Childcare providers use two-generational approach to help preschoolers from being expelled

It’s shocking: Preschoolers are three times more likely to be expelled than children in elementary, middle and high school, according to figures from the U.S. Department of Health & Human Services. Boys are four times more likely than girls to be kicked out, and African American children are twice as likely as Latinx and White children.

One organization with childcare centers and mental health providers in Kentucky and Ohio began a long journey 15 years ago, when they began hearing about young kids getting expelled. By integrating a whole family approach and the science of adverse childhood experiences, the Consortium for Resilient Young Children (CRYC) took a radically different approach to help little kids stay in school.

“We came together 15 years ago to start addressing the growing need for social emotional supports for young children,” says Carolyn Brinkmann. “Our organizations were getting phone calls from their own programs about younger children being expelled from preschool and childcare, and we tried to figure out how to start responding to that.”

Brinkmann is the director for the Resilient Children and Families Program (RCFP), a coaching and training arm of the CRYC. The CRYC comprises five childcare or educational agencies and three mental health provider agencies in southwest Ohio and northern Kentucky. The RCFP provides coaching and training to around 50 community-based programs that serve around 1,541 children.

Brinkmann and her colleagues began by looking for programs that address stressors and promote resilience in the whole family.

“We’re not working with little ones in a vacuum,” says Whitney Cundiff, the team leader of early childhood services for Northkey Community Care in Covington, Kentucky, part of the consortium. Along with Brinkmann, Cundiff led the research and training for the Consortium and they decided to use something commonly known as a two-generational approach—little kids and their parents or caregivers.

In 2008, Brinkmann trained childcare providers in the Strengthening Families Protective Factors approach, a framework developed by the Center for the Study of Social Policy. It includes building resilience in parents, strengthening families’ social connections in their communities, educating parents about child development, and helping parents link up with organizations that can help them when they’re struggling to feed and house their families or provide other basic needs. It does not, however, train people in PACEs science.

Then, in 2016, the RCFP joined a Cincinnati-based collaborative called Joining Forces for Children, a cross-sector collaborative that focuses on building resilience and preventing adversity in children and families. Among its founding members was Cincinnati Children’s Hospital pediatrician, Dr. Robert Shapiro, who was interested in their two-generational focus.

“He wanted us to think about how we could get childcare providers to do more in-depth work when it came to understanding and preventing ACEs,” Brinkmann says.

That involved finding out if there were traumatic experiences from the parents’ own childhoods that might still trouble them and affect how they deal with their children’s stress.

The term ACEs, or adverse childhood experiences, comes from the landmark Centers for Disease Control and Prevention/Kaiser Permanente Adverse Childhood Experiences Study, which tied 10 types of childhood trauma —such as experiencing or witnessing abuse, neglect, or having a parent with mental health or addiction struggles—to health problems in adulthood in 17,000 adults. The study found that ACEs were remarkably common, with most people reporting at least one ACE. People who have four or more different types of ACEs —about 12 percent of the population—have a 460 percent higher risk of depression and a 700 percent higher risk of becoming an alcoholic, compared with people who have no ACEs. (PACEs Science 101; Got Your ACE/Resilience Score?)

Fortunately, brains and lives are quite plastic. The appropriate integration of protective factors born of positive childhood experiences—such as feeling supported by family and able to share difficult emotions with them, having reliable adults outside of family who show they care, and developing trusting relationships with peers—can help people improve their lives.

With this in mind, Brinkmann and Cundiff, with Cincinnati Children’s Hospital researchers, developed a wellness questionnaire for childcare providers to hand out to parents. (They will make the questionnaire public after they finish doing some more research on it.) The survey included questions about parents’ ACEs, whether they suffer from depression, how resilient they are and how attuned they are to their child’s emotional needs. The hope was to help providers identify families who needed counseling and other support.

In 2017, Brinkmann and Cundiff trained coaches and a group of childcare providers from six childcare centers and four home-based day care programs. The two-hour training included the findings of the ACE Study and how protective factors can help prevent and ease childhood adversity. A core group of trainers took an additional five-hour session in communication techniques, known as motivational interviewing, to help their peers learn how to engage parents in conversations that are collaborative and that build rapport. They were also educated about how to mitigate their own stress and build resiliency.

Between August 2017 and May 2018, the childcare providers handed out the wellness surveys to parents as part of a pilot study with Cincinnati Children’s Hospital. To prepare respondents for the sensitive nature of the questions, the form included a statement telling parents they were asking the questions “to make sure they have the support and resources to cope with any potential stressors.” Parents were also told that they could skip any questions that made them feel uncomfortable.

Some 159 parents completed the surveys. Sixty percent disclosed that they had ACEs, and 53 percent said they had other risk factors that could potentially affect their children, such as feelings of depression and the fact that they used what the survey called “harsh punishment.” They found that parents who reported an ACE score of 3 or more had significantly less social support and other protective factors than parents whose ACE score was under 3.

According to the study, which appeared in the Early Childhood Education Journal in 2019, parents with ACE scores of 3 or more were nearly 1.5 times more likely to have a risk of current adversity in their family. Childcare providers reached out to 97 of these parents, and of those, 75 were steered to additional support such as mental health services, food and housing assistance, and parenting education programs. Another seven parents asked for referrals. After receiving support and referrals, 94 parents completed a wellness survey that “showed significant improvement” in family resiliency and protective factors.

How did the childcare providers feel about handing out these emotionally sensitive surveys to parents?

“Initially I was hesitant, but once I learned more about why we’re thinking about the whole family unit, it was a lot easier,” says Crystal Howard-Scott. “It allowed me to connect more with my families. And some of what they were going through, I could actually relate to.”

Overall, researchers found that the project helped childcare providers strengthen relationships with parents and fostered empathy and understanding about what they were going through.

Because the study results were so positive, Brinkmann and Cundiff have since expanded the training through a group of coaches to 24 childcare organizations and 195 childcare providers. And the coaches—who are on call and visit sites twice monthly—were able to help the providers with uncomfortable conversations with parents or difficult behavioral challenges of children. Since the fall of 2019, 396 wellness surveys have been filled out by parents.

Last year, COVID interrupted the training. Many childcare facilities were shut down during the first months of COVID. With the slow process of reopening, there was little in-person contact with parents, who were dropping off their kids at the door and leaving, says Brinkmann. As a result, many programs handed out wellness surveys without ACE questions. But beginning next fall, she said, they’ll begin distributing the versions with the ACEs questions.

However, the researchers know that the surveys help pinpoint families that need extra support. For both the 2019 and the 2020 academic year, childcare providers followed up with 29 percent of parents who had an ACE score of 3 or higher, evidence of depression, or a strained relationship with their child. Parents were also offered additional support if they said that they don’t praise their child or that they lack people they can count on for support. In the 2020 academic year, childcare providers reached out to an additional 14 percent of parents whose wellness survey showed they were struggling to put food on the table or maintain housing or were in fear of losing their job.

When they’re stumped about how to proceed with a disruptive child, teachers can reach out to a coach for help. Preschool teacher Melissa Ulmer has found that assistance invaluable. One of the children she works with was removed from her home and missed her mother. The two were scheduled to reunite, but that was postponed, “which made the child act out because she felt like [adults] were going to leave her.” The child’s disruptive behavior tended to emerge at the end of the day, when Ulmer was about to leave the center and go home.

With the help of coaching, Ulmer figured out ways to ease the child’s anxiety. “I’d prepare her by telling her that we’re both going to come back the next day, and that we’ll be together for five days in a row.” She created a daily chain made of construction paper; the girl pulls one chain link off at the end of each day. She provides activities for the child to do at home to give her some structure. “And when she comes in in the morning, I do this big song and dance and make sure she knows I’m excited to see her.” All this has completely calmed the girl’s behavior, she says.

As a result of their work, 90% of childcare providers that were trained report increased knowledge of protective factors and using practices that promote resilience and social emotional wellness. Some 85% said they felt more confident in responding to challenging behaviors in children and responding to families in crisis. Ninety-percent of children exhibited age-appropriate social and emotional development. Some 59% of the remaining children who needed and were provided with extra support demonstrated improved social and emotional skills, according to data provided by Brinkmann. They have not tracked expulsions. Brinkmann says some programs may remove a child from a program for safety reasons, "but we assist in making [an expulsion] a last resort used only after trying other strategies."

Some of the children who attend preschools that are part of the Consortium are referred to counseling, which is also offered to their parents. In 2018, Rachelle Swan and her sons were among those referred when her 4-year-old son, Mason, began acting aggressively in preschool.

“He was throwing things, hitting, screaming, and talking back,” she recalls. “Some of those things are normal for a four-year-old, but his outbursts were just uncontrollable.”

Swan was particularly concerned by aspects of Mason’s behavior that reminded her of the children’s father, with whom she had had an abusive relationship. She has since extricated herself from that relationship. The staff told her that he was being very controlling with his best girlfriend; he would try to limit the toys she could play with and prevent her from playing with anyone else.

“Hearing comments like that was just devastating,” says Swan. “It instilled so much fear in me [because] I do not want him to be like his father.”

Nicole Johnson, the coach who helped Ulmer, describes a number of approaches she might counsel staff to take with children like Mason. “It might be something as simple as saying, ‘It seems like you’re having a really hard time, and it’s too hard for you to be in the classroom right now. Let’s go outside and take a break.”

Many of the schools, including the one Swan’s sons attend, have designated areas where kids can decompress when they’ve had a meltdown. There they can play with calming tools like squeeze balls and kinetic sand and—when they’re calm enough—talk with providers, who are encouraged to zero in on each child to determine their baseline behavior.

Are they the kind of child that sits quietly in a chair or stands up and is constantly jiggling his leg? Are they crabby at a particular time of day? Are there certain activities that push them out of their comfort zone? Once they identify stress triggers, the teachers watch for subtle cues that a child is ready to have a meltdown and offer choices of ways to calm themselves.

For Mason, the school provided referrals for mental health counseling for him and his younger brother, who also attended the school, as well as for Swan herself.

Through counseling, Swan said she was able to learn ways to pinpoint her own triggers and bring herself back into the present. “It would be something so simple [that would set me off], like my kid calling me stupid,” she says. With the help of therapy, she was able to learn to pause, breathe and feel a sense of compassion for herself instead of moving right away to punishment.

Swan also benefited from being coached by her counselor in how to engage her son in positive play. The counselor observed Swan and her son through a mirrored window and offered Swan advice through an earpiece.

“The purpose was for me to learn to give my son a sense of control and for me to resist saying ‘no’ to him in order to help give him a sense of confidence,” says Swan. “I wasn’t supposed to give him any instructions, and she’d provide suggestions like, ‘Tell him you really like how calmly he’s playing with that blue truck.’”

Building trust with parents also helped them talk about the ACEs part of the wellness survey, even when that didn’t always happen right away. Crystal Howard-Scott, who ran a family daycare out of her home and now has her own childcare center, recalls taking in a two-year-old girl who had been expelled from another preschool. She found it curious that the girl’s mother kept asking her if there were males in her house, how old were they, and would they be in the same room as her daughter. The woman hadn’t filled out the ACEs part of the survey, but after her daughter had been attending the daycare for some time and she felt more comfortable with Howard-Scott, she disclosed something from her own childhood.

“Her car had broken down, and I was waiting with her for a tow truck,” says Howard-Scott. “And that’s when she was able to share that she didn’t answer the [ACE] questions because she didn’t know me and didn’t want me in her business. She told me that she had been molested as a child, and then said, ‘Miss Crystal, I must trust you, because I don’t normally tell anybody about it.’” For Howard-Scott, a light went off, and she now understood that the woman’s questions were just about trying to protect her daughter. Howard-Scott asked the woman if she wanted counseling to work on lingering feelings around the abuse, and the woman took her up on it.

Swan, too, says that her family’s experience with the childcare program at Costar and the therapy they provided through referrals have made a huge difference in their lives.

“My sons are still in the learning process, but now they’re able to pinpoint how they’re feeling and why they’re feeling that way, and they're able to use the tools that counseling gave them for calming down,” she says.

Both boys have their preferred methods. “My oldest son is more physical,” she explains. “He likes to go get a cup of ice and smash it on the ground. Or he’ll scream into a pillow. And then my younger one, his coping is that he likes to walk away and count to 10 and then come back and be ready to play again.”

Reflecting on the struggles she had before with her oldest son, Swan is more optimistic than she’s been in awhile.

“I feel like I have my child back,” she says. “Honestly, I feel like I have myself back. And I just have so much hope for him to continue to grow and mature.”

This story was first published on PACEs Connection.