Program Structure

Program Structure

An important first step in providing infant and early childhood mental health consultation (IECMHC) services – whether as a solo practitioner or a program – is to thoughtfully conceptualize and clearly articulate your program design. This section offers resources to help guide your thinking about the components of high-quality consultation and lend practical support as you strategically plan for service implementation. Some of the resources below provide implementation-level detail, while others offer best practice guidance and program design inspiration. As always, a critical first step is ensuring that all involved with planning and implementation efforts are grounded in IECMHC Basics.

Program Planning and Reflection Tool (PPRT)
A comprehensive program design resource. This program-level online assessment tool highlights the essential components of a high-quality IECMHC program and offers guidance on how to put these elements into place. Further, it provides a mechanism to assess program progress and potential in the five key IECMHC program implementation areas.

Laying the Groundwork: Community Context

As programs and practitioners develop IECMHC services, it is important to explore community needs and strengths – including the cultural and systemic context – and apply findings strategically to the consultation approach.

Sample Needs Assessment Conducting a needs assessment with stakeholders is a crucial first step in designing an IECMHC program. This resource provides a comprehensive overview and template of the necessary areas for data collection to complete a needs assessment specific to IECMHC program development.

Overview of the IECMHC Approach within the Early Childhood System Inventorying existing child and family service systems in the community is beneficial at the onset of program design. Service system partners can help generate referrals, address non-IECMHC needs for consultees, and/or advocate for IECMHC services. From a sustainability perspective, systems awareness can also uncover potential funding pathways. This resource is designed to help with all of the above, with a particular focus on how to embed IECMHC within systemic efforts to support early childhood/early childhood mental health.

Program Design

Step-by-Step Program Design Guidance

Program Planning & Reflection Tool (PPRT) The PPRT is a comprehensive program design tool, and a good starting point for program design efforts. This program-level online assessment tool highlights the essential components of a high-quality IECMHC program and offers guidance on how to put these elements into place. It also provides a mechanism to assess program progress and potential in five key implementation domains: Program Structure, Workforce, Equity, Program Evaluation and Policy & Financing. Users can complete an interactive version online, or simply download PDF versions for strategic planning. Access PDF files here: Program Structure PPRT Module only | Entire PPRT (all five modules).

Design Element 1: Mission, Vision & Values

Program design should be grounded in a well-articulated vision that reflects program values and aligns with program goals.

Creating Practice-Based Principles for Effective Early Childhood Mental Health Consultation Services  This report synthesizes findings from a collaborative, consensus-building effort called a Delphi process, in which IECMHC expert stakeholders refined a set of ten practice-based principles for IECMHC, in addition to a definition for IECMHC and a list of its primary goals. In lieu of a manualized approach, these ten principles are offered as an alternative measure of program fidelity to the essential elements of IECMHC, while also allowing for individualization across settings and communities.

Diversity Informed Tenets for Work with Infants, Children, and Families  The Diversity-Informed Tenets are guiding principles created to encourage the infant mental health field to intentionally and mindfully engage in standards of practice that promote and strive for a just and equitable society.

Developing and Implementing a Program wide Vision for Effective Mental Health Consultation This in-depth guide provides guidance and support for early childhood program administrators with respect to ensuring IECMHC is implemented in coordination with a wide vision for the center. It includes specific guidance on programmatic elements of IECMHC from hiring to supporting consultants.

Theories of Change and Logic Models for IECMHC To organize concepts for both program development and evaluation purposes, theories of change and logic models serve as “roadmaps” that graphically depict the connections between the community context, the actions to be undertaken, and the desired outcomes. These tools are important grounding elements for those designing IECMHC programs. The Center of Excellence has developed several resources to facilitate theory of change and logic model development, which are featured in the Research & Evaluation section of our website.

Design Element 2: Service Setting(s) & Eligibility

An essential component of service design is specifying where and to whom services will be provided.

Designing an IECMHC Program: Four Essential Building Blocks This brief reviews four key areas of program design, including eligibility determination, and offers examples of how they have been implemented in a range of IECMHC programs.

Overview of IECMHC within Tribal Communities  This resource brief explains how the collaborative and culturally respectful nature of IECMHC can make it particularly well suited for tribal programs in a variety of settings, and describes best practice steps programs can take to begin serving tribal communities.

Design Element 3: Service Array & Intensity

Clearly delineating the services that your program does – and does not – provide, as well as the “dosage” of consultation offered is critical. Articulating these program design elements supports program fidelity and helps to prevent confusion among staff, program partners, and consultees.

The Essential Activities of Infant and Early Childhood Mental Health Consultation: Guidance for the Field from a Consensus-Building Study The CoE conducted a consensus-building research study to distill the essential activities of IECMHC. The resulting list of IECMHC activities in this report offers direction for programs and practitioners seeking to deliver equitable, high-quality consultation in any setting. Further, it provides the foundation for developing a fidelity tool to guide training, implementation, and evaluation efforts.

Programmatic Infant and Early Childhood Mental Health Consultation – What is It?  This brief discusses different methods of thinking about what programmatic consultation is and is not, and includes examples to support IECMHC work at this level.

Supporting Children in Foster Care This resource brief explores various special considerations for providing infant and early childhood mental health consultation when children in foster care are involved.

Design Element 4: Consultation Phases

The sequencing of consultation services is another important design element. The Center of Excellence has identified three major phases of IECMHC work: Initiation, Service Delivery (encompassing plan development, implementation, and revision), and Service Conclusion. For additional information and resources that support these consultation phases, please visit the Workforce section of our website.

A Day in the Life of an Early Childhood Mental Health Consultant This resource contains a series of real-life vignettes that describe the different phases of the work that a MHC may encounter in the course of an average day.

The Georgetown Manual for School-Based Early Childhood Mental Health Consultation Services This manual describes a framework for the provision of ECMHC in school settings, and provides illustrative guidance on how to work through the various consultation phases.

Design Guidance from the Field

What Works This seminal reports summarizes the results of a mixed methods study that focused on six effective IECMHC programs in early care and education settings. A conceptual framework was developed which continues to influence the design of IECMHC programs nationally. Full Report | Executive Summary

What’s Working: IECMHC and Family Friend and Neighbor Care This report summarizes work done through a grant from the Robert Wood Johnson Foundation to the Georgetown University Center for Child and Human Development in 2018 to explore the role that IECMH consultants can play to support Family, Friend, and Neighbor providers.

The Georgetown Manual for School-Based Early Childhood Mental Health Consultation Services
This manual describes a framework to the provision of ECMHC in school settings. Georgetown University Center for Child and Human Development articulated this framework for ECMHC as implemented in a pilot program in a DC charter school for Pre-K 3- and 4-year-old classrooms. ECMHC services are organized into phases and described at multiple levels: child-/family-focused, classroom-focused, and programmatic consultation. The Appendix contains foundational materials describing the GU practice-based principles for ECMHC as well as tools to gather ECMHC data on children and classrooms. This document is intended as a resource that could aid other programs in the development of their manuals, though program manuals go beyond this content to also include site-specific implementation details.

Early Childhood Mental Health Consultation (ECMHC) Guide: Standards, Rationale, and Guidance for the State of Maryland This resource was developed in 2011 for the Maryland ECMH Project and an updated version appears on this page of the CoE website. We have included this earlier version here as an example of how to structure a program manual which includes: (1) a well-articulated set of program standards supported by (2) a rationale for each standard, based on the current evidence base; (3) examples of self-assessment indicators for each standard; and (4) a comprehensive appendix of forms that support all aspects of IECMHC work.

Early Childhood Mental Health Consultation: Brief Report of Adaptations in the Virtual Learning Environment (2022)
AppleTree Early Learning Public Charter Schools serve exclusively 3- and 4-year-olds in the District of Columbia and receive Early Childhood Mental Health Consultation (ECMHC). ECMHC at AppleTree has been guided by the Georgetown Model for School-Based ECMHC (Hunter et al., 2016) with consultation at AppleTree’s early learning campuses delivered at the programmatic, classroom, and individual student/family levels. ECMHC services were adapted to AppleTree’s virtual setting in March 2020 and during the 2020-2021 school year. This paper describes the core tenets of ECMHC, ECMH consultants core competencies, ECMHC adaptations in the virtual settings at AppleTree, identifies the central elements of in-person ECMHC that remained consistent during virtual learning, and presents key points for virtually adapting ECMHC.

IECMHC & The Pyramid Model: Different Yet Complementary

Understanding Infant and Early Childhood Mental Health Consultation and the Pyramid Model: How do these approaches fit together and how are they different?  Many programs have both IECMH consultants and Pyramid coaches working together or in parallel. This brief provides information on how consultation and coaches fit together and highlights important differences.

Crosswalk of Infant Early Childhood Mental Health Consultation and Pyramid Model Coaching: Building Capacity in Early Childhood for the Promotion of Social and Emotional Health This resource brief highlights and describes the unique and complementary aspects of two successful approaches early childhood programs can use to support children’s social and emotional skills: infant and early childhood mental health consultation (IECMHC) and the Pyramid Model.

All Hands on Deck: Partnering with Infant and Early Childhood Mental Health (IECMH) Consultants to Implement the Pyramid Model This product was created by the National Center for Pyramid Model Innovations to explore the relationship between IECMH consultants and Pyramid Model coaches. The focus is on how consultants can support coaches in early childhood settings.

Program Sustainability

Sustainability Modules Initiating and ultimately sustaining infant and early childhood mental health consultation activities involves more than just having a great program. Strategic funding decisions and policy development can be critical to ensuring that IECMHC activities are integrated into established child-serving systems and have the potential to have a lasting impact. This resource outlines six areas of sustainability to consider.

Status of the Evidence for Infant and Early Childhood Mental Health Consultation This brief summarizes the evidence base for IECMHC, integrating both peer-reviewed journal articles and evaluation reports. It underscores the positive impact of IECMHC and can be an effective tool in garnering support among policymakers, system leaders, and other potential program sustainability champions.

Program Evaluation Planning Worksheet Demonstrating the positive impact of an IECMHC program is one effective way to support sustainability efforts. This interactive document outlines the core elements of a comprehensive IECMHC evaluation plan. It is intended to be used as a resource for teams seeking to understand what to include in a written evaluation plan.

This product was developed [in part] under grant number 1H79SM082070-01 from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.