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Improved Classroom and Child Outcomes through Mental Health Consultation in New York City Subsidized Early Care and Education Programs

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Title: Improved Classroom and Child Outcomes through Mental Health Consultation in New York City Subsidized Early Care and Education Programs
Language: English
Authors: Fatima Zahra Kadik (ORCID 0000-0003-2945-1916), Elleanor Eng, Kristen Pappas, Shirley Berger
Source: Infant Mental Health Journal: Infancy and Early Childhood. 2025 46(5):604-614.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 11
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Early Childhood Education
Descriptors: Mental Health, Early Childhood Education, Consultation Programs, Program Evaluation, Social Emotional Learning, Classroom Techniques, Student Behavior, Student Characteristics
Geographic Terms: New York (New York)
DOI: 10.1002/imhj.22026
ISSN: 0163-9641
1097-0355
Abstract: This paper describes the evaluation of one year of infant/early childhood mental health consultation (IECMHC) in subsidized early care and education settings provided by the New York City Early Childhood Mental Health Network. The evaluation examined direct and indirect outcomes of IECMHC including (1) improved classroom practices by ECE teachers, and (2) improved social, emotional, and behavioral outcomes among children in the classroom. The study also reviewed child attributes that might have moderated outcomes. An analysis using paired t-tests of pre-and post-assessment data found significant improvements over time in the classroom environment and management practices, as well as in teachers' perceptions of the degree of difficulty presented by children's classroom behaviors. There were significant improvements in protective factors and problem behaviors among the subset of 138 children who received assessments. Improvements were greater for Black/African American children and for all children with pre-assessment scores in the concern range. Males showed greater improvement in protective factors whereas females showed greater improvement in behavioral concerns. IECMHC is a powerful intervention to improve teachers' classroom management and their perceptions of children's behavior and is important in the context of biases that place marginalized groups at risk of punitive actions by teachers and administrators.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1482978
Database: ERIC
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  Value: <anid>AN0187859952;bw601sep.25;2025Sep12.02:07;v2.2.500</anid> <title id="AN0187859952-1">Improved classroom and child outcomes through mental health consultation in New York City subsidized early care and education programs </title> <p>This paper describes the evaluation of one year of infant/early childhood mental health consultation (IECMHC) in subsidized early care and education settings provided by the New York City Early Childhood Mental Health Network. The evaluation examined direct and indirect outcomes of IECMHC including (<reflink idref="bib1" id="ref1">1</reflink>) improved classroom practices by ECE teachers, and (<reflink idref="bib2" id="ref2">2</reflink>) improved social, emotional, and behavioral outcomes among children in the classroom. The study also reviewed child attributes that might have moderated outcomes. An analysis using paired t‐tests of pre‐and post‐assessment data found significant improvements over time in the classroom environment and management practices, as well as in teachers' perceptions of the degree of difficulty presented by children's classroom behaviors. There were significant improvements in protective factors and problem behaviors among the subset of 138 children who received assessments. Improvements were greater for Black/African American children and for all children with pre‐assessment scores in the concern range. Males showed greater improvement in protective factors whereas females showed greater improvement in behavioral concerns. IECMHC is a powerful intervention to improve teachers' classroom management and their perceptions of children's behavior and is important in the context of biases that place marginalized groups at risk of punitive actions by teachers and administrators.</p> <p>Keywords: early care and education; infant/early childhood mental health consultation; mental health programs; preventive mental health services</p> <hd id="AN0187859952-2">INTRODUCTION</hd> <p>Early experiences are key to healthy development and lifelong wellbeing. Children who experience safe, nurturing environments with responsive, supportive caregivers can develop stronger foundations for resilience and growth (Shonkoff et al., [<reflink idref="bib29" id="ref3">29</reflink>]). Systems and services that reduce stress on families and provide children with equitable opportunities to build key capacities help lay the groundwork for their success at school and in life (National Scientific Council on the Developing Child, [<reflink idref="bib25" id="ref4">25</reflink>]). Access to high‐quality early care and education (ECE) programs can significantly contribute to young children's social, emotional, and cognitive development and increase their chances to succeed (Elango et al., [<reflink idref="bib13" id="ref5">13</reflink>]). However, racial, ethnic, and socioeconomic disparities exist in access to high‐quality, dependable, and affordable ECE programs (National Academies of Sciences, Engineering, and Medicine, 2018). Furthermore, racism and implicit bias affect Black, Indigenous, and People of Color (BIPOC)'s experiences in ECE programs, and young Black boys are disproportionately removed or expelled from ECE programs (Gilliam, [<reflink idref="bib15" id="ref6">15</reflink>]; Gilliam et al., [<reflink idref="bib16" id="ref7">16</reflink>]).</p> <hd id="AN0187859952-3">Infant/early childhood mental health consultation in ECEs</hd> <p>It is well documented that Infant/Early Childhood Mental Health Consultation (IECMHC) has been associated with a variety of positive outcomes for children and their care providers in early care and education settings (Brennan et al., [<reflink idref="bib4" id="ref8">4</reflink>]; Duran et al., 2010; Hepburn et al., [<reflink idref="bib18" id="ref9">18</reflink>]; Kaufmann et al., 2012; Perry et al., 2010). IECMHC supports and enhances relational health between children and their caregivers, as well as among adults in early care and education settings and systems (Johnston & Brinamen, [<reflink idref="bib19" id="ref10">19</reflink>]). It is a multilevel, capacity‐building, indirect mental health practice (Davis & Perry, [<reflink idref="bib11" id="ref11">11</reflink>]; Gilliam, [<reflink idref="bib15" id="ref12">15</reflink>]; Hepburn et al., 2013; Perry et al., [<reflink idref="bib27" id="ref13">27</reflink>]). Mental health consultants with expertise in infant and early childhood mental health partner with teachers, center directors, and families to build their knowledge and skills to support children's healthy social and emotional development and address behavioral concerns (Cohen & Kaufmann, [<reflink idref="bib8" id="ref14">8</reflink>], 2005; SAMHSA, 2014).</p> <hd id="AN0187859952-4">ECE programs may see improvements in climate and quality</hd> <p>IECMHC positively affects teachers and is associated with improved staff self‐efficacy, sensitivity, and competence in managing children's challenging behaviors, as well as reduced staff stress and teacher burnout (Alkon et al., [<reflink idref="bib2" id="ref15">2</reflink>]; Brennan et al., [<reflink idref="bib4" id="ref16">4</reflink>]). IECMHC has been associated with reduced staff turnover, higher quality of child care setting, and reduced expulsions (Gilliam, [<reflink idref="bib15" id="ref17">15</reflink>]; Gilliam et al., [<reflink idref="bib16" id="ref18">16</reflink>]). IECMHC also positively affects parents with an indirect effect on child outcomes (Bender et al., [<reflink idref="bib3" id="ref19">3</reflink>]). Much of the adult capacity building hinges on the formation of a relationship between the consultant and consultee, known as the consultative alliance (Davis et al., [<reflink idref="bib12" id="ref20">12</reflink>]).</p> <hd id="AN0187859952-5">Children's social and emotional well‐being is improved</hd> <p>IECMHC has been associated with the reduction of teacher‐child conflict, closing the racialized conflict gap (Shivers et al., [<reflink idref="bib28" id="ref21">28</reflink>]), and improved teacher and child classroom interactions (Heller et al., 2012). Child level measures have associated IECMHC with positive change over time, in which children in a classroom show improvement universally even if they are not the target of the intervention, and children who started with the lowest assessment scores showed the most improvement over time (Conners‐Burrow et al., [<reflink idref="bib9" id="ref22">9</reflink>]; Crusto et al., [<reflink idref="bib10" id="ref23">10</reflink>]).</p> <p>While there is considerable evidence that IECMHC leads to positive impacts for children, providers, and programs, few studies focused on quantifying reductions in disparities and most have not disaggregated children's outcomes by race/ethnicity to measure the role of IECMHC in enhancing equitable learning opportunities for young children. Studies have reported the demographic composition of the children served but often did not break down children's assessment results by race/ethnicity or sex (Albritton et al., [<reflink idref="bib1" id="ref24">1</reflink>]; Crusto et al., [<reflink idref="bib10" id="ref25">10</reflink>]; Conners‐Burrow et al., [<reflink idref="bib9" id="ref26">9</reflink>]). Potential program evaluations that report these assessments may have not reached the peer‐reviewed literature.</p> <p>It is essential not only to measure whether an intervention works but also how and why it works, and for whom it does or does not work. Disparities in access and outcomes may be linked to a wide range of systematic disenfranchisement of children and families based on characteristics marginalized by society (e.g., race/ethnicity, sex, age, disability, child welfare involvement, linguistic background) as well as caregiver and program‐level variables (Center of Excellence for Infant & Early Childhood Mental Health Consultation, [<reflink idref="bib6" id="ref27">6</reflink>]). Although tightly controlled research studies such as randomized control trials (RCTs) produce the strongest evidence of programs' efficacy, findings from these studies may not translate to fully scaled local systems with broader priorities, unique constraints, and large, diverse populations to serve (Duncan & Magnuson, 2013; Pianta et al., [<reflink idref="bib26" id="ref28">26</reflink>]).</p> <p>The current study sought to build off previous research by collecting IECMHC data from 69 subsidized early care and education programs in historically marginalized communities and collecting data on both the classroom level and the child level. The study also collected child demographic data, including race/ethnicity and sex, to allow for disaggregation of outcomes by demographic factors.</p> <hd id="AN0187859952-6">NYC ECMH network model</hd> <p>The New York City Department of Health and Mental Hygiene (NYC Health Department) has funded the NYC Early Childhood Mental Health Network (ECMH Network) since 2016 as an investment in prevention and early intervention to increase the availability of community‐based publicly funded early childhood mental health services in NYC (Kadik et al., [<reflink idref="bib20" id="ref29">20</reflink>]). The ECMH Network is comprised of seven mental health clinics specializing in serving children birth to five and their families, and one ECMH training and technical assistance center (TTAC). Along with providing mental health treatment and family peer support services to young children and their families, the clinics provided mental health consultation services to staff, teachers, and parents or caregivers of enrolled children at early care and education sites. Consultants partnered with government‐subsidized, center‐based ECE sites serving low‐income children under five years of age across NYC. ECMH consultants are trained by TTAC. Consultants developed expertise in early childhood development, mental health, and the tenets of the consultative stance, and they receive reflective supervision through the TTAC (Center for Early Childhood Mental Health Consultation, 2018; Center of Excellence for Infant & Early Childhood Mental Health Consultation, 2020; SAMHSA, 2017).</p> <p>The ECMH Network's consultation model operated at three levels: (a) site/programmatic consultation, (b) classroom consultation, and (c) child and family consultation (Center for Early Childhood Mental Health Consultation, 2018; Center of Excellence for Infant & Early Childhood Mental Health Consultation, 2020; Hepburn et al., [<reflink idref="bib18" id="ref30">18</reflink>]). Site/programmatic consultation focused on enhancing the climate of the whole early childhood program and improving program‐wide practices, policies, and strategies that benefit all the children, families, and staff in that setting. Classroom consultation involved the consultant working collaboratively with teachers to share strategies, solve problems, and model approaches to promote the social and emotional competencies of all children in that classroom. Child and family consultation was centered on understanding and addressing the specific mental health needs and challenges of an individual child and enhancing child and family well‐being by working with the adults on how to support the child. In addition to using this preventative consultation model, consultants could provide referrals back to the ECMH Network clinics for children and families who needed further mental health support.</p> <p>At the classroom level, consultants conducted a range of activities that included: engaging ECE staff in reflective discussions, coaching them on behavioral management techniques, modeling positive relationships, and facilitating communication among staff and families. The direct outcome of these consultation activities was for staff to feel confident, supported, and more knowledgeable about early childhood mental health; able to skillfully respond to children's behaviors, use positive classroom management techniques to create a safe classroom environment; and communicate effectively with families. Classroom and staff‐level changes could then lead to the indirect outcome of improved children's behavior and social and emotional functioning, and more engaged families. It is expected that direct outcomes of consultation are ECE staff focused, and indirect outcomes of consultations are child and family focused through the teacher's increased capacity to promote and positively affect children's mental health and social and emotional development.</p> <hd id="AN0187859952-7">Evaluation questions</hd> <p>In keeping with this theory of change, the evaluation questions included whether IECMHC was associated with (<reflink idref="bib1" id="ref31">1</reflink>) improved classroom practices by ECE teaching staff; and (<reflink idref="bib2" id="ref32">2</reflink>) improved social and emotional, and behavioral outcomes among children in the classroom. In addition to these questions, the study reviewed (<reflink idref="bib3" id="ref33">3</reflink>) which child attributes (e.g., race/ethnicity, sex, and severity of behavioral concerns) might have moderated improvements; in other words, who saw the most improvements and in which contexts?</p> <hd id="AN0187859952-8">METHODS</hd> <p></p> <hd id="AN0187859952-9">Procedures</hd> <p>During the evaluation period, infant/early childhood mental health consultation was provided by 35 part‐time or full‐time masters level mental health professionals employed by the ECMH Network's seven mental health clinics. Each full‐time consultant supported up to five ECE sites per school year (September to June), spending one day at each site every week, focusing on three classrooms per site. The average consultation period was approximately 7.5 months.</p> <p>At the beginning of the consultation year, classroom demographic information was collected by the consultant in collaboration with the ECE teacher. These data included descriptive information on the teacher and their classroom (number of teachers in the classroom, the lead teacher's years of experience, the number of children in the classroom) as well as demographic information of the children within the classroom (e.g., age, sex and race/ethnicity) that was reported by the teacher.</p> <p>Four weeks after the initiation of classroom consultation, consultants (<reflink idref="bib1" id="ref34">1</reflink>) performed a classroom observation of teacher‐directed and/or child‐directed activities, for at least two hours before completing the Teaching Pyramid Observation Tool Short Form (TPOT‐SF); and (<reflink idref="bib2" id="ref35">2</reflink>) established a 15–20 minutes appointment with the ECE teacher outside of classroom instruction to complete the Classroom‐Strengths and Difficulties Questionnaire (C‐SDQ) regarding the children within their classrooms. These measures were repeated at the end of the consultation period. Throughout the consultation period, ECE teachers and consultants identified children for child and family level services based on observation or teacher reports regarding a child's challenging behaviors or need for additional services. Child and family level consultation could be initiated at any point of the year, pending parent or caregiver consent. After receiving consent, the consultant would ask the ECE lead teacher to complete a Devereux Early Childhood Assessment (DECA) for the child. The DECA would be collected again at the end of child and family level consultation services, which varied for each child. Demographic data for the individual children receiving child and family level consultation was collected by the consultant in collaboration with the ECE teacher.</p> <p>All data were submitted to the NYC Health Department by the consultants at the Network clinic. Data were collected via paper format through mail or in‐person, or through the NYC Health Department data collection web portal, depending on the data tool.</p> <hd id="AN0187859952-10">Participants</hd> <p>Mental health consultation was provided to 69 ECE sites during the evaluation period. Sites were located within the five boroughs of New York City. Across the sites, there were 202 classrooms that received consultation, with a total of 2832 children. On average, there were 14 children per classroom, with six children per teacher. Children's ages ranged from 2 to 5 years old. Teachers had an average experience level of 11 years, and the median was 8 years. There were 196 children who received family and child level consultation with parental consent for an initial DECA to be administered.</p> <p>Table 1 shows the classroom and child and family (C/F) level consultation descriptive statistics of the analysis. Of the children in classrooms receiving classroom‐level consultation (<emph>N</emph> = 2832), 50.1% were reported as female and 49.9% as male. The most sizable race/ethnicity categories reported in those 202 classrooms were Hispanic (39.3%) and Black/African American (36.2%). Among the children who received child and family level consultation (<emph>N</emph> = 196), 56.1% of children were reported as male, and 34.2% as female, and most of the children were reported to be Hispanic (36.2%) or Black/African American (31.6%). Given the income disparities and residential segregation in the city, it is unsurprising that the subsidized ECE program sample had a greater representation of BIPOC children than the general New York City population (United States Census Bureau, [<reflink idref="bib33" id="ref36">33</reflink>]).</p> <p>1 TABLE Child demographics by consultation level</p> <p> <ephtml> <table><thead><tr><th /><th><italic>Classroom‐Level</italic></th><th /><th><italic>C/F‐ Level</italic></th><th /></tr><tr><th><p><bold>Sex</bold></p></th><th><italic>N = 2832</italic></th><th><italic>(%)</italic></th><th><italic>N = 196</italic></th><th><italic>(%)</italic></th></tr></thead><tbody><tr><td>Female</td><td>1418</td><td>50.07%</td><td>67</td><td>34.18%</td></tr><tr><td>Male</td><td>1414</td><td>49.93%</td><td>110</td><td>56.12%</td></tr><tr><td>Unknown</td><td>0</td><td>0.00%</td><td>19</td><td>9.69%</td></tr></tbody></table> </ephtml> </p> <p></p> <p> <ephtml> <table><thead><tr><th><p><bold>Race/Ethnicity</bold></p></th><th><italic>N = 2832</italic></th><th><italic>(%)</italic></th><th><italic>N = 196</italic></th><th><italic>(%)</italic></th></tr></thead><tbody><tr><td>Hispanic</td><td>1114</td><td>39.34%</td><td>71</td><td>36.22%</td></tr><tr><td>Black or African American</td><td>1024</td><td>36.16%</td><td>62</td><td>31.63%</td></tr><tr><td>Asian</td><td>337</td><td>11.90%</td><td>29</td><td>14.80%</td></tr><tr><td>Middle Eastern or North African</td><td>114</td><td>4.03%</td><td>4</td><td>2.04%</td></tr><tr><td>Bi‐/multi‐racial</td><td>102</td><td>3.60%</td><td>4</td><td>2.04%</td></tr><tr><td>White</td><td>33</td><td>1.17%</td><td>2</td><td>1.02%</td></tr><tr><td>American Indian/ Alaskan Native</td><td>0</td><td>0.00%</td><td>0</td><td>0.00%</td></tr><tr><td>Native Hawaiian or Other Pacific Islander</td><td>1</td><td>0.04%</td><td>1</td><td>0.51%</td></tr><tr><td>Other</td><td>16</td><td>0.56%</td><td>0</td><td>0.00%</td></tr><tr><td>Unknown</td><td>91</td><td>3.25%</td><td>23</td><td>11.73%</td></tr></tbody></table> </ephtml> </p> <hd id="AN0187859952-11">Measures</hd> <p>The evaluation included the use of pre‐and post‐assessment tools to measure the practices of ECE teachers and the social, emotional, and behavioral outcomes among young children.</p> <p></p> <ulist> <item> <emph>Measuring ECE teachers' classroom practices</emph>. To measure the change in classroom practices among ECE teaching staff, consultants used the TPOT‐SF, a classroom observation tool used to assess teachers' implementation of positive classroom management practices (Snyder, 2013). Among these practices were responsive relationships and supportive classroom environments, the integration of social and emotional teaching strategies and the prevention of behavioral challenges, and the provision of individualized social and emotional support interventions for children. (Snyder, 2013). For this evaluation, the TPOT was broken into two subscales: the Classroom Environment Index and the Classroom Management Index. The Classroom Environment Index consisted of eight (<reflink idref="bib8" id="ref37">8</reflink>) questions regarding the physical conditions in the classroom, with responses of "yes" or "no" on a binary scale ("1" or "0," respectively). The Classroom Management Index consisted of 26 questions regarding the behavior and interactions between ECE staff and young children, with responses on a 4‐point scale that ranged from "Never" represented as "1" to "Almost Always" represented as "4." The questions on the Classroom Management Index that were considered to be negative items were reverse coded in the analysis so that a "1" represented the least indication of classroom management and a "4" represented the greatest indication of classroom management.</item> <p></p> <item> <emph>Measuring child behavior as perceived by ECE teachers</emph>. To measure ECE teachers' perception of how easy or difficult it was to manage the classroom, consultants used the C‐SDQ (Goodman, [<reflink idref="bib17" id="ref38">17</reflink>]). ECE teachers rated their perception of the degree of difficulty of each child in their classroom with consideration to emotions, regulation, behavior, or relationships with family caregivers or peers. Teachers rated children perceived as "no difficulties" with a "0" while children perceived "with difficulties" were rated from "1" to "3" which represented "Minor Difficulties," "Definite Difficulties," or "Severe Difficulties," respectively. The cumulative perceived difficulty rating of all children in the classroom was divided by the number of children to create the Classroom Difficulties Index, with a potential range of 0 to 3. In addition, each classroom was reviewed for the percentage of children in the classroom rated as having any level of perceived difficulties, as well as the percentage of children in the classroom rated as having severe difficulties. For all three measures, a lower score was more desirable.</item> <p></p> <item> <emph>Measuring social, emotional, and behavioral outcomes among children</emph>. To assess the protective factors and potential risks in the social and emotional development of young children, teachers completed the DECA for each child receiving child and family level consultation for which consent was obtained (LeBuffe & Naglierie, 1999; 2003; Mackrain & LeBuffe, [<reflink idref="bib23" id="ref39">23</reflink>]). Each child received a T‐score for both subscales: the Total Protective Factor (TPF) and the Total Behavioral Concern (TBC). The TPF subscale focused on initiative, self‐control, and attachment, in which increasing protective factors indicated improvement (T‐scores of 40 and below = Area of Need; T‐Scores of 41–59 = Typical; T‐scores of 60 and above = Strengths). The TBC subscale focused on attention, aggression, emotional control, withdrawal, and depression, in which decreasing behavioral concerns indicated improvement (T‐scores of 60 and above = Area of Need; T‐scores of 59 and below = Typical) (Devereux Center for Resilient Children, [<reflink idref="bib14" id="ref40">14</reflink>]). For the purpose of the analysis "Area of Need" is referred to as the "Concern."</item> </ulist> <hd id="AN0187859952-12">Data analysis methods</hd> <p>Child demographic data were analyzed (<reflink idref="bib1" id="ref41">1</reflink>) for children in classrooms receiving any consultation, and (<reflink idref="bib2" id="ref42">2</reflink>) for the children who received child and family level consultation.</p> <p>Pre‐ and post‐assessment data were analyzed using paired sample <emph>t</emph>‐tests (<emph>p</emph> < 0.05 level) in which data needed to exist within both time periods. The effect size was measured using Cohen's d methodology for paired <emph>t</emph>‐tests. An effect size of 0.2 was considered a small effect size; 0.5 was considered a medium effect size; and 0.8 was considered a large effect size (Cohen, [<reflink idref="bib7" id="ref43">7</reflink>]). In addition, the Pearson product‐moment correlation was used to explore the relationships between assessment outcomes.</p> <hd id="AN0187859952-13">RESULTS</hd> <p>In general, the findings from the data support the theory of change in which IECMHC is associated with improved classroom practices by ECE teaching staff, as well as improved social and emotional, and behavioral outcomes among children in the classroom. The findings also provide insight into how children's outcomes vary across demographic characteristics, and how outcomes are influenced by their severity of behavioral concerns.</p> <hd id="AN0187859952-14">ECE teachers improved their classroom practices</hd> <p>Table 2 presents the results of the pre and post‐comparison for the TPOT‐SF. Of the 202 classrooms that received consultation during the evaluation period, there were 100 classrooms with both pre‐and post‐ TPOT‐SF assessment data. These 100 classrooms had significant improvements in both the classroom environment and classroom management (<emph>p</emph> < 0.001). The change in Classroom Environment Index had a medium effect size (Cohen's <emph>d</emph> = 0.58); and the change in Classroom Management Index had a large effect size (Cohen's <emph>d</emph> = 0.82).</p> <p>2 TABLE Classroom‐level consultation assessments</p> <p> <ephtml> <table><thead><tr><th align="left" /><th align="left"><italic>n</italic></th><th><italic>Mean time 1</italic></th><th><italic>Mean time 2</italic></th><th><italic>Mean change</italic></th><th><italic>Cohen's D</italic></th></tr></thead><tbody><tr><td>Teaching Pyramid Observation Tool – Short Form</td></tr><tr><td>Classroom Environment Index</td><td>100</td><td>0.90</td><td>0.97</td><td>0.07<ext-link href="***" /></td><td>0.58</td></tr><tr><td>Classroom Management Index</td><td>100</td><td>3.28</td><td>3.52</td><td>0.24<ext-link href="***" /></td><td>0.82</td></tr><tr><td>Classroom‐ Strengths and Difficulties Questionnaire</td></tr><tr><td>Classroom Difficulties Index</td><td>116</td><td>0.79</td><td>0.58</td><td>0.11<ext-link href="**" /></td><td>0.25</td></tr><tr><td>Percent of Children Rated as Any Difficulties</td><td>116</td><td>47.1%</td><td>42.7%</td><td>4.4%<ext-link href="*" /></td><td>0.19</td></tr><tr><td>Percent of Children Rated as Severe Difficulties</td><td>116</td><td>8.9%</td><td>6.0%</td><td>2.9%<ext-link href="**" /></td><td>0.25</td></tr></tbody></table> </ephtml> </p> <p>1 *<emph>p</emph> < 0.05; **<emph>p</emph> < 0.01; *** <emph>p</emph> < 0.001.</p> <hd id="AN0187859952-15">ECE teachers perceived improved child behavior (classroom level)</hd> <p>Table 2 also presents the findings from the C‐SDQ. Of the 202 classrooms that received consultation during the evaluation period, there were 116 classrooms with both pre and post‐ C‐SDQ assessment data. These classrooms had significant improvements across all C‐SDQ assessments. The Classroom Difficulties Index, an aggregate score that weighed the teacher‐reported perception of difficulties of children across the classroom, had a small, significant difference between pre and post‐measures (<emph>p</emph> < 0.01; Cohen's <emph>d</emph> = 0.25). The percentage of children in the classroom rated as having any level of difficulty had a small, significant improvement (<emph>p</emph> < 0.05; Cohen's <emph>d</emph> = 0.19). The percent of children in the classroom rated as having severe difficulties also had a small, significant improvement (<emph>p</emph> < 0.01; Cohen's <emph>d</emph> = 0.25).</p> <hd id="AN0187859952-16">Associations between improved classroom practices among ECE teachers and behavioral outcomes...</hd> <p>Furthermore, there were significant, small to moderate correlations between post‐ TPOT Classroom Management Index (CMI) scores and post‐C‐SDQ assessments, indicating a link between stronger teacher classroom management skills, as observed by the mental health consultant, and decreased perception of child difficulties reported by the teacher. Higher TPOT CMI scores were correlated with: lower C‐SDQ Index Scores (<emph>p</emph> < 0.001; Pearson's <emph>r</emph> = −0.38); lower percentages of children in the classroom rated as having any difficulties (<emph>p</emph> < 0.001; Pearson's <emph>r</emph> = −0.37); and lower percentages of children in the classroom rated as having severe difficulties (<emph>p</emph> < 0.05; Pearson's <emph>r</emph> = −0.27).</p> <hd id="AN0187859952-17">Improved social and emotional, and behavioral outcomes among children (child and family level...</hd> <p>Of the 196 individuals that received child and family level consultation during the evaluation period, there were 138 children with both pre‐and post‐DECA assessment data across 76 classrooms. Table 3 shows the findings from the DECA pre‐and post‐assessment data used in child and family level consultation. In the overall child and family level sample (<emph>n</emph> = 138) there were small, significant improvements over time in both of the DECA subscales, Total Protective Factors (TPF) and Total Behavioral Concerns (TBC) (<emph>p</emph> < 0.001). The mean T‐score of each subscale started in the Concern range at Time 1 and was either within or close to the Typical range at Time 2.</p> <p>3 TABLE DECA scores by concern status, sex, and race/ethnicity</p> <p> <ephtml> <table><thead><tr><th align="left" /><th /><th><italic>Total Protective Factors</italic></th><th><italic>Total Behavioral Concerns</italic></th></tr><tr><th align="left" /><th><italic>n</italic></th><th><italic>Mean TPF Time 1</italic></th><th><italic>Mean TPF Time 2</italic></th><th><italic>Change in TPF</italic></th><th><italic>Cohen's d</italic></th><th><italic>Mean TBC Time 1</italic></th><th><italic>Mean TBC Time 2</italic></th><th><italic>Change in TBC</italic></th><th><italic>Cohen's d</italic></th></tr></thead><tbody><tr><td align="left">Total Sample</td><td>138</td><td>36.6</td><td>40.1</td><td>3.5<ext-link href="***" /></td><td>0.40</td><td>62.5</td><td>59.6</td><td>2.9<ext-link href="***" /></td><td>0.31</td></tr><tr><td>Time 1 TPF Concern Subsample</td><td>96</td><td>32.2</td><td>37.3</td><td>5.1<ext-link href="***" /></td><td>0.65</td><td>63.9</td><td>60.8</td><td>3.1<ext-link href="**" /></td><td>0.31</td></tr><tr><td>Time 1 TBC Concern Subsample</td><td>91</td><td>34.4</td><td>38.9</td><td>4.5<ext-link href="***" /></td><td>0.61</td><td>67.9</td><td>63.4</td><td>4.5<ext-link href="***" /></td><td>0.62</td></tr><tr><td align="left">Sex</td><td>130</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Female</td><td>48</td><td>38.7</td><td>41.6</td><td>2.9<ext-link href="*" /></td><td>0.34</td><td>58.8</td><td>54.6</td><td>4.1<ext-link href="**" /></td><td>0.41</td></tr><tr><td>Male</td><td>82</td><td>35.7</td><td>39.4</td><td>3.6<ext-link href="***" /></td><td>0.41</td><td>64.3</td><td>62.4</td><td>1.9<ext-link href="^" /></td><td>0.22</td></tr><tr><td align="left">Race/Ethnicity</td><td>118</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Asian</td><td>24</td><td>38.4</td><td>42.6</td><td>4.2<ext-link href="*" /></td><td>0.56</td><td>62.9</td><td>59.1</td><td>3.8<ext-link href="*" /></td><td>0.49</td></tr><tr><td>Black or African American</td><td>34</td><td>35.5</td><td>40.2</td><td>4.7<ext-link href="**" /></td><td>0.45</td><td>62.4</td><td>57.9</td><td>4.5<ext-link href="**" /></td><td>0.56</td></tr><tr><td>Hispanic</td><td>60</td><td>37.7</td><td>40.4</td><td>2.7<ext-link href="*" /></td><td>0.31</td><td>61.6</td><td>59.2</td><td>2.4<ext-link href="^" /></td><td>0.24</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 *<emph>p</emph> < 0.05; **<emph>p</emph> < 0.01; *** <emph>p</emph> < 0.001.</item> <item>3 ^value is close to significance at the <emph>p</emph> < 0.05 level.</item> </ulist> <p>Furthermore, when disaggregating the child and family level sample to focus on the children who tested within the Concern range for each subscale at pre‐assessment, there was a greater magnitude of improvement than in the total child and family level sample. Among children who tested within the Concern range for their pre‐TPF T‐score (<emph>n</emph> = 96), there was a medium, significant improvement in the mean post‐TPF T‐score (<emph>p</emph> < 0.001, Cohen's <emph>d</emph> = 0.65). Similarly, among children who tested within the Concern range for their pre‐TBC T‐score (<emph>n</emph> = 91), there was a medium, significant improvement to the mean post‐TBC T‐score (<emph>p</emph> < 0.01, Cohen's <emph>d</emph> = 0.62).</p> <hd id="AN0187859952-18">Disproportionalities in social and emotional, and behavioral outcomes among children by sex a...</hd> <p>Table 3 also shows the child and family level data disaggregated by the reported sex and race/ethnicity of the child. Male and female children were found to have significant improvements in TBC and TPF over the consultation term; but on average, female children were rated more positively than male children within each time point. Furthermore, over the consultation term, female children showed greater improvements in TBC T‐scores than male children, while male children showed greater improvements in TPF T‐scores than female children.</p> <p>Significant improvements in DECA T‐scores were found for all race/ethnicity categories reviewed (Asian, Black/African American, and Hispanic). Race/ethnicity categories that comprised less than 5% of the child and family level sample (American Indian/Alaskan Native, Bi/Multi‐Racial, Hawaiian or Other Pacific Islander, Middle Eastern/North African, White) could not be reviewed due to the small sample size. These comparisons are illustrated in Figures 1 and 2.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BW6/01sep25/imhj22026-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="imhj22026-fig-0001.jpg" title="1 Child TPF T‐scores" /> </p> <p></p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/BW6/01sep25/imhj22026-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="imhj22026-fig-0002.jpg" title="2 Child TBC T‐scores" /> </p> <p></p> <p>Black/African American children, who comprised 24.6% of the child and family level sample, were rated as having the lowest TPF T‐scores and second‐highest TBC T‐scores at pre‐assessment and had the greatest magnitude of improvement across both subscales (<emph>p</emph> < 0.01) by post‐assessment. In comparison, Hispanic children, who made up 43.5% of the child and family level sample, had the lowest magnitude of improvement across both subscales.</p> <hd id="AN0187859952-21">DISCUSSION</hd> <p>The NYC Health Department funded community‐based mental health providers to provide mental health consultation to subsidized early care and education programs. Assessment data were collected during the 2018–2019 school year from ECE sites and classrooms serving a diverse urban population to determine changes in knowledge and skills of ECE staff and associated changes in the classroom environment and management and in children's behavior and protective factors. The current study is notable for its large sample size which allowed for an examination of change over time of classroom and child outcomes from data collected on both the classroom level and child and family level consultation, as well as the disaggregation of outcomes by demographic factors.</p> <hd id="AN0187859952-22">ECE teachers improved their classroom practices and perceived improved child behavior (classr...</hd> <p>The classroom level findings indicate that IECMHC is correlated with teachers' improved classroom practices, with notable effect sizes, as well as perceptions of children's behavioral difficulties, as evidenced by significant changes in assessment data over the consultation term. Furthermore, the significant association between stronger classroom management skills as reported by the consultant, and fewer teacher‐perceived instances of child difficulties aligns with the overall conceptual model that teachers' practices have an impact on children's behavior. Teachers may have felt increased competency in responding to children's needs. Additionally, teachers' understanding of developmentally appropriate expectations for children and the context of children's difficult behaviors may have changed over the consultation term, and this change in understanding could have positively influenced the assessment of children and the classroom at the end of the consultation period.</p> <hd id="AN0187859952-23">Improved social and emotional, and behavioral outcomes among children (child and family level...</hd> <p>At the child and family level, children showed an increase in protective factors and fewer behavioral concerns over the course of the consultation period. This was most notable among children initially assessed as having fewer protective factors or higher behavioral concerns at the beginning of the consultation period. Few previous IECMHC studies and program evaluations have disaggregated outcomes by race/ethnicity (Center of Excellence for Infant & Early Childhood Mental Health Consultation, 2020). This evaluation contributes to the evidence base by examining whether IECMHC child outcomes differ by race/ethnicity, and how to potentially reduce disparities in children's childcare experiences.</p> <hd id="AN0187859952-24">Disparities by race/ethnicity and sex</hd> <p>Upon disaggregating the data by reported race and ethnicity, Black/African American children who received child and family consultation showed the greatest improvement in both protective factors and behavioral concerns, and Hispanic children showed the least improvement in these areas. This disparity is worthy of further investigation. It is possible that teacher expectations of different groups of children resulted in different initial reasons for referral for child and family consultation. However, further investigation of potential qualitative data is required to clarify this issue. It is recommended that future data collection includes race and ethnicity of, and the languages spoken by, teachers and consultants, along with teachers' expressed reasons for referring children for child and family consultation. This would help ascertain whether a teacher's perceptions are affected by the degree of cultural and racial match between teacher and child (Davis et al., [<reflink idref="bib12" id="ref44">12</reflink>]; Shivers et al., [<reflink idref="bib28" id="ref45">28</reflink>]). It is also recommended that future data collection includes demographic characteristics of students who have been identified for child and family level consultation but for whom parental consent has not been obtained.</p> <p>When reviewing the data by reported sex, male children were more likely to receive child and family level interventions and in general, showed fewer protective factors and greater behavioral concerns than female children. However, there was greater improvement in protective factors for male children than female children. Teachers may have felt less able to support male students and their perceived externalizing behavior at the beginning of the school year, but over time were better able to manage perceived challenging behaviors, in which 1) teachers' scores reflected their change in perceptions of challenging behaviors and/or 2) male children were able to make gains in protective factors. Female children showed greater improvement in the behavioral concern subscale than male children, despite having stronger scores at the start of child and family consultation. The potential reasons for these results should be further investigated. This is important because of the historically disproportionate number of Black boys who are expelled from ECE (Gilliam, [<reflink idref="bib15" id="ref46">15</reflink>]). Better understanding sex disparities in how children are treated in the classroom will help inform IECMHC practices that focus on equity.</p> <hd id="AN0187859952-25">LIMITATIONS</hd> <p>There were limitations to the data collected for mental health consultation at the classroom level, and child and family level such as instances of interruption in consultation services due to ECE and consultant staff turnover, ECE site closures, and ECE organizational restructuring that impacted data collection, specifically post‐assessment data. To mitigate data collection issues related to staff turnover and service disruption, data management protocols included strategies such as training in data collection and entry for staff onboarded mid‐consultation year in addition to the beginning of the consultation year; and accurate logging of staff changes throughout the consultation year.</p> <p>Demographic data collection of children within the classroom did not include two distinct categories for race and ethnicity and did not disaggregate by Asian ancestry, which could reveal differences in outcomes across children identified as Asian.</p> <p>Finally, the sample size of complete DECA data from children receiving child and family level consultation was not large enough to assess statistically significant differences between subgroups of race/ethnicity and sex combined. Among children identified to receive child and family level consultation, only those whose parents/caregivers consented to this consultation were assessed using the DECA. This may have led to bias in the data based on caregiver receptivity to services.</p> <hd id="AN0187859952-26">Future directions</hd> <p>Future analyses that consider the mental health consultant's race and ethnicity in comparison to the ECE teachers and children served will provide the opportunity to learn more about the impact on the consultative alliance within a racial, ethnic, and cultural context. A more robust sample would allow for more detailed analyses of subgroups. These analyses should include a review of what specifically changed in ECE teachers' knowledge and use of new strategies such as learning more culturally tailored practices, to assess whether these factors predicted improvements in their classroom management and in their students' behavior. While these variables could be analyzed quantitatively, it is important to incorporate qualitative feedback from consultees and consultants to add context and meaning to quantitative results and to identify areas for enhanced analyses.</p> <p>Future analyses should consider the relationship between the outcomes among ECE teachers and children, and the dosage of consultation, including frequency, duration, and intensity at the site, classroom, and child and family levels. Additional attention should be paid to whether consultants' training and supervision have an impact on consultation outcomes, including how anti‐racist practices might be embedded in ongoing work.</p> <hd id="AN0187859952-27">CONCLUSION</hd> <p>In early care settings, Infant/Early Childhood Mental Health Consultation is a potentially powerful intervention to improve teachers' classroom management as well as teachers' perceptions of children's behavior. This may be particularly important in the context of biases that place marginalized groups, particularly Black male children or children whose dominant language(s) are not English, at risk of negative assessments and punitive actions from adults in educational settings. Responsive, safe early care experiences for young children contribute to strong foundations for healthy development. Policymakers and funders should consider supporting IECMHC as a proven approach to promoting the development and well‐being of young children. Importantly, to address race and sex disparities in mental health consultation outcomes, we must better understand the factors that impact these outcomes, including the composition and training of the early care provider and mental health consultant workforces. This may include racial and ethnic composition, language, anti‐racist practices, and cultural sensitivity of staff and how these work to the benefit of the young children and parents/caregivers receiving services. Contributing to the evidence base of IECMHC is worthwhile in order to improve the delivery of this service and to bring about sustainable funding for IECMHC.</p> <hd id="AN0187859952-28">ACKNOWLEDGEMENTS</hd> <p>Deborah Perry, Annie Davis, Janice Okeke, Megan Brown, IECMHC Center of Excellence, Early Childhood Mental Health Network ECTC & TTAC staff, NYC Early Care & Education staff, NYC children & families, NYC Mayor's Office of Community Mental Health.</p> <hd id="AN0187859952-29">DATA AVAILABILITY STATEMENT</hd> <p>The data that support the findings of this study are available on request from the corresponding author. 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American Community Survey Demographic and Housing Estimates. https://data.census.gov/cedsci/table?q=new%20york%20city&y=2018&tid=ACSDP1Y2018.DP05</bibtext> </blist> </ref> <aug> <p>By Fatima Zahra Kadik; Elleanor Eng; Kristen Pappas and Shirley Berger</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib29" firstref="ref3"></nolink> <nolink nlid="nl2" bibid="bib25" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib13" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib15" firstref="ref6"></nolink> <nolink nlid="nl5" bibid="bib16" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib18" firstref="ref9"></nolink> <nolink nlid="nl7" bibid="bib19" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib11" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib27" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib12" firstref="ref20"></nolink> <nolink nlid="nl11" bibid="bib28" firstref="ref21"></nolink> <nolink nlid="nl12" bibid="bib10" firstref="ref23"></nolink> <nolink nlid="nl13" bibid="bib26" firstref="ref28"></nolink> <nolink nlid="nl14" bibid="bib20" firstref="ref29"></nolink> <nolink nlid="nl15" bibid="bib33" firstref="ref36"></nolink> <nolink nlid="nl16" bibid="bib17" firstref="ref38"></nolink> <nolink nlid="nl17" bibid="bib23" firstref="ref39"></nolink> <nolink nlid="nl18" bibid="bib14" firstref="ref40"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Improved Classroom and Child Outcomes through Mental Health Consultation in New York City Subsidized Early Care and Education Programs
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Fatima+Zahra+Kadik%22">Fatima Zahra Kadik</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-2945-1916">0000-0003-2945-1916</externalLink>)<br /><searchLink fieldCode="AR" term="%22Elleanor+Eng%22">Elleanor Eng</searchLink><br /><searchLink fieldCode="AR" term="%22Kristen+Pappas%22">Kristen Pappas</searchLink><br /><searchLink fieldCode="AR" term="%22Shirley+Berger%22">Shirley Berger</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Infant+Mental+Health+Journal%3A+Infancy+and+Early+Childhood%22"><i>Infant Mental Health Journal: Infancy and Early Childhood</i></searchLink>. 2025 46(5):604-614.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="DE" term="%22Consultation+Programs%22">Consultation Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Evaluation%22">Program Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Emotional+Learning%22">Social Emotional Learning</searchLink><br /><searchLink fieldCode="DE" term="%22Classroom+Techniques%22">Classroom Techniques</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Behavior%22">Student Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Characteristics%22">Student Characteristics</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22New+York+%28New+York%29%22">New York (New York)</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/imhj.22026
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0163-9641<br />1097-0355
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This paper describes the evaluation of one year of infant/early childhood mental health consultation (IECMHC) in subsidized early care and education settings provided by the New York City Early Childhood Mental Health Network. The evaluation examined direct and indirect outcomes of IECMHC including (1) improved classroom practices by ECE teachers, and (2) improved social, emotional, and behavioral outcomes among children in the classroom. The study also reviewed child attributes that might have moderated outcomes. An analysis using paired t-tests of pre-and post-assessment data found significant improvements over time in the classroom environment and management practices, as well as in teachers' perceptions of the degree of difficulty presented by children's classroom behaviors. There were significant improvements in protective factors and problem behaviors among the subset of 138 children who received assessments. Improvements were greater for Black/African American children and for all children with pre-assessment scores in the concern range. Males showed greater improvement in protective factors whereas females showed greater improvement in behavioral concerns. IECMHC is a powerful intervention to improve teachers' classroom management and their perceptions of children's behavior and is important in the context of biases that place marginalized groups at risk of punitive actions by teachers and administrators.
– Name: AbstractInfo
  Label: Abstractor
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1482978
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1482978
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1002/imhj.22026
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 604
    Subjects:
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Early Childhood Education
        Type: general
      – SubjectFull: Consultation Programs
        Type: general
      – SubjectFull: Program Evaluation
        Type: general
      – SubjectFull: Social Emotional Learning
        Type: general
      – SubjectFull: Classroom Techniques
        Type: general
      – SubjectFull: Student Behavior
        Type: general
      – SubjectFull: Student Characteristics
        Type: general
      – SubjectFull: New York (New York)
        Type: general
    Titles:
      – TitleFull: Improved Classroom and Child Outcomes through Mental Health Consultation in New York City Subsidized Early Care and Education Programs
        Type: main
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            NameFull: Fatima Zahra Kadik
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            NameFull: Elleanor Eng
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          Name:
            NameFull: Kristen Pappas
      – PersonEntity:
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            NameFull: Shirley Berger
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      – BibEntity:
          Dates:
            – D: 01
              M: 09
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0163-9641
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              Value: 1097-0355
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              Value: 46
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: Infant Mental Health Journal: Infancy and Early Childhood
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