Today's preschool incorporates more than ABC's

  • In 2017, 574 youths under 20 received services at Clinical & Support Options’ Federal Street clinic in Greenfield. In 2018, 698 children were referred. This year, that number has increased to 860 children. In this file photo, children’s toys are seen at Cutchins Programs for Children and Families in Northampton. Staff file photo/Andy Castillo

  • Children's toys. Staff file photo/Andy Castillo—

  • Children's toys. Staff file photo/Andy Castillo—

For the Recorder
Published: 10/26/2019 9:00:16 AM

As the opioid crisis drags on without an end in sight, the number of behavioral health referrals has dramatically increased for preschoolers. In 2017, 574 youths under 20 received services at Clinical & Support Options’ Federal Street clinic in Greenfield. In 2018, 698 children were referred.

This year, that number has increased to 860 children.

Young children are being exposed to tremendous hardships and adverse experiences that cause them to exhibit behaviors that the mental health experts call “trauma.” Families affected by the opioid crisis, or experience any form of abuse and neglect, domestic violence, homelessness, incarceration or extreme poverty, are realizing those experiences have big impacts on the youngest members of their families. Trauma is defined by the American Psychological Association is an emotional response to a terrible event. Traumatic experiences make children feel fearful, angry and isolated.

According to CADCA (Community Anti-Drug Coalitions of America), Adverse Childhood Experiences (ACEs) can have a tremendous impact on broader lifelong health and well-being outcomes such as lower educational attainment, delayed brain development, underdeveloped social and mental skills and increased risk of substance misuse later in life. Because they are so young, children have limited ways to tell adults what they need. Through their behaviors, children are expressing what they can’t verbalize. What their lives are like and how petrifying their experiences have been, according to Gladys Noll Alvarez, coordinator of the Trauma Informed Care Project in Des Moines, Iowa. Trauma Informed Care (TIC) is an organizational structure and treatment framework that involves understanding, recognizing and responding to the effects of all types of trauma. It is one of the leading topics for professional development in the early education and care community.

Over the years, Alvarez says she has trained in trauma from National Child Traumatic Network (NCTSN), Trauma Focused-Cognitive Therapy (TF-CBT) and Child Parent Psychotherapy (CPP) both are evidenced-based trauma interventions for children.

“Trauma informed care emphasizes physical, psychological and emotional safety for both consumers and providers and helps survivors rebuild a sense of control and empowerment,” Alvarez said. “It is an organizational culture change from asking the question — ‘what is wrong with you?’ — to asking, ‘What happened to you?’ It recognizes that traumatic things happen to everyone and those experiences can impact how we view the world, relationships, our brain development and our health.”

Trauma informed care training helps teachers establish strategies on how to engage parents in supporting their child’s social-emotional development.

Alvarez states that the training helps educators understand a child’s behavioral issues may be coping strategies to get basic needs met or may be symptoms of a stress/trauma or a trauma reaction to a trigger not intentional bad behavior. It will help them respond in a different manner and have more patience to help regulate the child instead of punishing them for the symptom.

Anat Weisenfreund, director of Community Action’s Head Start and Early Learning Programs, says, “Behaviors are communication. We see young children with very significant relational challenges due to the absence of a stable invested caregiver. There are some children that spend ten hours in our care, so we’re able to build a strong partnership with these families and provide a nurturing environment for their children.”

The Head Start and Early Learning programs have 165 staff members and serve over 600 children every year in the areas of Franklin, Hampshire and western Hampden County.

This year, they served 623 children. Of those, 198 were infants and toddlers (children from birth through three years old) and 425 were children three to five with early childhood mental health consultants on-staff.

In 2018-2019, Weisenfreund states 48 children (from birth to 3 years old) were referred to their mental health consultants. One hundred sixty-three 3 to 5-year-old’s were referred. A small number of those were then referred to additional community support services because the staff believed the families need to be engaged in ongoing mental health support services. Out of children up to 3 years old, 36 percent had a developed mental delay or disability. For the children 3 to 5 years old, 11 percent were diagnosed with the same.

Weisenfreund stressed the difficulty of finding people in the area trained to work with young children and families cope with some of these mental health issues.

“In Western Massachusetts, there a very few quality services available in the community. The few people who know how to do that work are usually in private practice. It’s very difficult to find people who are able and have the time to work for a Head Start program to provide consultation,” she said.

Over the last five years, Weisenfreund said Head Start has implemented the Brazelton Touch Points approach, an evidence-based trauma-informed approach to engaging families and helping staff with their professional development. Along with the Pyramid Model as a way to improve teaching practices, increase children’s social skills and build positive relationships. The model gives children the skills to manage an regulate their own emotions while helping adults set up an environment and relationship for success.

Elizabeth Daniels, a licensed Mental Health Counselor and trainer/coach of the Pyramid Model for social-emotional competence in children, feels that implementing trauma-informed care practices in early childhood allows for all staff and families to have an understanding of what trauma is.

Trauma “can affect behavioral factors as well as educational learning and growth. With that knowledge helping staff and families to recognize the signs and symptoms of trauma so that support can be quickly mobilized for the child/family,” she said.

Daniels continues, “Teachers are craving the skills to help the children in their care that have been traumatized. Often times when teachers try to meet children where they are at and help, they feel overwhelmed and at a loss on how to be effective with their approach. They’re working on building a positive relationship with the child/family to understand how not to re-traumatize the child.”

Sarah Patton, an early childhood mental health clinician/consultant and trainer, is the co-founder and chair to the Franklin and Hampshire County Early Childhood Mental Health Roundtable; a community coalition of service providers working with children and families. She became one of the state’s first-round master cadre pyramid trainers and serves as a Pyramid Model Learning Community Facilitator. Patton is frequently sought out to provide training on the teaching pyramid and positive behavior support strategies for teachers and families alike.

“It’s not just about education, it’s about healing and safety in order for children to learn. We need to be talking about resiliency and building resilient children so they can buffer and bounce back from adverse experiences that could end up being traumatic if we aren’t focusing on all the things that build resiliency in young children,” Patton said.

Kristal Cleaver, director of Community Education with Clinical & Support Options in Greenfield manages the STAR project (Stress Trauma and Resilience) training clinicians in evidence-safe trauma treatment practices so that children are getting good health and healing. She goes out in the community to talk with teachers, childcare providers and administrators about adversity in childhood and its effects on learning, behavior and relationships. Cleaver has provided training to nine schools in Franklin County, one of them being Community Action Head Start Preschool, and in total has trained more than 2,500 individuals across Western Massachusetts at more than 60 schools and community organizations.

Cleaver believes the work she is doing with early childhood educators is important because she is helping teachers consider what they are seeing in the classroom.

“You have to be a lifelong learner and really think about within a school system what are the policies and procedures, how are teachers being taken care of, how are teachers being supported in their work, how are schools building relationships with parents and how do you create classrooms that when a child starts to act out they can help that child stay in the classroom and learn with as little disruption as possible,” Cleaver said.

Cleaver says she makes sure that every teacher, administrator and paraprofessional knows about the ACE’s study and the concept of vicarious trauma and burnout. She asks them to try and build a safe and trusting relationship with children in order for them to heal from their trauma. By having adults in their lives, they can turn to when things are stressful. One of the goals in her training is to reduce the stigma around the idea of stress and trauma.

Cleaver points out, “Adversity in childhood is common, so it’s not something that people need to feel ashamed of or stigmatized by. Life is stressful and children feel that. It doesn’t mean things are getting worse for children, it could very well mean that people are feeling safer reaching out.”

What may look like bad behavior might actually be the child has not had the ability or the privilege to have the kind of typical development that a child who was living in a community or in a home where there wasn’t stress and trauma happening. Children with stress and trauma in their lives don’t get the opportunity to practice problem-solving or developing safe and trusting relationships. Helping a child find someone they can connect with when they’re struggling is key.

Miasha Lee is a resident of Hatfield. She loves writing about music, health, culture and everyday people in the community. Contact her at


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