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AAP joins groups calling for drastic reduction in early childhood expulsions :

July 27, 2016

High-quality preschool programs provide a foundation for a child’s academic, social and emotional success. Research also shows those who attend preschool are more likely to graduate from high school and less likely to be involved in the criminal justice system. Yet recent data show young children are being expelled from preschool at an alarming rate.

Data collected by Walter S. Gilliam, Ph.D., child psychologist at the Yale Child Study Center, found that 6.7 children per 1,000 enrolled in state-funded preschool programs faced expulsion compared to 2.1 in grades K-12. Surveys of non-state-funded child care centers have found even higher expulsion rates.

Of preschoolers receiving out-of-school suspensions, 78% are boys, according to the U.S. Department of Education’s Office of Civil Rights. There are racial disparities as well: Black children are 3.6 times more likely to receive one or more out-of-school suspensions as white preschool children.

Anecdotally, Dr. Gilliam has found children with aggressive behaviors who are bigger than their peers are more likely to be expelled. “Big, black and boy,” Dr. Gilliam said. “If you have one of those, you’re at risk for expulsion. If you have all three, you’re at the greatest risk of all.”
Academy supports joint federal policy

In 2014, the U.S. Department of Health and Human Services and Department of Education called on early childhood educators to work immediately to “prevent and severely reduce and ultimately eliminate” suspensions and expulsions. The federal government’s Policy Statement on Expulsion and Suspension Policies in Early Childhood Settings (http://1.usa.gov/1YrNRmo), which the Academy supports, outlines recommendations that include developing preventive guidance and discipline practices, strengthening family partnerships, investing in teacher/staff development, and establishing appropriate expulsion and suspension policies.

Expulsion, however, should be a last resort in extraordinary circumstances and not disproportionately impact any group of children.

In April, the Academy was among 31 organizations that signed on to a joint statement drafted by the National Association for the Education of Young Children expressing support for the federal policy (http://bit.ly/1YrYcyJ).

Negative impactsThe Academy and 30 additional groups signed a statement supporting joint federal policy to reduce and ultimately eliminate suspensions and expulsions.The Academy and 30 additional groups signed a statement supporting joint federal policy to reduce and ultimately eliminate suspensions and expulsions.
Preschool expulsion creates an “enormous handicap,” said Peter A. Gorski, M.D., M.P.A., FAAP, a member of the AAP Council on School Health Executive Committee. “Any child who is expelled or suspended immediately loses a few absolutely vital experiences, supports and resources for success.”
Children who are struggling the most face these disciplinary actions, which puts them at an even higher risk for not completing high school, Dr. Gorski said.
“Worst of all, the child feels singled out, isolated and humiliated and grows to confirm a negative sense of self that he or she carries into subsequent interactions with the next school or next environment. That builds an expectation that ‘I will fail’,” he said.
Improve training
“Expulsion is not a child behavior, it’s an adult decision,” said Elizabeth A. Isakson, M.D., FAAP, co-director of Docs for Tots, an organization in New York that connects pediatricians, policymakers and early childhood practitioners to improve children’s health. When teachers feel they lack the capacity to guide and correct a child’s behaviors, that child is more likely to be suspended or expelled, she said.
“There is good evidence that professional development for teachers and staff, evidence-based social-emotional curriculum and early childhood mental health consultation can impact social-emotional skills,” Dr. Isakson said.
Just one in five early childhood educators received training on social-emotional development in the past year, the federal policy found. Early childhood staff also report a need for more training on coping with challenging behaviors.
In partnership with the Child Care Council of Nassau, Docs for Tots offers one example of an evidence-based model of mental health consultation. The consultants work with the teacher on improving the social-emotional health and behavior of an individual child and classroom wide.
“Over time, the entire social-emotional health of everyone in the program has improved. All children are benefiting,” Dr. Isakson said.
The model is a small replication of the Early Childhood Consultation Partnership in Connecticut, a free statewide program providing mental health consultations to early childhood programs requesting assistance. Dr. Gilliam said his latest research, which soon will be published in the Journal of the American Academy of Child & Adolescent Psychiatry (http://bit.ly/29t58qZ), shows the program has improved behaviors within the classroom.
Connecticut is one of the only states to invest in early childhood mental health consultations, Dr. Isakson said. There remains a strong need to fund programs like this, which prevent preschool suspension and expulsion, she said.
How pediatricians can help
“I'm quite sure that all thriving pediatric care centers have several children who have or will be expelled from a preschool setting,” Dr. Gilliam said.
In addition to serving as allies who help parents identify quality early childhood programs, pediatricians also should ask parents what they think about their child’s teacher or care provider, Dr. Gilliam suggested. When teachers and parents know and like each other, suspensions and expulsions do not occur, he said.
Many children with behavior problems also have learning disabilities, and pediatricians should conduct regular developmental screenings and make referrals to specialists if difficulties are identified, Dr. Gorski said. It’s important to “screen for strengths,” too.
Asking the child “what do you love?” or “what do you do well?” can help identify a child’s talents, which doctors, parents and teachers can use to build the self-esteem and self-confidence that’s critical to social-emotional health.
Most importantly, Dr. Gilliam said, pediatricians should regard suspension and expulsion as a safety concern, especially for working parents with limited child care options. Quickly connecting parents with their local child care resource and referral agency can prevent gaps in child care.
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