# data[].attributes.body
The organizational structure (for example, administrative support) has a strong impact on the effectiveness of early childhood mental health consultation.effectiveness

a) True
b) False

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Ongoing supervision and supports that encourage the practice of relationship-based work and the consultative stance include

a) Clinical supervision and guidance on diagnosis and intervention

b) Administrative supervision and guidance on how to change the organizational structure of the early care and education setting

c) Supervision that includes reflective practices and guidance on identifying motivations, feelings, and insight toward self-awareness

d) A and B

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When meeting with families and teachers to plan strategies for a child, the consultant’s practices which would represent the consultative stance include all of the following except

a) Sharing ideas clearly and soliciting ideas from others

b) Hypothesizing and interpreting a child’s behavior for those involved in the child’s care

c) Facilitating discussion to reach agreement on the goal(s), intervention plan, and measures of success

d) Preparing the plan before the meeting

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The essential tool(s) for transforming relationships through the “consultative stance” include the consultant’s

a) Expertise providing clinical therapy

b) Ability to take in and respect every person’s perspective

c) Commitment to incorporating their own expert opinion

d) Focusing exclusively on presenting problems

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In achieving the “consultative stance”, the consultant takes the position of the expert and addresses the mental health needs of children and families one-on-one and in lieu of those (staff and families) who provide regular care for the child

a)  True
b) False

# data[].attributes.body
The term “consultative stance” in early childhood mental health consultation refers to
a)  The consultant’s theoretical position on child development and mental health

b) The consultant’s opinion regarding how to deal with a child’s social emotional development or behavior

c) The consultant’s way of being or working in relationships with early care and education staff and families

d) None of the above

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Relationship-based work and the consultative stance are based on the central belief(s) that

a)  Relationships are key to effective consultation

b) How the consultant “is” – his or her demonstration of interest, empathy, respect and understanding – is central to successful consultation

c)  The positive experience of the relationship between the consultant and the consultee (early care and education staff and families) influences the relationship between the consultee and children in his or her care

d) All of the above

# data[].attributes.body
When Richard met with Sandra and Lisa again, he asked them how things were going with Andrew. They said that they both felt more comfortable with the intervention, but worried that they were still trying to get it right. Richard assured them they would get more comfortable with more practice and provided additional coaching. When Sandra described a poking and pinching event where it was difficult to help Andrew "do turtle", Richard again assured them that Andrew would make progress over time and reminded them of times when Andrew was able to "do turtle" and change his behavior.

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Sandra and Lisa were willing to give it a try, but expressed uncertainty, saying that it might be difficult for them to be consistent in the midst of all the classroom activities and the needs of other children. Richard explained the intervention and reviewed all the material with them. He demonstrated the technique during their meeting, and then spent time in the classroom modeling the technique with Andrew. He also spent time observing Sandra and Lisa using the technique and gave them feedback during their meetings. All along, he assured them that he was confident that they could learn and use "do turtle" successfully. To encourage them, he shared his own experience of learning and using the technique himself in working with individual children with good success, and agreed to meet with them after a week of trying the intervention to see how things were going.

# data[].attributes.body
Richard, Sandra, and Lisa began to meet regularly as Richard helped them learn about the intervention and working effectively with Andrew. The next week, Richard met with Sandra and Lisa to review the information he had sent to them and clarify the intervention plan.

# data[].attributes.body
Sandra asked Richard to be more specific and meet with her and Lisa after the children left for the day to go over exactly what they should do for Andrew. Richard agreed and said he would also provide some written materials about helping children "do turtle."

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Richard suggested that Lisa, the teacher's aide, might sit next to Andrew during table time to help him focus, and both Lisa and Sandra could teach Andrew to "do turtle" — stop, think, and use his words to express his feelings and choose more effective behaviors.

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Upon hearing more information from Sandra, Richard suggested that Andrew may have ADHD or attention difficulties and the more aggressive poking and pinching could be signs of poor impulse control when frustrated. Sandra wasn't sure, but was interested in what to try next.

# data[].attributes.body
Richard asked how Sandra has been dealing with Andrew's behavior and she described several strategies she had tried with only limited success. Richard acknowledged her skills and decision making based on what she had tried so far. He inquired about what she might be willing to try next and issues to consider in managing her classroom.

# data[].attributes.body
Richard asked Sandra how she understood or made sense of Andrew's behavior and the differences she noticed over time and at different times of day. Sandra provided her knowledge of Andrew's family situation and her own observations, but could not say why she thought Andrew behaved this way.

# data[].attributes.body
Richard empathized with Sandra's concerns about Andrew in the classroom, the concerns of the parents of other children, and the concern from her program director. Richard then described his observation of Andrew from the day before and asked Sandra if what he observed matched her own observations over time. Sandra agreed, restating that it would be important for Richard to see Andrew first thing in the morning when his behavior was more difficult.

# data[].attributes.body
The next day, Richard appeared at nap time to meet with Sandra. He restated the concerns expressed by the program director and inquired if she had the same concerns or others about Andrew. Sandra said that she was concerned about his behavior, but felt that some of his behaviors fell into the typical range for his age. The poking and pinching were difficult to manage and many parents of the other children were concerned about their own children being pinched or hurt and had expressed these concerns to her and the program director.

# data[].attributes.body
As the children transitioned to another activity, Richard intercepted Sandra and briefly said, "I can see your concerns about Andrew and would like to talk with you and your teacher's aide on my next visit. What time would be best for you?" Sandra suggested they meet during nap time — but noted that Lisa, the teacher's aide would have to stay with the children while they met. Richard said, "Nap time tomorrow, I'll see you then," and left the room.

# data[].attributes.body
Sandra went back to leading the classroom in their afternoon activities, glancing at Richard from time to time. The children were curious and peeked at him initially, but then were engaged in their activities. Andrew seemed distracted during "table time," and kept getting out of his seat, disturbing his neighbors, and sometimes poking or pinching those sitting next to him.

# data[].attributes.body
Richard went to Sandra's classroom, reintroduced himself, and explained that he understood that they had urgent concerns about Andrew's behavior and that the director had asked him to observe him in class. Sandra looked a bit uncertain, but nodded her agreement about concerns for Andrew. Richard said, "I'm sure that you have a lot of your own observations and knowledge to share, but I'll make my own observations first and then we can talk." Sandra suggested that it might be helpful to observe Andrew first thing in the morning when he had the most difficulties. Richard nodded, but since he was already there, Sandra showed Richard where he might sit to make his observation.

# data[].attributes.body
Richard had come on board as a consultant at 1-2-3 Head Start, as soon as the contract for consultation services between the Head Start program director and the local mental health center director had been negotiated and signed. He was eager to get started and involved with the teachers, children, and parents. After a brief introduction at an all-staff meeting, the program director met with Richard to describe some immediate concerns. The director asked Richard to spend the rest of his day observing Ms. Sandra's classroom and a child named Andrew, whose behavior had become increasingly disruptive and aggressive. Sensing the director's urgency, Richard agreed to visit Sandra's classroom that very afternoon.

# data[].attributes.headline
In the narrative below, identify some successes and struggles common to ECMH consultation:

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In the narrative below, identify some successes and struggles common to ECMH consultation:

# data[].attributes.headline
Element 10:                  Holding Hope    

# data[].attributes.subject
Element 10:                  Holding Hope    

# data[].attributes.body
Renee began to recognize her own values and strengths, gained support from Jasmine's interest and sensitive questioning. Renee appreciated how Jasmine understood her situation and offered assurance that she would make the "right decision" when she was ready. As Renee became clear about her decision, Renee realized that she was less stressed and felt more confident. In her work, Renee became more patient and effective working with her families like Shelby and Niya.

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Element 9:                  Patience      

# data[].attributes.subject
Element 9:                  Patience      

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Jasmine and Renee agreed to meet weekly for a period of time as Renee tries to resolve her decision about taking a supervisory role and, at the same time, remain aware of how her personal pressures might influence her direct work with the families in her care. Jasmine supports Renee in taking the time she needs to gather more information, discuss her situation with her Director, and "feel right" about her decision.

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Element 8:              Wondering       

# data[].attributes.subject
Element 8:              Wondering       

# data[].attributes.body
The consultation time between Jasmine and Renee took a new focus on Renee's perception of herself and her work goals and expectations. Rather than simply reassure Renee that she is perfectly capable of the managing the dual role of home visitor and supervisor, Jasmine helped Renee reflect on her feelings and explore her perceptions of herself from multiple perspectives. With Jasmine's support, gentle questions and reframing, Renee was able to generate some ideas for ways to "think through" decisions about her work roles and responsibilities.

# data[].attributes.headline
Element 7:                           Hear and Represent

# data[].attributes.subject
Element 7:                           Hear and Represent

# data[].attributes.body
Renee thought that she might need to spend some time really thinking about her interest in becoming a supervisor on top of her home visitor work. Jasmine helped Renee to talk about her thoughts and feelings and inquired about her supervisor's perspective that she is a successful home visitor who can guide others. Renee agreed to consider this view and discuss some of her concerns with her Director — including expectations and how to manage this dual responsibility.

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Element 6:                  Consider All Influences

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Element 6:                  Consider All Influences

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As Jasmine and Renee continued to talk, Renee mentioned that she was feeling under pressure by her Director to move to a supervisory position in addition to continuing her own work as a home visitor. Renee said, "If I can't be successful as a home visitor, like in the situation with Shelby and Niya, how can I supervise and support others?" Jasmine helped Renee to explore how the pressure she was feeling might have played a part in her reaction to what happened during the home visit and what steps she might take to relieve some of the pressure.

# data[].attributes.headline
Element 5:                  Consider Personal Context 

# data[].attributes.subject
Element 5:                  Consider Personal Context 

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The next time Renee had a home visit with Shelby and Niya, she tried the new activity that she and Jasmine had discussed. It didn't go as easily as she had hoped and Shelby ended up scolding Niya instead. Renee felt frustrated and upset, feeling she had failed to be effective. The next time she and Jasmine talked about Shelby and Niya, they spent time talking about Renee's high expectations for herself and their influence on her reaction to Shelby's behavior.

# data[].attributes.headline
Element 4:                  Establish Mutuality 

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Element 4:                  Establish Mutuality 

# data[].attributes.body
In addition to working together to devise a plan and new activity for the next home visit with Shelby and Niya, Jasmine and Renee agreed to work together more regularly — checking back and changing plans as needed to benefit Shelby and Niya. By sharing observations, exploring ideas, and working together, Renee felt she and Jasmine were partners.

# data[].attributes.headline
Element 3:                         Avoid Expert Stance

# data[].attributes.subject
Element 3:                         Avoid Expert Stance

# data[].attributes.body
Renee then asked for some new ideas and ways to work with Shelby and Niya. Rather than give immediate advice, Jasmine inquired about what Renee had already tried and what new ideas she might have, given her close relationship with Shelby, her observations of Shelby and Niya, and their home environment. Renee shared some of her ideas with Jasmine who then encouraged Renee to brainstorm other ideas and choose something that she thought she could try on her next home visit.

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Element 1:                Centrality of Relationships           

# data[].attributes.subject
Element 1:                Centrality of Relationships           

# data[].attributes.body
Renee, a home visitor for ABC Early Head Start, requested that Jasmine, the mental health consultant already familiar with Shelby and her 10 month old daughter Niya, observe and interact with them during a socialization time at ABC Early Head Start. When Jasmine visited the center, she observed Shelby sitting near her young daughter, Niya who was playing with a set of soft blocks. Shelby looked distracted and didn't notice as the child picked up a block and extended her arm to her mother. Jasmine approached the dyad, greeted Shelby, and said "Oh look how well your daughter can hold a block...and look, she wants to give it to you!" As the mother turned, took the block, and smiled, the child wiggled and squealed with delight. Jasmine said, "Niya learns more about the world around her when she plays with you."

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Element 2:                     Parallel Process  

# data[].attributes.subject
Element 2:                     Parallel Process  

# data[].attributes.body
After observing and supporting the interaction between Shelby and Niya, Jasmine talked to Renee, who visits and works with Shelby on a regular basis. Jasmine inquired about Shelby and Niya's interaction during home visits. Renee expressed concern and described how she had been trying to support more interactive and positive play between Shelby and Niya. Jasmine built on her positive relationship with Renee, acknowledging her excellent observations and appropriate efforts at intervention as well as offering her support in her work with Shelby and Niya. Renee began to feel more energized about her work with Shelby and Niya.

# data[].attributes.headline
Sharing ideas clearly and soliciting ideas from others

# data[].attributes.subject
Sharing ideas clearly and soliciting ideas from others

# data[].attributes.headline
Acknowledging and valuing the experiences of others

# data[].attributes.subject
Acknowledging and valuing the experiences of others

# data[].attributes.body
The consultant offers empathy and support to consultees through the consultant's belief in caregivers, families, and children and their capacity to grow, change, and be more effective.

# data[].attributes.body
— The consultant anticipates and takes the time to uncover, understand, and influence change, managing the pace of the collaboration between the consultant and the consultee(s).

# data[].attributes.body
By "wondering," the consultant avoids the position of the expert, encourages other perspectives, and facilitates the process of understanding that evolves within the relationship between consultant and consultee(s).

# data[].attributes.headline
Element 7: Hearing and representing all voices 

# data[].attributes.subject
Element 7: Hearing and representing all voices 

# data[].attributes.body
The consultant elicits information, hearing and voicing perspectives equally (especially the child's), and facilitating cooperation and collaboration.

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Element 6: Considering all levels of influence

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Element 6: Considering all levels of influence

# data[].attributes.body
The consultant considers the influences that come to the consultee as part of an organization, such as program philosophies, peers and co-workers, and others in the full context of an individual's work in early care and education.

# data[].attributes.headline
Element 5: Understanding another's subjective experience

# data[].attributes.subject
Element 5: Understanding another's subjective experience

# data[].attributes.body
The consultant listens to consultees (staff, parents, etc.) and considers their personal context (values, attitudes, beliefs, practices) and personal experience/histories and how these influence their perception, relationships, and on-the-job actions/interactions.

# data[].attributes.body
The consultant and consultee (provider or parent) both contribute to the process by identifying the concern, mutually sharing their perspectives, developing hypotheses, showing willingness to participate in changes, and generating ideas for moving forward.

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Element 3: Avoiding the position of the expert 

# data[].attributes.subject
Element 3: Avoiding the position of the expert 

# data[].attributes.body
The consultant relies on the relationships and a collaborative process with the caregivers in the child's life to build their capacity to deliver care and interventions in the context of the child's and caregiver's everyday activities.

# data[].attributes.headline
Element 2: Parallel process as an organizing principle

# data[].attributes.subject
Element 2: Parallel process as an organizing principle

# data[].attributes.body
The consultant takes the perspective that all relationships influence one another, and a positive experience in the relationship between the consultant and the early care and educator, positively influences the relationship between the early care and education provider and the children in his or her care and their families.

# data[].attributes.headline
Element 1: The centrality of relationships 

# data[].attributes.subject
Element 1: The centrality of relationships 

# data[].attributes.body
The consultant holds the theoretical and developmental perspective that relationships and the interaction between caregiving adults and children have a primary role in the social/emotional development and mental health of young children.