Laura Denatale dissertation

Institute for Clinical Social Work

MULTIPLE DIMENSIONS OF EARLY CHILDHOOD MENTAL HEALTH CONSULTATION

A Dissertation Submitted to the Faculty of the Institute for Clinical Social Work in Partial Fulfillment For the Degree of Doctor of Philosophy

By LAURA MICK DENATALE

Chicago, Illinois January, 2012

ABSTRACT Early childhood mental health consultation has emerged as one of the most popular and effective strategies for addressing young children’s challenging behaviors and supporting young children’s social-emotional development. A key contributing factor for successful outcomes with this approach is the consultant–program administrator (consultee) relationship. However, there have been no in-depth studies to examine the nature of this relationship. In this study, 10 early childhood mental health consultants and 15 program administrators who worked together on the Erikson Institute–Illinois State Board of Education Infant and Early Childhood Mental Health Consultation Project were interviewed using qualitative, grounded theory methodology. Contemporary Relational Psychoanalytic theory was used to interpret the results. Results of the study show that there are multiple internal and external dimensions that influence the consultantadministrator relationship. Implications for this study include important considerations when designing and implementing early childhood mental health consultation models.

This study demonstrates the need for future research on similar topics.

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For Marilyn Silin.

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ACKNOWLEDGMENTS

Thank you to the Illinois State Board of Education and Erikson Institute for providing me with the opportunity to complete this study, and to the mental health consultants and program administrators who participated in this study.

I extend my gratitude to my dissertation committee, R. Dennis Shelby, Ph.D., Dennis McCaughan, Ph.D., and Denise Duval, Ph.D., and my readers Judith Bertacchi, M.Ed., M.S.W. and Lynn Bornstein, L.C.S.W. Special thanks to R. Dennis Shelby, Ph.D., the chairman of my committee, who was there for me every step of the way.

LMD

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TABLE OF CONTENTS

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ABSTRACT .......................................................................................................................ii ACKNOWLEDGEMENTS…………….………………………………………………...iv LIST OF TABLES...........................................................................................................viii Chapter D.

INTRODUCTION.........................................................................................1 Overview of the Problem Description of the Erikson/ISBE Infant and Early Childhood Mental Health Consultation Project Significance for Clinical Social Work Formulation of the Problem

II.

LITERATURE REVIEW..........................................................................14 Relevant Knowledge and Review of Significant Literature Theoretical and Conceptual Framework of the Study Theoretical and Operational Definitions of Major Concepts Statement of Assumptions

III.

STUDY METHODOLOGY......................................................................48 Study Design Scope of Study, Population, and Sampling Data collection Methods and Instruments Procedure for Data Analysis Statement on Protecting the Rights of Human Subjects

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TABLE OF CONTENTS—Continued

IV.

INTRODUCTION TO RESULTS.............................................................58 Overview Participant Demographics Presentation of Results

V.

ENGAGEMENT IS CHALLENGING, COMPLEX, & CONFUSING...70 Do They Evan Want Me Here Boundaries and Role Confusion Influence of Administrator Characteristics

VI.

SO MUCH TO PROCESS ........................................................................79 Processing the Administrator’s Experience Identification with At-Risk Families Trickle-Up of At-Risk Families The Consultant’s Internal Experience

VII.

WORKING WITH ADMINISTRATORS................................................89 Building the Relationship Supporting the Administrator Degrees of Success Trickle-Down Endings and Debriefings

VIII.

WORKING WITH THE CONSULTANT..............................................105 Making Time for the Consultant Brainstorming Together Helping Me Support My Staff Confiding in the Consultant

IX.

FAMILIES AND PROGRAMS IN CRISIS……………........................116 At-Risk Families and Communities Vicarious Trauma and Countertransference Impact of the Economic Crisis

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TABLE OF CONTENTS—Continued

X.

MODEL PROS AND CONS ………………………………………......123 The Consultant’s Expertise Model Constraints Left in the Lurch

XI.

EVIDENCE OF CONSULTANT-ADMINISTRATOR PAIRS………133 Referencing Each Other Common Language Description of the Consultation Process

XII.

EXPERIENCE OF THE RELATIONSHIP.............................................139 Mutually Positive Experiences Mixed Feelings Change Over Time

XIII.

FINDINGS AND IMPLICATIONS .......................................................149 Findings and Theoretical Implications Credibility and Limitations of the Study Clinical Implications Social Implications Future Research Final Thoughts

Appendixes A. RECRUITMENT NOTICE………………...…………...…...…………......192 B. INFORMED CONSENT FORM....................................................................194 C. MHC-ESEI…………………………………………………………...……...198 D. PA-ESEI……………………………………………………………………. 204 REFERENCES…………………………………………………...…………….210

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LIST OF TABLES

Table

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1. Mental Health Demographic Information..............................................................62 2. Program Administrator Demographic Information...............................................66 3. Categories and Properties of Results.....................................................................70

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CHAPTER I

INTRODUCTION

Overview of the Problem The purpose of this exploratory study was to tell a story about the intersubjective experience of the early childhood mental health consultant and early childhood program administrator relationship within the context of a relationship-based early childhood mental health consultation project implemented in partnership by the Illinois State Board of Education and Erikson Institute.1 Perceptions and experiences of early childhood mental health consultant - early childhood program administrator (consultee) dyads that participated in the project were explored using grounded theory methodology.

Description of the Erikson/ISBE Infant and Early Childhood Mental Health Consultation Project In 2006, the Illinois State Board of Education (ISBE) began collaborating with Erikson Institute to invest in children’s well-being. In 2007 a decision was made by ISBE and Erikson Institute to build on the work they had been doing together to develop and sustain a statewide network of infant and early childhood mental health consultants for

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Erikson Institute is a graduate school specializing in child development that works to improve the care and education of children age birth to eight.

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state-funded Prevention Initiative (PI) programs for children birth to three and prekindergarten programs for children age three to five. The mission of the project was to develop an integrated mental health consultation program throughout the state of Illinois to promote the capacity of the systems providing family support and education to address the mental health needs of at-risk young children (ages 0–5) and their families. This was called the Erikson Institute–Illinois State Board of Education Infant and Early Childhood Mental Health Consultation Project (Erikson/ISBE IECMHC Project). Erikson Institute described the project’s approach to consultation as an individualized, relationship-based, reflective consultation process informed by Infant and Early Childhood Mental Health theory and practice.

Infant and early childhood program administrators (consultees) invited to participate in the Erikson/ISBE IECMHC Project were strongly encouraged to attend regional focus groups to learn about the project and to secure permission of agency/school district administrators to participate in the consultation. Following the early stages of the project when focus groups were held, project administrators and consultants individually recruited programs by contacting program administrators and offering consultation services. In 2010, ISBE reported to the researcher that 76 infant and early childhood programs had participated in the project; and Erikson Institute reported that 26 mental health consultants had worked on the project since it began in 2007.

At the time the project began in 2007, consultation activities could include reflective case or programmatic consultation meetings; observation of playgroups, classrooms, child/family activities; participant-observation on home visits; and reflective training for staff. In 2008, the project decided to no longer provide reflective staff

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trainings and to focus more on reflective case and programmatic consultation. Activities of the consultation process were informed by goals of each individual program developed mutually with their consultant using the Illinois Consultation Assessment Readiness Evaluation (I-CARE) process. The I-CARE process involved the consultant working with administrators, and staff, and conducting a needs assessment, determining readiness for consultation, and setting goals for consultation. Consultants worked with administrators to determine the frequency of on-site consultation, which ranged from weekly to monthly, with weekly consultation being the preferred frequency for consultants. Regular goal review and evaluation were built into the consultation process to insure that program needs were being met, and were performed by the consultants and the administrators (consultees) of the programs participating in the project. To support Erikson/ISBE IECMHC consultants in their work, consultants received weekly or bimonthly reflective supervision by Erikson project administrators. The project also provided opportunities for early childhood program administrators (consultees) to network with each other by holding network meetings.

In June, 2010, 2 years prior to the expected end of the project, Erikson Institute decided it was necessary to terminate the project due to non-payment by the state resulting from the state of Illinois budget crisis. The consultants and programs participating in the project were given approximately 1 month to terminate their work with each other. In an effort to continue the project without Erikson Institute’s involvement, in August, 2010, ISBE decided that programs that had participated in the Erikson/ISBE IECMHC Project could directly hire any mental health consultant that had worked for the project and that ISBE would reimburse the programs for the cost of the

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consultation. Programs that decided to contract with consultants through the new consultation project offered by ISBE resumed consultation in the fall of 2010. In the new project funded by ISBE, consultants and program administrators submitted a proposal to ISBE for the consultation. With Erikson no longer involved in the project, the consultation model remained relatively the same; however, programs were able to expand consultation services to include staff trainings and limited direct service to children and families.

Significance for Clinical Social Work Since its inception, the field of clinical social work has been concerned with the biological, psychological, and social well-being of individuals across the developmental spectrum. A large body of recent infant and child development literature has supported the importance of having a healthy developmental start in life in order to ensure wellness later in life. Specifically, the literature has shown that early experiences clearly influence brain development and that early intervention programs can improve the odds for vulnerable children (National Council and Institute of Medicine Report, 2000).

The role of clinical social work in early childhood mental health consultation can be traced back to Selma Fraiberg’s Child Development Project, developed at the University of Michigan in the early 1970s, and the Infant-Parent Program developed at the University of California San Francisco in 1979. These programs are considered to be the original templates for many early childhood mental health consultation models today.

Both of these programs worked from a psychodynamic social work perspective (Johnston & Brinamen, 2006). Many early childhood mental health consultants today are trained as

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clinical social workers before becoming mental health consultants, and clinical social workers continue to be one of the major providers of childhood mental health consultation. This study holds potential to make a valuable contribution to the education, training, and professional development in the field of clinical social work and related fields such as infant mental health and early childhood development and education by developing a theory of the early childhood mental health consultation consultant-director relationship from a psychodynamic theoretical perspective.

Formulation of Problem The overarching goal of early childhood mental health consultation is to address the mental health and social-emotional needs of young children and their families. This is achieved through collaborative relationships between mental health consultants, early childhood program staff, and young children and their families (Cohen & Kaufmann, 2005; Johnston & Brinamen, 2006). Early childhood mental health consultation primarily takes place in early childhood settings, such as preschools, childcare centers, and home daycare settings. Although this approach to providing mental health services to young children began in the 1970s, it has only recently emerged as a widely practiced, effective empirically based prevention and intervention model.

Social Emotional Problems in Young Children A major objective of early childhood mental health consultation is reducing the rate of social, emotional and behavioral problems of young children in order to give them a greater chance for success in the future. The U.S. Department of Health and Human

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Services reports that as many as one in 10 children and adolescents may have a diagnosable mental health disorder. In fact, suicide is the third leading cause of death for young children and adolescents (VanLandeghem, 2003), and the rate of suicide for this age group has nearly tripled since 1960, making it the third leading cause of death in adolescents and the second leading cause of death among college age youth (Mental Health America, 2009).

Far too many young children and their families continue to be chronically exposed to multiple and known environmental risk factors that greatly contribute to children’s development of emotional and behavioral disorders (Conroy & Brown, 2004). Given the relationship between known environmental risk factors such as poverty, substance abuse, and domestic violence, the high number of young children demonstrating severe and chronic problem behaviors is unsurprising. Researchers suggest that 12% to 16% of 1 and 2-year-olds demonstrate a significant delay in social-emotional competence, and 37% of those children continue to exhibit problem behaviors into their preschool years (BriggsGowen, Carter, & Skuban, 2001). Children who live in poverty are at even greater risk for the development of behavior problems than are children from higher SES backgrounds (Qi and Kaiser, 2003). Sadly, given the high number of young children with psychological problems, statistics show that very few children needing professional mental health services receive them, with minorities receiving fewer services than nonminorities (NIMH, 2009).

Social Emotional Development and Academic Performance Much attention has recently been brought to the connection between social-

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emotional development and school readiness. In fact, Cohen, Onunaku, Clothier, and Poppe (2005) suggest that ensuring that young children arrive at school ready to learn has become a national priority. Yet, more than one quarter of young children are perceived as not being ready to succeed in school, with many affected by social and emotional issues.

If not treated early, there can be severe consequences for these children. Positive research findings indicate that prevention and intervention efforts to address mental health problems in early childhood may reduce significant social-emotional difficulties in later childhood, adolescence, and adulthood. The earlier the intervention begins, the better the prognosis (Cohen & Kaufmann, 2005).

It has been found that the quality of childcare in relation to children’s socialemotional development also has an effect on children’s later academic performance. It is now known that early emotional skills lay the foundation for positive social interactions and, ultimately, academic success. The capacity to develop positive relationships, to concentrate on and persist in challenging tasks, to effectively communicate emotions, and to problem solve are just a few of the social-emotional competencies children need to be successful in school (Hemmeter et al., 2006). Quality childcare and preschool programs play a large role in fostering children’s development in these areas.

Children who are identified with aggressive behavior in the preschool years have a high probability of continuing to have difficulties in elementary school and beyond. For instance, there is a strong correlation between preschool-age aggression and aggression at age 10 (Kazdin, 1985). For preschoolers identified with clinical levels of disruptive behavior, 50% or more have been found to display problematic levels of challenging behaviors both four years later and into the school years (Shaw, Gilliom, & Giovannelli,

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2000). As a result of the growing evidence of the importance of young children’s socialemotional development, preschool programs are adapting emotion-related curricula for younger and younger populations. (Thompson & Raikes, 2007; Warren, Denham, & Bassett, 2008). Early childhood mental health consultation plays an important role in helping preschool programs adapt and implement social-emotional curricula for young children so that children have the greatest potential possible to succeed later in life.

Increasing Numbers of Children in Childcare Hungerford et al. (2000) report that greater portions of our youngest children’s days, weeks and lives are spent in childcare than in previous years, and the level of demand for out-of-home childcare for infants and toddlers is unprecedented. Between the 1970s and the 1990s the workforce participation of mothers of children under age 3 in the United States grew from 27% in to 42% (Shonkoff, Lippitt, & Cavanaugh, 2000). In 2010, over 60 percent of children ages 0–5 received non-parental childcare. Thirty-six percent of children under the age of 6 were enrolled in center-based childcare and the rest received other types of non-parental care including home-based relative or non-relative care. The average hours per week children spent in non-parental care was 29.1 for English speaking children and 23.5 for non-English speaking children (Institute of Education Sciences - National Center for Education Statistics, 2010). Children in centerbased care experience a higher mean child-to-provider ratio than children in relative care or non-relative care (Iruka & Carver, 2006).

As young children spend increasing amounts of time in childcare, their relationships with their childcare providers have increasing significance for development.

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The quality of the care-giving environment has an enormous impact on children’s development (Greenough et al., 2001), yet research indicates that there is growing concern about the quality of many childcare settings (Fenichel, Lurie-Hurvitz, & Griffin, 1999). A number of studies have linked low quality early childhood settings to poor child outcomes related to social-emotional development (Howes, Matheson, & Hamilton, 1994; Hungerford et al., 2000; National Research Council, 2001). Furthermore, low quality care appears to more negatively impact children already at risk and who need the most intervention; and early childhood settings often include children who have disabilities and children who are at risk for school failure (Hemmeter et al., 2006).

Research shows that significant numbers of toddlers and preschoolers exhibit behaviors severe enough to cause concern to parents, teachers, and other caregivers. For example, a survey of childcare providers in 10 Chicago centers found that 32% of children, including toddlers, had behavioral problems (VanLandeghem, 2003). These are children whose challenging behavior jeopardizes their preschool placement and affect their growth in social-emotional and other developmental domains (Powell, Dunlap, & Fox, 2006).

In response to the large percentage of children who are enrolled in childcare today and are at risk for mental health disorders, and to the lack of in-house mental health resources in childcare programs, mental health providers have realized the need to serve children where they spend the bulk of their day—in childcare (Collins et al., 2003). Even high quality childcare programs lack mental health resources and generally do not have sufficient in-house expertise to address the full range of children’s mental health needs.

This is significant given that with their increasing prominence, early childhood programs are typically the first to feel the impact of family stresses (Donohue, Faulk, & Provet,

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2000). It is no wonder that authors Gilliam and Shahar (2006) and others believe that early childhood mental health consultation provided in early childhood settings is emerging as a popular and effective strategy for addressing young children’s challenging behaviors and supporting their social-emotional development.

Duran et al. (2009) recommend that due to the need to provide young children and their families with mental health services in early childhood settings, early childhood program administrators need a clear vision, commitment, and program supports, including mental health consultation, to promote the healthy social and emotional development of young children and their families. Other recommendations to address children’s mental health problems made in 2003 by the Illinois Children’s Mental Health Task Force (ICMHTF) also support the need for early childhood mental health consultation (VanLandeghem, 2003). The ICMHTF recommendations specifically include (a) providing mental health consultation and training to early childhood programs and providers to build their capacity to identify and intervene with infants and children whose behavior has begun to deviate from the normal range of development, (b) building the capacity of early childhood programs to treat or refer for the mental health needs of all children and their families through a coordinated system that provides access to all available, evidence-based treatments in the least restrictive environment, and (c) assuring that children of all ages have access to an array of comprehensive assessment and treatment planning services and supports including mental health intervention services provided in children’s natural environment (e.g., the childcare center, preschool, etc.).

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Expulsion from Childcare Expulsion is the most severe disciplinary sanction that an educational program can impose. Increasing numbers of young children are expelled from childcare settings because of problem behavior. Perry et al. (2011) have stated that ―preschool children are being expelled from child care programs at an astonishing rate‖ (p. 4). Nationally, approximately seven preschoolers were expelled per 1000 children enrolled. Although this rate for state-subsidized pre-kindergarten is lower than what has been previously reported for childcare programs, the pre-kindergarten expulsion rate is over three times the rate for K-12 students. Rates were highest for older preschoolers and AfricanAmericans, and boys were over four and a half times more likely to be expelled than were girls (Gilliam, 2005). Results reported from a national study of 3,898 prekindergarten classrooms, representing all of the nation’s 52 state-funded pre-kindergarten systems currently operating across 40 states, show that 9.5% of pre-kindergarten teachers reported expelling at least one preschooler in the past 12 months, of which almost 20% expelled more than one child. Some children experience problems related to the amount of time they spend in childcare. The 2005 National Child Care (NCC) study documented a significant relationship between longer hours in care and increased problem behaviors.

The same study also reported that 42% of Illinois childcare programs participating in a recent survey reported having to ask a family to withdraw a child because staff were unable to manage the child’s behavior.

Although it is difficult to identify the specific reasons that children are expelled from childcare, In a recent study conducted by Perry et al. (2011), characteristics and situational factors that are often present when children are at risk of being expelled were

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identified. These include children exhibiting behavior problems, children with mental health or developmental health needs or challenges, children having complicated family situations, or a combination of these factors. Gilliam and Shahar (2006) found that larger classes, a higher proportion of 3-year-olds in the class, and elevated teacher job stress predicted increased likelihood of expulsion. Perry et al. (2008) suggest that one of the most significant positive effects of early childhood mental health consultation is the reduction of expulsion of children from preschools due to unmanageable behaviors and other challenges that children with special needs present preschool teachers.

Gap in Early Childhood Mental Health Consultation Literature Given the degree of children exhibiting problems in early childhood programs, and the alarming rate of expulsion, it is not surprising that much of the mental health consultation research has focused on child and staff outcomes, including reducing children’s emotional and behavior problems, reducing expulsion preschool rates, increasing the overall quality of childcare, improving preschool teachers’ self-efficacy and competence, and increasing staff satisfaction in early childhood programs (Alkon et al., 2003; Gilliam, 2005; Perry et al., 2008). Although this outcome research has provided extremely important findings for the field of early childhood mental health consultation, early childhood mental health consultation literature has noted the specific importance of the consultant-administrator relationship in the provision of effective mental health consultation (Brown, Pryzwansky, & Schulte, 2006; Bertacchi, 1996; Caplan, 1970; Cohen & Kaufmann, 2005; Donohue et al, 2000; Duran et al, 2009; Fenichel, 1991; Johnston & Brinamen, 2006; Wesley & Buysee, 2004; Westin et al, 1997). Yet, very few

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studies have been conducted on this relationship, and there have been no in-depth qualitative studies that focus solely or primarily on the consultant-administrator relation.

A significant finding in a recent early childhood mental health consultation study on the perceived characteristics of effective mental health consultation also strongly supports the need for additional research in this area. In a study on the characteristics of effective early childhood mental health consultation, Green et al. (2006) found that relationships are the foundation of effective early childhood intervention services, and that the single most significant factor of effective early childhood mental health consultation as perceived by consultees is the consultant-consultee relationship. The more positive the relationship between staff members and consultants, the more likely those staff members were to report that consultation was effective and helped them feel supported in their work. Although the study states that both administrative and direct staff were interviewed, this study did not attempt to focus on the specific characteristics and underlying processes of the early childhood consultant-program administrator relationship that contribute to effective consultation.

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CHAPTER II

LITERATURE REVIEW

Relevant Knowledge and Review of Significant Literature History of Early Childhood Mental Health Consultation Cohen and Kaufmann have developed the most widely accepted definition of early childhood mental health consultation: Early childhood mental health consultation is a problem-solving and capacitybuilding intervention implemented within a collaborative relationship between a professional consultant with mental health expertise and one or more individuals, primarily child care center staff, with other areas of expertise. Early childhood mental health consultation aims to build the capacity (improve the ability) of staff, families, programs, and systems to prevent, identify, treat, and reduce the impact of mental health problems among children from birth to age 6 and their families (Cohen & Kaufmann, 2005, p. 4).

According to Cohen and Kaufmann (2005), the goal of early childhood mental health consultation is neither to ―rescue‖ childcare staff by shifting their responsibility for dealing with difficult situations to a consultant nor to transform them into mental health professionals. Rather, the goals are to assist staff in understanding and incorporating the mental health perspective into their work, and to use their own roles, skills, and experience to help address the prevention and intervention of children’s mental health problems.

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The history of early childhood mental health consultation is somewhat difficult to track due to a lack of literature on the topic. However, Johnston and Brinamen (2006) present one of the most comprehensive accounts of the development of relationshipbased, reflective practice early childhood mental health consultation in childcare settings.

According to Johnston and Brinamen (2006), although child mental health consultation originated in the 1950s, it was based on a single-child model. In the early 1970s Selma Fraiberg developed the Child Development Project at the University of Michigan.

Through a program called Infant Mental Health, Fraiberg and her colleagues provided home visiting mental health services to at-risk infant populations and developed an effective approach to strengthening the well-being of children ages birth to 3 and their families (Johnston & Brinamen, 2006; Weatherston, 2000). Infant Mental Health was based on the infant-parent and infant mental health principles of collaboration, respect, self-examination, tolerance for ambiguity, and that a commitment to understanding everyone’s perspective can transform relationships and, thereby, young children’s experience in childcare (Johnston & Brinamen, 2006).

In 1979, the Infant Parent Program (IPP), based on Fraiberg’s infant mental health model, was developed at the University of California. Therapists working in the IPP program realized that early childhood program staff members could benefit from support as much as parents. Daycare Consultants was developed in 1988 as a component of the IPP program, and was also influenced by the National Center for Clinical Infant Programs, now known as ―Zero to Three,‖ of which Fraiberg was founder along with other infant mental health colleagues. The Daycare Consultants program extending their philosophy of treating young children to include providing on-site mental health

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consultation to all childcare centers and home childcare programs (Johnston and Brinamen, 2006).

Since the development of early childhood mental health consultation by Fraiberg and her colleagues, early childhood mental health consultation programs have been developed in many other states in the U.S. Duran et al. (2009) conducted a study that examined effective childhood mental health consultation programs in the U.S. in order to address critical knowledge gaps in the field of early childhood mental health consultation, provide data-driven guidance around consultation program design, and determine essential components of effective mental health consultation programs. It was in this study that the first National Scan was conducted in order to update the current status of early childhood mental health consultation (ECMHC) services. In the national scan conducted by Duran et al. (2009), 35 states and territories responded to the survey. Of those respondents, 29 (83%) confirmed that ECMHC services are available in their state and six (17%) indicated that ECMHC services were not currently available, although several provided descriptions of how their state/territory was moving in that direction. Of the 29 states currently offering mental health consultation, 21 respondents (72%) reported offering consultation statewide.

This same study also suggests that there are five factors that are important in the design of an effective ECMHC program (i.e., a program that achieves positive outcomes).

First, the following three core program components must be in place: (a) solid program infrastructure (e.g., strong leadership, clear model design, strategic partnerships, evaluation, and so on; (b) highly qualified mental health consultants; and (c) high quality services. Two other elements that are essential to achieving positive outcomes and, in

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fact, serve as catalysts for success are the quality of the relationships between and among consultants and consultees and the readiness of families and early childhood education providers/programs for ECMHC (e.g., openness to gaining new skills and knowledge, opportunities for collaboration) (Duran et al., 2009). According to Duran et al. (2009), through the collaborative efforts of diverse key stakeholders (e.g., policymakers/funders, early childhood mental health consultation providers, early childhood education program administrators, and researchers/evaluators), much progress has been made to increase access to ECMHC and address the rise in challenging behaviors among young children in early care and education settings. With further collaboration, states and communities can continue to expand consultation efforts, enhance the efficacy of services, and establish long-term sustainability for this emerging evidence-based practice.

Mental Health Consultation Models Cohen and Kaufman (2005) distinguished two primary types of consultation in early childhood mental health consultation. The first of these is child- and familycentered consultation, which occurs at the child or family level. Child- and familycentered consultation is the most traditional form of mental health consultation. Staff initially seek the assistance of a mental health consultant because they are worried, alarmed, or frustrated by a particular child’s behavior. With this type of consultation, the consultant provides direct services to particular children identified as having developmental problems. Screenings, assessments and referrals may be included in the consultation process and the consultant works closely with the provider to help the provider develop strategies for supporting the child’s development and reducing behavior

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problems. The primary goal of this type of consultation is to develop a plan to address both the factors that contribute to a child’s difficulties in functioning well in the early childhood setting and the family’s role (Cohen & Kaufmann, 2005).

The second type of consultation identified by Cohen and Kuafman (2005) is program-centered consultation, which is focused on supporting programs through training, coaching, and developing consistent programmatic approaches to serving children with emotional and behavioral challenges. Programmatic mental health consultation focuses on (a) improving the overall quality of the program or agency and (b) assisting the program in solving a specific issue that affects more than one child, staff member, and family. Consultation to programs usually takes a preventive perspective. By identifying strategies to improve the overall quality of care, the consultation empowers staff to enhance the healthy social and emotional development of children and the functioning of families—and of staff members, too (Cohen & Kaufmann, 2005). The goal of programmatic mental health consultation is to develop the capacity of the program and its staff members to successfully work with children with emotional and behavioral challenges (Green et al., 2006). The Erikson/ISBE IECMHC Project used a programcentered, or programmatic, consultation model.

The Mental Health Consultation Process Several practices help to get consultation services off to a good start. First, is setting the right tone and approaching consultees in a way that will foster healthy relationships. Another important component is clear communication between all involved parties about what the consultation program provides, individual roles and

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responsibilities, and what will happen as part of the consultation process (Duran et al., 2009). Marks (1995) states that most authors agree on the following stages or steps in the mental health consultation process: (a) entry (to include administration sanction), (b) problem definition, (c) problem analysis, (d) goal setting, (e) implementation, (f) evaluation, and (g) institutionalization. Research indicates that consultants are not aware of the importance of entry tasks (Wesley & Buysee, 2004).

Marks (1995) defines the entry process as including the following goals: (a) gaining access to administrators so that consultation efforts will be sanctioned; (b) utilizing the efforts of the teachers, as well as other program employees, to help make consultation work; and (c) overcoming resistance to consultation. Consultants need entry skills. Even when consultants have tried to deal with administrators in the consultation process, many have had long-standing difficulties in achieving an ongoing, productive relationship (Marks, 1995). To initiate a productive working relationship, the consultant and consultee discuss the roles that they both will take in the consultation process. This step ensures that both the consultant and consultee have an opportunity to express their preferences and that they both understand and agree on the basic parameters of consultation. In this initial discussion, it is critical for both parties to recognize the importance of a coordinated, nonhierarchical relationship in achieving the mutually agreed-upon goals (Cohen & Kaufmann, 2005).

In the first phase of the mental health consultation process, the entry phase, consultees must view themselves as active participants in the consultation process who educate the consultant regarding their professional role and its constraints so that the consultant can make relevant contributions (Donohue, Falk, & Provet, 2000). During the

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entry phase, the administrator should feel comfortable voicing needs and feelings to a responsive consultant who respects the administrator’s position. The administrator should be able to express program matters that range from more formal planning and decision making to less structured explorations of concerns about the program. Once a positive and ongoing relationship with the administrator is in place, the consultant can begin to form connections with the rest of the staff, formally or informally, although there may be a need for the consultant to arrange regular and frequent contact with the administrator.

In most settings, the consultant and administrator find that regularly scheduled meetings facilitate the establishment of a positive collaborative relationship.

In the entry phase of consultation, it is likely that consultees’ perceptions of consultants may be colored by a variety of anxiety-provoking fantasies that can potentially block and distort the communication process. Some of these distortions of perception and expectations may be cultural, that is, shared by the organization, and based on common held ideologies. Examples of these distortions and expectations include fearful perceptions of the mental health specialist as being a ―mind reader‖ who will uncover one’s forbidden thoughts or psychological weaknesses, as someone who will weaken defenses and advocate sexual and aggressive license, or as a judge who will condemn and make one lose face Caplan (1970).

In the second phase of the consultation process, once a basic relationship has been established between the consultant and administrator, the nature of consultant-consultee interactions tends to change. Although some consultant-consultee relationships may develop without any major problems, others are fraught with resistance, requiring much time, effort, and commitment before a working partnership is formed (Donohue et al.,

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2000). A personalized understanding of the problem is necessary if the consultee is to perceive a role for herself in problem resolution (Brown, Pryzwansky, & Schulte, 2006).

The Consultative Stance Johnston & Brinamen (2006) describe the consultative stance as the way in which the consultant approaches the consultation process in a relationship-based mental health consultation model. There are 10 elements of the consultant’s role that are considered essential to the ―consultative stance‖: 1. mutuality of endeavor 2. avoiding the position of expert 3. wondering instead of knowing 4. understanding another’s subjective experience 5. considering all levels of influence 6. hearing and representing all voices 7. the centrality of relationships 8. parallel process as an organizing principle 9. patience 10. holding hope According to Johnston and Brinamen, the consultative relationship has the power to transform other relationships in the childcare system. The power within the relationship between the consultant and others derives from the consultant’s ―way of being‖—the consultative stance (pp.14–20).

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For Johnston and Brinamen (2006), mutuality of endeavor refers to the focus on developing a stance of collaboration and wondering with childcare providers and staff.

The mental health consultant is an outsider who hopes to effect changes, but the potential for change is dependent upon the wishes, challenges, and abilities of all the participants.

This is a mutually constructed endeavor that requires the consultant’s flexibility and understanding as she joins with the providers. Consultant-consultee collaboration involves a relationship of equals involving mutual respect and collegiality (Brown et al., 2006) with each participant contributing different expertise and skills (Emmet, 1971).

Therefore it is the consultant’s job to think and work collaboratively (Pawl, 2005).

Although the early childhood mental health consultant does bring a certain expertise to the consultation process, positive changes in consultation only occur through a truly collaborative process (Johnston & Brinamen, 2006). A strong relationship between the consultant and administrator is central to an effective collaboration (Donahue et al., 2000). By relying on strong interpersonal skills to create a collaborative basis for their relationship, consultants are better equipped to address challenges that emerge with consultees in the consultation process (Wesley & Buysee, 2004).

Emmet (1971) notes that avoiding the position of expert is a common theme in the consultation literature which flows from the idea that consultation is a collaborative process. While Donohue et al. (2000) suggest that there is no hierarchical relationship in the consultant-consultee relationship, although there may be irrational attributions of authority that the consultant must dispel. The consultant must be careful to formulate a set of shared assumptions and goals and not assume a rigid expert stance regarding the best ways to facilitate change. Similarly, Cohen and Kaufman (2005) believe that

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consultation is a two-way process with mutual examination and participation that draws on the expertise of both the consultant and consultee. In the consultation process, the mental health consultant and early childhood staff are viewed as experts in their own fields. Unlike supervision, the consultant has no authority over the early childhood staff, who are free to accept or reject any of the consultant’s suggestions. Although the consultant may recommend certain interventions, staff members maintain sole responsibility for carrying them out.

Johnston & Brinamen (2006) also note that ―considering all levels of influence‖ (p. 16) refers to the numerous influences that impact the consultee’s approach to childcare. These include the consultee’s own history as well as internal (intrapsychic) and external influences. The intrapsychic influences include the consultee’s personal history and subjective experiences. External factors that influence the consultee include programmatic and bureaucratic pressures and program philosophies. There are also the interpersonal influences of the consultee’s relationship with coworkers, parents, and children. The consultant must strive to consider all these levels of influence that affect the consultee’s perceptions of the childcare process in order to gain an understanding of how best to approach the consultation process effectively. The principle of ―hearing all the voices‖ refers to hearing the multiple voices in the childcare community including voices of staff, parents, children. In doing so, the consultant demonstrates that various views can be ―held and heard equally‖ in an effort to elicit understanding and cooperation in developing shared goals and solving problems (Johnston & Brinamen, 2006).

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The Relationship-Based Approach Bertacchi (1996) suggests that the quality of relationships among all people involved in early childhood consultation is key to its effectiveness. Out of her experience as an early childhood administrator, clinician, educator and consultant, Bertacchi developed a Relationship-Based Organizational Design model. Within this theoretical model there are seven principles of relationship-based work: 1. respect for the person, making getting to know staff a priority for managers 2. sensitivity to context, by understanding the influence of individuals on and how they are influenced by the work environment 3. commitment to evolving growth and change, the importance of an organization’s commitment to staff development 4. mutuality of shared goals, the understanding that staff relationships are most effective when they are rooted in shared goals 5. open communication, the need for clear channels and forums for discussion of the work with colleagues and team members 6. commitment to reflecting on work, the need for regular supervisory time to discuss the relationships within the organization 7. setting standards for staff, the modeling of values and ethics of various professions involved in the organization’s delivery of quality services.

Centrality of relationships refers to a new organizing construct in the field of early childhood prevention and intervention referred to as the relationship-based approach to early childhood mental health consultation. Johnston and Brinamen (2006) suggest that the centrality of relationships underlies all beliefs of early childhood mental

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health consultation. Duran et al. (2009) state that positive relationships are a catalyst for success and that positive relationships between the consultant and consultee are central to successful consultation efforts. The conviction that relationship-based reflective practice is key to effective early childhood work has firmly taken root in the past three decades (Eggbeer, Mann, & Seibel, 2007). This approach integrates relationship-based concepts at all levels of service delivery and is guided by the understanding that relationships form the foundation for early care and education work with families: organizations that deliver early childhood services expect staff members to develop close interpersonal relationships with families and children (Heller, Jozefowicz, Reams, & Weinstock, 2004). All of the services that consultants, administrators and staff members engage in with each other take place within relationships formed between each other (Eggbeer et al., 1994). In a relationship-based theoretical model, relationships are organizers of development and are the medium for the intervention process (Westin, Ivins, Heffron, & Sweet, 1997).

Reflective Practice The relationship-based approach to early childhood work often goes hand-in-hand with reflective practice and reflective supervision. Together, these practices create a context and interpersonal environment that permit self-reflection and professional use of self. Reflective practice allows staff members to slow down, examine their thoughts and feelings, and identify interventions and strategies for meeting the needs of young children and their families. It involves paying close attention to their relationships in the early childhood setting, providing opportunities for staff members to reflect on their work and

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the ways in which their own history and cultural experiences affect it, and allowing them to use what they understand about relationships to develop effective practices and policies (Copa, Lucindki, & Wollenbeurg, 1999). Consultants must be able to observe themselves and to identify their own feelings, biases, and impact on others. Consultants must also be willing to consider their own history and experiences as a child, parent, and student, and how these affect their current understanding of developmentally appropriate care for children (Johnston & Brinamen, 2006). Reflection also corrects distortions in beliefs and errors in problem solving by critiquing the presuppositions on which beliefs have been built (Mezirow, 1990). Reflective practice has been found to be useful to early childhood workers, and early childhood staff members have reported positive changes from the use of reflective practice. In fact, several state affiliates have adopted a set of competencies that include a requirement for reflective supervision (Eggbeer, Mann, & Seibel, 2007).

Jeree Pawl, former administrator of the Infant-Family Program at San Francisco General Hospital, describes reflective supervision in the following way (Pawl, 2001): [It exists] to provide a respectful, understanding and thoughtful atmosphere where exchanges of information, thoughts, and feelings about the things that arise around one’s work can occur. The focus is on the families involved and on the experience of the supervisee. Depending on discipline, content may vary enormously, but it is not possible to work on behalf of human beings to try to help them without having powerful feelings aroused in yourself…I have coined a shorthand platinum rule to supplement the golden one in order to quickly convey a sense of this parallel process: ―Do unto others as you would have others do unto others.‖ This is an essential aspect of the supervisory relationship to appreciate.

The relationship between supervisor and supervisee sets a major tone that reverberates throughout the system, whether it does so for good or for ill. When it is positive, it can hasten exponentially the process of what the supervisee learns through experience and self-reflection. The practitioner’s experience in supervision directly affects the interactions he has with the child and the family. It is this complex nest of relationships that we care about.

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According to Parlakian and Seibel (2001), reflective leadership is the key to creating a relationship-based organization. Reflective leaders communicate a shared vision, are confident, exhibit a can-do attitude, facilitate and compromise, involve staff and use a team-based approach, are flexible and adaptive, listen attentively, motivate staff, provide support and encouragement, respect staff, set clear goals, share achievements, and trust employees. Reflective leadership is characterized by selfawareness, careful and continuous observation, and respectful, flexible responses that result in reflective and relationship-based programs. Although effectiveness as a leader is often measured in quantitative outcomes—increasing school readiness, decreasing incidences of abuse and neglect, decreasing staff turnover, and reducing child expulsion rates—it is one’s ability to reflect on, and optimize, relationships that makes these outcomes achievable.

Parallel Process as an Organizing Principle Similar to the supervisor-supervisee relationship in psychotherapy training, parallel process occurs in the consultant-consultee relationship. With psychotherapy, what happens in the therapist-client relationship is reflected in the supervisor-supervisee relationship. In the consultation process, parallel process extends and moves in all directions (Johnston & Brinamen, 2006). Parallel process is recognized as occurring between the organizational structure and the direct service level (Westin et al., 1997) and can be a useful mechanism to help the consultant understand the organizational structure and functioning of an organization at multiple levels. In the childcare environment, the parent-child relationship affects the caregiver-child relationship, which in turn affects the

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caregiver-administrator relationship. Likewise, the consultant-consultee relationship and its quality create change in other relationships in the childcare environment. ―If the power of parallel process is understood, organizations can plan an infrastructure that is prepared to deal with parallel process. Because work with young children and families engages emotions as well as the mind, in order to be successful, staff, supervisors, managers, and leaders of early childhood organizations must maintain an openness and commitment to examining their reactions and feelings—both positive and negative‖ (Bertacchi, 1996).

Pitfalls and Challenges of Early Childhood Mental Health Consultation Early childhood mental health consultants may encounter critical challenges in their work. According to Cohen and Kaufmann (2005), challenges in early childhood mental health consultation include: 1. difficulty in implementing the intervention plan 2. organizational setting 3. value conflicts 4. racial, ethnic, and socioeconomic issues 5. lack of mental health professionals with early childhood consultation experience 6. funding Cohen and Kaufmann (2005) suggest that staff members may find it difficult to follow through on the plan developed in the consultation process because the consultant’s expectations may not match those of staff. This situation can arise when insufficient structure has been introduced early in the consultation and when staff members do not fully understand the consultation process. The consultant and staff can avoid ambiguity

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by carefully discussing the consultation process at the outset, by writing a plan with concrete behavioral objectives and outcomes, and by occasionally revisiting the plan as the process continues. Consultants may also fail to remember that staff members are involved in a variety of activities. Consultants may take too much of their staff members’ time in meetings or may design interventions that require just too much extra work.

Careful scheduling and choice of interventions that require less time can reduce the risk of encountering this barrier to effective consultation. The design of the intervention is a major determinant of the outcome of the consultant’s efforts. Interventions aimed at change must be tailored to the setting, to the provider, and to the power structure. In addition, the consultant should suggest interventions that increase some aspect of the staff member’s comfort, require little change in the agency, do not threaten the worker’s approach, and can be communicated easily. Depending on the complexity of the intervention, it may be more difficult for staff members to implement the plan (Cohen & Kaufmann, 2005).

Early Childhood Mental Health Consultants A highly skilled workforce is critical to effective early childhood mental health consultation, yet there are few mental health professionals who are trained with the necessary skill set of a consultant (Duran et al., 2009). Early childhood consultants appear to be operating from the belief that providing consultation is parallel to providing direct early intervention services (Wesley & Buysee, 2004). However, Johnston and Brinamen (2006) believe that early childhood mental health consultation requires that the consultant have certain qualities and skills, such as knowledge of child development,

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childcare, psychotherapy, case management, organizational psychology, an understanding of systems functioning and influence on development, as well as a willingness to recognize countertransference and to acknowledge one’s role in the system. Johnston and Brinamen (2006) also suggest that mental health practitioners, usually from field of social work and psychology, are generally best prepared by their backgrounds for early childhood mental health consultation, but may require some adaptation to this role because neither traditional social work nor preschool experience fully prepares consultants for this role of an early childhood mental health consultant.

Not all clinicians, even with the right skills, are well suited for the demands of early childhood mental health consultation. In some cases it is not the consultant’s professional competence that is an issue but that her personal style may not mesh with the personality or culture of the center (Donohue, Falk, & Provet, 2000). Or the consultant may not have the interpersonal skills required for the work. Strong interpersonal skills are critically important for entry and building of alliances with staff members. Cohen and Kaufmann (2005) offer three interpersonal areas which effect the effectiveness of the mental health consultant: (a) warmth, the skill of listening to the staff member and of communicating care and commitment; (b) empathy, the consultant’s ability to convey an understanding of the staff member’s subjective experience; and (c) respect, the ability to suspend judgment and to communicate that the staff member is valued.

Inexperienced consultants may have greater challenges in their work. There are three sets of challenges that inexperienced consultants and their supervisors face: (a) the consultant’s struggle with expertise or lack of it, and related feelings that interfere with relationships with caregivers and their supervisors; (b) the consultant’s preconceived

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ideas about their roles and their resistance to shifts demanded by individuals and the setting; and (c) the difficulty of mastering the delicate weave of clinical work with consultation (Johnston & Brinamen, 2006). Poorly qualified early childhood mental health consultants can create a barrier to effective consultation. Finding qualified early childhood mental health consultants can be difficult, as agencies, staff, and families who interact with young children may find it difficult to identify local mental health consultants who are trained in both child development and family systems, understand the complexities of the childcare and early childhood education systems, and have training or experience in working with families and staff facing multiple challenges. In addition, few higher education programs provide mental health consultation training courses (Cohen & Kaufmann, 2005).

The consultant’s professional comfort in providing early childhood mental health consultation was examined by Wesley and Buysee (2004). Professional comfort was defined as ―feeling at ease or well-being in the professional role‖ (p. 129). Ironically, although the consultants stated that one purpose of their consultation services was to help consultees acquire new knowledge, skills, and attitudes, the stated cause of their discomfort was the early childhood professionals’ knowledge, skills, and beliefs about children and the consultees’ attitudes, expectations, and beliefs about consultation. The characteristics of specific programs were also a major source of comfort or discomfort.

Inadequate staff-child ratios, large group sizes, developmentally inappropriate curriculums, high staff turnover, and poorly trained staff were factors that challenged consultants. None of the consultants indicated that they proceeded through the consultation stages with knowledge about how to establish a trusting relationship, jointly

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assess needs, and collaboratively identify priorities and strategies for change and then implement those strategies and evaluate their effectiveness. Interestingly, most consultants did not elaborate on the likelihood that there were characteristics about themselves that influenced their comfort with consultation, although they explained that their level of knowledge influenced their comfort level and that better communication skills would take them beyond merely providing information to increasing rapport between consultants and consultees.

Early Childhood Program Administrators Administrators play an extremely important role in early childhood mental health consultation since they are considered to be the gatekeepers to consultation (Johnston & Brinamen, 2006). The administrator is also the person who controls the decision-making process and has the greatest amount of authority in the organization (Bertacchi, 1996). If the administrators do not ―buy in‖ to the relationship-based reflective practice consultation process, neither will the staff, because staff look to administrators to provide the environment, support, and modeling they need to effectively utilize the consultation process (Pitkin & Norman-Murch, 2005). Furthermore, readiness of an early childhood education program administrator to enter into a consultative partnership is a major determinant of the consultation’s efficacy. Indicators of a program’s readiness, according to Duran et al. (2009), include the presence of a supportive early childhood program administrator, flexibility to incorporate consultation into the program, and the willingness and ability to embrace a ―mental health perspective.‖

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The administrator’s style also has a profound impact on the overall qualities of the center, including the feelings of staff and the attitude toward children (Donohue, Falk, & Provet, 2000). Leadership in early childhood organizations begins any substantial move toward operationalizing the centrality of relationships at the program level. Leadership also provides a clear guiding vision and the ability to take risks. Ideally, the administrator will recognize the need to have a unifying construct for the program. Thus, leadership from the administrator is required to endorse the impetus for change, to provide direction, and to encourage all program staff to contribute by establishing and maintaining the conditions that allow true change to occur (Weston et al., 1997).

Strong leadership is a critical asset of any consultation program. Staff competence depends on the ability of program administrators to enable frontline practitioners to use their individual talents fully and to work effectively together (Fenichel, 1991). This requires strong leadership skills on the part of the administrator. Because administrators are considered agents of change, whose role is to effectively model behavior they expect of others in the organization, they must be clear about their own values and belief systems. In other words, ―the key to an administrator’s success is her ability to breathe life into the hopes and dreams of others and help them envision the exciting possibilities the future holds‖ (Bloom, 2004, p. 25).

Bertacchi (1996) suggests that the challenges for leaders of relationship-based organizations are to understand that he or she will constantly need to adjust priorities and make decisions calmly in an ever-changing environment, to manage staff resistance to new ideas, and to establish a comprehensive and well-integrated organizational infrastructure. Administrators of early childhood programs are challenged to consider and

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offer creative ways to build their staff’s capacity to address the mental health concerns of children and families living with many risks and stressors. They understand that there are no ―quick fixes‖ and that their objectives require attention, time, and resources (Cohen & Kaufmann, 2005). In some centers, the administrators initiate and implement consultation, while in others oversight agencies or previous administrators arrange the consultation (Donohue, Falk, & Provet, 2000).

The Consultant-Administrator Relationship In early childhood mental health consultation, a productive working relationship is not taken for granted; rather, it develops over time. Strong personal relationships enable a consultant and consultee to establish the trust and mutual respect essential to ―hearing‖ each other and being able to discuss issues despite differences of opinion. A productive working relationship between the consultant and early childhood program administrator is not a given, yet a strong relationship between the consultant and the administrator is central to the development of an effective collaboration. In getting to know the administrator, the consultant must bear in mind the myriad of tasks the administrator oversees. Thus, the first task for the consultant is to try and step into the administrator’s shoes, and to appreciate the delicate balancing act that administrators face every day (Donohue, Falk, & Provet, 2000). As the consultant becomes more familiar with the program, she is better able to offer useful ideas (Cohen & Kaufmann, 2005).

As the consultant is becoming familiar with the administrator, the administrator is becoming familiar with the consultant, evaluating her competence and deciding how the consultant can best support the program. Some administrators may feel intimidated by the

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consultant, assuming that her actions and decisions are somewhat legitimized by her status as a mental health ―expert‖ (Cohen & Kaufmann, 2005). At the same time, some administrators enjoy having another professional on board who shares similar goals and values yet remains outside the system; this can help the administrator manage difficulties without feeling isolated (Donohue et al., 2000).

Some consultants are unable to separate their own unresolved conflicts with authority from the need to use their skills to help people communicate. Consultants may view administrators as a threat to their own professional image because they resent functions of the administrator’s authority in the program that appear to treat them as underlings. In many situations, the consultant may consciously or unconsciously rebel, and a breakdown in communication with the administrator may occur (Marks, 1995). It is important for consultants to respect the education and training of the administrator. This requires an awareness and appreciation of the administrator’s experience and expertise in the fields not shared by the consultant. At the same time, the administrator’s apparent bid for domination over the consultant may reflect the administrator’s need to be aware of and control what is happening in their program and the heavy weight of responsibility they bear (Marks, 1995).

The psychoanalytic concept of externalization helps to explain the projective distortions that are regularly encountered in the consultee’s attitudes towards the consultant; however, externalizations do not imply dynamics that call for therapeutic responses that are at odds with the collaborative practice of consultation.

Characteristically, projections are experienced by the consultant as powerful, disruptive, and impeding discussion and understanding. If the consultant recognizes them as neither

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attributes of the consultant nor expressions of deep regressive transference, they may become manageable (Kris, 1978). Transference reactions can also complicate the consulation-consultee relationship since transference occurs in the professional functioning of most people, regardless of their state of mental health. It is not uncommon for unresolved present or past personal problems to be displaced onto current situations and for this to produce temporary ineffectuality and loss of emotional stability (Caplan, 1970).

Early Childhood Mental Health Consultation Research The research group of Allen, Brennan, and Green (2007) conducted a research review and synthesis with the intention of examining the design elements and findings of studies of mental health consultation in early childhood settings in order to determine the level of evidence for consultation effectiveness. The study looked at outcomes related to consulting activities, as well as at child, family, staff, and program outcomes. The review and synthesis suggests that early childhood mental health consultation research and evaluative studies have begun to establish favorable outcomes for children, families, and staff in early childhood settings. In addition, recent research on the critical role of social emotional development in school readiness and the negative trajectories of early problems has led to a national recognition of the importance of providing prevention and intervention services to young children with challenging behaviors (New Freedom Commission on Mental Health, 2003).

Alkon, Ramler, and MacLennan (2003) evaluated mental health consultation models provided to 25 urban childcare centers by four different agencies. A 1-year

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evaluation was conducted to assess the impact of the services. Results suggest that childcare centers with 1 year or more of mental health consultation increased their overall quality, teachers’ self-efficacy and competence, and staff satisfaction. Children served by early childhood programs clearly benefit from mental health consultation services, and access to mental health consultation is related to lower rates of expulsion (Gilliam, 2005; Perry et al., 2008).

In a study conducted by Perry et al. (2008), the majority of children who were at imminent risk for removal from their childcare settings were not expelled if they received mental health consultation, and nearly all children showed significant improvement in their behavior. Childcare providers who made referrals for mental health consultation services revealed that 80% found these services to be extremely helpful. Childcare providers that did not find mental health consultation services helpful reported that they felt the suggestions offered by the consultants clashed with their program’s philosophy or approach—interestingly, these were family day care home providers.

Willford and Shelton (2008) examined the effectiveness of empirically supported interventions delivered using mental health consultation to preschoolers who displayed elevated disruptive behaviors. Children in the intervention group received individualized mental health consultation focused on providing teachers with behaviorally based and empirically supported strategies for decreasing disruptive behaviors in the classroom.

Results show that the treatment approach was more effective than the nontreatment approach used with the comparison group in decreasing disruptive behavior and increasing the use of appropriate teacher strategies.

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Duran et al. suggest that model clarity is a cornerstone of effective programs, helping to prevent role confusion among consultants and consultees, support consistency in service delivery, and create a necessary foundation for evaluation efforts (Duran et al., 2009). Still, there is a lack of a comprehensive theory and model of early childhood mental health consultation and research examining mental health consultation practice and early intervention is extremely limited. There is a need for a clearly defined framework for implementing early childhood mental health consultation. Reliance on basic knowledge about team building, collaboration, or adult learning is not sufficient to inform this particular consultation process. Nor is a focus on knowledge and skills related to child development and child interventions sufficient to increase the professional development and competence of consultants within early childhood settings (Wesley & Buysee, 2004).

Brennan (2000) suggests that evidence-based research of early childhood mental health consultation includes few peer reviews, lacks studies with rigorous research designs, and has inconsistencies in the measures used to establish effectiveness. The relationship of consultant qualifications, training, and support to mental health consultation needs to be established by evidence-based research; this research is needed to examine staff-consultant interactions and to discover ways in which these interactions can be most effective. Additional empirical research is needed on early childhood mental health consultation to better describe what consultants do and how they work with staff members, and to identify what strategies are most important in supporting different types of desired outcomes (Green et al., 2006). More research is needed to develop a solid

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evidence base and provide guidance on which aspects of consultation are critical for achieving desired outcomes (Cohen & Kaufmann, 2005).

Out of 27 studies presented at the July 2006 ―Evidence Base on Mental Health Consultation in Early Childhood Settings: Child and Family Outcomes‖ Georgetown Training Institutes, only three made a clear distinction between administrators and other staff, with most studies examining teachers’ ratings of the perceived effectiveness of early childhood mental health consultation in relation or measuring child outcomes. The three studies that distinguished administrators as separate from other staff examined administrators’ perceptions of teacher-child interactions related to child and family outcomes (Alkon, Ramler, & MacLennan, 2003; Field, Mackrain, & Sawilowsky, 2004; Langkamp, 2003). None of the studies specifically examined the administrator-consultant relationship, which is considered a key relationship in the early childhood mental health consultation process.

Theoretical and Conceptual Framework of the Study Contemporary psychoanalytic relational theory provides a psychological framework for this study. Relational theory is a two-person psychology that characterizes dyadic relationships as mutual, interactive, and co-constructed (Aron, 1990) and, therefore, fits extremely well with the consultant-consultee dyadic relationship that is the unit of focus examined in this study. Relational theory will also be useful conceptually as it reflects the relationship-based approach of the mental health consultation model used in the Erikson/ISBE IECMHC project.

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Relational Theory The Relational Movement originated in New York in the early 1980s and was influenced by a number of important psychoanalytic theoretical perspectives, including interpersonal psychoanalysis in the 1930s and 1940s, object relations theory as practiced in the United States in the 1970s, Kohut’s self-psychology in the late 1970s, and American psychoanalytic feminism in the late 1970s and early 1980s (Mitchell & Aron, 1999). The object relational theorists, Winnicott, Fairbairn, Bion Loewald, and the founder of self-psychology, Kohut, are considered to represent the precursors to the paradigm shift to a relational model in psychoanalysis (Ornstein & Ganzer, 2005, p. 566).

In 1983, Greenberg and Mitchell used the term ―relational‖ to bridge traditions of interpersonal relations developed in interpersonal psychoanalysis and object relations theory as developed in contemporary British psychoanalytic theory. They originally defined the relational model as fundamentally alternative to classical drive theory.

Relational theorists rejected drive theory and placed relationships at the center of psychoanalytic theory (Greenberg & Mitchell, 1983). Relational theory encompasses a variety of relational approaches rather than one single model. Originally, the relational model was employed by theorists, such as Mitchell and Mahler, who maintained allegiance to the drive model but also developed perspectives that differed from it significantly. The relational model was also taken up by authors who use drive-model language but redefine key theoretical concepts from a relational perspective. These authors include Winnicott and Loewald, as well as Sullivan, Fairbairn, and Kohut, who had explicitly broken with drive theory (Aron & Harris, 2005). The most prominent contemporary psychoanalytic relational approaches are Mitchell’s relational conflict

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model, Aron’s mutuality and reciprocal influence model, Hoffman’s dialectical constructivism model, and the intersubjectivity theory of Benjamen, Ehrenberg, Ogden, Stolorow, Brandchaft, and Atwood.

Mitchell (1988) was the first to formulate a cohesive psychoanalytic model of relational theory, viewing psychological reality as operating within a relational matrix that encompasses both intrapsychic and interpersonal realms. Mitchell argued that the distinction between a monadic theory of mind (a one-person psychology) and an interactional relational theory of mind (a two-person psychology) is crucial in understanding psychoanalytic concepts. In Mitchell’s relational model, the relational matrix is understood as an organizing framework for assembling and integrating diverse relational theories into a fuller, more comprehensive perspective. Relational theory is considered a social theory of the mind in which the relationship is the basic unit of study and the mind is understood as being fundamentally dyadic in nature (Mitchell, 1988).

According to Greenberg and Mitchell (1983), the drive and relational models are both all-encompassing theoretical structures, each of which is independently capable of explaining all of the data generated by the psychoanalytic method. Each model is a complete and comprehensive account of human experience. They rest on fundamentally different and incompatible premises, and neither theory is reducible to the other.

Therefore, two-person relational theory does not need to neglect or minimize the intrapsychic or the importance of fantasy and psychic reality, and is not to be confused with an attempt to eliminate the unconscious and intrapsychic, or to deny the importance of fantasy and psychic reality (Aron, 1990).

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There are several main features or key theoretical concepts in the relational approach that are relevant and are useful in understanding the findings of the proposed study: 1. the clinician and client’s capacity to identify strengths and share power 2. inclusion and explicit valuing of the clinician’s participation 3. the co-construction of meaning 4. the concept of a two-person rather than one-person approach 5. the belief that the clinician operates from a fully engaged position in which he/she takes into account the nature of his/her own participation in addition to the client’s thoughts, feelings, and behaviors 6. the acknowledgement of the clinician’s participation 7. a shift in location of therapeutic action from exclusive focus on insight and interpretation to the mutual potential of the clinician-client relationship 8. viewing one’s own and client’s experience from multiple perspectives, including historical, cultural, and social contexts in which both clinician and client are embedded (Ornstein & Ganzer, 2005).

Although there is no literature in the area of psychoanalytic relational theory that focuses specifically on mental health consultation, the consultant-consultee relationship as discussed in the mental health consultation literature fits well with relational theory’s strong emphasis on not pathologizing the client and, rather, holding the client in high esteem in order to create an atmosphere of increased mutual respect and appreciation of the client’s cultural background and experiences. In both relational theory and mental health consultation, there is an elevation of the importance of the client’s experience of

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the clinician-client relationship. The clinician is not considered to be the expert and, therefore, does not have all the answers and must listen carefully to the client’s perceptions and concerns, including the client’s perception of the clinician (Ornstein & Ganzer, 2005).

The concept of ―multiplicity of voices‖ is a major feature of the relational model (Mitchell, 1988), and is found in the early mental health consultation literature’s principle of ―hearing all the voices‖ in the childcare community, including those of staff, parents, and children (Pawl, 2000). Similar to relationship-based, reflective practice models of early childhood mental health consultation, psychoanalytic relational perspectives focus on the interactive contexts of the work at hand. In relational theory, ―concepts of therapeutic interaction emphasize the central role of the professional relationship in the process of change and the functions of interpersonal interaction, empathic attunement, experiential learning, reinforcement, modeling, and identification in efforts to deepen self-understanding, strengthen coping capacities, and negotiate problems in living‖ (Borden, 2000, p. 368).

In most of the contemporary relational theories, countertransference enactments are considered to be unavoidable in the therapeutic process and necessary for therapeutic action to occur (Hoffman, 1983; Mitchell, 1988; Renik, 1993; Stern, 2004). Enactments occur as the analyst discovers himself embedded in the structures and strictures of repetitive configurations of the analysand’s relational matrix, or transferencecountertransference configurations (Mitchell, 1988, p. 292). In Stern’s (2004) concept of transference-countertransference enactments, enacted experience is unformulated, made up of dissociated states from both participants. These unformulated experiences cannot be

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symbolized and therefore do not exist in any explicit form other than the enactment itself.

According to Stern, an enactment ends by bringing the nature of the transferencecountertransference pattern to light, which provides opportunity for change.

Relational Theory and Supervision A relationally oriented view of supervision is one in which power and authority is shared by supervisor and supervisee, and knowledge about the client is co-constructed.

The relational model supervisory relationship is one of mutual influence of all parties: supervisor, supervisee, and client (Ganzer, 2007). Although the consultant-consultee relationship is different from the supervisor-supervisee relationship in many ways, Brennan’s relational account of the supervisor-supervisee relationship is worth considering as a way to understand the consultant-administrator relationship in the proposed study. For Brennan (2000), intersubjective reality is created by both the supervisor and supervisee. The supervisor-supervisee relationship is viewed as a matrix of object relations, each party bringing his or her psychic reality to the process, creating a joint intersubjective milieu. In good supervision, both the supervisor and supervisee enter into a process whereby they learn and change, with mutual evaluation occurring.

Supervision also involves examining the process of supervision as well as the content.

From this perspective, supervisors can take the stance of being less preoccupied with formulating what they should do in the supervisory process and more receptive to an exploration of what they actually do and undergo.

Brennan (2000) describes three potential basic patterns of the supervisor-supervisee relationship that create different supervisory climates. In the first, supervisor and

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supervisee form a close alliance as the concerned and mutually supportive parents of a problem. In the second, supervisor and supervisee form a close and secretive involvement in which the supervisee withholds part of what goes on in the therapeutic process between supervisee and client. This pattern can lead to the supervisor becoming bored and uninvested in the supervisory process. In the third pattern, the supervisor is deeply interested in the appealing client and critical of the supervisee’s unempathic work with the client; he or she develops a fantasy of rescuing the client from the supervisee.

Brennan suggests that a relational or intersubjective understanding of the supervisorsupervisee relationship also requires attention to the influences of the broader organizational, cultural, and historical currents of the subjective experiences of all individuals involved. This idea that the supervisory relationship can be colored by its institutional context can be described as moving from a two-person to a multi-person psychology.

Theoretical and Operational Definitions of Major Concepts

Early Childhood: For the purpose of this study, ―early childhood‖ is used to refer to children ages birth to 5 years old.

Early Childhood Mental Health Consultation: For the purpose of this study, ―early childhood mental health consultation‖ is used to refer to the relationship-based, reflective practice, programmatic mental health consultation model used in the Erikson/ISBE IECMHC Project.

46

Early Childhood Mental Health Consultant: For the purpose of this study, ―early childhood mental health consultant‖ is used to refer to mental health consultants that provided consultation through the Erikson/ISBE IECMHC Project.

Early Childhood Program Administrator: For the purpose of this study, ―early childhood program administrator‖ is used to refer to administrators of early childhood programs (consultees) that received consultation through the Erikson/ISBE IECMHC Project.

Early Childhood Consultant–Administrator Pairs/Dyads: For the purpose of this study, ―early childhood consultant–administrator Pairs/Dyads‖ is used to refer to consultants and administrators involved in the Erikson/ISBE IECMHC Project who worked directly with each other in the mental health consultation process as consultant and consultee.

Statement of Assumptions This study is based on a number of assumptions as noted below: 1. It is assumed that the relationship between the early childhood mental health consultant and early childhood education program administrator is central to the early childhood mental health consultation process.

2. It is assumed that there are certain characteristics of the early childhood mental health consultant and early childhood education program administrator relationship that impact the early childhood mental health consultation process, and are distinct from the consultant-teacher relationship.

47

3. It is assumed that in the mental health consultation process, early childhood mental health consultants and early childhood education program administrators have different perceptions, thoughts, and feelings regarding their experience of the relationship.

4. It is assumed that research participants will be able to articulate and express their thoughts and feelings.

5. It is assumed that the methodology of grounded theory will be effective in helping the researcher develop a theory of the early childhood mental health consultant– early childhood program administrator relationship.

6. It is assumed that contemporary relational theory will be useful in helping the researcher understand and interpret the findings of the proposed study.

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CHAPTER III

STUDY METHODOLOGY

Study Design This qualitative study utilized constructivist, grounded theory methodology as elaborated by Charmaz (2000, 2006). This methodology is designed to develop a theory based on the subjective experience of participants while also recognizing the mutual creation of knowledge by the viewer and the viewed. In this study, the data will not provide a window to reality. Rather, the discovered reality arises from the interactive process and its temporal, cultural, and structural contexts. This co-created research process was a good fit with the collaborative nature of the consultant-administrator relationship as described in the literature, as well as with the researcher’s theoretical framework of psychoanalytic relational theory.

Scope of Study, Setting, Population and Sampling, Sources and Nature of Data The participants for this study were recruited from a list provided by the Illinois State Board of Education (ISBE) of consultants that had worked for the Erikson/ISBE IECMHC Project and administrators of programs that received consultation through the project (consultees). There were 26 consultants and 77 administrators on this list. A recruitment notice was sent to consultants and administrators inviting them to participate

49

in the study (Appendix A). In order to recruit pairs of consultants and administrators, the researcher first recruited consultants and then recruited administrators from the pool of administrators that had worked with consultants that had volunteered to participate in this study. Ten Erikson/ISBE IECMHC Project consultants volunteered to participate in this study. A total of 45 administrators had worked with these 10 consultants, 15 of whom also volunteered to participate. Each consultant had at least one administrator they had worked with participate: six consultants had one, three had two, and one had three.

Data Collection Methods and Instruments According to Charmaz (2000), grounded theory methods do not detail data collection techniques. Rather, they move each step of the analytic process toward the development, refinement, and interrelation of concepts. The strategies of grounded theory include: 1. simultaneous collection and analysis of data 2. a two-step data coding process 3. comparative methods 4. memo writing 5. sampling to refine the researchers emerging theoretical ideas 6. integration of the theoretical framework.

Throughout the data collection and data analysis process, both the researcher’s meaning and participants’ meanings were considered. In order to seek and clarify the participants’ meanings, the researcher attempted to go beyond surface or presumed meanings and looked for beliefs, ideologies, situations, and structures (Charmaz, 2000).

50

The researcher conducted interviews with each participant using Charmaz’s constructivist approach to open-ended interviewing, which encouraged the researcher to foster relationships with participants in which they could cast their stories in their own terms. The researcher started all interviews by asking the question, ―Tell me about your relationship with the consultant/administrator you worked with on the Erikson/ISBE mental health consultation project.‖ The researcher carefully listened to participants’ stories regarding the consultant-director relationship with an openness to their feelings and subjective experiences (Charmaz, 2000). The interviews provided an open-ended, indepth exploration of the consultant-administrator relationship with individuals who had relevant experiences, going beneath the surface of ordinary conversation to examine earlier events, views, and feelings afresh (Charmaz, 2006).

Participants were asked to sign a consent form (Appendix B) prior to participating in the study; they did this when they met with the researcher for the interview. A brief inventory developed by the researcher was administered to participants in order to collect demographic and background information from them before beginning the interview.

Consultants completed the ―Mental Health Consultant Education, Skills & Experience Inventory‖ (MHC-ESEI) (Appendix C), and administrators completed the ―Program Administrator Mental Health Consultant Education, Skills & Experience Inventory‖ (PAESEI) (Appendix D). Participation in the study was voluntary, and those who chose to participate were informed that they could withdraw at any time without suffering any repercussions from the researcher, Erikson Institute, or the Illinois State Board of Education. Participants were also informed that all information they shared with the

51

researcher would be kept anonymous so that they could not be personally identified in the study.

A 45 minute to 1 hour open-ended interview was conducted with each participant at a location of their choice. Most often this was the participant’s office or the researcher’s office, but some interviews took place in the participant’s home at their request. Since the Erikson/ISBE IECMHC Project was a statewide project, the researcher traveled to several programs across the state to interview administrators. The interviews were audio-taped with a digital tape recorder, and these recordings were transcribed verbatim by the researcher and a professional transcription service. The researcher requested permission to take written notes of her impressions during the interview and stated that it was also permissible for the participant to take notes of any kind. The researcher informed participants that they would be asked to review the data collected from the interview during the data analysis process so that the researcher could confirm and fine-tune her interpretation of the data. The researcher explained this grounded theory ―member checking‖ as a technique in which the participants would be asked to review the researcher’s findings and provide feedback regarding whether her interpretation matched their experiences with the phenomenon being studied (Strauss & Corbin, 1998). For the member checking, the researcher contacted participants by e-mail and provided them with the results of the study. Consultants were given the results from the interviews of consultants and consultant-administrator pairs, and administrators were given the results from the interviews of administrators and consultant-administrator pairs.

52

Procedure for Data Analysis The data obtained from the interviews with consultants and the data obtained from the interviews with program administrators were analyzed separately in order to find themes among the separate groups of participants. The data of pairs as determined in the data collection process were also analyzed separately to determine themes among pairs.

In following the constructivist grounded theory methodology of Charmaz, the data analysis techniques used in this study attempted to tell a story about the consultants’ and administrators’ experience of the consultant-administrator relationships they had with each other (Charmaz, 2000). Data analysis began early in the data collection process and occurred simultaneously with the data collection process to help the researcher go further and deeper into the research problem and develop categories (Charmaz, 2006). Through initial coding, the researcher began to define and categorize the data. Coding shaped an analytic frame from which the researcher built the data analysis. Codes that accounted for the data took form together as a nascent theory. This in turn, helped to explain the data and direct further data gathering by the researcher. By interacting with the data and posing questions to the data, the researcher’s interpretation of the data helped to shape the emergent codes. Throughout the coding process, the researcher aimed to understand the assumptions underlying the data by piecing them together (Charmaz, 2000).

Memo writing as described by Charmaz (2006) was also used as a data analysis technique in this study as an intermediate step between data collection and the first draft of the completed analysis. Memo writing constitutes a crucial method in grounded theory because it prompts the researcher to analyze data and codes early in the research process.

Through memo writing, the researcher elaborates processes, assumptions, and actions

53

that are subsumed under codes. It also leads the researcher to explore codes by expanding upon the processes they identify or suggest. Memo writing aided the researcher in linking analytic interpretation with empirical reality by bringing raw data into memos so that the researcher could maintain those connections and examine them directly.

Open coding, or line-by-line coding, was the first major phase of data analysis, and proceeded by the researcher staying close to the data through examining each line of the data and then defining actions or events within it. This line-by-line coding helped deter the researcher from imposing her own beliefs on the data and kept her attuned to the participants’ views of reality. Line-by-line coding also sharpened the researcher’s use of sensitizing concepts (background ideas that inform the overall problem). During the process of open coding, grounded theory constant comparison data analysis techniques were used as a way to identify properties of emerging concepts (Charmaz, 2006).

Specifically, the researcher made constant comparisons among the levels of properties (characteristics of a category) and dimensions (the range along which general properties of a category vary). This allowed her to break the data apart and reconstruct them to form an interpretative stance at each level of analytic work. The constant comparison method of grounded theory involved comparing: 1. different people (with regard to views, situations, actions, accounts, and experiences) 2. data from the same individuals with themselves at different points in time 3. incident with incident 4. data with categories 5. a category with other categories.

54

Focused coding was the second major phase in coding and was used to synthesize and explain larger sections of data (Charmaz, 2006). Focused coding involves using the most significant and/or frequent codes to sift through large amounts of data. Through focused coding, initial codes that appeared frequently helped the researcher to sort through the large amount of data collected through the interviews. This is a more directed and conceptual method than line-by-line coding that helped categorize the data more precisely. Categories for synthesizing the data emerged from these more focused codes and categories, with some categories subsuming several codes. In turn, the categories developed by the researcher shaped the developing analytic frameworks (Charmaz, 2000).

Theoretical sampling was used in the data analysis process to elaborate and refine the categories constituting the theory (Charmaz, 2006). The aim of theoretical sampling is to refine the researcher’s emerging theoretical ideas, identify conceptual boundaries, and pinpoint the fit and relevance of categories. Theoretical sampling was conducted by sampling in order to develop properties of categories until no new properties emerged, or until categories had been saturated. Categories were considered saturated when gathering fresh data no longer sparked new theoretical insights or revealed new properties of core theoretical categories.

Interpretive theory was used to further develop the understanding of patterns and connections of the data (Charmaz, 2006). The analysis of qualitative data continued after the researcher had developed a theoretical framework. In addition to developing theory through data analysis, she continued to render theory through writing. In writing up the results of the study, she also attempted to frame key definitions and distinctions in words

55

that reproduce the experiences of the participants. The researcher attempted to evoke experiential feeling through writing up the findings of this study (Charmaz, 2000).

Demographic and background data collected from participants using consultant and administrator versions of the ―Education, Skills & Experience Inventory‖ (See Appendixes C and D) were used to strengthen and enrich the qualitative findings in the form of frequency distributions.

Statement on Protecting the Rights of Human Subjects

Risks and Benefits All participants were volunteers. There were no risks of causing physical harm to participants as a result of participating in the study. However, there was potential for emotional distress. These risks were explained to participants and precautions were taken by the researcher to minimize risk of harm as a result of participating in the study. The researcher, an experienced clinician, informed participants that they do not have to answer any questions that they are uncomfortable with and that they could take a break or terminate the interview process at any time during the interview if they were uncomfortable with the interview process. The researcher was aware of subtle dangers in the course of the interview process and guarded against them by staying attuned to participants’ verbal, nonverbal, and affective communications during the interviews. Any participant who expressed or exhibited a significant degree of discomfort, upset, or distress in the course of, or following, the interview would have been given a list of local counseling centers and qualified therapists, including contact information, whom the

56

participant could contact if needed. However, this was not necessary as none of the participants exhibited any signs of significant discomfort or distress during their participation in the study. All participants completed the interview and were given the opportunity to debrief with the researcher.

While there were no specific direct personal benefits of participation in this study, potential benefits to participants as a result of participating included knowing that the participant was making a valuable contribution of knowledge to the field of infant and early childhood mental health consultation. Given the potential to increase understanding in this area, the benefits appeared to outweigh the risks.

Informed Consent/Assent The participants of this study were a nonvulnerable population. Prior to participation in the study, all were given a consent form (Appendix B) to read and asked if they understood the purpose of the study as well as the risks and the benefits of participating. Participants were asked to sign the consent. To the best of her abillity, the researcher assessed participants’ responses to determine whether they understood the study, their part in it, and the risks and benifits of their participation. It they had not understood, the researcher would have assumed that informed consent had not been achieved irrespective of whether the participant had signed the consent document.

Use of the Data The researcher made every effort to insure the confidentiality and privacy of all the participants. Raw data collected from this study, including digital audio recordings,

57

questionnaire data, and/or transcriptions of interviews, with all identifying information removed, are stored on a computer maintained in the secure location of the principal researcher’s personal computer and can be accessed only through a password known only to the researcher. A professional transcription service was used for this study. The transcriptionist read and signed a confidentiality agreement prior to beginning transcription. The researcher saw to it that computers belonging to the transcription service and containing data related to this study were securely stored during the transcription process and that the data were deleted or destroyed upon completion of the transcription process. Raw data on questionnaires, digital audio recordings, and ―hard copy‖ written transcriptions of interview audio recordings are maintained in the secure location of a locked file cabinet in principal researcher’s home that only the principle researcher has access to. All data collected by the researcher will be destroyed 1 year after of completion of the dissertation. The dissertation study will be a permanent record.

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CHAPTER IV

INRODUCTION TO RESULTS

Overview This study applies grounded theory to the relationship between mental health consultants and program administrators that worked together on a statewide infant and early childhood mental health consultation project in Illinois. The project was a collaborative effort between the Illinois State Board of Education and Erikson Institute.

The project, which began in 2007 and was expected to run for 5 years, was terminated prematurely by Erikson Institute after only 3 years due to financial constraints resulting from the Illinois state budget crisis. All participants were interviewed within 6 months of the project ending. Consequently, the story that unfolds encompasses the full developmental course of the project, including the beginning, middle, and end of the project as experienced by participants. In this study, these different phases of the project will be characterized as the engagement phase, the relationship-building phase, and the termination phase.

The building of a mutually positive and effective relationship takes time and is best achieved through a co-constructed, collaborative process in which both the consultant and administrator have somewhat equal potential to influence the nature of the relationship and the way in of which the consultation model is implemented. The

59

consultant and administrator begin their relationship in a state of uncertainty and confusion and gradually move into a relationship characterized by shared understanding, increased clarity, and mutual respect. The process of co-creating the consultantadministrator relationship and the overall consultation process that occurs within the larger infant and early childhood programs were found to be inextricably interconnected for both consultants and administrators.

This study reveals that there are multiple interacting and mutually influencing dimensions constantly at play within consultant–administrator relationship. It is clearly a relationship in which conscious and unconscious processes of both the consultant and administrator mutually influence each other. This relationship functions as a container for the complex intrapsychic experiences of the collective individuals that exist within the consultation relational field. Overwhelming emotions and traumatic experiences of the atrisk children and families that are the focus of the consultation find their way into the consultant-administrator relationship as each relational configuration in the consultation field, beginning with the child-parent dyad, seeks containment from the individuals they look to for much needed support.

As powerful as the multidimensional influences of individuals within the consultation relational matrix are, political, economic, social, and cultural dimensions also influence the consultant-administrator relationship. The project itself, consultants and administrators were all adversely affected by past and present political and economic policies. Entrenched social and cultural dynamics, such as racism and poverty, also influence the consultant-administrator relationship. The young children and families struggling to survive in the face of overwhelming challenges coupled with a project in a

60

nascent state that lacked adequate financial support resulted in a project that can be considered a case of ―failure to thrive.‖

Participant Demographics A total of 25 participants (

) participated in this study. There were two

groups of participants that participated in this study: one group of mental health consultant participants ( (

) and one group of program administrator participants

).

Mental Health Consultant Participants A total of 10 mental health consultant participants (

) participated in this

study. All 10 consultants were female. Nine (90%) identified themselves as Caucasian and one as Hispanic. At the time of the study, most of the consultants were between the ages of 40 and 60 years old. Three (30%) were in their 40s, two were in their 20s, and one was over 60.

All 10 consultants have a master’s degree. Seven of the 10 consultants have a master’s degree in social work. Three have a master’s degree in education. One consultant also has a doctorate degree in human development. Three (30%) have a certificate in infant mental health in addition to their degrees. All 10 consultants had training or experience in child development and adult individual, group, or family therapy prior to working on the project. Six consultants have education or experience in early childhood education. More than half (60%) had more than 10 years of experience, two had 5–10 years of experience, and two had 3–5 years of experience providing mental

61

health services to birth to 5-year-old children and their families prior to working on the project. Seven (70%) had education or training in reflective practice prior to the project.

Experience that consultants had working as a mental health consultant prior to working on the Erikson/ISBE Project ranged widely with two (20%) having less than one year experience, four (40%) had 1–5 years, and four (40%) had 5–10 years. Four consultants (40%) worked as consultants for the Erikson/ISBE Project for 3–5 years, four (40%) worked for 2–3 years, and two (20%) worked on the project for less than 2 years (see Table 1).

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Table 1 Mental Health Consultant Demographic Information

Frequency Distributions

Characteristics Mental Health Consultants (

Frequency

Percentage

)

Gender

Female

10

100

Race/ethnicity

Hispanic

1

10

Caucasian

9

90

30–40

2

20

40–50

3

30

50–60

4

40

60+

1

10

Master

9

90

Doctorate

1

10

Social work

7

70

Education

3

30

Yes

3

30

No

7

70

Yes

6

60

No

4

40

Education, training, or work experience in child development

Yes

10

100

Education, training, or work experience in adult individual, group, or family therapy

Yes

10

100

Age

Educational background Area of master’s degree

Infant mental health certificate

Education, training, or work experience in early childhood education

63

Characteristics

Education/training in reflective practice prior to project

Years experience providing mental health service birth to 5

Years experience as infant or early childhood mental health consultant prior to Erikson/ISBE project

Years as Erikson/ISBE mental health consultant

Frequency

Percentage

Yes

7

70

No

3

3

3–5

2

20

5–7

1

10

7–10

1

10

10+

6

60

<1

2

20

1-2

1

10

2–5

3

30

5–7

1

10

7–10

1

10

10+

2

20

<1

1

10

1–2

1

10

2–3

4

40

3–5

4

40

64

Program Administrator Participants A total of 15 program administrators (

) participated in this study. Fourteen

were female, and one was male. Ten (67%) identified themselves as Caucasian, two as African American (13%), and two as Hispanic (13%). One administrator self- identified as being of mixed race (7%). At the time of the study, two of the administrators were between 20 and 30 years old, three were in their 30s, three were between 40 and 50 years old, six were in their 50s, and one was over 60 years old.

In regard to education, one administrator (7%) has an associate’s degree, five (33%) have a bachelor’s degree, and nine (60%) have a master’s degree. Four of the 15 administrators (27%) have a degree in education, three (20%) in social services/sociology, two (13%) in social work, two (13%) in administration, and two in early childhood (13%). Nine of the 15 administrators (60%) had experience or training in reflective practice.

The ages of children served in their programs ranged from birth to 5 years old.

Ten of the 15 administrators (67%) had programs that served children from birth to 3 years old, five (33%) served children from birth to 5 years old. The number of children enrolled in programs ranged from 20 to 150. Two programs had an enrollment of 20–50 children, seven had 50–75, one had 75–100, and five had 100–150.

Years of experience working as program administrators ranged widely, from 1 to 2 years (13%) to over 10 years (53%) at the time of the study. Interestingly, 8 of the 15 administrators (53%) had more than 10 years of experience providing direct service to children and families.

65

Six of the 15 administrators (40%) had received mental health consultation prior to receiving consultation through the Erikson/ISBE Project. The length of time that programs received consultation through the Erikson/ISBE Project ranged from less than a year to 4 years. Of the 15 administrators, two (13%) received consultation through the project for less than a year, five (33.5%) for 1–2 years, three (20%) for 2–3 years, and five (33.5%) for 3–5 years. Regarding the frequency of meetings with consultants, only one administrator reported meeting with a consultant on a weekly basis. Six (40%) reported meeting 2–3 times per month, seven (46.8) reported meeting monthly, and one reported meeting quarterly or less (see Table 2).

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Table 2 Program Administrator Demographic Information

Frequency Distributions

Characteristics

Gender

Race/ethnicity

Age

Educational background

Area of degree

Frequency

Percentage

1

7

Female

14

93

African American

2

13

Hispanic

2

13

Caucasian

10

67

Mixed

1

7

20–30

2

13

30–40

3

20

40–50

3

20

Program Administrators ( Male

)

60+

1

7

Associate

1

7

Bachelor

5

33

Master

9

60

Education

4

27

Social services/sociology

3

20

Social work

2

13

Administration

2

13

Early childhood

2

13

Other

2

13

67

Characteristics

Ages of children served in program

Number of children enrolled in program

Years as program administrator

Training/experience in reflective practice Received mental health consultation prior to Erickson/ISBE project

Frequency

Percentage

Birth to 3

10

67

Birth to 5

5

33

20–50

2

13

50–75

7

47

75–100

1

7

100–150

5

33

1–2

2

13

2–3

3

20

3-5

1

7

5–7

0

0

7–10

4

27

10+

5

33.5

1–3

2

13

3–5

1

7

5-7

3

20

More than 10

8

53

Yes

9

60

No

6

40

Yes

6

40

No

9

60

68

Characteristics Years of Erikson/ISBE mental health consultation

Frequency of consultation

Frequency

Percentage

Less than 1

2

13

1–2

5

33.5

2–3

3

20

3–5

5

33.5

2–3 times per month

6

40

Monthly

7

46.8

Quarterly or less

1

6.6

69

Presentation of Results The following chapters present the results of this study. There are three chapters for mental health consultant results, three for program administrator results, and two for consultantâ&#x20AC;&#x201C;program administrator pair results. Each chapter title is a category. As described in the methodology section of this paper, this is the result of breaking down the interviews into discreet data and reorganizing the data into categories. Each chapter category is further broken down and organized into descriptive properties. All interviews began with the researcher asking an open ended question: â&#x20AC;&#x2022;Tell me about your relationship with the consultant/administrator you worked with on the Erikson/ISBE Infant and Early Childhood Mental Health Consultation Project.â&#x20AC;&#x2013; The categories and the properties discussed under each of them are shown in Table 3.

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Table 3 Categories and Properties of Results Results

Consultants

Administrators

ConsultantAdministrator Pairs

Category I

Engagement is challenging, complex, and confusing Do they even want me here Boundaries and role confusion Influence of administrator characteristics

Working with the consultant

Evidence of consultantadministrator pairs

Making time for the consultant Brainstorming together Helping me support my staff Confiding in the consultant

Referencing each other Common language Description of the consultation process

Families and programs in crisis At-risk families and communities Vicarious trauma and countertransference Impact of the economic crisis

Experience of the relationship Mutually positive experiences Mixed feelings Change over time

Properties

Category II Properties

Category III Properties

So much to process Processing the administratorâ&#x20AC;&#x2122;s experience Identification with atrisk families Trickle-up of at-risk families The consultantâ&#x20AC;&#x2122;s internal experience Working with administrators Building the relationship Supporting the administrator Degrees of success Trickle-down Endings and debriefings

Model pros and cons The consultantâ&#x20AC;&#x2122;s expertise Model constraints Left In the lurch

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CHAPTER V

ENGAGEMENT IS CHALLENGING, COMPLEX, AND CONFUSING

The next three chapters present findings from interviews with the 10 consultants that participated in the study. This one focuses on the complexity of consultantsâ&#x20AC;&#x2122; subjective experience of the engagement process with program administrators they worked with directly. As the chapter title suggests, most consultants found engagement to be a very challenging, complex, and confusing process.

There are three properties in this category. The properties are Do They Evan Want Me Here, Boundaries and Role Confusion, and Influence of Administrator Characteristics.

The first property, Do They Even Want Me Here, presents data from consultants that reflect a strong and troubling feeling experienced by most consultants. In the initial phase of the engagement process many consultants struggled with feelings of rejection because program administrators and staff did not make it known that they were glad to have, or even interested in having, the consultants working with them and their program.

The most significant way this dynamic seemed to play out for consultants was when they made efforts to meet with the administrator and the administrator failed to show up or keep the appointment. When this occurred, consultants tended to persevere and keep

72

showing up while using individual and group supervision to support them through the process.

The second property, Boundaries and Role Confusion, captures consultants’ experience of feeling confused regarding their role with administrators. Consultants tended to experience more confusion earlier in the consultation process, especially if they were new to working as a mental health consultant. Consultants felt most confused about their role in relation to boundaries. Boundaries tend to be less clear for consultants than therapists, with consultants having somewhat looser boundaries in terms of selfdisclosure. It was also difficult for some consultants to know where to set the boundary and find a balance with administrators in terms of administrators’ use of the consultant as a consultant verses as a ―therapist‖. The confusion consultants experienced regarding their role and boundaries was further complicated by the fact that the Erikson/ISBE Project was a new project and in the process of developing its consultation model.

The third and final property, Influence of Administrative Characteristics, represents consultants who found that administrators’ individual characteristics influenced the engagement process. Some of the administrator characteristics that consultants identified as affecting the engagement process include administrators’ personality, style, culture, ethnicity, and professional background.

Do They Even Want Me Here?

Many consultants struggled with the feeling of not knowing if or how much administrators at either level wanted them to be providing consultation to their program.

73

Many consultants described getting blown off or stood up by administrators. The following quotes illustrate this explicitly: I struggled with how much they want me there.

One of the things I struggled with as a consultant was, how much do people really want you there? Like entering the system and finding a way to do that, and not taking it personally if they blew you off or didn’t want you there very often. I’d show up and they wouldn’t be there, or they’d say they forgot I was coming.

I would get there and maybe they would forget, or they wouldn’t even be there. I really struggled with how much did they really want me there, or am I even being useful? I think I got past that, but at first it was really hard for me.

They would forget that I was coming. I couldn’t drill into them enough that this is the time I was coming.

She found the time to meet with me, but even then I would go and she wouldn’t be there.

The administrator was like, ―Oh this will be great, we’ll have lots to talk about.‖ Then she wouldn’t show up, or they’d have a meeting and they wouldn’t even tell me their meeting schedule.

One consultant talked about her experience of taking a gift and finding no one there to accept it: I brought the cake and I had this big box, and I walk in and no one was there. It was a symbol, like ―Here I’m bringing you this gift and you’re not even here to receive it.‖ Another consultant commented on how her failed attempts to engage administrators several times made it difficult for her to keep trying to do so: They’re not willing to spend the time with you, and you’re thinking, ―Well, I don’t want to drive them crazy and keep bothering them.‖ You call them five times and they haven’t gotten back to you, and you send them five e-mails and they don’t return them and you are sitting there thinking, ―They’re so busy. They don’t really have time for you.‖

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One of the major strategies consultants used to deal with getting blown off by administrators was to persevere by continuing to show and check in with the administrator: I just would say, ―Hey, how’s it going?‖ And she would say, ―It’s a rough day.‖ And she wouldn’t even know that we were having a meeting. I was just dropping in and checking to see how things were going. That’s good how that came about.

We just continued to do that. At some point she said, ―When are you coming back? I’m going to write you in my calendar.‖ With my work with one of the first tier administrator, sometimes she was hard for me to read and I always made a point to just show up with her. I was there a lot, so I always said, ―Hey can we talk?‖ Some consultants mentioned reasons that administrators may have had resistance to engaging with them: I think this idea of mental health and me being a mental health person—some people embrace that and are like, ―That’s interesting. You might have a different perspective than I have.‖ And I think some people are like, ―You’re trying to encroach on my discipline with your discipline.‖ Or ―You’re going to get to my vulnerabilities in a way that doesn’t feel good or comfortable.‖ I don’t know that I knew them long enough to know.

I think it took a longer time to develop because people were afraid, especially as funding began to be an issue. If the relationship was in the developing stages, or it hadn’t been developed, some of the programs fell by the way side. And they would say, ―This is a luxury and we can’t afford this.‖ One consultant quoted an administrator to illustrate her perception of the administrator’s suspiciousness about her presence: Why are you here? Why are they sending you here?

When resistance interfered with the engagement process, some consultants addressed this directly. The following is from a consultant who expressed what she would say to administrators that were difficult to engage:

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You probably wonder why I’m here. And I’m totally okay with you saying to me, ―What do you want from me?‖ Because I wonder how that is for you when it’s like, ―Here comes this consultant.‖ So I’m just going to go do my thing and then hopefully at some point you believe that I’m here to help you. But I don’t expect you to trust me because I’m telling you that you can. Either I’m going to offer you another way of thinking about the work and how you can use consultation or not, but I just ask for a chance.

As one might expect, it was easier for consultants to engage administrators if they had worked with the administrator prior to working together on the Erikson/ISBE project: I knew the administrator from previous work that I had done in the community.

But I knew her in a different capacity. At one time we were colleagues. I was doing the same thing at a program in a district where she was working. So when I contacted her to see if she was interested, there was already that familiarity, so I didn’t need to build my relationship with her. They were very eager to have me be a part of their work at that program.

Boundaries and Role Confusion Most consultants described experiencing difficulties with boundaries in relation to their role as a consultant, and with their role as consultant in general. As an example, boundaries were described by one consultant as ―major issues,‖ and something that takes time to develop: You could be pulled into being their therapist, so you need to have a lot of discipline and feel clear about your role, which no one does in the beginning. I just feel kind of fortunate. I feel pretty clear about it. Boundaries are major issues.

Other consultants commented on boundaries in their role as consultant and how they felt more comfortable sharing more of their self with administrators in their role as consultant: They know about my family, they know my kid went off to college, things like that.

I bring more of myself, and it is with intention.

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Boundaries for me meant something different than boundaries for somebody who might have been trained clinically. I didn’t have a problem with self-disclosure.

There was a purpose for it. These are people, like I’m sitting across from you and I’m a person and I need to relate to you.

The majority of consultants expressed having experienced difficulty understanding their role as a consultant: The clinical skill and judgments needed with how far to go and holding in mind what our role is, is very challenging. I don’t know why I’m thinking of that, and when you ask, ―Is there anything else to say?‖ I think a lot about that, and that this is a really hard job.

I think as a consultant that was the biggest struggle: ―What is my role, what are we doing?‖ But I think that’s okay. I’m not saying that as a criticism because I think that happens all of the time.

Over a third of consultants discussed experiencing role confusion because they felt that the Erikson/ISBE project administrators were not clear about what consultants’ role should be: There was always this confusion. I think that they even thought differently. When one administrator was here, she talked about things one way and then she left, then the new administrator didn’t really agree on some of those things.

So even though we’re not supposed to be an expert model and tell programs what to do, we still want to feel like we know what we’re doing. It’s hard when you go into these programs and the whole project is just not really clear because it is in the beginning stages, like, ―We got to get out there and work.‖ And we’re not really sure.

Part of that was probably because I really didn’t know. Then when you have a program administrator telling you what to do and you’re like ―Okay, we can do this…‖ Some consultants discussed the added confusion regarding their role as a consultant due to their experience of also practicing as a therapist professionally:

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I think it was confusing being new to consultation, even though I was used to doing it in treatment. In this role, suddenly it felt stranger to do.

Most consultants wear many hats professionally, and the hat rack is full. There’s a big hat rack, so we have to find ways to change hats. Because one hour we’re a therapist, and then we go and become a consultant. The next hour we’re supervising. And how do each of us change hats? In therapy, we know we’re a therapist and we still make those choices, but consultation, I feel pretty clear about it but it’s a very intimate relationship, but it’s not therapy and supervision.

So that’s what I mean by delicate. There are more choices that you have to rule out.

One of the consultants quoted above also commented on how she attempts to clarify her professional role: There are things that I bring to it to help clarify my role, and clarify the boundaries for me. And help differentiate consultation from the other roles that I do.

Another consultant commented on administrators’ confusion about what the consultant’s role should be: They weren’t exactly sure what it was about and what they were supposed to do. I think it’s the whole thing about consultation in the sense that when it’s reflective, and it’s not like I’m going to come in and give a training, it’s like ―I don’t know what it’s about, and I would tell you if I knew what we were going to do and what it’s going to look like.‖ And people would ask that question often, like ―What exactly are you going to do? What can you do?‖ And I would say that other sites had done this and that, but I tried not to do that as much as possible because it was so different at every site.

Another consultant struggled with how much she should try to influence the consultation process and how much she should just let go and let her role unfold within the relationship with the administrator: I think what’s hard is whether we’re looking to our consultation sites to come to us about what the consultation is or should we be bringing our agenda? I think for myself I’ve struggled about that in supervision. Like, ―Okay how much of this do I think could be good?‖ And how much of this is something they’re actually interested in addressing? I think there’s a mix of that all the time. So I think, as a

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consultant, being able to let go of how much control, or how much am I going to get to. Does it matter that I just support the director and they’re able to do something different with their staff or does somebody need to work directly with the staff in order for there to be system change?

Some consultants expressed that as they gained experience they felt more comfortable in their role as a consultant: I felt like getting started with the new programs was so much different than starting one I started in September just because of the comfort and the role that I was in. I felt much more confident going in and selling it. I knew how I was going to do it. Not that I couldn’t meet them where they were, but it just felt much smoother and more comfortable.

Influence of Administrator Characteristics Although many consultants commented on how the engagement process varied depending on the administrator or program, half of the consultants expressed how the characteristics of each individual administrator influenced the engagement process. The characteristics of administrators as described by consultants ranged from administrators’ personality, style, culture, ethnicity, and professional background: I’m trying to think why she would not want to meet with me . . . I think a lot of it is personality.

I think depending on where people are professionally and their confidence about what they’re doing—like if someone’s been the director forever versus a new director—all of those things matter.

A few consultants described how having specific characteristics in common with administrators made the engagement process easier for them: I feel like my relationship with the administrator who was a social worker too was my easiest consultation. She knew what reflective supervision was.

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One of the areas was very rural, and I’m from a rural area so we connected that way . . . so just finding ways to let them know that I could connect with them helped.

One consultant expressed how she felt that a particular administrator’s insightfulness and eagerness to learn from the consultant facilitated the engagement process: I think she really was motivated to understand why she did things, and why her staff did things, and try to understand what was going on around her. So she was really insightful… She was an older student going back for her master’s, which I think might make a difference sometimes. So I’m thinking that’s probably something that was specific to her personality. She was very engaged and very eager to learn.

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CHAPTER VI

SO MUCH TO PROCESS

This chapter focuses on consultants’ internal experience of processing multiple dimensions of the consultation process simultaneously. This proved to be a very emotionally demanding and challenging experience for many consultants. There are four properties in this category: Processing the Administrator’s Experience, Identification with At-Risk Families, Trickle Up of At-Risk Families, and The Consultant’s Internal Experiences.

The first property, Processing the Administrator’s Experience, includes consultants’ attempt to be attuned to administrators’ external and internal experiences, including administrators’ conscious and unconscious modes of communication, in order to locate the administrators in relation to the consultant-administrator relationship and consultation process. Consultants directly and indirectly described the unconscious resistance and avoidance by administrators in dealing with the unpleasant feelings generated by the intense internal and external situations that the front-line staff experienced. Consultants described the manifestation of this as administrators’ desire to have the consultants work directly with staff rather than having the consultant help the administrator support the staff around more emotionally difficult issues. This property also describes consultants’ experience of dealing with other internal experiences of

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administrators including their feelings about the program as well as personal experiences.

It also includes their reactions to the actual or threat of the closing of their program due to financial difficulties. Some consultants expressed how they viewed themselves as providing emotional holding for administrators.

The second property, Identification of At-Risk Families, illustrates how consultants experienced administrators and staff as identifying with the at-risk families they served. The identifications were described as being along the lines of administrators and staff as being of the same race and culture or living in the same community as the families they served. Consultants processed the assumptions that some administrators had about them, the consultants, not being of the same race and culture, or community and how this presented a challenge for them at times, especially in the earlier phase of the consultation process, before relationships were developed. Some of the consultants expressed being aware of the difficulty the administrators and staff faced as a result of working with at-risk families who they identify with while also having their own personal life challenges.

The third property, Trickle-Up of At-Risk Families, is descriptive of a phenomenon termed â&#x20AC;&#x2022;trickle-upâ&#x20AC;&#x2013; by one of the consultants. Trickle-up refers to a type of reverse parallel process in which the difficulties and traumas experienced by at-risk families unconsciously affect all who work within the system or program serving at-risk families. Consultants and administrators that participated in the study characterized atrisk families as those experiencing multiple risk factors, including parental mental illness, parental substance abuse, domestic violence, teen pregnancy, poverty, illegal immigration status, and children with physical disabilities. One of the consultants labeled the affects

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of working with these types of at-risk families as a form of ―vicarious trauma.‖ The trauma of at-risk families affected the front-line staff most noticeably; however, administrators and consultants also experienced adverse vicarious trauma to some degree.

The consultant-administrator relationship was a receptacle of the challenges and trauma experienced by at-risk families.

The fourth and final property, The Consultant’s Internal Experiences, illustrates how consultants simultaneously process the multiple dimensions of consultation in the various programs they serve and their own internal reactions to their experiences as a consultant. Consultants described having feelings about, and reflecting on, their role as a consultant, their relationship with administrators, and their fear and the reality of losing their job. Feelings about their personal experience of the consultation ranged widely, with negative ones far outweighing positive ones. The experience was described as challenging, intense, frustrating, and confusing. It could great, but it could also cause feelings of helplessness. Feelings naturally changed over time. Consultants felt that having supervision by other mental health professionals was crucial so that they had a place to intentionally process their feelings, make sense of their feelings in relation to their work, and manage their emotional reactions.

Processing the Administrator’s Experience One way in which consultants experienced themselves in relation to their work with administrators was by being aware of and processing administrators’ interpersonal and affective experiences within the consultation process. In the interviews, some

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consultants also described situations in which they experienced and interpreted administrators’ underlying and unconscious feelings.

Half of the consultants expressed that some of the administrators they worked with wanted the consultant to provide support to the staff because they did not feel that they themselves had the skills needed to help staff with the work they did in the way the consultant could. Some consultants implied that these administrators were unconsciously expressing resistance to providing consultation that involved mental health issues to their staff. Consultants did not necessarily believe that the administrator lacked the skills needed to work with staff in this way: I think that some of them recognized that their staff needed more support, but they just felt like they didn’t have enough time, or they couldn’t provide it—none of them said this directly, but I think some of them might have felt like they didn’t have the skills to talk with their staff about some of the work. I don’t think that was necessarily true, but they would say ―Oh well, you’re a mental health person so you can talk to them about this family who’s having mental health problems.‖ And again, I don’t think that they didn’t have the skill, but I had a different perspective.

Some consultants commented on how administrators’ involvement with the consultant and staff when mental health issues were involved varied depending on the individual director. Some directors did not want to be involved at all when the consultants met with staff, while others would participate in staff case consultations: It was different at different sites. Some directors said, ―Here’s my staff. Do whatever you’re going to do with them.‖ And then we would talk about it maybe quarterly or something. Other directors wanted, like if we would have a case consultation, to be there. I encouraged that. I felt like that was more appropriate.

But I do feel like in some situations they’re just like ―Okay staff, go on without me.‖ Another consultant described how an administrator she worked with would tell her that she wanted to work on staff conflict issues by meeting with the staff and

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consultant. The administrator would schedule the meetings, but they never actually took place. The administrator would cancel them for ―conscious or unconscious reasons‖: I think she was definitely supportive of it. But again, I think things always came up, consciously or unconsciously.

One consultant directly stated her belief that an administrator felt threatened dealing directly with clinical issues: I think she felt all of this clinical stuff was threatening.

One consultant spoke of her unsuccessful attempt to get at what she believed was the administrator’s unconscious wish for the consultant to provide emotional containment for the administrator: I tried to get a little bit at the wish that I felt like became my growing understanding of my role as helping with emotional containment. I feel like I tried to look for points of entry to get in there, but I don’t feel like we ever really got to that.

Consultants spoke about helping administrators deal with feelings about their programs closing due to the state’s budget cuts. One consultant referred to this as helping the administrator grieve: I think that for me it was very difficult because it was the supervisor, the principal, who found out that the birth–3 program was going to close for good, so I had to deal a lot with the closing and the grieving and the transition. So I helped the birth–three staff because they knew they were no longer going to be working anymore. They were losing their jobs.

Identification with At-Risk Families Half of the consultants described their awareness and experience of administrators or staff identifying in some way with the at-risk families they serve. In some cases, this was specified as administrators and staff being of the same race or from the same

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community as their clients. From the perspective of many consultants, their relationships with administrators were impacted by administrators’ and staff’s viewing the consultant as an insider or outsider of their culture or community.

The following comment is from a consultant describing her perception of how administrators and staff felt about the consultant being from outside their culture: I also think there was a race issue. Every person who worked in the program was African American. And pretty much everyone they served was African American.

And so I personally feel that there was some assumption like, ―This lady doesn’t know anything.‖ And I don’t know their community that well. I don’t know exactly what they do. But I told them I’d gone on home visits and that I’d done that for a long time.

The same consultant further commented on how the staff talked to the consultant about their own experiences within the community of the families they served: They talked to me a lot about their families, but they talked to me a lot about their own lives. All of the people involved in this program were very involved and had lived in the community for their whole lives.

Another consultant also spoke about the staff and families being from the same culture and community and the conflict between the staff and the administrator, who was of a different race and from a different community: There was some of that conflict. The town is a very racially divided area and the school district is incredibly divided racially and there is tremendous tension. So she is white and the staff is African-American except for one other consultant or one other home visitor. And there was a lot of tension because the families they work with are African-American. This particular group, the home visitors live in the communities with the families they serve. They’re friends. She does not and didn’t quite understand and was mistrusted. So there was some of that to work through.

One consultant expressed the sense of helplessness she felt the staff experienced in their effort to help at-risk families and the identification and shame administrators and staff had as a result of being from the same community as the families:

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I also think as a program, there was this real sense of helplessness. So the staff felt very overwhelmed by their – some of them had a hundred kids that would come in a room and they worked in high schools where principals didn’t want to advertise that they had pregnant teens. Tons of shame. There’s a lot of identification with the community violence and the teen pregnancy by the staff that come from the same communities they work in. So there’s a lot of helplessness on the part of the staff, I think. The directors soaked a lot of that up, and I think I would certainly feel that every time I was there.

Trickle-Up of At-Risk Families As stated previously, the programs that participated in the Erikson/ISBE Project served at-risk children and families. These families experienced a range of risk factors, including family violence, substance abuse, teen pregnancy, immigrant or refugee status, and poverty. Many of the communities in which these programs were located and served families struggled with these problems. Sixty percent of consultants described, either directly or indirectly, experiencing a reverse parallel process in their work with administrators and programs. Early on in the data collection process one consultant used the term ―trickle-up‖ to describe the type of parallel process that occurs as a result of the disturbing and distressing issues and emotions of at-risk families and communities that enter into their work with administrators and staff. The researcher used this term in consequent interviews when consultants seemed to be expressing an experience or thought that was descriptive of this concept.

Several consultants mentioned specific types of difficult issues that the programs were dealing with in relation to serving at-risk families: They presented one case of a child from an immigrant family. The mom is depressed and disabled, and they’re very, very poor and they don’t have food.

They work with teen moms. Difficult, difficult cases.

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The situation there was that they had a Prevention Initiative program and they worked in high schools serving pregnant parenting teens, both mothers and fathers. And they work in very high risk communities.

One consultant went further and described how an administrator and staff who had no experience working with teen moms were affected by learning that an 8 th grader had become pregnant: They had no experience with teen moms, and they had recently gotten an 8th grader who was pregnant into the program. It stirred them all up, so we talked about that several times.

The following quotes are illustrative of the different issues that at-risk families experience and how these issues are experienced as a sort of ―vicarious trauma‖ by administrators and staff. These comments also include the consultant’s experience of how she supported administrators through providing opportunities for them to reflect on their work: I think the reflection helped her have a place to talk about the vicarious trauma related to working with families that are really coping with these significant medical and developmental issues. I think a theme in that is the whole diagnosis and then the grieving process, and how the whole time in their different roles [they] are often put in the position of holding that. I think it helped her have a place to have that contained and held so she could hold that for the staff. I think she began to be more open to having that role with her staff.

I use the term ―vicarious trauma.‖ I think I just see that in everyone that works with high-risk folks. You just soak that up, and people need somewhere to go with that.

The Consultant’s Internal Experiences Consultants not only internally processed the experiences of administrators, staff, and the programs as a whole; they were simultaneously busy experiencing their own internal process. Their own experiences, and associated feelings, were wide ranging,

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including feelings about their role as a consultant, their relationship with the administrator, their fear and the reality of losing their job, and more.

The following comments include consultants’ positive experiences and feelings about their relationship with administrators and their role as consultant: I feel very fortunate that there were very positive relationships in all programs, and I think there was a lot of trust in them.

Making it come together and feeling as comfortable as you can with that weirdness is one of the things I like about consultation and dread about consultation. If I can work through it with the the site and muddle through it, and 6, 12, 18 months later we can say, ―Wow, we’ve come to this thing. We’ve developed this relationship and this way of doing things and it’s working and it’s really cool.‖ That feels really good.

I think it was a great experience on both sides. I’m sure they won’t all say it’s great, but I feel like it was a great experience for them to have and to figure out what the relationship is about and getting to that place where it feels like you are all on the same page.

Consultants also described feeling that the work they did as a consultant was intense and difficult: This is very intense work.

I found consultation very challenging in a variety of ways. And I like it, but I do feel that it’s a lot to mentally wrap your head around when you’re working with systems.

It’s very delicate work. And what do I bring? I bring a very keen awareness of that all of the time even though 20 minutes ago I’m saying how silly I am in the role. I’m always processing who and what I am to them, and with them. .

Another consultant described how her background as a clinician was helpful to her in dealing with the uncertainty she encountered in her work as a mental health consultant: I felt like it’s very clinical and that my background in doing clinical work was helpful, because you just never know. You don’t really know what’s going to happen in therapy. And I feel like it’s the same with consultation. I guess one of

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the things I struggled with was this whole idea of people viewing you as an authority or as an expert, even though that wasn’t the attitude. That’s definitely what people thought at first.

Some consultants described feeling helpless and ineffective, and that it was hard to know if they were even being helpful: I felt helpless there. It’s so hard to know until you leave and somebody says something to you. You don’t get the feedback, so I don’t know if it was helpful or not. I definitely felt ineffective when I was going to the center. Then one day my grandson was playing baseball and I met an administrator I had worked with, she was the assistant director of the childcare program. And she said, ―We miss you so much. You just did such a great job.‖ I never in a million years thought that that would happen. So you just don’t know what your legacy is, I guess, or whether you’re being helpful or not.

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CHAPTER VII

WORKING WITH ADMINISTRATORS This category presents a picture of consultants’ experience of working with program administrators. Consultants viewed their relationship and work with administrators as a gradual building of the relationship. One of the major roles consultants found themselves in with administrators was supporting them in their work with staff and in their struggles in their administrative role. Consultants tended to perceive their work with administrators as having had varying degrees of success. Engaging administrators in regular reflective practice meetings resulting in administrators becoming more reflective with their staff was considered to be the most successful consultation experience. The category concludes with consultants’ experience of the termination of the project and the use of the interviews as a form of debriefing.

There are five properties in this category: Building the Relationship, Supporting the Administrator, Degrees of Success, Trickle-Down, and Endings and Debriefings.

For the first property, Building the Relationship, consultants describe their experience of what it was like to build relationships with the administrators they worked with following the initial engagement phase. Many consultants expressed that ―it takes time‖ to build the relationships with administrators. Consultants also stated that the type of relationship that they developed with administrators depended on how ready the administrator was to work with the consultant and, to a lesser degree, on how they

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themselves influenced the relationship-building process. Consultants had different approaches and ways of thinking about what it meant to build a relationship with administrators. They found supervision to be helpful when they experienced challenges building relationships with particular administrators.

The second property, Supporting the Administrator, provides a picture of how consultants saw their primary role in working with administrators to be providing support to them. Consultants perceived many administrators as being overwhelmed, and as having lonely, hard jobs with no one to talk to about the struggles they experienced as administrators. Many consultants found themselves supporting these administrators by providing reflective consultation, validation, empathy, and emotional containment. Some consultants spoke about supporting administrators by helping them with staff-related issues as well as with difficulties they experienced with their own supervisors.

The third property, Degrees of Success, is illustrative of the many consultants who described experiencing varying degrees of success in their work with administrators.

Several consultants expressed that the degree of success they had working with administrators depended on the individual administrator. Many consultants felt as though they were unsuccessful to some degree and that their work as a consultant was more difficult if they were not able to meet with administrators on a consistent basis and engage them in reflective practice. Those who felt most successful in their relationship with administrators attributed the success to the administrators understanding of the programmatic, reflective practice model and willingness to meet regularly and engage in reflective practice with the consultant. Interestingly, consultants stated that having a good

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relationship did not correlate with the relationship being easy, and a bad relationship did not correlate with the relationship being difficult.

The fourth property, Trickle-Down, illustrates results that show that the majority of consultants expressed that they experienced parallel process within, or as a result of, their relationship with administrators. The term â&#x20AC;&#x2022;trickle-downâ&#x20AC;&#x2013; emerged in an early interview to describe this process. Evidence of parallel process occurring by way of reflective practice within the consultants-administrator relationship, and later emerging in administrator-staff relationships, was viewed by consultants as a sign of success of the consultation. Consultants described noticing differences in what trickled down depending on the individual administrator. Intentional parallel process was described by consultants as the consultant deliberately helping administrators think about what in their relationship with their staff gets carried into their work with their families. Notions of parallel process as being co-created by the consultant and administrator, as well as external variables such as community violence, emerged in consultantsâ&#x20AC;&#x2122; narratives regarding parallel process.

The fifth and final property in this chapter, and the end of the consultant results section, is focused on the ending of the consultation process, and the ending of the Erikson/ISBE IECMHC Project itself. It is entitled Endings and Debriefings, in order to reflect that the ending of the project was a significant experience for consultants, and that the interview process served as a debriefing process for those that participated in the study. Throughout the life of the project, there were funding problems resulting from the Illinois State budget crisis. Funding for the programs served by the project and the project itself was constantly under threat of being cut. As a result, the programs that participated in the project and the Erikson/ISBE Project feared being shut down.

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Understandably, this chronic financial instability caused a great deal of anxiety for administrators and staff that worked in the state-funded early childhood programs.

Consultants described experiencing anxiety and fear about losing their own jobs while also attempting to help manage the anxiety and fear experienced by the administrators and staff of the programs they consulted as they feared losing their programs and jobs.

Some consultants stated that they worked for programs that shut down prior to the project ending as a result of not receiving state funding needed to continue to operate. In these cases, consultants described going through a grieving process with the programs. It was anticipated by the researcher that the results would in some way reflect the impact of the unstable and devastating financial context in which the project took place. What was somewhat surprising was that many of the consultants used the interviews as a debriefing session to process their experience of the project ending and losing their jobs.

Building the Relationship All 15 consultants described their experience of what it was like to build their relationship with administrators following the initial engagement phase. As stated previously, many expressed that â&#x20AC;&#x2022;it takes timeâ&#x20AC;&#x2013; to build relationships with administrators.

Consultants also stated that the type of relationship they developed with administrators depended on the administratorâ&#x20AC;&#x2122;s readiness to work with the consultant. To a lesser degree, consultants expressed that they also influenced the relationship-building process.

Consultants had different ways of approaching and thinking about what it meant to build a relationship with administrators. The following is from a consultant who

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compared building a relationship with an administrator to working first with parents in a family therapy context: It’s interesting because it’s kind of a parallel process for me clinically with working with families. I usually work with parents first before I bring the kids in.

I could see doing consultation with meeting with the director for a while before I meet the staff and saying, ―Can you help me understand the program, your role in the program, and who you are?‖ And, ―I’ll help you understand who I am.‖ One consultant talked about what she brought to the relationship with an administrator she experienced as ―quirky‖: I think that I was as accepting as I could be. When you ask about her, she was quirky, but I was open and respectful and accepting and interested and caring, and I think that’s what she would say about me if she could say anything. I was trustworthy and a little challenging, and dependable. And those were what I brought to the relationship. . . . This is all by way of saying this kind of thing that I also bring to the relationship, it’s not just humor; it’s affection —an interesting word to bring into what was in the relationship.

Several consultants expressed that it takes time to get to the point in the relationship that you can do meaningful work with an administrator: It takes so long. It could take years of work.

I think once you’re able to form a relationship and people do trust you, they are like, ―Maybe you could be helpful.‖ I think then it can take time about negotiating how that’s going to work and whatever everybody’s roles are.

It’s not like you experience it once. You have to experience it like 10 times and then maybe they’ll start to be like, ―Oh, maybe we’ll make time in our meeting to just talk about how people are doing or how the kids are doing in general as a classroom,‖ versus, ―Who’s the trouble maker?‖ One consultant described how long it can take to build a relationship in which the administrator feels comfortable opening up to the consultant: I think a lot of the initial stage would be a kind of joining, if I can use that word.

That would take a long time. I don’t know what a long time is. It could be 6 months, or it could be a year. I think what we found was it took at least a year for a lot of the sites to say, ―Okay, I can open up to you.‖

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Another consultant commented on how it always takes time to build relationships with administrators, and that the strength of the relationship can influence how long it takes to build the relationship: It always takes a while, but it could have been different if I had a stronger relationship with her.

Consultants talked about different approaches to building the relationship with administrators. Some consultants used supervision and perseverance to help them build relationships with administrators who took more time to come to value the reflective practice model that the project used. Other consultants talked about a more mutual process of the consultant and administrator seeing the value in each other. Using a non-expert approach and being flexible and available was also considered important: I think that as relationships developed, we saw the value in each other. I could see also what their struggles were a little better because I think it’s easy to go in there as an outsider and say, ―This program is really messed up, they need reflective supervision, they need A, B, and C.‖ But once you get to know people, I think you understand about what their struggles are and why this doesn’t always happen.

Other consultants described helping to build the relationship by being flexible and available: I guess on the positive side, I’m more flexible, and when something comes up they’ll call me and say, ―Can you come this time because this family is this? Or you can you just talk to me on the phone, I want to run some things by you?‖ Some consultants talked about feeling that they were a burden to the administrator while they were building the relationship with them: I think in consultation, one of the things I’ve found is while you’re building your relationship, the consultation feels a little like a burden to the people who you are consulting with.

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One consultant shared how attending the program’s special events had helped her to build relationships, by getting to know people better and feeling more connected to the program. It also made the work feel more fulfilling: I felt like I knew more about the program and I appreciate the program better.

Like going to a Christmas party that they have for the families. I was so happy that I went because it was so awesome to see the kids and to see the staff helping the kids. I felt like they appreciated it. Do I want to go to every one? No. It’s something that they worked really hard on, so I want to appreciate their work. I think for me personally, it helps me know the people better and feel connected to them. Again, I think you can be a perfectly good consultant if you don’t do that.

But it’s me. It makes the work bigger, bolder, more interesting.

A less experienced consultant commented on taking a non-expert approach to building the relationship: I think the more you are comfortable with the non-expert approach, the less struggles you may have with developing a relationship with somebody because you truly are a novice. You have no idea.

The following quote is from a new consultant who talked about the time it took to build trust with an administrator who had a previous consultant who left the project. The consultant also described how she built the trust with the administrator by listening and letting the administrator talk about her relationship with the previous consultant: I think the beginning was very slow. Because they had a consultant before me it took quite a long time to build trust with those administrators. It took a good 4 months or so just to transition from the old consultants into the new…talking about the old consultant and the things they liked and they didn’t like. The things they wish they would have had versus things that really worked well.

A more experienced consultant described how she viewed building relationships with administrators as moving through different phases. Following the initial engagement phase, which she termed ―joining,‖ and which can take as long as a year, the consultant describes a phase characterized by the relationship taking hold, in which the administrator makes time to co-construct with the consultant a way to work together to

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create the changes that the administrator would like to see happen in the program. The co-creating or co-construction phase is illustrated by the consultant in the following: I think it comes out of, ―What I heard you talking about over this time is this is something you would really like to see changed and put some more effort into. I was thinking about that, and I’m wondering how I can be useful if at all in making that happen for you. How do you think I can be useful, because it seems to keep coming up as something you are wanting? What do you think prevents you? Is there anything I can do to eliminate some of those things?‖ So just thinking together and co-creating or co-constructing it.

Supporting the Administrator A large majority of consultants interviewed expressed that they viewed providing support as one of their major roles in working with administrators. Consultants perceived many administrators as being overwhelmed and having lonely, hard jobs and having no one to talk to about their struggles as an administrator. Consultants described their role as providing reflective consultation in which they used empathy and provided emotional containment in supporting overwhelmed administrators in lonely and difficult jobs.

We talked a lot about what her struggles as an administrator were. She just looked pulled in so many directions.

It would be a lot of talking with her about all of her stress and all of the stuff going on and all of the pressures and how overwhelmed she was. That was the general theme. I would try to empathize, and try to understand how my role could help her.

I would provide the kind of reflective consultation where she could talk about how the job was for her. She could talk about what’s going well, what’s not going well.

One consultant described how the administrator used her for support for both personal and professional issues, which had a similar theme of loss: I think it was a lot of personal support, honestly. Her personal struggles and her position being eliminated happened all at the same time. So we worked a lot on,

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―Okay so this is awful because you’re mourning what you’re losing.‖ So we talked a lot about loss and fears because usually why people don’t want to change is the fear of the new, so we talked a lot about that. So I think it was kind of a combination. She was suffering loss personally and at work.

The following quote is from a consultant who expressed supporting the administrator by validating her so that the administrator felt more confident implementing changes in her program: I think it supported her in feeling confident and implementing some things she was interested in trying to do but just needed the place to be validated.

Consultants also described supporting administrators by helping them with staff related issues: The program has a huge problem with a lot of lack of teamwork, and there were a lot of problems between the staff members. So we worked a lot with how to address that with the staff. She worked really hard at trying to figure out how to get the people to work together.

I feel like one of the things she was struggling with was how to help teachers that had a conflicted relationship. So I think it was important for her to have the space to reflect about how much she had control of that and what she saw her role as, and did she want her role to be different, and how to help them.

Other consultants spoke of supporting second tier administrators in an effort to help them deal with difficulty they were experiencing in their relationships with first tier administrators: She really trusted me with a lot of herself, and she had things happen to her in this job where her supervisor really didn’t treat her well at times and it was very difficult for her, and it was very difficult for me to watch that happening.

The coordinator, who I worked closely with, really began examining her relationship with her boss.

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Degrees of Success A large majority of consultants specifically expressed experiencing varying degrees of success in their work with administrators. Several consultants expressed that the degree of success depended on the individual administrator. Many felt that they were unsuccessful to some degree, and that the work was more difficult if they were not able to meet with administrators on a consistent basis and engage them in reflective practice.

Those consultants who felt most successful in their relationship with administrators met regularly with the administrator and were able to engage in reflective practice with them.

The following comments are from consultants who enjoyed working with administrators because of the administrator’s capacity to be reflective and think together with the consultant about how to create change: I loved that site so much. They were very active at the administrative level. Like, ―We’re thinking about this, how can she be involved in that? How can those things come together?‖ And they just had all of these awesome ideas and so when I had to go from there to sites where it was really ambiguous, I was really struggling.

I also think that those people in that agency on that administrative level, they all had some experience with reflection. So they knew what it was about and I think they valued it. More importantly than knowing what it’s about, they actually valued it.

I feel like my relationship with the administrator, who was a social worker too, was my easiest consultation. She knew what reflective supervision was.

Administrators who understood the importance of making time to meet with consultants made the consultant feel better about their relationships with administrators: So I’m thinking about these other two programs where I feel like I had better relationships with the administrators, they gave the time.

I really feel this model works better with working directly with an administrator that can give you their time.

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The consultants who felt they were less successful or unsuccessful described relationships or interactions with administrators in which administrators wanted the consultant to provide an expert model of consultation rather than the reflective practice model used by the project: I kept really trying to make it more collaborative and I could tell both from her and her staff that that was not what they were looking for. They wanted an expert.

They wanted someone to come in and teach them things and tell them things. And I just don’t think that is helpful.

I’m not saying we had a bad relationship. I just don’t think she ever really understood. We tell her what we’re there for. We’re not an expert model, but I still felt like that’s what she expected.

Other reasons for consultants feeling that their relationship with administrators or with the consultation overall was unsuccessful was if administrators were too busy to meet with the consultant: Because they were so, ―Go ahead and do this‖ because they were so busy. So I sometimes felt like there wasn’t even a relationship. I think personally I felt like ―Man, this person is so busy.‖ You feel like you just don’t want to bother then too much because then they might say, ―You’re not worth it, and I don’t have time for you.‖ It’s like they’re so busy, they’re not going to want us there if we say, ―You have to spend this amount of time with us every week or every two weeks…‖ However, some consultants specifically expressed that having a good relationship with administrators did not necessarily equate with the relationship being easy for the consultant. Conversely, others expressed that a relationship might not be considered a bad relationship even though it is a hard one: I feel that I had a good relationship with her, but it was not easy.

In fact, one consultant stated that the most difficult relationship she had with an administrator turned out to be the best relationship: It was probably my hardest relationship, and even the previous consultant said this. She said they’re very slow to warm, they’re hard to engage, not so much the

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home visitors but the administrator, and she really was. It turned out to be the best relationship.

One consultant spoke about how it was the way in which she handled a relationship with an administrator that caused the relationship to be unsuccessful: I think it really sabotaged my relationship with the director. I ended up switching gears midway and just tried to concentrate on the staff. But I think I still lost the director.

Trickle-Down The majority of consultants stated that they experienced parallel process within their relationship, or as a result of their relationship, with administrators. Parallel process occurred through reflective practice taking place between the consultant and administrator and later emerging in administrator-staff relationships. As noted above, the term ―trickle-down‖ emerged in an early interview to describe this form of parallel, which consultants viewed as a sign of success for the consultation.

This following comment is from a consultant who felt that there was an observable shift in the administrator’s capacity to help her staff empathize with parents that was a result of the consultant helping the administrator to understand how to do this: In my helping her understand how to support her families, she was able to help the staff understand. So I feel like there was a shift in her staff’s capacity to empathize with parents.

The following comments are from consultants who found differences in what trickled down depending on the individual administrators: It’s really interesting going to all of these programs and just seeing the difference, the administration and how that trickles down and affects everything. It’s just really interesting.

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I think it depends on the administrator and their degree of, their capacity for reflection. I think it can’t help but carry through, because in my relationship with them, things do become apparent and transparent and made visible such that it does affect how they are with their teams, which does affect how they are with the families. So, I believe in that, but I believe that it’s influenced by the individuals’ capacities and then their leadership capacity, their capacity for reflection, their capacity for their leadership capacities.

The latter comment was made by a consultant who also talked about the conscious and unconscious forms of parallel process that occur in the consultation process. She also discusses the complexity of this process in terms of what the consultant and administrator each bring to the process, as well as the influence of external variables: There’s the unconscious bringing of it and then there’s the intentional bringing of it, and then there’s the administrator’s capacities, their skills with their staff. So I believe in parallel process… but the degree to which it trickles down has so many variables contributing to it: the economic situation, the external variables, the communities with a lot of violence. So I’m doing what I’m doing with them, and they’re doing what they’re doing with their teams, and they’re doing what they’re doing with their families, and so maybe that’s filtering down in positive ways, and then there’s a shooting in the neighborhood…

A more conscious and deliberate form of parallel process, or trickle-down, was described by the same consultant as the consultant’s conscious attempt to help the administrator reflect on how the administrator’s experience affects staff in their program, verses the consultant being exclusively a sounding board for administrators: If I’m a sounding board exclusively, will that enable them to be a sounding board more for their staff, which allows them to be a sounding board for the families?

Or as a consultant, do I want more than that for the program? Do I want to go, I am a sounding board and I’m going to inquire of you how your fears about losing your job affect your way of being with your team.

Another consultant clearly stated that she believes that it is parallel process that administrators learn from in the end as a result of the consultation process: It’s a parallel process that I think the directors learn from in the end. Hopefully you hear this from some of the administrators: ―I know now how to be with my

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staff. Not how to be with them, how to actually be present with them. I know how to listen a little bit differently when someone says something. Not just the words, but saying, ―What’s going on that makes you feel that way?‖ It trickles down to the children, to the families.

However, not all consultants found that parallel process, or trickle-down, occurred in the way they wished it had. According to one consultant, parallel process did not occur because the administrators she worked with often wanted the consultant to work directly with staff rather than the administrator providing reflective supervision to the staff.

I think I had hopes that it would start at the top and kind of trickle down, but I didn’t find that this happened in reality. They wanted their staff to feel the benefit of it directly through me rather than through them. I could certainly see the value of ―trickle-down theory,‖ but the practice of it was imperfect, and to feel effective you have to go with where the sites are and what they want. I think that works. I think that at any point in that system, if you can intervene and help them understand the work that they’re doing, [that] is helpful.

Endings and Debriefing Although the study was initially planned to be conducted while the project was in its fourth year, the project was terminated prematurely by Erikson Institute due to nonpayment by the state of Illinois. Fortunately, the Illinois State Board of Education felt that the findings of the study may be useful even though the project had been terminated. The researcher began recruiting for the study in August, 2010, and began interviewing in September, 2010, 2 months after the project ended. The last consultant was interviewed 4 months after the project was terminated. What follows are comments that represent consultants’ experience of programs closing, the project ending and consultants’ use of the interviews as a way to process the effect that the multiple endings had on them.

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Some of the consultants expressed their experience of what it was like to work with programs that closed because of funding problems due to the state budget crisis: I have to say, even though I wasn’t there very long—it was a little less than a year—we were there just as their organization closed down all together. So we ended the consultation. It was terrible, it was terrible. I felt like towards the end, we were finally getting to a place of thinking more programmatically.

I think that towards the end we started meeting more, partly because she was very nervous about the program going under and what did I know? The ISBE boat was sinking. She was very, very stressed.

Other consultants expressed the difficulty they experienced as a result of the Erikson/ISBE project being terminated: It ended really abruptly. We had a conversation right before I left where I was trying to understand her perspective of her staff and their strengths and where she thought they could grow. I feel like that’s when she started to think, ―Oh, this could be good.‖ It was over. And there was some anger on my part like, ―You guys just killed the project?‖ I was very angry with Erikson. Like, ―You don’t practice what you preach.‖ The following quote is from a consultant who was dealing with the impending termination of the project and consequent loss of her own job while also working with a program that was worried about closing down. She talked about how they were both in the same situation: Our leadership team was telling us to think about ourselves too—the selfpreservation type of thing. But that was probably in May when we started thinking about that. So I did start talking to some of my sites then because some of them were pre-K programs so they wouldn’t be going over the summer, so I had to say before we ended for the year – I kind of prepared them. I said, ―We’re all in the same situation, we don’t know if we’re going to be here either.‖ One of the consultants stated that as she looked back at the experience through the process of the interview she felt that her relationship with administrators was affected by her knowing the project was coming to an end:

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Looking back I’m sure it affected my relationships with them. I didn’t think that at the time, but I think that was in the back of my head because there was so much talk of all of my programs saying they didn’t know if they were going to be there.

It was on both ends. But then thinking we’re all investing all of this time in consultation and trying to get to know each other. Again, not consciously thinking I’m going to hold back. But looking back, I’m absolutely sure I held back compared to the beginning of the year when I started gung ho.

The following quotes are from consultants that expressed experiencing feelings of guilt for leaving the programs because of the Erikson/ISBE project ending: Looking back I was probably thinking, ―How long am I going to be here and available to them?‖ And I was almost feeling guilty that I might not be here, and here I’m setting all of these expectations for them.

I think it takes a while to get really in with them and build those relationships. So I feel like the majority of my sites towards the end, like I had one that was still hanging on but I felt like all of the others were so new. I felt like I just teased them a little bit. Like, ―We can do this,‖ and then, ―Sorry.‖ I think I had a lot of guilt feelings. Like I really set them up thinking we were going to do great things.

Some of the consultants commented directly on how the interview process was helpful to them in processing their experience of the project ending: I’m glad I’m doing this now as opposed to right after because I don’t know if I could have sorted it all out then.

It’s really nice to think back about the project.

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CHAPTER VIII

WORKING WITH THE CONSULTANT

In the next chapters I turn to program administrator results. When the 15 administrators that participated in this study were asked the question, â&#x20AC;&#x2022;Tell me about your relationship with the consultants you worked with on the Erikson/ISBE IECMHC Project,â&#x20AC;&#x2013; the most common response was to describe the different ways in which they worked with the consultants. Overall, administrators described having positive experiences working with consultants. Similar to the perceptions of consultants that participated in the study, first tier and second tier administrators described their work with consultants differently. For the most part, first tier consultants saw their role with the consultant as planning and overseeing the consultantâ&#x20AC;&#x2122;s work with second tier administrators and staff, whereas second tier administrators viewed their role as working more closely with the consultant. The major ways in which administrators described their work with consultants can be grouped into three areas. These include brainstorming with the consultant, the consultant helping administrators support their staff, and having the consultant to confide in about struggles they experienced in their role as an administrator.

There are four properties in this category: Making Time for the Consultant, Brainstorming Together, Helping Me Support My Staff, and Confiding in the Consultant.

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The first property, Making Time for the Consultant, illustrates administrators’ perceptions of their role with the consultants in terms of how they made time to work with consultants. First tier administrators found time to meet with consultants much less frequently than second tier consultants mostly because they viewed the consultant as a resource to second tier administrators who supervised front-line staff and as a resource to the front-line staff. They greatly appreciated the support and expertise the consultants provided to their program. The heading ―Making Time for the Consultant‖ also refers to the difficulty that all administrators had making time for the consultant due to their busy and demanding schedules. Many second tier administrators found it difficult to find time to meet with consultants initially. However, the more they engaged with them, the more they found taking that time to be valuable. For some of these administrators, this time came to feel like a ―guilty pleasure‖ because they enjoyed it so much.

The second property, Brainstorming Together, reflects administrators’ appreciation of having consultants to brainstorm with about a range of issues related to their programs.

This was the case for a large majority of administrators (12 out of 15). Administrators appreciated consultants’ non-expert approach to working with them and the experience of working collaboratively together.

The third property, Helping Me Support My Staff, captures administrators’ view that the consultant’s primary role was to help the administrator support front-line staff either directly or indirectly, and that administrators found this to be extremely useful. All but one administrator commented on consultants’ ability to help staff in ways that they as administrators were not able to because they do not possess the same skill set that consultants have. Direct ways of consultants supporting staff involved the consultant

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working directly with staff either with an administrator or without the administrator being present.

The fourth and final property, Confiding in the Consultant, speaks to the more than 50% of administrators who described their use of the consultants as someone to confide in about struggles or challenges related to their job. Administrators who used the consultant in this way described talking with the consultant about relationship struggles with colleagues, challenges in their role as a supervisor, personal situations that made their job challenging, and general concerns in relation to being an administrator. These administrators expressed their appreciation of the consultant listening to their struggles and concerns.

Making Time for the Consultant Only 2 of the 15 administrators that participated in the study were first tier administrators. These two viewed their relationship with the consultant differently than second tier administrators. They saw their role with the consultant as contracting and working with them to determine the services the consultant would provide to their program, and to oversee the consultantâ&#x20AC;&#x2122;s work with staff, which included second tier administrators and direct-service staff. Second tier administrators viewed their role as working more closely with consultants.

The following quote is from one of the two first tier administrators that participated in the study and captures their view of their role with the consultants they worked with: I didnâ&#x20AC;&#x2122;t meet with her often because I knew what the goals were. I had pretty good awareness most of the time of what was going on anyway without being in

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the room. I think because I evaluate staff, I have a sense of their own strengths and weaknesses, and so what I could see is that the interaction of the staff with her facilitation could help strengthen some of those areas that needed strengthening.

First tier administrators did not necessarily see their role as meeting with the consultant on a regular basis. Rather, they met with the consultant two to four times per year and communicated by phone or e-mail with the consultant as needed: I did not meet very often with the consultant. We would have one or two informal meetings a year, and perhaps one or two formal meetings. So perhaps every few months we would get together and talk things out.

She’s just very approachable, very knowledgeable—the ultimate professional. She gets back to you quickly.

One first tier administrator spoke about why they did not feel a need to meet with the consultant more frequently: She wasn’t in any way a decision maker and so her involvement with the staff was not resulting in program changes. So as a result of that I think my own role with her did not need to be very involved.

The same first tier administrator expressed that as consultant and consultee they experienced a stylistic divide between them. The administrator stated having a more directive, business approach and viewed the consultant as having a more reflective approach: I think that it’s probably just mostly a stylistic thing that the consultant brings a call of deliberativeness that is admirable and sometimes just feels kind of stretched out.

Second tier administrators tended to work with the consultant in a variety of ways.

At least 8 of the 13 second tier administrators met with the consultant individually and also in a group along with their direct-service staff. Some of these administrators met

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with the consultant prior to the group meetings to discuss current issues in their program and to determine what to focus on in the group meetings: The consultants met with me first to get an idea of what’s going on and what the staff need help with. I met for 1 hour once a month with the consultant to talk about what kind of group to conduct, what kind of support I would like to put in place for them. That was also translated into how the consultant will go about helping or working with them that day.

One administrator who worked with two different consultants on the project expressed how much she valued meeting with consultants individually and engaging in reflective practice with them. This particular administrator had education, training and experience with reflective practice prior to participating in the Erikson/ISBE project: I had the same experience in terms of the first consultant that I worked with. I got to the point when I was looking forward to our meetings and that level of discussion. It kind of added the reason you go to school to do this work, because when you’re an administrator you get bogged down with all of the reports and paperwork…that kind of higher level. It makes you feel like you’re in grad school again, which is hard to come by in the day-to-day setting in the childcare world.

Having the consultant carved out that time and space and made it a priority and made sure it happened.

This administrator also expressed that carving out the time and space to meet with the consultant individually felt like a guilty pleasure: It felt like a guilty pleasure because I personally liked it so much. Like this can’t really be work, this is too much fun!

A couple of administrators only met with the consultant individually. In these cases, the consultant never met with the direct-service staff at all. One of these administrators described that this arrangement occurred as a result of her need to work out some personal issues related to her job, which she was struggling with: At the time the consultant began, and for the first year of working with her, I was in a major transition. This was just coming into play when the consultant started, and I couldn’t even begin to think of the mental health needs of the program. And it was wonderful to have someone to talk to about it.

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Another second tier administrator who only met with the consultant individually, and never had the consultant meet with her staff, explained that this way of working with the consultant came about because the staff was too busy to meet with the consultant: Initially, the relationship was open to all of our staff and it just so happened through everyone’s schedules being quite hectic that it was myself who ended up having the relationship with her.

Half of the second tier administrators directly commented that they and or their staff initially felt that they were too busy to make time to meet with the consultant: When we first started that very first year, we were happy that we were able to be part of the project, but we were also thinking that we’re always just so busy in the trenches and it’s just another thing we have to go to, and another afternoon that takes time away from a home visit.

Everybody’s got a pretty packed schedule. I’m still part-time, our developmental therapist is part-time, and our occupational therapist is full-time, but she works in a lot of different places. We’re packed. We’re very busy when we’re there.

Others commented on how they would have liked to have met with the consultant more than once a month, but that it would have been too difficult given their time constraints: Retrospectively, I would have liked it to have been more frequent, but there was no way that was going to happen with my schedule.

I think we would have had them come more frequently, but I think it’s the time and also just the amount of work they have that makes it too difficult.

Brainstorming Together A large majority of administrators directly commented on how they worked with the consultant to brainstorm about ways to address issues that they wanted help with or

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were working on in their program. The remaining administrators alluded to brainstorming with the consultant in some way.

The following comments are from administrators who described brainstorming with the consultant: So we did a lot of brainstorming of how we were going to roll this out to staff.

We brainstormed. Let’s brainstorm. Where are the program needs?

Other administrators talked about how they appreciated consultants using a nonexpert approach.

I like that about people, because none of us have all of the answers, and the consultant was able to do that. She would be honest and we would brainstorm.

She didn’t come in like she was the expert. She came in like we were the experts and she needed the information from us.

Goal setting was another part of the consultation process in which the administrator and consultant would collaborate. The following comments are from an administrator who described determining a goal together with the consultant: It was hard to make a program goal, so together we made the goal of establishing boundaries.

The consultant met with me and the program supervisor to develop goals, and then what was important, when we would see a need she was there to provide support and to help us, but we were really the ones who needed to set goals and work with the families.

Another form of administrators and consultants brainstorming together was captured in administrators’ descriptions about how the consultant worked with the administrator and direct-service staff to bounce ideas off of each other: The case consultation is where you really learn—when you do a case study and have something actually happening and something you can think of as a group or individual and then kind of bounce it off of people.

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It’s nice to have time to discuss [something] as a group. Then everybody has their own information about that, and it’s nice to just share the work with each other.

The staff would talk about a case and then she would just bring all of this knowledge and share her own experiences and how she felt at that moment, but then also guide us to find answers.

An indirect way in which administrators described working collaboratively with consultants is reflected in comments made by administrators who described interactions with consultants in which the consultant helped them reflect on their work: She helped me to reflect on things. The consultant has this way of getting us to come to these conclusions or way of think about things, that for me, I really didn’t realize that that’s what I was thinking.

It gave me the space. It forced me to schedule something and then slow down in order to look at the bigger picture because in the work I do I am so slammed with all of the different hats I wear that I miss that.

Helping Me Support My Staff All but one administrator commented on how the consultant helped them support the front-line staff they supervised. One of the first tier administrators expressed how helpful it was to have the consultant help train childcare staff given that the staff was still working at acquiring their early childhood education: The early childhood staff is much less qualified than the staff in the adult program staff. Having the consultant on hand really gave me a good sense of confidence that we were doing good things.

The other first tier administrator discussed how the consultant helped her and her staff determine what their priorities were regarding consultation: I have two team leaders who are in the zero to three program, and the consultant and I and those folks sat and we talked about what we thought the priorities were.

So the consultant stored that information and then met with the group.

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Approximately one third of the administrators stated that the consultant helped them to deal with staff-related issues. The following quotes illustrate second tier administrators’ thoughts on how consultants helped them with staff-related issues: Sometimes I would notice something going on with a particular staff member.

Sometimes staff wouldn’t be able to really talk to me about what they were dealing with. I would suggest that they go and talk to the consultant, and I would let the consultant know what I was seeing.

In the second year of working with the consultant, the consultant helped me deal with staff issues like making sure teachers provide kids with gross motor and outside time.

The consultant gave input regarding a difficult issue I was having with a new staff member. We ended up working on this issue for most of the consultation.

Other administrators spoke about how consultants helped them to train their staff in early childhood development: My role with the consultant was to talk to them about developmental issues and what topics and articles are best fitted for the parent educators.

I would talk to her and tell her what the concerns were, or what the trend was that I was seeing and why I was hoping to have the training and what I wanted to address. She would just take it from there and create the training.

The following quotes are from administrators who spoke about how consultants helped them maintain a reflective practice stance with staff rather than focusing on concrete or administrative issues: I still struggle with it. I’m a lot better at being self-reflective than I am at supporting the reflective process of others, but I know that I haven’t practiced it enough. So the consultant was able to make sure I stayed nudged on the professional development part. Without the consultant it would not have ended up being truly reflective.

I think in terms of how it affected my work. It increased my competency to help our staff deal with issues, not just the concrete ones like, ―how do we stop this kid from screaming?‖ but how it stems from something larger, like, ―what is his relationship with his mother like right now?‖

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Some administrators talked about how the consultant trained them in reflective supervision so they could provide reflective supervision to their staff: When we were doing reflective supervision, she would hand the supervisor role over to us. In a way, she was training both the other staff member and myself to take over the reflective supervision.

I think it helped me learn how to answer questions when they approached me instead of me answering, ―You should do this and this.‖ It modeled for me how to answer back.

Confiding in the Consultant More than half of the administrators specifically described interactions with the consultant that illustrate their use of the consultants as someone to confide in about difficulties related to their job. The administrators who did this described talking with the consultant about relationship struggles with colleagues, challenges in their role as a supervisor, personal situations that made their job challenging, and general concerns related to being an administrator. Administrators expressed their appreciation for the consultant being there for them to listen to their concerns.

The following comment is from an administrator who described talking with the consultant about difficulties they were having with colleagues: It was wonderful to have someone to talk to about it. She wasn’t involved in all the politics of it and just came in and let me talk, and let me get it out, backed me up, and gave me ideas how to deal with it temporarily until it was worked out.

One administrator stated that having a consultant is ―like having your own private therapist.‖ Another spoke about how the consultant helped support her in dealing with internal changes in the program that were making it difficult for her to support her staff:

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There was a lot changing about the program internally, so it was very difficult for me to personally deal with and to continue to be able to support the staff in the way that I felt they needed.

One administrator shared an example of how the consultant helped her manage overwhelming emotions in reaction to her role and work as an administrator: The consultant is able to give me perspective, like, ―You’re fine, calm down.‖ Because sometimes I think I overreact to things. She helps me focus and see that it’s not too bad and I can handle it.

Some administrators explicitly mentioned that they thought that having the consultant come into their program from the outside made it feel safer to share concerns they had in relation to their work: I should say that with all of the consultants that I worked with, there’s this sense of confidentiality that no matter where you’re at and what you say, it’s okay. You can share bigger picture concerns and you can share daily annoyances, and there’s an understanding that it does all impact us and that we’re human, and it’s okay. If you’re having difficulty, you could share organizational information that an outsider wouldn’t necessarily be aware of and know it’s not going to go any further.

She didn’t work for the agency and she was somebody from the outside with a different set of experiences. It was very helpful. She had that distance that wasn’t threatening. I think that’s what you need. She didn’t have a stake in the organization or anything.

Finally, other administrators simply spoke about the importance of the consultant being a good listener: Her greatest virtue is her ability to listen.

She has a great way of listening. She’s a great listener. She listened very carefully.

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CHAPTER IX

FAMILIES AND PROGRAMS IN CRISIS

This chapter presents a category that was somewhat of a surprise for the researcher to find in this study. It was not surprising to find that administrators perceive working with at-risk families to be challenging for front-line staff due to the nature of the problems that these families experience. What was unexpected was the degree to which administrators focused on the effects that working with at-risk families had on their staff, and to a lesser degree, on themselves. Issues related to staffâ&#x20AC;&#x2122;s transference and countertransference reactions, the impact of working with families experiencing multiple stressors and trauma on staff and administrators, and the added stressor for families and programs due to the economic crisis powerfully emerged from the interviews with administrators.

There are three properties in this category: At-Risk Families and Communities, Vicarious Trauma and Countertransference, and Impact of the Economic Crisis.

The first property, At-Risk Families and Communities, illustrates the tremendous problems of at-risk families and the needs associated with these problems as described by administrators. As stated previously, these problems include domestic violence, child abuse and neglect, illegal immigrant status, teen parenthood, single parenthood, substance abuse, poverty, hunger, community violence, homelessness, mental illness, and parents in

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prison. Many of the administrators described the problems of families they serve with a sense of helplessness and heaviness in their hearts.

The second property, Vicarious Trauma and Countertransference, reflects how some administrators used the interview process to delve into the emotional and psychological impact of working with at-risk families. Because several of the second-tier administrators provide direct service to at-risk families in addition to supervising frontline staff, they are required to deal with their own reactions to the work as well as the reactions of their staff. Working on a regular basis with families experiencing chronic stress and trauma caused administrators and staff to experience intense emotional reactions, or what one might call ―vicarious trauma.‖ The third and final property, Impact of the Economic Crisis, deserved being highlighted on its own as several administrators specifically and loudly voiced their experience of how the economic crisis impacted them and their programs. Administrators expressed that they were worried about whether their program would survive the financial crisis. Some programs had been closed and in others staff had to be let go due to funding problems. Families already experiencing serious circumstances became worse off because of higher unemployment and because fewer resources were available through community and government programs. Programs experienced ―enrollment overload,‖ as one administrator termed it, yet had fewer resources to meet the needs of families they served. A difficult and stressful job became overwhelming for administrators and their staff.

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At-Risk Families and Communities The Erikson/ISBE IECMHC Project was designed to provide mental health consultation to programs funded by the State of Illinois through the Illinois State Board of Education that serve many at-risk birth to 5 children and their families. Because it was a statewide project, the programs served were located in urban, suburban, and rural communities. Problems of families served by the programs of administrators who participated in the study include a wide range of extremely serious conditions.

Administrators specifically mentioned domestic violence, child abuse and neglect, illegal immigration status, teen parenthood, single parenthood, substance abuse, poverty, hunger, community violence, homelessness, mental illness, and parents in prison. Recent economic problems on the national and state levels further impacted at-risk families, putting them at even greater risk.

One administrator gave an example of the kinds of issues that the families the program serves present with: Our average mother’s educational level was between 6th and 8th grade. Young, some single, some married. So they’re uneducated and unemployed and having babies. You’re seeing substance abuse and perhaps some psychical abuse, but mostly you’re seeing hunger…So we were able to deal with some of those kinds of things. Those were the kinds of things we were dealing with programmatically.

One administrator identified some of the problems found in the families they serve by way of listing topics on which the consultant based staff trainings: Some topics are related to how children are affected by a family going through domestic violence, some would be sexual assault, parents having children with disabilities. It was related to what the needs were.

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Another administrator expressed how hard it is to work with ―DCFS-involved‖ families, especially since neither she nor her staff had prior experience working with these types of cases: We have especially hard cases, some that were with DCFS. And even though I’ve done this work for 10 years, I haven’t really been faced with DCFS cases, and they’re always heard, especially for new parent educators.

Some administrators referred to the children and families in their programs as ―the most needy and at risk‖: When you come to this program, you’ll see the most needy kids, kids that really aren’t being served in their districts. We’ve historically worked with the most atrisk of the most at-risk.

Another administrator explained the goal of infant and early childhood prevention programs as reducing problems found in at-risk families: If we do prevention, we don’t have to go through that intervention stuff and put people in jail or detention centers, or have children with school problems. And 0– 3 is the perfect age for prevention work.

Vicarious Trauma and Countertransference Approximately half of the administrators interviewed for this study described the difficult emotional reactions—the stress and emotional upset—that they and their staff had to working with the at-risk families that their programs serve. The following quote captures many of the difficult issues that confronted them: We work with difficult, challenging populations: substance abusers, prostitutes, child abuse offenders and victims—and in one of the worst, poorest, and dangerous neighborhoods of Chicago.

One administrator noted that it can seem to be beyond their usual job description to deal with such serious issues:

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The stress level is high because it’s a very stressful job at times. You have a huge responsibility and not a lot of time to do it. It goes beyond you regular job description. If we only had to do what our job description said, it would be nice.

Low-income families, limited literacy and with all that comes other issues and it can be very, very, very stressful.

Other administrators described how staff members sometimes get very upset about their work with families, but may not know what it is that’s upsetting them: It leaves them very upset. They’ll come to me and tell me what’s going on and say, ―We need you to take a look at this.‖ They clearly get upset when they’re dealing with families where they recognize that something’s going on and they don’t know what it is but it clearly is upsetting them.

One administrator stated that it is difficult for her to stop reacting to upsetting issues when she is not at work: I think especially with you work in special education, you’re constantly looking at kids and relationships and it’s like, ―Stop! Just stop!‖ I just want to be me and not look at if the child is autistic or what’s quirky about that kid. But when you do this for so long, it’s hard.

Other administrators described specific scenarios that they and their staff encounter in the work that cause them to feel emotionally uncomfortable: What do we do when we’re in a home and domestic violence comes up? We’re not counselors, so we would talk with the consultant about how uncomfortable we felt in certain situations, like, ―What do I tell this mom when she is saying this?

How do I handle this?‖ Doing all the supervisions with staff is what was pretty difficult for me. Hearing about some of the more difficult situations that families were dealing with, or even little things, like a teen mom who was pregnant with her second kid and wouldn’t take prenatal vitamins.

One administrator, a social worker who stated that she understands the importance of transference and countertransference in the work her staff does with families, had the consultant work with them to understand and manage transference and countertransference reactions in their work:

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At times you may have a parent with a child and you cannot wait to see that person, and others may come to you and you can’t wait for that person to go home. So the consultant helped them identify issues like that and how to check them out, because at the end it’s not about you, it’s about the parents. It’s about the service that they come to you to get, and how you put your own issues aside to give the families undivided attention.

Impact of the Economic Crisis This property illustrates administrators’ experience of the adverse effects that the national and state economic crises had had on themselves and their programs, staff, and the families that they serve. One administrator commented on the chronic funding challenges the program and field of education experience: The program is still here and we’ll take another budget cut and we’ll be fine.

That’s the way of the world in Illinois, especially in education. It’s the most important [thing], but it’s always the last to get funded.

Several administrators commented specifically on how recent economic problems have impacted the at-risk families in their programs: As the economy crashed, it really impacted our families even more, because they were losing the jobs in the restaurants and the factories and in the service industry, and at a time that there’s been some backlash around immigration.

It’s tough working with families when they’re experiencing the hard times of the economy and seeing more issues with domestic violence or substance abuse or depression.

Another administrator described what she refers to as ―enrollment overload‖ as being a serious problem her program faces as a result of budget cuts on her program and the families it serves: The needs are great. The needs are profound. Our current challenge is just enrollment overload and not being able to serve the number of families that need us and want us.

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Some administrators referred to how state funding cuts have impacted both staff and clients: We work with a very hard client population. It’s especially hard work since there have been significant funding cuts for the program that affects staff and clients.

I think two years ago we had the big budget cuts and lost some staff. That changed the dynamic of everything because we still have all these families, yet we’re down staff members. The consultant helped us work through losing those people and clarifying the roles and who’s taking families and who’s going to do this and that. That was helpful.

The following quote is from an administrator who feared that her program would close down because of the state funding cuts and how the families and community would suffer as a consequence: There will be a ripple effect from the lack of money: if our children don’t have a program, staff will get laid off, and the community will suffer.

Another administrator described how staff, knowing the Erikson/ISBE project was state funded, reacted to the consultant entering into their program given the pervasive threat of budget cuts and fear of losing their jobs: Staff initially thought the consultant came to close down their program and take over their jobs. It was a process for staff to trust the consultant.

Other administrators spoke to how the economic climate has impacted them personally: Financially they were in a lot trouble. There were a lot of furloughs. The work environment and the staff there were amazing, but the work environment was sort of squeezing you until you had nothing left to give. It really wasn’t conducive to what I was trying to do.

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CHAPTER X

MODEL PROS AND CONS

This final category for the administrator results presents administrators’ experience of the programmatic consultation model used by the Erikson/ISBE IECMHC project. Administrators found consultants’ expertise in infant mental health and child and adult development to be the most important thing they had to offer. Many administrators expressed that they felt their program would have benefitted from consultants sharing their expertise in ways that were not permitted with the model. The category ends with administrators’ experiences of the termination of the project and loss of the consultant.

This category has three properties: The Consultant’s Expertise, Model Constraints, and Left in the Lurch.

The first property, The Consultant’s Expertise, describes the various ways in which all 15 administrators expressed the importance and value of consultants’ expertise in infant and adult mental health and child development. Administrators commented on how valuable consultants’ knowledge of infant mental health is to them, especially given that for the most part they and their staff do not have mental health backgrounds yet they work with children and families who have significant mental health issues. Having an outside consultant come in and bring in a mental health perspective that administrators

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and staff can learn about and apply to their work with children and families proved invaluable to many of the administrators.

The second property, Model Constraints, is illustrative of administratorsâ&#x20AC;&#x2122; experience of the programmatic, reflective practice consultation model used by the Erikson/ISBE IECMHC Project as limiting or as not necessarily meeting the needs of their program. Many administrators expressed a desire to have consultants provide topicfocused trainings for staff and provide some form of direct-service to the families they serve. As a result of the project ending under the leadership of Erikson Institute, programs were offered the option of contracting independently with a consultant from the project through ISBE. With this new arrangement, consultants would be able to work with administrators to renegotiate their role. Administrators that had already made arrangements to continue working with a consultant within this new framework by the time they were interview for this study looked forward to having the increased flexibility in how they used the consultant.

The fourth and final property, Left In the Lurch, speaks to how all 15 administrators that participated in the study expressed feeling sorry that the project had ended, with many administrators expressing how much they missed having a mental health consultant. It is worth mentioning again that the Erikson/ISBE IECMHC Project was terminated in July, 2010, approximately 4 months prior to interviewing administrators for this study. Themes about the project ending that emerged from administrators include the abruptness of the ending, the importance of having a termination process, and the need for mental health consultation to be built into infant and early childhood program given that although administrators and staff gain knowledge

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from the consultation process, it is not entirely sustainable. It is also worth noting that several of the administrators utilized the researcher as a mental health consultant in some way during the interview process, which perhaps was an expression of their feelings of loss of their consultant and a wish for their return.

The Consultant’s Expertise Most administrators that participated in the study, and their staff, do not have mental health backgrounds yet work with children and families who have mental health issues or can benefit from an infant mental health approach. All 15 administrators commented on their appreciation of the consultant’s expertise in the areas of child development, infant mental health, or adult mental health. Having an outside consultant bring in an infant mental health perspective that administrators and staff can learn and apply to their work with children and families proved invaluable to many of the administrators. In addition to the consultant’s knowledge and expertise, administrators valued consultants’ professionalism. Specifically, administrators appreciated consultants’ resourcefulness, cultural sensitivity, and knowledge, and ability to maintain confidentiality. Consultants’ personal style, availability, and flexibility were also important to administrators.

Some administrators commented on the consultant’s expertise in infant mental health: Before we started working with her we didn’t have an idea of what we thought infant mental health meant. And that was one of the things we learned after the first year: what is infant mental health, and what do we mean by that?

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The first meeting we just talked about what we thought infant mental health was and who we thought needed it more than others…She is the expert whether we know it or not.

It provided me with infant mental health back up in terms of talking about cases and situations that we had that would come up with clients.

Other administrators spoke positively about consultants’ knowledge of child development related to the children and families they serve: She’s knowledgeable about child development.

The consultant has a lot of expertise in child development and working with families. Just this past week I gave her this scenario and I kind of had an idea about what I wanted to have happen, but I said that I needed another pair of eyes looking at it and she gave me some things to think about. So she always gave me that little extra insight, and I appreciate that.

The consultant’s expertise in reflective practice was also important to some administrators: She was really good at reflective practice.

Other administrators commented on how the consultant provided expertise in areas the administrator felt the staff needed help with in regards to current issues that arose with clients: One time I noticed that a lot of staff were having trouble with clients who were in abusive relationships. So we had the consultant do a presentation about that. So if I notice a trend coming up with a lot of the staff during our staff meeting I would just have her present, and that was really helpful.

I think it helped the staff because when we were meeting with our mental health consultants, they would give us tips or just knowledge on what we should do and how we should approach things.

The following remarks make it clear how much administrators appreciated consultants’ resourcefulness: She was very resourceful, and at times she would provide me with information regarding ISBE, where we are, what we need to do, and she also helped us in

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terms of where we would like the program to go. This is what she could do in terms of her resource network. It was very helpful.

Well, she’s supportive of us because she’ll go out and look for information for me and because she has a nice knowledge base. She’ll come with her own ideas.

She’s always willing to look up things and to me that’s important because she has a different set of eyes. I like that about her.

The consultant’s expertise with cultural aspects of the client population served by programs was also important to some administrators: She has a lot of expertise in the field. She’s sensitive to the target population and the population we serve because she is not only bilingual, but bicultural too. I found that very helpful.

One administrator stated that she appreciated that the consultants came across as unbiased: And she gives everyone an even break. She has no biases. I think that’s really hard, not to have a bias. And if she does, I would not know it. I like that she’s always been very respectful to all of our families and the staff here.

Another administrator commented on the importance of trust in the consultant and the consultant’s ability to maintain confidentiality: Another thing about the consultant is that with confidentiality she is a locked safe.

We may open up to her a little more because of our familiarity with her and trust, and the respect we have for her.

Model Constraints The Erikson/ISBE IECMHC Project used a reflective practice, programmatic consultation model. This meant that consultants approached consultation by meeting with administrators and staff to help them reflect on various aspects of their program and the work they did with children and families. Some consultants also provided case consultation to direct-service staff, and approximately half of the administrators

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participated in the case consultations with staff. Half of the administrators who participated in the case consultations provided direct service to families themselves. In the early stages of the project, consultants were able to provide topic-focused trainings to staff; however, later on in the project the topic-focused staff trainings were phased out.

Approximately two thirds of administrators interviewed for the study expressed that they felt that the Erikson/ISBE Project Model was in some way limited in the range of services that consultants were able to provide.

After the project ended, programs that had participated were offered the option of contracting independently with a consultant from the project, with ISBE reimbursing them for the cost. Because consultants would become independent contractors, they would not necessarily have to strictly adhere to the consultation model used by Erikson Institute and would be able to renegotiate their role with administrators. Administrators were interviewed for the study just prior to beginning this new arrangement. Some of the administrators who had already arranged to continue working with a consultant within this new framework commented on how they were looking forward to having the increased flexibility in how they used the consultant, especially having the consultant provide some direct service to families.

One administrator discussed how the projectâ&#x20AC;&#x2122;s reflective-based approach may have limited the consultant in sharing her full range of expertise: Mental health professionals, they certainly have a school of thought that the person is very much a listener in some waysâ&#x20AC;&#x201D;almost exclusively a listener and much less director and guider. I see that both have value, and my interactions with the consultant have made me question if she is using her ability to guide in the most effective way.

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Other administrators who disclosed that the consultant would be returning as an independent contractor echoed this notion and stated that they will have the consultant observe, lead, or co-lead parent groups and trainings when they return: When the consultant comes back she will come and observe our playgroups. I would like her to offer at least one time in the evening when parents can come. In the proposal, we wrote that she would sit down and do consultation with us individually and with us as a group and then would do some parent trainings, maybe, or train us in different areas that came up.

I’d like to have more input of how the services are going to be provided. I like the reflective supervision. I love the training. We all benefit from that. And if my staff gets training on mental health issues, they’re able to transfer that knowledge to families and work with them. The only part that I would like to see would to have her start groups, run groups, or at least give us more feedback on that, and observe groups.

Other administrators stated that they would have liked the consultant to run or cofacilitate groups for their clients prior to the project ending: It was different than we expected. I don’t want to use the word ―frustration,‖ but the only thing that I know staff wanted was for her to do groups with our parents, which really wasn’t her role. It really would have been nice to have her do groups directly with parents. And I know that wasn’t part of the project.

I wanted to see her do home visiting, and then I wanted her to be involved in some of the groups that we had because we had groups for moms on site and I could see her facilitating the group. I also wanted to bring dads into the mix. So I wanted her to facilitate or maybe co-facilitate a group.

Two administrators explained in positive terms how the consultant worked outside the project’s model: It was helpful that the consultant was able to help with what I felt would be most helpful even though it was outside the project’s focus.

She wasn’t able as a mental health consultant with Erikson to provide any direct service. She made that pretty clear, so I think she only did a small amount of it.

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Left in the Lurch As stated previously, due to the state’s financial problems, the Erikson/ISBE IECMHC Project was terminated by Erikson in June, 2010, approximately 2–4 months prior to interviewing administrators for the study. Administrators were given approximately 1 month’s notice that the project would be ending. Even though ISBE had decided that they would reimburse programs if they independently contracted with a consultant who had worked on the project, there was a gap of time between the termination of the Erikson/ISBE IECMHC Project and when ISBE informed programs that they could resume working with consultants. Over half of the administrators interviewed for this study already had plans to have the consultant they had worked with on the Erikson/ISBE project return. One administrator had already hired the consultant independently with program funds to return once the project had been terminated. The remaining administrators who were still working in the programs that received consultation were not aware that ISBE had proposed that they could hire consultants independently. They stated that they had not received any communication from ISBE with the information about the proposal.

All 15 administrators who participated in this study commented on the ending of the project. Many of them spoke about how they and their staff were disappointed by the termination of the project and about losing their consultant: We were very upset when it ended because it was just so artificial and abrupt.

They’re not very happy that the Erikson contract was cancelled with ISBE. They don’t want to give it up. There was great concern when the contract was dropped. And there was hope that I would find a way to pay for the consultant to keep coming.

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They were very touched when they were told that the consultant was not going to come back.

We had our end of the year celebration and she came to that. We talked a little bit about it, and we knew that it was going to happen given the state of Illinois being the way it is. So we knew we were on the verge of her not coming back. It was rather sad. So we talked about if we could find funding, would she be willing to come back?

I miss her. I wish it could have been here longer.

One administrator expressed how she appreciated that the consultant understood the importance of the termination process for the staff: I like that the consultant took time out to come and do closure, because they didn’t have any more funding. They could have said, ―we don’t have time to do this.‖ They were very committed and very respectful in terms of what they do, and they understand the meaning of termination. They did come to do that, and that was very appreciated. We sat and processed everything. It was really nice.

Another administrator stated that she felt that her staff may have internalized some of what they gained from working with the consultant, but that it is has not proven to be entirely sustainable: Maybe they internalized some of what they learned. So now they go and do the work with some of the things they learned, and they might bring that into the work. But the ongoing support and education has not been sustained.

The same administrator commented on how she and other administrators tried to develop a support group for their home visitors and from other programs once the project ended, but that it didn’t last: We did it with other agencies and other home visitor agencies in our area, but the other agencies did not value it. And so now we’ve stopped. But I want to do it with my group again because they need that—just being able to talk about what’s going on with their work.

Another administrator stated how the loss of the project had negative consequences for a family:

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A family lost their child to DCFS after the consultant left because the project ended and she wasn’t here to help us with the case.

Some administrators expressed that because the project ended prematurely they weren’t able to accomplish goals they had hoped to achieve: The goal for the third year was to meet with teachers and have staff express their concerns about the mental health issues of families they work with and the children in their classrooms, but the project ended before we could do that.

Administrators that had made plans for a consultant to return as an independent contractor expressed that they were very excited that the consultant could return: I was delighted to request funds and to request for the consultant to come. We just found out that she was approved. I’m very pleased about that.

The opportunity to have her come back just kind of came to us and so it was like, ―Okay, let’s do it!‖ I’m just glad that she was able to come back to us.

Other administrators commented that mental health consultation with an outside consultant should be built into infant and early childhood programs: I personally think it should be part of the services that we offer as a program. It should be built in.

I think that it is a really, really important concept that mental health consultants have the ability to support programs. I wish every program had one. I do think Early Head Start has it built in to their program for a reason.

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CHAPTER XI

EVIDENCE OF CONSULTANT-ADMINISTRATOR PAIRS

The next two chapters describe results for consultant-administrator pairs as determined in the data collection process. This first category illustrates narrative themes that emerged from interviews of consultants and administrators who worked with each other, and that are supported in the narrative data of the pairs. There are three properties in this category: Referencing Each Other, Common Language, and Description of the Consultation Process.

The first property, Referencing Each Other, depicts the ways in which pairs of consultants and administrators referenced each other. For the most part, administrators specifically referred to the consultant, or consultants, they were paired with by name.

Similarly, the majority of consultants specifically named the programs and or administrators they worked with. However, most consultants referred to the programs’ names rather than using the administrators’ names. This may be a result of consultants’ working with multiple programs and needing a way to differentiate them, and consultants viewing their role as working with the whole program, not just the administrators.

The second property, Common Language, speaks to ways in which consultantadministrator pairs used similar language. There were multiple ways this expressed itself in the data. One type of common language was evidenced by pairs’ use of the same or

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similar words. Another way in which pairs spoke the same language was found in pairs that were of similar professional backgrounds and spoke the same professional language.

These consultants and administrators spoke about how helpful it was to speak the same language.

The third and final property, Description of the Consultation Process, was another way in which pairs could clearly be identified in the data. There were several ways in which this was borne out in the narratives of pairs. One way this emerged was in pairs’ similar descriptions of issues, situations, interactions, and projects they worked on together. Another way pairs described the consultation process similarly was in their descriptions of the consultant being the administrator’s only source of reflective practice.

Referencing Each Other Most consultants and administrators clearly identified each other in the narrative data. The majority of administrators specifically referred to the consultant, or consultants, they were paired with in the study by name: Having [name of consultant] really gave me a good sense of confidence.

[Name of consultant] did a nice job of from the beginning of helping us.

That is what I established with the first consultant, [name of consultant].

Similarly, the majority of consultants specifically named the programs and/or the administrators that they worked with. Several consultants referred to the programs’ name rather than using the administrators’ name: My relationship with the [name of program] administrator was my easiest consultation.

At [name of program], they were primed and really ready and open to it.

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I’m thinking of, for example, one site in particular, [name of program].

Some consultants referred to the name of the city or town that the program was in rather than the name of the program: The administrator I told you about at [name of city/town]…

Anyway, [name of city/town] was another site.

She’s the director of [name of town/city].

Approximately 25% of the consultants referred to an administrator by name: So I would go and meet with her before the group and talk to [name of administrator].

One of the directors, [name of administrator], I probably met with her the most.

I popped in to talk with [name of administrator].

Common Language One way in which pairs were identified in the narrative data was by their use of common language. The following paired quotes are examples of pairs that used similar language that would suggest they are a pair: Consultant: Making it come together and feeling as comfortable as you can with that weirdness is one of the things I like about consultation and dread about consultation.

Administrator: I think we weren’t able to do it long enough for them to work out all the ―this feels weird‖ kinks. [and] Consultant: You need to have a lot of discipline, and feel clear about the job, which no one does in the beginning. I feel pretty clear about it. Boundaries are major issues.

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Administrator: We worked on boundaries because that had come up in the small group consultation where as staff we questioned, ―What are our boundaries with families?‖ The consultant and administrator in one pair each spoke about how helpful it was that they were both social workers and therefore spoke the same professional language: Consultant: I really think it made a difference that we spoke the same language.

Administrator: It provided me not only the infant mental health back up in terms of talking about cases and situations that would come up with clients, but it also was helpful for me because she was also a social worker and I’m the only social worker there.

Description of the Consultation Process The most common way in which consultants and administrators can be identified as pairs in the data is in the way that they similarly described how they worked with each other or how they described some aspect of working with each other as consultant and consultee.

With one consultant-administrator pair, in their respective interviews both the consultant and administrator described an issue they had discussed with each other. In the interview with the administrator, the administrator described a situation in which she had been experiencing difficulty in her role as the administrator and that she had shared this specific issue with the consultant as they were figuring out what the consultant’s role would be with the program. The consultant described the same situation: Consultant: The director thought it was important to meet with the staff, but she also wanted to meet with me. She was immediately like, ―I know there is going to be stuff you’re going to want to talk to the whole group about, but there’s also going to be a piece of me having struggles being an administrator here.‖

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Another consultant-administrator pair similarly described including the administrator’s coworker in their regular meetings with each other: Consultant: There’s a director of the program and the woman that worked with her in the groups they had. I would meet with both of them before the group and talk to the director and the other woman who is her coworker.

Administrator: We did it as a group. And she offered to meet individually, but we felt like it wasn’t for the group at that time…She respected my paraprofessional enough to include her in the conversations and that’s important to me.

The following quotes are from a consultant-administrator pair that had worked together as consultant and consultee before the Erikson/ISBE Project. The consultant transitioned from working with the program as a consultant with another organization to becoming a consultant for the Erikson/ISBE Project. The consultant and administrator each spoke about a similar aspect of their experience of the consultant’s transition: Consultant: I think one problem that I had with this program when my services increased as a result of becoming an Erikson/ISBE consultant is that they wanted the consultation to be based on their needs a little more.

Administrator: The consultant used to only come two times a month, and it was mostly just to meet with staff. So it was a little bit different. When the Erikson project came into place we had her for more time, weekly, so we were able to use her for all staff.

Another consultant-administrator pair mutually described how the consultant was the administrator’s only source of reflective practice: Consultant: She knew what reflective supervision was, but she wasn’t getting any in her program.

Administrator: I wasn’t getting any time to reflect because I was the only social worker.

One consultant-administrator pair exhibited multiple examples that illustrate that they were a pair by describing what they worked on together. One example is their respective descriptions of a reflective practice project for staff that they developed and

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implemented together. It is notable that the consultant did not take credit for the project; whereas the administrator perceived the project as a joint effort: Consultant: She had her own ideas, so I was just there to help her implement them. She created this whole video project where she videotaped the classroom and then we would sit down with the teachers and review the video tapes. She didn’t need me to do that.

Administrator: We did this fantastic reflective practice project where she would videotape the teachers in action and then we problem-solved how to show them what they looked like in action.

The same consultant-administrator pair commented on the fact that the administrator had prior experience with reflective practice, and valued it: Consultant: I also think that the people in the agency on the administrative level, they all had experience with reflection. So they knew what it was about and I think they valued it. More important than knowing what it’s about, they actually valued it.

Administrator: Even for myself, I had done a little bit of that in undergrad and in grad school, but it wasn’t until the infant/toddler studies at Erikson that I began to really embrace that process.

The last example of identifying consultant-administrator pairs is from a pair in which each person described the administrator as being a supervisor who had her own caseload and how she participated in the case presentations with her staff. The consultant and administrator presented slightly different perspectives of the administrator’s role in the case consultation meetings: Consultant: With the two home-visiting based programs the second tier administrators were, for the most part, always there. They were there I think sometimes as a supervisor for their staff. But one of them also had cases, whereas the other supervisor was only supervising cases.

Administrator: I’m a supervisor, but I see myself as a home visitor. And not so much as a supervisor there to see what they were talking about when we were meeting as a group. I would share my cases and then they’d help me too.

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CHAPTER XII

EXPERIENCE OF THE RELATIONSHIP

For this final category of the results for consultant-administrator pairs, and the results as a whole, the researcher looked at the narrative data from interviews of consultant-administrators pairs in order to find themes, similarities and differences that emerged in relation to how pairs described their experience of the consultantadministrator relationship. The majority of pairs expressed their experience with each other in positive terms. However, not all relationships were experienced as mutually positive, and for some pairs there was evidence that a range of feelings emerged within their relationships with each other as their relationships changed over time.

There are three properties in this category: Mutually Positive Experiences, Mixed Feelings, and Change Over Time.

The first property, Mutually Positive Experiences, illustrates the ways in which pairs described and expressed having mutually positive experiences in their relationship with each other. Consultants tended to describe their experience of the relationship being a positive in terms of the quality and degree of engagement of administrators. Positive qualifiers for consultants include degree of closeness, enjoyment, affection, and having a positive experience engaging in reflective practice together as found in the narrative data

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of pairs. Qualifiers of a positive experience used by administrators include the administrator feeling that the consultant was friendly, professional, helpful, trusting, and supportive.

The second property, Mixed Feelings, reflects consultant-administrator pairs that did not necessarily experience the consultation process as being mutually positive, or experience it in the same way. In these cases it was often, but not always, the consultant that had a less positive experience of the relationship. This was especially found to be the case during the engagement process. Other areas in which consultants and administrators expressed having different feelings was the consultantâ&#x20AC;&#x2122;s style and approach to the consultation process. When differences in this area were apparent it was usually because the administrator preferred a more expert approach over a reflective practice approach.

The third and final property of this category, Change Over Time, illustrates how pairs described their experience of the relationship as changing over time. This change was usually described by consultants and administrators as the consultation process or relationship starting off with uncomfortable feelings and gradually becoming a more positive experience. For administrators, the consultation was often experienced initially as an intrusion as it was one more thing to fit into their busy schedules. As time went on, however, administrators began to value and look forward to meeting with the consultant.

Consultants of these pairs described their changing responses to administrators as their reactions to the consultant changed. Consultants also expressed how building trust in their relationships with administrators took time, and how the relationship and consultation process typically starts out feeling unclear and uncomfortable and gradually becomes clearer and more satisfying.

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Mutually Positive Experiences The first category, Mutually Positive Experiences, captures consultantadministrator pairs in which both the consultant and administrator expressed having a positive experience of the consultation process. The majority of consultant-administrator pairs described a positive experience of the consultation process with each other. With one consultant-administrator pair, the consultant felt all her relationships with the administrators she worked with were positive. One of the administrators she worked with also described the experience with the consultant in positive terms: Consultant: I feel very fortunate that they were very positive relationships in all three programs, and I think there was a lot of trust in them.

Administrator: My own interactions with the consultant are always friendly and courteous and professional.

Other consultant-administrator pairs mutually described their experience with each other as positive. In the following example, the consultant speaks positively about the experience with the administrator in relation to the administrator involving her in attaining program goals. The administrator speaks about how she felt that the relationship was helpful as a result of the consultant’s professionalism and expertise: Consultant: I loved that site so much. They were very active at the administrative level. Like, ―We’re thinking about this, how can the consultant be involved in that? How can those things come together?‖ And they just had all of these awesome ideas.

Administrator: It was a very helpful relationship in that I personally trusted her feedback, her professionalism, and her experience and expertise, so I saw her as a great resource.

With another pair, the consultant spoke about how her relationships with administrators varied, some being more positive than others. She felt more positively

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about the relationships in which the administrators understood the programmatic, reflective focus of the project. The administrator she worked with that participated in the study was one of the administrators who understood the project’s approach and engaged with the consultant in reflective practice on a regular basis, which suggests a mutually positive experience: Consultant: The relationships varied. I had some really positive relationships. I guess I shouldn’t say they were bad, but some of the others weren’t as good. In the relationships that I thought were better I think that they just understood the project. And they listened.

Administrator: If it weren’t for the consultant, I wouldn’t have anyone to work out my problems out with. She helped me step back and look at things differently. It was wonderful to have someone to talk to about it.

Other consultant-administrator pairs found the experience of doing reflective practice together to be a positive experience. In the following example, the consultant found it to be an easy relationship because the administrator knew what reflective supervision was. Similarly, the administrator spoke about not having space to reflect on her work prior to working with the consultant, and about how the reflective work she did with the consultant made her feel more competent as an administrator: Consultant: I feel like my relationship with the [name of program] person who was filling in for another administrator was my easiest consultation because she valued reflective practice.

Administrator: It was very helpful talking to someone who could sort of look at things. I felt more supported, which made me feel more competent in the work I was doing with the staff.

Mixed Feelings The engagement process refers to the initial phase of the consultation process, in which the consultant and administrator begin the process of working together. All 10

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consultants described some aspect of their experience of engaging administrators in the consultation process as difficult and challenging. Some of the words used by consultant to describe the feelings they experienced while working to engage administrators include, ―hard,‖ ―intense,‖ ―a chore,‖ ―aggravating,‖ ―a struggle,‖ ―challenging,‖ and ―frustrating.‖ It is notable that to a large degree, consultants tended to use the interviews to talk about the difficulties and frustrations in their work with administrators and programs in general rather than focusing on the positive aspects of their experience as consultants. This may be a result of consultants feeling freed up to discuss their struggles regarding their experience of the project because it had ended by the time they were interviewed. Consultants’ more negative experiences may also be expressive of their disappointment, frustration and anger in relation to the termination of the project.

Administrators, on the other hand, described their experience in much more positive terms. The exception was administrators who spoke positively about the consultation experience overall but noted that it took time for them and/or their staff to come to appreciate the consultation and find it to be valuable. This was generally presented as being a result of administrators’ and staffs’ busy schedules and the consequent difficulty in carving out time to meet with the consultant. Once these meetings began it did not take long before they experienced working with the consultant as valuable, and in some cases, ―invaluable.‖ Several consultants spoke about administrators’ resistance to meeting with them individually on a regular basis to engage in reflective practice, which in the Erikson/ISBE IECMHC Project model was considered to be the ideal way for consultants to do programmatic consultation with administrators. Administrators of the

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pairs that did not engage with the consultant on a frequent or regular basis did not necessarily see the need to. In the following example, the consultant of a pair speaks about her frustration in trying to engage some of the first-tier administrators she worked with. The administrator of the pair talks about being interested in being reflective about the program, yet feeling as though the staff are the ones that have the ―real relationship‖ with the consultant: Consultant: I used humor with two of the programs in the first tier leadership. I especially brought it with two first tier leaders who would want to be more handsoff. I used humor a lot to engage them in being more involved in the consultation.

Administrator: I did not meet very often with the consultant. We would have one or two informal meetings a year and perhaps one or two informal meetings…She met with the staff every week and I think that they’re the ones that had the real relationship with her.

The following quote is another example of a consultant describing how her attempt to engage administrators in working more closely met with resistance from administrators: Consultant: Another thing is that it was hard for the director to see my services as being a support to them. They always wanted me to support the staff. I felt like I was the one calling them and saying, ―I’m here.‖ The administrator of the pair stated that after meeting with the consultant initially to set the initial consultation goals, she and the consultant didn’t meet again until 2 months later. The administrator did not seem at all disappointed about this and, rather, felt that this arrangement was perfectly adequate: Administrator: After setting the goals we would meet in two months unless she and I had a topic to plan. Because we would plan for 8–12 weeks for what topics she would focus on.

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Some consultant-administrator pairs did not necessarily experience the consultation process as mutually positive, or in the same way. In these cases it was often, but not always, the consultant that had a less positive experience of the relationship.

In the following example, the consultant replaced another consultant, and then a third consultant replaced her. The consultant suggested that it could have been a more positive experience if they had met more frequently and if she had more influence on how she worked with the program. The administrator found the consultation process with all three consultants to be a positive experience: Consultant: It’s hard to get to know a whole group of people based on once a month and fitting into a niche that had already been carved out. Maybe part of that was because I came in on the heels of another consultant.

Administrator: I can definitely say we had a positive relationship with the consultants. And when the consultants came, the staff had a positive relationship with them. It was very helpful.

An administrator of a pair that expressed having an overall positive experience commented on how the relationship with the consultant had a downside as a result of their different styles of approaching the relationship. The consultant expressed having a positive relationship with the administrator: Administrator: The maple syrup flowing in February rather than May, or whenever they sap the trees. I’m not in any way talking about her performance in relation to the people that do the direct service. I think that I feel a certain stylistic divide with her.

Mixed feelings on the part of the consultant were also apparent with consultantadministrator pairs in which the consultant felt that administrators used them to meet a program requirement. For example, one consultant describes her experience as feeling like a ―checklist‖ to some administrators:

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Consultant: I worried that on some level these staff were saying, ―We need reflective supervision,‖ even if they didn’t know what it was. And then I felt like, this is my assumption, but I felt like I was kind of a checklist. I provided them with this sort of support, check.

In contrast, the administrator of this pair appreciated the consultant’s expertise in reflective supervision and was glad that the consultant was able to provide it to her staff: Administrator: She was good at reflective supervision…She was like another pair of arms for me.

This following example is of a consultant-administrator pair in which the consultant expressed that being new to consultation made her feel unsure about herself in that role. The administrator of the pair did not feel that the consultant’s level of experience was an issue and clearly stated that she felt the consultant was ―knowledgeable about child development,‖ and that she ―felt comfortable with the consultant from the beginning‖ and found her to be ―very helpful‖: Consultant: Even though I was used to addressing difficult issues in treatment, I think being new to consultation suddenly it felt strange to do. I’m not sure, but I think there was something for me about getting past the professionalism of, ―Okay, how is that going to be taken in the context of this sort of relationship?‖ And I think that made me feel unsure.

Change Over Time Naturally, all of the consultant-administrator relationships changed as they moved through the engagement phase into the middle phase and then the termination phase.

Overall, consultants and administrators described starting the consultation process or relationship with feelings of uncertainty and gradually moving into shared understanding of each other and the nature of the consultation process. The termination phase of the relationship was described by consultants and administrators as a separate phase of the

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relationship. For the consultant-administrator pairs in this study, this phase was strongly influenced by the premature termination of the Erikson/ISBE Project. It is important to note that although all relationships moved through the different phases, the specific ways in which pairs experienced changes in the relationship varied depending on the consultant-administrator dyad.

It is difficult to capture the changes that occurred over the course of relationships as experienced by consultant-administrator pairs by providing isolated quotes. These changes were more evident when the researcher stepped back and viewed the data in terms of process rather than content. However, there are a few examples of quotes from consultant-administrator pairs that help to illustrate these changes.

In the following example, one administrator noted that although she was initially excited to be part of the project, she and her staff were reluctant because of the time it would require. She explained that over time, however, she and her staff came to value their time with the consultant. The consultant of this pair described how delicate the work of being a consultant is, in part because she responds differently to administrators based on where she thinks the administrator is in relation to her, which for the administrator of this pair changed over time: Administrator: When we first started that very first year, we were happy to be part of the project, but we were also thinking, we’re always so busy in the trenches and it’s another thing we have go to and an afternoon that takes time away from another home visit. And by the end of the year, everyone was so happy that we decided to do this.

Consultant: I feel like I’m a really a good consultant, but that’s not without saying it is very delicate work because I am always processing who and what I am to them, and with them.

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This last example is from a pair that described how the consultant-administrator relationship moved through an uncertain and uncomfortable phase earlier in the consultation into being mutually satisfying: Consultant: Making it come together and feeling as comfortable as you can with that weirdness is one of the things I like about consultation and dread about consultation. If I can work through it with the site and muddle through it, and 6, 12, 18 months later we can say, ―Wow, we’ve come to this thing. We’ve developed this relationship and this way of doing things, and it’s working and it’s really cool.‖ That feels really good.

Administrator: I got to the point when I was looking forward to our meetings and that level of discussion. It was a very gradual process. By that point she and I had already established our working relationship. We were both really excited.

This consultant-administrator pair respectively spoke about the unfortunate ending of the consultation process and their relationship. The administrator expressed the importance of early childhood mental health consultation for administrators of early childhood programs: Administrator: As a general plug for mental health consultants, I think the program is fantastic. I think it’s really, really needed. I think mental health consultation helps administrators understand program needs in a different way that they may not be able to understand on their own. I think it’s really, really important that programs receive support from mental health consultants.

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CHAPTER XIII

FINDINGS AND IMPLICATIONS

This chapter presents four findings. The findings will be briefly outlined, and then implications of each finding will be discussed in-depth. Following the findings and implications section are sections on the credibility, limitations, clinical implications, and social implications of this study, as well as implications for future research.

Findings and Theoretical Implications In this study, the majority of consultants were trained as clinicians. Most consultants viewed their role as working to bring about positive change in administratorsâ&#x20AC;&#x2122; ways of thinking about infant mental health. Fraiberg, Adelson, & Shapiro (1975) describe reflective practice as a psychoanalytic approach that encourages participants to develop alternative ways of understanding oneself in relation to the work, and helps participants understand and make use of their internal experiences while minimizing the influence of unexamined internal processes. The Erikson/ISBE IECMHC Project used a reflective practice approach to consultation much like the one described by Fraiberg et al.

Thus, psychoanalytic relational theory is fitting as a lens and framework for interpreting the results of this study. Early childhood mental health consultation literature will be used to a much lesser degree to contextualize the findings.

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Contemporary relational theory has been developed by a diverse group of psychoanalysts to promote a particular, yet pluralistic, theoretical perspective and set of theoretical concepts within the psychoanalytic community. These theoretical concepts were developed to illuminate and inform the psychoanalytic process between analysts and their patients. Even within the context of psychoanalysis, the application of theory can be messy, challenging or become an obstacle to the therapeutic process at hand resulting in degrees of disillusionment within the therapeutic dyad. Therefore, in using contemporary relational psychoanalytic theory to understand the implications of this study or to apply this theory to the practice of early childhood mental health consultation it is important to keep in mind that psychoanalytic theoretical concepts are in no way understood to be a seamless fit. Rather, the following theoretical implications are intended to offer the field of early childhood mental health consultation new ideas to consider and play with in an effort to increase the potential for effective consultation.

What follows are four findings along with implications of the findings from a contemporary relational psychoanalytic theoretical perspective.

Finding 1: There Are Multiple Interacting Dimensions that Powerfully Influence the Intersubjective Experience of the Consultant-Administrator Relationship Finding 2: The Consultant-Administrator Relationship Is Co-Constructed by Consultants and Administrators in Three Identifiable Phases Finding 3: The Consultant-Administrator Relationship Functions as a Container for Representations of the Internal Worlds of Individuals within the Consultation Matrix Finding 4: Unconscious Relational Processes Underlie and Come Alive within the Consultant-Administrator Relationship

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Theoretical Implications

Finding 1: There Are Multiple Interacting Dimensions that Powerfully Influence the Intersubjective Experience of the Consultant-Administrator Relationship The consultants and administrators that participated in this study described a range of factors that influenced their subjective experience of the infant and early childhood mental health consultant-administrator relationship. The dimensions described include individual characteristics of consultants and administrators, interpersonal experiences, organizational structures and systems, cultural influences, and economic and political factors. Mitchell’s relational-conflict model of psychoanalysis describes the relational matrix of individuals as encompassing the intrapsychic and the interpersonal, the biological and the social, the inner world and the outer world, and psychic reality and actuality (Mitchell, 1988). Mitchell’s dimensions of the relational matrix will be used to discuss the dimensions of experience that were found to influence the consultantadministrator relationship in this study.

Intrapsychic and Interpersonal Dimensions From the perspective of Mitchell’s relational-conflict model, ―the most useful way to view psychological reality is as operating within a relational matrix which encompasses both intrapsychic and interpersonal realms.‖ According to Mitchell, ―the interpersonal and the intrapsychic realms create, interpenetrate, and transform each other in a subtle and complex manner‖ (Mitchell, 1988, p. 9), with the intrapsychic and the interpersonal realms each having their own set of processes, mechanisms, and constraints.

Johnston and Brinamen (2006) suggest that internal or intrapsychic influences, including

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one’s personal history, affect relationships in the consultation process. Intrapsychic and interpersonal realms of experience, and the interplay of these realms, clearly emerged in the narratives of both consultants and administrators. Participants’ intrapsychic or internal experiences were most evident in their expression of affect in relation to consultants’ and administrators’ relationships with each other, and to the overall consultation process. Affective experiences were different for consultants and administrators. Consultants expressed more intense and wider ranging affective experiences than administrators, and also expressed experiencing a more negative set of feelings, including frustration, helplessness, and confusion. Another significant difference regarding internal experiences for consultants and administrators is that many consultants described ways in which they were aware of some of the internal or intrapsychic processes they experienced. For example, many consultants stated that they were aware of their feelings that emerged in response to the consultant-administrator relationship.

Mitchell (1988) draws from Bowlby’s attachment theory and infant research to support his view of individuals as being relational by design. Mitchell also looks to Sullivan’s interpersonal theory and, in particular, Sullivan’s belief that human beings manifest themselves according to their interpersonal interactions with others, and not in identical ways with others, to underscore his perspective that humans are inherently structured in relational terms. Mitchell views the human mind as dyadic and interactive, seeking contact and engagement with other minds, and composed of relational configurations. Individuals are comprehensible only within this tapestry of relationships, a tapestry whose design is rich with interacting figures. Similar to the perspective of Mitchell, interpersonal experiences were different for each individual and each dyad as

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described by participants. For example, all consultants worked with multiple administrators and although there were some common themes across the different relationships, each interpersonal experience and relationship was described in different terms by consultants. Similarly, in administrators’ description of their subjective experience of interpersonal experiences with multiple consultants, differences in each relationship were made evident.

Biological Dimensions In focusing on the relationship as the basic unit of study, Mitchell (1988) considers both nature and nurture dimensions to be important, with social relations being regarded equally as important as the primary biological functions of individuals. Mitchell proposes that each individual’s personality is uniquely shaped by her biological constitution as well as by the conflicts with early significant others. Johnston & Brinamen (2006) believe that diversity among consultees, as well as individual differences among consultants, contribute to variations in the consulation relationships and experiences.

Biological dimensions of participants were not prominent in the data, yet emerged in ways such as consultants’ and administrators’ comments and descriptions of how the other’s unique personality traits or styles influenced their experience of the relationship.

Additionally, some consultants spoke about how their own unique way of approaching or experiencing the work influenced the consultant-administrator relationship. It was also clear to the researcher that in the interview process each participant had a unique way of thinking about and describing the consultant-administrator relationship, and interacting with the researcher.

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Social Dimensions Consultants and administrators explicitly revealed a wide range of social dimensions that they felt affected their work and entered into the consultant-administrator relationship. The social dimensions described by participants include race, culture, and class. A willingness to acknowledge dimensions of race, class, and culture helped to promote a more genuine acknowledgement of both difference and common ground, and helped consultants and administrators create a positive relationship (Donahue et al., 2000). When these dimensions did not get examined in the context of the consultantadministrator relationship, problems in the relationship resulted.

Altman (1993) considers the psychoanalytic endeavor to involve what he calls a ―three-person field‖ in which the third ―person‖ is the social context of both the analyst and patient. Altman’s believes that it is necessary for psychoanalytic models to understand the impact of the institutional context on work with inner city and lower income individuals. Altman’s work in this area relates to this study since the early childhood program administrators that participated in this study worked in programs that served low-income families, some of which were located in the inner city of Chicago.

Altman believes that any attempt to understand the meaning of what an inner-city patient presents in treatment must take account of the institutional context of that work, as well as the patient's and analyst's ethnicity, culture, and socioeconomic status (Altman, 1993).

According to Altman, ―not only does the inner world structure experience of the outer

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world, but the outer world structures the inner worldâ&#x20AC;&#x2013;, with the outer world extending to the social, political, and economic environment (Altman, 2005, p.338).

Social, cultural, and political dimensions were found to be extremely powerful influences on the consultant-administrator relationship: most participants in this study described the impact of the social contexts of their work with each other. In many cases this was described as societal structures that adversely impact the families served by the programs that received consultation, as well as the adverse societal conditions in which the programs themselves are embedded. For some consultants, it was distressing to work in multiple systems that experienced significant social problems. For administrators, it was overwhelming to be faced with the many social problems the families they serve experience without having adequate resources to meet their needs. This was exacerbated by a sense that the problems may only get worse given the current harsh economic climate.

Issues of racism and poverty permeated participantsâ&#x20AC;&#x2122; narratives of the consultantadministrator relationship, and both consultants and administrators saw these as influencing the relationship. These dimensions were described by participants in relation to themselves or the administrator/consultant they worked with, in relation to the staff that were involved in the consultation process, and in relation to the children and families served by the programs that received consultation. When considering influences of the political and economic factors on the clinical process, Walls (2004) suggests that although clinicians cannot offer magical solutions to racism, poverty, sexism, or the class system, or to their emotional consequences in terms of depression, anxiety, and injuries to

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self-esteem, clinicians can help patients learn to think about their suffering in ways that go beyond an analysis of their inner emotional dynamics when that is appropriate.

Culture was also found to play a role in the consultant-administrator relationship.

Fairfield (2001) proposes that each culture, and ―within it each subculture, makes certain modes of subjectivity possible and renders others difficult to maintain or even invisible‖ (p. 226). In this study, participants found it to be helpful to the building and experience of the relationship if the consultant and administrator were from the same or similar cultures. This was especially true regarding ethnicity and type of community (rural or urban). Participants also found that similarity of the culture of one’s profession, such as both individuals having social work backgrounds or having reflective practice experience, contributed to having a positive experience of the consultant-administrator relationship. By anticipating and honoring differences in the cultural backgrounds of consultants, administrators, and others (Johnston & Brinamen, 2006), in the consultation matrix, consultants created an atmosphere that promoted an acceptance and understanding of differences.

The multiple factors that influence the consultant-administrator relationship can also be understood in terms of Johnston & Brinamen’s (2006) notion of ―considering all levels of influence.‖ This refers to the numerous influences that impact the consultee’s approach to childcare. These influences include internal (intrapsychic) and external influences. Intrapsychic influences include the consultee’s personal history and subjective experiences. External factors that influence the consultee include programmatic pressures and the interpersonal influences of the consultee’s relationship with coworkers, parents, and children. Johnston and Brinamen strongly suggest that the consultant must consider

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all these levels of influence that affect the consultee’s perceptions of the childcare process in order to gain an understanding of how best to approach the consultation process effectively.

Finding 2: The Consultant-Administrator Relationship Is Co-Constructed by Consultants and Administrators in Three Identifiable Phases

Theories of Co-Construction The early childhood mental health consultation literature describes the consultant and consultee as engaging in a collaborative effort in the consultation process.

Collaboration is defined as a two-way process with mutual examination and participation that draws on the expertise of both the consultant and consultee (Cohen & Kaufmann, 2005; Emmet, 1971; Johnston & Brinamen, 2006). Johnston & Brinamen (2006) use the concept of ―mutuality of endeavor‖ to describe consultants developing a stance of collaboration and wondering with consultees, and view the consultant-consultee relationship as a mutually constructed endeavor that requires the consultant’s flexibility and understanding as she joins with the providers.

In relational psychoanalysis, there are two major theoretical concepts that are used to describe the two-way, mutual process between the analyst and analysand. These concepts are co-construction (Beebe et al., 2003; Hoffman, 1991; Mitchell, 1988), and mutual influence (Aron, 1990; Mitchell, 1988). In his relational-conflict model, Mitchell (1988) proposes that mental processes occur in a ―cycle of mutual influence‖ developed in a relational context (p. 5). For Mitchell, relational configurations exist in a relational field consisting of three dimensions: the self pole, object pole, and interactional pole.

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These dimensions, or poles, are interwoven, knitting together the individual’s subjective world. There is no meaningful object without some particular sense of relation to it, and therefore there is no sense of self in isolation, outside of a relational matrix. The third dimension, the interactional pole, is defined as the space in which people interact. From Mitchell’s perspective, all experience is co-created as the three dimensions are interdependent upon each other and together create the relational field.

In Aron’s mutuality and reciprocal influence model, the patient-analyst relationship is viewed as continually being established and reestablished through ongoing mutual influence in which both patient and analyst systematically affect, and are affected by, each other. A communication process is established between patient and analyst in which influence flows in both directions. This approach implies a ―two-person psychology,‖ or a regulatory-systems conceptualization of the analytic process (Aron, 1990). In his later work, Aron emphasizes the concept of thirdness, which differs from Ogden’s original concept. Aron’s concept of thirdness represents an ―intersubjective dyadic system in which both individuals continually influence each other‖ (Aron, 2006, p.364). For Aron, thirdness is a theory of thinking that transcends the mind in isolation.

In Hoffman’s dialectical constructivist model, the analytic situation is considered as being comprised of two people, both participating in charged interpersonal interaction (Hoffman, 1983). According to Hoffman, both the patient and the analyst bring powerful internal structures into the analytic relationship, and realities are co-constructed, bearing the stamp of those internal structures. Thinking in terms of the co-construction of the analytic endeavor from Hoffman’s perspective results in more subtle distinctions between the roles and responsibilities allocated to the analyst and to the patient. Both participants

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must take responsibility as free agents for what they do at any moment to shape their relationship (Hoffman, 2003).

Beebe and Lachmann (1998) developed a dyadic systems view based on infant research. In their dyadic systems view, inner and relational processes are co-constructed and are considered equally important. By emphasizing a reciprocal co-construction, this approach places psychoanalysts in a stronger position to examine how dyadic processes organize and reorganize both inner and relational processes, and reciprocally, how changes in self-regulation in either partner may alter the interactive process (Beebe & Lachmann, 1998). From this perspective, self-regulation processes and other-regulation processes emerge together in a reciprocal, interpenetrating way and therefore regulation is considered a mutual regulation process. Dyadic systems theory of interaction also considers how each person is affected by his own behavior as well as by the partner's behavior through interactive regulation (Beebe & Lachmann, 2003).

Phase I: Engagement In this study, evidence of the co-construction of the consultant-administrator relationship was found in the narratives of both consultants and administrators, and in the analysis of consultant-administrator pairs. In the early stages of the consultantadministrator relationship, co-construction of the relationship proved challenging for many of the consultants that participated in this study. They saw themselves as attempting to create a collaborative working relationship with each administrator and program to determine the nature of their relationship and roles.

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Research suggests that early childhood mental health consultants are often unaware of the tasks involved in, and the importance of, the entry or engagement phase of the consultation process (Wesley, Buysee, & Skinner, 2001). Challenges arose for many consultants when they attempted to engage administrators in meeting regularly to determine the goals for the consultation or reflect on the work of the program. Many administrators desired alternative ways to engage with the consultant, such as meeting informally or meeting with staff for case consultation. Some chose not to engage with the consultant at all. Frustrations, challenges, struggles, and confusion were typical affective experiences for consultants when this occurred. These affective reactions and experiences made it difficult for consultants to internally maintain the stance of mutuality of endeavor (Johnston & Brinamen, 2006). Consultants, however, did demonstrate flexibility (Johnston & Brinamen, 2006) in their interactions with administrators despite their internal reactions, and they continued to work to find ways of engaging administrators.

Many administrators acknowledged the difficulty they had, due to busy schedules, of making time for the consultant in the engagement phase. Other administrators talked about their desire to have the consultant work with their staff, or together with staff, rather than with the consultant individually. From the perspective of Hoffmanâ&#x20AC;&#x2122;s dialectical constructivism model, even if the relationship was experienced as challenging, the consultant and the administrator were each bringing their internal structures into the relationship and therefore co-constructing it (Hoffman, 2003).

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Phase II: Building the Relationship Emde, Mann, and Bertacchi (2001) think of relationships in organizational environments that support mental health as ―building over time and relying on accumulating trust and emotionally sensitive communications‖ (p. 67). Once a relationship had been established between the consultant and administrator, the nature of consultant-administrator interactions tended to change (Donohue et al., 2000). Coconstruction in this phase of the relationship was viewed by consultants and administrators as becoming a more reciprocal, dyadic process that organized and reorganized both inner and relational aspects of consultants, administrators and their relationships (Beebe & Lachmann, 1998). For this phase, consultants and administrators each described how their own behaviors in the relationship, as well as the other’s, affected the relationship through a more interactive process (Beebe & Lachmann, 2003).

Once consultants and administrators had engaged with each other, the consultantadministrator relationship was continually being established and reestablished through ongoing mutual influence in which both the consultant and administrator affected each other (Aron, 1990). For consultants this process, and second phase of the relationship, was described as building the relationship. Participants, especially consultants, experienced the relationship- building phase as taking a considerable amount of time—up to a year in some cases. For the consultant, building the relationship involved experiencing and simultaneously processing multiple dimensions of their relationship with administrators. Consultants expressed being highly aware of and attuned to their own internal reactions, the internal experiences and actions of the administrators, and the space in which the consultant and administrator interacted (Mitchell, 1988). Consultants

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described their role in the relationship during this phase as listening to the administrator, supporting the administrator, helping administrators deal with their own and their staff’s emotional reactions to the work, reflecting on the work with administrators, and developing ideas together. Administrators described this phase of the relationship similarly and explained how they brainstormed together, reflected on the work together, and learned how to provide reflective supervision for their staff from the consultant.

Administrators found these experiences to be useful, valuable, and enjoyable.

Administrators also expressed their appreciation of consultants’ emotional support in this phase of the relationship.

Phase III: Termination The third, and final, phase of the consultant-administrator relationship is the termination phase. As described by both consultants and administrators, the termination of the Erikson/ISBE IECMHC Project resulted in a major shift in the consultantadministrator relationship. This can be thought of in terms of the way in which the cocreated matrix fluctuated from moment to moment (Blum, 1998), culminating in the end of the relationship. The emotional reactions of consultants and administrators to the end of the project, and to the end of the consultant-administrator relationships, had a profound impact on the individuals and their relationships with each other. Consultants’ and administrators’ reactions mutually influenced the experience of the termination phase for participants. Consultants expressed having intense emotional reactions to the ending of the project that impacted their interactions with administrators. Many consultants found it difficult to manage their own reactions separately from administrators’ reactions, with

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some consultants sharing their own reactions to the project ending with administrators.

Hoffman (1992) suggests that what a clinician does at such moments may reflect a great deal of clinical and theoretical sophistication but that personal expressions can never be understood merely as the application of a principle of technique in any simple sense.

All of the administrators that participated in this study talked about the termination of the project and the consequent loss of the consultant. Most administrators spoke about their emotional reaction to the loss of the consultant, and their wish, or plan in some cases, for the consultant to return. Others spoke about the impact of the project ending on their program, the staff, and families. Consultants spoke of helping administrators cope with the ending of the project and the potential closing of their programs. This involved responding to administratorsâ&#x20AC;&#x2122; personal reactions as well as helping administrators support the staff and families they served in the face of anticipated and actual loss. Given the emotionally intense reactions on the part of both consultants and administrators in response to the termination of the project, and their descriptions of working through this phase of the relationship with each other, the termination phase can be viewed as co-created and involving a self-regulation and other-regulation process that emerged in a reciprocal, interpenetrating way as described in Beebe and Lachmannâ&#x20AC;&#x2122;s dyadic systems model (1998).

Finding 3: The Consultant-Administrator Relationship Functions as a Container for Representations of the Internal Worlds of Individuals within the Consultation Matrix In this study, there were patterns in the data that strongly suggest that the consultant-administrator relationship functions as a container for the complex intrapsychic experiences of the many individuals that exist within the consultation

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relational matrix. Participantsâ&#x20AC;&#x2122; narratives reflected the strong presence of overwhelming emotional experiences as a result of working with at-risk children and families. It became evident that different relational configurations in the consultation field seek emotional containment from individuals they perceive as objects who can help them manage their overwhelming and disturbing emotional experiences. The process of seeking containment of painful emotional experiences begins with the parent-child dyad seeking emotional containment from front-line staff. The front-line staff then looked for emotional containment from their supervisors. Supervisors of direct-service staff looked to their supervisor, if they had one, for emotional containment of overwhelming and disturbing experiences in relation to their work with families. Many of the administrators in this study, however, did not seem to feel they had someone in their work environment to help them manage and contain their overwhelming and disturbing feelings. These administrators utilized the consultant-administrator relationship to help them contain and manage their emotional or affective reactions and experiences, as well as the emotional experiences of those who sought containment from them within the consultation matrix.

The research process itself served as an additional source of data that suggests containment occurs in the consultant-administrator relationship. While interviewing administrators the researcher, a clinician and former Erikson Institute mental health consultant, subjectively experienced administratorsâ&#x20AC;&#x2122; use of the researcher as providing a containment function for overwhelming and disturbing thoughts and emotions in relation to the children and families served in their program.

In his theory of containment, the object relations theorist Bion (1962) argues that the infant cannot yet make sense of himself or the world because of his immature mind.

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As a result, experiences of need threaten to overwhelm the infant. The infant's experience, not thinkable within the infant's mind, is projected outward toward the mother. In order for the infant to manage these experiences, his projection must be contained by its mother. When things go well, the mother accepts the projection as a communication. For Bion, individuals must find ways to convert raw stimulus into the stuff of thought, and the first step in rendering experience thinkable is containment. In this sense, the consultant-administrator relationship can be viewed as functioning much in the same way as in Bionâ&#x20AC;&#x2122;s concept of containment. In this study, one way that consultants and administrators made this process evident was by describing how the consultantadministrator relationship was experienced as a place to talk about, feel, and manage the overwhelming experiences of parents, children, front-line staff, administrators, and consultants.

Bionâ&#x20AC;&#x2122;s concept of containment has influenced contemporary relational writers and clinicians. Cooper (2000), for example, describes that a mutual containment process occurs in the therapeutic process. For Cooper, mutual aspects of containment are extremely important in the expression and titration of anger and disappointment, desire, hope, humor, and the negotiation of psychic possibility within the analytic dyad. Cooper argues that no matter how much therapists provide a holding environment for their patients, they are also asking patients to engage in aspects of reciprocal holding. He goes on to say that there are ways in which our limitations in containment can be good enough, or not so destructive, that both patient and analyst can hold the level of disillusionment, anger, and frustration so that new learning and experience can occur. Because consultants described having powerful emotional experiences in relation to the consultant-

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administrator relationship and consultation process, and in response to their attempts to manage the emotional experiences of administrators, it is highly conceivable that a mutual containment process becomes activated in the consultant-administrator relationship as described by Cooper.

This process of multiple relational configurations working to contain overwhelming emotional experiences is also similar to Johnston & Brinamen’s principle of ―hearing all the voices,‖ which refers to hearing the multiple voices in the childcare community, including those of staff, parents, and children (Johnston & Brinamen, 2006).

Hoffman’s (1991) idea that we all live in innumerable, concentric worlds within worlds also speaks to the phenomenon of the containment function of the consultantadministrator relationship. Hoffman views the psychoanalytic situation as a special kind of interaction involving the activity of patients in constructing certain problematic aspects of their lives, past and present. This concept can be applied to what was found to occur within the consultant-administrator relationship as problematic aspects of the past and present lives of the children and their families made their way into the relationship.

Ogden describes his concept of ―the intersubjective analytic third‖ as ―being simultaneously within and outside of the intersubjectivity of the analyst-analysand‖ and ―a product of a unique dialectic generated by (between) the separate subjectivities of the analyst and analysand within the analytic setting‖ (Ogden, 1994, p.4). Ogden considers his concept of the analytic third as an elaboration and extension of Winnicott's notion that '"There is no such thing as an infant" (Winnicott, 1960, p. 39) apart from its relationship with the mother, and believes there is no such thing as an analyst apart from the relationship with the analysand (Ogden, 1994, p.4). In his article, ―The Analytic Third:

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Working with Intersubjective Clinical Facts,‖ Ogden (1994) describes that no thought, feeling, or sensation can be considered to be the same as it was or will be outside the context of the specific, and continually shifting, intersubjectivity created by the analyst and analysand. Beebe, Knoblauch, Rustin, and Sorter (2003) propose that in the therapeutic relationship both partners jointly create something new, an emergent property of the relationship that they refer to as being along the lines of Ogden’s intersubjective third. They argue that ―the analyst's own ability to evoke, contain, and transform the patient's nonsymbolized and dissociated states into symbolized communications is a central form of therapeutic action‖ (p. 759). In this way, Beebe et al. emphasize a containment function that occurs within the therapeutic dyad, much like the consultants that participated in this study described their attempts to manage and contain, and help the administrators manage and contain, the many communications, conscious and unconscious, that were experienced in the consultant-administrator relationship.

In the paper ―Containers without Lids‖ (2006), Carnochan states that when we think of containment, we tend to think of containers as things with boundaries and lids.

She contrasts the container with discrete boundaries to the concept of infinity, which is without boundary and made up of what cannot be closed with a lid. Carnachon suggests that when we allow our imagination to come into this sense of limitlessness, we can feel like we will ―spill out into the impossibly far gravity of forever, and that it will pull us apart into a fragmenting diffusion‖ (p.350). Therefore, according to Carnochan, the task of analysis is to make contact with the patient's unfolding experience and strengthen the capacity to make meaning, and this process is dependent on the relational containment of experience.

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In thinking of the consultant-administrator relationship as the relational containment of experience as described by Carnochan, it is easy to see how the consultant-administrator relationship functions as a container for the experiences of the consultant, administrator, staff, children and families served by the early childhood program, and community in which the program is embedded. When, as was found in this study, consultants and administrators subjectively and intersubjectively experienced the consultant-administrator relationship as making contact with the unfolding experience of the multiple individuals and dyads that make up the consultation matrix or field, there was a sense of a spilling out into the ―impossibly far gravity of forever‖ that was experienced as a ―fragmenting diffusion‖ of sorts by both consultants and administrators.

The consultants struggled to make meaning of and contain these uncontained, limitless experiences. They worked hard to strengthen the capacity to make meaning of these experiences for administrators. The success of creating relational containment within the consultant-administrator relationship proved to be more difficult for some dyads more than for others. When certain administrators viewed the consultant as having expertise in dealing with the ―mental health‖ issues of at-risk children and their families, and thus viewed the consultant’s role as working directly with the front-line staff, containment was seen primarily as a function of the consultant rather than as a shared function of the relationship. This may be why consultants who did not feel successful at engaging administrators in reflective practice felt significantly less effective in regard to the consultation, and more overwhelmed and frustrated with the consultation process. From this perspective, reflective practice with administrators can be understood as a form of relational containment in which both the consultant and administrator share in the

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containment of overwhelming experiences that emerge from experiences in the bigger consultation relational matrix.

Finding 4: Unconscious Relational Processes Underlie and Come Alive within the Consultant-Administrator Relationship Not surprisingly, unconscious processes were somewhat difficult to clearly discern and firmly establish as occurring in the consultant-administrator relationship in this study. However, through listening to the participants talk about their experiences and through more formal modes of data analysis, the researcher did find that unconscious processes were present and active in the consultant-administrator relationship. When talking about their experience of the consultant-administrator relationship and the consultation process, participants’ narratives directly or indirectly included references to dynamic unconscious processes. Unconscious processes that emerged from the narratives of participants include resistance, transference, countertransference, enactments, and parallel process. These processes all have a relational aspect to them as they involve two individuals, consultants and administrator, participating with each other in unconscious relational configurations. In the early childhood mental health consultation literature, Johnston & Brinamen (2006) state that most important to their thesis that relationships form the cornerstone of consultation is the idea that ―one’s expectations of the consulting relationship expresses that person’s internal experiences of relationships in general‖ (p.

73). In using relational psychoanalysis as a theoretical framework for this study, unconscious processes can therefore be best understood as expressions of a relational unconscious (Davies, 1996; Gerson, 2004; Lyons-Ruth, 1999).

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The Relational Unconscious Davies’ (1996) relational unconscious is made up of unformulated dyadic representations, which Davies calls ―free radicals.‖ These dyadic representations ―[roam] the mind in a hungry search for vulnerable moments, using their magnetic charge to disrupt the established order and to pull the patient into all forms of mystifying, inexplicable interactions‖ (p.563). In the very early stages of consultant-administrator relationship, or the engagement phase, consultants described being involved in various confusing and frustrating situations over which they felt they had no control. These situations included ways in which they interacted with the administrator in their role as consultant, which frequently involved consultants tirelessly pursuing administrators as administrators avoided, or made themselves unavailable, to consultants. This relational dynamic can also be explained by Gerson’s (2004) concept of the relational unconscious as the fundamental structuring property of each interpersonal relationship. Gerson’s relational unconscious permits, as well as constrains, modes of engagement specific to each particular dyad and influences individual subjective experience within the dyad. It is a dynamic process through which individuals communicate with each other without awareness about their wishes and fears, and in doing so, search for recognition and expression of their individual subjectivities. It can be said that the consultantadministrator pairs in this study were constrained or permitted to engage with each other in particular modes of interaction based on the unique relational unconscious of the consultant and administrator of each pair.

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Resistance Both consultants and administrators described administrators as being too busy to meet with consultants initially. Some consultants interpreted this as resistance on the part of administrators, yet both consultants and administrators described the importance of building a trusting relationship. There were also consultants that felt the administrator was suspicious or mistrusting of the consultant early on. Caplan (1970) proposes that in the entry phase of consultation, it is likely that consultees’ perceptions of consultants may be colored by a variety of anxiety-provoking fantasies that can potentially block and distort the communication process. Examples of these distortions and expectations as described by Caplan include consultees’ fearful perceptions of the mental health specialist as being a ―mind reader‖ who might expose hidden thoughts and weaknesses, judge or condemn, or make one lose face (Caplan,1970). Because the Erikson/ISBE IECMHC Project was state-funded, and because the early childhood programs involved with the project received state-funding to operate, some administrators were initially suspicious of the consultant, perceiving them as an extension of the state placed to evaluate both them and their program. This feeling was heightened by the larger economic context, in which programs were struggling financially and feared losing their funding from the state. Some consultants directly spoke about administrators’ resistance, while others described interactions and administrators’ relational patterns as including some form of unconscious resistance to the relationship with the consultant and the consultation. This was mostly made evident in consultants’ descriptions of having difficulty establishing consistent meeting times or being ―blown off‖ by the administrator.

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Another form of resistance was found in consultant-administrator relationships in which administrators who had worked with a different consultant previously strongly resisted entering into a relationship with a new consultant and negotiating a new, cocreated way of working with them. Rather, these administrators found ways to have the new consultant fit into a way of working with the administrator that was familiar to them.

This is also supported in the early childhood mental health literature of Duran and colleagues (2009), who describe a form of resistance that may occur in the consultation process as a result of new approaches threatening tradition and, therefore, creating ambiguity and even fear in the consultee.

Marks (1995) looks at resistance as coming from the consultant and suggests that in many consultation situations it is the consultant who consciously or unconsciously rebels, resulting in a breakdown in communication with the administrator. Although there is no evidence that consultants in this study explicitly expressed resistance, it is quite possible that there were some unconsciously expressed forms of resistance by consultants. For example, several consultants expressed that they found the engagement process to be extremely difficult, and that they felt unwanted by administrators although administrators did not directly express this. These consultants felt hopeless and helpless, with some consultants stating that they could have tried harder to engage administrators.

These experiences and reactions by the consultant may have caused the consultant to unconsciously respond or act in ways that interfered with the development of the consultant-administrator relationship.

From the relational psychoanalytic perspective of Gerson (1996), resistance is regarded as an â&#x20AC;&#x2022;intersubjective,â&#x20AC;&#x2013; a mutually constituted effort by patient and analyst to

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create and maintain nonprogressive interactive dynamics. According to Gerson, these mutually and reciprocally motivated states are sustained by each participant's efforts to maintain the other in the familiar transference-countertransference configuration. In many cases, consultants and administrators resisted entering the consultant-administrator relationship in ways that were different from their respective expectations, and both parties attempted to approach the relationship in ways that were familiar to them, especially in the early stages of the relationship.

Transference With the consultee being the recipient of mental health consultation provided by a mental health professional, administrators are most aligned with the patientâ&#x20AC;&#x2122;s role in the clinical process. In his definition of transference in the relational paradigm, Hoffman (1983) refers to transference as the patient's selective attention and sensitivity to certain facets of the analyst based on each patientâ&#x20AC;&#x2122;s unique character structure, rather than the classical definition of transference as a distortion of reality, with each patient building their subjective reality out of a plausible interpretation as to what is actually going on.

This relational notion of transference seems to fit well with administratorsâ&#x20AC;&#x2122; descriptions of their experiences of consultants. For example, different administrators focused on different aspects of the consultant they worked with and their relationship with the consultant. Moreover, each administrator had their own unique way of describing their experiences with the consultants they worked with, even though all administrators expressed having positive experiences with consultants overall. Administrators who worked with more than one consultant made clear distinctions regarding their experience

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of the different consultants they worked with, preferring certain consultants over others based on consultants’ personalities and styles rather than level of expertise. Different administrators that worked with the same consultant also had different experiences of the consultant.

Overall, administrators’ transference to consultants, or their experiences of consultants, was much more positive than consultants’ experiences of administrators.

This is perhaps due to the nature of consultation in that consultants perceived their role as working to engage administrators in a particular way, which didn’t necessarily correspond to administrators’ wishes. Administrators, on the other hand, were in their own familiar environment and tended to view the consultant as someone coming in from the outside to support them and their program, although in some cases they initially viewed the consultant somewhat suspiciously, as noted above. Administrators that had worked with consultants previously tended to be much less suspicious and perceived the consultants positively. In general, administrators’ transference to consultants can be characterized as administrators experiencing consultants as supportive, helpful, and having invaluable expertise. Additionally, some administrators demonstrated institutional transferences to ISBE and Erikson Institute.

Countertransference As the clinician in the consultant-administrator dyad, the consultant is most analogous to the therapist in the clinical process. Consultants confirm this comparison as they viewed their role as working clinically with administrators to help them reflect on and transform their understanding and practice of infant mental health. Some consultants

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explicitly described feeling like the administrator’s therapist, while others described consultation as ―gigantic family therapy,‖ with the administrator being the parent.

Consultants in this study were quite clear and direct in describing their countertransference reactions to administrators in terms of their thoughts and feelings about, and experiences of, the administrators they worked with (Stern, 2004). As stated previously, consultants’ experiences of administrators ranged from seeing them as frustrating, rejecting, and resistant to experiencing them as lonely, stressed, overwhelmed, quirky, likeable, intelligent, and so on.

Fosshage (1995) defines countertransference as the analyst's experience of the patient through a process in which analyst and analysand variably co-determine the countertransference, with the contribution of each ranging from minimal to considerable moment to moment. From this perspective, consultants’ descriptions of responding uniquely to each administrator’s personality, wishes, and actions can be viewed as consultants and administrators co-creating or codetermining consultants’ countertransference. Consultants, for example, described how certain administrators, and certain types of participation in the consultation process by administrators, shaped or impacted their experience of the administrator, and the relationship.

Enactments Donahue et al. (2000) state that, ―the task of the consultant in not just to observe, to comment, or to instruct, but to live with the individuals in the program and become part of their community‖ (p. 47). In his relational-conflict model, Mitchell (1988) suggests that because of the analysand’s embeddedness in her relational configurations,

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the analyst constantly finds himself in the midst of transference-countertransference enactments, which are shaped by the analysand’s relational configurations. For the analysand enters treatment looking for something new and something old, or looking for something new in old ways. In other words, enactments occur as the analyst discovers himself embedded in the ―structures and strictures of repetitive configurations of the analysand’s relational matrix‖ or transference-countertransference configurations (Mitchell, 1988, p. 292) even as the analysand hopes to create change through the therapeutic process. In developing a theory of the consultant-administrator relationship, the engagement phase of the consultant - administrator relationship may be best understood as both parties engaging in transference-countertransference enactments.

Most consultants felt they could only enter administrators’ worlds in ways that were familiar and comfortable to administrators. During the engagement phase, consultants frustratingly often discovered themselves embedded in administrators’ relational matrix, from which they struggled to extricate themselves (Mitchell, 1988). Consultants, therefore, can be seen as playing assigned roles in relation to the administrator to varying degrees (Mitchell, 1988). However, unlike the therapeutic process in psychotherapy, the consultant’s therapeutic frame is much less clear, and to make matters more challenging, consultants sometimes experienced the administrator as a resistant mandated client.

Consultants, however, held on to the notion that there was the possibility of creating something new with the administrator and attempted to find ways to emerge from the structures or break free of the jointly created transference-countertransference configurations (Hoffman, 1983; Mitchell, 1988; Stern, 2004). As with enactments in psychoanalysis or psychotherapy, after repeated interactions with each other, many

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consultants and administrators gradually found themselves in a new relational configuration.

Another way to think about enactments occurring within the consultantadministrator relationships is in Sternâ&#x20AC;&#x2122;s (2004) concept of transferencecountertransference enactments. According to Stern, enacted experiences are unformulated and made up of dissociated states from both participants. These unformulated experiences cannot be symbolized and therefore do not exist in any other explicit form other than enactment itself. According to Stern, an enactment ends by bringing the nature of the transference-countertransference pattern to light, which provides opportunity for change. A challenge for many consultants resulted to some degree from the nature of consultation. Unlike therapist and patient, consultants and administrators did not have a therapeutic relationship in which they felt they could speak freely about the relational patterns they found themselves in. Rather, consultants relied on their supervisors to help them break free of enactments, especially in consultantsâ&#x20AC;&#x2122; more difficult relationships with administrators.

Parallel Process In the consultation process, parallel process is considered to be multidirectional, extending and moving in all directions (Johnston & Brinamen, 2006). In the childcare environment, the parent-child relationship affects the caregiver-child relationship, which in turn affects the caregiver-caregiver relationship and caregiver-director relationship.

Likewise, the consultant-consultee relationship and its quality create change in other relationships in the childcare environment (Bertacchi, 1996). According to most

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consultants, parallel process occurred, and in two directions: up and down. Parallel process occurred in a downward fashion when consultants experienced how dimensions of their relationships with administrators emerged in the relationships between administrators and their staff members. This was usually referred to by consultants as the ―trickle-down‖ of dimensions of the relationship-based, reflective practice model used by consultants. For some consultants, parallel process was also experienced in the reverse direction, when dimensions of the lives of at-risk families and front-line staff entered into the consultant-administrator relationship.

Although consultation is not a supervisory relationship and is considered to be a relationship of two equals with different areas of expertise (Cohen & Kaufmann, 2005, p.

4), the supervisory relationship in clinical practice can be useful in understanding parallel process in the consultant-administrator relationship. Consultants viewed themselves and administrators as helping administrators and their staff increase their capacity in working with at-risk children and their families, which is similar to the role of a clinical supervisor in many ways. Frawley-O’Dea (1997) offers a contemporary relational model of supervision in which parallel process is a common phenomenon of the supervisory encounter and seems to be particularly noticeable and compelling when the supervised patient’s history and character are ―marked by chaos, pronounced dissociative processes, early trauma, or a combination of these‖ (p. 8). The programs of the administrators that participated in this study served at-risk children, many of whom lived in families and communities with a host of extremely challenging circumstances (e.g., violence, substance abuse, physical abuse, poverty, etc.). In some cases, administrators lived in the same communities and for this and other reasons identified with the children and families

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they served. This created a complex form of parallel process in the consultantadministrator relationship, making it a doubly daunting experience in terms of the many relational fields involved (Frawley-O’Dea, 1997).

Credibility and Limitations of the Study Credibility The constructivist view as proposed by Charmaz (2000, 2006) that was used in this study views grounded theory as offering plausible accounts rather than contributing verified knowledge as done in quantitative research. According to Charmaz, the credibility of grounded theory research requires (a) achieving intimate familiarity with the research topic; (b) sufficient range, number, and depth of observations contained in the data; (c) categories that cover a wide range of empirical observations; (d) strong logical links between gathered data and the researcher’s argument and analysis; and (e) providing enough evidence for the researcher’s claim to allow the reader to form an independent assessment and agree with the researcher’s claim. The results obtained and presented in chapters IV through XII meet the credibility criteria outlined by Charmaz.

Results from this study show sufficient range and depth in the data, wide-ranging categories based on participants’ narratives, and sufficient and strong links between the data and the researcher’s analysis and findings. The researcher presented sufficient evidence for readers to form an independent assessment of the credibility of the research.

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Member Checking As described in the methodology section for this study, the researcher used the grounded theory technique of member checking as defined by Strauss & Corbin (1998) to determine credibility by determining if what she found in the data and her interpretation of the data matched participantsâ&#x20AC;&#x2122; experiences of the consultant-administrator relationship.

At the time of the interview, each participant was informed that they would be asked to review the results of the study to confirm and fine-tune the researcherâ&#x20AC;&#x2122;s interpretation of the data. Consultants were e-mailed the three chapters of consultant results and the two chapters of results for consultant-administrator pairs. Similarly, administrators were emailed the three chapters of results for administrators and the two chapters of results for consultant-administrator pairs.

Of the 10 consultants and 15 administrators that participated in this study, five consultants and five administrators responded to the member checking request. Other participants expressed their intention to provide feedback on the results. However, the researcher did not receive further responses after sending an e-mail reminder and leaving a voice message for participants. Some of the participants that expressed their intention to respond, yet did not, stated that they were very busy and that it was difficult to find the time to read the results. The low percentage of response may also be a result of the Erikson/ISBE IECMHC Project and the interview process for this study having ended significantly before the member checking phase of this study. Therefore, participants might have chosen not to revisit their experience because they felt disconnected from their experience of the project and the study by the time of the member checking. Those

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participants that did provide feedback on the results did so in the form of brief comments that were received by the researcher via e-mail.

Consultants The five consultants that participated in the member checking for this study reported that the results matched their experiences in different ways. One stated that like other consultants she had feelings of not being sure what administrators wanted from her and felt frustrated when they would not make the time for her. However, this consultant expressed that she did not have any significant struggles with administrators wanting her to provide consultation services that fell outside the project model, and that she knew that was not her role. Two consultants expressed that they felt that they had more positive experiences with administrators than many of the other consultants. However, one of these consultants stated that she felt the results accurately reflected what she had heard other consultants talking about in the group supervision she received through Erikson Institute for consultants. This consultant also stated that she felt the finding that it is easier to work with administrators with similar professional backgrounds was congruent with her own experience. Interestingly, the second consultant that stated that she felt her experiences with administrators were more positive than the results reported had expressed in the interview process how intense and difficult being a consultant is.

Another consultant stated that she could identify with the results and the different categories and, in particular, the need for both programmatic and child/family/teacher centered consultation. Some of the consultants expressed their appreciation to the researcher for conducting this study and their hope that it would provide useful

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information to the field of early childhood mental health consultation. One consultant in particular stated that she appreciated that the study offered consultants a chance to reflect on and process their experiences on the project, and that based on the results, it was very necessary for consultants to have this opportunity.

Administrators Similar to consultants, the five administrators that participated in the member checking for this study felt that the results matched their experience in some way. One expressed surprise at how similar many of the other administrators’ and programs’ experiences were to her own, and felt that the researcher captured the most important aspects of the consultation project. A second tier administrator, who expressed having a positive experience with the consultant she worked with, stated that she found the results that identified differences between first and second tier administrators’ experiences to be interesting. Another administrator stated that the results generally matched her experience with the project and that the way that the data analyzed the responses and broke experiences down into categories actually helped her to examine the relationship in a more critical light. One of the two first tier administrators that participated in the study expressed that the results pretty accurately reflect the program’s experience with the consultants they worked with. Finally, one administrator felt that the results matched her experience but also provided her with knowledge of how other programs used their consultants.

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Limitations Constructivist grounded theory research takes into account that what a researcher defines as data, and how he or she interprets the data, will be influenced by the researcherâ&#x20AC;&#x2122;s biases. It is therefore considered that in this study the researcher had a particular and subjective interpretation of the data. The constructivist view assumes a fixed yet ever-changing world, and also recognizes the diverse local worlds and multiple realities of individuals. This study takes into account the complexities of particular worlds, views, and actions as those expressed by participants and therefore may not be representative of other consultants and administrators. Given that the focus of this study was limited to the Erikson/ISBE IECMHC Project at a specific point in time and that the sample size was relatively small given the size of the project, it may not be possible to generalize the findings of this study to other early childhood mental health consultation projects.

Clinical Implications Clinical implications of this study of the intersubjective experience of the consultant-administrator relationship provide ideas for the structure and implementation of early childhood consultation models in four areas. On a structural level, consultants and administrators that participated in this study expressed their experience of the usefulness and challenges of the consultation model used by the Erikson/ISBE IECMHC Project. From a direct practice perspective, the results and findings of this study illuminate and reflect participantsâ&#x20AC;&#x2122; experience of the engagement process, working together, and the termination process.

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Implication 1: Consultation Model Conoley, Conoley, & Gumm (1992) found that problem formulation is an interactive phenomenon and, therefore, a collaborative (early childhood experts, early childhood mental health consultation consultants, and early childhood program administrators) evaluation of problems to be addressed by consultation could be helpful in ensuring that an effective consultation model is developed. The Erikson/ISBE IECMHC Project used a programmatic, relationship-based reflective practice model.

Consultants provided weekly, bimonthly, or monthly on site consultation to ISBE-funded early childhood programs. To initiate consultation, consultants contacted administrators of these programs and asked if they were interested in participating in the project.

Administrators were informed that participation in the project was voluntary for programs. Consultants described the programmatic model that was used by the project in their initial meeting with administrators. In the Erikson/ISBE IECMHC Project programmatic model, consultants were expected to work directly with administrators and staff, and to facilitate a reflective process that involved meeting with the consultant on a regular basis to discuss and reflect on the work that was being done in the program. The goal of the programmatic model was to help administrators and staff expand the ways in which they view their work in an effort to create sustainable change within the systems of early childhood programs so that they can provide more effective services to children and families. Early on in the project, consultants were able to provide trainings to staff on early childhood topics, but this was phased out later on in the project. Consultants did not provide any direct service to the children and families.

According to the participants in this study, even though administrators were

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informed of the Erikson/ISBE IECMHC Projectâ&#x20AC;&#x2122;s programmatic consultation approach, it was challenging for many consultants and administrators to effectively utilize and/or adhere to the model. A primary reason it was difficult for consultants to adhere to the model was that it was difficult for consultants to engage administrators in regularly scheduled reflective practice meetings. Administrators expressed wishing that consultants had been able to provide direct service to the families they served given that the consultants had expertise in this area and that the families could benefit from these services. Many administrators also stated that they viewed the consultant as a mental health expert that could be best utilized by working directly with frontline staff.

In this study, it was difficult for consultants to effectively engage administrators using a programmatic reflective consultation model when the consultant and administrator did not agree on how best to meet the mental health consultation needs of the program. Drawing from the results of this study, early childhood consultation models may be more effective if they are designed collaboratively, or co-created, by consultants and administrators. Early childhood mental health consultation models also require adequately trained consultants. There is a need for more targeted and effective training methods and programs for early childhood mental health consultants both within and outside of graduate education programs. With the goal of developing effective consultation models and increasing the number of adequately trained consultants, early childhood mental health consultation should be built into every early childhood program.

Implication 2: The Engagement Process Donohue, Falk, & Provet (2000) suggest that the first task for the consultant is to

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try and step into the administrator’s shoes, and to appreciate the delicate balancing act that administrators face every day. One of the most important findings of this study suggests that it may be extremely useful for consultants to understand and approach the engagement process from a contemporary relational psychoanalytic perspective. All of the consultants that participated in this study described their experience of the engagement process with administrators to be challenging, frustrating, and very slowgoing. Consultants entered the engagement process by attempting to engage administrators in meeting regularly, preferably weekly, to reflectively discuss their program. For various reasons, many administrators resisted meeting regularly with consultants individually. Over time, only some of the administrators came to find meeting with the consultant individually to be valuable.

In thinking of the engagement process as an enactment involving resistance, transference, and countertransference rather than a process of attempting with great effort to engage a resistant administrator, consultants may find the engagement process to be far more useful and less challenging. From a contemporary relational psychoanalytic perspective of enactments, the consultant would not have the expectation that the goal of the engagement process is for the administrator to conform to the consultant’s way of working. Rather, upon entering the relationship through the form of an enactment, the consultant would discover herself ―embedded in the structures and strictures of repetitive configurations of the [administrator’s] relational matrix‖ (Mitchell, 1988, p. 292). By living out the administrator’s world through an enactment, the consultant gains access into the administrator’s internal world as it relates to her role as an administrator (Gerson, 2004). It is through this process that the consultant and administrator can begin co-

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creating new experiences and expanded ways of thinking about the mental health needs of the children and families served by the program.

Implication 3: The Consultant-Administrator Relationship Consultant and administrator participants in this study described the consultantadministrator relationship as being influenced by multiple dimensions. Based on this finding, it is important for consultants to take into consideration their own and administratorsâ&#x20AC;&#x2122; intrapsychic or internal processes; the interpersonal dimensions of the relationship; and the larger cultural, social, economic, and political forces that affect programs. One way for consultants to think about these dimensions is found in the concept of â&#x20AC;&#x2022;thirdnessâ&#x20AC;&#x2013; as described by Cavell (1988). For Cavell, the third is an entity beyond the dyad which may be real or imagined and permits experiences that arise within the dyad to be reflectively organized through shared as well as external experiences.

In the narratives of consultants and administrators, the consultant-administrator relationship was depicted as functioning as a container for emotions experienced within the consultation matrix. Specifically, consultants and administrators experienced the strong presence of overwhelming emotional experiences that entered into the relationship originating from the many individuals in the consultation field (front-line staff, children, families) seeking emotional containment from consultants and administrators to help them manage their overwhelming emotional experiences. By having an awareness of this phenomenon as it occurs in the consultant-administrator relationship, consultants may be better able to understand, listen for, and help manage the emotional impact of working with at-risk children and families on administrators and front-line staff. Consultants will

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also be in a better position to help administrators better understand, listen for, and manage the emotional impact of working with at-risk children and families on their staff.

Implication 4: The Termination Process Based on the findings of this study, termination should be considered a separate and important phase of the consultant-administrator relationship that has unique clinical implications. In this study, consultants and administrators expressed the difficulty of going through an abrupt termination of the Erikson/ISBE IECMHC Project. The difficulty of termination due to funding problems was exacerbated by the funding problems experienced by administrators that simultaneously threatened the stability and/or existence of their early childhood programs. Given the abrupt nature of the termination of the project as expressed by consultants and the consequent loss of their jobs, termination proved very challenging for consultants. In terms of the consultantadministrator relationship, this made it difficult for consultants to provide support to programs during the termination process and to help transition programs so that they felt prepared to meet the mental health needs of children and families once consultation ended.

Johnson and Tittnich (2004) suggest that termination is a common stage of consultation and that it is therefore important to acknowledge separations, endings, and goodbyes. They argue that a â&#x20AC;&#x2022;clear endpoint to the consultation process establishes boundaries around the consultation experienceâ&#x20AC;&#x2013; (p. 46). Early childhood mental health consultation should have clear but flexible termination criteria. Termination of mental health consultation services should be planned and allow for enough time for all involved

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to navigate the termination process as â&#x20AC;&#x2022;successfullyâ&#x20AC;&#x2013; as possible. A transition plan should be made so that the administrator understands how, without the support of the consultant, the program will address the mental health needs of the children and families served. It is also important for consultants to take into consideration the experiences of administrators, program staff, and the children and families served by programs during the termination phase of consultation. Finally, support for consultants through clinical supervision is indicated so that consultants are able to process their own reactions to termination of consultation services. In this study, this was made evident in consultantsâ&#x20AC;&#x2122; narratives of their experience of termination, and in their use of the interviews to process the termination of their relationships with administrators, and the project.

Social Implications The social-emotional well-being of young children has tremendous implications for society. Young children with social-emotional and behavioral problems have been found to have a myriad of problems later in life. Reaching young children and their families through early childhood mental health consultation provided to them in their community is an extremely effective way to provide prevention and early intervention services, especially to those that are at risk for serious problems. Findings from this study illuminate the need for those who directly work to support young children and their families to receive ongoing support from professionals trained in early childhood development, with a special emphasis on mental health. This study also underscores the importance for policy makers and society at large to secure and provide the necessary

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resources needed to design and implement effective statewide early childhood mental health consultation projects for all early childhood programs.

Future Research The findings of this study provide a foundational theory of the intersubjective experience of the early childhood mental health consultantâ&#x20AC;&#x201C;program administrator relationship. The consultant-administrator relationship has been described as a key relationship in early childhood mental health consultation, yet remains inadequately studied. This study provides insight into a specific group of consultant-administrator dyads. Further studies of the consultant-administrator relationship as experienced by consultants and administrators from a range of consultation projects and at different points in time during the course of the consultation process would be useful.

This study elicited consultantsâ&#x20AC;&#x2122; and administratorsâ&#x20AC;&#x2122; perceptions of the experience of the relationships they developed with each other. There were significant differences in the perceptions and experiences of consultants and administrators in the areas of engagement and usefulness of consultation. Further exploration into these differences would provide useful information for developing early childhood mental health consultation models. It was found that the consultant-administrator relationship is an extremely complex relationship with multiple dimensions. Additional qualitative studies that explore the various dimensions that influence the consultant-administrator relationship could be extremely useful to the field of early childhood mental health consultation. The intrapsychic and interpersonal processes that affect the consultantadministrator relationship are among the specific things that would be useful to study.

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Based on the findings of this study, the phenomenon and process of emotional communication and containment within the consultant-administrator relationship is also an important area to be considered for future research.

Final Thoughts This study set out to investigate the intersubjective experience of consultantadministrator (consultee) dyads that worked together on the Erikson/ISBE Infant and Early Childhood Mental Health Consultation Project. The stories that were shared by participants provided rich, complex, and illuminating data. Data obtained from consultants revealed the many internal, external, and interpersonal dimensions that they encounter in their relationships with early childhood program administrators. As powerfully, the administrators gave voice to their experience and role in the consultation process in ways that brought to life the multiple challenges they face in working to support young children and their families. Despite the increase in early childhood research, early childhood mental health consultation is a field that is considered important yet continues to be undervalued and underfunded. It is the researcherâ&#x20AC;&#x2122;s hope that this study will shine a light on the importance of supporting early childhood mental health consultation projects.

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APPENDIX A RECRUITMENT NOTICE

194

Infant and Early Childhood Mental Health Consultation Study: Participant Invitation

I am a doctoral student at the Institute for Clinical Social Work, and former Erikson/ISBE IECMHC Project consultant. I am conducting a study for my doctoral dissertation entitled: “The Intersubjective Experience of the Early Childhood Mental Health Consultant – Program Administrator Relationship” The purpose of this study is to find out about the thoughts and perceptions of consultants and program administrators who participated in the Erikson/ISBE IECMHC project regarding their experience of the consultant-administrator relationship so I can look for themes that emerge within the consultant-administrator relationship.

Findings from the study may be used in the education and training of infant and early childhood mental health consultants. Findings from the study may also potentially guide much needed future research on the infant and early childhood mental health consultation process, and help to develop more effective models of infant and early childhood mental health consultation. The final dissertation will be published.

Participants will be asked to fill out a brief questionnaire, take part in a one-time individual in-person interview with the researcher that will not last more than 60 minutes and take part in a brief 15-30 minute in-person or telephone follow-up interview so participants can review the findings of the study and provide feedback to the researcher.

In-person interviews will take place at the participant’s location of choice (participant’s home or office, or researcher’s office).

Participation in this study is completely voluntary and participants’ identity will be kept confidential. The study will be conducted by the researcher through the Institute of Clinical Social Work, which is completely independent from Erikson Institute, the Herr Research Center and ISBE. Participation in the study will in no way threaten participants’ relationships with Erikson Institute or ISBE. If you are interested in participating in the study, please contact: Laura Orogun: (847) 602-2876 or lorogun@sbcglobal.net

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APPENDIX B INFORMED CONSENT FORM

196

Individual Consent for Participation in Research INSTITUTE FOR CLINICAL SOCIAL WORK

I, , acting for myself, agree to take part in the research entitled: ―The Experience of the Early Childhood Mental Health Consultant–Program Administrator Relationship.‖ This research will be carried out by Laura Mick Orogun, L.C.S.W., Principal Researcher, under the supervision of R. Dennis Shelby, Ph.D., L.C.S.W. This work is supported by Erikson Institute and conducted under the auspices of the Institute for Clinical Social Work, 200 N. Michigan Ave., Suite 407, Chicago, IL 60601, (312) 726-8480.

Purpose This is a research study that involves talking to early childhood mental health consultants and early childhood program administrators involved in the Erikson/ISBE Infant and Early Childhood Mental Health Consultation (IECMHC) Project. The purpose of this study is to find out about each individual’s thoughts and perceptions about their experience of the consultant–administrator relationship. The hope is that the information collected from this study can be used to help professionals who work in the field of early childhood mental health consultation better understand the consultation process that occurs between mental health consultants and program administrators. The goal is to use this information to increase the effectiveness of the early childhood mental health consultation process.

Procedures Used In The Study And The Duration If you agree to participate in this study, you will be asked to take part in a one time interview that will not last more than 60 minutes, and a follow-up meeting to review the findings of the study that will not last longer than 45 minutes. The interviews will be audio recorded so that the conversation can be transcribed into written documents later so that the researcher can look for themes in what you said about your experience in the consultant-director relationship. At the time of the interview, you will also be asked to fill out a brief questionnaire about your educational and professional experience. These three components of your participation in this study relate in some way to finding out about your experience of the consultant-director relationship.

Benefits Information gained from your sharing your experiences may help to improve our knowledge and understanding of the early childhood mental health consultation process that occurs between mental health consultants and program directors. What is learned

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from this study may also contribute to the professional development of early childhood mental health consultants and other individuals who work in the field of early childhood education and mental health consultation. The results of this study will hopefully increase the effectiveness of mental health consultation and may therefore have a positive impact on the lives of young children and families who receive mental health consultation services directly or indirectly.

Costs There is no cost for participation in this study.

Possible Risks and/or Side Effects The potential risks to you for talking about your experience of the consultant-director relationship as part of this study are minimal. There is no possibility that you will be physically hurt in any way, and nothing you say will cause you any problems regarding your involvement in the Erikson/ISBE Mental Health Consultation Project. The only possible risk to you is that you may feel uncomfortable sharing your private information or talking about your experience of the consultant- administrator relationship. Because some of the things talked about might feel very personal, if you start to feel uneasy, you have the right to skip questions that you do not want to respond to. You can also choose to take a break during the interview, and you can end the interview altogether at any time without any consequence. If at some point you decide that you would like to talk more about your experience of the consultant- administrator relationship or any feeling that might have been brought up during the interview the researcher can help you find a professional that you can continue to talk to about these issues.

Privacy and Confidentiality The researcher will make every effort to protect your privacy and confidentiality. Your name will not be written down on the questionnaire nor will any other specific information identify you. The audio recordings of the interviews will be transcribed on a computer as a word for word conversation shortly after the interview by either the researcher or a professional transcription service. The audio recordings of the interview, the transcription/written interview, and the questionnaire will be labeled with a number only. These items will be stored either in the secure location of the researcherâ&#x20AC;&#x2122;s personal computer that can only be accessed through a password known only to the researcher or a locked file cabinet in principal researcherâ&#x20AC;&#x2122;s home that only the researcher has access to.

Actual digital recordings used for collection of interview data will be erased or destroyed after one year. If the researcher uses a professional transcription service to transcribe the interview discussion, the researcher will make sure that the transcriber erases and/or destroys all information they have from the interviews on their computer. The transcribed/written interviews and questionnaires will be kept by the researcher for five

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years after the dissertation is approved. None of your specific information will be shared with anyone from Erikson Institute, and your participation in this study will not affect your relationship with Erikson Institute or the Illinois State Board of Education. The dissertation study will be a permanent record. No one else will have access to the information.

Subject Assurances By signing this consent form, I agree to take part in this study. I have not given up any of my rights or released this institution from responsibility for carelessness.

I may cancel my consent and refuse to continue in this study at any time without penalty or loss of benefits. My relationship with the staff of the Institute for Clinical Social Work (ICSW) will not be affected in any way, now or in the future, if I refuse to take part, or if I begin the study and then withdraw.

If I have any questions about the research methods, I may contact Laura Orogun, LCSW, Principal Researcher at (847) 602-2876 or Dennis Shelby, Ph.D., Chair of the Researcherâ&#x20AC;&#x2122;s Dissertation Committee at (312) 726-4840. If I have any questions about my rights as a research subject, I may contact Daniel Rosenfeld, Chair of Institutional Review Board, ICSW, 200 N. Michigan Ave., Suite 407, Chicago, IL 60601, (312) 7268480.

SIGNATURES I HAVE READ THIS CONSENT FORM AND I AGREE TO TAKE PART IN THIS STUDY AS IT IS EXPLAINED IN THIS CONSENT FORM.

Signature of Participant

Date

I CERTIFY THAT I HAVE EXPLAINED THE RESEARCH TO (Name of Subject) AND BELIEVE THAT THEY UNDERSTAND AND THAT THEY HAVE AGREED TO PARTICIPATE FREELY. I AGREE TO ANSWER ANY ADDITIONAL QUESTIONS WHEN THEY ARISE DURING THE RESEARCH OR AFTERWARD.

Signature of Researcher

Date

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APPENDIX C MENTAL HEALTH CONSULTANT EDUCATION SKILLS & EXPERIENCE INVENTORY (MHC-ESEI)

200 Participant Code:

-

Mental Health Consultant Education, Skills & Experience Inventory (MHC-ESEI)

1. What is your race/ethnicity? (Please mark the one box that describes the race/ethnicity category with which you primarily identify): [ ] Asian or Pacific Islander: Persons having origins in any of the peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa. [ ] African American (not of Hispanic origin): Person having origins in any of the black ethnic groups. [ ] Hispanic: Persons having origins in any of the Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Cultures, regardless of ethnicity. [ ] Native American or Alaskan Native: Persons having origins in any of the original peoples of North America. [ ] Caucasian (not of Hispanic origin): Persons having origins in any of the original peoples of Europe, North Africa or the Middle East. [ ] Other: 2. What is your age? [ ] 20-25 [ ] 25-30 [ ] 30-35 [ ] 35-40 [ ] 40-45 [ ] 45-50 [ ] 50-55 [ ] 55-60 [ ] 60-65 [ ] 65+

201 3. What is your educational background (note all that apply)?

Degree

Area/Field (Education, Child Development, Social Work, Psychology, etc.)

Year Degree Earned

Associates Bachelor Master Doctorate Certificate Other

4. If any of your degrees are in the mental health field, which specific fields are they in? [ ]Social Work

[ ]Counseling

[ ]Psychology

[ ]Other:

5. How many years of experience did you have as an infant and/or early childhood mental health consultant prior to beginning your position as a mental health consultant for the Erikson/ISBE IECMHC Project?

5a. Please describe your experience working as a mental health consultant prior to your experience working for the Erikson/ISBE IECMHC Project.

6. How many total years of experience do you have providing mental health services to children birth to five years old (includes providing therapy, consultation, infant mental health, etc.)? [ [ [ [ [ [ [

] less than 1 year ] 1-2 Years ] 2-3 Years ] 3-5 Years ] 5-7 Years ] 7-10 Years ] more that 10 Years

202

7. What other types of mental health settings have you worked in?

8. Do you have any education, training or work experience in early childhood education other than as an early childhood mental health consultant (e.g., preschool, childcare, etc.)? [ ] Yes

[ ] No

8a. If yes, what is the specific work experience you’ve had?

9. Do you have any education, training or work experience in child development? [ ] Yes

[ ] No

9a. If yes, what is the specific education, training or work experience you’ve had?

10. Do you have any education, training or work experience in adult development? [ ] Yes

[ ] No

10a. If yes, what is the specific education, training or work experience you’ve had?

203 11. Do you have any education, training or work experience in adult therapy, group therapy, family therapy, or systems theory? [ ] Yes

[ ] No

11a. If yes, what is the specific experience youâ&#x20AC;&#x2122;ve had?

12. What education and training do you have in reflective supervision?

13. How many years were you a mental health consultant for the Erikson/ISBE IECMHC Project? [ [ [ [

] less than 1 year ] 1-2 Years ] 2-3 Years ] 3-5 Years

14. What type of programs did you provide services to as a mental health consultant for the Erikson/ISBE IECMHC Project (check all that apply)? [ [ [ [ [ [

] home visiting ] center based ] school district ] prevention initiative (PI) ] pre-kindergarten / pre-school for all (Pre-K) ] other:

15. What are the ages of the children in the Erikson/ISBE IECMHC project programs you served (check all that apply)? [ ] birth to three years old [ ] three to five years old [ ] other:

204

16. What type of services did you provide as an Erikson/ISBE IECMHC Project mental health consultant to programs (check all that apply)? [ [ [ [ [ [ [ [

] program/classroom observation (e.g., â&#x20AC;&#x153;mindful hanging outâ&#x20AC;?) ] consultation with directors/program administrators ] consultation with staff/teachers/childcare providers ] consultation with home visitors ] consultation with family support staff ] consultation with parents ] trainings ] other:

17. Who did you work with most frequently in the programs you served as an Erikson/ISBE IECMHC project mental health consultant? [ [ [ [ [ [ [

] program administrators/directors ] staff/teachers/childcare providers ] home visitors ] family support staff ] children ] parents ] other:

205

APPENDIX D PROGRAM ADMINISTRATOR EDUCATION SKILLS & EXPERIENCE INVENTORY (PA-ESEI)

206 Participant Code:

-

Program Administrator Education, Skills & Experience Inventory (PA-ESEI)

1. What is your race/ethnicity? (Please mark the one box that describes the race/ethnicity category with which you primarily identify.) [ ] Asian or Pacific Islander: Persons having origins in any of the peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa. [ ] African American (not of Hispanic origin): Person having origins in any of the black ethnic groups. [ ] Hispanic: Persons having origins in any of the Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Cultures, regardless of ethnicity. [ ] Native American or Alaskan Native: Persons having origins in any of the original peoples of North America. [ ] Caucasian (not of Hispanic origin): Persons having origins in any of the original peoples of Europe, North Africa or the Middle East. [ ] Other:

2. What is your age? [ ] 20-25 [ ] 25-30 [ ] 30-35 [ ] 35-40 [ ] 40-45 [ ] 45-50 [ ] 50-55 [ ] 55-60 [ ] 60-65 [ ] 65+

207 3. What is your educational background (note all that apply)?

Degree

Area/Field (Education, Child Development, Social Work, Psychology, etc.)

Year Degree Earned

Associates Bachelor Master Doctorate Certificate Other

4. Please check the description that best describes your program (check all that apply): [ [ [ [ [ [

] home visiting ] center based ] school district ] prevention initiative (PI) ] pre-kindergarten / pre-school for all (Pre-K) ] other:

5. What are the ages of the children served in your program? [ [ [ [

] birth to three years old ] three to five years old ] birth to five years old ] other:

6. How many children are currently enrolled in your program?

7.

8. [ [ [ [ [

Please indicate the number and type of staff members in your program: ] administrators ] teachers/childcare providers ] other (please list type and number): Type: ] other (please list type and number): Type: ] other (please list type and number): Type:

Number: Number: Number:

208

9. What is your position/title at the program you currently work for?

8a. How many years have you been in this position?

10. Were you a direct service provider in the program you are currently the administrator/director of prior to becoming the program administrator/director? [ ] Yes

[ ] No

9a. If yes, how many years were you a direct service provider before becoming the program administrator/director? [ [ [ [ [ [ [

] less than 1 year ] 1-2 Years ] 2-3 Years ] 3-5 Years ] 5-7 Years ] 7-10 Years ] more that 10 Years

11. How many total years of experience do you have as a birth to three coordinator and/or infant/early childhood program administrator/director? [ [ [ [ [ [ [

] less than 1 year ] 1-2 Years ] 2-3 Years ] 3-5 Years ] 5-7 Years ] 7-10 Years ] more that 10 Years

12. How many years of work experience do you have in child development, family support and/or infant/early childhood education? [ [ [ [ [ [ [

] less than 1 year ] 1-2 Years ] 2-3 Years ] 3-5 Years ] 5-7 Years ] 7-10 Years ] more that 10 Years

209

13. How many years of work experience do you have as an infant or early childhood (0-5 yearsold) direct service provider (teacher, home visitor, etc.)? [ [ [ [ [ [ [ [

] none ] less than 1 year ] 1-2 Years ] 2-3 Years ] 3-5 Years ] 5-7 Years ] 7-10 Years ] more that 10 Years

14. Do you have any training in or previous experience with reflective practice or supervision? [ ] Yes

[ ] No

13a. If yes, what specific training or experience do you have?

15. Did you or your program ever receive infant or early childhood mental health consultation services before participating in the Erikson/ISBE IECMHC Project? [ ] Yes

[ ] No

14a. If yes, please briefly describe:

16. How long did you receive mental health consultation services through the Erikson/ISBE IECMHC Project? [ [ [ [

] less than 1 year ] 1-2 years ] 2-3 years ] 3-5 years

210 17. How frequently did you meet with the Erikson/ISBE IECMHC mental health consultant? [ [ [ [

] weekly ] two to three times per month ] monthly ] other:

16a. Did the frequency seem adequate? [ ] Yes

[ ] No

16b. If no, how frequently would you liked to have met with the mental health consultant?

18. Rate the services provided by the Erikson/ISBE consultant in the order they were helpful to your program (1=most helpful, 7=least helpful). [ [ [ [ [ [ [ [

] reflective consultation with program administrators ] I-CARE Process (staff questionnaires, goal-setting, etc.) ] reflective consultation with staff/teachers/providers/ home visitors ] case consultation with staff/teachers/providers/ home visitors ] classroom observation ] trainings/workshops ] consultation with parents ] other:

19. How could the Erikson/ISBE consultant have met your programâ&#x20AC;&#x2122;s mental health consultation needs better?

20. How could the Erikson/ISBE consultant have worked with you, the program administrator, more effectively?

211

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