IECMHC in Home Visiting
Home visitors often carry the earliest relationships in the system alone. Consultation gives them a partner who helps them understand what a family is going through and how to respond.
Watch the home visiting open house
Recorded 53 min
Trista Vonada, Tiffany Ajayi and Shai Idelson talk with home visiting leaders about what consultation adds to the work. Then they show how programs bring it in without waiting for a funded consultant position.
- What consultation looks like inside a home visiting program
- How consultation builds on reflective supervision
- Why so few home visiting programs have consultation today
- How programs bring it in without a funded consultant position
What consultation is in home visiting
In home visiting, consultation pairs a mental health consultant with the people who support families: home visitors, their supervisors, program leaders or a whole team. It isn't therapy. It works through those adults so they can support a family's relationships and a child's social and emotional development. It also builds the adults' own resilience and confidence.
Who the consultant works with
Consultants work with home visitors, their supervisors, program leaders or a whole team. The work happens in case consultation, reflective sessions and training.
What changes
Home visitors ask what may be happening in a family developmentally, relationally, emotionally or behaviorally. Then they ask how to respond, and they become more responsive to families.
Where it fits
Consultation fits alongside the model you already run. Colorado's evaluation covered five home visiting models: Parents as Teachers, Nurse-Family Partnership, HIPPY, SafeCare and Healthy Steps. A 24-month pilot(opens in a new tab) ran inside a Healthy Families America program.
It works at three levels
- Read Story 4: Case consultation(opens in a new tab)
Child and family
A home visitor brings one family to case consultation. The consultant's questions help the visitor understand the parent's behavior in light of the parent's own history. With the family's consent, the consultant may also join a home visit.
- Read Story 5: Group consultation(opens in a new tab)
Home visitor and team
The consultant joins supervisors and home visitors in reflective supervision. In group consultation, the team reflects on a family together. The consultant also builds training around what home visitors need to know.
- Read Story 2: Connecting with the supervisor(opens in a new tab)
Supervisor and program
A new consultant meets each supervisor and learns how the program runs. Supervisors get their own reflective consultation and clear agreements about what that time is for.
What's the difference between consultation and reflective supervision?
Consultation builds on reflective supervision and adds to it. Both matter in home visiting.
Reflective supervision asks
How is this work, and these situations, affecting you, your relationships and your practice?
Consultation adds
What may be happening here developmentally, relationally, emotionally or behaviorally? How can we respond in ways that help the relationship, the child and their family, and us?
What the evidence says about its impact
Most of the evidence for consultation comes from center-based early childhood programs, and only a few studies(opens in a new tab) have looked at home visiting. Here is what they found.
- 21 months
- of consultation grew reflective capacity for Illinois home visitors and educatorsSource for 21 months, of consultation grew reflective capacity for Illinois home visitors and educators
- 3.63 to 3.86
- home visitors' self-efficacy on a 5-point scale after working with a consultant in MichiganSource for 3.63 to 3.86, home visitors' self-efficacy on a 5-point scale after working with a consultant in Michigan
- 92% vs 40%
- of Colorado respondents valued trauma experience in a consultant vs a professional licenseSource for 92% vs 40%, of Colorado respondents valued trauma experience in a consultant vs a professional license
Home visitors become more responsive to families
In Illinois, researchers scored recordings of real home visits. Home visitors receiving consultation rated significantly higher on responsiveness to the family over time than a matched comparison group.
Reflective capacity grows
The same Illinois pilot followed 136 staff for 21 months. Staff receiving consultation, including home visitors, significantly increased their reflective capacity.
Self-efficacy rises and job stress falls
Michigan's Home Visiting Initiative measured home visitors at 4 sites before and after they worked with a consultant. Their self-efficacy rose from 3.63 to 3.86 on a 5-point scale. The gain was statistically significant. Job demands fell and job resources rose.
Michigan Public Health Institute, 2019
Knowledge and confidence improve
In a 24-month Healthy Families America pilot, home visitors gained knowledge of mental health and confidence partnering with parents.
Colorado home visiting teams rank trauma experience above a license
Colorado MIECHV asked 40 home visitors, supervisors, consultants and administrators what matters most in a consultant. 92% valued experience with trauma and toxic stress, and 40% valued a professional license. Scheduling was the top barrier at 44%. Four more tied at 40%, including consultation not being built into the program and too little time with the consultant.
Read the full evidence
See it in practice
- Colorado MIECHV Evaluation (opens in a new tab)How consultation runs in Colorado's MIECHV programs and what helps or gets in the way.
- Embedding IECMHC in MIECHV Programs (opens in a new tab)Federal guidance and a getting-started checklist for MIECHV awardees and local agencies.
- IECMHC and the Pyramid Model (opens in a new tab)How consultation and the Pyramid Model fit together and what the consultant does in home visiting.
- Five actions on maternal depressionWhat programs can do: identify families, train staff, use reflective supervision, connect families to care and reduce stigma.
- Reflective Supervision Info Sheet (opens in a new tab)A guide to reflective supervision for supervisors.
Plan and pay for it
- Logic Model for Home Visiting (opens in a new tab)A one-page view of the inputs, activities and expected outcomes of consultation in a home visiting program.
- Logic Model Template (opens in a new tab)Build your own logic model using guiding questions for each part.
- Financing IECMHC (opens in a new tab)Common questions on paying for consultation, from Medicaid to child care funds. MIECHV is one of the sources it lists.
- Illinois's Approach (opens in a new tab)How Illinois built and sustained consultation. It covers consultation at MIECHV sites.
Bring it to your home visiting program
You don't need a funded position to bring consultation into your program.
Three ways in
- Train your own staff: build consultation capacity inside your program with the Practical Certificate.See the Practical Certificate
- Get consultation now: Georgetown consultants work with your staff virtually, starting within days.See Virtual Consultation
- Design your system: we help you plan and build a system of consultation support.See Technical Assistance