HAMILTON, Ohio — Suzanne Prescott first noticed the changes in children’s behaviors in 2015.
She was fielding reports of kids knocking over bookshelves, tables and chairs; hitting their classmates; and causing physical harm to themselves and their teachers. Not only were more 3-, 4- and 5-year-olds having outbursts, they were doing so with an intensity Prescott had never before seen. In some cases, staff had to evacuate entire classrooms to ensure the safety of the other children in their care.
Prescott oversees 18 Head Start preschool programs across two Ohio counties sandwiched between Dayton and Cincinnati. She recalls that when she got the job in 2011 as director of early childhood programs for the Butler County Educational Service Center, which encompasses Butler and Preble counties, “It was usually a couple of classrooms that we’d be like, ‘Whoa, this is really chaotic.’ I would get that call maybe two or three times a year.”
But in recent years, as the opioid crisis has transformed homes and communities across Ohio—overdose death rates in the state are up 300 percent since 2009—those calls have skyrocketed in number. Prescott says that every year for the last few years, she’s seen an average of two, sometimes three, children with significant behavioral challenges in each of the 40 Head Start classrooms under her purview.
She attributes this shift to the onslaught of the opioid epidemic, adding that “we saw behaviors in every single classroom we had.”
These challenges hit her staff hard. But fortunately, they had a playbook to pull from. A few miles down the road is the therapeutic interagency preschool (TIP), a 30-year-old program designed for children who have experienced severe trauma and face significant behavioral and developmental challenges as a result.
Read the EdSurge feature story about Butler County’s TIP program
Through a targeted combination of one-on-one mental health counseling, low teacher-to-child ratios, regular home visits and a social-emotional learning curriculum, the TIP program serves children who have been abused, neglected or otherwise mistreated. Evidence suggests it works: children’s trauma symptoms, including anxiety, depression and post-traumatic stress disorder, are on average reduced by 30 to 50 percent over one school year.
While TIP has proven effective, it is a small program, available to only 36 children at a given time who have been referred through the local child welfare agency. But demand for its services are growing, as teachers in traditional Head Start programs report an uptick in the number of children with trauma symptoms.
Growing Evidence of Trauma
When the behavioral issues started to increase in traditional Head Start classrooms, Prescott and her staff saw an opportunity to borrow elements from the TIP program and adapt them for all students. To support that effort, Prescott brought on Cara Brown, a licensed independent social worker, in July 2017.
One of the approaches Brown adapted from TIP and implemented at all Head Start programs is a screening for every child referred, to gauge the extent of trauma they experienced in the past. The 10-question assessment is based on the Adverse Childhood Experiences (ACEs) framework, which is derived from a landmark study conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente about the impact of childhood hardship and dysfunction on their quality of life.
The screening yields an ACEs score ranging from 0 to 10, which quantifies the different kinds of severe trauma that a child may have accumulated over time, including physical, emotional and sexual abuse; neglect; and familial death, mental illness and substance abuse. According to the CDC, more than one-third of Americans have never had an adverse childhood experience, 26 percent have had one and about 12 percent have had four or more.
By contrast, across the 40 traditional Head Start classrooms she serves, Brown found this year that children had experienced an average of seven to eight ACEs. That’s just as high as their peers at TIP—and higher than all but a very small subset of children across the country.
But unlike TIP, the traditional Head Start programs did not historically offer the full range of services to help children address and overcome their traumatic experiences.
That is changing. Prescott is bringing on a second mental health worker to share Brown’s caseload. With their help, the Head Start teachers now have trained professionals to turn to for guidance—and the children get specialized support to address their unique histories and behavioral needs.
Folding in New Services
In addition to expanding the team of mental health professionals, Prescott has also scaled Conscious Discipline, an approach that’s helping teachers support children’s social-emotional skills. Conscious Discipline isn’t new to Head Start staff—they have been using it in some form for over a decade. But in 2017, Head Start programs in Butler County ramped up their commitment by providing a full-day training to all new staff during orientation, and by adding regular classroom observations that assess what remaining support teachers and students need.
The Conscious Discipline strategies are used school-wide and help all children by establishing a supportive classroom culture. This complements another element of the TIP program that Prescott adopted: the Devereux Early Childhood Assessment (DECA), which staff use to evaluate kids’ social-emotional competencies and offer targeted strategies depending on each child’s areas for growth.
For example, when a teacher notices a child experiencing outbursts, Brown may suggest some adjustments based on her observation about something that may be setting off the child, such as an abrupt transition between activities. If, after making that change, the teacher determines that the child needs additional support, Brown will return for a second observation. After that, Brown will meet with the teacher and the child’s family to develop a behavior plan, through which they will implement interventions based on Conscious Discipline and DECA.
Brown checks in with these children every other week, then monthly if she sees the child is progressing. Last year, she served more than 80 kids in Head Start.
Reflecting on how the TIP program’s successes were woven into traditional Head Start classrooms, Prescott explains: “We had something that worked, and we were able to take pieces from that and sprinkle it into classrooms. … It was a beautiful thing to have the TIP program.”
Serving Adults, Too
In addition to supporting the children, Brown has also helped the adults—more specifically, by keeping them in the Head Start program.
As tantrums and outbursts increased, many Head Start teachers became overwhelmed and, at times, were unable to manage their classrooms. As a result, lead teachers started leaving in droves, Prescott says. Some years, they lost as much as 25 percent of the staff.
By hiring Brown, Prescott gave teachers someone to turn to when they had a child who needed intervention, and that helped reduce turnover.
“We did a survey with our teaching staff who had the services from Cara [Brown], and they all say Cara helps with retention here: ‘She helps us want to stay here and be here,’” recalls Prescott. “So that’s huge, because you can teach Conscious Discipline and start working with people but if you continuously lose them, it's really hard.”
In the two school years since Brown has been on board, Prescott says, only one or two Head Start lead teachers have left each year.
Scaling Beyond Butler County
What’s happening in Butler County is not so different from the trauma and subsequent behaviors that early childhood educators across the country are observing.
The National Head Start Association (NHSA), a nonprofit advocacy organization for the federal Head Start program, has been hearing from educators for several years—especially those in areas with higher rates of substance abuse—that more of their students are exhibiting challenging behaviors, explains Cody Kornack, the NHSA’s opioid campaign manager.
As a result, the NHSA has fought for additional federal funding that can help Head Start programs launch or expand counseling services, train staff in trauma-informed care, ramp up home visits and reduce class sizes.
“What we know is that trauma has the potential to have a really lasting, detrimental effect on a child’s ability to reach their full potential,” Kornack explains. “What we also know is that early intervention can turn that ship around, that you can do things, like build protective factors, to be able to ensure that that child is able to succeed despite trauma or adverse childhood experiences that happen early in life.”
The nonprofit’s efforts were successful in December, when Congress appropriated $250 million for fiscal year 2020 to Head Start programs to provide trauma-informed care, especially in communities with high ACEs scores and high rates of substance abuse.
The Office of Head Start is responsible for distributing the $250 million to existing Head Start programs across the country and will do so based on the number of children each serves. The exact funding each program will receive is still unclear, but in the 2018-19 school year, Head Start funded about 815,000 total classroom seats, according to a spokesperson at the NHSA.
In Butler County, Prescott plans to use the additional funds to pay the salary of a second mental health consultant—the one who will share Brown’s caseload.
Prescott was part of the effort to secure that funding, Kornack says. The two met in September 2019 when Prescott was in Washington, D.C, to speak in front of a House Working Group about the challenges she’s seeing and the work she’s doing in Ohio. Kornack, who was familiar with TIP and what Prescott has done to improve traditional Head Start programs in Butler County, describes Prescott as a leader and champion of the services that many programs across the country are desperate for.
“The professional development that she’s providing across her program … [is] incredibly important to being able to regulate what’s happening across a day, to be able to make that teacher feel supported and feel successful in their day-to-day work,” Kornack says. “And that’s incredibly important when we’re thinking about how to retain teachers, and not only how to retain staff at all, but also retain quality staff.”