This story about early childhood mental health was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education.

SAN JOSE, Calif. — Chally Grundwag, a mental health consultant, faced three teachers gathered around a pint-size preschool table. “What kind of kids really push your buttons?” she asked the group.

The teachers at Kidango’s Dorsa Center in San Jose thought for a moment. “Crying ones,” one responded. “I want to say, ‘Stop crying; you’re going to be OK!’ But I can’t.”

A crying toddler may be a commonplace challenge for a parent, but for teachers confronted with more than a dozen meltdowns at once, stress can spike. And overwhelmed teachers may respond in a way that upsets the children further, setting off a cycle that contributes to a high rate of suspensions and expulsions for preschool children. That’s why Grundwag is trying to help.

Chally Grundwag, a mental health consultant, talks to director Chari Plumeri in an empty classroom at the latter's child care center. Jackie Mader / The Hechinger Report

“What do you do?” Grundwag asked the teachers who were sharing their frustrations with her.

“I say, ‘You can be upset. You can cry. I’m going to be right here,’” a teacher responded.

“We let them know we’re here to support them,” added Linda Aguilar, director of the colorful one-room preschool, one of 50 infant and toddler centers and preschools Kidango runs across the San Francisco Bay Area, serving mostly low-income students. “We try to be mindful all the time because you just never know. A lot are going through things.”

Grundwag nodded her approval.

She’s been working with this group and 20 other preschool teachers and directors in the area since the beginning of the school year.

Grundwag, who has a master’s degree in counseling psychology, says some preschool teachers may do things that can aggravate students’ misbehavior, such as talking about a student’s conduct in front of the child or speaking loudly and shaming students in front of their peers. By working with mental health consultants, Grundwag says teachers have a chance to vent, reflect and understand the needs of their students rather than getting frustrated, feeling isolated or losing their patience.

Every Tuesday, Grundwag spends hours here at Kidango’s Dorsa Center and another one nearby run by the same organization. She interacts with children, observes teachers and meets with staff members to help them develop strategies for dealing with difficult behaviors without resorting to yelling, time-outs or suspension. She also meets with families to share information on children’s social and emotional development, and conducts home visits as needed. One of the most important parts of her job is to act as a therapist of sorts to the teachers. She listens as teachers and center directors talk about their challenges, offers advice if needed and compliments teachers on what they’re doing well.

A student at a Kidango child care center in San Jose colors during play time. Jackie Mader / The Hechinger Report

Last fall, former California Gov. Jerry Brown signed legislation that will support putting more mental health consultants like Grundwag into publicly funded preschools and child care centers. The hope is that these experts will help teachers remain calm and focused in the classroom so they can be patient with their most challenging students. “Kids benefit from that, 100 percent,” Grundwag said.

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Nationwide, studies show that early childhood mental health consultations can help curb suspension and expulsion rates in preschools. In 2016, about 50,000 preschoolers were suspended at least once, and at least 17,000 were expelled, according to the Center for American Progress, a Washington-based liberal research and advocacy institute, which arrived at the estimate based on data from the 2016 National Survey of Children’s Health.

Black children and boys are more likely than their peers to be suspended, a fact experts attribute in part to implicit racial bias among educators. These suspensions don’t improve behavior and can have far-reaching consequences — children who are suspended in preschool are more likely to drop out of high school and later to be incarcerated.

California’s new legislation, written by Assemblywoman Blanca Rubio, D-Baldwin Park, and backed by Kidango, will increase the amount of money a preschool or child care center receives by 5 percent for each child who gets state funding if that center provides early childhood mental health consultation services.

Even a simple piece of advice the consultants provide can be transformative for both teachers and children. For example, a consultant’s assistance helped a pair of teachers who were at a loss on how to deal with a boy who arrived each day to his preschool classroom crying. No matter what the teachers did, he cried for several hours until it was time to go home. One of the teachers, becoming more and more frustrated, gave up. She decided to focus on the other children. The other teacher kept trying, but she felt like she was failing. She began to lose her patience, too.

That’s when Tena Sloan, a licensed therapist and now a clinical supervisor who oversees Kidango’s mental health consultants, made a visit. She and another consultant met with the child’s parents and then sat down to listen to the teachers. They soon discovered that at the child’s previous daycare, he was put in a locked closet when he misbehaved. That trauma was clearly sticking with him, Sloan recalled recently. “This child is now coming into this other setting not knowing that these teachers are going to be safe and supportive,” she said.

Almost instantly, the two preschool teachers felt more empathy for the child. They became more patient and their motivation to help the boy returned. With the help of their consultants, they created a plan focused around his needs. Instead of encouraging the boy to join in activities, they sat next to him to let him know he wasn’t alone. They found another child in the classroom who spoke his home language to provide more comfort. The boy still struggled, but slowly he began to feel more comfortable.

Student artwork hangs in a Kidango child care center. Kidango has been rolling out early childhood mental health consultations in many of its centers to help teachers better understand student mental health needs. Jackie Mader / The Hechinger Report

This support for early childhood staff can be immensely helpful for a stressed-out workforce. Early childhood teachers are often underpaid and work in demanding environments in which they must meet the needs of dozens of students each day. Research shows early childhood teachers deal with chronic illnesses at rates higher than other teachers of the same age. One survey found that almost one in four staff members at federally funded Head Start centers have clinically significant levels of depression.

These challenges can drive teachers to leave the profession: Some reports estimate the average annual turnover rate for early childhood teachers is as high as 40 percent, while others put it closer to 25 to 30 percent, nearly double the rate of K-12 teachers who leave the field or change schools each year.

Chari Plumeri, director of Kidango’s Ryan Center in San Jose, feels she is better able to understand her students’ home lives now that she talks to Grundwag on a regular basis, which has made working with challenging behaviors, such as hitting and talk of violence, easier. “Sometimes I see my kids’ behavior and I wonder what do they have to go through when they go home,” Plumeri said. “I try to understand that.”

Thanks to Grundwag, Plumeri has learned strategies such as modeling behavior to children who are nonverbal and tend to get frustrated. She also learned how to provide students with positive feedback to change their behavior and encourage “gentle hands” when dealing with aggression. “It’s really helpful,” Plumeri said. “I’m definitely more calm. The children really have a lot of energy, so you have to remain calm.”

In a recent survey of state mental health consultation programs completed by the Georgetown University Center for Child and Human Development, researchers found that at least 20 states use early childhood mental health consultations to some degree, and 11 have a statewide program. Every federally funded Head Start center across the country is required to use a mental health consultant, although the breadth of the services offered varies.

Research shows consultations work. A 2009 study found that, despite differences in approach or intensity, early childhood mental health consultations are “consistently associated with teachers reporting fewer problem behaviors among their students.” And a 2007 study found consultations increased staff “confidence and competence in dealing with troubling or difficult behaviors of young children in their care.” The consultations “generally helped improve overall quality of early care and education settings and was linked to reduced staff turnover,” the report stated.

Related: Rural schools find an online resource to fill gaps in mental health services for students

California has previously taken steps to curb preschool suspensions. In 2017, Brown signed legislation that prohibits state-funded preschools from expelling students until the programs have conducted various interventions and referrals to help children and their families. The state’s new focus on putting more mental health experts in preschools expands this effort.

“It’s all about supporting teachers,” said Scott Moore, CEO of Kidango’s child care center network. “It’s the teachers that ultimately are the ones that provide the support and the strategies that enable children to shift from challenging behaviors to positive behaviors.”

On the day Grundwag sat with the three teachers from the Kidango’s Dorsa Center, the teachers began to reminisce about one of their former students. The little boy had been particularly difficult, at times getting aggressive, hurting other students, and telling his teachers he was a zombie. “He watched ‘The Walking Dead,’” one teacher explained, referring to AMC’s zombie apocalypse television show.

“What shifted?” Grundwag asked.

Aguilar, the center’s director, explained that the staff changed their approach after working with the boy, trying to understand what he needed to help him cope in class without using violence. “We told him how he made people feel when he hurt them,” Aguilar said. “It wasn’t just the kids. He was affecting us too. He started to feel empathy.”

“You really read his cues and understood his world,” Grundwag said.

Linda Aguilar, director of a Kidango child care center in San Jose, meets with Chally Grundwag as part of the center's early childhood mental health consultation program Jackie Mader / The Hechinger Report

One reason the mental health consultant approach is so helpful for teachers is because many early childhood teacher-training programs include little, if anything, on the social and emotional needs of young children. “A lot of teachers are not coming to the classroom prepared to deal with the range of behaviors that they see in very young children,” said Deborah Perry, a research professor and director of research and evaluation at the Georgetown University Center for Child and Human Development.

Related: Opinion: We must acknowledge the connection between race, trauma and mental health

Although California’s recent steps have been promising, Kidango’s Moore said it will take time for such a large state to launch the program: Creating standards and regulations around mental health consultations can’t be rushed. It may also be difficult to find enough experienced mental health clinicians to work in the state’s publicly funded child care centers.

Teachers at the centers where consultants are already working said they’ve noticed a difference in both their ability to do their job and the behavior of students. “It helps you to vent,” said Ysabel Ramos, one of the teachers at Kidango’s Dorsa Center. “It’s very challenging being in the classroom. At the end of the day, we’re exhausted.”

Related: A new movement to treat troubled children as ‘sad not bad’

Aguilar recalled a little boy at her previous center who punched students and teachers. His behavior led to him being suspended from several centers before he arrived in her classroom. With the help of a mental health consultant, she created a “toolbox,” which the child could use if he needed to calm down and release some energy. Aguilar filled the box with a stress ball, a teddy bear, bubble blowers and other small toys that would distract and calm the child when he became angry.

In addition to giving Aguilar a way to redirect the behavior, this strategy had a clear impact on the child. “After he knew we weren’t going to kick him out,” she said, “his behavior started changing.”