115 Promoting Infant/Early Childhood Mental Health Practices Through Teleconsultation: Lessons Learned from a Statewide Program

Faculty Mentor: Alysse Loomis (Social Work, University of Utah)

Introduction

Early childhood is a critical period for cognitive, social, and biological development, laying foundation for well-being in adulthood (Zeanah & Zeanah, 2019). Ample evidence suggests that early environments and nurturing relationships play a crucial role in supporting healthy lifelong physical and mental development of children (National Scientific Council on the Developing Child, 2004).

Mental health disorders are particularly a common concern for children with a prevalence rate of over 20% worldwide (Vasileva et al., 2021). Therefore, early childhood providers must be trained to identify unique mental health needs of each child, be able to adjust and adapt to provide culturally informed interventions, support, and systems to children and families. Virtual training and teleconsultation services can help fill this gap, as they can increase training access for a large number of audiences (Lipschitz et al., 2022) from a diverse racial and educational background (Olson et al., 2021). The training and teleconsultation program (TTP) offers an innovative, interdisciplinary approach to support early childhood providers’ ability to provide trauma-informed services and fill in the knowledge gaps they frequently face (Loomis et al., 2024).

Despite being a valuable resource for providers, the TTP services have limitations that pose barriers to accessibility and effectiveness of the program. Since January 2022, providers have engaged in either or both webinar or teleconsultation with a licensed clinician – the two components of TTP. Webinar training ranges from 45 to 120 minutes and covers a variety of topics including child development, trauma-informed care, early attachment, and diversity-informed practice. Teleconsultation is another component of the TTP that offers consultation services to providers such as case consultation, resource coordination, and individual or group reflective supervision (Loomis et al., 2024). As for engagement, the average number of webinars attended was 65 over the course of three years, only 24 teleconsultation sessions have been attended on average. Thus, the current study aims to identify common barriers providers face when engaging with the TTP services, specifically teleconsultation, and future directions to best support the needs of early childhood providers.

Method

Participants

The top 10% of the TTP users were identified and recruited to represent one of the following groups: High Webinar and High Teleconsultation. Participants in the high webinar group ( n = 3) were providers who attended an average of 95 webinar sessions over the course of three years. Participants in the high teleconsultation group (n = 7) represent providers who engaged in an average of 25 teleconsultation sessions over the span of three years. The sample contains providers from a diverse range of sectors: Home Visiting (40%), Mental Health (20%), Early Intervention (20%), Childcare (10%), Other (10%). There was no cross-over in this study.

Procedure

Participants in each of the two focus groups were invited to an online focus group to share their experiences with the TTP. All focus groups were facilitated by two undergraduate research assistants supervised by a faculty mentor. Each focus group was set at an hour limit. The questions for the focus groups followed a semi-structured interview guide. Each participant was offered an incentive for participation of either $40 Amazon or Kroger gift card or $20 gift cards of each brand. A brief survey was administered at the end of the interview for participants to share any additional comments and list gift card preferences.

Data analysis

All the focus group interviews were recorded and transcribed for qualitative coding. Finalized interview transcripts were uploaded to a qualitative data software called Dedoose to conduct thematic analysis. Two research assistants each coded two transcripts to develop and refine the initial code book and cross-coded the other two transcripts to reach coding consensus. Once the coding process was completed, common themes and subthemes were identified.

Results

Ten main themes were identified across 4 high teleconsultation focus group interviews: Routine, Motivation to Return, Positive – Work, Positive – Other, Barriers, Roles Benefit, Similar Services, W+T Interaction, Organizational Supports, Other Recommendations. This study focuses on Barriers and Other Recommendations themes along with their subthemes.

Barriers

The following theme captured barriers to teleconsultation. Four following subthemes emerged based on participants’ responses.

Table 1. Subthemes of “Barriers – Teleconsultation” theme

Several providers emphasized the lack of confidentiality and comfort with joining group teleconsultation sessions with their coworkers or supervisors as a major barrier to teleconsultation. Participant #898 from an Early Intervention sector said:

“I wasn’t sure I wanted coworkers in my group, because I wanted to be able to just say how I felt about some things without it going back to where I didn’t want it to go…”

Another common barrier to teleconsultation highlighted by providers was people’s lack of awareness or knowledge about teleconsultation. Participant #1104 from a Mental Health sector stated:

“there’s a lack of awareness around what exactly constitutes reflective consultation and why it would be valuable. I think people in general just maybe don’t know exactly what it is, or how to go about like incorporating it into their practice.”

Other Recommendations

This theme captures any discussion of future directions and ways to improve the TTP services. Three subthemes emerged under this theme.

Table 2. Subthemes of “Other recommendations” theme

A prominent recommendation for improving the TTP services was spreading the knowledge of the TTP better. Participant #776 representing early intervention sector said:

“having access to it and knowing it exists, is, I think, the very most important part, because if nobody exists, then they can’t utilize that time when they have it available.”

Additionally, providers suggested the program directors to work more closely with supervisors and higher organizations beyond providers to expand the accessibility and change perceptions of the TTP services. Participant #1104 from a Mental Health sector stated:

“I think really just working with organizations from the top down and getting the leadership on board would have such a huge impact.”

Discussion

Programs and policies that support early childhood providers’ capacity to deliver services effectively to children and families are crucial for supporting healthy development of young children. The training and teleconsultation program (TTP) offers a feasible way to support the needs of providers from diverse sectors and educational backgrounds across the state of Utah (Loomis et al., 2024). The current study provides preliminary data for what barriers are present as well as how to navigate them to ensure accessible and effective use of the TTP services.

Common barriers providers encounter when accessing the TTP services are providers’ reluctance to talk about personal matters, busy work schedule, and lack of understanding about teleconsultation. Some future recommendations to minimize these barriers include tailoring the description of teleconsultation to specific sectors, collaborating with supervisors and higher organizations, and spreading the knowledge of the TTP services more effectively. These findings helped identify barriers that providers from various sectors face and considerations for program coordinators to improve these services moving forward.

Limitations

Several limitations were a part of this study. First, as this study aimed to get in-depth understanding of each provider’s unique and shared experiences with the TTP, a small sample size was utilized. Thus, the findings should be interpreted as exploratory and context specific. Second, not all sectors were represented in this study’s focus groups. Future research should recruit a more representative sample of providers to get a broader perspective on the effectiveness and shortcomings of the TTP services.

Acknowledgements

Special thanks to McCall Lyon, PsyD, Akari Geraldo, and The Children’s Center of Utah for making this project happen.

This study was funded by the Utah Office of Substance Use and Mental Health and the Office of Undergraduate Research at the University of Utah.

Bibliography

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