Guidance for Program Design: Addressing the Mental Health Needs of Young Children and their Families in Early Childhood Education Settings

Personnel

Purpose

This project is designed to develop, test and disseminate a research-based approach to mental health program planning that can be used by early childhood staff in Head Start and other early childhood settings. To use a research-driven approach to develop, test, and disseminate an integrated strategy for program decision-making aimed at addressing the needs of young children with or at risk of emotional, behavioral, or mental disorders and their families.

Project Objectives

1. To build a conceptual framework that encompasses the relationships between organizational characteristics, program philosophy, program design, and outcomes for children, families, and staff in early childhood settings.

2. To conduct research within this conceptual framework to answer specific questions needed to assist early childhood program administrators, staff, and families in decision-making about organizational factors and program design.

3. To develop materials and technical assistance and training strategies for use with early childhood programs that will enhance their capacity and competence, including the ability to evaluate the effectiveness of their efforts

4. To test and refine these materials and technical assistance and training methods.

5. To widely disseminate these materials and the training and technical assistance approach to early childhood programs, educators, family members, and other interested audiences.

Research Phases

This project involves an iterative, applied research process that combines a number of research phases:
(I) Synthesis of existing knowledge across organizational research, program effectiveness studies in early childhood education and early intervention, and mental health services research, along with ongoing review of relevant training packages and other related materials;
(II) Qualitative research in three contrasting Head Start programs to increase the validity of the conceptual framework for the project;
(III) A quantitative study that involves combining new information with existing data available in annual Program Information Reports completed by Head Start programs;
(IV) Application of the knowledge gained through the development and testing of a training and technical assistance package.

1. How do the observed characteristics of the mental health programs in contrasting Head Start programs compare to a conceptual framework derived from the research and conceptual literature?

2. To what extent can the conceptual framework be verified in research with a large number of Head Start programs?

3. What are useful approaches (materials and training methods) to meeting the mental health and program development information needs of Head Start staff with regard to developing and/or improving mental health programming for Head Start children and families?

4. Does it appear that the introduction of a mental health program curriculum and training process affects program level and individual level (child, family, and teacher) outcomes in Head Start programs?

Phase II: Qualitative study of three contrasting programs

A qualitative study has been conducted in three contrasting Head Start programs. Programs were selected that had different approaches to the delivery of mental health services.

The qualitative study was guided by a series of general questions, for example:

1. To what extent is there an articulated philosophy of mental health? What is the evidence for a common philosophy? What are the elements of the philosophy with regard to mental health? Do all program staff appear to share a common philosophy, or are there divisions among categories of staff, by geographic location, by training, by rank, or according to other designations?

2. How important does a common philosophy appear to be, where it exists and where it does not? What kinds of decisions appear to be linked or guided by a shared vision for the program?

3. If there is a common philosophy or shared agreement about children with apparent mental health needs, how did it come about?

4. What program outcomes do staff identify as important for children with challenging behaviors and their families? Do they correspond to those identified by families? How do these outcomes compare to the frequently measured individual and program-level outcomes in the literature?

The program observations were conducted by project staff under the supervision of Jennifer Simpson, Ph.D., and Beth Green, Ph.D., who have expertise in a variety of qualitative research methods. The information gained through the qualitative study, along with the literature, will be used to revise the conceptual framework, which also serves as the framework for addressing the next project objective.

Phase III: Develop a measure of organizational philosophy

The qualitative study will provide a rich foundation for the measure development phase. Based on this information, and on other measures of organizational philosophy, we will decide on scale items, then pilot the scale administration through interviews with Head Start personnel, and by administering the items to approximately 20 Head Start administrators, management staff, teachers, and parents in the Northwest region. We will aim to keep the intrusiveness and burden to a minimum, and will work to keep the response rate high by offering to provide training in the mental health program planning approach to the two programs with the highest (relative) response rate.

Data analysis will follow steps for scale development: examine the items for response distribution, and conduct exploratory factor analysis to examine the underlying structure of the data; create one or more multi-item scales; examine inter-item correlations for items within scales; and finally, examine the scales for internal consistency and reliability using Cronbach's alpha. Hierarchical linear modeling and other forms of cluster analysis will be pursued to identify further groupings of important organizational factors.

Phase IV: Survey of Head Start Programs

The next step is to use the measure of organizational philosophy and selected other items to survey a sample of personnel in approximately 80 Head Start programs. We will distribute the questionnaires to all administrators and supervisors, and a sample of teachers and parents; the unit of analysis will be organizations.

The information collected from programs will be combined with information available from the Program Information Reports (PIR) submitted annually by all Head Start programs to the federal Head Start Bureau. These data are in the public domain, and it is possible to obtain selected data, such as demographic data, number of children identified as needing mental health services, and number of children receiving mental health services for each program. Because the unit of analysis will of necessity be the organization, data will be summed at each level (supervisors, teachers, and parents). The zero-order correlations among all variables will be examined, in preparation for multivariate analysis. At this time we will carefully examine the criterion variables (e.g., the percent of children referred because of mental health problems, the percent of children receiving treatment). The analysis will be conducted in relation to the research questions:

1. To what extent do organizational variables (e.g., size, auspice, level of staffing, education and experience of staff) explain variance in organizational outcomes (e.g., number of children referred and/or receiving mental health treatment, identified under as "emotional or behavioral and/or receiving special services")? This question will be examined by regressing outcome variable(s) on organizational variables. To avoid conducting many multiple regressions, thus enhancing the possibility of achieving statistically significant findings by chance, the criterion variables will be carefully examined to choose the best one or two variables from among the choices in the PIR data.

2. To what extent does program philosophy (values, beliefs, and ideology) explain variance in organizational outcomes (number of children referred and or receiving treatment? At present it is not possible to know the nature of the measure of program philosophy (e.g., the number of dimensions); so the exact nature of the statistical analysis cannot be determined.

3. To what extent do internal and external program resources account for variance in organizational outcomes? This question may be addressed through examination of zero-order correlations.

4. Taken together, how do organizational variables, program philosophy, and program resources account for variance in organizational outcomes? Multiple regression analysis will be undertaken to explore this question, using the most appropriate criterion variable as the dependent variable. Organizational size and auspice will be entered first, followed by other organizational variables in a block, then program philosophy, and program resources.

Family and Youth Participation

Parents and other adult caregivers will be involved at all steps of this process. They have participated in the design and development of this project through our proposal development committee, and Head Start parents will serve as local advisors to the project. In addition, several members of our National Advisory Committee (NAC) are family members, and they, along with the youth members of the NAC, will be asked to review materials and products at each step. We will also pay careful attention to family perspectives on program philosophy, and where there are discrepancies between their perceptions and those of staff, include those points of contrast in the training materials. Family and youth advisors will also be consulted about product preparation and dissemination strategies.

Plan for Cultural Competence

The population of Head Start programs is very diverse, economically, geographically, and in terms of ethnic and cultural background. One important issue that we will track throughout the project are the different meanings and values attached to the term, "mental health," differences in child rearing practices, as well as the variety of beliefs about intervention. Many Head Start families are cautious about contacts with any formal system (e.g., mental health, health, child welfare); this is one reason why the on-site consultation model is recommended. We will include staff and parents from culturally diverse backgrounds in our local advisory group, and our national advisors represent a variety of cultural backgrounds as well. These advisors will review every step of the research and development process. We will translate the questionnaire for Head Start administrators, staff, and parents into Spanish, and will work with participating programs to determine the best approach to having a wide range of cultures among our respondents.

The qualitative study of contrasting organizations will provide a good opportunity to learn in more depth about all of the challenges that we face with regard to working toward cultural competence in our research and in the development of materials and training methods. Fortunately, we have two staff members at the RRTC who speak fluent Spanish, and we will ask those staff to conduct some interviews with parents who are more comfortable in Spanish in the two Head Start programs.

Training and Dissemination

This project is designed to increase the resources available for training and support of Head Start program staff and parents to develop and/or improve programmatic approaches to addressing the mental health needs of children and families. The training materials and approaches that will be developed should be of great interest to Head Start and other early childhood programs across the country. We will feature this work at our annual conference, "Building on Family Strengths," which is attended by family members, researchers, and service providers from across the U.S., and will also present at the annual conference of the Federation of Families for Children's Mental Health, the children's mental health research conference sponsored by the University of South Florida, the Head Start Research Conference, and the biannual Training Institutes organized by the Georgetown University Technical Assistance Center.

Our written products will be publicized in our bulletin, Focal Point, which has a readership of nearly 30,000 persons, and in newsletters of family organizations, and publications within the Head Start network. As with all other Center products, products from this project will also be featured on our web page.

This project has explicit plans to develop training materials and technical assistance designed to be useful to early childhood education programs in the efforts to plan for the mental health needs of the children that they serve. Beginning in year 3, we will be conducting training sessions to obtain feedback about the materials, and also to identify the technical assistance needs of program administrators, staff, and family members with regard to developing and/or augmenting their plans addressing mental health issues.

Latest Updates

The culmination of this project was the development, publication, and presentation of the training manual you can download at the top of this web page: "Management Strategies for Positive Mental Health Outcomes." Overhead slides describe findings from the national survey of over 800 staff at over 70 Head Starts, and what the research means for early childhood leaders wanting to promote healthy social-emotional development. The manual adds explanatory and resource material and received positive comments at Region X, Oregon, and National Head Start Association training conferences in 2004. We continue to seek opportunities to present the 2-3 hour training to audiences of early childhood program managers. If travel can be reimbursed by the host, we can present a tailored training at no charge.

Watch this "Guidance" page for news of publication for two articles that will be submitted to a research-focused journal and a provider-focused journal. We have learned that the Guidance project is among a handful of early childhood mental health consultation empirical studies that go beyond individual agency evidence into inferential statistical evidence, so peer-reviewed publication has some urgency beyond the end of the project grant September 30, 2004.

Also, the national survey analysis and other research findings continue to be used in RTC's 2004-2009 project- Transforming Transitions to Kindergarten: A Family-Provider Team Approach. This new "T2K" project is testing the impact of the "Guidance" training and long-term technical assistance in two Oregon Head Starts, while also intervening in the practices surrounding the transition to Kindergarten. Look for more on Transforming Transitions pages of the RTC website.