U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

A Training Guide for the

Early Childhood Services

Community

Promotion of Mental Health and 

Prevention of Mental and 

Behavioral Disorders

2005 Series

Volume 2
A Training Guide for the

Early Childhood Services

Community

Kathy Seitzinger Hepburn

Roxane K. Kaufmann

Georgetown University

Center for Child and Human Development

Promotion of Mental Health and 

Prevention of Mental and 

Behavioral Disorders

2005 Series

Volume 2

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov
Acknowledgments

Numerous people contributed to the development of this volume in addition to the authors, including 

Elena Cohen, Joan Dodge, Kris Hansen, Paul Donohue, and Kym Khyle. This volume was prepared 

by the Georgetown University Center for Child and Human Development for the Center for Mental 

Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. 

Department of Health and Human Services (DHHS). Gail Ritchie served as the Government Project 

Officer.

Disclaimer

The views, opinions, and content of this publication are those of the authors and contributors and do 

not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or DHHS.

Public Domain Notice

All material appearing in this volume is in the public domain and may be reproduced or copied 

without permission from SAMHSA. Citation of the source is appreciated. However, this publication may 

not be reproduced or distributed for a fee without the specific, written authorization of the Office of 

Communications, SAMHSA, DHHS.

Electronic Access and Copies of Publication

This publication can be accessed electronically through the following Internet World Wide Web 

connection: www.samhsa.gov. For additional free copies of this document, please call SAMHSA’s 

National Mental Health Information Center at 1-800-789-2647.

Recommended Citation

Hepburn, K. S., & Kaufmann, R. K. A Training Guide for the Early Childhood Services Community. 

DHHS Pub. No. CMHS-SVP0152. Rockville, MD: Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, 2005.

Originating Office

Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 

1 Choke Cherry Road, Rockville, MD 20857

DHHS Publication No. CMHS-SVP0152

Printed 2005
v

A Training Guide for the Early Childhood Services Community

Foreword

We envision a future when everyone with a mental illness will recover, 

a future when mental illness can be prevented or cured, a future when 

mental illnesses are detected early, and a future when everyone with a 

mental illness at any stage of life has access to effective treatment and 

supports—essentials for living, working, learning, and participating fully 

in the community.

“Vision Statement,” President’s New Freedom Commission on Mental 

Health, Achieving the Promise: Transforming Mental Health Care in 

America. Final Report.

We are living in exciting times for the promotion of mental health and the prevention 

of mental disorders. Prevention science has made enormous strides in advancing the 

health of those at risk for a number of illnesses, such as cancer and heart disease. The 

research community is beginning to yield promising results for the mental health field.

In 2005, the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 

Center for Mental Health Services is launching its first series on the Promotion of 

Mental Health and Prevention of Mental and Behavioral Disorders. This series has 

six monographs, and each topic conveys the work of national experts in the fields 

of prevention science and child development. The first two monographs are Early 

Childhood Mental Health Consultation (Volume 1) and A Training Guide for the Early 

Childhood Services Community (Volume 2). This set addresses young children’s 

mental health.

SAMHSA recognizes the critical role of child care providers in facilitating a young 

child’s social, emotional, and cognitive development in collaboration with the child’s 

parent and significant caretakers. Increasingly, child care providers report difficulty 

working with children who are experiencing multiple challenges. Mental health 

consultants, trained to work with young children and their families, can serve as 

important resources to help the child care provider find effective ways to work with 

these children. A Training Guide for the Early Childhood Services Community offers 

a guide for trainers to use when teaching the early childhood community how to 

use the blueprint. The companion piece to this monograph, Early Childhood Mental 

Health Consultation, provides a blueprint for child care providers to use when hiring a 

mental health consultant. 

We are very grateful to child care providers for their invaluable work in giving our 

children a solid foundation for future growth. Please help us create a health care 

system in which all individuals, including our youngest and most vulnerable, can 

access quality services to promote mental health and can live quality lives in their 

community.

Charles G. Curie, M.A., A.C.S.W. A. Kathryn Power, M.Ed.

Administrator Director

Substance Abuse and Mental Health Center for Mental Health

 Services Administration Services

vii

A Training Guide for the Early Childhood Services Community

Contents

LETTER TO TRAINER ................................................................................... xi

OPENING

Audience.................................................................................................xiii

Overview and Introduction.......................................................................xiii

Major Themes .........................................................................................xiii

Outcomes ...............................................................................................xiv

Modules ..................................................................................................xiv

Special Notes ...........................................................................................xv

Module Structure ..................................................................................xv

Background Information: A Mini-Lecture................................................xv

Planning Guides ...................................................................................xv

At-A-Glance..........................................................................................xv

OVERVIEW AND INTRODUCTION TO THE TRAINING ................................1

MODULE 1 – Valuing and Understanding Mental 

Health Consultation ................................................................................3

Handouts .......................................................................................... 13–41

Planning Guide 1: Ideas to Take Home ....................................................13

1-1 Children’s Mental Health in America ...........................................15

1-2 Values Inherent in the Mental Health Perspective.........................19

1-3 Definition of Mental Health Consultation.....................................21

1-4 Other Capacity-Building Interventions .........................................23

1-5 Scenes 1–6: Takes 1 and 2 ..........................................................25

1-6 Steps in Problem Solving and Capacity Building...........................39

1-7 Reminders About Communication ...............................................41

Overheads ........................................................................................ 43-51

1-1 Definition of Mental Health Consultation.....................................43

1-2 Other Capacity-Building Interventions .........................................45

continued
viii 

1-3 Instructions (for Scenes)...............................................................47

1-4 Steps in Problem Solving and Capacity Building [2 overheads] .....49

MODULE 2 – The Effective Mental Health Consultant ...............................53

Handouts .......................................................................................... 61–82

Planning Guide 2 ....................................................................................61

2-1 Consultant Skills and Areas of Expertise.......................................63

2-2 Consultant Roles and Responsibilities ..........................................65

2-3 Philosophy Cards ........................................................................67

2-4 Administrative Process for Engaging a Consultant........................75

2-5 Interviewing and Reaching Agreement ........................................81

Overheads ........................................................................................ 83–91

2-1 Consultant Skills and Areas of Expertise [2 overheads] ................83

2-2 Consultant Roles and Responsibilities ..........................................87

2-3 Wanted: The Perfect Mental Health Consultant ............................89

2-4 Administrative Process for Engaging a Consultant........................91

MODULE 3 – The Importance of a Collaborative Relationship ..................93

Handouts ...................................................................................... 103–118

Planning Guide 3: Ideas to Take Home ..................................................103

3-1 Key Elements of Partnership ......................................................105

3-2 Principles of a Consultative Relationship ....................................107

3-3 Role-Play Cards ........................................................................109

3-4 The Cultural Iceberg .................................................................113

3-5 Vignette....................................................................................115

3-6 Key Definitions..........................................................................117

Overheads .................................................................................... 119-123

3-1 Key Elements of Partnership ......................................................119

3-2 Principles of a Consultative Relationship ....................................121

3-3 The Cultural Iceberg .................................................................123

Contents (Continued)
ix

A Training Guide for the Early Childhood Services Community

MODULE 4 – Understanding Challenges and 

Developing Strategies .........................................................................125

Handouts ...................................................................................... 131–133

4-1 Common Challenges ................................................................131

4-2 Financing Early Childhood Mental Health 

Consultation Services ................................................................133

Worksheet 1 – My Own Challenges........................................................135

Overheads .................................................................................... 137–141

4-1 Common Challenges [3 overheads] ..........................................137

APPENDIX A – Selected Resources on Mental Health Consultation in Early 

Childhood Settings ..............................................................................143

Contents (Continued)

xi

A Training Guide for the Early Childhood Services Community

Early Childhood Mental Health Consultation

A TRAINING GUIDE FOR THE EARLY 

CHILDHOOD SERVICES COMMUNITY

DEAR TRAINER:

Welcome to the training guide companion to the publication Early Childhood 

Mental Health Consultation. After reading the publication, you will be prepared to 

use the training materials to inform and guide programmatic planning for mental 

health consultation within the context of early childhood services.

The training is intended to be one full day. The Overview and Introduction and 

four modules are sequential and build on one another as a day of progressive 

learning and planning for mental health consultation. If necessary, the modules 

may be used independently. As always, it is important to tailor the materials and 

discussions to a particular audience. We encourage making the learning most 

meaningful to your audience by supplementing the materials with relevant, 

culturally appropriate local information and resources to support the major themes 

and outcomes of the training activities.

The training guide derives most of its content directly from the publication Early 

Childhood Mental Health Consultation and, refers to specific pages in it that are 

relevant to a module, activity, or discussion. 

The design of the training materials relies on the basic principles of adult learning:

n Motivation

n Experience

n Active involvement

n Climate of respect

The training is interactive, and the materials and activities are appropriate for 

various learning styles to maximize the experience and benefit of all participants.

We welcome your interest, energy, and creativity as you use this training guide 

and support early childhood mental health consultation services. In doing so, 

you join us in (1) caring about young children and their families and (2) building 

productive interdisciplinary relationships between the early childhood community 

and the mental health specialists who understand the unique challenges of 

working with infants, toddlers, preschoolers, and their families.

xiii

A Training Guide for the Early Childhood Services Community

AUDIENCE

This manual is written for use with early childhood program administrators, 

directors, supervisors, and staff; mental health service administrators and 

providers; and families. Any individuals interested in early childhood mental health 

consultation are potential participants. Trainers can be early childhood or mental 

health staff or administrators with experience in human resource development.

OVERVIEW AND INTRODUCTION

Administrators and providers of early childhood services have the opportunity to 

greatly impact the lives of the young children and their families for whom they 

provide care. The years between birth and age 6 are a time of close relationships 

with adult caregivers who offer the nurturing, love, protection, guidance, 

stimulation, and support that are critical to the emotional health and well-being 

of each child. Prevention and early intervention efforts to address social and 

emotional development and mental health problems in early childhood make a 

difference in the lives of the children and their families.

Mental health consultation, as one effort, provides an avenue and opportunity for 

both early childhood and mental health administrators, as well as early childhood 

and mental health service providers, to work together to offer a supportive 

environment for children and families. This manual is a companion training guide 

to the Early Childhood Mental Health Consultation publication. It represents a 

learning process and text for defining, designing, and implementing mental health 

consultation in early childhood settings. Its dual purpose is ultimately to:

n Broaden the discussion on mental health consultation.

n Help integrate mental health consultation into early childhood services and 

systems of care.

MAJOR THEMES

The major themes of this Guide are:

n Mental health consultation is an effective preventive intervention that 

addresses mental health problems in early childhood. This type of 

consultation also may reduce significant personal and social difficulties in 

later childhood, adolescence, and adulthood.

n On-site consultation with a mental health expert can provide helpful 

assistance to support early childhood providers and build staff capacity in 

caring for children with challenging behaviors.

n Specific skills and understanding relevant to early childhood are essential 

for the effective mental health consultant.

n Collaborative relationships among consultants, early childhood service 

staff, and families are the essential contexts in which support for early 

social and emotional development and intervention for mental health 

concerns takes place.
xiv 

n Directors and administrators of early childhood programs can meet the 

challenge of offering creative ways to support and build their staff’s 

capacity to address the mental health concerns of children and families.

n Mental health consultants and early childhood staff should increase their 

cultural competence so that they can work together effectively to best meet 

the needs of the children and families they serve.

OUTCOMES

After completing the training guided by this manual, participants will be able to:

n Describe the value of mental health consultation, including its 

definition, in supporting young children and their families.

n Clarify the essential knowledge, skills, roles, and responsibilities

of the mental health consultant and the administrative process for 

implementing a consultation model within an early childhood setting.

n Understand the importance of collaborative relationships in effective 

mental health consultation.

n Identify the critical issues and challenges in the consulting process and 

strategies to address them.

MODULES

This guide includes the following sections:

n Overview and Introduction to the Training: This section helps 

participants learn the intent and structure of the training and describe their 

experiences and learning expectations.

n Module 1: Valuing and Understanding Mental Health Consultation

helps participants describe the value of mental health consultation,

including its definition, in supporting young children and their families.

n Module 2: The Effective Mental Health Consultant helps participants 

clarify the essential knowledge, skills, roles, and responsibilities 

of the mental health consultant and the administrative process for 

implementing a consultation model within an early childhood setting.

n Module 3: The Importance of a Collaborative Relationship helps 

participants understand the importance of collaborative relationships in 

effective mental health consultation.

n Module 4: Understanding Challenges and Developing Strategies helps 

participants identify the critical issues and challenges in the consulting 

process and strategies to address them.

n Appendix A: Selected Resources on Mental Health Consultation in 

Early Childhood Settings.
xv

A Training Guide for the Early Childhood Services Community

SPECIAL NOTES

Module Structure

Each Module is written in a format that encourages planning, preparation, and 

presentation. Most modules include sections with headings as follows: Goal, 

Objectives, Key Concepts, Background Information: A Mini-Lecture, and Activity 

1-1 (1-2 and 1-3). In addition, each Activity is written in a format that includes 

subsections titled Purpose, Preparation, Leading the Activity, Discussion Guide, 

and Summing Up.

Background Information: A Mini-Lecture

Those sections titled Background Information: A Mini-Lecture provide content 

information relevant to the module or activity within which it appears. The content 

can be presented in 10–15 minutes and used as an introduction to the module or 

activity. In some cases, this content is supported by an Overhead or Handout for 

use during the presentation and distribution to the participants as they continue to 

use the information through the activities or back-home learning.

Planning Guides

A Planning Guide, intended to be used by participants for note taking, individual 

planning, and as a take-home tool, accompanies each of the four modules. The 

Planning Guide is used in Module 4 to synthesize and integrate learning from 

throughout the training. The first mention of the Planning Guides appears in 

the Opening, Overview and Introduction to the Training, Activity 1, in which 

participants learn the intent and structure of the training.

At-A-Glance

The At-A-Glance table, on pages xiv through xvi, offers a quick reference for 

planning and preparation. The columns from left to right provide information 

about each module and its specific goal; each activity and its purpose or objective; 

the estimated time for each training activity; and the materials to support the 

activity. The materials are noted by category (HO–Handout and OH–Overhead) 

and, where appropriate, by title. For example, under the Materials heading in 

Module 1, Activity 1-1, HO 1 is Handout 1 titled “Children’s Mental Health in 

America.” Each handout and overhead is provided in the training materials for 

reproduction on paper or transparencies.
xvi 

MODULE ACTIVITY TIME MATERIALS

OVERVIEW AND 

INTRODUCTION TO THE 

TRAINING

Goal: Participants will describe 

the intent of the training, the 

structure of the training event 

or day, and their personal 

expectations for the training.

Activity 1

Introducing the Training

Participants will learn the 

intent and structure of the 

training event or day and 

will become familiar with the 

training materials.

15

minutes

Training materials include:

n Name badges

n Agenda

n Handouts

n Publication—Early 

Childhood Mental Health 

Consultation

n Planning Guides 1, 2, 

and 3

n Easel, chart paper, Post-it 

notes, and markers

Activity 2

Experience and 

Expectations (Warm-Up)

Participants will introduce 

themselves and identify 

their experience with mental 

health consultation and their 

individual expectations for the 

training.

15

minutes

n Easel, chart paper, and 

markers

MODULE 1

Valuing and Understanding 

Mental Health Consultation

Goal: Participants will describe 

the value of mental health 

consultation, including its 

definition, in supporting 

young children and their 

families.

Activity 1-1

Values Clarification

Participants will reflect on 

their own assumptions about 

early childhood mental 

health, current trends, and 

the mental health perspective.

30 

minutes

n Planning Guide 1

n HO 1: Children’s Mental 

Health in America

n HO 2: Values Inherent 

in the Mental Health 

Perspective

n Easel, chart paper, 

markers, and masking 

tape

Activity 1-2

Defining Mental Health 

Consultation

Participants will define 

two types of mental health 

consultation and will practice 

differentiating between 

the two.

40 

minutes

n HO 3: Definition 

of Mental Health 

Consultation

n HO 4: Other CapacityBuilding Interventions

n HO 5: Scenes 1–6: 

Takes 1 and 2

n HO 6: Steps in Problem

Solving and Capacity 

Building

n HO 7: Reminders About 

Communication

n OH 1: Definition 

of Mental Health 

Consultation

n OH 2: Other CapacityBuilding Interventions

n OH 3: Scene Instructions

n OH 4: Steps in Problem

Solving and Capacity 

Building

n Overhead projector 

and screen, easel, chart 

paper, markers, and 

masking tape

continued

AT-A-GLANCE
xvii

A Training Guide for the Early Childhood Services Community

MODULE ACTIVITY TIME MATERIALS

MODULE 2

The Effective Mental Health 

Consultant

Goal: Participants will clarify 

the essential knowledge, 

skills, roles, and 

responsibilities of the mental 

health consultant and the 

administrative process for 

implementing a consultation 

model within an early 

childhood setting.

Activity 2-1

Imagine and Create...

Participants will begin to 

identify desirable qualities 

and traits of an early 

childhood mental health 

consultant.

30

minutes

n Planning Guide 2

n HO 1: Consultant Skills 

and Areas of Expertise

n HO 2: Consultant Roles 

and Responsibilities

n OH 1: Consultant Skills 

and Areas of Expertise

n OH 2: Consultant Roles 

and Responsibilities

n Colored paper, markers, 

scissors, crayons, glue, 

other craft materials as 

desired, masking tape, 

and a large sheet of 

poster paper

Activity 2-2

Wanted: The Perfect Mental 

Health Consultant

Participants will understand 

the importance of a 

philosophical match and will 

describe knowledge, skills, 

roles, and responsibilities of 

the mental health consultant.

60

minutes

n HO 3: Philosophy Cards

n OH 3: Wanted: The 

Perfect Mental Health 

Consultant

n Flip chart paper, 

masking tape, and 

markers

Activity 2-3

Engaging the Mental Health 

Consultant

Participants will learn the 

administrative process for 

including mental health 

consultation in program 

services.

20

minutes

n HO 4: Administrative 

Process for Engaging a 

Consultant

n HO 5: Interviewing and 

Reaching Agreement

n OH 4: Administrative 

Process for Engaging a 

Consultant

n Overhead projector 

and screen, easel, chart 

paper, markers, masking 

tape, and envelopes for 

puzzle pieces

continued

AT-A-GLANCE (Continued)
xviii 

MODULE ACTIVITY TIME MATERIALS

MODULE 3

The Importance of a 

Collaborative Relationship

Goal: Participants will understand 

the importance of collaborative 

relationships in effective mental 

health consultation.

Activity 3-1

What Does Collaboration 

Mean?

Participants will experience 

the complexity of 

collaboration, which is the 

basis for positive collaborative 

relationships.

15 

minutes

n Planning Guide 3

n HO 1: Key Elements of 

Partnership

n OH 1: Key Elements of 

Partnership

n Overhead projector and 

screen, easel, chart paper, 

markers, masking tape, 

pieces of string or ribbon, 

and pen or pencil

Activity 3-2

Essential Principles of a 

Collaborative Relationship

Participants will explore

principles that contribute to 

the success of relationshipbased work among the 

mental health consultant, 

staff, and parents.

30 

minutes

n HO 2: Principles of a 

Consultative Relationship

n HO 3: Role-Play Cards

n OH 2: Principles of a 

Consultative Relationship

n Overhead projector, 

screen, and slide or a 

flip chart

Activity 3-3

The Roles of Culture, Race, 

Sex, Gender, and Class in 

Influencing Relationships

Participants will explore the 

importance of culture as an 

influence on the collaborative 

process (a two-part activity).

Part 1

15 

minutes

Part 2

30 

minutes

n HO 4: The Cultural 

Iceberg

n HO 5: Vignette

n HO 6: Key Definitions

n OH 3: The Cultural 

Iceberg

n Easel, chart paper, 

markers, masking tape, 

and overhead projector 

(if available)

MODULE 4

Understanding Challenges 

and Developing Strategies

Goal: Participants will identify 

critical issues and challenges

in the consulting process 

and will develop strategies to 

address them.

Activity 4-1

Identifying My Own 

Challenges

Participants will identify 

challenges to mental health 

consultation in an early 

childhood setting based on 

the publication and will 

identify their own system or 

program challenges and share 

them with others.

30 

minutes

n OH 1: Common 

Challenges

n HO 1: Common 

Challenges

n Pens, Post-it notes, easel 

and flip chart paper, and 

markers

Activity 4-2

Problem-Solving Strategies 

for the Challenge

Participants will problem 

solve strategies to overcome 

challenges.

40 

minutes

n Worksheet 1: My Own 

Challenges

n Post-it notes, pens, flip 

chart paper, and markers

Activity 4-3

Next Steps and Who Do

I Need

Participants will develop their 

own individualized system or 

program profile of challenges, 

strategies, next steps, and 

whom they need.

20 

minutes

n Worksheet 1: My Own 

Challenges

n Planning Guides 1, 2, 

and 3

n HO 2: Financing Early 

Childhood Mental Health 

Consultation Services

n Pens

AT-A-GLANCE (Continued)
1

A Training Guide for the Early Childhood Services Community

ACTIVITY 1

Overview and Introduction to the Training

GOAL Participants will describe the intent of the training, the structure of the

training event or day, and their personal expectations for the training.

OBJECTIVES

After completing the Overview and Introduction to the training, participants will 

be able to:

n Describe the intent of the training.

n Describe the general design of the training and the materials provided.

n Identify their individual expectations for the training.

 INTRODUCING THE TRAINING (15 Minutes)

Purpose

This activity will help participants understand the intent of the training, have an 

overview of the content of the training modules, and become familiar with the 

training materials.

Preparation

Arrange for: Room setup of rounds for 4–6 participants

 Name badges for each participant

 Easel, chart paper, Post-it notes, and markers

 Copies of the publication Early Childhood Mental Health

Consultation for each participant

Duplicate: Training materials including the agenda and handouts for each 

participant for initial distribution. These should include Planning 

Guides 1, 2, and 3 and materials selected by the trainer and 

appropriate to her training style.

Leading the Activity

1. Introduce yourself and the intent of the training.

2. Welcome participants, and describe an overview of the content of the training 

modules and the intended outcomes.

3. Review the training agenda and time frames for each module.

Overview and Introduction to the Training
ACTIVITY 2

2 Overview and Introduction to the Training

4. Review the packets and materials. Explain that the training is based on the 

publication Early Childhood Mental Health Consultation and that although 

most of the content is from this publication, it does not follow the text 

in sequence. Advise the group that you will give page references when 

appropriate during the training activities; however, the publication can help 

them back home when they have a better opportunity to read it and apply 

their learning from today’s training.

5. Make particular note of Planning Guides 1, 2, and 3 for the respective 

modules. Explain that these are intended as note-taking pages to support their 

learning, the planning process in Module 4, and back-home implementation.

 EXPERIENCE AND EXPECTATIONS (WARM-UP)

 (15 Minutes)

Purpose

Participants will introduce themselves and identify and describe their experiences 

with mental health consultation and their individual expectations for the training.

Preparation

Arrange for: Easel, chart paper, and markers

Leading the Activity

1. Invite participants to introduce themselves and briefly (1–3 sentences) identify 

their experiences with mental health consultation and their expectations for 

the training.

2. Use the flip chart to record expectations, if desired.
3

A Training Guide for the Early Childhood Services Community

MODULE 1 

Valuing and Understanding Mental Health 

Consultation

GOAL 1 Participants will describe the value of mental health consultation 

and its definition in supporting young children and their families.

OBJECTIVES

After completing Module 1, participants will be able to:

n Identify reasons that mental health consultation is important to the wellbeing of children, families, and providers.

n Define two types of mental health consultation: Program Consultation and 

Child- and Family-Centered Consultation.

KEY CONCEPTS

n The mental health perspective in early childhood programs is based on a 

set of values that underpin its models and approaches in policy, practice, 

and attitude.

n Changes in child and family relationships, the home environment, and the 

community context have increased the need for mental health consultation 

support to children, families, and staff.

n Changes in mental health financing (e.g., managed care and restricted 

eligibility for funding) may limit mental health services and access to care 

for mental health concerns of young children.

n There is a lack of infant mental health “specialists” as well as a limited 

number of those who serve young children and their families.

n Mental health consultation is one piece in a continuum of support and 

capacity-building interventions for early childhood program staff, young 

children, and their families.

n Two types of mental health consultation—Child- and Family-Centered 

Consultation and Program Consultation—are the most effective in 

supporting young children and families as well as the programs and staff 

that serve them. Both are uniquely different from other types of capacitybuilding interventions, such as teaching and training, clinical supervision, 

and psychotherapy.

MODULE 1: Valuing and Understanding Mental Health Consultation
4 MODULE 1: Valuing and Understanding Mental Health Consultation

ACTIVITY 1-1

BACKGROUND INFORMATION: A MINI-LECTURE

Promoting healthy development and the future well-being of infants, toddlers, 

and preschool children is a vital public health issue. This issue has important 

implications for families, businesses, private philanthropy, and government. 

Fostering mental health in the early childhood years is a special opportunity 

to prepare a child for school and life and, when possible, to avoid future 

developmental and emotional problems. Early childhood providers have a 

particular opportunity to provide mental health support in a wide variety of 

settings. These are child care providers, early childhood educators, and early 

intervention specialists for children with special needs (including mental health 

service providers). 

Early childhood service providers report increasing numbers of children under 

stress for whom violence, abuse, parental substance exposure, losses due to 

incarceration or death, or residing with multiple caregivers or in foster homes 

has had an impact. Challenging behaviors increase with the complexity of the 

difficulties that families and communities confront. Teachers and parents of infants 

and young children need support to respond to these challenging behaviors and 

to promote healthy development. Directors, administrators, and providers of early 

childhood programs must consider and offer creative ways to build their staff’s 

capacity to address the mental health concerns of children and families living with 

many risks and stressors.

Recent neurobiological research has produced a solid basis for introducing an 

early childhood mental health perspective into programs and systems that serve 

young children and their families. The way in which the brain develops during 

the early years of life, and the role nurturing relationships play, is crucial in young 

children’s social and emotional development. This information has influenced 

the understanding of early childhood mental health. This information is also 

influencing the perspective and practices of child care and other early childhoodfocused programs. The mental health perspective focuses on enhancing the wellbeing of all children, minimizing or avoiding behavioral problems in children 

under stress. Programs that emphasize the mental health of children and families 

reflect this mental health perspective and include preventive intervention activities.

For more background information, see pages vii–ix in Volume 1, Early Childhood 

Mental Health Consultation. Use Handout 1: Children’s Mental Health in 

America to reinforce information about children’s mental health.

 VALUES CLARIFICATION (30 Minutes)

 PERSONAL REFLECTIONS (Optional) (20 Minutes)

Purpose

This activity will help participants reflect on their own values and assumptions 

about early childhood mental health. Discussion will identify current trends 

that focus our attention on early childhood mental health and that clarify the 

underpinning values of the mental health perspective in early childhood.
A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 5

Preparation

Arrange for: Easel, chart paper, markers, and masking tape

Duplicate: Handouts:

 Planning Guide 1: Ideas to Take Home

 Handout 1: Early Childhood Mental Health in America: The Need 

for Early Childhood Mental Health Consultation

 Handout 2: Values Inherent in the Mental Health Perspective

Make: Line of tape on the wall, with ends marked “1” and “10” and 

midpoint marked “5”.

Leading the Activity

1. Remind participants to use Planning Guide 1 for note taking.

2. Introduce the activity and review its purpose with the participants. Emphasize 

that understanding the underpinning values provides the foundation necessary 

for defining early childhood mental health consultation.

3. Note that this exercise will use statements that take an extreme point of view 

to illustrate the diversity of perspectives toward mental health.

4. Ask 8 volunteers to stand under the line of tape on the wall. Explain that 

you will be asking them to take on the identity of particular groups, such as 

parents, child care workers, and others. Define their job as representing a 

particular group’s beliefs or assumptions. Tell them that you will be reading 

some provocative statements about early childhood mental health. After each 

statement, you want them to stand at the point on the line that represents a 

particular group’s beliefs or assumptions. Explain that the line represents a 

scale of 1–10, with 1 being strongly disagree and 10 being strongly agree.

5. Ask the rest of the participants to observe where members of the group 

stand on the Agree-Disagree scale. Encourage them to notice the different 

perspectives of each group as they shift on the scale.

6. Read 3–5 of the statements below. When you read each statement, pose the 

following:

n From the perspective of our current society in America...

n From the perspective of parents in your community...

n From the perspective of early childhood service providers...

n From the perspective of mental health professionals...
6 MODULE 1: Valuing and Understanding Mental Health Consultation

Therefore, you will pose each statement 4 times.

Statements:

n Families with mental health problems may pass the problems on to the next 

generation.

n Mental health is a major focus of an early childhood program.

n Mental health services apply only to those with social emotional and 

addiction problems.

n Infants do not have mental health “issues.”

n If we train child care providers appropriately, they should be able to take 

care of behavioral problems in their program.

7. Invite the group to describe beliefs and values that they have noted from the 

activity. Facilitate the discussion. Refer to Handout 1: Children’s Mental 

Health in America and the mini-lecture to support the need to focus attention 

on mental health services to young children. Emphasize that we each have our 

own perspective and values about early childhood mental health.

8. Distribute and review Handout 2: Values Inherent in the Mental Health 

Perspective that reflects the underpinning framework for early childhood 

mental health services and supports (see Discussion Guide and Summing Up 

below).

OPTIONAL ACTIVITY

On a more personal level, ask each participant to take a moment to reflect on the 

discussion thus far. Use the following questions as a guide:

n Think about your time as a young child. How are the stressors today 

different from those during your childhood? How might mental health 

consultation support children, families, and staff working in a communitybased program?

n Think about your choice to work in your field. How were your 

expectations different from the reality of your work? How might mental 

health consultation change the work you do?

Discussion Guide

Use the following points to guide the large-group discussion:

n When discussing the statements on the 1–10 scale and perceptions of early 

childhood mental health, point out the variety of perceptions about early 

childhood mental health. Many simply think about mental illness and the 

stigma associated with this perspective. It is important to think about social 

and emotional development as a critical aspect to a child’s growing up. It is 

also important to consider promoting mental health as a way to support not 
A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 7

ACTIVITY 1-2

only a child’s development but also the and foundation of a positive future 

for each and every child. Add that it is important to address a “holistic” 

approach to mental health, which includes prevention, early intervention, 

and treatment for children and families as well as providers.

n Optional: In facilitating the personal reflections about early childhood, help 

the participants to consider how today’s level of stress on young children 

and families has changed. Use some of the statistics and current trends 

from Handout 1: Children’s Mental Health in America to emphasize 

these points. Remind them of some critical factors that positively impact 

young children (e.g., the importance of close relationships, consistent and 

available caregivers, stimulation and support, and nurturing love).

n Optional: In facilitating the personal reflections about working with 

children, help the participants consider their personal values and beliefs 

about young children and mental health. Also help them consider their 

level of concern and stress in their work. What are some strategies that 

would support them? Present the idea that mental health consultation is 

one strategy that we will be looking at as a supportive, strengthening, and 

skill-developing experience that can enhance personal and professional 

capacity.

Summing Up

Summarize some key points of the activity and the discussion. Lay out the 

challenges that face the participants (whatever their role—administrators, service 

providers, and others—see page ix in the publication Early Childhood Mental 

Health Consultation)—and the need for creative ways to support young children 

and families and respond to mental health developmental needs. Review the 

mental health perspectives and values, point by point, using Handout 2: Values 

Inherent in the Mental Health Perspective, and emphasize that the training 

they have begun will help them think more completely and creatively about the 

potential for early childhood mental health consultation.

 DEFINING MENTAL HEALTH CONSULTATION

 (40 Minutes)

Purpose

In this activity, participants will define two types of mental health consultation: 

Child- and Family-Centered Consultation and Programmatic Consultation. 

Participants will understand each type and be able to differentiate between 

consultation and other problem-solving and capacity-building interventions.

Preparation

Arrange for: Easel, chart paper, markers, and masking tape

 Tables in rounds of 4–6

 Overhead projector and screen
8 MODULE 1: Valuing and Understanding Mental Health Consultation

Duplicate: Handouts:

 Handout 3: Definition of Mental Health Consultation

 Handout 4: Other Capacity-Building Interventions

 Handout 5: Vignettes—Scene 1: Take 1 through Scene 6: Take 1, 

 double sided on card stock

 Handout 6: Steps in Problem Solving and Capacity Building

 Handout 7: Reminders About Communication

Overheads:

 Overhead 1: Definition of Mental Health Consultation

 Overhead 2: Other Capacity-Building Interventions

 Overhead 3: Scene Instructions

 Overhead 4: Steps in Problem Solving and Capacity Building

Make: Fold the 6 vignettes on card stock in half so that the heading 

Scene 1: Take 1 appears on the outside. Seal the folded cards with 

a replaceable sticker or tape at the bottom. Have enough copies to 

give 1 vignette to each group.

Leading the Activity

1. Introduce the activity and review its purpose with the participants. Explain 

that the focus of this activity is to help participants learn about mental 

health consultation as a problem-solving and capacity-building intervention 

implemented within a collaborative relationship between a professional 

mental health consultant and early childhood service providers.

2. Mini-Lecture:

Review the definition of mental health consultation. Clarify the term 

“capacity building” as any interaction or activity that improves the ability 

of staff, families, programs, and systems to prevent, identify, treat, and 

reduce the impact of mental health problems among children from birth to 

age 6 and their families. Present information about the two types of mental 

health consultation. Define Child- and Family-Centered Consultation and 

Programmatic Consultation, giving examples (pages 5–9 in Early Childhood 

Mental Health Consultation). Highlight the differences. Then, continue 

to discuss other problem-solving, capacity-building activities including 

teaching and training, clinical supervision, and psychotherapy, being clear 

about the differences (pages 4 and 5 in Early Childhood Mental Health 

Consultation). Use Overhead 1: Definition of Mental Health Consultation

and Overhead 2: Other Capacity-Building Interventions and their 

corresponding Handout 3 and Handout 4 with the same titles to share this 

information.

Part 1:

1. Divide the large group into small groups of 4–6 (or smaller). Now that 

they understand the definitions of each type of mental health consultation, 

begin this segment by encouraging them to keep these definitions in mind 

(Overhead 1).
A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 9

2. Distribute 1 vignette (Handout 5, Scenes 1–6: Take 1) to each table. Be 

sure to use a mix of vignettes that represent both types of consultation. Use 

Overhead 3: Scene Instructions to give instructions to the group.

3. Tell participants that this activity has two parts. Each group has received 

a different vignette that represents a true consultation story from an early 

childhood setting. Ask participants not to break the seal during the first part 

of the exercise. You will tell them when to begin Part 2.

4. Make sure each group has a facilitator who will read the vignette and lead 

the discussion.

5. Give instructions to the group that they are to read the vignette and decide 

as a group what type of mental health consultation is appropriate—

without breaking the seal on the card. Like the director of a play, they 

must imagine that they have a scene before them and must decide the “rest 

of the story” and how it might play out. Remind them that these are true 

events and that during Part 2 of the exercise they can see how close their 

decisions came to the real story.

Part 2:

1. After giving groups 15–20 minutes to discuss the scenario and reach a 

group decision, have them break the seal and read Take 2 to see how the 

real scenario played out. Use Overhead 3: Scene Instructions.

2. Small groups report out (select 3 or 4 if time is limited). Have each group’s 

participants read their vignette and share their decision about which type of 

consultation they selected and why. Then, have them share Take 2 with the 

group.

Discussion Guide

When presenting the definitions of the types of mental health consultation, be 

sure to emphasize the capacity-building and problem-solving aspects of this 

collaborative relationship. Use the following points to guide the large-group 

discussion:

n Guide programmatic decisions and quality care for young children.

n Support social and emotional development in prevention and promotion.

n Help parents and providers address challenging behavior.

n Contribute to staff development.

The consultant is not there to “fix the child” but to work with staff members. 

Both programmatic and child- and family-centered consultation assist staff in 

understanding and incorporating the mental health perspective into their work and 

enhance their own roles, skills, and experience.
10 MODULE 1: Valuing and Understanding Mental Health Consultation

n Remind the group that the Scene 1: Take 1 vignettes are based on real 

stories within an early childhood program setting. As each group reports 

out, facilitate discussion about what “process” they followed to review 

the scenario, what points came up in their discussion or decision making, 

and what they decided. Emphasize that in real life, the specific type of 

mental health consultation may not be so clear and separate. In fact, many 

vignettes combine the two types of consultation and other strategies, with 

one being primary and the other secondary, so it makes sense that they 

influence one another.

Hint: The following list identifies each vignette and the primary type of 

consultation:

n Scene 1: Dr. Stuart—Programmatic

n Scene 2: Ms. Jones—Programmatic

n Scene 3: Dr. Pryor—Programmatic

n Scene 4: Mr. Adams—Child and Family Centered

n Scene 5: Dr. Gregory—Child and Family Centered

n Scene 6: Ms. Raven—Child and Family Centered

n Emphasize the point that the primary role of either type of early childhood 

mental health consultation is problem solving and capacity building. In 

working with a consultant, the process will include several steps—just as 

they noticed in their small groups. These steps include the assessment 

phase, selection of interventions, implementation of the plan, 

and evaluation and feedback. Review each of these steps briefly using 

Overhead 4: Steps in Problem Solving and Capacity Building and its 

related handout, Handout 6: Steps in Problem Solving and Capacity 

Building (see text pages 12 and 13 and Appendixes B and C in Early 

Childhood Mental Health Consultation).

Summing Up

In bringing the discussion to a close, inform the participants that they now 

know the basic definition of mental health consultation and the two primary 

types within an early childhood service setting. Summarize the definition of each 

type and use an example from one of the scenarios to illustrate each type of 

mental health consultation. The process for deciding what type of mental health 

consultation might be most useful may have been reflected in some of their smallgroup discussions and fits with the steps of the problem-solving and capacitybuilding process. The collaborative relationships between staff and consultants 

and a continuous communication feedback loop are critical to supporting this 

interactive process.
A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 11

The interactive process between staff and consultants is most effective when 

it occurs on a regular schedule. The program director, the childhood staff, and 

the mental health consultant must value and build in adequate time and other 

supports for team meetings, problem solving, discussing observations, expressing 

concerns, and planning and evaluating strategies. Distribute Handout 7: 

Reminders About Communication.

A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 13

Planning Guide 1:

Ideas to Take Home

While the information is still fresh, jot down some notes and ideas to take back home as next 

steps in planning for mental health consultation:

Good Information:

Great Ideas:

Next Steps Back Home:

A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 15

continued

HANDOUT 1-1 

Children’s Mental Health in America

THE NEED FOR EARLY CHILDHOOD MENTAL 

HEALTH CONSULTATION

Never before have we known so much about how infants and young 

children learn, think, and act. The earliest interventions are important because:

n The newborn brain develops at an astonishing rate and is directly influenced 

by the quality of relationships

n Strong, stable relationships give infants and toddlers their best chance to 

become emotionally competent

n Forty-six percent of kindergarten teachers said that half their class had specific 

problems in basic social and emotional development

n Children who have poor academic achievement early on are at risk for 

delinquent and antisocial behavior

n Risk and protective factors need to be identified early, and interventions should 

target both

Developmental psychopathology arises from the complex interplay of 

child characteristics, family characteristics, and community-level factors.

Although biological factors are implicated in some conditions (e.g., autism and 

Attention-Deficit/Hyperactivity Disorder), psychosocial factors present significant 

risks for many conditions. The most prevalent psychosocial risk factors are:

n Poverty (1 in 4 children are born poor)

n Quality of early attachments

n Parental depression (1 in 10 women experience postpartum depression)

n Parental substance abuse (the majority of parents with children in child 

protective services have problems with alcohol and drugs)

n Divorce (1 in 60 children sees their parents divorce each year)

n Inconsistent or harsh parenting (3 million children are maltreated each year)

n Exposure to domestic violence (1 million incidents of intimate partner violence 

in 1998)

n Exposure to community violence (40 to 60 percent of urban youth reported 

seeing a shooting)
16 MODULE 1: Valuing and Understanding Mental Health Consultation

HANDOUT 1-1 (Continued)

continued

Seventy percent of children with mental health problems are not receiving 

needed services. (U.S. Department of Health and Human Services, 1999; 

Yoshikawa & Knitzar, 1997). Barriers include:

n Lack of early identification, intervention, and prevention

n Lack of diagnosis

n Lack of health insurance

n Lack of pediatric specialty providers

n Stigma

n Cost of treatment services

n Lack of reimbursement for consultative services

Effective prevention and intervention programs are available. Targeting 

high-risk families when children are younger yields larger savings and generates 

better development outcomes, for example:

n High/Scope Perry Project: for every dollar spent, $7 was shared in avoided 

costs by age 27 (Karoly, Greenwood, & Everingham, 1998)

n Prenatal/Early Infancy Home Visiting Project: higher risk families showed 

$20,000 net savings in 15 years (Karoly et al.)

n Infant Health and Development Program: treatment children had fewer 

behavioral problems (Shonkoff & Phillips, 2000)

n AVANCE: treatment mothers were more verbally active and initiated more 

playful interactions (Kaufmann & Wischman, 1999)
A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 17

HANDOUT 1-1 (Continued)

References:

Karoly, L. A., Greenwood, P. W., & Everingham, S. S., et al. (1998). Investing in 

our children: What we know and don’t know about the costs and benefits of early 

childhood interventions. Santa Monica, CA: RAND Corporation.

Kaufmann, R., & Wischman, A. L. (1999). Communities supporting the mental 

health of young children and their families. In Roberts, R., & Magrab, P. Where 

children live: Solutions for serving young children and their families. Stamford, CT: 

Ablex Publishing Corporation.

Shonkoff, J. P., & Phillips, D. A. (2000). From neurons to neighborhoods: The 

science of early childhood development. Washington, DC: National Academy Press.

U.S. Department of Health and Human Services. (1999). Mental health: A report of 

the surgeon general. Rockville, MD: Author.

U.S. Public Health Services. Report of the surgeon general’s conference on 

children’s mental health: Developing a national action agenda. Washington, DC: 

Author.

Yoshikawa, H., & Knitzer, J. (1997). Lessons from the field: Head Start mental 

health strategies to meet changing needs. New York: National Center for Children 

in Poverty and American Orthopsychiatric Association.

A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 19

HANDOUT 1-2 

Values Inherent in the Mental Health Perspective*

n All young children deserve to spend their days in a safe, stable, caring, and 

nurturing environment.

n A safe, stable, caring, and nurturing environment is crucial to promoting 

healthy social and emotional growth and resiliency, to protecting young 

children from psychological harm, and to creating conditions conducive to 

appropriate social and emotional well-being.

n The quality of the child’s many relationships with parents and other 

important people in her life is critical to positive social and emotional 

development.

n The mental health of a child’s parents and caregivers is important in 

meeting the mental health needs of very young children.

n Families are considered to be full participants in all aspects of design, 

implementation, and evaluation of programs and services for their young 

children.

n Early childhood mental health services are responsive to the cultural, racial, 

and ethnic differences of the populations that they serve.

n Practices build on, promote, and enhance the strengths of the individual, 

the family, and child care staff.

These values were developed by a group of mental health experts at a roundtable convened by Georgetown 

Child Development Center (now known as the Georgetown University Center for Child and Human 

Development) for SAMHSA.

*

A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 21

HANDOUT 1-3 

Definition of Mental Health Consultation

MENTAL HEALTH CONSULTATION

A problem-solving and capacity-building intervention implemented within a 

collaborative relationship between a professional consultant with mental health 

expertise and one or more individuals with other areas of expertise or parenting 

responsibilities.

CHILD- AND FAMILY-CENTERED CONSULTATION

n Is the most traditional form of mental health consultation

n Addresses a child’s behavior and functioning through the collaborative 

development of a plan that can be implemented by the staff and family 

members that interact with the child.

PROGRAMMATIC CONSULTATION

n Focuses on improving the overall quality of the program

n Assists the program in solving a specific issue that affects more than one 

child, staff member, or family

n Improves the capacity of the program to respond to the needs of all young 

children in their care

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MODULE 1: Valuing and Understanding Mental Health Consultation 23

HANDOUT 1-4 

Other Capacity-Building Interventions

TEACHING AND TRAINING

A teacher or trainer uses a didactic, expert approach toward their students and 

chooses the content and format of information to be conveyed. By contrast, a 

mental health consultant to an early childhood program provides information on 

topics specifically requested by program staff. Teaching is commonly used as a 

tool in the consultative process, but much of that teaching is informal and involves 

various forms of modeling, rather than presentations in a typical classroom format.

CLINICAL SUPERVISION

Both clinical supervisors and mental health consultants help program staff improve 

their skills to understand and accomplish their work, and to crease their capacity 

to master future problems. A supervisory relationship implies administrative 

and legal accountability of staff members for following the supervisor’s 

recommendations, but in a consulting relationship, staff take responsibility for 

deciding whether or not to implement the consultant’s recommendations.

PSYCHOTHERAPY

In therapy, as in consultation, a client seeks assistance (or treatment) to solve a 

problem. Both therapeutic and consultative relationships are characterized by 

genuineness and trust, and the goal of each is to foster understanding in the client. 

Therapists focus completely on personal, psychological problems. Consultants may 

look at the factors in a staff member’s experience that contribute to his subjective 

perception of the situation. Sometimes, consultants may suggest that a staff 

member seek therapeutic services; at other times, the actual consultation can have 

coincidental therapeutic results. But consultation mainly focuses on improving the 

effectiveness of the individual staff member in her work with the child and family.

A variety of factors enter into choosing the best intervention to address a 

particular issue. Among them are:

n Specific goals of the mental health consultation

n Nature of the issues or concerns

n Setting

n Availability of the mental health practitioners and other experts in the field

n Time frame

n Cost

A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 25

HANDOUT 1-5 

Scenes 1–6: Takes 1 and 2

SEE FOLLOWING PAGES FOR ALL SCENES.

A Training Guide for the Early Childhood Services Community

Dr. Stuart was scheduled to observe Sandra in her classroom. When he 

discovered that she was no longer in 

the program, he realized that she was 

the fourth child to leave suddenly. 

The school is located near a public 

housing development that is being 

relocated. Neither the program 

director nor staff, families, or 

children have addressed this 

issue.

SCENE 1

TAKE 1

WHAT’S YOUR TAKE ON THIS SCENE?
Dr. Stuart convened a meeting for staff to discuss separation and loss. Together, they designed a 

way to talk about “goodbyes and missing friends” 

with children in the classroom. The program director 

asked Dr. Stuart to come to the next family meeting 

to share ways to prepare children for moving 

to new homes and child care programs. As a 

consultant to the program and as someone 

only a step removed from the classroom 

experience and community events, Dr. Stuart 

was able to observe the situation from a 

different perspective. He helped program staff and 

families recognize how changes in the community can impact 

children and their families—one at a time or as a large group. 

He also helped them develop specific preventive intervention 

approaches and strategies to deal with a community issue that 

had an impact on all children and families—those who were 

moving and those who remained behind.

TAKE 2

SCENE 1
A Training Guide for the Early Childhood Services Community

One morning as children were arriving at the Head Start program, a young

man shot a father who had just dropped

off his child. Although no one else 

was hurt, some children and staff had 

witnessed the event. The teachers 

and staff immediately implemented 

their emergency procedures, and 

the program director secured the 

building. Everyone was very 

anxious and upset. The director 

called the police.

SCENE 2

TAKE 1

WHAT’S YOUR TAKE ON THIS SCENE?
Once the director was sure that all children and teachers were in the classroom, secure in the 

building, and police on their way, her own anxiety 

level guided her to contact the program’s mental health 

consultant. Ms. Jones assured the director that she 

had taken all the appropriate immediate steps. The 

consultant then helped to calm the director and 

agreed to come to the school immediately. Ms. Jones 

arrived within a half-hour and met with the director. 

Ms. Jones worked with the director to develop a 

crisis intervention plan. Ms. Jones went into each 

classroom to talk directly with staff and children. She 

knew that this kind of trauma affects individuals differently 

and is best resolved over time. Parent and staff support groups 

were initiated to process fears about safety and reactions to the 

event. Through the use of conversation, dramatic play, books, and 

storytelling, children were encouraged to share their feelings and 

fears. By offering immediate and longer term support, the consultant 

was able to help everyone deal with this trauma.

TAKE 2

SCENE 2
A Training Guide for the Early Childhood Services Community

Mr. Neil, the three-year-olds’ classroom teacher, seemed to be 

avoiding the mental health consultant, 

Dr. Pryor. On consultation days, he 

often scheduled special activities or 

outings. He was very verbal in his 

belief that “consultants” look for 

only what’s wrong with children. 

Although he sometimes described 

his own concern about some 

children in his class, he strongly 

believed that they would grow 

out of most of their problems.

SCENE 3

TAKE 1

WHAT’S YOUR TAKE ON THIS SCENE?
Dr. Pryor arranged a meeting with Mr. Neil at a time that was convenient to the teacher. 

During the meeting, he asked Mr. Neil to share his 

observations about the strengths and interests of the 

children in his classroom. After acknowledging that 

Mr. Neil’s observations were very astute, Dr. Pryor 

shared that he also looked for the strengths in 

children and families. They found a common 

understanding of the roles that growth and 

development play in helping children learn 

new skills to manage their own emotions and 

behavior. Together, they explored the many ways that 

Dr. Pryor could be useful to Mr. Neil, the children, and their 

families. A clear understanding of expectations, communication, 

and professional respect is essential to building rapport between 

the teacher and the mental health professional, which is in the 

best interest of children and families.

TAKE 2

SCENE 3
A Training Guide for the Early Childhood Services Community

Mary, the toddler classroom teacher at the Flower Street Child Care 

Center, has been increasingly concerned 

about Robert. He has always been shy 

and withdrawn, but during the last 

3 months—ever since he moved to 

his new class—he has had difficulty 

during naptime. He often cries, 

revealing his own distress as well 

as disturbing other children. He 

stops crying when Mary is by 

his side but starts up again the 

minute she leaves. She also 

noted that he has not been 

eating much lately.

SCENE 4

TAKE 1

WHAT’S YOUR TAKE ON THIS SCENE?
Mary approached Mr. Adams, the consultant, to discuss her concerns about Robert’s change in behavior. To 

assess Robert’s abilities, limitations, vulnerabilities, and 

strengths, the consultant visited the center and observed 

him at various times during the course of a day. He 

also assessed the quality of the interactions in the 

classroom—those involving Robert as well as the other 

children. The consultant met with Robert’s parents and 

discovered that because of a new work schedule, 

there were frequent disruptions in their family 

schedule. The consultant shared this information 

with staff to increase their understanding of Robert’s 

behavior. With the consultant’s assistance, staff developed new 

strategies to help Robert develop a sense of predictability, including 

consistent contact with one staff member, transition to nap time, and 

a routine and “rules” under which Robert would be given the same 

toy or book before he went to sleep. By observing and encouraging 

communication between staff and parents, Mr. Adams helped Robert’s 

caregivers implement strategies to help him adjust to change.

TAKE 2

SCENE 4
A Training Guide for the Early Childhood Services Community

A 16-year-old mother, Wanda, complained to the teacher that 

Juanita, her 18 month old, was a 

stubborn, “bad” little girl who did 

not listen to her. Wanda expressed 

frustration and anger, saying that she 

is afraid that she might lose control 

one day. She went on to say 

that she has tried talking to her, 

threatening to put her to bed, 

and taking away toys. Nothing 

seems to make a difference in 

Juanita’s willful behavior.

SCENE 5

TAKE 1

WHAT’S YOUR TAKE ON THIS SCENE?
The teacher suggested that Wanda speak with Dr. Gregory, the mental health consultant, 

about her frustration and concerns for Juanita. 

They arranged a home visit where Dr. Gregory 

could observe Juanita at play and mealtime. After 

they met, Dr. Gregory helped Wanda to better 

understand typical 18-month-old behavior. He 

also helped her structure their daily routine, set 

reasonable limits, and build in time for Wanda 

and Juanita to play together. By joining with 

Wanda in her concerns about her daughter, by offering 

support, and by increasing her understanding of her daughter’s 

development, Dr. Gregory was able to help Wanda find new 

strategies to feel more in control and to enjoy her daughter and 

their relationship.

TAKE 2

SCENE 5
A Training Guide for the Early Childhood Services Community

Gabrielle, a 4-year-old girl who was small for her age, had a sad, 

solemn expression during much of 

the school year. She did not willingly 

participate in group activities or play 

with other children. Instead, she 

chose to look at books or stare into 

space, holding a favorite stuffed 

animal. She also seemed tired a SCENE 6

lot of the time. TAKE 1

WHAT’S YOUR TAKE ON THIS SCENE?
The mental health consultant, Ms. Raven, noticed Gabrielle’s lack of affect and asked to meet with 

her teacher and parents. She shared her observations 

and asked whether these were consistent with the 

observations at home and school. Ms. Raven also then 

recommended that Gabrielle see her pediatrician 

to rule out any health problems. At a followup meeting, after the doctor found no health 

problems, Ms. Raven designed a sequenced plan 

to engage Gabrielle in classroom activities. She 

suggested that the teacher pair Gabrielle with another 

gentle child around a preferred activity, as a place to start. They 

agreed that the teacher would regularly observe Gabrielle for any 

progress and report back to Ms. Raven and Gabrielle’s parents. 

Through the consultation process, the teachers and parents were 

coached to observe, offer specific support, and follow up with one 

another to monitor Gabrielle’s mood and progress.

TAKE 2

SCENE 6
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MODULE 1: Valuing and Understanding Mental Health Consultation 39

HANDOUT 1-6 

Steps in Problem Solving and Capacity Building

ASSESSMENT

 Joint examination of the issues between the consultant and staff 

 Consideration of factors including characteristics of the child and family, 

staff, and the environment

 Broad assessment including all relevant factors and complexities of the 

concern or circumstance

 Clarification and problem definition

 Sufficient time to assess and clarify goals

 Family role and involvement

SELECTION OF INTERVENTIONS

 Joint discussion of intervention options

 Selection of the most effective and most easily implementable

 Considerations given to time, staff availability, “fit,” impact, duration, and 

expected results

 Cultural sensitivity and appropriateness

 Family role and involvement

 Final decision by program staff

IMPLEMENTATION OF THE PLAN

 Understanding and skills of program staff 

 Opportunities for support and frequent contact between program staff and 

the consultant

 Observations of impact and effect

 Family role and involvement

 Evaluation of effectiveness and outcomes

A Training Guide for the Early Childhood Services Community

MODULE 1: Valuing and Understanding Mental Health Consultation 41

HANDOUT 1-7 

Reminders About Communication

IN MY PROGRAM:

 Planned, regular team meetings take place between the mental health 

consultant and staff

 The mental health consultant meets with the program director

 The team reviews and evaluates mental health recommendations and 

strategies

 All children in each group or classroom are discussed

 We understand issues about confidentiality

 We meet with family members at times convenient to them

43

A Training Guide for the Early Childhood Services Community

OVERHEAD 1-1

Definition of Mental Health Consultation

MENTAL HEALTH CONSULTATION

A problem-solving and capacity-building intervention 

implemented within a collaborative relationship between a 

professional consultant with mental health expertise and one 

or more individuals with other areas of expertise or parenting 

responsibilities.

CHILD- AND FAMILY-CENTERED CONSULTATION

 Most traditional form of mental health consultation

 Addresses a child’s behavior and functioning through 

the collaborative development of a plan that can be 

implemented by the staff and family members interacting 

with the child

PROGRAMMATIC CONSULTATION

 Focuses on improving the overall quality of the program

 Assists the program in solving a specific issue that affects 

more than one child, staff member, and family

 Improves the capacity of the program to respond to the 

needs of all young children in their care

45

A Training Guide for the Early Childhood Services Community

OVERHEAD 1-2

Other Capacity-Building Interventions

TEACHING AND TRAINING

A traditional teacher or trainer chooses the content and format 

of the information to be conveyed. By contrast, a mental health 

consultant to an early childhood program provides information 

on topics specifically requested by program staff. Teaching 

is commonly used as a tool in the consultative process, but 

much of that teaching is informal and involves various forms 

of modeling, rather than presentations in a typical classroom 

format.

CLINICAL SUPERVISION

Both clinical supervisors and mental health consultants help 

program staff improve their skills to understand and accomplish 

their work and to increase their capacity to master future 

problems. A supervisory relationship implies administrative 

and legal accountability of staff members for following the 

supervisor’s recommendations, but in a consulting relationship, 

staff take responsibility for deciding whether or not to implement 

the consultant’s recommendations.

PSYCHOTHERAPY

In therapy, as in consultation, a client seeks assistance (or 

treatment) to solve a problem. Both therapeutic and consultative 

relationships are characterized by genuineness and trust, and the 

goal of each is to foster understanding in the client. Therapists 

focus completely on personal, psychological problems. 

Consultants may look at the factors in a staff member’s 

experience that contribute to her subjective perception of 

the situation. Sometimes, consultants may suggest that a staff 

member seek therapeutic services; at other times, the actual 

consultation can have coincidental therapeutic results. But 

consultation is mainly focused on improving the effectiveness of 

the individual staff member in his work.

47

A Training Guide for the Early Childhood Services Community

SCENE 1

TAKE 1

OVERHEAD 1-3

INSTRUCTIONS

 Read the SCENE on the front of the 

card or envelope

 Discuss your TAKE on the scene 

and decide:

 What type of consultation is 

 indicated?

 What might be the role of the 

 Mental Health Consultant?

 Read TAKE 2 and check your 

thinking

49

A Training Guide for the Early Childhood Services Community

OVERHEAD 1-4A

continued

Steps in Problem Solving and 

Capacity Building

ASSESSMENT

 Joint examination of the issues between the consultant and 

staff

 Consideration of factors including characteristics of the 

child and family, staff, and the environment

 Broad assessment including all relevant factors and 

complexities of the concern or circumstance

 Clarification and problem definition

 Sufficient time to assess and clarify goals

 Family role and involvement

SELECTION OF INTERVENTIONS

 Joint discussion of intervention options

 Selection of the most effective and most easily 

implementable

 Considerations given to time, staff availability “fit,” impact, 

duration, and expected results

 Cultural sensitivity and appropriateness

 Family role and involvement

 Final decision by program staff

51

A Training Guide for the Early Childhood Services Community

OVERHEAD 1-4B

Steps in Problem Solving and 

Capacity Building (Continued)

IMPLEMENTATION OF THE PLAN

 Understanding and skills of program staff

 Opportunities for support and frequent contact between 

program staff and the consultant

 Observations of impact and effect

 Family role and involvement

 Evaluation of effectiveness and outcomes

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 53

MODULE 2 

The Effective Mental Health Consultant

GOAL 2 Participants will clarify the essential knowledge, skills, roles, 

and responsibilities of the mental health consultant and the 

administrative process for implementing a consultation model 

within an early childhood setting.

OBJECTIVES

After completing Module 2, participants will be able to:

n Identify expert knowledge and skills of an effective early childhood mental 

health consultant.

n Define roles and responsibilities that a mental health consultant may have 

in an early childhood mental health consultation model.

n Describe the administrative process for mental health consultation.

KEY CONCEPTS

n Early childhood mental health consultants working with infants, young 

children, and families are licensed or certified within their state.

n Effective early childhood mental health consultants have particular skills 

and expertise relevant to working with young children, parents, families, 

and program staff.

n Specialized knowledge, expertise, or experience in certain content areas 

depends on the community and families served by the program and the 

consultant.

n A consultant has interpersonal skills that move staff and families to action. 

These skills are critical for working within a program and for building 

alliances with families.

n A match between the early childhood program and the mental health 

consultant in philosophy, values, and approach is critical to a successful 

consulting relationship and partnership.

n The roles and responsibilities of the early childhood mental health 

consultant are determined by the match between the program’s needs and 

the consultant’s skills.

n The administrative processes for mental health consultation include 

selection of a consultant to match program needs and approach as well as 

entry, contracting, termination, and evaluation processes.
54 MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant

ACTIVITY 2-1

BACKGROUND INFORMATION: A MINI-LECTURE

Although States license diverse types of professionals as mental health providers, 

the most commonly licensed specialties are child psychiatry, psychology, clinical 

social work, marriage and family therapy, counseling, and psychiatric nursing. 

Mental health consultants who interact with staff, families, and young children 

should be State-licensed or certified mental health professionals.

The licensed or certified professional as the mental health consultant brings 

skills, experience, and areas of expertise to individual families, staff, and the 

program setting. Early childhood programs face the challenges of (1) knowing 

what a consultation has to offer, (2) knowing what they want from a consultant, 

(3) determining what philosophy and approach match their needs, and (4) 

determining how they can use the consultant’s services effectively. Programs also 

face the challenge of accessing resources and making changes within their own 

program to design and implement a consultation model. Mental health providers 

have their own challenges in determining the best way to apply their clinical skills 

in the context of an early childhood setting and ways to provide services in a 

consultant role.

 IMAGINE AND CREATE... (30 Minutes)

Purpose

In this activity, participants will begin to identify desirable qualities and traits of an 

early childhood mental health consultant.

Preparation

Arrange for: Colored paper, markers, scissors, crayons, glue, other craft 

materials as desired, masking tape, and a large sheet of poster 

paper

Duplicate: Handouts:

Planning Guide 2: Ideas to Take Home

Handout 1: Consultant Skills and Areas of Expertise

Handout 2: Consultant Roles and Responsibilities

Overheads:

Overhead 1: Consultant Skills and Areas of Expertise

Overhead 2: Consultant Roles and Responsibilities

Make: On the large sheet of poster paper, draw the outline of a human 

figure (the mental health consultant)
A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 55

Leading the Activity

1. Refer to Planning Guide 2 for note taking throughout this module.

2. Tell the participants that they will be using their imagination and creativity 

to identify desirable qualities and traits of an early childhood mental health 

consultant.

3. Ask the participants to take a minute to think about a quality or trait that 

they believe is the most important for a consultant to have working in early 

childhood mental health.

4. Encourage participants to use the paper, markers, and other craft materials to 

create a representation of that quality or trait.

5. Ask each participant to tape his “trait” to the previously drawn figure of the 

mental health consultant that you have prepared (see p. 54 preparation) to 

identify the quality or trait, and to explain why it is so important.

Summing Up

Summarize some key points of participants as they are added to the illustration of 

the mental health consultant. List some qualities or traits emphasizing the ones that 

were repeated as perhaps the most valued. Emphasize that programs should seek 

individuals with these traits as they contract with a mental health consultant. Using 

Overheads 1: Consultant Skills and Areas of Expertise and 2: Consultant 

Roles and Responsibilities and the corresponding Handouts 1 and 2, review 

desirable skills and attributes for consultants as well as real knowledge, skills, 

roles, responsibilities, and activities for the consultant within the context of an 

early childhood setting. Reflect on examples under each type of consultation from 

Module 1. For example:

n Scene 1 with Dr. Stuart required a consultant who had knowledge 

of child development and specifically grief and loss; possessed good 

communication, facilitation, and group work skills; and could observe 

classroom interaction, meet with staff, and offer therapeutic group work in 

the classroom environment.

n Scene 6 with Ms. Raven required a consultant who had knowledge of 

child development; possessed good observation skills; could take a holistic 

approach to behavioral concerns; and could engage staff and parents in a 

team approach to intervention that involved systematic support and 

follow-up.

Suggest that the group keep these ideas in mind for the next activity. It is 

important, however, to realize that no consultant will possess all the skills and 

attributes mentioned. They will need to consider their program’s philosophy, set 

priorities for their needs, and consider training options for consultants to obtain 

the best possible results from mental health consultation.
56 MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant

 ACTIVITY 2-2 WANTED: THE PERFECT MENTAL HEALTH 

 CONSULTANT (60 Minutes)

Purpose

In this activity, participants will focus on understanding the importance of a 

philosophical match between an early childhood services program and the mental 

health consultant. This activity will help participants understand the important 

aspects of philosophy and approach, program needs, and a consultant’s expert 

knowledge and skills in defining the roles and responsibilities of a mental health 

consultant in an early childhood mental health consultation model.

Preparation

Arrange for: Philosophy Cards (1 set per table group or 4–6 participants)

Flip chart paper and markers, enough for each table

Masking tape

Duplicate: Copy philosophy statements onto card stock

Handout:

Handout 3: Philosophy Cards

Overhead:

Overhead 3: Wanted: The Perfect Mental Health Consultant

Make: Create sets of Philosophy Cards by cutting copies apart on dotted 

lines and binding sets with rubber bands.

Option 1: Additional cards can be created to individualize content 

or context for particular audiences.

Option 2: For groups of fewer than 25, cards can be divided so 

that no table receives the same selections and each group chooses 

a different philosophy.

Leading the Activity

1. Introduce the activity and describe its purpose to the participants. Explain 

that the design of this activity is to have participants (1) assume the role of an 

early childhood program team and identify their program’s philosophy about 

mental health; (2) discuss their philosophy’s influence on their mental health 

consultant needs; and (3) identify the specific knowledge, skills, services, and 

desirable attributes of the “perfect mental health consultant.”

2. Set the stage by telling the participants that each table team must imagine 

being an early childhood program in search of a mental health consultant. 

Explain that this activity has two steps. In the first part of the activity, they 

must determine their program philosophy about mental health services to 

young children and families. In the second part of the activity, they will write 

a newspaper Want Ad for the perfect mental health consultant to fit within 

their philosophical framework.
A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 57

Part 1:

1. Distribute the packets of Philosophy Cards (Handout 3: Philosophy 

Cards) and request that someone at each table spread them face down on 

the table.

2. Explain that each card represents diverse—and sometimes extreme—beliefs, 

values, and philosophies about mental health. State that these thoughts are 

drawn from the mental health and child-serving community, to stimulate 

discussion.

3. Have each team member select two cards and keep the ONE card with 

which they can most agree. (Participants can select another card if neither is 

agreeable.) Now they each have an individual philosophy.

4. Ask each team member to read her individual philosophy to her group.

5. Have the group reach consensus or agreement on ONE card or philosophy 

for their early childhood program. Once this step is completed, they are 

ready for Part 2.

Part 2:

1. Explain that, on the basis of their program philosophy, they will spend the 

next 20–30 minutes creating a newspaper Want Ad for the perfect mental 

health consultant.

2. Using Overhead 3, Wanted: The Perfect Mental Health Consultant,

instruct the groups to discuss and identify the knowledge, skills, expected 

services, and any special attributes they would like their job candidate to 

possess. Explain that they will transfer this information onto the flip chart 

paper for reporting out. Suggest the format outlined on the overhead.

3. Have each group place its flip chart paper on the wall and identify 

someone to report out to the large group.

4. As they report out, have them read their Philosophy card first, and then 

read the Want Ad.

5. After the first group reports out, ask the participants to describe how their 

ad reflects their program philosophy. Are there any particular consultant 

qualities, such as special knowledge, skills, and attributes, unique to their 

program approach?

6. As each subsequent group reports out, ask the participants if they notice 

any differences between groups. Follow up with your observations of 

differences between Want Ads that reflect the differences in philosophy.

For Example:

n If the philosophy is that behavioral management is the basis for early 

childhood mental health intervention, the consultant should have behavior 

management skills.
58 MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant

ACTIVITY 2-3

n If the philosophy is that teamwork is key to a supportive environment for 

children, the consultant should have expertise in organizational dynamics 

and team building.

Summing Up

Emphasize the following points:

n Statements on the cards represent beliefs and philosophies with which 

mental health and early childhood providers struggle everyday.

n Each early childhood program and mental health consultant comes with his 

own philosophy and approach to early childhood mental health services.

n Reaching team or program consensus on a mental health philosophy or 

approach can be challenging but is essential.

n Choosing a philosophy that is too narrow can limit the range and scope of 

services available to children, families, and staff.

n A program’s philosophy and approach will greatly influence the match 

between the program and the consultant, as well as the preferred 

knowledge, skills, roles, and responsibilities of the consultant.

n Certain core knowledge and skills are essential for early childhood mental 

health consultants. Other areas of content expertise may be desirable, 

depending on the needs of the early childhood program or the community 

they serve. Remind participants to write notes, ideas, and next steps on 

their Planning Guide 2.

 ENGAGING THE MENTAL HEALTH 

 CONSULTANT (20 Minutes)

Purpose

In this activity, participants will learn the essential administrative process for 

engaging a mental health consultant. The steps in the process represent the way 

that consultation “unfolds” within an agency or service setting. The administrative 

process may be unique in each particular setting but comprises key elements or 

“pieces of the puzzle.”

Preparation

Arrange for: Envelopes for puzzle pieces—2 puzzles per table

Easel, chart paper, markers, and masking tape

Overhead projector and screen

Duplicate: Oversized pages of Administrative Process for Engaging a 

Consultant puzzle copied onto cover stock (1 for every 2 or 

3 people or 2 per table)
A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 59

Handouts:

Handout 4: Administrative Process for Engaging a Consultant

Handout 5: Interviewing and Reaching Agreement

Overhead:

Overhead 4: Administrative Process for Engaging a Consultant

Make: Cut out puzzle pieces, detaching each structure’s interlocking 

definition and the 4 separate pieces of the puzzle (end up with 

8 pieces for each puzzle).

Put each complete set of puzzle pieces into 1 envelope per table.

Leading the Activity

1. Introduce the activity and review its purpose with the participants. Point 

out that these elements are administrative steps for including mental health 

consultation in program services as a component of an early childhood 

program.

2. Distribute 1 envelope to each table.

3. Explain that each group has all the pieces to the puzzle inside the envelope.

4. Give instructions that it takes 2 steps to get the big picture of the puzzle. 

First, the group must connect the puzzle pieces that represent each structure 

and its definition. Then, they must connect those combined pieces together to 

produce the whole puzzle.

5. Explain that they have 5 minutes to do the puzzle. The first group of 

participants to finish the puzzle should raise their hands.

6. Have the first group to finish report out the first piece of the puzzle. As 

they provide a brief definition, add more material by using Overhead 4: 

Administrative Process for Engaging a Consultant as a guide (also see 

the Discussion Guide that follows). Ask for volunteers for each remaining 

piece to further engage the whole group.

7. Distribute Handout 4: Administrative Process for Engaging a Consultant

to all participants.

Discussion Guide

Use the following points to guide the large-group discussion:

n In discussing the entry stage of the consultant into the program, emphasize 

the importance of matching the consultant to the program. Remind the 

group that in addition to matching qualifications, skills, and experience 

to program needs, it is important to match the philosophy or approach. 

Other considerations include race, class, language, and other program or 

consultant attributes. Exploring shared or varying beliefs and values around 

mental health, young children, and support to families is a critical part of 

building trust and beginning a collaborative relationship. Briefly refer to 
60 MODULE 2: The Effective Mental Health Consultant

60 

the “values exercise” in Activity 1-1. Emphasize that once this common 

ground is established, the group can discuss the roles and responsibilities 

more specifically. Distribute Handout 5: Interviewing and Reaching 

Agreement.

n In discussing the contracting stage of the collaboration, remind participants 

that this is the stage when the consultant and the agency negotiate and 

reach agreement on roles, responsibilities, activities, scope of work, and 

financial arrangements. Review the specific topics that should be covered 

during this phase of the collaboration, using Handout 5: Interviewing 

and Reaching Agreement. Remind participants that a written contract 

representing a clear understanding and agreement by both parties and the 

responsibilities of each party is recommended.

n In discussing the evaluation stage of the collaboration, review the two types 

of evaluation: formative and summative:

Formative:

n “Nuts and bolts”

n “What we are doing”

n “Describing our activity”

Summative:

n “What happened”

n “Did we make a difference?”

n “Did we change any behavior? policy? procedure?”

Remind participants that evaluation assists programs in making decisions 

by answering such key questions as, “How is consultation being used?”, 

“Is this consultation helpful and useful?”, “How is consultation making a 

difference and for whom?”, and “What aspects of consultation do we want 

to do differently?”

n In discussing the termination stage of the collaboration, remind participants 

that termination should be part of the early discussion with the potential 

consultant. Termination may be either based on the consultant’s success 

in building the skills and capacity of staff to work effectively on their own 

or related to dissatisfaction with the consultant’s services, job performance 

difficulties, or other violations of the contractual terms. Point out that the 

process for termination should be clear, should include appropriate staff, 

and should be binding for both parties.

Summing Up

Summarize the key points of the activity and the discussion, reviewing the pieces 

of the puzzle. Remind the participants that this session has described the process 

of engaging a mental health consultant and the relevant administrative structures. 

These administrative structures provide the framework for the consultative 

relationship. Encourage participants to take a few minutes to jot down some notes, 

ideas, and next steps back home on their Planning Guide 2 for this module.
A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 61

Planning Guide 2:

Ideas to Take Home

While the information is still fresh, jot down some notes and ideas to take back home as next 

steps in planning for mental health consultation:

Good Information:

Great Ideas:

Next Steps Back Home:

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 63

continued

HANDOUT 2-1 

Consultant Skills and Areas of Expertise

STATE LICENSURE OR CERTIFICATION REQUIREMENTS

KNOWLEDGE

n Child developmental milestones

n Normal growth and development of young children

n Atypical behavior in infants, toddlers, and preschoolers

n Underlying concepts of socio-emotional development such as attachment, 

separation, and relationship development

n Basic medical and genetics information

n Understanding of cultural differences (cultural competence)

n Treatment alternatives, including behavioral intervention

n Family systems

n Early childhood, child care, family support, and early intervention systems, 

both public and private

n Adult learning principles

SKILLS AND EXPERIENCE

n Ability to integrate mental health activities and philosophies into group 

settings

n Observation, listening, interviewing, and assessment

n Ability to work with adults

n Sensitivity to community’s attitudes and strengths

n Cultural competence

n Ability to recognize diverse perspectives of program staff and families

n Communication facilitation

n Interventions, including behavioral interventions, working with families, 

and other treatments
64 MODULE 2: The Effective Mental Health Consultant

HANDOUT 2-1 (Continued)

SPECIALIZED EXPERTISE

n Separation and loss

n Substance abuse

n Maternal depression

n Adolescent mothers

n Abuse and neglect issues

n Childhood mental health disorders

n Issues related to prematurity and low birth-weight infants

n Failure-to-thrive infants

n Children with aggressive behavior

n Learning disabilities and speech and language difficulties

n Infants, toddlers, and preschoolers with developmental disabilities

n Working with fathers
A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 65

HANDOUT 2-2 

Consultant Roles and Responsibilities

n Help staff in a collaborative manner to understand and problem solve when 

faced with challenging child behaviors, both in and out of the classroom

n Provide a receptive atmosphere to explore cultural differences and 

workplace conflicts

n Overcome resistance to mental health services by being a regular, 

reassuring presence at the classroom, program, or agency

n Provide staff with specialized workshops, training, support groups, and 

team-building exercises

n Offer a mental health and wellness perspective to participants in case 

discussion meetings

n Support staff in discussing their own stressors, concerns, and personal 

problems and the ways in which these factors affect their work

n Provide immediate and follow-up crisis intervention when crises occur

n Consult closely with parents and families (e.g., through workshops, crisis 

intervention, family therapy, and parent groups)

n Refer a child or families for follow-up or more intensive services

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 67

HANDOUT 2-3 PHILOSOPHY CARDS

The most important role of the mental 

health consultant is to support staff.

Teamwork and the team approach 

maximize the impact of any mental 

health intervention.

Programs should consider adopting 

behavior management strategies that 

all staff learn and apply 

throughout the program.

Families with mental health problems 

may pass the problems on to the next 

generation no matter what 

the staff do.

Crises occur when families are out 

of control and not caring about 

things that they should.

Diagnosis of a mental disorder or 

social/emotional disability helps 

in the understanding of a child’s 

difficulties.

One primary focus of mental health 

is mental well-being.

Programs should have the option 

and a procedure for determining 

whether a child’s behavior should 

lead to removal from the program.

When program and staff meetings 

are held about a family, all family 

members should be present and 

encouraged to be participants.

Program staff should reach out 

to troubled families, even when they 

are not asking for help and even 

when they resist efforts of help.

continued

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 69

The most important role of 

the mental health consultant 

is to support families.

Behavioral intervention in 

the classroom is a powerful support 

to a child.

Program staff should recognize 

and remember the impact of

limitations on a child’s behavior.

Mental wellness is a central purpose 

of an early childhood program.

Mental health is a minor part of an 

early childhood program.

Staff members bring their own issues 

to the relationships they have with 

children and families.

Young children learn best about 

getting along with others through 

experience and one-on-one 

caregiver guidance.

Families with immediate daily living 

demands and difficulties cannot focus 

on feelings and relationships.

Behavior management is the 

primary mental health intervention 

needed for young children.

Mental health consultants must 

be open to learning from families.

HANDOUT 2-3 PHILOSOPHY CARDS

continued

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 71

Families are resistant to talking 

about feelings and relationships.

Without parental involvement and 

family intervention, work with 

the child on behavioral problems 

is less effective.

Mental disabilities and 

diagnoses should not be used

 to label a young child.

When a number of agencies are 

involved with a family, it’s a good 

idea to meet and work together.

Asking for help is a sign of strength 

in staff and families.

Most parents known to early 

childhood programs need 

counseling.

Early intervention minimizes or 

prevents the development of more 

serious emotional, social, and 

academic problems.

Therapy in the classroom singles 

out children and interrupts the 

daily routine.

Crises are part of any family’s life.

Young children can learn about 

getting along with others through 

structured curricula.

HANDOUT 2-3 PHILOSOPHY CARDS

continued

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MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 73

HANDOUT 2-3 PHILOSOPHY CARDS

Mental health services apply only 

to those individuals with social, 

emotional, behavioral, or

addiction problems.

Mental health and challenging 

behaviors are major concerns in 

early childhood programs.

Child rearing is based on culture.

Child care programs are a 

“dumping ground” for children with 

behavioral problems whose parents 

do not know what else to do.

The most important role of the 

mental health consultant is to 

support children.

Discipline and child-rearing 

practices should be universal.

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 75

HANDOUT 2-4 

Administrative Process for Engaging a Consultant

n Explore match between program needs and 

consultant skills

n Exchange information

n Define goals of consultation

n Delineate role and relationship to administration

n Identify continuous feedback loop

n Introduce formally to staff

n Provide orientation to staff about roles and 

responsibilities

n Define nature of consultation

n Reach consensus about consultant’s roles and 

responsibilities

n Negotiate agreement between consultant and 

organization

n Agree on financial arrangements

n Reach clear understanding and agree on 

contractual terms

n Document agreement

n Revisit goals of consultation

n Match evaluation strategies to goals and 

community

n Use continuous feedback loop including all key 

players (Formative)

n Assess overall effectiveness and performance 

(Summative)

n Communicate results

n Observe staff’s autonomous skill application

n Withdraw consultant’s active support

n Validate success and problem resolution

n Discuss impending departure

continued

77

A Training Guide for the Early Childhood Services Community

n Explore match between program needs and 

consultant skills

n Exchange informationn Define goals of consultationn Delineate role and relationship to administrationn Identify continuous feedback loopn Introduce formally to staffn Provide orientation to staff about roles and responsibilities

n Define nature of consultationn Reach consensus about consultant’s roles and 

responsibilities

n Negotiate agreement between consultant and 

organization

n Agree on financial arrangementsn Reach clear understanding and contractual termsn Document agreement

HANDOUT 2-4 (Continued)

continued

79

A Training Guide for the Early Childhood Services Community

n Revisit goals of consultationn Match evaluation strategies to goals and communityn Use continuous feedback loop including all key players 

(Formative)

n Assess overall effectiveness and performance (Summative)n Communicate results

n Observe staff’s autonomous skill applicationn Withdraw consultant’s active supportn Validate success and problem resolutionn Discuss impending departure

HANDOUT 2-4 (Continued)

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MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 81

continued

HANDOUT 2-5 

Interviewing and Reaching Agreement

n Do the consultants have the skills to meet the needs of your agency?

n Is their general philosophy of service consistent with your program 

philosophy?

n Do they have a background in, and experience working with, children 

from birth to 5 or with expectant mothers? Was it a supervised 

internship? Was it paid employment?

n Do they have an educational background in normal development 

(especially courses in child development), developmental problems, 

and psychopathology (such as abnormal psychology and abnormal 

behavior)?

n Do they have the skills to identify developmental problems, emotional 

and mental disorders, or family problems?

n Are they as adept in identifying strengths as they are in identifying needs?

n Are they comfortable with a “wellness approach” that focuses on 

preventing problems or addressing minor problems before they get 

out of hand?

n Are they willing to learn from parents?

n Are they willing to learn from children?

n Are they willing to learn from staff?

n Are they aware of and sensitive to cultural differences, including 

low-income, racial, and ethnic factors?

n Do they possess language skills that match those of the community?

n Do they have good interpersonal skills?

n How comfortable are you with the individuals in general? Do they 

seem as if they can get along well with staff and with parents?
82 MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant

NEGOTIATION CONSIDERATIONS

n Be clear about job expectations:

n How many hours a week are expected?

n What are the job responsibilities?

n Does the work include parent meetings, consultation with staff, 

observation, direct interaction with children, or other responsibilities?

n What documentation is required?

n What other meetings might be required?

n Ensure that the consultants understand the chain of authority within your 

agency. Clarify how the consultants will be introduced to staff and expected 

to interact with them.

n Also ensure that the consultants understand the agency policies that would 

impact their work within the agency and with staff, children, and families.

n Try to have the consultants on site frequently so that parents and staff are 

familiar and comfortable with them.

n Will the professional provide the services directly or will a supervisee 

actually deliver the services? If a supervisee delivers the services, describe 

the nature and frequency of the supervision. Will the nature and frequency 

of supervision be adequate to ensure good quality services?

n How much travel is involved? Consultants, like employees, typically pay 

for their travel to the worksite. However, some consultants may want to get 

paid for travel between worksites on the same day.

n Are expenses (travel, photocopying, and others) involved? If so, are they 

reimbursed?

n How will the consultants be paid? What are the customary rates for the 

professionals with whom you are negotiating and what is the flexibility?

HANDOUT 2-5 (Continued)
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MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 83

OVERHEAD 2-1A

Consultant Skills and Areas of Expertise

STATE LICENSURE OR CERTIFICATION REQUIREMENTS

KNOWLEDGE

 Child developmental milestones

 Normal growth and development of young children

 Atypical behavior in infants, toddlers, and preschoolers

 Underlying concepts of socio-emotional development such as 

attachment, separation, and relationship development

 Basic medical and genetics information

 Understanding of cultural differences (cultural competence)

 Treatment alternatives, including behavioral intervention

 Family systems

 Early childhood, child care, family support, and early intervention 

systems, both public and private

 Adult learning principles

SKILLS AND EXPERIENCE

 Ability to integrate mental health activities and philosophies into group 

settings

 Observation, listening, interviewing, and assessment

 Ability to work with adults

 Sensitivity to community’s attitudes and strengths

 Cultural competence

 Ability to recognize diverse perspectives of program staff and families

 Communication facilitation

 Interventions, including behavioral interventions, working with families, 

and other treatments

continued

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MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 85

Consultant Skills and Areas of Expertise (Continued)

SPECIALIZED EXPERTISE

 Separation and loss

 Substance abuse

 Maternal depression

 Adolescent mothers

 Abuse and neglect issues

 Childhood mental health disorders

 Issues related to prematurity and low birth-weight infants

 Failure-to-thrive infants

 Children with aggressive behavior

 Learning disabilities and speech and language difficulties

 Infants, toddlers, and preschoolers with developmental 

 Working with fathers

OVERHEAD 2-1B

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MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 87

Consultant Roles and Responsibilities

 Help staff in a collaborative manner to understand and problem solve 

when faced with challenging child behaviors, both in and out of the 

classroom

 Provide a receptive atmosphere to explore cultural differences and 

workplace conflicts

 Overcome resistance to mental health services by being a regular, 

reassuring presence at the classroom, program, or agency

 Provide staff with specialized workshops, training, support groups, and 

team-building exercises

 Offer a mental health and wellness perspective to participants in case 

discussion meetings

 Support staff in discussing their own stressors, concerns, and personal 

problems and the ways in which these factors affect their work

 Provide immediate and follow-up crisis intervention when crises occur

 Consult closely with parents and families (e.g., through workshops, crisis 

intervention, family therapy, and parent groups)

 Refer a child or families for follow-up or more intensive services

OVERHEAD 2-2

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MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 89

OVERHEAD 2-3

W•A•N•T•E•D

The Perfect Mental Health Consultant

 Select your team’s “philosophy” about mental health

 Consider the implications for who would be the “perfect” 

consultant

 Write a Want Ad that includes information about:

n Knowledge + experience desired

n Skills required

n Services expected

n Other attributes preferred

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MODULE 1: MODULE 2: Valuing and Understanding Mental Health Consultation The Effective Mental Health Consultant 91

Administrative Process for Engaging a Consultant

ENTRY n Explore match between program needs and consultant skills

n Exchange information

n Define goals of consultation

n Delineate role and relationship to administration

n Identify continuous feedback loop

n Introduce formally to staff

n Provide orientation to staff about roles and responsibilities

CONTRACTING n Define nature of consultation

n Reach consensus about consultant’s roles and 

responsibilities

n Negotiate agreement between consultant and organization

n Agree on financial arrangements

n Reach clear understanding and agree on contractual terms

n Document agreement

EVALUATION n Revisit goals of consultation

n Match evaluation strategies to goals and community

n Use continuous feedback loop including all key players 

(Formative)

n Assess overall effectiveness and performance (Summative)

n Communicate results

TERMINATION n Observe staff’s autonomous skill application

n Withdraw consultant’s active support

n Validate success and problem resolution

n Discuss impending departure

OVERHEAD 2-4

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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 93

MODULE 3 

The Importance of a Collaborative Relationship

GOAL 3 Participants will understand the importance of collaborative 

relationships in effective mental health consultation.

OBJECTIVES

After completing Module 3, participants will be able to:

n Identify the principles that provide the framework for collaborative 

relationships.

n Identify where key relationships that build effective mental health 

consultation develop: child and family, child care setting, and community.

n Identify the roles that race, culture, sex, gender, and class play in 

influencing relationships.

KEY CONCEPTS

n Collaborative relationships are built on respect, sensitivity, commitment to 

change, shared goals and decision making, and open communication.

n Professional perspectives and experiences that each partner brings to the 

consultation process help build trust and positive working relationships.

n Cultural diversity appropriate to each situation and achieving cultural 

competency is a critical requirement of the collaborative consultation 

process.

BACKGROUND INFORMATION: A MINI-LECTURE

In the consultation process, two or more professionals with different areas of 

expertise come together to solve problems, usually more effectively than if just 

one works alone to tackle the problem. The mental health consultant and early 

childhood staff are viewed as experts in their own fields. The consultant has no 

authority over the early childhood staff, who are free to accept or reject any of the 

consultant’s suggestions.

In consultation, a productive working relationship is not taken for granted; rather, 

it develops over time. Strong personal relationships enable a consultant and staff 

to establish the trust and mutual respect essential to “hearing” each other and 

being able to discuss issues despite differences of opinion. For more information, 

see pages 11 and 12 of Volume 1, Early Childhood Mental Health Consultation.
94 MODULE 3: The Importance of a Collaborative Relationship

 WHAT DOES COLLABORATION MEAN? 

 (WARM-UP) (15 Minutes)

Purpose

In this workshop activity, participants will experience the importance of 

clear communication and the variety of ways that problems can be solved 

collaboratively.

Preparation

Arrange for: Easel, chart paper, markers, and masking tape

Pieces of string or ribbon cut into 10-inch lengths

Pen or pencil for each pair

Overhead projector and screen

Duplicate: Handouts:

Planning Guide 3: Ideas to Take Home

Handout 1: Key Elements of Partnership

Overhead:

Overhead 1: Key Elements of Partnership

Leading the Activity

1. Refer to Planning Guide 3: Ideas to Take Home for participants to 

continue their note taking and planning process.

2. Ask the participants to divide into pairs.

3. Give each pair a piece of string or ribbon and a pen or pencil.

4. Ask participant pairs to hold onto a single, shared pen or pencil, using one 

hand each.

5. Tell them that they can communicate with each other but must work as a 

team. Using their other hands, and working together, they should use the 

ribbon to tie a bow on the pen or pencil.

6. Give them 2 minutes to accomplish the task.

Discussion Guide

Discuss the experience with the group using the following key questions:

n How did you work together?

n What made you feel successful?

n What made you feel frustrated?

n Were both parties heard?

n Was this an equal partnership?

ACTIVITY 3-1
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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 95

n Was this a collaborative process?

n Did diversity or culture play a role in the outcome?

Summing Up

Ask the participants to brainstorm (use newsprint) the elements they think 

are critical for good partnerships (2 minutes). Then pass out Handout 1: Key 

Elements of Partnership and Overhead 1 with the same name. Reinforce the 

following general points that lead to a better understanding of the collaborative 

process:

n People approach problems differently.

n Clear communication is essential.

n Goals should be mutually developed.

n Developing a joint strategy leads to greater success.

n Avoid blaming and labeling.

n Avoid stereotypes.

n Everyone has different strengths to bring to the collaborative process.

 ESSENTIAL PRINCIPLES OF A COLLABORATIVE 

 RELATIONSHIP (30 Minutes)

Purpose

In this activity, participants will explore principles that contribute to the success of 

relationship-based work between the mental health consultant, staff, and parents.

Preparation

Arrange for: Overhead projector, screen, and overhead slide showing the 

5 principles or a flip chart with the 5 principles written in 

large print

Duplicate: Handouts:

Handout 2: Principles of a Consultative Relationship

Handout 3: Role-Play Cards

Overhead:

Overhead 2: Principles of a Consultative Relationship

ACTIVITY 3-2
96 MODULE 3: The Importance of a Collaborative Relationship

Leading the Activity

1. Explain that this activity will use brief role plays to focus on essential features 

that characterize early childhood mental health collaboration. The role 

plays are very short examples of effective and ineffective collaboration and 

are exaggerated to make specific points in a humorous way. These roleplay characterizations are out of context and do not provide full pictures 

of a situation. Several principles may apply and both positive and negative 

approaches may be illustrated. The discussion that follows each role play 

helps illustrate the many factors that influence successful mental health 

consultation.

2. Using Handout 2 and Overhead 2: Principles of a Consultative 

Relationship or a flip chart listing each principle, review the principles that 

provide the context for building a collaborative relationship. Read each one, 

telling participants that they will have a chance to see how these principles 

facilitate collaboration. However, when these principles are not adhered to, 

collaboration is much more difficult to achieve.

Principles:

n Respect for the person

n Sensitivity to context

n Commitment to evolving growth and change

n Mutuality of shared goals

n Open communication

3. Tell participants that the activity is a “fish bowl” where the group gets to 

watch the action and make a judgment about each role.

4. Choose 3 or 4 role plays for this activity.

5. Ask for volunteers to come up to the front one at a time to act out a 

situation.

6. Give each volunteer a card (Handout 3: Role-Play Cards) with a role to 

act out. Tell volunteers that all they have to do is read what is printed on the 

card. If no one volunteers, act out the first role and ask again for volunteers 

for the next role play.

7. Ask participants to watch the role play.

8. Ask participants to identify which principles are or are not being 

implemented. Elicit different perspectives; point out the complexity of the 

collaborative relationship.

Role 1 The mental health consultant says to the staff member, “Hello, I am 

Dr. Kay. I am your new mental health consultant, and I want to tell you 

some of the things I can do for you. For instance, I know that you do 

not have enough rules in your classroom and that is why the children 

are acting out. I will give you some rules to use.”
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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 97

Role 2 The staff member says to the mental health consultant, “We all agree 

that James is having trouble at school and at home and that his mom, 

Mrs. Smith, wants help. I don’t think you should go to his home on your 

own. I live near Mrs. Smith and know that the neighborhood is very 

dangerous, and I am concerned for your safety. Maybe I can pick up 

Mrs. Smith and bring her to the center, or we can go on the home visit 

together.”

Role 3 The mental health consultant says to the child care program director, 

“Based on conversations with the classroom teaching team, I think that 

staff in the bluebird group are feeling like failures because Tomika is so 

hard to manage. I will spend more time with them in the classroom to 

model some new behavior management techniques. I also know about 

a free evening workshop, ‘Teachers Avoiding Burnout: Strategies for 

Taking Care of Yourself,’ at the community college. Maybe I can call and 

get tickets so that your staff can attend the event.”

Role 4 The teacher says to the assistant teacher, “I don’t want that new mental 

health consultant in our classroom. I don’t quite understand how she can 

help. I asked her to help us stop Mica from crying all the time, but she 

said she is going to check out our daily schedule and transitions between 

activities. I’m not sure what that means—she seems to be blaming us 

instead of doing something to solve our problem.”

Role 5 The staff member says to the mental health consultant, “I am glad you 

asked me about Johnny, because what I am really concerned about is 

his not participating in class. He just doesn’t seem to have any friends. 

I think we need to figure out ways to get him to feel more comfortable 

in the group. What do you think we can work on first?”

Role 6 The program director says to the mental health consultant, “You can tell 

me what you observe in the classroom rather than talk directly with staff. 

I will convey the information to staff, because they really don’t have any 

free time to meet with you and because I want to hear your observations 

before staff do.”

Discussion Guide

n Share your own experiences about the complexity of collaboration, 

illustrating that sometimes the best intentions are not adequate for the 

situation.

n Ask participants to share any experiences they have had with mental health 

consultation. What has worked well and what has not worked well?

Summing Up

Drawing on points made in the discussion by the group, review each principle 

with a brief description of its definition (pages 11 and 12 of Early Childhood 

Mental Health Consultation):
98 MODULE 3: The Importance of a Collaborative Relationship

n Respect for the person. This principle implies an attitude of positive 

regard toward individuals, including recognition of both strengths and 

vulnerabilities.

n Sensitivity to context. The staff member and the consultant must 

understand each other as influencing and being influenced by their 

environment.

n Commitment to evolving growth and change. Consultants must be 

equally dedicated to promoting the development and mental health of both 

children and caregivers.

n Mutuality of shared goals. Sharing and communicating goals forms 

the basis for the consulting work. It is an ongoing process that occurs 

throughout the consultation.

n Open communication. The channels and process of communication must 

be clarified from the beginning of the consultation process. Communication 

must be regular, frequent, and consistent.

 THE ROLES OF CULTURE, RACE, SEX, GENDER,

 AND CLASS IN INFLUENCING RELATIONSHIPS

 (Total Time: 45 Minutes)

A. Your Own Culture (15 Minutes)

B. Diversity and Consultation (30 Minutes)

Purpose

In these activities, participants will explore the importance of culture as an 

influence on the collaborative process.

Preparation

Arrange for: Easel, chart paper, markers, and masking tape 

Overhead projector (if available)

Duplicate: Handouts:

Handout 4: The Cultural Iceberg

Handout 5: Vignette

Handout 6: Key Definitions

Overhead:

Overhead 3: The Cultural Iceberg

ACTIVITY 3-3
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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 99

Leading the Activity

Tell participants that this activity comprises 2 parts:

A. Your own culture

B. Diversity and consultation

A. YOUR OWN CULTURE

1. Ask participants the following questions:

a. When you were a young child and had a bad cold, how did your family 

or caregivers respond?

b. What do you do when your own children have colds?

2. Solicit answers and write key responses on a flip chart. Answers may include 

orange juice, hot tea, chicken soup, lots of clothing and covers, Vicks rub 

eaten or put on the chest, open windows, and closed windows.

3. Ask the group why there are so many different answers and whether some 

answers are better than others. Ask why the group was unaware of all these 

perspectives.

4. Use Overhead 3: The Cultural Iceberg of the iceberg diagram or draw an 

iceberg on flip chart paper with 1/3 above the “water” line and 2/3 below 

the line. This example will further illustrate how culture influences who we 

are, what we do, and what we value and believe. Distribute Handout 4: 

The Cultural Iceberg.

5. Ask participants to list the visible attributes of culture, and record their ideas 

(such as language, foods, skin color, gender, music, and dance) on the top 

part of the iceberg.

6. Ask participants to list attributes that are invisible and that go below the water 

line (such as values, attitudes, religion, health practices, child-rearing beliefs, 

patterns of superior or subordinate roles, and patterns of handling emotion).

Discussion Guide

Use the following points to guide the large-group discussion:

n Emphasize that we all have our own cultural beliefs and customs, based 

on our experiences. We often repeat what we saw as children because it is 

familiar or natural. As this exercise illustrates, there are many ways to show 

we “care,” and it is important that we be aware of the variety of practices 

and approaches that are considered correct and normative.
100 MODULE 3: The Importance of a Collaborative Relationship

n Remember to encourage participants to transition their discussion 

on the intrapersonal and interpersonal aspects of cultural beliefs and 

customs to the ways in which these aspects manifest in the professional 

area. Some examples include effective communication across cultures, 

quality assessments, and formulation of treatment plans and treatment 

interventions.

n Point out that the culturally competent consultant is familiar with how selfhelp and other concepts might manifest differently among various racial, 

ethnic, and cultural groups. The consultant acknowledges and respects 

the significant role assigned to any prominent caregiver (mother, father, 

extended family member, clergy, and community members). Additionally, 

the consultant must be informed about valued community resources and 

natural supports within majority and minority communities.

Summing Up

Emphasize the following points:

n Tell participants that we are all influenced in some way by our own 

experiences, culture, sex, belief system, and class.

n Culture is very powerful in determining who we are but is not always 

visible to others. As the culture iceberg illustrates, the majority of culture is 

out of conscious awareness.

n Denying cultural and belief differences can interfere with building authentic 

relationships. A willingness to examine these factors helps acknowledge 

both difference and common ground that can eventually lead to a warm 

and effective collaboration.

n Effective cross-cultural consultants have an awareness of their own personal 

values and beliefs, a well-developed awareness of their personal ways 

of both relating to others and showing care and respect, and the ability 

to adapt interventions appropriately to meet staff members’ and families’ 

needs.

B. DIVERSITY AND CONSULTATION

Background Information: A Mini-Lecture

To ensure cultural competence among consultants and to promote effective 

response to the mental health of diverse populations, consultants should obtain 

knowledge and skills in the following areas:

n Understanding of populations’ backgrounds

n Clinical issues (differences in symptom expression and nonverbal language) 

n Provision of appropriate treatment (use of culturally informed individuals 

and interpreters)

n Agency or provider role (personal biases)
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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 101

n Effective communication across cultures (listening and establishing rapport 

using socially and culturally appropriate conventions)

n Provision of quality assessments (using culturally appropriate instruments 

and other tools)

n Formation and implementation of quality care and treatment plans (using 

culturally appropriate community resources)

n Provision of quality treatment (using preferred language)

n Using one’s self-knowledge (recognizing one’s own limitations)

n Attitudes (demonstrating attitudes that indicate respect for diverse heritages)

Leading the Activity

1. Pass out Handout 5: Vignette and read the following vignette (point out 

that this is a real situation): Dr. Shannon, a Caucasian therapist beginning 

work as a consultant at a preschool program, met for the first time with 

an experienced Mexican American teacher to discuss the children he had 

observed. Historically reticent to share “her” children with outsiders, the 

teacher joined Dr. Shannon for a review of her class, all of whom lived 

in a poor neighborhood where violence and drug abuse were common. 

Dr. Shannon chose to address two children as his first concerns. He 

remarked that one well-liked, African American boy might develop gender 

identification problems because he wore a diamond earring in his left 

ear. He also expressed concern that a petite, doll-like Mexican American 

girl came to school adorned in a party dress, crinolines, and shoes with 

inch-high heels. He felt that these clothes were inappropriate for a school 

setting and that her parents might not understand what is developmentally 

appropriate attire.

2. Ask the participants to break into small groups.

3. Have each group choose a recorder and someone to report back to the 

larger group.

4. Ask each group to answer the following questions that are posted on a flip 

chart, provided on Handout 5, or shown on the overhead projector:

Questions:

a. Why do you think Dr. Shannon chose to focus on these issues?

b. What might the teacher feel in this situation?

c. What message might this convey to these children if the 

recommendation to deal with the appearance of each child moves 

forward?

d. Is the consultant being culturally sensitive?

e. What can be done to turn this situation into a learning opportunity that 

will lead to better consultation?
102 MODULE 3: The Importance of a Collaborative Relationship

5. After the groups finish deliberating, ask for answers to each question. 

Encourage discussion of different points of view.

Discussion Guide

As groups present the answers to the questions, ask them to look at the role of 

cultural empathy (the ability to understand cultural differences and appreciate the 

cultural perspective of others) and cultural knowledge (the willingness to learn 

about other cultures). Participants might say that the consultant should be fired. 

Point out that experienced early childhood mental health consultants are hard to 

find, that we all learn from our mistakes, and that in a consulting relationship, all 

parties have some responsibility to help one another learn and grow. Encourage 

the group to address the last question that asks how to turn this situation into an 

opportunity for growth and change. Ask the participants whether they have been 

in similar situations.

Summing Up

Summarize the activity by referring to the principles and pointing out that respect, 

sensitivity, commitment, and mutuality are critical to dealing effectively with 

cultural differences. Also make the following points:

n The success of collaboration ultimately relies on the personal relationships 

forged between consultants, staff, and families. Many variables, including 

race, culture, class, gender, and sex, impact those relationships. It is 

important to recognize and examine differences and commonalities to 

develop good relationships.

n Cultural understanding is part of an ongoing learning process. It starts with 

an open-minded approach to learning about oneself and others. A good 

way to begin the learning process is to ask others to share information 

about their culture.

n The attitude that we are all the same may have a negative impact on 

the consulting relationship and eventually have a stifling effect on the 

classroom, where children notice differences and want to address issues of 

race and culture.

n Consultants, staff, and parents can plan together to develop an atmosphere 

that is rich in promoting cultural diversity and competence. All aspects 

of the classroom curriculum, program policies and procedures, and open 

communication among children, staff, families, and consultants lead to 

better communication and mutual understanding.

Pass out Handout 6: Key Definitions for participants to use as a resource. 

Encourage participants to use the handout to further clarify the language and 

concepts of cultural diversity. Remind participants to write notes, ideas, and next 

steps on this module’s Planning Guide 3.
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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 103

Planning Guide 3:

Ideas to Take Home

While the information is still fresh, jot down some notes and ideas to take back home as next 

steps in planning for mental health consultation:

Good Information:

Great Ideas:

Next Steps Back Home:

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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 105

HANDOUT 3-1 

Key Elements of Partnership

n Mutual respect for skills

n Honest and clear communication

n Understanding and empathy

n Mutually agreed-upon goals

n Shared planning and decision making

n Exchange of resources

n Accessibility and responsiveness

n Joint evaluation process

n Absence of labeling and blame

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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 107

HANDOUT 3-2 

Principles of a Consultative Relationship

n Respect for the person.

This principle implies an attitude of positive regard toward individuals, 

including recognition of both strengths and vulnerabilities.

n Sensitivity to context.

The staff member and consultant must understand each other as influencing 

and being influenced by their environment.

n Commitment to evolving growth and change.

Consultants must be equally dedicated to promoting the development and 

mental health of both children and caregivers.

n Mutuality of shared goals.

Sharing and communicating goals forms the basis for the consulting work. 

It is an ongoing process that occurs throughout the consultation.

n Open communication.

The channels and process of communication must be clarified from the 

beginning of the consultation process. Communication must be regular, 

frequent, and consistent.

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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 109

HANDOUT 3-3 ROLE-PLAY CARDS

Role 1

The mental health consultant says to the staff member, “Hello, I 

am Dr. Kay. I am your new mental health consultant, and I want 

to tell you some of the things I can do for you. For instance, I 

know that you do not have enough rules in your classroom and 

that is why the children are acting out. I will give you some rules 

to use.”

Role 2

The staff member says to the mental health consultant, “We all 

agree that James is having trouble at school and at home and 

that his mom, Mrs. Smith, wants help. I don’t think you should 

go to his home on your own. I live near Mrs. Smith and know 

that the neighborhood is very dangerous, and I am concerned 

for your safety. Maybe I can pick up Mrs. Smith and bring her to 

the center, or we can go on the home visit together.”

Role 3

The mental health consultant says to the child care program 

director, “On the basis of conversations with the classroom 

teaching team, I think that staff in the bluebird group are feeling 

like failures because Tomika is so hard to manage. I will spend 

more time with them in the classroom to model some new 

behavior management techniques. I also know about a free 

evening workshop, ‘Teachers Avoiding Burnout: Strategies for 

Taking Care of Yourself,’ at the community college. Maybe I can 

call and get tickets so that your staff can attend the event.”

continued

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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 111

HANDOUT 3-3 ROLE-PLAY CARDS

Role 4

The teacher says to the assistant teacher, “I don’t want that 

new mental health consultant in our classroom. I don’t quite 

understand how she can help. I asked her to help us stop Mica 

from crying all the time, but she said she is going to check out 

our daily schedule and transitions between activities. I’m not 

sure what that means—she seems to be blaming us instead of 

doing something to solve our problem.”

Role 5

The staff member says to the mental health consultant, “I am 

glad you asked me about Johnny, because what I am really 

concerned about is his not participating in class. He just doesn’t 

seem to have any friends. I think we need to figure out ways 

to get him to feel more comfortable in the group. What do you 

think we can work on first?”

Role 6

The program director says to the consultant, “You can tell me 

what you observe in the classroom rather than talk directly 

with staff. I will convey the information to staff, because they 

really don’t have any free time to meet with you and because I 

want to hear your observations before staff do.”

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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 113

HANDOUT 3-4 

The Cultural Iceberg

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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 115

HANDOUT 3-5 

Vignette

READ THE FOLLOWING VIGNETTE AND DISCUSS THE KEY 

QUESTIONS.

Dr. Shannon, a Caucasian therapist beginning work as a consultant at a preschool 

program, met for the first time with an experienced Mexican American teacher 

to discuss the children he had observed. Historically reticent to share “her” 

children with outsiders, the teacher joined Dr. Shannon for a review of her 

class, all of whom lived in a poor neighborhood where violence and drug abuse 

were common. Dr. Shannon chose to address two children as his first concerns. 

He remarked that one well-liked, African American boy might develop gender 

identification problems because he wore a diamond earring in his left ear. He also 

expressed concern that a petite, doll-like Mexican American girl came to school 

adorned in a party dress, crinolines, and shoes with inch-high heels. He felt that 

these clothes were inappropriate for a school setting and that her parents might 

not understand what is developmentally appropriate attire.

QUESTIONS:

A. Why do you think Dr. Shannon chose to focus on these issues?

B. What might the teacher feel in this situation?

C. What message might this convey to these children if the recommendation to 

deal with the appearance of each child moves forward?

D. Is the consultant being culturally sensitive?

E. What can be done to turn this situation into a learning opportunity that will 

lead to better consultation?

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 117

HANDOUT 3-6 

Key Definitions

Acculturation: Cultural modification of an individual, group, or people by 

adapting or borrowing traits from another culture; a merging of cultures as a result 

of prolonged contact.

Assimilation: To assume the cultural traditions of a given people or group.

Bi-cultural: The ability to understand and function effectively in two or more 

cultural environments. An individual who is bi-cultural is not necessarily culturally 

competent.

Bilingual: The ability to speak effectively in two or more languages. Individuals 

who are involved in serving limited English-proficient persons shall be certified to 

do so.

Competence: The application of knowledge and the interpersonal, decisionmaking, and psychomotor skills expected for the practice role (National Council of 

State Boards of Nursing, Inc., 1996).

Competent: Properly or well qualified and capable.

Culture: The integrated pattern of human behavior that includes thought, 

communication, actions, customs, beliefs, values, and institutions of a racial, ethnic, 

religious, or social group. Culture defines the preferred ways to meet needs.

Cultural Competency: An acceptance and respect for difference, a continuing 

self-assessment regarding culture, a regard for and attention to the dynamics of 

difference, engagement in ongoing development of cultural knowledge, and 

resources and flexibility within service models to work toward better meeting the 

needs of minority populations.

Cultural Sensitivity: Understanding the needs and emotions of your own culture 

and the culture of others.

Ethnic: Of or relating to large groups of people classed according to common 

racial, national, tribal, religious, linguistic, or cultural origin or background.

Ethnicity: Ethnic quality or affiliation.

Race: There is an array of different beliefs about the definition of race and 

what race means within social, political, and biological contexts. The following 

definitions are representative of these perspectives:

n A tribe, people, or nation belonging to the same stock; a division of 

humankind possessing traits that are transmissible by descent and sufficient 

to characterize it as a distinctive human type.

continued
118 MODULE 3: The Importance of a Collaborative Relationship

n Race is a social construct used to separate the world’s peoples. There is 

only one race, the human race, comprising individuals and characteristics 

that are more or less similar to others.

n Evidence from the Human Genome project indicates that the genetic code 

for all human beings is 99.9% identical; there are more differences within 

groups (or races) than across groups.

Definitions 1 and 2 and 9–12 taken from Tawara D. Goode, Georgetown University Child 

Development Center, Center for Child Health and Mental Health Policy, University Affiliated Program, 

1997, Revised 2000.

Definitions 3–8 taken from from Cultural Competence Standards In Managed Mental Health Care 

Services: Four Underserved/Underrepresented Racial/Ethnic Groups, Center for Mental Health Services, 

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human 

Services. To obtain a copy, call 1-800-789-2497 or www.mentalhealth.org to view Standards online.

Other valuable information can be found in Towards A Culturally Competent System of Care: A 

Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed (1989). 

Written by Cross, T.L., B.J. Bazron, K.W. Dennis, and M.R. Isaacs. Available through Georgetown 

University Center for Child and Human Development, www.gucchd.georgetown.edu.

HANDOUT 3-6 (Continued)
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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 119

OVERHEAD 3-1

Key Elements of Partnership

 Mutual respect for skills

 Honest and clear communication

 Understanding and empathy

 Mutually agreed-upon goals

 Shared planning and decision making

 Exchange of resources

 Accessibility and responsiveness

 Joint evaluation process

 Absence of labeling and blame

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MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 121

OVERHEAD 3-2

Principles of a Consultative Relationship

 Respect for the person.

This principle implies an attitude of positive regard 

toward individuals, including recognition of both 

strengths and vulnerabilities.

 Sensitivity to context.

The staff member and the consultant must understand 

each other as influencing and being influenced by 

their environment.

 Commitment to evolving growth and change.

Consultants must be equally dedicated to promoting 

the development and mental health of both children 

and caregivers.

 Mutuality of shared goals.

Sharing and communicating goals forms the basis for 

the consulting work. It is an ongoing process that 

occurs throughout the consultation.

 Open communication.

The channels and process of communication must 

be clarified from the beginning of the consultation 

process. Communication must be regular and 

consistent.

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 3: Valuing and Understanding Mental Health Consultation The Importance of a Collaborative Relationship 123

The Cultural Iceberg

OVERHEAD 3-3

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 4: Valuing and Understanding Mental Health Consultation Understanding Challenges and Developing Strategies 125

MODULE 4 

Understanding Challenges and Developing Strategies

GOAL 4 Participants will identify critical issues and challenges in the 

consulting process and will develop strategies to address them.

OBJECTIVES

After completing Module 4, participants will be able to:

n Identify their own specific challenges to early childhood mental health 

consultation from their perspective or role.

n Identify several strategies for each challenge.

KEY CONCEPTS

n Challenges are a natural part of any problem-solving effort including the 

consultative process.

n Awareness of challenges is important; solutions and strategies need to be 

implemented to address these challenges.

n Developing consensus and working with community partners are essential 

to meeting the challenges.

n Strategies should be culturally sensitive and relevant to the settings.

BACKGROUND INFORMATION: A MINI-LECTURE

Early childhood mental health consultation enhances the well-being of children, 

families, and staff and program capacity. The consultant has the personal 

satisfaction of making a difference. However, developing an early childhood 

mental health consultation effort presents challenges. Some of these challenges 

include:

n Difficulty in implementing the intervention plan

n Organizational setting

n Value conflicts

n Racial, ethnic, cultural, and socioeconomic issues
126 MODULE 4: Understanding Challenges and Developing Strategies

n Lack of mental health professionals with early childhood consultation 

experience

n Funding

Use Overhead 1 and Handout 1: Common Challenges to share information 

from Section IV (pages 19–23) in Early Childhood Mental Health 

Consultation.

Challenges to implementing an intervention plan include ambiguity in the 

plan itself and lack of clarity about the consultative process; lack of awareness of 

work load or time demands on staff; complexity of the plan itself and difficulty in 

implementing it; and other entrenched habits.

Challenges in the organizational setting include overworked staff, high staff 

turnover and low morale, autocratic decision making, and inadequate resources. 

Consultants begin the process of consultation by defining the organizational 

structure, establishing the different roles and boundaries within the organization, 

and setting achievable goals and outcomes.

Challenges around values focus on moving away from the traditional approach 

of identifying an individual’s problems toward assuming a strengths-based 

approach and capitalizing on the strengths of both children and their families. It is 

essential for the mental health consultant to be aware of strengths as problems are 

being addressed.

Challenges around racial, ethnic, cultural, and socioeconomic issues may 

inhibit the success of the consultation. The consultant needs to be both culturally 

empathic and culturally knowledgeable. A consultant working in cross-cultural 

situations should be aware of cultural differences and address these differences 

openly and in a nonjudgmental manner with staff.

Challenge of lack of mental health professionals with early childhood 

experience, training, and consultation skills. It is sometimes difficult 

to identify mental health consultants who are knowledgeable about child 

development, family systems, child care issues, and early childhood education. 

Few higher education programs offer mental health training courses that teach 

students how to be consultants.

Challenges of funding is one of the most frequently cited barriers to mental 

health consultation. Obtaining funds for program consultation is even more 

challenging than paying for child-focused consultation in which Medicaid may 

provide some funds through its Early and Periodic Screening, Diagnosis, and 

Treatment (EPSDT) program. Some states and communities are recognizing the 

benefits of providing mental health services to young children and their families 

and are using creative approaches to plan, provide, and pay for these services.
A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 4: Valuing and Understanding Mental Health Consultation Understanding Challenges and Developing Strategies 127

 IDENTIFYING MY OWN CHALLENGES

 (30 Minutes)

Purpose

In this activity, participants will identify challenges to mental health consultation 

in an early childhood setting and will identify their own system or program 

challenges and share them with others.

Preparation

Arrange for: Post-it notes, pens, easel and flip chart paper, and markers

Duplicate: Handouts:

Handout 1: Common Challenges

Overhead:

Overhead 1: Common Challenges

Make: On 8 separate flip chart pages posted around the room, make 

headings for:

n Difficulty in implementing the intervention plan

n Organizational setting

n Value conflicts

n Racial, ethnic, cultural, and socioeconomic issues

n Lack of mental health professionals with early childhood consultation 

experience

n Funding

n Other

Leading the Activity

1. Present information on Common Challenges to the large group.

2. Have participants count off by two and give each pair some Post-it notes and 

markers.

3. Give the following instructions:

n Based on Handout 1: Common Challenges, as well as what you know 

about early childhood mental health consultation, talk with your partner 

about what you think may be the challenges to mental health consultation 

as part of your own system or program.

n Write at least 2 or 3 challenges on separate Post-it notes.

ACTIVITY 4-1
128 MODULE 4: Understanding Challenges and Developing Strategies

4. Have the participants read one challenge aloud and place all their Post-it 

notes under the appropriate headings on the flip chart paper around 

the room.

Summing Up

Using Overhead 1 point out the variety of challenges that may be related to the 

particular organizational and operational issues. Inquire about headings with no 

Post-it notes, and explore whether participants did not think about this category or 

whether it is not an issue or challenge.

 PROBLEM-SOLVING STRATEGIES FOR THE 

 CHALLENGE (40 Minutes)

Purpose

In this activity, participants will problem solve strategies to overcome challenges.

Preparation

Arrange for: Pens, Post-it notes, flip chart paper, and markers

Duplicate: Handout:

 Worksheet 1: My Own Challenges

Leading the Activity

1. Acknowledge that challenges are normal and expected but that there may be 

specific interventions or strategies that we can do either immediately or long 

range that could be helpful to overcoming the challenges.

2. Describe a few helpful strategies either from the publication Early Childhood 

Mental Health Consultation or from your own experience. Emphasize that 

mental health consultation is a mutual problem-solving approach.

3. Create small groups, one for each poster with Post-it notes indicating specific 

challenges.

4. Assign each group a flip chart poster.

5. Give the following instructions:

n Explain that each group is a mini-consultant team.

n As a team, they will review the challenges listed on their flip chart poster 

and will discuss possible solutions to the barriers posted. Try to be as 

realistic as possible.

6. As a team, identify possible solutions, and post them on the flip chart paper 

next to the relevant challenges. If time allows, invite each individual participant 

to wander around the room to each poster and add strategies where they can.

ACTIVITY 4-2
A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 4: Valuing and Understanding Mental Health Consultation Understanding Challenges and Developing Strategies 129

7. Finally, have all the participants walk around the room using their Worksheet 

1: My Own Challenges to record the specific challenges and strategies they 

want to remember for their individual challenges.

Summing Up

Offer observations about the group process of teamwork in identifying specific 

strategies. Note that it is often helpful to engage others in a problem-solving 

process to generate a variety of ideas. However, another challenge is to make the 

strategies specific and doable and something that can really make a difference 

back home within the context of your own early childhood or mental health 

services program.

 NEXT STEPS AND WHO DO I NEED (20 Minutes)

Purpose

In this activity, participants will prioritize challenges and strategies, delineate next 

steps, and think about who might be needed to accomplish the tasks.

Preparation

Arrange for: Pens

Duplicate: Handouts:

 Planning Guide 1, 2, and 3 Worksheets

 Worksheet 1: My Own Challenges

 Handout 2: Financing Early Childhood Mental Health Consultation 

 Services

Leading the Activity

1. Discuss the importance of formulating clear next steps for each strategy.

2. Encourage participants to spend some time reviewing their Planning Guide 

1, 2, and 3 Worksheets from the three previous modules, in addition to the 

strategies they have learned from the flip charts.

3. Explain that this is an opportunity to integrate the ideas and next steps that 

they noted throughout the training. Have people recognize that they may need 

others to help them implement a strategy.

4. Give the following instructions:

n Spend a few minutes alone and review your Worksheet 1: My Own 

Challenges and Planning Guides.

n Select a strategy that you want to work on very soon after this training. 

Pick something doable.

n Write your Next Steps.

ACTIVITY 4-3
130 MODULE 4: Understanding Challenges and Developing Strategies

5. In the large group, ask for someone to share one priority—a challenge, a 

strategy to address the challenge, a next step or steps, and others they need to 

enlist in the effort.

Summing Up

Remind participants that they can use the planning sheets when they get back 

to their programs to further develop a plan for early childhood mental health 

consultation. Suggest that they can use a planning process similar to the one in 

which they just participated, pulling together a team of colleagues to complete 

the work. Distribute Handout 2: Financing Early Childhood Mental Health 

Consultation Services, acknowledging that financing is one of the most common 

challenges.
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MODULE 1: MODULE 4: Valuing and Understanding Mental Health Consultation Understanding Challenges and Developing Strategies 131

HANDOUT 4-1 

Common Challenges

Challenges to implementing an intervention plan include ambiguity in the 

plan itself and lack of clarity about the consultative process; lack of awareness of 

work load or time demands on staff; complexity of the plan itself and difficulty in 

implementing it; and other entrenched habits.

Challenges in the organizational setting include overworked staff, high staff 

turnover and low morale, autocratic decision making, and inadequate resources. 

Consultants begin the process of consultation by defining the organizational 

structure, by establishing the different roles and boundaries within the 

organization, and by setting achievable goals and outcomes.

Challenges around values focus on moving away from the traditional approach 

of identifying an individual’s problems toward assuming a strengths-based 

approach and capitalizing on the strengths of both children and their families. It is 

essential for the mental health consultant to be aware of strengths as problems are 

being addressed.

Challenges around racial, ethnic, cultural, and socioeconomic issues may 

inhibit the success of the consultation. The consultant needs to be both culturally 

empathic and culturally knowledgeable. A consultant working in cross-cultural 

situations should be aware of cultural differences and address these differences 

openly and in a nonjudgmental manner with staff.

Challenge of lack of mental health professionals with early childhood 

experience, training, and consultation skills. It is sometimes difficult 

to identify mental health consultants who are knowledgeable about child 

development, family systems, child care issues, and early childhood education. 

Few higher education programs provide mental health training courses that teach 

students how to be consultants.

Challenges of funding is one of the most frequently cited barriers to mental 

health consultation. Obtaining funds for program consultation is even more 

challenging than paying for child-focused consultation in which Medicaid may 

provide some funds through its Early and Periodic Screening, Diagnosis, and 

Treatment (EPSDT) program. Some states and communities are recognizing the 

benefits of providing mental health services to young children and their families 

and are using creative approaches to plan, provide, and pay for these services.

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 4: Valuing and Understanding Mental Health Consultation Understanding Challenges and Developing Strategies 133

HANDOUT 4-2 

Financing Early Childhood Mental Health 

Consultation Services

n A broad array of public and private entities provides early childhood 

services. Half of all preschool-aged children have a mother in the labor 

force. Children are cared for by their relatives, by their in-home sitter, in 

family day care homes, in public and private child care centers, in public 

preschool programs, and in private preschools.

n A complex system exists for financing children’s mental health 

services. A variety of public agencies and programs provide for mental 

health services for young children, including child welfare and protective 

services, Part C early intervention systems, preschool special education 

programs, Medicaid, and Head Start. Foundations and private nonprofit 

groups also pay for services in communities.

n Private health insurance plans typically pay for a narrow array of direct 

services provided. Our current health care financing systems fail to cover 

mental health services to the same extent as physical health services. Barriers 

often exist for providers seeking reimbursement for consultation services.

n Major sources of funding do exist for early childhood mental health 

services, including some types of consultation:

n Medicaid

n Head Start and Early Head Start

n Individuals with Disabilities Education Act (Part B, Section 619; and 

Part C)

n Mental Health and Substance Abuse Block Grants

n Child Care and Development Fund

n Child Welfare funds (Title IV-E of the Social Security Act)

n Maternal and Child Health Block Grant (Title V of the Social Security Act)

n Temporary Assistance to Needy Families (TANF, replaced AFDC)

n Housing and Urban Development

n State and County Appropriations

n Foundations (e.g., Annie E. Casey Foundation and Ounce of 

Prevention Fund)

n Community Organizations (e.g., churches, Elks clubs, sororities, and 

Junior League)

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 4: Valuing and Understanding Mental Health Consultation Understanding Challenges and Developing Strategies 135 CHALLENGES STRATEGIES NEXT STEPS WHO DO I NEED 1. 2. 3. 1. 2. 3. 1. 2. 3. 1. 2. 3.

WORKSHEET 1 MY OWN CHALLENGES

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 4: Valuing and Understanding Mental Health Consultation Understanding Challenges and Developing Strategies 137

OVERHEAD 4-1A

Common Challenges

Challenges to implementing an intervention 

plan:

 Ambiguity in the plan itself

 Lack of clarity about the consultative process

 Lack of awareness of work load or time demands 

on staff

 Complexity of the plan and difficulty in 

implementing it

 Other entrenched habits

Challenges in the organizational setting:

 Overworked staff

 High staff turnover

 Low morale

 Autocratic decision making

 Inadequate resources

 Beginning the process of consultation by defining 

the organizational structure, by establishing 

the different roles and boundaries within the 

organization, and by setting achievable goals and 

outcomes

continued

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 4: Valuing and Understanding Mental Health Consultation Understanding Challenges and Developing Strategies 139

Common Challenges (Continued)

Challenges around values:

 Moving away from the traditional approach of 

identifying an individual’s problems

 Moving toward assuming a strengths-based 

approach and capitalizing on the strengths of both 

children and their families as problems are being 

addressed

Challenges around racial, ethnic, cultural, and 

socioeconomic issues:

 May inhibit the success of the consultation

 Consultant is culturally empathic and culturally 

knowledgeable

 Awareness of cultural differences

 Willingness and ability to address these differences 

in an open and nonjudgmental manner

OVERHEAD 4-1B

continued

A Training Guide for the Early Childhood Services Community

MODULE 1: MODULE 4: Valuing and Understanding Mental Health Consultation Understanding Challenges and Developing Strategies 141

OVERHEAD 4-1C

Common Challenges (Continued)

Challenge of lack of mental health professionals 

with early childhood experience, training, and 

consultation skills:

 Difficult to identify consultants who are 

knowledgeable about child development, family 

systems, child care issues, and early childhood 

education

 Few higher education programs offer courses that 

teach students how to be consultants

Challenges of funding:

 Obtaining funds for program consultation

 Available reimbursement for services through 

Medicaid and its Early and Periodic Screening, 

Diagnosis, and Treatment (EPSDT) program

 Other creative approaches to plan, provide, and pay 

for these services

143

A Training Guide for the Early Childhood Services Community

APPENDIX A

Selected Resources on Mental Health Consultation in 

Early Childhood Settings

Cohen, E., & Kaufmann, R. K. (2005). Early childhood mental health consultation.

DHHS Pub. No. (SMA) ___. Rockville, MD: Center for Mental Health Services, 

Substance Abuse and Mental Health Services Administration.

Donohue, P., Falk, B., & Provet, A. G. (2000). Mental health consultation in early 

childhood programs. Baltimore: Brookes.

Green, B., Simpson, J., Everhart, M., Vale, E., & Gettman, M. (2004). Understanding 

integrated mental health services in Head Start: Staff perspectives on mental 

health consultation. National Head Start Association Dialog, 7(1), 35–60.

Johns, B. (2003). The early childhood mental health project: Child care consultation 

in action. San Francisco: Jewish Family and Children’s Services.

Johnston, K., & Brinamen, C. (2005). Mental health consultation in childcare.

Washington, DC: Zero to Three.

Gilliam, W. S. (2005). Prekindergartners left behind: Expulsion rates in state 

prekindergarten systems. New Haven, CT: Yale University Child Study Center.


DHHS Publication No. CMHS-SVP0152

Printed 2005