There are several steps in the consultation process. Brown et al.

(2011) bring

awareness that while consultation unfolds differently within each type, there are common

concerns and tasks for each (p. 20). The first steps include building a relationship with a

consultee or the consultee institution. While this may be a lengthy process, it is a central

element of all facets of mental health consultation. In this step, it is important that this

relationship remain positive and cooperative so that empathy, tolerance of feeling, and the

goal of human behavior may be understood. The next step is assessment, varying between

each type of consultation. Sometimes private, the assessment is aimed at expanding

consultee's views of their problems and discovering new tactics to prevent similar problems in

the future. Interventions are used as another step in the process to lessen deficiencies.

Sometimes simple, like questioning, or more complex like theme inference reduction are

interventions used to successfully resolve each issue. The final step is follow-up and

evaluation. While the responsibility of this step relies heavily on the consultee, it is important

for the consultant to share an interest in knowing the outcome to ensure professional

effectiveness (Brown et al., 2011).

The mental health consultation process organically fits into a preventative approach to

mental health. "Consultation connotes an imparting of specific expertise in intervention

techniques as well as experience and knowledge of the application of these techniques in

different settings" (Nadeem et al., 2013). When consultation happens with fidelity, it can

affect individuals and groups. The effect is often in the form of prevention. The early leader in

the development of consultation, Gerald Caplan, viewed consultation as a tool for the

prevention of mental disorders. The act of consultation would be a systemic support

improvement resulting in a reduced need for more intense mental health services (Brown et
al., 2011). The Centers for Disease Control (CDC) used consultation as a preventative

measure. As a matter of public health and prevention, it is important that the manner of death

(MOD) be recorded accurately for research and policy that directly drive prevention efforts.

They specifically looked at drug intoxication deaths and how they relate to suicide and other

MOD. Some objectives were to look at factors affecting the MOD classification and to

identify probable solutions to classification barriers. Some strategies like improving the

standardization of death scene investigations and greater accountability were found to be

needed by stakeholders for the CDC to improve its prevention efforts (Stone et al., 2017).

Caplan witnessed prevention as an outcome of consultation when he supervised nearly 16,000

immigrant children who were cared for in residential institutions throughout Isreal. He

witnessed the need for services, but the geographical area was too large for traditional mental

health services. Therefore, rather than unsuccessfully attempt to provide services to each

child, he and his team discussed different ways of helping the children that would resolve

their problems while still at their respective institutions. They found that when they worked

with the staff to cope with an issue, a larger amount of children's problems were resolved

without the need for direct services (Brown et al., 2011). Whenever there are multiple

instances of challenges that would benefit from intervention, consultation may be used to

address the issue on the macro level as a preventative effort for further problems or the need

to address each individual crisis.

Brown, D., Pryzwansky, W. B., & Schulte, A. C. (2011). Psychological consultation and

collaboration: introduction to theory and practice (Seventh edition). Pearson.

for evidence-based practices across multiple contexts: Unpacking the black box.

Administration and Policy in Mental Health and Mental Health Services Research, 40(6),

439-450. [Link]

Stone, D. M., Holland, K. M., Bartholow, B., Logan, J. E., McIntosh, W. L., Trudeau, A., &

Rockett, I. R. H. (2017). Deciphering Suicide and Other Manners of Death Associated

with Drug Intoxication: A Centers for Disease Control and Prevention Consultation

Meeting Summary. American Journal of Public Health 107(8), 1233-1239.

Great post, Elisa! I welcome your example of the school counselor seeking consultation from

students' teachers. I would add that the teacher may seek consultation from the school counselor

as well. As school counselors are busy, it would be an effective use of consultation for the

counselor to look for trends in classes or grades experiencing the same problems. For example,

if there are a lot of behavioral referrals in 3rd grade, it may be beneficial for the school counselor

to work as a consultant for the small group of third-grade teachers, rather than with each

individual student of the large group who experienced a behavioral issue. An interesting note is

that Caplan had reservations about group-based consultation, whereas Altrocchi argued for its

advantages. Eventually, Caplan came around and saw some benefits (Brown et al., 2011). The

acceptance of this work in the school system has contributed to prevention efforts. As Brown et

al. (2011) mention, there is a three-tier model of intervention now used by many schools as a
means of reducing the need for more intensive services for students (p. 38). This tiered system is

in place in the school I work, and the school counselor sits in on the student support team (SST)

meetings to help meet the diverse needs of the students. The cooperative consultation from the

school psychologist offers prevention in the form of helping the SST process close students

learning gaps in the least restrictive environment rather than pushing for more intensive support.

In this way, consultation has offered "a shift in thinking from viewing special education as a

means to an end, to using prevention models for struggling students within the general

education" (Savitz et al., 2018). In addition, as you mentioned, this preventative outcome of

consultation ensures effectiveness and efficiency for all parties.

Brown, D., Pryzwansky, W. B., & Schulte, A. C. (2011). Psychological consultation and

collaboration: introduction to theory and practice (Seventh edition). Pearson.

Savitz, R. S., Allington, R. L., & Wilkins, J. (2018). Response to Intervention: A Summary of

the Guidance State Departments of Education Provide to Schools and School Districts.

Clearning House, 91(6), 243-249.

Hi again, Averie! I liked how you offered an example for each type of mental health consultation.

For the client-centered case, I have seen the example you mentioned happen. In addition to a

therapist going into the school and working with a teacher, I have witnessed the school counselor

who serves as a consultant for the teacher who is having more than twenty percent of the

students demonstrating behavior issues. It is a beautiful representation of efficiency, especially in

report. I have, however, witnessed this for other consultants such as occupational therapists or

speech and language pathologists. It would be beneficial for the mental health professional to use

the report as well so that the consultee may use the information to "develop and implement his or

her own plan for dealing with the client with minimal involvement of the consultant" (Brown et

al., 2011). In the consultee-centered case consultation, I agree that it would be beneficial for the

consultee to reach out to a supervisor for consultation regarding a specific problem. The four

domains of difficulty you mentioned could be tricky if the consultant is not intentional in their

role and education. For example, if the school counselor asks for consultation in dealing with a

student's drug-related problem and there is some transference, the consultee may become

defensive if the consultant isn't skilled in strategies to reduce the transference. However, if the

consultant provides support and models objectivity, it will increase the consultee's "distance and

objectivity" (Brown et al., 2011). This does require effective communication skills. "Competent

consultants are expected to strategically use communication skills when consulting, with such

interactions presumably supporting positive outcomes for both consultees and clients" (Newman

et al., 2022). Brown et al. (2011), gives some wonderful examples of how to be creative in the

area of communications. One such example that I appreciated was when the consultant noted the

overinvolvement of a childcare worker and rather than communicate that in a way the consultee

would feel defensive, the consultant could note how the child seems to be relating to the

childcare worker as a parent (pp. 26-27). The creative use of communication would not only help

in this situation but in any similar problems this consultee may have in the future. The final two

approaches you mentioned seem systemic in nature, but actively play a role in prevention as well

as evidenced by your examples. Thanks again for your thought-provoking post!

collaboration: introduction to theory and practice (Seventh edition). Pearson.

Newman, D. S., Villarreal, J. N., Gerrard, M. K., McIntire, H., Barrett, C. A., & Kaiser, L. T.

(2022). Deliberate practice of consultation communication skills: A randomized

controlled trial. School Psychology, 37(3), 225-235.