Complete a Trauma-Informed Education Presentation for Educators

Trauma-Informed Preschool Education in Public School Classrooms: Responding to Suspension, Expulsion, and Mental Health Issues of Young Children Dolores (Dee) Stegelin, Carmen Leggett, Diane Ricketts, Misty Bgant, Chanci Peterson, and Andrea Holzner

Abstract: The mpid expansion of public-school Meschool programs significantly challenges America's school administratom, teachers, and school professionals. The complex issues of preschool mental health needs, expulsion, and suspension are at the forefTont In the United States, schools aTe reporting Tapidly increasing numbers of Meschool programs, Mimarily in the form of 3K, 4K, and inclusion Mograms. This dramatic increase of young childmn in the public schools is a result of (a) TeseaTch on the long·term cognitive and social benefits of high-quality early childhood programs, (b) fedual and state legislation supporting statefunded preschool education, and (c) the continued need to support working parents via public-funded education for their young children. This article is a review of the TeseaTch on Meschool mental health. and early Mauma Bom adverse childhood experiences (ACEs), the impact of suspension and expulsion on preschool children, and the benefits of high-quality preschool programs in the public schools. Also included is a review of current policies and pmctices in ex- emplary public-school preschool tn-ograms related to mental health services, ACEs, suspension, and expulsion. Recommendations for future policy and practices for the pieschool population are presented. Appendix B provides resources for school administrators and professionals.

The issues of preschool mental health, suspension, Furthermore, teachers are reporting higher levels of and expulsion are timely ones as significant societal stress and inadequate support to meet the needs of these forces are converging to bring these important issues children (Carolan & Connors-Tadros, 2015). Some profes-

to the forefront (Carolan & Connors-Tadros, 2015). Public sionals describe this phenomenon as a secondary traumatic schools across the nation are reporting rapidly expanding stress reaction; teachers are absorbing and responding to preschool programs, primarily in the form of 3K, 4K, and the primary trauma ofyoung children with whom they are inclusion programs (Bouffard, 2018). The growth in num- working (Carolan & Connors-Tadros, 2015). Compassion bers of young children in the public schools is a result of fatigue, or secondary traumatic stress disorder, is a natural a) recognition ofthe research-based and long-term benefits but disruptive by-product of working with traumatized of high- quality early childhood programs, b) federal and individuals (Lawson et al., 2019). It is a set of observable state legislation supporting public-funded preschool edu- reactions to working with people who have been trauma- cation, and c) the continued need for support of working tized and mirrors the symptoms of posttraumatic stress parents via public-funded preschool education (Heckman, disorder (PTSD; Osofsky et al., 2008). In short, school 2017; Schweinhart et al., 2011). See Appendix A for appli- administrators, many with limited education regarding and cable definitions. experience with the preschool population, must confront

In the United States, childcare for most families is complex decisions on how best to address developmental, among the largest of their household expenses; thus, par- behavioral, and emotional needs of 3- and 4-year-old chil- ents are supportive of public-funded preschool programs dren as well as preschool teachers' fatigue and secondary for their 3- to 5-year-olds (Whitehurst, 2018). In addition to trauma (Hancock & Carter, 2016; Stegelin, 2018). the sheer growth of preschool programs in school settings First, there is a critical need for increased awareness from coast to coast (Bouffard, 2018), schools are reporting that young children have mental health issues and that the an increased incidence of behavioral and developmental problems that they encounter will require comprehensive challenges in the preschool population (Hancock & solutions (Giannakopoulos et al., 2014). Children are Carter, 2016). This is documented in the relatively high developmentally less able to express their feelings and rate of preschool suspension and/or expulsion and is verbalize their needs (Choi & Graham-Bermann, 2018). a practice that is often a last resort for the teacher and The tendency is to believe that mental health issues devel- school administrator (Gilliam, 2005; Gilliam et al., 2016). op over time and arise later, thus not directly impacting The practice of suspension and expulsion reflects how young children (Choi & Graham-Bermann, 2018). The difficult it is for teachers and administrators to sufficiently important study of adverse childhood experiences (ACEs) address challenging, complex, and sometimes disruptive provides information on how major trauma very early in child behaviors (Gilliam et al., 2016; Stegelin, 2018). The a person's life can have a lasting and profound impact result is that many preschool children are unable to cope on long-term mental and physical well-being (Centers for with or negotiate the demands of public-school preschool's Disease Control and Prevention, 2019; Giannakopoulos daily routines, structured environments, and academic et al., 2014). ACEs research clearly offers evidence that expectations (Statman-Weil, 2015) children with higher levels of trauma in the early years

THE JOURNAL OF AT-RISK ISSUES 9

are associated with poorer physical and mental health child development (Knopf, 2016). All young children are outcomes as adults (Centers for Disease Control and vulnerable to mental health issues, and those children with Prevention, 2019). Those working with children need to early trauma are more at risk (Liming & Grube, 2018). The increase their awareness and understanding that young research on adverse childhood experiences (ACEs) height- children-birth to age 5-do in fact experience feelings of ens awareness of the impact of early trauma on children's anxiety, depression, and other mental health conditions, overall development and the apparent relationship between many of which are related to early traumatic experiences early trauma and associated adult health conditions, both (Knopf, 2016; Liming & Grube, 2018). physical and mental (Liming & Grube, 2018). This research

Second, there is a need to educate professionals, is important to consider within the context of preschool parents, and the public about the need for trauma- children in public schools (Whitted, 2011). According to informed education in our school systems (Nicholson et Carolan and Connors-Tadros (2015), the criteria for enroll- al., 2019). To meet the needs of individual young children ment in public-school preschool programs are frequently in our public-school classrooms, a multidisciplinary team based on factors such as being low-income, having single approach with teachers, social workers, nurses, school parent status, parental distress, developmental delays, counselors, psychologists, parents, pediatricians, adminis- immigrant status, and other family stressors. Thus, the , trators, and others is recommended (O'Reilly et al., 2018; children who are accepted into state-funded preschool Statman-Weil, 2015). Trauma-informed early education programs in the schools are more likely to have experienced is aligned with the concept of individualized education early trauma that is associated with their developmental plans (IEPs) for older students with special needs. Teachers.~ and social demographics (Carolan & Connors-Tadros, administrators, and professional staff (school psycholo- 2015). In addition, children and families who meet these gists, counselors, social workers, nurses, special education criteria are more likely to be represented by minority pop- coordinators, and preschool program directors) need to provide ongoing systemic and individualized assessment ulations, especially African American and Latinx families

and support for children demonstrating the developmental (Gilliam et al., 2016). Not only are preschool children more likely to ex-

and behavioral impacts of early trauma and mental health perience early trauma and subsequent changes in brainconditions (Nicholson et al., 2019). Third, there is a need to implement trauma-informed development, but they are also more likely to present men-

early education in schools (Fazel et al., 2014). Based on tal health issues when compared to the general preschool

guidance from Fazel et al. (2014) and Nicholson et al. population (Nicholson et al., 2019). They are also more (2019), trauma-informed early education requires all pro- likely to experience associated health-related conditions

fessionals to (a) understand the impact of trauma on early later, such as cardiovascular diseases, respiratory diseas-

brain development, (b) construct school and classroom en- es, obesity, cancer, and other chronic health conditions

vironments that support trauma-impacted young children's (Liming & Grube, 2018). Finding a solution to the mental emotional and developmental needs and those with mental health needs of preschool children requires understand- health issues, (c) implement instructional and assessment ing the phenomenon of early trauma, its impact on brain strategies that are developmentally appropriate and attuned development, and its impact on later development and to the social-emotional needs of these children, (d) follow quality of life in adolescence and adulthood (Carolan & up intervention as a team and with written documenta- Connors-Tadros, 2015). The research on ACEs provides a tion of progress, and (e) engage and educate parents and useful framework for professionals who work with young families about trauma and the team effort to intervene children impacted by trauma and mental health issues and maintain consistency in expectations between the (Centers for Disease Control and Prevention (CDC), 2019; home and classroom. Liming & Grube, 2018). The impact of children's early

In summary, the convergence of several major forces traumatic experiences can be lessened and remediated creates a complex and challenging situation for America's (CDC, 2019). Children are inherently resilient; thus, they public schools. In addition, public-funded preschool pro- are responsive to teachers, caregivers, and parents who are grams, such as state-funded 4K and federally funded Head nurturing, responsive, and in tune with the child's needs Start, typically have enrollment criteria that are aligned (Pianta et al., 2009). This offers hope for these young with such factors as lower family income and parental children and motivates researchers and practitioners to educational levels, developmental delay, special education garner the necessary resources to meet their needs while needs, and other family/social/health indicators (Carolan the children are still in the formative preschool years (U.S. & Connors-Tadros, 2015). This translates into a preschool Department of Education, 2016). population in public-school classrooms that is more in need of social, emotional, economic, and academic support and Expulsion and Suspension of Preschool Children early intervention than the general preschool population Each year, thousands of preschool children are sus- (Carolan & Connors-Tadros, 2015; Knopf, 2016). pended or expelled from their early childhood care and

education programs (Hancock & Carter, 2016; Zeng et al., Review of Research Literature 2019). As an example, over 8,700 children 3- and 4-years- Eady Mental Health and Tmuma Impacts old are expelled from state-funded preschool or prekinder-

The growing emphasis on preschool mental health garten classroorns (Hancock and Carter 2016; Stegelin, is related to understanding the impact of early trauma on 2018). Hancock and Carter (2016) found that preschool

10 VOLUME 23 NUMBER 2

children are expelled at three times the rate of children the form of 4-year-old kindergarten (4K) designed to meet in kindergarten through 12th grade. Importantly, marry of the needs of the state's young children who have demon- these preschool children suspended are identified as Afri- strated developmental delays or disabilities (Best & Cohen, can American boys (Gilliam et al., 2016). These racial and 2013; U.S. Department of Education, 2018). According gender disparities are evident as early as preschool, where to the U.S. Department of Education (2018), hundreds of Black students are 3.6 times more likely to receive an out- thousands of preschool children across the country have of-school suspension as their White classmates (Hancock access to high-quality early learning programs. In 2013, & Carter, 2016; Stegelin, 2018). In addition, while boys President Obama put forth the Preschool for All proposal represent 54% of preschool enrollment, they constitute to establish a federal-state partnership that would provide 79% of all suspended preschool children (Stegelin, 2018). high quality preschool for all 4-year-olds from low and More than 10 years after foundational research by Gilliam moderate income families (U.S. Department of Education, (2005), federal data reflect a disproportionate number of 2016), These evidence-based programs document the long- male students representing minority populations. African term benefits of high-quality early childhood programs, American and Latinx children are expelled along with especially young children from economically challenged English Language Learners and students with disabili- households (Heckman, 2017; Schweinhart et al., 2011). ties, all of whom would benefit from daily attendance in After President Obama's call for expanded programs high-quality preschool programs (Horowitz, 2015). for 4-year-olds, many states took action, and nearly all states

Early suspension or expulsion from their preschool now offer preschool programs in the public schools for programs creates another form of trauma for these young young children (U.S. Department of Education, 2016). In children (Morrison, 2015). According to the joint policy the 2015-16 budget year, for example, states increased their statement on suspension and expulsion policies in early investments in preschool programs by nearly $767 million childhood settings, the beginning years of any child's life or 12% over the 2014-15 fiscal year (U.S. Departmentare critical for building the early foundation of learning health and wellness needed for school and in adulthood of Education, 2016). From 2009 to 2015, states enrolled

(U.S. Health and Human Resources and Education, 2014). 48,000 more 4-year-olds in state-run preschool programs

Bronfenbrenner's ecological systems theory explains the (U.S. Department of Education, 2016). The Obama dynamics of preschool suspension and expulsion within Administration increased investments by over $6 billion the context and dynamics of the child's microsystem (Mor- in early childhood programs from FY 2009 to FY 2016, rison, 2015; Psychology Notes Headquarters, 2019). During including high-quality preschool, Head Start, childcare these early years, children's brains are developing rapidly, subsidies, evidence-based home visiting, and programs for

influenced by the experiences that they share within their infants and toddlers with disabilities (U.S. Department microsystems: their families, caregivers, teachers, peers, of Education, 2018). Former U. S. Secretary of Education and communities. Both positive and negative experiences John B. King Jr., said: play major roles (Morrison, 2015; Stegelin, 2018).

The practice of preschool suspension and expulsion A high-quality early education provides the foun- should direct focus even more on the mental health of dation that every child needs to start kindergarten preschool children and the likelihood that these children prepared for success. Because of historic invest- are more vulnerable to mental health issues (Knopf, 2016). ments from the Obama Administration, states and Preschool suspension and expulsion impact the young cities, more children, particularly those who have child, the family, and society in general (Stegelin, 2018). been historically underserved, now have access to The effect of suspension and expulsion on the child is high-quality early learning. But we can't stop there. immediate and can have long-term implications for the We must continue our collective work to ensure child's overall emotional and social development as well that all children regardless of socioeconomic status, as the likelihood of permanent school dropout in the later race, background, language spoken at home, dis- years (Horowitz, 2015). In the long run, the negative effects ability or zip code have access to the opportunities of early suspension and expulsion may play out in middle that prepare them to thrive in school and beyond. and secondary education settings, future employment, (U.S. Department of Education, 2016) and, in some cases, the criminal justice system (Stegelin, 2018). Young students who are suspended or expelled State-funded preschool programs continue to expand are as much as 10 times more likely to drop out of high across the United States, with some states also adding 3K school, experience academic failure and grade retention, and inclusion programs to the more typical 4K programs hold negative school attitudes, and face incarceration than (Stegelin, 2018). These programs are diverse and com- those preschoolers who do not experience suspension or munity driven in terms of admission criteria, selected expulsion (U.S. Department of Health and Human Ser- curriculum, and program locations, and some state-fund- vices and Education, 2014; U.S. Department of Education ed 4K programs are situated in childcare or Head Start Office for Civil Rights, 2014). programs, reflecting new partnerships in the delivery of

high-quality preschool programs (Stegelin, 2018). Even Rapid Growth of Public-School Preschool Programs though this new early education initiative is state direct-

Across the United States there has been a rapid ex- ed, there are common goals regarding the establishment pansion of classrooms for preschool children, especially in and implementation of public-school preschool programs

THE JOURNAL OF AT-RISK ISSUES 11

(Stegelin, 2018). Common goals across the states imple- Preschool Mental Health Initiatives and the menting preschool programs funded at the state level are Public Schools premised on the belief that high-quality early childhood As preschool programs expand in the public schools, programs lead to more robust and successful academic and some school districts are developing innovative approaches employment futures for these children (Heckman, 2017; to meet the mental health needs of these young children Schweinhart er al., 2011). The program goals include en- (Statman-Weil, 2015). These school settings provide a hanced overall child development; cognitive development fertile ground for both research and program innovation and attainment of basic concepts related to mathematics related to preschool mental health issues (Fenwick-Smith and science; social-emotional development and the skills et al., 2018). Children spend more time in public schools to work with others, negotiate group settings, and develop than in any other formal institutional structure (Fazel et a strong sense of self and positive self-esteem; language al., 2014).Thus, the public schools play a key part in chil- development and the ability to recognize letters and the dren's development, ranging from peer relationships and rudimentary elements of reading and writing; physical social interactions to academic attainment and cognitive development and the ability to make good nutrition de- progress (U.S. Department of Education, 2016). All these cisions and understand the need for physical movement developmental areas affect and are reciprocally affected and activity; and character development and the ability to by mental health in a dynamic and interactive manner demonstrate empathy, respect for the needs of others, and (Hancock & Carter, 2016). An increase in recognition of tolerance for diversity and differences (Morrison, 2015; the effects of mental health problems on academic attain- Nicholson et al., 2019). ment, alongwith the unique platform that schools can offer

Along with the rapid and expansive growth of pre. in access to and support for children with psychological school programs in the public schools has come a range of difficulties, has led to an expansion of school-based mental adaptations and challenges for school administrators (Bouf- health interventions, particularly in high-income countries fard, 2018). The adaptations and challenges include but are (Fazel et al., 2014). According to research, the prevalence of not limited to expansion of physical space in elementary psychiatric disorders varies among children from preschool schools to accommodate younger students ; assessment through secondary age levels (Carolan & Connors-Tadros , and curriculum development for preschool learners; hip 2015; O'Reilly et al., 2018). The most common difficulties ing of certified early childhood educators (ECE) teachers in school-age children are disruptive behaviors and anx- and assistant teachers; enhanced parent education and iety disorders (Fazel et al., 2014). Separation anxiety and engagement; developmentally appropriate instructional oppositional defiant disorder are seen mainly in primary strategies and behavior management; and diverse school school children (age 4-10 years), whereas generalized anx- professionals to meet the unique social-emotional, men- iety, conduct disorder, and depression are more common tal health, and special needs of such a large and diverse in secondary school (age 11-18 years) students (Fazel et al., student population (Bouffard, 2018). School dibit kib have 2014). Attention deficiL liypeiditivily Jioorder (ADHD) and been challenged with the rapid explosion of preschool pro- autism spectrum disorders pose particular difficulties for grams and are still working to secure adequate resources, children in the school environment, and the incidence of personnel, and funds to meet the complex needs of these eating disorders and psychosis starts to increase rapidly young children (Bouffard, 2018). from mid-adolescence onwards (Fazel et al., 2014).

In summary, preschool childieit in the public-school Schools ate complex environments, varying by size, sector have increased dramatically over the past decade racial makeup, socio-economic levels, language, gender, in the United States (Carolan & Connors-Tadros, 2015; and cultural variations (Bouffard, 2018). As the school U.S. Department of Education, 2016), presenting great population increases in diversity, the dynamics between challenges to school systems, administrators, and school students, teachers and students, and parents and school personnel (Bouffard, 2018). Many of these young children personnel also become more complex (Fenwick-Smith et demonstrate trauma-impacted behaviors and mental health al., 2018). Within the school context, some school-specific needs, reflected in teachers reporting increased incidences factors are related to mental health during childhood of difficult, challenging, aggressive, and disruptive child (Whitted, 2011). For example, bullying often takes place behaviors (Choi & Graham-Bermann, 2018; Zeng et al., within the school context; a study in the United King- 2019). School personnel are challenged to meet the assess- dom showed that 46% of school-aged children had been ment, intervention, and follow-up needs of these children bullied (Department for Children, Schools, and Families, (Hancock & Carter, 2016). In some cases, schools resort 2015). The odds ofsuicidal ideation and suicidal attempts to suspension or expulsion of the most challenging chil- are more than doubled in young people who report peer dren (Carolan & Connors-Tadros, 2015). Paradoxically, victimization (Meltzer et al., 2011). Bullying can affect these are the children who are most at risk for healthy children into adulthood, with increases in the prevalence development and are in greatest need of psychological and of anxiety, depression, and self-harm (Meltzer et al., 2011). developmental assessment and individualized intervention (Knopf, 2016). In addition, teachers in these preschool Mental Health Strategy: Needs Assessment classrooms are frequently stressed and are experiencing Among the several school-based strategies addressing fatigue, burnout, and, in many cases, secondary traumatic mental health needs of the preschool population is that of stress disorder (Osofsky et al., 2008). assessment (Fazel et al., 2014). Many professionals working

12 VOLUME 23 NUMBER 2

with children advocate the use of a multiple-gated screening systems; this varies across countries (Bouffard, 2018). In system to determine mental health need in schools (Fazel the United States, staff employed at schools are limited etal., 2014). If one considers the school environment from by school policies that restrict the type of direct services the Bronfenbrenner systems approach (Morrison, 2015), that they can provide (Dowdy et al., 2015). For example, there are opportunities to observe, assess, and document because of funding and special education mandates, school the mental health needs of young students at several differ- psychologists in the United States spend much of their time ent levels. For example, a school might complete a school conducting routine psychological testing and eligibility climate scale (measures students' or teachers' perceptions assessments rather than applying their broader consultative of how the environment of classrooms and schools as a and direct intervention skills (Eklund et al., 2018). In many whole affects education) to review and select a universal other countries, school-employed personnel work mainly intervention of school-wide character development, or they with students who have educational difficulties that result might use a screening program to identify children at risk from emotional and behavioral issues and provide direct of suicide (Fazel et al., 2014; Morrison, 2015). This type mental health services and interventions (Giannakopoulos of assessment focuses on the larger learning environment et al., 2014). Thus, in the United States, school personnel (macro) of the school which is the environment for students are frequently restricted from providing therapeutic ser- and teachers and how the environment affects education, vices for mental health needs (Fazel et al., 2014). relationship building, and other important dynamics of Community mental health professionals in schools the school environment (Fazel et al., 2014). work in a range of disciplines, including counselling, social

On an individual student level, schools utilize various work, occupational therapy, psychology, and psychiatry methods to identify students who could benefit from inter- (Nicholson etal., 2019). Three broad models of integration ventions (Doll et al., 2017; Lenares-Solomon et al., 2019). are com mon: These methods include functional behavioral assessments, 1. Individuals from an outside agency are contracted teacher or student recommendations, and systematic to work within a school. universal screening (Doll et al., 2017). Screening can pose 2. The school includes a mental health clinic staffed a risk of over-identification of children or failure to recog- by professionals who deliver mental health services. nize a condition (Doll et al., 2017). Provided these risks 3. The school has a health center with mental health are managed, and if screening is done with standardized as a subspecialty (Allen-Meares et al., 2013). methods and by qualified staff with appropriate informed consent, this technique can provide a useful avenue for Counselors and social workers are more likely to schools to identify and support students with mental health provide direct school-based mental health services than disorders (Doll et al., 2017; Dowdy et al., 2015; Lenares-Sol- psychologists or psychiatrists (O'Dea et al., 2017). In some omon et al., 2019). This type of individualized student countries, schools collaborate with psychologists and assessment is costly, both in terms of time and manpower psychiatrists to provide consultation and intervention for (Lenares-Solomon et al., 2019). In addition, specialized specific students with complex challenges. Still, this model school personnel are essential. Specialized personnel is unlikely to be scalable given the global scarcity of child include school psychologists, school counselors, social and adolescent psychiatrists and the financial resources workers, and other professionals with formal training in required for this model (Fazel et al., 2014). Technology individual preschool child assessment (Dowdy et al., 2015; is rapidly opening new avenues for intervention (Ramsey Statman-Weil, 2015). For very large school systems, this et al., 2016). For example, telemedicine can increase the approach can be very expensive (Doll et al., 2017). However, capacity of mental health services in schools, although sue- at the preschool level, some forward-thinking schools are cessful models have additional on-site school mental health requiring comprehensive developmental, mental health, providers to support engagement and continuous psycho- and academic screening of all enrolled preschool children social intervention (Ramsey et al., 2016). Some schools (Best & Cohen, 2013). With these assessment data in hand, have recruited advanced nurse practitioners to manage the school districts are more able to advocate for additional nee ds of students (Bohnemkamp et al., 2019). However, funding to provide smaller classes, higher teacher-to-child most schools rely on internal resources for mental health ratios, and the hiring of mental health specialists (Doll intervention, such as school nurses, school social workers, et al., 2017). Thus, screening and assessment seem to school counselors, or special education personnel with be fundamental strategies for giving equal attention to specialized training in mental health (Sanchez et al., 2018). all students regarding mental health needs (Doll et al., It is clear that providing mental health services in 2017; Lenares-Soloman et al., 2019). With experience and the school environment varies widely and is related to the focused effort, these screening mechanisms can become size of the school, geographical location (urban vs. rural), more efficient and effective in identifying young students general funding of the school, and leadership priority for with mental health indicators (Dowdy et al., 2015). addressing mental health issues (Moon et al., 2017). More

evidence-based models with these varied configurations to

Mental Health Stmtegy: Specialists in the Schools provide to school districts who are determining their own

Globally, mental health services in schools are pro- mental health policies and practices are needed. Preschool vided by a variety of professional staff whose training or children who are screened, identified, and served earlier in

employment might be within education or healthcare their lives are more likely to have positive developmental,

THE JOURNAL OF AT-RISK ISSUES 13

social, and academic outcomes than young children who behaviors, social inclusion, effective problem solving, and are not identified at the preschool level (Abo El Elella et good citizenry (Fenwick-Smith et al., 2018). Examples in al., 2017). From this review of school based mental health the 4K curriculum include strategies to recognize one's strategies, the need for more school professionals trained own emotions, verbalize feelings, listen to peers as they in mental health intervention is indicated. There is a need talk about their emotions, and then respond appropriately for more school-based counselors, social workers, nurses, to be socially supportive. and psychologists, as well as for partnerships between the In whole-school and classroom-based interventions, schools and community-based mental health agencies, to universal mental health promotion programs are often meet the mental health needs of these preschool children delivered by the school's own staff and are done in both (Bradshaw et al., 2012). primary and secondary schools (Fazel et al., 2014). Mental

health promotion should begin at the earliest levels in the Mental Health Strategy: A Tiered Approach to Mental school, including preschool (O'Reilly et at., 2018). One Health Services example is a program known as MindMatters, developed

An empirically driven approach to school strategies in the late 1990s. This approach is the leading national has been used in parts of the United States (Safari et al., initiative for promotion of mental health in schools in

2020). Known as a tiered approach, this includes univer- Australia, with substantial national investment to equip sal strategies for all students, followed by interventions schools and educators with skills to promote student

to assist selected students who face particular risks, and wellbeing (O'Reilly et al., 2018). Specific strategies to help finally a tier with specific treatment interventions for those students include social and emotional learning programs, with the greatest needs (Safari et al., 2020). An advantage increasing student connection to school, building student of this public health and tiered approach is that schools skills in understanding and management of emotions, and teachers can support students with varying needs effective communication, and stress management (Taylor and create classroom and whole-school environments that et al., 2017). Teachers participate in various professional support the learning of all children (O'Reilly et al., 2018). development opportunities to support their learning in Additionally, this tiered approach utilizes resources most these curricular domains (Zin et al., 2019). These programs effectively, with some resources provided to screen and are included in many schools in the United Kingdom, deliver services for all students, followed by more selective and United States schools could include this strategy and focused interventions for fewer students with greater with limited additional expense. School buy-in is import- needs (Bradshaw et al., 2012). ant to create a school environment that is nurtured and

This approach is also most useful for very large supported by all participants, including administrators, school districts that are serving many children of diverse teachers, school professionals, cafeteria staff, and janitorial backgrounds (Bradshaw et al., 2012). Regarding person- personnel (Yoon, 2016). nel, the tiered approach aligns resources in a graduated way so that more highly specialized school personnel are Examples of Early Childhood Mental Health available to serve the needs of more high-need students, (ECMH) School-Based Models and universal screening and mental health specialists and The Florida Center for Early Childhood teachers who have received professional development can An example of a highlysuccessful school-based mental provide daily interventions and formal training related to 1 tealth model for the early childhood student population is general mental health assessment (Bradshaw et al., 2012). in Sarasota, Florida. In partnership with the school district The authors note mental health specialists and teachers ofSarasota County and the community foundation of Sara- who have more training can provide observation and sota County, the Florida Center provides mental health identification of students who may need more in-depth counseling services to students in 15 Sarasota County assessment and services as well as daily positive support elementary schools (Florida Center, 2019). The purpose of strategies with students. the program is to help students succeed in school despite

outside influences that may hinder that success. Integrated Mental Health Stmtegy: Promotion of Mental Health elementary school therapists at each elementary school

Mental health promotion is a positive strategy that conducted one-on-one counseling with students who had enhances awareness of mental health, encourages prac- a variety of issues (Florida Center, 2019). ACEs research tices to support good health, and serves as a preventive informs us that many young children in the United States measure (0'Reilly et al., 2018). Interestingly, principles of are exposed to violence and trauma at an alarming rate school mental health promotion have been espoused since (Liming & Grube, 2018). By age 16, two-thirds of children Plato's Republic, in which he identified the importance of in the United States have already experienced a potentially the school environment to children's social development traumatic event such as physical or sexual abuse; natural (Fenwick-Smith et al., 2018). Plato also noted that by disaster or terrorism; sudden or violent loss ofa loved one; maintaining a sound system of education and upbringing, refugee and war experiences; serious accident or life-threat- schools then produce citizens of good character. Universal ening illness; or military family-related stress, according promotion of mental health programs often focuses on to the National Child Traumatic Stress Network (Bartlett constructs such as social and emotional skills, positive & Steber, 2019). With support, many children can heal

14 VOLUME 23 NUMBER 2

and overcome such traumatic experiences through mental and private early childhood programs to help identify health therapy (Sanchez et al., 2018; Zin et al., 2019). As and provide intervention for young children's mental schools maintain their critical focus on education and health needs and to support their families (Ohio Depart- achievement, elementary students have access to trained, ment of Mental Health and Addiction Services, 2019). school-based mental health counselors who nurture their This initiative assumes a community-based approach mental health and wellness, two components that are and focuses on each child's surrounding environments, integrally connected to students' success in the classroom including the home, childcare or other early learning and to a thriving school environment (Bartlett & Steber, setting, neighborhood, and community contexts (Ohio 2019; Sanchez et al., 2018; WestED, 2019). Department of Mental Health and Addiction Services,

The comprehensive partnership in Florida is truly 2019). Aligned with Bronfenbrenner system's theory of a successful early childhood mental health model that child development (Morrison, 2015), this approach views provides mental health services to infants, toddlers, pre- the child within several meaningful daily contexts. For schoolers, and young children through age eight (Florida example, early childhood mental health specialists provide Center, 2019). School-based mental health specialists are consultation and intervention within the child's home, trained in social work, mental health counseling, and school, childcare, preschool, and community-based set- child development (Doll et al., 2017). Each elementary tings (Ohio Department of Mental Health and Addiction school in this school district has its own mental health Services, 2019). In this way, mental health specialists are specialist, and the learning environment and curriculum able to meet the needs of individual children within the provide an understanding of self, well-being, and mental setting that is best suited for the child and their family. health (Florida Center, 2019). One of the school-based partnership goals is to reduce the stigma associated with Chicago Public Schools Initiative mental health issues and to make accessible to all families The Chicago Public School (CPS) system provides an the support they need to negotiate difficult and challenging extensive network of preschool programs for young chil- life situations (Florida Center, 2019). dren, and these programs are recognized for their quality

and inclusive practices (Chicago Public Schools, 2019). As Ohio's Early Childhood Mental Health (ECMH) part of an effort to maintain quality and reduce preschool Initiatig,e: Schools and Communities Partnership suspension and expulsion incidents, the CPS system un-

Ohio provides an excellent model of school and dertook a sel f-study of its practices related to managing the community partnerships through the Early Childhood behavioral challenges among their preschool population Mental Health (ECMH) Initiative via Ohio's Schools (Chicago Public Schools, 2019). This study was conducted and Communities program (Ohio Department of Mental on preschool programs from academic years 2011-2015 in Health and Addiction Services, 2019). In this partnership, all pre-k through second grade classrooms (Chicago Public the Ohio Department of Mental Health and Addiction Ser- Schools, 2019). The primary goal of the self-study was to vices provides leadership for this school program situated gain insight into CPS practices with preschool children in Ohio communities and their respective public schools with a focus on those children who demonstrated be- (Ohio Department of Mental Health and Addiction Ser- havioral challenges to teachers and school staff (Chicago vices, 2019). This initiative defines early childhood mental Public Schools, 2019). The study was conducted within the health as the social, emotional, and behavioral well-being context of rapidly expanding preschool programs for the of children birth through six years old and their families preschool child population in Chicago and a rising number (Ohio Department of Mental Health and Addiction Ser- of classroom management issues that were reflected in an vices, 2019). The goals of this ECMH program are to build increase of reported incidences of challenging or disruptive capacity to experience, regulate and express emotion, form child behaviors (Chicago Public Schools, 2019). School close, secure relationships, and explore the environment officials were also concerned with the relatively high rate and learn. of preschool suspension and expulsion (Chicago Public

1n this state-wide initiative, early childhood mental Schools, 2019). The CPS wanted to better understand health is believed to be influenced and shaped by the how they were addressing the needs of young children following factors: with special needs and health-related issues, including

mental health (Chicago Public Schools, 2019). Officials (a) physical characteristics of the young child wanted to determine if their practices with these children (b) quality of the adult relationships in the child's life were more restorative than more punitive or disciplinary (c) the child's caregiving environments (i.e., out-of-class suspensions or expulsions; Stegelin, 2018). (d) community context in which the child and family Preschoolers are not suspended and expelled on an equal

lives. basis; Black and Latinx preschoolers are expelled and Ohio's initiative includes ECMH consultation and suspended at higher rates than White preschoolers (CT

treatment and partnerships between schools and state- Mirror Viewpoints, 2019). level, health-related agencies within each community (Ohio Data from the assessment study of Chicago Public Department of Mental Health and Addiction Services, Schools (2019) reflected a shift in practices beginning in 2019). Early childhood mental health specialists work the 2013-14 academic year, compared with those during with childcare providers, Head Start, and school-based 2011-12 and 2012-13 academic years. Duringthe 2013-14

THE JOURNAL OF AT-RISK ISSUES 15

academic year, the data reflected a change to more restor- a collaborative, cooperative, comprehensive, and inclusive ative responses-practices that help children respond to way (Office of Early Education and Development; 2016); and work through challenges rather than disciplining Stegelin, 2018). In 2011 a plan was developed to address them for acting out-that outnumbered the out of school the social and emotional needs of a growing number of pre- suspensions (Chicago Public Schools, 2019). In 2014-15, school children who were enrolling in their school-based there were 2,273 restorative responses compared to only 77 programs (Office of Early Education and Development; out-of-school suspensions (Chicago Public Schools, 2019). 2016). 1 his plan included a series of efforts to educate This shift in practice denotes a significant change in how and prepare teachers, administrators, and all school staff the school district chose to address preschool behavioral about the reasons and intervention options for challeng- challenges and reflects a commitment to enhancing the ing behaviors among preschool children (Office of Early qUality preschool classroom experience (Chicago Public Education and Development, 2016). After several years Schools, 2019). of making policy and practice changes, the 2014-2015

This Chicago Public Schools (2019) self-study was academic year reflected a significant shift from higher informative, and the data guided decision-making that re- levels of preschool suspension and expulsion to substantial sulted in substantial changes in the preschool classrooms. restorative responses to behavioral challenges (Office of One of these changes was to establish an Office of Social Early Education and Development, 2016). and Emotional Learning with a network of stakeholders School districts across the country are beginning to to engage in self-study and policy development (Chicago address preschool children's social and emotional needs in Public Schools, 2019). The Office of Social and Emotional their school-based programs (Office of Early Education and Learning within the CPS system provided leadership for Development, 2016; Chicago Public Schools, 2019; U.S. changes in practice and policy related to preschool suspen- Department of Health and Human Services and Educa- sion and expulsion (Chicago Public Schools, 2019). One tion, 2014). These school districts are to be commended for of their strategies was to build a Stakeholders Engagement their efforts to address the developmentally inappropriate group that included the following: practice of preschool suspension and expulsion (Chicago

• District-wide committee known as the Social and Public Schools, 2019). The CPS initiative brings together Emotional Learning, Early Childhood Education, stakeholders and constituents to plan and implement

Safety & Security, Office of Diverse Learner P olicy changes sensitive to at-risk young children's needs for learning (Chicago Public Schools, 2019). Viewing theirSupports & Services, Law and Labor Relations.

• School staff focus groups (including deans, developmental needs as a necessity for responsive inter-

principals, teachers, counselors, social workers, vention rather than out of class suspension or expulsion is the first step in addressing these issues (Chicago Publicand others).

• Chicago Teachers Union (CTU) and the Chi- Schools, 2019). cago Principals and Administrators Association (CPAA). Recommendations for Future Policy and Research

According to the American Psychological Association,• Network chiefs and deputies • Citywide collaborative approximately half the children in this country experience

trauma during their childhood (Nicholson et al., 2019).• Community forums • Student focus groups (Chicago Public Schools, 2019). Schools are increasingly leveraged as intervention points

to address childhood trauma due to the established links In short, the CPS initiated a self-study of their between childhood trauma exposure and poor child

practices regarding dealing with preschool children who well-being outcomes (Loomis, 2018). Several organizations demonstrated behavioral challenges (Stegelin, 2018). This provide leadership to make changes in policies related to study was undertaken within the context of a large school serving the needs of young children who have experienced district's rapidly expanding preschool education programs trauma (Statman-Weil, 2015; WestED, 2019; Zero to Three, across the entire system (Chicago Public Schools, 2019; 2010). The following are recommendations for policy Stegelin, 2018). During the 2013 academic year, the CPS development to support trauma-informed early education launched the district-wide Suspensions & Expulsions in the United States (Giannakopoulos et al., 2014; Moon Reduction Project aimed at policy change, accountability et al., 2017). They represent a compilation and synthesis systems, resource development, professional development, of best practices related to early trauma intervention and collaboration (Chicago Public Schools, 2019). In the (Statman-Weil, 2015). 2014 academic year, a new Student Code of Conduct was implemented that placed strict limits on suspension and Workforce Recommendationsexpulsion for Pre-K through Grade 2 classrooms (van With the rapid expansion of preschool programs in Ausdal, 2015; U.S. Department of Health and Human the public-school sector, many professionals provide care Services and Education, 2014). and education for children (Giannakopoulos et al., 2014).

The findings were significant and demonstrated the Most of these professionals are in need of professional positive impact of the self-study (Vanassche & Kelchtermans, development related to caring for young children impact- 2016). This resulted in initiatives developed to address the ed by trauma since most teacher education programs in preschool children's social and emotional learning needs in the United States do not include the knowledge and skill

16 VOLUME 23 NUMBER 2

development necessary to assess, provide intervention, and We know that children who have experienced trauma in evaluate young children with these special needs (Gianna- their early development are also more likely to demonstrate kopoulos et al., 2014; Moon et al., 2017). Along with an challenging behaviors and are more likely to be perceived increased focus on preschool education academics, there in negatively by preschool teachers (Statman-Weil, 2015). is also a need to increase teacher awareness and under- Trauma-impacted children are also more at risk for mental standing of social and emotional development of young health issues. These children need assessment, responsive children and to recognize when children have experienced care, and education to work through their social and emo- trauma (Moon et al., 2017). Based on a synthesis of reo tional problems (Carolan & Connors-Tadros, 2015; Eklund ommendations, early childhood teachers, administrators, et al., 2018; Whitted, 2011). Finally, trauma-impacted and other school professionals according to Statman-Weil children respond more positively to restorative strategies (2015) should be: than exclusionary and punitive strategies (Chicago Public

• Informed about trauma and its effects on chil- Schools, 2019). With this important research in mind, the followingdren's development and learning

• Sensitive to those effects of trauma when interact- research questions are posed (Chicago Public Schools, ing and making decisions about interventions for 2019): these children 1. Which strategies are most aligned with which kinds

• Equipped with skills and knowledge that promote of trauma and child's gender, race, and ethnicity? responsive and caring programs for children 2. What kinds of professional development are most affected by all kinds of trauma (Nicholson et al., appropriate for early childhood care and education 2019) teachers and paraprofessionals to prepare them for

• Capable of planning and implementing strategies working with young children with trauma and/ that are sensitive to children with trauma and that or mental health issues? What content is most support the overall health, healing, and well-being important to include in trauma-informed profes- of these children sional development? What are the most effective

• Knowledgeable of an assets-based approach when professional development strategies to use with working with all young trauma-impacted children teac hers and other school personnel? and helping them build resilience 3. In what ways are parents engaged most successfully

• Eager to seek professional development to strength- in interventions for trauma-informed children? en their capacity to observe, Llnderstand, assess, What roles can parents play in the interventions and provide interventions for young children with process? What are home-school intervention trauma backgrounds strategies that both teachers and parents can

• Able to provide leadership for their organizations employ? and embrace policies and practices that support 4. Which child populations are most at-risk for children and families experiencing trauma trauma in their early lives? Are we including in

our research immigrant children, children with Research Recommendations diverse economic backgrounds, children with

More research is needed on preschool mental health, special needs, and possible gender- and race-based trauma, and publioschool suspension and expulsion. factors? Foundational research by Gilliam (2005) and Gilliam et 5. What are the perceptions of public-school ad- al. (2016) has contributed to our understanding of the ministrators, program coordinators, and other complexity of teacher-child interactions and preschool decision-makers ofyoung children with challenging suspension and expulsion. The research by Gilliam (2005) behaviors? To what extent are future school admin- uncovered the alarming rate of preschool suspension and istrators prepared to meet the needs of very young expulsion that occurs in the United States. In addition, learners (e.g.,3- and 4-year-old children), especially Gilliam et al. (2016) focused on implicit teacher bias and those who have experienced trauma in their early how a teacher's perceptions of a child may be related to lives? their suspension and expulsion rates. Gilliam's study found 6. What are the relationships between childhood that suspension and expulsion were related to a preschool trauma, preschool suspension and expulsion, and child's gender, size, ethnicity, and other demographics. Im- the incidence of mental health issues? portantly, they found that male Latino and African Amer- 7. What research strategies-quantitative, qualitative, ican children were more likely to experience suspension mixed methods-are most effective in capturing or expulsion than children with different demographics the authentic voices of trauma-impacted children (Gilliam et al., 2016). or those with mental health needs?

Other areas of research needing further exploration 8. How can the community most effectively provide include explaining the relationships between trauma, resources for trauma-impacted preschool children social-emotional development, teacher perceptions of and their families? How can partnerships between children's behavior, and mental health issues (Centers for these community resources and schools be devel- Disease Control and Prevention, 2019; Zeng et al, 2019). oped and maintained?

THE JOURNAL OF AT-RISK ISSUES 17

Policy Recommendations With these recommendations for research, policy, While progress is being made to address the needs of and practice, school districts will be better able to serve

young children with mental health issues and those with the preschool student population with mental health and

early traumatic experiences, as well as the harmful practice trauma-related needs. Creating innovative partnerships of preschool suspension and expulsion, many changes in between education and health providers is a good start to-

school policies are indicated (Liming & Grube, 2018). ward building a trauma-informed and restorative approach The federal government has taken the leadership role in to early education. Punitive practices, such as suspension addressing these complex issues, supporting state-level and expulsion, should decline and become unnecessary.

efforts to reduce preschool expulsion and suspension, and reinforcing the understanding of the federal Individ- uals with Disabilities Education Act (IDEA) to protect the rights of children with special needs or disabilities References without discrimination (Office of Early Education and Development, 2016; U.S. Department of Education, 2014; Abo El Elella, S., Tawfik, M. A. M., Abo El Fotoh W.

U.S. Department of Health and Human Services and M. M., & Barseem, N. R (2017). Screening for

Education, 2014). developmental delay in preschool-aged children using

Based on a review of the policy literature, the follow- parent-completed ages and stages questionnaires:

ing recommendations are made for policy development at Additional insights into child development.

the state and local levels: Postgraduate Medical JouTnal, 93(1104), 597-602. https://doi.org/10.1136/postgradmedj-2016-134694

• Establish developmentally appropriate expulsion Allen-Meares, R, Montgomery, K. L., & Kim, J. S. (2013). and suspension policies for preschool programs in School-based social work interventions: A cross- the schools, implement them without bias, and set national systematic review. Social Work, 58(3), 253-262. a goal of eliminating this practice. https://doi.org/10.1093/sw/swt022

• Invest in and support an informed and skilled Bartlett, J. D., & Steber, K. (2019, May 9). How to implement workforce that includes professional development trauma-informed care to build resilience to childhood for preschool teachers and school staff related to trauma. Child Trends. https://www.childtrends.org/' trauma-impacts on child development, responsive publications/how-to-implement-trauma-informed- strategies to address the child's social and emo- care-to-build-resilience-to-childhood-trauma tional needs, and the needs of teachers related to Best, J., & Cohen, C., (2013). EaTly care and education: Policy secondary trauma and stress as well as individual considerations fo~ ensu·ing high-quality pre-K programs teacher's implicit biases toward children. (ED544246). ERIC. https://eric.ed.gov/?id=ED544246

• Address mental health issues of preschool children Bohnemkamp, J. H. Hoover, S. A., Conners, E. H., from a health perspective rather than a disci- Wissow, L., Bobo, N., & Mazyck, D. (2019). plinary perspective. Identify and provide resources The mental health training intervention for in the school to meet the unique mental health school nurses and other health providers in

needs of very young children, including hiring of schools. Journal of School Nursing, 35(6), 422-433. early childhood mental health specialists, leduced https//rloi.org/10.1177/1059840518785437

class sizes, and lower child to teacher ratios. Seek Bouffard, S. (2018, February 13). Principals aren't ready additional funding for health purposes. for public pre-K. Education Week. https:#www.edweek.

• Engage parents of trauma-impacted children and org/teaching-learning/opinion-principals-arent-ready- for-public-pre-k/2018/02

collaborate with the family to develop both home- and school-based strategies to support and provide Bradshaw, C., Pas, E., Bloom, J., Barrett, S., Hershfeldt,

P., Alexander, A., McKenna, M., Chafin, A., & consistency for the child. Leaf, R (2012). A state-wide partnership to promote

• Provide comprehensive developmental and behav- safe and supportive schools: The PBIS Maryland ioral screening for all preschool children as part Initiative. Administration 8 Policy in Mental Health of the induction process into the school setting. 8 Mental Health Se~vices Resea~ch, 39(4), 225-237.

• Set goals and track data on all preschool children https://doi.org/10.1007/s10488-011-0384-6 so that interventions are data driven. Carolan, M. E., & Connors-Tadros, L. (2015). Approaches

• Provide individualized education/intervention to state Me-k eligibility policy: Considerations for policy plans for each child identified as trauma-impacted makeTs in revising policy to increase access foT high needs or needing mental health services. children (CEELO Policy Report). Center on Enhancing

• Engage the school administrators, teachers, and Early Learning Outcomes. http://ceelo.org/wp- all professional staff in professional development content/uploads/2015/05/ceelo_policy_report_prek_ and training on federal legislation and guidelines eligibility_approaches.pdf for preschool children with special needs (IDEA) Centers for Disease Control and Prevention. (2019). and how schools can build a sense of a caring Preventing adverse childhood experiences: Leveraging the community for all students and families. best available evidence. National Center for Injury

18 VOLUME 23 NUMBER 2

Prevention and Control. https://www.cdc.gov/ Gilliam, W. S. (2005). Prekindergartners left behind: ffxpulsion violenceprevention/pdf/preventingACES.pdf rates in state prekindergartneT systems. Foundation for

Chicago Public Schools. (2019). Chicago public schools Child Development. https://medicine.yale.edu/ preschool programs. http//www.eps.edu/Schools/ childstudy/zigler/publications/National%20 EarlyChildhood/Pages/Preschoolprogramtypes.aspx Prek%20Study_expulsion%20brief_34775_5379_

Choi, K. R., & Graham-Bermann, S. A. (2018). vl.pdf Developmental considerations for assessment of Gilliam, W. S., Maupin, A. N., Reyes, C. R., Accavitti, trauma symptoms in preschoolers: A review of M., & Shic, F. (2016, September 28). Do eady measures and diagnoses. Journal of Child and Family educators' implicit biases regarding sex and race relate Studies, 27, 3427-3439. https://doi.org/10.1007/ to behavioT expectations and recommendations of s10826-018-1177-2 pTeschool expulsions and suspensions? (A Research

CT Mirror-Viewpoints. (2019, August 22). We need Brief). Yale University Child Study Center. https:/7 trauma-informed preschool practices: Laws medicine.yale.edu/childstudy/zigler/publications/ banning or limiting suspension and expulsion for Preschool%20Implicit%20Bias%20Policy%20 preschoolers are not enough, Connecticut MiTTor. Brief_final_9_26_276766_5379_vl.pdf https://ctmirror.org/category/ct-viewpoints/ Hancock, C., & Carter, D. (2016). Building environments we-need-trauma-informed-preschool-practices/ that encourage positive behavior: The preschoolDepartment for Children, Schools, and Families. (2015). behavior support self-assessment. Young Children,Working together tosafeguard children: Aguide to intepagency 71(1). https://www.naeyc.org/resources/pubs/yc/working to safeguard and pmmote the welfare of children.

mar2016/building-environments-encourage-positive-Department for Children, Schools, and Families, behavior-preschoolHM Government, Nottingham, United Kingdom.

Heckman,J.J. (2017). Heckman on quality early childhoodhttps://www.gov.uk/government/publications/ working-together-to-safeguard-children-2 education: There is no "Fadeout, only lastingbenefits.

Doll, B., Nastasi, B. K., Cornell, L., & Song, S. Y. (2017). The Washington Post. https://www.ffyf.org/beckman- School-based mental health services: Defirtitions and quality-early.childhood-education-no-fadeout-lasting- models of effective practice. Journal of Applied School benefits/ Psychology, 33(3), 179-194. https://doi.org/10.1080/ Horowitz, M. (2015, August). Early childhood suspension 15377903.2017.1317143 and expulsion. Center on Enhancing Early

Dowdy, E., Furlong, M., Raines, T. C., Bovery, B., Learning Outcomes. http://ceelo.org/wpcontent/ Kauffman, B., Kamphaus, R. W., Dever, B. V., uploads/2015/08/ceelo_annotated_bib_ Price, M., & Murdock, J. (2015). Enhancing school- expulsion_2015_08_final_web.pdfe based mental health services with a preventive Knopf, A. (2016). Officials discourage preschool and promotive approach to universal screening suspensions, encourage mental health consultations. for complete mental health. Journal of Educational Brown Uniumity Child 8 Adolescent Behavior Lettg 8 Psychological Consultation, 25(2/3), 178-197. 32(10), 1-2. https://doi.org/10.1002/cbl.30161 https://doi.org./10.1080/10474412.2014.929951 Lenares-Solomon, D., Brown, M. H., & Czerepak, R.

Eklund, K., Rossen, E., Koriakin, T., Chafouleas, S. (2019). The necessity for school-based mental health M., & Resnick, C. (2018). A systematic review services. Journal of Professional Counseling: Practice, of trauma screening measures for children and Theory 8 Research, 46(1/2), 3-13. https://doi.org/ adolescents. School Psychology Quarterly, 33(1), 30-43. 10.1080/15566382.2019.1674074 https://doi.org/10.1037/spq0000244 Lawson, H. A., Caringi, J. C., Gottfried, R., Bride, B. E., &

Fazel,M.,Patel,V., Thomas, S.,&Tol, W.(2014). Mentalhealth Hydon, S. R (2019). Educators' secondary traumatic interventions in schools in low-income and middle- stress, children's trauma, and the need for trauma income countries. Lancet Psychiatry, 1(5), 388-398. literacy. Haward Educational Review, 89(3), 421-448. https://doi.org/10.1016/s2215-0366 (14)70357-8 https://doi.org/10.17763/1943-5045-89.3.421

Fenwick-Smith, A., Dahlberg, E. E., & Thompson, S. C. (2018). Systematic review of resilience-enhancing, Liming, K. W., & Grube, W. A. (2018). Wellbeing

outcomes for children exposed to multiple adverse universal, primary school-based mental health experiences in early childhood: A systematic review. promotion programs. BMC Psychology, 6(1), 1-17. Child 8 Adolescent Social Work Journal, 35(4), 317-335.https://doi.org/10.1186/s40359-018-0242-3 https://doi.org/10.1007/s10560-018-0532-xFlorida Center for Early Childhood. (2019). haps://www Loomis, A. (2018). The role of preschool as a pointthefloridacenter.org/

of intervention and prevention for trauma-Giannakopoulos, G., Agapidaki, E., Dimitrakaki, C., Oikonomidou, D., Petanidou, D., Tsermidou, L., exposed children: Recommendations for practice, Kolaitis, G., Tountas, Y., & Papadopoulou, K. policy, and research. Topics in Early Childhood (2014). Early childhood educators' perceptions of Special Education, 38(3), 134-145. https://doi.org/ preschoolers' mental health problems: A qualitative 10.1177/0271121418789254 analysis. Annals of General Psychiatry, 13(1), 1-12. Morrison, G. (2015). Eady childhood education today (13th https://doi.org/10.1186/1744-859X-13-1 ed.). Pearson Publishers.

THE JOURNAL OF AT-RISK ISSUES 19

Meltzer, H., Vostanis, R, Ford, T, Bebbington, P., & Identifying key barriers to use of technology-based Dennis, M. S. (2011). Victims of bullyingin childhood therapeutic tools for behavioral health care. The and suicide attempts in adulthood. European Journal of Behavioral Health Services 8 Research, 43(1), Psychiatry, 26(8), 498-503. https://doi.org/10.1016/ 54-70. https://doi.org/10.1007/s11414-9436-5 j.eurpsy.2010.11.006 Safari, S., Abedi, A., & Faramarzi, S. (2020). Implementing

Moon, I., Williford, A., & Mendenhall, A. (2017). an RTI approach: A qualitative study of prerequisites Educators' perceptions of youth mental health: and obstacles. Educational Research for Policy and Implications for training and the promotion of Pmctice, 19, 261-279. https://doi.org/10.1007/s10671- mental health services in schools. ChildTen and Youth 020-09258-6 Services Review, 73, 384-391. https://doi.org/10.1016/ Sanchez, A. L., Cornacchio, D., Poznanski, B., Golik, A. j.rhildyotith.2017.01.006 M., Chou, T., & Comer, J. S. (2018). The effectiveness

National Center for Pyramid Model Innovations. of school-based mental health services for elementary- (2020). Suspension and expulsion in early childhood. aged children: A meta-analysis. Journal of the American https://challengingbehavior.cbcs.usf.edu/Pyramid/ Academy of Child SAdolescent Psychiatyy, 57(3), 153-165. suspension.html https://doi.org/10.1016/j.jaac.2017.11.022

Nicholson, J., Perez, L., & Kurtz, J. (2019). Trauma-informed Schweinhart, L. J., Montie, J., Xiang, Z., Barnette, W. S., practices for early childhood educators: Relationship based Bolfieldm, C. R., & Nores, M. (2011). The High/Scope approaches that support healing and build Tesilience in young Perry Preschool Study through age 40: Summary, conclusions, children. Routledge Publishers. and frequently asked questions. High/Scope Press.

O'Dea, B., King, C., Subotic-Kerry, M., O'Moore, K., Statman-Wei K. (2015). Creating trauma-sensitive & Christensen, H. (2017). School counselors' classrooms. YC: Young Children, 70(2), 72-79. https:// perspectives ofaweb-based stepped care mental health www.naeyc.org/system/files/YC0515_Trauma- service for schools: Cross-sectional online survey. Sensitive_Classrooms_Statman-Weil.pdf JMIR Mental Health, 4(4). https://doi.org/10.2196/ Stegelin, D. (2018). Preschool suspension and expulsion: mental.8369 Defining the issues [Policy brief]. Institute for Child

Office of Early Education and Development. (2016). Success. https://www.instituteforchildsuccess.org/ Reducing suspension and expulsion practices in early publication/preschool-suspension-and-expulsion- childhood: Expulsion Wei)inar 2. Department of Health defining-the-issues/ and Human Services. https://www. acf.hhs.gov/ecd/ Taylor, R. D., Oberle, E., Durlak, J. A., & Weissberg, R. child-health-development/reducing-suspension-and- P. (2017). Promoting positive youth development expulsion-practices through school-based social and emotional

Ohio Department of Mental Health and Addiction learning interventions: A meta-analysis of follow- Services. (2019, October 19). Early childhood mental up effects. Child Development, 88(4), 1156-1171. health (ECMH) initiative. https://mha.ohio.gov/ https://doi.org/10.1111/cdev.12864 Portals/0/assets/SchoolsAndCommunities/ U.S. Department of Education. (2014). Data snapshot: Emb Funding%20Opportunities/2020/2020_ECMH_ childhood education highlights (Issue Brief No. 2). Office EI_RFP_10.23.19_HH.GK.LH_approved_final_VA6. for Civil Rights. https://www2.ed.gov/about/offices/ pdf?vcr=2019·10-23-122842-733 list/ocr/docs/crdc early-learning-snapshot,pdf

O'Reilly, M., Svirydzenka, N., Adams, S., & Dogra, U.S. Department of Education. (2016, September 15). N. (2018). Review of mental health promotion Obama administrative investments in ea~ly learning have interventions in schools. Social Psychiatry and led to more children enTolled in high,quality preschool [Press Psychiatric Epidemiology, 53(7), 647-662. https://doi. release]. https://www.ed.gov/news/press-releases/ org/10.1007/s00127-018-1530-1 obama-administration-investments-early-learning-

Osofsky, J. D., Putnam, R W., & Lederman, C. (2008). have-led-thousands-more-children-enrolled-high- How to maintain emotional health when working with quality-preschool trauma. Juvenile and Family Court Journal, 59(4), 91-102. U.S. Department of Education. (2018). Early learning. https:/7 https://doi.org/10.1111/j.1755-6988.2008.00023.x www2.ed.gov/about/inits/ed/earlylearning/index.html

Pianta, R. C., Barnett, W. S., Burchinal, M., & Thornburg, U.S. Department of Health and Human Services and K. R. (2009). The effects of preschool education: Education. (2014). Policy statement on suspension What we know. How public policy is or is not aligned and expulsion policies in early childhood settings. https:// with the evidence base, and what we need to know. www2.ed.gov/policy/gen/guid/school-discipline/ Psychological Science in the Public Interest, 10(2), 49-88. policy-statement-ece-expulsions-suspensions.pdf https:#doi.org/10.1177/1529100610381908 Vanassche, E., & Kelchtermans, G. (2016). Facilitating

Psychology Notes Headquarters. (2019). What is self-study of teacher education practices: Toward Bronfenbrenner's ecological systems theoTy. littps://www. a pedagogy of teacher educator professional psychologynoteshq.com/bronfenbrenner-ecological- development. Professional Development in theory/ Education, 42(1), 100-122. https://doi.org/10.1080/

Ramsey, A., Lord, S., Torrey, J., Marsch, L., & Lardiete, M. 19415257.2014.986813(2016). Paving the way to successful implementation:

20 VOLUME 23 NUMBER 2

Van Ausdal, K. (2015). Suspensions and expulsions reduction project (SERP Update). Chicago Public Schools. https://www.cpsboe.org/content/documents/ cps_serp_03252015.pdf

WestED. (2019). Trauma-informed practices in early childhood education. https://www.wested.org/service/trauma- informed-practices-in-early-education/

Whitehurst, G. J. (2018, April 19). What is the market price of daycare and preschool? Brookings Institute-Evidence Speaks Reports, 2(48). https://www.brookings.edu/ research/what-is-the-market-price-of-daycare-and- preschool/

Whitted, K. (2011). Understanding how social and emotional skill deficits contribute to school failure. Preventing School Failun, 55(1), 10-16. https://doi.org/10.1080/10459880903286755

Yoon, S. Y. (2016). Principals' data-driven practice and its influences on teacher buy-in and student achievement in comprehensive school reform models. Leadership and Policy in Schools, 15(4), 500-523. https://doi.org/ 10.1080/15700763.2016.1181187

Zeng, S., Corn C. P., O'Grady, C., & Guan, Y. (2019). Adverse childhood experiences and preschool suspension expulsion: A population study. Child Abuse 8 Neglect, 97. https://doi.org/10.1016/ j.chiabu.2019.104149

Zero to Three. (2019). Trauma and stress in early childhood. https://www.zerotothree.org/espanol/trauma-and- stress

Zin, D. M. M., Mohamed, S., Kashim, M. I. A. M., Jamsari, E. A., Kamaruzaman, A. F., & Rahman, Z. A. (2019). Teachers' knowledge and practice in implementing the therapeutic approach in pre-school. International Journal of Civil Engineering and Technology, 10(1), 1870-1881. https://oarep.usim.edu.my/jspui/ handle/123456789/1449

THE JOURNAL OF AT-RISK ISSUES 21

Appendix A Defining Suspension and Expulsion St,spension Expulsion • In School/Program Suspension: The child is Expulsion/Dismissal: Permanent dismissal of the child

temporarily removed from classroom and/or class from the program in response to problem behavior.

peers. Child is sent to some other part of the school/ Does not include transition to another program, program (e.g., other classroom, director's office) service, or classroom (e.g., special education,

for part of the day or multiple days in response to liansitional classroom, or therapeutir preschool

problem behavior. This includes when the child is program) deemed more appropriate for the child

removed from the classroom to spend extended time if done in collaboration with the family and the

with administrator, counselor, behavior therapist or receiving classroom, program or service.

another adult. • Short Term Out-of-School/Program Suspension: Source: National Center for Pyramid Model Innovations

Child is sent home for some part of the school/ (NCMPI) https://challengingbehavior.cbcs.us£ program day in response to problem behavior. edu/Pyramid/suspension.html)

• Out-of-School/Program Suspension: Child is not allowed to return to school/program for one or more days in response to problem behavior.

• For children with disabilities served under IDEA (with an IEP or IFSP): Out-of-school/program suspension is an instance in which a child is temporarily removed from his/her regular school/program to another setting (e.g., home, behavior center) for at least half a day in response to problem behavior. Out-of-school/ program suspensions include both removals in which no individualized family service plan (IFSP) or individualized education program (1EP) services are provided because the removal is 10 days or less as well as removals in which the child continues to receive services according to his/her IFSP or IER

22 VOLUME 23 NUMBER 2

Appendix B Resources for School Professionals Professional Organizations Online Articles • National Association for the Education of Young • 50,000 Meschoolers aTe suspended each yeaT. Can mental..

Children (NAEYC) http//www.nbcnews.com/news/us-news/50-000- Creating Trauma-Sensitive Classrooms preschoolers-are-suspended-each-year.can-mental- http//www.naeyc.org/resources/pubs/yc/may2015/ health-n962691 an 26, 2019. Mental health consultants trauma-sensitive-classrooms aim to equip early childhood teachers with the tools

they need.• Centers for Disease Control and Prevention (CDC) Preventing Adverse Childhood Experiences: Leveraging the • Should Childhood Trauma Be Treated as A PublicBest Available Evidence

Health Crisis? http//www.npr.org/sections/health-CDC: Childhood trauma is a public health issue shots/2018/11/09/666143092/shorild<hildhood-http//www.npr.org/sections/health-shots/2019/

11/05/776550377/cdc-childhood-trauma-i trauma...

• Administration for Children and Families (ACF). Researchers followed a group of kids from childhood Expulsion and suspension prevention webinar series. into adulthood to track the link between trauma in WebinaT 2. Reducing Suspension and ffxpulsion Practices early life and adult mental health. in Eady Childhood. Department of Health and Human Services, Washington, DC 20037. • Childhood Trauma Tied to Greater Social Dysfunction https://www.acf.hhs.gov/ecd/child-health- in... development/reducing -suspension-and-expulsion- psychcentral.com/news/2018/09/14/childhood- practices trauma-tied-to-greater-social...

• United States Department of Health and Human Childhood trauma is tied to impaired social cognition Services and Education in adults diagnosed with major psychiatric disorders, Joint policy statement on suspension and expulsion policies according to a new Irish study published in the journal in early childhood settings. European Psychiatry. https://www2.ed.gov/policy/gen/guid/school- discipline/policy-statement-ece-expulsions- • Childhood Trauma and Chronic Illness in Adulthood: suspensions.pdf Mental

http//www.nebi.nlm.nih.gov/pmc/articles/ • United States Department of Education, Office for PMC3153850

Civil Rights Mental health and socioeconomic status are also tested Data Snapshot: Early Childhood Education Highlights. as buffers against the typically adverse consequences Issues Brief #2. Washington, DC. http://ocrdata.ed.gov of childhood trauma. The results suggest mental

• Zero to Three: Infant and Early Childhood Mental health and socioeconomic status partially explain the Health association of childhood trauma with chronic illness 'Infant mental health" refers to how well a child in adulthood, with mental health showing a stronger develops socially and emotionally from birth to three. effect. Understanding infant mental health is the key to preventing and treating the mental health problems of very young children and their families. http//www. zerotothree.org/espanol/infant-and-early- childhood-mental-health

Books Nicholson, J., Perez, L., & Kurtz, J. (2019). Trauma-Informed

Practices for Early Childhood Educators - Relationship Based Approaches that Support Healing and Build Resilience in Young Children, First Edition, Routledge Publishers.

Souers, K. & Hall, R (2018). Creating a Tmuma-Sensitive Classroom. ASCD Publishers.

Souers, K. & Hall, R (2016). Fostering Resilient Learners: Strategies foy Creating a Trauma-Sensitive Classroom. ASCD Publishers.

THE JOURNAL OF AT-RISK ISSUES 23

Andrea Holzner, MPH, is pursuing a doctorate in Authors Gerontology at Walden University. She is a doctoral

mentor and National Society of Leadership and Success Dolores (Dee) Stegelin, PhD, is a professor emeritus at member. Her career has been spent in advocacy for aging Clemson University where she serves on the advisory board of the Emeritus College and the steering committee of the and disability policy, ethical standards, and human rights.

US Play Coalition, headquartered at Clemson University. She maintains a clinical practice for comprehensive aging

She was a professor in the College of Education with treatment planning. While she is finishing her qualitative

an area of expertise in early childhood education. Her research, she focuses on rural aging sustainability in the

research interests are public policy, public school preschool United States and globally with Aging Nepal. Additionally,

programs, and professional development for professionals she volunteers for orEanizations focusing on aging rights

serving students with traumatic experiences and mental and age-related issues.

health needs. Dr. Stegelin is a Research Fellow for the National Dropout Prevention Center and Successful Practices Network. She is the author of numerous journal articles and several books.

Carmen Leggett, PhD, is a recent graduate of Walden University where she earned her doctorate. in Human Services. She has spent years cultivating social change by advocating for military families, promoting violence-free environments, and increased educational opportunities to enhance quality of life. Dr. Leggett's research interests include adoption and education. She is retired from the United States Army and currently serving as the Family Advocacy Program Manager, USAG Italy, and as a mentor for PhD candidates at Walden University.

Diane Ricketts, PhD, is an adjunct instructor and a Director for a structural engineering company. She was appointed by the Cayman Islands Government as a Guardian Ad Litem, effective May 2020. Dr. Ricketts represents infants' interests, the unborn, children, or incompetent persons involved in various legal actions before the courts in the Cayman Islands. She has volunteered on multiple committees that mentor young people, advancing yniith's lives globally. She currently works for a non-profit organization.

Misty Bryant, PhD, has been a Program Director for a nonprofit organization since 2015 and an Education Consultant since 2017. Dr. Bryant is a recent graduate of Walden University with a PhD in Human Services. She spent 17 years providing school-based preparatory one-to-one mentoring and group mentoring for students who require academic, social, and developmental support. Dr. Bryant is a mentor for Walden University doctoral candidates and the lead mentor trainer for undergraduate students seeking mentor opportunities for local nonprofit organizations.

Chanci Peterson, MSHS, is pursuing a doctorate in Human and Social Services at Walden University. Her research interests are parenting, adolescent behavior, relationship studies, and familial research. She is a member of the National Society of Leadership and Success as well as the Tau Upsilon Alpha Honor Society.

24 VOLUME 23 NUMBER 2

Copyright of Journal of At-Risk Issues is the property of National Dropout Prevention Center and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.