HPC “White Paper” on Child Care and Consultation

 Jeffrey Longhofer, Ph.D.; LSW, Barbara Streeter, LPPC; Thomas F. Barrett, Ph.D.;

Marlo Micelli; Laura Johnson

August 2004

Introduction

For more than 40 years the Hanna Perkins Center has been involved in consultation to nursery schools and child care centers.  Beginning in 1993, a ten-year grant from the TRW Foundation elevated our Cleveland-based initiative to a national level.  TRW asserted their wish to “make a significant difference in the lives of children.”  They were especially interested in the preschool years.

We agreed with this focus on the preschool years.  Decades of research at Hanna Perkins supported the findings of the emerging studies of early brain development.  The earliest years provide the foundation for all that will follow.  Moreover, our research stressed the importance of mastery in areas of self-care and the crucial contribution of parental involvement and stable relationships in the attainment of such mastery. 

The project funded by the TRW Foundation – the Early Childhood Intervention Alliance – has proven immensely successful.  It has identified practical strategies and solutions that have led to effective early interventions.  While many qualitative changes in care giver attitudes and performance have resulted, among the most significant outcomes is the fact that, in centers with ongoing consultation, staff turnover rates have greatly diminished.  Also, in these centers it virtually never occurs that a child is asked to leave because of behavior that is felt to be unmanageable. 

Three crucial ideas inform our interventions:

• Relationships that are consistent, reliable and emotionally responsive best prepare children to learn in the context of a teacher-pupil dyad.

• Behavior which provides the pathway through which young children express emotions must be recognized as a communication.  When children are helped to understand this verbalization of affect, increased frustration tolerance and improved behavior follows.

• A child’s first learning is focused on his or her own body.  Mastery in areas of self-care provides the foundation for self-esteem and all future learning.  Such mastery is most reliably obtained when the daycare provider supports the child’s relationship with his mother, a relationship that is stressed by daycare and separation from the mother.

The current goal of the Hanna Perkins Center is to broadly disseminate and share findings and experiences with all who hold a stake in the future of our children.  Through the establishment of the National Child Care Consultation Alliance we will continue our intervention-based research and communicate our findings and our message of advocacy to our colleagues, to policy makers, and to all young parents who yearn to be able to feel safe and supported when they embark upon the conflict-laden decision of asking others to help in the daily care and rearing of their young children. 

The Current Status of Child care – The Problem and a Potential Solution

As we proceed into the new millennium, we are confronted by the following sobering statistics:

• 61 percent of children, birth through age six—three of five young children, including six million infants and toddlers—are in some form of non-parental care.[1] 

• More than three-quarters of our nation’s children under five are regularly cared for by someone other than their parents.[2] 
• 65% of mothers with children under age six and 59% with infants under age one are in the labor force.  
• In 77% of families with children under six both parents work. 
• Children enter care as early as six weeks of age and they can be in care for as many as 40 hours per week.[3]  

Substitute care is here to stay.   It is part of our everyday reality.   Yet, according to one national study, fewer than 25% of child care centers meet the standards for developmentally appropriate care (Cost, Quality and Outcomes Study, 1999).  

Although there is general agreement that consultation is a most important and effective intervention, little is understood about how and why it works. 

The consultation model developed at the Hanna Perkins Center for Child Development (HPC) and its National Child care Consultation Alliance (NCCCA) has succeeded in improving the quality of child care in three essential ways:

• The professionalism of child care providers has been elevated.  They understand how parents trust them as a “bridge to home” that takes the form of keeping parents and “home ways of doing things” in mind. 
• Child care providers have been helped to understand that it is through behavior that young children communicate feelings.  This awareness leads to an increased appreciation of the crucial role they play in supporting the emotional and social development of the children in their care. 
• Through training in child development that is tailored to each developmental phase the care givers come to appreciate how a child’s future capacity to learn is grounded in the mastery he or she achieves with regard to the care of his own body.  This results in improved support for mastery in areas of self-care and recognition of the need for continuity between home and center care. 

In this report we have selected prominent themes that relate directly to those seen over many decades of observational and case study research at HPC and we relate our work to a recent and growing research and practice literature on care giving in child care settings.   Throughout, we explore various perspectives on child care consultation and share illustrative vignettes from our TRW-funded consultation sites.  

What We Know and Should Know About Early Childhood Development and Education  

The need for higher quality childcare is broadly documented.  Deborah Phillips, developmental psychologist and chair of the Department of Psychology at Georgetown University, said in her 2001 testimony before the U.S. House of Representatives Committee on Education and the Workforce, “The distribution of children across centers of differing quality does not appear to vary with family income.”  It has been shown that children in poor quality childcare are delayed in language and reading skills and display more aggression toward other children and adults.[4]  Many have noted that higher quality care is related to better parent-child relationships, improved cognitive performance, increased language ability, improved levels of school readiness, and fewer problem behaviors.[5]   And “virtually all experts in early education and related fields agree that intensive, high-quality interventions for young children in poverty can have substantial impacts on their future school and life success.”[6] In several studies researchers have followed children in their transition to school and have found that children from the higher quality centers are less distractible, more task-oriented, and more considerate.[7]  Child Development, the flagship journal of the Society for Research in Child Development, devoted most of Volume 74 (2003) to current research related to child care.   Two of the lead articles present findings showing that the number of hours a child spends in child care relates to behavioral problems and potential physiological difficulties.   Below, we look at the role consultation plays in helping to reduce the stress and create the conditions for high quality care. 

Growing numbers of child care providers and preschool teachers report significant increases in disturbing school behaviors and name aggressive and disruptive ones as their greatest challenge.[8]  Phillips, in her testimony, noted that “research is now quite clear that later anti-social behavior can have its roots in the preschool years, just as learning problems can be traced back to these earliest years of life.”[9]  One study reports that “young children who act in anti-social ways participate less in classroom activities and are less likely to be accepted by classmates and teachers…”[10] Their academic performance is poor, they are more likely to be held back, and they have higher drop out rates.[11]   Indeed, the same study shows that self-control and lower levels of acting out are more predictive of academic success than cognitive skills and family background.[12]  John J. Wilson, Acting Administrator of the Office of Juvenile Justice and Delinquency Prevention, writes that “a growing number of children are experiencing conduct problems—aggression, noncompliance, and defiance—and at earlier ages.  Because these problems may be predictive of delinquency, violence, and other antisocial behavior, escalating aggression in preschool and elementary school children is a particular cause for concern.”[13] Carolee Howes, UCLA, shows that “the quality of children’s early relationships with their teachers in child care is emerging as an important predictor of children’s social relations with peers as older children.”[14]

Not well documented is what constitutes high quality in situations of substitute care.  Ross Thompson succinctly addresses the importance of the care giving relationship–an essential point of focus in the method of consultation developed at HPC over many decades.  “A young child’s capacities for emotion regulation rely on the support of care givers who provide soothing when it is needed, suggest alternative goals when initial goals are frustrated, and provide reassurance that things will get better.”  He continues, “more broadly, the security and trust that has developed between young children and their care givers provides children with the confidence that their feelings are manageable and not overwhelming, frightening or confusing.”[15]  In other words, he addresses the need of each child to develop the ability to notice, name and contain their own feelings.

Are Our Children Ready to Learn?— Making the Case for Consultation

An unprecedented number of research reports and monographs have recently appeared. They address mounting concerns about the quality of early childhood education and the time our children spend in substandard substitute care.[16]  In 1994, a Carnegie Task Force, Meeting the Needs of Young Children, sounded the alarm.  In their report, Starting Points, they referred to the growing problem as a quiet crisis.  In their summary of the key research findings they noted especially the importance of early environmental influences on brain development.   By the end of the decade researchers, government agencies, and foundations had turned attention to what was increasingly seen as one of our nation’s most pressing problems: readiness to learn.  Were our children emotionally, socially, and cognitively prepared to enter school?  What were the possible repercussions on brain development if early care giving relationships were compromised?   Although reports have differed in the direction and nature of their findings, there has been nearly universal agreement that our children are ill-equipped and that we have much to learn about the kinds of environments and interventions that best prepare children for learning and healthy development.   In this report, we focus on the relevance of these findings to the Hanna Perkins National Child care Consultation Alliance.  We are especially interested in how these findings relate specifically to the method of consultation that has been developed at HPC with support from the TRW Foundation.    

In 1997, The National Center for Children in Poverty, Columbia School of Public Health, and the American Orthopsychiatric Association Task Force on Head Start and Mental Health, released their report, Lessons from the Field: Head Start Mental Health Strategies to Meet Changing Needs.  Among the key findings, they noted that “children are showing more and more evidence of stress in the classroom, with a significant number exhibiting withdrawn, aggressive or “out of control” behaviors that challenge the staff and sometimes threaten the overall classroom climate.”[17]  Moreover, the authors stressed that it “has been difficult for Head Start program directors and others to find, or pay for, mental health consultants who have expertise in working with young children and/or low-income families.”[18] 

They argued for the necessity of moving from an on-call model of consultation to an “…on-site, family supportive, non-stigmatizing…” one, “where services are less threatening than the usual referral for therapy.”[19]  “Ongoing, trusting relationships among consultants with mental health expertise, staff, and families,” they write, “is crucial.”    The mental health consultant, moreover, “must be a familiar part of the program.”[20]  The on-call approach, they believe, fails to promote mental health, and, because of its lack of integration into other services in a programmatic way, “staff do not turn to the consultant for help.  Parents are suspicious.  There is limited follow-through on referrals to outside mental health agencies, and when referrals do occur, Head Start staff may disengage themselves, not seeing themselves as part of an ongoing partnership to help a particular child and family.”[21]  Through “close and regular on-site partnerships, a shared sense has emerged that the critical mental health challenge is not so much diagnosing problems or building specific skills such as setting limits, but is supporting the staff in caring for children and helping them ensure that the children’s emotional and social needs are  being met in the classroom.”[22] 

Finally, they note the importance of our need to understand more about how consultation has contributed to positive outcomes.[23]  In short, good research on the consultation process does not exist.  C. Cybele Raver and Jane Knitzer, of the National Center for Children in Poverty, more recently reported that “on-site mental health consultation is the dominant strategy emerging across the country.”  Although they note the very limited research evaluating this strategy,[24] they have observed that consultation effectively produces “…a continuum of interventions, from classroom-focused interventions serving all children, to more intensive classroom and sometimes home-linked interventions for more high-risk young children, to referrals for those who need more specialized services.”  They write that “it can be effective for infants and toddlers as well as preschoolers.  Further, consultation approaches emphasizing linkages between parents and teachers encourage both sets of adults in a child’s life to develop a sense of shared responsibility and support in addressing the child’s emotional and behavioral difficulties.”[25]  More research is needed before we can fully appreciate all the factors that contribute to effective consultation. [26]  At HPC, we have conducted an evaluation of our consultation methods and are continuing this effort at four newly established sites. 

In 2000, the National Research Council and Institute of Medicine released From Neurons to Neighborhoods: The Science of Early Childhood Development.  This influential collection of research findings and synthesis of current knowledge, already in its fifth printing, is aimed at fundamentally changing the ways we think about policy, service, and research in early childhood.   There were among the findings four especially relevant to our research and practice at HPC.[27] First, as noted by the Carnegie task force,  early experience affects brain development and prepares a child for learning, emotional wellbeing, and conscience development; however, they concluded that the emphasis on “zero-to-three” was too narrow.   Second, they emphasized the importance of nurturing and reliable relationships in early development.  Third, and especially important to our more than fifty years of case study and observational research and publication at HPC, was their insistence that a child’s feelings are as important as their thinking in the preparation for learning and life.   Finally, they noted that societal changes are outpacing the needs of young children.  The recommendations are too many to summarize here but important among them was the recognition of the need for increasing resources to meet the emotional and social needs of young children.  Foremost among their challenges was the insistence that we give up the tired and facile distinctions often made between nature and nurture.  Both make a difference and both must be attended to in ways that support a child’s healthy early development. 

Also in 2000 the National Research Council Committee on Early Childhood Pedagogy issued their extensive report, Eager to Learn: Educating Our Preschoolers.  Here, as in From Neurons to Neighborhoods, it was argued that “cognitive, social-emotional (mental health), and physical development are complementary, mutually supportive areas of growth all requiring active attention in the preschool years.”  As well, the committee noted that “responsive interpersonal relationships with teachers nurture young children’s dispositions to learn and their emerging abilities.”[28]  Among their recommendations for professional development was one especially relevant to our work at HPC.  The committee insisted that “education programs for teachers should provide them with a stronger and more specific foundational knowledge of the development of children’s social and affective behavior, thinking and language.”[29] 

At HPC we understand that children move from body to mind, from mastery of bodily functions and self care tasks in infancy and toddlerhood to the development of increasingly complex mental capacities such as the ability to communicate needs and feelings with words.  To name a few, the continuum includes the development of self protective mechanisms, the control of bodily functions and behaviors, self regulation skills such as frustration tolerance, concern for others, curiosity, concentration, and conscience development.  All contribute to self esteem, increasing autonomy and readiness to learn.  All emerge out of interactions with invested parents and substitute care givers: children invest themselves and their developing abilities only to the degree that they and their abilities are invested by their parents and care givers.  In other words, caring for and investing in one’s own body provides a fundamental template for all future learning.  This results from a child identifying with the bodily investment that is shown in him/her, ideally, in a parallel way, by both parents and substitute care givers.[30]

The focus on early self-care mastery, and the fact that such mastery can only be accomplished in the context of a close working relationship between parents and substitute caregivers, responds to the challenge put forth in the 2000 report and review of research issued by The Child Mental Health Foundations and Agencies Network (FAN), A Good Beginning: Sending America’s Children to School with the Social and Emotional Competence they Need to Succeed.  In their concluding remarks, the authors write that we must pay more “attention to the protective factors that reduce susceptibility to disorder…and explore models of resilience and the plausibility that positive relationships with parents, teachers and peers may serve as protective shields for at-risk children.”[31]  They note the importance of understanding more “about the critical periods during which children are particularly vulnerable or invulnerable to assumed risks.”

Our experience at HPC has been that such critical periods begin as early as the first half of the first year of life.  It is at this time that a child begins to develop a loving self-investment, including an ability to keep safe and seek comfort.[32]  During the second year of life, the achievement of toilet mastery and control over bodily functions brings an exhilarating sense of new found autonomy.  This move towards independence is accompanied by the challenge of managing aggression and the wish for power and control without losing a sense of caring for and a wish to cooperate with others.[33]  As language skills develop during the second and third years, self-care mastery extends to the ability to label, express, and modulate feelings.  This is a crucial accomplishment that results in improved frustration tolerance, less aggressive acting but, the emergence of a capacity for empathy and kindness, and, ultimately, conscience development. [34]

Several authors have noted this important focus on emotional development as a prerequisite for learning and intellectual development.  In November of 2001, The Ewing Marion Kauffman Foundation convened a conference in the Kauffman Early Education Exchange.  Leading scholars, practitioners, and policymakers gathered to present research and discuss the complex relationships between social-emotional and cognitive development (subsequently published by the Foundation, Set for Success: Building a Strong Foundation for School Readiness Based on the Social-Emotional Development of Young Children).  Ross Thompson, one of the contributors to the National Academy of Sciences report, From Neurons to Neighborhoods, argued in his contribution to the Kauffman proceedings that readiness for school and learning requires that young children “understand their own feelings and the viewpoint and feelings of others…and young children who have established positive relationships with parents, care givers and teachers are secure and confident in exploring new situations and mastering learning challenges.”[35] In their review of the research and in their own work, Linda Espinosa and Rebecca McCathren, offer compelling evidence for the importance of  “nurturing relationships and responsive social environments” in providing the foundation for language and literacy…”[36]   Oscar Barbarin, in his discussion of the role of culture and ethnicity and their relationship to readiness, argues that because “behavioral problems are literally ‘in your face,’ it may be easy to miss the underlying emotional turmoil that undergirds and perhaps drives the acting-out behavior.”[37]  

HPC consultants assist parents and care givers in approaching children’s behavior as their way of trying to convey feelings that need to be understood.  It is only with the help of parents and caregivers who know the children well enough to be able to “read” their behavior that they can be helped to express the feelings in words instead of showing them in behaviors.  Since children in child care often show feelings about things that have happened at home (and vice versa), it is crucial that parents share important aspects of the child’s home experience with the care givers.  Likewise, care givers should share with parents what has gone on during the day.  When communication falters self-care is not supported, mastery lags and gains are lost.  Child care providers frequently complain of toileting “accidents,” sleep disturbances at naptime, biting, etc.  Such problems can be addressed early and effectively when care givers and parents are helped to have regular contact.

Cognizant of these difficulties, several authors have pointed to the potential positive impact of consultants as a method of both intervention and prevention.  Roxane Kaufmann and Deborah Perry, in their contribution to the Kauffman report, write that “there is an urgent need to identify and train a cadre of mental health professionals who understand the unique developmental challenges of children, ages birth to 5, and can serve as consultants to early childhood professionals.”[38]  And in her discussion of the public policy implications Jane Knitzer argues that “early childhood mental health consultants enter into the culture of the program and are able to meet a variety of needs, sometimes working with the staff, sometimes with specific children, and sometimes with families.”[39]

In our HPC consultation work we have learned that the introductory period requires extreme respect, sensitivity, care, and responsiveness, with minimal action on the part of the consultant.  We often liken the initial phase of entering a child care center to that of entering a family’s home.  You need to get to know the family members, gain their trust, and convey your intention of empowering them, to let them know you are not there to give advice or take over.  This is not easy to do as many care givers deal with their anxiety and sense of inadequacy by asking the consultant to tell them what to do.  Through the consultation process it is often possible to help the caregivers understand that the problems they encounter are neither their fault nor the fault of the parents, but instead a result of the situation.   

At HPC we have discovered that when stress becomes high, relations between parents and care givers can become uncooperative and contentious.  Caregivers and parents alike feel an intense and basic conflict over the necessity of placing children in situations of substitute care for many hours each week.  Because they feel helpless about this in the face of the financial demands faced by each – parents must provide for home and family and child care staff must meet census requirements to stay in business – both tend to avoid discussion of this reality.  When caregivers can be helped to acknowledge and face this painful reality, they are more able to develop close working relationships with parents.  They are also more able to work together with the consultant to discover their own capacities to understand and respond to the emotional needs of highly stressed infants, toddlers, preschool-aged children, and their parents – instead of focusing on educational techniques.

Ross Thompson, a developmental psychologist and contributor to the Kauffman Foundation report, Set for Success, and Neurons to Neighborhoods, agrees: “…the quality of early relationships is a far more significant influence on early learning than are educational toys, preschool curricula or Mozart CDs.  Relationships guide how young children learn about the world, people and themselves.”[40]  He continues, “some preschools feel they must move forward with learning tasks before many children have the developmental skills to succeed, including the ability to separate and work independently, to tolerate frustration and persevere, and to remain attentive and delay gratification.”  From the Hanna Perkins perspective we would note that all of these abilities are consequences of self-care mastery.[41]  

Paul Donahue, consultation advocate and co-author of Mental Health Consultation in Early Childhood, shares with HPC the concern that “early childhood programs are typically the first to feel the impact of family stresses…early childhood programs are often…asked to take a more primary role in child rearing.”[42]  He points to the fact that, as stressors increase in the lives of young families, incidents of domestic violence and abuse also increase.  While he recognizes the need to maintain clarity with regard to boundaries, Donahue emphasizes the helpful role that consultants can play in child care centers, not only by working with staff but also, on a selective basis, by being available to parents, either to help during a crisis, or, on a more benign basis, to respond to developmental questions and concerns, with the latter sometimes being addressed during parent workshops.  Donahue also describes improved professionalism and increased empathy and effectiveness on the part of child care providers when caring for children who are demonstrating severe behavioral difficulties. 

This parallels the HPC experience:  in centers with established relationships with consultants, it rarely occurs that a child is asked to leave the center because of behavioral difficulties.  As well, in these centers, staff turnover is markedly reduced.  The staff report that the opportunity to meet with a consultant on a regular basis to engage in joint problem solving has helped them be more effective, feel more confident, and enjoy their work.  Prior to consultations, many had been working in isolation, with minimal support or knowledge to deal with the daily challenges of caring for young children, many of whom come from problematic homes.  Consultations empower care givers to approach their work knowing they can make a difference.[43]

The National Child care Consultation Alliance

The Hanna Perkins Center for Child Development (HPC) in Cleveland, Ohio is internationally known for its service and research programs for young children and their families. The Hanna Perkins Center’s National Child care Consultation Alliance (NCCCA) is a signature program that works to alleviate the stresses in child care and promote the healthy personality development of young children.  Local consultants provide weekly support and consultation to child care directors in various locations (Cleveland, Ohio; Detroit, Michigan; Huntsville, Alabama; San Bernardino, San Diego, and Redondo Beach, California; and Scottsdale, Arizona).

Consultants establish relationships and trust with directors by understanding their priorities as well as assisting child care directors and their staff in improving working conditions, relationships with parents, and the quality of services provided to children.

In addition, the consultant acts as a facilitator, responding to the child care providers’ concerns and questions about children, and assists them in gaining competence in understanding and developing solutions to problematic behaviors.  During this process the staff begin to understand the developmental needs of all children and the particular stresses inherent in the child care situation—such as a child’s separation anxiety.  They understand and appreciate a child’s behavior as communication that conveys feelings that need to be understood and put into words.

The goal of the NCCCA is to enable child care providers to offer children the foundation they need for success in school, work, relationships, leadership, and as contributing members of the community. The consulting teams of the NCCCA have produced important changes that have led to improved child care services:

• Child care director and staff interactions have improved so that staff feel supported and assist one another in difficult situations. 

• Care givers’ perceptions of themselves have changed. They feel respected and valued as professionals and have become more objective and informed observers and more thoughtful in their work with children.  As a consequence, they have felt and have become more competent.

•  Care givers have improved their ability to speak with parents and develop partnerships for the benefit of children.  As the care givers have developed confidence in their own skills, they have interacted with parents with confidence.

• Care givers have become more empathic with and supportive of parents and children rather than judgmental, impatient, and frustrated.

•  Care givers have become able to recognize the importance of the parents’ relationships to their children. They have come to recognize children’s separation feelings and have helped children keep their parents in mind.

Consultation provides a window on the problems in child care and an opportunity to test interventions that can inform systemic changes.  Preliminary data collection in focus groups with childcare staff and consultants from the NCCCA sites indicate that consultations have dramatically improved childcare. The next critical step is to understand which of these consultative interventions have resulted in positive changes and which can be widely disseminated and implemented, whether through consultation or other mechanisms.  Our ongoing research and practice interventions through the NCCCA offers the opportunity to transform what has been service into a consultation network for learning that will improve public policy, parent and provider interactions, and most importantly—America’s future  leaders and workforce. 

Vignettes from the NCCCA Consultation Work

 It is 6:30 a.m. in the Williams home.  Three-year-old Justin is watching cartoons while his mother diapers his infant sister, Stephanie.  As a commercial comes on, Justin looks up to see his mother grab her purse, a sandwich bag of Cheerios, and Stephanie's diaper bag.  He accepts Mother’s good-bye kiss and returns to watching cartoons.  Mrs. Williams scoops up Stephanie and hurries out the door.  Justin knows Mom will drop Stephanie at the babysitter's on her way to work.  Shortly, Justin's father enters the room, hands Justin his backpack, and tells him it's time to go.  Justin hesitates and is about to object as his father turns off the TV.  He dutifully follows Dad out the door.  They take the bus to the child care center, which is not far from where Dad works. 

When they arrive, Mr. Williams helps Justin hang up his coat and backpack.  After giving Justin a hug and telling him to be good, he deposits him in the dining room where most of the children are sitting at a breakfast table.  Ms. Cadwell, the early morning caregiver, is dishing out oatmeal.  She nods to Mr. Williams, who does the same, and invites Justin to join the group.  Justin starts for the table then pauses to look back out the door.  He catches a glimpse of his father's back as he turns the corner and disappears. 

Justin's longing gaze is broken by a shout. "Justin! I got a Batman watch!" exclaims Alex.  "I do, too, and a Lion King shirt!" Justin responds excitedly.  He doesn't really have either, but to be left by Dad and have less than Alex would be too much to bear.  It will be another 30 minutes before Justin's regular caregiver, Ms. Ashley, arrives to take the three-year-olds to their classroom. 

This is a typical morning for many children and parents throughout the United States.  The growing number of single parents and the growing number of mothers in the workforce has resulted in an increasing reliance on various types of child care arrangements.  Young children—from infancy on—may spend as much as ten hours a day away from home in the care of people other than their parents.

Are caregivers other than parents able to provide these children with the quality of care they need during the most formative years of their lives?  Are others able to assist children in mastering self-care tasks, forming positive relationships and developing the abilities to learn and think for themselves?  There is growing evidence that, as the child care world exists today, the caregivers are not able to provide the quality of care needed.  There is growing evidence that children in child care are at great risk and, given the fact that the workforce and communities of tomorrow will be made up of the child care children of today, the nation is at great risk. 

Robert A. Furman, former director of the Hanna Perkins Center, describes the observed impact of the existing child care system on children’s development:  “Many children coming from child care have difficulty learning in school and eventually have trouble performing in the workplace and thinking for themselves as responsible community members.  This occurs because child caregivers simply cannot enter into the steady relationship that a parent does—a relationship that allows children to relate positively to others and to develop the ability to think for themselves.  A close look at most children in child care settings reveals how often they do not originate ideas in play and cannot sustain interest in ordinary nursery school activities in the absence of the supporting presence of a teacher.” 

The Hanna Perkins Center is addressing this concern through the "National Child care Consultation Alliance [NCCCA],” a program that supports high-quality child care by supporting the professional development of child care staff.  The program demonstrates how child development consultants can work with child care directors and staff over time to empower the child care staff to work more effectively in partnership with parents and better support the healthy personality development of the children in their care.

Justin and Alex have a good time playing with blocks, stacking some as buildings and extending others as roads.  When Justin sees Alex take the red car from the basket, though, he grabs it, claiming it as his.  "NOOOO!" screeches Alex.  He grabs at Justin's shirt sleeve to retrieve the precious car.  Startled by Alex’s clutch, Justin swings and hits Alex’s nose.  Alex starts to cry and calls for Ms. Ashley, who has just arrived.  Justin quietly begins rolling the red car on his road, his back to his tearful classmate.  

Justin does not know why he so needed the red car, why the blue or green one wouldn't do.  He doesn’t know that he’s still feeling deprived, smaller and lesser than Alex, whose possession of the Batman watch made him seem all the more privileged in Justin's eyes.  He doesn’t know how to say what he wants without grabbing, nor does he have the skills to deal with the panic he felt when Alex grabbed at his shirt sleeve.  Already, at age three, he is learning to turn his back on another's distress and pretend he doesn't care.

Ms. Ashley has told the children many times not to grab or hit, to use words instead.  Justin doesn’t grasp this concept as the other children do.  He seems impervious.  Ms. Ashley doesn’t know that what is really bothering Justin is that he misses his father - she wasn't there when Father left.  For that matter, she’s rarely had a chance to see Justin interact with either of his parents.

Research shows that children form perceptions of themselves and the world around them early in life.  They develop the ability to manage their feelings and put them into words within the context of relationships with caring adults.  In order to manage aggression, get along with others, and learn in school, children first must feel valued and know they will be kept safe.  In order for children to invest in learning, they first must feel that someone has invested in them.  To be capable of understanding how things work, children first must feel understood.  Children reared in a home environment where the parental focus is on self-care are often able to develop these abilities instinctively.

In order for caregivers to help children manage their feelings, they need to be able to form meaningful relationships with children, recognize that it is through behavior that feelings are often expressed, be with the children continuously enough to observe behaviors so the feelings behind them can be explored, and have a solid understanding of child development.  Too often, children are cared for by several different caregivers over the course of their eight- to ten-hour day in the center.  In addition, they must share a caregiver with many other children.  These circumstances can interfere with the formation of meaningful relationships and can make it difficult for caregivers to know what the children are reacting to.

Since Ms. Ashley doesn't know what else to do, she sends Justin to the "time out corner" for hurting Alex.  Justin does as he’s told, but within minutes of being released, he pushes Brittany into the toy shelf.  Justin’s angry at having been sent to time out and this anger has spilled onto Brittany, who (in his perception) was in his way.  Brittany bursts into tears and cries for her mommy. 

Brittany has been at the center only a few weeks after being suddenly placed there when her mother received a welfare-to-work job training voucher.  Time was not taken to settle her in and she does not feel safe at the center.  She spends much of each day aimlessly wandering, thumb in mouth, waiting for her mother to return.  When Ms. Ashley tries to engage Brittany in coloring, she dutifully pulls the green crayon across the paper several times.  As soon as Ms. Ashley leaves to attend to another child's toileting needs, Brittany lets the crayon drop.

In order for a child to invest in learning, she must first feel that someone has invested in her.  In order for a child to feel she is capable of understanding how things work, she must first feel understood.  Caregivers have the challenging task of substituting for parents, investing in and maintaining a relationship with each child, even when they are not "on duty."  In Brittany we see signs of apathy as she acts like a younger child.  She lacks sufficient self-esteem to carry her through when she is required to function independently.  These patterns auger poorly for her future ability to take initiative, work independently, and gain pleasure from individual accomplishment.

Ms. Ashley's schedule is as follows:  from 9:00 a.m. to 12:30 p.m. she is in charge of a group of ten three-year-olds.  From 12:30 to 1:30, she watches over the children taking naps.  From 1:30-2:30, she has a break, part of which is used for planning time.  From 2:30-4:30, she is back with the three-year-olds.  After 4:30, the three-year-olds join the four-year-olds in the "large muscle room" to wait until they are picked up.

Ms. Ashley is usually exhausted by the time she leaves and she welcomed her week-long vacation.  Upon return, however, she regrets having left.  Justin's behavior is worse than ever.  While she was gone, he’d hit, spit, and bit, not only the children, but her substitute as well.  His use of bad language has increased.  When Ms. Ashley reprimands him, Justin declares that he is a "bad boy" and should be "thrown in the garbage."

Professionally trained child development specialists at Hanna Perkins have over fifty years of experience working with children and families in the Hanna Perkins Clinic and Therapeutic Preschool.  Throughout that time they have provided courses and consultations to preschool teachers and child care caregivers, assisting them in better understanding the meanings conveyed in children’s behaviors and how they can use such understandings to better help children master the challenges they encounter as they grow.  In the course of consulting with caregivers, Hanna Perkins specialists become increasingly concerned about the inherent risks in the child care situation and work with the caregivers to find ways to alleviate the stresses and minimize the risks.

The assistance of HPC trained consultants is provided in the context of long term relationships based on mutual respect and trust and is provided in response to the expressed needs of the child care directors and staff.  Staff often request help with specific children and begin to apply what they learn in their work with these children to all the children in their care.  Over time, the child care staffs develop their professional abilities and find ways to provide an environment better suited the needs of each child in their care. 

Ms. Ashley takes her concerns about Justin to the child care director and the consultant assigned to her center.  "He's out of control and I don’t know what to do with him!" she declares.  "I do care about him, but I get so angry.  It's as if he doesn't care!”  Ms. Ashley describes his lack of impulse control.  "It’s as if he can't stop himself.  When he gets angry that's all there is—anger."  "Do you mean," said the consultant, "when he gets so angry he forgets he also has fond feelings for you and the other children?  Perhaps as you contain him, you could remind him of those caring feelings that go both ways, until he can find them again for himself."  As Ms. Ashley thinks about sending Justin to the time out corner, she realizes that when he was kept apart from her and the other children, he could not so readily recover his fond, caring feelings.

The consultant then asks Ms. Ashley why she thinks Justin was worse during her week-long vacation.  Could it be that he missed her?  Ms. Ashley realizes that she knew other children missed her, but it hadn't occurred to her that Justin missed her too.  After all, he doesn't seem to care.  "But he does care," the consultant says.  "If he didn't, he wouldn't have gotten worse when you were gone.  Also, if he didn't care, he wouldn't worry about being a bad boy who should be thrown out.  He just doesn't know how to show his caring.  Perhaps, he thought you didn't care because you disappeared on him."

When Ms. Ashley returns to the classroom after the meeting, the aide informs her that Justin spit at her.  Ms. Ashley finds herself wondering about the meaning behind this behavior and asks Justin if he wondered where she was.  Justin looks at her intently.  "Are you sick?" he asks.  “Why do you think I was sick?” Ms. Ashley asks.  “Because you said you were going to see the doctor.”  Ms. Ashley recalls that she had said she was going to meet with “Dr. Gray” [the consultant]. “Oh no, Justin, I’m fine.  Dr. Gray is a lady who talks with us about how to be helpful teachers.”  Ms. Ashley then wonders what Justin thought when she was away for a whole week.  “My grandpa got sick and died,” says Justin.  Ms. Ashley reassures Justin that she will not die and she promises to always let him know where she is going and when she is coming back.  Justin leans into her gently, for once quiet and calm.

Ms. Ashley is struck by Justin’s responsiveness to her and by his confusions.  She does not know about the timing and nature of the grandfather’s death and she wonders if Justin worries that his own father might die, too.  She discusses this with the director and consultant at their next meeting and everyone agrees that it would be helpful to meet with the parents.

For caregivers to respond effectively to children's developmental needs, they must have ongoing working relationships with parents. Caregivers must bridge the transition from home to the child care center and back again for the children. 

When Justin's parents don’t attend an the arranged meeting, the director and Ms. Ashley are angry—until the consultant helps them realize that Justin's parents are probably overwhelmed with guilt and worried that Justin might be asked to leave the center.  With this understanding, the director approaches the father in the hallway and reassures him that she knows they are fine parents and that Justin is not going to be kicked out. 

As a result, the parents show for the next scheduled meeting.  They express considerable concern, as Justin is having difficulty at home too.  Everyone agrees on the importance of working on Justin's behalf. They arrange for weekly phone calls between the parents and Ms. Ashley. 

It is not easy for caregivers to work together with parents for a number of reasons.  Both caregivers and parents are doing their very best, but are stressed by the many demands they are trying to meet and unable to live up to their own unrealistic expectations of what they should be doing for their children.  Both caregivers and parents feel guilty and worry they will be criticized.  At times, in their worry, they blame each other and unhelpful antagonisms arise.  These feelings can be overcome if mechanisms are set up for caregivers and parents to have regular communication and realize that they share a mutual concern for the children's development.

On a later morning, Justin arrives in a cranky mood.  He calls Alex a bad name and knocks over a chair.  Recognizing that some unspoken feeling must be compelling this behavior, Ms. Ashley says, "Justin, I think you need some time sitting with me."  She puts her arm around him and encourages him to talk about his morning.  What had he done at home?  Who brought him to the child care center?  What had he eaten for breakfast? 

"Daddy's at work," Justin says. 

"And I bet he's thinking about you here, wondering how you're doing," responds Ms. Ashley.  "Would you like to make him a picture and have me write a note on it?" 

Justin nods.  He draws a face with eyes and lots of squiggly hair.  The note he dictates says, "Daddy, I’m going to make you five Lego cars.  I love you. Justin.”  Justin then goes to work on the Lego while Ms. Ashley helps Brittany change the baby doll's clothes—gently, just like Brittany's mommy does with her.

Justin’s "sit with me times" with Ms. Ashley becomes a regular way for him to calm down.  The containment and understanding provided during these times gradually help him become more able to contain himself.  In one of the phone calls with Ms. Ashley, Justin's mother says, "Let me tell you what happened over the weekend.  Everything was going wrong and I was about to yell when Justin said, ‘Mom, I think we need some sit together time.’  He calmed me right down and we read a book together.  I couldn’t believe it!”

At the Hanna Perkins Center we’ve noted the progressive steps that lead to mastery in areas of self-care—“doing for,” “doing with,” “standing by to admire,” “independent mastery.”  These steps need to be adjusted to each child’s age, developmental level, and the nature of the task.  We find it helpful to think in terms of a “mastery equation:” “self-care = self-confidence = self-control.”

Justin was unable to figure out on his own the meaning behind his behavior.  At his relatively advanced age it would have been unhelpful if Ms. Ashley had simply told him what she thought was wrong.  He needed to be an active participant in the process.  The “sit with me times” let Ms. Ashley literally be “with” Justin, providing a containing moment when he could become more self-observant (identifying with her observations of him) and put words to his feelings.  As this ability developed, parents and caregiver alike could notice and be admiring of his accomplishment.  It is this kind of self-care mastery—in this instance gaining mastery over the ability to verbalize feelings—that paves the way for further learning and pleasure in accomplishment. 

Justin is now in the class for four-year-olds, working hard at learning to print his name.  He enjoys sharing building activities with Alex and recently helped Brittany organize toys on a shelf. 

A child who could have spiraled into a pattern of problems is now progressing with learning and productive work.  Meanwhile, Ms. Ashley is helping more Justins and Brittanys develop as independent, caring, and productive persons. 

The directors and staff at the child care centers participating in the NCCCA are most grateful for the assistance provided by the consultants.  One director commented with pride on the changes she has witnessed:  "The staff are thinking about and reflecting upon the things the children do and their responses to them.  Staff in other centers I've observed do not talk about the motives or the developmental levels of the children in their care." 

Ms. Ashley noted, "I think the children are attached to the caregivers and are aware of their attachment.  I think it’s because they DO know who should be here and who IS here for them."

Another caregiver commented, “Now that I feel more effective in my work, I am more able to communicate with parents in a confident manner.  It makes such a difference for the children when we have working relationships with the parents and can help the children maintain their relationships with the parents while they are in child care.”

In their years of work with early childhood educators and child caregivers, Hanna Perkins consultants have observed that one of the reasons that child care is so stressful for children is that the child care system has been patterned after that of nursery school, without sufficiently taking into account the fact that the hours of child care are three times as long as those of traditional nursery schools.  The result is that those needs of the children which are taken care of by parents in the nursery school model are not met in child care.  In order to better meet the needs of child care children, the child care system must change.  Researchers at the Hanna Perkins Center are convinced that the work of the consultants in the NCCCA will serve as a model that can be replicated and bring about this needed change.

In summary, our experience has been that care centers can become more responsive to the developmental needs of children if they focus on three important concepts:

•  A child’s first learning is about his or her body.  Mastery in areas of self-care provides the foundation for self-esteem and all future learning.  Such mastery is most reliably obtained when there are strong parallels between home and center in terms of how care is provided.

•  Behavior, which provides the pathway through which young children express emotions, must be recognized as a communication.  When children are helped to understand this, verbalization of affect, increased frustration tolerance, and improved behavior follows.

• Relationships that are consistent, reliable and emotionally responsive best prepare children to learn in the context of a teacher-pupil dyad.

When these concepts inform how the child care functions it follows that:

• Relationships are made with the parents of children being enrolled. 

•  Those parents are encouraged to take time to settle their children in. 

• After a child has settled-in, parents are encouraged to take time at drop-off and pick-up each day to communicate with staff in a way that includes and involves the children. 

•  Throughout the care day staff members take every opportunity, based on a child’s level of development, to use words, pictures, or items from home to think with each child about their parents and to help to maintain their mental images and feeling connections to Mom and Dad.

• Routines are kept as consistent as possible and preparation is carefully provided for changes and transitions.  Each transition to a new activity is talked about in advance.  When staff transition, the arrival of a caregiver is anticipated; there is a period of overlap for greeting and saying “good-bye” and for the children to hear the staff members share information about each of them, in turn,

•  Self-care is supported by doing everything possible to individualize care moments, especially those that involve activities that are in process of mastery – feeding, changing, dressing, sleeping, etc.  Infants, toddlers, and preschoolers are not latency age children.  They are not developmentally ready to be fed, changed, toileted, dressed, and put to sleep in groups.  They need as much individual attention during these times as possible and quality centers place a premium on finding ways to creatively accomplish this to the greatest degree possible.

•  Communication between home and center is carefully maintained so that the staff member returning a child to a parent at the end of a day can share information that has been passed on to her from all of the staff that have cared for that child throughout the day.

Over the past ten years, with the support of the TRW Foundation, HPC successfully replicated consultations based on the Cleveland model in California, Michigan, Alabama, and Arizona.  The next phase of the project involves continuing study of the consultation process so that curriculum materials can be developed so that training in this model can be more widely reproduced.

With ever increasing numbers of children spending more and more of their formative preschool years in situations of substitute care, it is essential that we do all we can to parallel that care with the care they receive in their relationships with their parents.  The National Child care Consultation Alliance (NCCCA) is a project designed to empower caregivers to provide high-quality care for all children and to effectively intervene with individual children with problems—to change the course of their lives at an early age before it is too late. 

HPC's investment seeks to end the cycle of violence, poverty and illiteracy that exists in our society today by producing children with self-esteem and healthy personalities.  These children will grow into adults knowing that they can and will make a difference in their life and the lives of others.

What Next?  Summary and Future Goals of NCCCA

• We have developed, implemented, and evaluated a consultation—based model of child care intervention/prevention that focuses on the area most neglected when considering educational preparedness—namely, mastery in areas of self-care, which provide the foundation for the social and emotional readiness that enables a young child to be “ready to learn.”
• We’ve partnered with business and industry to expand our intervention model into a heterogeneous geographic, racial, ethnic, and socio-economic mix of centers that establishes the wide-ranging applicability of our model. 
• We’ve successfully trained consultants and are ready to respond to the challenge of making our relationship-based training more widely available.
• Our success with implementation of practical strategies is well-documented through our observational, case study methods.  We are now poised to further harvest our data, expand our research with the addition of empirical measures, and disseminate our findings to colleagues, policymakers, and parents.
• To implement our dissemination strategy, we have explored the possibility of forging partnerships with scholars, researchers, and information sharing organizations (e.g., Zero to Three, Connect for Kids).

Our plan is to go forward with a three-pronged approach:

Training – Using the expansive data base of theoretical and clinical materials that we have generated through our consultation efforts over the past many years, we will develop, implement, and evaluate training materials, curricula, and programs that provide a solid foundation for understanding the importance of early self-care mastery as part of healthy child development.  Training programs are not only needed for those interested in developing consultation programs for child care but also for caregivers in the field and those in training, whether it be at the high school, community college, undergraduate, or graduate school level.  We will look to establish partnerships, not only throughout these various levels of education but outside of formal academia, as well. 

Dissemination – We will develop, implement, and evaluate effective strategies for sharing our findings with several audiences, including early childhood educators and care givers; researchers and professional colleagues in child development and mental health; representatives of foundations and public policy makers with an investment in improving the ability of our young children to reach elementary school “ready to learn;” and parents who have perhaps the most immediate stake in assuring that they can be confident of the quality of the substitute care they obtain for their preschool age children.  Again, we look to forge partnerships with organizations that already have in place pathways for communication through print or electronic media.

Research – As a result of the program supported by TRW and by blending with it established Cleveland area sites and five new local sites that we inaugurating this year, we now have a consortium of 16 child care sites wherein our consultation-based model of intervention/prevention is underway and ongoing.  These sites provide a solid base of centers where research on the impact of early childhood substitute care and the efficacy of our model can be studied.  More broadly, this heterogeneous array of centers that span a broad spectrum, representing virtually all types of facilities and demographic constellations can provide opportunities for study and evaluation for colleagues interested in joining us as research partners to consider a myriad of questions and issues related to early childhood development and care, including the factors that might support or interfere with readiness to learn.

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