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Reflective Consultation in Child Care for Medically Fragile Young Children

by Melissa Buchholz, Verenea Serrano, Sara Hills, and Catherine Wolcott


Consultation in infant mental health is a relationship-based approach to building reflective capacity in professionals who work with young children. Consultants support various professionals such as child care and medical providers with meeting the social, emotional, and developmental needs of infants and children. This article describes a reflective approach to consultation (Johnston & Brinamen, 2006) in a child care setting for children with complex medical needs. The authors provide examples of consultation at various levels (child, classroom, and director).

Infant mental health is multifaceted; it is challenging and emotionally taxing in addition to being rewarding and uplifting. This combination of emotions calls for reflective practice, including reflective supervision, to ensure effectiveness, reduce burnout, and improve impact. Reflective practice is an established way of interacting with others that has been a hallmark of infant mental health for decades. Reflective practice involves a constellation of techniques that prioritize the importance of relationships to facilitate self-understanding and a consideration of how complex interactions and events occur. A goal of reflective practice is to improve the impact and effectiveness of professionals’ work by supporting them to engage in continuous learning and insight into their own experiences and consideration of how those experiences impact their work.

Reflective consultation is a type of reflective practice that emerged as an approach to prevention and intervention services for young children, wherein clinicians with expertise in infant mental health engage with alternative settings (e.g., child care centers, primary care clinics, early intervention, and child welfare teams) to provide support to other professionals who interface with young children (Ash, Mackrain, & Johnston, 2013). Reflective consultation is a critical strategy for providing a continuum of services to young children and their families. A primary goal of consultation is to build the reflective capacity of the adults in the system as they do their work to support the young children in their care. Infant and early childhood consultants promote self-reflection and growth not by what they do or say but in how they are in relationship. Consultation in infant and early childhood settings requires a way of being in relationship to create a holding environment that allows the consultee to keep the young child in mind. There is extensive literature detailing the intricacies of mental health consultation (Johnston & Brinamen, 2012; Jones Harden, 2005; Weigand, 2007) and outlining the complexities of the work. An early childhood consultant must consider multiple factors including adult mental health, adult relationships, child mental health, relationships with caregivers, and systems influences. Consultation presents the opportunity to transform a system, and consultation from a reflective standpoint can enhance the likelihood and nature of the transformation.

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