Systems Reform Group

Preventing Expulsion from Child Care

Addressing the Mental Health Needs of Young Children

The mental health system in the United States was not designed to address the needs of infants, toddlers, and preschoolers. The very idea that young children can have mental health problems is unfathomable to the general public and is still a fairly radical proposition in the eyes of policymakers. However, research shows that young children do, in fact, experience mental health problems including depression, anxiety, post-traumatic stress, and negative/defiant disorders. Michigan was one of the first states to recognize the mental health needs of infants and toddlers when it funded local community mental health agencies to pilot infant mental health services in 1975.

When discussing young children, mental health problems are often referred to as social-emotional or behavioral problems. Although there is no national epidemiological data at this time, an estimated 17% of children up to age five have diagnosable disorders, while an additional 10% have problem behaviors. Young children from low-income communities are three times more likely to have social-emotional or behavioral problems compared to young children from higher-income neighborhoods.

The President’s New Freedom Commission on Mental Health Report (2003) states that early childhood is a critical period for the onset of emotional and behavioral impairments, and young children are being expelled from preschools and child care facilities for severely disruptive behaviors and emotional disorders. Since children develop rapidly, early and swift delivery of mental health services and support is necessary to avoid permanent consequences and to ensure that children are ready for school. Emerging neuroscience highlights the ability of environmental factors to shape brain development and related behavior. Consequently, early detection, assessment, and links with treatment and support can prevent mental health problems from worsening. Without intervention, child and adolescent disorders frequently continue into adulthood.

Kaufmann & Hepburn (2005) identified seven factors that have converged to compel policy makers to acknowledge that the time has come to address the mental health needs of young children: 1) increased awareness of the mental health problems of young children; 2) evidence on early brain development; 3) increasing use of psychotropic drugs with young children; 4) increasing numbers of young children being expelled from child care and early education settings due to challenging behaviors; 5) the emergence of infant and early childhood mental health as a field; 6) the importance of environment and relationships to the mental health of young children, and 7) the relationship between healthy social and emotional development and later school success.

Child Care Expulsion Prevention (CCEP) Initiative

Nearly 61 percent of Michigan’s children under the age of six require child care. In recent years, child care providers have begun clamoring for help in working with young children with challenging behaviors. Challenging behaviors include externalizing behaviors (e.g., prolonged crying, biting, hitting, kicking, etc.), as well as internalizing behaviors (e.g., social withdrawal, depressed affect, fearfulness, recurring physical symptoms, etc.).

The prevalence of challenging behavior among infants, toddlers and preschool-age children in early care and learning settings ranges from 3 to 15%, and child care programs are expelling increasing numbers of children due to challenging behavior. A national study (Gilliam, 2005) found that pre-kindergarten students are expelled at a rate more than three times that of their older peers in the K-12 grades, but that the likelihood of expulsion decreases significantly with access to classroom-based behavioral consultation.

In 1998, Michigan became one of the first states to establish an early childhood mental health consultation initiative to address the problem of infants, toddlers and preschoolers being expelled from child care. Child Care Expulsion Prevention (CCEP) is funded through the Michigan Department of Human Services and administered by the Michigan Department of Community Health, (MDCH) in collaboration with the Michigan Community Coordinated Child Care Association (4C) and Michigan State University Extension (MSUE). MDCH contracts with community mental health agencies to implement CCEP projects at the local level, in partnership with local/regional 4C and MSUE offices.

CCEP projects are integrated within child care settings not only to prevent expulsions, but to promote the socialemotional development of infants, toddlers, and preschoolers. CCEP projects serve licensed child day care centers, licensed group day care homes, registered family day care homes, day care aides, and relative care providers.

Currently, there are 16 CCEP projects serving 31 Michigan counties. These projects are staffed by masters-level consultants with expertise in early childhood mental health. MDCH Mental Health Services to Children and Families contracts with MPHI Systems Reform to coordinate technical assistance for CCEP consultants and administrators, and to provide program support at the state level.

CCEP projects provide two types of relationship-based consultation:

1. Child-family centered consultation for parents and child care providers concerned about a young child who is exhibiting challenging behaviors that put him at risk for expulsion. The CCEP consultant works with parents and child care providers as a team to determine the underlying reason for a particular child’s challenging behavior, and then helps the child by using strategies that specifically target the underlying reason. For example, one child may be hitting and kicking because the adults in his life are expecting him to do something he is not yet developmentally capable of doing; another child because of sensory integration problems; a third because of a very stressful home environment; a fourth because he is hungry; and a fifth because he has a severe socialemotional or behavioral disorder. The child-family centered consultation process includes: observation of the child at child care and at home; functional assessment of child’s behavior; development of an individualized positive guidance action plan for the child; and support for parents and providers to implement the plan (e.g., coaching and supporting them to learn new ways to interact with the child, providing educational resources for them, arranging for specialized evaluations, modifying the physical environment, connecting the family to community resources, etc.).
2. Programmatic consultation for child care providers who want to strengthen the overall social-emotional quality of the care they provide.This may include training and coaching for administrators, caregivers and parents on: the importance of consistent, nurturing relationships between caregivers and children for social-emotional development; using strategies and curricula to promote social-emotional competence and reduce challenging behaviors; partnering with parents; strengthening communication between child care administrators and caregivers to improve the work climate; and other quality improvement activities.

In FY 2006, CCEP projects served 590 children with challenging behaviors. Ninety six percent of these children remained in their child care placement. An additional 5,214 children were served indirectly, in that they benefited from changes implemented by their child care providers subsequent to programmatic consultation. CCEP has garnered national attention and was featured in USA Today in 2005. A comprehensive, multi-year evaluation of CCEP will begin in March 2007.

Learn More
For more information about the CCEP initiative, contact Sheri Falvay, Director, MDCH Mental Health Services to Children & Families, Falvey@michigan.gov or call (517) 241-5762.

Author
Deb Marciniak, MA, has worked at the local and state levels as a consultant and technical assistance coordinator in early childhood mental health, maternal and child health, and early intervention programs.