Consultation from the consultee''s perspective

School-based and other mental health consultants are confronted with consultees who must adjust to the process of consultation by learning the parameters of the interaction. Consultees must learn how to act in this unique setting, must learn to use the consultant and the process for their own ends, and must learn about ways that they, themselves, contribute to problems which assail them. Consultation is successful to the extent that consultees come to a quick understanding of how to proceed. By being aware of what it is that the consultee must learn, the consultant may expedite the necessary insight.     

A conceptual review of discipline in the schools: A consultation service model

Although discipline has been identified consistently as the major problem in U.S. education, few conceptual models are available to guide the analysis of discipline problems and to integrate the consultation and preventive mental health perspectives. A model is presented that integrates a consultation problem-solving process (involving problem identification, problem analysis, intervention, and evaluation) with the preventive mental health levels (i.e., primary, secondary, and tertiary preventions). These perspective interface because discipline-related problems can occur and be resolved at all three prevention levels, although most are addressed only at the tertiary level. A review of the relevant literature is presented with each component of the model, and pragmatic applications are suggested to facilitate both problem-solving and consultation. Although the tertiary prevention level is emphasized, consultants are reminded that secondary and primary prevention programs are potentially more cost-effective and efficacious.     

The School-Based Mental Health Collaboration (SBMHC): A Multi-Level University-School Partnership

This article describes The School-Based Mental Health Collaboration (SBMHC), a novel school-based mental health partnership between Teachers College, Columbia University, and several high-poverty public grade schools in New York City. SBMHC is grounded in attachment and mentalization theory and practice. It applies nested mentalization to multilevel work with all school stakeholders, encouraging school leaders, faculty, staff, and parents to use mentalization with children, many of whom have experienced trauma. Graduate students serve as classroom consultants (CC), spending a half day per week in the classroom observing, doing push-in interventions, co-teaching a social-emotional learning curriculum, coaching the teacher, and making referrals for children. CCs follow up on referrals and coordinate among parents, teachers, and off-site providers. The CCs in turn receive weekly didactics and reflective clinical supervision. SBMHC works with school leaders to assess the school’s social-emotional climate, identify unmet need for mental health services, and locate low-cost providers in the community. SBMHC is a promising model that aims to enhance social-emotional learning for all students while also identifying and referring symptomatic students. It thus combines universal and targeted approaches to serving high-risk students at low-resourced schools.     

An “issue-focused” model for mental health consultation with groups of teachers

This paper presents and evaluates a model for group mental health consultation with teachers in which sessions are organized around mental health issues rather than cases. The rationale and advantages of the model are explicated and compared with other models of group consultation and group work with teachers. The model incorporates a heavy emphasis on educational preventive measures and is designed to simultaneously satisfy a wide range of consultee needs and to reduce anxiety and defensiveness. Consultant's preparations for the group sessions are highlighted so as to maximize their contribution to the participants' level of involvement, knowledge, skills, confidence, and objectivity. The different roles of the consultant during the session and the variety of techniques employed are described as they relate to group processes and consultation needs. Specific guidelines for the organization of consultation groups and training of group consultants are offered. Evaluation data based on feedback from participants in ten groups are included.     

Preparation of school psychologists for school-based consultation: A training activity and a service to community schools

Presents a set of training experiences to develop school-based consultation skills in preservice school psychologists and discusses problems in implementing this model of service. Based on their experience in training school psychologists at the University of California, Berkeley, the authors report on preparing students to deal with teacher and principal expectations. Also discussed are methods for mobilizing teachers to plan more precisely to meet the needs of individual pupils in the classroom. A distinction is made in the paper between school-based and community-based mental health consultation.     

Early childhood mental health consultation: Care providers’ experiences of the consultative relationship

This article presents findings from a qualitative research study exploring child care teachers’ experiences receiving early childhood mental health consultation (ECMHC). As an emerging intervention in early childhood education, ECMHC is already yielding promising results, namely in helping teachers better address challenging behaviors in their classroom and promote a more nurturing classroom environment. However, there remains a lack of personal testimony from teachers who receive this intervention. Considering that teachers are the primary focus of most ECMHC interventions, the purpose of this study was to examine child care teachers’ personal experiences receiving consultation. Eight child care teachers were interviewed for this study. Results from this study illuminate key interpersonal processes in the development of the consultant–consultee relationship, indicate what teachers consider to be the most helpful components of consultation, and speak to the challenges that teachers experience in consultation. By examining the personal testimony of child care teachers who have received ECMHC services, consultants and researchers can consider ways to expand and improve future implementation of ECMHC.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

Evaluation of outcome in school consultation

To further understanding regarding how content of change, degree of change, and initial level of functioning influence consultants' evaluation of consulation outcome, 14 mental health consultants completed a questionnaire. For each of the 18 prepost consultation ratings on the questionnaire (2 context × 3 degrees of change × 3 initial levels = 18), consultants rated the success of consultation and the degree to which they would like to have been the consultant. Analysis of variance results for both dependent measures indicate main effects for degree of change and initial level. Neither main effects for content nor interaction effects are indicated. It appears that consultants perceive consultation as more successful with and prefer working with consultees who improve the most and who function at a higher initial level.     

Effectiveness of School-Based Mental Health Services for Children: A 10-Year Research Review

A review of the literature from 1985 to 1995 on school-based mental health services for children was conducted using a computerized data-base search. Of the 5,046 references initially identified, 228 were program evaluations. Three inclusion criteria were applied to those studies: use of random assignment to the intervention; inclusion of a control group; and use of standardized outcome measures. Only 16 studies met these criteria. Three types of interventions were found to have empirical support for their effectiveness, although some of the evidence was mixed: cognitive-behavioral therapy, social skills training, and teacher consultation. The studies are discussed with reference to the sample, targeted problem, implementation, and types of outcomes assessed, using a comprehensive model of outcome domains, called the SFCES model. Future studies of school-based mental health services should (a) investigate the effectiveness of these interventions with a wider range of children's psychiatric disorders; (b) broaden the range of outcomes to include variables related to service placements and family perspectives; (c) examine the combined effectiveness of these empirically-validated interventions; and (d) evaluate the impact of these services when linked to home-based interventions.     

Negotiating the Cultural Steps in Developing an Online Intervention for Korean American Intimate Partner Violence

Korean American (KA) immigrants experiencing intimate partner violence (IPV) underutilize existing services, but instead rely on KA clergy for assistance. However, there had not yet been an intervention curriculum developed for KA clergy to help them address IPV in their congregations. There was a lack of understanding regarding what needed to be included in an intervention curriculum for KA clergy, as well as the most effective form of curriculum design and delivery for such an intervention. This article discusses the process of developing an online IPV intervention curriculum for KA clergy to increase their capacity for IPV prevention and intervention within their congregations. Researchers developed Korean Clergy for Healthy Families by incorporating feedback from expert consultants and engaging study participants. The result is an IPV curriculum that speaks to participants’ cultural values and religious beliefs, and identifies barriers KA clergy experience when confronted with IPV. Specific steps to assist those who would want to develop culturally appropriate interventions are provided.     

Mental health consultation to law enforcement: Secret Service development of a Mental Health Liaison Program

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants—psychologists and psychiatrists—with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions. © 1998 John Wiley & Sons, Ltd.     

A Code of Ethics for Health Care Ethics Consultants: Journey to the Present and Implications for the Field

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here.     

Lessons Learned About Barriers to Implementing School-Based Interventions for Adolescents: Ideas for Enhancing Future Research and Clinical Projects

The majority of youth with mental health problems do not receive treatment, highlighting the critical need to transport evidence-based interventions into community settings, such as schools. Despite being able to reach a large number of adolescents and minority youth, the process of implementing evidence-based interventions to schools is challenging. This paper discusses some expected and unexpected challenges experienced during the implementation of an open trial and a pilot randomized controlled trial examining the acceptability and effectiveness of a school-based preventive intervention for adolescents at risk for internalizing disorders. First, we highlight key programs and findings on preventive interventions for adolescents at risk for depression and anxiety. Next, we provide a brief overview of the preventive intervention we implemented in schools. This provides a context for the section that describes implementation issues and highlights specific challenges and potential solutions for intervention implementation. Finally, the paper offers recommendations for researchers and clinicians interested in implementing school-based mental health services for adolescents.     

Political and interpersonal aspects of ethics consultation

Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record.     

Consultation and the Suicidal Patient

This paper presents an argument for a paradigm shift in the way that mental health professionals approach their work with psychiatric patients in the midst of a suicidal crisis and suggests that the time has come to discuss a standard of care based on integration of detected risk factors, effective education and training in suicidology, and most importantly, the routine use of consultation and teamwork. Also proposed is a workable model for the use of consultation that has a number of major components: quality education in suicidology, the training and availability of appropriate consultants, clinical teamwork, and the recognition by training programs and clinical institutions that it is necessary to routinely consider a consultative risk management approach for work with suicidal patients.     

The relationship variable in behavioral consultation

Behavioral consultation has traditionally been conceptualized as a scientific-technological exchange process where the primary goal is the transfer of information. Perceived reluctance of school personnel to use behavioral techniques has been seen as a special problem of educational settings. However, current understanding of this reluctance has emerged from the treatment adherence literature which stresses the complexity of adherence in clinical settings. One important issue which has emerged is the critical importance of the consultation relationship. While behavioral consultation has utilized an expert model focused on client behavior and problem solving, the efficacy of a more collaborative consultation style has been recommended. Behavioral consultants need to attend to factors such as communication strategies that facilitate shared responsibility as well as to understand consultees' explanations for their problems and their treatment expectations. Such skills need to be incorporated directly into the education of behavioral consultants along with behavioral technology if the behavioral model is to be disseminated widely into educational practice.     

ONGOING CONSULTATION AS A METHOD OF IMPROVING PERFORMANCE OF STAFF MEMBERS IN A GROUP HOME

A model of ongoing consultation was implemented in a community group home for 8 adults with severe and profound mental retardation. Two consultants, highly experienced in working with people with mental retardation and in the procedures used in group homes, taught staff members to use a token reinforcement system, to engage the adults in a variety of activities, and to improve the content and style of the staff members' interactions with the adults. The consultants taught skills to 9 staff members through brief mini-workshops, direct observation of the staff members' use of the skills during regular activities in the group home, and individual verbal feedback regarding a staff member's performance of the skills. Evaluation of the ongoing consultation process by the 2 consultants showed it to be effective in improving the performance of the staff members and in changing the behaviors of the adults who lived in the home. Continued implementation of the process, however, appeared to be necessary for the behavior changes of staff members to be maintained at high levels.     

School-Based Mental Health Services: A Research Review

This paper provides a synthetic review of research on school-based mental health services. Schools play an increasingly important role in providing mental health services to children, yet most school-based programs being provided have no evidence to support their impact. A computerized search of references published between 1985 and 1999 was used to identify studies of school-based mental health services for children. Study inclusion was determined by (i) use of randomized, quasi-experimental, or multiple baseline research design; (ii) inclusion of a control group; (iii) use of standardized outcome measures; and (iv) baseline and postintervention outcome assessment. The application of these criteria yielded a final sample of 47 studies on which this review is based. Results suggest that there are a strong group of school-based mental health programs that have evidence of impact across a range of emotional and behavioral problems. However, there were no programs that specifically targeted particular clinical syndromes. Important features of the implementation process that increase the probability of service sustainability and maintenance were identified. These include (i) consistent program implementation; (ii) inclusion of parents, teachers, or peers; (iii) use of multiple modalities; (iv) integration of program content into general classroom curriculum; and (v) developmentally appropriate program components. Implications of these findings and directions for future research are discussed.     

The Effectiveness of Cultural Adjustment and Trauma Services (CATS): Generating Practice-Based Evidence on a Comprehensive, School-Based Mental Health Intervention for Immigrant Youth

A collaborative study of Cultural Adjustment and Trauma Services (CATS), a comprehensive, school-based mental health program for traumatized immigrant children and adolescents, was conducted to generate practice-based evidence on the service delivery model across two school districts. Program effectiveness was assessed by testing whether client functioning and PTSD symptoms improved as a result of 7 separate service elements. An array of clinical services including CBT, supportive therapy, and coordinating services were provided to all students, and an evidence-based intervention for trauma, TF-CBT, was implemented with a subset of students. Greater quantities of CBT and supportive therapy increased functioning, while greater quantities of coordinating services decreased symptoms of PTSD. TF-CBT services were associated with both improved functioning and PTSD symptoms, although TF-CBT was implemented with fidelity to the overall comprehensive service model rather than the structured intervention model. Results suggest the comprehensive school-based model was effective, though different service components affected different student outcomes. Implications of these findings for immigrant mental health interventions and implementing structured evidence-based practices into community mental health programs are discussed. Suggestions are made for future research on existing mental health practices with immigrants.