Alliance for Advancement of Infant Mental Health

Problem:

Timing is everything in brain development.  We must ensure that every professional who touches the lives of infants, young children, and families is prepared to support stable, nurturing caregiving relationships that build strong brain architecture.  Access to professional learning opportunities to do so is limited in rural and some global communities.  

Solution:

In order to optimize outcomes for infants and young children, we propose a technological solution to increase access in isolated communities to the credential that documents competency.

Global change:

This professional credential for the infant and early childhood workforce has been adopted by 30 US states and 2 countries. The credential’s value is widely recognized; 2500 professionals have earned it to date. The proposed solutions will allow The Alliance to broaden its domestic and global reach dramatically.

The professional member associations who license and implement the Endorsement® credential for infant and early childhood professionals are small non-profits.  Only 66% have paid staff.  Of those who do, the average number is 1.3 FTEs.  Associations report volunteer burnout, budget constraints and high turnover. As a result, fidelity to the Endorsement® process is compromised. In an effort to support quality and access, the Alliance is seeking funds for a tech solution regarding the Endorsement® examination. The Endorsement exam documents competency for the professionals who work with the most overburdened, under-resourced families.  Currently, exam scoring requires two volunteers reviewers donating 2-3 hours per exam, plus staff time to coordinate.  And because the exam is not currently online, professionals must travel to a central location to have it administered.  This limits access to the exam in ways that are inequitable. 

The impact on people and community is wide-reaching. To help illustrate:

- In Michigan, professionals from the Upper Peninsula must allocate three days away from home and work to make the 9 hour drive each way as well as funding for lodging to travel to a central site in southeast Michigan to take the Endorsement exam. 

-Alaska’s communities are the most remote and rural in the nation, scattered across underdeveloped land and challenging topographical features. Most communities (86%) cannot be reached by road and are either along the coast or on a river and waterways serve as the primary means to transport people and goods. 

- In Western Australia, there are vast differences between population centers making travel to test cites onerous

-The mountainous geography of Tennessee and West Virginia present challenges with accessibility to centralized test sites.

-Endorsement applicants in Hawaii need to fly to a central island to take exam 

These are only a few examples, but nearly every state struggles to reach a rural population within their borders.

An online, virtually proctored exam eliminates the time, expense, and inconvenience associated with travel for applicants from a rural/isolated region to a central proctored site, and is more equitable as it allows those in rural areas to have the same access as those in urban/suburban areas.  Because rural regions already struggle with a shortage of resources, it is particularly important to ensure that the higher categories of Endorsement (that require the exam) are available. Those endorsed in the higher categories are the ones qualified to provide reflective supervision/consultation and specialized in-service training to practitioners, who in rural regions, are serving vulnerable and isolated infants and families.      

Currently, to accommodate exam takers over distance, associations must identify additional exam sites, train additional proctors and retrieve confidentiality statements from each, and send exam packets via FedEx. Materials are then returned from each site/proctor via FedEx.  Next the Endorsement Coordinator at each site must randomly mix exams and then send exam review packets to identified exam reviewers via FedEx.  Completed exam reviews are returned this way as well.  Delays and lost packets have occurred, creating frustrations, lost time, and lost resources.

Moving from paper to a digital process will provide a far greater capacity for analytics regarding what types of questions are frequently missed.  This data will help to identify areas of regional and national learning gaps and thereby informs the development of continuing education to address them.  The exam analytics will be a tremendous aid in the continuous quality improvement process, will provide regional and national pass/fail rates and much more.

Exam results could be analyzed quickly and efficiently with an online tool allowing for timely quality improvements and identification of knowledge/skill gaps. The development of an online testing system would streamline and replace the current process needed to create and administer the exam. Exams are scheduled twice annually; each exam consisting of 60 multiple choice questions and 3-4 open-ended questions pulled from an Excel database, then manually transferred to Word. Formatting, duplication and errors are challenges with the current system. Zip drives of exams are sent via FedEx to test sites where online proctors administer the exam, then collect and return to the Alliance.  The tests are then manually checked for accuracy and exam reviewers review the responses to the open-ended vignettes. This entire process would be more efficient, more accurate, and more relevant with adaptation of an online system. 

Online exam taking is not new.  However, our exam review system is unique in that we utilize volunteer exam reviewers from around the world.  Each exam will be scored once by a pair of trained reviewers, who may live thousands of miles apart.  Many exams require a third review, again from someone who may live on the other side of the world.  Therefore, we need an innovative system that is customized and enables us to list dozens (eventually hundreds) of qualified reviewers who can be assigned to a score a particular exam or set of exams.

With the technological advancement of a customized online exam portal, sustaining the quality and relevancy of the exam will be more efficient than the current methods of maintaining exams in Microsoft Excel and Word.  It eliminates the need to securely ship thumb drives around the US/world and the chance they could be lost or compromised during shipping.  

Importantly, an online exam frees up precious resources that professionals in rural and isolated regions expend traveling to and from a central exam site, thereby providing more equitable access to the higher categories of the Endorsement® credential. The categories that require an exam: Infant and Early Childhood Mental Health Specialists providing treatment/intervention with infants, young children, and families with the highest need and Infant and Early Childhood Mental Health Mentors for Clinical (supervisors), Policy (systems leaders), and Research/Faculty (those who teach and/or conduct research); these are the professionals who build capacity in their communities.

Questionmark is a vendor capable of customizing its platform to meet The Alliance's unique needs.  They specialize in assessment management enabling us to document competency for the highest categories of Endorsement, thereby assuring quality services and leadership in the infant/young child-family field.

Questionmark OnDemand is a cloud-based Assessment Management System that will enable us to author, deliver and analyze our exams.

• Create/edit questions 
• Deliver via browser, secure browser, mobile devices or paper
• Analyze and distribute meaningful reports on results 
• Ensure the integrity of test and exam results securely

Questionmark's system will allow us to administer exams with a broad range of devices including smartphones, tablets and touchscreen devices.  Questionmark auto-senses the participant’s device and browser, then delivers the assessment formatted appropriately for the device/browser’s requirements. Questionmark's “on the fly” auto-sizing dynamically adjusts and sizes the assessment’s navigation buttons, controls and template graphics so they fit (and look great) on just about any screen size or resolution imaginable.  This flexibility increases equitable access to our exam.

Putting the exam online means Alliance staff will spend less time on formatting, transferring questions between files and manually tracking question validity, but instead will easily select from a menu of questions online to create new versions of exams. Analytics and reporting will be more thorough and extensive through Questionmark’s system.

The development of an online testing system would streamline and replace the current process needed to create and administer the exam. Exams are scheduled twice annually, with each exam consisting of 60 multiple choice questions and 3-4 open-ended questions pulled from an Excel database, then manually transferred to Word. Formatting, duplication and errors are challenges with the current system. Zip drives of exams are sent via FedEx to test sites where online proctors administer the exam, then collect and return to the Alliance.  The tests are then manually checked for accuracy and exam reviewers review the responses to the open-ended vignettes.  By implementing an electronic version of the exam, this entire process would be more efficient, more accurate, and more relevant. An electronic database of questions could be built and generate exams, as well as quickly check tests for accurate responses and provide trends in answers. 

The Alliance currently serves 30 state associations, as well as 2 international associations. 

To date, nearly 3000 professionals have been endorsed with the IMH Endorsement® (IMH-E®) credential, with another 2000 currently in the process of earning Endorsement. Demand for Endorsement continues to excel. We expect numbers to grow quickly as different governing bodies continue to support efforts to enrich the lives of infants and young children. For example, Washington state's King County passed a tax levy to support social emotional health of children prenatal to 21 in King County (Best Starts for Kids) resulting in 300 applications over the next 2-3 years from King County alone. In addition, Washington’s Project LAUNCH is supporting workforce development leading to another 120 applicants (projected) over the next 1 ½ years.  Similar efforts are being made in other areas of the country and we anticipate it to continue with a more refined focus on mental health. 

With more of a national focus on early childhood mental health than ever, the Alliance’s approach to development is multi-faceted:

-       Continue to collaborate with strategic partners who share the same interests in advancing infant and early childhood mental health. Develop solutions that not only benefit the partnership but can be applied in practice and scaled to the entire, national organization.

-       Work with state government(s) to request federal funding allocated to mental health wellness

-      Pursue new state and international licensees

-      Develop Training Hub to provide training to all Infant/Early Childhood providers within and outside of Alliance.

-       Expand promotion of early relational health throughout Alliance licensees, including developing training models 

Lack of funding is our largest barrier to accomplishing the goals we've set to achieve. We have ideas of how to better reach and support spanish-speaking populations, promote diversity and inclusion with all efforts, further our reach nationally and internationally, but we need to first secure the funding and resources to do so. as well as multiple technical solutions that would help streamline processes, thereby allowing us to focus on other vital improvements. 

The Alliance has developed a model for earning funding. 

-       Earn revenue from Training Hub from those who train and receive training

-       Create a new product that Alliance can market to a large audience

-       Pursue new state and international licensees

-       Continue collaborations and grow new relationships with contractual partners

-       Develop approaches and training models to understand and use the Early Relational Health Screen

We have a total of 5 staff members; 3 of which work full-time and 2 work part-time. We contract with 3 additional qualified contractors for additional assignments when necessary. 

Like most of our staff, the Quality Assurance Director (QAD) of the Alliance for the Advancement of Infant Mental Health has years of experience as an infant and early childhood mental health therapist and clinical supervisor in Arizona and Michigan. The QAD manages the development of the content of the 8 separate exams, including a rigorous continuous quality improvement process.  

The Endorsement® exam is a critical tool for documenting the competency of infant and early childhood mental health professionals, particularly those identified as therapists, supervisors, trainers, university faculty, researchers, and program/policy leaders.  Access to the exam means those communities have access to professionals who have documented their qualifications and are in the best position to offer knowledgeable and skillful support.

Since 2005, we ensure fidelity of MI-AIMH Competency Guidelines® and Endorsement® in member associations who license their use. The Alliance staff administers and/or supports the administration of written exams to every member association twice a year and has seen growth in test-takers year after year.  Notably, we have overseen the exam administration in Alaska, Hawaii, and Western Australia. Since 2004, MI-AIMH alone has administered nearly 600 exams. 

The Alliance partners with the infant mental health associations who have licensed the use of the workforce development initiative that includes the Competency Guidelines® and the Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant and Early Childhood Mental Health®.  To date there are 30 US state and 2 international IMH associations who are members of The Alliance.

The Alliance has partnership agreements with organizations whose missions and objectives align with our focus on workforce development strategies for infant/young child-family professionals.   

We have a contractual partnership with Prevent Child Abuse America – Healthy Families America, and strategic partnerships with Center for Reflective Practice at the Center for Early Education and Development at the University of Minnesota, Erikson Institute: FAN Training, Fielding University, Think Babies, University of California Davis Extension Napa Infant-Parent Mental Health Fellowship and the Parent-Child Institute and Wayne State University Merrill Palmer Skillman Institute. Additionally, we partner with David Willis, MD, and the University of Michigan, around the promotion and dissemination of the Early Relational Health Screening (ERHS) Tool.

The Alliance enjoys a strong collaborative relationship with the World Association for Infant Mental Health(WAIMH).  The Alliance manages the peer-reviewed Infant Mental Health Journal, the official journal of WAIMH.

The Alliance is unique in that its primary focus is on workforce development strategies for infant/young child-family professionals. The Endorsement® is one of the first and most comprehensive efforts, nationally and internationally, to identify best practice competencies across disciplines and practice settings, offering multiple career designations for professional development in the infant, early childhood and family field. Endorsement® is meant to honor professionals who apply infant & early childhood mental health principles to their practice. It is granted through documentation and verification of the required specialized education, work, in-service training, and reflective supervision/consultation experiences. Endorsement® is not a license but an overlay that complements one’s professional license and/or other credentials.

The Alliance was based on a grassroots principle, focusing on self-organization and continues to encourage communal involvement and reciprocity. In order to provide quality assurance, technical assistance and guidance to leaders, The Alliance provides multiple opportunities for connection and support across its members, including;

•       monthly calls to support the leaders of each association

•       monthly calls for those who coordinate Endorsement in each association

•       opportunities to collaborate in committees. (policy, research, training)

•       Annual Leadership Summit (formerly known as a Leadership Retreat) that enable members to learn from one another and to voice their successes as well as their challenges and barriers. 

Currently, all test-takers currently pay a registration and processing fee to their member association prior to taking an exam.  The association pays the Alliance a minimal fee ($500) every 3 years in exchange of a new version of the exam, which they then manually administer.  In order to sustain he online exam, the pricing model would evolve from $500 every three years into an annual exam fee of $200 for every member state association to cover monthly maintenance fees of the exam portal, as well as exam development.  This only slightly increases the association’s commitment from $500 every three years to $600. With the 2019 anticipated member participation number of 32 associations, this will generate $6400.  The annual maintenance fees for the exam service is $7200, leaving the Alliance to cover just $800 annually.  As the number of member associations increases, that balance will be reduced.  There are currently six additional associations working to adopt the Endorsement®; we are confident we will have at least 34 member associations by 2020.

The Alliance eagerly pursues opportunities to partner with organizations that share a common goal of improving the mental development of infants and young children. The Alliance and Solve are aligned in that children succeed when provided with protective home environments, opportunities for social and physical exploration, and cognitive stimulation through positive play and responsive caregiver-to-child interactions. A partnership with Solve would result in the Alliance moving forward with our mission of building and sustaining a reflective, skilled, culturally competent, and relationship-based workforce that supports infants, young children and their families. A grant from Solve would allow the Alliance to move forward with goals to make the Endorsement more widely available to the workforce that directly impacts the families of infant and young children.