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

1. HANDLE WITH CARE:STRATEGIES FOR PROMOTING THE MENTAL HEALTH OF YOUNG CHILDREN Nancy J. Cohen Hincks-Dellcrest Centre & University of Toronto Supporting Children’s Social and Emotional Health: Assessment Tools, Research and Practice University of British Columbia Vancouver, May 11, 2006

2. COLLABORATORS:Bonnie Pape&Heidi Kiefer

3. 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

4. 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

6. BRITISH COLUMBIADay 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

7. 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

8. 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

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

10. 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.

11. 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.

12. 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 BEHAVIOURS THAT HELP CHILDREN ATTAIN SECURITY

13. 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

14. 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

15. “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.”

16. STAGES OF ATTACHMENT • Preattachment • Attachment in the making • Clear-cut attachment • Goal-corrected partnership

17. 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

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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 WHAT GETS IN THE WAY

27. 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.”

28. 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.”

29. 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.

30. 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?

31. 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?

32. 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? INTERVIEW WITH PARENT

33. 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?

34. 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

35. 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

36. 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?

37. 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?

38. 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).”

39. 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.

40. 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