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Texas Strategies
Infant-Early Childhood Mental Health Consultation Pilot in Part C Early Intervention
In 2023, the Texas Part C Early Intervention program, called Early Childhood Intervention (ECI), used funding from the American Rescue Plan Act to develop a pilot initiative offering infant-early childhood mental health (IEMCH) consultation to its providers. After completion of a competitive bid process, a contract to deliver IECMH consultation was awarded to First3Years, an organization that supports IECMH in Texas through awareness, training, and intervention programs including Help Me Grow, Infant Mental Health Endorsement, and Safe Babies. Of the 41 agencies contracted to deliver early intervention services in the state, eight expressed interest in the pilot and were selected for participation.
The eight ECI agencies participating in the pilot represented a variety of ECI agency types and were a geographical representation of the state. They were allotted weekly IECMH consultation hours based on their March 2023 enrollment, with the largest (enrollment just over 1,600 children) receiving 10 hours and the smallest (enrollment just over 200 children) receiving 2 hours. IECMH consultation was delivered remotely by three licensed masters-level clinicians with First3Years, all of whom had Infant Mental Health Endorsement at the Infant Mental Health Specialist level. IECMH consultants were not licensed to deliver early intervention services directly to families without the ECI provider present, as their role was to support ECI providers and programs.
ECI agency staff and First3Years consultants received training from the ECI state office in May 2023, and by July all eight agencies were using consultation services. Before requesting IECMH consultation ECI agency staff were required to take the training, delivered online and available as a recording. The training helped ECI staff understand what IECMH is; how IECMH consultation can support an ECI provider, children and families; when consultation may be appropriate; and requirements for implementation of the pilot. Staff from the state ECI office and First3Years co-presented this single-session training. The required training for IECMH consultants, as provided by the state, included an overview of the pilot with contract information and requirements, as well as covering basic information about ECI, including eligibility determination and evaluation tools that are used, and the approach to delivering early intervention services.
The training information for ECI agency staff on when to request consultation suggested a variety of circumstances in which an ECI provider, child, and family might benefit from IECMH consultation. These included referrals, screenings, and assessments that indicate social-emotional challenges; parents’ report or observation of child behavior difficulties, attachment, and self-regulation; family involvement with child welfare and family disruptions; parent mental health or substance use challenges; and the ECI provider needing extra support and guidance with strategies to develop and address a child’s social-emotional needs and goals. Some ECI program supervisors would review children’s files and if social-emotional concerns were identified, they would ask providers if they would like to request a consultation.
IECMH consultants offered a range of supports to ECI providers. During the child’s eligibility evaluation, the consultant could provide a clinical opinion to identify possible social-emotional delays. When developing an IFSP, the IECMH consultant could assist in identifying social-emotional needs, formulating goals, and recommending services and supports. IECMH consultants could also join the ECI provider remotely on service delivery visits with families, where they could offer guidance, support, and strategies to ECI providers as they address child and family needs, including parents’ mental health concerns and recommending outside referrals to IECMH and parent mental health providers as needed.
ECI providers requested IECMH consultation through an online referral request form collected by First3Years, whose consultants responded in 48 business hours. In an effort to maintain consistency among staff, the state recommended that one person at each agency be responsible for submitting and tracking referrals. The form asked what type of needs and support being requested as well as the primary social-emotional concern (e.g., eligibility evaluation, IFSP, service delivery). Prior written notice and parental consent was required if the consultant participated in the eligibility evaluation or IFSP development, but not if they joined the provider on a family visit. However, the state recommended that in all cases the provider talk with the family in advance to ensure parents agreed before inviting the consultant to participate in the visit. In addition, if the consultant was joining remotely, written parental consent was required for the consultant to join via telehealth. For the pilot, it was decided that the consultation would not be listed as a service on the IFSP as it would be treated as a service for the provider rather than the child and family, but it was documented as a case note on the child’s record.
Most of the consultation requests were related to delivering services to families, either with or without the family present. Once ECI providers had a relationship with a consultant, they would often directly contact the consultant about new or existing cases without formally submitting a new request. The majority of providers in ECI agencies are early interventions specialists, who work with children with a variety of delays and disabilities including social-emotional issues. Sixty requests for consultation came from early intervention specialists followed by speech-language pathologists (8), service coordinators (3), and physical therapists (1). When consultants joined ECI providers on family visits, they typically did so for one (25) or two (13).
Financing
Funding for the pilot initiative came from the American Rescue Plan Act, with a stipulation that it be spent by August 31, 2023. The state is using federal Preschool Development Grant Birth Through 5 funding to support IECMH consultation from August 2024 through December 2015 in 11 high-need counties to early childhood service providers, including ECI.
Monitoring and Evaluation
An evaluation conducted as part of the pilot collected a range of data from providers, consultants, and families. ECI providers and IECMH consultants completed pre-post surveys and also completed monthly spreadsheets to track their consultative services. ECI providers reported increased understanding of what infant mental health is and where to get professional social-emotional support for children and families. Forums are also being conducted with ECI providers who participated in the pilot to collect additional, qualitative data on their experiences of the pilot.
Of the 72 families who took part in pilot, eight completed a family survey (six in English, two in Spanish). All families responded that the support they received was very useful and that their child’s feelings, behaviors, or skills to form positive relationships were much or somewhat better because of the services received. At least half of the families reported receiving support in the following areas: building their child’s social-emotional skills (eight families), developing goals for their child (seven families), addressing child’s behaviors (six families), coping skills (five families), identifying their child’s needs (four families), parenting skills (four families), and improving the parent-child relationship.
Special thanks to Carol Baisdon, OTR, Lead Quality Assurance Therapist Consultant with Texas Early Childhood Intervention, for providing information for this profile.
Last updated September 2024