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The Hanna Perkins Center Model for Consultation in Childcare: Meeting the Needs of Children and Their Caregivers Thomas Barrett, Barbara Streeter, Peter Lawson, Maggie Zraly, Jeffrey Longhofer, Mara Buchbinder Hanna Perkins Center for Child Development - August 2005 The Scope of the ProblemAccording to a recent report, approximately 60 % of children under the age of five in the United States spend a portion of their day in some form of non-parental care (Week 2002). This figure is not significantly different than that encountered in most western countries. For example, the estimated 50% of Finnish preschool age children who are reported to be in municipal day care and in countries such as Sweden and France where there are policies that protect parental time coupled with high-quality, public early-childhood education and care, the numbers are even higher (Meyers & Gornik 2004). Substitute care is here to stay. However, according to one national study, in the United States fewer than 25% of day care centers meet the standards for developmentally appropriate care (Peisner-Feinberg, et al. 1999). In contrast to their counterparts in many European countries, the difficulties faced by child care professionals in the U. S. include low rates of pay, poor training, and a lack of recognition for the important work they do everyday. The result is high levels of job stress, high levels of staff turnover, and high rates of expulsion of children. These factors can be present even in high quality facilities (Gilliam 2005). Few will argue that the relationships child care providers develop with the children in their care and their parents are the foundation upon which all support, interventions, and education takes place. Many assert that the healthy emotional development of children is central to their abilities to develop social and cognitive skills. Indeed, the positive correlation of high quality early education experiences to a range of cognitive, social and emotional outcomes are well documented in the literature (Clarke-Stewart et al. 2002; National Institute of Child Health and Human Development 2000; Shonkoff and Phillips 2000; Shpancer 2002). Additionally, it is widely noted that the negative effects of poor early care may hinder development and impair later educational attainment. A report published in 2002 by the Kauffman Early Education Exchange asserts that school readiness may be jeopardized when “children are in child care settings that are stressful or unstimulating, with teachers who are unknowledgeable or uninterested in the importance of fostering growing minds and personalities, or with staff turnover so high that it is difficult for children to develop stable relationships with their caregivers.” There is less agreement as to how caregivers can learn to build relationships and support the emotional development of children. As well, there is considerable lack of clarity as to the ways in which relationships and emotional development can be evaluated. Each caregiver comes with her own personality and perspective on how children are to be handled. Each child and parent come with their own personalities and complex ways of interacting (or not) with child care staff. Not all are sufficiently able to appreciate the importance of relationships and mastery of early self-care tasks and not all are sufficiently able to respond to the emotional needs of the children. Why Consultation? As an intervention designed to improve the quality of the childcare experience for children, families and providers, consultation has been shown to be particularly effective (Gilliam 2005; Alkon et al. 2003; Bagnato et al. 2002). The consultation process has been demonstrated to affect the provision of quality child care services in a number of important ways including a marked reduction in the number of children expelled from such programs (Gilliam 2005); the empowerment and professionalization of child care center staff; reduction in staff turnover rates; and improvements in more global measures of child care quality (Alkon et al. 2003). In fact it has even been suggested that consultation to non-parental caregivers in early childhood programs may be one of the most important strategies to foster the healthy mental and emotional development of young children in childcare (Knitzer 2000). Consultation can also provide mechanisms for professional development and can support organizational change, enhancing the healthy development of all children within a center, rather than exclusively focusing on the needs of particular children (Collins et al. 2003). Our consultation work at HPC has lead to similar findings; particularly, we have noted (like Gilliam 2005) that ongoing consultation has markedly decreased the practice of removing children with unmanageable behavior from the center, decreased staff turnover rates, and encouraged staff to identify practical solutions to child care work problems and to develop strategies leading to effective, early interventions. Importantly, our consultation work has lead us to conclude that collaborative relationships built with child care center directors and staff support a sense of self-efficacy which allows child care workers to better adapt to the challenges and day-to-day problems of the child care environment (Streeter & Nelson 2003). Hanna Perkins Center National Child Care Consultation Alliance (HPC/NCCCA) Though many excellent training and intervention programs have attempted to help child caregivers learn to develop relationships with children and families, and, in that context, support healthy emotional development, the theory and methods underlying these efforts have not always been clearly defined. As well, child care providers often lament that the challenges they face are bigger than anything that can be addressed through in-service training sessions, college courses, or topic-focused on-site consultations or supervision. In a similar vein, when mental health consultants are accessed to help child care providers deal with identified children in their classrooms, it is not uncommon for them to encounter a variety of communication barriers impeding the implementation of what they believe are appropriate methods of intervention. In addition to disagreements around specific interventions, there are often differences among staff, directors, and parents and feelings of resentment that surface when “experts” attempt to “take over.” For nearly half a century, the Hanna Perkins Center for Child Development (HPC) has provided consultation to preschools and child care centers to assist child care workers in offering developmentally appropriate care for children. The result has been the formation at the center in 2003 of the National Child Care Consultation Alliance (NCCCA), an initiative dedicated to further refining, explicating, and replicating the Hanna Perkins consultation model. In our many years of work with center directors, child care workers, parents, and children we have come to understand that non-parental childcare can be stressful for all. We have come to appreciate the importance of collaborative relationships between the many adults who come together to provide a nurturing environment for a child’s development. As a result, our consultation efforts have focused on building and facilitating trusting relationships with child care workers in order to help them help the young children in their care to thrive socially and emotionally. Throughout our work we have learned that developing trusting, respectful relationships takes time and requires an ability to be sensitive to the caregivers’ experience; to think together with them about the challenges they face (rather than telling them what to do or trying to do the work for them). It also takes an unwavering determination to assess a child’s emotional status and development and to appreciate the importance of the relationships he or she has with his or her parents and caregivers. As we have struggled to develop our model and its goals our biggest challenge by far was to develop a consultation approach that would be valued by the directors and caregivers for how it helped them to develop more in-tune interactions between themselves, the children, and their parents and ultimately empower them to reliably provide lasting and effective interventions for children in distress. Long-time Hanna Perkins consultant Erna Furman characterized the challenge in the following way. “A primary goal of the consultant is to help caregivers to observe the child’s behavior in order to understand what he experiences and to achieve this by feeling with him. This involves helping caregivers know and feel comfortable with the boundaries of their own role while, at the same time, coming to appreciate the role of the parents and, not least, the independent functioning of the child’s personality. When a caregiver, for example, starts to puzzle about the meaning of a toddler’s obstreperous lunchtime behavior and perhaps wonders whether it has something to do with his missing of his mother at this time of bodily need satisfaction, she has accomplished a vital shift in attitude. Instead of getting angry at herself, or the child, or even the parent ‘who hasn’t raised the child properly,’ her new attitude will inform all her subsequent behavior--she may decide to share her observation and feeling with the child and/or with the mother, and/or they may find ways of helping to put missing feelings into words (instead of showing them in behavior), and they may even find ways to make the stress more manageable with the help of a phone call with mother or reading a note mother has prepared especially for lunch time. Most importantly, the caregiver’s approach and problem solving will naturally flow out of her understanding the child’s experience. Such an achievement brings real self-esteem. Understanding behavior as communication is an essential part of the caregivers’ efforts to support children’s masteries. It is also a part of this understanding to learn to differentiate manifestations of normal developmental concerns from manifestations resulting from excessive stress or indicating interferences in development.” (Furman, E. 2000) The Development of the HPC/NCCCA Consultation Model Our studies began in the 1950s with ongoing consultations in Cleveland area preschools and child care centers. Consultants met on site with staff every other week for 90 minute seminars during nap time. These consultations were expanded in the 1980s as consultants spent four hours per week at centers, meeting with the director and staff, working together with staff to address the specific needs of identified children, meeting with parents of the children, and observing the children in their classrooms. Beginning In 1993, the Early Childhood Intervention Alliance (ECIA), a ten-year program funded by the TRW Corporate Foundation, implemented what is now known as the HPC/NCCCA model at five child care center sites in cities across the United States where TRW had facilities. With a ten year commitment from the TRW Foundation, HPC consultants identified and recruited consultants in Michigan, Alabama, Texas, Arizona, and California and helped them to identify child care centers in each location that, as a group, constituted a heterogeneous array representing virtually all types of facilities and demographic constellations. The consultations were aimed primarily at empowering the centers to provide quality care for all the children. Consultants were available to respond to the needs of the director and staff as the needs were brought to them – and often this entailed addressing problems that directors and staff had with each other and with their administrations. Though discussions often focused on problematic children, the consultants never worked directly with the children, rarely met directly with parents, and only occasionally observed in the classrooms. They focused instead on assisting the caregivers in trying to conceptualize the underlying reasons for the problems and to use this knowledge in addressing the problems themselves. As the caregivers gained understandings about individual children, they began to apply their insights to all of the children. During 1999 and 2000, evaluation research was conducted to assess the emerging outcomes of the ECIA initiative. The primary research objective of this study was to examine how the HPC/NCCCA consultation model was received and whether its implementation had a causal impact on the knowledge, attitudes and practices of the caregiving staff and directors of the child care centers. Qualitative data on the emerging outcomes were collected through three research methods: 1) focus groups of caregivers at each site, 2) a focus group of the directors from all of the sites, and 3) a focus group of the consultants from all of the sites. The data collected through each of these methods were entered into Altas.ti software and systematically coded to analyze themes related to the processes and outcomes of the consultation. The coded themes were then triangulated across sites and participant professions. When this was done, three major processes linking consultation practice to child care center quality and children’s healthy social and emotional outcomes emerged from the data: 1. Understanding children’s behavior as communication involved an attitudinal shift among caregivers that enabled them to listen to children, accompanied by a conceptual change among caregivers directed towards recognizing the importance of sincerely thinking about children’s behavior. The process of understanding children’s behavior as communication also involved a cultural transformation in the child care center world centered on acknowledging that children’s behavior is meaningful, and linking behavior and feelings.
2. Developing trusting relationships with parents involved an attitudinal shift among caregivers that enabled them to reach out to parents, followed by a conceptual change among caregivers organized around the importance of talking to parents everyday. The process of developing trusting relationships with parents also appeared to involve a cultural transformation in the child care center world regarding the practice of respecting parents. In addition, collaboration among child care center staff in the form of providing communication support for each other was an important piece of this process.
3. Elevating the professionalism of caregivers involved an attitudinal shift among caregivers leading toward their establishing a professional identity. The caregivers also experienced a conceptual change that revealed a sense of newfound agency. The process of elevating the professionalism of caregivers also appeared to involve a cultural transformation in the child care center world relating to approaching caregivers as valued resources. Collaboration among child care center staff appeared to support professional growth, while empowerment surfaced as an important part of this process involving increased competency among caregivers.
Description of the HPC/NCCCA Childcare Consultation Model The HPC/NCCCA Childcare Consultation Model has evolved from an interaction of theory, concept, and function so that the actual intervention operates by shifting modally across a spectrum of consultation models. These models include process consultation (Schien, 1997), consultee-centered consultation (Caplan, 1995; Sandoval, 2004), and client-centered case consultation (Caplan, 1995). In the process consultation mode, the consultant engages with the child care center as a complex client system (Schein, 1997). The consultant also works with both child care center directors and caregivers in the consultee-centered consultation mode, at times using the constructivist paradigm (Sandoval 1996,) and at other times using the psychodynamic paradigm (Caplan, 1995, 2004). Additionally, the consultant may selectively enter into the mode of collaborative client-centered case consultation (Caplan, 1995) with caregivers and/or parents regarding the case of a specific child in the center. At the “direct service” end of this spectrum, the consultant may provide prescriptive guidance to caregivers and/or parents about a particular child or situation. However, the NCCCA consultant tends to operate most often through the more indirect approaches of process and consultee-centered consultation, spending as little time as possible in the “prescriptive” form of the client-centered case consultation mode. In what follows we present a description of NCCCA consultation practice. The theoretical underpinnings of this multi-modal practice are established and discussed following this description. Entry – Building Trusting RelationshipsBefore entering into a consultation situation, a child care center consultant must first understand the impetus for the consultation. At whose urging is the consultation being undertaken? In assessing this it is essential to understand the complex interactions within the child care center. For example, it is important for a consultant to understand the particulars of organizational hierarchies, which constitute lines of authority and responsibility. Since our consultation is grounded in the concept that trusting, collaborative relationships are the key to successful consultation work and successful childcare practice, our consultants begin by building a relationship with the director of a child care center. Then, with the permission of the director services are expanded to other members of the staff. At entry, consultants clarify the primary goal of the consultation: to provide support for all (directors, staff, parents, and children) in addressing the stresses of non-parental child care. During this earliest phase of consultation, HPC consultants listen to administrators and directors as they describe challenges in the classrooms and the center. The phase of relationship-building within a child care center requires respect, sensitivity, care, and responsiveness, with minimal invasive action on the part of the consultant. Consultants establish trusting relationships with child care center directors by admiring their work, empathizing with their concerns, and understanding their priorities. As consultants begin to get to know the caregivers in the center, they similarly seek to gain their trust by conveying respect and admiration for their efforts. Consultants do not simply give advice or take over; they engage in active listening, nonverbally expressing that their intent is to empower directors and caregivers and to support their skill development and professionalism. During entry, consultants expressly focus on facilitating relationships with directors and caregivers that are consistent, reliable and emotionally responsive. Efforts are taken to clarify some of the potential roles of the consultant. These early interactions are not always without tension. Consultants must carefully balance their alignment with particular groups within the center and work to build trust throughout. An example from an HPC/NCCCA consultation may be illustrative of this delicate balance. At one of our consultation sites, the director asked the consultant to meet with particular caregivers in order to modify their approaches to the children in their care. In this particular situation, the consultant recognized that to attempt to change the caregivers’ behavior would threaten and potentially alienate valuable partners in the consultation process. If caregivers felt that the consultant was clearly on the side of the director, even sent by her to change them, the consultation process would have little hope of developing long-term success. Therefore, the consultant wisely refrained from meeting the director’s request directly, suggesting instead that it was her wish to get to know the caregivers and the director before attempting any sort of intervention. Additionally, the consultant suggested that perhaps it would be more productive for the director, the caregivers and the consultant to meet together as a group in order to discuss a particular child who was presenting the center with some challenges. In this way, the consultant avoided a potentially damaging interaction that could split or fracture alliances and instead facilitated the creation of a working group that held the potential to foster trust and build a set of collaborative relationships. Consultants approach these early entry stages of the collaborative relationship with respect, sensitivity, care, and responsiveness, while maintaining a minimal level of invasive action. Consultants establish trusting relationships with child care center directors by admiring their work, empathizing with their concerns, and understanding their priorities. As they expand their work to include other members of the child care staff, consultants do not simply offer advice, and they never attempt to take over; rather, they engage in active listening and questioning, in order to reinforce their attempts to empower directors and caregivers, to support skill development, to aid in the development of professionalism, and to foster a sense of self-efficacy. During this period, consultants facilitate relationships with directors and caregivers that are consistent, reliable and emotionally responsive. The consultants’ approach to problems and situations that arise can then serve as a model for the collaborative problem-solving approach that they intend to diffuse into the network of relationships surrounding the childcare experience. Collaborative Problem-Solving Our method of consultation works to build collaborative problem-solving relationships among consultants, directors, caregivers, and parents. While interactions among these various groups present unique challenges, the central means by which problems are solved is built upon the trust built during the consultant’s entry into the center. As noted, early consultation sessions with caregivers often take the form of group discussions about specific children who are causing caregivers’ difficulty. The consultant uses these opportunities to both evaluate and build upon caregivers’ preexisting knowledge of the child’s problems and particular background. Throughout the consultation process, the consultant invites the caregivers to explore their own ideas about the root causes of problematic behavior, the possible strategies that might be employed to handle difficult situations that arise in the center, and the possible consequences of these various strategies. All the while, the consultant may watch for opportunities to interject in a timely way, his or her particular knowledge about child development, the emotional life of children, or some of the potential stresses that exist in the child care environment from a child’s perspective. In this way, the consultant acknowledges and values the special relationship that the caregivers have with the children and with the parents while subtly expanding their repertoire of developmentally appropriate understanding and capacity to be responsive to children’s needs. The consultant also seeks to build relationships between the caregivers and the director in order to assist them in building a community that is mutually supportive and able to engage in collaborative problem-solving beyond the consultation sessions themselves, which typically last from two to four hours per week. Additionally, during consultation visits, the consultant may be asked to observe a particular child in order to better assist caregivers in solving a particular problem. However, even in this capacity the consultant continues to resist playing the role of the “expert.” Instead, the consultant works with the caregivers to see problems in different ways by carefully drawing their attention to particular details of the situation that may have been previously overlooked. The consultant may also ask questions to enhance caregivers’ own skills at evaluation and problem solving. Supporting Continuity One of the particular insights that HPC consultants bring to the childcare context is an emphasis on supporting continuity in care. This may take many forms. One way a consultant can assist caregivers in providing more appropriate care is to raise the awareness among caregivers that a child’s experiences at home before entering the routines of the child care center play an important role in shaping a given child’s behavior throughout the day. By encouraging caregivers to recognize the multiple barriers that exist in effectively communicating with parents and other caregivers throughout the day, a consultant may encourage the center to develop structural methods to foster continuity for the children in their care. For example, at one of the sites where we have had an ongoing consultation relationship, the consultant was able to assist center directors in developing more comprehensive intake procedures that fostered better relationships between parents and the childcare center staff. At other sites, consultants were able to assist in reorganizing the structure of drop-off and pick-up times to more effectively facilitate communication between parents and caregivers. By drawing attention to these important transition times, consultants aided caregivers, directors and parents in providing more continuity for the children. As parents were drawn into discussions of the events that had taken place at home, and caregivers were better able to communicate the events that took place during the child’s time in the center, more effective collaborations developed between parents and caregivers and children benefited from these closer working relationships. As caregivers become more confident in their roles as professionals providing quality care for children, they are better able to discuss problems and successes with parents and parents are more apt to discuss the challenges they may be facing at home. They become better able to address some of the unique needs of their children. The Important Focus on Self-Care Mastery Decades of research and experience in consultation at the Hanna Perkins Center have underscored the importance of mastery in areas of bodily self-care as an essential component in the establishment of self-esteem in preschool-age children. “The child’s mastery of bodily self-care is the vehicle by which ownership of his body is transferred from mother to him through identification with her…a source of self-regard and self-esteem (that) builds important tolerance for frustration and pleasure, and confidence in achievement through effort, all of which underlie the later ability to learn and work…Mastery of self-care, more than any other single development, makes the toddler feel he is a person, a somebody” (E. Furman, 1992). Our experience has also revealed that it is in the area of self-care development and mastery that difficulties most often arise for children in situations of substitute care. A child’s first learning is about his or her body. The myriad experiences of being held, comforted, fed, cleaned, dressed, talked to, put to sleep, etc. provide the impetus for learning and for wanting to do these very tasks for one self. This learning process is facilitated and mastery is most reliably obtained when there is continuity in this experience of being cared “for.” While this experience begins in the mother-child relationship, for children in substitute care, their ability to achieve mastery is dependent upon the extent to which their other caregivers are able to invest in their bodily care in a way that attempts to approximate, replicate, or remind the children of the care they receive at home. When Hanna Perkins consultants discuss individual children with caregivers it often occurs that the reported vignettes reveal struggles or concerns revolving around self-care tasks. These problems are most effectively resolved when caregivers can be helped to consider strategies for more closely involving the parents in addressing these concerns. We have come to learn that it is this focus on bodily care and the gradual transition from being “cared-for” to “cared-with” to “being admired for doing for one’s self” that is the prerequisite for healthy emotional and social development in preschool-age children. When parents and caregivers can establish strong, communicative, relationships that focus on self-care mastery, children more reliably develop healthy personalities and readiness to learn. Seeing Things Differently At the Hanna Perkins Center, our decades of work with young children have borne out the importance of seeing children’s behavior as a meaningful mode of communication. Behavior that may initially be seen as simply disruptive or “bad” by caregivers in the child care context is often less a problem of improper discipline or poor parenting (two notions that can result in blame and a breakdown of empathic relationships between parents and caregivers) than it is an attempt by a child to communicate a level of distress or discomfort with circumstances that are largely out of his or her control. One important task for a consultant is to assist childcare workers to see children’s behavior as a meaningful expression of their inner emotional worlds. This process by which caregivers come to see things differently is one of the most interesting and rewarding aspects of consultation for consultants, caregivers, directors and the children themselves. The following vignette is offered to more fully illustrate the points outlined above. It was morning at the Hastings Child Care Center. Three year old Jonathon was standing next to the coat hook, head hanging down and forehead wrinkled. To no one in particular, he grumbled, "she left me in the dark!" Mrs. Samson, one of his caregivers, passed by at this moment and, in her sunshine voice, refuted what he said. "She didn't leave you in the dark Jonathon! She said good-by to you and - see - she hung your coat up on the rack. Now come on and play." Jonathon complied, following Mrs. Samson to the play area, but he did not let go of the dark cloud over his head. Melanie was on the green block, peering out the window to see if she could see her mother get into her car. Mrs. Samson squatted down next to her and pointed at the birdies on the tree branch immediately outside the window. This cued Jonathon in to the possibility that he might be missing out on something. He wanted to see out the window, too, and tried to climb up on to the block next to Melanie, but she shoved him back. There was really only room enough for one person on the block. Melanie’s shove made Jonathon angry. He swung at Melanie who promptly burst into tears. At this, Mrs. Samson admonished Jonathon: "Oh Jonathon! Look what you've done. You've hurt Melanie!" Jonathon was quick with the obligatory make-up hug. He had learned long since that that's what one is to do when another child is crying and you had something to do with that crying. The observing consultant felt for Jonathon. He felt hurt by and angry at his mom, who was too concerned about getting to work on time to notice his feelings, and his anger, unassuaged, had spilled on to Melanie. Now he felt worse than before because Mrs. Samson was unhappy with him. The best he could do was give Melanie the hug, but it had little meaning for him. Instead of learning to trust his own perceptions and listen to his feelings, Jonathon was learning that the goal is to follow Mrs. Samson's rules because she tells him to. This goal was too hard for him to meet, however, because his "not listened to feelings" got the better of him. He ended up feeling no good. As the consultant reflected upon what she had observed, she imagined an early morning exchange that could have been more supportive of Jonathon. Mrs. Samson could have acknowledged Jonathon's feeling about his mother and perhaps helped him to write a note to his mom about how he felt. Later, she might have helped Jonathon to call Mom at work or spoken together with Jonathon and Mom at the end of the day. She could have addressed her appreciation of the mother before bringing up Jonathon’s distress, perhaps saying: "I imagine it's quite a challenge getting everyone going in the morning. I'm always impressed how you always manage to help Jonathon remember his back pack and get yourself looking so nice at such an early hour!" She could then talk with the mother about how important she is to Jonathon and how it might be less stressful for him if mom were able to talk with him about his missing and angry feelings, if he knows that she understands. Even as she considered these ideas however, the consultant recognized that they were her ideas and realized that much further work and relationship building with Mrs. Samson would be required to help her come to approach such a situation in this fashion. When the consultant asked Mrs. Samson about the incident later, Mrs. Samson explained, "Oh, I know Jonathon was really missing his mom. And I know that Melanie wasn't really hurt - it was just her feelings that were hurt. But Jonathon needs to learn to wait his turn." Knowing that separation issues had been discussed previously, the consultant asked, "Is there a reason you didn’t talk with Jonathon about his mom?" Mrs. Samson responded, "That would only have made it worse." Mrs. Samson had a hard time imagining that young children could manage their missing feelings. She, in fact, shared the children's anger at their parents for leaving them. Mrs. Samson had stayed at home with her own children. She tried to understand the single moms, the teenage moms who had kids only to leave them with her, but more often than not she noticed what they didn't do right instead of the things they did do right. The consultant realized that progress would come slowly and would have to come from an attitudinal shift within Mrs. Samson, one resulting from an elevated awareness of the importance of her ability to help Jonathan keep his mother in his mind and heart throughout his day spent apart from her. The consultant decided to respond in a way that might begin to help Mrs. Samson achieve such awareness. She said, “You are probably right that if you had talked with Jonathan about missing his mom he might have become even more distressed. But I couldn’t help but notice how he stayed so close to you, even when you were turning your attention to Melanie. I wonder if he didn’t know that, as you said, you understood he was really missing his mom and he wanted your help with those feelings.” Helped to think of it this way Mrs. Samson became reflective and said, “It’s true that Jonathan is usually not so clinging in the morning. I wonder if there was something that was making him feel more upset today. And it really isn’t like his mother to leave so quickly. Maybe something was hard at home this morning.” The consultant agreed with Mrs. Samson’s thought and they were then able to think together of how she might go back to Jonathan to help him consider writing a note his mother or placing a call to her at work to touch base. As the consultant left the center that day and reflected on what had occurred she found herself hoping that Mrs. Samson had helped Jonathan decide make a call to his mother as that would give Mrs. Samson a chance to talk with her, too. The consultant realized that the parents brought their own share of difficulties. Many felt inadequate and perceived Mrs. Samson as being critical of them - even when she wasn't. They were doing all they could to juggle the care of their children, work, school, and family relationships. They knew on some level that they weren't able to be as available to and patient with their children as they wished they could be and some were able to tolerate this knowledge more readily than others. The consultant thought that if Jonathon's mother was able to tolerate her own guilt, she might be able to use Mrs. Samson’s empathy and assistance in a helpful way; she might be able to speak with Jonathon about his separation feelings. If, on the other hand, she had low self esteem and heard any suggestion that she may have played a part in her son's unhappiness as an attack, she might respond to such talk defensively. She would likely explain away Jonathon's distress. She might even criticize Mrs. Samson for not being at the door when she dropped Jonathon off. It is very hard for a caregiver to be empathic with a defensive, attacking parent. As well, there were logistics. Because Jonathon and many others were at the center for as long as ten hours a day and caregivers only work eight hours a day, Mrs. Samson was not present when Jonathon's mom picked him up. Sometimes it wasn't his mom who picked him up anyway. Indeed, it was a stressful situation for all. (B. Streeter) In a recent study of the consultant-caregiver relationship in early childcare contexts, Hylander (2003) found that shifts in cognitive and emotional conceptualizations and representations of problems were often associated with changes in the way caregivers interacted with the children for whom they were caring. Hylander refers to this change in a caregiver’s perception and internal concepts as a turning. In our work with caregivers and childcare center directors, we have found these moments of turning to be significant. In the example above, it is just such a turning that occurs when Mrs. Samson is helped to think of how important she is to Jonathan as someone who understands his feelings. Empowered by this awareness, she is able to begin to think differently about her interaction with him. Often the ability to see things differently is one of the most valuable effects that the process of consultation can have for caregivers. Because one of the goals of the consultation process we practice is to develop the capacity of caregivers to meet the challenges of the childcare environment in appropriate ways, it is often very useful for a consultant to facilitate positive changes in the ways in which caregivers view the children’s (or even parent’s) behavior or the dynamics of a particular situation. Consultants must understand that caregivers already have mental models and detailed ideas of what is appropriate for young children. Everyone carries ideas and mental models for approaching particular situations in our lives. Often these ways of seeing the world are not part of our conscious thought processes; rather, they are deeply rooted in our unique cultural and family backgrounds. By acknowledging that caregivers deal with situations based on these internal concepts of what is best for children, a consultant is better able to work with the caregiver in a process by which new potentials for seeing are created. Connecting Theoretical Moments to NCCCA Practice Over the last 35 years, the problem of disconnect between theory and practice in consultation has remained a central challenge to the field. In a historically important attempt to move towards integrating the field of consultation studies, Gallessich (1985) worked to break the impasse between the steady proliferation of consultation methods during the 1960s and 1970s, and the lack of theoretical and empirical foundations for these methods. Arcing toward a meta-theory of consultation, Gallessich (1985) proposed that inquiring about the universe of different consultation approaches and examining how they relate could serve to guide consultation research agendas and ground consultation training. Froehle and Rominger (1993) echo these claims, suggesting that without empirical findings, and a value placed on them, a unified body of consultation research is inhibited. In an article that appeared in a 1993 issue of Journal of Counseling and Development devoted entirely to advancing consultation research, G. Brack et al. highlighted Gallessich’s (1985) claim that the basic atheoretical, trial-and-error approach to consultation impeded the development of responsive and ethical consultation practices. However, G. Brack et al. (1993) sought to demonstrate that a solution to the problem of “psychologists typically carry[ing] their primary practices and the theories governing them into the consultant role and…not follow[ing] a theory of consultation” (Gellessich, 1985, p. 341) lay within everyday consultation practice. G. Brack et al. (1993) saw that the ongoing, iterative process of matching a conceptual map to consultation interactions held the potential for linking practice to theory, and proposed that if consultants were to explicitly ‘map’ their consultation environments across multiple theoretical frames, the most effective and humane approaches to consultation would emerge. By advocating for consultants to define their work through a flexible worldview, G. Brack et al. (1993) supported the concept that consultants themselves should expand their everyday matching process to connect multiple theories to consultation practice. We used this reflexive consultant-centered methodology for linking practice to theory proposed by G. Brack et al. (1993), namely mapping our practice to consultation theories, thereby advancing our articulation of the theoretical underpinnings of the NCCCA consultation practice to support future child care consultation research. Through this approach, we found that the NCCCA consultation practice maps to multiple theories. Moreover, Lambert, Hylander, and Sandoval (2004) have also recognized that no single theory is sufficient to prepare consultants to respond to the complex work problems they encounter. In discovering these multiple theoretical connections, we have come to realize that establishing the theoretical basis of child care center consultation, and perhaps consultation in general, does not hinge on the problematic process of synthesizing these theories into meta-theory. Instead, we propose that the most productive way to conceive of a broad theoretical perspective for child care consultation research is to conceptualize the particular theoretical moments that comprise a consultation practice. In reviewing the literature on consultation, we identified five consultation theories that are relevant to the NCCCA consultation practice: organizational, psychodynamic, constructivist learning, diffusion of innovations, and social learning (Table 1). In the section below, we summarize the general points of each of these theories, and delineate the particular moments of NCCCA consultation practice (Longhofer et al., 2004; Streeter & Barrett, 1999) that are based on the theories.
Organizational Theory Child care centers are organizations. Organizational theory views the consultation process as helping the manager or the organization to figure out the nature of the work problem first, before deciding what other kinds of help are needed (Schein, 1988). To do this, the consultant must come to understand the structures and processes of the particular organization, such as the forms of communication used among staff, through observation (Schein, 1988). Only by respecting the complex web of meanings within an organization will a consultant be able to understand why people in the organization do what they do (Fitzgerald, 1987). The key to constructive organizational consultation is that someone in the organization, often a manager, has the intention to improve operations (Schein, 1988). The goal of organizational consultation is “to help humans grow and develop in an organizational setting,” (G. Brack et al., 1993; see also Huse, 1978). Organizational theory is most relevant to NCCCA practice during entry, when the consultant establishes a helping relationship with the director of the child care center and refrains from engaging in direct problem solving until the nature of the problem in the child care center is identified. Each consultation interaction is approached with respect for child care professionals, and an important role for the consultant is to observe the operation of the organization, paying particular attention to the communication and relationships between directors, caregivers and parents. The consultant only enters modes of actively facilitating the child care center staff in their efforts to improve the quality of the center when prompted by the expressed needs of the staff. Psychodynamic Theory The psychodynamic theoretical framework, the philosophical basis for Caplan’s “mental health consultation” (Caplan, 1970, 1995, 2004; Caplan et al., 1995; Lambert et al., 2004), identifies the role of the consultant is to promote the mental health of clients through improved services. By entering into noncoersive, coordinate relationship with consultees, which are sanctioned by those at the top of the organizational hierarchy (Mendoza, 1993), consultants support consultees’ professional autonomy and increase their sensitivity to and understanding of their own actions as the keys to resolving work problems (Caplan, 2004). Learning from their success, consultees incorporate this experience “into their future patterns of functioning,” (Caplan, 2004, p. 26). The psychodynamic theory of consultation recognizes that an interpenetrating field of social, psychological, ecological, and cultural forces needs to be considered to grasp the work problem; however, these forces are understood as originating in the conscious and unconscious minds of individuals embedded in a variety of interpersonal relationships, including families and communities (Caplan, 2004). Therefore, the consultant must look deeply into the unconscious aspects of organizations and individuals to help with work problems (G. Brack et al., 1993), while strictly limiting this level of analysis to the application of consulting professionals and not engaging in psychotherapy (Caplan et al., 1995). During the entry phase of NCCCA practice, consultants employ a psychodynamic approach as they engage with directors at the top of the organizational hierarchy and support their autonomy by showing admiration for their work. At all moments when the consultants learn and think with directors and caregivers, whether to conceptualize how child development can be supported in the child care setting or to assist in problem-solving regarding a particular child’s situation, they relate with empathy and trust to establish noncoersive, coordinate relationships. The consultant engages in this process to provide a template for trusting and empathic relationships, which directors and caregivers can learn to use to create future patterns of relationships among themselves and with parents and children. Constructivist Learning Theory Constructivism defines learning as “the active process of constructing a conceptual framework” (Cobern, 1993, p. 109). For constructivist based consultation, this means that “the consultee must be an active participant in the process” (Sandoval, 2004, p. 37), and both consultees and consultants will construct new understandings of the work dilemma through consultation (Sandoval, 1996, 2004). These new understandings are brought about by conceptual changes: “the development of cognitive constructions, or schema, over time” (Sandoval, 2004, p. 37). The consultation goal is not to have the consultee adopt the understanding of the consultant, but for the consultant and consultee to create a “mutual construction of a conceptualization that fits the situation and permits action,” (Sandoval, 2003, p. 258). In addition, “constructivism recognizes the multiplicity of ways in which knowledge is formed” (Henning-Stout, 1994, p. 9). Furthermore, “constructing understanding collectively, suspending expert agendas in order to ‘listen’ to the situation and the people involved, and adapting to the requirements revealed with that listening” (Henning-Stout, 1994, p. 12) requires attention to engagement and relationship. Constructivist theory relates to the NCCCA practice throughout consultation as consultants are present in the child care center to learn and understand in order to think and work together with child care staff. Consultants work together with directors, caregivers and parents to conceptualize a variety of issues particular to the child care setting, including how the stresses of child care affect children, caregivers and parents, the multiple, stressful transitions in the daily routine of child care, young children’s development in the child care setting, and potential responses to theses issues and others. Consultants also work together with directors, caregivers and parents to conceptualize a variety of issues particular to the child care setting, including: 1) how the stresses of child care affect children, caregivers and parents, 2) the multiple, stressful transitions in the daily routine of child care, 3) young children’s development in the child care setting, and 4) potential responses to theses issues and others. Consultants also work together with directors, caregivers and parents to co-construct the practical strategies to support the processes of: understanding children’s development, gaining insight into ways of overcoming stress-related feelings, and interpreting the meaning of a child’s behavior. Diffusion of Innovations Theory In writing about mental health consultation in schools, Meyers et al. (1979) proposed the diffusion of innovations theory to ground consultation practice and research in a clearly articulated theoretical framework. Building on the work of Rogers and Shoemaker (1971), Meyers et al. (1979) put forth the notion that the consultant could be seen as an agent bridging two unique cultural systems. The consultant system produces a set of knowledge and seeks to create change by disseminating this knowledge to potential client systems. Because the two systems/cultures use different languages (technical jargon), hold different values, and have established different goals, the client system may or may not perceive the consultant system’s knowledge as relevant. Therefore, the client system may have to be convinced that the foreign body of knowledge introduced has utility. The consultant’s role, then, is to bridge the gap between these cultures by being conversant in the languages and value systems of both, thereby disseminating knowledge that is useful to the client system (Meyers et al., 1979). While NCCCA consultants are bridging the unique psychoanalytically informed culture of HPC and the culture of contemporary commercial child care centers, they do not attempt to transmit knowledge unilaterally from one culture to the other; rather, they actively learn about the culture of the particular child care center in order to develop sustainable relationships that support children’s social and emotional well-being. In addition to learning about the culture of the child care center through observing and listening to child care center directors, caregivers, parents and children, NCCCA consultants also offer innovations for child development while participating in co-construction and working in the mode of client-centered case consultation. Drawing upon the long history of HPC focused on conceptualizing the challenges of child care center work, NCCCA consultants are able to offer a number of key innovations to child care centers. The cornerstone of these innovations can be summarized in the following three points (Longhofer et al., 2004): 1. Relationships that are consistent, reliable and emotionally responsive best prepare children to learn in the context of a teacher-pupil dyad. 2. Behavior which provides the pathway through which young children express emotions must be recognized as a communication. When children are helped to understand this verbalization of affect, increased frustration tolerance and improved behavior follows. 3. A child’s first learning is focused on his or her own body. Mastery in areas of self-care provides the foundation for self-esteem and all future learning. Such mastery is most reliably obtained when a close working relationship is maintained between caregiver and parents. Because NCCCA consultation is a holistic practice, these innovations exemplify and parallel the NCCCA approach to consultation. However, the NCCCA consultation practice involves coordinate relationships of respect; therefore, the consultant does not work to convince directors and caregivers of the utility of these innovations. Through the process of conceptual change (Sandoval, 1996, 2003) more closely associated with constructivist moments of the practice, these innovations may ultimately be disseminated to the child care center. How these innovations will be taken up in the process of co-construction is unique to each child care center, as well as to the individual consultative relationships. Social Learning Theory Consultation that is based in social learning theory (see Bandura,1977) helps consultees meet their goals with clients by considering how the behavioral, interpersonal and environmental factors can be used to effect change in clients’ behavior as they acquire new skills (G. Brack et al., 1993). By engineering the organizational environment to support desired changes, both consultees’ and clients’ self-efficacy increases, which allows consultees to find realistic solutions to work problems, and to manage these problem in the future without the assistance of the consultant (G. Brack et al., 1993). As described above, constructivist theory directs consultants to listen to directors and caregivers in order to acquire knowledge of the child care culture and to co-construct appropriate, organizational mechanisms in the daily routine of the child care center. Of particular interest to NCCCA consultants are those organizational mechanisms developed to handle transitions, and the practical strategies that assist caregivers to support children’s self-care mastery. As described above, the NCCCA consultants participate in the process of co-construction not only by listening, but also by offering innovations to support child development in child care centers. When co-constructed mechanisms and strategies take-up selected aspects of the innovations shared by the NCCCA consultant, the organizational environment of the child care center changes—including its interpersonal relationships. By promoting contexts within which routine challenges and intermittent crises can be effectively managed, the self-efficacy of directors, caregivers and children is increased. The NCCCA practice utilizes principles of social learning theory when consultants respectfully offer their knowledge and skills as resources that directors may access as they work through problems with the consultant over time. Through consultation, directors may decide to change the daily routines of the child care center to encourage and support caregiver communication with parents, children and each other. And through consultation, caregivers may become better able to provide children with individualized care, which supports them in developmentally appropriate ways. Conclusion Nearly forty years ago, Robert Furman, the former director of the Hanna Perkins Center, wrote an article entitled “Experiences in Nursery School Consultation” (Young Children, 1966). In that article he noted that nursery school teachers were in a unique position to provide support for the healthy mental and emotional development of the children in their care. Furman suggested that, aside from parents, care providers in the nursery were the only people with the necessary insight into a child’s emotional world to properly understand and interpret their behavior. As a child psychoanalyst, Furman believed that important work could be done with child development experts providing a supportive role of the childcare workers he so obviously admired. Today, we are proud of the rich tradition we have established at the Hanna Perkins Center of building effective collaborations through establishing trusting relationships and facilitating caregivers as they provide such a crucial and often under-appreciated service for our society. Never before in our history has the scope of non-parental childcare been so massive; never before has the need for child development experts and childcare professionals to work together been so great. We are confident that the next forty years will bring new innovations and insight into the important process of consultation in childcare. Bibliography Alkon, Abbey, Maria Ramler, and Katharine MacLennan. 2003. Evaluation of mental health consultation in child care centers. Early Childhood Education Journal 31(2):91-99. Bagnato, S., H.K. Suen, D. Brickley, J. Smith-Jones, and E. Dettore. 2002. 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Sandoval (Eds.), Consultee-centered consultation: Improving the quality of professional services in schools and community organizations (pp. 21- 36). Mahwah, New Jersey: Lawrence Erlbaum Associates. Caplan, G., Caplan, R. B., & Erchul, W. P. (1995). A contemporary view of mental-health consultation - comments on types of mental-health consultation by Gerald Caplan (1963). Journal of Educational and Psychological Consultation, 6(1), 23-30. Clarke-Stewart, K.A., D.L. Vandell, D.L. Burchinal, M. O’Brien, and K. McCarney. 2002. Do regulated features of child-care homes affect children’s development? Early Childhood Research Quarterly 17:52-86. Cobern, W. W. (1993). Constructivism. Journal of Educational and Psychological Consultation, 4(1), 105-112. Collins, R., J. Mascia, R. Kendall, O. Golden, L. Schock, and R. Parlakian. 2003. Promoting mental health in child care settings: Caring for the whole child. Zero to Three 23(4):39-45. Fitzgerald, T. H. (1987). The OD practitioner in the business world - theory versus reality. Organizational Dynamics, 16(1), 21-33. Froehle, T. C., & Rominger, R. L. (1993). Directions in consultation research: Bridging the gap between science and practice. Journal of Counseling and Development, 71, 693-699. Furman, Erna. 1992. Toddlers and Their Mothers: A Study in Early Personality Development. Madison, Connecticut: International Universities Press. Furman, Robert. 1966. Experiences in nursery school consultation. Young Children November: 84-95. Gallessich, J. (1985). Toward a meta-theory of consultation. Counseling Psychologist, 13(3), 336-354. Gilliam, Walter S. 2005. Prekindergarteners left behind: Expulsion rates in state Prekindergarten systems. Foundation for Child Development. Henning-Stout, M. (1994). Consultation and connected knowing: What we know is determined by the questions we ask. Journal of Educational and Psychological Consultation, 5(1), 5-21. Henning-Stout, M. (1999). 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Mahwah, New Jersey: Lawrence Erlbaum Associates, Publishers. Longhofer, J., Streeter, B., Barrett, T., Micelli, M., & Johnson, L. (2004). Day care and consultation. Hanna Perkins Center for Child Development. Mendoza, D. W. (1993). A Review of Gerald Caplan's Theory and Practice of Mental Health Consultation. Journal of Counseling and Development, 71(July/August), 629-635. Meyers, J., Parsons, R. D., & Martin, R. (1979). Mental health consultation in the schools. San Francisco: Josey-Bass. Meyers, M. & Gornik, J. 2004. The European model: What we can learn from how other nations support families at work. The American Prospect Magazine. November. National Institute of Child Health and Human Development. 2000. The relation of child care to cognitive and language development. Child Development 71(4):960-980. Peisner-Feinberg, E.S., Burchinal, M. R., Clifford, R. M., Culkin, M., Howes, C., Kagan, S. L., Yazejian, N., Byler, P., & Rustici, J. (1999). The children of the Cost, Quality, & Outcomes Study go to school: Executive summary. Chapel Hill, NC: Frank Porter Graham Child Development Center, University of North Carolina at Chapel Hill. Rogers, E. M., & Shoemaker, F. F. (1971). Communication of innovations: A cross-cultural approach. New York: Free Press. Sandoval, J. (1996). Constructivism, consultee-centered consultation, and conceptual change. Journal of Educational and Psychological Consultation, 7(1), 89-97. Sandoval, J. (2003). Constructing conceptual change in consultee-centered consultation. Journal of Educational and Psychological Consultation, 14(3-4), 251-261. Sandoval, J. H. (2004). Evaluation issues and strategies in consultee-centered consultation. In N. M. Lambert, I. Hylander & J. H. Sandoval (Eds.), Consultee-centered consultation: Improving the quality of professional services in schools and community organizations (pp. 391-400). Mahwah, New Jersey: Lawrence Erlbaum Associates. Schein, E. H. (1988). Process consultation, Volume I: Its role in organization development. Reading, MA: Addison-Wesley Publishing Company. Shonkoff, Jack P., and Deborah A. Phillips, eds. 2000. From neurons to neighborhoods: The science of early childhood development. Washington, D.C.: National Research Council and Institute of Medicine. Shpancer, Noam. 2002. The home-daycare link: Mapping children’s new world order. Early Childhood Research Quarterly 17(3):374-392. Streeter, B., & Barrett, T. (1999). Consultation with day care centers: Supporting quality care for preschool aged children. Child Analysis, 10. Streeter, Barbara, and Martha Nelson. 2003. Week, E. 2002. Quality counts 2002: Building blocks for success, state efforts in early-childhood education. Bethesda, MD: Education Week. | ||||||||||||||||||||||
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