HANDLE WITH CARE:
STRATEGIES FOR PROMOTING THE MENTAL
HEALTH OF YOUNG CHILDREN
Nancy J. Cohen
Hincks-Dellcrest Centre & University of Toronto
Supporting Children’s Social and Emotional Health:
Assessment Tools, Research and Practice
University of British Columbia
Vancouver, May 11, 2006
COLLABORATORS:
Bonnie Pape
&
Heidi Kiefer
WHAT IS MENTAL HEALTH
PROMOTION?
 activities that seek to enhance mental health and
take into account the broad psychosocial factors
that affect mental health
 for young children, activities to develop age-
appropriate and culturally relevant life skills
 in centre-based care, mental health promotion is
associated with good practices that foster
children’s social and emotional development,
build family and community connections, and
create a positive working climate for those in the
child care field
WHY PROMOTING MENTAL HEALTH IN
EARLY CHILDHOOD PROGRAMS IS
IMPORTANT
 more children are entering the childcare
system at younger ages and many are
exposed to stresses
 early disruptions in emotional development
can have long-term negative consequences
on social and emotional functioning and
learning
 social and emotional development are
important to ensure that when children
enter school they are ready to learn
Day Care Centre Acknowledgements
British Columbia
Cariboo Child Care Centre, Kamloops
College of New Caledonia Demonstration Day Care Centre, Prince George
Grandview Terrace Child Care Centre, Vancouver
Langara Child Development Centre, Vancouver
Plum Blossom, Vancouver
Simon Fraser University Child Care Society, Burnaby
University of British Columbia Child Care Services, Vancouver
West Wood Players Ltd., Port Coquitlam
Alberta
Churchill Park Child Development Centre, Calgary
City West Day Care, Edmonton
Edmonton Northwest Child Care Centre, Edmonton
Fulton Child Care Association, Edmonton
Jasper Place Child and Family Resource Society, Edmonton
Louise Dean Child Care Centre, Northwest Calgary
Marlborough Day Nursery, Calgary
Primrose Place Family Centre, Edmonton
Red Deer Day Care, Red Deer
Southview Child Care, Edmonton
Saskatchewan
Children’s Choice Child Development Centre, Prince Albert
Families First Child Care Centre, Saskatoon
Kidzone Child Care, Regina
MacKenzie Infant Centre, Regina
Meadow Lake and Area Play Corner Centre, Meadow Lake
SIAST Children’s Day Care Centre, Regina
Southwest Day Care Centre, Southwest Moosejaw
Wascana Day Care, Regina
YWCA Child Development Centre, Saskatoon
Manitoba
Care-A-Lot Nursery Inc., Winnipeg
Discovery Children’s Centre Inc., Winnipeg
Knox Day Nursery, Winnipeg
Morrow Avenue Child Care Program for Families, Vital
Sunnyside Child Care, Winnipeg
Univillage Student Day Care, Winnipeg
Yukon
Ashea Day Care, Whitehorse
Child Development Centre, Whitehorse
Creative Play Day Care, Whitehorse
Dluwkat Hit Day Care, Teslin
Ontario
Cardinal Leger Child Care Centre, Scarborough
Guildwood Child Care Centre, Scarborough
N’Sheemaehn Child Care, Scarborough
Owen Community Child Care Centre, North York
St. Bede Child Care Centre, Scarborough
Sunnybrook Creche, Toronto
Quebec
Centre de la Petites Enfants Les Bois Verts, Montreal
CPE Dorval, Dorval
CPE St. Mary’s, Montreal
McGill Community Child Care Centre, Montreal
Royal Victoria Hospital Child Care Centre, Montreal
Saint Andrews Early Childhood Centre, Westmount
West End Day Care, Montreal
New Brunswick
Chatham Day Care, Miramichi
Energi Centre, Val D’amour
Garderie ABC Day Care, Moncton
Kindertots Children’s Centre, Miramichi
Saint John YMCA Child Care Centre, Saint John
Nova Scotia
Apple Tree Landing Children’s Centre, Canning
Bell Road Child Care Centre, Halifax
Boys and Girls Club Child Care Centre, Yarmouth
Children’s Place Day Care, Antigonish
Cobequid Children’s Centre, Lower Sackville
Creative Approach Preschool, Halifax
East Preston Day Care Centre, East Preston
Playschool Day Care, New Waterford
Point Pleasant Child Care Centre, Halifax
Sydney Day Care Centre, Sydney Cape Breton
Town Day Care, Glace Bay
Wee Care Developmental Centre, Halifax
Newfoundland
College of the North Atlantic Children’s Centre, St. John’s
Creative Beginnings Child Care Centre, St. John’s
Daybreak Parent Child Centre, St. John’s
Fisher’s Children’s Centre, Cornerbrook
The Children’s Centre, St. John’s
Prince Edward Island
Campus Kids Child Care Centre, Charlottetown
BRITISH COLUMBIA
Day Care Centres
Cariboo Child Care Centre, Kamloops
College of New Caledonia Demonstration Day Care
Centre, Prince George
Grandview Terrace Child Care Centre, Vancouver
Langara Child Development Centre, Vancouver
Plum Blossom, Vancouver
Simon Fraser University Child Care Society, Burnaby
University of British Columbia Child Care Services,
Vancouver
West Wood Players Ltd., Port Coquitlam
AREAS EXPLORED IN INTERVIEWS WITH
PRACTITIONERS AND DIRECTORS (1)
 building trusting relationships between






practitioners and children
supporting individual characteristics and selfesteem
fostering independence and problem solving skills
encouraging understanding and expression of
emotions
respecting diversity and the rights of others
helping children build positive peer relationships
helping children deal with changes and transitions
AREAS EXPLORED IN INTERVIEWS WITH
PRACTITIONERS AND DIRECTORS (2)
 centres’ policies and arrangements of the
physical setting underpinning mental health
promotion
 ways that practitioners:
 interact with parents
 support and respect a child’s home
language and culture
 receive support themselves in the work
environment
Handle
with Care
Strategies for Promoting the
Mental Health of Young Children
in Community-Based Child Care
WHY FOCUS ON ATTACHMENT
SECURITY?
When children are securely attached
they can feel free to explore the
world, show curiosity and benefit
from learning experiences.
ATTACHMENT
Attachment is a biologically primed
behavioral system which operates
under threatening conditions and
enables infants to seek safety and
comfort from distress through
proximity to their mothers.
BEHAVIOURS THAT HELP CHILDREN
ATTAIN SECURITY
Infants
 crying
 clinging/grasping
 responding to comfort
 smiling
 reaching out
 sharing affect
Toddlers and Preschoolers
 crying/tantrums
 following (crawling,
walking)
 using language
 affective sharing
 smiling
 initiating interaction
 exploring from a secure
base
CAREGIVER BEHAVIOURS THAT
FACILITATE SECURE ATTACHMENT
 rapidly responding to a child who is frightened, ill,
or otherwise distressed by physically comforting
and talking
 building trust in their availability and consistency
 providing predictable routines, responses, and
traditions
 creating a safe environment for children to explore,
and gradually become more autonomous
 taking an active interest in the children and
offering them encouragement that is supportive
and reciprocal rather than directive
 showing positive feelings to children
ESSENTIALS OF ATTACHMENT
 Attachment relationships provide the foundation for






social and emotional development
A secure relationship involves children feeling that
they are safe and important
Children typically have the strongest attachments to
their parents
However, children also form attachments to other
important people in their lives
For practitioners, building trust with children usually
involves building trust with their families
It takes time for children to develop a secure
attachment
Attachments are informed by cultural, family and
individual beliefs and preferences
“I give the children time to become
comfortable with me. I won’t push
myself on them. The first time at the
center I don’t hug and snuggle
children right away. It’s not appropriate
because I am a stranger to them. The
second time I put a toy between myself
and the child as a way of getting
closer, but not too close. Maybe the
third time, I will share some physical
affection with the child.”
STAGES OF ATTACHMENT
 Preattachment
 Attachment in the making
 Clear-cut attachment
 Goal-corrected partnership
SECURE ATTACHMENT PROVIDES A
FOUNDATION FOR CHILDREN TO:
 regulate their emotions and behaviour
 have a sense of inner confidence and
efficacy
 express curiosity and eagerness to explore
 enjoy more pleasure and harmony in
relationships
 show greater competence in cognitive and
language development
CHILDREN WITH SPECIAL NEEDS
Children with special needs
develop attachment relationships,
but for some this happens later.
Attachment signals may be subtle
so it is important to be a good
observer.
INDIVIDUAL DIFFERENCES IN
ATTACHMENT
 Secure
 Avoidant
 Resistant or ambivalent
 Disorganized
Insecurely attached and disorganized children
often behave in ways that make them more
difficult to care for, which further exacerbates
their insecurity.
Insecure and disorganized
behaviours occur some of the
time in most children. It is when
the behaviour becomes a
repetitive and persistent pattern
that it is of concern.
RESULTS OF STUDIES OF ATTACHMENT
OF CHILDREN IN CHILDCARE
 Childcare alone does not have a negative impact
on attachment security with mothers at any age.
 There is not a simple or direct relationship
between childcare attendance and children’s
attachment security.
 When children’s relationships with their mothers
are not secure, coupled with enrolment in low
quality care for extensive periods or in unstable
childcare arrangements, children’s mental health
suffers.
 Attachment relationships of children to a
professional caregiver can be
independent of the children’s attachment
to parents.
 Characteristics of practitioners in
relationships with children that promote
mental health are the same as those of
parents.
 Structural features of child care and
education and training of practitioners
also contribute to attachment security.
Sometimes we are led to believe that if
secure attachment relationships are
established early that is enough to
inoculate children against stress.
However, benefits actually come about
from persistence of secure attachment
and sensitive parent and practitioner
care rather than secure attachment
specific to the first year.
COMPENSATORY EFFECTS OF
CHILDCARE ON MENTAL HEALTH (1)
 Depressed mothers who rely on childcare have
more positive interactions with their infants than
do depressed mothers who do not.
 When maternal sensitive responsiveness and
affection are low but child care quality if high,
children are more likely to be securely attached
than when quality of care is low both at home and
in child care
 Children who had an insecure relationship with
their mother, and who attended childcare early,
are less withdrawn than were insecure children
who remained at home.
COMPENSATORY EFFECTS OF
CHILDCARE ON MENTAL HEALTH (2)
 Childcare quality had a positive effect on
externalizing behaviours for children from less
advantaged homes as well as a positive effects on
boys’ internalizing problems and sense of
effectiveness.
 Children in enriched programs have fewer
behaviour problems than comparison groups who
do not have an enriched experience.
 High quality childcare can serve a compensatory
function for children who are temperamentally
difficult in infancy.
WHAT GETS IN THE WAY





unfortunately, not all centres meet standards for
high quality
rate of child care practitioner turnover is high
which has an impact on children’s security
many individuals working in childcare settings
have minimal training
practitioners must feel secure in order to help
children feel the same
practitioner-parent relationships are important
but training often does not include how to work
with families
SUGGESTIONS FOR HOW TO INVOLVE
PARENTS (1)
“We do home visits, ideally before the start of
care. Two teachers visit in the evening or on
the weekend and stay for an hour. They leave
the child with a book/CD from the centre. It
creates a different relationship with the child
and parents because they are more at ease. We
also give parents a questionnaire to fill out
about the home visits to get feedback.”
SUGGESTIONS FOR HOW TO INVOLVE
PARENTS (2)
“We have pamphlets available for parents to
know what kinds of things they might expect to
see in their child when starting at the centre. I
always acknowledge parents’ feeling about
separation from their child and provide
materials and support for the child to show
feelings through play. I keep a record of the
child’s behaviours so I can talk about them
with my supervisor and the parents.”
WHEN TO WORRY: Assessment Tool
 The best tool that you have at your
disposal is careful observation of children
and mothers with their children.
 Discussion with a parent or co-worker or
consultant about your observations.
 Parents also should be encouraged to
make observations of their children.
WHEN TO WORRY: What to look for (1)
 Do you see the child “checking” with the
parent or practitioner visually or verbally, or
physically, while playing”?
 Does the child show a reasonable mix of
exploring and checking back?
 What does the parent do to stay in touch
with the exploring child?
 What is the child’s/preschooler’s activity
level?
WHEN TO WORRY: What to look for (2)
 What evidence do you see that supports the idea
that children are intensely interested in learning
about their immediate world?
 What examples do you see where the children take
the initiative?
 How do the toddler/preschooler and parent react
when the child’s assertion of will runs contrary to
the parent’s wishes or intentions?
 How do the parent and toddler/preschooler
negotiate conflicts over safety?
INTERVIEW WITH PARENT
 How is your child different at age 1, or 2 (or 3 or
4 ) compared with a year ago?
 How has your relationship changed during the
past year (months)?
 What do you recall about your child during the
3-4 months immediately after learning to walk?
To talk? Has this changed your relationship?
 Do you find it easier or harder (or perhaps some
of each) to parent a toddler compared to an
infant?
WHAT TO LOOK FOR: POSITIVES
 pleasure
 empathy, support
 accurate interpretations of the child’s
behaviour or signals
 respect of child’s moods
 can parent see things from their
child’s perspective?
WHAT TO LOOK FOR: NEGATIVES (1)
 intrusive, directive, or rough with child
 lack of empathy and support
 distortions in interpretations of the child’s
behaviour
 consistently nonresponsive
 minimizes or distorts the child’s feelings or
mood
 gives contradictory messages to child
 asks child for reassurance or attention
 sexualized behaviours in tone of voice or
actions
WHAT TO LOOK FOR: NEGATIVE (2)
 disorientation; using unusual voices that
suggest fear and tension
 spacing out
 pulling child or otherwise invading the
child’s personal space
 mocking the child or hushing a crying child
 using an angry voice or being critical
 teasing the child or removing or withholding
a toy withdrawal
QUESTIONS FOR REFLECTION AND
DISCUSSION
 What did you see happening?
 What do you imagine it feels like for
the child? For the adult?
 What did you see that makes you
think this?
QUESTIONS FOR REFLECTION AND
DISCUSSION

If you were the child what might you
want adults to do?
 What strong feelings did it stir in
you?
 How do you manage these feelings?
 Does it help to discuss these
feelings with someone else?
SUGGESTIONS FOR HOW TO INVOLVE
PARENTS
“When parents use harsh discipline methods such as
yelling at home, it makes children more stressed
when they know they’ve done something wrong at the
centre. For example, one child dropped some paint
and started crying immediately, expecting to be yelled
at. I’m meeting with the parents over time and
handling it carefully.”
“I work with parents and deal with their anxieties and
concerns about what goes on in the classroom. It has
an effect on the children and reflects in their
behaviour (e.g., more assertive, better able to express
their needs).”
Note
It is important to remember that
these patterns need to be seen
frequently and not just occasionally.
Mothers need not be perfect but
good enough.
RESOURCES THAT CAN BE USED
TO FURTHER FOSTER ATTACHMENT
SECURITY?
 A Simple Gift – Infant Mental Health
Promotion Project
 Canadian Child Care Federation tip
sheets
 Zero-toThree resources
 Watch, Wait, and Wonder play – follow
the child’s lead