National Center for Effective Mental Halth Consultation
   

Understanding the Administrator and Consultant Roles in Accountability and Quality Improvement

Head Start administrators and mental health consultants (MHCs) have important roles in developing and implementing accountability and quality improvement procedures.

  • Accountability establishes the degree to which the MHC and the program are implementing the ECMHC services outlined in the mental health services plan, job description and/or contract, which should be consistent with existing policies and procedures, the program work plan, and the Head Start Performance Standards. (For a resource that pairs areas for policy and procedures development for mental health consultation with relevant Head Start Performance Standards (0ffice of Head Start, 2009), see Developing Policies and Procedures to Support Mental Health Consultation.) Head Start administrators are ultimately responsible for providing the agreed upon supports and structures necessary for effective consultation and ensuring that the mental health services provided to the program by the mental health consultant are those that are outlined in the MHCs job description and / or contract. The MHC is responsible for delivering the mental health services in accordance with the job description and/or contract, documenting and reporting these services, and communicating through supervision any need for additional resources, supports and structures necessary for implementing effective consultation.
  • Quality Improvement focuses on the content and quality of ECMHC services. The process for quality improvement involves gathering information for review, reflection, analysis, and feedback leading to improved ECMH services. In addition, quality improvement relies on evaluation strategies to help determine if the consultation services are achieving the expected outcomes for children, families, staff, and programs. The Head Start administrator and the MHC along with others engaged in designing, planning, implementing, monitoring, and evaluating the program’s mental health services (Mental Health Workgroup, consumers, etc.) have a role in continuous quality improvement. To that end, Head Start programs must also have useful strategies for maintaining accountability and assuring ongoing quality improvement.

Accountability of the Administrator

The Head Start program administrator has responsibilities for establishing policies, plans, procedures, and resources to support the MHC. Many of these structures - strategic plan, mental health service plan, administrative supervision, clear goals and expectations, etc. are discussed in Tutorial 8: Developing a Vision and Strategic Planning for Early Childhood Mental Health Consultation Services. Additional structures, described throughout this tutorial, include a strong job description and a clear contractual agreement, documentation of contract-based services delivery information, regular supervision, strategies for feedback from those who utilize or receive consultation services, and a defined process for reviewing service activities data and other mental health goal-based data for continuous quality improvement.

Some areas that could be monitored to ensure that programs are providing these structures and supports include:

  • Has the MHC had an orientation to the Head Start program’s Performance Standards, policies, procedures, mental health strategic plan, and mental health services plan?
  • Has the MHC’s role and responsibility been shared with staff, families, and community partners?
  • Does the MHC have adequate space for providing MHC services (such as a private area where they can provide confidential consultation services to teachers, children, and parents)?
  • Do the teachers have opportunities for meeting with the MHC built into their schedule?
  • Are the number of hours allocated to the MHC sufficient for accomplishing the expected activities?
  • How many hours of Head Start administrative supervision is the MHC receiving? Is this taking place on a regular schedule?
  • How many hours of administrative and clinical supervision is the MHC receiving?
  • Is their adequate and regular documentation of service delivery?

The MHC can provide important information to Head Start administrators regarding the degree to which the program is providing the structure and supports needed to build and deliver effective consultation services. The supervision process is an ideal place for these issues to be discussed, and to generate ideas and strategies to strengthen services further.

Accountability measures and the role of the Consultant

Head Start administrators can implement accountability measures for MHCs using multiple structures and strategies. As noted above, administrators should utilize administrative supervision sessions with the MHC to discuss the degree to which the MHC is engaging in the activities and responsibilities as outlined in the job description and / or contract. In addition, it is important to have a well established plan for the MHC to document consultation activities. The documentation plan should detail the data to be collected, the measures to be used, a timeline for data collection, and the process for reviewing the data. Measures for documenting MHC accountability can be developed from a variety of sources, such as the MHC job description or contract, the Head Start Performance Standards, and the Head Start program information report (PIR) (Office of Head Start 2010).

Examples of MHC accountability measures and a sample of PIR data requirements (indicated by *), might include:

  • Average number of hours per operating month the MHC spends on-site*
  • Total number of enrolled children served by the MHC (since last year’s PIR)*
  • Number of formal classroom observations completed by the MHC
  • Number of children who received direct coaching or support from the MHC
  • Number of children who were the focus of consultation between the MHC and staff*
  • Number of children who were the focus on consultation between the MHC and parents/guardians*
  • Number of children for whom the MHC provided three or more consultations with staff or parents*
  • Number of home visits attended by the MHC
  • Number of children for whom the MH professional provided an individual observation or mental health assessment*
  • Number of children for whom the MHC facilitated a referral for mental health services*
  • Number of staff and parent trainings provided by the MHC
  • Amount of time MHC is spending: working directly with children, staff, and families; observing individual children or classrooms; developing relationships with staff; attending team meetings; attending other meetings; providing trainings; record keeping

For an example reporting form, see Consultant Monthly Activities Report, for tracking these types of activities.

Regular reports (at least monthly) from the consultant to the designated Head Start supervisor should include the information that is most important to ensuring that the consultant is, in fact, delivering the types of services that the program believes to be important --- ideally, based on a systematic program needs assessment and strategic planning process.

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