Head Start Head Start Bulletin Bulletin a a

HeadSt ar

ISSUE 80 

2009

ENHANCING HEAD START COMMUNICATION 

http://www.acf.hhs.gov 

t 

Bulletin 

Mental 

Health 
The Head Start Bulletin is published by the Office of Head Start, Administration for 

Children and Families, U.S. Department of Health and Human Services. 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Charles E. Johnson, Acting Secretary 

ADMINISTRATION FOR CHILDREN AND FAMILIES 

Curtis L. Coy, Acting Assistant Secretary 

OFFICE OF HEAD START 

Patricia E. Brown, Acting Director 

The Bulletin is a service of the Office of Head Start. Its purpose is to enhance 

communication among the Office of Head Start, Head Start programs, and 

interested national, regional, and state organizations and agencies. 

OFFICE OF HEAD START 

Ann Linehan, Director, Quality Assurance Division 

HEAD START BULLETIN 

The Head Start Bulletin is prepared by the Head Start Resource Center under 

Contract No. HHSP 233-2007-00300G. 

Head Start Bulletin 

Mental Health 

Issue No. 80 

The Head Start Bulletin is available online at the Early Childhood Learning and Knowledge 

Center (ECLKC) at http://eclkc.ohs.acf.hhs.gov/ 

Cover photo by H. Wilson. Community Services for Children HS. 

Page 2 photos by J. Brough Schamp. Top L—RCMA Immokalee Community MHS CDC, Top R—Rosemount Center 

HS/EHS, Bottom R—South East Community Organization HS, Bottom L—Child Care Associates 

®

Office of Head Start 

Administration for Children and Families 

U.S. Department of Health and Human Services 
HeadStart 

Bulletin 

2009 Issue No. 80 

page 12: Mental health 

is key to school success. 

page 33: Resilience helps 

children respond to adversity. 

page 86: Staff listen to children. 

INTRODUCTION 

3 Welcome to the Mental Health Bulletin 

5 Mental Health in Head Start 

APPROACHES TO SERVICES 

9 A Collaborative Approach to Mental Health 

11 The Center on the Social and Emotional 

Foundations for Early Learning (CSEFEL) 

12 The Role of Mental Health Consultants 

14 Working With Mental Health Professionals 

CHILD MENTAL HEALTH 

17 Unpacking the Meaning of Infant and Toddler Behavior 

20 Understanding Attachment

23 Signs of a Young Child’s Trust in Your Caregiving 

24 Risk Factors for Emotional and Behavioral Problems 

26 Prevalence Data on Mental Health Problems 

27 The Power and Value of Play 

30 Trauma in the Lives of EHS Children 

33 Three Sources of Resilience 

37 Post-Traumatic Stress Disorder in Children 

38 Helping Preschoolers Develop Self-Concept 

and Self-Control 

40 Social & Emotional Development: The Child 

Outcomes Framework 

41 National Mentoring Children of Prisoners Program 

43 Should I Be Worried? Supporting Language 

Acquisition 

PARENTS AND FAMILY 

46 Using Storytelling to Support Mental Health 

48 Maternal Depression in EHS and Head Start 

51 A Profile of Parental and Caregiver Mental Health 

53 Family Connections: Intervention for Parental 

Depression 

56 Will They Think I’m Crazy? 

57 Depressive Symptoms in Latina Mothers 

60 Shared Caregiving and Its Implications 

62 A Teen Parent’s Story of Resilience 

63 Fathers for Life 

66 Grandparents: Making a Difference 

LIFE-CHANGING EVENTS
 

68 What Is Trauma? 

68 Bouncing Back from Katrina 

69 Understanding Loss and Grief 

70 Trauma and Domestic Violence 

72 Supporting Children and Families in the Child 

Welfare System 

74 My Life in Foster Care 

76 Supporting the Mental Health of Homeless Children 

78 A Historical Look: Serving Homeless Children 

and Families in Head Start 

79 Learning to Live in the U.S. 

PROGRAM APPROACHES 

81 The Early Promotion and Intervention Research 

Consortium 

82 Free To Grow: Partnerships to Strengthen Families 

82 Unlikely Partners in Rural America 

84 Tackling Violence in Maui 

85 Videotaping Builds Parent-Child Relationships 

86 A Change of Focus with Positive Behavior Support 

89 Promoting Positive Behavior in MSHS 

90 Early Intervention at Oneida Head Start 

STAFF WELL-BEING 

91 Nurturing the Nurturer 

94 Creating a Supportive Work Environment 

95 Being an Effective Mentor-Coach 

97 Employee Assistance Programs 

RESOURCES 

35 PULL-OUT: Promoting Resilience in Young Children 

36 Documento desprendible: Promoviendo la Resilencia 

en Niños Pequeños 

98 Webliography 

Head Start Bulletin 1 
Mental Health 
Welcome to the 


Mental Health Bulletin
 

PROMOTING MENTAL HEALTH is a vital 

component of the work we do every day to 

enrich the lives of the children and families 

in Head Start. That is why we are devoting 

this issue of the Head Start Bulletin to mental health. 

We know that to prepare children for school, we must 

support their social and emotional well-being. We also 

know that children’s caregivers at home and in Head 

Start benefit from resources that can support their 

own mental health, and in turn, help them support 

the children in their care. 

We also recognize that risk factors affecting social 

and emotional well-being are present in the lives of 

many Head Start children and families. One common 

thread among the Head Start population is poverty. In 

a report on mental health, the Surgeon General cites 

“multigenerational poverty” as a factor that puts children at greater risk for mental health problems (U.S. 

Department of Health & Human Services 1999). Our 

programs, often in conjunction with community partners, can help reduce the impact of such risk factors. 

We understand too, that a healthy body and mind 

are connected. In 2005, the Administration for 

Children and Families (ACF) Region III Office initiated a pilot project, I Am Moving, I Am Learning, to 

prevent and reverse the negative consequences of obesity. This successful project is being disseminated to 

grantees nation-wide. Knowing what we know about 

the challenges faced by the children and families we 

serve, it is important that we recognize the creative 

approaches that Head Start takes to promote mental 

well-being and learning. 

We acknowledge that mental health also has been 

a priority for former President George W. Bush, who 

established the President’s New Freedom Commission 

on Mental Health. The Commission’s full report (2003) 

recommended “a 

national focus on the 

mental health needs of 

young children and 

their families that 

includes screening, 

assessment, early 

intervention, treatment, training, and Patricia E. Brown 

Photo courtesy of HSRC Image Library. 

financing services. A coordinated, national approach to 

these issues will help eliminate social and emotional 

barriers to learning and will promote success in school 

and in other community settings for young children.” 

What is in the Mental Health Bulletin? 

Given the longstanding commitment that Head 

Start has shown to promoting mental health, it is 

timely to issue this Mental Health Bulletin. Its themes 

are fostering the mental health of children, families, 

and staff; prevention of onset; reduction of risk; early 

intervention; effective service delivery; and perhaps 

most important, strengthening resilience. The Bulletin 

is divided into these sections: 

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Approaches to Services, including current
 

research
 

Child Mental Health, including resilience and 

social and emotional development 

Parents and Family, including maternal depression and its impact on families 

Life-Changing Events, including refugee resettlement and homelessness 

Program Approaches, including examples of 

promising practices across the country 

Staff Well-being, including teacher mentoring 

Resources, both online and in print 

While some articles focus exclusively on Early 

online...For more information on Head Start, visit our site at http://www.acf.hhs.gov/programs/ohs 

Head Start Bulletin 3 
Introduction 

WELCOME TO THE MENTAL HEALTH BULLETIN 

Head Start and others focus on preschool Head Start, it is 

important to remember that much of the information is 

applicable to both programs. Many articles are researchbased. Some reflect research conducted in Head Start; some 

interventions described here include evaluation of their 

impact on Head Start children and families and their community. Many voices are represented—program managers, 

mental health specialists, professionals who work closely 

with special populations, and academicians and researchers. 

We also hear the voices of Head Start children and families, 

speaking of their struggles and their unyielding capacity to 

triumph over adversity. Throughout this Bulletin, you will 

also find examples of program models and success stories of 

programs and parents that demonstrate the resilience of the 

Head Start community and offer insight on how other programs can learn from their successes. 

Because there is simply so much we can say about mental health in the context of Head Start, we are continuing 

this discussion online. You will see at the bottom of some 

articles, such as the first one, “Mental Health in Head 

Start,” a link to the Early Childhood Learning and 

Knowledge Center (ECLKC) Web site 

http://www.eclkc.ohs.acf.hhs.gov/ where supplemental information can be found. We encourage you to check out this 

resource to learn more. 

Also on the ECLKC, you will find a 2002 edition of the 

Bulletin dedicated to Child Mental Health. This 2009 edition of the Bulletin on Mental Health builds on the information provided in the earlier edition. 

One final note... on December 12, 2007, former 

President George W. Bush signed into law, The Improving 

Head Start for School Readiness Act of 2007 (P.L. 110-134). 

The law upholds Head Start’s longstanding commitment to 

the social and emotional well-being of our children, our 

families, and our staff. The Office of Head Start (OHS) will 

be issuing regulations to reflect the new law and to inform 

programs of policy changes. Currently, the Head Start 

Program Performance Standards, first published in 1972, 

remain in effect. They list more than 40 standards related to 

promoting and supporting mental health, and they are referenced throughout this Bulletin. As OHS continues to 

respond to the new law, it will be important for programs to 

consider any implications for their mental health services. 

In support of the many varied efforts to support mental 

health in Head Start, I am proud to present this Mental 

Health Bulletin. I hope that you find this Bulletin as valuable a resource as we intend it to be. ■ 

REFERENCES 

New Freedom Commission on Mental Health. 2003. 

Achieving the promise: Transforming mental health care 

in America. Final report. Rockville, MD: U.S. 

Department of Health and Human Services. Available at 

www.mentalhealthcommission.gov/reports/reports.htm 

Region III Administration for Children and Families with 

Caliber, an ICF International Company. I am moving, I 

am learning: A proactive approach for addressing childhood obesity in Head Start children. Summary report: 

The first two years. Available at 

www.acf.hhs.gov/programs/region3/docs/Fatherhood/i_a 

m_moving_summary_report.pdf 

U.S. Department of Health and Human Services. 1999. 

Mental health: A report of the Surgeon General. 

Rockville, MD: U.S. Department of Health and Human 

Services. Substance Abuse and Mental Health Services 

Administration, Center for Mental Health Services, 

National Institutes of Health, National Institute of 

Mental Health. Available at 

www.surgeongeneral.gov/library/mentalhealth/home.html 

Patricia E. Brown is the Acting Director of the Office of 

Head Start. 

4 2009 
Introduction 

MENTAL HEALTH IN HEAD START
 

For over 40 years, Head Start has been committed to 

promoting the mental health of children, families, and staff. 

by Amy Hunter and Jim O’Brien 

A home visitor is sitting on the floor with a 9-monthold baby who is crawling toward his mother. The baby 

smiles and babbles. The home visitor encourages the mother 

to speak back to him, “Look how he’s telling you, ‘I’m coming. I see the rattle in your hand.’ See how he talks faster 

and louder as he gets closer. He’s so excited.” The mother 

holds out the rattle to the baby and says, “Here is your 

favorite rattle. You are such a fast crawler!” The home visitor affirms, “Yes, that’s just what he wanted. He wants to be 

close to you.” 

In this scene, the home visitor is helping the mother 

tune into the baby’s cues—what he wants and how he 

feels. She encourages the mother to talk with her baby and 

express love and pride. These everyday interactions help 

build secure attachments between young children and 

adults and lay the foundation for early learning. 

A teacher sits on the floor with the children and as he 

reads a story to them, he smiles and makes eye contact with 

each child. Along the way, he asks the group how they think 

the character feels, drawing their attention to facial expressions. He asks them how they would feel in a similar situation and if it has ever happened to them. After the story, the 

teacher encourages the children to draw a picture of a time 

when they felt happy or sad, angry or surprised. 

This is an example of how interactions between staff 

and children promote children’s mental health. The teacher 

is friendly, sensitive, and engaging. He encourages the children to talk about their feelings. He provides a learning 

activity that further helps them articulate their inner emotional life. He offers a safe and supportive environment in 

which the children can learn about themselves and others. 

Taken together, these are some of the ingredients that help 

promote mental health in early childhood. 

What is Mental Health? 

According to the U.S. Surgeon General (U.S. Department 

of Health and Human Services 1999), mental health: 

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is a state of successful performance of mental function; 

results in productive activities, fulfilling relationships 

with other people, and the ability to adapt to change 

and to cope with adversity; and 

is indispensable to personal well-being, family and
 

interpersonal relationships, and contributions to
 

community and society.
 

Promoting Mental Health in Early Childhood 

The following description of early childhood mental 

health reflects the connection between young children and 

parents and caregivers who nurture, stimulate, and care for 

them. Serving the mental health needs of young children 

includes working to promote health and well-being in parMental health in early childhood (birth to five) 

has been described this way by the Infant and 

Toddler Services Summit Mental Health 

Subcommittee (2004) in Massachusetts 

(adapted from ZERO TO THREE): 

Early childhood mental health is the developing 

capacity of children birth through age five to: 

experience, regulate, and express emotion; form 

close, secure, interpersonal relationships; and 

explore the environment and learn—all in the 

cultural context of family and community. 

Early childhood mental health is synonymous 

with general health and well-being and healthy 

social, emotional, and behavioral development. 

It is affected by a child’s biological 

predisposition, the child’s environment, 

including access to adequate food, clothing, 

and safe shelter, and the continuity of 

nurturing relationships. 

Head Start Bulletin 5 
MENTAL HEALTH IN HEAD START 

Introduction Photo by J. Brough Schamp. RCMA Immokalee Community MHS CDC. 

ents and other caregivers. Promoting and protecting children’s mental health is part of a comprehensive approach 

to supporting healthy child development. 

Promoting mental health is much broader than treating mental illness. As described in the Report of the 

Surgeon General (1999), an individual’s mental health, like 

physical health, may vary throughout the life span and 

may even vary within a given day. Over the course of a 

lifetime, personal characteristics, such as temperament, 

medical history, personality, cognitive skills, interpersonal 

skills, and life circumstances, including relationships with 

family and friends, losses and traumatic events, may affect 

one’s mental health. 

School Readiness 

Children’s mental health affects their capacity to explore 

their environment and learn. It is critical to school readiness. 

Research on early brain development, child development, 

and clinical practice has confirmed what the founders and 

providers of Head Start have known for years: promoting 

mental health of young children is key to healthy development and later school success (Knitzer 2000). 

Furthermore, mental health is closely tied to physical 

health. The Head Start mission of supporting the “whole 

child” includes the recognition of the mind-body connection. I Am Moving, I Am Learning, a national initiative 

supported by OHS, reinforces that physical activity and 

nutritious eating foster healthy early childhood development and learning. 

The Head Start Child Outcomes Framework includes 

positive outcomes in the Social & Emotional Domain that 

encompass self-concept, self-control, cooperation, social 

relationships, and knowledge of families and communities. 

Growth in these areas is integral to a child’s readiness for 

school. A child who can perform tasks independently and 

with confidence, and who is cooperative and friendly, is 

better prepared to learn in Head Start and later, in elementary school. 

Children’s mental 

health is critical to 

school readiness 

Head Start Program Performance Standards 

Promoting mental health for children, families, and staff 

has been an integral part of the Head Start program since its 

inception in 1965. Mental health in Head Start includes a 

broad spectrum of services to children and families—from 

promotion and prevention to early identification and treatment. Staff also benefit from mental health activities geared 

to promoting staff mental health awareness and education. 

In the Head Start Program Performance Standards 

(1998), more than 40 Standards address the mental health 

of children, families, and staff. The Standards are woven 

into various service components, but many are concentrated under Child Mental Health 45 C.F.R. Part 1304.24. 

They support a comprehensive approach to promoting children’s social and emotional development. For instance, 

programs are required to: 

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build trust, foster independence, and encourage children’s self-control; 

support and respect the home language, culture, and 

family composition of each child in ways that support the child’s well-being; and 

6 2009 
Introduction 

� encourage the development of self-awareness and 

autonomy and provide daily opportunities for each 

child to interact with others and to express him 

or herself. 

The Program Performance Standards recognize that 

parents are their children’s most important teachers, and 

therefore involve parents in classroom and service decisions. Programs are required to: 

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implement a curriculum for infants, toddlers, and 

preschoolers in collaboration with parents that supports each child’s individual pattern of development 

and learning; 

solicit information and concerns from parents about 

their children’s mental health and establish a system 

of ongoing communication about children with identified mental health needs; and 

involve parents in planning and implementing any 

mental health interventions for their children. 

Parents and staff are best equipped to help address a 

child’s mental health needs when their own mental health 

needs are met. Consequently, the Program Performance 

Standards require programs to: 

� provide mental health education for program staff, 

parents, and families that include individual opportunities for parents to discuss mental health issues 

related to their child and family; 

� facilitate opportunities for parents to participate in 

counseling programs or receive information on issues 

that put families at risk, including substance abuse, 

child abuse, and domestic violence; and 

� support pregnant women with mental health interventions and follow-up, including substance abuse 

prevention and treatment services and postpartum 

recovery (including depression). 

Children’s and families’ mental health needs are best 

addressed when they are identified early on. The Program 

Performance Standards require programs to: 

� ensure that each child receives an appropriate and 

timely screening to identify behavioral, social, and 

emotional concerns and to obtain or arrange for further diagnostic testing or treatment if necessary; 

� implement ongoing procedures to identify any new 

or recurring medical, dental, or developmental concerns (including changes in emotional and behavioral 

patterns); and 

� design and implement program practices responsive 

to the identified behavioral and mental health concerns of an individual child or group of children. 

Other Program Performance Standards are related to 

program planning and management. For example, staff or 

consultants who deliver mental health services must be 

licensed or certified mental health professionals with expertise in serving young children and their families. Other program requirements are to: 

� ensure that services of a mental health professional 

are sufficient to provide timely and effective identification and intervention in family and staff concerns; 

� utilize other community health resources as needed; and 

� make mental health and wellness information 

available to staff with concerns that may affect their 

job performance. 

Early childhood mental health is synonymous 

with general health and well-being. It impacts 

children’s learning and school readiness. 

Head Start’s commitment to ensure that programs provide mental health services is also reflected in the FY 2009 

Office of Head Start Monitoring Protocol. The Mental 

Head Start Bulletin 7 
Introduction 

MENTAL HEALTH IN HEAD START 

Health Services section of the protocol that determines 

whether grantees meet the requirements is divided into 

three subsections: Section 1—Human Resources; Section 

2—Implementation of Mental Health Services; and Section 

3—Ongoing Monitoring. 

Conclusion 

For more than 40 years, Head Start has embraced and 

promoted mental health and wellness. The Head Start 

Program Performance Standards underline the importance 

of assessing, supporting, and facilitating the treatment of 

mental health needs of children, families, and staff. The 

Child Outcomes Framework provides social and emotional 

goals that relate to learning and school readiness. New regulations based on the Improving Head Start for School 

Readiness Act of 2007 will continue to emphasize the 

importance of promoting mental health and providing services. In recognizing the everyday opportunities to promote 

mental health, Head Start staff can make a difference in 

the lives of children, families, and staff facing some of life’s 

toughest challenges. When programs do all of this consistently—and consistently well—they can help ensure children’s future success in school, community, and life. ■ 

REFERENCES 

Commonwealth of Massachusetts. 2004. Massachusetts 

infant and toddler services summit mental health subcommittee. Boston, MA: Commonwealth of 

Massachusetts. Department of Health and Human 

Services. Head Start-State Collaboration Project. 

Knitzer, J. 2000. Using mental health strategies to move the 

early childhood agenda and promote school readiness. 

New York, NY: Carnegie Corporation of New York, 

and National Center for Children in Poverty, Columbia 

University. 

National Center for Children in Poverty (NCCP). n.d. Quick 

facts. Retrieved on August 3, 2007 from 

http://www.nccp.org/topics/mentalhealth.html 

U.S. Department of Health and Human Services. 1999. 

Mental health: A report of the Surgeon General. 

Rockville, MD: U.S. Department of Health and Human 

Services. Substance Abuse and Mental Health Services 

Administration, Center for Mental Health Services, 

National Institutes of Health, National Institute of 

Mental Health. Available at 

www.surgeongeneral.gov/library/mentalhealth/home.html 

Visit the Early Childhood Learning and Knowledge 

Center Web site at http://eclkc.ohs.acf.hhs.gov/ in 

order to view a Pyramid of Mental Health Strategies, 

which depicts Head Start’s work to support and 

increase protective factors and decrease risk factors. 

The pyramid spans the range of support from the promotion of mental health services for all children, families, and staff to intervention with the most vulnerable 

children and families. 

Amy Hunter is an Early Childhood Mental Health Specialist 

at the Early Head Start National Resource Center in 

Washington, D.C., and is a former Head Start Fellow. 

T: 202-857-2679. E: ahunter@zerotothree.org 

Jim O’Brien is a Disabilities Services Specialist in the Office 

of Head Start’s Educational Development and Partnerships 

Division. T: 202-205-8646; E: jim.obrien@acf.hhs.gov 

8 2009 
Approaches to Services 

A COLLABORATIVE APPROACH TO MENTAL HEALTH
 

A mental health caregiving team can include anyone who 

touches the life of a child. by Amy Hunter 

Introduction 

Head Start has emphasized the importance of a comprehensive team approach to services for young children and 

families since its inception in 1965. In the following story, 

Amy Hunter, a licensed clinical social worker, shares her 

experience of learning first-hand the benefits of using a team 

approach to mental health in Head Start. We hear how her 

views evolved from thinking she needed to have all the 

answers herself, to valuing the expertise and knowledge of 

each team member. Ultimately, she learned the benefit of 

using a team approach as well as strategies for developing a 

team approach in order to meet the mental health needs of 

children and families in Head Start. 

The Challenge 

During one of my first weeks as a Behavior Specialist 

(mental health professional) in a medium-sized Head Start program, a 4-year-old child, I'll call Jess, shouted a string of profanities at me. As he was yelling, he hurled his shoes and socks 

in my direction. After the words and the socks and the shoes, 

came spit. Luckily, he missed my face by a bit. Jess was on top 

of an outdoor play structure, and I was at the bottom, trying to 

coax him down. It had been five minutes, but felt like an hour. 

The Expectations 

Although there were other children and teachers on the 

playground at the time, I felt compelled to be in control of the 

situation myself. I thought that because I was a specialist, I 

should be able to change this child's behavior immediately by 

myself. And yet, I felt incredibly inadequate. 

No one offered assistance. At the time, there was no team 

approach. The teachers probably wondered whether I would 

be scared off easily and whether I could be trusted to help 

without undermining their knowledge. They were probably 

hoping that I had a magic solution. Staff wondered if I, the 

“expert,” was going to be able to stop the behavior that Jess 

had been engaging in for months. There was a clear wish that 

I would simply “fix” this child. 

The Self-Doubt 

During this challenging time, I asked myself if I was the 

right person for the job. I wondered if maybe another, more 

competent mental health professional would be able to snap 

this child's behavior into shape. Yet, despite my feelings of 

insecurity, there was a small nagging part of me that thought, 

maybe it's not me, maybe there is something about this situation that I can learn from. 

Multiple Challenges Bring On More Expectations 

The situation with Jess, as well as other situations with 

children, families, and staff that I encountered over the years, 

tested my skills, patience, training, and knowledge about how 

to best work with children and families. As my skills were 

challenged and my anxiety was heightened, I believed that I 

alone could and should do the work (the emotional support, 

the behavioral and therapeutic work with the child, the relationship and meetings with the families, the consultation to 

the staff, evaluating the problem, developing an understanding 

for the situation, and creating change). 

But I was only one person and, no matter how much professional advice I gained from others or from reading, I alone 

would never be a substitute for the wealth of knowledge and 

experience of parents and other staff who had formed enduring and meaningful relationships with the child. No relationship I could ever build with a child could be effective without 

parental involvement. No one was benefiting from my trying 

to do it alone. 

A Shift in Thinking 

With support from good supervisors, mentors, and colleagues and with ongoing self-reflection, I realized that I cannot and should not work alone. I was reminded that change 

happens in the context of caring and supportive relationships 

that are built over time. Change is rarely the result of a sole 

expert imparting wisdom. 

Head Start Bulletin 9 
Approaches to Services 

A COLLABORATIVE APPROACH TO MENTAL HEALTH 

It took time to shift my thinking about my role and to let 

go of the heavy burden I had put upon myself. It was hard 

work convincing staff and parents that I didn't have all the 

answers and that in fact, no one person did. 

Everyone desired a simple and quick fix. Everybody 

involved in a given situation wished that someone would just 

“fix” the problem—the staff person, child, or the parent. A 

teacher believed a child was the “problem” and wanted him 

to change. A Director wanted a certain staff person's attitude 

to be adjusted. A teacher wanted a child's behavior to be 

modified. Another teacher wanted a supervisor's perspective 

to be more understanding. Another teacher wanted a parent 

to be more involved in the child's life. A parent wanted someone to explain why the child “acted up” at school but not at 

home or vice versa. I desperately wanted to have all the 

answers to be helpful. 

Evolution of the Work 

Over time, my work became less and less about working directly with individual children and more and more 

about working to establish and maintain the relationships 

with the team or others who interacted with the children 

and families much more than I ever would. My goal became 

not to modify a child's challenging behavior, but rather to 

support the staff and parent team and work together to 

develop an understanding of the child's behavior. I worked 

to help staff build their confidence and capacity to work 

with children and families. 

The children and families who made the most progress in 

terms of their social and emotional or behavioral development 

were those who benefited from a team that included the parent(s), teachers, family advocate, the education supervisor, the 

bus driver, the kitchen staff, and other care providers that functioned in a cohesive, supportive, and integrated way. Similarly, 

staff who felt most satisfied in their work were those who 

most often participated and contributed to the team. Each 

member of the team had a unique perspective to help us understand and guide our strategies for a situation. 

Recognizing that change happens in the context of caring 

relationships, I cultivated these relationships among team 

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members. I learned to pay as much attention and energy to 

the adults (including myself) as I initially gave to children. 

Every team member needed to feel that his or her expertise 

and experience were valid and provided meaningful direction 

to the understanding of a concern or problem. 

Who can be on the Mental Health Caregiving Team in Head Start 

and EHS? 

arents 

eachers 

amily advocates 

upervisors 

Mental health consultant/professional 

ansportation staff 

itchen staff 

Other care providers, extended family, physicians, therapists 

Anyone who is involved with and touches the life of a child 

Steps to Developing a Team Approach to Mental Health 

Build trust among members of the team by establishing 

regular meetings 

Recognize that each team member has knowledge, expertise, 

and perspective to contribute 

Ask each team member to share hopes and concerns 

The Change 

As a result of our efforts, later when I was faced with 

another “Jess,” I no longer felt alone. I felt confident that if I 

was working individually with a child, it was because we 

agreed as a team that it was the appropriate thing to do. The 

teachers became my allies, and I became their support. 

Together, we learned that the only people who could turn 

behavior around were those who had a special relationship 

with the child and who were nurtured by special relationships 

from others on their team. ■ 

Amy Hunter is an Early Childhood Mental Health Specialist at 

the Early Head Start National Resource Center in 

Washington, D.C., and is a former Head Start Fellow. 

T: 202-857-2679. E: ahunter@zerotothree.org 

10 2009 
Approaches to Services 

BY R OB C ORSO 

THE CENTER ON THE SOCIAL AND EMOTIONAL

FOUNDATIONS FOR EARLY LEARNING (CSEFEL) 

We have found that emotional 

and intellectual development cannot 

be separated; that these two functions 

come together as the child actively 

explores the emotional, social, and 

cognitive challenges at each of these 

stages. Stanley Greenspan, M.D. 

(Connors-Tadros & Yates 2003) 

The Center on the Social and 

Emotional Foundations for Early 

Learning (CSEFEL) is a national 

resource center that promotes the 

social and emotional development 

and enhances school readiness of lowincome young children ages birth to 

five. CSEFEL disseminates researchand evidence-based practices to the 

early childhood community. As of 

2007, CSEFEL was in its second fiveyear funding cycle. CSEFEL is jointly 

funded by the Office of Head Start 

and the Child Care Bureau. 

CSEFEL offers training modules 

in the form of trainer scripts, 

PowerPoint slides, participant handouts, activity descriptions, resources, 

and video clips. Early Head Start and 

Head Start programs, as well as state 

and regional T/TA systems, have used 

the CSEFEL training modules as the 

foundation for training personnel on 

effective strategies for promoting 

young children’s social and emotional 

development and for preventing and 

addressing challenging behaviors. 

The modules highlight the importance of designing environments that 

support children’s success by engaging 

them in meaningful activities, teaching 

the expectations of the environment, 

and implementing a predictable and 

engaging schedule for the child. Also 

they offer administrative and leadership 

strategies for ensuring that educators 

and families have the support they need 

to implement these strategies. 

CSEFEL also offers What Work 

Briefs, which are summaries of effective 

evidence-based practices for supporting 

children's social and emotional development and preventing and addressing 

challenging behavior. The Briefs include 

a description of practical strategies, references to information about how to 

implement the practice, and a one-page 

handout that highlights the major 

points of the Brief. They are designed 

for in-service providers and other professionals who conduct staff development activities. The information is valuable for professionals, parents, and 

other caregivers. Topics include: 

Promoting Positive Peer Social 

Interactions; Understanding the Impact 

of Language Differences on Classroom 

Behavior; and What Are Children 

Trying to Tell Us: Assessing the 

Function of Their Behavior. 

Over the next several years, CSEFEL will target several states to build 

capacity to effect and sustain change in 

practice and improve outcomes for children, families, and personnel. The 

overall goal is to foster professional 

development of the early care and education workforce through intensive 

training and technical assistance. 

Another priority for CSEFEL is to 

address staff and family mental health. 

The Center has developed a comprehensive set of products and materials, which can be accessed in both 

English and Spanish at no cost from 

www.vanderbilt.edu/csefel or by calling 866-433-1966. ■ 

REFERENCE 

Connors-Tadros, L., & T. Yates. 

2003. Linking literacy with 

social-emotional development. 

Southern stories: Literacy traditions for young children. 

Presentation presented May 7, 

2003. Available at 

http://www.vanderbilt.edu/csefel/ 

ppt.html 

Rob Corso is a Project Coordinator 

associated with the Center on the 

Social and Emotional Foundations for 

Early Learning at Vanderbilt 

University. T: 217-390-0403; 

E: rob.corso@vanderbilt.edu 

Head Start Bulletin 11 
Approaches to Services 

THE ROLE OF MENTAL HEALTH CONSULTANTS
 

Programs and consultants can work together to support wellness 

and provide classroom interventions. by Paul J. Donahue 

Head Start staff are often the first to observe the 

effects of trauma and stress in families, yet many feel illprepared to cope with this added responsibility. An ongoing partnership between the Head Start program and a 

mental health consultant is useful in supporting wellness, 

as well as early interventions. 

The consultant’s primary role is to foster the behavioral, 

emotional, and cognitive development of all children. 

Prevention-oriented, this collaborative model includes classroom check-ups via observation, participation in team meetings, and wellness visits with children. The approach allows 

the consultant to anticipate, as well as respond to crises and 

dire situations and to intervene early with children at risk. 

Developing an Effective Collaboration 

Mental health collaboration calls for considerable and 

mutual enthusiasm, respect, and support. Rather than assume 

a rigid “expert” stance regarding child development, the mental health consultant, with Head Start staff, should develop a 

set of shared assumptions and goals. A team approach can 

demystify notions of promoting mental health, assuring teachers that the consultant is present to support their work and to 

help the children feel more comfortable. 

An effective consultant must be flexible and team-oriented, enjoy community-based settings, feel comfortable 

working autonomously, and be adept at handling multiple 

roles and responsibilities. The consultant should be willing to 

share knowledge and training with teachers and parents. The 

consultant should appreciate that Head Start teachers often 

are embedded firmly in the communities they serve and maintain longstanding relationships with the families they refer. 

Consultants can foster the social and emotional development of all children 

Classroom Management 

Classroom management techniques typically require more 

intensive and joint planning but generally begin with the 

teacher’s request for help with difficult-to-manage children. 

Photo by J. Brough Schamp. Higher Horizons HS/EHS. 

Impulsive and somewhat aggressive, Andrew frequently 

would run about the classroom crashing into other children 

and toys, disturbing free play and story time. A behavior 

modification plan designed by the consulting psychologist and 

Ms. Winn, his teacher, and adopted by his parents was somewhat successful. However, Andrew’s impulsivity and hyperactivity continued to wreak havoc, especially during circle time. 

Finally, Ms. Winn chose to seat Andrew in an adult-size 

chair by her side. No other children were allowed to sit in this 

chair. Andrew readily took to his new place and began to sit 

throughout most circle times, though fidgety and often inattentive. Few children complained about Andrew’s “special 

chair,” seeming to recognize that this seating arrangement 

allowed them to enjoy the teacher’s stories. 

The consultant helped to design a behavior rewards system to address this classroom situation but actually played a 

more critical role by supporting the teacher’s ideas for managing and containing her student’s behavior. Together, they 

charted his progress, identifying changes in the frequency, 

intensity, and duration of the targeted behaviors. This process 

often is critical with more active or impulsive children as it 

highlights attention, impulse control, and inhibition as developmental processes rather than as fixed entities. 

12 2009 
Approaches to Services 

Interventions with Children 

After becoming a more familiar presence in the classroom, the consultant may work with the children as a group. 

This is an alternative way to reach young children whose 

development may be affected negatively by stressful life events 

as reflected in such maladaptive behaviors as withdrawal, 

aggression, or hyperactivity. Children actually are more likely 

to become unruly and disruptive when their feelings remain 

unspoken but continue to lurk beneath the surface. Often, 

they are calmed notably when given the opportunity to 

express themselves to adults who listen. By working with children in the small group setting, the therapist can observe and 

further assess social and emotional problems identified in the 

classroom, interpret and address problems in peer relationships, and intervene to improve adjustments to transitions, listening, and taking turns. 

Ms. Marano, an experienced teacher, was preparing to 

leave her job and relocate out of state. Her initial attempts to 

engage the children in a discussion about her departure was 

met by anger in some students and silence by others. The 

Head Start Program Performance Standards require that all 

toddlers and preschool children and assigned classroom staff, 

including volunteers, eat together family style. Ms. Saunders, 

the mental health consultant saw this as an opportunity for 

emotional growth. She suggested that Ms. Marano discuss her 

departure with the group and then follow up with discussions 

at lunch and snack times with small groups or individual children. At times, Ms. Saunders joined the class during meals to 

help the children open up about their anxiety over their 

teacher’s departure. 

In some instances, mental health consultants are available 

to provide brief assessment and treatment services for the children. Teachers often identify children who could benefit from 

brief, preventive intervention. The most frequent referrals are 

for children with behavior problems or those exhibiting symptoms of depression or anxiety. 

Philip was referred for brief treatment after his teachers 

became more aware of his isolation and self-deprecating 

remarks and behaviors. His mother, depressed and overburdened, was unable to offer him much support. She frequently 

referred to him as “bad,” comparing him negatively to his 

younger brother and openly expressing a wish to be rid of him. 

In the early phase of treatment, Philip repeatedly depicted 

a mother rejecting and killing her son, then running off with 

her younger child. The therapist openly discussed his mother’s 

difficulties with Philip; emphasized and attempted to engage 

his strengths and skills, particularly his keen intelligence; as 

well as supported and facilitated his creative use of materials 

and his dramatic and symbolic play. In addition, the therapist 

helped Philip’s teachers identify and support his strengths and 

need for nurturance. 

Initially, work with Philip’s mother proved difficult, as 

her depression left her detached from both his and her own 

feelings. She did, however, support his treatment and the 

classroom interventions and, gradually, she began to identify 

with the positive view of Philip communicated to her by his 

therapist and teachers. 

Conclusion 

The early childhood consultation model offers a comprehensive approach to children’s social and emotional development, allowing teachers, parents, and mental health professionals to work together to identify and respond to children’s 

needs, plan classroom interventions, and support the effort of 

families to develop coping strategies. 

Children and families benefit from the combined focus 

on children’s social and emotional development and early 

intervention efforts aimed at preventing more serious problems from emerging later in childhood. Further, an effective 

mental health collaboration can serve to enhance a program’s resilience and to reduce stress experienced on the part 

of staff by joining together to face the day-to-day challenges 

of meeting the educational and emotional needs of the 

young children both serve. ■ 

Paul J. Donahue is Director of Child Development 

Associates in Scarsdale, NY. T: 914-723-2929; 

E: pjd@drpauldonahue.com. 

Head Start Bulletin 13 
Approaches to Services 

WORKING WITH MENTAL HEALTH PROFESSIONALS
 

Guidance about effective practices, consultants, and 

leadership emerge from the Mental Health Services Survey. 

by Beth L. Green, Maria C. Everhart, and 

Lynwood Gordon 

The increasing numbers of young children with challenging behaviors and emotional problems have led many child 

care providers and early childhood education programs to 

employ or contract with mental health professionals (Lavigne 

et al. 1996). Head Start programs, for example, are required 

by the Head Start Program Performance Standards to utilize 

the services of mental health professionals with sufficient frequency to meet the needs of children and families. However, 

there has been little research to help program managers make 

informed choices and answer their questions: 

�

�

�

What services are most important to support staff 


and families? 


Who might provide them? 

How to make the best use of limited program resources? 

In 2002, a Mental Health Services Survey was conducted 

to address these important questions. A nationally representative sample of over 950 Head Start directors, teachers, parents, mental health coordinators, and consultants was surveyed about program structure and mental health services; 

their beliefs, attitudes, and practices; and perceived effectiveness of mental health services and supports. 

The key findings are summarized in this article and provide guidance to Head Start and other early childhood programs about how to promote the mental health of children, 

families, and staff. A list of selected findings is available at 

http://eclkc.ohs.acf.hhs.gov/; the research report is available 

at www.rtc.pdx.edu/PDF/pbMHConsultHS.pdf. 

Promising Practices 

Growing evidence shows that organizations that provide 

effective early childhood mental health services share a set of 

core principles or promising practices (Simpson et al. 2001). 

The ten principles describe effective services as: strengthsbased, individualized and comprehensive, relationship-based 

Photo by J. Brough Schamp. South East Community Organization HS. 

(that is, focused on building positive, nurturing relationships 

with each child and family), family-focused, preventative, 

inclusive, culturally sensitive, integrated, and promoting staff 

wellness and strong community partnerships. 

The Head Start staff and mental health professionals 

who indicated that their mental health services were implementing these promising practices more completely also 

reported that their services were more effective—both in 

reducing children’s problem behaviors and in increasing their 

Effective 

consultants can 

help build quality 

programs. 

positive and pro-social behaviors. Moreover, best practices 

were related to staff perceptions of program outcomes independent of how much money was spent on mental health 

services or how frequently these services were provided. 

Higher staff ratings for program outcomes were consistently linked to two principles: cultural sensitivity and family focus/parent involvement. The ability of staff and consultants to recognize and be sensitive to cultural variability in 

approaches to and beliefs about mental health was important over and above all other promising practices. Those 

programs where staff and consultants valued and were able 

to more successfully involve parents in working collabora14 2009 
Approaches to Services 

tively to address children’s mental health issues were also 

perceived as being more effective. 

The only principle that was not consistently associated 

with staff perceptions of positive outcomes was inclusion. 

Some staff who strongly endorsed all other promising practices thought children with challenging behaviors would be 

best served outside the regular child care environment. 

Clearly, more support and training around the issue of inclusion are needed. 

Effective Consultants 

The survey asked about the characteristics of the mental health consultants and the programs they worked with. 

As reported by staff, some characteristics turned out to be 

surprisingly unimportant to program outcomes, including 

total number of hours per child of consulting provided, 

percent of program’s budget spent on mental health services, size and location (urban vs. rural) of program, primary race/ethnicity of families served, and credentials and 

education of the consultant. 

So, what was important? Three findings emerge. 

1.	 The experience of the mental health professional in 

working with both young children and low-income 

families. Not surprisingly, programs struggled to find 

mental health professionals with expertise in both 

areas. 

2.	 The ability of consultants to make a long-term commitment to the program. Those with longer-term relationships were generally perceived as being more 

effective. 

3.	 The consultants’ approach to service delivery. 

Consultants who were able to provide services consistent with the promising practice principles and whose 

approach reflected the Head Start program philosophy were seen by staff as being more effective. 

Effective Consultation Services 

Cohen & Kaufman (2000) define two general types of 

services that can be provided by an early childhood mental 

health professional. One is a more traditional, problemfocused service that targets the specific needs of a child or 

family, sometimes referred to as individual consultation. 

Services include screening, assessment, or treatment of individual children or family. 

Another type of service, called program-level consultation, aims to improve overall program or classroom quality 

and to help the program and its staff address broad issues 

that affect more than one child, family, or worker. Activities 

include working with teachers and family service advocates, 

training staff, attending management team meetings, and 

advising on program policy. 

High levels of either type of service were associated with 

perceptions of positive outcomes for children. But there were 

differences in outcomes for staff. When mental health consultants worked at the program-level, staff felt better about 

their jobs, and in turn, they were better able to successfully 

work with children with challenging behaviors. The survey 

findings suggest that while both strategies can work well for 

children, programs that utilize mental health professionals to 

provide program-level consultation may be getting “more 

bang for the buck.” 

In addition, consultants who were integrated into dayto-day program functioning seemed to be more effective and 

to provide more services regardless of how many hours they 

were paid (Green et al. 2004). 

Leadership and Shared Vision 

Program management and leadership play an essential 

role in setting the tone for how an entire program thinks 

about and approaches early childhood mental health issues. 

Results suggest that program leaders should pay particular 

attention to three aspects: 

�

�

�

ensuring that all staff share a similar vision for early 

childhood mental health efforts that is strongly rooted 

in best practices; 

becoming visible advocates for community resources 

related to early childhood mental health; and 

structuring and facilitating the work of mental 

Head Start Bulletin 15 
Approaches to Services 

WORKING WITH MENTAL HEALTH PROFESSIONALS 

health professionals through integrated, programlevel consultation. 

The effect of strong program leadership around mental 

health issues supported more positive staff-consultant relationships, which led to staff perceiving more positive program outcomes. 

Conclusion 

Finding ways to effectively address children’s mental 

health issues remains a challenge to many early childhood 

programs. But, the Mental Health Services Survey shows 

that many Head Start programs have established successful 

approaches to achieving positive outcomes for children and 

staff. These programs embrace promising practices, use 

effective consultants, provide an integrated, program-level 

approach, and are supported by leaders with a commitment 

to mental health services. ■ 

REFERENCES 

Cohen, E., & R. Kaufmann. 2000. Early childhood mental 

health consultation. Washington, D.C.: U.S. Department 

of Health and Human Services, Substance Abuse and 

Mental Health Services Administration, Center for 

Mental Health Services. Available at 

www.gucchd.georgetown.edu. 

Green, B. L., M.C. Everhart, M. Garcia, L. Gordon, & B. 

Friesen. 2003. Mental health consultation in Head Start: 

Selected national findings: Mental health services survey 

report. Portland, OR: U.S. Department of Health and 

Human Services, Portland State University, Research & 

Training Center on Family Support & Children’s Mental 

Health, Regional. 

Green, B. L., J. Simpson, M. Everhart, & E. Vale. 2004. 

Mental health consultation in Head Start programs: 

The importance of shared vision. National Head Start 

Association Dialog: A Research-to-Practice Journal 

for the Early Intervention Field. 2. Washington, DC: 

U.S. Department of Health and Human Services, 

Administration for Children and Families, Head 

Start Bureau. 

Lavigne, J. V., R. D. Gibbons., K. K. Christofel, R. Arend, 

D. Rosenbaum, H. Binns, N. Dawson, H. Sobel, & 

C. Isaacs. 1996. Prevalence rates and correlates of psychiatric disorder among preschool children. Journal of 

the American Academy of Child and Adolescent 

Psychiatry. 35(2): 204-214. 

Simpson, J. S., P. Jivanjee, N. Koroloff, A. 	Doerfler, & M. 

Garcia. 2001. Promising practices in early childhood 

mental health. Systems of care: Promising practices in 

children’s mental health. 3. Washington, D.C.: Center 

for Effective Collaboration and Practice, American 

Institutes for Research. 

This article has been adapted from What Early 

Childhood Directors Should Know about Working with 

Mental Health Professionals in Focal Point. Partnering with 

Families. 18 (1), Summer 2004. Focal Point is a national 

bulletin on family support and children’s mental health. 

Beth L. Green is Vice President, NPC Research in Portland, 

OR. T: 503-243-2436; E: green@npcresearch.com. 

Maria C. Everhart is a freelance evaluator and writer working 

with the Portland State University Center for Improvement 

of Child & Family Services in Oregon. T: 503-704-7156; E: 

maria_everhart@comcast.net 

Lyn Gordon is Quality Review and Reports Specialist at 

Clark County Department of Community Services in 

Vancouver, WA. T: 360-397-2130; 

E: Lyn.Gordon@clark.wa.gov. 

16 2009 
 

Child Mental Health 

UNPACKING THE MEANING OF INFANT AND
 

TODDLER BEHAVIOR
 

Understanding the meaning of a child’s behavior is the first 

step to responding appropriately. by Jennifer Boss, 

Kim Diamond-Berry, and Tammy Mann 

How does an infant tell us what he wants? When a 

young toddler points and grunts, what is she saying to us? 

Why do 2-year-olds bite other children? 

For adults who are used to relying on words to communicate and understand one another, deciphering the 

“language” of infants and toddlers can sometimes be a 

challenge. But it is precisely through their behavior—gestures, looks, babbles, and cries—that infants and toddlers 

communicate with us. It is incumbent upon the adults in 

the babies’ world to decode this mysterious behavior and 

make sense of it. 

Once we understand what the behavior is communicating, we can respond appropriately. Of course, young children do not behave in a vacuum. They behave in the context of their relationships, their environment, and their 

developmental level. Understanding this context will allow 

us to unpack the meaning of infant and toddler behavior. 

Behavior Within Relationships 

The first step in making sense of a young child’s behavior is to look at the quality of the relationships with important adult caregivers in the baby’s life. Parents, as well as 

Head Start and Early Head Start (EHS) teachers and caregivers, have important relationships with infants and toddlers. These early relationships, whether they are healthy or 

compromised, greatly influence how a baby or young toddler expresses himself in the world. 

If the relationship between a child and an adult grows 

in a healthy way, their interactions are characterized by 

mutual understanding and effective communication. For 

example, when a 2-month-old discovers that his smile elicits 

enthusiastic smiles and warm hugs from a loving adult, he 

might smile even more broadly and enthusiastically at adults 

with each encounter. When the adult continues to respond 

to his smiles or attempts to communicate with more positive 

Photo by D. Drake. NOWCAP MSHS. 

feedback, a cycle develops with each partner knowing what 

to expect from the other. 

On the other hand, if the baby’s attempts at communicating with adults are consistently ignored or met with negative feedback, he may learn that relating to adults is not 

pleasurable and does not meet his needs. In extreme cases, 

the baby might begin to turn away from an adult’s gaze, or 

seem listless, quiet, and depressed. These two contrasting 

qualities of relationships lead to very different behavioral 

expressions by the baby. 

A baby discovers his 

smile elicits enthusiastic 

smiles from a caregiver. 

Behavior Within Development 

Another important way to understand early behavior is 

to pay attention to the developmental domain the child is 

currently mastering. As children progress through the different domains of development (cognitive, social, emotional, 

and physical), we expect certain behaviors. For example, a 

child who is working to master language may begin with 

crying, gurgles, coos, and babbles. When adults respond 

positively to these behaviors, the baby adds more sounds 

and gestures as she grows. The baby learns how language is 

a powerful tool for getting attention and communicating her 

needs. Later, the baby will become more intentional with her 

gestures (e.g., grasping, grabbing, hitting, pointing) and better able to expand the dialogue with adults. 

Head Start Bulletin 17 
Child Mental Health 

UNPACKING THE MEANING OF INFANT AND TODDLER BEHAVIOR 

These increasingly complex behaviors occur in a predictable sequence and are influenced by her significant relationships. When we understand the infant or toddler’s development we can better understand the child’s behavior and 

support her emerging developmental skills with awareness 

and sensitivity. 

Development, however, does not proceed in a linear 

fashion. There is a natural ebb and flow to early childhood 

development, with each area of development progressing at 

its own pace. Children may progress quickly in one area of 

development and seem to remain static in others, or it may 

seem that they “take two steps forward and one step back” 

as they master new skills. 

Children need time and experience to practice emerging skills and may approximate new skills before they are 

fully able to master a task. For example, an 8-week-old 

who has recently discovered her hand but who has limited 

gross motor control, may spend several minutes banging 

her hand into her face while trying to maneuver her fist 

into her mouth. A toddler who is developing his language 

skills but does not yet have the ability to understand and 

clearly express his emotions, may resort to biting his classmates when he is frustrated or anxious. Infants and toddlers are growing and developing at a rapid pace and need 

many opportunities to practice new skills in order to master them. 

By observing and asking 

questions, caregivers have 

clues that can aid in understanding infant and toddler 

behavior, making it possible 

to respond in a way that lets 

the child know she is an 

important person whose 

behavioral “language” is 

heard and understood. 

Individual Differences 

We know that each child has a unique way of understanding and relating to his or her world. Temperamental 

differences in young children lead to differences in behavioral expressions. A 30-month-old who has a quiet, slowto-warm temperament may need extra time in the morning 

to get accustomed to the high activity level in the classroom. This child may be clingy with his parents and fussy 

during drop-off. In contrast, a 30-month-old who has a 

feisty temperament and enjoys the high activity level of the 

classroom may enthusiastically run into the classroom during morning drop-off, eagerly looking for her friends and 

ready to jump into the activities. In both of these examples, the temperamental preferences of the children give 

you clues as to the meaning of their behavior—“I’m clingy 

and fussy because the activity level of the class is too stimulating for me” or “I’m active and busy because the activity level of the class excites me.” 

Impact of the Environment 

The environment also plays a factor in how children 

express themselves through their behavior. The quality and 

layout of the physical environment (e.g., an EHS classroom, the home, or an outdoor play area) can have a great 

impact on children’s behavior. In some cases, problematic 

behavior is easily influenced by environmental factors, and 

the behavior will improve by intervening with the environment rather than the child (U.S. Department of Health and 

Human Services 1996). For example, lowering the stimulation in the classroom may help temper the clingy and fussy 

behavior of the 30-month-old with a slow-to-warm up disposition. Planning some quiet activities in the early morn18 2009 
Child Mental Health 

ing, even playing some relaxing “mood” music, may ease 

the child’s transition. 

In addition to the physical space, the presence of the 

adult caregiver has an impact on the child’s behavior. In an 

early childhood program, the behavior of the staff sets the 

climate or culture of the classroom, which in turn has an 

impact on the behavior of the children. Understanding how 

the environment (both the physical space and people in the 

environment) influences infant and toddler behavior is a critical part of unpacking the meaning of behavior. 

Implications for Head Start and Early Head Start 

Programs 

The Head Start Program Performance Standards 

(1998) require ongoing observation and gathering of information about children’s development and behavior from a 

variety of sources [45 CFR 1304.20(b)(3) and 1304.20(d)]. 

Head Start and EHS programs gather information about a 

child’s development through the required screening process 

[45 CFR 1304.20(b)(1-3)] and use the information from 

ongoing assessment procedures to plan for children’s needs 

[45 CFR 1304.3]. 

Infant and toddler behavior is influenced by numerous 

factors. The task for Head Start and EHS staff is to look 

closely at each of these factors, gather as many clues as 

possible, and develop fair and accurate assessment of the 

child’s behavior. 

When young children present challenging behavior, it 

can leave teachers and caregivers unsure of how to 

respond. Caregivers are cautioned against assuming the 

problem lies solely within the child. Instead of thinking of 

the child as “bad,” the caregiver might ask herself, “What 

are this child’s important relationships like (including the 

relationship with the caregiver)? What developmental tasks 

is she trying to master? What is her temperament like? 

How does she behave in a variety of environmental settings 

—in the EHS classroom, at home, with her parents, with 

the teachers?” 

By observing and asking questions, caregivers have clues 

that can aid in understanding infant and toddler behavior, 

making it possible to respond in a way that lets the child 

know she is an important person whose behavioral “language” is heard and understood. 

For more information on understanding infant and toddler behavior, see the resources available at EHS/NRC @ 

ZERO TO THREE 

(http://www.ehsnrc.org/AboutUs/Index.htm) ■ 

REFERENCES 

Early Head Start National Resource Center. 2000. 

Developmental screening, assessment, and evaluation: 

Key elements for individualizing curricula in Early Head 

Start Programs. Washington, D.C.: Head Start Bureau, 

U.S. Department of Health and Human Services. 

U.S. Department of Health and Human Services. 1996. 

Training guides for the Head Start learning community: 

Promoting mental health. Washington, D.C.: Author. 

Jennifer Boss is the Assistant Director of the Early Head Start 

National Resource Center in Washington, D.C. T: 202-638­

1144; E: jboss@zerotothree.org 

Kim Diamond-Berry is a Writer/Training Specialist with the 

Early Head Start National Resource Center in Washington, 

D.C. T: 202-638-1144; E: kdberry@zerotothree.org 

Tammy Mann is the Deputy Director of ZERO TO THREE 

in Washington, D.C. T: 202-638-1144; 

E: tmann@zerotothree.org 

Head Start Bulletin 19 
Child Mental Health 

UNDERSTANDING ATTACHMENT
 

Building a secure attachment is the keystone for ensuring 

children’s sound mental health. by Alice S. Honig 

Sitting on the beach close to his mother and baby sister, 

3-year-old Aaron digs in the sand with his shovel. He looks 

up and sees what appears to be a huge metal monster rolling 

toward them. Although the path to safety lies toward the 

boardwalk, Aaron drops his shovel and leaps into his mama’s 

lap, burying his face in her shoulder. His deep, secure attachment to his mother makes her the preferred source of safety— 

even when reason tells him that to escape “the monster” he 

should run away. Patting him soothingly, Aaron’s mother 

explains that the machine is cleaning the beach and will certainly swerve around them, which in fact it does. 

Child care providers and early childhood teachers hear a 

lot about attachment and how important it is for the emotional well-being of infants, toddlers, and preschoolers. But 

what exactly do we mean by attachment? What is meant 

when we say that Aaron is securely attached to his mother? 

Young children form attachments with their parents and caregivers. 

What Is Attachment? 

The term attachment describes a strong emotional bond 

between a baby or young child and a caring adult who is part 

of the child’s everyday life—the child’s attachment figure. It is 

usually an affectionate or loving bond: the attachment of a 

child to his mother comes immediately to mind. However, a 

baby is not born with this attachment to his mother; it develops over time. Each day as the mother looks into the baby’s 

eyes while nursing him; as she carries him in a pack on her 

chest, talking to him while raking leaves; or as she holds him 

on her lap, including him while reading to an older sibling, 

the baby’s attachment to his mother grows stronger. 

But what happens if the caring adult is not the baby’s 

mother? Can someone besides the mother become an attachment figure? What if the father or an aunt cares for the baby 

each day while her mother is away at work? What happens if 

the baby is cared for in a center or a family child care home 

by an adult who is not even related to her? Such situations are 

not at all unusual; many mothers work even when their 

babies are quite young. In these cases the baby will most 

Photo by D. Mentzer. Courtesy of HSRC Image Library. 

likely become attached to the other adult—in addition to 

being attached to mom and dad. The bond between a baby 

and her parent tends to be a strong one, but babies and young 

children are capable of forming attachments to more than one 

adult. When a provider showers the babies and toddlers in her 

care with warmth, caring, and individual attention, these children are very likely to develop a secure bond with her. 

Furthermore, children benefit from positive attachments to 

adults who are not their parents (Main & Weston 1981). 

Attachment is a developmental system that builds 

slowly from a child’s first days through his or her early years. 

It describes and explains people’s enduring patterns of relationships from birth to death. From the infant’s experiences 

and interactions during the first year with the key adult caregivers in her life—her attachment figures—she gradually 

builds up pictures of relationships between herself and others 

(Bowlby [1973] 2000). For the most part these internalized 

working models are not a part of the child’s conscious 

thought, yet they have profound effects throughout life. The 

influence of these models plays a crucial role in the development of later personality. They are templates that serve as 

guides for and interpreters of emotions, perceptions, and 

behaviors in all future relationships (Bretherton & Waters 

1985; Belsky & Nezworski 1988; Brazelton & Cramer 1990; 

20 2009 
Child Mental Health 

Bretherton 1991; Crowell & Waters 1994; Colin 1996; De 

Wolff & van IJzendoorn 1997; Koops, Hoeksma, & van den 

Boom 1997). 

Another key realm influenced by attachment is self-regulation. Children’s ability to regulate their emotions and behaviors 

depends on the security of their attachments to caregivers and 

the quality of care they receive (Shore 1997). A child who is 

upset shows self-regulation when she soothes herself and 

restores balance. For example, a baby in slight distress may 

calm herself by putting her fist in her mouth and sucking vigorously. Securely attached babies are more able to maintain 

physical and emotional balance than are insecurely attached 

babies (Matas, Arend, & Sroufe 1978; Sroufe 1979; 

Braungart-Rieker et al. 2001). Secure attachments also seem 

to prepare children to be confident and independent learners 

with strong social skills (Ainsworth & Bell 1974; Arend, Gove, 

& Sroufe 1979; Erickson, Korfmacher, & Egeland 1992). 

The strength of attachment is such that the treatment and 

acceptance we grow up expecting from others corresponds to 

what we got from our own attachment figures. We tend to go 

through life feeling the way our attachment persons made us 

feel—be that happy or depressed, loved or neglected, at peace 

or in turmoil. The prospects are good that Aaron’s loving, 

trusting relationship with his mother will predispose him to 

expect warm, healthy relationships with others in his childhood and throughout his life. Contrast Aaron’s predisposition 

with that of a neglected or abused toddler. Based on her early 

experiences, she will likely expect cold, erratic relationships 

and little comfort in times of stress. These expectations may 

lead her to act in inappropriate ways in child care, such as 

showing anger or aggression toward an upset peer or not 

responding to warm adult overtures. Her difficult behaviors 

may ensnare an unwary caregiver and create a relationship 

fraught with punitive, unhappy interactions—like those the 

child has already come to expect. In the all-too-usual course 

of events, unhappiness and disappointment beget more 

unhappiness and disappointment. 

Knowledge about attachment helps teachers, parents, and 

caregivers to understand how children’s emotional behavioral 

styles and interactions are shaped and how the quality of 

early relationships affects later patterns of intimate relationships. This knowledge enables adults to temper their interactions to children’s needs, thus influencing children’s emotional 

security. Building secure attachment is a prime goal in early 

care and education; it is in fact the keystone for ensuring children’s sound mental health (Honig 1993). ■ 

REFERENCES 

Ainsworth, M., & S. Bell. 1974. Mother-infant interaction 

and the development of competence. In The growth of 

competence, eds. K.J. Connelly & J. Brunner, 97-118. 

London and New York: Academic Press. 

Arend, R., F.L. Gove, & L.A. Sroufe. 1979. Continuity of 

individual adaptation from infancy to kindergarten: A 

predictive study of ego resiliency and curiosity in 

preschoolers. Child Development 50: 950-59. 

Belsky, J., & T. Nezworski, eds. 1988. Clinical implications of 

attachments. Hillsdale, NJ: Lawrence Erlbaum Associates. 

Bowlby, J. [1973] 2000. Separation: Anxiety and anger. Vol. 2 

in Attachment and loss. New York: Basic Books. 

Braungart-Rieker, J.M., M.M. Garwood, B.P. Power, & X. 

Wang. 2001. Parental sensitivity, infant affect, and affect 

regulation: Predictors of later attachment. Child 

Development 72 (1): 252-70. 

Brazelton, T.B., & B.G. Cramer. 1990. The earliest relationship: Parents, infants, and the drama of early attachment. 

Reading, MA: Addison-Wesley. 

Bretherton, I. 1991. Pouring new wine into old bottles: The 

social self as internal working model. In Self-processes 

and development, eds. M.R. Gunnar & L.A. Sroufe, 1-4. 

Vol. 23 in The Minnesota symposia on child development. Hillsdale, NJ: Lawrence Erlbaum Associates. 

Bretherton, I., & E. Waters, eds. 1985. Growing points of 

attachment theory and research. Monographs of the 

Society for Research in Child Development, vol. 50, nos. 

1-2, serial no. 209. Chicago: University of Chicago Press. 

Colin, V.L. 1996. Human attachment. Philadelphia, PA: 

Temple University Press. 

Head Start Bulletin 21 
UNDERSTANDING ATTACHMENT 

Child Mental Health 

Crowell, J.A., & R. Waters. 1994. Bowlby’s theory grown up: 

The role of attachment in adult love relationships. 

Psychological Inquiry 5: 31-34. 

De Wolff, M.S., & M.H. van IJzendoorn. 1997. Sensitivity 

and attachment: A meta-analysis on parental antecedents 

of infant attachment. Child Development 68: 571-91. 

Erickson, M.F., J. Korfmacher, & B. Egeland. 1992. 

Attachments past and present: Implications for therapeutic intervention with mother-infant dyads. Development 

and Psychopathology 4 (4): 495-507. 

Honig, A.S. 1993. Mental health for babies: What do theory 

and research teach us? Young Children 48 (3): 69-76. 

Koops, W., J.B. Hoeksma, & D.C. van den Boom, eds. 1997. 

Development of interaction and attachment: Traditional 

and non-traditional approaches. Amsterdam: North 

Holland. 

Main, M., & D.R.Weston. 1981. The quality of the toddler’s 

relationship to mother and to father related to conflict 

behavior and readiness to establish new relationships. 

Child Development 52: 932-40. 

Matas, L., R.A. Arend, & L.A. Sroufe. 1978. Continuity of 

adaptation in the second year: The relationship between 

quality of attachment and later competence. Child 

Development 19: 547-56. 

Shore, R. 1997. Rethinking the brain: New insights into early 

development. New York: Families and Work Institute. 

Sroufe, L.A. 1979. The coherence of individual development: 

Early care, attachment and subsequent developmental 

issues. American Psychologist 34 (10): 834-41. 

This article is excerpted with permission from Alice S. 

Honig’s book, Secure Relationships: Nurturing Infant/Toddler 

Attachment in Early Care Settings (published in 2002 by the 

National Association for the Education of Young Children, 

Washington, D.C.). 

Dr. Alice S. Honig, Ph.D., is Professor Emerita of child development at Syracuse University and is well-known for her 

work in infant/toddler development, parent involvement, and 

early child care and education. 

Building Attachment 

In this excerpt, Dr. Honig refers to the research findings of Ainsworth and her colleagues (Ainsworth, Bell, & Stayton 1971; Stayton, 

Hogan, & Ainsworth 1971) about maternal behaviors and infant attachment. 

Mothers of securely [attached] infants are sensitive and responsive; they 

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hold the baby in a tenderly careful way 

enjoy close cuddles and playful, affectionate interactions with the baby 

feed in tempo with infant needs and feeding styles 

give babies floor freedom to play 

interpret infant emotional signals sensitively 

respond promptly and appropriately to infant distress 

provide contingent feedback (respond immediately and purposefully to infant behaviors they want to
 

reinforce or discourage) in face-to-face interactions during routines and play
 

REFERENCES 

Ainsworth, M.D.S., M.V. Bell, & D.J. Stayton. 1971. Individual differences in the strange situation behavior of 

one-year-olds. In The origins of human social relations, ed. H.R. Schaffer. London: Academic Press. 

Stayton, D.J., R. Hogan, & M.D.S. Ainsworth. 1971. Infant obedience and maternal behavior: The origins of 

socialization reconsidered. Child Development 42 (4): 1057-69. 

22 2009 
Child Mental Health 

SIGNS OF A YOUNG CHILD’S TRUST IN YOUR CAREGIVING 

by Alice S. Honig 

Developing a bond between you and the 

babies, toddlers, or young children in your care is 

one of your major goals. You act quickly and 

warmly to comply with their needs, and you temper 

your responses to their individual styles. You show 

respect to children and shower them with praise in 

the wake of their good deeds. You use contingent 

feedback to support or alter their behaviors. You 

talk to them, hold them, hug them, read to them, 

and smile across the room at them. You communicate and work with their families in the interest of 

the children’s well-being. 

How can you tell when you have succeeded in 

forming a strong bond with a child? When the child: 

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smiles with pleasure when you greet her 

warmly or admire her accomplishments 

reaches out to you to be picked up 

calls out to you to get your attention 

relaxes and molds comfortably to your body 

when you hold her 

leans into your body when you read to him 

accepts your gentle touches and warm gestures of intimacy 

climbs on you, clings to you, or even sucks on 

your knuckles to regain emotional balance 

looks up occasionally to check for your 

presence when playing across the room 

becomes stressed when he notices you are not 

in the room 

runs to you, her safe base, to “refuel,” then 

returns to play 

turns to you for help in stressful situations 

takes your hand in new or unfamiliar 

circumstances 

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calms down at your reassuring touch 

and words 

is cooperative and compliant with your 

requests and directions 

works longer at challenging tasks when you 

are near 

looks into your eyes when you crouch down to 

talk to him 

talks to you truthfully about the bad as well as 

the good 

When babies and young children show a number of these behaviors, they are well along in forming a secure attachment to you, their warm, responsive, and reliable caregiver. And you have given 

them a gift that will serve them for a lifetime. 

This article is excerpted with permission from Alice S. 

Honig’s book, Secure Relationships: Nurturing Infant/Toddler 

Attachment in Early Care Settings (published in 2002 by the 

National Association for the Education of Young Children, 

Washington, D.C.). ■ 

Photo by J. Brough Schamp. South East Community Organizations HS. 

Positive staff-child relationships foster children’s mental health. 

Head Start Bulletin 23 
Child Mental Health 

RISK FACTORS FOR EMOTIONAL AND 


BEHAVIORAL PROBLEMS
 

Risk factors include characteristics of the child, family, and 

community. by W. Douglas Tynan, Meredith Dreyer, 

and Meredith Lutz Stehl 

Promoting young children’s social and emotional 

development has been a goal of Head Start since its inception in 1965. The Head Start Child Outcomes Framework 

(2003) includes Social and Emotional Development as one 

of the eight areas (or Domains) of preschoolers’ learning and 

development that programs must address. Self-Concept, SelfControl, Cooperation (with peers and adults), Social 

Relationships, and Knowledge of Community and Families 

are identified as Domain Elements that are important to 

social and emotional growth. When Head Start staff intentionally support children to develop a strong sense of self, 

regulate their behavior, make friends, and learn about the 

social world, they are preparing children to be successful 

learners in school. 

Some children exhibit challenging behaviors that are 

indicative of social and self-control problems. While those 

problems are sometimes attributed to a specific cause or diagnosis, there is a growing realization that usually there is no 

single cause and that the best programs address several risk 

factors at culturally sensitive and appropriate levels of intensity. To understand emotional and behavioral difficulties in 

children, we can start by looking at the factors involved and 

plan appropriate interventions. 

What Are the Risk Factors? 

Risk factors include specific characteristics of the child, 

difficulties of the family, and factors in the community. They 

include: 

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Constitutional factors of the child: complications 

during pregnancy or immediately after birth, strong 

family history of neuropsychiatric disorder, and sensory disabilities 

Skill development delays: low cognitive ability, attention deficits, delayed speech and language skills 

Emotional difficulties and social behavior problems: 

emotional immaturity, peer rejection, alienation, 

and isolation 

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Family circumstances: stressful life events, conflict
 

within the family, ineffective parenting skills, and
 

mental illness within the family
 

Environmental risks: neighborhood safety factors,
 

extreme poverty, and unemployment
 

While most of us are aware of these risk factors and 

their impact on young children, sometimes we develop interventions that lose sight of some of the contributing factors. 

Perhaps the best way to address the problems is to link each 

risk factor associated with the child, family, and community 

with the appropriate interventions. When there is a good fit 

between the risk factors and the interventions, there is more 

likely to be a successful outcome. 

Risk Factors and Interventions 

Constitutional factors. We know that younger mothers 

and mothers in poverty are more at risk for premature delivery. Children born prematurely are at much greater risk for 

vision, hearing, and motor difficulties, which may impact 

their social and emotional functioning. These children may 

have difficulty learning to self-regulate. We certainly cannot 

undo constitutional factors, but knowing a child’s early 

medical history can help staff anticipate and plan for social 

and emotional delays of the children in their care. 

A family history of close relatives having neuropsychiatric disorders also may predispose a child to having some 

behavioral difficulties. Well-designed behavior interventions 

that recognize these contributing factors and emphasize positive behavior support practices can be very effective with 

children who exhibit challenging behavior in Head Start 

programs. (See the article “A Change of Focus with Positive 

Behavior Support” in this Bulletin.) 

Skill delays. The Center for the Social and Emotional 

Foundations of Early Learning (CSEFEL at 

www.vanderbilt.edu/csefel/) is funded by the Office of Head 

Start and the Child Care Bureau. The Center is a national 

resource center that promotes the social and emotional 

24 2009 
Child Mental Health 

development of young children as a means of preventing 

challenging behaviors. The Center recommends classroom 

strategies that emphasize clear structure in order to teach 

children to communicate, follow directions, and cooperate 

and play with peers more appropriately. We know that 

screening, diagnosis, and intervention are critically important to improve communication and decrease behavior problems for children with significant speech and language
 

delays.
 

Emotional difficulties and social behavior problems. 

Development of self-control, cooperation, and social relationships are goals specified in the Head Start Child Outcomes 

Framework and thus need to be addressed by programs serving preschoolers. The What Works Briefs and other materials from CSEFEL describe a curriculum that promotes selfcontrol and interpersonal skills in young children. 

Family circumstances. These risk factors are addressed 

by therapies that treat the parent-child relationship and 

work to improve parenting skills, decrease conflicts among 

adults, and thus encourage parents to interact more effectively with their children. Screening parents for depression, 

the most common adult emotional disorder, and referral for 

treatment can also have a significant positive impact on 

children's emotional development. 

Environmental risks at large. Although mental health 

interventions do not directly address the risk factors of 

neighborhoods, racism, and extreme poverty, we need to be 

aware of their impact. There are a number of ways we can 

structure our services so these factors do not disrupt service 

delivery. Making sure that transportation is available, scheduling appointments at convenient times for parents, providing culturally sensitive interventions, and working with 

existing community organizations to deliver programs at 

sites that are accessible, acceptable, and safe for families are 

all ways of addressing this last set of risk factors. We can 

work with families to make sure that their basic needs are 

met and help them to set goals to improve their employment 

or economic status. Matching risk factors with 

interventions is an effective 

approach to addressing 

behavior challenges. 

Conclusion 

Current research tells us that the origins of behavioral 

difficulties stem from many factors and that behavioral difficulties do respond to treatment. The challenge for the 

future is to develop effective treatments that address not 

only the specific problem, but also fit within the context of 

other risk factors. ■ 

REFERENCES 

U.S. Department of Health and Human Services, 

Administration for Youth and Families, Head Start 

Bureau. 2003. The Head Start path to positive child 

outcomes. The Head Start child outcomes framework. 

Washington, D.C.: Author. Available at 

http://eclkc.ohs.acf.hhs.gov/ 

W. Douglas Tynan is the Chief Preventive Health 

Psychologist at Nemours Health and Prevention Services in 

Newark, DE. T: 302-444-9075. E: dtynan@nemours.org 

Meredith Dreyer is an Assistant Professor of Pediatrics at 

Children's Mercy Hospital in Kansas City, MO. T: 816-983­

6418. E: mldreyer@cmh.edu 

Meredith Lutz Stehl is a Staff Psychologist in Weight 

Management and Behavioral Health at the A.I. duPont 

Hospital for Children in Wilmington, DE. T: 302-651-4968; 

E: mlutzste@nemours.org 

Head Start Bulletin 25 
Child Mental Health 

PREVALENCE DATA ON MENTAL HEALTH PROBLEMS 

National Prevalence Data 

Research conducted over the past two decades has produced a range of findings about the prevalence rate of mental 

health problems in children. For instance, Campbell (1995) 

estimated that approximately 10-15% of all typically developing preschool children have chronic to moderate levels of 

behavior problems. Similarly, other researchers (BriggsGowan, et al. 2001) found 10-15% of one-and two-year-old 

children experience significant social and emotional problems. 

However, another study found the prevalence of young children with behavioral or emotional challenges to be as high as 

30-50% (Qi & Kaiser 2003). 

There are many reasons why the findings vary. Studies 

may define mental health problems differently (identify different symptoms and criteria); they study different populations 

(geographically, demographically); and they use different measurement techniques (parent surveys, clinical diagnoses). 

Despite the variations in the prevalence findings, 

research consistently suggests that children from low-income 

families are more vulnerable to developing behavior problems than children from the general population and that 

behavior problems in early childhood remain stable over 

time and often predict additional problems (Qi & Kaiser 

2003). The research on prevalence of young children with 

mental health problems underscores the critical importance 

of Head Start’s mental health services. 

Head Start and Early Head Start Data 

Head Start and Early Head Start (EHS) programs are 

required to report on certain indicators of the need for and 

delivery of mental health services for children enrolled in 

their programs. Data collected from Head Start’s FY 2006­

07 Program Information Report (PIR) indicate that: 

� Mental health professionals provided consultation to 

staff regarding children’s behavior/mental health for 

over 143,000 Head Start and EHS children (13.5% 

of all enrolled children); for over 47,000 (nearly 

one-third) of these children, staff received three or 

more consultations. 

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For over 60,000 children, (5.7% of all enrolled children) at least one behavioral/ mental health consultation was provided to a parent by the program’s mental health professional; for over 25,000 (nearly half) 

of these children, parents received three or more consultations. 

About 22,700 children (2.1% of all enrolled children) 

were referred for mental health services outside of 

Head Start or EHS; about 16,700 (nearly three-quarters) of these children received mental health services 

from an external provider. ■ 

Compared to the national prevalence data, the PIR data may 

underestimate the true number of Head Start and EHS children 

who have mental health needs. Some possible reasons are selfreporting and insufficient screening and diagnosis. Head Start and 

EHS programs are committed to doing a better job of identifying 

needs and connecting children and families to appropriate mental 

health services. 

REFERENCES 

Briggs-Gowan, M., A. Carter, E. Skuban, & S. Horwitz. 

Prevalence of social-emotional and behavioral problems 

in a community sample of 1-and-2 year old children. 

Journal of American Academy of Adolescent Psychiatry, 

2001 July; 40(7): 811-819. 

Campbell, S. B. (1995). Behavior problems in preschool children: A review of recent research. Journal of Child 

Psychology and Psychiatry, 36, 113-149. 

Qi C.H. & A. Kaiser. 2003. Behavior problems of preschool 

children from low-income families: Review of literature. 

Topics in Early Childhood Special Education, 23. 

U.S. Department of Health and Human Services. 1999. 

Mental health: A report of the Surgeon General. 

Rockville, MD: U.S. Department of Health and Human 

Services, Substance Abuse and Mental Health Services 

Administration, Center for Mental Health Services, 

National Institutes of Health, National Institute of 

Mental Health. Available at www.surgeongeneral.gov/ 

library/mentalhealth/home.html 

26 2009
 
Child Mental Health 

THE POWER AND VALUE OF PLAY
 

Child-directed, unstructured play promotes social and 

emotional development in young children. by Amy Hunter 

Play is essential to a child’s physical, social, emotional, 

and cognitive development. It is the outward expression of 

children’s inner, emotional life. Play also offers young children, including infants and toddlers, many rich learning 

opportunities, such as learning how to: 

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�

�

Organize and make sense of their experiences. As I 

roll this ball, I’m discovering how to control and use 

my body. 

Discover and explore the world. When the ball rolls 

away and under the table, I am learning how things 

move and fit in space. 

Relate to others. I feel delighted and powerful when I 

point to the ball and you roll it back to me. 

Play is so critical to children’s development that the 

American Academy of Pediatrics has released a clinical report 

that outlines the importance of play and encourages pediatricians to support parents in encouraging children to participate 

in child-directed, unstructured play (Ginsburg et al. 2007). 

Parents and caregivers can understand a great deal about 

what children are feeling and thinking by watching their play. 

Their play reflects themes common to their stage of development as well as the individual’s own experience. Infants and 

toddlers who are not yet capable of using words can use play 

to demonstrate and express how they feel. Older, more verbal 

children may feel safer playing out their angry, confusing, or 

upsetting feelings than speaking about them. Because play is 

such a central and powerful activity for young children, it is 

widely considered the appropriate therapeutic medium for 

helping young children resolve conflicts or difficulties. 

The following vignettes illustrate a few ways in which 

young children use play to learn and/or to heal and cope 

with challenges. 

Pretend play promotes all aspects of development. 

Kadyn 

Five-month-old Kadyn delights in peek-a-boo. As her 

caregiver, John, covers his face, Kadyn kicks her feet and 

shows a curious interest. She likely wonders, “Where did 

Photo courtesy of MSHS Telamon, Corporation TN. 

John go?” As John uncovers his face, Kadyn’s eyes widen, 

and she smiles, coos, and giggles, as if to say, “more, more, 

more.” Kadyn and John play this game of peek-a-boo over 

and over, day after day. 

What is Kadyn learning in this very familiar game? She 

is beginning to learn object permanence. In other words, 

she is learning that when John is hidden, he didn’t really 

go away. Kadyn is learning about predictability and the 

give-and-take of social games. Emotionally, she is learning 

that playing games with an attentive and caring adult is 

enjoyable. Through this interaction, Kadyn is learning and 

internalizing that she is a worthwhile, loveable baby with 

whom her caregiver likes to spend time. She is learning the 

meaning of language as John repeats words with his 

actions. Over time, John makes peek-a-boo more complex 

by hiding other objects and helping Kadyn to hide herself. 

As her mobility increases, Kadyn uses her gross and fine 

motor skills to grasp and move the blanket and to actively 

search for objects. Kadyn is practicing problem-solving 

skills as she figures out where to search. She is refining her 

visual discrimination skills as she distinguishes the differences between objects. 

Head Start Bulletin 27 
Child Mental Health 

THE POWER AND VALUE OF PLAY 

Tommy 

Three-year-old Tommy’s favorite game was “I scare 

you.” In this game, Tommy would “hide,” and I, his play 

therapist, would “look” for him, asking out loud if he was 

“behind the desk” or “behind the couch.” He would giggle 

and tell me he wasn’t in any of those spaces. As I would 

gradually approach his “secret hiding spot,” he would jump 

out and “scare” me. He got a thrill from “surprising” and 

“scaring” me. Sometimes when I went to find Tommy, he 

would explain he was “dead,” only to come alive and scare 

me a few seconds later. Tommy played this “scare” game 

over and over, week after week in our therapy sessions. 

At home, Tommy had observed his mother endure 

domestic violence, and he often hid. Although he was too 

young to express his complex feelings using words, he 

likely felt helpless and scared. As Tommy’s therapist, I 

encouraged him to play out his game in the safe space of 

the therapy room. By scaring me, Tommy was playing a 

powerful role in which he was no longer scared and helpless but instead was in control. Tommy was using play to 

help him develop a better understanding of the scary things 

he experienced. 

Jacob 

Four-year-old Jacob plays out an elaborate scene of 

“cooking” for friends. He “reads” the recipe, measures the 

“ingredients” with a measuring cup, and stirs the bowl. As 

he tells his fellow players where to sit, he turns to another 

child standing on the outskirts and tells her, “You can’t 

come to my party.” To another child, Jacob says, “We 

already have four people,” referring to a classroom rule. 

Through play, Jacob is practicing tasks and roles he 

has observed at home. He is using abstraction, verbalization, as well as pre-math and pre-literacy skills. The children are learning and experimenting with rules, social 

roles, and social skills. Language skills are being developed. Emotional skills are being tested as the children are 

challenged by directions, words, and actions that they 

don’t like. Negotiations take place to attempt to problem 

solve. Pretend play, like Jacob’s, has been found to be 

directly and positively linked to school readiness. 

Because play is such 

a central and powerful 

activity for young children, 

it is widely considered an 

appropriate therapeutic 

medium. 

Sienna and Friends 

Five-year-old Sienna and her friends often gravitated 

outside in the direction of stacked crates. They would 

climb onto this precarious structure and try to balance. 

Sometimes the children on the ground would shake the 

structure while the child on top tried to maintain her balance before tumbling off. 

The community had recently experienced a powerful 

earthquake, and residents were now living in a temporary 

shelter. A mental health consultant working with the community wondered if the children were acting out being 

shaken and out of control. By recreating their own “earthquake,” they were attempting to integrate, understand, and 

master their experience. 

At the consultant’s suggestion, a gym was used to 

create a safe place where the children could build precarious structures with safe materials and mats to fall onto. 

The children were encouraged to talk about their experience and to paint, draw pictures, and make books about 

their experience. The consultant talked with teachers, parents, and shelter staff about ways to talk to the young children about the earthquake. 

28 2009 
Child Mental Health 

How to Support Play 

In today’s push for academic and cognitive outcomes for 

even the youngest children, the value of the learning that 

takes place from unstructured, child-initiated play is often 

lost. Parents and caregivers may need guidance about how 

they can support play. Useful strategies include: 

Recognizing the value of play. Maximize children’s 

learning by understanding and describing to others that 

what looks like play is in fact how children learn, explore, 

and discover. Facilitate children’s development by validating 

and respecting children’s use of play as a vehicle for their 

social, emotional, physical, and cognitive development. 

Providing opportunities for young children to imitate 

and explore in the context of secure, safe, nurturing, and 

consistent relationships. As you offer acceptance and interest 

in a young child’s play you will be creating interactions that 

build a positive relationship. 

Following the child’s lead. Become involved only as you 

are invited to do so. Respond to the child’s inquiries, but do 

not take over the direction of the play. Your interest communicates: “What interests you is important to me. You are 

important to me.” 

Observing and documenting the child’s play, including 

his or her actions and verbalizations. Look for patterns or 

repetition in children’s play. Notice the feelings that the child 

is expressing. Use reflective supervision, consultation, or 

staff meetings to explore the potential meaning of play for a 

child or group of children. 

Allowing repetitive play. Young children repeat play in 

order to master a challenge or task. The more you allow 

time for the child to master the challenge or skill, the more 

likely she will take on new challenges. 

Accepting expressions of intense feelings. Avoid judging the child’s language or play. If a child angrily says, 

“I’m going to hit you,” avoid comments, such as “That’s 

not nice,” “You’re being mean,” or “Play nicely.” Instead, 

validate the child’s feelings. Say, “It sounds like you’re 

really angry.” Encourage safe play, such as offering paint 

to create an angry picture or providing dolls to act out 

the situation. 

Trying to understand the value, meaning, and cultural 

context of a child’s play before imposing limits or restrictions. 

For example, gun play, while threatening or symbolically 

unsafe, may reflect children’s experiences as witnesses to hunting, gun activity, or violent television, movies, or video games. 

Consider ways to explore the play or redirect it to be safe for 

all children. Ask about what may happen next or suggest rescue props for the injured. Ask how the injured feels, how they 

can make peace, and how they might solve the problem in 

other ways. 

Play is essential to children’s social and emotional 

development. It offers them opportunities to develop their 

interpersonal skills and a safe place to express their feelings and concerns. Although play seems to come naturally 

to young children, adults can learn how to appreciate its 

value and meaning. 

While all caregivers can learn to facilitate young children’s play, some children and caregivers may benefit from 

a trained play therapist who can help caregivers understand children’s play as well as help children with the way 

they think or feel, develop problem-solving skills, and 

resolve conflicts. 

For more information on play therapy, visit the 

Association for Play Therapy at www.a4pt.org/ 

ps.playtherapy.cfm?ID=1158. ■ 

REFERENCES 

Ginsburg, K.R., et al. 2007. The importance of play in promoting healthy child development and maintaining 

strong parent-child bonds. Pediatrics. 119(1): 182-191. 

Available at http://aap.org/pressroom/playFINAL.pdf 

Amy Hunter is an Early Childhood Mental Health Specialist 

at the Early Head Start National Resource Center in 

Washington, D.C. and is a former Head Start Fellow. 

T: 202-857-2679. E: ahunter@zerotothree.org 

Head Start Bulletin 29 
Child Mental Health 

TRAUMA IN THE LIVES OF EHS CHILDREN
 

Research provides guidance on how programs can support 

children and families who have experienced trauma. 

by Neena Malik, Sherryl Heller, and 

Rachel Chazan-Cohen 

Ruby was a 21⁄2-year-old enrolled in Early Head Start 

who suddenly began exhibiting kicking and biting behaviors. 

She and her mother, Karen, had recently moved after a violent episode involving Ruby’s father. During a heated argument, while Karen was holding Ruby, Ruby’s father pushed 

Karen, nearly causing mother and daughter to fall down the 

stairs. Karen was not sure if Ruby knew what happened, 

since she never talked about it. EHS staff worried about 

Karen and Ruby and were having a hard time managing 

Ruby’s behavior in class. 

Trauma is a dangerous or threatening act or series of 

events that are beyond what a child would be expected to 

experience in the course of everyday life. In recent years, the 

early childhood field has come to recognize the implications 

of trauma for young children. Research shows that traumatic events have significant effects on young children, 

whether the trauma is a single event or an ongoing stressful 

situation. Both Early Head Start (EHS) and Head Start, as 

child development and family-focused programs, are 

uniquely able to help families recognize how trauma affects 

their lives and to support their developing coping strategies. 

Research on Trauma 

The Early Promotion and Intervention Research 

Consortium (E-PIRC) projects were designed to develop and 

test approaches to supporting the mental health of infants, 

toddlers, and their families in EHS. The findings from these 

studies also are relevant for older children in Head Start 

programs and their families. The five E-PIRC projects were 

partnerships between academic institutions and EHS programs funded by the Head Start Bureau (now OHS) and the 

Office of Planning, Research, and Evaluation (OPRE). (See 

the article “The Early Promotion and Intervention Research 

Consortium (E-PIRC)” in this Bulletin.) 

Photo by J. Brough Schamp. Higher Horizons HS/EHS. 

Findings from two E-PIRC studies: Infusing Infant 

Mental Health Services in Early Head Start through a 

Research-Based Collaborative Partnership conducted by 

the University of Miami and High-Risk Adolescent 

Mothers and Their Children: Comparing Two Preventative 

Interventions conducted by Tulane University are highlighted here. They provide guidance to programs serving 

young children. 

Having dolls and other toys available may help children play out memories 

of a traumatic event. 

Prevalence of Trauma in EHS Families 

The University of Miami E-PIRC study found that 

71% of the young children in the study had experienced at 

least one trauma. Many children experienced more than 

one trauma. 

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38% of children experienced a serious illness or injury. 

23% experienced a prolonged separation from their 

primary caregiver and/or had experienced eviction 

and/or homelessness. 

21% experienced the death of a close relative. 

11% experienced the serious injury or illness of a 

close relative. 

30 2009 
Child Mental Health 

� 9% were in or witnessed a serious accident. 

Children also were exposed to violence in the community and home. 

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39% of parents reported that people in the family 

threw objects, hit each other, or lost their tempers. 

30% of children witnessed violence in their communities/neighborhoods. 

15% witnessed a close relative being attacked 


or beaten.
 

Trauma Symptoms in Young Children 

The University of Miami study found that 44% of the 

children were reported by parents to be experiencing trauma 

symptoms. The children evidenced: 

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Re-experiencing: playing out memories of the event in 

verbalization, play, or behavior 

Sleep problems: trouble falling asleep and nightmares 

Eating problems: over-eating or finicky eating 

Regression in developmental functioning or acting like 

a baby 

Withdrawal: talking less, avoiding interactions, seeming less joyful 

Onset of new fears 

Aggressive outbursts or increase in activity level 

Increased clinginess/separation anxiety 

Preoccupation with the traumatic event: bringing up 

the episode in ways that are repetitious, pressured, 

or uncontrollable 

The E-PIRC research from the University of Miami and 

from Tulane University helps inform EHS and Head Start 

staff about how to support children who have experienced 

trauma, their families, and the staff who care for them. 

Staff Interactions With the Child 

When interacting with the child, the following principles 

can be helpful: 

� Have patience. By being understanding, staff can provide extra support to children. 

� Support the child emotionally. When young children 

experience trauma, they can lose control. Taking them 

aside, patiently talking with them in a soothing way, 

and allowing them a few minutes alone or in a quiet 

spot will help them regain emotional control. Some 

children, both EHS and Head Start children, may 

need physical comfort. When the child calms down, 

praise them for regaining control, helping to reinforce 

the positive behavior. 

� Help children label how they feel. Give children
 

words to express their feelings and gain control. 


� Follow the child’s lead. An out-of-control child may 

be telling us he needs nurturing, a few moments 

alone, or help saying how he feels. 

� Provide safety and trust with predictable routines and 

calm interaction. A calm word or two to a child will 

help focus her, calm her down, and make her feel 

cared for. Maintaining predictable routines and schedules can also help the child feel secure. 

� Promote children’s play as an opportunity to express 

their feelings and gain mastery over events in their 

lives. Make props available to support their play. Also, 

encourage children to use drawing, painting, dancing, 

or other artistic avenues to express their feelings. 

� Prepare them for change or transition, even in everyday activities. Quick, gentle reminders can help with a 

child’s ability to control his behavior. 

� Understand regressive behavior. When a child who 

has behaved in an age-appropriate way regresses in 

areas such as language, sleeping habits, eating 

habits, or behavioral control, she may have had a 

trauma and needs some extra nurturing or possibly 

some professional intervention. 

When Ruby would lose control, staff learned to take 

turns, depending on who felt most patient at the time. Staff 

soon realized that her behavior was not manipulative, but 

an indication that she needed help and comfort. They 

would gently pick up Ruby after she fought with another 

child or if she was having a tantrum. They separated her 

from others and gently helped her say what she felt. 

Head Start Bulletin 31 
Child Mental Health 

TRAUMA IN THE LIVES OF EHS CHILDREN 

Sometimes they asked Ruby what she needed to feel better, 

and she sometimes was able to say she wanted a hug, a 

book, or a drink of water. To help Ruby deal with transitions, staff emphasized their everyday practice of telling the 

whole class when they were going to go out to play or 

when they would need to clean up. 

Paying close attention 

to behavior changes 

in children can help 

staff recognize signs 

of trauma. 

Staff Interactions With the Child’s Parent 

When interacting with the parent, remember that parents may also have been traumatized. They may need support and perhaps a referral to a mental health specialist. 

Parents may also need patience and help with understanding 

child behaviors. Staff should support the parent-child relationship by helping parents use the same principles with children that are listed above. 

Ruby’s mother was traumatized, too, and didn’t quite 

realize how traumatized Ruby was. But when a parent feels 

unsafe, a child feels it, too. Staff helped Karen realize that 

Ruby probably suffered some consequences of the trauma. 

Staff also praised Karen and told her how impressed they 

were that she was able to protect Ruby so well. They were 

gentle and patient with Karen when she had trouble with 

Ruby. They suggested to Karen that she talk to the social 

worker to get some support for herself. 

Supporting Staff 

Staff who work with children and families who have 

experienced trauma may experience compassion fatigue 

and/or sadness. They may experience some of the same 

symptoms as the traumatized families they serve: nightmares, sense of disconnection from loved ones, work addiction, sense of hopelessness, heightened startle response, 

increased sensitivity to violence, and professional burnout. 

Staff can support one another through reflective 

supervision, peer support, and self-care strategies. These 

strategies include: avoiding professional isolation, knowing your vulnerabilities, knowing when to say “no,” 

respecting your boundaries, balancing work and personal 

life, developing realistic self-expectations, and addressing 

your own feelings. 

In Ruby’s case, program staff recognized how hard it was 

to care for her along with all the other children. After talking 

with one another and their supervisors, they decided to take 

turns working with Ruby and her mother. They paid attention 

to how they themselves felt. Talking about how frustrated or 

sad they felt helped them to support one another and helped 

them to acknowledge the difficulties without feeling guilty. 

Conclusion 

Trauma impacts children, parents, and program staff. 

Paying close attention to behavior changes in EHS and Head 

Start children can help staff recognize signs of trauma and 

provide appropriate support to the child, family, and other 

program staff as they cope with life’s uncontrollable events. ■ 

Neena M. Malik is a Scientist and Psychology Training 

Director in the Department of Pediatrics at the University of 

Miami School of Medicine in Florida. T: 305-243-6857; E: 

nmalik@med.miami.edu 

Sherryl S. Heller is a consultant for Early Head Start and for 

the Tulane Institute of Infant and Early Childhood Mental 

Health. T: 504-988-8686; E: sheller1@tulane.edu 

Rachel Chazan-Cohen is a Senior Research Analyst in the 

Office of Planning, Research and Evaluation at the 

Administration for Children and Families. T: 202-205-8810; 

E: rccohen@acf.hhs.gov 

32 2009 
Child Mental Health 

THREE SOURCES OF RESILIENCE
 Photo by J. Brough Schamp. Higher Horizons HS/EHS. 

An international study indicates that parents and caregivers 

can do more to promote resilience in children. 

by Edith Grotberg 

Day in and day out, all around the world, children 

encounter difficult situations in their families and communities. When children face illness, separation, death, or natural 

catastrophes, they feel lonely, fearful, and vulnerable. These 

feelings can overwhelm them and diminish their capacity to 

learn and grow. But when children have the skills, attitudes, 

beliefs, and resources of resilience, they can prevent, minimize or overcome these traumas. 

Resilience may be described as the human capacity to 

face, overcome, and be strengthened by or even transformed 

by the adversities of life. Although some languages do not 

have a word for resilience, most people around the world 

understand the idea. They understand that people overcome 

adversity with courage, skills, and faith. 

Taking an International Perspective 

The International Resilience Project set out to examine 

what parents, caregivers or children do that promotes 

resilience. Participants from 30 countries were asked about 

their own experiences of adversity and their reactions (see 

the checklist in the Bulletin pull-out). A total of 589 children 

participated as well as their families and caregivers. Boys 

and girls were equally represented; half were 9-11 years and 

the remainder were 6 or younger. 

Resilience helps 

children respond 

to adversity. 

Taking a Close Look at Resilience 

The findings suggest that every country in the study was 

drawing on a common set of resilience factors to promote 

resilience in children. The project identified three factors: 

I have, I am, I can. 

The I have factors are the external supports and 

resources that promote feelings of safety and security. 

Originating in early childhood, these factors are the core for 

developing resilience. 

The resilient child says I have: 

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People around me I trust and who love me, no matter 

what 

People who set limits for me so I know when to stop 

before there is danger or trouble 

People who show me how to do things right by the 

way they do things 

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People who want me to learn to do things on my own 

People who help me when I am sick, in danger or
 

need to learn
 

The I am factors are the child’s internal, personal 

strengths. These are feelings, attitudes, and beliefs within 

the child. 

The resilient child says I am: 

� A person people can like and love 

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Glad to do nice things for others and show my concern 

Respectful of myself and others 

Willing to be responsible for what I do 

Sure things will be all right 

The I can factors are the child’s social and interpersonal 

skills. Children learn these skills by interacting with others 

and from those who teach them. 

Head Start Bulletin 33 
THREE SOURCES OF RESILIENCE 

Child Mental Health 

The resilient child says I can: 

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Talk to others about things that frighten me or
 

bother me 


Find ways to solve problems that I face 

Control myself when I feel like doing something not 

right or dangerous 

Figure out when it is a good time to talk to someone 

or to take action 

Find someone to help me when I need it 

Each of the I have, I am, I can factors suggest numerous 

actions that children, parents, and other caregivers can take 

to promote resilience. No one child or adult will use or need 

the entire pool of resilience factors. However, the more factors that are available to them, the more flexible they can be 

when they respond to adversity. 

Taking a Developmental Perspective 

At different ages, children rely more or less heavily on their 

I have, I am, and I can resources. As children grow, they 

increasingly shift their reliance from outside supports (I have) to 

their own skills (I can), while continually building and strengthening their personal attitudes and feelings (I am). Just as the 

resilience skills used by children vary at different ages, so must 

parents and other caregivers vary their resilience-promoting language and behavior to match the child’s developmental stage. 

Along with the child’s family, Head Start staff can promote resilience in the first three years of life in many ways. 

They can: 

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Provide unconditional love and express love both physically and verbally 

Acknowledge and label the child’s feelings 

Balance the freedom to explore with safe supports 

Model behavior that communicates confidence 


and optimism
 

Encourage the child to try things and do them on 


her own
 

The baby is lying in the crib, crying and kicking his 

feet. You do not know what is wrong. He just keeps crying 

and kicking. 

You promote resilience if you pick him up and begin 

to soothe him while finding out if he is wet, too cold or 

too hot, needs patting on his back to remove air, or mainly 

needs comforting (I have). You help him calm down if he 

feels loved and cared for (I am) and if he can begin to calm 

himself down (I can). 

The toddler is at the store with you. She sees some candy, 

grabs it, and starts to eat it. When you try to take it away, 

she shouts, “No! Mine, mine!” 

You promote resilience if you remove her from the situation so you do not disturb others, explain calmly that she 

cannot take things without your permission, and give her 

something else to hold onto (a shopping item). You help her 

understand limits of behavior (I have), help her feel responsible for her own behavior (I am), and communicate with 

her as she listens (I can). 

For preschoolers, 3-5 years of age, Head Start staff, 

along with the child’s family, can promote resilience in 

numerous ways. They can: 

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Express love verbally 

Praise the child for accomplishments 

Encourage the child to take independent action 

Offer explanations along with rules 

Show empathy and caring 

A mother had to go to another city to find a job and 

could not take her four-year-old daughter because there 

was no one to care for her and she could not afford child 

care there. 

You promote resilience if you explain to your daughter 

that you are going to take a job so you can have money to 

rent a place for both of you. You tell her how much you 

love her and that she will stay with your sister and still continue to go to Head Start (I have). You let her protest and 

assure her you love her (I am) and will talk with her on the 

phone. You let her ask questions and express feelings (I can), 

but help her understand that this is a necessary move. 

How parents and other caregivers respond to situations 

and assist a child to respond can either promote resilience or 

Continued on page 102 

34 2009 
A HEAD START BULLETIN PULL- OUT 

PROMOTING RESILIENCE IN YOUNG CHILDREN


Head Start children often encounter many adversities in their first five years. Some face stresses such as divorce or illness or 

moving, while others confront catastrophe, maybe a natural disaster or war in their homeland. Whether these experiences in 

their families and communities overwhelm or strengthen a child depends, in part, on his or her resilience. Researchers define 

resilience as a “universal capacity which allows a person, group, or community to prevent, minimize, or overcome the 

damaging effects of adversity” (Grotberg 1995). With resilience, children can triumph over trauma. 

How do you know when children are developing resilience? What are the features of resilient children? What strengths can 

you identify and nurture in Head Start children? 

You can use this checklist to provide a general sense of resilience in a child (Grotberg 1995). First, check the statements that 

describe the child. Many apply to children of all ages—all children need love and trust, and all children need to try new 

things. Some statements need to be interpreted differently depending on the child’s developmental level. For example, how a 

toddler focuses on a task or makes a plan differs from a preschooler’s approach. 

After you complete the checklist, think about how you, as Head Start staff or parent, can continue to promote resilience in 

this young child. 

Child’s Name: __________________ Age: __________ 

I. Features of Resilience 

1. _____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

The child has someone who loves him/her unconditionally. 

2. The child has an older person outside the home she/he can tell about problems or feelings. 

3. The child is praised for doing things on his/her own. 

4. The child can count on her/his family being there when needed. 

5. The child knows someone he/she wants to be like. 

6. The child believes things will turn out all right. 

7. The child does endearing things that make people like her/him. 

8. The child believes in a power greater than seen. 

9. The child is willing to try new things. 

10. The child likes to achieve in what he/she does. 

11. The child feels that what she/he does makes a difference in how things come out. 

12. The child likes himself/herself. 

13. The child can focus on a task and stay with it. 

14. The child has a sense of humor. 

15. The child makes plans to do things. 

II. What can I do to help this child develop resilience? 

Grotberg, E. 1995. A guide to promoting resilience in children: Strengthening the human spirit. The Hague: Bernard van 

Leer Foundation. 

Head Start Bulletin 35 
HOJA DESPRENDIBLE DE BOLETIN DE HEAD START 

PROMOVIENDO LA RESILENCIA EN NIÑOS 

PEQUEÑOS

Los niños de Head Start con frecuencia se enfrentan a muchas adversidades durante los primeros cinco años de vida. Algunos 

enfrentan situaciones estresantes tales como divorcio, enfermedades, mudanzas mientras otros enfrentan catástrofes— desastres 

naturales o guerra en su país de origen. Sea que estas experiencias en sus familias y sus comunidades oprima o fortalezca al niño 

depende, en parte de su resilencia. Los investigadores definen la resilencia como “la capacidad universal que le permite a la persona, 

grupo o comunidad el prevenir, minimizar, o sobreponerse a los efectos nocivos de la adversidad” (Grotberg 1995). Con resilencia, 

los niños pueden triunfar sobre el trauma. 

¿Cómo sabe usted cuando los niños están desarrollando resilencia? ¿Cuáles son las características del niño resilente? ¿Cuáles son las 

fortalezas que puede usted identificar y fomentar en los niños de Head Start? 

Usted puede utilizar esta lista de referencia para proveer el sentido general de la resilencia en el niño (Grotberg 1995). Primero 

repase los enunciados que describen al niño. Muchos aplican a niños de todas las edades—todos los niños necesitan amor y 

confianza, y necesitan probar nuevas cosas. Algunos enunciados necesitan ser interpretados de forma diferente dependiendo del nivel 

de desarrollo del niño, tales como un niño pequeño o en edad preescolar se enfoca en las tareas o hace que un plan sea diferente. 

Después de completar la lista de referencia, piense como usted, como personal de Head Start o padre, puede continuar promoviendo 

la resilencia en estos niños pequeños. 

Nombre del Niño: __________________	 Edad: __________ 

I. Características de la Resilencia 

1. _____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

_____ 

El niño/niña tiene alguien que lo ama incondicionalmente. 

2.	 El niño tiene una persona mayor fuera de la casa a la cual le puede contar sus 

problemas o sentimientos. 

3. El niño es reconocido por hacer cosas por sí solo. 

4. El niño/niña puede contar con que su familia este ahí cuando la necesite. 

5. El niño sabe como quien el/ella quiere ser cuando sea grande. 

6. El niño confía en que las cosas saldrán bien. 

7. El niño realiza cosas con cariño que hacen que el/ella les agrade a las personas. 

8. El niño cree en un poder más grande de lo que se puede percibir. 

9. El niño esta dispuesto a tratar cosas nuevas. 

10. El niño le gusta tener éxito en las cosas que el/ella realizan. 

11. El niño siente que lo que el/ella realiza hace la diferencia en como las cosas resultan al final. 

12. El niño esta contento con el/ella mismo/a. 

13. El niño se puede enfocar en una tarea hasta terminarla. 

14. El niño tiene sentido de humor. 

15. El niño planifica para hacer cosas. 

II. ¿Qué puedo hacer para ayudar a este niño a desarrollar la resilencia? 

Grotberg, E. 1995. A guide to promoting resilience in children: Strengthening the human spirit. The Hague: Bernard van Leer Foundation. 

36 2009 
Child Mental Health 

BY	 J. ONI DAKHARI & C OLLEEN S HERMAN 

POST-TRAUMATIC STRESS DISORDER IN CHILDREN
 

Post-traumatic Stress Disorder (PTSD) is a condition 

that may develop after experiencing or hearing about 

trauma. PTSD research, historically focused on adults, is 

now investigating infant, toddler, and preschool populations. 

Research suggests that children as young as 18 months are 

Caregivers should know about the 

common symptoms of PTSD displayed

by young children and understand 

their vital role in providing support 

and making referrals. 

 

developmentally capable of PTSD (Pfefferbaum 1997). 

Common symptoms displayed by young children include: 

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sleep problems; irritability (e.g., tantrums) 

separation anxiety; aggression and new fears (e.g., hitting, kicking, fear of the dark) 

numbing or avoidance of trauma reminders; being 

always on the lookout for danger (e.g., exaggerated 

startle response) 

loss of or regression in developmental skills (e.g., 

speech, toileting, acting younger) 

re-experiencing (e.g., compulsive re-enactment of the 

trauma, recurrent statements or questions about the 

event, repeated nightmares linked to trauma) 

Caregivers play a vital role in observing behavior, providing support, and recommending professional services. 

Caregivers suspecting PTSD symptoms are encouraged to listen and be available to children to talk about scary and confusing feelings and to respond to children’s questions calmly. 

They need to use age-appropriate language and keep in mind 

the child’s individual situation (e.g., sensitivity, social support, chronic life-adversity, family functioning, trauma history/subsequent trauma). 

Caregivers also should remember 

that children at different developmental 

levels respond differently to trauma. 

Even so, children at similar developmental levels can react differently to the same 

event, and a child’s response may change 

over time. As much as possible, caregivers should provide consistent and caring but firm discipline and try to keep 

normal routines. 

While aspects of PTSD can be 

expected or even an adaptive response to trauma, children 

who are developing signs of PTSD should be referred early for 

mental health services to maximize adjustment. 

REFERENCES 

Pfefferbaum, B. 1997. Posttraumatic stress disorder in children: A review of the past 10 years. Journal of the 

American Academy of Child & Adolescent Psychiatry 

36(11): 1503-1511. 

J. Oni Dakhari is a pediatric pyschologist at the Wexford 

Medical Center, Cherry Hill, NJ. T: 856-796-3392; 

E: onidakhari@aol.com 

Colleen Sherman is a pediatric psychologist at A.I. duPont 

Hospital for Children, Wilmington, DE. T: 302-651-4515; 

E: csherman@nemours.org 

Head Start Bulletin 37 
Child Mental Health 

HELPING PRESCHOOLERS DEVELOP SELF-CONCEPT
 

AND SELF-CONTROL
 

Positive social and emotional development is a foundation for life-long learning. 

This article is adapted from The Head Start Leaders 

Guide to Positive Child Outcomes (Head Start Bureau 

2003). The Guide includes descriptions of each of the 8 

Domains of the Child Outcomes Framework and suggestions for effective teaching practices. The Outcomes 

Framework provides a comprehensive set of learning and 

developmental goals for 3-to 5-year-olds in Head Start. The 

Domain of Social and Emotional Development includes the 

Domain Elements of self-concept and self-control. As teaching teams help preschoolers develop an understanding of 

self, demonstrate independence, express confidence (self-concept), and learn how to express their feelings, how their 

actions affect others, and how to follow rules (self-control), 

they will be promoting the mental health and resilience of 

young children. 

Promoting young children’s social and emotional development is vital for three interrelated reasons: 

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Positive social and emotional development provides a 

base for life-long learning. 

Social skills and emotional self-regulation are integrally related to later academic success in school. 

Prevention of future social and behavioral difficulties 

is more effective than later remediation. 

A major developmental task of the first five years of life 

is the development of self-regulation in its broadest sense. In 

fact, “providing the experiences that allow children to take 

over and self-regulate in one aspect of their lives after 

another is a very general description of the job of the parents, teachers, and protectors of children that extends 

throughout early childhood and into the adolescent years” 

(Shonkoff & Phillips 2000, p. 94). This process begins in 

infancy as babies learn to regulate their crying, sleeping, and 

other behavior patterns. It extends during the preschool 

years to more complex self-regulation—the ability to control 

emotional states, to learn to delay gratification, to build 

relationships with other people, and to modulate other functions essential for healthy development (Shonkoff & Phillips 

2000). These developmental tasks are best accomplished 

during the preschool years because building positive social 

Photo by J. Brough Schamp. San Xavier Head Start. 

skills and healthy emotional relationships in young children 

is much easier than later trying to correct behavior and 

adjustment problems. 

In the school years too, social and emotional development is linked to academic success. A recent review of 

research on social and emotional risk and protective factors 

that predict early school problems or success found that 

“children who do not begin kindergarten socially and emotionally competent are often not successful in the early years 

of school—and can be plagued by behavioral, emotional, 

academic, and social development problems that follow them 

into adulthood” (The Child Mental Health Foundations and 

Agencies Network [FAN] 2000). The review describes a child 

who is socially and emotionally healthy and school-ready as 

someone who is confident and friendly, has good peer relationships, and is able to tackle and persevere at challenging 

tasks. The child also has effective communication skills and 

the ability to listen to instruction (FAN 2000). 

Promoting young children’s social and emotional development is a major responsibility of any early childhood program. Because so many Head Start children experience emotional and social risk factors, the Head Start program has 

the added responsibility of taking steps to help children 

38 2009 
Child Mental Health 

develop skills that contribute to resiliency. These steps 

include providing warm, positive relationships with teachers 

and other adults, helping children make friends with other 

children, and developing their interests and abilities. 

Domain Element: Self-Concept 

Self-concept—children’s stable perceptions about themselves despite variations in their behavior—is forming during 

the preschool years as children gain in reasoning and the 

ability to make comparisons between themselves and others. 

Their self-esteem, which comes in part from their perception 

of their own worth, is also in its formative stages during 

these years. 

Children are often overconfident about their own 

abilities in these years because their skills are developing 

rapidly. They often misjudge their capabilities in relation to 

others. Every child in the preschool class may state confidently, “I am the smartest” or “I am the fastest runner.” At 

the same time, their blossoming egos are fragile. Young children quickly become discouraged if they experience too 

much frustration or failure. During the preschool years, children develop a positive self-concept not only by being told 

they are special, but by taking initiative and succeeding at 

challenging tasks and by receiving specific adult encouragement related to a task or accomplishment. Therefore, it is 

important for the teaching team to observe children and 

track their progress in order to provide learning experiences 

that are appropriately challenging and that instill genuine 

feelings of success. 

Teaching strategies that promote self-control include: 

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�

�

Making sure the learning environment is welcoming 

to every child and reflects his identity and culture. 

Organizing the environment so children can independently choose their own activities for part of each day. 

Acknowledging and encouraging children’s efforts and 

accomplishments using specific feedback. For example, say, “You wrote your M” or “Thank you for 

helping Keisha with her coat,” rather than offering 

nonspecific praise such as, “That’s really nice.” 

Photo by J. Brough Schamp. San Xavier Head Start. 

Receiving adult encouragement at challenging tasks promotes a positive 

self-concept. 

Domain Element: Self-Control 

The preschool years are the prime time for children to 

acquire self-control, the ability to recognize and regulate their 

own emotions and behaviors. By preschool, most children 

have acquired sufficient language to begin using speaking and 

listening skills to solve social problems. 

Teachers of young children frequently report that their 

toughest problem is dealing with children exhibiting challenging behaviors—children who are hostile, are physically 

aggressive, and do not follow the classroom rules. When 

children exhibit these behaviors, it is very easy for teachers 

to automatically react. The teachers’ understandable impatience and frustration can undermine their ability to think 

strategically about how to support young children’s prosocial behavior and self-control. Reacting to children’s challenging behavior is not an effective way to decrease challenging behavior—in fact, in most cases it causes the behavior to 

get worse! So what is a teacher to do? Research has shown 

that teachers can structure the physical arrangement of the 

classroom, the schedule and transitions, the planned experiences, and the interactions they have with children to simultaneously decrease challenging behavior and increase prosocial skills such as self-control. 

Continued on page 102 

Head Start Bulletin 39 
Child Mental Health 

SOCIAL & EMOTIONAL DEVELOPMENT
 

Head Start Child Outcomes Framework 

Released in 2000, the Head Start Child Outcomes Framework is intended to guide Head Start programs in their curriculum 

planning and ongoing assessment of the progress and accomplishments of preschool children. The Framework also is helpful to 

programs in their efforts to analyze and use data on child outcomes in program self-assessment and continuous improvement. 

The Framework is composed of 8 general Domains, 27 Domain Elements, and numerous examples of specific Indicators of children’s skills, abilities, knowledge, and behaviors. The Domains include Language Development, Literacy, Mathematics, Science, 

Creative Arts, Social & Emotional Development, Approaches to Learning, and Physical Health & Development. The Domain of 

Social & Emotional Development is linked to a child’s mental health. 

DOMAIN 

ELEMENT DOMAIN INDICATORS SOCIAL & EMOTIONAL DEVELOPMENT 

◆ Begins to develop and express awareness of self in terms of specific abilities, 

characteristics, and preferences. 

SelfConcept

◆ Develops growing capacity for independence in a range of activities, routines, 

and tasks. 

◆ Demonstrates growing confidence in a range of abilities and expresses pride 

in accomplishments. 

◆ Shows progress in expressing feelings, needs, and opinions in difficult 

situations and conflicts without harming themselves, others, or property. SelfControl 

◆ Develops growing understanding of how their actions affect others and 

begins to accept the consequences of their actions. 

◆ Demonstrates increasing capacity to follow rules and routines and use 

materials purposefully, safely, and respectfully. 

◆ Increases abilities to sustain interactions with peers by helping, sharing, and discussion. 

◆ Shows increasing abilities to use compromise and discussion in working, 

playing, and resolving conflicts with peers. Cooperation ◆ Develops increasing abilities to give and take in interactions; to take turns 

in games or using materials; and to interact without being overly submissive 

or directive. 

◆ Demonstrates increasing comfort in talking with and accepting guidance and 

directions from a range of familiar adults. Social 

Relationships

◆ Shows progress in developing friendships with peers. 

◆ Progresses in responding sympathetically to peers who are in need, upset, 

hurt, or angry; and in expressing empathy or caring for others. 

◆ Develops ability to identify personal characteristics, including gender and Knowledge family composition. 

of 

Families & 

Communities

◆ Progresses in understanding similarities and respecting differences among people, 

such as genders, race, special needs, culture, language, and family structures. 

◆ Develops growing awareness of jobs and what is required to perform them. 

◆ Begins to express and understand concepts and language of geography in the 

contexts of the classroom, home, and community. 

40 2009 
Child Mental Health 

BY RICCO HALL 

NATIONAL MENTORING CHILDREN
 

OF PRISONERS PROGRAM
 

As many as 2 million children and 

youth in this country have at least one 

parent in a correctional facility. These 

youngsters are at risk—economically, 

socially, academically, and emotionally. 

Research has found that the longterm physical absence of a parent has 

profound effects on a child’s development. For instance, children of incarcerated parents are significantly more 

likely to become involved in the juvenile and adult criminal justice systems. 

Witnessing and living with the arrest 

and incarceration of a parent are devastating events for children and families. The living conditions, family configurations, and problems faced by the 

parents make it likely that significant 

numbers of children of prisoners will 

suffer emotional and behavioral difficulties. Family relationships are often 

strained, and any existing stability may 

be compromised. As a result, the 

majority of the children of prisoners 

experience multiple changes of caregivers and/or living arrangements. 

It has been demonstrated that 

mentoring is a potent force for 

improving youth outcomes. 

Mentoring increases the likelihood of 

regular school attendance and academic achievement. It also decreases 

the chances of engaging in selfdestructive or violent behavior. A 

trusting relationship with a caring 

adult will provide stability and often 

have a profound, life-changing effect 

on the child. 

The Mentoring Children of 

Prisoners (MCP) program was introduced by former President George W. 

Bush in his 2003 State of the Union 

Address. The program is administered 

by the Family and Youth Services 

Bureau, Administration for Children 

and Families in the U.S. Department of 

Health and Human Services (HHS). In 

Fiscal Year 2007, the MCP program 

was funded at $50 million; the threeyear grants support approximately 238 

grantees across the country. By the end 

of FY08, the MCP program served 

100,000 children ages 4-18. As former 

HHS Secretary Michael Leavitt said, 

“With these grants, we are helping 

train mentors and match them with 

children in need, because every child 

needs an enduring relationship with a 

caring adult.” 

What Are MCP Programs? 

Local MCP mentoring programs 

recruit, screen, train, and oversee volunteers who want to serve as positive 

role models. MCP mentors provide 

one-on-one time and are trained to 

encourage older children and youth to 

fully participate in school and become 

involved in civic and other community 

activities. Mentors provide safe and 

trusting relationships. 

MCP programs require that mentors commit to spending at least one 

hour per week with their assigned 

child for a period of at least one year. 

MCP programs are required to provide 

ongoing support and oversight of the 

mentoring relationship to ensure that 

young people are receiving appropriate 

support and are benefiting from the 

mentor match. Further, programs are 

required to monitor key outcomes on 

children and youth served by the initiative—including school performance 

and avoidance of risky behavior. 

With the reauthorization of the 

MCP in September 2006, a voucher 

demonstration was added to the program. More children will be able to be 

served throughout the country and 

beyond the geographic location of the 

current 238 MCP grantees. The 

voucher demonstration was implemented by the end of FY07. 

Success Stories 

Several MCP programs report 

having worked with Head Start families. In one case, a 5-year-old Head 

Start child was matched with a mentor. 

The child’s father was in prison, and 

the boy was exhibiting challenging 

behavior in the classroom. Head Start 

staff were concerned about his social, 

emotional, and cognitive development. 

Working closely with the child’s 

mother, Head Start staff helped 

arrange mentoring through the local 

MCP program. 

Each Sunday afternoon, the mentor picked the child up from his home. 

Sometimes they went for ice cream and 

to the park; sometimes they went to 

the library or went fishing. Head Start 

Head Start Bulletin 41 
Child Mental Health 

NATIONAL MENTORING CHILDREN OF PRISONERS PROGRAM 

staff and the child’s mother spoke regularly about his progress. After six 

months of a steady routine with the 

mentor, the child’s teacher reported 

that his classroom behavior had 

improved dramatically. He had 

become much more respectful and 

helpful to other children and to the 

teacher during activities. The mother 

and teacher were very impressed by 

the turnaround and credited the MCP 

with providing support to the child. 

Another Head Start program contacted the local MCP to work with an 

older brother of a Head Start child. 

The father was incarcerated, the 

mother had left the area, and the children were living with their grandmother. The older boy was defiant and 

uncommunicative. He fought with 

classmates and was told by friends and 

neighbors, “You’re gonna be just like 

your daddy.” His grandmother told 

the MCP staff that he needed a male 

mentor who could “teach him how to 

be a man and not be violent.” 

The mentor engaged the boy in 

playing basketball and watching local 

baseball games. After several 

months, they began focusing on the 

boy’s homework and even visiting 

local museums. His school performance improved. His grandmother 

reported that he had begun to talk 

with her and his mentor about his 

feelings of anger or sadness. In addition, the home atmosphere became 

calmer and more positive which benefited everyone, including the younger 

Head Start child. 

Mentors provide safe and trusting 

relationships. They offer one-on-one 

time and encourage children and 

youth to fully participate in school 

and community activities. 

What Can Head Start Programs Do? 

Mentoring services can be offered 

to preschoolers in Head Start or to 

their older siblings. Family Service 

Workers or other Head Start staff can 

explore the availability of this program 

in their own community by contacting 

the National Clearinghouse on 

Families and Youth at (301) 608-8098 

or email: info@ncfy.com. For general 

information regarding the MCP program, visit the Family and Youth 

Services Bureau Web site at: 

http://www.acf.hhs.gov/programs/fysb/ 

content/youthdivision/programs/mcpfa 

ctsheet.htm 

For additional information on 

how Head Start programs can work 

with children and families with an 

incarcerated father, see the article 

“Fathers for Life: Strengthening 

Families and Fatherhood” in this 

Bulletin about an Innovation and 

Improvement Project in Missouri dedicated to helping incarcerated fathers 

and their children. ■ 

After this article was accepted for 

publication, the following information 

was made available: There are several 

Head Start—MCP grantees, including 

the Sunbelt Human Advancement 

Resources (SHARE) located in South 

Carolina. The program received high 

level praise when former President 

George W. Bush and former ACYF 

Commissioner Joan E. Ohl visited 

MCP grantees across the country. 

Additional collaborative efforts to further enhance the MCP missions and 

goals have been underway since funding began. ACYF hopes to have a 

FY09 Program 

Announcement/Competitive Process 

Selection to award a new group of 

FY09-12 MCP grantees. 

Ricco Hall is a Program Specialist, 

Mentoring Children of Prisoners 

Project, at the Family and Youth 

Services Bureau. T: 202- 401-6968; E: 

ricco.hall@acf.hhs.gov 

42 2009 
Child Mental Health 

SHOULD I BE WORRIED? SUPPORTING 


LANGUAGE ACQUISITION
 

Caregivers can support children’s language acquisition in 

many ways. by Sylvia Y. Sánchez and Eva K. Thorp 

It’s story time in Ms. Carol’s Head Start class. Most of 

the preschoolers come eagerly to the library corner and 

find a cozy spot on the rug. But Elena, who has been playing alone with dolls, appears to be roaming aimlessly. 

Eventually, she sits down at the back of the group, at least 

four feet from the others. Ms. Carol invites her, “C’mon 

Elena, we’d love to have you join the group for our story.” 

But Elena shakes her head “no” and stays where she is 

without any expression or apparent interest in the story. 

Ms. Carol reads the story and engages in animated conversation about it with the children. Elena doesn’t participate. 

Her teacher is worried and wonders if something is wrong 

with Elena. She doesn’t seem to have any friends and most 

of the time seems disinterested in the activities. 

Ms. Carol is right to be concerned about behaviors 

that seem so different from what she is used to in the 

4-year-olds she teaches. Yet, it is important to know that 

Elena has only been in this class for a short time. It is 

the first time that she has been exposed to a structured 

classroom environment in which only English is spoken 

and where no one speaks her home language. In fact, 

the program does not have any staff who speaks Elena’s 

home language. 

However, this does not mean that it is OK for Elena to 

be uninvolved. The teaching staff needs to find ways to 

include Elena and to support her healthy social and emotional development during this transition. What does Ms. 

Carol need to know to better understand Elena’s behavior 

and to support her learning and development? 

Play offers many opportunities for teachers to promote language development. 

�

�

�

What Is It Like for Elena Right Now? 

First, it helps if Ms. Carol, like any caring adult who 

comes into contact with Elena, can “put herself in Elena’s 

place.” If the teaching staff can understand the challenges 

that Elena faces when she comes to Head Start, then they 

are better able to find solutions. Elena has a mix of feelPhoto by J. Brough Schamp. Higher Horizons HS/EHS. 

ings and thoughts about being away from her family and 

adjusting to the classroom. 

� Elena is transitioning from the familiar environment 

of home and the comforting sounds of her home language. She misses her family when she is in Head 

Start, but she tries not to cry or worry when she is 

apart from them. 

She is in an environment with new people, new 

expectations, and a new language. The words, the 

teachers’ cues, the daily schedule, the materials, all 

seem familiar to the other children, further compounding her sense of insecurity. 

It is very hard work for Elena—or any child—to make 

sense of her new surroundings and grasp concepts in 

an unfamiliar language. She exerts a lot of mental 

energy while she is in Head Start; understandably, she 

gets frustrated and tired from her efforts. 

The relationships that would typically help Elena 

transition are not available. Her parents are unfamiliar with the expectations of a preschool classroom. 

As helpful as the teachers and other children want to 

be, they do not speak her language. At home, she is 

very social and talkative; in the classroom, she is 

lonely and quiet. 

Head Start Bulletin 43 
Child Mental Health 

SHOULD I BE WORRIED? SUPPORTING LANGUAGE ACQUISITION 

What Does Ms. Carol Need to Know About Second 

Language Learners? 

Like many Head Start teachers, Ms. Carol knows a lot 

about first language learning. She has found effective ways to 

promote the children’s language and literacy development in 

Head Start. But she is not so sure about how children learn a 

second language and what strategies would help Elena learn 

English. Ms. Carol needs to know what research says. 

�

�

�

�

�

�

�

Learning a second language takes time and there are 

wide individual differences in the rate of learning a 

second language (Genesee 2007). 

For most children, learning a second language is not a 

serious cognitive challenge; the human brain is able to 

learn two languages as easily as one (Genesee 2007). 

Young children learn a second language by being 

exposed to meaningful, sustained, rich, and varied language. They do not need specific “lessons,” nor do 

they need drill-and-recital (Stechuk & Burns 2005). 

The demands of being in a new language environment can result in behaviors that may look suggestive of a mental health problem. For example, most 

children learning a second language go through a 

silent or observational period (Tabors 1997) when 

they are gathering information about the new language. Like Elena, they communicate nonverbally. 

The process of acquiring two languages from a very 

early age has cognitive as well as social benefits 

(Bialystok 2001). Being bilingual is an asset starting 

at an early age. 

Children do not confuse their first and second languages, even though they may interchange vocabulary. 

Referred to as code-switching, this is typical behavior 

and not a cause for concern (Stechuk & Burns 2005). 

The home language should be maintained while children are learning another language (as required in 

the Head Start Program Performance Standards (45 

CFR 1304.21(a)(3)(i)(E)). Second language learning 

is an additive process and should never take away 

from the home language. 

What Can Ms. Carol Do to Support Elena? 

Ms. Carol and all the Head Start staff are eager to help 

Elena have a positive experience. They know how the program can benefit children and families. Ideally, Ms. Carol 

would be working with another teacher in her class who 

could actively support Elena’s first language. But, this is not 

the case. Yet, there are many strategies the teaching team can 

use to support Elena’s transition and promote 

her development. 

�

�

�

�

�

�

�

Get to know Elena and her family. If possible, use an 

interpreter to talk with her family about her likes and 

dislikes, her play at home, her favorite foods, and so 

on. Observing Elena during a home visit, as well as in 

the classroom, will provide clues. 

Take into account what Elena already knows—“her 

background knowledge”—to plan curriculum experiences to help her learn new information (Stechuk & 

Burns 2005). Incorporate already familiar objects and 

concepts into Elena’s learning experiences, so she will 

be able to learn the new vocabulary. 

Use simple phrases in her home language, such as 

friendly greetings in the morning, to ease her separation from her family and prepare her transition into 

the classroom. 

Bring the home language and culture into the classroom. Record familiar songs or stories. Display photos 

of Elena’s family and include cooking utensils, musical 

instruments, and other cultural objects in the room. 

Provide many meaningful opportunities for interaction 

and active involvement. A nonverbal period does not 

mean the child should be left alone. Bring Elena into 

activities that are pleasurable for all children. 

Convey messages of acceptance and validate her feelings. Read Elena’s nonverbal cues for expressions of 

joy, interest, and curiosity and label them. 

Give Elena some simple, telegraphic phrases that will 

help her communicate and give her a sense of competence in the classroom. For example, “Where is ...?” 

“My turn...” “I want...” 

44 2009 
Child Mental Health 

� Physical closeness is essential to relationship building. It 

is easier to communicate if Ms. Carol and Elena are 

near each other. Stories can be read from the location 

where Elena is sitting. 

How Can Ms. Carol Know When Behavior Indicates 

More Than a Language Issue? 

Researchers have pointed out that some common behaviors associated with language acquisition may be misinterpreted as challenging behaviors (Tabors 1997). So a first step is 

for Ms. Carol and other Head Start staff to be knowledgeable 

about the process of second language learning. Recognizing the 

child as an individual is important too—Elena is developing at 

her own rate with her own areas of strength. 

Clues that might indicate that Elena is struggling with 

more than second language acquisition include: 

�

�

�

�

A prolonged silent or observational period, beyond 

the typical 3-6 months (Roseberry-McKibbin 1995) 

and little evidence of progression into the next stage 

where she begins to use some English. 

A noticeable increase in Elena’s withdrawn behavior 

in the classroom or displays of aggression or other 

challenging behaviors. 

A marked difficulty in saying goodbye to her family 

when she comes to Head Start. 

A report from the parents that Elena’s behavior at 

home is changing or that development in her first 

language is not progressing as expected. 

It would be important for the teaching team to work with 

the family, the Head Start mental health coordinator, the disabilities manager, and other specialists to assess the situation. 

In order to support Elena and to provide intervention, if necessary, the staff should be well-informed about the process of 

first and second language acquisition, as well as the impact of 

language differences on child behavior. ■ 

Editor’s Note: The Improving Head Start for School 

Readiness Act of 2007 designates funds to support staff 

training and child counseling and other services to meet the 

needs of special populations, including dual language learners. It also emphasizes improving outreach and increasing 

enrollment and quality of services to these children and their 

families, particularly in communities that have experienced a 

large percentage increase in the population of limited 

English proficient children. 

REFERENCES 

Bialystok, E. 2001. Bilingualism in development: 

Language, literacy & cognition. Cambridge: 

Cambridge University Press. 

Genesee, F. 2007. Myths and realities about dual language 

learning and young children. Extracted from Fred 

Genesee’s plenary presentation at the CRADLE workshop. Arlington, VA, Feb. 26, 2007. 

Roseberry-McKibbin, C. 1995. Multicultural students with 

special language needs. Oceanside, CA: Academic 

Communication Associates. 

Stechuk, R. & S. Burns. 2005. Making a difference: A 

framework for supporting first and second language 

development in preschool children of migrant farm 

workers. Washington, D.C.: Academy for Educational 

Development. 

Tabors, P. 1997. One child, two languages: A guide for 

preschool educators of children learning English as a 

second language. Baltimore, MD: Paul H. Brookes 

Publishing Co. 

Sylvia Y. Sanchez is an Associate Professor at George Mason 

University, Fairfax, VA. T: 703-993-2041; 

E: ssanche2@gmu.edu. 

Eva K. Thorp is an Associate Professor at George Mason 

University, Fairfax, VA. T: 703-993-2035; 

E: ethorp@gmu.edu. 

Head Start Bulletin 45 
Parents and Family 

USING STORYTELLING TO SUPPORT MENTAL HEALTH
 

Storytelling can support mental health by building 

relationships between families and staff. by Dee Wetzel, 

Angela Branch, and Nina Salomon 

“Storytelling is a social experience that allows a connection to develop between the teller and the listener” 

(Smyth 2005). 

Storytelling is a powerful approach to sharing information that Head Start families can use to describe their experiences. What are the benefits? 

�

�

�

For programs, it is a way to learn meaningful information about families, while allowing families to view their 

stories from a positive, strengths-based perspective. 

For parents and the Head Start program, it creates 

meaningful relationships. 

For staff, it allows them to identify true family needs 

and interests, leading to more significant partnerships with parents. 

Everyone benefits from storytelling when it is part of a 

program’s proactive approach to mental health. Building significant relationships with parents and helping them to see 

their strengths and needs in new ways, which happens with 

storytelling, promotes parental well-being and in turn, their 

children’s mental health. In Migrant and Seasonal Head Start 

(MSHS) programs, the storytelling approach has proved profoundly meaningful for staff and parents in developing 

Family Partnership Agreements. This approach can easily be 

used in all Head Start and Early Head Start programs. 

There are features of storytelling that contribute to its 

success. The storytelling approach is based on unconditional positive regard and uses open-ended questions, 

active listening, empathy, reframing, and looking for 

strengths to elicit family stories. 

Unconditional Positive Regard 

Unconditional positive regard is an attitude of acceptance and valuing of families. Parents are automatically 

valued for who they are and what they bring to the program and to the education of their children. Families are 

considered experts about themselves and their children, 

and the Head Start staff are their guides. 

One employee from Agri-Business Child Development 

MSHS commented on the storytelling process: 

The important thing you have to recognize is that it’s not 

your story. It’s not going to be told the way you want but the 

way the family wants to tell it to you (AED DVD 2003). 

To develop meaningful 

relationships with 

families, staff needs to 

engage in a dialogue 

with them Asking openended questions will 

elicit families’ stories 

and interesting 

conversation. 

Open-Ended Questions 

In developing meaningful relationships with families, it 

is important to engage in a dialogue with them rather than 

asking for a set of information that can result in short 

answers with little back-and-forth conversation. Openended questions elicit stories and conversation and create 

an atmosphere demonstrating that staff is interested in 

learning about the parent and family. For example, you can 

elicit more information and begin to cultivate a more 

meaningful relationship by saying: Every family has a story 

that is unique to them. Can you tell me about the most 

important people in your life? 

46 2009 
Parents and Family 

Active Listening 

Active listening means being fully present and engaged 

with the family or the individual with whom one is talking. 

The lives of staff and parents are extremely busy and fastpaced. Sometimes while talking with families, the mind can 

be somewhere else thinking of other things. Active listening 

means clearing the mind of all the other distractions and 

truly sitting and listening to what the speaker is saying. 

When staff take the time to focus their attention and 

energy solely on what parents have to say, active listening 

sends a very positive message to families that they are 

extremely valuable and important. 

Empathy 

Empathy refers to being able to communicate to the 

family that their feelings are being understood. When taking an empathic stance, staff shows families that their feelings are understood in a way that helps them advance 

through the emotion. The key to empathy is that the listener reflects back the emotion that is hidden beneath the 

words. Empathy is expressed in this example: 

Parent/family: I went to the doctor with my daughter; 

she’s only 6 months old, and she’s very sick. 

Listener: It sounds like you were very frightened and concerned when the doctor told you about the baby’s illness. 

Reframing 

Often families get caught in the day-to-day struggle and 

do not realize they are doing amazing things every day. 

Reframing is a process whereby the listener is able to help 

families see the positive by reflecting back what they have said 

using different words. This allows them to hear their story in 

a new way and is extremely powerful in helping families to 

see their strengths despite adversity. Reframing provides families with “Ah ha!” moments whereby they recognize that 

there is something positive and amazing about their lives no 

matter what their circumstances. This helps families to focus 

on their strengths and enables them to feel powerful and 

capable of influencing their current and future life situations. 

An example of reframing might be: 

Parent/family: It made me sorry for having been drinking (in the past), because if I hadn’t been drinking, I’d have 

all that money to go see my mother (when she was sick). 

Listener: But you know that the fact you went to see 

her there (in Mexico) and that your mother could see you 

healthy, sober, that also must have given your mother satisfaction (AED DVD 2003). 

Looking for Strengths 

In working with families, it is important to ask what 

has helped them get through difficult times. Many Head 

Start families have endured overwhelming hardships, 

demonstrating great strength and resilience. When parents 

are asked what has helped them get through challenging 

times, they provide many answers, including friends, faith, 

togetherness, and love of family. It is important to honor, 

respect, and learn about the unique strengths of each family. This, in turn, promotes the creation of meaningful partnerships with parents that support positive mental health 

for both parents and children. An employee from 

Enterprise for Progress in the Community MSHS said this 

about strengths: 

I see parents blossom when they discover the skills to 

tap into their strengths and when they recognize their 

resiliency within that keeps them growing (AED 2003). 

Summary 

The techniques shared here for supporting mental health 

through the use of storytelling—unconditional positive 

regard, open-ended questions, empathy, active listening, 

reframing, and looking for strengths—are universal techniques that can be applied in any situation. All human beings 

have stories to tell, and embedded within those stories are 

rich lessons and strengths that can be used to help parents 

view themselves and their families in a new, more powerful 

way. This process helps to promote parental mental 

Continued on page 103 

Head Start Bulletin 47 
Parents and Family 

MATERNAL DEPRESSION IN EHS AND HEAD START
 

Findings from three maternal depression studies 

are discussed. by Rachel Chazan-Cohen and 

Maria Woolverton 

As a comprehensive child development program, Head 

Start has long been concerned with supporting the social 

and emotional well-being of children and families and with 

providing and/or accessing services for those families with 

mental health needs. In fact, the Head Start Program 

Performance Standards requires each program to obtain a 

mental health consultant (1304.52), as well as timely and 

responsive services (1304.24), and family-centered mental 

health services and education (1304.40). 

This article presents research-based information on 

maternal depression in Early Head Start (EHS) and Head 

Start families and on the programs’ role in helping families 

struggling with maternal depression. 

This information comes from three sources: 1) the Early 

Head Start Research and Evaluation Project (EHSREP), a 

random assignment evaluation of EHS; 2) the Head Start 

Family and Children Experiences Survey (FACES), a descriptive study of children and families in Head Start; and 3) the 

Survey of Early Head Start Programs (SEHSP), a survey 

about programs’ management systems and services. 

Why focus on maternal depression? The answers are 

that depression is among the most prevalent mental health 

concerns, especially for low-income families served by 

Head Start programs, and there is broad literature on the 

detrimental effects of maternal depression for children 

and families. 

Findings 

Prevalence of maternal depression is high in Head 

Start programs. Rates are highest when children are 

younger. A short form of the CES-D was used in EHSREP 

and FACES. (For more information about the instrument, 

refer to the end of this article.) 

� The EHSREP found that at entry into EHS, over half 

(57%) of mothers reported elevated symptoms. The 

rate falls to 38% when children are 1 year old and 

about one-third at age 3 (32%) and at age 5 (31%). 

� FACES data show that when children begin preschool 

Head Start, just over a quarter (26.5%) of mothers 

reported elevated symptoms. There were no significant differences in rates of depression based on race 

or ethnicity in the FACES study. 

Outcomes 

Depression is associated with family risk factors, as well
 

as with parenting, child outcomes, and family participation
 

in Head Start services. 


Not all parents experiencing 

depression have difficulty 

parenting, and not all children 

of depressed parents have 

developmental difficulties. 

However, the EHSREP and FACES support the common
 

wisdom that families struggling with maternal depression can
 

be challenging for program staff to engage and that depression can be harmful for parenting and for child functioning. 


�

�

Families struggling with maternal depression also 

report lower household incomes and are more likely 

to be headed by a single woman. They also report 

higher rates of family violence and are more likely to 

report that a household or family member is involved 

in criminal activities. 

Depressed mothers are observed to be more negative 

in play with their children than non-depressed mothers. They report engaging in fewer activities with their 

children and having more stress associated with parenting. They also report more authoritarian parenting 

styles and are more likely to report spanking as a discipline technique. 

48 2009 
Parents and Family 

�

�

�

Families struggling with maternal depression have less 

involvement with Head Start and were found to participate at lower levels in EHS. 

Children of depressed mothers were reported (by 

mothers and teachers) to have higher rates of problem 

behaviors, as well as lower rates of positive social 

behavior and creativity. 

Children of depressed mothers also fared worse in 

direct child cognitive assessments; this was true for 

toddlers and for preschoolers. For preschoolers, 

depression was associated with less optimal emergent 

literacy as well as math skills. 

Access to Services 

Head Start programs are required to have mental health 

consultation. 

�

�

�

In fact, the SEHSP found that nearly all programs 

(96%) have their own mental health specialists, on 

staff or as consultants, and many (80%) programs 

also have partnership agreements with community 

mental health providers. Most (92%) programs report 

screening families for mental health concerns and 

report referring families for mental health services 

(98%). 

However, the EHSREP found no impact on families 

receiving mental health services while they were in the 

program. By the time of exit from the program, just 

under a quarter (23%) of families in EHS reported 

that someone in the family had received treatment, a 

rate similar to the control group. 

Use of mental health services was slightly higher for 

families where mothers were depressed when they 

enrolled in EHS. Roughly one-third (32%) of mothers who were depressed at enrollment reported that 

at least one family member had received mental 

health services. 

symptoms of depression. However, for women who 

were depressed at the time of enrollment into EHS, the 

program did reduce depressive symptoms and improve 

parenting and the parent-child relationship. The program may protect children from some of the negative 

effects of maternal depression. 

� A follow-up of the EHSREP sample in the spring 

prior to the children entering kindergarten found an 

overall reduction in depressive symptoms for mothers 

who had previously participated in EHS. Additional 

analyses revealed that impacts of the program for parents and children, ages 2 and 3 years, led to this later 

emergence of an impact on maternal depression 

(Chazen-Cohen et al. 2007). For children, the earlier 

impacts of the program on reducing parent report of 

aggressive behavior, as well as direct assessment of 

cognitive functioning, were most important. For parents, it was program impacts on reducing parenting 

distress and spanking that were most important. 

� FACES findings also indicate that Head Start may 

protect children from the negative outcomes, both 

cognitive and behavioral, associated with parental 

depression. Having a parent who reported positive 

experiences with Head Start, who had higher satisfaction with Head Start, or who was more involved with 

Head Start, lessened the associations between family 

risk factors (including depression, violence, and 

domestic violence) and child outcomes. 

Conclusion 

The research has shown that maternal depression is 

common in the EHS and Head Start population where 

families are more likely to face challenges and adversities 

than the general population. By studying and understanding the rates of depression among mothers of infants, toddlers, and preschoolers, Head Start will be better able to 

develop approaches to address maternal depression and 

develop interventions to promote the well-being of children 

and families. 

Addressing Maternal Depression	 

� Overall, the EHSREP found that EHS did not reduce 

Head Start Bulletin 49 
Parents and Family 

MATERNAL DEPRESSION IN EHS AND HEAD START 

For more information on these studies, visit their 

Web sites. 

For EHSREP: The Early Head Start Research and 

Evaluation Project, see http://www.acf.hhs.gov/programs/ 

opre/ehs/ehs_resrch/index.html 

For FACES: The Head Start Family and Child 

Experiences Survey, see http://www.acf.hhs.gov/programs/ 

opre/hs/faces/index.html 

For SEHSP: The Survey of Early Head Start Programs, 

see http://www.acf.hhs.gov/programs/opre/ehs/ 

survey_ehs/index.html 

For information on depression among Latina mothers, 

see the article entitled, “Depressive Symptoms in Latina 

Mothers,” in this Bulletin. ■ 

REFERENCES 

Chazan-Cohen, R., C. Ayoub, B. Pan, L. Roggman, H. 

Raikes, L. McKelvey, L. Whiteside-Mansell, & A. Hart. 

2007. It takes time: Impacts of Early Head Start that 

lead to reductions in maternal depression two years 

later. Infant Mental Health Journal. 28(2): 151-170. 

Radloff, L.S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. 

Applied Psychological Measurement, 1: 385-401. 

Ross, C.E., J. Mirowsky, & J. Huber (1983). Dividing work, 

sharing work, and in-between: Marriage patterns and 

depression. American Sociological Review, 48: 809-823. 

Rachel Chazan-Cohen is a Senior Research Analyst in the 

Office of Planning, Research and Evaluation at the 

Administration for Children and Families. 

T: 202-205-8810; E: rccohen@acf.hhs.gov 

Maria Woolverton is a Senior Research Analyst in the Office 

of Planning, Research and Evaluation at the Administration 

for Children and Families. T: 202-205-4039; 

E: mwoolverton@acf.hhs.gov 

The Measure of Depressive Symptoms Used in FACES and EHSREP; A Short 

Form of The Center for Epidemiologic Studies-Depression (CES-D-SF) 

The CES-D-SF measures symptoms of depression. While it does not indicate a diagnosis of clinical depression, it 

does discriminate between depressed patients and others. The 12 items on the short form are taken from the full 

20-item CESD scale (Radloff 1977; Ross et al. 1983). Items are coded by the number of days in the past week 

the person had a particular symptom: rarely or never (less than one day) =0; some or a little (1-2 days)=1; occasionally or moderate (3-4 days)=2; and most or all days (5-7 days)=3. Scores range from 0 to 36 and scores of 

greater than or equal to 10 indicate the cutoff for possible depression. 

1) Bothered by things that usually don’t bother you 

2) You did not feel like eating; your appetite was poor 

3) That you could not shake off the blues, even with help from family or friends 

4) You had trouble keeping your mind on what you were doing 

5) Depressed 

6) That everything you did was an effort 

7) Fearful 

8) Your sleep was restless 

9) You talked less then usual 

10) You felt lonely 

11) You felt sad 

12) You could not “get going” 

50 2009 
Parents and Family 

A PROFILE OF PARENTAL 

AND CAREGIVER MENTAL HEALTH 

The connection between the mental health of young children and that of their parents or other 

caregivers has been well established. When they feel supported, satisfied, and fulfilled in their 

relationships and work, they are better able to provide sensitive, responsive, individualized care for 

children. Head Start plays a vital role in supporting and promoting the mental health of parents and 

other caregivers. 

The statistics below describe the prevalence and interconnectedness of mental health-related problems 

(including depression, substance abuse, and trauma) among certain populations, including mothers 

and fathers. 

Mental health disorders are common 

� One in four adults in our nation suffer from a diagnosable mental health disorder.1 

� Mental health disorders are the leading cause of disability for people ages 15-44.2 

Depression is the most prevalent mental health disorder, and women are disproportionately 

affected. 

� Depression is most prevalent among women in child-bearing years (i.e. ages 16 – 43). 

� Poverty significantly impacts rates of depression. Women from low-income groups are roughly twice as likely to 

suffer from depression.3 

� 48% of mothers in Early Head Start meet the criteria for depression.4 

� Depression in fathers increases if a mother is depressed (24% – 50% of men experienced depression when 

their partners were experiencing postpartum depression).5 

� Depression is one of the most treatable disorders; treatment is successful 80% – 90% of the time. 

Substance abuse is common and is often ignored. 

Results from the 2005 National Survey on Drug Use and Health,6 sponsored by the Substance Abuse and Mental 

Health Services Administration (SAMHSA), indicated that: 

� 9.1% of the U.S. population aged 12 or older experienced substance dependence or abuse. 

� Rates of substance dependence or abuse are higher among specific populations, including: young adults 

(21.8%); American Indian or Alaska Native adults (21%); adults who did not finish high school and/or had little college (10.2% – 10.3% respectively); persons who were unemployed (17.6%); and adults who were on 

probation or supervised leave (33.7%) or parole (37%) from jail. 

� Only 1.6% of the population received some kind of treatment for substance abuse. 

A strong association exists between depression, substance abuse, and trauma; yet trauma is 

often untreated in parents. 

� Although there are no national prevalence rates on parents’ traumatic experiences, it is believed that parents’ 

current or childhood traumas, along with maternal depression, parental substance abuse, and domestic violence, can put young children at risk for poor developmental and emotional outcomes.7 

Head Start Bulletin 51 
Parents and Family 

A PROFILE OF PARENTAL AND CAREGIVER MENTAL HEALTH 

� Trauma earlier in life is likely to impact adult functioning, especially parenting, yet mental health professionals 

do not always assess trauma histories sufficiently to consider the impact of trauma on parenting.8 

� In a sample of 220 homeless mothers with young children, more than 33% of mothers experienced PostTraumatic Stress Disorder (PTSD).9 

� In a study of children in EHS, 71% had experienced or witnessed at least one trauma: a serious injury or illness, prolonged separation from their primary caregiver, homelessness, death of a close relative, or a serious 

accident. (See the article, “Trauma in the Lives of EHS Children” in this Bulletin.) 

1 Out of the shadows: Exploring the barriers to mental health, prevention, and treatment, American Public Health 

Association, 9/28/2006, National Press Club, Washington, DC (David Satcher, former Surgeon General speech) 

2 IBID 

3 Miranda, J. & B.L. Green. 1999. The need for mental health services research focusing on poor young women. The 

Journal of Mental Health Policy and Economics. 2: 73-80. 

4 U.S. Department of Health and Human Services. Administration for Children and Families, Head Start Bureau. 2003. 

Research to practice: Depression in the lives of Early Head Start families. Early Head Start research and evaluation 

project. Washington, D.C.: Author. 

5 Goodman, J. 2004. Paternal postpartum depression, its relationship to maternal depression and its implications for 

family health. Journal of Advanced Nursing. 45 (1): 26-35 

6 Substance Abuse and Mental Health Services Administration. 2006. Results from the 2005 National Survey on Drug 

Use and Health: National findings (Office of Applied Studies, NSDUH Series H-30, DHHS Publication No. SMA 06­

4194). Rockville, MD. Available at http://www.oas.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm#Ch3 

7 Knitzer, J. & J. Lefkowitz. 2006. Helping the most vulnerable infants, toddlers, and their families. Pathways to early school 

success. Issue Brief No. 1. New York: Columbia University School of Public Health. National Center for Children in 

Poverty. 

8 Nicholson, J., K. Biebel, B. Hinden, A. Henry, & L. Stier. 2001. Critical issues for parents with mental illness and their families. Rockville, MD: U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services 

Administration. Center for Mental Health Services. 

9 Bassuk, E.L., J.C. Buckner, J.N. Perloff, & S.S. Bassuk. 1998. Prevalence of mental health and substance use disorders 

among homeless and low-income housed mothers. American Journal of Psychiatry. 155(11): 1561-1564. 

52 2009 
Parents and Family 

FAMILY CONNECTIONS: INTERVENTION FOR
 

PARENTAL DEPRESSION
 

A preventive intervention model aims to reach families 

before children are impacted by parental depression. 

by Catherine Ayoub, William Beardslee, 

Mary Watson Avery, and Caroline Watts 

It is mid-morning in a Boston Head Start classroom 

and a group of children is having circle time. The teacher 

begins a song that asks each child, “How do you feel 

today?” A few respond by smiling and saying, “OK.” But 

then a child, who appears tired and a little sullen, answers, 

“Sad.” The teacher asks him, “Why are you sad?” He 

replies, “Because my mommy cries too much.” 

Given their holistic two-generational approach, EHS 

and Head Start are ideal vehicles to address mental health 

concerns in the context of enhancing parenting and parentchild relationships. 

The Family Connections project is an effort to 

develop a model to help Head Start and EHS families 

deal with depression and related adversity. Its goal is to 

build the strengths and long-term resilience of children 

and parents through enhancing programs’ capacity to 

engage all families, but especially where parents are struggling with depression. 

Why depression? The prevalence is higher in lowincome families. In EHS research, 48% of mothers at enrollment reported enough symptoms to be considered 

depressed; one-third of mothers of 1-year-olds and one-third 

of mothers of 3-year-olds were depressed as well (U.S. 

Department of Health and Human Services 2003). 

Numerous studies have reported significant negative impacts 

of parental depression on children. Children of depressed 

parents have higher rates of psychiatric disorders and are at 

increased risk for language and cognitive problems, insecure 

attachments, difficulties with managing emotions, social 

competence, and behavioral problems (Beardslee 2006, 

2002). Yet, mental health professionals rarely see these 

young children, even if they are enrolled in early childhood 

programs and receive regular medical check-ups. 

The Family Connections project works with Head Start 

staff to identify parents who might need extra support. The 

project also works with children in classrooms to improve 

their ability to cope with adversity and works with the community to develop resources and make use of referral systems. The program is based on three key assumptions: 

�

�

�

EHS/Head Start families and staff are often in difficult situations—including poverty, exposure to violence, and social isolation. 

Depression is a common response to such difficulties. 

These difficulties affect the ability of parents to 

effectively relate with other adults, their children or 

the children in their care, and with the EHS/Head 

Start community. 

The Family Connections Prevention Approach 

The Family Connections project is a joint effort of 

Children’s Hospital Boston, Action for Boston Community 

Development (ABCD), Dimock Community Health Center, 

Associated Early Care and Education, and Harvard Graduate 

School of Education. Family Connections was launched as a 

pilot site in summer 2002 at the Boston ABCD Jamaica Plain 

Head Start. In 2005, Family Connections received an 

Innovation and Improvement Project (IIP) grant from the 

Head Start Bureau (now OHS) to expand to eight centers and 

provide two city-wide training conferences. 

Family Connections has identified several key strategies for addressing depression in Head Start families: 

� Every interaction between staff and families is an 

opportunity to build trust and capacity. 

� A focus on engagement with staff provides meaningful training and an emphasis on the importance of 

reflection and attention to one’s own mental health. 

� The promotion of stronger relationships and communication among parents, children, and staff at all 

levels is central to all training and consultation. 

� Providing information about depression and related 

adversity to staff, parents, and children is an ongoHead Start Bulletin 53 
Parents and Family 

FAMILY CONNECTIONS: INTERVENTION FOR PARENTAL DEPRESSION 

�

�

�

�

ing process that includes gaining knowledge, understanding the meaning for each person, and translating this learning into using better skills. 

The Family Connections model utilizes preventive 

intervention strategies to provide services for children, parents, and EHS/Head Start staff along a continuum of need 

from prevention to intensive intervention. A pyramid 

(Figure 1) depicts how Family Connections uses the four 

EHS cornerstones—child development, family development, community building, and staff development—with 

each level building upon the others to provide a comprehensive approach for individual, group, and systems-level 

support. At the base of the pyramid is an all-encompassing 

approach for prevention aimed at staff. At the apex of the 

pyramid is intensive intervention targeting parents in need. 

The preventative approach has two components. First, 

center-based strategies that include training and consultation 

for staff help build skills in dealing with children and their 

parents who struggle with depression. Second, home-based 

strategies are designed to increase parent engagement and 

include home visitation, outreach to hard-to-reach parents, 

and community resource networking and referral services. 

Figure 1: The Family 

Connection Pyramid 

Clinical 

Intervention 

Identification and 

referral for depression 

and parenting difficulties/ 

disconnections; extended 

outreach and crisis services 

Targeted Prevention
 

(At Risk Adults/Children)
 

Enriched prevention programming, mental 

health outreach, promotion of school readiness and social skills, referral to specialized 

services in mental health 

Universal Prevention (All Children and Families) 

Education on depression; parenting education focused upon 

communication and relationship-building in families; classroombased enrichment activities to support social and academic 

readiness; community networks to connect families to supportive 

prevention services 

Community and Systems Development (All Head Start Staff) 

Education on depression, mental health, and building resilience; professional skill 

development, including reflective practice and parenting skill support; classroom 

consultation; community connections to enrichment and family nurturing programs 

Intervention is implemented by a team of two consultants, one with a strong mental health background and one 

with a strong early childhood background. Twice a week at 

each center, the consultants work with: 

�

�

�

�

Program managers and staff to share new skills, 

understanding, and meaning around dealing with 

difficult emotional issues, adversity, and depression 

Children to build positive interactions through onsite activities such as social skill building and play 

interventions that help children build friendships 

Parents in group and individual consultation on issues 

around parenting and dealing with adversity 

Organizations and institutions to improve access to 

quality mental health services within the community 

Lessons Learned 

After five years of fostering positive interactions for 

families facing adversity, we offer critical lessons learned 

through our work on the project. 

� The importance of parent engagement cannot be underestimated. Leading with this message helps staff grasp 

that it is the key to much successful intervention. 

Readiness for each center should be defined clearly. 

Centers in transition or with leadership vacancies are 

often unable to devote the time and energy to the 

kind of staff change necessary for this ongoing preventive mental health work. Timing is everything in 

implementation; a variety of interventions and the

speed of the process can be adapted to each center to 

get the best positive outcomes for staff and families.

Consultants must carefully understand the uniqueness of each EHS/Head Start program. 

A critical skill for engagement is learning to use crisis as opportunity. 

Each child care professional develops competence in

the mental health equivalent of medical first aid, 

through training in what we call “Mental Health

First Aid.” They are then able to feel confident and

informed about understanding, decision-making, 

54 2009 
Parents and Family 

consultation, and referral related to mental health 

issues. 

�

�

�

�

It is critical to engage the entire staff in the ongoing 

training process. 

Providing training around depression and mental 

health issues is not enough. Increased knowledge 

must be followed by consultation that supports onsite modeling and ways of developing and practicing 

new skills for staff. 

An important outcome of system-wide intervention 

that focuses first on staff learning and change is 

increased staff satisfaction. 

System-wide change is feasible and has the potential 

to effect the largest sustainable improvement in mental health practice within Head Start programs. 

Back in the Boston Head Start classroom, the teacher 

asks calmly, “Why do you think your mother is crying?” 

He answers, “Because her brother died.” The teacher nods 

as she listens and then tells the children, “When someone 

dies, it can make us feel like crying.” She then turns her 

attention back to the boy. “It can also make you feel sad 

to see your mom cry.” As he nods emphatically, the teacher 

leans forward, touches his hand and says, “We’re going to 

give your mom a call to make sure she’s OK.” And with 

this, the boy turns to his right, ready to hear how the next 

child will answer how she feels that day. 

Conclusion 

Building the capacity of EHS/Head Start staff and programs to better understand and respond to the needs of 

depressed parents and their children through a preventive 

intervention model, such as Family Connections, strengthens 

staff’s ability to engage depressed parents in services. In turn, 

this increases their parental functioning and improves their 

relationships with their children. As a result, the damaging 

impact of depression on children and families is reduced. ■ 

Materials developed from this project are expected to be 

made available on the Early Childhood Learning and 

Knowledge Center (ECLKC) Web site in 2009. 

REFERENCES 

Beardslee, W.R. 2006. When a parent is depressed: How to 

protect your children from the effects of depression in 

the family. Boston: Little, Brown & Company. 

Beardslee, W.R. 2002. Out of the darkened room: When a 

parent is depressed. Protecting the children and 

strengthening the family. Boston: Little, Brown & 

Company. 

U.S. Department of Health and Human Services. 

Administration for Children and Families, Office of 

Head Start. 2003. Research to practice: Depression in 

the lives of Early Head Start families. Early Head Start 

research and evaluation project. Washington, D.C.: 

Author. Available at www.acf.hhs.gov/programs/opre/ 

ehs/ehs_resrch/reports/dissemination/research_briefs/res 

earch_brief_depression.pdf. 

Catherine C. Ayoub is an Associate Professor at the Harvard 

Medical School in Boston, MA. T: 617-355-0494; E: catherine.ayoub@childrens.harvard.edu. 

William R. Beardslee, M.D., is the Gardner-Monk Professor 

of Child Psychiatry at the Harvard Medical School in 

Boston, MA. T: 617-919-4629; 

E: william.beardslee@childrens.harvard.edu. 

Mary Watson Avery is the director of the Family Connections 

Project in Boston, MA. T: 617-355-1896; 

E: mary.avery2@childrens.harvard.edu 

Caroline Watts is the former director of the Children’s 

Hospital Neighborhood Partnership at Children’s Hospital 

Boston in Boston, MA. She is a senior lecturer at the 

University of Pennsylvania Graduate School of Education 

and Assistant Professor at Harvard Medical School. T: 215­

746-4584; E: wattasca@gse.upenn.edu 

Head Start Bulletin 55 
Parents and Family 

BY MY LINH NGUYEN 

WILL THEY THINK I’M CRAZY? 

A Head Start teacher struggles to deal with life’s problems, but is afraid to talk about them because she does not 

want to be labeled “crazy.” 

A father of two children in Head Start struggles with 

depression, but fears that if he seeks help, his employer may 

find out, and he may lose his job. 

Parents of a 3-year-old in Head Start struggle with their 

child’s challenging behavior at home, but worry that if they 

discuss it with Head Start staff, they will be “blamed” for 

their child’s behavior. 

Immigrant parents struggle with adapting to their new 

life, but fear that seeking help during this transition would be 

viewed as a sign of “weakness” by their friends and family. 

These are just a few examples of how the stigma and 

shame associated with mental health needs can keep people 

from accessing much-needed care and support. Whether 

young or old, male or female, rich or poor, many people 

worry that seeking help is a sign of weakness, failure, or 

severe illness. Not surprisingly, a government report states that 

stigma is “the most formidable obstacle to future progress in 

the arena of mental illness and health” (U.S. Dept. of Health 

& Human Services 2001). 

Education about preventative mental health interventions 

as well as about direct services is key to reducing stigma. In 

fact, the Head Start Program Performance Standards states 

that programs must “promote children’s mental wellness by 

providing group and individual staff and parent education on 

mental health issues” [45 C.F.R. 1304.24(a)(3)(ii)]. When 

people learn that mental health and mental illness are points 

along a continuum and that mental health issues often are 

brought on by difficult circumstances, such as the death of a 

loved one, then they are more likely to value and use 

resources. And when people learn that most mental health 

issues are treatable, they are more receptive to getting help. 

Just as individuals have different views of mental health 

and effective treatments, cultural groups do too. Some populations believe that “problems” should be resolved within the 

family or that spiritual healing is the answer (U.S. Dept. of 

Health & Human Services, Office of Refugee Resettlement 

2001). Mental health concepts may conflict with their own 

beliefs and values, and they may not be willing to accept 

mental health services. The stigma attached to seeking help 

for mental health issues looms large among some groups and 

may affect the individual’s or the family’s standing in their 

community (U.S. Dept. of Health & Human Services, Office of 

Refugee Resettlement 2001). 

Public attitudes toward mental health must change before 

stigma can abate. Head Start programs can help staff and 

families by educating them that mental health is an aspect of 

overall health and well-being. When they learn to view mental health without stigma, they will be more likely to seek help 

for themselves or support others who need help. ■ 

REFERENCES 

U.S. Department of Health and Human Services. 2001. 

Mental health: Culture, race, and ethnicity—A supplement to mental health: A report of the Surgeon General. 

Rockville, MD: U.S. Department of Health and Human 

Services, Substance Abuse and Mental Health 

Administration, Center for Mental Health Services. 

U.S. Department of Health and Human Services, 

Administration for Children and Families, Office of 

Refugee Resettlement. 2001. Refugee mental health 

and access to services. Technical Assistance Workshop 

on Mental Health. Washington, D.C.: Author. 

My Linh Nguyen is a Senior Writer/Editor at the Head Start 

Resource Center in Arlington, VA. T: 703-908-8868. 

E: mnguyen@pal-tech.com 

56 2009 
Parents and Family 

BY LINDA S. BEEBER 

DEPRESSIVE SYMPTOMS IN LATINA MOTHERS
 

Mis sentimientos me roban las palabras. Nunca le 

hablo. Lo único que tengo para decirle a la niña son palabras de tristeza. Es mejor no hablarle para nada. Soy una 

mala mamá. 

My feelings rob me of my words. I never talk to her. I 

have nothing but words of sadness to say to her. It’s better not 

to talk at all to her. I am a bad mother. 

A Latina mother enrolled in Early Head Start described 

her silence in this powerful quote, a silence brought on by 

profound depressive symptoms. Despite her efforts and those 

of her husband, extended family, and her devoted Early Head 

Start (EHS) home visitor, the depressive symptoms had taken 

away her ability to talk to her toddler and introduce her to 

the greater world. For this family and especially for their toddler, the loss of this mother’s ability to talk, sing, play, teach 

was a threat, especially to the toddler’s ability to thrive and 

learn. 

Fortunately, this mother’s symptoms were recognized by 

the EHS home visitor. The mother received treatment and 

both the mother and family recovered. They are an example 

of the critical role infant-toddler programs can play in helping 

families get support and treatment for depressive symptoms. 

Yet many EHS Latina mothers remain at risk for developing 

symptoms of severe depression, which interfere with their parenting and predispose their infant to irritability and feeding 

problems, their toddler to severe tantrums and disregulated 

behavior, and both infants and toddlers to language, motor, 

and social developmental delays. 

While any parent can struggle with serious depressive 

symptoms, the Latina mothers in the study, who were of 

Mexican origin and had been in the United States for about 

5 years, were at high risk for depression and for threats to 

their parenting abilities. Most of these mothers spoke little 

or no English, and all were encountering severe stressors in 

the form of previous trauma and episodes of depression, 

poverty, substandard housing, dangerous neighborhoods, 

isolation, the pressures of separation from their extended 

families, and immersion in a new culture. As a result, these 

mothers exemplified well-supported risk factors for the 

development of severe depressive symptoms—“pile-up” of 

stressful life events, lack of social support, previous depressive episodes, loss of a sense of control and self-esteem, and 

demanding life roles. While an early childhood intervention 

staff person might easily identify the risk factors for a Latina 

mother, the recognition of depressive symptoms may be 

complicated by other factors. 

For example, the EHS staff person who served as the 

interpreter and I, a psychiatric mental health nurse, had been 

meeting with a group of profoundly depressed EHS Latina 

mothers for several months to explore their depressive symptoms and tailor the intervention content to their needs. One 

day, toward the end of a very difficult group session when 

most of the women were sobbing, there was a loud knock 

on the door. When the EHS staff person went to answer the 

door, it was the bus driver who had arrived early to take the 

mothers home. I was startled to witness the transformation 

that took place right before my eyes: every mother was smiling broadly without a visible tear. After the EHS staff person 

talked briefly with the driver and he left, she shut the door— 

the mothers immediately resumed crying. In asking them 

about their behavioral turn-about, they chuckled and shook 

their heads and said, “Linda, it is not safe to be depressed 

here.” 

In the next meeting, I resumed the discussion. What these 

mothers revealed were deep fears of being put in jail or in 

some cases being abandoned by their husbands or subjected 

to treatment, which in their country could mean institutionalization and electroconvulsive (shock) therapy. To them, to 

outwardly show depression meant to risk being labeled as 

“crazy” or removed from their children and bringing disgrace 

to their family forever. For these women, suffering without 

revealing their depressive symptoms to the world was the 

wiser and safer route to take. 

Warning Signs 

The well-documented signs of depression—lack of joy, 

Head Start Bulletin 57 
Parents and Family 

DEPRESSIVE SYMPTOMS IN LATINA MOTHERS 

prolonged sadness, difficulty concentrating, excessive guilt, 

social withdrawal, low energy, too little or too much sleeping, 

frequent stomach upsets or headaches, and parenting difficulties—are seen in depressed Latina mothers. But these mothers 

may also exhibit a warning sign that may confuse EHS staff 

who are familiar with classical depression literature that cites 

weight loss as a sign of depression (American Psychiatric 

Association 2000). In our work with newly-immigrated 

Latina mothers who were struggling with depressive symptoms, mothers typically gained weight. There are multiple reasons, including a shift to U.S. food consisting of processed, 

high-carbohydrate diets; confinement to small living spaces; 

transition from rural lifestyles where walking was the primary 

mode of transportation; and a pattern of eating to reduce 

stress and depressive feelings. 

Other early warning signs may appear in the infant or 

toddler as the behavioral and developmental problems mentioned previously. In particular, their language development 

may be delayed, especially if their depressed mothers rarely 

verbalize or interact with them. Infants and toddlers, like their 

depressed mothers, may show rapid or excessive weight gain. 

In our project, Latina mothers who were struggling with 

depressive symptoms conserved their energy by using feeding 

or food to calm the infant or occupy the toddler. At the same 

time, some mothers maintained the cultural belief that heavy 

babies were healthy babies. Thus, assessment of weight gain 

in the young children had to be done carefully with attention 

to the cultural values of the mother. Many of our mothers 

were breastfeeding, and thus, how much time spent feeding 

was a useful indicator of the amount of daily intake by the 

infant. Other factors such as living in small spaces and passive 

play (e.g., watching videos) probably contributed to weight 

gain in the toddlers. 

Program Strategies 

Comprehensive early childhood programs such as EHS 

serve an essential bridge for newly-immigrated mothers by 

offering support, socialization, guidance, and linkages to 

essential services. Optimally, the immigrant Latina mother 

maintains interpersonal ties to her primary ethnic significant 

others, while developing new mentors through acculturating 

and socializing her infant or toddler (Acevedo 1999; Munoz 

et al. 1985; Petterson & Albers 2001; Rhodes, Contreras, & 

Mangelsdorf 1994). 

Sensitive parenting guidance given by a trusted staff person can help the mother deliberately choose which elements of 

her culture of origin to preserve and which elements of 

American mainstream culture to integrate into her childrearing practices (U.S. Department of Health and Human Services 

2000). However, depressive symptoms interfere with this vital 

process (Munet-Vilaro, Folkman, & Gregorich 1999; Munoz 

et al. 1985; NICHD Early Child Care Research Network 

1999; Vega, Kolody, & Valle 1986). 

EHS and other child-focused programs can support the 

depressed Latina mother. The most critical step toward recognizing depressive symptoms in Latina mothers is the 

establishment of a trusting relationship in which the mother 

can relax her guard and show her “true face.” As the 

mother develops trusting relationships, it is crucial for EHS 

staff to be aware and have the ability to recognize possible 

symptoms of depression. 

Programs can support such relationships by hiring fullybilingual staff who are skilled in relationship-based work 

and by offering home-based options that reach mothers who 

may be unable to drive a car or use the bus system or who 

exercise a culturally-influenced belief that children should be 

reared at home. If a mother struggles with depressive symptoms and is socially isolated, she may be overlooked in a 

center-based program. 

Timely mental health intervention can help the Latina 

mother regain the energy to talk, play, and provide an 

envelope of affection and protection in which the infant or 

toddler can explore, grow, achieve balanced acculturation, 

and achieve optimal mental health (Jones, Lamb-Parker, & 

Ripple 2001; Kisker et al. 2000; Roggman, Newland, & 

Coyl 2001). 

58 2009 
Parents and Family 

This study was part of the E-PIRC Consortium, a group 

of five intervention studies that brought infant and toddler 

mental health services directly to participating EHS programs 

across the country.* The project “EHS Latina Mothers: 

Reducing Depressive Symptoms and Improving 

Infant/Toddler Mental Health” was funded through an 

ACF/ACYF University-Early Head Start Partnership grant 

(ACF/ACYF 90YF0042/01) that brought a team of interventionists consisting of a psychiatric mental health nurse and an 

EHS bilingual staff person to work with Spanish-speaking 

depressed EHS mothers in their homes. The team was trained 

to work as a nurse-interpreter dyad. 

*For more information on the E-PIRC studies, see the 

article “The Early Promotion and Intervention Research 

Consortium (E-PIRC)” in this Bulletin. ■ 

REFERENCES 

Acevedo, M. 1999. The role of acculturation in explaining 

ethnic differences in the prenatal health-risk behaviors, 

mental health, and parenting beliefs of Mexican 

American and European American at risk women. Child 

Abuse and Neglect 24(1): 111-27. 

American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders. Washington, D.C.: 

Author. 

Jones S., F. Lamb-Parker, A. Schweder, & C. Ripple. 2001. 

Parent involvement in Head Start: Context and consequences. Developmental and contextual transitions of 

children and families. New York: Columbia University: 

243-4. 

Kisker E., J. Love, D. Paulsell, & H. Raikes. 2000. Leading 

the way: Characteristics and early experiences of selected 

Early Head Start programs. Washington, D.C.: U.S. 

Department of Health and Human Services. 

Munet-Vilaro, F., S. Folkman, & S. Gregorich. 1999. 

Depressive symptoms in three Latino groups. Western 

Journal of Nursing Research 21: 209-224. 

Munoz R., Y. Ying, G. Bernal, E. Perez-Stable, J. Sorensen, W. 

Hargreaves, J. Miranda, & L. Miller. 1995. Prevention of 

depression with primary care patients: A randomized 

controlled trial. American Journal of Community 

Psychology 23(2): 199-222. 

National Institute of Child Health & Human Development 

(NICHD) Early Child Care Research Network. 1999. 

Child outcomes when child care center classes meet recommended standards for quality. American Journal of 

Public Health 89: 1072-1077. 

Petterson, S. M. & A. B. Albers. 2001. Effects of poverty and 

maternal depression on early child development. Child 

Development 72(6): 1994-1813. 

Rhodes, J. E., J. M. Contreras, & S. C. Mangelsdorf. 1994. 

Natural mentor relationships among Latina adolescent 

mothers: Psychological adjustment, moderating processes, 

and the role of early parental acceptance. American 

Journal of Community Psychology 22(2): 211-27. 

Roggman, L. A., L. A. Newland, & D. D. Coyl. 2001. 

Language-rich activities with mothers and fathers and 

toddlers’ language development. Paper presented at the 

biennial meeting of the Society for Research in Child 

Development, Minneapolis, MN. 

U.S. Department of Health and Human Services. 2000. 

Leading the way: Characteristics and early experiences of 

selected Early Head Start programs—Executive Summary. 

Early Head Start Research: 1-25. 

Vega, W., B. Kolody, & J. Valle. 1986. The relationship of 

marital status, confidant support, and depression among 

Mexican immigrant women. Journal of Marriage and the 

Family 48(3): 597-605. 

Linda S. Beeber is a professor at the University of North 

Carolina at Chapel Hill, School of Nursing. 

T: 919-966-8148; E: beeber@email.unc.edu 

Head Start Bulletin 59 
Parents and Family 

SHARED CAREGIVING AND ITS IMPLICATIONS 


A preventive intervention model aims to reach families 

before children are impacted by parental depression. 

by Katie Sellers and Neil Boris 

Family structures and the roles that caregivers play in a 

child’s life vary. For an adolescent mother and child, the 

family structure may include many other family members 

who play a role in raising the child. Early Head Start (EHS) 

and Head Start’s mission of supporting the social and emotional well-being of children and families begins with identifying the family structure. 

Research shows that adolescent mothers are particularly 

likely to rely on a network of family members and close 

friends, called a kin network, to help them rear their children. Often the young child’s grandparents, great-grandmothers, aunts, uncles, godparents, cousins, and fathers 

interact with adolescent mothers in providing care. 

Important Terms: 

Shared kinship caregiving
 

(or shared caregiving)
 

refers to arrangements
 

whereby the child is cared
 

for by friends or family in
 

addition to the care given
 

by the parent(s).
 

The kin network includes 

extended family members 

and close friends who 

assume traditional family 

behaviors such as childrearing or sharing a household. 

How can Head Start programs help adolescent mothers 

continue to support their children’s healthy development in 

the context of shared caregiving? 

Conflict in Shared Caregiving 

Head Start families vary greatly in how much support 

the kin network provides to the parent(s), but also in how 

much conflict exists in the shared caregiving relationships. 

Conflict is distinct from lack of support and exists at various 

levels. Thus, a grandmother-mother relationship can contain 

high levels of support and conflict, or abundant support 

with little conflict, or sometimes high levels of conflict with 

very little support. 

The birth of a child, particularly to a very young 

mother, can bring a stressful period of adjustment for the 

entire family. One study of shared caregiving among EHS 

families in an urban location found that mothers experienced various forms of conflict with their family and the 

family of the child’s father (Sellers 2005): 

�

�

�

�

Kin network members provided unwanted or conflicting childrearing advice. 

Others’ child care undermined the mother’s discipline. 

The father’s family refused to publicly acknowledge 

paternity. 

The mother’s family isolated the child from the father. 

Of particular relevance to Head Start programs is the 

extent to which various members of the kin network make 

important childrearing decisions. If a Head Start program 

aims to improve child outcomes, it should acknowledge 

the key decision-makers in the kin network, provide support, and address the conflicts if necessary. One strategy is 

to help the young mother gain confidence and feel good 

about her maternal role by nurturing and developing her 

negotiation skills. Sometimes the conflict between the 

mother and other caregivers is about how to handle 

important aspects of the child’s development, and the 

consequences may be far-reaching for the child. This 

was the case for Christine, a young mother enrolled in an 

EHS program. 

60 2009 
Parents and Family 

Christine, an 18-year-old, was at odds with her 

mother over how and when to toilet train her 20-monthold son. Every morning, the grandmother would dress the 

boy in underwear, not a diaper, before dropping him off at 

EHS, in an effort to have the staff toilet train her grandson. But the boy showed no interest in the process, and 

Christine and his teacher believed that he was not yet 

ready and that was normal. The teacher knew that the 

Head Start Program Performance Standards requires that 

programs “allow and enable children to independently use 

toilet facilities when it is a developmentally appropriate 

and when efforts to encourage toilet training are supported by the parents.” [45 CFR 1304.21(a)(1)(v)] 

Christine was a reserved young woman who thus far 

had deferred to her mother regarding major decisions 

about her son. To help her gain confidence in negotiating 

with her mother, the program’s family service advocate 

sat down with Christine. Together, they went over a 

checklist to see if the child was ready to be toilet trained. 

She provided Christine with information about toilet 

training that supported the mother’s belief that her 

son would accept toilet training when he was ready. 

The family service advocate helped Christine develop 

negotiation skills by role playing, in which the family 

advocate acted out the part of Christine’s mother, while 

Christine learned to make her case. The family service 

advocate asked Christine whether she wanted to speak to 

her mother at home or at the center with the family service advocate present. Christine chose to speak to her 

mother at the center, and they set up an appointment for 

the following week. 

The Caregiving Context 

Head Start should consider kin network relationships 

in designing and implementing service delivery to support 

the social and emotional well-being of the child and 

family. Capturing the caregiving context of adolescent 

mothers requires: 

� Determining the kin network 

� Talking with the adolescent mother about how roles 

and responsibilities are defined 

� Identifying important relationships in which there is 

support and/or conflict about caregiving 

� Helping the adolescent mother learn ways to manage 

shared caregiving 

It is important to recognize the bond that adolescent 

mothers have with their children, and that even the youngest 

mothers want what’s best for their child. Identifying the 

family structure and understanding the caregiving context 

allows staff to empower the adolescent mother, identify 

areas needing support (such as working through kin relationships), and customize service delivery (by including key 

decision-makers in discussions, for example). In doing so, 

programs will be able to effectively support the mother and 

her kin network to the benefit of the child. ■ 

REFERENCES 

Sellers, K. 2005. She calls us both ‘Mama’: Shared kinship 

caregiving among low-income, African-American 

families. Poster presented at the American Public Health 

Association 133rd Annual Meeting, Philadelphia. 

Katie Sellers is Senior Director for Survey Research at the 

Association of State and Territorial Health Officials 

(ASTHO) T: 202-351-1465; E: cas133@columbia.edu 

Neil Boris, M.D., is an Associate Professor of Community 

Health Sciences at the Tulane University School of Public 

Health and Tropical Medicine. T: 504-988-3673; 

E: nboris@tulane.edu 

Head Start Bulletin 61 
Parents and Family 

A TEEN PARENT’S STORY OF RESILIENCE
 

Adolescent mothers face many 

challenges in raising their children. But 

when a child is born with disabilities, 

the challenges are compounded. This is 

the story of the resilience of one teen 

mom whose daughter has faced serious 

medical problems. 

Missy Ulmer was 16 years old 

when her daughter Jade was born with 

Down Syndrome in 1998. Luckily for 

Missy, she had a strong support system 

that included her mother and Early 

Head Start (EHS). 

Missy was pregnant and had just 

started high school at a traditional 

school when her mother helped her 

enroll in Discovery Alternative High 

School in Port Orchard, Washington. 

The school had a teen parenting program and was about to open an Early 

Head Start center. When Jade was 

born with Down Syndrome that 

December, the staff at EHS rallied to 

Missy’s side. 

Over the years, her mother and 

EHS would support Missy as her 

daughter faced medical challenges 

including reconstructive heart surgery 

at age 2 and Acute Lymphoblastic 

Leukemia at age 3, followed by two 

years of chemotherapy. Jade also regularly battled a respiratory virus that 

causes pneumonia. 

Building Self-Confidence 

From the beginning, EHS was 

instrumental in building Missy’s selfconfidence as a young parent. Staff 

Photo courtesy of Missy Ulmer. 

taught her that she could be a good 

parent regardless of her circumstances. 

“They taught us how to deal with 

being a parent because it’s a blow to 

Jade Ulmer continues to thrive. 

your psyche to be a teen with a baby. 

Early Head Start helped me with my 

self-confidence to raise a baby with disabilities. They pointed out my strengths 

and helped me see that I was the only 

one who needed proof of my parenting 

skills,” Missy said. 

At her most difficult times, EHS 

staff offered Missy emotional support as she struggled with her daughter’s many hospitalizations. Staff 

encouraged her to talk about her 

feelings and provided her with a 

comfortable setting where she could 

feel safe to talk. 

“They were really good at telling 

if something was wrong. They would 

pull me into the office and encourage 

me to talk about it,” Missy said. 

“They didn’t care if I screamed or 

cried or just sat there. They helped me 

get through it. They were my counselors, friends, and confidantes.” 

Parenting Skills and Knowledge 

As a requirement for the EHS program at the high school, adolescent parents were required to take parenting 

classes daily and to spend a minimum 

number of hours in the EHS “lab” with 

their child, where staff could support 

parent-child interactions. The program 

helped Missy and the other teen moms 

(and one teen dad) develop the parenting skills, including the emotional tools, 

they needed to be good parents. 

“They taught us how to put ourselves in time-out because being teens, 

our emotions were running high anyway,” Ulmer said. “They taught us 

how to calm down. They taught us 

everything. They taught us how to 

be parents.” 

Missy said the parenting skills she 

learned at EHS were reinforced by her 

mother at home. She was lucky to have 

a supportive mother who helped her 

care for Jade. Not all of the adolescent 

mothers in the program could rely on 

their parents for help, and in those 

cases, EHS provided their only source 

of support. 

Help With Resources 

As soon as Jade was diagnosed 

with Down Syndrome, EHS provided 

Missy with information on her daughter’s condition. Every time Jade faced a 

Continued on page 103 

62 2009 
Parents and Family 

FATHERS FOR LIFE
 

Incarcerated fathers are provided the tools and skills to nurture 

their children. by Kathy LeFebvre, Stacy Owsley, 

Kathryn L. Fuger, and Marnie Morgan 

In Missouri, approximately 10 percent of the nearly 

19,000 children enrolled in Head Start and Early Head Start 

have an incarcerated parent. An even higher percentage of 

the children have a parent on probation or parole. 

Since its launch in 2002, Fathers for Life has brought 

about unprecedented change in the culture of the Missouri 

prison system by providing incarcerated fathers with the tools 

and skills to nurture their children while in prison and after 

their release. In 2005, the Head Start Bureau funded the second phase of the project in two prisons with an Innovation 

and Improvement Projects (IIP) grant. In addition to providing services and support to fathers, the project promotes the 

social and emotional development of young children. 

The incarceration of a father has a ripple effect. The 

children are at increased risk for educational, social, and 

emotional problems. The families face challenges, such as 

single parenting, stigma, legal challenges, lack of child care, 

and poverty. Upon release, fathers encounter obstacles to 

their successful re-entry and to effective parenting. Head 

Start staff often lack specialized training and resources to 

meet the confounding needs of families affected by a parent’s 

involvement in the criminal justice system. Fathers for Life 

addresses these risks in multiple ways. 

Support for Fathers 

Group classes, facilitated by Parents as Teachers educators, teach fathers how to support their child’s development 

and learning. Fathers also may request one-on-one 

Individual Parent Coaching sessions with Parents as 

Teachers educators. 

“Long-Distance Dads,” a 12-session parenting program for incarcerated fathers, explores what it means to 

be a father and how important fathers are to their children. Participating fathers have changed their attitudes 

about parenting. 

Photo courtesy of Fathers for Life. 

There are a lot of things a father is expected to do 

that I didn’t even realize that it was expected. I mean like 

nurturing your child. I always thought that was mom’s 

thing. ... I’ve learned that they need that from you too. 

The program allowed me to break down some walls and 

some barriers I had to deal with—the guilt and shame over 

the years of how I’ve not been a good dad. ... It’s about me 

growing to be a better father for my child (Missouri Head 

Start-State Collaboration Office Video 2003). 

Since 2005, more than 120 fathers have successfully 

completed the parenting program. “Graduates” of the program have learned the skills to become more involved and 

supportive fathers for their children. 

A play area gives fathers and children a place to bond. 

Supporting Children in Head Start 

Fathers for Life supports children’s social and emotional 

development directly by: 

�

�

�

Referring increased numbers of target children to
 

local Head Start and EHS.
 

Offering supports to enrolled children and their families, such as structured parent/child activities during 

the father’s probation or parole. 

Encouraging Head Start staff, as part of each child’s 

enrollment process, to ask whether the family is dealHead Start Bulletin 63 
Parents and Family 

FATHERS FOR LIFE 

ing with the incarceration of a father. With this information, staff are better able to provide appropriate 

referrals for social, emotional, and other community 

support services. 

And indirectly by: 

�

�

Providing training and resources to Head Start and 

EHS staff and other professionals on the challenges 

faced by families with incarcerated fathers. 

Opportunities include: training on how to use special 

topic books for children, cross-training with other 

agencies working with the same families, and introducing staff to services such as mediation for parents 

to resolve child-related issues. 

Providing Head Start and EHS programs with teaching 

materials, such as children’s books designed to help 

children cope with an incarcerated parent. 

Changes in Prison Life 

Fathers for Life has forged a unique collaboration with 

government agencies, not-for-profits, and educational and 

faith-based groups, including the Missouri Departments of 

Social Services, Corrections, Economic Development; the 

Head Start Collaboration Office; the Missouri Head Start 

Association; Office of State Courts Administrator; Parents as 

Teachers National Center; United Methodist Church; 

University of Missouri Extension; Children’s Services 

Commission; and University of Missouri-Kansas City 

Institute for Human Development. 

Together, they have created broad-based forms of support 

for fathers and their families. They have instituted changes in 

traditional ways of treating the fathers and their families at 

the demonstration sites. They have put the children’s needs at 

the center of their efforts and have formed a support system 

for fathers who have felt isolated and frustrated in the past. 

Family visiting areas are now bright and colorful spaces 

designed to foster children’s development of motor skills, 

hand-eye coordination, and problem solving. Indoor spaces 

include puppet theaters and reading corners. Outdoor spaces 

include playground equipment and walking trails lined with 

trees and flowers. These areas invite adult-child interaction 

and encourage families to explore, create, and learn together. 

Unlike many prisons, the Fathers for Life demonstration 

sites promote physical contact between fathers and children. 

Children may sit in their fathers’ laps as they share a book. 

Fathers are encouraged to hug and play with their children. 

In this way, the father-child bond is strengthened. 

To stay connected in between visits, fathers may record 

children’s books on tape and send these tapes and books to 

their children. Such activities involve the fathers in their children’s learning and reinforce the joy of literacy. 

The message that parenting is important is conveyed in 

many ways. Parenting, child development, and relationship 

books are made available in prison libraries. Father/Child 

Activity Days are funded by the State’s Department of 

Corrections, which provides craft supplies and snacks. Weekly 

Parenting Education Days let inmates take advantage of parenting sessions. 

Unlike many prisons, the Fathers for Life sites promote 

physical contact between fathers and their children. 

Fathers are encouraged to hug and play with their 

children and to snuggle with them as they share a book. 

Changes After Prison 

Fathers for Life has inspired social services, workforce 

64 2009 
Parents and Family 

development, mental heath, and other professionals to work 

together to help ensure successful re-entry of fathers into the 

community. As part of their initial intake interviews of men 

recently released from the Fathers for Life demonstration 

sites, probation and parole officers ask whether they have 

young children, what their relationship is with their children 

and the children’s mother, and whether their children are eligible children for Head Start. Referrals are made to Head 

Start as appropriate. 

Once referred to Head Start, fathers are offered individualized fathering plans through a specialized intake and assessment process. The plans may include support groups, parent 

coaching, and referrals to jobs training and career support. 

System-Wide Changes 

The depth of collaboration on this project is stimulating 

system-wide changes in the way that agencies and organizations work with fathers and families dealing with incarceration. Head Start and Early Head Start staff and other professionals are gaining the knowledge and skills to effectively 

serve them and offer appropriate referrals and resources. All 

partners in Fathers for Life, including Head Start programs, 

see their goals reflected in the project, and therefore, they 

are committed to its success. It is anticipated that the partnerships will develop into a strong, sustainable, statewide 

coalition committed to supporting families and children with 

incarcerated and ex-offender fathers. 

One notable systems-wide change has been instituted 

by the Department of Corrections. As a result of the positive outcomes associated with the Fathers for Life demonstration projects, the department has expanded parenting 

education to all Missouri prisons. The department now 

believes that it has a stake in children, especially at-risk 

children, and supports interventions for children and parents to avoid future incarceration. 

Some of the Fathers for Life project materials will be 

made available on the Early Childhood Learning and 

Knowledge Center (http://www.eclkc.ohs.acf.hhs.gov/) to 

support Head Start and other early childhood programs that 

want to learn about working with incarcerated fathers or 

want to replicate aspects of the project. ■ 

REFERENCE 

Missouri Head Start-State Collaboration Office. 2003. 

Fathers for life: Strengthening connections between 

incarcerated fathers and their children. Video. 

Columbia, MO: Author. 

Kathy LeFebvre is a former Grant Coordinator at the 

Missouri Department of Social Services Family Support 

Division in Cape Girardeau, MO. T: 573-450-6280; 

E: klefebvre3@sbcglobal.net 

Stacey Owsley is the Director of the Missouri Head StartState Collaboration Office in Columbia, MO. T: 573-884­

3080; E: owsleys@missouri.edu 

Kathryn L. Fuger is the Principal Evaluator for the IIP project 

at the Institute for Human Development at the University of 

Missouri-Kansas City in Kansas City, MO. T: 815-235­

5351; E: fugerk@umkc.edu 

Marnie Morgan is a Project Coordinator for Fathers for Life 

at the Missouri Department of Social Services in 

Higginsville, MO. T: 660-584-8302; 

E: marnie.a.morgan@dss.mo.gov 

Head Start Bulletin 65 
Parents and Family 

BY	 JACQUELINE M. DAVIS 

GRANDPARENTS: MAKING A DIFFERENCE
 

A woman, who is struggling with 

mental illness, is unable to provide 

consistent, ongoing care for her two 

children. The grandmother steps in to 

make a difference. 

A young mother and father have 

decided that they can no longer raise 

their two children at this time. 

Although the grandmother has a 

heart condition, the grandparents step 

in to make a difference. 

A daughter with four young children, a husband, and two graduate 

degrees passes away suddenly. The 

father of the children decides he cannot care for the children alone and 

makes arrangements to place them in 

separate homes. The grandparents 

step in to make a difference. 

Regardless of the circumstances, 

grandparents today are increasingly 

assuming the responsibility of partial 

or primary caregiver for their grandchildren, often to avoid having the 

children enter foster care. According 

to the 2000 Census, nearly 2.5 million grandparents in the United States 

are heads of households with primary 

caregiving responsibility for more 

than 4.5 million children under age 

18—the children of their children 

(Simmons & Dye 2003). 

Regardless of the situation, children still have the desire to be loved 

and cared for by a parent. The ability 

to step in and fill the void is an awesome responsibility. Grandparents 

may be required to make major 

lifestyle changes, interact with social 

services to get services for their 

grandchildren, and advocate on 

behalf of their grandchildren. 

They may have to defer their 

needs for the grandchild’s needs. 

Unlike traditional foster parents, 

grandparents often receive no training 

to care for children who may be at risk 

and receive limited financial assistance 

to meet the children’s needs (U.S. Dept. 

of Health & Human Services 2007). 

The result can be emotional strain on 

the grandparents and the heightening of 

any mental health issues they already 

have. A study of grandparents raising 

grandchildren in Illinois found that onethird (36.8%) of the grandparents 

reported significant symptoms of 

depression (Smithgall et al. 2006). It 

was also found that nearly four-fifths of 

the grandmothers reported at least one 

health problem, and many had three or 

more health problems such as arthritis, 

high blood pressure, and diabetes. 

Grandparents who are caregivers 

of grandchildren face a number of 

issues that can impact their own wellbeing, including: 

� Legal issues related to raising 

their grandchildren. Whether 

obtaining legal custody, power 

of attorney, temporary 

guardianship or adoption, the 

steps getting there create stress. 

“My stress came from not 

being able to get the documentation...the necessary papers.” 

�

�

�

Concern for or anger and 

resentment toward their own 

child (the parent of the grandchildren). “I know my daughter is not getting all the benefits 

she should get considering her 

multiple disabilities...those 

types of things contribute to 

[my] mental state.” 

Red tape in obtaining necessary 

resources and services for 

financial assistance, health 

care, and a nurturing learning 

environment for the grandchildren. “We went through a battle to get food stamps. We went 

through a battle to get 

Medicaid... It seems like our 

legal system faults us [grandparents] for how things have 

transpired.” 

Deterioration of physical 

health. “I never knew I had a 

heart problem. I was working 

two jobs and was a Union 

Rep...They told me my arteries 

are blocked. I [now] have tubes 

in my chest...I lost my job.” 

While there are many stressors 

that might upset the mental wellness 

of grandparents who are raising 

grandchildren, many grandparents 

find joy in seeing their grandchildren 

happy. Furthermore, if other family 

members share the responsibilities, 

some of the stress can be alleviated. 

66 2009 
Parents and Family 

What Can Head Start Do? dren. Grandparents can sometimes be ambivalent about initiating contact with these agencies 

and service organizations but 

may be more willing to seek help 

if Head Start can pave the way. 

lies. When grandparents are the 

primary caregivers, but the parents are still involved, Head 

Start programs can encourage 

open communication lines and 

support grandparents with 

regard to issues such as 

parental visits and discipline. 

Grandparents often cannot do 

it alone. Head Start can help them 

get the services they need for their 

grandchildren. 

“My 4-year-old granddaughter 

has learning disabilities and some 

physical disabilities, and they [Head 

Start] are really working wonders in 

helping me get her all the programs 

she needs. My granddaughter wouldn’t talk. Now she talks very fluently 

and in complete sentences.” 

�

�

�

�

�

Enlist the assistance of grandparents in forming grandparent 

support groups to provide education and information as well 

as emotional support. 

Grandparents, who embrace the 

responsibilities as caregivers of grandchildren and who overcome many 

obstacles along the way, are to be 

applauded. Molded by the magical 

hands and the mystical wisdom of 

their grandparents, the grandchildren 

do not forget the unconditional love 

and care bestowed upon them. It goes 

a long way to brighten the hearts and 

lives of the grandparents and 

strengthens their resolve to join with 

other grandparents and lift their 

voices to make a difference. ■ 

Consider specialized training 

for Head Start staff that 

focuses on grandparent/grandchildren relationships. 

Staff can help grandparents 

build communication skills, 

promote healthy boundaries, 

and instill values and beliefs. 

“We knew something was 

wrong... It took going to a Head 

Start conference and sharing my story 

with the lady that I was sharing a 

room with. She was actually able to 

get me a grant to pay for my [grandson’s] speech therapy and developmental therapy. The difference is 

remarkable. It has taken a lot of 

stress off of me.” 

Seek out legal organizations, 

family attorneys, or others who 

are willing to volunteer time to 

work with families facing grandparent/grandchildren challenges. 

Legal issues top the list of challenges faced by grandparents 

raising grandchildren. 

The vignettes and the quotations 

in this article came from a focus 

group of grandparents raising grandchildren enrolled in Head Start that 

was conducted May 16, 2007, by 

Jacqueline M. Davis. 

In addition, Head Start can play 

a vital role by supporting the grandparent generation. Programs can: 

�

�

Recognize the issues related to 

aging, especially the physical 

and mental health needs of 

grandparents, and help connect 

the grandparents with the medical, mental health, and other 

health services they need. 

Tap in to the resources offered 

by the American Association of 

Retired Persons (AARP). The 

Association’s ever-expanding 

resources provide grandparents 

with information on state and 

Federal guidelines about tax 

credits, health insurance, and 

public benefits. 

REFERENCES 

Simmons, T., & J.L. Dye. 2003. 

Grandparents living with grandchildren: 2000. A Census 2000 

Brief. Washington, D.C.: U.S. 

Census Bureau. Available at 

http://www.census.gov/prod/2003 

pubs/c2kbr-31.pdf 

Build partnerships with local 

agencies and service organizations in the public and private 

sector that serve as advocates for 

grandparents raising grandchilTake a cross-generational 

approach to supporting fami- Continued on page 104 

Head Start Bulletin 67 
TITLE

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tk. by TK

Life-Changing Events 

WHAT IS TRAUMA?
 

As defined by the National Institute of Mental Health, emotional 

trauma refers to “an experience that is emotionally painful, distressful, 

or shocking, which often results in lasting mental and physical 

effects... Psychiatric trauma, or emotional harm, is essentially a normal response to an extreme event” (U.S. Department of Health and 

Human Services 2001). 

The Child Traumatic Stress Network (2007) distinguishes two different types of emotional traumas: 

Acute traumatic events occur at a particular time and place and 

are usually short-lived. They can involve sustaining or witnessing a 

serious injury or witnessing the death of someone else; facing imminent threats of serious injury or death to yourself or others; or experiencing a violation of personal physical integrity. 

Exposure to chronic trauma situations occurs repeatedly over 

long periods of time and can create intense feelings of fear, loss of 

trust in others, decreased sense of personal safety, guilt, and shame. 

These kinds of traumatic situations include: 

�

�

�

�

physical abuse 

long-standing sexual abuse 

domestic violence 

wars and other forms of political violence 

Child traumatic stress occurs when children and adolescents 

are exposed to traumatic events or traumatic situations and when 

this exposure overwhelms their ability to cope with what they 

have experienced. 

In this Bulletin, we examine trauma in terms of domestic violence, family disruption and welfare placement, and natural disasters 

and their impact on the lives of young children, their families, and 

other caregivers, including Head Start staff. 

Editor’s Note: The Improving Head Start for School Readiness 

Act of 2007 designates funds to support staff training and child counseling and other services to meet the needs of special populations, 

including children who are exposed to chronic violence. The Act also 

requires that the Secretary submit a report to Congress with an evaluation of Head Start agencies’ procedures for responding to largescale emergencies, including procedures for communicating with families, staff training, and recommendations for improvements as related 

to Head Start and EHS. 

REFERENCES 

National Child Traumatic Stress Network. 2007. Defining trauma 

and child traumatic stress. Los Angeles, CA: Author. Available at 

http://www.nctsnet.org/nccts/nav.do?pid=faq_def 

U.S. Department of Health and Human Services. National Institute of 

Mental Health. National Institutes of Health. 2001. Helping children and adolescents cope with violence and disasters: Fact 

sheet. Bethesda, MD: Author. 

BOUNCING BACK FROM KATRINA
 

What does resilience look like for people who have endured a disaster that has 

made the headlines day after day? 

In 2006, one year after Hurricane 

Katrina struck the Gulf Coast, researchers 

from the Henry J. Kaiser Family 

Foundation conducted a door-to-door survey of the residents of New Orleans and 

the surrounding area. What they found was 

a strong resolve among the residents to 

rebuild their lives and their community. 

“We found an incredible sense of optimism, hope for the future. And when we 

asked people ‘Do you plan to stay? or Do 

you plan to go?,’ only a modest number, 11 

percent of the people we talked to said, ‘I 

plan to go.’ So we found an incredible 

resilience among the people in New 

Orleans. And that was the good news in 

the survey because that resilience, that 

strength, that hope for the future is the 

foundation to build on.” 

Drew Altman, President and CEO of 

the Henry J. Kaiser Family Foundation, 

from an interview with Michele Norris, All 

Things Considered, May 10, 2007. 

National Public Radio. Available at 

http://www.npr.org/ 

templates/story/story.php?storyId=1 

0119566&sc=emaf. 

To read the full survey report Giving 

voice to the people of New Orleans: The 

Kaiser Post-Katrina baseline survey, visit 

http://www.kff.org/kaiserpolls/pomr051007 

pkg.cfm. ■ 

68 2009 
Life-Changing Events 

BY	 KAREN MC KINNEY 

UNDERSTANDING LOSS AND GRIEF
 

A 5-year-old girl was on the playground when she noticed a picture of 

a little boy posted at the entrance. 

She had seen the picture many times, 

but today she studied the picture, 

then asked her teacher why the picture of the little boy was there. The 

teacher took a deep breath and held 

back tears, then told her it was the 

picture of a little boy who used to be 

in her class. She told the little girl 

that the boy died several years ago, 

and his parents wanted to make sure 

that he was remembered so they built 

a playground for other children to 

enjoy. The teacher then took the little 

girl to see another picture of the boy 

that was located in the library. She 

also showed her that the same picture 

was placed in the library books. 

Again, she said that his parents 

wanted other boys and girls and their 

families to remember the little boy 

who loved to play outside and wished 

for more books in the library. 

The little girl went home that 

night and told her mother about the 

picture of the little boy who died. The 

mother was surprised to learn that 

the little boy was the child of a 

teacher at the school. The next day 

the parent went to this teacher to ask 

more about her child’s death. The 

mother expressed that she didn’t 

know how to talk to her daughter 

about death and that she was hesitant 

to ask questions herself. The teacher 

replied that it gave her much joy to 

talk about her son and to know that 

others wanted to learn more. 

This is just one example of how 

death or loss can have an impact on 

children, early childhood educators, 

and families. Often the subject of 

death provokes fear and anxiety that 

prevents us from engaging in open 

discussions. Furthermore, because 

there is a certain stigma surrounding 

death in our society, most individuals 

are not given the opportunity to view 

death simply as the final phase of 

life—an approach that contributes to 

overall health and wellness. 

Therefore, it is important to increase 

our own awareness of death and loss, 

recognize associated issues, and also 

consider planning for dealing with 

death or loss within our early care 

and education programs. 

Most Head Start programs have 

been forced to address issues of loss 

and grief with little preparation. A 

program may be forced to deal with 

the death of a staff member, a child in 

the program, or a pet in the classroom. Sometimes, a program encounters multiple losses created by a natural disaster with the accompanying 

loss of life, property, and community. 

More often programs address the 

countless numbers of “deathless 

deaths,” such as divorce or separation; a change in employment or residence; a change in health that results 

in a loss or impairment; or learning a 

child has special needs. 

Any type of loss involves the 

process of grief. Grief is the normal 

response of sorrow, emotion, and 

confusion that comes from losing 

someone or something important. The 

grieving pattern that people experience may include shock, denial, anger, 

guilt, depression, and acceptance. 

Head Start programs are in a 

unique position to support children, 

families, and staff in dealing with loss 

and grief. While there are no quick 

answers to dealing with loss and the 

subsequent grief that typically follows, there are many proactive steps a 

program can take to provide awareness, understanding, and support. 

The following resources may be 

available to support programs as they 

address issues of loss and grief. 

�

�

�

�

A mental health professional 

who is certified as a death educator or grief counselor may 

offer classes on death awareness or provide grief counseling. 

A local hospital or funeral 

home may also offer classes or 

support groups. 

Web-based grief support groups 

address specific types of loss, 

such as loss of a spouse, child, 

or pet. 

Colleges often offer courses 

such as death, dying, and 

human health; psychological 

impact of death and loss; and 

Continued on page 104 

Head Start Bulletin 69 
Life-Changing Events 

TRAUMA AND DOMESTIC VIOLENCE
 

Recognizing the signs of domestic violence is key to 

providing proper support. by My Linh Nguyen 

The American Psychiatric Association (2005) defines 

domestic violence as control by one partner over another 

in a dating, marital, or live-in relationship. The means of 

control include physical, sexual, emotional, and economic 

abuse, threats, and isolation. 

Estimates vary greatly regarding the number of children 

exposed to domestic violence each year. According to the 

Child Welfare Information Gateway, 3.3 million to 10 million children a year are estimated to be at risk for witnessing 

or being exposed to domestic violence (Bragg 2003). 

While domestic violence occurs among all social and 

economic groups, it is more likely to affect low-income families. It is important for Head Start programs to recognize the 

signs of domestic violence among families and children and 

to provide proper support to these vulnerable victims. 

Effects on Children 

Children experience domestic violence in many ways. 

In addition to witnessing domestic violence, children can 

also hear or infer violence, such as when they see cuts, 

bruises, or broken limbs. The impact of witnessing domestic violence can be just as significant as if the child had 

been the intended victim. Children who witness domestic 

violence can suffer severe emotional and developmental 

difficulties similar to children who are the direct victims of 

abuse (Schecter & Edleson 1999). 

Many adults wrongly assume that very young children 

are not affected by domestic violence. In reality, they are often 

too young to talk about the violence or too afraid to bring it 

up. But even if infants and toddlers do not fully understand 

violence, they can feel danger and loss. Exposure to violence 

may be particularly harmful to children when it occurs very 

close to them, especially in their homes. They may become 

fearful and distrustful. The process of developing trusting relationships may be delayed or may not take place at all (Cohen 

& Walthall 2003). However, when a child’s primary caregiver 

is the victim of abuse, the caregiver may still try to maintain a 

safe, loving, and nurturing environment, even if emotionally 

unable to offer the child adequate comfort and support 

(Cooley 2007). 

The impact of witnessing 

domestic violence can be just 

as significant as if the child 

had been the intended victim. 

Nearly 10% of Head Start 

children were reported by 

their parents to have 

witnessed domestic 

violence in the previous year. 

Young children’s reactions to domestic violence are 

similar to their responses to other kinds of trauma. They 

may display signs of regression, separation anxiety, fear, 

acting out, and nightmares. The effects of trauma and 

ways to support trauma victims are discussed in numerous 

articles in this Bulletin: “Trauma in the Lives of EHS 

Children,” “Post-Traumatic Stress Disorder in Young 

Children,” and “Supporting Children and Families in the 

Child Welfare System.” 

Head Start Families 

According to the findings of the FACES 2000 survey of 

Head Start families and programs, nearly 10 percent of 

Head Start children were reported by their parents to have 

witnessed domestic violence during the previous year. 

70 2009 
Life-Changing Events 

Almost 13 percent of the parents reported that they had 

been victims of domestic violence in the past year. Head 

Start parents experiencing domestic violence were significantly more depressed, and they reported their children to 

be more aggressive, more hyperactive, more withdrawn, 

and to have more overall problem behavior. Teachers also 

reported these children to be more withdrawn and have 

more overall problem behavior than children whose parents were not experiencing domestic violence (U.S. Dept. of 

Health and Human Services 2003). 

Fortunately, for children exposed to domestic violence 

and other stressors, both formal early childhood programs 

(e.g., child care centers, Head Start, nursery schools, and 

pre-kindergarten), as well as care by family child care 

providers, neighbors, and relatives, can offer a kind of “safe 

haven” (Cohen & Knitzer 2004). Head Start programs, 

because of their comprehensive commitment to children and 

families, are ideally suited to provide that “safe haven.” In 

some states, the Head Start-State Collaboration Office and 

the State Domestic Violence Coalition have partnered to 

train Head Start programs in a domestic violence curriculum 

using a “train the trainers” approach (Cooley 2007). 

Given the effects of domestic violence on families and 

young children, Head Start programs should be aware of 

resources to help families at risk and provide appropriate 

support for young children who are affected by such troubling events. (See the “Webliography” section at the end of 

this Bulletin.) 

Editor’s Note: The Improving Head Start for School 

Readiness Act of 2007 promotes partnerships between Head 

Start agencies and other entities to reduce the impact of substance abuse, child abuse, domestic violence, and other highrisk behaviors on healthy child development. ■ 

REFERENCES 

American Psychiatric Association. 2005. Let’s talk facts 

about domestic violence. Arlington, VA: Author. 

Available at http://healthyminds.org/factsheets/LTFDomesticViolence.pdf. 

Bragg, H.L. 2003. Child protection in families experiencing 

domestic violence. Child abuse and neglect user manual series. 3rd Edition. Washington, D.C.: U.S. 

Department of Health and Human Services, Office on 

Child Abuse and Neglect. 

Cohen, E., & J. Knitzer. 2003. Young children living with 

domestic violence: The role of early childhood programs. Paper #2 in the Series: Early childhood, domestic 

violence, and poverty: Helping young children and their 

families. ed. S. Schechter. Iowa City: University of Iowa. 

Cohen, E. & B. Walthall. 2003. Silent realities: Supporting 

young children and their families who experience violence. Washington, D.C.: The National Child Welfare 

Resource Center for Family-Centered Practice. 

Cooley, T. 2007. An update on the Safe Families Safe 

Homes Project—Fact sheet. Winterport, ME: T. 

Cooley & Associates. Available from T. Cooley & 

Associates at tacooley@onebox.com. 

Schecter, S., & J. Edleson. 1999. Effective intervention in 

domestic violence and child maltreatment cases: 

Guidelines for policy and practice. Reno, NV: 

National Council of Juvenile and Family Court Judges. 

U.S. Department of Health and Human Services. 

Administration for Children and Families. 2003. Head 

Start FACES 2000: A whole-child perspective on program performance. Washington, D.C.: Author. 

My Linh Nguyen is a Senior Writer/Editor at the Head Start 

Resource Center in Arlington, VA. T: 703-908-8868; 

E: mnguyen@pal-tech.com 

Head Start Bulletin 71 
Life-Changing Events 

SUPPORTING CHILDREN AND FAMILIES IN THE
 

CHILD WELFARE SYSTEM
 

Program staff, child welfare workers, and families can work 

together to support abused and neglected children. 

by Elena Cohen 

Infants and very young children are the largest group of 

children to enter, remain, and re-enter the child welfare system. They are more likely to be reported for neglect than 

for any other reason. And they are at great risk for socioemotional, behavioral, and psychiatric problems (Dicker, 

Gordon & Knitzer 2001). 

To provide effective support and services, it is critical 

for Head Start and Early Head Start (EHS) programs to 

understand the unique emotional needs of these most vulnerable children. 

Vulnerabilities 

Typically, children turn to their parents in times of stress 

or fear. Research indicates that children who have access to 

a nurturing caregiver are more resilient in response to 

trauma than are children who do not (Cohen & Knitzer 

2003). Unfortunately, children who are neglected or abused 

by their primary caregiver or who witness domestic violence 

may not have such emotional refuge. Their primary caregiver may mistreat them or, in the case of domestic violence, 

the battered parent may be emotionally unavailable because 

of her own trauma. As a result, maltreated children often 

have complicated, ambivalent, and overwhelming feelings 

toward the parent who either perpetrates the violence or 

neglects them. They may be placed in high-risk environments characterized by poverty, instability, and caregivers 

who may be well-meaning but are psychologically vulnerable 

themselves (Macomber, Green, & Clark 2001). 

In addition, abused and neglected children suffer cumulative losses when they must leave their home. Often the 

psychological effects of neglect and witnessing violence in 

the community and within the family are less visible than 

the effects of physical abuse. 

All Head Start staff—but especially teachers—can help 

maltreated children cope with their feelings through daily routines, developmentally appropriate learning experiences, and 

play and creative activities that may reduce the impact of 

trauma and help children work through their fear and anxieties. 

Working together, program staff, child welfare workers, and 

families can achieve the best possible outcomes for the child. 

Josue was the youngest child of a single mother who 

was unable to care for him along with his three older siblings. He was placed with a foster family in the same neighborhood and was referred to an EHS program. 

The family service worker, child welfare worker, mental 

health consultant, and EHS teacher met with Josue’s birth 

mother and foster family to teach them about the program 

and help them enroll Josue. Before the first day of school, 

they developed a plan to provide a structure of predictability, 

nurturance, and support for Josue. In addition, and in cooperation with the child welfare worker, the parent coordinator 

began to work with both birth and foster families to help 

them get connected to needed services in the neighborhood. 

The goal is to maintain the child’s contact with his birth family and to reunite them as soon as possible. 

Support for Children 

By providing a stable, supportive environment, EHS and 

Head Start staff can help children develop secure attachments, acquire self-regulation skills, and maintain continuity. 

Secure Attachments 

Separation from caregivers and other traumatic events 

during early childhood can have long-term consequences. 

Even children with conflicted and negative attachments—a 

characteristic of children who have been abused or 

neglected—have strong emotional reactions when relationships to caregivers are disrupted. 

Head Start staff can facilitate the formation of new 

attachments and lessen the impact of potentially traumatic 

events by supporting children throughout the grieving 

process that may accompany changes in placement and by 

providing the continuity of a stable caregiver and a nurturing environment. 

72 2009 
Life-Changing Events 

Self-regulation Skills 

Many abused or neglected children have an impaired 

capacity to self-regulate, to manage new stressors, and to 

make use of relational forms of soothing and comfort. As a 

result, they may exhibit challenging behaviors including 

colic, excessive fussiness, and sleep or feeding disturbances. 

Head Start staff can screen and refer for assessment and 

intervention those children who are hard to console, have 

sleeping or feeding problems, or those who are not demonstrating appropriate milestones in any area of social, emotional, cognitive, or physical development. 

Continuity 

Head Start staff can support children by sharing their 

knowledge of the child’s needs, wants, comforts, beliefs, likes, 

and dislikes with extended family, foster families, caseworkers 

making decisions about placement, and other professionals. 

This sharing of information can help overcome the many discontinuities that children can experience in the child welfare 

system. Besides the disrupted attachment that occurs when a 

child is placed in foster care, the child may endure multiple 

changes in child welfare workers and mental health providers, 

among others. This lack of continuity is disruptive to the 

child. It also results in a fragmented or total lack of knowledge about the child’s internal experience and reality. 

Support for Families 

Designing a support system for young children must 

include a carefully considered and appropriate involvement 

of the child’s caregivers (biological, substitute, and adoptive parents). When safety can be ensured, it is in the best 

interest of the child that biological and substitute caregivers maintain an ongoing relationship with the child and 

other caregivers. Head Start staff can provide caregivers 

with guidance about the child’s needs for consistent and 

reassuring daily routines, the child’s complex feelings 

toward parents or foster parents, and appropriate (nonaggressive) techniques for managing the child’s behavior. 

When caregivers feel that their emotional needs are met, 

they are more capable of doing the same for their children. 

By listening non-judgmentally and sensitively to the stresses, 

stories, and family histories, teachers and family service staff 

can identify the special strengths and needs of each caregiver 

and how each of them feels about what is happening. 

Conclusion 

EHS and Head Start staff are in an optimal position to 

meet the specific developmental challenges faced by young 

children involved in the child welfare system. By providing a 

stable, secure environment, programs can have a positive 

impact on a child whose life has been disrupted by abuse or 

neglect. 

Editor’s Note: The Improving Head Start for School 

Readiness Act of 2007 designates funds to support staff training 

and child counseling and other services to meet the needs of special populations, including children in the child welfare system. It 

also calls on programs to enhance collaboration and coordination 

of services with other entities providing services for children 

referred to Head Start programs by child welfare agencies. ■ 

REFERENCES 

Cohen, E., & J. Knitzer. 2003. Young children living with 

domestic violence: The role of early childhood programs. 

Paper #2 in the Series Early Childhood, Domestic 

Violence and Poverty: Helping Young Children and Their 

Families, ed. S. Schechter. Iowa City: University of Iowa. 

Dicker, S., E. Gordon, & J. Knitzer. 2001. Improving the odds 

for the healthy development of young children in foster 

care. New York: National Center for Children in Poverty. 

Macomber, J., R. Green, & R. Clark. 2001. Children cared 

for by relatives: Who are they and how are they faring? 

Assessing the New Federalism Policy Brief. Washington, 

D.C.: The Urban Institute. 

Elena Cohen is the Director of the Safe Start Center at 

JBS International in Silver Spring, MD. 

T: 202-439-1749; E: ecohen@jbsinternational.com 

Head Start Bulletin 73 
Life-Changing Events 

BY	 JULIE PALMER -BLACKWELL 

MY LIFE IN FOSTER CARE
 

In 1947, when I was just 9 

months old, my dad, an immigrant 

from India, brought me to live with 

Clara McBride Hale, known as 

Mother Hale. She was the nice lady 

who lived upstairs in a five-room 

apartment in Harlem’s Sugar Hill 

neighborhood. The famous Hale 

House, now a sanctuary for young 

children whose parents cannot care 

for them, did not exist yet. 

Back then, my dad had a heart 

condition and had to work. My mother 

was not in the picture at the time. I can 

only imagine my dad’s sense of urgency. 

He had been my caregiver and was the 

parent with whom I had bonded. He 

had to find a place where I could be 

safe and cared for. Mother Hale’s home 

was the answer. 

Mother Hale had been taking care 

of other peoples’ babies and children 

since her own husband had died years 

before, leaving her with two young 

children. She knew first-hand the desperate circumstances that parents 

experienced in their quest for safe and 

reliable child care. 

Today, we know that when we 

leave our babies, we say, “Good-bye. 

I love you, and I’ll be back.” It is not 

likely that my dad knew that. So, 

absent of some coaching from the 

very wise Mother Hale, he left me, 

alone and afraid of being in a strange 

place with people I did not know. I 

was told that at first I would just sit 

and stare off into space. Gradually, 

Photo courtesy of Julie Palmer-Blackwell. 

with sensitive and loving care and 

attention from Mother Hale, I formed 

a bond with her. Under her care, I 

passed all the developmental mileJulie Palmer and her sister. 

stones in the early years, such as 

walking, talking, and learning to feed 

myself. In later years, two of my sisters joined me at Mother Hale’s home 

and helped make this family unit 

complete with loving adults (including Mother Hale’s adult children) and 

other foster children. 

Research on Foster Care 

A study of “alumni” of foster care 

was conducted in 2003 to determine 

how youth formerly in foster care have 

fared as adults and what changes in 

foster care services could improve their 

lives (Casey Family Programs 2005). 

The study reviewed 659 case records 

and interviewed 479 alumni. 

Here are some of the findings: 

� More than half entered foster 

care at age 12 or older, but 

14.9% were placed at age 5 

or younger. 

�

�

�

�

�

�

�

The average number of years 

spent in foster care was 6.1 years. 

On average, they experienced 

1.4 placement changes a year. 

A disproportionate number of 

alumni had mental health problems compared to the general 

population. 

As adults, more than half had 

one or more mental problems, 

and one-quarter suffered from 

post-traumatic stress disorder. 

Their high school completion 

rate was comparable to the general population, although the 

former foster children were more 

than six times likely to use GED 

programs to get their diplomas. 

Many had experienced seven or 

more school changes during 

their foster care years. 

As adults, their employment 

rate was lower than the general 

population, and they lacked 

health insurance at twice the 

rate of the general population. 

More than one in five alumni 

experienced homelessness for 

one day or more within a year 

of leaving foster care. 

Although public attention often 

focuses on the negative side of foster 

care and extreme cases of maltreatment, the benefits of foster care 

should not be ignored. The study concluded that “the majority of alumni 

reported positive experiences with 

their foster parents. More than four 

74 2009 
Life-Changing Events 

in five said they felt loved while in 

care” (Casey Family Programs 2005). 

According to Misty Stenslie, deputy 

director of the Foster Care Alumni of 

America, there are an estimated 12 

million adult alumni of foster care in 

the United States. “Most of us alumni 

will report that being in foster care 

was an overall positive part of our 

lives,” said Ms. Stenslie. 

Some Protective Factors 

It is clear from the alumni survey 

that growing up in foster care can have 

long-term consequences. Thankfully, 

my experience in Mother Hale’s home 

provided enough protective factors to 

promote my positive development. 

These protective factors included: 

Family Life. Our family included 

Mother Hale; her children, Nathan, 

Lorraine, and Kenneth; and my sisters, 

Carol and Robin. We ate dinner 

together on a nightly basis, and during 

this time, we talked about our day, 

laughed, and sometimes argued. In this 

very “normal” setting, we were acquiring the tools for a successful life. 

Spiritual Anchor. As a family, we 

attended church regularly. I sang in the 

church choir and was active in the 

youth group. 

Lasting Relationships. Because we 

bonded together and formed a family, 

my sisters and I were able to have lifelong relationships with the Hales, our 

birth parents, and one another. This 

made it possible to have a healthy, 

developmentally appropriate childhood and gave us a foundation for 

forming healthy relationships as 

adults. 

Stability. I was fortunate to have 

only one placement. I left Mother 

Hale’s home when it was time for me 

to go to college. 

Relationship with Birth Family. It 

is better to have a relationship with 

one’s family than not, as long as the 

child is physically and emotionally 

safe. In my case, I grew up with two 

of my three sisters and had ongoing 

relationships with my birth mother 

(very difficult at first, but later on, a 

wonderful relationship shortly before 

she died) and with my dad (always 

wonderful). I also formed a lasting 

bond with my baby sister, Mary, who 

was reared by our mother. 

High-Quality Early Care and 

Education. As early childhood educators, we know that high-quality early 

childhood education, including continuity of care, can be an effective intervention for distressed and/or disorganized families and children by providing respite, regularity, and structure; 

modeling appropriate practice; and 

offering opportunities for positive relationships. Because Mother Hale was 

essentially a stay-at-home mother and 

her daughter Lorraine was a teacher, 

my early childhood education took 

place at home. Mother and Lorraine 

were voracious readers who taught us 

to value education and encouraged us 

to read and talk. We were all great 

talkers! When I entered school in the 

first grade, I was already reading. 

Few School Changes. I attended 

three elementary schools and attended 

just one junior high school and one high 

school. My school environment was 

fairly stable, especially as I got older. 

Education. Good grades and 

higher education were non-negotiable. 

All but one of us completed college. 

Many of us earned advanced degrees. 

Resources When Leaving Care. 

Although I made the transition to college and adult life, I continued to be 

part of the family. When I brought my 

children to visit their grandmothers, 

Mother Hale was one of them. I still 

receive a lot of support from the Hales 

who were truly my other family. 

A Happy Ending 

I am happy to say that today I 

am a motivational speaker, jazz 

singer, and a dedicated educator and 

advocate for children and families. I 

owe all of my accomplishments and 

successes to my wonderful foster 

mother, Mommy Hale, and her family 

who gave me the tools for living, as 

well as to my parents, Carolyn 

Truesdale and Tony Alli, who gave 

me life. 

Perhaps the most important lesson 

I gained from my life with Mother 

Hale was the power of family. I am the 

proud mother of four adult children, 

Continued on page 105 

Head Start Bulletin 75 
Life-Changing Events 

SUPPORTING THE MENTAL HEALTH OF 


HOMELESS CHILDREN
 

Specific strategies can ease the strain of homelessness in 

young children. by Karin Elliott and Sarah Fujiwara 

Every year 600,000 families with 1.35 million children 

experience homelessness in the United States, making up 

about 50 percent of the homeless population over the course 

of the year (National Alliance to End Homelessness 2007). 

Key factors contributing to the increased number of 

homeless families are extreme poverty and a lack of affordable housing in many parts of the country. Many families 

become homeless because they earn low wages and cannot 

keep up with expenses. Many families lack a network or 

support system upon which they can rely in a crisis. Families 

also become homeless as a result of domestic violence, physical and mental health issues, or substance abuse. Often, families who become homeless live with friends or relatives 

before moving into a shelter. 

The Impact of Homelessness on Young Children 

Research shows that children experiencing homelessness face mental health challenges. Homeless children have 

higher levels of anxiety, withdrawal, and depression than 

their counterparts who are not homeless. Homeless children 

are also more likely to have increased health problems, 

increased behavioral issues, developmental delays, and 

lower educational achievement (The Better Homes Fund 

1999). Some homeless children have either witnessed or 

experienced violence. 

More than 20 percent of homeless children between 

the ages of 3 and 6 have emotional problems serious 

enough to require professional care (The Better Homes 

Fund 1999). Behaviors commonly displayed by children 

who have experienced homelessness include anxiety and 

withdrawal, depression, aggression, hoarding, eating and 

sleeping disruptions, and acting overly friendly or mature 

beyond a child’s years. Children experiencing homelessness need strong supports, resources, and nurturing 

relationships from consistent caregivers to help alleviate 

these impacts. 

How Head Start Can Help 

Head Start can offer a supportive environment to homeless children and their families. Head Start programs can 

help alleviate the impact of homelessness on young children. 

Head Start providers can offer a safe and stable environment, activities in the classroom geared towards social and 

emotional support, and referrals for children and families to 

appropriate community services. 

There are also specific strategies that Head Start staff 

can use when they see signs of strain in a homeless child’s 

social and emotional health. Examples of typical behaviors 

seen in homeless children and ways to address them are 

described below. 

Hoarding. Children who may not have had “enough” 

may hoard markers, food, or other items to help them 

feel better. 

�

�

Have enough supplies for children to play with,
 

including multiples of popular items. It is best to
 

have fewer toys but to have several of each type.
 

Sharing will come later. 


Reassure children that the play dough or other toys 

will be there tomorrow and that they will be able to 

play with them again. 

Acting Mature Beyond Years. Many children will have 

experienced a need to “take on” responsibility for younger 

children or even occasionally for parents. 

�

�

�

Explain to children that the adults are there to keep 

them safe. Let them know that there are adults who 

can help their parents (if they are sad or need support). It doesn’t have to be the child’s job. 

Head Start teachers can help children by “teaching 

them to play” and by removing the burden of responsibility from them. 

Be sure to have parent discussions and conferences 

away from the children so that they are not re-traumatized by hearing the family story again and again. 

Lack of Boundaries. Very often children who have 

experienced the trauma of homelessness lack appropriate 

boundaries. 

76 2009 
Life-Changing Events 

�

�

It is critical to always introduce yourself and classroom visitors to a child. 

Reinforce safety by creating clear expectations 


and limits.
 

However, no single program can provide the full array 

of support services that homeless families need. Head Start 

programs need to seek out and establish active partnerships 

with relevant service providers in their communities to 

ensure that homeless children and families receive effective, 

comprehensive services. 

Horizons for Homeless Children 

Horizons for Homeless Children (HHC), a nonprofit 

organization based in Massachusetts, operates three child 

care centers that provide a nurturing environment for homeless children, while offering their families support and services to help them achieve personal and economic self-sufficiency. HHC has 34 slots for Head Start children. 

The program is funded with a combination of private 

dollars (60%) and public funding (40%) that includes Head 

Start, child care vouchers, community partnerships, homeless 

child care vouchers, and teen parenting program funding. 

HHC is committed to providing a child care environment and experience that promotes positive mental health 

for children. An aspect of its unique programming is the 

presence of an extra teacher in each classroom for additional attention. 

Quality, nurturing relationships can help to alleviate some 

of the stress that homeless children experience. Additional 

opportunities for individual attention can contribute to children’s positive social and emotional development. 

Conclusion 

Serving the homeless presents unique challenges to local 

Head Start programs. It is possible to reduce the negative 

impact of homelessness on the health and well-being of 

infants, toddlers, and preschoolers. Creating supportive 

environments, promoting stable and nurturing relationships, 

providing quality interactions, and dealing effectively with 

challenging behaviors in the classroom are just some of the 

ways that you can make a difference. ■ 

Massachusetts law 

requires child care 

centers have: 

At Horizons for 

Homeless Children, 

each classroom has: 

� 2 teachers for 7 infants � 3 teachers for 7 infants 

� 2 teachers for 9 

infants/toddlers 

� 3 teachers for 9 

infants/toddlers 

REFERENCES 

National Alliance to End Homelessness. 2007. Fact checker: 

Family homelessness. Washington, D.C.: Author. 

Better Homes Fund (now The National Center on Family 

Homelessness). 1999. Homeless children: American’s 

new outcasts. A public policy report from the Better 

Homes Fund. Newton, MA: Author. 

Karen Elliott is the former Director of Training and 

Technical Assistance at Horizons for Homeless Children in 

Roxbury, MA. 

Sarah Fujiwara is the Chief Programs Officer. For more 

information, contact Shirley Fan-Chan, Chief of External 

Programs at T: 617-445-1480 Ext. 304; 

E: sfanchan@horizonsforhomelesschildren.org. 

Head Start Bulletin 77 
Life-Changing Events 

A Historical Look:
 

tkSERVING HOMELESS CHILDREN AND FAMILIES 

tk. IN HEAD ST by TK ART 

Perhaps no children speak more directly to the mission of 

Head Start than those who are homeless. Recognizing 

both the essential need to serve this population and the 

need programs might have for guidance in this area, the 

Head Start Bureau launched several initiatives aimed at 

enhancing services to homeless children and families. 

�

�

A 1992 policy brief on Homeless Children 

and the Head Start Program encouraged 

local Head Start programs to target for enrollment 

those families with preschool-aged children experiencing homelessness. This guidance is still relevant 

today (ACF-IM-92-12, issued 06/05/92). 

In October 1993, the Head Start Bureau funded 

16 Head Start grantees to implement three-year 

demonstration projects for homeless children and 

their families. The objectives of this initiative were 

to: (1) enhance access of homeless families to 

Head Start services; (2) provide services responsive to the special needs of homeless children and 

families; (3) identify effective methods of addressing the needs of homeless families; and (4) implement and document replicable strategies for collaboration between Head Start programs and community agencies on behalf of homeless families. 

Findings from the demonstration projects are summarized in the report, Head Start 

Demonstration Projects Serving Homeless 

Families: Descriptions, Effective Practices, 

and Lessons Learned. The document details 

effective approaches and challenges as well as 

recommendations from Project Directors. The report 

(attachment to ACYF-IM-HS-99-02, issued 

03/12/1999) is available at the Early Childhood 

Learning and Knowledge Center at 

http://eclkc.ohs.acf.hhs.gov/. 

One former demonstration project that has continued 

to support homeless children and families is Parents 

in Community Action, Inc. (PICA) Head Start in 

Minneapolis. The program’s “Project Secure” provides transportation and other support services for 

eligible children living in homeless shelters to attend 

full-day Head Start and Early Head Start. Support 

for parents includes a life skills and housing subsidy 

support program to help families move from shelters 

into permanent housing. For more information, visit 

http://www.picaheadstart.org/hs/ 

projectsecure.html. 

Another former demonstration project that has continued its efforts is Action for Boston Community 

Development, Inc. (ABCD), which now partners 

with Horizons for Homeless Children (see article 

“Supporting the Mental Health of Homeless 

Children” in this Bulletin). 

� In 1995, Congress passed legislation requiring 

Head Start programs to coordinate with efforts to 

implement subtitle VII-B of the McKinney-Vento 

Homeless Assistance Act regarding education for 

homeless children, pre-k through grade 12, and 

ensure that homeless children are identified and 

prioritized for enrollment. The legislation also 

allows homeless families to apply, enroll in, and 

attend Head Start programs while required documents are obtained within a reasonable timeframe. 

Editor’s Note: The Improving Head Start for School 

Readiness Act of 2007 prioritizes homeless children for 

enrollment in Head Start. The Act also calls on programs 

to better meet the needs of homeless children, including 

transportation needs, and to improve the outreach and 

quality of services to homeless children and families. 

78 2009 
Life-Changing Events 

BY	 JUDY DAVID 

LEARNING TO LIVE IN THE U.S.
 

Imagine fleeing your home and all 

that is familiar. Imagine huddling in a 

refugee camp with thousands of other 

people, sleeping under a tent in the 

boiling sun or the freezing cold. 

Imagine surviving that way, in limbo, 

for weeks, months, or even years while 

you wait for another country to accept 

you as a resident. And then imagine 

landing in your new country, where 

everyone speaks and acts differently 

than what you are used to. This is the 

reality for many refugees from all parts 

of the world. 

Over 41,000 refugees arrived in the 

U.S. in 2006, and many of the families 

and young children were eligible for 

Head Start. The mental health issues 

they may face include (Birman 2007): 

�

�

�

Migration stress—Many families 

have endured great difficulty on 

their journeys to the U.S. and 

have been separated from family 

members and their community. 

Acculturation stress or culture 

shock—There may be vast differences between the new culture 

and the native culture; there may 

be a generation gap as the children adapt and learn English 

faster than their parents. 

Traumatic stress—Many families 

have experienced war, violence, 

and multiple traumas. Refugees 

may suffer post-traumatic stress. 

At a refugee camp in 1979, Vietnamese children await resettlement in the U.S. The youngest child later 

enrolled in Head Start. 

Many Head Start programs have 

found culturally appropriate ways to 

address the mental health needs of 

Photo courtesy of My Linh Nguyen. 

refugee families and children. 

Designated a refugee resettlement city, 

Boise, Idaho, has become home to 

many African, Asian, and Eastern 

European refugees. With an active outreach and recruitment effort, Friends 

of Children and Families, Inc. Head 

Start/Early Head Start, enrolls a 

diverse population. Providing mental 

health support requires understanding 

the culture and respecting its traditions. Elizabeth Dilley, Executive 

Director, explains: 

Many families are used to living in 

one small community or village in 

their homeland. They often move into 

the same apartment complex here. 

They typically turn to each other to 

discuss important matters. We’re 

working on ways to bring the mental 

health services to them where they live 

and feel comfortable. We also are 

learning how to communicate effectively with the families given the different roles that men and women have. 

The staff at Friends of Children 

and Families also recognize how 

important it is to prevent challenging 

behaviors and to build resilience in all 

children. Anticipating that some 

refugee children initially will want to 

hold onto their toys or play things 

because they have experienced extreme 

deprivation, the educational staff make 

sure that there are enough classroom 

materials so that all children can participate in activities. 

Some Head Start programs partner with community agencies whose 

staff are bilingual and bicultural mental health professionals. In Falls 

Church, VA, the Center for 

Multicultural Human Services offers a 

wide range of services in 30 languages; its staff include trained professionals, 80% of whom are immigrants or refugees. The Center has 

partnered with Higher Horizons Head 

Start and Early Head Start to serve its 

diverse population of families and 

Head Start Bulletin 79 
LEARNING TO LIVE IN THE U.S. 

Life-Changing Events 

children from all over the world. The 

program turns to Center staff to 

make classroom observations when 

there are mental health concerns 

about children; to consult with teachers and parents; and to provide individual therapy and parenting education and support groups, including a 

program for Survivors of Torture and 

Severe Trauma. Most of these services 

are delivered at the Head Start site 

which makes them readily accessible 

to families. 

What makes this partnership 

work? Mary Ann Cornish, Director of 

Higher Horizons, credits the sensitivity 

and diversity of the Center’s staff. But 

she also describes the very special role 

that Head Start plays: 

Once families come into our program, they quickly see that we have 

their best interests at heart. They trust 

us. If we have to make mental health 

referrals, families know that we wouldn’t send them to a place where people 

didn’t speak their language or who 

couldn’t connect with their experiences 

as immigrants or refugees. Because they 

trust us, they trust the Center too. 

Given the stress or trauma that 

refugees often experience in their 

homelands or during their escape and 

the challenge of adjusting to a new 

country and culture, it is important 

that Head Start programs be alert to 

their mental health needs. Head Start 

programs and its community partners 

are in an optimal position to promote 

the resilience and mental well-being 

of this vulnerable population. ■ 

Editor’s Note: The Improving 

Head Start for School Readiness Act of 

2007 designates funds to support staff 

training and child counseling and other 

services to meet the needs of special 

populations, including refugee children. 

REFERENCES 

Birman, D. 2007. Risk and resilience in 

young children and their families. 

Presentation at The National Head 

Start Institute on Hispanic & 

Other Emerging Populations. San 

Antonio, TX. 

Elizabeth Dilley is the Executive Director 

of Friends of Children and Families, Inc. 

in Boise, ID. T: 208-344-9187; 

E: ldilley@focaf.org 

Mary Ann Cornish is Director of Higher 

Horizons Head Start and Early Head 

Start in Falls Church, VA. 

T: 703-820-2457; 

E: maryann.cornish@fairfaxcounty.gov. 

Judy David is a Senior Analyst/Writer/ 

Editor at the Head Start Resource Center 

in Arlington, VA. T: 703-247-8313; 

E: jdavid@pal-tech.com 

The Refugee Mental Health Program (RMHP), located in the Substance Abuse and Mental 

Health Services Administration (SAMHSA), provides refugee mental health consultation and 

technical assistance to Federal, state, or local agencies at no cost. Specific RMHP services and 

activities include: on-site and distance consultation; community assessments, program development, dissemination of technical assistance documents; and development and provision of workshops and training programs for resettlement staff, mental health personnel, or other providers. 

Priority is given to programs funded by the Office of Refugee Resettlement (ORR, ACF, HHS). 

For more information, as well as products and other resources, visit 

http://mentalhealth.samhsa.gov/cmhs/SpecialPopulations/refugmhnew.asp. 

The Head Start Connection Web page has been specifically designated to connect the Office of 

Refugee Resettlement (ORR), service providers, and Head Start programs. A list of ORR partners 

and resources is included. 

http://www.acf.hhs.gov/programs/orr/whatsnew/headstartconnection.htm 

80 2009 
tk

Caption tk tktktk

ktkt

Photo by Tk

THE EARLY PROMOTION AND INTERVENTION
 

RESEARCH CONSORTIUM
 

Program Approaches 

Did you know that Early Head Start (EHS) programs are 

involved in research on mental health in early childhood? 

The Early Head Start Infant Mental Health Initiative, 

begun in 2001, consisted of both programmatic and 

research components. At the program level, the Pathways 

to Prevention training experience provided a specialized 

infant mental health consultant for 25 EHS and Migrant 

and Seasonal Head Start programs to help them work 

toward their goals in mental health. 

The Early Promotion and Intervention Research 

Consortium (E-PIRC) is the research component of the 

Initiative. In 2002, the Head Start Bureau and the Office of 

Planning, Research, and Evaluation (OPRE) funded fouryear grants to support five partnerships between academic 

institutions and EHS programs. 

The purpose of the research was to develop and test 

approaches to supporting the mental health of infants, toddlers, and their families in EHS. The five projects incorporated diverse ethnic and linguistic groups, teen mothers, 

urban and rural populations, and homeless families. 

As described in the next section, the approaches fit 

into two broad categories: 

�

�

providing training and assistance to EHS staff 

providing direct intervention and support to 


EHS families
 

Training and Assistance to Program Staff 

Project HAPPI: Healthy Attachment Promotion for 

Parents and Infants (An Early Head Start Infant Mental 

Health Initiative), led by Brenda Jones Harden at the 

University of Maryland, provided training on infant mental 

health and ongoing support to home visiting staff and center-based caregivers/teachers. 

Early Head Start-University Partnerships: Improving 

Mental Health in Children Served by Early Head Start, led 

by Jane Squires at the University of Oregon, implemented 

and evaluated a preventative intervention program aimed 

at enhancing developmental growth and social and emotional competence in children through enhancing home 

visitors’ knowledge and skills regarding mental health. 

Interventions with Families 

High-Risk Adolescent Mothers and Their Children: 

Comparing Two Preventive Interventions, led by Neil Boris 

and Sherry Heller at Tulane University, compared two 

interventions that use a relationship focus—Circle of 

Security and the Nurturing Program—to increase attachment organization between high-risk adolescent mothers 

and their children. 

Infusing Infant Mental Health Services in Early Head 

Start Through a Research-Based Collaborative Partnership, 

led by Neena M. Malik at the University of Miami, conducted screenings, including observations of parent-child 

interactions, and provided intensive parent-infant psychotherapy to families observed to be at risk for relationship difficulties and developmental delays. 

EHS Latina Mothers: Reducing Depression and 

Improving Infant/Toddler Mental Health, led by Linda S. 

Beeber at the University of North Carolina, tested a fivemonth home-based, manual-guided intervention for depressive symptoms with Latina mothers. 

For more information on the Pathways Training provided by the Early Head Start National Resource Center, 

see www.ehsnrc.org/highlights/mentalhealth.htm. 

For more information on these E-PIRC studies, see 

www.acf.hhs.gov/programs/opre/ehs/epirc/index.html. 

Head Start Bulletin 81 
Program Approaches 

FREE TO GROW: PARTNERSHIPS TO 

STRENGTHEN FAMILIES 

From 1994 to 2005, Free To Grow (FTG), a national demonstration program, worked with 15 local Head Start programs and their community partners to test an innovative approach to substance abuse and child abuse—two closely 

related public health problems. FTG focused on reducing risk factors and increasing protective factors by strengthening the 

family and neighborhood environment of small children. FTG fostered partnerships among local Head Starts and schools, 

law enforcement agencies, county governments, the public housing authority, homeless shelters, and substance abuse and 

mental health treatment organizations. The initiative was funded partly by the national Head Start Bureau (now Office of 

Head Start), the Robert Wood Johnson and Doris Duke Charitable Foundations, and local programs. 

From 2001 to 2006, Wake Forest University School of Medicine conducted a process and impact evaluation of FTG. 

The process evaluation included an assessment of technical assistance to local sites and the perceptions of stakeholders 

such as Head Start. The impact evaluation assessed the effects of FTG interventions in reducing the risk and increasing 

resilience of targeted families and neighborhoods, as well as strengthening community partnerships. Results of the evaluation were presented at various conferences. 

UNLIKELY PARTNERS IN RURAL AMERICA 

BY JULIE ADRIAN 

At Head Start, we are all champions for children, and 

as champions we cannot stop until we see that each Head 

Start family is on the way to reaching their full potential. 

When we know that we have impacted a Head Start family, then we know that we have touched the life of a child. 

(Almeta Keys, Executive Head Start Director) 

Sorrel, Four Corners, Glencoe, and Ashton are four 

low-income communities in St. Mary Parish, LA, served by 

St. Mary-Vermilion Community Action Agency (CAAHead Start). These neighborhoods were vulnerable and 

ridden with substance abuse, drug dealing, and crime. 

Some parents, themselves jobless, were reluctant to report 

their child’s money-making drug dealing. That was the status quo until the inception of Free To Grow (FTG) 2000, 

when CAA-Head Start and its partners made innovative 

and foundational change and inspired members of the 

community to help themselves. But changing the minds and 

hearts of people who had become accustomed to their 

environment was not easy. 

Holistic Approach 

To increase family support and to better serve the children, CAA-Head Start/FTG integrated an encounter form 

into its initial intake interview which would make it easier 

to track support services for families during their child’s 

enrollment. The form was designed to share special concerns and needs and to better address the family’s and 

child’s needs. In this way, a more holistic approach was 

undertaken to better serve families and children. 

Drug Awareness 

The CAA-Head Start/FTG collaboration led a series of 

classes for parents within the community. In one class, a 

state trooper displayed drugs and drug paraphernalia to the 

parents. Parents learned about what each drug did to the 

body and the consequences for selling drugs. District 

Attorney Phil Haney described his office’s open-door policy. 

82 2009 
Program Approaches 

Leadership Development 

Leadership Development classes, a 9-12 week series led 

by Denise Teno, Neighborhood Family Advocate, also were 

offered to parents and community residents. After successful 

completion of the course, parents in the community graduated 

with caps and gowns, a first for many who had not graduated 

from high school. Some of the graduates have taken leadership roles, such as Ray Manuel, a Head Start parent, who was 

motivated to run for public office and was appointed Justice 

of the Peace in Glencoe. 

Neighborhood Watch 

The local police departments were one of the FTG partners, and they took new steps to support the communities. 

For example, a police car was designated by the St. Mary 

Parish Sheriff, David Naquin, to patrol the area. This was 

very significant to the community. The closest police station 

was 20 minutes away, and even after many in the community 

had complained, there was a reluctance to assign a patrol car 

specifically to the area. On the heels of FTG, the Sheriff himself stood with the community to put up the neighborhood 

watch sign which, to the community, symbolized his commitment and support. 

Role of Faith-Based Organizations 

Faith-based organizations had an ongoing major role in 

strengthening the community and supporting the efforts initiated 

by FTG. They made announcements about events held by CAAHead Start/FTG. In turn, they were inspired by the energy and 

support they received from FTG. St. Moses Baptist Church organized the March for Jesus, which rallied about 200 people on a 

7-mile walk to a park. Once overgrown with weeds and a drugdealers’ domain, the park had been cleaned up thanks to FTG. It 

became the site for a Resource Fair. Community residents visited 

booths set up by local organizations, businesses, and educational 

institutions. The community now can plan events in the park, 

such as an Easter egg hunt and baseball games. 

Recreation Center 

Although plans were underway to build a recreation 

center in the Four Corners area, the facility was not fully 

funded because neighbors complained that it would draw 

noisy, disruptive groups. To complete the project, Rev. Brian 

K. Stevens, a key player in the FTG project, led target area 

residents to move beyond complaints to petition the Parish 

Council. Eventually the new multi-use recreation center was 

built under the oversight of Rev. Craig Mathew to include a 

kitchen, basketball court, and much-needed community 

space. The dream of the residents for over 30 years became 

a reality thanks to the major efforts of family-strengthening 

and partnership-building by the agency and FTG. 

Replication 

To inform other programs of the knowledge and successes 

they found, Almetra Franklin, CEO, and Almeta Keys, 

Executive Head Start Director, St. Mary-Vermilion CAAHead Start, shared information about community engagement and partnership-building with other FTG grantees, 

such as Head Start of Greater Dallas. They also spoke at 

national conferences, trainings, and hearings, including testifying at Congress and presenting at the National Head 

Start Association Academy in Albuquerque, NM. 

Lessons Learned 

In this impoverished and vulnerable Head Start community, FTG left a legacy of greater coordination among 

the stakeholders—the residents, the police, the District 

Attorney’s office, and the churches, to name a few. 

What lessons can be passed on to other Head Start 

programs committed to making community-wide changes? 

� Hire a consultant who can play the role of a coordinator to facilitate non-conventional community partnerships. Select a person who is a community resident, “a familiar face” and is deeply rooted in the 

community. 

Head Start Bulletin 83 
Program Approaches 

UNLIKELY PARTNERS IN RURAL AMERICA 

�

�

�

�

Employ community leaders to take active roles; never 

underestimate any available resources including faithbased groups. 

Employ other staff who are members of the community 

or encourage staff to have a presence in the community. 

Be optimistic even if members of the community do 

not think positive change is likely and may resist the 

unknown. Use your community’s available resources, 

such as churches, to convince members of the community that change is possible. 

Present a holistic program approach that integrates 

the family and community, and thus, ensures the 

child and family are on the way to self-sufficiency. 

� Reach out to local funding resources. ■ 

REFERENCES 

Free To Grow (FTG). 2005. Free To Grow: Building community strength in rural America. Available at 

www.rwjf.org/reports/npreports/vermont.pdf. 

Julie Adrian is a former Writer/Editor at the Head Start 

Resource Center in Arlington, VA. 

TACKLING VIOLENCE IN MAUI 

BY	 T ERRY L OCK 

From 2000-2005, Maui Economic Opportunity (MEO) 

Head Start/Free To Grow (FTG) project targeted the community of Wailuku that included two low-income housing complexes, a large elementary school, a prison, and a homeless 

shelter. Wailuku had the highest reported rates of child abuse, 

domestic abuse, and alcohol and methamphetamine abuse in 

Maui County. 

Tackling Community Violence 

The MEO Head Start/FTG collaboration worked to 

decrease the violence in communities. To help Head Start families and residents of a low-income housing complex who 

were frustrated with drug dealing and violence in their neighborhood, staff assisted them in taking action by initiating a 

partnership with police. With the guidance of the community 

police and the local housing authority, families and resident 

volunteers were trained as patrol members. 

Supporting Incarcerated Mothers 

FTG also worked closely to bring inmate mothers and 

their children together through a project called “Ohana 

Strengthening.” At the Maui Community Correctional Center, 

inmate mothers participated in supervised parent-child interaction and parenting classes. Temporary caregivers in the 

community were given the chance to utilize the assistance of 

case managers and attend regular support group meetings. 

As the incarcerated women spent time with their children, 

the guards learned to see them in a different role. Instead of 

viewing the women only as inmates, the guards learned to 

view them as mothers whose children depended on them. 

Seeing the women in this new light helped the warden and 

guards change their attitudes, thoughts, and feelings toward 

the female inmates and led to better treatment for the women. 

When FTG ended, the activities of Ohana Strengthening were 

continued with funding from the Hawaii Children’s Trust. ■ 

Terry Lock is a director at Community-Based Early Childhood 

Education, Kamehameha Schools and is a former Head Start 

Fellow. T: 808-534-8305; E: thlock@ksbe.edu 

84 2009 
Program Approaches 

BY MILLY BURROWS 

VIDEOTAPING BUILDS PARENT-CHILD RELATIONSHIPS
 

The Early Head Start (EHS) program at Associates for Human 

Services, Inc. in Taunton, MA, serves 

42 infants, toddlers, and expectant 

families. It is a delegate of Triumph, 

Inc., Head Start and is fully funded 

through Triumph. The EHS program 

employs nine staff, including four 

parent-child advocates who deliver 

home-based services. The on-staff 

mental health services manager is a 

licensed social worker who provides 

regular observations of parents and 

children, clinical guidance to staff, 

and consultation to parents. 

Staff use a variety of tools and 

techniques to strengthen relationships 

with parents and to support them in 

meeting their children’s social and 

emotional needs. One technique is to 

videotape parent-child interaction 

and make it into a “Watch Me 

Grow” videotape for the family. This 

is a way for parents and staff to learn 

about the parent-child relationship 

and is also a souvenir of the child’s 

development. The technique is based 

on the University of Minnesota’s 

Center for Early Education and 

Development’s “Seeing is Believing” 

videotape strategy, which helps program staff partner with parents to 

document the parents’ successes, see 

the child’s development, and learn 

about the parent-child relationship. 

All EHS families are offered a 

chance to make a “Watch Me Grow” 

videotape twice a year (or more if 

Photo courtesy of Associates for Human Services Inc. 

parents wish). Ideally, the videotaping is conducted by the parent-child 

advocate during a routine home visit 

A parent-child advocate makes a home visit to 

an EHS family. 

because she has already established a 

trusting relationship with the family 

and is better able to make the parent 

feel at ease in front of the camera. 

With the parent-child advocate 

behind the camera, it is up to the 

parent to direct the play activity with 

the child. 

The videos, which last 10-20 

minutes, do not capture the entire 

home visit. Rather the focus is on the 

play activities between parent and 

child that occur during the visit. 

After the taping, the parent-child 

advocate and mental health services 

manager review the video together. 

The mental health manager writes a 

summary that highlights the parent’s 

strengths and skills and includes 

guidance to help the parent enhance 

her skills and strengthen her relationship with her baby. 

Shortly after the taping, the parent sits down with the parent-child 

advocate and the mental health services manager for a guided viewing 

of the video. They ask reflective, 

open-ended questions such as, “Did 

you notice what happened there?” or 

“How do you think your child felt 

when that happened?” These questions help lead the parent to make 

discoveries on their own. 

Here is an example of how this 

approach benefited one family: 

Maria, an EHS parent-child 

advocate, met with 32-year-old 

Olivia and her children on a weekly 

basis. Olivia’s devotion to her children was obvious. She had very high 

expectations, particularly of her oldest child, 21⁄2 -year-old Natasha, who 

had just rejoined the family after living temporarily with her grandmother. Olivia expected Natasha to 

sit obediently while her infant twin 

sisters played, relinquish toys to 

them, and take on other more mature 

responsibilities. Maria was concerned 

that Olivia was frequently harsh in 

disciplining Natasha. Although Maria 

worked diligently to help Olivia see 

the differences in her children’s temperaments and understand their 

developmental levels, Olivia maintained her unrealistic view. As a 

result, Natasha could never seem to 

meet her mother’s expectations. 

After discussions with the program’s mental health manager, Maria 

offered to videotape her next visit as 

Continued on page 105 

Head Start Bulletin 85 
Program Approaches 

A CHANGE OF FOCUS WITH POSITIVE 


BEHAVIOR SUPPORT
 

Photo courtesy of SEK-CAP. 

Positive Behavior Support helps develop social and 

communication skills and enhances relationships. 

This article is based on an interview with Linda 

Broyles and is partially adapted from the report Programwide positive behavior support: Supporting young children’s social-emotional development and addressing challenging behavior, by Lise Fox, Susan Jack, and 

Linda Broyles. 

Southeast Kansas Community Action Program (SEKCAP) Head Start serves more than 800 children and families 

in 12 rural counties across 7,200 square miles in what is 

considered the most depressed area of the State. For many 

years, it seemed that SEK-CAP staff spent the majority of 

their day “putting out fires” and addressing challenging 

behaviors. Supervisors and program managers were constantly engaged in crisis management. 

“In the past, we would call in the mental health 

provider or special educator,” said Linda Broyles, Director 

of Early Childhood Programs at SEK-CAP. “They were our 

SWAT Team, but they couldn’t fix a problem permanently.” 

So in 2001, Broyles contacted Susan Jack, an early 

childhood behavioral consultant in Kansas to see if there 

was a workshop that would help her teachers and program 

staff. Susan told Linda that a one-shot workshop was not 

what was needed. She advised SEK-CAP to adopt a program-wide model called Positive Behavior Support (PBS) to 

promote children’s social competence and address challenging behavior. Staff training would be an essential piece of 

the effort, but much more would be needed for sustained 

change to occur. 

The SEK-CAP model represents one of the first program-wide applications of PBS within a Head Start program. 

Implementing the model involved change on all levels 

including policy, administrative practices, allocation of 

resources, relationships with community partners, staff 

training, professional development, technical assistance, staff 

support, classroom practices, and partnerships with families. 

What is Positive Behavior Support? 

Positive Behavior Support (PBS) is an evidenced-based 

intervention approach that is based on an understanding of 

the cause or purpose of children’s challenging behavior and 

a focus on teaching them new skills to replace the behavior. 

PBS is based on research and humanistic values. It 

offers a method for identifying the environmental events, 

circumstances, and interactions that trigger problem behavior, the purpose of the problem behavior, and the development of support strategies for preventing problem behavior 

and teaching new skills (Fox, Dunlap, & Cushing 2002). 

The focus of PBS is to help the child develop new social 

Staff take time to 

get at the cause of 

children’s behaviors. 

and communication skills, enhance relationships with peers 

and adults, and experience an improved quality of life (Fox 

et al. 2003). 

The Teaching Pyramid 

To implement PBS, SEK-CAP adopted The Teaching 

Pyramid, a process for promoting children’s social and 

emotional development and addressing their challenging 

behavior (Fox et al. 2003). The framework involves four 

levels of classroom practices that represent prevention, promotion, and intervention. 

86 2009 
Program Approaches 

At the foundation of the pyramid is the development 

of positive relationships with children, families, and staff. 

The second level is the use of classroom practices that prevent problem behavior, support the engagement of all children, and support the development of social skills. For 

many children, the first two levels may be enough to support their healthy development. 

However, some children may need intentional instruction in social skills, social problem solving, emotional literacy, friendship development, and anger management. The 

next level of the pyramid, social and emotional teaching 

strategies, addresses the needs of these children. 

The top level of the pyramid includes the use of individualized positive behavior support interventions for children who have the most persistent challenging behavior. 

Even when all other levels of the pyramid are in place, 

some children will need an individualized behavior support 

plan that includes prevention strategies, the instruction of 

replacement skills, and guidance on how to respond to 

problem behavior so that it is not maintained. 

Comprehensive Professional Development 

“Teachers are teaching socio-emotional strategies for 

life, but we discovered that adults, including educators, 

didn’t always have those skills. So we had to teach the 

adults first,” said Broyles. 

To implement this model, SEK-CAP reconfigured its 

professional training. A PBS leadership team has been 

established to identify the training needs of staff and to 

plan in-service time across the program year. Initially, 

classroom teaching staff were trained in the core components of the teaching pyramid and how to implement these 

strategies in their classrooms. Refresher trainings were provided at regular intervals to address any challenges they 

faced or to update information. Over time, training has 

been extended to include: 

�

�

�

all center-based staff 

home visitors 

PBS facilitators trained to support teams 

Intensive 

Individualized 

Interventions 

Social and Emotional 

Teaching Strategies 

Classroom Preventive Practices 

Positive Relationship with Children, 

Families, and Colleagues 

The Teaching Pyramid Model 

From: Fox, L., G. Dunlap, M.L. Hemmeter, G.E. Joseph, & P.S. Strain. 2003. The 

teaching pyramid: A model for supporting social competence and preventing 

challenging behavior in young children. Young Children, 58 (4):48-52. 

In the SEK-CAP program, all classroom staff are 

focused on teaching children the emotional and social skills 

they need to express their feelings, solve conflicts with 

peers, and develop friendships. In each of the classrooms, 

teachers carefully plan activities (sharing books, discussions, art projects, songs, etc.) that help children learn 

these concepts. Most importantly, all of the classroom staff 

look for moments throughout the day when they can guide 

children to use these skills in their interactions with adults 

and peers. 

Key Partnerships 

“It is also very important to share successes with community partners,” said Broyles. “If we happen to find a 

system of supporting children and families that works, we 

should be good neighbors and share the news with the rest 

of our early learning community.” 

SEK-CAP has relied on meaningful partnerships with 

families, child care providers, mental health teams, and 

special services staff to extend this work beyond the classrooms. This has been accomplished through joint training 

Head Start Bulletin 87 
Program Approaches 

A CHANGE OF FOCUS WITH POSITIVE BEHAVIOR SUPOPRT 

opportunities, planning/problem solving, and team-based 

support for individual children. Families have been asked 

to participate in family-focused training programs as well 

as be members of the collaborative team that will develop 

support plans for their children. 

SEK-CAP has 19 center partners who serve 51 Early 

Head Start children alongside nearly 300 non-EHS 

infants and toddlers, all of whom have benefited from the 

PBS approach. 

Both state and Federal funds support SEK-CAP’s mental health component. SEK-CAP has formed collaborative 

partnerships with community mental health agencies to 

provide services. In Kansas, where there were few early 

childhood mental health professionals, SEK-CAP developed 

that capacity in its communities through joint training 

opportunities with the community mental health agencies. 

A Change of Focus 

The role of mental health consultants with SEK-CAP 

has drastically changed over the course of this initiative. 

Prior to PBS, most of the money the program spent on 

mental health services was devoted to intervention. Now, 

mental health dollars have shifted to prevention with just a 

small portion dedicated toward intervention. Mental health 

providers are actively engaged in supporting the social and 

emotional development of Head Start children through 

skill development and ongoing instruction. 

Continuous Improvement 

Since the introduction of PBS in 2001, SEK-CAP has 

met its initial goals of building program expertise, decreasing episodes of child challenging behaviors, reducing referrals to outside experts, and improving staff satisfaction. 

SEK-CAP is committed to continuous improvement and 

innovation. In the future, the program plans to offer PBS 

training to every enrolled family; offer a class on PBS for 

college credit at a local community college; conduct community-wide PBS strategy sessions; and become a training 

site for other early childhood programs. ■ 

For more on the Teaching Pyramid, see the article referenced below: “The teaching model: A model for supporting 

social competence and preventing challenging behavior in 

young children” in Young Children, 58(4): 48-52. 

REFERENCES 

Fox, L., G. Dunlap, & L. Cushing. 2002. Early intervention, positive behavior support, and transition to 

school. Journal of Emotional and Behavioral 

Disorders, 10(3): 149-57. 

Fox, L., G. Dunlap, M.L. Hemmeter, G. Joseph & P. Strain. 

2003. The teaching model: A model for supporting 

social competence and preventing challenging behavior 

in young children. Young Children, 58 (4): 48-52. 

Fox, L., S. Jack, & L. Broyles. 2005. Program-wide positive 

behavior support: Supporting young children’s socialemotional development and addressing challenging 

behavior. Tampa, Florida: University of South Florida, 

Louis de la Parte Florida Mental Health Institute. 

Linda Broyles is Director of Early Childhood Programs at 

SEK-CAP in Girard, KS. T: 620-724-8204; 

E: lindab@sek-cap.com 

88 2009 
Program Approaches 

PROMOT ING POS IT IVE BEHAV IOR IN MSHS 

The Oregon Child 

Development Coalition (OCDC) 

is a Migrant and Seasonal 

Head Start (MSHS) serving 

2,500 children in 29 centers 

throughout the State of Oregon 

and an additional 250 children 

in state-funded pre-kindergarten. Three years ago, 

OCDC began implementing a 

system-wide approach to 

addressing children’s challenging behaviors. 

After receiving training from 

the Center on the Social and 

Emotional Foundations of Early 

Learning (CSEFEL), OCDC central 

office staff developed a systemwide model called the OCDC 

Positive Guidance Program 

Directive. OCDC’s model is 

based on the Teaching Pyramid 

and adapted to meet the needs 

of migrant children and families 

(see the article “A Change of 

Focus: Positive Behavior Support” 

in this Bulletin). 

Now in the second year of a 

3- to 4-year implementation 

plan, the initial focus has been 

on the first two levels of the 

Teaching Pyramid — development of positive relationships 

with children, families, and staff 

and classroom preventive practices. The current phase 

involves the implementation of a 

defined process for response to 

challenging behaviors, which 

incorporates teaching social 

skills to the children and providing positive behavior support. 

At the outset, OCDC’s 

biggest challenge was finding 

qualified mental health consultants who were bilingual or 

bicultural, experienced in early 

childhood, and available to 

work in rural communities. 

Finding qualified mental health 

providers, like recruiting families, is a continuous process of 

outreach to every community 

partner, such as other Head 

Start programs, education agencies, health organizations, the 

existing network of consultants, 

and local colleges and universities. Thanks to these efforts, 

competent mental health consultants have been identified. 

OCDC’s mental health services are funded with MSHS dollars, with a few exceptions. In 

one county, the program partnered with community agencies 

to pay for mental health services 

through a State Improvement 

Grant. In other parts of the 

State, some consultants bill 

Oregon’s healthcare program 

for low-income children and 

families. And several community 

mental health programs provide 

discounted or matching services. 

The program is currently 

developing additional trainings 

and information for its family 

service teams and parents. 

Eventually, OCDC would like to 

provide additional supports for 

staff around developing and 

implementing positive behavior 

support plans. ■ 

Staff from OCDC were interviewed by My Linh Nguyen of the 

Head Start Resource Center. 

Myra Classen is the Mental Health 

Disabilities Specialist for OCDC. 

T: 503-570-1110; 

E: myra.classen@ocdc.net 

Holly Whittleton is the Head Start 

Director for OCDC. T: 503-570-1110 

ext 1007; E: holly.whittleton@ocdc.net 

Diane Meisenheimer is the Lead 

Education and Mental Health 

Disabilities Specialist for OCDC. 

T: 503-570-1110; 

E: diane.meisenheimer@ocdc.net. 

Head Start Bulletin 89 
Program Approach 

EARLY INTERVENTION AT ONEIDA HEAD START 

The Oneida Tribe of Indians of Wisconsin Head Start 

program had been in need of support services to address 

the social and emotional needs of the children. When a 

new director, John Pavek, took over a few years ago, he 

forged a new collaborative approach, drawing on the 

expertise of the Tribe’s Early Intervention and Behavioral 

Health programs. Now the children, families, and staff are 

benefiting from these partnerships. 

The Early Intervention program includes a nurse, two 

occupational therapists, three speech pathologists, and an 

exceptional educational needs (behavioral) specialist. Mental 

health consultation is provided through a specialist from the 

Tribal Behavioral Health program. The Early Intervention 

program is funded by the Bureau of Indian Education. Head 

Start pays a discounted rate for the mental health specialist 

from the Tribal Behavioral Health program, which also 

offers a range of services to the Tribe’s families. 

The Early Intervention program and the mental health 

specialist work in tandem with the Head Start program to 

provide preventative training for Head Start teachers to 

help them deal with challenging classroom behaviors. For 

example, specialists train teachers on techniques to teach 

basic social skills to children that in turn help the children 

avoid frustration and conflicts. The specialists work with 

staff in the classroom, provide observations, and make recommendations for classroom management. They also provide skills training to parents. 

In addition to the preventative approach, a multitiered intervention approach ensures that children’s mental 

health needs are identified and addressed or treated as 

early as possible. 

The approach includes: 

� Monthly child staffing meetings. Staff, including 

teachers, family service workers, educational supervisors, health specialists, the mental health specialist, 

and the Early Intervention behavioral specialist, 

meet monthly to discuss the development and behavior of every child. When there are concerns about 

the child, the team develops techniques that teachers 

can use in the classroom to address the specific challenging behavior. 

� In-house referral system. When changes in the classroom are not enough, the mental health specialist is 

asked to observe the child and work with the teaching 

staff and family to develop appropriate interventions. 

� External referrals. When the Head Start staff and mental health specialist recognize that a child needs more 

mental health expertise than they can offer, the program may refer the child to its community partners, 

such as the school districts, the counties, the state of 

Wisconsin, and the Great Lakes Tribal Council. 

Since the comprehensive mental health approach has 

been in place, teachers have become more confident in 

their classroom interactions. Teachers know that they are 

not working in isolation to address the mental health needs 

of children. And all Head Start staff know that the surrounding community is a partner in providing mental 

health services in the best interest of the children. 

The Oneida Tribe’s Head Start program has a center 

on the Oneida reservation and another in the city of Green 

Bay. The program serves 108 Federally-funded Head Start 

children and 15 state-funded children. ■ 

John Pavek is Director of the Oneida Tribe of Indians of 

Wisconsin Head Start. T: 920-496-5201; 

E: jpavek1@oneidanation.org 

BY J OHN PAV E K 

90 2009
 
Staff Well-Being 

NURTURING THE NURTURER
 

Supporting the needs of caregivers improves staff capacity 

to deliver effective interventions. by Dale H. Saul and 

Brenda Jones Harden 

Dropping her keys and heavy toy bag on her desk, 

Alissa heads toward her supervisor’s open door. Sticking her 

head in, she asks, “Got a minute? I was just at Keisha’s—-” 

“How’s she doing?” 

“Never got off the couch, just like our last three visits. 

Jason came over with a book, and she pulled a pillow over 

her head!” 

“And you’ve been trying so many things. Is the mental 

health specialist still here? Would you want to see if he can 

join us?” 

*********************************** 

Maria has worked in the Panda classroom only five 

months. As the staff meeting begins to wrap up, she hesitates, then raises her hand. “I know I talked about this last 

time, but it’s Julia’s bottles again—sour, twice this week. Her

mom was so apologetic when I talked to her, but nothing’s 

changed. ...” 

Photo courtesy of IMIL training in Grafton, WV. 

“Maria,” another teacher says, “Why don’t you call me 

next time her mom comes in? Her son’s in my classroom. 

Maybe we could talk with mom together.” 

*********************************** 

Scenarios such as these underscore the challenges Head 

Start and Early Head Start (EHS) staff face, as well as ways 

they can receive informal and formal support in their work. 

When staff reach out to families, they count on relationships to open the door to conversation. Ideally, families see 

staff as informed, helpful professionals. For staff to build 

and maintain these relationships, their own needs must also 

be met. This is especially true when addressing parents’ mental health needs and crises. 

How do we nurture caregivers who support high-risk 

families with young children? The first step is to identify 

staff’s general and individual needs. The second step is 

building a strong organization, not only to ensure that program missions are achieved, but to provide a healthy environment for staff. The last step is implementing strategies 

that provide ongoing nurturing experiences for staff. 

Needs of Caregivers 

Stress management. Serving high-risk families can be 

hard work. In this high-stress environment, some staff may 

experience stress-related health problems, such as bad backs, 

migraines, and high blood pressure. For some staff, securing 

time in a busy schedule to address work stress, time management, and accountability can improve their productivity and 

availability to families. 

HS staff are enjoying moving at an I Am Moving, I Am Learning training. 

Setting Boundaries. Passionate about the well-being of 

children, staff often have years of experience in community 

child care agencies. Some EHS and Head Start staff had 

their children in the program; most are women. Head Start 

emphasizes having staff who are representative of the community. While this emphasis facilitates participant engagement, it may also contribute to the difficulty staff encounter 

in maintaining appropriate boundaries with the families they 

serve. Issues can arise when staff, who have strong feelings 

about what worked and what did not in their own lives, 

encounter families with similar issues. 

Head Start Bulletin 91 
NURTURING THE NURTURER 

Staff Well-Being 

Professional Development. Many caregivers have not 

had mental health or family studies training. They may 

require specialized training and consultation to understand 

how a child’s overall development and social and emotional 

health are impacted by a parent’s mental health. 

One home educator said after a training on depression: 

I appreciate the mental health stuff ‘cause I see so much of it 

with my families—it looks normal, but it’s not. Now I see 

it’s not just poverty, it’s what’s keeping them where they 

are—or what got them there in the first place (EHS focus 

group, University of Maryland 2004). 

Healthy Relationships 

A major goal of Head Start programs should be 

enhancing staff’s capacity to serve families and 

children in the healthiest manner possible. What 

does a caregiver in a healthy helping relationship 

look like? The caregiver— 

•

•

•

•

•

•

 Recognizes when issues are too close to 

home; knows when to step back and take a 

neutral stance with a distressed parent 

 Understands his or her role with families and 

prioritizes the goals of the parents regarding 

their children’s development 

 Listens actively instead of jumping in to “fix” 

 Offers information but not advice 

 Collaboratively problem solves with relevant, 

open-ended questions 

 Acknowledges that each parent—not staff—is 

potentially the ultimate expert with a child 

Supportive Environment 

How can organizations provide a supportive environment? In the relationship-based organization, relationships 

among staff and between staff and families are based on 

trust, empathy, and responsiveness. 

Organizational Structure. Regular staff meetings and 

supervision enhance staff’s connection to the agency and 

their internalization of the organization’s service mission. 

Clearly defined agency expectations (mission, goals, job 

description) are essential for staff to know their jobs and 

improve their skills. The pay-off for revising organizational 

structure, practices, and goals to support staff is in the 

parallel process. Experiencing support from peers and supervisors enables staff to support families more effectively. 

Parents, in turn, can then support their children through 

trust, empathy, and responsiveness. 

Reflective Practice. A key element in parallel process is 

reflective practice, which can be achieved through reflective 

supervision at all levels of the organization. Reflective supervision moves beyond staff accountability and case management. It provides the opportunity to slow down and review 

events and dynamics in a non-crisis mode. It can be “a bubble of peace in a crazy work week” (EHS focus group, 

University of Maryland 2005). 

Through reflective supervision, staff can become more 

attuned to child and parent psychological functioning, 

address their own boundary issues, and think about how 

they can best promote positive child and family development. Staff can explore the impact families and children 

have on them and the impact they, in turn, may have on 

families and children. Working reflectively helps to address 

the recurring challenges families present and “face the 

unthinkable,” such as suspected child abuse, neglect, and 

domestic violence. (For more information on reflective 

supervision see the Steps to Success Unit 3: Reflective 

Practice Mentor-Coach Manual available at the Early 

Childhood Learning and Knowledge Center at 

http://eclkc.ohs.acf.hhs.gov/) 

Resources. Successful intervention with high-risk children and families requires the collaboration of many service providers. Head Start staff should always have an upto-date referral list, screened by the supervisor, in order to 

feel confident in making referrals. Consultation from a 

variety of disciplines (e.g., disability, employment) is 

important to appropriately address family and child development. In particular, staff need ready access to a welcoming mental health professional who can provide guidance 

92 2009 
 

Staff Well-Being 

to staff on young children’s behavioral and emotional 

issues and on parental mental health. 

Staff Training. Training should focus on specific competencies for a particular job as well as specialized areas, such 

as maternal depression. Training is enhanced if it is experiential and concrete, occurs in a small group, and utilizes 

multimedia formats (such as videotapes of staff working). 

Information and skills acquired through training can be sustained only through ongoing mentoring, supervision, and 

professional development. Importantly, opportunities should 

be created to enhance and share professional knowledge 

through informal and formal peer interaction. 

Strategies for Nurturing 

What are specific ways that management can nurture 

the nurturer? 

�

�

�

�

Incorporating workshops on stress management and 

self-care, physical exercise and psychological healing 

into staff development, promotes general well-being. 

Mental health consultants should be available for 

addressing staff concerns and experiences that could 

affect their work. 

Adhering to safety protocols shows acknowledgment 

of the risks staff face and their importance to the 

agency. For home visitors, there should be a system 

for knowing where staff are, accompanying home visitors to new families, and assigning teams, rather than 

individuals, to work in more dangerous communities 

and with more difficult families. 

Providing “mental health days” as part of leave 

acknowledges the difficulty of dealing with job stress 

and simultaneously encourages more appropriate use 

of sick leave. 

Acknowledging staff effort and sharing examples of 

expertise in supervision during staff meetings, in 

newsletters, and to funders, demonstrates to staff that 

what they do is valued. Having a journal or box where 

staff accomplishments are recorded and shared encourages managers, supervisors, and peers to document 

staff’s positive interactions and interventions with program participants. 

� Conducting periodic “retreats” away from the agency 

provides an opportunity for staff to reflect on their 

work, get recharged, and reconnect with the overarching mission of the agency. 

Summary 

Enhancing Head Start’s capacity to address the mental 

health of participant children and families is rooted in the 

support of their caregivers, the front-line staff. Understanding 

and addressing their needs promote the parallel process that 

facilitates their responsive intervention with families and children. An emphasis on staff nurturing within ongoing professional development and organizational activities improves 

staff morale and staff capacity to deliver effective interventions. Applying these principles enables Head Start programs 

to move closer to their mission to enhance the overall development of children and families. ■ 

Dale H. Saul is an infant mental health specialist in the 

Family Based Recovery program at the Yale Child Study 

Center in New Haven, CT. T: 203-785-7822; 

E: dale.saul@yale.edu. 

Brenda Jones Harden is an Associate Professor at the 

Institute for Child Study at the University of Maryland in 

College Park, MD. T: 301-405-2580; E: bjharden@umd.edu 

Head Start Bulletin 93 
Staff Well-Being 

CREATING A SUPPORTIVE WORK ENVIRONMENT 

by Jean Simpson 

A nurturing work environment values and supports its child care staff. 

How do we assure a nurturing environment that is supportive and shows child care staff they 

are valued and appreciated? Towards that end, an informal survey of preschool (including 

Head Start) staff was conducted in 1999 by the Head Start Bureau. Comment sheets were 

distributed to 125 teachers, child care coordinators, and program specialists, representing 

African American, European American, Native American, Hispanic, and Asian origins. Eighty 

of the 100 who responded indicated that feeling valued as an employee is very important to 

them. The results were presented at the National Head Start Conference in 1999. The 

findings still hold true today. 

The respondents specified numerous circumstances when they feel valued: 

�

�

�

�

�

�

Supervisor listens to an idea, gives feedback. 

Valuable work is assigned. 

Competence, skill, and a job well done are recognized and acknowledged. 

Colleagues request assistance. 

Difficult task is accomplished by collaboration with co-workers. 

Children learn or express positive feelings, such as letting child care worker know they 

like/miss her. 

Circumstances in which staff felt valued helped to influence and affect their performance. 

Staff reported they were: 

�

�

�

�

�

�

�

Energized, enthusiastic; investing more time and effort into their work 

Motivated; more willing and able to help others 

Happier; more confident, better able to perform their job 

Comfortable; experiencing less stress 

Seeking challenges and wanting to experience growth 

Feeling loyal, dependable; supportive and interested in organization’s success 

Deriving a sense of value from within themselves, not from others 

Jean Simpson is an Education Program Specialist at the Office of Head Start in Washington, D.C. T: 202­

205-8421; E: jean.simpson@acf.hhs.gov 

94 2009
 
Staff Well-Being 

BEING AN EFFECTIVE MENTOR-COACH 


A Mentor-Coach serves as a catalyst for individual growth. 

by JoAn Knight Herren 

A Mentor-Coach is a journey guide—someone who 

walks beside another on her journey. Mentor-Coaches support professional development and work to build excellence 

in the daily practice of teaching staff. Teachers benefit from 

the support they receive from a more experienced professional who helps them reach their goals and share their challenges. How do Mentor-Coaches do their work? 

Getting Started 

In the beginning, they build trust and develop a positive, 

non-judgmental relationship with their protégé. They must 

set aside time for learning about the protégé. As an introduction and to set the tone, the Mentor-Coach could share 

her own story about a past learning experience that was 

meaningful. Or she could ask open-ended questions that 

encourage dialogue, such as, “What is one thing that you 

like to do or care about that most people don’t know?” or 

“What is an environment that made you feel really comfortable and happy when you were a young child?” 

The answers help Mentor-Coaches better understand the 

protégé as a person, give insight to what she was like as a 

child and what her beliefs and goals might be about the children and families in the Head Start program. Open communication lays a strong foundation for the MentorCoach/protégé relationship. 

Working as a Mentor-Coach 

Similar to how early childhood teachers individualize the 

curriculum to meet each child’s needs, Mentor-Coaches individualize their support to fit the protégé’s unique strengths, 

needs, and learning style. Individualizing support is a collaborative process, which includes planning, discussing, trying out, 

and reflecting together. Approaching the relationship with 

openness and sensitivity regardless of age, sex, racial/ethnic 

background, language, or origin enhances a Mentor-Coach’s 

ability to offer support and adds richness to the relationship. 

The role of a Mentor-Coach is to be a catalyst for individual growth by engaging the protégé in dialogue and problem solving that challenges the protégé to stretch herself. 

The Mentor-Coach helps the protégé come to her own conclusions through reflective inquiry. It is not necessary for the 

Mentor-Coach to have all the answers; sometimes it is best 

just to listen carefully and pose helpful questions. 

It is normal for protégés and Mentor-Coaches to grapple with challenges as they experiment with what learning 

processes work best. Protégés will face challenges, such as 

a fear of failure, feelings of inadequacy, or sensitivity to 

criticism, which may hinder them as they work to achieve 

their goals and experiment with new practices. These challenges are “growing pains” that are a natural part of learning and experimentation. 

One successful approach to these challenges is appreciative inquiry. The Mentor-Coach starts by showing appreciation for what she notices the protégé is doing well and then 

uses inquiry — in a non-threatening way — to query how 

things might be done differently. For example, the MentorCoach and protégé discuss a teaching strategy the protégé is 

using and then consider how it may be improved. This is a 

positive, non-judgmental approach which enriches and helps 

secure a trusting relationship. At the same time, the MentorCoach learns more about the reasons behind the teacher’s 

behavior and has a greater understanding of the teacher’s 

thinking which helps inform the mentoring process. For 

appreciative inquiry to be successful, Mentor-Coaches and 

protégés must share a common goal—to help the teacher be 

as effective as possible. 

Engaging the Protégé 

Effectively engaging the protégé may come in the form of 

a wide variety of mentor-coaching activities, such as written 

exercises, shared reading, videotaping of classroom teaching 

followed by discussion, and role-playing. Presenting a scenario—perhaps based on one of the protégé’s concerns—and 

asking her to identify a solution can effectively build upon 

the protégé’s ability to reflect and make decisions. 

Head Start Bulletin 95 
Staff Well-Being 

BEING AN EFFECTIVE MENTOR-COACH 

Another activity is to ask protégés to write a poem, 

song, or short creative-writing piece about their vision of 

effective teaching and then work together to strategize how 

to effectively apply their vision in the classroom. 

Supporting the Mentor-Coach 

It takes a lot of energy, dedication, and hard work to 

engage the protégé. To do so, the Mentor-Coach must tap 

into a deep well of creativity and emotion, which must be 

refilled daily. It helps to find nourishment in a personal way, 

such as by meditating, reading, singing, or exercising. Also, 

setting aside time to reflect on mentor-coaching and to plan 

new approaches keeps the process fresh, interesting, productive, and satisfying. 

Early on, establish clear expectations for your relationships with protégés. (Many protégé and Mentor-Coach pairs 

find it helpful to write these expectations down.) 

�

�

�

�

Give a brief overview of the mentor-coaching process. 

Ask your protégé if she’d like to start keeping a 

shared journal. Doing so will give her the chance to 

reflect on her teaching and respond to your questions 

in writing, if that is her preference. Discuss possible 

topics and frequency of entries. 

Make a plan to meet regularly whether on the phone 

or in person. Encourage your protégé to help you set 

an agenda for your next meeting. 

Reinforce that your conversations are confidential. 

Throughout, ask questions and encourage your protégé’s active involvement in the process: 

�

�

�

Discuss ways to develop a reciprocal relationship 

and treat her as an equal partner who brings unique 

strengths. 

Support and encourage your protégé to make positive 

changes by sharing relevant knowledge and resources. 

Encourage your protégé to talk about how he or she 

learns best and try to adapt your approach to meet 

the needs of the protégé. 

�

�

�

Invite your protégé to share her professional goals 

and relevant ideas about teaching early childhood 

education. 

Encourage her to identify any issues and interpersonal 

professional needs that she is facing. 

Set aside time on a regular basis to make classroom 

and home visits with your protégé. 

Lastly, remember that building a learning relationship is 

a process: 

�

�

�

�

Reflect on how you talk with your protégé on an
 

ongoing basis and make changes as needed. For
 

example, do you ask open-ended questions that
 

encourage her to share? 


Experiment with different approaches and make 

changes to improve the relationship to build upon her 

strengths and interests. 

Ask a colleague to do a role-play with you and pretend to be the protégé. Then, ask your colleague to 

give you feedback on your communication style. 

There will always be room for improvement, but
 

remember to pat yourself on the back for any
 

progress that you have made. ■
 

REFERENCES 

U.S. Department of Health and Human Services, Office of 

Head Start. STEP-Notes 2. Washington, D.C. 

U.S. Department of Health and Human Services, Office of 

Head Start. STEP-Notes 3. Washington, D.C. 

U.S. Department of Health and Human Services, Office of 

Head Start. STEP-Notes 4. Washington, D.C. 

JoAn Knight Herren is the former Chief of the Training and 

Technical Assistance Branch at the Office of Head Start in 

Washington, D.C. 

96 2009 
tk

tk. by TK

Staff Well-Being 

EMPLOYEE ASSISTANCE PROGRAMS
 

What happens when staff face personal problems so great that the problems begin to 

adversely affect how they do their jobs? Many Head Start programs turn to an 

Employee Assistance Program (EAP) for help. EAPs provide confidential assessment 

and short-term counseling to employees and their families to help them cope with 

issues, such as marriage and family problems, stress-related problems, financial and 

legal difficulties, and psychological and workplace conflict. 

At one urban Head Start program, teachers became concerned, and even alarmed, 

when a beloved teacher who had been with the program for more than 10 years 

began to lose her temper with children, families, and staff. The teacher was known for 

her sweet, easy-going demeanor and near-perfect attendance, and it was a surprise to 

everyone when she began to miss many days of work. 

Her fellow teachers were so concerned for her well-being that they brought the situation to the attention of a Head Start manager. The manager sat down with the teacher 

and listened as the teacher talked about the problems that had been plaguing her. Her 

adult son was struggling with mental illness and was displaying inappropriate behavior. Under the weight of this stress, the teacher had recently suffered a mild heart 

attack. And it was this stress that was causing her to miss work and to lose her temper 

so easily. 

When the manager learned that the teacher was trying to cope with these problems on 

her own, the manager suggested that she turn to the program’s EAP for counseling. 

The teacher was initially reluctant to go to counseling, fearing that she might be 

labeled “crazy.” But after being assured that it was common for people to seek confidential counseling during difficult times, the teacher agreed to talk to an EAP counselor 

on a regular basis. Over time, she learned to manage her stress and to perform effectively on the job. The EAP program served her well and helped the Head Start program retain a valuable employee. 

For more information on how a Head Start program can benefit from an EAP, please 

see the article “The Best for Your Employees: What an EAP Can Do” in the Head Start 

Bulletin on Adult Health, Issue 75, published in 2003, available at the Early Childhood 

Learning and Knowledge Center at http://www.eclkc.ohs.acf.hhs.gov/. 

Head Start Bulletin 97 
WEBLIOGRAPHY
 

The following is a sample of Federal agencies and national organizations that have information 

about early childhood mental health, professional development, and general mental health topics. 

http://www.aap.org/mentalhealth 

AMERICAN ACADEMY OF PEDIATRICS’ mental health Web 

site has resources on mental health, including state and local 

programs and links to Federal resources and children’s mental 

health organizations. 

http://www.childrensdefense.org 

CHILDREN’S DEFENSE FUND MENTAL HEALTH RESOURCE 

KIT is designed to help promote access to state mental health 

screens and assessments for children. The Kit contains fact 

sheets, action strategies, and resource guide. Go to the Web 

site and search for “Mental Health Resource.” 

http://www.connectforkids.org/node/3003 

THE CONNECT FOR KIDS EARLY CHILDHOOD (0-5) MENTAL 

HEALTH AND DEVELOPMENT TOOLKIT includes links to fact 

sheets, trainings, and Web sites covering topics such as child 

development, intervention, and prevention. 

http://www.nctsnet.org 

THE NATIONAL CHILD TRAUMATIC STRESS NETWORK 

provides resources for parents, caregivers, and educators 

including informational guides, statistics, and breaking 

information aimed at raising the standard of care and 

increasing access to services for traumatized children and 

their families. 

http://www.nimh.nih.gov/healthinformation/ 

childmenu.cfm 

NATIONAL INSTITUTE OF MENTAL HEALTH: CHILD AND 

ADOLESCENT MENTAL HEALTH. This comprehensive site 

covers mental disorders, treatments, materials, research, and 

news topics on child and adolescent mental health. 

http://gucchd.georgetown.edu/programs/ta_c 

enter/index.html 

THE NATIONAL TECHNICAL ASSISTANCE CENTER FOR 

CHILDREN’S MENTAL HEALTH provides publications, training, 

and technical assistance to promote service delivery systems 

for children with mental health needs and their families. 

The resources listed below are directly 

related to articles in this Bulletin. 

MENTAL HEALTH RESOURCES TO HELP CHILDREN 

DEAL WITH VIOLENCE AND TRAUMA 

http://www.naeyc.org/ece/critical/violence.asp 

THE NATIONAL ASSOCIATION FOR THE EDUCATION OF 

YOUNG CHILDREN has created a resource page with reports 

and guidance on preventing violence and helping young 

children cope with violence. 

http://www.connectforkids.org/node/392 

CONNECT FOR KIDS created Help with the Healing on the 

Web after high-profile school shootings and the 9/11 attacks. 

The Web site provides resources for parents and caregivers to 

help children cope with trauma, violence, and loss. 

http://www.aboutourkids.org/articles/talking_kids 

_about_school_violence 

THE NEW YORK UNIVERSITY CHILD STUDY CENTER’S 

Talking to Kids about School Violence resource page provides 

links to articles and guidelines to help parents, teachers, child 

care workers, and others support children exposed to 

violence and trauma. 

98 2009 
WEBLIOGRAPHY
 

Continued from previous page 

RESOURCES TO SUPPORT LOSS AND GRIEF 

http://www.adec.org 

ASSOCIATION FOR DEATH EDUCATION AND COUNSELING 

is an interdisciplinary organization that offers educational 

opportunities in the field of dying, death, and bereavement. 

http://www.compassionatefriends.org 

COMPASSIONATE FRIENDS is a national support organization 

for bereaved parents, grandparents, and siblings. 

http://www.hospicefoundation.org 

HOSPICE FOUNDATION OF AMERICA offers professional 

development for heath care professionals who assist those 

coping with terminal illness, death, and grief. 

RESOURCES FOR GRANDPARENTS RAISING 

GRANDCHILDREN 

http://www.aoa.gov 

THE ADMINISTRATION ON AGING Web site provides links 

to Federal benefit and foundation programs, information 

resource sites, state and cooperative extension programs, 

reports, and research articles. 

http://www.aarp.org/grandparents 

AARP offers links to state resources and fact sheets, resources 

for job seekers, and a benefits tool to help grandparents 

determine if they are eligible for public and private benefits. 

http://www.gu.org/Defin8191322.asp 

GENERATIONS UNITED/GRANDFAMILIES offers an online 

program directory search tool that allows users to search for 

local services, including child care and after-school programs. 

http://www.nassembly.org/fspc/documents/ 

Brief20.pdf 

THE STRENGTHENING GRANDFAMILIES THROUGH RESPITE 

CARE policy brief describes ways to nurture grandfamilies to 

allow children to flourish. It offers a listing of Federal and 

national organizations dedicated to supporting grandparents 

raising grandchildren. 

RESOURCES TO SUPPORT REFUGEES 

http://www.acf.hhs.gov/programs/orr/ 

OFFICE OF REFUGEE RESETTLEMENT (ORR), in the 

Administration for Children and Families, U.S. Department of 

Health and Human Services, provides resources to assist 

refugees in becoming integrated members of American 

society. 

http://www.refugeewellbeing.samhsa.gov/ 

THE REFUGEE MENTAL HEALTH PROGRAM within the Substance 

Abuse and Mental Health Services Administration (SAMHSA) 

provides information on mental health consultation and technical 

assistance about community assessments, program development, 

and workshops and training programs for resettlement staff, 

mental health personnel, or other providers. 

RESOURCES ON DOMESTIC VIOLENCE 

http://www.dvalianza.org/resor/brochures.htm 

NATIONAL LATINO ALLIANCE FOR THE ELIMINATION OF 

DOMESTIC VIOLENCE has a series of brochures available in 

English and Spanish to assist victims of domestic violence, 

including teens and immigrants/refugees. 

http://pathwayscourses.samhsa.gov/vawc/ 

vawc_intro_pg1.htm 

“IT WON’T HAPPEN TO ME: ALCOHOL ABUSE AND 

VIOLENCE AGAINST WOMEN” is a free online course 

sponsored by SAMSHA’s Center for Substance Abuse Prevention. 

Head Start Bulletin 99 
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WEBLIOGRAPHY
 

Continued from previous page 

http://www.ndvh.org 

NATIONAL DOMESTIC VIOLENCE HOTLINE provides 

assistance in English and Spanish with access to more than 

140 languages. Help is available for victims and witnesses 

24 hours a day, 365 days a year. 1-800-799-SAFE (7233) or 

TTY 1-800-787-3224. 

http://www.nnedv.org/resources/coalitions.html 

NATIONAL NETWORK TO END DOMESTIC VIOLENCE 

represents state domestic violence coalitions in all 50 states 

and the District of Columbia, as well as Puerto Rico and the 

Virgin Islands. The coalitions connect local domestic violence 

services throughout each state. 

http://www.nationalcenterdvtraumamh.org/home. 

php/ 

NATIONAL TRAINING AND TECHNICAL ASSISTANCE 

CENTER ON DOMESTIC VIOLENCE, TRAUMA AND MENTAL 

HEALTH is designed to cultivate a deeper understanding 

about the mental health and advocacy needs of survivors of 

domestic violence and their children. 

RESOURCES ON HOMELESSNESS 

http://www.serve.org/nche/ 

THE NATIONAL CENTER FOR HOMELESS EDUCATION has 

links to state resources on homelessness and homeless 

education, including links to each state’s State Coordinator for 

Homeless Education. 

http://www.familyhomelessness.org 

THE NATIONAL CENTER ON FAMILY HOMELESSNESS has 

fact sheets and links to inform policy makers, service 

providers, and the public about the issues facing homeless 

children and families, such as housing, mental health, 

substance abuse, trauma, and violence. 

http://www.pathprogram.samhsa.gov 

PROJECTS FOR ASSISTANCE IN TRANSITION FROM 

HOMELESSNESS in SAMSHA supports service delivery to people 

with serious mental illnesses or co-occurring substance use 

disorders who are homeless or at risk of becoming homeless. 

Substance Abuse and Mental Health Services 

Administration (SAMHSA) is a Federal agency tasked 

with building resilience and facilitating recovery for people 

with or at risk for mental or substance use disorders. The 

following are descriptions of some of SAMHSA s services and 

resources useful to the early childhood field: 

http://mentalhealth.samhsa.gov/ 

THE CENTER FOR MENTAL HEALTH SERVICES Web site offers 

a mental health services locator by state, links to mental 

health resources, and fact sheets and reports on strengthening 

parenting and enhancing resilience for children. 

PROMOTION OF MENTAL HEALTH AND PREVENTION OF 

MENTAL AND BEHAVIORAL DISORDERS SERIES offers two 

free training guides aimed at early childhood mental health 

consultation: 

http://mentalhealth.samhsa.gov/publications/allpu 

bs/svp05-0151/ 

Volume 1, Early Childhood Mental Health Consultation 

provides a blueprint for child care providers to use when 

hiring a mental health consultant. 

http://mentalhealth.samhsa.gov/publications/ 

allpubs/svp05-0151B/ 

Volume 2, A Training Guide for the Early Childhood Services 

Community offers a guide for trainers to use when teaching 

the early childhood community how to use the blueprint 

described in Volume 1. 

100 2009 
WEBLIOGRAPHY
 

Continued from previous page 

http://mentalhealth.samhsa.gov/15plus/ 

15+ MAKE TIME TO LISTEN...TAKE TIME TO TALK campaign 

provides practical guidance for parents and caregivers on ways 

to strengthen their relationship with their children by spending at 

least 15 minutes of daily, undivided time with them. 

http://bblocks.samhsa.gov/ 

BUILDING BLOCKS FOR A HEALTHY FUTURE is an early 

prevention program for parents and caregivers of 3-6 year 

olds designed to educate about the basics of prevention in 

order to promote a healthy lifestyle. 

http://mentalhealth.samhsa.gov/child/default.asp 

CARING FOR EVERY CHILD’S MENTAL HEALTH CAMPAIGN 

helps to increase awareness about protecting and nurturing 

the mental health of young people; foster recognition of 

childhood mental health problems; and encourage caregivers 

to seek early, appropriate treatment and services. 

http://www.fascenter.samhsa.gov/index.cfm 

FETAL ALCOHOL SPECTRUM DISORDERS (FASD) CENTER 

provides information and resources about FASD and also 

materials to raise awareness about FASD. 

http://www.ncsacw.samhsa.gov 

NATIONAL CENTER ON SUBSTANCE ABUSE AND CHILD 

WELFARE’S mission is to improve systems and practice for 

families with substance use disorders who are involved in the 

child welfare and family judicial systems. 

Editor’s Note: The URL addresses listed in the Webliography 

are current as of this Bulletin’s publication. Because Web sites 

are often updated, pages may be moved or no longer 

available at a later date. If a Web site that you are trying to 

access is no longer available, please contact the organization 

directly for assistance. 

Head Start Bulletin 101 
Continued from page 34, Three Sources of 

Resilience 

inhibit it. Adults who promote 

resilience encourage children to 

become increasingly autonomous, 

responsible, empathetic, and altruistic 

and to approach people and situations 

with hope, faith, and trust. They teach 

them how to communicate with others, solve problems by accessing family 

and institutional supports, and successfully handle negative thoughts, 

feelings, and behaviors. As children 

grow and develop these skills, they 

increasingly become more active in 

promoting their own resilience. 

What Can We Do? 

The International Resilience Project 

found that children learned resilience 

from their parents and other adults up 

to the age of 11; after that, they learned 

from their peers. Income level did not 

seem to matter; poor parents taught 

resilience as often as other parents. 

One surprising finding emerged. 

Adult caregivers promote resilience only 

about one-third of the time. There are 

many lost opportunities at home and in 

school settings. Too many adults inhibit 

or thwart the development of resilience, 

leaving children feeling helpless, sad, 

and unloved. The message is loud and 

clear: We need to do better to help our 

children develop resilience. ■ 

This article was adapted from A Guide 

to promoting resilience in children: 

Strengthening the human spirit by 

Edith Grotberg. Published in The 

Hague by the Bernard van Leer 

Foundation in 1995. 

Continued from page 39, Helping Preschoolers Develop Self-Concept 

and Self-Control 

Teaching strategies that promote the development of selfconcept include: 

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�

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Providing a sufficiently engaging curriculum and variety of learning experiences to ensure that children are 

not bored or aimlessly wandering. Often teachers 

think they cannot provide interesting learning experiences until the children are under control, when, in 

fact, the real problem is that the children are out-ofcontrol because there is nothing interesting to do. 

Getting to know each child, establishing relationships 

with parents, and supporting their strengths as well as 

their needs. 

Giving time and attention to children when they are 

behaving appropriately. Be sure to “catch them 

doing something right” and those desirable behaviors will increase. 

As Head Start children develop a positive self-concept 

and self-regulation skills, they are building a foundation for 

their mental health and for their success in school. 

The Center on the Social and Emotional Foundations for 

Early Learning (CSEFEL) has numerous resources available to 

assist staff in exploring environment, schedule, learning experience, and their interactions with children. Visit CSEFEL’s 

Web site at www.vanderbilt.edu/csefel or call 866-433-1966. ■ 

REFERENCES 

The Child Mental Health Foundations and Agencies 

Network (FAN). 2000. A good beginning: Sending 

America’s children to school with the social and emotional competence they need to succeed. Bethesda, MD: 

National Institute of Mental Health. 

Shonkoff, J.P., & D.A. Phillips, eds. 2000. From neurons to 

neighborhoods: The science of early childhood development. Washington, D.C.: National Academy Press. 

U.S. Dept. of Health and Human Services, Administration for 

Children and Youth, Head Start Bureau. 2003. The Head 

Start leaders guide to positive child outcomes. 

Washington, D.C.: Author. Available at
 

www.eclkc.ohs.acf.hhs.gov/
 

102 2009 
Continued from page 47, Using Storytelling 

to Support Mental Health 

health and self-esteem and, in turn, 

supports the development of positive 

self-esteem in their children. ■ 

REFERENCES 

Academy for Educational 

Development (AED). 2003. 

Jornadas de valor y esperanza 

(Journeys of hope and courage). 

DVD. Washington, D.C.: Author. 

Academy for Educational 

Development (AED). 2003. 

Historias de exitos 2003 (Success 

stories 2003): 34th Migrant and 

Seasonal Head Start National 

Conference. Washington, D.C.: 

Author. 

Smyth, J. 2005. Storytelling with 

young children. Research in 

Practice Series, 12(1). Watson, 

Australia: Early Childhood 

Australia. 

Dee Wetzel is Special Projects 

Manager at the Academy for 

Educational Development. 

T: (503) 848-7720; 

E: dwetzel@aed.org. 

Angela Branch is the Disabilities 

Specialist for the National Migrant 

and Seasonal Head Start Technical 

Assistance Center. T: (202) 884-8852; 

E: abranch@aed.org. 

Nina Salomon is the former Project 

Associate for the Migrant and 

Seasonal Head Start Technical 

Assistance Center. 

Continued from page 62, A Teen Parent’s Story of Resilience 

medical challenge, EHS helped her find resources and taught 

her where to look and how to ask for assistance. When she 

missed classes to care for her daughter who was hospitalized 

or too sick to leave their home, staff from EHS or the high 

school brought Missy’s schoolwork to her. Missy believes 

that one of the most important lessons she learned from EHS 

was how to be an advocate for her daughter’s medical care 

and education. 

When Missy registered Jade for kindergarten in St. 

Louis, MO, where they now live, school officials suggested 

she enroll Jade in a special education program. Missy 

insisted that her daughter attend regular classes while 

receiving special services. She credits EHS, the Olympic 

Educational Service District 114 in Washington State, and 

the Office of Head Start with teaching her the skills and 

giving her the confidence to demand services for her child. 

At the invitation of the Office of Head Start, Missy 

attended Special Quest as the parent representative for 

three years, was featured in the Family Stories Video, and 

spoke at a Birth to Three conference. 

Resilience 

Today, Jade is thriving in her mainstream classroom 

and has learned to recognize words. She has been cancer 

free for 8 years. Missy is also thriving. As a testament to 

her resilience, she said this about her experience as a teen 

mother of a child with significant disabilities: 

“Apparently, I was meant to do what I’m doing because 

I’ve had support all along the way. It’s been a long tough 

road, but I honestly don’t feel like I’ve ever fallen down. 

Early Head Start and my mother helped me to stay standing.” 

Missy’s family now includes her husband, Jerret, and 

their daughter Nova. They are all standing tall and strong. ■ 

Missy Ulmer was interviewed by My Linh Nguyen of the 

Head Start Resource Center. 

Head Start Bulletin 103 
Continued from page 67, Grandparents: 

Making a Difference 

Smithgall, C., S. Mason, L. Michels, 

C. LiCalsi, & R. George. 2006. 

Caring for their children’s children: Assessing the mental health 

needs of and service experiences 

of grandparent caregiver families. 

Chapin Hall Working Paper. 

Chicago: Chapin Hall Center for 

Children, University of Chicago. 

Available at 

www.chapinhall.org/article_abstr 

act.aspx?ar=1427 

U.S. Department of Health and 

Human Services. Administration 

for Children and Families, Region 

IV. 2007. Grandparents raising 

grandchildren: A call to action. 

Washington, D.C.: Author. 

Available at 

http://www.eclkc.ohs.acf.hhs.gov/ 

Jacqueline M. Davis is the Family 

Community Partnerships Specialist at 

the Head Start Knowledge and 

Information Management Services. 

T: 202-737-1030; 

E: jacquied@headstartinfo.org 

Continued from page 69, Understanding Loss and Grief 

stress and the impact of loss on young children. 

These courses may be offered through the departments of health promotion, psychology, or early 

childhood education. Many courses include experiential learning opportunities, such as meeting a 

death educator, visiting a funeral home, or writing 

an obituary and will. 

Head Start programs also can offer the opportunity for 

staff to explore their own feelings, attitudes, and values 

about loss. By learning more about ourselves, we will deal 

more effectively with the loss and grief that each of us will 

inevitably experience. We also will be better able to support others in their grief. 

Head Start programs can help children, staff, and parents begin to explore these issues by launching a dialogue 

about the events in life that contribute to loss and grief. In 

this way, the Head Start program can contribute a crucial 

element to the overall mental health and well-being of 

those in its community—an approach that contributes to 

overall health and wellness. ■ 

Each day is a reminder of the fragility of life, yet few 

are prepared for the final phase of life known as death. 

The author encourages individuals to become involved in 

learning more about death and playing a role in helping 

others become aware of death and loss. Useful resources 

for early childhood educators include: 

REFERENCES 

Hopkins, A.R. 2002. Children and grief: The role of the early 

childhood educator. Young Children, 57(1), 40- 47. 

Mercurio, M.L. & A. McNamee. 2006. Healing words, 

healing hearts: Using children’s literature to cope with 

the loss of a pet. Childhood Education, 82(3), p153. 

Karen McKinney is a former Early Head Start Director 

at Rosemount Center in Washington, D.C. She has had 

extensive experience with loss and grief. Her first experience occurred when she learned her son had a significant 

disability. She then experienced his death at age 5. Her 

greatest contribution to death awareness and education 

occurred through teaching a college course on Death, 

Dying and Human Health. This article was written in 

memory of Scott McKinney and Tyler Nordgren, the 

author’s son and nephew. 

Karen McKinney is the Senior Grants Policy Specialist in the 

Division of Grants Policy, ACF. T: 202-401-5436; 

E: Karen.McKinney@acf.hhs.gov 

104 2009 
Continued from page 75, My Life in Foster 

Care 

three adult step-children, and grandmother to 14 grandchildren. All four of 

my children have benefited from the 

values passed onto them through me 

from Mother Hale and have become 

high achievers in their careers. When 

people call Mother Hale and myself a 

success story of foster care, I like to 

point out that my children are part of 

that story as well. ■ 

Editor’s Note: The Improving 

Head Start for School Readiness Act of 

2007 designates funds to support staff 

training and child counseling and other 

services to meet the needs of special 

populations, including children in foster 

care. It also emphasizes community 

assessment to identify children in foster 

care who are eligible for Head Start. 

REFERENCES 

Casey Family Programs. 2005. 

Improving family foster care: 

Findings from the Northwest 

Foster Care Alumni Study. The 

Foster Care Alumni Studies: Stories 

from the past to shape the future. 

Seattle, WA: Author. Available at 

www.casey.org/Resources/Publicati 

ons/NorthwestAlumniStudy.htm 

Mother Hale passed away in 1992. 

To learn about her legacy and the work 

carried on by the Hale House, visit 

www.halehouse.org 

Julie Alli Palmer-Blackwell is a Senior 

Program Advisor for the Bounce 

Learning Network, a Division of the 

Ounce of Prevention Fund in Chicago, 

IL, and a 2004-05 Head Start Fellow. 

T: 312-922-3863 ext. 3555. 

E: jpalmer@ounceofprevention.org 

Continued from page 85, Videotaping Builds Parent-Child Relationships 

the first of several “souvenirs” of the children’s development 

and as a tool to “see what the children can teach us.” Olivia 

welcomed the observation, but agreed to the videotaping 

only after being reassured that it was her choice and that she 

would be the only person with a copy of the tape. 

The following week, Olivia, Maria, and the mental 

health manager watched the videotape together. As they 

reflected on what they were seeing, the mental health 

manager affirmed Olivia’s efforts to encourage her children’s skills. She then asked Olivia, “Did you notice what 

happened there?,” drawing attention to the chain of 

responses occurring between mother and children. Olivia 

commented: “I’m hard on her [Natasha]. I never noticed 

how really good she is with her sisters!” 

This was a turning point for Olivia. She recognized 

that Natasha was trying to engage her sisters in play and 

conversation. Natasha was sometimes, but not always, 

able to control her own impulses while they explored the 

toys together. Olivia was finally able to see Natasha’s 

interactions as age-appropriate. During the months that 

followed, Maria and Olivia had many other discussions 

about Natasha’s development. Olivia was able to understand Natasha’s strengths and challenges. Eventually, 

Natasha was enrolled in a preschool program where she 

made a very easy adjustment. 

Conclusion 

Olivia’s story demonstrates the effectiveness of a 

reflective videotaping technique together with a diligent, 

caring parent-child advocate and an on-staff mental health 

services manager who provides regular observations of 

parents and children, clinical guidance to staff, and consultation to parents. In Olivia’s case, videotaping was 

effective because the home visitor had developed a trusting 

and positive relationship with the family and used every 

opportunity she had to reinforce Olivia’s positive interactions with her children. ■ 

Milly Burrows is the Family Partnerships and Mental Health 

Services Manager at Associates for Human Services, Inc. 

Early Head Start in Taunton, MA. T: 508-880-0202. 

E: mburrows@ahsinc.org 

Head Start Bulletin 105 
U.S. Department of 

Health and Human Services 

ACF/ACYF/HSB 

Washington, DC 20201 

OFFICIAL BUSINESS 

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