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ESS Integrates Early Childhood Education Program with Mental Health Model


10 min read

Effective School Solutions (ESS) is nearing the end of its first year piloting an innovative evidence-based mental health programming model for early childhood. The model blends ESS’s proprietary Trauma Attuned Model® TAM® with a DIR® informed approach. During the ’21-22 school year leaders in the Monterey, California school district expressed concern to ESS staff about a distressing increase in disruptive behavior and other problems amongst its youngest learners. Many students who had spent their early years in COVID-related isolation were showing delays in reaching developmental milestones, and particularly in their ability to effectively self-regulate and socialize to classroom-based learning. Hoping to build on a successful partnership with ESS in the delivery of Tier II and III services for older students, administrators asked ESS to develop a Tier I program to assist its youngest students and agreed that ESS’s trauma-informed clinical approach combined with the child development model known as DIR® offered an excellent starting point.

The ESS Clinical Approach

Over the years ESS has incorporated numerous evidence-based clinical methodologies and perspectives into its clinical model. These include cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) along with The Nurtured Heart® and trauma attuned approaches.

The ESS Trauma Attuned Model® (TAM®) is a trademarked relationship-centered, evidence-based professional development model. The essence of trauma informed clinical approaches can be summarized in a simple question: that is, asking a disruptive student “What happened to you?” rather than “What’s wrong with you?”. “Bad” behavior is conceptualized as a survival response to past or ongoing trauma rather than as a child’s intent to be oppositional or difficult.

TAM® differentiates itself from traditional trauma informed approaches by stressing the creation of safe, nurturing, supportive, process-oriented, and socially cooperative classroom settings. In addition to providing ongoing professional development on TAM® for its own clinical staff, ESS offers teacher resources including Trauma Attuned professional development content for all teachers in districts that contract with ESS to provide mental health services in schools. The goal is to help teachers strengthen their own resiliency through awareness of trauma and its effects on overall health, development, and success. ESS consultants also offer practical advice about how to create and maintain safe and well-regulated trauma attuned classrooms. Teachers who strengthen and model their own resiliency will naturally strengthen the resiliency of their students, and TAM® offers a powerful way to become more attuned to trauma and thus promote health and wellness.

What is the DIR® model in Early Childhood Education?

DIR® is a Developmental, Individual-differences, and Relationship-based approach to child development. As described on its website, “DIR provides a foundational framework for understanding human development and how each person individually perceives and interacts with the world differently. It outlines the critical role social-emotional development has on overall human development starting at birth and continuing throughout the lifespan. The model highlights the power of relationships and emotional connections to fuel development. Through a deep understanding of the “D” and the “I” we can use the “R” to promote healthy development and to help everyone reach their fullest potential.”

Stanley Greenspan, MD, emphasizes that the model is solidly rooted in the science of human development, integrating major neuroscience discoveries from the last 10-20 years. It both incorporates and goes beyond existing methods that emphasize a behavioral approach to developing language competencies, behavioral self-regulation, and cognitive skills. A central concept of the approach is that most child development takes place within emotional interactions, that is, within the context of relationships, and does not simply follow a pre-existing biological-developmental roadmap.

Originally popularized as a method to help children with autism spectrum disorder, DIR® promotes the idea of entering a child’s world to determine how he/she experiences the environment, rather than superimposing pre-conceived notions about how the child “should” experience the world at a particular developmental stage. The identification of individual differences in the processing of both external stimuli and one’s own sensations is prioritized. Behaviors that are typically seen in individuals on the autism spectrum, such as repetitive behaviors and the tendency to either avoid or seek out sensory stimulation, are re-conceptualized in relation to developmental tasks that were skipped or not sufficiently mastered.

DIRFloortime® (Floortime) is the application of the DIR® model into practice and has become widely known as an approach to support children with developmental or emotional challenges such as autism spectrum disorder (ASD). Practitioners of the model strive to describe development from the unique perspective of each child, as well as how that individual youngster takes in, regulates, responds to, and comprehends the world, and how relationships fuel the child’s developmental journey. Emphasis is placed on finding the natural interests of each child is, rather than working from preconceived notions about what is rewarding or punishing for a child.

Children participating in DIR Floortime Model

The ESS — Monterey, CA Pilot Program

Long time ESS employee, Elizabeth Cotter, LPC, has led the development and oversight of the pilot program in Monterey, CA. She is a licensed professional counselor with certifications in the Nurtured Heart Approach and DIR® Floortime. Prior to her current role as Supervisor of Professional Learning and Development she was the Regional Director for ESS’s clinical services in Connecticut. She took time from her busy schedule to sit down for an interview about ESS’s newest initiative.

Ms. Cotter, please describe the scope of the problems that educators and parents are facing with early learners.

Well, it is clear that the youth mental health crisis is affecting all children, even preschoolers. Prior to the pandemic, prevalence rates of mental health problems in children aged birth through five years ranged from 16 to 21%, with 0.7% of children being expelled from preschool each year due to disruptive behavior. Not surprisingly, the risk of expulsion increases significantly for those children in preschools without on-site mental health services. Even more alarming is that American kindergarten teachers consistently report that 35% of children reach kindergarten each year unprepared to learn.

During the pandemic changes in daily routines and the stress of social isolation took a toll on children of all ages. Insurance claims for mental health related visits for children aged 5-11 increased by 24% between March and August of 2019-2020. ​Fifty percent of parents with children under 5 reported higher levels of stress during the height of the pandemic, and predictably we saw corresponding increases in children’s stress because families were exposed to such adversity.​

So, to say the least, parents and educators across the country are scrambling to bolster both academic and mental health support for students.

What are the key components of the Monterey pilot program?

This ESS-School district partnership was conceptualized as a comprehensive, year-long professional development experience for the district’s teachers. There are three distinct components or workstreams: collaborative, classroom-based coaching; professional development and reflective group practice; and mental health workshops for parents. The focus is helping adults attune to children — that is, to change the behavior of adults in a child’s orbit, rather than to find ways to make the child change.

The goals of the program are to help each child develop the capacity to form close and secure relationships with both adults and peers; to experience, manage, and express a full range of emotions; and to safely explore the environment and learn within the context of family, community, and culture. Psychoeducation and coaching experiences with teachers are designed to increase the understanding of child development, emphasizing the importance of play, sensory integration, and relational issues within a trauma-informed perspective.

A full-time, licensed early childhood mental health consultant with DIR® certification was hired to promote the development of the district’s young children by guiding and supporting the teachers and caregivers in their lives. The program includes 14 schools in Monterey Peninsula Unified School District and has concentrated on transitional kindergarten and kindergarten classes during the 2022-2023 school year. Within the framework of ESS’s TAM® model, the consultant helps teachers focus on both individual students and on creating classroom environments that take into account differences in sensory processing and integration.

Over the course of the year consultations were offered for 24 classrooms, and each received an average of six to seven weeks of observation and individual consulting. After the initial series of consultations, weekly meetings were offered as needed. Our consultant was also included in IEP meetings, mental health collaboration meetings, and in meetings of the MCBH mental health team located in Monterey.

What specific activities does the mental health consultant engage in?

One hallmark of the program is that the consultant tailors interventions to the needs and requests of individual teachers. These interventions are conducted both one-on-one in the classroom, and in small groups of teachers and parents, and can include any of the following:

  • Helping a teacher design a safe, structured, and nurturing classroom environment that minimizes triggers and maximizes opportunities for self-regulation.
  • Supporting a teacher’s efforts to effectively imbed evidence-based social emotional learning strategies and sensory integration activities into the academic classroom.
  • Observing and advising teachers on individual students and how the students interact with and respond to various aspects of the environment.
  • Developing a shared understanding of the effects of trauma and adversity on the developing brain and on how adults can support children’s positive behavior and development.
  • Modeling and demonstrating the application of early child mental health theory via group activities that teach how to support students’ social-emotional and self-regulation skills.
  • Gathering and analyzing data from child and classroom assessment tools to monitor outcomes.
  • Conducting training and reflective practices to help educators protect their own mental health.
  • Conducting parent training workshops to strengthen parent-child interactions, to increase awareness of attachment security, to foster school-family partnerships, and to connect families to community resources.

The program is very new, but what feedback have you received so far about its effects?

First let me say that the success of this program has been possible only because of the openness and vulnerability of the Education and MTSS teams. Teachers expressed curiosity for more child development knowledge and ways to assist students with challenging behaviors. Professional Development Workshops and consultations reached over 200 teachers who participated in advanced training in early childhood mental health. The year isn’t over yet, and we are gathering data as we go, but the responsiveness and effort of the teachers involved have been extraordinary and we are optimistic about what the data will show.

Perhaps the effects of the program so far can best be summed up by a School District Administrator who shared that “navigating the education system through the endemic environment has been a huge challenge with many new needs surfacing. MPUSD has recognized the increased behavioral and social emotional needs among our early learners, specifically our Transitional Kindergarten and Kindergarten ages. Effective School Solutions has provided us with integral support through providing our district access to essential services for our TK and Kinder teachers in navigating these new challenges from in a responsive and equitable way through ongoing professional development and direct coaching support.”

A Final Note: A New Frontier for Effective School Solutions

ESS’s partnership with the Monterey Peninsula Unified School District has yielded an innovative and exciting approach to supporting the academic and mental health needs of young children. It is designed to build the relational and emotional wellness that forms the foundation for school readiness and academic success. The model is designed to help adults learn strategies for attuning to children, entering their world via play, sensory integration, SEL, and other activities. Educators and caregivers who operate from this model give children the safety and space to develop a strong sense of self, helping to cultivate confidence, curiosity, self-control, goal-directed behavior, persistence, communication skills, cooperation, and the ability to relate to others, all of which are building blocks for academic and life success.


Home of DIRFloortime® (Floortime) – DIR® (

What is DIR.pdf – Google Drive

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