so, what strategies have been effective? For example:
      1. There was a little girl with separation anxiety and we found that using puppets to role play "leaving and coming back" helped her to feel more secure.
      2. I conducted a series of program-wide workshops for HS/EHS, including one on infant and early childhood mental health and another on addressing stigma associated with mental health. Teachers reported that this gave them more confidence in identifying mental health issues early on.
    • How might I need to tailor strategies that have worked before to align with the strengths and needs of this particular child, family, provider and/or program? For example:
      1. Johnny's mother has very little time or financial resources now that she is a single parent working two minimum-wage jobs. I will need to develop strategies that do not require purchasing equipment and that can be integrated into existing daily routines. I might suggest that instead of using puppets, she simply play the game of Peek-a-Boo with Johnny using a towel or other household item when she spends time with him in the mornings before her first shift.
      2. Given that the teachers are specifically having trouble communicating with parents about mental health issues, I am going to develop a sample "script" for teachers to use and give them time to practice during the workshop series. Since this HS/EHS program serves a lot of Hispanic families, I will have copies of the script in Spanish and English.

  • Collaborative service planning. Once the consultant has a better understanding of the issue(s) at hand and the individuals who should be engaged in the service planning and implementation process, plan development and initial service/strategy selection can begin. Ideally, the planning meeting(s) would be face-to-face and include all key partners [e.g., consultant, teacher(s) and parent(s)]. To ensure that the planning process is truly collaborative and results in sound strategy selection, the consultant must create an environment where all partners feel their opinions and ideas are valued and respected. While the consultant might kick off the meeting with a review of the initial concerns and his/her observations, the consultant will support exploration of ideas for service planning with the planning team. The consultant will use his/her knowledge of early childhood mental health and intervention to make initial recommendations for intervention strategies, however, the final decision regarding which strategies to pursue should emerge from the group. Group buy-in is particularly important in ECMHC, as it is the caregivers — not the consultant — who are ultimately charged with strategy implementation.
  • Ongoing support and, as needed, course correction. After the initial service plan is developed and strategy implementation has begun, it is important for the consultant to have regular contact with each consultee to offer support and coaching as needed and solicit feedback on how well the strategy(s) are working. This ongoing, supportive interaction not only bolsters the chances that strategy implementation will succeed, but also helps the consultant determine if it might be necessary to engage the planning group in selecting a different strategy. In some cases, when a strategy is flailing, it simply requires more targeted assistance from the consultant to help the caregiver succeed in implementation. Other times, the strategy is simply not the "right" strategy. It is important that the consultant listen to those caring for the child and implementing the plan, be flexible, and remain open to amending the service plan to ensure that the consultation is meeting the child, family and/or program's needs. At times, the recommended strategy might be to make a referral to other services or supports within or outside of the HS/EHS setting.
  • Concluding services. Although not technically part of the service/strategy selection process, it is important that consultants have a plan for concluding services. Ideally, the criteria or process for "case closure" will be determined in advance of service initiation and in collaboration with HS/EHS program management, and will be communicated up front to those caregivers and families receiving consultation services. Key questions to consider regarding service conclusion are:
    • Who will make the decision to stop services?
    • What factors will be considered in determining when to stop services? (Length of time? Demonstrated improvement? Parent readiness?)
    • How will these factors be measured (Parent/teacher report? Consultant observation? Both?)
    • Will there be a mechanism for parents, teachers and the HS/EHS program to evaluate the service experience?

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