By Deborah F. Perry, PhD (Associate Professor, Georgetown University Center for Child and Human Development)
When Dr. Walter Gilliam published his landmark study documenting that preschool children were getting expelled at 3 times the rate of kids in K-12 settings, a small but important finding was included. Rates of preschool expulsion were consistently lower when teachers had on-site access to a mental health professional for consultation. Since then, many studies have replicated this finding: having a mental health consultant working with preschool teachers lowers the risk for expulsion for young children with challenging behavior.
The 2005 preschool expulsion study made headlines across the country. It showed troubling data about racial and gender inequities in expulsion rates:
- Boys were almost 5 times as likely as girls to be expelled;
- African Americans were expelled at twice the rates of Whites.
A 2014 report from the U.S. Department of Education, Office of Civil Rights confirmed this disparity persists:
- 48% of the preschoolers who received more than one out of school suspension were Black, even though African Americans make up only 18% of the preschool population.
- Likewise, nearly 80% of the children suspended more than once were boys.
While neither study elucidated the underlying reasons for these disparities, preschool teachers clearly need better options for dealing with the wide range of mental health issues that young kids have.
Unfortunately, the risk factors for behavior problems are prevalent: nearly one-third of all young children are affected by at least one sociodemographic stressor (e.g., low income, low maternal education) that increases risk of adverse social, emotional, and cognitive outcomes.
Two types of problem behavior are common: (a) externalizing and (b) internalizing. Externalizing behaviors include hyperactivity, impulsivity, aggression, and anger. Children who exhibit internalizing behaviors are often withdrawn, anxious, or sad. The vast majority of the kids expelled from preschool are externalizers; and very young children with mental health problems can be missed by the special education system.
But there is reason to be hopeful: a decade of increasingly rigorous studies of early childhood mental health consultation (ECMHC) show that it can reduce the risk for expulsion. It does this by building teachers’ capacity to understand and address challenging behavior in young kids.
This approach teams a mental health professional with an early childhood provider in an ongoing problem-solving and capacity-building relationship. Mental health consultants help early childhood professionals to manage problem behavior and enhance the social skills of the children in their programs. They integrate evidence-based strategies into teachers’ ongoing practice through modeling, coaching and support. These approaches can focus on the needs of an individual child who is presenting with a specific problem behavior, and can also target the social climate for all the children in a classroom.
For example, Amika is a 4 year-old placed in foster care due to extreme neglect. She is in child care up to 10 hours a day while her foster parents work. While at care, Amika cries inconsolably and has trouble relating with other children in her class. Recently, Amika has been lashing out at children who are playing nearby. Other parents are complaining and the director is threatening expulsion. The foster parent reports that if she misses work to care for Amika she will lose her job. The mental health consultant carefully observes, listens to each person’s perspective and they discuss together what it must be like for Amika, given all she has been through.
Then the consultant develops a plan to address some of Amika’s problematic behavior. She coaches the teacher on strategies to help Amika join activities throughout the day with the other kids in her class. The consultant suggests adding a quiet corner to the classroom where Amika can go and cuddle with soft toys and pillows when she is feeling overwhelmed. And the consultant suggests that the foster family bring in photos of the family doing fun things together to put up in Amika’s cubby for her to look at when she is feeling sad. Many of these strategies help other kids in Amika’s class and create a warmer classroom climate.
These services address a broad range of issues that contribute to expulsions and the gender and racial disparities noted above. Because of their background and training, a mental health professional can enable teachers to reflect on their understandings and perceptions of children’s behavior. Reflection is an important mechanism for teachers to unearth biases that may underlie disproportionate expulsion rates for boys and children of color. When we gain insights into teachers’ preconceived notions of what may be developmentally appropriate for boys versus girls as well as sources of bias, we gain a powerful tool to reduce expulsions.
Research supports the effectiveness of early childhood mental health consultation. Studies show that ECMHC helps increase staff self-efficacy/competence and confidence in dealing with troubling or difficult behaviors of young children in their care. In turn, ECMHC services are consistently associated with reductions in teacher-reported externalizing behaviors (such as hitting, kicking and biting). In encouraging news, a recent review of the results from seven statewide ECMHC evaluations, expulsions were prevented in children at highest risk.
Early childhood mental health consultation is being implemented in more than half of the states and in many communities in the U. S., but far too many children are still at risk of expulsion because their teachers do not have access to this effective intervention. As states begin to use the federal grants announced at the White House summit earlier this month, ECMHC should be one of the strategies funded to reduce preschool expulsions. Pre-K expansion grants, the Head Start-Child Care Partnership grants and the recent reauthorization of the Child Care Development Fund all provide opportunities to expand access to ECMHC for at risk children in preschool.
No child should be expelled from their preschool program—and we now know how to help teachers understand that children who are sad and mad are not just bad.
 National Center for Children in Poverty (2009). Low-income children in the United States. National and state trend data, 1998–2008. New York, NY: Columbia University. Retrieved from http://www.nccp.org/publications/pdf/text_907.pdf
 Perry, D. F., Holland, C., Darling-Kuria, N., & Nadiv, S. (2011). Challenging behavior and expulsion from child care: the role of mental health consultation. Zero to Three, November, p. 4-11. Retrieved from: http://main.zerotothree.org/site/DocServer/32-2_Perry.pdf?docID=12901
 Cohen, E., & Kaufmann, R. (2005). Early childhood mental health consultation. Washington, DC: Substance Abuse and Mental Health Services Administration. Retrieved from: http://store.samhsa.gov/shin/content/SVP05-0151/SVP05-0151.pdf
 Brennan, E. M., Bradley, J. R., Allen, M. D., & Perry, D. F. (2008). The evidence base for mental health consultation in early childhood settings: Research synthesis addressing staff and program outcomes. Early Education and Development, 19, 982-1022.
Perry, D. F., Allen, M. D., Brennan, E., Bradley, J. (2010). Establishing the evidence base for early childhood mental health consultation: A research synthesis of child outcomes. Early Education and Development, 21, 795-824.
 Hepburn, Perry, Shivers, & Gilliam (2013). Early childhood mental health consultation as an evidence-based practice: Where does it stand? Zero to Three, May, p. 10-19.
 Duran, F., et al. (2009). What works? A study of effective early childhood mental health consultation programs. Washington, DC: Georgetown University Center for Child and Human Development. Retrieved from: http://gucchdtacenter.georgetown.edu/publications/ECMHCStudy_Report.pdf
Deborah F. Perry, PhD is an associate professor at the Georgetown University Center for Child and Human Development. Over the last two decades, she has served as an external evaluator for a broad array of state and federally funded initiatives and conducted many community-based research projects. She has served as the lead evaluator on several early childhood mental health consultation projects and as the Project Director for the national Center for Early Childhood Mental Health Consultation, funded by the Office of Head Start. Dr. Perry has published extensively—with more than 40 peer-reviewed articles and dozens of translational research to practice briefs—and currently serves as an Associate Editor for the Infant Mental Health Journal. She has a PhD in maternal and child health from the Johns Hopkins School of Public Health and a master’s degree in psychology.
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