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Ubuntu: NHA Therapeutic Head Start Village (An Ecosystemic Therapeutic Classroom Milieu)

We aim to build a multi-sensory, play-based, trauma-informed therapeutic classroom (utilizing the outdoor as an extension of the classroom)

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Name or Organization

Neighborhood House Association (NHA)

Geography

San Diego, CA

What is your stage of development?

  • Advanced Innovator with 3 to 10+ years of experience in ECD

Type

  • Non - Profit

What is the stage of your proposal?

  • Prototyping: I have done some small tests or experiments with prospective users to continue developing my idea.

Describe your submission in one clear sentence

We aim to build a multi-sensory, play-based, trauma-informed therapeutic classroom (utilizing the outdoor as an extension of the classroom) to support Head Start children and families with diverse social- emotional needs and to enhance the care system surrounding them.

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

A significant number of preschool aged children with severe behavioral and social-emotional challenges are being expelled from preschools at an alarming rate. These children require a higher level of care and intervention difficult to achieve in traditional classrooms. Research shows that early intervention establishes the social emotional foundation that leads to school readiness and reduces/eliminates preschool suspensions and expulsions. Our Therapeutic Classroom Milieu (TCM) will address this gap in early childhood education and will be shared with community partners for replication.

Select an Innovation Target

  • Service: A new or enhanced service that creates value for end beneficiaries.

Tell us more about your innovation (1500 characters)

Tell us more about your innovation We aim to offer a therapeutic preschool classroom that includes comprehensive services to Head Start children at risk of suspension and expulsion. The TCM Model will be guided by the following pillars: (1) Enhance parental involvement/increase knowledge of parenting skills Caregivers will participate in “hands on” training in the educational environment with their child in an effort to improve their parenting skills and enhance the parent-child relationship. A licensed mental health clinician will head the TCM team and work closely with the family on attachment-based strategies to improve parent-child relationships. (2) Improve children’s self-regulation and coping skills We will use evidence based interventions and social-emotional curricula, including mindful movement and occupational therapy to identify a child’s sensory needs, and strategies to promote executive functioning skill development. (3) Reduce teaching and support staff stress and promote coping skills Staff will receive psycho-education and support to improve coping, effectively manage challenging behaviors, and implement trauma informed care. Staff will learn how to engage parents in conversations about difficult and sensitive issues as well as model responsive caregiving. Teaching and support staff will engage in on-going professional learning communities and coaching circles to effectively manage classroom challenges, and implement trauma informed care.

What problem are you aiming to solve? (3 sentences)

There continues to be an increasing number of children coming to school with serious social, emotional, and behavioral challenges which jeopardize the classroom’s overall safety and require highly skilled supports and interventions for them to gain the skills necessary to be successful in later life. The therapeutic preschool is a way to address the mental health issues and traumatic experiences that lead to challenging behaviors; help promote child, family, and teacher wellness; and ensure our

Explain your idea (5000 characters)

Our program’s current mental health services are built around the pyramid model of care (see diagram 1). Head Start’s comprehensive model, interconnected with the pyramid model is the building foundation of an integrated system of care. At the bottom tier, all teachers are trained to develop nurturing and responsive relationships with children and to maintain high quality environments that support children’s individual needs. At the middle tier, teachers and the TCM team implement targeted social-emotional supports, based on the needs of the classroom. At the top of the tier TCM team supports teachers in developing and implementing individualized interventions for children with persistent challenging behaviors. Currently, for children who require a higher level of therapeutic services that cannot be obtained in the general preschool classroom, TCM team assists with facilitating referrals to outside agencies where children and families can receive these services. We aim to expand our services to address the need of children whose safety concerns overwhelm the resources of a standard center-based classroom (see diagram 2). The Therapeutic Classroom Milieu (TCM) is designed to promote and implement effective early interventions for young children, ages, birth to 5 years old, and their families through the enhancement of NHA’s current comprehensive services (see diagram 3). The goal is to provide a therapeutic classroom environment with more specialized and intensive social-emotional services and developmental support for children and families in the program. The added component of the TCM will provide opportunities for both children and caregivers to participate in guided and coached early education experiences in the classroom setting, and onsite therapeutic treatment with the goal of decreasing challenging behaviors, increasing social skills and emotional resiliency, improving parent-child relationships, and improving educational outcomes. The TCM is unique in that services will take place in the child care setting, with the child to teacher ratio of 4:1, with a combination of typically developing children and children requiring intervention/support plans. The proposed TCM will utilize evidence and research based social-emotional curricula to complement the primary classroom curricula (Creative Curriculum). The above mentioned curricula are designed to teach children self-regulation and executive-function skills that help children learn and practice techniques to manage their feelings, control their impulses, make friends, and solve problems. Teaching and Support Staff will also receive training in conducting Mindful Movement Groups in the classroom. Evidence shows that physical activity and self-regulatory exercises, such as stretching and deep breathing have beneficial impacts across developmental milestones. Providing movement activities such as climbing, balance challenges, obstacle courses and games that encourage complex motor sequencing (ex. hokey pokey) provide the brain the exercise it needs to help focus attention, plan and adjust actions, and persevere to achieve a goal. Likewise, encouraging attention control through quieter activities that require children to tone down stimulation and focus attention—such as stretching or yoga-like poses that include slow breathing, help bring about self-regulation. Introducing breathing exercises to very young children enhance their practice of executive function skills by having to focus on the breath and the rhythm of air inhalation and exhalation. Deep breathing can slow the heartbeat, encouraging relaxation, thus promoting a sense of calmness. The proposed TCM team will consist of the project coordinator, licensed mental health clinicians, master teacher, occupational therapist, speech and language pathologist, and program specialists all trained and skilled in providing behavioral interventions and family and caregiver support. TCM offers an additional level of care and intervention that cannot be achieved in the traditional Head Start classroom. In addition, the TCM team will support teachers and caregivers in consistent implementation of trauma-informed practices. By making these services available to those children with significant social/emotional concerns, we are able to increase stability in their Early Education placement, increase parent’s knowledge of parenting skills, increase parent and child resiliency, and improve parent-child relationships (see diagram 4). We will collect data to measure outcomes in the foundational pillar areas: 1. Enhanced parental involvement/increased knowledge of parenting skills 2. Improved children’s self-regulation and coping skills 3. Reduced teacher stress and improved coping skills 4. Coordinated referrals, services, and support plans to address identified needs

Who benefits? (1500 characters)

Our HS/EHS program’s current mental health services are built around the pyramid model of care [See Diagram 2 above]. At the bottom tier, all teachers are trained to develop nurturing and responsive relationships with children and to maintain high quality environments that support children’s individual needs. At the middle tier, teachers and Program Support staff implement targeted social-emotional supports, based on the needs of the classroom. At the top tier, Program Support staff supports teachers in developing and implementing individualized interventions for children with persistent challenging behaviors. The TCM will benefit all Head Start children, families, and staff. Children at the top tier of the pyramid are at the highest risk of emotional and behavioral dysregulation and these children and families will benefit the most from the TCM. Children with undiagnosed or undertreated mental health issues will directly benefit from the TCM and the early intervention services that will be provided. Healthy interactions in which supportive adults teach practical strategies to create an environment to bring about hope. NHA’s at-risk children and their families receiving Head Start services, their teachers, and other support staff will benefit. Ultimately, other San Diego early care and education professionals and programs, as well as national-level Head Start programs, will gain from our shared learnings.

What kind of impact will your idea have? (1500 characters)

We know from evidence-based interventions that when behavioral challenges in the classrooms are supported with mental health consultations, behavioral support/intervention plans, referrals to community resources, and additional services, the rate of suspension and expulsion decreases dramatically. The TCM will address and reduce the amount of preschool suspensions and expulsions that we currently see in early childhood education. Creating a high quality supportive environment and using intensive intervention strategies will provide a relationship-based service model that positively impacts everyone in the classroom environment. The goal is to provide specialized and intensive mental health services and developmental support for children and families in the EHS/HS program who might otherwise not have access to services. The TCM will allow a greater number of children ages birth to 5 and their families who are enrolled in our HS/EHS program to gain access to critical services designed to improve outcomes. The goal of the TCM is decreasing challenging behaviors, increasing social skills and resiliency, improving parent-child relationships, and improving educational outcomes. Teachers and center- based staff who have ongoing communication with families will be encouraged to promote the services and initiate the “warm-hand off.” By doing so, we hope to decrease stigma around mental health treatment, and increase follow through with recommended services.

How does or how could your idea impact low-income children? (1500 characters)

Head Start serves children from low income families that meet federal poverty guidelines. The TCM fosters resiliency by aligning with the Strengthening Families Protective Factors Framework in which five key protective factors are promoted and risk factors, addressed. Resiliency helps children and families adapt well to adversity, trauma, and significant sources of stress, like poverty; it helps one overcome risk for juvenile delinquency, substance abuse, and mental illness. It’s the same skill that helps enable one to break out of the cycle of poverty, to thrive in spite of challenges. One protective factor, for example, that demonstrates this is “concrete supports in times of needs”. Head Start parents often face significant barriers when accessing varied services. These can include a lack of health insurance, limited English proficiency, cultural differences, and transportation issues. The TCM will provide culturally competent, trauma-informed services to high risk children and families in the classroom environment, addressing some of these barriers and facilitating access to “concrete supports”. Nurturing, attuned caregiving relationships are also a protective factor. By addressing teacher and parent stress, children benefit from being in relationship with well-regulated adults who can help them learn to self-regulate. Forming strong attachments and having the ability to self-regulate leads to emotional intelligence, a foundation for success in all aspects of life.

Innovation: What makes your concept innovative? (1500 characters)

The TCM is a new way of meeting the needs of children at-risk for preschool suspension/expulsion that are undiagnosed or undertreated for mental health concerns by bringing clinicians to them. When parents are referred to outside agencies for follow-up services, they are not always able to follow through and their children remain at high risk for suspension/expulsion and having ongoing problems in school throughout their lives. The TCM is innovative because it offers a way for families to obtain mental health services for their children without creating an additional burden for the family. It also has the added benefit of being an environment that the child is already familiar with and providing high quality intervention strategies that can be used by staff in the classroom environment.

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

NHA understands that sustainability requires structural transformation; moving resources from lower to higher productivity. It requires effective governance, accountability and access to information and growth, particularly income and capital. The program will be sustained through a combination of individual support, corporate sponsorships, and grant funding. The project already has strong support from community partners and leaders and we are confident that with data collected on outcomes from the TCM, that we can leverage this support to obtain additional funding and sustainability. The promotion of outcomes and system change will also help sustain the program and leverage resources in both manpower and monetarily to sustain the program. We will work to build a diverse funding portfolio and fundraising efforts will be ongoing. Additionally, we will garner opportunities for reimbursable services, as well as fee for service opportunities.

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

The feasibility of implementing our TCM is high; it’s grounded in evidence-based practices, rooted in highly qualified and motivated staff with experience in implementing trauma-informed care in early childhood education, and it’s nestled in a solid organization with a history of delivering. The need is here for us to respond to, and our community partners eager for and supportive of leadership in addressing the severity of social-emotional and behavioral challenges in early care and education. Good planning with a sound program design has been undertaken. A budget and an implementation timeline have been developed to support segments of the model that we started implementing in 2009 (See Implementation Phases). We have an identified classroom that is centrally located, with transportation assistance if requested. In addition, we have alternative funding that we continue to pursue in order to move the needle in addressing social-emotional wellness in our Head Start community. The buy-in and support of NHA’s leadership has been offered, with a clear commitment of support articulated. Many elements of the TCM have already been successfully implemented within our system of care. The next step of integrating the elements into a whole is desired.

Business Viability: How viable is your business model? (1500 characters)

For over 100 years the Neighborhood House Association (NHA) has been afforded the opportunity to help thousands of families in need throughout San Diego County. Our vision has been to lead the way in developing confident, self-sufficient, healthy families and communities. Our goal is to continue this vision for the next 100 years. NHA is a multi-purpose, social service agency and has 23 programs which collectively meet the needs of those individuals who are unable to be totally self-sufficient. We provide assistance in the area of community development, on-the-job training, education and human services. NHA has been operating Head Start Early Childhood Education programs for over 50 years. Currently, NHA directly operates 30 early childhood education centers and collaborates with other childcare partners to provider Head Start/Early Head Start services to over 7,000 children annually.

HCD: How have you used human centered design to build or refine your concept? (1500 characters)

NHA’s Head Start program utilizes a continuous quality improvement process to identify successful processes and strategies to engage key stakeholders--parents, staff, and our community partners. NHA has utilized a variety of informal and formal methods to inform the development of our proposed design: impact surveys, annual Community Needs Assessment, annual Self-Assessment, Policy Council parent feedback, varied screening tools such as the Strength and Needs Screening Tool, specialized professional learning communities, and Care and Case Coordination. Reflective conversations intentionally designed to ensure safe and transparent discussion have helped to identify the needs and inform the development of the TCM model. Participation in meetings such as the Community Behavioral Health Services System of Care Council, Early Childhood Subcommittee meeting, have established NHA’s Head Start as a leader in addressing the social-emotional well-being of young children and helped to understand the breadth of this challenge in our community.

Tell us more about you (3000 characters)

When I think of an environment that would support the learning and social-emotional experience of "David and Rinna," 4 year old fraternal twins at our center, with a history of in-utero drug and alcohol exposure, physical abuse and multiple kinship and foster care placements, I imagine an indoor/outdoor classroom that invites curiosity, adventure, and joy with a variety of multi-sensorial experiences to aid in their self-regulation. Our centers have several little "Davids and Rinnas." These are some of our children who would benefit from a therapeutic classroom community. I believe this type of environment would contribute to the child’s success, not only in preschool, but also in life! I am inspired by the philosophy of Ubuntu, and envision our therapeutic classroom community to embrace the belief in our interconnectedness and the importance of showing compassion to oneself and others. Incorporating mindfulness and movement in our social-emotional curriculum would not only aid in self-regulation, but would also help bring about strong and lasting adult to child and child to child connections. I started my career in early childhood mental health as a Registered Art Therapist and Play Therapist. I utilized art and play modalities to help youngsters create narratives about their experiences. I furthered my career by becoming a clinical psychologist in San Diego, where I specialized in trauma work and infant-toddler-preschool mental health, focusing on attachment and self-regulation and the impact of culture in care-giving practices I’m a child psychologist and the Associate VP of Comprehensive Services & Quality Improvement at NHA Head Start. Even as an administrator, I continue to be immersed in the direct service of mental health services in Head Start. I truly believe in the importance of early childhood experiences and their impact in creating blueprints for future relationships. I am keenly aware of the profound impact of poverty, trauma and in-utero drug exposure on the child’s development, the way he/she perceives the world and the way healthy relationships are developed and sustained. I am excited about the meaningful difference we could make in helping create therapeutic classroom communities which help build strong connection and partnerships with families as we support their children in their healthy development.

Do you have the people and partners you need to do what you’ve described? (500 characters)

We currently have a partnership with Live Well San Diego to promote wellness for teachers, support staff, and parents through physical fitness classes and nutrition education. We are hoping to also partner with San Diego State University to participate in a study that they are conducting that is intended to reduce stress among preschool teachers.

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