1. EARLY CHILDHOOD MENTAL HEALTH CONSULTATION AND INCREDIBLE YEARS An 8 year project implementation at Morrison Child and Family Services Portland, Oregon

2. ECMHC & Incredible Years Portland, Oregon Kathryn Falkenstern, MSW, LCSW Kathryn Falkenstern, MSW, LCSW Clinical Supervisor Clinical Supervisor Morrison Child and Family Services Morrison Child and Family Services 15 sites located in Portland, Oregon. 15 sites located in Portland, Oregon. Provides a comprehensive range of community mental health, substance abuse, juvenile justice, and prevention services to more than 5,000 children and their families. Provides a comprehensive range of community mental health, substance abuse, juvenile justice, and prevention services to more than 5,000 children and their families. Programs include outpatient counseling, early childhood mental health consultation, parent education, home and school-based programs, and foster care, residential, and day treatment. Programs include outpatient counseling, early childhood mental health consultation, parent education, home and school-based programs, and foster care, residential, and day treatment.

3. Agenda Introduction of the ECMHC and IY Project in Portland, OR Introduction of the ECMHC and IY Project in Portland, OR The Incredible Years Objectives The Incredible Years Objectives Project Design Project Design Advantages of addition IY to ECMHC services Advantages of addition IY to ECMHC services Implementation Lessons Learned Implementation Lessons Learned Evaluation Evaluation

4. 3 year grant from The Substance Abuse and Mental Health Services Administration (SAMHSA) 3 year grant from The Substance Abuse and Mental Health Services Administration (SAMHSA) Received by Multnomah County Behavioral Health. Received by Multnomah County Behavioral Health. Morrison implemented the service component of the grant. Morrison implemented the service component of the grant. Funded: Funded: Early Childhood Mental Health Consultation (ECMHC) Early Childhood Mental Health Consultation (ECMHC) Incredible Years Parent Groups at childcare programs. Incredible Years Parent Groups at childcare programs. This project ran from 2002 – 2005. This project ran from 2002 – 2005. 2002 Initial Implementation

5. Team: Team: 2 members at 1.75 FTE with one part-time support person. 2 members at 1.75 FTE with one part-time support person..3 of supervisors time..3 of supervisors time. Implementation Implementation Two staff as well as the Supervisor and Director of Outpatient programs were trained in The Incredible Years Parent Program. Two staff as well as the Supervisor and Director of Outpatient programs were trained in The Incredible Years Parent Program. ECMHC offered to four childcare sites. ECMHC offered to four childcare sites. IY parent groups offered at the rate of about 6 per year, two at a time. IY parent groups offered at the rate of about 6 per year, two at a time. 2002 Initial Implementation

6. 2003 Sustainable Funding: The Portland Childrens Investment Fund 2000, Dan Saltzman, Portland City Commissioner, developed The Portland Childrens Investment Fund. 2000, Dan Saltzman, Portland City Commissioner, developed The Portland Childrens Investment Fund. 2001, Portland voters passed levy with 53% approval and renewed in 2009 with 73% support. Pooled approximately 10 million dollars per year at a cost of about $60 per year for the average Portland homeowner. 2001, Portland voters passed levy with 53% approval and renewed in 2009 with 73% support. Pooled approximately 10 million dollars per year at a cost of about $60 per year for the average Portland homeowner. Funding supported 66 different programs for children in 4 categories: Funding supported 66 different programs for children in 4 categories: Early childhood health and education Early childhood health and education After-school and mentoring programs After-school and mentoring programs Child abuse prevention & intervention Child abuse prevention & intervention Support for children in foster care. Support for children in foster care.

7. 2003 Sustainable Funding: The Portland Childrens Investment Fund Levy: Levy: operated with a 5% administrative cap operated with a 5% administrative cap required agencies to invest in proven programs and track and report outcomes via yearly audit. required agencies to invest in proven programs and track and report outcomes via yearly audit. For more information on The Portland Childrens Levy: For more information on The Portland Childrens Levy: www.portlandchildrenslevy.org www.portlandchildrenslevy.org www.portlandchildrenslevy.org http://bayopliskonesansrenmenyoplis.org/docs/TheChildre nsTrustBook.pdf http://bayopliskonesansrenmenyoplis.org/docs/TheChildre nsTrustBook.pdf http://bayopliskonesansrenmenyoplis.org/docs/TheChildre nsTrustBook.pdf http://bayopliskonesansrenmenyoplis.org/docs/TheChildre nsTrustBook.pdf

8. The Incredible Years Parent, child and teacher training programs Parent, child and teacher training programs Goals: Goals: to prevent, reduce, & treat aggression and behavior problems in young children. to prevent, reduce, & treat aggression and behavior problems in young children. Promote social, emotional, and academic competence Promote social, emotional, and academic competencewww.incredibleyears.com

9. Incredible Years Parenting Series: Methods & Processes Relationship: collaborative process Relationship: collaborative process Culturally sensitive Culturally sensitive Video modeling/DVDs Video modeling/DVDs Role play practice & rehearsal Role play practice & rehearsal Home assignments Home assignments Group support Group support

10. Project Design: ECMHC Integrating Evidenced Based Parent Groups ECMHC Components: ECMHC Components: Child and family specific consultation Child and family specific consultation Child observations/screenings Child observations/screenings Parent/teacher coaching Parent/teacher coaching Evidenced Based Groups: Evidenced Based Groups: Primarily IY Parent Group (Basic preschool series) Primarily IY Parent Group (Basic preschool series) Also, offer the Advanced Parent Series; Infant Group Also, offer the Advanced Parent Series; Infant Group Incredible Years Dinosaur School Incredible Years Dinosaur School CBT based parent stress/mood mgt classes CBT based parent stress/mood mgt classes

11. Project Design…continued Program Level Consultation Adapted from Incredible Years principles Social/Emotional Circle-time activity with puppets teaching : Self-regulation skills Friendship skills Emotional literacy Problem solving Utilized IY training to design classroom strategies Staff trainings

12. Special Populations Work with or assist with referrals for any family in our designated childcare centers. Work with or assist with referrals for any family in our designated childcare centers. Work towards maintaining a child in the normative settings through both ECMHC and Incredible Years offerings. Work towards maintaining a child in the normative settings through both ECMHC and Incredible Years offerings. Offer a limited number of Dinosaur School pull out groups for top of the pyramid children. Offer a limited number of Dinosaur School pull out groups for top of the pyramid children. Offer IY groups with translation and/or led by bi- lingual staff. Offer IY groups with translation and/or led by bi- lingual staff.

13. Mental Health Staff training and credentials Mental Health Staff training and credentials 5.5 FTE (7 staff members) of masters level mental health staff with Early Childhood experience/training. 5.5 FTE (7 staff members) of masters level mental health staff with Early Childhood experience/training. 5 of 7 are licensed mental health professionals. 5 of 7 are licensed mental health professionals. All are trained in IY Basic, Advanced, and Dinosaur School. All are trained in IY Basic, Advanced, and Dinosaur School. 5 of 7 have achieved certification in IY. 5 of 7 have achieved certification in IY. One person is a mentor/trainer, and may train others within our agency. One person is a mentor/trainer, and may train others within our agency.

14. Role of the Mental Health Staff Each Staff member is assigned to one or more early childhood care/education sites. Each Staff member is assigned to one or more early childhood care/education sites. Each Consultant position includes the role of evidenced based group leader. Each Consultant position includes the role of evidenced based group leader.

15. Team Approach to Consultation Consultant Staff: Consultant Staff: Plan and co-lead groups together Plan and co-lead groups together Collaborate in recruitment efforts for groups Collaborate in recruitment efforts for groups Substitute in groups when a regular leader is absent Substitute in groups when a regular leader is absent Form a learning environment of sharing ideas and mentoring newer consultants Form a learning environment of sharing ideas and mentoring newer consultants Provide peer support Provide peer support

16. ECMHC Role Initial role Initial role Establishing relationships within the childcare center with administrators, teachers/childcare staff, and families. Establishing relationships within the childcare center with administrators, teachers/childcare staff, and families. Begin initial ECMHC roles, such as child observations, teacher support. Begin initial ECMHC roles, such as child observations, teacher support. Promote upcoming Incredible Years Parent Groups at all levels with the ECE site. Promote upcoming Incredible Years Parent Groups at all levels with the ECE site.

17. Forming the IY Parent Group: Think Relationship Recruitment Strategies: Recruitment Strategies: Relationship with Childcare Center Staff Relationship with Childcare Center Staff Flyers : Flyers : Used only in conjunction with other more dynamic forms of recruitment. Used only in conjunction with other more dynamic forms of recruitment. Dont over rely on flyers as a recruitment strategy Dont over rely on flyers as a recruitment strategy

18. Forming the IY Parent Group: Think Relationship Recruitment Strategies: Recruitment Strategies: Direct Recruitment with Parents: Direct Recruitment with Parents: Juice and Cookies recruitment: Juice and Cookies recruitment: Consultant meets and talks one-on-one with parents about the group at drop of or pick up time at the childcare center.. Consultant meets and talks one-on-one with parents about the group at drop of or pick up time at the childcare center.. LET US MAKE YOU DINNER AND WATCH THE KIDS…. while you connect with other parents and enhance your parenting skills… LET US MAKE YOU DINNER AND WATCH THE KIDS…. while you connect with other parents and enhance your parenting skills… Promotion at other childcare center events: Promotion at other childcare center events: Parent Nights Parent Nights Holiday Parties Holiday Parties

19. Forming the Group…continued: Indirect Recruitment Indirect Recruitment Promotion with teachers/childcare staff who encourage parents to attend Promotion with teachers/childcare staff who encourage parents to attend Works best after the IY Program has been established in the center and teachers have confidence in it. Works best after the IY Program has been established in the center and teachers have confidence in it. Use of incentives to reward teachers for their efforts at promotion. Use of incentives to reward teachers for their efforts at promotion. Coordinated Recruitment Coordinated Recruitment Consultant and Teacher collaborate to approach selected families who may particularly benefit from the group. Consultant and Teacher collaborate to approach selected families who may particularly benefit from the group.

20. Decreasing Barriers to Attendance All parents at the center are invited to attend…not just parents identified as needing parenting help. All parents at the center are invited to attend…not just parents identified as needing parenting help. The IY group is held at the childcare center The IY group is held at the childcare center decreases transportation issues decreases transportation issues decreases stigma decreases stigma Dinner offered Dinner offered Childcare Childcare Transportation supports Transportation supports

21. Groups Offered Yearly Team offers each year: Team offers each year: 10 Incredible Years Parent Groups 10 Incredible Years Parent Groups 2 Dinosaur School Groups 2 Dinosaur School Groups 4 Parent Stress/Mood Mgt Prevention Groups based on CBT principles. 4 Parent Stress/Mood Mgt Prevention Groups based on CBT principles.

22. Advantages of combining ECMHC with Incredible Years Enhances the Consultants visibility and role within the ECE center Enhances the Consultants visibility and role within the ECE center Extends what the Consultant can offer to families Extends what the Consultant can offer to families Builds rapport with parents at the center Builds rapport with parents at the center Increases practical offerings to ECE program staff Increases practical offerings to ECE program staff

23. Implementation Lessons Learned Hiring the right staff is critical Hiring the right staff is critical Clear job descriptions Clear job descriptions Skills in community based jobs Skills in community based jobs Flexible, team-oriented Flexible, team-oriented Budget Budget Identify all the related costs to offering a group in a community childcare center Identify all the related costs to offering a group in a community childcare center Maintain fidelity of the IY model Maintain fidelity of the IY model Encourage certification Encourage certification Utilize consultation Utilize consultation Take on group recruitment challenges Take on group recruitment challenges Be thorough, patient, and creative Be thorough, patient, and creative

24. Evaluationof IY Groups IY Group Evaluation IY Group Evaluation Pre/post tests: Pre/post tests: DECA - parent and teacher/childcare staff DECA - parent and teacher/childcare staff ECBI - parent ECBI - parent SESBI - teacher SESBI - teacher Parent Satisfaction Survey Parent Satisfaction Survey ECMHC Evaluation ECMHC Evaluation Retrospective Preschool Teacher Survey Retrospective Preschool Teacher Survey Satisfaction Survey Satisfaction Survey

25. IY Parent Outcomes - DECA 151 DECAs collected Findings: Statistically significant change on 3 of 4 subscales (protective factors; self-control; initiative.) p<.001. Statistically significant change on the Behavioral Concerns scale. P<.001

26. ECBI Parent *p<.001

27. Parent Satisfaction 228 surveys collected from IY Parent Groups 228 surveys collected from IY Parent Groups Findings: Findings: 99% would recommend the program 99% would recommend the program 98% reported overall satisfaction with the program 98% reported overall satisfaction with the program 91% were confident they could manage child behavior problems on their own. 91% were confident they could manage child behavior problems on their own.

28. Retrospective Preschool Teacher Survey n=57 *p<.001 Strongly disagree Strongly Agree