At therapeutic preschool, emotionally challenged youngsters flourish

June 1, 2019


SANTA MONICA, Calif. — Patricia Pacheco and her husband had experienced rough patches raising their three eldest children, but she says they were unprepared for the mental health and behavioral challenges that have been arising with their two youngest children, 4-year-old Jacob and 2-year-old Thomas.

Pacheco, of west Los Angeles County, says because of developmental delays, Jacob has had severe speech impairments. He communicated his needs, wants and feelings by screaming. He found it difficult to play with other children. Lacking self-control, he frequently banged his head against the wall in anger and frustration. Pacheco and her husband struggled to find the right ways to address the behavior. Unable to change their son's behavior, they mostly stayed home rather than risk public outbursts, says Pacheco.

Hope came in 2017 when a child development organization recommended the family enroll Jacob in the Day Treatment Intensive Therapeutic Preschool at the Providence Saint John's Child and Family Development Center in Santa Monica.

Jacob started at the school in July 2017. Pacheco enrolled her youngest child Thomas this year because he was beginning to exhibit aggressive and defiant behaviors.

Therapeutic Preschool
Kabretta Wright engages with a student in the Day Treatment Intensive Therapeutic Preschool at the Child and Family Development Center. Wright is the program coordinator of the preschool, which provides intensive intervention to prepare students with serious behavioral issues to succeed in mainstream elementary schools. David Crane/©CHA

The preschool, which operates from 8 a.m. to 12:30 p.m. weekdays, provides early intervention for children with neurological, behavioral, emotional and/or psychological conditions. Children can be referred to the preschool after exhibiting troubling symptoms, such as frequent and intense tantrums, excessive defiance, depression, anxiety, withdrawal, trouble sitting still or inability to focus on an activity. The behaviors may be symptomatic of developmental disorders, post-traumatic stress disorder, prenatal substance exposure, or child abuse and neglect.

Purposeful play
The therapeutic preschool only has 20 spots. They are reserved for children ages 2½ through 5 with a high level of needs. (There is a wait list.)

The Child and Family Development Center started the therapeutic preschool in 1992. The preschool has two classrooms: one for the youngest children, the other for children who are more developmentally advanced. Each class can accept up to 10 children. Two mental health rehabilitation specialists staff each room. Members of a multidisciplinary team of specialists support them by circulating in and out of the classrooms throughout the day depending on the needs of individual children.

Team members include licensed clinical psychologists, speech therapists, early education specialists, occupational therapists, a child psychiatrist, licensed clinical social workers and psychology interns. The professionals are specialized in early childhood intervention and well versed in the mental health needs of children, birth through age 5, says Kabretta Wright, a clinical psychologist who is program coordinator of the therapeutic preschool.

The children play with toys and playground equipment; they have snack time; they have art time; and they talk about colors, shapes, letters and numbers. They do yoga exercises. Wright says the curriculum focuses on building social and communication skills, sensory processing and self-control (affect regulation, in the field's vernacular).

Playtime at therapeutic school
Agatha Morello, a doctoral psychology intern at the Child and Family Development Center, checks out a plastic pizza served to her by Leslie Santiago, during playtime at the center's playground. David Crane/©CHA

During every activity, the staff gets kids to talk about their feelings, in order to explore how to process those feelings. They build social skills by guiding the children in how to relate to one another and recognize the feelings of others. They teach the children how to self soothe and maintain control when they have intense feelings. The entire day, and every interaction, is structured around therapeutic goals, says Wright.

Those goals differ by child; treatment plans are based on thorough assessments of the child's diagnosis and developmental stage. They are devised in partnership with parents or guardians, who are taught to incorporate the relational and attachment techniques they learn at the center, back home. Preschoolers with developmental delays also receive occupational therapy, which can help improve organizational skills, fine motor development, gross motor development, communication, play and sensory processing skills.

Building trust
"Our first goal is to establish a secure attachment with the children," says Denise Sweeney, mental health rehabilitation specialist. "We do this by meeting them where they are — letting them know that whatever they are feeling is alright by validating and reflecting feelings and actions to them."

When a child is accepted into the therapeutic preschool, the staff conducts an extensive intake interview with parents or guardians. They answer questions about their history in relationships and how it impacts family dynamics now. Past or current upheaval in the adult family members' lives, such as violence, substance abuse and loss of a loved one could have led to dysfunction that can span generations.

Sweeney says because of their own trauma histories, many of the children struggle with forming secure attachments and trusting adults to take care of them. Alternately, children who have been traumatized may have trouble separating from the adults who are with them. Staff help the children to recognize and process their emotions, and model coping techniques, to establish healthier patterns.

Mental health rehabilitation specialist Rosalie Evans says the ultimate goal is to help children transition to a typical preschool or kindergarten.

Group effort
Allison Mininsky, a licensed clinical social worker and therapist, conducts sessions with parents to talk through parenting challenges and provides advice.She models effective strategies and helps to solve problems.

The therapeutic preschool rooms have one-way viewing windows so parents can watch as staff use behavior modification and other therapeutic interventions with the children.

Mininsky and other staff may use play therapy techniques to establish a safe environment for parents and children to process their feelings together and make sense of their past, while strengthening the parent-child relationship.

Parents often participate in individual, group and family therapy and parent support groups. Therapists can conduct counseling or observation sessions in clients' homes to get a feel for the family dynamics. The various interventions help parents work through their own history, so they can respond in a new way to their children.

Mininsky says, "We look at the parents' own attachment history, we analyze their attachments, because when they understand their own attachment history and how that plays out in their own parenting decisions, that can be eye-opening for them."

Pacheco says this type of intense work with staff and Jacob and now Thomas has been life-changing. She says Jacob is less anxious and has learned to express himself more calmly. Speech therapy has taught him to form words more clearly and he is more easily understood. His aggression has decreased as his communication has increased, she says.

"When people ask me about his school, I say, 'He has people who are prepared for the challenge, and they do this with love and patience.'"


Copyright © 2019 by the Catholic Health Association of the United States

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