HANDLE WITH CARE: STRATEGIES FOR PROMOTING THE MENTAL

HEALTH OF YOUNG CHILDREN

Nancy J. CohenHincks-Dellcrest Centre & University of Toronto

Supporting Children’s Social and Emotional Health:Assessment Tools, Research and Practice

University of British ColumbiaVancouver, May 11, 2006

COLLABORATORS:

Bonnie Pape&

Heidi Kiefer

WHAT IS MENTAL HEALTH PROMOTION?

activities that seek to enhance mental health and take into account the broad psychosocial factors that affect mental health

for young children, activities to develop age-appropriate and culturally relevant life skills

in centre-based care, mental health promotion is associated with good practices that foster children’s social and emotional development, build family and community connections, and create a positive working climate for those in the child care field

more children are entering the childcare system at younger ages and many are exposed to stresses

early disruptions in emotional development can have long-term negative consequences on social and emotional functioning and learning

social and emotional development are important to ensure that when children enter school they are ready to learn

WHY PROMOTING MENTAL HEALTH IN EARLY CHILDHOOD PROGRAMS IS IMPORTANT

Day Care Centre AcknowledgementsBritish ColumbiaCariboo Child Care Centre, KamloopsCollege of New Caledonia Demonstration Day Care Centre, Prince GeorgeGrandview Terrace Child Care Centre, VancouverLangara Child Development Centre, VancouverPlum Blossom, VancouverSimon Fraser University Child Care Society, BurnabyUniversity of British Columbia Child Care Services, VancouverWest Wood Players Ltd., Port Coquitlam

AlbertaChurchill Park Child Development Centre, CalgaryCity West Day Care, EdmontonEdmonton Northwest Child Care Centre, EdmontonFulton Child Care Association, EdmontonJasper Place Child and Family Resource Society, EdmontonLouise Dean Child Care Centre, Northwest CalgaryMarlborough Day Nursery, CalgaryPrimrose Place Family Centre, EdmontonRed Deer Day Care, Red DeerSouthview Child Care, Edmonton

SaskatchewanChildren’s Choice Child Development Centre, Prince AlbertFamilies First Child Care Centre, SaskatoonKidzone Child Care, ReginaMacKenzie Infant Centre, ReginaMeadow Lake and Area Play Corner Centre, Meadow Lake SIAST Children’s Day Care Centre, ReginaSouthwest Day Care Centre, Southwest MoosejawWascana Day Care, ReginaYWCA Child Development Centre, Saskatoon

ManitobaCare-A-Lot Nursery Inc., WinnipegDiscovery Children’s Centre Inc., WinnipegKnox Day Nursery, WinnipegMorrow Avenue Child Care Program for Families, VitalSunnyside Child Care, WinnipegUnivillage Student Day Care, Winnipeg

YukonAshea Day Care, WhitehorseChild Development Centre, WhitehorseCreative Play Day Care, WhitehorseDluwkat Hit Day Care, TeslinNakwaye Ku Child Care Society, WhitehorseTri’inke Zho Day Care, Dawson City

Northwest TerritoriesNorthern Tikes Association, YellowknifeWomen’s and Children’s Healing and Recovery Program/Child Care Centre, Yellowknife

OntarioCardinal Leger Child Care Centre, ScarboroughGuildwood Child Care Centre, ScarboroughN’Sheemaehn Child Care, ScarboroughOwen Community Child Care Centre, North YorkSt. Bede Child Care Centre, ScarboroughSunnybrook Creche, Toronto

QuebecCentre de la Petites Enfants Les Bois Verts, MontrealCPE Dorval, DorvalCPE St. Mary’s, MontrealMcGill Community Child Care Centre, MontrealRoyal Victoria Hospital Child Care Centre, MontrealSaint Andrews Early Childhood Centre, WestmountWest End Day Care, Montreal

New BrunswickChatham Day Care, MiramichiEnergi Centre, Val D’amourGarderie ABC Day Care, MonctonKindertots Children’s Centre, MiramichiSaint John YMCA Child Care Centre, Saint John

Nova ScotiaApple Tree Landing Children’s Centre, CanningBell Road Child Care Centre, HalifaxBoys and Girls Club Child Care Centre, YarmouthChildren’s Place Day Care, AntigonishCobequid Children’s Centre, Lower SackvilleCreative Approach Preschool, HalifaxEast Preston Day Care Centre, East PrestonPlayschool Day Care, New WaterfordPoint Pleasant Child Care Centre, HalifaxSydney Day Care Centre, Sydney Cape BretonTown Day Care, Glace BayWee Care Developmental Centre, Halifax

NewfoundlandCollege of the North Atlantic Children’s Centre, St. John’sCreative Beginnings Child Care Centre, St. John’sDaybreak Parent Child Centre, St. John’sFisher’s Children’s Centre, CornerbrookThe Children’s Centre, St. John’s

Prince Edward IslandCampus Kids Child Care Centre, CharlottetownChild Development Centre, CharlottetownMagic Moments Child Care Centre, TignishMontessori Kindergarten and Nursery School, Pool’s CornerThe Kid’s Place, Summerside

BRITISH COLUMBIA Day Care Centres

Cariboo Child Care Centre, Kamloops

College of New Caledonia Demonstration Day Care Centre, Prince George

Grandview Terrace Child Care Centre, Vancouver

Langara Child Development Centre, Vancouver

Plum Blossom, Vancouver

Simon Fraser University Child Care Society, Burnaby

University of British Columbia Child Care Services, Vancouver

West Wood Players Ltd., Port Coquitlam

AREAS EXPLORED IN INTERVIEWS WITH PRACTITIONERS AND DIRECTORS (1)

building trusting relationships between practitioners and children

supporting individual characteristics and self-esteem

fostering independence and problem solving skills encouraging understanding and expression of

emotions respecting diversity and the rights of others helping children build positive peer relationships helping children deal with changes and transitions

AREAS EXPLORED IN INTERVIEWS WITH PRACTITIONERS AND DIRECTORS (2)

centres’ policies and arrangements of the physical setting underpinning mental health promotion

ways that practitioners: interact with parents support and respect a child’s home

language and culture receive support themselves in the work

environment

Handle with Care Strategies for Promoting the Mental Health of Young Children in Community-Based Child Care

WHY FOCUS ON ATTACHMENT SECURITY?

When children are securely attached they can feel free to explore the world, show curiosity and benefit from learning experiences.

ATTACHMENT

Attachment is a biologically primed behavioral system which operates under threatening conditions and enables infants to seek safety and comfort from distress through proximity to their mothers.

BEHAVIOURS THAT HELP CHILDREN ATTAIN SECURITY

Infants crying clinging/grasping responding to comfort smiling reaching out sharing affect

Toddlers and Preschoolers

crying/tantrums following (crawling,

walking) using language affective sharing smiling initiating interaction exploring from a secure

base

CAREGIVER BEHAVIOURS THAT FACILITATE SECURE ATTACHMENT

rapidly responding to a child who is frightened, ill, or otherwise distressed by physically comforting and talking

building trust in their availability and consistency

providing predictable routines, responses, and traditions

creating a safe environment for children to explore, and gradually become more autonomous

taking an active interest in the children and offering them encouragement that is supportive and reciprocal rather than directive

showing positive feelings to children

ESSENTIALS OF ATTACHMENT

Attachment relationships provide the foundation for social and emotional development

A secure relationship involves children feeling that they are safe and important

Children typically have the strongest attachments to their parents

However, children also form attachments to other important people in their lives

For practitioners, building trust with children usually involves building trust with their families

It takes time for children to develop a secure attachment

Attachments are informed by cultural, family and individual beliefs and preferences

“I give the children time to become comfortable with me. I won’t push myself on them. The first time at the center I don’t hug and snuggle children right away. It’s not appropriate because I am a stranger to them. The second time I put a toy between myself and the child as a way of getting closer, but not too close. Maybe the third time, I will share some physical affection with the child.”

STAGES OF ATTACHMENT

Preattachment Attachment in the making Clear-cut attachment Goal-corrected partnership

SECURE ATTACHMENT PROVIDES A FOUNDATION FOR CHILDREN TO:

regulate their emotions and behaviour

have a sense of inner confidence and efficacy

express curiosity and eagerness to explore

enjoy more pleasure and harmony in relationships

show greater competence in cognitive and language development

Children with special needs develop attachment relationships, but for some this happens later.

Attachment signals may be subtle so it is important to be a good observer.

CHILDREN WITH SPECIAL NEEDS

INDIVIDUAL DIFFERENCES IN ATTACHMENT

Secure

Avoidant

Resistant or ambivalent

Disorganized

Insecurely attached and disorganized children often behave in ways that make them more difficult to care for, which further exacerbates their insecurity.

Insecure and disorganized behaviours occur some of the time in most children. It is when the behaviour becomes a repetitive and persistent pattern that it is of concern.

RESULTS OF STUDIES OF ATTACHMENT OF CHILDREN IN CHILDCARE Childcare alone does not have a negative impact

on attachment security with mothers at any age.

There is not a simple or direct relationship between childcare attendance and children’s attachment security.

When children’s relationships with their mothers are not secure, coupled with enrolment in low quality care for extensive periods or in unstable childcare arrangements, children’s mental health suffers.

Attachment relationships of children to a professional caregiver can be independent of the children’s attachment to parents.

Characteristics of practitioners in relationships with children that promote mental health are the same as those of parents.

Structural features of child care and education and training of practitioners also contribute to attachment security.

Sometimes we are led to believe that if secure attachment relationships are established early that is enough to inoculate children against stress. However, benefits actually come about from persistence of secure attachment and sensitive parent and practitioner care rather than secure attachment specific to the first year.

COMPENSATORY EFFECTS OF CHILDCARE ON MENTAL HEALTH (1)

Depressed mothers who rely on childcare have more positive interactions with their infants than do depressed mothers who do not.

When maternal sensitive responsiveness and affection are low but child care quality if high, children are more likely to be securely attached than when quality of care is low both at home and in child care

Children who had an insecure relationship with their mother, and who attended childcare early, are less withdrawn than were insecure children who remained at home.

COMPENSATORY EFFECTS OF CHILDCARE ON MENTAL HEALTH (2)

Childcare quality had a positive effect on externalizing behaviours for children from less advantaged homes as well as a positive effects on boys’ internalizing problems and sense of effectiveness.

Children in enriched programs have fewer behaviour problems than comparison groups who do not have an enriched experience.

High quality childcare can serve a compensatory function for children who are temperamentally difficult in infancy.

WHAT GETS IN THE WAY

unfortunately, not all centres meet standards for high quality

rate of child care practitioner turnover is high which has an impact on children’s security

many individuals working in childcare settings have minimal training

practitioners must feel secure in order to help children feel the same

practitioner-parent relationships are important but training often does not include how to work with families

SUGGESTIONS FOR HOW TO INVOLVE PARENTS (1)

“We do home visits, ideally before the start of care. Two teachers visit in the evening or on the weekend and stay for an hour. They leave the child with a book/CD from the centre. It creates a different relationship with the child and parents because they are more at ease. We also give parents a questionnaire to fill out about the home visits to get feedback.”

SUGGESTIONS FOR HOW TO INVOLVE PARENTS (2)

“We have pamphlets available for parents to know what kinds of things they might expect to see in their child when starting at the centre. I always acknowledge parents’ feeling about separation from their child and provide materials and support for the child to show feelings through play. I keep a record of the child’s behaviours so I can talk about them with my supervisor and the parents.”

WHEN TO WORRY: Assessment Tool

The best tool that you have at your disposal is careful observation of children and mothers with their children.

Discussion with a parent or co-worker or consultant about your observations.

Parents also should be encouraged to make observations of their children.

WHEN TO WORRY: What to look for (1)

Do you see the child “checking” with the parent or practitioner visually or verbally, or physically, while playing”?

Does the child show a reasonable mix of exploring and checking back?

What does the parent do to stay in touch with the exploring child?

What is the child’s/preschooler’s activity level?

WHEN TO WORRY: What to look for (2)

What evidence do you see that supports the idea that children are intensely interested in learning about their immediate world?

What examples do you see where the children take the initiative?

How do the toddler/preschooler and parent react when the child’s assertion of will runs contrary to the parent’s wishes or intentions?

How do the parent and toddler/preschooler negotiate conflicts over safety?

INTERVIEW WITH PARENT

How is your child different at age 1, or 2 (or 3 or 4 ) compared with a year ago?

How has your relationship changed during the past year (months)?

What do you recall about your child during the 3-4 months immediately after learning to walk? To talk? Has this changed your relationship?

Do you find it easier or harder (or perhaps some of each) to parent a toddler compared to an infant?

WHAT TO LOOK FOR: POSITIVES

pleasure

empathy, support

accurate interpretations of the child’s behaviour or signals

respect of child’s moods

can parent see things from their child’s perspective?

WHAT TO LOOK FOR: NEGATIVES (1)

intrusive, directive, or rough with child lack of empathy and support distortions in interpretations of the child’s

behaviour consistently nonresponsive minimizes or distorts the child’s feelings or

mood gives contradictory messages to child asks child for reassurance or attention sexualized behaviours in tone of voice or

actions

WHAT TO LOOK FOR: NEGATIVE (2)

disorientation; using unusual voices that suggest fear and tension

spacing out pulling child or otherwise invading the

child’s personal space mocking the child or hushing a crying child using an angry voice or being critical teasing the child or removing or withholding

a toy withdrawal

QUESTIONS FOR REFLECTION AND DISCUSSION

What did you see happening?

What do you imagine it feels like for the child? For the adult?

What did you see that makes you think this?

If you were the child what might you

want adults to do?

What strong feelings did it stir in you?

How do you manage these feelings?

Does it help to discuss these feelings with someone else?

QUESTIONS FOR REFLECTION AND DISCUSSION

SUGGESTIONS FOR HOW TO INVOLVE PARENTS

“When parents use harsh discipline methods such as yelling at home, it makes children more stressed when they know they’ve done something wrong at the centre. For example, one child dropped some paint and started crying immediately, expecting to be yelled at. I’m meeting with the parents over time and handling it carefully.”

“I work with parents and deal with their anxieties and concerns about what goes on in the classroom. It has an effect on the children and reflects in their behaviour (e.g., more assertive, better able to express their needs).”

Note

It is important to remember that these patterns need to be seen frequently and not just occasionally. Mothers need not be perfect but good enough.

RESOURCES THAT CAN BE USED TO FURTHER FOSTER ATTACHMENT SECURITY?

A Simple Gift – Infant Mental Health Promotion Project

Canadian Child Care Federation tip sheets

Zero-toThree resources Watch, Wait, and Wonder play – follow

the child’s lead