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Children's Voice Article, July/August, 2005

Challenging Behavior

Child care centers are finding ways to cope with increasing numbers of preschool children with behavior problems.

By Deborah J. Amend
"Often violent or harmful to others."
"Extreme problems with transitions."
"Inability to follow directions."
"Verbally explosive behavior."
"Vulgar speech."
"Severe depression."
"Noncommunicative behavior."
"Previous expulsions."
These are descriptions, not of problematic adolescents, but of preschool-aged children--children, according to one state's child care licensing law, "whose presence is detrimental to the group." Too often, these children have teachers who lack the resources to help them mature past their behavioral problems. The result? The child is bounced from program to program. And the problem is on the rise, as more and more child care centers are seeing higher numbers of young children with challenging behavior.

"My staff tells me again and again they are seeing more and more children with more and more serious issues," says Sheri Adlin, Executive Director of South Shore Day Care Services (SSDCS), just outside Boston. Of the 219 preschoolers served at SSDCS in 2004, 69 were involved in some sort of intervention plan.

Expelling children from preschool programs for problem behavior is a common but increasingly controversial response. Many programs are just saying no to expulsion. Instead, they are developing prevention and intervention strategies to ensure the young children in their programs work through their behavioral issues successfully.

Centers are finding they can prevent behavior problems even before a child's first day at school by closely observing children before they enter a child care program. Training teachers in developmentally appropriate approaches to challenging behavior is also proving successful. Where intervention is necessary, child care centers are creating customized intervention plans and even establishing separate "therapeutic preschools."

Some child care centers have resorted to using mental health consultants to intervene and address the difficult behavior of their young charges. The Children's Council of San Francisco (CCSF) has a Mental Health Consultant Program that serves 75 child care centers in the San Francisco area. It is just one of eight agencies offering mental health consultation in the Bay area.

What Is Challenging Behavior?

Challenging behavior is difficult to define. What one teacher might perceive as difficult behavior, another may not. The Council for Exceptional Children's Division for Early Child-hood urges professionals "to consider cultural and community beliefs, developmentally appropriate expectations, and one's own beliefs about behavior [when identifying] children's behavior as challenging." 1

The Center for Evidence-Based Practice: Young Children with Challenging Behavior defines challenging behavior on the basis of its effect: "any repeated pattern of behavior, or perception of behavior, that interferes with or is at risk of interfering with optimal learning or engagement in pro-social interactions with peers and adults." 2

"Consistent inappropriate and antisocial behavior, where the child does not respond to redirection and/or guidance" is how Patricia King defines challenging behavior. King, Director for Early Childhood Services for the Child and Family Agency of Southeast Connecticut (CFASC), says, "The violence level and the consistency of the behavior are two key parts of the definition."

Violent, aggressive behavior is the most notable problem, but CCSF Executive Director Linnea Klee points out that a child who suffers extreme depression and withdrawal presents significant problems as well. Extending the definition, she deems any behavior that disrupts the relationship between the child and child care provider as challenging.

The reasons behind challenging behavior are as great as the number of children who struggle with it. Certainly, many of these children have serious mental health issues, but Karen Selman, Vice President of the North West Suburban Region of the Children's Home and Aid Society of Illinois (CHASI) stresses, "We need to sort out…what is true mental illness and what behavior comes from the child dealing with grief and anger over neglect, abuse, divorce, and other issues."

Prevention

SSDCS operates four preschools for at-risk children, and contracts family child care services for more than 50 children. Most children attend while their parents work, but 10% are referred to the preschools through the Department of Human Services as victims of abuse and neglect who need the support that SSDCS offers.

SSDCS has dealt with challenging behavior on many occasions, and the staff keeps prevention in mind with their child care work.

SSDCS believes all children benefit from small group settings, low teacher-child ratios, specialized teacher training and developmentally appropriate approaches, and it structures its preschools with that in mind. Ideally, classes have 15 or fewer children, with several smaller classes for children who present more difficult behavior. SSDCS has one teacher for every six or seven students, and the staff is highly trained. An SSDCS social worker visits each center at least once a week to consult with each teacher.

SSDCS's efforts to prevent challenging behavior begins before the child's first day at the school. After making it through the waiting list, a family must go through an enrollment process, beginning with an SSDCS staff member observing the child in his or her current child care setting. Interviews with the family and any other pertinent individuals are also helpful. The intent isn't to screen children out, but to discover what they need to be successful.
When he entered SSDCS's preschool program, 3-year-old Thomas had specific behavioral problems that required adaptations for his classroom. 3 The most difficult was keeping him out of potentially harmful situations, such as wandering into the bathroom or mouthing toys with small parts. SSDCS built a short wall in front of the bathroom to keep Thomas from wandering in and also removed all toys that could present a choking hazard. Toys were reinstated into the room as Thomas could handle them, and after about six months, the short wall came down. Because of the enrollment process, SSDCS was able to anticipate Thomas's behavioral needs and prepare an environment where he could learn and be successful.
CFASC has developed another successful approach to prevention, a training curriculum for teaching staff at early childhood education centers. The curriculum, the Bingham Early Childhood Prosocial Behavior Program, trains teachers how to foster positive interactions during classroom activities. Teachers learn to integrate five key social skills into their daily lessons, teaching children
  • to understand kindness and to be kind,
  • to understand their own emotions and others' emotions,
  • to respect themselves and others,
  • how to cooperate with others, and
  • self-control.
Through two-day train-the-trainer seminars, CFASC is able to take its curriculum to other child care programs. After training, coaches return to their centers to train their own teachers and support them as the teachers apply the new principles to their classrooms, and to observe students and report to CFASC for further help and insight.

Research has shown the curriculum to be very effective--hundreds of observations of child-to-child and child-to-teacher interactions showed significant increase in prosocial behavior. The research also suggests what factors are necessary for the curriculum's success. Increase in prosocial behavior is highly correlated with how much interest child care center staff has in participating in the training. The role of the coach is also very important--simply reading and following the curriculum doesn't have the same effect as the complete training.

Currently, only Connecticut agencies have participated in the training. CWLA is exploring ways to work with CFASC so the curriculum can be implemented in more centers nationwide.

Intervention

Prevention, however, is not always enough. For various reasons, some children's behaviors have progressed past the point where prevention is useful. At that point, intervention becomes   necessary.

CCSF's Mental Health Consultants, CFASC's Helping Hands Program, and CHASI's Resource and Referral Program all provide intervention through the use of consultants, who act as mental health workers, social workers, and parent educators. Consultants are highly trained, with backgrounds in social work or psychology and experience with child care, family intervention, and child development; in the case of CCSF, they are often multilingual.

When a child is referred to an agency, the consultant begins with an initial observation and some follow-up interviews with teachers, parents, and other interested parties. The agency establishes a team for the child: The consultant, teacher, and parents form the core, and others, including child psychologists, additional social workers, family therapists, or speech and occupational therapists, may be added depending on the child's needs.

The team develops a plan to help the child overcome his or her challenging behavior. Sometimes the plan can be quite simple--perhaps a room rearrangement or a midmorning nap in the book corner. It can be more complex if necessary, involving therapy, removal to home-based child care, or intensive family intervention.

CHASI social workers also offer support to parents, referring them for additional assistance and sometimes accompanying them to various referral appointments. CHASI staff understand this process can be very daunting for parents, and they believe support for the parents ultimately will help the child.

Many child care centers do not consider expulsion a solution, but a last resort. CHASI, for example, has a no-expulsion policy, but it can be upheld only to the extent allowed by Illinois law, which states,
Any child who, after attempts have been made to meet the child's individual needs, demonstrates inability to benefit from the type of care offered by the facility, or whose presence is detrimental to the group, shall be discharged from the facility." 4
In fear of losing its license, CHASI did have to expel a child who continued to bite. CHASI was able to legally reinstate him after six months, but the experience was still traumatic for the child.

"Simply expelling the child does not solve the long-term problem," Selman says. "Behavior problems at a young age have ominous implications for years down the road. I can't see the logic in closing the door on any child under the age of 5."

CFASC has created Helping Hands, an intervention that addresses the increasing number of children expelled from child care centers in New London County, Connecticut. With permission from the parents, the child care provider refers the child to the program when the child is facing expulsion due to his or her behavior. A parent educator meets with the parents, observes the child at home and in the classroom, and completes a developmental history on the child. Social workers, child psychologists, and other specialists may be called for observation when necessary. The team, including the parents, then meets and develops a plan. The plan can be as simple as a 15-minute morning nap or as complex as a series of counseling sessions for the family and intervention by a child psychologist.

Helping Hands has a 90% success rate--measured by the child's ability to stay in the program and avoid being expelled. Data gathered for both the Bingham project and Helping Hands have shown the interest of both staff and family are crucial elements in the success of any intervention.

Perhaps the most intense intervention program is CCSF's Therapeutic Preschool in San Francisco's Visitation Valley, a high-crime, low-income neighborhood. The program serves children ages 3 - 5 with serious behavior problems and has a capacity of just 12 students. The preschool employs three full time adults--a master teacher, an assistant teacher, and a mental health consultant.

When a child is referred to the preschool, a consultant goes to his or her current school. Observations of the child in class; meetings with teachers, parents, and others involved with the child; and other research help the consultant determine if the child is a good fit for the preschool; if so, the child is invited to enroll. The child is guaranteed an entire year at the preschool, regardless of behavior.

A unique feature of the program is one hour of clinical supervision per week for the adults working with the children. During the session, the clinician addresses the child's behavior and what that triggers in the adults. Farris Page, Director of Clinical and Child Development for CCSF, believes this is a critical aspect of the program. "One of the biggest difficulties lies with the fact that teachers are not equipped to deal with the behaviors these children present," she says. "These difficult behaviors trigger reactions in the teachers." The counseling helps the teachers understand how those behaviors produce responses in them. Once they are able to recognize their own reactions to challenging behavior, the teachers can learn to shape their responses in ways that help the child.

SSDCS's prevention work also creates an environment where intervention can happen naturally. When a student has a behavioral problem, the agency combats that problem through teaming. The team develops an individualized plan to address the behavior problem, based on what works best for that child. The plan is reevaluated as it is implemented, and the agency's social services director and others review all teaming plans throughout the agency to look for trends and highlight gaps in services.

For instance, a previous review showed that many students' families were in crisis. SSDCS secured a grant that enabled the agency to contract with a local family service clinician. Carrying a caseload of no more than a dozen families at a time, the clinician is able to offer the entire family intense, in-depth, long-term assistance.

Best Evidence

All of the programs discussed have gathered data over the years and shown that prevent and intervention works. The best evidence, however, is always the changes in the children.

Page tells of a 4-year-old boy referred to CCSF's Therapeutic Preschool. "He was a very bright boy," she says, "[but] he was physically aggressive, uncontrollably biting and hitting, and verbally aggressive--a lot of cursing and threatening violence. He came to us with a very foul mouth . . . [and] not having experienced success in any other center."

CCSF staff continued to work with him and began to see a dramatic change within six weeks. Taking into consideration how bright he was, staff began to teach him how to read as they worked with him on his issues with anger.

The time came for him to leave the program and move to kindergarten. He took the entrance exam for a local private school and not only was accepted but awarded a scholarship. He is now in second grade and a straight-A student. Rather than doors being closed on him, they are being opened. Not only are his mother and teachers proud, but now he, too, is aware of his own potential.

Deborah Amend is a freelance writer in Cincinnati, Ohio.
     
  1. Division for Early Childhood. (1999). Concept Paper on the Identification of and Intervention with Challenging Behavior. Available online. Missoula, MT: Division for Early Childhood, Council for Exceptional Children.
  2. Definition obtained from the Center for Evidence-Based Practice: Young Children with Challenging Behavior website.
  3. The child's name has been changed.
  4. Licensing Standards for Day Care Centers 1998, Subpart F, Structure and Safety, Section 407.250, Articles J-K. 22 Ill. Reg., Effective January 1, 1998.

Resources

Many child care centers may not have access to the resources described in this article, but many others are available.

Bingham Early Childhood Prosocial Behavior Program
The curriculum is available in A Blueprint for the Promotion of Pro-Social Behavior in Early Childhood (Vol. 4 in the series Issues in Children's and Families' Lives), edited by Elda Chesebrough, Patricia King, Thomas P. Gullotta, and Martin Bloom (New York: Springer, 2005). Includes articles that supporting the need and the curriculum, as well as teacher training and activities. According to coeditor Patricia King, however, the book does not cover one of the most fundamental components--the coach.
Available Online.

Center for Evidenced Based Practice: Young Children with Challenging Behavior
Funded by the U.S. Department of Education, Office of Special Education Programs, the center promotes the use of evidence-based practice to meet the needs of young children who have or are at risk for problem behavior. Resources include presentations, workshops, training, live chats, and links to other organizations.
Available Online.

Center on Social and Emotional Foundations for Early Learning
CSEFEL's website is rich in resources. Many are available in both English and Spanish and are for use by directors and staff of any child care center. Funded by the Head Start and Child Care Bureaus, U.S. Department of Health and Human Services, CSEFEL is the federal government's response to the growing problem of challenging behavior in preschool students.

In addition to valuable links to other resources and centers, this website has two very useful tools:
  • Training modules can be downloaded free of charge for any center to use. Topics range from building relationships to creating an emotionally healthy environment.

  • Live chats offer an opportunity to engage in discussions with experts in the field of child mental health and development. Archives from past live chats are also available.
Available Online.

Circle of Inclusion Project
The Circle of Inclusion website is also funded by the U.S. Department of Education, Office of Special Education. Among other resources, it offers two useful tools for working with challenging behavior:
  • Downloadable forms can help teachers support children with challenging behavior by documenting the situation and keeping accurate records. Includes a behavior log, behavior intervention program, environmental and curricular checklist, social skills training, and a problem behavior analysis worksheet.

  • An inclusion manual is available, with a chapter that deals with challenging behavior specifically. Topics include supporting children with challenging behavior, intervention strategies, and social and communication strategies, among others.
Available Online.

Division for Early Childhood, Council for Exceptional Children
DEC is one of 17 divisions of the Council for Exceptional Children. DEC is especially for individuals who work with or on behalf of children with special needs, birth through age 8, and their families. DEC promotes policies and practices that support families and enhance children's optimal development. Children with special needs include those who have disabilities or developmental delays, are gifted or talented, or are at risk for developmental problems. The website includes position statements and concept papers on a variety of topics, information on publications, and specific information on addressing challenging behavior.
Available Online.

National Association for the Education of Young Children
NAEYC has additional print resources. Books on topics such as violence, negative media exposure, and teaching children to cope with trauma can give teachers a fresh outlook on a child's behavior. Emotional and social development is another area that can offer insight into why a child behaves the way he or she does.

CFASC's Patricia King also recommends that child care centers be in contact with local public school systems, social service agencies, and child psychologists. Be aware of what services are available before being confronted with a problem.
NAEYC website.

Read More: A Yale University study has found that pre-K students are expelled three times more often than children in grades K - 12. See "Bulletin Board," page 46.


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