Alhassanain(p) Network for Heritage and Islamic Thought

Volume 12 Number 1

©The Author(s) 2010

Perspectives of Play in Three Nations: A Comparative Study in Japan, the United States, and Sweden

Satomi Izumi-Taylor

University of Memphis

Ingrid Pramling Samuelsson

Göteborg University

Cosby Steele Rogers

Virginia Polytechnic Institute and State University

Abstract

This reflective paper discusses findings about differences and similarities in perspectives on play among early childhood educators in Japan, the United States, and Sweden. Analysis of survey data collected from educators in those nations yielded six themes regarding the meanings and uses of play: (1) process of learning, (2) source of possibilities, (3) empowerment, (4) creativity, (5) child’s work, and (6) fun activities. Processes of learning, fun activities, and creativity were the universal themes of play that emerged during analysis. Japanese and Swedish teachers related play to the theme source of possibilities, but American teachers did not. The theme play as child’s work was represented in the American and Swedish teachers’ notions of play but not in those of the Japanese teachers. The theme of play as empowerment differentiated Japanese teachers from the others. Japanese and Swedish teachers reported offering unstructured play to children, while their American counterparts did not. Two themes emerged in the participants’ responses regarding adult play: “state of heart” (state of mind) and positive feelings. Although American and Japanese teachers associated playfulness with a “state of the heart/mind,” their Swedish counterparts did not indicate such associations. Teachers from all three nations did, however, agree that playfulness involves and promotes positive feelings.

Introduction

Research regarding play is complex, and culture is a key factor in determining how people in different nations view play. People with different cultural backgrounds tend to pay attention to different characteristics of the same phenomena (Azuma, 1986); because teachers’ perspectives on play are influenced by their own cultures, these perspectives vary widely. Teachers’ perceptions of play affect children’s experiences in their classrooms. Thus, we felt, as scholars doing research in Japan, Sweden, and the United States, that comparing teachers’ perceptions of play in those countries could provide insights that might expand the discourse about play in those countries and internationally. We also felt that our findings could prove useful to those who wish to design effective early childhood education programs.

We anticipate that our research on perspectives on play expressed by American, Japanese, and Swedish early childhood educators can provide a basis for reflection and understanding among the educators in these nations who, in spite of cultural differences, all recognize play as essential in children’s development and learning (Izumi-Taylor, Rogers, & Pramling Samuelsson, 2007).

Multiple Contexts of Our Research

Official Perspectives on Play in Japan, the United States, and Sweden

The importance of play in Japanese early childhood education can be seen in the National Curriculum Standards for Kindergarten (NCSK) set forth by the Japanese government (Ministry of Education, Culture, Sports, Science, and Technology, 2000), which state the following goal:

To comprehensively achieve the aims outlined in Chapter 2, through the instruction centered around play, based on the consideration that play as voluntary activity of children is an important aspect of learning which cultivates foundation of a balanced mind and body development. (p. i)

The NCSK also describe how play provides children with the “foundation for a zest for living” (Ministry of Education, Culture, Sports, Science, and Technology, 2000, p. ii), and through the use of play, the NCSK list the following developmental skills to be nurtured in children - physical, emotional, social, and language. Because the Japanese view consideration of others to be important in their lives (Markus & Kitayama, 1991), one focus of Japanese early childhood education programs is on providing group-oriented environments where children learn to play harmoniously with others (Izumi-Taylor, 2008; Izumi Taylor, 2004). Japanese early childhood education is based on the idea that children construct their own knowledge through play by interacting with their environments, and that these environments are part of group-oriented and caring communities (Izumi-Taylor, 2008; Muto, 2004; Izumi Taylor, 2004).

Although no federal guidelines that correspond to the NCSK exist for early childhood education programs in the United Sates, play is considered by many in the field to be the best mode for children’s learning and development (Kieff & Casbergue, 2000; Rogers & Izumi Taylor, 1999). The National Association for the Education of Young Children (NAEYC), in its third revision of the book on developmentally appropriate practice (DAP) (Copple & Bredekamp, 2009), notes that “Play is an important vehicle for developing self-regulation as well as for promoting language, cognition, and social competence” (p. 14). The main tenets of DAP describe how children learn best through play. However, in recent years, the pressure to meet standards of learning for knowledge and skills has led many teachers and administrators to strive to enhance children's performance on tests that demonstrate accountability (Astuto, 2007; Nourot, 2005; Van Hoorn, Nourt, Scales, & Alward, 2007). To meet high standards for knowledge and skills, the curriculum may be focused only on content rather than on the developmental learning needs of children. One result is often the elimination of play, recess, field trips, or physical education in favor of more “academic” activities.

According to the Swedish National Curriculum for Preschool (Ministry of Education and Sciences, 2006), play is a central concept in the Swedish curriculum that aims to nurture children as persons and learners. The current national curriculum states:

Play is important for the child’s development and learning. Conscious use of play to promote the development and learning of each individual child should be an omnipresent activity in the preschool. Play and enjoyment in learning in all its various forms stimulates the imagination, insight, communication, and the ability to co-operate and solve problems. Through creative and imaginary games, the child will get opportunities to express and work through their experiences and feelings. (p. 6)

Early Childhood Credentials in Japan, Sweden, and the United States

In order to teach in early childhood settings in Japan, teachers need to have 2-year associate degrees in early childhood education. Japanese early childhood education college programs offer two kinds of degrees: one for working in child care centers and the other for working in programs that are the equivalent of U.S. preschools (that is, with children ages 3-5) (Izumi Taylor, 2004).

In Sweden, preschool teachers need to have a 3½-year university degree.

In the United States, policies may vary from state to state and setting to setting, but in general, teachers need to have bachelor’s degrees to teach in kindergartens and in many state-funded prekindergarten programs but not in child care centers. Child care teachers ages 18 years and older who hold high school diplomas can obtain the Child Development Associate credential that indicates competencies in caring for young children.

Our Previous Studies of Teacher Perspectives on Play

In spite of the current emphasis on the importance of play in early childhood settings (Van Hoorn, Nourot, Scales, & Alward, 2007), few studies have shown how teachers in different cultures view play. We base our reflections in this paper on a comparative study that grew out of our earlier work in Japan, the United States, and Sweden. The purpose of the research discussed here was to examine similarities and differences in the perceptions of play among early childhood educators in Japan, the United States, and Sweden.

Izumi Taylor and colleagues (2004) examined American and Japanese teachers’ perceptions of play and found that teachers in both countries “used the rhetoric that is congruent with the current zeitgeist of developmentally appropriate early education” (p. 311) and that their perceptions of play were clearly related to their cultures. Those findings suggested that Japanese teachers offered children play in classroom environments that reflected an orientation to the needs of the group, while their American counterparts did not. Japanese teachers perceived children’s play as reflecting “the power of living” (“the basic foundation of their feelings, desires, and attitudes”) (Izumi Taylor et al., 2004, p. 315), while the American teachers tended to think of play as related to learning and development. The same study found that Japanese children engaged in more unstructured play than did their American counterparts.

When American and Japanese teachers responded to the inquiry “Tell me about play in your classroom,” the majority of Japanese teachers described what their children did in the classroom as related to unstructured play. Unstructured play included children initiating play and having many choices as well as a long play period. Both American and Japanese teachers believed that the effects of play on children included cognitive, social, emotional, and physical development. When asked to describe their notions of adult play, teachers in both nations wrote that adults play for enjoyment. Japanese teachers further elaborated by defining playfulness as the state of one’s heart (spirit, mind, lightheartedness), whereas their American counterparts tended to describe playfulness in terms of “fun feelings.”

In a related Swedish study, Johansson and Pramling Samuelsson (2006) examined integration of play and learning as a whole into preschool programs. Teachers received inservice training about integrating play with learning when working with children. During analysis of subsequent interactions between teachers and children, the following three categories of interaction were noted: exploratory interactions, narrative interactions, and formal interactions. In the first two categories, play and learning were closely related to each other, although some differences were noted between the two. For example, exploratory interactions appear to include challenges to innovation and creativity, and narrative interactions have the tendency to build a joint effort between children and teachers. In the third category of interaction (formalistic), the interactions were typically driven by teachers trying to guide children to “a correct answer,” a category in which play and learning were strongly separated. The Swedish teachers involved in the study held the following concepts of play and learning: (1) children will always learn when playing; (2) through play, children work on what they already learned in preschools; and (3) children can define the play aspect in learning and the learning aspect in play.

Comparing Teachers’ Perspectives on Play in Three Cultures

Conducting the Research

The American and Japanese data were collected by the first author in 2004, and the Swedish data were gathered by the second author in 2007.

The participants in the 2004 study consisted of 40 teachers (one male and 39 females) from the southeastern and northeastern United States and 40 teachers (one male and 39 females) from the midwestern and southeastern parts of Japan. Participants in the 2007 study were 40 Swedish teachers (two males and 38 females) from the Göteborg area in Sweden. The Japanese and American teachers taught children between the ages of 1 and 5 years. The Swedish teachers worked with children between 1 and 6 years of age. The respondent pools in all three countries were selected for convenience of access. Information was collected on teachers’ educational background and years in the field, but those data were not used to disaggregate our findings for the comparative study.

We mailed participants a questionnaire, asking them to respond anonymously to five inquiries (Izumi Taylor et al., 2004, p. 313):

Tell me, what is play?

Tell me about play in your classroom.

Tell me, how do you think play affects students?

Tell me of your concept of adult play.

Tell me what playfulness is to you.

Emergent Themes

Our analysis of the teachers’ responses revealed six themes related to play, which we identified as (1) process of learning, (2) source of possibilities, (3) empowerment, (4) creativity, (5) children’s work, and (6) fun activities. The theme play as a process of learning was identified when a response referred to play as a means of obtaining knowledge or skills. Play as a source of possibilities was the theme applied when a teacher’s responses had to do with children having possibilities to make choices and changes according to their own wishes and interactions with others. Play as empowerment was the theme when a response was related to giving children the fundamental power to deal with life (Izumi Taylor et al., 2004) and granting them their own volition. Play as creativity was characterized in comments referring to fostering originality or imagination through play. Responses reflected the theme of children’s work if they were related to the notion that in their play worlds children construct meaning from their own experiences, feelings, and knowledge in order to understand their environments. Play as fun activities was considered to be the theme of responses relating to pleasure and feelings of joy during play. Finally, two themes regarding adults’ play emerged, which we referred to as state of heart (state of mind) and positive feelings. State of heart is defined as “the heart unifying enjoyment, interest, fulfillment, and curiosity,” or “lightheartedness, spirit, and mind” (Izumi Taylor et al., 2004, p. 316). A theme of play associated with positive feelings was assigned when a response included reference to feelings of happiness, satisfaction, joy, excitement, enjoyment, fun, or similar emotional states.

Findings from the Surveys

Play as a Process of Learning

Responses from 28 Swedish, 22 American, and 11 Japanese teachers indicated that they perceived play as a process of learning and developing. An American teacher noted, “Play is a means by which children explore and create an understanding about the world around them.” A Swedish teacher wrote, “Through play, children create new experiences and learn from each other.” A Japanese teacher commented, “Through play, children learn to interact with others, learn to make their play enjoyable, and learn to develop their power to make their lives easy to manage.” However, none of the Japanese teachers related play to academic learning; their notions of play were focused on social and emotional development. One comment summed up this perspective: “Children play together and learn to be friends and to be a member of a group.”

A number of respondents from all three contexts saw play as related to social development and learning. An American teacher referred to opportunities for developing social skills: “Play helps students feel good about themselves. I think it helps self-esteem because with play, they are always successful.” Similarly, many Japanese teachers saw play as relating to social skills. One teacher wrote, “Play gives children the opportunity to learn to interact with others and to develop physical skills so they know how to interact with others in a group. It also develops children’s emotions and nurtures their curiosity, and, in turn, it leads to their knowledge.” Swedish teachers tended to comment in terms of children’s emotional development, referring to the fact that during play children can adapt their play to a level where they feel successful, or to cases when “(play) separates reality from fantasy.”

The notion of play as a process of learning, expressed by a large number of the teachers in our study, corresponds to the widely held view that play is the best mode for children to learn (Elkind, 1986; Izumi-Taylor, 2006; Morrison, 2009; Izumi Taylor et al., 2004). In Sweden, play is considered to be an important process that relates to children’s learning and education (Pramling Samuelsson, 2007). In the United States, according to Copple and Bredekamp (2009), play is a vital part of teaching. Kieff and Casbergue (2000) state that “play is certainly not the only way children learn, but it has been demonstrated repeatedly that it is an effective way of learning” (p. 18). From a Japanese perspective, Muto (2004) notes that “within the child’s play, there is learning” (p. 17), and when children engage in meaningful and authentic play, their intellectual growth can be nurtured. However, in Japan “learning through play” means that children learn their social and emotional skills and that play does not have academic purposes (Izumi-Taylor, 2008; Izumi Taylor, 2004).

Play as a Source of Possibilities

We found that many Swedish and Japanese respondents related play to what we called sources of possibilities, though the Americans did not. A number of Swedish responses reflected the notion that in play nothing is impossible. For example, one Swedish teacher remarked, “In play everything is possible. A chair can be changed into a boat on the open sea.” A Japanese teacher commented, “Play provides children with possibilities to expand their will and opens up everything that play has to offer.” Another Japanese educator extended this concept: “Play has a ripple effect of possibility since, through play, children can exchange their information, listen to different ideas, experience something new, understand themselves better, and find new hobbies and enjoy them.”

Such a notion of play is congruent with that expressed in some professional literature. For example, Perlmutter and Burrell (1995) claim that play is “about possibilities” (p. 21). The Japanese educator Teshi (1999) also observes that play offers children many options to stimulate their inner willingness and energy to engage in activities. Though some Swedish studies have suggested negative potential of some forms of play (Johansson, 1999), there is at the same time a strong belief that play provides children with positive possibilities.

Play as Empowerment

Play as empowerment was mentioned by many of the Japanese participants but not by those from Sweden or the United States. “Empowering children for living” is a priority in Japanese early childhood education (Izumi-Taylor, 2006; Muto, 2004), and play is seen as one mode of developing the power to live (Izumi-Taylor, 2006; Izumi-Taylor, Rogers, & Pramling Samuelsson, 2007). At the governmental level, play is seen as empowering children to be competent citizens. The Japanese government’s early childhood education guidelines (Ministry of Education, Culture, Sports, and Technology, 2000; Muto, 2004) state that early childhood educational settings must provide children with the opportunity to develop their “power to live through play.”

Responses from the Japanese teachers echoed this idea. “The child’s life itself is play, and children find out how to live through the process of playing,” said one teacher. Another commented, “Play is a must and provides us with the power to live through optimism and initiative.” This notion of empowerment was further expressed by a third teacher: “Empowering children can be accomplished through play, and thus children use such powers to cope with everyday life, such as sharing toys with others, conducting themselves as members of the group, and being away from their parents.”

Play as Creativity

Responses of teachers from all three nations referred to the relationship of play to children’s creativity. One American teacher’s comment was straightforward: “Play promotes children’s creativity.” Swedish teachers’ responses referred to both creativity and fantasy, which they valued as being of great importance for children’s well-being and learning. One Swedish teacher said, “An allowing environment which challenges children’s fantasy - the play becomes important.” A Japanese teacher also alluded to creativity: “Play is the process in which children can think for themselves, can create their own ideas, and can fully use their imaginations.” Another response from Japan related playfulness to creativity: “Playfulness provides a way of looking at things from different perspectives rather than thinking of a problem as being something very hard to work out, or it is a way of coming up with different solutions.” Another Japanese teacher’s comment connected creativity to empowerment: “Through play, children learn to interact with others, to develop their independence, to work with others harmoniously, and to use imagination. For these reasons, play empowers children how to live.”

Some literature on play has also linked it to creativity (Barnes, 1998; Lieberman, 1977; Kogan, 1983; Pepler & Ross, 1981; Nakagawa, 1991; Izumi Taylor & Rogers, 2001; Izumi Taylor, Rogers, & Kaiser, 1999; Teshi, 1999). According to Vygotsky (1930/1990), children’s play is an early form of creativity; play is creative when it remakes or reinvents past experiences into new realities rather than simply reproducing reality. Similarly, Perlmutter and Burrell (1995) note that “Playful people are risk takers whose thinking is open ended and whose minds are creative” (p. 21). The Japanese educators Nakagawa (1991) and Tatsumi (1990) have found that when children have freedom to play with their peers, they tend to be creative. These observations support Vygotsky’s perspective that imagination is the internalization of children’s play, that creativity exists when one’s imagination combines, changes, and creates something new, and that imagination is the basis for any creative activity (Vygotsky, 1930/1990). According to Iverson (1982), the link between play and creativity is based on the ability to view things playfully. In the Swedish study by Johansson and Pramling Samuelsson (2006, 2007), it has been shown that some teachers became preoccupied with getting children to arrive at correct answers and that this preoccupation excluded all kinds of playfulness. By focusing on only correct answers, teachers may discourage playfulness in the classroom and often diminish creativity.

Play as Children’s Work

Significant numbers of American and Swedish teachers perceived play as children’s work, but none of the Japanese teachers considered it in this way. Izumi Taylor et al. (2004) found that American teachers considered play to be children’s work, whereas none of their Japanese counterparts described it in such a manner. Play as children’s work was the most common view of Swedish teachers. Their comments included: “Children’s play is like work for adults,” and “When children play, they work hard.” An American teacher noted, “Their work is their play. Play includes social interactions as well as completing center work.”

The notion that play is children’s work has been discussed in the professional literature; however, some researchers and advocates disagree with this idea (Anderson, 1998; Elkind, 1993, 2003; King, 1982; Holmes, 1999). For example, Elkind (1993) comments, “Play is not the child’s work, and work is hardly child’s play” (p. 29), adding that early childhood teachers should “resist the pressures to transform play into work - into academic instruction” (Elkind, 2003, p. 50). Moreover, kindergartners tend to see their work differently from their play. When children voluntarily select their activities for themselves, they consider it to be play, but when engaging in activities with teachers’ instructions, they consider it as work (King, 1982; Holmes, 1999). Kieff and Casbergue (2000) caution that “play is different for different children” (p. 8), and early childhood classrooms need to balance play and work. Also, Frost, Wortham, and Reifel (2005) note that “children know the difference between play and work” (p. 73).

Play as Fun Activities

Significant numbers of teachers in all three countries agreed that play is related to fun activities; that is, play is a source of enjoyment, joyfulness, happiness, or amusement. One American teacher noted, “Play is participating in activities you find enjoyable and fun.” A Japanese teacher commented, “To play means that we pursue the joy and enjoyment we feel in our hearts.” A Swedish teacher said, “Play is joyful to children since children are free to choose.”

Other research also suggests that play is generally perceived to involve “fun activities”; from children’s perspectives, too, research suggests that play is fun when it is not planned, when it offers a choice, and when it affords the freedom to create, imagine, or construct something (Frost et al., 2005; Garza, Briley, & Reifel, 1985; Teshi, 1999). Likewise, Teshi (1999) observes that Japanese children should enjoy self-initiated play during early childhood years, and the NCSK clearly state that children need to enjoy their kindergarten lives, spending time together with teachers and peers engaged in fun play activities (Ministry of Education, Culture, Sports, Science, and Technology, 2000).

Responses Regarding Play in Classrooms

In response to the question “Tell me about play in your classroom,” 38 Japanese and 30 Swedish teachers indicated that they provided their charges with unstructured play, while American teachers did not report that they offer such play.

Swedish teachers appeared to focus on how they provide children with choices in their play. For example, one teacher in Sweden commented about unstructured play: “It is important for children to make their own choices and decide for themselves with whom they want to play and what they want to play, without any involvement by the teachers.”

When describing play in their classrooms, Japanese teachers mentioned children’s specific play activities. For example, one Japanese teacher commented:

The children in my classroom initiate play. They move around and find what they would like to play. I don’t tell them to play with this or that. Right now, they are interested in hunting bugs, collecting leaves and flowers, gathering nuts, and play with water outside.

All of the Japanese teachers explained what children did while at play in the classroom, while a majority of the American teachers mentioned their classroom play schedules rather than what children did. For example, an American teacher responded, “We have one full hour of play time at the beginning of the day.”

Only American teachers (13) reported that they used centers to offer play activities to children. None of their Japanese and Swedish counterparts mentioned centers.

The responses from Japanese teachers appear to confirm observations of Lee and Zusho (2002) who found that Japanese teachers are familiar with the NCSK set forth by the government and are provided with ample teaching manuals focusing on appropriate play activities. American teachers’ responses on this issue may be related to the fact that in their classrooms, play might be “set aside from work by providing a separate time” (Izumi Taylor et al., 2004, p. 317). In Sweden, children’s play activities in classrooms may have two purposes. One is children’s free play during which they make their own choices and engage their imaginations in role-play; teachers seldom become involved. In the curriculum (Ministry of Education and Sciences, 2006) and in practice, there also is a purposeful tendency toward integrating play and learning as a whole into the pedagogy (Pramling Samuelsson, 2006).

Participants’ Comments on Adult Play

Playfulness as a State of the Heart (State of Mind). The relationship between play and one’s “state of mind” or “of heart” has been noted in Japan and the United States (Rogers & Izumi Taylor, 1999; Izumi Taylor et al., 2004). When describing playfulness in our study, 23 Japanese and 3 American teachers related it to “their hearts.” None of their Swedish counterparts did so. These Japanese and American teachers used such words as “lighthearted,” “mind,” and “spirit” to explain their concepts of playfulness. One Japanese teacher wrote, “Playfulness means that I find fun in doing something, and my heart finds everything I do to be enjoyable.” Another Japanese teacher said, “Playfulness means that my heart enjoys what life offers, and while playing, it is okay to be mischievous.” One of the American teachers commented, “Playfulness is pleasurable, refreshes, and renews the human spirit.”

Playfulness as Positive Feelings. More American (21) and Swedish (21) teachers described playfulness as being associated with one’s positive feelings than did their Japanese counterparts (3). One Swedish teacher said, “To give one’s best,” in providing an example of positive feelings. Another said, “Humans need to play to feel good.” An American teacher also related positive feelings to “laughing, having fun, and living carefree for the moment.” Likewise, a Japanese teacher observed, “Playfulness means that you have the heart or the attitude to enjoy and be positive about your surroundings.”

Reflections on Findings from Japan, Sweden, and the United States

The notion of play as children’s work was mentioned by both American and Swedish teachers in this study but not by their Japanese counterparts. Both American and Japanese teachers described how playfulness promotes one’s state of heart or one’s state of mind, but none of their Swedish counterparts mentioned this aspect of either adult or childhood playfulness. In general, the Japanese tend to relate the enrichment of hearts to their happy lives (Hoshino, 2002; Itoh, 2002), and it is not surprising to find that they perceive playfulness to be a state of the heart (state of mind) (Izumi Taylor et al., 2004). In a similar view, in the United States, this domain of the heart/mind is described by Levy (1977) who considers playfulness as contributing to the unification of body, mind, and spirit. Relating playfulness to one’s heart/mind is not new; Froebel viewed play as important to children’s development of spirituality (Brosterman, 1997). To carry this notion of playfulness further, Elkind (1987) remarks that playful attitudes unify the child’s mental, physical, and socioemotional development.

Although teachers in all three nations noted that playfulness involves positive feelings, more American and Swedish teachers mentioned this than did their Japanese counterparts. Playfulness as positive feelings is further supported by Rogers and Izumi Taylor (1999) who articulate that playful people can turn difficult tasks into enjoyment with positive feelings. To promote playful contexts for children, Rogers and Izumi Taylor (1999) recommend that teachers model positive feelings through their playful attitudes; through varying degrees of playfulness, teachers can offer a variety of playful activities that nurture children’s positive feelings. It seems likely that, to understand the importance of playfulness in education, adults also need to play in playful environments in which there exists freedom from external rules (Rogers, 2007).

In a global community, interpreting early childhood education in different countries can be accomplished by sharing educators’ knowledge of children’s play and their perspectives of how to educate children through the use of play (Roopnarine & Metindogan, 2006). Because of differences in contexts for play as well as in the composition of the players, it is helpful for educators to view play from different perspectives in order to “make sound decisions about classroom play” (Frost et al., 2005, p. 58). As global notions of play tend to include “vague general statements to justify the play-oriented curriculum and vague characterizations to describe play in early education” (DeVries, Zan, Hildebrandt, Edmiaston, & Sales, 2002, p. 6), an examination of American, Japanese, and Swedish teachers’ perspectives on play can shed light on how the nature of play activities can be mediated by their own cultural influences on their understandings of play.

We believe that our comparison of teacher perspectives in three nations suggests some possible courses of action. First, because Japanese teachers’ perceptions of play are very closely related to the NCSK set forth by the Japanese government (Ministry of Education, Culture, Sports, Science, and Technology, 2000), teachers in the United States and Sweden might benefit from working with Japanese teachers to expand their knowledge of ways to implement play-related activities and promote a group orientation in classrooms.

Second, researchers and teachers not only need to understand play and its relation to children’s learning but also to scrutinize play as a cultural phenomenon and try to create more knowledge about the general and cultural aspects of play. Our research can also inform teachers of the notion of “the playing learning child” (Pramling-Samuelsson & Asplund-Carlsson, 2008) and challenge them to understand that children cannot separate play and learning in the early years.

Scholars and practitioners in early childhood education have much to learn about play from colleagues in different cultures; such knowledge could be valuable for multicultural communities (Pramling Samuelsson & Fleer, 2008). Comparing one’s own with other perspectives on play, as we have attempted to do here, can be helpful in understanding ways to approach play in one’s own setting, as well as in communities with diverse populations.

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Author Information

Satomi Izumi-Taylor is professor of early childhood education with the Department of Instruction and Curriculum Leadership at the University of Memphis.

Satomi Izumi-Taylor

Professor of Early Childhood Education

Dept. of Instruction and Curriculum Leadership

University of Memphis

Memphis, TN 38152

Telephone: 901-678-5363

Email: sitaylor@memphis.edu

Ingrid Pramling Samuelsson is professor of early childhood education with the Department of Teacher Education with Göteborg University, Sweden.

Ingrid Pramling Samuelsson

Professor

Göteborg University

Department of Education

Child Studies

Box 300 SE-405 30 Göteborg

Sweden

Email: ingrid.pramling@ped.gu.se

Cosby Steele Rogers is professor emeritus with the Department of Human Development at Virginia Polytechnic Institute and State University.

Cosby Steele Rogers

Email: rogersco@vt.edu

Volume 14 Number 2

©The Author(s) 2012

Mental Health Screening in Child Care: Impact of a Statewide Training Session

Mary Margaret Gleason

Tulane University School of Medicine, Department of Psychiatry and Behavioral Sciences and Department of Pediatrics

Sherryl Scott Heller, Geoffrey A. Nagle, Allison Boothe, Angela Keyes

Tulane University School of Medicine, Department of Psychiatry and Behavioral Sciences

Janet Rice

Tulane University School of Public Health and Tropical Medicine

Abstract

Child care settings may provide an optimal setting for identification of early childhood mental health problems. However, little is known about child care providers’ attitudes or knowledge about screening for children’s mental health problems. Both attitudes and perceived knowledge could affect the successful implementation of mental health screening in child care settings. This report discusses two related pilot studies. In the first, the authors adapted an existing measure to assess child care providers’ attitudes and knowledge about mental health screening, and they examined the factors of the new measure in 275 child care professionals. In the second study, the authors examined 203 child care providers’ attitudes toward and perceived knowledge about mental health screening before and after a single 3-hour training session. Study 1 factor analysis revealed two factors: attitude about screening and perceived knowledge about screening. Both factors were associated with experience with a mental health consultant and with comfort with children with special needs. Participants in Study 2 demonstrated significant increases in positive attitude and perceived knowledge about mental health screening in child care following the 3-hour training session. Results indicate that child care providers were positively inclined toward participating in mental health screening. Attitudes toward and perceived knowledge of mental health screening increased after a single training session. Findings of this research provide a first step toward understanding child care providers’ attitudes about and perceived knowledge of mental health screening in very young children and indicate that both positive attitudes and perceived knowledge can be increased through training.

Introduction

Prejudice about and discrimination against people with mental health problems are pervasive throughout Western society. Misunderstandings about young children’s mental health in particular may serve as a barrier to early detection and treatment of children with mental health problems.

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Importance of Early Screening

Early childhood mental health problems, which can include anxiety disorder, depression, attention deficit hyperactivity disorder, and oppositional defiant disorder, occur at rates of about 10% nationally and are associated with long-term emotional, academic, and relationship problems (Briggs-Gowan & Carter, 2008; Briggs-Gowan, Carter, Bosson-Heenan, Guyer, & Horwitz, 2006; Eggers & Angold, 2006; Lahey et al., 2004; Lavigne et al., 1998). These early childhood mental health problems are not “phases”; they are predictive of mental health problems in school-age children (Briggs-Gowan, 2005; Lahey et al., 2004; Luby, Si, Belden, Tandon, & Spitznagel, 2009). Fortunately, research indicates that intervention is effective and can produce lasting positive effects (Hood & Eyberg, 2003; Lieberman, Ghosh Ippen, & Van Horn, 2006; Olds et al., 1997; Schweinhart & Weikart, 1998; Webster-Stratton, Reid, & Hammond, 2004); however, some studies suggest that only about 8% of children in need of mental health services receive any treatment (Horwitz, Gary, Briggs-Gowen, & Carter, 2008; Costello, Messer, Bird, Cohen, & Reinherz, 1998). The first step toward intervention is identification; early identification has been shown to be feasible and can facilitate intervention (Briggs-Gowan & Carter, 2008; Meagher, Arnold, Doctoroff, Dobbs, & Fisher, 2009). Specialists in multiple disciplines advocate for screening and treatment of mental health problems in very young children (American Academy of Pediatrics Committee on Children with Disabilities, 2001; Jellinek, Patel, & Froehle, 1998; U.S. Public Health Service, 2000).

Social-Emotional Screening in Child Care Settings

Some early childhood experts have called for universal mental health screening in child care settings to increase early identification and enhance treatment outcomes (Bricker, Davis, & Squires, 2004; Carter, Briggs-Gowan, & Davis, 2004; Gleason, Zeanah, & Dickstein, 2010; U.S. Department of Health and Human Services, 1999; U.S. Public Health Service, 2000). Mental health screening has been shown to be both feasible and effective in Head Start centers (Miller et al., 2003). Screening in the child care center is seen as providing a number of advantages over other screening settings. The majority of children in the United States attend child care; in 2008, it was estimated that 51% of preschoolers and 30% of infants and toddlers were in child care (U.S. Census Bureau, 2008). Children spend extensive time in child care - infants average 29 hours a week, and by age 3, children average 34.4 hours a week (NICHD Early Child Care Research Network, 2005). A child care provider is thus able to observe a child’s typical behavior over time in a setting that is comfortable for and familiar to the child.

Most parents view their children’s child care providers as trustworthy and knowledgeable about child development, increasing the likelihood that they would be comfortable with the practice of mental health screening in child care settings. Having both child care providers and parents report their observations about a child can contribute to the richness of information (Carter, Briggs-Gowan, & Davis, 2004) and can eliminate potential bias of a single informant (Briggs-Gowan, Carter, & Schwab-Stone, 1996; Richters, 1992; Fergusson, Horwood, & Lynskey, 1995). It is possible that early identification of (and intervention with) children who are at risk of mental health disorders may reduce the risk of preschool expulsion for behavior problems, which occurs at rates higher than in the K-12 population (Gilliam, 2005).

Provider Characteristics and Attitudes toward Mental Health Problems

Little research exists on public attitudes toward or knowledge of children’s mental health (Pescosolido, 2007). An exception is the National Stigma Study–Children (NSS–C), in which nearly 1,400 randomly selected adults, with race, gender, and socioeconomic distribution mirroring the U.S. population, were interviewed about their attitudes toward children with mental health problems. Findings from the NSS–C indicate that U.S. adults’ attitudes and perceptions about children’s mental health are complex and cannot be inferred from research findings regarding beliefs about adult mental illness nor predicted by sociodemographic characteristics, such as socioeconomic status, ethnicity, education level, and gender (McLeod, Fettes, Jensen, Pescosolido, & Martin, 2007; Perry, Pescosolido, Martin, McLeod, & Jensen, 2007; Pescosolido, 2007; Pescosolido, Perry, Martin, McLeod, & Jensen, 2007). One study (McLennan, Jansen-McWilliams, Comer, Gardner, & Kelleher, 1999) suggested that female medical providers and medical providers who have more recent training on mental health conditions are more open to working with children with mental health issues than other providers.

Although few studies have examined the attitudes and beliefs of child care providers and teachers about young children’s mental health, the general consensus seems to be that personnel in early care and education settings should be involved in addressing the mental health of children. However, research suggests that a minority of providers and teachers feel they have the skills to support these needs (Reinke, Stormont, Herman, Puri, & Goel, 2011).

Training Child Care Providers

The limited information available about child care providers’ training in mental health or mental health screening indicates that education on these topics is not only needed but would be well received. Child care providers report that working with children with severe behavioral disorders is as challenging as working with those with severe physical disabilities (Buysse, Wesley, Keyes, & Bailey, 1996); in fact, research suggests that child care providers rank training in mental health issues as a priority (Fuchs, Monson, & Hatcher, 2010; Buck & Ambrosino, 2004; Reinke et al., 2011). Reviews of early childhood education curricula conducted by faculty, students, and outside reviewers, however, reveal limited training about children’s behavioral problems (Ackerman, 2005; Hemmeter, Corso, & Cheatham, 2006; Reinke et al., 2011).

Research shows that child care providers identify ongoing inservice training as a way to increase their comfort in working with children with disabilities and that they respond positively to structured curricula, training workshops, and handouts that can be taken home for later reference (Fukkink & Lont, 2007; Hadadian, Tomlin, & Sherwood-Puzzello, 2005). Content on early childhood mental health can be provided through such training methods, targeting attitudes and common misconceptions about mental health in early childhood. Commonly held misconceptions include that the child’s behavior is “only a phase,” that preschoolers are too young to have emotional problems, that nothing can be done to help these children, or that an early diagnosis of mental health problems will need to be included in all future documents about a child, continuing to affect professionals’ perceptions of the child.

Positive changes in knowledge and attitudes have been demonstrated after training about children with special needs (Mulvihill, Schearer, & Van Horn, 2002). It seems reasonable to expect similar effects from training on mental health.

Purpose of the Research

In summary, early childhood mental health problems occur in 10% of the national population; however, the majority of these young children are not being identified - much less treated. Developmental screening in early childhood settings has been demonstrated to be feasible and effective; in fact, child care settings may be ideal locations to conduct screenings for young children’s mental health issues. In addition, research has demonstrated that child care providers are not only open to training on early childhood mental health but also identify it as a priority.

Extrapolating from the research on training with teachers (on education and special needs) and medical providers (on mental health conditions), we hypothesize that training on mental health screening would have a positive impact on child care provider attitudes. Understanding caregiver attitudes about screening is important for those involved in designing and implementing effective training modules for child care providers and in developing classroom strategies to support healthy social-emotional development in all children. To be successful, training about young children’s mental health must address mental-health-related stigma and common misconceptions about screening. Training caregivers to implement mental health screening can also address mistaken beliefs and highlight the role of the child care provider in protecting children from such potentially harmful misattributions.

In Study 1, we examined a new child care provider-focused measure of attitudes and knowledge about early childhood mental health and screening - the Screening Belief Scale (SBS), which is described below. We sought to confirm the underlying factors in the measure in this population and to examine whether providers’ background characteristics related to responses on the measure. In Study 2, we examined changes in responses to the measure after a brief training session focused on early childhood mental health and screening. Finally, we sought to identify characteristics of child care providers related to changes after training.

Research Questions

Study 1 addressed the following research questions:

Do child care providers’ responses to the Screening Belief Scale (SBS), a modified version of the Physician Belief Scale (PBS; Ashworth, Williamson, & Montano, 1984), yield definable factors?

Are specific child care provider background characteristics (e.g., demographic characteristics, reported comfort with children with mental health problems) associated with SBS constructs?

Study 2 addressed the following research questions:

Do constructs assessed by the SBS change after a 3-hour training session on early childhood mental health and screening?

Are specific child care provider background characteristics (e.g., demographic characteristics, reported comfort with children with mental health problems) associated with changes in their SBS factor(s) following training?

Methods

Training

As part of a larger state effort to build and sustain high-quality child care in conjunction with the implementation of the state’s child care rating system, child care providers participated in a voluntary 3-hour training session focused on mental health screening in child care. This structured training focused on the concepts and strategies for mental health screening in child care settings and included a comprehensive handout summarizing the presented material.

The institutional review board at Tulane University School of Medicine approved the evaluation of the project. Twelve mental health professionals were trained by three doctoral-level psychologists to deliver the training session. The 3-hour training sessions included such topics as rationale for mental health screening in young children, considerations about informal identification strategies, a review of sample screening measures, and a step-by-step approach for initiating a screening program in a child care setting with attention to the process of providing feedback to families. The training also highlighted the importance of partnering with families, discussed developing community partnerships, and emphasized that screening results are not diagnostic.

Each trainer provided up to six training sessions in 2008-2009. All participants completed a background questionnaire and a survey focused on attitudes and knowledge prior to and after the training session.

Participants

Child care providers attended training on children’s social-emotional development as part of the state’s quality rating and improvement system. During the study period, 821 child care teachers, directors, and regional technical assistance agents who were attending a single training session on children’s social-emotional issues and development were invited to participate in the assessment. Study 1 participants were drawn from the 361 attendees at the first two social-emotional training sessions offered. Of these attendees, 275 completed every item of both the pre- and post-training attitude questionnaire. Study 2 included participants from the subsequent single training session. Of the 460 providers who attended the training sessions, 203 completed all items on both questionnaires. The post-test was administered immediately after the training session ended. See Table 1 for more details on background characteristics.

Table 1

The only demographic factor that differentiated the individuals who participated at both time periods (n = 478) from those who completed only the pre-assessment (n = 343) was ethnicity. Caucasian child care providers were more likely to complete both questionnaires than African American child care providers (x2(3) = 25.3, p < 0.001). No significant differences were found between the two study groups in terms of years in child care, education (certification beyond high school or not), or current role (supervisor in child care vs. teacher and assistant teacher). Study 2 included a higher proportion of African American participants than Study 1 (x2(6) = 38, p < 0.01).

Measures

Demographic Questionnaire. All participants completed an anonymous demographic questionnaire. This 6-item questionnaire inquired about their role in the child care setting, years working in child care, education level, gender, and ethnicity. Participants were also asked to estimate the rate of expulsions from their classroom or center and to report whether the center had an early childhood mental health consultant.

Measuring Participant Comfort with Teaching Children with Special Needs. Using a 6-point Likert scale, the participants were asked to identify their level of comfort teaching children with four common early childhood issues: developmental delays, emotional problems, behavioral problems, and peer relationship difficulties. The scale ranged from “1” indicating “very uncomfortable” to “6” representing “very comfortable.” Overall, teachers reported more comfort with children with developmental delays than emotional or behavioral problems; however, these items were highly correlated (r = .70-.80). For this reason, analyses employed the mean of the three scales as a composite marker of comfort working with children with special needs.

Measuring Participant Attitudes about Mental Health Screening. To our knowledge, no questionnaire has been published regarding mental health screening in child care. For this study, we modified the Physician Belief Scale (PBS), a measure of physician attitudes toward mental health (Ashworth, Williamson, & Montano, 1984) to create the Screening Belief Scale (SBS, see the Appendix). The SBS includes 16 items scored on a 5-point Likert scale, with responses ranging from “Strongly Agree” (1) to “Strongly Disagree” (5). Six items were reverse scored. Modifications from the PBS were intended to shift the focus from attitudes and comfort about mental health issues in general to the child care setting specifically.

Analyses

Data were analyzed using SPSS 13.0. Responses to the survey’s Likert scales were treated as continuous measures. The scale was analyzed using Principal Component Analysis (PCA), and items on the scale were assigned to subscales or eliminated based on PCA and item-total correlations. Differences in categorical variables were examined using chi square analyses, and T-tests were used to compare continuous variables.

Results

Study 1: SBS Factor Analysis

A PCA of the 16 items of the scale yielded two primary factors with eigenvalues of 2.3 and 1.7, respectively. A scree plot indicated that these two were the main factors, and the slope of the plot leveled off beyond these two factors, which accounted for 39% of the variance of the items.

Factor 1 - “screening attitude” - included nine items that reflected participants’ opinions on mental health screening in child care settings, such as “I believe that screening for emotional and behavioral issues is not very important in the child care setting” (see the Appendix). Internal consistency was high (Cronbach’s alpha = .79). The second factor - “perceived knowledge” - included four items that reflected trainees’ perception of whether they had sufficient knowledge to administer mental health screenings, including items such as “I do not know what to do if I think a child has emotional or behavioral issues.” A fifth item focused on concern that the family would find screening offensive appeared to load onto this factor but had low (< 0.1) item-total correlations and was removed. The resulting factor demonstrated acceptable internal consistency (Cronbach’s alpha = .60).

Factor Correlates

Screening Attitude. The mean score on the pre-training attitudes about screening scale was 36.7 (SD 5.3, range of 21-45). Child care providers who had achieved some certification beyond high school showed more positive attitudes toward screening than those who had a high school degree or no degree (38.2 vs. 36.0, t(273) = -3.4, p < 0.001). Years of experience was also associated with more positive attitudes (r = 0.22, p < 0.001). Working in a center with a mental health consultant was associated with positive attitudes toward screening (37.8 vs. 36.7, t(249) = 2.2, p < 0.03). The comfort composite measure showed a small association with screening attitude (r = .19, p <0.003). Number of children expelled by a teacher was similarly negatively associated with positive attitudes toward screening at a small magnitude (r = -0.18, p < 0.03).

A stepwise multivariable regression analysis was computed (see Table 2). In the first step, we entered the demographic factors (experience, race, role, and education). In the second step, we entered early childhood mental health consultant history, number of expulsions reported by participant, and reported comfort with children with special needs. We used this order because demographic factors might influence the participant’s response to an early childhood mental health consultant, expulsion patterns, or comfort with children with special needs. The model explained 11% of the variance of attitude toward screening; comfort and experience with an early childhood mental health consultant contributed independently (Table 2). Expulsion rate approached significance (p = .056).

Table 2

Perceived Knowledge. On the perceived knowledge scale, the mean score was 13.4, with a standard deviation of 2.4 and a range of 4-20. Perceived knowledge had a positive relationship with having a degree beyond high school (14.1 vs. 12.9, t(196.3) = -3.6, p < 0.001) and with being a supervisor in the center (13.8 vs. 12.5, t(272) = 4.1, p < 0.001) and years in child care (r = 0.28, p < 0.001). Participants who reported higher levels of comfort with having children with special needs in the classroom also reported a modestly higher level of perceived knowledge of mental health screening (correlations, respectively, r = .26, p < 0.001). In the perceived knowledge multiple regression, we entered variables in the same order as in the screening attitude multiple regression. The resultant model explained 12% of the variance; comfort with children who have special needs and experience with an early childhood mental health consultant contributed independently.

Study 2: Change Following Training

SBS Factors

Screening Attitude. We found a significant increase in positive attitude toward mental health screening following training (see Table 3). Change in attitude about screening was negatively associated with pre-training attitude (r = -0.41, p < 0.001). No significant associations were found with the other participant characteristics.

Perceived Knowledge. Perceived knowledge also increased significantly between pre-training and post-training (see Table 3). Pre-training knowledge score was inversely associated with change in perceived knowledge (r = -.60, p < 0.001). There was a nonsignificant trend toward larger changes in perceived knowledge in Caucasian trainees than other racial groups (1.7 vs. 1.0, t(218) = -19, p < 0.06). No significant associations with other variables were found.

Table 3

Discussion

To our knowledge, the two studies reported here are the first to examine child care providers’ attitudes toward mental health screening. Together they constitute an important first step toward characterizing child care providers’ attitudes about mental health screening and their perceived knowledge regarding mental health screening. The studies identify factors involved in positive changes in attitude and knowledge. With attention in the field increasingly focused on early childhood mental health, it is essential to understand child care providers’ attitudes toward and perceived knowledge about mental health screening and their role in the process (especially if screening occurs in a child care setting).

Overall, participants reported relatively positive attitudes toward mental health screening in child care, which suggests that child care providers may be open to helping identify children in need of mental health assessment. Despite the overall high endorsement of positive attitudes, there was sufficient variability to explore our hypotheses.

Having an early childhood mental health consultant (MHC) in the center was associated with positive attitude about mental health screening but not with perceived knowledge. This finding is consistent with previous research focused on educational settings for children with a diverse set of disabilities, in which supporting the teacher’s ability to meet the child’s needs is associated with a positive attitude toward educating children with disabilities (Avramidis & Kalyva, 2007). Prior research on early childhood mental health consultation has demonstrated that teachers see the MHC as a valuable resource and source of support (Heller, Boothe, Keyes, Nagle, Sidell, & Rice, 2011). These findings suggest that experience with an early childhood mental health consultant may increase teachers’ sense of support around mental health issues and may promote a positive view of mental health screening in early care settings.

The primary goal of Study 2 was to examine changes in attitude toward and perceived knowledge about screening following training. Our results indicate that the training was useful in modifying self-reported attitudes and perceived knowledge related to mental health screening. The fixed curriculum and use of locally based trainers, which have been identified elsewhere as characteristics of effective child care provider training, may have been important factors contributing in the effectiveness of the training (Fukkink & Lont, 2007).

The finding that changes in attitude and knowledge were not associated with specific background variables highlights the potential for training to influence attitudes and perceived knowledge about screening across the boundaries of roles in child care settings, experience, and education. This finding is also in line with prior research that found that professional education seminars or workshops had more impact on classroom quality than teacher education or years of experience (Honig & Hirallal, 1998). The strongest predictor of change in attitude and knowledge was the pre-training measure; this finding emphasizes that less positive attitude toward screening or less knowledge about screening did not reflect a fixed negative perspective toward screening.

Some limitations warrant discussion. First, a substantial proportion of respondents did not complete every item of the pre-training and post-training questionnaires. The only significant difference between the completers and noncompleters was race, with Caucasian child care providers being more likely to complete both questionnaires than child care providers of other races. Differences by race in participation in mental health projects are not unique to this project (U.S. Department of Health and Human Services, 1999), but further assessment of how cultural factors influence responses to the training and the questionnaire is warranted. Because of the importance of culture in defining both child development and beliefs about mental health (Zeanah & Smyke, 2008; dosReis, Mychailyszyn, Myers, & Riley, 2007), training programs may require adaptations that address the cultural beliefs of learners in different communities. Additionally, this project did not allow for effective reliability assessment. More formal assessment of test-retest reliability would strengthen the generalizability of the findings, although the correlates suggest some concurrent validity, as do the factors.

With any training assessment, the potential for social desirability response bias exists; respondents may provide responses that they think are socially appropriate rather than those that reflect their beliefs, especially immediately after training. Prior research has found that teachers may revert back to former behaviors when a post-test is delayed rather than administered immediately after training (Honig & Martin, 2009). This bias cannot be ruled out in our study. However, the differential changes in scores between the two scales (0.18 points per item on the attitude scale versus 0.32 points per item on perceived knowledge) suggest that something more than response bias played a role in the change between pre- and post-training.

This study is also limited by a potential threat to internal validity due to pretest sensitization (Campbell, Stanley, & Gage, 1963); that is, participants’ scores may have increased merely by being exposed to the pre-test. Future research should include a control group to rule out the possibility of this effect.

Implications for Practice

Experience with an early childhood mental health consultant seems to have a positive impact on both child care providers’ attitudes toward screening and their perceived knowledge regarding mental health screening in young children. An early childhood mental health consultant can support a teacher in creating an environment that fosters social-emotional development and can assist with the inclusion of children who have mental-health-related special needs. Ideally, a center would seek out an early childhood mental health consultant to lead any training on mental health screening in very young children. Although the number of individuals trained to provide mental health consultation in early childhood settings is increasing, programs in some geographical areas have no access to early childhood mental health consultants. From our work in the child care community, we know that financial and professional resources can be limited. Often, a center director must create and provide training sessions herself. We believe a well-prepared director could provide adequate training on mental health screening, especially given the large number of related resources available on the Internet (e.g., from the Center on the Social and Emotional Foundations for Early Learning at http://csefel.vanderbilt.edu, Early Head Start National Resource Center at http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/ehsnrc/center, National Association for the Education of Young Children at http://www.naeyc.org, and the Ages and Stages Questionnaire at http://www.agesandstages.com). Our findings suggest that providing training on the importance of screening and on how to screen helps staff to develop more positive attitudes and greater perceived knowledge about the screening process, which should support smoother screening implementation processes for identifying children in need of additional support.

Interestingly, expulsion rate was inversely associated with knowledge but not attitude. This finding suggests that training or mental health consultation may help to decrease expulsion rates by addressing knowledge gaps about children with special needs, including mental health needs. This finding is in line with prior research that has found that child care programs with access to a mental health consultant had fewer expulsions than programs without such access (Gilliam, 2005).

Future Research

Our findings invite multiple lines of further research. Examining longer-term effects of training will be a valuable pursuit. For example, post-assessment done months after the training could examine the durability of lasting early change and limit social desirability effects. Another question would be if positive attitude or perceived knowledge would differ based on whether the director or a mental health professional administers the training. In addition, research on families’ attitudes toward screening in child care settings would be beneficial, as would studies focused on cultural issues and populations affected by health disparities in mental health screening. Perhaps most importantly, future studies should focus on whether changes in attitudes and knowledge are associated with specific changes in caregiver behavior, such as implementation of a screening project and increased testable knowledge about early childhood mental health.

Conclusions

Early childhood mental health screening in child care settings is an innovative and important opportunity to identify children in need of further mental health assessment and possibly treatment. In our study, child care providers were generally positively inclined toward participating in mental health screening, and their attitudes and perceived knowledge about mental health screening increased after a single 3-hour training session. Despite some methodological limitations of this preliminary study, we believe that our findings offer an important first step toward understanding the attitudes and perceived preparedness of child care providers toward mental health screening.

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Author Information

Dr. Gleason is a pediatrician and child and adolescent psychiatrist is an early childhood mental health clinician and researcher. She is the clinical co-director for Louisiana’s early childhood mental health program, Early Childhood Supports and Services program, where she also serves as a child psychiatrist, and she serves on the American Academy of Pediatrics Early Childhood and Brain Development Leadership Work Group. Her academic work focuses on early identification of childhood mental health disorders, mental health disorders in high-risk children, especially reactive attachment disorder, and the translation of research findings into real-world practices across disciplines.

Mary Margaret Gleason, M.D.

Assistant Professor

Department of Psychiatry and Behavioral Science

Tulane University School of Medicine

New Orleans, LA 70112

Email: mgleason@tulane.edu

Sherryl Scott Heller, Ph.D., is currently an associate professor at Tulane University School of Medicine and the Tulane Institute of Infant and Early Childhood Mental Health. Dr. Heller serves as a senior consultant director for Tulane’s Quality Start Early Childhood Mental Health Consultation (ECMHC) program. Dr. Heller is currently collaborating with local community agencies to pilot the ECMHC program in kindergarten classrooms in charter school settings. Dr. Heller has recently co-edited a book on providing reflective supervision to professionals in the field of early childhood intervention. Dr. Heller has long-standing clinical and research interests in the effects of maltreatment on child development, the development of attachment and attachment disturbances in very young children, child care, the effects of violence on child development, perinatal loss, and reflective supervision.

Geoffrey Nagle, Ph.D., L.S.C.W., M.P.H., is the director of the Tulane University Institute of Infant and Early Childhood Mental Health and an associate professor of psychiatry at the Tulane University School of Medicine. Geoff has served as the state director of BrightStart since 2003, which has been designated by Governor Bobby Jindal as Louisiana’s State Early Childhood Advisory Council. Geoff works closely with state government leaders to enhance Louisiana’s early childhood system and to increase the opportunities to provide high-quality early care and education. This advocacy has resulted in Quality Start, Louisiana’s child care quality rating system, and new laws that create an Early Childhood System Integration Budget, the School Readiness Tax Credits, and for the future phased-in expansion to universal PreK.

Allison B. Boothe, Ph.D., is a licensed clinical psychologist with specialized training in Infant and Early Childhood Mental Health. She is an assistant professor of clinical psychiatry at Tulane University School of Medicine and is the coordinator of the Louisiana Quality Start Mental Health Consultation to Childcare Centers Program. Allison co-developed the Louisiana Quality Start mental health consultation model, which focuses on supporting young children’s social-emotional development in the context of child care centers. As a senior mental health consultant for the program, Allison has provided mental health consultation to child care centers across the greater New Orleans are, and she supervises mental health consultants across the state. Allison is a member of the steering committee for the Bridge to Quality Project of the Greater New Orleans Child Care Rebuild Collaborative. Her research interests include the impact of mental health consultation on child care quality, school readiness, clinical interventions, and identity development.

Angela Keyes, Ph.D., joined the Tulane Institute of Infant and Early Childhood Mental Health in 2002. She is currently an assistant professor of psychiatry and director of the Environment Rating Scales Assessment Team for Quality Start, Louisiana’s Tiered Quality Rating and Improvement System. Dr. Keyes facilitates a course on multiculturalism in clinical practice for psychology interns as well as a course on working with parents in managing their children’s behavior. She has assisted in developing a model for mental health consultation to support child care centers with a focus on fostering children’s social-emotional development as well as teaching techniques to modify children’s challenging behaviors in a positive way. Dr. Keyes also provides reflective supervision to the mental health consultants who serve child care centers that are working toward improving the quality of care they provide to children birth to 5 years.

Appendix

Factor Loadings of Individual Items on the Survey*

This scale is designed to assess a variety of beliefs that you may or may not hold as a child care professional. Statements representing these beliefs are listed below. Next to each statement, circle the number that most closely represents your agreement or disagreement with the statements.