When the parents or caregivers of young children start the San Bernardino County, California, CARE program, they are desperate.
One mother said she hadn’t been able to go to the store in four years because of her 5-year-old son’s challenging behaviors. A grandfather recalled that before his preschool-age grandson started classes, he wasn’t yet verbal, but after the 10-week CARE program, he was able to hear the boy express love for his mother in words for the first time.
“If you visit CARE during the first week, the kids are off the hook,” said Ron Powell, the former administrator of special education programs in San Bernardino County who helped design the program 11 years ago. “There’s a lot of screaming, crying and kicking, all kinds of protest behaviors going on because they can’t control their big feelings. And then you come back toward the end, they’re walking in lines, they’re sitting together and playing together and sharing things with one another. It’s quite a transformation.”
The CARE program is one the state’s therapeutic preschools, designed to address the behavioral and educational issues often faced by many preschoolers in the state, often those who already have a sizeable history of trauma. In recent years, Powell’s CARE program has spread to San Francisco, Solano and Fresno counties, part of an effort to extend a robust onramp to early childhood education to children who can fall through the cracks.
But therapeutic preschool environments are more than just a warm and fuzzy exercise in helping youngsters learn — they’re also an important bulwark against what some call the preschool to prison pipeline. As California implements an ambitious effort to curb school suspensions and expulsions, schools across the state are exploring therapeutic preschool models like Powell’s as a way to help children address significant behavioral issues and keep them prepared to succeed in the state’s education system.
In 2005, Yale researcher Walter Gilliam released a ground-breaking study that provided an alarming look at a school discipline issue that few had imagined. Pre-K students, ages 3 and 4, are expelled from school at a rate more than three times that of children in grades K-12. African American children were twice as likely to be expelled than white kids.
More recent data — like this 2017 analysis from the 2016 National Survey of Children’s Health — found that about 50,000 preschoolers were suspended at least once during the year and an additional 17,000 preschoolers believed to have been expelled, with continuing racial and gender disparities.
As a result, preschool can quickly become a place of stress rather than a safe space to learn and grow, make friends and have fun.
“There is a sense of, ‘I’m not going to be liked here; I’m going to be scolded all the time,’” said Alicia Lieberman, the director of child trauma research at the University of California, San Francisco.
Experiencing this kind of discipline in preschool can have lasting impacts on the child — research has shown that children who are suspended in preschool are more likely to drop out of high school and become incarcerated, according to the Center for American Progress.
Over the past four years, that research has propelled many states to propose legislation that would restrict preschool and kindergarten suspensions and establish processes for intervening in cases of extreme behavioral issues.
That includes California, which has taken big steps to curb suspensions and expulsions for school children in recent years, including legislation this year that extends a ban on school suspensions related to disruptive behaviors and defying school authorities to now include grades K-8.
And in 2017, the state passed an anti-exclusion law that would address preschool pushout by requiring state preschools to exhaust a series of interventions before expelling a student. If a California school does resort to expulsion, they must help find an alternative program for that child. That has meant many school administrators are searching to give early childhood education and pre-K teachers better tools to work with preschoolers who exhibit behavioral issues.
“What we found is that those who work with young children are not prepared to deal with their emotionally dysregulated states,” said Powell of San Bernardino County. “They don’t know how to deal with that. The only tool available to them often ends up being exclusion, where they end up suspending children for misbehaviors.”
Inside the Classroom
In a boxy building on the outskirts of a large medical center in Torrance, California, 12 children ages of 3 to 5 gather each weekday to undergo four hours of therapy. This may sound impossibly intense, but to these little ones — students at the Children’s Institute therapeutic preschool — it’s just another day at school.
They’ll sing songs, enjoy story time in a cozy nook stuffed with cushy, oversized pillows and get in some messy play with arts and crafts. The colorful classrooms are adorned with finger-painted masterpieces and well stocked with picture books, stuffed animals and building blocks. In one corner, bowls of sand and seashells for little hands to explore are spread out atop a “sensory table” and in another part of the room, a play kitchen, complete with a wooden stove, holds endless opportunity for make-believe games. Outside is a tree-shaded playground, a set of tricycles and prolific sidewalk chalk drawings.
Here each activity is designed with a therapeutic purpose in mind and led by counselors specialized in addressing childhood trauma — even playing with dolls often leads to kids talking through problems they’ve experienced at home.
Therapeutic preschools like this one were created to serve young children who fail to thrive in traditional preschool and daycare settings. Some have been suspended or even expelled from mainstream programs due to aggressive or otherwise “out-of-control” behaviors. Others show developmental delays that hinder their growth and learning capacity.
Many of these children have some kind of history with the child welfare system — around 50 percent of the students at the Children’s Institute program are system-involved. Oftentimes, the behaviors that result in kids struggling in preschool develop in response to early childhood traumas like physical or sexual abuse, neglect and even poverty.
The behaviors that lead to kids struggling in traditional preschool settings include things like biting, spitting, hitting and running away, though sometimes the effects of maltreatment also show up as anxiety, depression and withdrawn behaviors, according to Nicole Fauscette of the Children’s Institute. Children who have experienced sexual abuse sometimes display sexualized behaviors.
Research shows that these experiences impact children’s brain development to the point of resulting in a noticeable difference in brain size and structure when compared with the brains of children who weren’t maltreated. This can affect their ability to grow, plan and regulate stress.
Typical preschools aren’t equipped to care for kids showing these behaviors or recognize trauma as the underlying cause, according to Lieberman. Aggressive behaviors can scare teachers and other parents, and trying to manage kids who are facing these challenges can frustrate staff and lead them to respond in ways that exacerbate rather than de-escalate the situation.
At therapeutic preschools, staff and volunteers are trained to understand the symptoms of trauma, what the resulting behaviors might mean and how to respond in ways that help the child move past the moment’s outburst, grow and heal.
At the Children’s Institute, in addition to the specially trained staff, they have design elements in place to help mitigate the somatic stress responses that can become problematic. A “quiet cube” — a child-sized cubby in the corner of a room — offers kids a place to escape to when they feel themselves getting worked up and needing a break to calm down. According to Fauscette, this tool helps the children feel a sense of autonomy over their body and emotional regulation.
For the past 11 years, the San Bernardino County CARE program has been working with preschoolers with the most intensive emotional and behavioral health needs. Based on a partial hospitalization model, the program serves children with significant behavioral problems, including children who have been prenatally exposed to drugs and alcohol, those with developmental delays and children on the autism spectrum.
The 10-week program provides 10 children younger than 6 with 4.5 hours a day of specialized treatment and therapy while requiring the daily participation of parents or caregivers. After 10 weeks, children go on to other educational programs, including mainstream pre-k or kindergarten programs, and staff checks in on children at their new schools for three weeks to make sure their new teachers are prepared to handle challenges when they arise.
Powell said that the program arose because of the heavy need there, including many children from the county’s foster care system.
“We had kids that were just falling through the cracks,” Powell said. “They weren’t making it in school and parents were keeping them home. We really didn’t have anything for them. If we didn’t get ahead of them early on, these kids wouldn’t even be able to get into school.”
To make the CARE program sustainable, the county created a multi-agency model of providing care through school-based health centers that drew on a blended pot of funding from the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) entitlement, as well as money from several different county departments.
But while Powell saw the success of the CARE program, he also wondered if there wasn’t an opportunity to do more, especially for a wider number of children who didn’t all exhibit strong symptoms. But California’s mental health system is based on a model where only diagnosable conditions are eligible for reimbursement under EPSDT and then, usually for services based more on treatment rather than prevention.
To create the new Mini-Miracles program, Powell drew from the early childhood mental health consultation model, a promising practice that 14 other states have deployed. It places mental health professionals in mainstream preschool classrooms to support teachers and provide an immediate response during class for students who become emotionally dysregulated, or severely agitated. By having an embedded therapist in class, Powell said children who need more intensive services are able to be identified and linked to services much earlier.
In addition to the in-class therapists, the classrooms were also stocked with “calming center” tools, like weighted blankets and rocking chairs, methods kids can use to help them self-regulate.
“You don’t always have use the most intensive level of therapy in order to solve the problem,” Powell said. “We may not be able to control what happens to a child, but we can change the environment in order to teach children how to identify their big feelings and to regulate their own behaviors.”
The program has since expanded throughout all of the school districts in the county with funding from several sources, including the Department of Mental Health. The program is also being offered through the state’s preschool and kindergarten programs in the county after the benefit of program caught the eye of school administrators who have chipped in money from the state’s Local Control Funding Formula program.
Partnering with Caregivers
While these early education intervention models focus on providing mental health care to the child, working with parents or caregivers is a big part of the process to set the family up for ongoing progress.
“The parent is really the long-term therapist, so our goal is to give them all the tools that we can,” said Fauscette, senior clinical supervisor for day treatment intensive at the Children’s Institute.
At the Children’s Institute, the therapists on staff do home visits and meet in teams with the children and parents to identify stressors in the kids’ lives and discuss how the school can support them through those challenges. They try to educate parents about the developmental lags associated with trauma and what kind of associated symptoms and behaviors they might see in their kids.
Powell’s model also focuses on working hand-in-hand with children’s parents and teachers “creating an environmental milieu that includes pretty much all the meaningful adults in a child’s life and getting them on the same page.”
Though there’s a lack of rigorous methodological evaluations of therapeutic preschool environments, studies have shown that when used as an intervention, they lead to improved cognitive and motor skills and better emotional regulation. And importantly, these programs show high levels of success in helping children reintegrate into mainstream classrooms, putting them back on normalized academic tracks early on. At the Children’s Institute, virtually all of the kids either exit into a traditional kindergarten program or reintegrate into a typical preschool setting.
“When you relationally help a child, that becomes a healing aspect, that’s the buffer against all the negative experiences they’ve had,” explained Jesus Parra of the Children’s Institute. “That kickstarts the development again and we see cognitive leaps.”
Don’t miss the Breaking Barriers Symposium, a working conference that focuses on providing practical ideas to help break the barriers to care for California’s youth and their families. The fourth annual Breaking Barriers Symposium will be held November 20-21, 2019, in Sacramento. You can register here.