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.     

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.     

Barriers to treatment success in behavioral consultation: Current limitations and future directions

Behavioral consultation is a prominent indirect service model in the practice of psychology in the schools. Despite some empirical support for the use of behavioral consultation strategies, consultants frequently face a number of barriers to implementation of treatment in practice. This article outlines a number of these barriers in behavioral consultation, including the lack of standardization of consultation, lack of specific training of consultants, little or no consultee (teacher) training, problems surrounding target behavior identification, and external constraints to consultation. Each of these areas is described along several dimensions that need to be addressed in future research.     

Cognitive modeling of consultation processes: A means for improving consultees'' problem definition skills

This study investigated whether consultees' understanding and use of problem definition skills could be enhanced by increasing their awareness of these processes during consultation interactions. Subjects assigned to a consultation with cognitive modeling group viewed videotaped consultation interactions in which consultants' verbalizations during the problem definition stage of consultation frequently included overt references to the problem-solving processes being used by these consultants. Subjects in a consultation without cognitive modeling group viewed similar interactions except that the consultants' statements did not include overt references to problem-solving processes. A control group viewed irrelevant interactions between consultants and consultees. Data analyses indicated that the subjects exposed to consultations that included cognitive modeling components wrote better problem definitions and were better able to describe the process for defining children's problems than subjects in either the consultation without cognitive modeling or control groups. The subjects in the consultation without cognitive modeling group generally did better than those in the control group.     

Certifying clinical ethics consultants: who pays?

The movement advocating the formal certification of clinical ethics consultants may result in major changes to the field of clinical ethics consultation by creating a new standard of care. The actual certification process is still in the development phase, but unanswered questions include: What will certification cost, and, Who will pay? Currently there is little salary support for ethics consultants and no regulation requiring healthcare institutions to offer clinical ethics consultation. Without the support of healthcare administrators and accreditation bodies, this may remain unchanged. Healthcare administrators may be unwilling to pay for certification or professional services if accreditation bodies do not require healthcare institutions to provide certified ethics consultants' services. If consultants will not be reimbursed or paid, they may not seek certification. If certified consultants are required, healthcare administrators may look for ways to cover the costs for providing this service, including insurance or third-party reimbursement and direct billing of patients for consultations, which may affect who performs and who participates in ethics consultation. However, this is less than ideal, as bioethicists believe ethics consultation should be available to all as part of providing safe, quality ethical care and support and guidance for patients, families, and healthcare staff. Going forward, bioethicists should study quality improvement, patient safety, and cost-savings resulting from certification-eligible clinical ethics consultants' activities. Administrators and financial personnel can be surveyed regarding their support for the certification process. Bioethicists should enlist the help of patient rights and safety advocacy groups, professional medical associations, and healthcare administrators. Bioethicists should invite accreditation bodies, healthcare administrators, and financial personnel to collaborate in the development of the certification process. Without their support, certification may be of value only to the bioethics community, and may have little standing in actual clinical healthcare institution settings.     

A school-based mental health consultation curriculum

Many articles have been written about mental health consultation and school-based consultation, but little has been written about how consultants are to be prepared for their role. Other authors focus on the theory or process aspects of the approach but do not take the next step in specifying what neophite consultants need to learn. The following paper presents one position on consultation that integrates a theoretical model, a process model, and a curriculum for training school-based mental health consultants. Elements of the proposed curriculum include: ethics, relationship building, maintaining rapport, defining problems, gathering data on what has already transpired, gathering data on the client, sharing information, generating interventions, supporting interventions, and following up and disengaging.     

Culturally competent outcome evaluation in systems of care for children's mental health

Conclusions The area of culturally competent outcome evaluation and cross-cultural mental health research in general needs to be greatly developed given the culturally diverse nation we live in and the different needs of culturally diverse children and their families. Such evaluation is crucial in supporting the need for and effectiveness of culturally competent programs and special programs with a focus on particular cultural populations. The imperatives for cost effectiveness and clinical effectiveness which have been promoted by the transition to managed systems of care may actually promote the development of higher levels of cultural competence in community-based systems of care. Culturally competent care may well be the most cost-effective and clinically effective care.     

Fundamental Issues in Defining Consultation

Understanding and articulating one's definition of consultation is essential for successful consultation to occur. Early definitions presented the consultant primarily as a one-an-one content expert. Today there are many definitions ranging from the original one-on-one content expert to system-wide operations. Several different definitions are reviewed and presented for consideration, The main issues that surround the operational definitions of consultation are also included. The final conclusion is that consultants define consultation depending on their work setting, educational backgrounds, goals, and conceptual models.     

Selection of consultees in school mental health consultation

To further understanding regarding the selection of teacher consultees, 15 mental health consultants completed a questionnaire. Consultants ranked teachers in their school consultation placements on ability to meet academic and socioemotional needs of children, receptivity to change, and likability. Next, after indicating which teachers they would most and least like to work with, consultants rated the teachers on nine 5-point rating scales. In general, results indicate that most preferred consultees, in comparison to least preferred consultees, are perceived as less needy of assistance around issues concerning children and lessons, more responsive to consultation, and more likable. It appears that teachers most in need of assistance are not selected for consultation.     

Implementation of a mental health consultation model and its impact on early childhood teachers' efficacy and competence

Early childhood mental health (MH) consultants work closely with childcare teachers onsite to serve as a resource for childcare providers as they foster and enhance children's early development. The increase in the quality of care that can be supported through an early childhood MH consultation program makes this type of consultation an optimal tool for enhancing the childcare environment and overall child development. This article details the initial launch of the MH consultation program to childcare centers in the state of Louisiana. Analyses support the assertions that (a) a model of MH consultation can be implemented successfully at a statewide level, (b) MH consultation is associated with an increase in teacher self‐efficacy, and (c) teachers' report that the MH consultation increased their competence in specific areas related to children's socioemotional development. Analyses indicate that there is a differential impact on teachers based on their age and level of experience. The clinical implications of these findings are discussed.     

Enhancing CBT Consultation With Multicultural Counseling Principles

The use of multicultural principles to enhance cognitive behavioral therapy (CBT) for individuals of marginalized backgrounds has received increased attention in light of the heightened national awareness of systemic oppression and racialized violence directed towards Black, Indigenous, and People of Color. However, there has been less of a focus on applying such principles to consultation for skill development. If ethical guidelines are expected to influence the behavior of clinicians in session, guidance is needed to indicate how and where and when clinicians should receive training in implementing culturally responsive CBT. Individual reading and reflection are necessary but are not sufficient in acquiring new clinical skills. Consultation is recommended and strongly suggested when clinicians are working with new populations or delivering a new treatment, or even using a new modality. Consultation can also be useful when adopting a new approach or stance to therapy. For practicing clinicians who have not developed these skills, additional consultation can and should be used to address this gap. Moving forward, integration of cultural responsiveness into standard consultation will ensure that these skills are seen as a core competency, rather than an optional additional skill that may be (or not be) elected. This paper presents core experiences that may be integral to a CBT consultation model that aims to enhance providers’ ability to provide CBT in a way that is culturally responsive to their clients. These recommendations attend to both content and process within CBT consultation and reflect guiding assumptions for helping clinicians to develop the ability to practice CBT in a culturally responsive manner, including (a) normalizing discussions of cultural identity and oppression, (b) an emphasis on cultural self-awareness, (c) emphasizing culturally informed CBT case conceptualization, and (d) skill development in applying cultural elements to CBT interventions.     

Training in clinical ethics consultation: the Washington Hospital Center course

How can one be trained to enter the evolving field of clinical ethics consultation? The classroom is not the proper place to teach clinical ethics consultation; it is best done in a clinical setting. The author maps the elements that might be included in an apprenticeship, and sets out propositions for debate regarding the training needed for clinical ethics consultants and directors of clinical ethics consultation services. I was invited to be an observer of the first Intensive Course in Clinical Ethics at the Washington Hospital Center (WHC). I had no input into the planning. Having been present at a meeting of the Clinical Ethics Consultation Affinity Group of the American Society of Bioethics and Humanities (ASBH) when the issue of a lack of training programs was discussed, I was acutely aware of the need. Knowing how popular the various four-day intensive courses in bioethics have been, held at Georgetown University first, and then in Seattle and locations in the Midwest, it seemed time to have a four-day intensive course that was devoted to clinical ethics. The differences between bioethics and clinical ethics is substantial and largely unappreciated by those in bioethics. So when the WHC team agreed to take on the task of offering an intensive in clinical ethics, it was an important step for the field.     

Ethical Issues in Consultation,Associate Professor and Director

Consulting relationships differ from traditional counseling and psychotherapeutic relationships in several fundamental ways. These differences require special consideration in evaluating ethical questions and conflicts, identifying ethical parameters within any given situation, and using existing ethical guidelines in determining appropriate courses of action. Currently, formal guidelines specific to the practice of consultation are not available, and existing codes of ethics for the helping professions provide only limited guidance for consultation practice. Consequently, consultants bear a heavy personal responsibility for the consequences of their professional decisions and actions. In this article the author reviews several important ethical issues relevant to consultation and examines their implications for consultation practice.     

Ethics Consultation and Autonomy

Services of ethics consultants are nowadays commonly used in such various spheres of life as engineering, public administration, business, law, health care, journalism, and scientific research. It has however been maintained that use of ethics consultants is incompatible with personal autonomy; in moral matters individuals should be allowed to make their own decisions. The problem this criticism refers to can be conceived of as a conflict between the professional autonomy of ethics experts and the autonomy of the persons they serve. This paper addresses this conflict and maintains that when the nature of both ethics consultation and individual autonomy is properly understood, the professional autonomy of ethics experts is compatible with the autonomy of the persons they assist.     

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.     

Psychology and capital litigation: Research contributions to courtroom consultation

After briefly reviewing the history of capital punishment in the United States, we describe the activities most often performed by behavioral science litigation consultants, and we review five areas of psycholegal research that courtroom consultants can call on to guide their interventions. The research literatures of most frequent use to psycholegal researchers and litigation consultants are (a) assessment of public opinion about crime and punishment, (b) the effects of death qualification during voir dire, (c) the process and effects of sentencing-phase evidence, (d) the possibility of discriminatory application of the death penalty, and (e) the effects of litigation consultation itself. Practical implications for consultants from each of these literatures are considered.     

The identification of resources and constraints influencing plan design in consultation

The present study investigated the effects of consultant verbalizations on consultee verbalizations reflecting consultee resources that might be used in plan implementation and constraints potentially limiting the nature of plans implemented in consultation. Interviews of 50 consultants trained in behavioral consultation and participating in a field experience with public school teachers were analyzed. Plan-tactic-elicitors verbalized by consultants were shown to have a positive effect on the incidence of resources as opposed to responses not reflecting resources or constraints. Other types of consultant elicitors all had a negative impact on resource incidence when compared to the incidence of other types of consultee responses.     

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.     

The effects of two conditions of client-centered consultation on student teacher problem descriptions and remedial plans

Nineteen trained consultants implemented two conditions of client-centered consultation and a control condition with 42 student teacher subjects. The dependent measures were skills in describing classroom problems and generating appropriate remedial plans. Both conditions of consultation were effective in improving problem identification skills. Consultation with observation seemed to be related to a faster improvement than was consultation with no observation. Skills in developing remedial plans were not affected by treatment.