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PACEs in Early Childhood

As More Children Show Symptoms of Trauma, Head Start Programs Expand Support Services



This story is part of an EdSurge Research series about the early childhood education workforce.

  HAMILTON, Ohio — Suzanne Prescott first noticed the changes in children’s behaviors in 2015

"She was fielding reports of kids knocking over bookshelves, tables and chairs; hitting their classmates; and causing physical harm to themselves and their teachers. Not only were more 3-, 4- and 5-year-olds having outbursts, they were doing so with an intensity Prescott had never before seen. In some cases, staff had to evacuate entire classrooms to ensure the safety of the other children in their care.

Prescott oversees 18 Head Start preschool programs across two Ohio counties sandwiched between Dayton and Cincinnati. She recalls that when she got the job in 2011 as director of early childhood programs for the Butler County Educational Service Center, which encompasses Butler and Preble counties, “It was usually a couple of classrooms that we’d be like, ‘Whoa, this is really chaotic.’ I would get that call maybe two or three times a year.”

But in recent years, as the opioid crisis has transformed homes and communities across Ohio—overdose death rates in the state are up 300 percent since 2009—those calls have skyrocketed in number. Prescott says that every year for the last few years, she’s seen an average of two, sometimes three, children with significant behavioral challenges in each of the 40 Head Start classrooms under her purview.

She attributes this shift to the onslaught of the opioid epidemic, adding that “we saw behaviors in every single classroom we had.”

These challenges hit her staff hard. But fortunately, they had a playbook to pull from. A few miles down the road is the therapeutic interagency preschool (TIP), a 30-year-old program designed for children who have experienced severe trauma and face significant behavioral and developmental challenges as a result......."

By: Emily Tate


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These kids were my patients in rural Michigan.  They are everywhere.  In the article they  find the average ACE score for these kids to be 8 at 4 years old.  I found most of my infant patients had 3 or 4 of the 5 household dysfunction ACES at the first visit at a week of age.  

These are the kids who were the babies that I found on the 4 month Ages and Stages Social Emotional Screening but couldn't get the services that these babies needed via infant mental health for dyad work in the state's early intervention Zero to Three program (Early On).

Doctors or Visiting Home Nursing or basically anyone can give a family the social emotional developmental screening at 4 months of age and can find these kids too.   And these are the kids who start with Social Emotional Delays in Infancy, end up throwing chairs in Head Start at 3 - 4 years of age and that end up being kicked out of school at 8.  If I  can't get help for a baby who ends up being a 4 year old throwing a chair in Head Start, what can I do for the 8 year old with the High ACE Score?    It won't work to medicalize social problems.  I can't find safe daycare, provide safe employment, transportation, or education for all the parents of my newborn patients, but that is what the family needs and the baby needs the family to be healthy and safe.   We have one tool in medicine, a prescription pad.   So this is what happens.  These acting out kids might come to me at 4. They certainly get to me at 8 if they don't get to someone by 4.  If I don't give the diagnosis to them, and I won't,  they usually get a diagnosis of ADHD certainly by 8 and get started on a stimulant or because of the behavioral outbursts, very frequently these kids can be started on an antipsychotic at 4 years old for behavior control. Like I said, we have one tool in medicine, a prescription pad.  

Also the numbers of these kids in rural Ohio are 15-20 percent acting out..... what about the equally devastating damage being done to the kids who are acting in and just get passed along and never noticed? 

Can anyone see how big of a problem this is?   With no services to change these developmental trajectories, why we are attempting to force Peds doctors to get ACE scores on 8 year olds while we ignore the early signs that any one who is concerned can find when the baby is 4 months old and the developmental trajectory is easily modified with proper intervention?

It's a fair question. 

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