Accountability for Implementation of MHC

Accountability establishes the degree to which the consultant and the program implement the early childhood MHC services outlined in the job description or contract, which should be consistent with existing policies and procedures, program work plan, and the Performance Standards. Head Start administrators are responsible for ensuring that the mental health services that the consultant provides to the program are those that are outlined in the consultant’s job description and contract. On the other hand, the consultant is responsible for holding the program accountable for providing the agreed-upon support and structures necessary for implementing effective consultation.

Mental Health Consultant Accountability

Head Start administrators can implement accountability measures for mental health consultants using multiple strategies. First, administrators should use administrative supervision sessions with the consultant to discuss the degree to which the consultant is engaging in the activities and responsibilities as outlined in the job description and contract. Second, have a way for the mental health consultant to document consultation activities. The documentation plan should detail the measures to use, a timeline for data collection, and the process for reviewing the data. Measures for documenting consultant accountability can be developed from a variety of sources, such as the consultant job description or contract, the Performance Standards, and the Head Start Program Information Report. 

Examples of mental health consultant accountability measures might include:

• Number of children who were the focus of consultation between the consultant and program staff
• Number of home visits attended by the consultant
• Number of children for whom the consultant provided an individual observation or mental health assessment
• Number of children for whom the consultant facilitated a referral for mental health services
• Number of staff and family trainings provided by the consultant
• Amount of time the consultant spends on these activities:
  • Working directly with staff and families
  • Observing or reviewing observations of individual children or classrooms
  • Developing relationships with staff
  • Attending team meetings
  • Attending other meetings
  • Providing trainings
  • Recordkeeping

Program Accountability

Program accountability for supporting MHC is equally important. Not only does the consultant have responsibilities to the program, but the program also has responsibilities for supporting the consultant. The consultant can provide important information to Head Start administrators regarding the degree to which the program provides the structure and supports needed to build effective MHC services. Some areas that could be monitored to ensure that programs are providing these structures and supports include:

• Does the consultant have adequate space for providing MHC services (e.g., a private area where they can provide confidential consultation services to teachers, children, and families)?
• Do the teachers have opportunities for meeting with the consultant built into their schedule?
• Is the number of hours allocated to the consultant sufficient for accomplishing the expected activities?
• How many hours of Head Start administrative supervision is the consultant receiving?
• How many hours of clinical supervision is the consultant receiving?

Accountability Reporting

Regular reports (at least monthly) from the consultant to the designated Head Start supervisor should include the information that is most important for ensuring that the consultant delivers the types of services that the program believes to be important — ideally, based on a systematic program needs assessment and strategic planning process.

For the reports to be useful, however, your program will need to have clear feedback and review processes for collecting, reflecting on, and using the information. The supervision process is an ideal place to discuss these issues and to generate ideas and strategies to strengthen services further.

Accountability, or the degree to which the consultant and the program are implementing the specified number and type of MHC services, is a necessary but not sufficient component of quality improvement. While counting such things as the number of children the consultant serves, number of hours spent coaching teachers in classrooms, or number of screenings and referrals made is important and relatively straightforward to document and monitor, these types of indicators provide little information about whether the consultation is working effectively. A broader quality improvement strategy is needed to better determine if consultation services are meeting the needs of children, families, and staff — and if not, to identify areas in need of strengthening.

Most importantly, quality improvement strategies should take the approach that all individuals, practices, and services can benefit from ongoing review, feedback, and improvement efforts. After developing the initial strategic plan for your program’s mental health approach, developing and monitoring a quality improvement plan is a key function for your program’s mental health work group.

There are several outcome areas for MHC that may be important to monitor as part of your program’s ongoing quality improvement efforts, including these: child outcomes, family outcomes, staff and classroom outcomes, and program outcomes. The most important outcomes for your program to monitor should be decided based on your strategic plan and the intended goals of consultation services.

It is important to note that this approach for continuous program improvement does not strive to achieve a high level of scientific rigor that would involve the use of comparison groups or other strategies to determine whether the mental health services and consultation “caused” specific outcomes. This strategy relies on collecting and using various types of information to determine whether there is evidence that children, families, staff, and programs show outcomes consistent with those that the mental health approach and services is intended to achieve, and to inform ongoing program practice.

Activity: Accountability

Review the scenario below and respond to the questions that follow.

East Bank Head Start is a large Head Start program with 10 centers. Each center has two classrooms, serves 40 children, and has four full-time teachers. One of the centers, Friendly Head Start, has two components to their mental health services and approach: MHC and staff wellness. The overall vision of its mental health services is to improve relationships between children and teachers, to improve relationships between teachers and families, to support children who show emotional and behavioral concerns, and to increase staff wellness. It has one mental health consultant for the program. The mental health consultant is an employee of the local community mental health center and is contracted to provide 10 hours a week of MHC services to the children, staff, and families of Friendly Head Start (360 hours per school year).

The mental health consultant contract states that the mental health consultant will:

• Conduct two family trainings a year
• Conduct one staff training a quarter
• Conduct classroom consultation, including providing feedback to classroom teams, meeting with teams to develop plans for improving the classroom’s social and emotional climate, addressing child behavior, etc.
• Consult with teachers and families about children who experience social and emotional challenges
• Make referrals for children and families needing additional services
• Implement staff wellness activities

Question 1: If you were the administrator for this program, what accountability measures would you use? List three specific things that you would want the consultant to report to you or their designated supervisor each month.

Question 2: What outcomes would you want to try to evaluate to determine if the program is meeting its vision for mental health services? List at least three key outcomes that you’d want to evaluate.

Last Updated: August 6, 2025