Head Start or Early Head Start programs can influence the effectiveness of mental health consultation by supporting relationship-based work and making the most of the consultant’s skills associated with the consultative stance. These supports begin with the program’s values and beliefs that guide program philosophy and approach to early childhood mental health and include administrative and organizational structures for relationship building, collaboration and reflective practices.

Program philosophy
The program philosophy — values and beliefs — guides program practices. A program philosophy related to early childhood mental health that includes the view that healthy social emotional development takes place in the context of caregiving relationships is a good fit with relationship-based consultation. Other beliefs essential to an organizational culture that facilitates the relationship-based work of consultation include:

• Learning is a lifelong process. Everyone learns through interest, experience, reflection, and openness to new information.
• Learning is reciprocal. Everyone in an organization learns and develops together and can learn from one another.
• Relationships build over time, relying on trust and emotionally sensitive communications.
• Relationships influence relationships in “parallel process” (the relationship between the consultant and caregiver and its quality creates changes in the child and caregiver [staff and family] relationships).

To actively embrace these four beliefs, the program (staff, families and mental health consultant) engage in “reflective practice” — the art of stepping back to examine what one is observing or doing through self-examination (Emde, et al, 2001). This practice is an essential element in the consultative stance as well as the relationship-based work of consultation.

Relationship building and collaboration opportunities
Effective mental health consultation can only occur if there is organizational and administrative support for consultants, staff, and families to spend time together. Early on, the parameters of the relationship between the consultant and staff or caregivers and when and with whom the consultant will meet must be established. While this may evolve over time, regular meetings and adequate time to work together helps build the foundation for relationship-based work. Regular opportunities to work together and consultation practices associated with the consultative stance encourage a collaborative process essential to effective consultation. Some specific examples of these opportunities may include:

• An introduction and program entry process for the consultant that communicates collaboration, shared expectations, and provides time for relationship building
• Consistency in consultants — minimal consultant turnover, and regular, timely consultation visits
• Consultant visits of sufficient frequency to build and maintain strong relationships with staff and families
• Flexibility in scheduling and availability by phone
• Participation in program staff meetings, open houses, and other program activities
• Set-aside time to meet staff and adequate classroom coverage during that time
• Opportunities for meeting and learning together — staff in-service, team conferencing, etc. — that is inclusive of as many staff as possible
• Physical setting and space that supports privacy for consultation activities
• Regular communication with the program director and services supervisor

(Adapted from Donahue et al, 2000, Duran et al, 2009)

Reflective practices for staff and caregivers
Staff and caregivers must find ways to address the stress involved in their work, take care of themselves, and have supports that provide opportunity for reflection, guidance, and skill development. It is important to build supports for early care and education staff in the consultation model that may include experiences in reflective practices, peer support, and one-on-one consultation. Mental health consultation that includes the elements and practices associated with the consultative stance incorporates time for regular opportunities to reflect with staff members on their work in an open and supportive environment.

In some Head Start and Early Head Start programs, the mental health consultant to the program provides staff development and staff support that include opportunities for reflective practices. Programs have incorporated both team and individual opportunities for a safe, nonjudgmental, and relationship-based process for staff to share their successes as well as their challenges with an experienced listener (Kaufmann & Hepburn, 2007). These reflective practices, sometimes called “reflective supervision”, can help staff members understand their own reactions to the children and families with whom they work and help them to use this self-awareness to develop strategies to enrich their work (Mann et al 2007).