How a Preschool for At-Risk Children Is Prioritizing Mental Health...

EdSurge Podcast

How a Preschool for At-Risk Children Is Prioritizing Mental Health During COVID-19 Closures

By Emily Tate Sullivan     Mar 31, 2020

How a Preschool for At-Risk Children Is Prioritizing Mental Health During COVID-19 Closures

This article is part of the guide: Navigating Uncertain Times: How Schools Can Cope With Coronavirus.

As the nation’s educators navigate the sudden school closures that the COVID-19 outbreak has brought upon them, many debates, decisions and news stories are focused on how students will continue to learn and receive instruction outside their brick-and-mortar school buildings.

And while academics are certainly important, for many kids school is so much more than a place for learning. It can be a reliable source of two meals a day, a refuge from an unstable home environment, or a way to access counseling and other mental health services.

So how are the children who depend on schools for those additional services getting by, now that seemingly everything in the country has ground to a halt?

Last fall, this EdSurge reporter spent a few days in southwest Ohio, visiting a specialized preschool program for kids who have experienced severe trauma. These are kids who depend on wraparound services such as meals, transportation and mental health services.

The program is called the therapeutic interagency preschool, or TIP. It serves 3-, 4- and 5-year-olds who have been abused, neglected or otherwise mistreated. Some have seen parents become violent with each other, or watched adults use drugs. As a result, about two-thirds of the kids are in foster care or live with a family member other than their parents. And all of them experience some variety of behavioral challenges and developmental delays.

To combat those delays—and reduce kids’ trauma symptoms, from anxiety and depression to aggression and dissociation—TIP staff use a combination of services, including one-on-one mental health counseling, a hallmark of the program. Children in TIP meet regularly with one of two licensed counselors on staff to talk through their experiences and build skills to overcome them.

So when the coronavirus hit the U.S., and Ohio Governor Mike DeWine ordered the closure of all schools statewide, beginning March 16, the staff at TIP had to scramble to come up with a plan: How would they ensure their kids got fed? Would they have to stop counseling sessions? Would the TIP kids slip further behind?

Ashley Dobrozsi-Ferguson, the director of the TIP program, and Jenny Minnick, one of the mental health counselors on staff, were gracious enough to make time to check in with EdSurge last week about what this crisis has been like for them, and how they are managing to make the most of an incredibly difficult situation.

Listen to this week’s podcast on Apple Podcasts, Overcast, Spotify, Stitcher, Google Play Music, or wherever you listen to podcasts, or use the player below. Or read the partial transcript, which has been lightly edited for clarity.

EdSurge: So when did this virus start to creep into your lives—into Ohio, and the TIP program?

Ashley Dobrozsi-Ferguson: Really, for the longest time we didn't think it was coming close to us. We knew it was out there, but then the second it started getting closer and closer to the United States, that's when we started going, "Hm, I think this is going to be a bigger problem than we realize.”

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And then, at the beginning of March, I think that's when we started thinking, “Something's going to change. This is going to affect our programming.” And I would say, in the span of that week before Gov. DeWine said that the schools should close, we knew something was about to happen. So we all started brainstorming pretty quickly. And it was a lot of trying to close the door to the office, listen to the [governor’s] addresses, and try to come up with the plan—just in case—until he finally said school should close for extended spring break.

How did it change the operation of your preschool? What does school at TIP even look like right now?

Dobrozsi-Ferguson: Well, it's kind of sad. That week after DeWine had schools close, it was just the site manager, myself, and even Jenny and Jasmine, the counselors, were at home at that time, too. We were kind of scrambling to come up with that plan. We normally have kids in here every single day, face-to-face, and we had heard of and toyed with the teletherapy thing to help Jenny and Jasmine ... but it was still that thought of, “Can we really do this with preschoolers?” And that was something that kept coming through. “Are we going to have to make days up?” And coming up with a calendar for Ohio Job and Family Services (another funder) to appease them, of making sure we fit our contract days.

We're trying the best we can, but there's still that sense of anxiety of, we have no clue how long this is really going to go.

Every day last week seemed like a week long, trying to figure out “How do we help families?” And then the next problem was, we work with families mainly in poverty, so we want to figure out how we can best serve them. And getting food out to them, and working with [the food bank] Shared Harvest and getting all of these plans set up very quickly. It seems like a lot more time has passed since then.

So you were weighing your options and whether you could do teletherapy and how you'd be able to deliver the normal services of the TIP program in some sort of remote or virtual way. What sort of solution have you arrived at?

Jenny Minnick: Well, I work for Talbert House, which is one of the largest mental health agencies in Cincinnati, and I don't think they've ever been faced with a situation such as this. Every day there have been daily communications by our CEO, and their original plan of action was business as usual.

Now, more than ever, is when our clients need the counseling services, and there are lots of adult programs and outpatient programs, so those doors continued to stay open.

But of course, for our program, with very young children in a collaborative nature, we had three different programs trying to come together to try to make TIP work in this situation. So we got continuous updates from our agency, from Talbert House, letting us know what was going to be acceptable practice as the use of telehealth was just kind of unfolding for us.

So it presents some interesting challenges with 3-, 4- and 5-year-olds, and it's been very interesting. Can I talk for a minute about some of the sessions I've been able to do so far?

Please do.

Minnick: So there were several platforms offered to us to use. The one I think that they really were preferring was Google Duo, [a video communication app]. And as [Dobrozsi-Ferguson] mentioned before, our families are families of poverty, but they do all seem to have cell phones and tablets. So this was a really easy platform for them to use and most of them already had it.

The interesting things I have found out since starting to do some sessions, is ... it's very different. The kids have had a hard time settling down and getting into the mindset of actually doing our “talk work,” which is what we typically call it with this age group.

And having a guardian or parent in the room with them has also shifted the whole [dynamic] of the session. As we all know, children typically tend to act differently when they're around their parent or their adult than they would in other settings. And so when, typically, they would listen to me, follow directives, engage with me, they were really struggling to do that because … some of them tried to engage the parents.

So there was a lot of time spent just getting acclimated to the platform. They wanted to show me around their room. They wanted to show me pictures of the backyard. They wanted to ask me where I was because they could see in the background where I was sitting in my home. So the first sessions were a lot of … rebuilding that rapport that we had.

Thankfully, I was able to bring home with me a lot of the tools that I use. So I was able to show them visuals of things that they were very familiar with. And I think that kind of helped draw them back into the right frame of mind to actually do a little bit of counseling.

So it's been interesting. This week was, really, my first week of using telehealth. I'm hoping sessions next week go a little bit more smoothly and that we can actually get some good work done.

But these first sessions have been interesting because I've been able to ask each of them how they feel about school being closed, about not being able to see their friends. And they've all had really interesting responses to that. So I think that in itself was therapeutic.

What were some of those responses? I mean, obviously this disruption is hard for anyone, and I would think especially so for kids who have been through what some of the TIP children have been through.

Minnick: It was interesting because the responses I got were not the responses I was expecting.

Some of the kids were excited to be home. They were glad to be spending time with their families. Some of them were really upset about not being able to come to school every day and being... A couple of them were angry. They didn't understand why they couldn't come. They wanted to know what their friends were doing.

One of the little boys I work with that I thought was going to be just the prime candidate for telehealth, he did not want to look at me. Every time he got his face in the screen, he just couldn't engage with me, and his mom was sitting right there. And I feel like that might've been part of it. But when I told him that two of his best pals in his classroom were also doing this with me from their homes, he got a little bit more interested in getting engaged with me. And he wanted to know about them, and how their sessions went, and what they talked about.

And I feel like what we're missing here is that universality… of all of the members of that group feeling like they're a part of the same thing. Because we're all in our own homes and we're all in different places, this one little boy I'm speaking of just recently was reunified with his biological mother, so that's all new to him too.

For many kids, the TIP program is a refuge. It's a safe haven from an otherwise complicated or fragile home environment. But the situation we all find ourselves in now is that people's home environments are at an even greater risk. There's an increased chance for anxiety and depression, suicide, substance abuse. So how are you thinking about that, and are you doing anything extra to support them and prevent a regression?

Minnick: One nice thing about this—this is a new aspect for me—but because the sessions are taking place in a virtual capacity, the telehealth, and the grownup who's responsible for their care is right there in the room with them in most cases, it also has allowed me to get a little bit of a better bond and connection with the caregiver. They're asking me for ideas and interventions. What can they do to continue to build on what the child was doing in counseling sessions? When our session with the child is over, they get on [with me] and they want to talk longer and it's almost like a therapy session for them.

And that's a piece that I really miss. The way we've advanced in our program, that's a piece for me that has gotten lost along the way.

I have phone conversations with [caregivers], and we exchange emails occasionally, but I'm really enjoying being able to see their faces, talk to them about what they can be doing at home with their child to continue to build the skills we're working on, and actually giving them each a little bit of counseling in addition to the counseling with the child.

We have a lot of families that are out of jobs now, because they worked in food service or a job that was not considered to be an essential service. So their anxiety is ramped up and some of our parents are recovering, are in the process of recovery from substance abuse, and I feel like any shoulder, any port in a storm, any ear they can get to them and empathize with them—this is just a really neat opportunity for me to do that.

Given that there may not be a near end in sight, and especially for TIP which is year-round, do you see the new arrangement you're trying to get to as something you could do for a few months? Is it somewhat sustainable?

Dobrozsi-Ferguson: I think so, for now. I think it's going to change the way that we do even outpatient sessions from here on. There are big breaks that we've had naturally in the past, and it's a nice thing to have in place just in case something catastrophic ever happens in the future.

Minnick: Definitely best of care, best practice, would be our face-to-face counseling sessions, and there's nothing that's going to substitute that. However, I do feel like this was good for us to learn how to do, for things like snow days or times when school is closed for some reason and we can't go in and do it face-to-face. Even in our two-week breaks at the end of the school year, before our summer session begins, I can bring children in for outpatient counseling sessions. They're still coming into my treatment room. But for something like a snow day or if a child's home sick, or something, I could still see being able to do a counseling session in this way.

And again, I think I'm really going to look at what I can do with more parent engagement using this platform to have some time to talk to parents about, like, “Try this intervention,” or “Say it this way.” I could do some in-the-moment coaching. I can do some PCIT-type things with them over telehealth, and I think this is just expanding our world a little bit.

Even though it seems like everything is closed down, I think this has opened up some opportunities and maybe some other options for us.

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