Early Childhood Mental Health Consultation: Results of a Statewide Random-Controlled Evaluation

J Am Acad Child Adolesc Psychiatry. 2016 Sep;55(9):754-61. doi: 10.1016/j.jaac.2016.06.006. Epub 2016 Jun 28.


Objective: Despite recent federal recommendations calling for increased funding for early childhood mental health consultation (ECMHC) as a means to decrease preschool expulsions, no randomized-controlled evaluations of this form of intervention have been reported in the scientific literature. This study is the first attempt to isolate the effects of ECMHC for enhancing classroom quality, decreasing teacher-rated behavior problems, and decreasing the likelihood of expulsion in targeted children in early childhood classrooms.

Method: The sample consisted of 176 target children (3-4 years old) and 88 preschool classrooms and teachers randomly assigned to receive ECMHC through Connecticut's statewide Early Childhood Consultation Partnership (ECCP) or waitlist control treatment. Before randomization, teachers selected 2 target children in each classroom whose behaviors most prompted the request for ECCP. Evaluation measurements were collected before and after treatment, and child behavior and social skills and overall quality of the childcare environment were assessed. Hierarchical linear modeling was used to evaluate the effectiveness of ECCP and to account for the nested structure of the study design.

Results: Children who received ECCP had significantly lower ratings of hyperactivity, restlessness, externalizing behaviors, problem behaviors, and total problems compared with children in the control group even after controlling for gender and pretest scores. No effects were found on likelihood of expulsion and quality of childcare environment.

Conclusion: ECCP resulted in significant decreases across several domains of teacher-rated externalizing and problem behaviors and is a viable and potentially cost-effective means for infusing mental health services into early childhood settings. Clinical and policy implications for ECMHC are discussed.

Keywords: behavioral outcomes; early childhood education; early childhood mental health consultation; preschool children; preschool expulsion.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Child Behavior Disorders / diagnosis*
  • Child Behavior Disorders / prevention & control*
  • Child Health Services*
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Mental Health Services*
  • Outcome and Process Assessment, Health Care
  • Referral and Consultation*
  • School Teachers
  • Schools