Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, July 17, 2012

Attachment and Day Care, Part 1


A few days ago I had an e-mail from a young mother who is concerned about her toddler and his behavior at day care. She commented correctly I think, that many parents have concerns similar to hers but don’t know how to find answers to their questions. I told her I would answer her by means of blog posts--  and there are so many issues to be considered that I think this will require several posts.

I should point out, by the way that I have never met this lady whom I will call Elisa B., or her child. I am not a clinical psychologist, but a developmentalist, in any case, so I can’t offer clinical suggestions--  but even if I were trained in that way, it would be against professional ethics for me to comment on individuals I have never worked with. Elisa also kindly offered to pay me for my time, but it would be inappropriate for me to accept payment.

I’ll summarize some elements of Elisa’s story. Her little boy, whom we can call Billy because as far as I know that isn’t his name, is two years and three months old. He has been attending a day care center since he was 13 months old. Billy was very attached to one teacher, but several weeks ago his group of children was moved to a different level. His favorite friend is now in a different group, and he rarely sees the favorite teacher. He cries when his mother leaves and when he sees the favorite teacher in the hall. The new teachers say he is adjusting, but Elisa says he gets quiet when she asks about the new people.

Elisa says Billy has always been shy around other people, even if his parents are there, and she describes him as always having cried a lot. She also says of herself that she is inclined to be anxious and depressed and that she decided on day care for Billy because she was worried that being at home with a depressed mother was not good for him. (Incidentally, I would like to point out how important it is that Elisa is considering her own possible contribution to the situation—this is a difficult step for most people to take.)

Elisa wants to know what the day care center might do to help and how she can communicate with the staff without making them get defensive. She also asked whether it would be good to have Billy’s attachment status evaluated and whether some intervention might be possible.

Like most real-life situations, this is a complicated one. Some factors at work are the day care center’s practices, Billy’s temperament and why he cries when he sees his favorite teacher, Elisa’s own personality, and the advisability of evaluation and treatment. I know there is a lot to say about each of these, so I’m going to give each topic a post of its own, starting with day care practices today.

High-quality child care centers comply with the standards for voluntary accreditation set by the National Association for the Education of Young Children and administered by its state affiliates. Important among the NAEYC standards are staff to child ratio and group size. NAEYC recommends that for children in Billy’s toddler age group the ratio of adult caregivers to children should be no higher than one adult to six children, and that the whole group of children together in a room should be no more than 12. NAEYC also recommends “assigned caregivers”--  adults whose responsibilities are for particular children and who do not “float” or look after children no one else is dealing with, unless there is a real emergency. These rules are aimed at providing a comfortable, familiar social setting in which each caregiver can genuinely learn to know each child, and each child will feel at home with his or her caregivers. Because children are often at a center for periods that overlap two caregiver shifts, the rules emphasize assuring that all the caregivers are familiar to the children they will meet--  even when there is a “substitute” (which there often must be, because people who work with young children catch colds often).  Without specifically addressing attachment issues, these rules attempt to create a supportive, responsive social environment for young children and to help them respond with resilience to any disturbing events. Standards for NAEYC accreditation also include center rules that allow parents to drop in at any time and that name support of the family as a center goal.

About 20 years ago, incidentally, there was a serious proposal in early childhood circles that young children not be moved from one room and teacher to another, as Billy was moved. The idea was that a caregiver would begin with a group of young children and continue with them from infancy right up to kindergarten entry. This excellent proposal, which would have allowed teachers and children to know each other very well, never developed any traction, in part because it was rejected by many teachers. When I asked day care staff and preschool teachers about it at the time, almost every one declared that she was a “two-year-old teacher” (or three-  , or four--) and that she wanted to go on doing the things she did to teach children in that age group; the group was more important to the caregiver than the individuals within it, in many cases. For whatever reason, the proposal was never widely accepted and is not part of accreditation standards--  but how much difficulty for children could be prevented if it were!

If Billy’s day care center is NAEYC accredited, Elisa’s problem about consulting with the staff is much simplified. The accreditation standards require that this be done (although not necessarily without a planned appointment), and specifically require compliance with standards that help give children a familiar social group. But accreditation is not the same as licensure, and state-licensed, unaccredited day care centers may stay within the law without meeting the high standards mentioned earlier. Those centers may be much less available for consultation than Elisa would like, and especially if they are for-profit franchises of national companies, they may be under great pressure to maintain the “bottom line” by reducing the staff expenses that are the major cost of running a day care center. For-profit centers may turn a higher profit by hiring staff part-time or even by failing to provide a substitute for a sick caregiver, thus reducing for all practical purposes the staff to child ratio they advertise. Under those circumstances, Elisa’s concerns would not be likely to be heard.

What if  Billy’s center will not cooperate, or if Elisa goes on feeling that she cannot make herself heard without making staff members angry? With a sensitive child like Billy, of course, one dreads the idea of changing to a new care setting. However, if the present situation is too difficult, it may be best to make a change to a place that will help him feel secure over the next several years. I would suggest that Elisa and her husband look into family day care rather than center-based care. The small group and consistent caregiving of this form of care can be much more comforting for some children than the experience of a large day care center. A family day care program is ideally part of a day care network that offers support and education to care providers and often helps them with business insurance and benefits like health care. Parents who perceive nonparental care as “school” may turn up their noses at family day care, but for a young and anxious child like Billy, it’s probable that much more learning will go on when he feels comfortable than can possibly happen in a highly academic but emotionally uncomfortable day care center.

   

4 comments:

  1. I agree that a family daycare can be superior to a commercial "preschool". My twins (2.5yrs) go to school at an in home daycare. Not only are they receiving great intellectual guidance, but also a smaller class size, and very consistent environment. Also important, it is MUCH less expensive that the national chains. Their teacher is a licensed preschool teacher. I looked very hard to find her(shout out to Craigslist), but I have no doubt that it is a gem of a school!

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  2. Family day care arrangements can be wonderful, but everyone should remember that they usually have only one caregiver present. This means that if there's an emergency, there's no one to give back-up. Also, some family day care providers are unaware that their homeowner's insurance will not cover any problems that arise in the course of doing business in their home. like most things in life, choosing a day care arrangement is a matter of trade-offs.

    Nora, I wonder why you say the twins "go to school" there. People have very different ideas of whether care outside the home is school,or what. Some are comfortable with the idea that the caregiver "watches" the child-- others want some educational efforts that resemble kindergarten, which nowadays resembles first grade. Another reason why it can be hard to find what you want--

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  3. She structures it more like a school day with set times each day for certain activities. Also, she calls it school. Additionally, she engages the children in more kindergarten prep activities than the average "daycare". In fact the older kids there(5 yrs) are kindergarten ready and my kids often join in on the reading and writing excersizes (to the best of their abilites of course).
    One of the most important factors for me choosing a care provider was that I dont want my kids watching tv. This does require more work for their teacher/caregiver.
    It is true that I have had to take sick time from work becuase their teacher is sick, so that is indeed a trade off. Luckily for me, she does not get sick often

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  4. An impressive post, I just gave this to a colleague who is doing a little analysis on Childcare Seven Hills and he is very happy and thanking me for finding it. But all thanks to you for writing in such simple words. Big thumb up for this blog post

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