Head Start Self-Assessment: Booklet 19 - Child Development and Health Services: Mental Health

Head Start Self-Assessment: Your Foundation for Building Program Excellence

Program Self-Assessment Booklet 19

Child Development and Health Services: Mental Health

Core Question to guide the Self-Assessment team:

How does the grantee implement a comprehensive system of mental health prevention and intervention services for children and families including providing mental health awareness and education to staff?

Purpose:

The purpose is to ensure the healthy mental development of young children enrolled in the program by designing and implementing program practices that support each child’s mental health, prevent mental health problems, and are responsive to identified concerns. (Introduction to 1304.21, p. 58; Introduction to 1304.24, p.116; Introduction to 1304.40, p.125)

This booklet will help the Self-Assessment team determine if the program meets Federal Performance Standards relating to Mental Health Services. Related Performance Standards include: 1304.20(a)(1)(ii)–1304.20(a)(1)(iv); 1304.20(b); 304.20(c)(1); 1304.20(d); 1304.20(e)(2)-1304.20(e)(3); 1304.20(f)(1); 1304.21(a)(3)(i); 1304.21(b)(1)(i)-1304.21(b)(1)(ii); 1304.21(b)(2)(i); 1304.21(c)(1)(iii)-1304.21(c)(1)(vi); 1304.24; 1304.40(b) 1304.40(c)(1)(iii); 1304.40(c)(2); 1304.40(f)(1); 1304.40(f)(4); 1304.41(a)(1)-1304.41(a)(2); 1304.41(c)(1)(ii); 1304.51(a)(1)(iii), 1304.52(j)(3)

As you conduct your assessment of the program’s mental health services, pay close attention to:

The process used by your program to plan and utilize community resources to meet the wellness and mental health needs of children, families, and staff
The process used by your program to screen children to identify needs in the area of mental health
How your program supports families with helpful information about how to respond to children’s behaviors, with a special emphasis on environment and relationships
How your program provides mental health education for families and how services are accessed when families need mental health intervention
How your program responds to the identified behavioral and mental health issues of individual children and groups of children

Helpful tools to support data collection in this area follow.

Before you begin, determine if mental health services in your program are provided directly by program staff or through a contractual agreement with outside individuals or organizations. This information will assist you in planning your approach to the assessment

Review:

Ask the Head Start director and/or responsible manager to provide you with access to the following documents:

Contracts and job descriptions for mental health professionals
Job descriptions of mental health staff and/or staff who oversee the mental health contracts
Posted schedules for mental health professionals
Interagency agreements with community partners providing mental health services to the program
Budget information reflecting allocation for mental health services
Service plan describing mental health services
List of members on any relevant advisory committees and minutes
Confidentiality policies
Information for staff mental health and wellness
Home visitor protocol/curricula
Records/ ongoing monitoring reports of mental health services provided over the past year including tracking for 45 day screening requirements
Staff training and orientation plans, agendas, evaluations, and most recent T/TA Plan
Staff and parent handbooks
Sample child/family files, including files that contain multiple sources of information, documentation of parent involvement, screenings and follow up, family partnership agreements and IEPs/IFSPs
Screening tool(s)
Parent resource information (i.e.: community resource book, parent bulletin boards)
Parent education materials, training agendas, and training evaluations
Individualized plans or reports related to mental health or behavioral concerns for a child or a group of children (e.g. behavioral/treatment plans, report recommendations, classroom charts)
Important data sources relevant to this area such as the PRISM report, results of last year’s self-assessment, PIR data, Community Assessment, strategic plan or short and long term program goals

Use the questions below to assist your document review.

Can you determine from your review of documents listed above if your program has service plans that address both mental wellness and mental health interventions?
Yes No
Comment:___________________________________________________________________________

Is there a written plan describing mental health services for children, families, and staff? Has the plan been updated within the past year to reflect how the program responds to the changing needs of children, families and staff?
Yes No
Comment:___________________________________________________________________________

Do administrative/policy records demonstrate attention to and support of mental health services? (Records of policy council, budgets, records of staff training, reports about mental health service delivery)
Comment___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Are there plans in place to:
Address the mental health needs of children and families involved with traumatic events affecting the program or in the wider community (natural disasters, fire, violence)? Look for examples of emergency plans and follow-up services.
Yes No
Address psychiatric emergencies for children and adults?
Yes No
Comment:___________________________________________________________________________

Make mental health and wellness information available to staff with concerns that may affect their job performance?
Yes No
Comment:___________________________________________________________________________

Do the budget and staffing provide sufficient resources to accomplish goals in the area of mental health and wellness?
Yes No
Comment:___________________________________________________________________________

If your program contracts mental health services with an outside organization or individual:
Is there a designated manager assigned to oversee mental health services? Who is it?
Yes No
Is there a contract that is regularly reviewed and updated to reflect the changing needs of the program?
Yes No
Are the terms of the contract consistent with the needs of the program and the written plan describing mental health services?
Yes No
Comment:___________________________________________________________________________

Do interagency agreements exist with community partners for referrals and additional mental health services?
Comment:___________________________________________________________________________

Do mental health professionals have the appropriate licenses/certifications? Do they have experience and expertise that correspond to the mental health services outlined by the program for supporting children, families, and staff?
Yes No
Comment:___________________________________________________________________________

Does training and orientation adequately prepare staff, including staff conducting home visits with families, to work in ways that support the mental health of families?
Yes No
Comment:___________________________________________________________________________

Can you find ongoing documentation in child/family files that indicates families are referred for counseling, substance abuse treatment, parental depression or other mental health interventions? Do staff follow up on referrals?
Yes No
Comment:___________________________________________________________________________

Does your program follow-up with families to ensure that other community mental health resources/services met the families’ expectations and needs?
Yes No
Comment:___________________________________________________________________________

Do child/family files and training plans indicate that the program provides opportunities for parents to:
Share their mental health and/or behavioral concerns about their child?
Yes No
Be involved in the planning of mental health services for their child?
Yes No
Learn about and get support to strengthen parent-child relationships and create healthy environments?
Yes No
Understand child and family mental health issues?
Yes No
Learn appropriate responses to children’s behavior?
Yes No
Learn about mental health services for parents, including support regarding substance abuse, domestic violence, and mental health issues for pregnant women?
Yes No
Comment:___________________________________________________________________________

Do child/family files note evidence of staff:
Sharing mental health or behavioral concerns about a child with parents?
Yes No
Sharing observations of a child with parents?
Yes No
Discussing and anticipating with parents their child’s behavior and development?
Yes No
Comment:___________________________________________________________________________

Does your program provide information and resources to families and staff on the availability of mental health services in the community?
Yes No
Comment:___________________________________________________________________________

Is there a system for child mental health screening and assessment?
Is the screening tool reliable and valid? Does it screen for social, emotional, and behavioral concerns?
Yes No
Is behavioral screening completed within the required 45 day timeframe?
Yes No
Comment:___________________________________________________________________________

Do IEPs/IFSPs include mental health and behavioral services, as appropriate, for children?
Yes No
Comment:___________________________________________________________________________

Is there a system in place to track and provide regular updates on the delivery of mental health services throughout the program?
Yes No
Comment:___________________________________________________________________________

Is there evidence of follow up when screenings have identified a need for further assessment or treatment?
Yes No
Comment:___________________________________________________________________________

Are the 45 day screenings done in collaboration with each child’s parent?
Yes No
Comment:___________________________________________________________________________

Are the 45 day screenings linguistically and age appropriate for the following areas: developmental, sensory (auditory and visual), behavioral, motor, language, social, cognitive, perceptual, and emotional skills?
Yes No
Comment:___________________________________________________________________________

Is there evidence that parents are informed and made aware of the various screenings as they occur (permission forms, contact notes, home visit reports, notification of results)?
Yes No
Comment:___________________________________________________________________________

Observe:
It is important to observe a number of classroom settings, home visits, and/or socializations to obtain an assessment of mental health services across all program options. Observations should be conducted by persons with background and expertise in mental heath and/or child development, paying particular attention to the interactions between teachers and children, staff and parents, and also between mental health professionals and children, families, and staff. Team members may want to coordinate this work with team members assessing curriculum and individualization. Their insights can inform your work.

Use the following questions to focus your observations and/or to guide conversations with other team members:

Are classroom practices responsive to the mental health and behavioral needs of children?

Are interactions and/or services sensitive to cultural and linguistic differences?

Does teaching staff set age-appropriate limits?

Does teaching staff encourage the development of trust, self-esteem, and identity through respectful and responsive communication?

Does teaching staff demonstrate an understanding of age appropriate social behaviors, varying temperaments, realistic behavioral expectations for young children, setting appropriate limits and opportunities to encourage self-discipline?

Does staff encourage and support parents to respond to their children in appropriate ways?

If you have the opportunity to observe mental health professionals at work, how would you describe the role they have and the strategies they use in supporting children, staff, and families with mental health issues?

Does the program’s record-keeping system protect confidentiality and promote the use of information needed?

Does the program have space for meetings with parents which allows privacy for discussing sensitive issues?

Interview:
The Self-Assessment team member should interview:

The manager of mental health services (including Early Head Start, if appropriate)
Mental health professionals and community mental health providers
Staff
Families

Use the questions below to assist you with interviews:

Questions for the manager of mental health services:

What process do you use to determine the mental health needs of children, families, and staff and develop plans for the delivery of mental health services in this program? Who is involved?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Describe the role of mental health professionals in the program and how community mental health providers are utilized.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Provide examples of the strategies they use in supporting children, staff, and families around mental health issues.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

If you provide Early Head Start Services, how do you address the specific needs of pregnant women, new mothers and fathers, and children from birth to three?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Describe the process you use to screen for mental health and behavioral issues (listen for information on how the screening tool was selected, when screening occurs, and how results are used).
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Describe your process for monitoring mental health services throughout the program.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Provide an example of an issue that has surfaced as a result of monitoring mental health services and the action that the program has taken to address the issue.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

How do you know the mental health services provided were useful and sufficient?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Tell me how the program collaborates with community partners in the area of mental health (listen for examples of how community partners provide prevention and intervention services).
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

How does the program coordinate mental health and disability services within the program?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

How does the program help parents to understand how their own mental health is connected to and impacts their children’s mental health?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

In what ways does the program support the mental health wellness of staff?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

What kinds of services are available to staff? Without mentioning any names, can you provide an example of how a staff person has accessed these services?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Questions for mental health professionals:

Describe how you are involved with designing and implementing program practices for identified behavioral or mental health needs for an individual child or for a group of children, including providing special help to children with atypical behavior.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Describe the services you provide and the strategies you use to support mental wellness for staff, children, and/or families. Describe the strategies you use to provide mental health services for identified mental health needs of children and families.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Describe how you assist in promoting children’s mental wellness by providing individual and group education on mental health issues for staff and parents.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Describe the process you use to arrange for further diagnostic testing, examination and/or treatment as needed for mental health issues.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Describe how you use and coordinate with other community mental health resources as needed.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Without mentioning names, provide examples of how you and the program have supported children with identified mental health or behavioral needs.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

How do you know if the mental health services are provided to children with sufficient frequency to identify and address staff and family concerns in a timely and effective manner?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Questions for teaching staff

Describe the screening process you use (listen for inclusion of mental health/behavioral issues and if screening is accomplished within 45 days, and how results are used).
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

How is mental health integrated into the curriculum? Describe some specific ways that you support children’s social and emotional development.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

For Early Head Start:

What practices do you use to promote the social and emotional development of children?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Questions for teaching staff and/or family partnership staff:

How do you access mental health services for a child or family you serve? (Listen for information on referral and follow-up procedures).
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

How quickly are services and consultations provided?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

In what ways does the program support you in your work with children and families with mental health issues?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

How do you help families to access mental health assistance?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Without mentioning names, can you provide examples of how you have supported parents to understand and respond to their child’s behavior?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

What mental health services in the community are most helpful to children and families?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Questions for parents:

In what ways has Head Start helped you to:

Strengthen your relationship with your child? _________________________________
Communicate better with your child? ______________________________________
Answer your questions about your child’s behavior? ___________________________
Understand your child’s development and how to make him feel good about himself? ____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

How has Head Start helped you to know what counseling and mental health services are available to you?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

If you had concerns about your child’s development, behavior, or mental health, what kind of help is available through the Head Start program?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Questions for community partners:

Describe the role your program has in supporting Head Start children and families in the area of mental health.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Incorporating Relevant Data Sources:

Additional observations, document reviews, or interview questions that this team may choose to add:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Include any key insights you may have learned from reviewing important data sources such as the PRISM report, results of last year’s self-assessment, PIR data, Community Assessment, strategic plan or short and long term program goals:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Team Member Summary Worksheet

Summary of Results for Mental Health Services

Areas where the program is working well. Provide examples of program strengths or areas where the program exceeds Performance Standards:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Areas where the program needs improvement:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Additional areas of concern:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

TEAM LEADER BOOKLET ANALYSIS

Booklet # ____________
Booklet Name: ________________________________________________________________________

Program Strengths	Data Source









Specific Program Weaknesses and Areas to Strengthen	Data Source


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