Together For Kids
SAMPLE AGREEMENT DEVELOPED IN COLLABORATION WITH PROGRAM
Early Childhood Behavioral Health Consultation Agreement
Between
(Name of Childcare Agency) and TFK/Community Healthlink
This consultation agreement is between (Name of Childcare Agency) and
TFK/Community Healthlink. It is based upon funding received by Community Healthlink
(CHL) as the Fiscal Agent for the Together For Kids “Mental Health Consultation
Services Grant” awarded by the MA Department of Early Education and Care (EEC).
SERVICES TO BE OFFERED AND ROLE OF EACH PARTNER
Under this Agreement, CHL will:
 Provide embedded behavioral health consultation services for children ages 2-5 as
specified below.
The TFK Clinician will:
 Provide general classroom/child specific observations and consultations as
requested.
 Provide written consultation reports to staff and parents/guardians.
 Facilitate staff and family consultation sessions.
 Facilitate the development of intervention plans to address challenging behavior
in the classroom.
 Assist staff to understand why a child may be exhibiting a challenging behavior.
 Work collaboratively with staff, families and child care administrators to enhance
a child’s preschool experience while maintaining confidentiality.
 Support staff to find solutions to stressors and concerns.
 Provide child/family psychotherapy services according to caseload availability.
 Provide referral assistance for follow-up or more intensive services.
 Provide training on specialized topics as requested and as time permits.
 Provide a weekly schedule to the Preschool Director.
Under this Agreement, (name of childcare agency) will:
 Provide active collaboration in the planning and implementation of the service.
 Participate in consultation discussions, implement intervention plans and make a
commitment to “stay the course” with the plan until the team determines that
another strategy may be more effective.
 Initiate contact with the parent/guardian of a child with challenging behavior to
discuss the child’s strengths and challenges (teachers will work with (name of
clinician) to develop a “conversation script”, if necessary).
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Invite the parent/guardian to participate in a team meeting at the center. If the
parent does not participate after a few attempts to engage him/her in the process,
the Preschool Director will be notified.
Provide regularly scheduled time periods for observations and consultation
meetings (parent/teacher/clinician).
Provide regularly scheduled time for the Preschool Director to meet with the
clinician to discuss consultation suggestions and other relevant issues.
Consider implementing the “Collaborative Classroom Assessment” on a bi-annual
basis. The Preschool Director, Teacher(s) and Clinician would complete the form
independently and would meet together to achieve consensus on the ratings and
formulate classroom goals.
Provide clinically appropriate private office space for therapy sessions.
Provide access to telephone messages through the childcare agency system.
Provide data required for clinical/administrative program documentation and the
evaluation process (e.g., functional analysis of child behavior, Eyberg behavioral
screenings, teacher surveys, etc.).
Assigned clinician:
Days on site:
The clinician/childcare director will notify concerned parties if any changes are
made to the schedule.
ACCOUNTABILITY MEASURES
This agreement will be monitored by (Name of Preschool Director) and Lynn Hennigan,
CHL Director of Services for Young Children. Supervision of childcare staff will be the
responsibility of (name of director) or her designee and supervision of CHL clinicians
will be the responsibility of Lynn Hennigan or her designee.
(Name of childcare agency) will be responsible for: 1) ensuring that childcare staff obtain
parental/guardian consent prior to conducting a child specific observation/consultation; 2)
ensuring that childcare programs provide written notification to parents regarding general
classroom observation/consultations; 3) supervising the implementation of child specific
and general classroom interventions that are designed to promote social-emotional
competence in young children; 4) supervising staff compliance with the (name of agency)
behavior management policy; 5) supervising teacher-child interactions; 6) ensuring that
staff utilize scheduled team consultation sessions in an appropriate manner, 7) ensuring
that staff complete Eyberg classroom behavioral screenings in the Fall and Spring and
provide requisite summary data to TFK; and 8) ensuring that staff complete teacher
satisfaction questionnaires.
CHL will be responsible for: 1) ensuring that clinicians provide timely service and
written documentation of observations/consultations/intervention plans to
parents/guardians and agency personnel and 2) providing childcare staff with data
regarding outcome measures.
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Lynn Hennigan
Director of Services for Young Children
_______________________
Date
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Name
Preschool Director
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Date