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Early Childhood Mental Health Consultation: Results of a Statewide Random-Controlled Evaluation

https://doi.org/10.1016/j.jaac.2016.06.006Get rights and content

Objective

Despite recent federal recommendations calling for increased funding for early childhood mental health consultation (ECMHC) as a means to decrease preschool expulsions, no randomized-controlled evaluations of this form of intervention have been reported in the scientific literature. This study is the first attempt to isolate the effects of ECMHC for enhancing classroom quality, decreasing teacher-rated behavior problems, and decreasing the likelihood of expulsion in targeted children in early childhood classrooms.

Method

The sample consisted of 176 target children (3–4 years old) and 88 preschool classrooms and teachers randomly assigned to receive ECMHC through Connecticut’s statewide Early Childhood Consultation Partnership (ECCP) or waitlist control treatment. Before randomization, teachers selected 2 target children in each classroom whose behaviors most prompted the request for ECCP. Evaluation measurements were collected before and after treatment, and child behavior and social skills and overall quality of the childcare environment were assessed. Hierarchical linear modeling was used to evaluate the effectiveness of ECCP and to account for the nested structure of the study design.

Results

Children who received ECCP had significantly lower ratings of hyperactivity, restlessness, externalizing behaviors, problem behaviors, and total problems compared with children in the control group even after controlling for gender and pretest scores. No effects were found on likelihood of expulsion and quality of childcare environment.

Conclusion

ECCP resulted in significant decreases across several domains of teacher-rated externalizing and problem behaviors and is a viable and potentially cost-effective means for infusing mental health services into early childhood settings. Clinical and policy implications for ECMHC are discussed.

Section snippets

Early Childhood Consultation Partnership

The Early Childhood Consultation Partnership (ECCP) is an ECMHC program available to staff at all public and private early care and education centers serving young children (infants to 5-year-olds) throughout Connecticut and is funded by the state. Typically, services are requested by childcare center directors or staff when there are behavioral or social-emotional concerns for individual children or classroom-wide behavioral management challenges. The mental health consultation focuses on the

Study Design and Research Participants

The ECCP was evaluated in a randomized-controlled treatment design using pretests and posttests conducted from 2008 through 2010. Study inclusion criteria were that the program must have had a regularly meeting classroom-based component and the classroom served predominately children 3 to 5 years old, although older and younger children also could be served. The only exclusion criterion was that the classroom must not have been located at a building-level site that had previously received ECCP

Descriptive Statistics

There were no statistically significant differences between children for whom complete data were obtained and those for whom complete data were not obtained in gender (χ21 = 1.19) or age at pretest (F1,156 = 0.36). Mean ratings of overall classroom quality and teacher-reported child behavior problems are listed in Table 1.

Impact on Classroom Quality

For classroom quality, as measured by the CLASS, there were no significant differences between the treatment and control groups for any domain of quality after the evaluation

Discussion

The present study investigated the impact of a statewide ECMHC system on decreasing teacher-rated behavioral problems in preschool children and improving overall classroom quality. This is the first statewide randomized-controlled trial of ECMHC as a singular intervention. Overall, the ECCP contributed to statistically significant decreases in teacher-rated externalizing or acting-out behavior problems in the classroom compared with the control group and after controlling for differences

References (42)

  • M. Fazel et al.

    Mental health interventions in schools in high-income countries

    Lancet Psychiatry

    (2014)
  • C. Upshur et al.

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

    Early Child Res Q

    (2009)
  • US Department of Health and Human Services, US Department of Education. Policy statement on expulsion and suspension...
  • Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2016....
  • R.B. Howes et al.

    Regulatory contributors to children’s kindergarten achievement

    Early Educ Dev

    (2003)
  • S.P. Keane et al.

    Predicting kindergarten peer social status from toddler and preschool behavior

    J Abnorm Child Psychol

    (2004)
  • S.B. Campbell

    Behavior problems in preschool children: a review of recent research

    J Child Psychol Psychiatry

    (1995)
  • D.S. Shaw et al.

    What we have learned about early childhood and the development of delinquency

  • M.R. Greenberg et al.

    The prevention of mental disorders in school-aged children: current state of the field

    Prev Treat

    (2001)
  • S.P. Hinshaw

    Academic underachievement, attention deficits, and aggression: comorbidity and implications for intervention

    J Consult Clin Psychol

    (1992)
  • H. Yoshikawa

    Long-term effects of early childhood programs on social outcomes and delinquency

    Future Child

    (1995)
  • E. Zigler et al.

    Early childhood intervention: a promising preventive for juvenile delinquency

    Am Psychol

    (1992)
  • C.C. Raver et al.

    Targeting children’s behavior problems in preschool classrooms: a cluster-randomized controlled trial

    J Consult Clin Psychol

    (2009)
  • Gilliam WS. Prekindergarteners left behind: expulsion rates in state prekindergarten programs. Foundation for Child...
  • Boyd J, Barnett WS, Bodrova E et al. Promoting children’s social and emotional development through preschool—policy...
  • W.S. Gilliam et al.

    Preschool and child care expulsion and suspension: rates and predictors in one state

    Infants Young Child

    (2006)
  • E. Cohen et al.

    Early Childhood Mental Health Consultation

    (2000)
  • P.J. Donahue et al.

    Mental Health Consultation in Early Childhood

    (2000)
  • B.L. Green et al.

    Characteristics of effective mental health consultation in early childhood settings

    Topics Early Child Spec Educ

    (2006)
  • K. Johnston et al.

    Mental Health Consultation in Child Care: Transforming Relationships among Directors, Staff, and Families

    (2006)
  • D.F. Perry et al.

    Social and Emotional Health in Early Childhood: Building Bridges between Services and Systems

    (2007)

    • Cited by (0)

    This article is discussed in an editorial by Dr. Jeff Q. Bostic on page 749.

    Clinical guidance is available at the end of this article.

    This article was reviewed under and accepted by Associate Editor James J. Hudziak, MD.

    An interview with the author is available by podcast at www.jaacap.org or by scanning the QR code to the right.

    This third-party evaluation of the Early Childhood Consultation Partnership (ECCP) was funded by a contract from the Connecticut Department of Children and Families.

    Dr. Reyes served as the statistical expert for this research.

    Disclosure: Drs. Gilliam, Maupin, and Reyes report no biomedical financial interests or potential conflicts of interest.

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