HANDLE WITH CARE: STRATEGIES FOR PROMOTING THE MENTAL HEALTH OF YOUNG CHILDREN

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HANDLE WITH CARE STRATEGIES FOR PROMOTING THE
MENTAL HEALTH OF YOUNG CHILDREN

• Nancy J. Cohen
• Hincks-Dellcrest Centre University of Toronto
• Supporting Childrens Social and Emotional
  Health
• Assessment Tools, Research and Practice
• University of British Columbia
• Vancouver, May 11, 2006

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COLLABORATORSBonnie PapeHeidi Kiefer
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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
  childrens social and emotional development,
  build family and community connections, and
  create a positive working climate for those in
  the child care field

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WHY PROMOTING MENTAL HEALTH IN EARLY CHILDHOOD
PROGRAMS IS IMPORTANT

• 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

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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

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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

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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 childs home language and
  culture
• receive support themselves in the work environment

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

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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.

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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

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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

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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

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• I give the children time to become comfortable
  with me. I wont push myself on them. The first
  time at the center I dont hug and snuggle
  children right away. Its 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.

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STAGES OF ATTACHMENT

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

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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

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CHILDREN WITH SPECIAL NEEDS
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.
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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.

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• 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.

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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 childrens
  attachment security.
• When childrens relationships with their mothers
  are not secure, coupled with enrolment in low
  quality care for extensive periods or in unstable
  childcare arrangements, childrens mental health
  suffers.

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• Attachment relationships of children to a
  professional caregiver can be independent of
  the childrens 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.

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• 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.

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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.

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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.

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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 childrens 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

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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.

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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 childs behaviours
  so I can talk about them with my supervisor and
  the parents.

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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.

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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 childs/preschoolers activity level?
  

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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 childs assertion of will runs contrary
  to the parents wishes or intentions?
• How do the parent and toddler/preschooler
  negotiate conflicts over safety?

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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?

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WHAT TO LOOK FOR POSITIVES

• pleasure
• empathy, support
• accurate interpretations of the childs behaviour
  or signals
• respect of childs moods
• can parent see things from their childs
  perspective?

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WHAT TO LOOK FOR NEGATIVES (1)

• intrusive, directive, or rough with child
• lack of empathy and support
• distortions in interpretations of the childs
  behaviour
• consistently nonresponsive
• minimizes or distorts the childs feelings or
  mood
• gives contradictory messages to child
• asks child for reassurance or attention
• sexualized behaviours in tone of voice or actions

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WHAT TO LOOK FOR NEGATIVE (2)

• disorientation using unusual voices that suggest
  fear and tension
• spacing out
• pulling child or otherwise invading the childs
  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

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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?

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QUESTIONS FOR REFLECTION AND DISCUSSION

• 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?

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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 theyve done something
  wrong at the centre. For example, one child
  dropped some paint and started crying
  immediately, expecting to be yelled at. Im
  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).

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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.

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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 childs
  lead