WHAT WORKS?A Series on Effective Early Childhood

Mental Health Consultation

Preparing and Supporting the Workforce, Part 2Training and Supervision of ECMH Consultants

June 30, 2010 Deborah Hirschland, MSW

Together for Kids – Worcester, MA.

SETTING THE STAGE Massachusetts in the Nineties

A BEGINNING

A friendly overture, some impassioned conversation, and the start of a training

initiative

THERE WERE MANY QUESTIONS TO ANSWER…

WHO WOULD ATTEND?

A mix of participants…

1. TFK (AND PARTNER AGENCY) CLINICIANS doing ECMH consultation

2. GRADUATE LEVEL INTERNS doing their placements at TFK/partner agencies with a specialty in ECMH/ECMH consultation

3. TFK SUPERVISORS who felt a need for additional training in the specifics of consultation

4. TFK STAFF TRAINERS working with the early care and education community, who wanted to more fully understand and partner with the work of TFK’s ECMH consultants.

HOW SHOULD COURSE CONTENTBE FRAMED?

Given the complexity of the work and the wide ranging knowledge base on which it relies, how could we balance a focus on:

(1) the consultative process,

(2) the knowledge base needed to understand children, families, early care and education staff, and the relationships between them, and

(3) approaches to intervention for specific behavioral, emotional, and developmental issues?

WHAT MIX OF TEACHING STYLES AND APPROACHES WOULD WORK BEST?

• Didactic presentation• Discussion of readings• Open-ended check-ins• Discussion and

deconstruction of observational and journaling assignments

• Spacious conversation about the work as it “lives and breathes” on the ground

• Case presentations• Guest speakers• Experiential exercises• Dissemination and

exploration of relevant resources

HOW MUCH READING WOULDBE REQUIRED?

Required reading: •Mental Health Consultation in Child Care (Johnston and Brinamen) •Collaborative Intervention in Early Childhood (Hirschland)

Strongly recommended texts: •Unsmiling Faces – How Preschools Can Heal (Koplow)•Hope and Healing – A Caregiver’s Guide to Helping Young Children Affected by Trauma (Fitzgerald Rice & McAlister Groves)•Working with Families of the Poor (Minuchin, Minuchin, & Colapinto)•DC-O3 Casebook (Lieberman, Wieder, & Fenichel, Eds.)•First Feelings: Milestones in the Emotional Development of Your Baby and Child (Greenspan & Greenspan)

Supplementary readings

Extensive annotated bibliography

WHAT ADDITIONAL WORK WOULD BE REQUIRED IN ADVANCE OF SESSIONS?

In preparation for each session, participants are required to do an observational and/or journaling assignment that asks them to look at the session’s targeted content through the lens of:

•What is happening with a child/family/care-giving program “on the ground,”

•How they understand what they see, and

•What their questions and thoughts are about possibilities for/challenges of collaborative intervention.

AT WHAT LEVEL SHOULD MATERIAL BE PRESENTED?

The seminar offers a mix of approaches, and targets a mix of learning needs.

•Didactic material is presented at a high level – in the hopes of meeting the needs of the most experienced attendees, while challenging interns to integrate material that deepens course content they’re getting in graduate school.

•There are many opportunities for small group sharing and case discussion – which allow participants to encounter material at whatever level works for them.

•The observational/journaling assignments offer many opportunities for individualized learning.

•Our experience has suggested that a mix of participant levels offers significant invitations for and experiences of “cross fertilization.”

WHAT WOULD BE THE OPTIMAL SIZEFOR THE GROUP?

•Ten to twenty participants is ideal.

•Twenty-five participants is doable.

•Above that number, the learning in the room isn’t as spacious or richly textured as we hope to see.

HOW WOULD WE THINK ABOUT THE CONTEXT IN WHICH THE SEMINAR WOULD BE TAKING PLACE?

•Supervision: All (clinician) participants receive individual supervision. Interns also participate in weekly group supervision.

•Team Meetings: Staff clinicians also participate in an “early childhood mental health team” facilitated by a team leader who is one of the agency’s senior clinicians.

•Collaborative Case Presentation: In addition, staff meet three to four times a year with clinicians in subcontracted, partner agencies

– for discussion, case presentation, and exploration.

•Targeted Trainings: Throughout the year, TFK offers targeted trainings on specific topics (play therapy, trauma, referral to and collaboration with outside agencies/programs, etc.)

•Evidence-based Practices: A large number of the clinical staff have been trained in the CSEFEL model (see Vanderbilt.edu/csefel) and some are now participating in ongoing training on Alicia Lieberman’s model of child/parent psychotherapy.

WHAT WOULD BE THE BEST TIME FRAME FOR THE SEMINAR?

The seminar has been run in a number of forms:

•Two hours a week every other week over eight months

•Once a month with two full days (the introductory day and one midway through) and six three-hour sessions over eight months.

•In a compressed form with two full days (the introductory day and one midway through) and six three-hour sessions over three months.

SEMINAR CONTENT AND PROGRESSION

1. Session one (full day) includes foundational explorations about ourselves and our questions – and an in-depth presentation of an overall framework on which to base our thinking.

2. Sessions two to four (three hours each) place developmental mastery at the “hub” of exploration, and offer a multi-layered approach to understanding behavior, developmental mastery, and emotional experience in the context of relationships – along with an examination of possibilities for consultation and collaborative intervention in support of emotional, developmental, and behavioral mastery

With a steady mix of conversation, didactic content, discussion of readings and observational assignments, case presentations and discussions, experiential exercises and more…

3. Session five (full day) involves a morning exploring the use of self in consultation/reflective practice and an afternoon exploring challenges in working with hard-to-reach/engage families and early care and education staff. (Although these challenges are highlighted throughout the seminar, they’re put center stage here.)

4. Sessions six through eight (three hours each) look at trauma and loss, examine the power of play and of creative approaches to helping children “story” their experiences in the service of emotional and developmental mastery, and explore approaches to parent /teacher training and support in group contexts. Each session includes extensive case presentations and discussion. In addition, at the latter part of the last session, there is ample time for reflection and evaluation.

SEMINAR CONTENT AND PROGRESSION

A FEW HIGHLIGHTS…

A Core Framework

From day one, an important consciousness…

That we bring all of ourselves to our work – and all have work to do on ourselves!

A focus on the power of language… and the importance of an accessible, down-to-earth approach to practice

Constant attention to the importance of collaboration

A joint focus on development and

relationships as the initial “hub” of our explorations

An emphasis on reflective practice and the power of asking questions…

And, above all…. As we progress through our multi-layered explorations, an ongoing look at how we “co-create meaning”* with our partners in care as we ask:

• How do we understand what we see? • How can we join together to open up

pathways for growth, mastery, and pleasurable connection for children and adults alike?

*With credit and appreciation to Kadija Johnston and Charles Brinamen for a phrase so many of us now use.

CREATING A LEARNING ENVIRONMENT

The instructor’s role ranges from:

• Questioner• Facilitator• Lecturer• Co-discussant• Learner• Framer• Challenger• Supporter• Resource provider

The learning environment includes:

• Safety• Encouragement• Allowing questions• Taking risks• Sharing what one doesn’t

know and has to offer• Identifying what one wants

to learn• Absence of intimidation

MOVING FORWARD

Building capacity in the work force, not just of early childhood consultants, but of practitioners who can teach this kind of content - a model from TFK…

SEMINAR RESOURCES Here’s what you’ll find on-line at: sites.google.com/site/deborahhirschland

• Course syllabus of seminar• Annotated bibliography• List of supplemental readings• Session evaluation form• List of targeted competencies• Template to guide consultant:

– Gathering information– Understanding the experiences

of child, family, provider and clinician

– Setting the stage for intervention

• Template for discussion and creating action plans in child-focused team meetings

• Several in-class exercises• Set of observational/

journaling assignments and required readings

• Additional handouts distributed over the course of the seminar

What Works ?

Question Review and Response