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Oregon’s Early Childhood

Health and Mental Health Consultation
System Planning

A report to Health Matters

From the Child Care Health and Mental
Health Consultation
Priority Action Work Group

December 2010
We wish to acknowledge the following individuals and organizations
for their vision, expertise and guidance in creating this report and the
underlying documents, which can be viewed at
http://healthoregon.org/hcco.
Name Agency

Beth Green .............................................. NPC Research

Betty Shuler ............................................. Neighbor Impact
Bruce Spilde ............................................ Multnomah County Mental Health and
Addictions Services
Candace Artemenko ................................ Oregon Center for Children and Youth with
Special Health Needs
Charlotte Schley ...................................... Oregon Center for Children and Youth with
Special Health Needs
Cynthia Hurkes........................................ Oregon Child Care Resource and Referral Network
David Anderson ....................................... Oregon Public Health Division Office of
Family Health
David Willis ............................................. The Artz Center
Dawn Sly ................................................. Mental health consultant
Deanna Humphry ................................... Oregon Public Health Division Office of
Family Health
Deborah Murray ..................................... Peninsula Children’s Center
Dell Ford .................................................. Oregon Head Start Collaboration Project
Diana Stotz .............................................. Washington County Commission on Children
and Families
Diane Ponder ........................................... Zero To Three
Diane Smith............................................. Child Care Resource and Referral of
Clackamas County
Dianna Pickett ......................................... Oregon Public Health Division Office of
Family Health
Donalda Dodson ..................................... Oregon Child Development Coalition
Farzana Siddiqui ...................................... Community Action Head Start
Washington County
Gerry Morgan ......................................... Early Childhood Cares
Gil Nicholson-Nelson .............................. Valley Mental Health
Ginna Oliver ............................................ Oregon Department of Education
Gracie Lee ............................................... Multnomah County Health Department

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Janelle McCleod ...................................... Clackamas County Health Department
Jean Johnson ............................................ Oregon Public Health Division Office of
Family Health
Jeanette Ewald ......................................... Oregon Child Care Resource and
Referral Network
Jennifer Haake ......................................... Early Intervention, Klamath Falls, City
School District
Jennifer Olsen .......................................... Oregon Child Development Coalition
Jill Archer................................................. Washington County Mental Health Organization
Jill Dale .................................................... Oregon Addictions and Mental Health Division
Jin Song ................................................... Oregon Public Health Division
Office of Family Health
Joanne Trzcinski ...................................... Oregon Addictions and Mental Health Division
Joy Rowley ............................................... Oregon Child Development Coalition
Judy Cleave .............................................. Marion County Health Department
Julie Dotson ............................................. Mental health consultant, Central Oregon
Karen Hamilton .................................... Head Start of Lane County
Karen VanTassel ...................................... Oregon Commission on Children and Families
Kathryn Falkenstern ................................ Morrison Child & Family Services
Kathy Seubert ......................................... Oregon Addictions and Mental Health Division
Katrina Miller ......................................... Morrison Child & Family Services
Kevin Burns ............................................. Family Relief Nursery
Katrina Miller ......................................... Morrison Child & Family Services
Kevin Burns ............................................ Family Relief Nursery
Kim Ashley .............................................. Oregon Child Care Resource and
Referral Network
Kim Cardona .......................................... Oregon Commission on Children and Families
Kristen Becker ........................................ Oregon Public Health Division Office of
Family Health
Laurie Danahy......................................... Oregon Department of Education Head Start
Lucia Aleman .......................................... Oregon Child Development Coalition
Lynne Reinoso ......................................... Oregon Department of Education Child Nutrition
Program
Maria Everhart ........................................ The Children’s Institute
Marilyn Berardinelli ................................ Oregon Center for Children and Youth with
Special Health Needs

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Marilyn Hartzell ...................................... Oregon Center for Children and Youth with
Special Health Needs
Marilyn Kennelly .................................... Yamhill County Commission on Children
and Families
Mark Anderson ........................................ Oregon Child Care Resource and
Referral Network
Marti Franc ............................................. Clackamas County Health Department
Mary Rumbaugh ..................................... Clackamas County Mental
Health Organization
Maureen Short, RN................................. UCAN Head Start assistant director
Michele Limpens ..................................... Morrison Child & Family Services
Patricia Blasco ......................................... Oregon Health & Science University, Portland
State University, Western Oregon University,
Early Childhood Inclusion Project
Patricia Trow ........................................... Oregon Child Development Coalition
Patti Blasco .............................................. Portland State University,
Western Oregon University
Paula Zaninovich ..................................... Multnomah County Mental Health and Addiction
Services Division
Shawna M. Rodrigues ............................. Clackamas County Children’s Commission
Head Start
Stacy Liskey ............................................. Oregon Child Care Resource and
Referral Network
Ted Keys .................................................. Department of Human Services Children Adults
and Families Division
Teresa Cooper ......................................... Washington State Department of Health
Terry Butler ............................................ Inclusive Child Care Program
Tom Olsen ............................................... Employment Department Child Care Division
Tom Udell ................................................ Western Oregon University
Wendy Nakatsukasa-Ono ........................ Child Care Health Consultation
Network Support

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IV
 Executive summary

Quality child care is essential to the health and safety of our children, our
families and our society. Daily experiences, both positive and negative, are the
raw materials that build children’s brain structure and functioning, including
intelligence and personality. Because the majority of young children are in child
care, early care and education providers play an essential role in
their development.

Children face some important challenges in early care and education settings while
their parents are working or away. Care environments and practices powerfully
affect their safety, health and well-being. For example:

• Children attending early childhood care and education (ECCE) programs

are at much higher risk of exposure to infectious diseases, gastrointestinal
illness, upper respiratory disease and ear infections than those cared for at
home

• They are exposed to challenging behavior or engage in challenging

behavior with both adults and other children.

• Children are cared for by a work force that receives low wages, has a
historically low level of education with frequent turnover, and works in
relative isolation with limited infrastructure for support.

To address these needs, the Child Care Health and Mental Health Consultation
Priority Action Work Group (PAWG) proposes a statewide early childhood health
and mental health consultation system to provide services in early childhood care
and education settings. This system must be developed based on a clear vision for
system infrastructure, a consultation delivery model and consultation services. This
report outlines the essential system elements, as well as a logic model summarizing
resources and actions to reach the desired outcomes of an effective child care
consultation system. The PAWG report also describes the infrastructure that
supports the consultation work force with training and technical assistance and
proposes an evaluation strategy to measure effects. Finding sustainable funding is
essential and likely to be challenging in the current fiscal environment. Finally, this
report explores the costs of services and potential funding sources. It is intended as
a condensed description and summary with recommended next steps. In addition,
the PAWG developed a variety of products available online at
http://healthoregon.org/hcco.

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The PAWG recommends the following steps in the development of a
consultation system:
• Build consensus on priority and direction with the Health Matters, Early
Learning Matters and Family Matters committees and the Early Childhood
Matters Advisory Council.
• Ensure that early childhood health and mental health are included as
priorities in current health reform activities.
• Conduct a comprehensive statewide assessment of the health and mental
health consultation services now available in the state to use in program
development and as a baseline to measure the effect of future efforts. The
assessment should include a focus on gaps in services, as well as information
on target population, model designs, funding resources, evidence-based
practices used, and evaluation processes and tools.
• Explore sustainable funding strategies to address the need for consultation in
multiple types of early care and education programs.
• Explore short- and long-term strategies for staging services as funding
is available.

Introduction
Quality child care is essential to the health and safety of our children, our families
and our society. Early childhood care and education (ECCE) enables parents to
work, attend school, contribute to the well-being of their families and participate in
their communities. Skilled child care providers play a key role in young children’s
lives — creating opportunities for them to learn new skills, develop friendships and
prepare for a lifetime of success in education, relationships and careers.
An enormous number of children in the United States — 63 percent — are in some
type of formal or informal child care; 18.5 million of those children are under the
age of 5. Nationally, preschoolers spent an average of 32 hours per week in child care.1
In Oregon only 32.9 percent of children in care under the age of 4 were in paid (usually
licensed) child care in 2008.2
Children’s daily experiences have long-term effects on them, their families and
society. The ECCE work force, composed of teachers working in child care
centers and caregivers working in homes, is foundational to young children’s daily
experiences. Warm, nurturing and stimulating interactions between teachers/
caregivers and children is the single most important predictor of positive child
outcomes from child care and early education. Though only 10 percent of child
care is estimated to be of poor quality, most of child care is considered of fair or
minimal quality, which does not offer the ideal safe and nurturing environment for
these children.3 Clearly, there is work to be done to improve child care quality.

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Children in safe and healthy environments are more likely to grow into healthy
adults. Warm, nurturing and attuned responses from caring adults within
the context of sound physical health provide the foundation for early brain
development and are associated with a broad range of abilities and learning
capacities. Infants and young children’s early relationships, family, community and
culture support their healthy growth and development.
Skilled ECCE providers can preserve, protect and promote children’s health
through daily opportunities for healthy meals and regular physical activity;
protection from communicable disease by sanitary practices and community
connections to health insurance and to routine health, mental health and dental
care services as needed.
Research consistently suggests that higher levels of provider education and
training predict program quality in child care settings.4 Professional development
encompasses education, training and related activities such as consultation. Most
of the related activities involve individualized instruction and are sometimes
described as “relationship-based professional development.” Education and
training that increase positive interactions between adults and children affect
multiple areas of the children’s development.

Problem
Although the professionalism of child care is gaining momentum, this work
force — which fills such a critical function for families and our society — needs
substantially more support.
There are major problems facing children in early care and education settings.
Children attending ECCE programs are at much higher risk of exposure to
infectious diseases, gastrointestinal illness, upper respiratory disease and ear
infections than those cared for at home.4 Caregivers must provide healthy, safe,
nurturing environments while simultaneously responding to the challenges
posed by increasingly difficult behaviors from young children in their care. This
demanding work is done by caregivers who are paid a marginal wage, generally
work in isolation and are characterized by historically low levels of education and
high job turnover.
Parents, as well as early childhood care and education (ECCE) providers, have
concerns regarding the experiences of children in ECCE settings and the quality
of their care, health and safety. Of all Oregon parents with children in ECCE
settings, 16 percent reported their children did not always feel safe in child
care. Only 44 percent agreed with the statement, “My child always got a lot of
attention,” and 53 percent agreed that “My child’s caregiver/teacher was always
open to new learning.”5
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Children arrive in child care with health risks and challenges. Poor health in
children can lead to chronic disease as adults. Obesity, hypertension and diabetes
are on the rise in children. In the United States, 11 percent of children age 2 to
5 are considered obese. In Oregon in 2005 nearly 25 percent of Oregon eighth
graders were overweight or at risk for being overweight.7 More than 20 percent of
Oregon’s 2-year-olds are not fully immunized against serious childhood diseases.8
There was a drop in the number of uninsured children (under the age of 18)
between 2008 and 2009 from approximately 109,200 (12.5 percent) to 90,500 (10.4
percent); however, the uninsured rate for Oregon’s children under the age of 18 was
higher than that of 40 other states in 2009.9
It is estimated that between 9 percent and 14 percent of children from birth to 5
years of age experience social and emotional problems that negatively affect their
functioning and development. These are expressed by behaviors such as aggression
and tantrums or through withdrawal and lack of engagement. According to the
Center on the Social and Emotional Foundations for Early Learning (CSEFEL), the
rate of expulsion for preschool children is three times that of school-age children.
In very young children these behaviors can be severe enough to overwhelm their
caregivers and warrant their removal from their preschool programs, setting into
motion a cascade of negative experiences.6
How can we best solve these problems and facilitate a system of early childhood
care and education that contributes to children’s healthy development? Because
children’s physical, cognitive and emotional capabilities are integrated, early
care and education practices are most successful when they incorporate health
and mental health approaches. The positive effects of this holistic approach are
magnified for children from disadvantaged situations or with special needs.
The authors of this report are convinced that an effective system of consultation
that helps ECCE providers and families best meet children’s needs is fundamental
to healthier children. The report’s goal is to engage support to implement a
statewide health and mental health consultation program that approaches
children’s health and mental health needs in a well-coordinated, holistic way.

Background
Oregon’s early childhood system has one overarching goal: Children are healthy,
growing and learning. Over the last decade, a group of cross-agency, public
and private partners have collaborated to develop the vision for Oregon’s early
childhood system, supported by legislation (ORS 417.727) that led to the early
childhood system.. In March 2008 the Governor’s Summit on Early Childhood
engaged Oregon’s most influential partners in meaningful dialogue and action
around Early Childhood Matters, Oregon’s framework for a statewide birth-
through-5 early childhood system.7 The committees charged with developing the
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system and integrating suggestions from the summit into strategies and actions
included Early Learning Matters, Family Matters and Health Matters.
Following the Governor’s Summit, Health Matters charged the Priority Action
Work Group (PAWG) with developing approaches to expand and sustain
statewide early childhood health and mental health consultation in child care.
The Child Care Health and Mental Health Consultation Priority Action Work
Group (PAWG) consisted of more than 50 people representing state and local
early childhood, health, mental health and special needs communities across the
state. The work group used technologies such as teleconferencing and interactive
websites that allowed for participation from a distance. Smaller groups developed
to address specific tasks and responsibilities.
PAWG members were charged with developing the following products:
• Approaches to consultation, which incorporate the essential elements, a
logic model and identification of outcomes at the system and service
delivery levels;
• Survey to determine what is occurring across the state;
• Needed supports including consultant competencies, training, supports and
supervision (in particular, consultants need reflective supervision);
• An evaluation approach that would monitor implementation and outcomes
of a system of early childhood care and education health and mental health
consultation services; and
• Funding and sustained resources necessary for an ongoing system of
health and mental health consultation in early childhood care and
education settings.
These products are available at http://healthoregon.org/hcco.
Putting these components together, the group developed a statewide approach
with a consultation delivery model that can be implemented in urban or rural
settings, with incremental implementation as resources are available.

Definitions
Common language that supports clarity and understanding among partners from
multiple disciplines is essential.
The following working definition used to describe consultation provides key
context to the PAWG’s work. It is derived from the Early Childhood Mental
Health Consultation Evaluation Tool Kit.8

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Early childhood consultation includes developmentally appropriate, culturally
sensitive and primarily indirect services for children in child care and early
education settings. Services build capacity of staff and family members to
support healthy child development. This may include observing children and the
caregiving environment; identifying concerns and needs; and problem solving
and recommending interventions that involve changes in the environments, skills,
knowledge, attitudes and behavior of caregivers. Early childhood consultants
collaborate with administrators, staff, family members and caregivers who
intervene directly with children in child care, early education and/or home settings.

Figure 1 Consultation dynamics

Early care
and education Child and family
providers
Infrastructure
supports health and
mental health
consultation for child
care providers and the
child’s family.

Health and
mental health
consultants

The consultant’s primary goal is to strengthen the ECCE providers’ knowledge

and skills to assure high-quality care of all children. The solid arrows in Figure
1 show the direct relationship between the consultant and the ECCE provider,
as well as between the provider and the child and family. However, children in
child care with higher needs and those children who are at risk for poor health
and mental health outcomes (refer to Definitions in appendix) can also benefit
from consultation that includes early identification, screening and referral to
more intensive services. The goal of consultation focused on individual children
is to meet their needs and keep them in child care. The consultant offers
recommendations for the child’s care based on a professional assessment for use in
planning with both the ECCE provider and the family. The consultant’s indirect
relationship with the child and family represents a general approach to making
referrals out for treatment needs rather than providing direct health or mental
health treatment. This indirect relationship is shown with an intermittent arrow.

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Building toward a statewide health and mental health
consultation system
An effective system of health and mental health consultation has at its core a
strong and coordinated state and local infrastructure supporting high-quality
services that meet the needs of ECCE providers, children and their families. This
system assumes close collaboration among early childhood partners to develop a
skilled consultant work force; makes use of relevant research and evidence-based
tools; secures adequate and sustainable funding; and provides process and
service evaluation.
The Child Care Health and Mental Health Consultation Priority Action Work
Group proposes the following vision and steps for building toward a statewide
health and mental health consultation system.
Essential elements
The following essential elements of a statewide health and mental health
consultation program are strongly interconnected: a consistent, statewide
infrastructure at the system level; a regional or local consultation delivery model;
and consultation services in the early childhood care and education setting.

Figure 2 Essential elements

Services provided by consultant

to assist child care providers and/or
the child and family

Delivery model supports

high quality health and mental
health consultation

System infrastructure

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Components of essential elements
System infrastructure
1. Statewide oversight and cross-system support;
2. Core competencies for consultants;
3. Criteria and standards for consultation;
4. Buy-in from key partners;
5. Evaluation and continuous quality
improvement processes;
6. Stable, sustainable funding;
7. Service availability to all providers serving
infants, toddlers and preschool-age children;
Consultation delivery model
1. Strong, effective working relationships;
2. Consultation available as an on-site, online/e-
mail and telephone service;
3. Implementation in ready communities;
4. Relationship-based, team-oriented,
collaborative framework;
5. Culturally relevant perspective;
6. Responsive and reflective practice;
7. Multidisciplinary teams with, at minimum,
a health consultant and a mental
health consultant;
Consultation services
1. Program-focused consultation that addresses
the health and well-being of the organization
and the entire population of children and
families served. Services include:
a. Observing classroom interactions,
relationships and environments;
b. Training and support for staff;
c. Supporting and advising child care providers
and center directors to:
(1) Develop, review and update policies,
procedures and records and
(2) Adapt child care practices
and environments.
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8. Accessibility to all providers statewide;
9. Program-focused, provider-focused and child-
and-family-focused consultation;
10. Recognition that consultation is not
direct health care or mental health
treatment services;
11. Recognition that consultation is based on
identified needs and strengths of the system
and participating programs.
8. Developmentally informed and
evidence-based strategies;
9. Strategies that enhance child care
provider capacity for:
a. Health, safety and mental health/social
emotional development promotion and
prevention and
b. Maintenance of children and families with
special needs in inclusive
care environments;
10. Customized combination of system-,
program/provider- and child-and-family-
focused approaches.
2. Child- and family-focused
consultation includes:
a. Observing individual children in care;
b. Sharing observation results with early care
and education providers and parents;
c. Recommending strategies to support
individual children;
d. Assessing and/or making referrals;
e. Facilitating/supporting staff in
making referrals;
f. Modeling and coaching;
g. Disseminating information;
h. Providing reflective support;
i. Providing parent training/parent education.
The logic model

The essential elements describe a vision for health and mental health
consultation that promotes health and mental health and prevents problems
during the early years. How can Oregon create a system and services based
on this vision? The logic model presents strategies that support this vision
and meet both system and service delivery outcomes. The logic model
includes strategies to support:

• Cross-disciplinary partnerships, relationships and services;

• Evidence-based consultation practice and tools;

• Quality assurance;

• Adequate and sustainable funding.

These strategies are relevant to the needs of ECCE providers, families and
children and address state and community priorities.

Collaboration among partners at both the state and community levels and
across health, mental health and child care disciplines is critical. Champions
and leaders who are committed to this vision must emerge at both the
state and community levels to support the effort. Leaders must set to work
exploring and securing needed funding to build the system. Processes
must be put in place to provide a system of coordination and oversight and
assure high-quality services through work force development and support.
Evaluation of the effect of services is essential.

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Logic model summary for a statewide health and mental health consultation system
Part 1. Statewide consultation system
Goal 1: Oregon child care health and mental health consultation services will be supported by a strong partnership of
both state and local level stakeholders.
Inputs Strategies
Communication a. Complete a baseline assessment of
and planning current health and mental health
discussions among consultation services;
potential partners and b. Identify shared values and develop a
stakeholders about the shared vision and mission;
development of a health c. Develop state and local processes for
and mental health communication, shared decision
consultation system for making and funding;
child care. d. Create state and local
interagency agreements;
e. Cultivate cross-system relationships
that support referral and access to
community health, mental health
and social resources for care providers
and families;
f. Conduct local community needs
assessment to identify local priorities;
g. Provide local program oversight to
assure the program meets the essential
elements and addresses local and
partner priorities.
Outputs Outcomes
a. The completion of a baseline 1. There is an objective
assessment and report; description of
b-c. The completion of a partnership system processes
document that includes a vision and and the outcomes of
mission statement and processes for consultation services.
communication, shared decision
making and funding;
d. Signed memoranda of
understanding among state and
local agencies;
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e. The development of cross-system
relationships that support referral
and access to community health,
mental health and social resources
for care providers and families;
f. The completion of local community
needs assessments;
g. The development of local
program oversight.
 Logic model summary for a statewide health and mental health consultation system
Goal 2: There will be adequate funding to initiate and sustain a statewide system of consultation services.

Inputs Strategies Outputs Outcomes

Cost estimates for a. Develop strategies to
a system, based on fund consultation
identified needs services statewide;
that provide b. Create and implement a
essential elements. plan, including steps and
a timeline, to develop and
sustain needed resources.
a. The development of a list of
strategies and cost estimates for
consultation services;
b. The completion of a plan to fund and
sustain services statewide.
2. Adequate funding is dedicated to
initiate and sustain a system of
consultation services at statewide
and community levels.

Goal 3: Skilled and competent health and mental health consultants will provide services to child care providers
across Oregon.
Inputs Strategies Outputs Outcomes

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Essential elements: a. Develop a plan for a statewide a. The development of an 3. High-quality and evidence-
• Consultation system including a timeframe implementation plan; based consultation services are
service model; and measurable steps; b. The development of strategies provided statewide;
• Consultation b. Create strategies to that support high-quality health 4. Consultants are skilled
service standards; implement and and mental health consultation and competent.
• Quality assurance evaluate statewide; services in child care and support a
procedures c. Create state-level team to competent health and mental
and consultant assure quality health and health consultation work force;
competencies; mental health c. The creation of a state-level
• Consultation work consultation services; implementation team;
force training d. Develop statewide training d. The development of training and
and technical and technical assistance technical assistance strategies.
assistance needs. strategies for consultants.
Logic model summary for a statewide health and mental health consultation system
Part 2. Consultation services
Goal 4: The Oregon child care provider work force will have the skills and knowledge to provide children with safe,
developmentally appropriate and nurturing care.
Goal 5: Oregon children in child care will display high levels of physical, social/emotional and mental health.
Inputs Strategies
• Consultant staff a. Develop and implement a
that meet core plan for establishing local
competencies; health and mental health
• Reflective supervision consultation program(s) that
opportunities for meet the essential elements
consultation staff; and address local priorities;
• Quality assurance b. Use a multidisciplinary,
and evaluation data cross-system team approach
collection processes; to consultation;
• Child care providers c. Provide reflective
and program supervision for consultation
managers ready to team members;
receive consultation d. Provide for training and
(good understanding technical assistance
of EC consultation for consultation
and how staff development;
to engage/work e. Use evidence-based
with consultants). consultation practices;
f. Develop strategies to meet
the cultural and individual
needs and preferences of
care providers and families;
g. Collect accurate data using
evidence-based evaluation
tools for process and
outcome evaluation.
Outputs
a-b. The implementation of
integrated and collaborative
consultation services at the
program, family and child
care levels;
c-d. The implementation of
competent, skilled and
supported consultant services;
e. The implementation of high-
quality, evidence-based health
and mental health
consultation services;
f. The implementation of
consultant services that meet
the individual needs of care
providers and families;
g. The availability of data to
describe program services
as well as local and
system outcomes.
Outcomes
5. The child care provider work force is
knowledgeable and skilled;
6. Child care providers are supported
as professionals.
7. Child care providers have increased
confidence and self-efficacy;
8. Preschool and child care
environments are supportive of
children’s health, growth and social
and emotional development;
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9. Preschool and child care policies
and practices support children’s
health, growth and social and
emotional development;
10. Children individually and as
a group show increased
protective factors and decreased
challenging behavior;
11. Families have an increased
connection to needed health,
mental health and social resources;
12. Children with special needs have
access to, and are retained in,
inclusive child care settings.
Funding and support
The vision for statewide health and mental health consultation presented here is
likely to require some new funding.
Potential sources of public and other funding include the following:
• Medicaid;
• Early Head Start/Head Start;
• Individuals with Disabilities Education Act (IDEA Part B,
Section 619, Part C);
• Mental Health and Substance Abuse Block Grants;
• Child Care and Development Fund, including funding for quality;
• Child welfare funds, such as Title IVE of the Social Security Act;
• Maternal and Child Health Block Grant under Title V of the Social
Security Act;
• Temporary Assistance to Needy Families (TANF);
• Supplemental Security Income (SSI, Title XVI of the Social Security Act);
• Private insurance coverage;
• Child care licensing fees; 9
• Service fees.
Costs of health and mental health consultation
Oregon consultation program strategies differ from each other in depth and
intensity. An informal scan of Oregon’s known health and/or mental health
consultation service budgets was conducted. Oregon programs with more
consultant staff tend to receive more prevention services. Those with fewer
consultants tend to focus on children with special needs and serious behavior
issues. Cost levels are higher when programs employ more consultants or
services include consultation covering the continuum from promotion and
prevention to treatment.
The scan compared information about costs from programs within Oregon and
from other states to develop an estimate of costs for health and/or mental health
consultation. While these programs have differences, they have the common
element of consultation. The cost-per-child in Oregon programs ranged from $258
to $348. One Oregon program has 342 children per consultant. In comparison, the
Massachusetts-Worcester and South County Together For Kids (TFK) program
has a cost-per-child of $295 with 200 children per consultant. Estimated return
for Together For Kids is $1.67 to $2.23 for every dollar invested.10 Summaries
of other mental health consultation programs, including program costs and staff
compositions, can be obtained from What Works? A Study of Effective Early
Childhood Mental Health Consultation Programs.11

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The current federal and state economic environment has severely limited available
funding for most services. It is unlikely that the vision for statewide health and
mental health consultation can be realized without new funds. A recommended
strategy for building the necessary statewide infrastructure and services may be
to stage them over time, beginning with limited services and the infrastructure to
support them and expanding as funds become available. Effectively leveraging
funds where possible and including private funds such as grants or fees for services
should be considered. Collaboration that results in braided funding streams and
builds on existing services could reduce the amount of new funds needed.
Recommendations and next steps
• Build consensus on priority and direction with the Health Matters, Early
Learning Matters and Family Matters committees and the Early Childhood
Matters Advisory Council.
• Ensure that early childhood health and mental health are included as
priorities in current health reform activities.
• Conduct a comprehensive statewide assessment of the health and mental
health consultation services now available in the state to use in program
development and as a baseline to measure the effect of future efforts. The
assessment should include a focus on gaps in services, as well as information
on target population, model designs, funding resources, evidence-based
practices used, and evaluation processes and tools.
• Explore sustainable funding strategies to address the need for consultation in
multiple types of early care and education programs.
• Explore short- and long-term strategies for staging services as funding
is available.
For additional information contact:
Dianna Pickett, 971-673-0259, Dianna.L.Pickett@state.or.us, or;
Kathy Seubert, 503-947-5526, Kathy.K.Seubert@state.or.us

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References Return to last page read
1. Census report on child care. (2005). Based on 2002 data.

2. 2008 Oregon Child Care Research Partnership (June 2009). Child care and education in
Oregon and its counties.
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