Social and emotional development is "fundamental" to children's mental health, says Kadija Johnston, program coordinator of the UCSF Infant-Parent Program. That's why child care providers, by promoting positive development, play such a key role in the prevention of mental health problems. Johnston and other experts suggest ways that child care providers can foster social and emotional development-and find help when they need it.

Value relationships

"It's not about teaching children," says Johnston, "but valuing relationships that develop between provider and child. [Infants] shake a rattle and it's exciting-because they made something happen and because an adult beams at them. The infant feels charming and wonderful...later they walk into a school feeling capable and confident," she adds.

Be "child focused"

"How you interact with a child makes the difference, being 'child focused' not 'task focused,'" says Janice Perry, mental health manager for Berkeley Head Start. "When children are playing ball [you should be] in there developing their social skills, helping them learn how to be in relationships," she adds.

At the Children's Collective in Los Angeles, the children have activities to build their sense of self-worth, including making life-size paper dolls and talking to the class about themselves, says director Jackie Kimbrough.

Help build friendships

"[Help] children learn how to make friends," says child care consultant Jean Monroe. "Have [them] work in partners, form groups around a project, have two children set the table or take out materials. Use [sharing time] to begin to teach the art of dialogue. Have the children pair off and talk with each other-telling each other stories, talking about feelings or how you help a friend who is sad."

"Do activities like making ice cream," says Kimbrough, "where each child has to contribute something to the task and all kids get something good at the end."

Respect culture

"Spend time talking with parents," adds Monroe, "observing how [parents and children] touch. [When hugging a child,] ask first. Or find someone [from the same culture] you trust and ask them: 'I'm a hugger, is that inappropriate?'"

"Hire staff that represents the populations you serve," says Tressa Tucker, family and child program coordinator at the Children's Collective. "If that's not possible, do research, train staff, bring in consultants. We had a growing East African population, but no [staff] from East Africa. We asked some of the parents to help us communicate with families and share about their culture."

Involve parents

"Every parent/teacher conference should report to parents on how a child is taking responsibility, standing up for his rights," says Monroe. "Make your class's goal for the month 'how to make friends' and talk to parents: 'Can you follow up at home? Help plan activities?'"

Watch for mental health issues

"Children can show problems by being hypersensitive or closing down," says Bill Carter, deputy director of the California Institute for Mental Health. Providers should look at children's emotional behavior, interaction with providers and their environment, and how well they meet developmental milestones, he adds.

But don't expect all children to be the same. "Keep temperament in mind," cautions Monroe. "Some children cannot sit in a circle-look to see if the child will sing the songs. Watch a child's play habits-do they dominate the play? Cry when they don't get their way? Can they make friendships with other children? Are they self-starters? Or does the teacher have to initiate [activities] because they don't know how to make choices? Look at everything and look for patterns."

Work with mental health professionals

When a provider is concerned or puzzled by a child's behavior, they should consult "a mental health person who understands child development and education," advises Monroe. "[Tell them] 'this is the behavior I'm noticing, can you help me understand it? What am I doing? What's the environment doing? What can I try?' [This person] comes in as someone who's objective-they can give informed suggestions and come back to see if they're working. They can work out alternatives with the input of parents and teachers."

The mental health professional can also do an assessment to see if the child would benefit from a play group to build social skills, mental health treatment, or a more thorough assessment. Head Start guidelines mandate mental health screening for new children and require each Head Start site to have a mental health consultant, Perry says.

Some child care centers have mental health staff-others centers may have ongoing relationships with drop-in mental health consultants, or provide mental health training for staff. "When I have the opportunity to be in the classroom more, I can make a tremendous difference," says Perry. "[I'm] there as a different pair of eyes, I can model different ways of behaving," she adds. Perry also plans to be trained through Project Relationship (see resources) to facilitate weekly sessions where staff talk about behavior concerns and ways to address them.

But most child care centers don't have any mental health professionals to consult. "The money needs to be there," says Kimbrough. "Teachers can't be expected to do the work of professional psychologists. [We need to] acknowledge that mental health needs are a basic part of child development."

Resources on fostering social/emotional development

• Fostering children's social competence, by Lilian Katz and Diane McClellan, $9. National Association for the Education of Young Children, 800-424-2460
  
  
• The child care provider: Promoting young children's development, by Carol Klass, $28. Brookes Publishing, 800-638-3775,
  http://www.brookespublishing.com
  
  
• How you are is as important as what you do, by Jeree Pawl and Maria St John, $12. Zero to Three, 800-899-4301, http://www.zerotothree.org

Resources on mental health consultants

• Project Relationship, provides trainings on facilitating discussions with child care staff about behavior issues, WestEd, Stephanie Myers, 916-492-4032
  
  
• Mental Health Screening Tool 0-5, a tool to identify young children most urgently in need of a thorough mental health assessment. Free. California Institute of Mental Health, 916-556-3480, http://www.cimh.org
  
  
• UCSF Infant/Parent Program, 415-206-5953
  
  
• Children's Collective, 323-231-1367
  
  
• Local child care resource and referral agency (for your local number call 800-543-7793) or community mental health clinic (look under "mental health" in the yellow pages)
  
  
• Child Care Health Program's statewide hotline includes mental health professionals, 800-333-3212.