Behavioral Consultation

Consultation services usually involve the parents or school personnel. In consultation, the psychologist helps to train and educate parents on a problem to increase their understanding of the problem and increase their ability to handle it without further help from the psychologist. Effective consultation is, essentially, the psychologist trying to put him/herself out of work (because the parents no longer need them). Consultation is usually done to address a specific behavior problem, emotional problem, or skill-based problem. It includes three general phases: 1) Introduction, 2) Education/Training, and 3) Completion. Professionals may use different terminology or further divide these phases, but the same general process is used in some form.

The strength of consultation is that the parents (or teachers) are learning new skills to be able to help the child now and in the future. However, this can be frustrating for parents if they don't know what to expect. Parents may enter a clinic with the expectation that the psychologist will work directly with their child and "fix" the problem. This is especially true when working with behavior problems. A psychologist may be able to work with your child and fix the problem within the clinic setting, but this is no guarantee that the problem will be fixed outside of the clinic. There are reasons for this, but it can be more easily understood with an example of adult behavior:

If a particular traffic intersection has a camera that records when people run a red light and gives them a ticket, people will quickly adjust their behavior and quit running that red light. However, at another intersection that does not have a camera, they will return to their original behavior of running the red light. 

Because we want to make sure the child's behavior is successful in many situations (at school, at home, with the parents, and with the teachers), consultation focuses on teaching the parents how to manage and modify the behavior. The psychologist will regularly meet with the parents during the consultation process to provide guidance on what to expect, feedback on how things are going, and suggestions on what to do differently. The following information is what you might expect to experience in each of the three phases described earlier:

Introduction
This is the initial interview phase, sometimes called a "diagnostic interview." It is intended to give you a chance to meet the psychologist and for the psychologist to learn about your child and the current concerns.

The psychologist will meet with the parent to learn about the child's current behavior difficulties,  developmental history, and behavioral history. Information will include previous diagnoses and some general information about the child's current physical and mental health (for example, sleep habits, eating habits, and medical problems).

Important information includes the child's early development (for example, when did the child learn to crawl, talk, walk, and be toilet-trained), current school performance (behavior and academic concerns), social relationships with peers and family, and current support systems (such as the school or extended family). If the child has previous diagnoses (medical or psychological), then this information should also be included at this time. Asking about the child's sleeping and eating habits and medical problems is important because a child's physical health has a significant effect on his behavior and mental health.

Education and Training
This is the majority of the consultation process. It could be further divided into "initial education/planning" and "maintenance." During this phase the psychologist will talk with you about the current problem behaviors, their antecedent conditions, and their consequences. These terms don't always make a lot of sense, but they are important factors in managing a child's behavior.

The "antecedent conditions" might include the time of day the misbehavior tends to occur, the location where it occurs, and events that occur right before it. The antecedent conditions are basically everything that might prime the misbehavior. The "consequences" are simply everything that occurs right after the behavior. There are obvious consequences, such as punishment or scolding the child, but there are also the not-so-obvious consequences, such as the child getting out of doing a task or escaping a situation.

After the antecedent conditions and consequences have been identified for the targeted behaviors, then the psychologist will help you develop a plan for how to modify them so the behavior changes. This may include teaching the child a new behavior, setting a reward system, modifying the current approach to punishment, or sometimes just ignoring the behavior.

After the plan has been developed, then the parent will implement the plan for a period of time (it may be only a few days or it may be a month) while tracking the behavior to see if it is changing (collecting behavior data). Then the parent will meet with the psychologist again to review the behavior data, determine if the plan is working, or modify the plan if it appears necessary. This process continues until the parent and psychologist are satisfied that the behavior is no longer a problem or is manageable. It is an ongoing process of planning, doing, and reviewing.

Completion
Once the parent and psychologist are satisfied that the behavior is under control, then the psychologist will suggest it is time to "terminate." Termination is simply a way of ending the appointments combined with a little additional education for the parent about how to continue to modify and manage the behavior in the future. Termination is done in a controlled manner to make sure the parent isn't suddenly set loose before they're ready (which can produce a lot of anxiety for parents). Once the parent is comfortable and the psychologist agrees that the behavior problem is solved, then the therapeutic relationship is ended. Of course the parent can return again anytime there is a need. Some psychologists may leave an open line for ongoing support (for example, using trouble-shooting emails).