A pilot study of early childhood mental health consultation for children with behavioral problems in preschool

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Abstract

This study reports the findings of a pilot demonstration project called Together for Kids, which used a mental health consultation model to address the needs of young children with challenging behaviors who are identified in preschool classrooms. The study was conducted in four preschool programs and one Head Start program serving children ages 3–5, including both private-pay families and those using public subsidies. Rates of significant behavior problems as assessed by preschool teachers using a standardized scale were high, with 34% of all children enrolled in preschool classrooms in these sites over a 3-year period identified at-risk of externalizing or internalizing problems. Classroom teachers, as well as individual children and families identified as at-risk, were provided services, including, classroom observation and teacher training, individual child assessment and therapy, family assessment and support, and referrals for other family needs. Analysis of outcomes for 47 children and families with externalizing behavior problems who received individualized consultation, compared to 89 control children, and analysis of outcomes of a matched group of 19 intervention and 19 control children, revealed that the intervention was associated with significant improvements in classroom aggressive and maladaptive behavior, and growth in adaptive behavior. Improvements in child behavior were associated with total hours of individual child services provided, and with improvements in child developmental skills. Significant reductions in the rate of children suspended or terminated from child care programs were also found. Implications for further development of models of early childhood mental health consultation are discussed.

Section snippets

Recruitment of preschool programs

Preschools were recruited based on willingness to participate actively in required program components. These included: (1) conducting center-wide parent and staff surveys; (2) participating in education/training sessions for staff and parents; (3) training staff in conducting standardized assessment of children's behavior twice a year; (4) allowing the Child Development Advisor to observe classrooms and provide individual services to children, parents, and teachers on site; and (5) providing

Changes in child behavior ratings

This analysis includes 37 intervention children and 49 control children with complete pre- and post-teacher behavioral ratings (although one intervention child had missing data on the aggressive behavior scale at follow-up). Separate Two (time) by Two (intervention vs. control) Repeated Measures ANOVA's (using SPSS 14.0 statistical software) were conducted to examine change in aggressive, maladaptive, and adaptive behavior scores as rated by the teacher (see Table 3). In terms of aggressive

Discussion

Preschool children's behavioral difficulties have received increasing attention in recent years. High rates of prevalence have been documented across both Head Start and community child care programs (Kupersmidt et al., 2000, Qi and Kaiser, 2003), along with rates of preschool expulsion and suspension that far exceed those for K-12 school years (Gilliam, 2005). Simultaneously, it has been recognized that social skills and emotional regulation are key ingredients of school readiness skills, and

Practical implications

Our data provide additional support for the efficacy of early childhood mental health consultation programs to address children's problem behavior in child care settings. Further, our study, in combination with prior studies, seems to suggest that program-focused versus child-focused models may have differential outcomes. Programs that provide more emphasis on teacher skill development and teachers as the primary change agent (Williford & Shelton, 2008) may demonstrate more improvement in

Acknowledgements

This study and the intervention services were funded by The Health Foundation of Central Massachusetts and the United Way of Central Massachusetts. We would like to thank Lynn Hennigan, LICSW, Project Coordinator for Community Healthlink, Youth and Family Services, the 50 members of the Together for Kids Coalition, the dedicated Child Development Advisors, and the staff and families of the following Worcester-area child care programs: Rainbow Child Development Center, Worcester Community Action

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