ECMH Consultation: Promising Practices in Preventing Preschool Expulsion

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(No Transcript)
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ECMH Consultation Promising Practices in
Preventing Preschool Expulsion

• Deborah F. Perry, Ph.D.
• Director, Womens and Childrens Health Policy
  Center
• Johns Hopkins School of Public Health
• September 25, 2006

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Overview

• Review prevalence estimates
• Data from three Maryland models
• Lessons Learned
• Policy Recommendations

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Prevalence of Problem Behaviors

• No national epidemiological data
• Early Childhood Longitudinal Study 10 of all
  kindergarten children show problematic behavior
• Review of Literature by Qi Kaiser (2003)
• Across 6 studies of Head Start children
  externalizing 16-30 internalizing 7-31
• Across 18 studies in low-income community
  samples ranges from 8 to 57, depending on
  where sample was drawn, risk factors

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Preschool Expulsion Prevalence

• No systematic collection of data on the number of
  young children expelled from child care settings
  nationally
• First published report of statewide data in MA
  (Gilliam Sharar, in press)
• Sample of 185 randomly selected classrooms in
  broad array of child care settings (n119)
• 39.3 teachers had expelled at least 1 child,
  14.7 suspended at least 1 child in past year
• Expulsion rate 27.4 per 1,000 was 34 times K-12
  rate

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First National Estimates

• National Pre-kindergarten Study (n3,898)
  classroom data from all 52 state-funded pre-K
  programs in 40 states
• Telephone survey led teacher 50 minutes
• Weighted national average of 6.67 per 1,000
  enrolled range 0-24 (KY, NM)
• In all but 3 states, preschool expulsion rates
  exceeded the K-12 rates (KY, SC, LA)
• Differences by age of child, sex, ethnicity,
  setting, availability of MH consultation

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Early Childhood Mental Health Consultation
Definition A problem-solving and
capacitybuilding intervention implemented within
a collaborative relationship between a
professional consultant with mental health
expertise and one or more individuals with other
areas of expertise - primarily child care, child
development, and families or individuals with
child care responsibilities. (Cohen Kaufmann,
2000)
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Types of Mental Health Consultation

• Child- or Family- Centered Consultation
• Primary goal is to address the factors that
  contribute to an individual childs (and/or
  familys) difficulties in functioning well in the
  early childhood setting
• Develop a plan to address the childs behavior

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Types of Mental Health Consultation

• Programmatic MH Consultation
• Focuses on improving the overall quality of the
  program
• Assists staff in addressing specific issues that
  affect more than one child, family or staff
  member
• Increases the capacity of staff to respond to the
  needs of all young children in their care

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Steps in MH Consultation

• Assessment observation joint examination of
  issues, factors, antecedents.
• Intervention Selection joint discussion of
  effective options match with program approach
  and ease of implementation.
• Implementation Evaluation opportunities for
  support and frequent contact modeling feedback
  on issues encountered linkage with families.

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Maryland ECMH Consultation

• Began with Anne Arundel, BEST Project
• Funded two pilot sites using Child Care
  Development Block Grant quality improvement
  dollars (Baltimore City and 5-county rural region
  of Eastern Shore)
• Montgomery County locally-funded programmatic
  model
• Statewide Project ACT, Abilities Network
• Aligned evaluation tools and collecting similar
  data

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BEST Program

• Behavioral/Emotional Support and Training
• Assessment and intervention provided to any child
  identified as at-risk for expulsion from child
  care
• Available to all licensed/registered child care
  providers in Anne Arundel County, Maryland
• Intervention delivered by masters level
  behavioral specialists

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BEST Objectives

• Increase appropriate behaviors and positive
  interactions
• Increase child care providers abilities to
  prevent/handle behavior problems
• Increase child care providers general skill
  levels
• Improve services for children and families

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Evaluation Design

• Pre-test/post-test measurement of behavior
  problems in children
• Rated by parents at baseline using the TABS
  (Bagnato, et al., 1999)
• Rated by child care providers at baseline and
  discharge using the PKBS (Merrell, 1994)

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Improved Social Skills
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Decreased Problem Behavior
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Removed from Child Care
(n135)
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Pilot Sites

• Project Right Steps (PRS)
• Chesapeake Child Care Resource and Referral
  Center
• Five counties on Eastern Shore

• Early Intervention Project (EIP)
• Baltimore City Child Care Resource Center
• Low Income families in Baltimore

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Common Activities

• On site observation of children and CC staff
• Modeling appropriate child-staff interactions
• Written feedback
• Advice about effective practices for addressing
  specific behaviors
• Referrals

• Scoring assessment data
• Data input and management
• Meetings with clinical consultants
• Clinical Psychologist
• Developmental Pediatrician
• Training and technical assistance

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Differences in Approach

• Project Right Steps
• Child care environment and home visits
• Greater emphasis on child-specific consultation
• Family rated childrens social emotional
  development and behaviors in addition to child
  care providers

• Early Intervention Project
• Program-focused model, embed consultants into
  specific child care programs for 3-6 months
• Child-specific consultation provided on sub-set
  of children

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Children Served
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Expulsions

• In each site only 2 children were expelled
• 90 maintained in current child care
• Kids at highest risk
• Some kids were moved by parents on voluntary basis

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Kids at High Risk (1SD)
PKBS Preschool Kindergarten Behavior Scales
scoring more than 1 standard deviation beyond the
mean
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Improved BehaviorsRated by Child Care Providers
Percentage of children 3-5 years old who showed
improvement on PKBS (EIP n42 PRS n73)
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Improved BehaviorsParent Ratings
Infants/Toddlers
BITSEA Brief Infant Toddler Social Emotional
Assessment Competence and Problem Scales (ages
1-3, n12) Ages and Stages Questionnaires Social
Emotional (Parent Ratings, ages 0-5 n68)
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Common Challenges

• Organizational
• Implementation of Plan
• Values
• Stigma
• Lack of qualified staff

• Racial, ethnic and cultural
• Intensive needs
• Sustainability
• Funding

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Lessons Learned

• Consensus on key components of effective
  consultation
• Logic models and theories of change
• Reliable, valid and relevant tools
• Systematic studies