Early Childhood Mental Health Consultation and Incredible Years Project in Portland, Oregon

1. An 8 year project implementation at Morrison Child and Family Services Portland, Oregon EARLY CHILDHOOD MENTAL HEALTH CONSULTATION AND INCREDIBLE YEARS

2. ECMHC & Incredible Years Portland, Oregon • Kathryn Falkenstern, MSW, LCSW • Clinical Supervisor • Morrison Child and Family Services • 15 sites located in Portland, Oregon. • Provides a comprehensive range of community mental health, substance abuse, juvenile justice, and prevention services to more than 5,000 children and their families. • Programs include outpatient counseling, early childhood mental health consultation, parent education, home and school-based programs, and foster care, residential, and day treatment.

3. Agenda • Introduction of the ECMHC and IY Project in Portland, OR • The Incredible Years Objectives • Project Design • Advantages of addition IY to ECMHC services • Implementation “Lessons Learned” • Evaluation

4. 2002 Initial Implementation • 3 year grant from The Substance Abuse and Mental Health Services Administration (SAMHSA) • Received by Multnomah County Behavioral Health. • Morrison implemented the service component of the grant. • Funded: • Early Childhood Mental Health Consultation (ECMHC) • Incredible Years Parent Groups at childcare programs. • This project ran from 2002 – 2005.

5. 2002 Initial Implementation • Team: • 2 members at 1.75 FTE with one part-time support person. • .3 of supervisor’s time. • Implementation • Two staff as well as the Supervisor and Director of Outpatient programs were trained in The Incredible Years Parent Program. • ECMHC offered to four childcare sites. • IY parent groups offered at the rate of about 6 per year, two at a time.

6. 2003 Sustainable Funding: The Portland Children’s Investment Fund • 2000, Dan Saltzman, Portland City Commissioner, developed The Portland Children’s Investment Fund . • 2001, Portland voters passed levy with 53% approval and renewed in 2009 with 73% support. Pooled approximately 10 million dollars per year at a cost of about $60 per year for the average Portland homeowner. • Funding supported 66 different programs for children in 4 categories: • Early childhood health and education • After-school and mentoring programs • Child abuse prevention & intervention • Support for children in foster care.

7. 2003 Sustainable Funding: The Portland Children’s Investment Fund • Levy: • operated with a 5% administrative cap • required agencies to invest in proven programs and track and report outcomes via yearly audit. • For more information on The Portland Children’s Levy: • www.portlandchildrenslevy.org • http://bayopliskonesansrenmenyoplis.org/docs/TheChildrensTrustBook.pdf

8. The Incredible Years • Parent, child and teacher training programs • Goals: • to prevent, reduce, & treat aggression and behavior problems in young children. • Promote social, emotional, and academic competence www.incredibleyears.com

9. Incredible Years Parenting Series:Methods & Processes • Relationship: “collaborative process” • Culturally sensitive • Video modeling/DVDs • Role play practice & rehearsal • Home assignments • Group support

10. Project Design:ECMHC Integrating Evidenced Based Parent Groups • ECMHC Components: • Child and family specific consultation • Child observations/screenings • Parent/teacher coaching • Evidenced Based Groups: • Primarily IY Parent Group (Basic preschool series) • Also, offer the Advanced Parent Series; Infant Group • Incredible Years Dinosaur School • CBT based parent stress/mood mgt classes

11. Project Design…continued • Program Level Consultation • Adapted from Incredible Years principles • Social/Emotional Circle-time activity with puppets teaching : • Self-regulation skills • Friendship skills • Emotional literacy • Problem solving • Utilized IY training to design classroom strategies • Staff trainings

12. Special Populations • Work with or assist with referrals for any family in our designated childcare centers. • Work towards maintaining a child in the normative settings through both ECMHC and Incredible Years offerings. • Offer a limited number of Dinosaur School pull out groups for “top of the pyramid” children. • Offer IY groups with translation and/or led by bi-lingual staff.

13. Mental Health Staff training and credentials • 5.5 FTE (7 staff members) of master’s level mental health staff with Early Childhood experience/training. • 5 of 7 are licensed mental health professionals. • All are trained in IY Basic, Advanced, and Dinosaur School. • 5 of 7 have achieved certification in IY. • One person is a mentor/trainer, and may train others within our agency.

14. Role of the Mental Health Staff • Each Staff member is assigned to one or more early childhood care/education sites. • Each Consultant position includes the role of evidenced based group leader.

15. Team Approach to Consultation • Consultant Staff: • Plan and co-lead groups together • Collaborate in recruitment efforts for groups • Substitute in groups when a regular leader is absent • Form a “learning environment” of sharing ideas and mentoring newer consultants • Provide peer support

16. ECMHC Role • Initial role • Establishing relationships within the childcare center with administrators, teachers/childcare staff, and families. • Begin initial ECMHC roles, such as child observations, teacher support. • Promote upcoming Incredible Years Parent Groups at all levels with the ECE site.

17. Forming the IY Parent Group:Think Relationship • Recruitment Strategies: • Relationship with Childcare Center Staff • Flyers : • Used only in conjunction with other more dynamic forms of recruitment. • Don’t over rely on flyers as a recruitment strategy

18. Forming the IY Parent Group:Think Relationship • Recruitment Strategies: • Direct Recruitment with Parents: • “Juice and Cookies” recruitment: • Consultant meets and talks one-on-one with parents about the group at drop of or pick up time at the childcare center. . • “LET US MAKE YOU DINNER AND WATCH THE KIDS…. while you connect with other parents and enhance your parenting skills…” • Promotion at other childcare center events: • Parent Nights • Holiday Parties

19. Forming the Group…continued: • Indirect Recruitment • Promotion with teachers/childcare staff who encourage parents to attend • Works best after the IY Program has been established in the center and teachers have confidence in it. • Use of incentives to reward teachers for their efforts at promotion. • Coordinated Recruitment • Consultant and Teacher collaborate to approach selected families who may particularly benefit from the group.

20. Decreasing Barriers to Attendance • All parents at the center are invited to attend…not just parents identified as needing parenting help. • The IY group is held at the childcare center • decreases transportation issues • decreases stigma • Dinner offered • Childcare • Transportation supports

21. Groups Offered Yearly • Team offers each year: • 10 Incredible Years Parent Groups • 2 Dinosaur School Groups • 4 Parent Stress/Mood Mgt Prevention Groups based on CBT principles.

22. Advantages of combining ECMHC with Incredible Years • Enhances the Consultants visibility and role within the ECE center • Extends what the Consultant can offer to families • Builds rapport with parents at the center • Increases practical offerings to ECE program staff

23. Implementation Lessons Learned • Hiring the right staff is critical • Clear job descriptions • Skills in community based jobs • Flexible, team-oriented • Budget • Identify all the related costs to offering a group in a community childcare center • Maintain fidelity of the IY model • Encourage certification • Utilize consultation • Take on group recruitment challenges • Be thorough, patient, and creative

24. Evaluation of IY Groups • IY Group Evaluation • Pre/post tests: • DECA - parent and teacher/childcare staff • ECBI - parent • SESBI - teacher • Parent Satisfaction Survey • ECMHC Evaluation • Retrospective Preschool Teacher Survey • Satisfaction Survey

25. IY Parent Outcomes - DECA • 151 DECAs collected • Findings: • Statistically significant change on 3 of 4 subscales (“protective factors; self-control; “initiative.”) p<.001. • Statistically significant change on the “Behavioral Concerns” scale. P<.001

26. ECBI Parent *p<.001

27. Parent Satisfaction • 228 surveys collected from IY Parent Groups • Findings: • 99% would recommend the program • 98% reported overall satisfaction with the program • 91% were confident they could manage child behavior problems on their own.

28. Retrospective Preschool Teacher Survey n=57 Strongly disagree *p<.001 Strongly Agree