Envisioning a System of Interdisciplinary Consultation for Early Care and Education

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Envisioning a System of Interdisciplinary
Consultation for Early Care and Education

• Angela Crowley, PhD, APRN, BC, PNP
• Judith Meyers, PhD
• Grace Whitney, PhD, MPA
• USDHHS MCHB ECCS Grantee Meeting
• September 25, 2006 - Reston VA

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Overview of Presentation

• National Context
• National Models
• System Development in Connecticut
• Training
• Financing
• Challenges and Lessons Learned
• Discussion

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Interdisciplinary Consultation

• Providing the supports of specialists from
  several fields to Early Care and Education (ECE)
  settings
• Health/Oral Health
• Mental Health
• Education/Special education
• Nutrition
• Social Service

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National ContextMCHB Initiatives

• 1992 APHA-AAP National Health and
  2002 Safety Performance Standards (CFOC)
• 1993- National Resource Center HSCC
• 1995 ACYF-Child Care Bureau
• 1996 Healthy Child Care America Campaign
• 1997 Stepping Stones to the National Stds
  2003
• 1999- National Training Institute for Child
  Care Health Consultants (CCHC)
• 2004- State Early Childhood
• 2007 Comprehensive Systems grants

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HCCA Blueprint for Action Action Step Nine

• Use Child Care Health Consultants to help
  develop and maintain healthy child care

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USDHHS MCHBNational Health and Safety
Performance Standard

• Standard
• Each center and organized family child care
  home system shall utilize the services of a
  health consultant.
• (CFOC, 1992, 2002)

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National ContextConnecting Multiple Initiatives

• Early Care and Education
• Early Learning Guidelines and Infant Toddler
  Specialists
• Pre-K NAEYC Accreditation Standards
• Map to Inclusive Child Care, IDEA
• Changes in Head Start T/TA System
• Mental Health
• Starting Early Starting Smart
• Comprehensive Community MH Systems Grant
• Behavior Concerns/Data on Expulsions

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Examples of Integrated Systems Models

• Day Care Plus, Cuyahoga County, Ohio
• Rhode Islands Comprehensive Child Care
• Abbot Preschool, New Jersey
• U.S. Military Child Care
• Head Start Early Head Start

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State Early Childhood Development System
Early Learning
Health, Mental Health and Nutrition
Family Support
Special Needs/ Early Intervention
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Development in ConnecticutA Case Study of
Integrating Supports

• Child Care Regulations and Timely Data
• Health, Education, Social Service, Dental
  Nutrition consultants required
• Study of CT child care health consultation
  (Crowley, 1998)
• HCCCT Broadly Conceived
• Core Committee 1997-2005
• Representatives of health and ECE, state
  agencies, advocates
• Adoption of WHO definition of health

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World Health Organization Definition of Health

• A state of complete physical, mental, and social
  well-being and not merely the absence of
  infirmity.
• Tempkin, O. (1953). What is health? Looking
  back and ahead. In Gladston, I. (Ed),
  Epidemiology of Health. New YorkNew York
  Academy of Medicine, Health Education Council

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Development in ConnecticutA Case Study of
Integrating Supports

• HCCCT initiatives
• Health in ECE and health consultation
• Interest in social and emotional well-being
• Inclusive NTI Training implementation
• Annual - beginning in 2002 (4-5 days)
• Included ECE and Head Start health consultants,
  teams of consultants and directors, focus on team
  building
• Collaboration with Region 1- New England states
• 2003-2006
• Simultaneous telecasts

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Development in ConnecticutA Case Study of
Integrating Supports

• HCCCT initiatives (cont)
• Statewide forums and DECA training
• Adapted NTI curriculum as part of training to
  prepare new Mental Health consultants - Early
  Childhood Consultation Partnership (ECCP) -
  through Dept. of Children and Families
• Mental health consultation system based on state
  and national initiatives (ECCP)

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Development in ConnecticutA Case Study of
Integrating Supports

• Impetus to develop multidisciplinary model with
  support from Child Health and Development
  Institute (CHDI)
• Statewide conference on ECE consultation
• Symposium and paper
• Early Childhood Partners (SECCS)
• Governors Early Childhood Education Cabinet
• Among Top Ten priorities

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Interdisciplinary TrainingEngaging multiple
disciplines

• Identified NTI modules relevant across
  disciplines
• Field of Child Care, Consultation skills, Quality
  in Child Care, CSHCN, Mental Health, Child
  Maltreatment, Staff Health, National Standards
  and Resources
• In addition to health consultants, invited other
  disciplines (education, mental health,
  nutrition), teams, directors, Head Start
• 2004 CHDI grant to UConn to develop education
  content for NTI

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Interdisciplinary TrainingEngaging multiple
disciplines

• 2005-2006 Working with ECCP and CAEYC on mental
  health and education content areas
• 4 day training includes NTI modules across
  disciplines
• ½ day health specific (NTI modules) and
  education/mental health specific training
• Using interdisciplinary scenarios in annual
  training and including assessment, teambuilding,
  and action planning

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Interdisciplinary Training2005 Evaluation

• Participants
• N26
• Health consultants 18
• Education consultants 4 (1 director)
• Mental health consultants 3
• Nutrition consultant 1
• Degrees (n20)
• RN 4
• Bachelors 6
• Masters 7
• EdD/ PhD (RNs) 2
• JD (RN) 1

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Interdisciplinary Training2005 Evaluation

• 67 programs served by consultants
• Centers 43
• Head Start 13
• Preschool/ School Readiness 11
• 3,241 children enrolled
• 19 respondents

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Interdisciplinary Training2005 EvaluationPre
and post (preliminary analysis)

• Awareness of other consultants pre-training
  (n16)
• 56

• Awareness of other consultants post-training
  (n17)
• 94
• Increased awareness due to training
• 76
• How valuable is collaborative planning with other
  consultants
• 100 valuable/ very valuable

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Critical Componentsfor an Interdisciplinary
System of ECE Consultation

• Clear leadership and coordination structure
• Specificity in regulations about frequency,
  duration and outcomes of consultation
• Centralized database of consultants
• Standard training curriculum within and across
  disciplines
• Regular training and networking activities for
  consultants within and across systems
• Program managers in centers ready to receive
  consultation
• Fiscal resources to support network
• Public accountability for child and system
  results

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Logic Model
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Strategies for FinancingPublic and Private

• Federal
• MCHB HCCA (DSS) and SECCS (DPH)
• Head Start Head Start Collaboration Supplemental
  Grants
• DOE/IDEA State Department of Education
• Child Care Bureau/CCDF Department of Social
  Services
• State
• State legislature
• Department of Children and Families
• Private Philanthropy
• Childrens Fund (CHDI)
• CT Health Foundation
• Graustein Memorial Fund

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FinancingFinding Opportunities

• Mental Health Strategies Board
• Early Childhood Consultation Partnership
• State Department of Education (IDEA)
• Early Childhood Consultation Partnership
• State Department of Public Health (SECCS)
• CT Nurses Association Child Care Consultant
  Training

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Challenges

• Disciplines at varying levels of development
• Constraint of fiscal resources
• Strategies, standards used are different
• Different homes/different champions
• Support can vary with trends Whats HOT
• Strong pre-k focus on school readiness doesnt
  always include broader developmental focus
• Workforce Issues - Competencies and capacity
• Training integrating cross disciplinary
  approach
• Collaboration - Connecting systems is hard work

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Recommendations for Building an Interdisciplinary
Consultation System

• Program Design
• Include full range of disciplines
• Provide both program-level and child-specific
• Offer to full spectrum of ECE settings center,
  family-based
• Quality Assurance
• Establish consistent qualifications for
  consultants and system to certify and register
  them
• Clarify consultants roles/responsibilities
• Provide integrated training and networking
  opportunities
• Provide training and info. for directors to make
  best use of consultation
• Incorporate evaluation

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Recommendations (cont.)

• Delivery structure/process
• Develop structure for centralized oversight
• Create local/regional delivery system with clear
  entry points
• Establish database that is easily accessible and
  kept updated
• Develop realistic funding plan pooled
  resources/new funding

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Lessons Learned

• Use inside/outside system building strategies
• Find champions and use them
• Broad-based ongoing working group of front line
  professionals is important
• Have regulatory agency at the table
• External funding helpful and more flexible
• Evaluate and share results often to support
  moving ahead

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Discussion