MOKSLO STRAIPSNIAI COMPARING PERCEIVED IMPORTANCE AND PERFORMANCE OF INFANT MENTAL HEALTH SERVICES AS RATED BY GRADUATE STUDENTS IN THE UNITED STATES AND LITHUANIA Max McFarland 1, Kyndra Bendickson, Tammi Ohmstede Beckman University of Nebraska at Kearney, USA Abstract. Background. The goal of providing early intervention services is to decrease costs to society by decreasing the need for special services in school and beyond (Carpenter, 2007; Jacob, Hartshorne, 2007). Purpose. The purpose of this study was to compare the perceived importance of infant mental health services and the perceived performance of these services as provided in the United States and Lithuania. Material and methods. A questionnaire was created by the researcher and comparisons were made for importance and performance as rated by Lithuanian students as compared to that rated by students and practitioners in the United States. Results. Results indicated that both Lithuanian and American respondents rated significant differences between importance and performance of services. When groups were compared, Lithuanian students rated services provided in the appropriate environment significantly higher in importance than American respondents. American students and practitioners rated services being coordinated by a single agency as being performed signifiantly better than Lithuanian students ratings. Conclusion. This study brings awareness to the international differences that exist when providing early intervention services to students. Keywords: mental health services, comparison, international. The areas of infant mental health and early intervention are receiving increased attention in recent years in the field of school psychology. The goal of providing early intervention services is to decrease costs to society by decreasing the need for special education when the individual reaches school age and further decreasing the need for specialized services 1 Address for correspondence: Department of Counseling and School Psychology, University of Nebraska at Kearney, NE, USA 68849, e-mail: mcfarlandm@unk.edu, tel: 308-865-8318. 29
Max McFarland, Kyndra Bendickson, Tammi Ohmstede Beckman when the individual reaches adult age (Carpenter, 2007; Jacob, Hartshorne, 2007). Studies have shown that early intervention programs for children with disabilities and children from disadvantaged backgrounds are a sound investment and that the money spent on early intervention programs is earned back by stakeholders in savings on social services when the child reaches adulthood (Barnett, 2000; Barnett, Escobar, 2002; Breitenstein et al., 2007; Jacobson, Mulick, Green, 1998). In the United States, each individual state is responsible for developing programs to serve children ages birth to three with disabilities or suspected disabilities and their families. Public Law No. 108-446, the Individuals with Disabilities Education Improvement Act (IDEIA) of 2004 Part C, provides grants to states to develop infant mental health services (i.e., early intervention services) for infants and toddlers with disabilities (108th Congress, 2004). As outlined in IDEIA, each state that receives this grant money is required to designate a lead agency or agencies to coordinate and monitor the activities and to develop a state wide directory of services available. Each state is also required to develop a child find program to identify children who have or who may be at-risk for having a disability, particularly children from historically underserved populations such as individuals living in poverty or rural areas or those from minority groups (Jacob, Hartshorne, 2007). According to the best practices literature and IDEIA Part C, an effective early intervention program should contain the following elements: (a) screening and identification of children who are suspected to have a disability or developmental delay in order to receive early intervention services, (b) service providers who implement developmentally appropriate interventions for the individual being served, (c) services that are coordinated by one single agency responsible for administration and monitoring of services being provided, (d) services provided in the most appropriate environment for the individual or family, whether that is home- based, center-based, or another environment, (e) selected interventions that serve the goals and interests of the entire family involved, not just the individual (108th Congress, 2004; Barnett, 2002). The interest in infant mental health services is not confined to the U.S. In May of 2006, the administration from Vytautus Magnus University (VDU) in Lithuania invited faculty members from the University of Nebraska at Kearney (UNK) to teach a one week course in infant mental health to 30
International Journal of Psychology: A Biopsychosocial Approach Tarptautinis psichologijos žurnalas: biopsichosocialinis požiūris 2011, 8, 29 40 p. master s and doctoral level students in school psychology. Infant mental health / early intervention services are not provided by government grant money in Lithuania; however, the administration of that university felt so strongly that a background in infant mental health was important for their students that they hired instructors from the other side of the globe to develop their students knowledge in this area. Students at University of Nebraska Kearney (UNK) also take a course in infant mental health. However, it is unclear if the importance of infant mental health services and the components of these programs are reflected in the attitudes and dispositions of the students who have taken these courses. The continuance of early intervention programs in the future depends on the attitudes and perceptions of current students in training. Therefore, the purpose of this study was to compare the perceived importance of infant mental health services and the perceived performance of these services as rated by students at VDU in Lithuania as compared to that rated by students and practitioners at UNK (referred to hereafter as respondents) in the United States. The specific research questions are as follows. 1. Is there a difference between perceived importance and perceived performance when comparing two average ratings of infant mental health services in each of the areas of: screening and identification, implementing developmentally appropriate interventions, services coordination, services provided in the appropriate environment, and family involvement as rated by students at VDU? 2. Is there a difference between perceived importance and perceived performance when comparing two average ratings in each of the areas of: screening and identification, implementing developmentally appropriate interventions, services coordination, services provided in the appropriate environment, and family involvement as rated by respondents at UNK? 3. Is there a difference in the percieved importance of infant mental health services in each of the five areas of: screening and identification, implementing developmentally appropriate interventions, services coordination, services provided in the appropriate environment, and family involvement when comparing two average ratings as rated by students at VDU and respondents at UNK? 31
Max McFarland, Kyndra Bendickson, Tammi Ohmstede Beckman 4. Is there a difference in the percieved performance of infant mental health services in each of the five areas of: screening and identification, implementing developmentally appropriate interventions, services coordination, services provided in the appropriate environment, and family involvement when comparing two average ratings as rated by students at VDU and respondents at UNK? METHOD Participants The participants consisted of 30 master s level school psychology students from VDU and 50 specialist degree students and recent graduates, starting with the graduating class of May 2007, from UNK in the United States. The return rate from the Lithuanian sample was 100 %. The return rate from the American sample was 48 %. Many of the participants from the Lithuanian university were employed as teachers or other professionals working with young children. Students from both universities have taken a class in infant mental health taught by faculty from the American university. Some of the participants from the United States were current students (N = 8) from whom data were collected during a class period. The remaining participants from the United States were working as practitioners (N = 35) or interns (N = 6) in the field at the time of data collection. Instrumentation A needs assessment survey was developed in collaboration with faculty who teach the infant mental health course. The survey consists of 32 items that measure the perceived importance of infant mental health services and the perceived performance of those services by service providers in the respective communities. Each item was rated on importance and performance on a Likert scale from 1 to 5 (1 being not important or not performed well, 5 being highly important or performed well). The Cronbach Alpha Reliability Index computed for these rating items when used with the Lithuanian sample was 0.94. The Cronbach Alpha Reliability Index computed for these rating items when used with the American sample was 0.96. 32
International Journal of Psychology: A Biopsychosocial Approach Tarptautinis psichologijos žurnalas: biopsichosocialinis požiūris 2011, 8, 29 40 p. The items were divided into five domains of infant mental health services based on services outlined in IDEA Part C and best practices literature. The five domains are: (a) screening and identification of children with disabilities or at-risk for disabilities; (b) providing developmentally appropriate interventions; (c) services coordination of needed services; (d) providing services within the appropriate environment; (e) involving the family in services planning and implementation. Some of the items relating to assessment were further divided into the five developmental areas that each child must be assessed in as required by Nebraska Rule 51 (Nebraska Department of Education, 2006). These areas are: cognitive development, motor skills development, social-emotional / behavioral development, language development, and adaptive skills development (Nebraska Department of Education, 2006). Each participant made two ratings for each item. The first rating relates to how important the student perceives that particular item to be. The second rating relates to how well the student perceives that the service is being performed in his / her own country. All responses were in a Microsoft 2007 Excel database to be stored until data analysis. Procedure The survey was given to students at VDU at the beginning of a oneweek course in infant mental health. The archival data collected at that time were analyzed as the Lithuanian students portion of that data set. The survey was distributed to American students and graduates in class and by mail. Data were collected from current students by the researcher during a class period. Students were handed the survey and instructed to fill it out and turn it in before they left class. In order to collect data from those participants working in the field, a cover letter was sent, along with the survey and a return envelope to each of the six current interns and recent graduates starting with the class of May 2007 and going back until 35 practitioners were reached. Surveys were coded and reminder post cards were sent to those who had not returned their surveys within two weeks. This process was repeated until at least 22 surveys were returned. Once all the surveys were returned to 33
Max McFarland, Kyndra Bendickson, Tammi Ohmstede Beckman the researcher, all identifying information was destroyed. Only group data were analyzed and reported. The data collected were recorded in the data collection form described previously. RESULTS The first question addressed in this study was: Is there a difference between perceived importance and perceived performance when comparing two average ratings of infant mental health services in each of the areas of: screening and identification (domain 1), implementing developmentally appropriate interventions (domain 2), services coordination (domain 3), services provided in the appropriate environment (domain 4), and family involvement (domain 5) as rated by students at VDU? The answer was determined by calculating an average rating for percieved importance and an average rating for perceived performance for each of the five domains and then comparing them using a Two-Way Analysis of Variance with Repeated Measures on One Factor. The results, as shown in Table 1, indicate that Lithuanian students feel that all five domains of service are very important, but none of them are being performed as well as they could be. The difference between the average importance rating and the average performance rating was significant for all five domains (p <.05). Table 1. Mean ratings of perceived importance and perceived performance on five domains of infant mental health services as rated by Lithuanian students, and standard deviations Importance Performance Domain M D N M SD N F 1 4.904 0.229 30 3.015 0.667 0 203.393* 2 4.922 0.191 30 3.093 0.799 30 148.851* 3 4.885 0.228 30 2.806 0.676 30 273.111* 4 4.917 0.227 30 3.317 0.831 30 101.556* 5 4.948 0.125 30 3.149 0.638 30 169.537* * p <.05. 34
International Journal of Psychology: A Biopsychosocial Approach Tarptautinis psichologijos žurnalas: biopsichosocialinis požiūris 2011, 8, 29 40 p. The second research question was: Is there a difference between perceived importance and perceived performance when comparing two average ratings in each of the areas of: screening and identification, implementing developmentally appropriate interventions, services coordination, services provided in the appropriate environment, and family involvement as rated by respondents at UNK? The results, as shown in Table 2, indicate that American respondents also feel that all five domains of service are very important, but none of them are being performed as well as they could be. The difference between the average importance rating and the average performance rating, although smaller than the difference for the Lithuanian participants, was significant for all five domains (p <.05). Table 2. Mean ratings of perceived importance and perceived performance on five domains of infant mental health services as rated by American respondents, and standard deviations Importance Performance Domain M SD N M SD N F 1 4.781 0.649 24 3.342 0.649 24 118.034* 2 4.759 0.373 24 3.481 0.703 24 72.657* 3 4.734 0.424 24 3.676 0.588 24 70.725* 4 4.558 0.487 24 3.531 0.818 24 41.848* 5 4.810 0.285 24 3.464 0.795 24 94.884* * p <.05. The third research question was: Is there a difference in the percieved importance of infant mental health services in each of the five areas of: screening and identification, implementing developmentally appropriate interventions, services coordination, services provided in the appropriate environment, and family involvement comparing two average ratings across five domains as rated by respondents at UNK and students at VDU? The results, as shown in Table 3 and Figure 1, indicate that Lithuanian participants and American participants rated domains one, two, three, and five as about equally important. The only significant difference in ratings was on domain four: services provided in the appropriate environment (i.e., home-based versus center-based). 35
Max McFarland, Kyndra Bendickson, Tammi Ohmstede Beckman Table 3. Mean ratings of perceived importance across five domains of infant mental health services as rated by Lithuanian students and American respondents, and standard deviations Lithuanian American Domain M SD N M SD N F 1 4.904 0.229 30 4.781 0.333 24 2.171 2 4.922 0.191 30 4.759 0.373 24 3.805 3 4.885 0.228 30 4.734 0.424 24 3.279 4 4.917 0.227 30 4.558 0.487 24 18.441* 5 4.948 0.125 30 4.810 0.285 24 2.733 * p <.05. Figure 1. Interaction effect between Domain (domain 1, domain 2, domain 3, domain 4, or domain 5) and Location on importance rating, F (4, 208) = 2.912, p <.05 The fourth research question was: Is there a difference in the percieved performance of infant mental health services in each of the five areas of: screening and identification, implementing developmentally appropriate interventions, services coordination, services provided in the appropriate environment, and family involvement comparing two average ratings as rated by students at VDU and by respondents at UNK? The results, as shown in Table 4 and Figure 2, indicate that both Lithuanian students and American respondents perceive that infant mental health services in all five domains are being performed at a just above average 36
International Journal of Psychology: A Biopsychosocial Approach Tarptautinis psichologijos žurnalas: biopsichosocialinis požiūris 2011, 8, 29 40 p. level. The only signficant difference between the Lithuanian participants ratings and the American respondents rating was on domain 3: services coordination. American participants rated this as being performed significantly better than Lithuanian participants. Table 4. Mean ratings of perceived performance across five domains of infant mental health services as rated by Lithuanian students and American respondents, and standard deviations Lithuanian American Domain M SD N M SD N F 1 3.015 0.667 30 3.342 0.649 24 2.635 2 3.093 0.799 30 3.481 0.703 24 3.716 3 2.806 0.676 30 3.676 0.588 24 18.659* 4 3.317 0.831 30 3.531 0.818 24 1.131 5 3.149 0.638 30 3.464 0.795 24 2.445 * p <.05. Figure 2. Interaction effect between Domain and Location (Lithuanian versus American) on performance rating, F (4, 208) = 4.135, p <.05 DISCUSSION A comparison of importance and performance of infant mental health services as rated by respondents in the United States and in Lithuania revealed that students and respondents see both some similarities and 37
Max McFarland, Kyndra Bendickson, Tammi Ohmstede Beckman some differences between the two countries. In the United States, infant mental health services are provided by government grants to states, however, in Lithuania, they are not. Students and respondents in both countries rated all services as very important and both countries saw a significant difference between importance of infant mental health services and current performance of these services. It appears that providing government money for these services does not necessarily improve the perceived provision of these services. On the comparison of performance and importance as rated by Lithuanian students, there was a slightly greater difference within domain 3 (services coordination) than the other domains. Students rated the importance of this service as 4.885 and current performance as 2.806. On the same comparison when rated by American respondents, there were not any similar large differences. When the ratings for percieved importance were compared between America and Europe, there was a significant difference on domain 4 (i.e., providing services in the appropriate environment) with Lithuanian students rating it as more important than American respondents. This was also the domain that was rated lowest by American respondents. This difference could be because infant mental health services in America are available both center-based and home-based and it could be that students do not think that the place is important as long as the child is receiving services. When the ratings for percieved performance were compared between America and Europe, there was a significant difference on domain 3 (i.e., services coordination). American students rated this as being performed better than Lithuanian students. In the United States, special education law requires that there would be a coordinating agency for infant mental health services for any state that wants grant money to provide them. In this case, mandating a service by law does appear to lead to it being performed better, at least students and practitioners perceive it that way. Overall, these results indicate that mandating services by law, as they are in the United States, does not necessarily lead to students and practitioners feeling that they are more important. Students and practitioners in the United States and in the Lithuanian country rated infant mental health services as very important. This likely means that current students 38
International Journal of Psychology: A Biopsychosocial Approach Tarptautinis psichologijos žurnalas: biopsichosocialinis požiūris 2011, 8, 29 40 p. and practitioners will advocate to continue these services in the future, especially if research continues to show that they are cost effective over the long term. In the future, it would be interesting to survey students and practitioners in other countries to see if their perceptions of the importance and performance of infant mental health services are similar. In this study, there was a minimal difference in perceptions of students in a country where these services are provided by government grant money, and a country where they are not. It would be interesting to see if there were differences between other countries where infant mental health services are provided by government money and countries where they are not. Responses could be broken down by state to see if different states perform some services better than other states as well. In this study, student and practitioner responses were analyzed together. In future studies, students and practitioners could be separated to see if there are differences in what students perceive compared to what practitioners working out in the field perceive, especially in performance. Practitioners who are working in the field may see services being performed very differently than what students perceive. Also, in this study, all of the participants took a course in infant mental health from the same university. It would be interesting to see if students who took a course from another university rated importance and performance similar to the participants in this study. References 108th Congress (2004). Public Law 108-446. Individuals with Disabilities Education Improvement Act of 2004. Washington, DC: Author. Barnett, D. W. (2002). Best Practices in Early Intervention. In A. Thomas, J. Grimes (Eds.), Best Practices in School Psychology (4th ed., pp. 1247 1262). Bethesda, MD: National Association of School Psychologists. Barnett, W. S., Escobar, C. M. (2002). Research on the Cost Effectiveness of Early Educational Intervention; Implications for Research and Policy. In T. A. Revenson, A. R. D Augelli, S. E. French, D. L. Hughes, D. Livert et al. (Eds.), Ecological Research to Promote Social Change; Methodological Advances from Community Psychology (pp. 63 92). New York: Kluwer Academic/Plenum Publishers. Barnett, W. S. (2000). Economics of Early Childhood Intervention. In J. P. Shonkoff, S. J. Meisel (Eds.), Handbook of Early Childhood Intervention (2nd ed., pp. 589 610). New York: Cambridge University Press. 39
Max McFarland, Kyndra Bendickson, Tammi Ohmstede Beckman Breitenstein, S. M., Gross, D., Ordaz, I., Julion, W., Garvey, C., Ridge, A. (2007). Promoting Mental Health in Early Childhood Programs Serving Families from Low-income Neighborhoods. Journal of the American Psychiatric Nurses Association, 13, 313 320. Carpenter, S. (2007). The Impetus for Family-centered Early Childhood Intervention. Child: Care, Health and Development, 33, 664 669. Jacob, S., Hartstorne, T. S. (2007). Ethics and Law for School Psychologists (5 th ed.). Hoboken, NJ: John Wiley & Sons, Inc. Jacobson, J. W., Mulick, J. A., Green, G. (1998). Cost-benefit Estimates for Early Intensive Behavioral Intervention for Young Children with Autism General Model and Single State Case. Behavioral Interventions, 13, 201 226. Nebraska Department of Education (2006). Title 92, Nebraska Administrative Code, Chapter 1: Rule 51: Regulations and Standards for Special Education Programs. Lincoln, NE: Department of Education. JAV IR LIETUVOS STUDENTŲ SUVOKIAMOS KŪDIKIŲ PSICHIKOS SVEIKATOS PASLAUGŲ SVARBOS PALYGINIMAS Max McFarland, Kyndra Bendickson, Tammi Ohmstede Beckman Nebraskos Kearney universitetas, JAV Santrauka. Mokslinė problema. Ankstyvųjų vaikystės intervencijų pagrindinis tikslas yra sumažinti išlaidas, kurios vėliau būtų reikalingos teikiant specialiąsias paslaugas mokyklose ir vėlesniais laikotarpiais (Carpenter, 2007; Jacob, Hartshorne, 2007). Tyrimo tikslas. Šio tyrimo tikslas yra palyginti kūdikių psichikos sveikatos paslaugų svarbos ir jų funkcijų suvokimo skirtumus Lietuvos studentų bei JAV praktikų ir studentų imtyse. Metodika. Tyrime buvo naudojamas straipsnio autorių sudarytas klausimynas. Remiantis surinktais duomenimis buvo palyginta kūdikių psichikos sveikatos paslaugų svarba ir funkcijų suvokimas Lietuvos ir JAV studentų bei praktikų imtyse. Rezultatai. Tyrimo rezultatai atskleidė gana ženklius kūdikių psichikos sveikatos paslaugų ir jų funkcijų vertinimo skirtumus Lietuvoje ir JAV. Lietuvos studentai, lyginant su JAV studentais ir praktikais, gerokai didesnę reikšmę priskyrė tinkamoje aplinkoje teikiamoms paslaugoms. JAV studentai ir praktikai psichikos sveikatos paslaugas, kurias koordinuoja viena institucija, buvo linkę vertinti kaip daug kokybiškesnes nei Lietuvos studentai. Išvada. Tyrimo rezultatai atskleidė tarptautinius skirtumus ruošiant studentus teikti ankstyvas psichikos sveikatos paslaugas. Pagrindiniai žodžiai: psichikos sveikatos paslaugos, palyginimas, tarptautiškumas. Received: 13 May, 2011 Accepted: 16 May, 2011 40