Individualized Intervention with Infants and Toddlerscsefel.vanderbilt.edu/resources/inftodd/mod3/script.pdfIndividualized Intervention with Infants and Toddlers: ... support plan

Rev. 11/11

The Center on the Social and EmotionalFoundations for Early Learning

Infant Toddler Module 3

Individualized Interventionwith Infants and Toddlers:

Determining the Meaning of Behavior and DevelopingAppropriate Responses

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This material was developed by the Center on the Social and Emotional Foundations for Early Learning with federal funds from the U.S. Department of Healthand Human Services, Administration for Children and Families (Cooperative Agreement N. PHS 90YD0215). The contents of this publication do not necessarilyreflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizationsimply endorsement by the U.S. Government. You may reproduce this material for training and information purposes. s

Developed by Amy Hunter and Kristin Tenney Blackwell

Office ofChild Care

Office ofHead Start

Administration forChildren & Families

Rev. 11/11 The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel P 3.1

Learner Objectives Suggested Agenda

Participants will be able to:

• Define and identify thecharacteristics ofchallenging behavior forinfants and toddlers.

• Describe the relationshipbetween behavior andcommunication of infantsand toddlers.

• Identify ways to partnerwith families inunderstanding andaddressing concernsabout infant and toddlerbehavior.

• Describe and use aprocess for developingand implementing asupport plan to respondto challenging behavior.

I. Setting the Stage 30 minutes

II. What is Challenging Behavior 45 minutes

III. A Relationship Based Approach to Challenging 210 minutesBehavior

IV. Developing an Individual Support Plan 120 minutes

V. Wrap-up, Reflection and Action Planning 30 minutes

Total Time 7 hours and 15 minutes*

* Trainer’s Note: Total time does not include optional activities.The seven plus hours worth of training content is recommendedto be delivered over the course of multiple days rather than tryingto fit the full content into one day

Individualized Intervention with Infants and ToddlersModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel


P 3.2Rev. 11/11

Materials and Equipment Needed

! Agenda

! PowerPoint Slides

! Facilitator’s Guide

! LCD Projector and computorfor displaying Powerpointslides and videos

! Chart paper or white boardand markers

! Masking tape for postingchart paper

! Sticky notes

! Markers

! CSEFEL VIdeo Clips

! Handouts3.1 Participant PowerPoint Slides

3.2 Overview of CSEFEL Infant Toddler Modules

3.3 Classroom Considerations

3.4 Considering Circumstances

3.5 Acting Out and Withdrawing Behaviors

3.6 A Different Perspective

3.7 What is My Perspective?

3.8 Strategies for Responding to Infant and Toddlers’Challenging Behavior

3.9 Infant-Toddler Observation Documentation

3.10 Getting to Know Michael

3.11 Infant-Toddler Behavior Review

3.12 Talking with Families about Problem Behavior:Do’s and Don’ts

3.13 Infant-Toddler Action Support Plan

3.14 Maria: A Case Study

3.15 Trainer Discussion Points (Maria’s Case Study)

3.16 Planning for Change

3.17 Session Evaluation

! Video Clips3.1: What is the biting trying to tell us?

3.2: Looking at behavior that is of concern

3.3: Katie and Muk

3.4: Muk

3.5: Observing Michael

3.6: A full response to challenging behavior



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Trainer Preparation

! Setting the Stage: chart paper, markers, sticky notes

! Setting the Stage (Optional Activity A: Building on Strengths): index cards (2-3 per participant,bend edges prior to passing out), chart paper, markers

! What is Challenging Behavior? (Optional Activity B: Classroom Considerations): pens or pencils

! What is Challenging Behavior? (Activity: Considering Circumstances): chart paper, markers

! A Relationship Based Approach to Challenging Behavior: Examining Behaviors: chart paper, markers

! A Relationship Based Approach to Challenging Behavior: Responding to Infant and Toddler Distress(Optional Activity C: Who Am I?): blank paper, pens or pencils

! Developing an Individual Support Plan: Program Protocol: chart paper, markers

! Developing an Individual Support Plan: Program Protocol(Optional Activity E: Examining My Own Behavior and Setting Goals): blank paper, pens or pencils

I. Setting the Stage(30 minutes)

I. Setting the Stage (30 min.)

A. Slide 1. CSEFEL Module 3: Infant Toddler and introduceModule 3 by name. Then begin with a welcome to thegroup; an introduction of all speakers; and a brief overviewof who you are, where you are from, and any backgroundthat is relevant to this training event.

B. Slide 2. Activity: Find Someone Who… Have participantsfind someone with the same first or last initial (if possible).Once participants have paired up or come together in smallgroups, have pairs/groups discuss their previousexperience in trainings related to challenging behavior (ifthey have had any). Have participants also discuss howmany years of experience each person has in the infanttoddler field. Bring participants back together as a largegroup and encourage participants to share some highlightsfrom their partner discussion. Elicit the following points:

• Participants have likely had a varying level ofexperience with past training on challenging behavior.Some past training experiences may have been positiveand helpful and other training experiences have perhapsnot been as helpful. Our past experiences with trainingslikely inform our expectations regarding this training.

• There is likely a great deal of experience in the room ofparticipants. Encourage participants to share theirexperiences and real life examples throughout thetraining to keep the training applicable to their work withchildren and families.

C. Distribute all handouts including PowerPoint Slides(Handout 3.1) and other resources.

D. Slides 3 and 4: Learner Objectives. Review withparticipants. Show Slide 5: Agenda and reviewwith participants. Also refer participants toHandout 3.2 for a more detailed list of all thetopics in each of the modules including those inModule 3.

E. Address logistical issues (e.g. breaks, bathrooms,lunch plans).

F. Encourage participants to ask questions throughout thetraining or to post them in a specially marked place(parking lot).



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Handout 3.2: Overview of CSEFEL Infant Toddler Training Module ContentModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H 3.211/11

Module One: Social Emotional Development within the Context of RelationshipsI. Setting the Stage

Learner ObjectivesAgendaTraining EnvironmentShared AgreementsWords We UseUnderstanding the Pyramid

II. Understanding Social Emotional DevelopmentWhy Focus on Social Emotional Development?CSEFEL Definition of Social Emotional DevelopmentABC’s of Social Emotional DevelopmentKeys to School ReadinessStrategies Caregivers Can Use to Support Social Emotional DevelopmentSelf RegulationThe Developing Brain and Strategies to Build Brain ConnectionsObservation and Reflection as a StrategiesLearning from Families

III. Understanding Behavior: Making Sense of What You See and HearReading CuesHow do you Respond?Knowing Social Emotional MilestonesDevelopmental Challenges and OpportunitiesTemperamentThe Relationship between Social Emotional Development and BehaviorThe Basics of BehaviorSocial Emotional Development and Values, Beliefs and AssumptionsExamining Our Emotional ReactionsStrategies for Responding to FeelingsCultural Influences

III. Forming and Sustaining Relationships with Young Children and FamiliesWhat are Relationships?Strategies to Build Relationships with Young ChildrenAttachment RelationshipsStrategies to Build Relationships with Families

IV. Nurturing and Supporting the Social and Emotional Development of Infants Toddlers and TheirFamilies

Understanding FamiliesRisk Factors Affecting FamiliesMaternal DepressionStrategies to Respond to Maternal DepressionWorking with Families

V. Essential Positive Messages

VI. Major Take Home Messages

Handout 3.2

Handout 3.1 Powerpoint HandoutsModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H3.111/11

Handout 3.1

G. Slide 6. Our Learning Environment.Ask the group: “Are there ideas or requests that you mightwant to ask of your colleagues to make the trainingenvironment effective and conducive to learning?” or“Think about what makes a positive learning environmentfor you. What are those things?” If participants don’t havesuggestions, suggest some of the typical sharedagreements listed on the next slide.

Trainer!s Note: You may want to share with the group thatyou are choosing to use the term “shared agreements”instead of “ground rules.” “Shared agreements” is meant toreflect agreements made by the group rather than “rules”imposed on by others. Also, “rules” sometimes have anegative connotation. Some people say “rules are made tobe broken.”

Once the group determines the shared agreements, theymight also discuss how the group will hold to theagreements during their time together.

Explain that participants and trainers will be spending asignificant amount of time together whether it is all in oneday or it is over a period of days. It is important that thegroup decide what kinds of agreements (sometimesreferred to as ground rules) they feel are important.Shared agreements describe the expectations for howtrainers and participants behave with one another. It isimportant for participants to share with one another someideas about how the training environment can bestructured to maximize comfort, learning, and reflection.This discussion, sharing and agreement of expectationshelps contribute to the development of a safe, respectfullearning environment for adults.

Slide 7. Possible Shared Agreements. Use chart paperto write the list of shared agreements the group createdand/or review the list of potential shared agreements onthis slide to help generate ideas. Let participants knowthey can add to the list of shared agreements throughoutyour time together.



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Slide 8. The Words We Will Use.Discuss with participants the words that have beenchosen and will be shared and used at different pointsthroughout the training session. Describe to participantsthat it is important to be on the same page about what ismeant by the words used in the training.

• Teaching and Supporting: The significant role of theadult caregiver is referenced differently nationwide -teachers, care teachers, early learning caregivers, etc.Whether using “teaching” or “supporting,” we arereferring to the responsibility of the adult to observeand reflect on what infants/toddlers are experiencingand how they learn, as well as how to support thislearning through consistent, responsive interactions(e.g., ways they care for infants, read cues, meet theirneeds, etc.) and their relationship with the child andfamily. It is about facilitating development or in otherwords, supporting growth and development. Ascaregivers observe and think about what they see andhear they can plan for and design experiences in anenvironment that contributes to a child’s success.When we refer to “teaching and supporting” we alsomean individualized approaches that “meet” the youngchild where he or she is developmentally.

• Caregiving: The practices caregivers use to identifystrengths in infants, toddlers and families as theycreate supportive environments and help to nurtureand support the growth and development of infantsand toddlers socially and emotionally.

• Young Children, Infants, Toddlers and Preschoolers:Using “young children” generally refers to infants andtoddlers; however, there will be times that wespecifically reference and talk about a particular agerange such as infants, toddlers or preschoolers.

• Caregivers: “Caregivers” refers to a general categoryof ALL the adults who support the growth anddevelopment of infants and/or toddlers (e.g., child careproviders, parents, extended families, guardians,teachers, home visitors, public health professionals).

• Families: “Families” represents those primary,significant, familiar, caring adults in the infant and/ortoddler’s life.



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J. Point out that as the participants can see from theAgenda, we are going to talk about understanding andsupporting the behavior of infants and toddlers. Inaddition, we are going to spend time thinking about howto develop a systematic, relationship based approach toaddress infant and toddler behavior that has notresponded to the promotion and prevention efforts wehave already incorporated into care settings.

K. Show Slide 9: Pyramid. Point out that today’s training willfocus on the top level of the Pyramid.

Remind participants that the top of the Pyramid isreserved for the very few children who continue to exhibitbehavior that causes them difficulties even whencaregivers have attended to the issues addressed at thebase of the Pyramid: staff and parents have positiverelationships with children; the care setting has beenarranged carefully to promote appropriate behavior; andthere is an intentional approach to supporting thedevelopment of social and emotional skills.The infantsand toddlers we are focusing on are children whodemonstrate behaviors that do not appear to beimproving on their own or with the typical level of caredescribed in Modules 1 and 2.

a) Some infants and toddlers may come to us with thesebehaviors while others may develop them while in ourcare.

b) Our goal is to address the distress of these veryyoung children and to intervene before the behaviorbecomes entrenched for the child and seriouslyimpacts the family, the care setting, and the child’srelationships.

c) Explain that an important reason to be able to respondeffectively to this group of children is that we know thatmany of them are vulnerable and are at risk of beingexpelled from child care settings, if these behaviorspersist.

d) These are often the children (and families) who couldmost benefit from the support of a high quality careand education program.



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e) Persistent challenging behavior (i.e., not the normalchallenges that are frequently related to typicaldevelopment) usually does not just go away on its ownbut rather continues over time and creates moreproblems for the child in his/her relationships anddevelopment.

f) Research shows that for older children with behaviorproblems, these problems were regularly identified inthe earlier years.

L. Slide 10: Social Emotional Wellness. In Module 1, wedescribed and explored the definition of social emotionaldevelopment in infants and toddlers as the developingcapacity to:

• experience, regulate and express emotions;• form close and secure interpersonal relationships; and• explore the environment and learn• all in the context of family, community and culture.

These are the skills and characteristics that infants andtoddlers bring to their ability to cope with distress. One ofour tasks as caregivers is to support the development ofthese coping skills that are the hallmarks of early mentalhealth.

In this module you will learn how to support infants andtoddlers who struggle with these tasks to the extent thattheir overall development is threatened. We will: 1)explore reasons for these struggles, 2) describestrategies for understanding the child’s uniqueexperience, and 3) consider ways to support andreinforce the child’s skills.

II. What is Challenging Behavior? (45 min)

A. Slide 11. What is Challenging Behavior? Share withparticipants that in this section of the training the focuswill be on defining and identifying the characteristics ofchallenging behavior.



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II. What is ChallengingBehavior? (45 min)

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B. Activity: What is Challenging Behavior? Ask participantsto work in small groups. Brainstorm what specificbehaviors (e.g. crying, hitting, non responsive, etc.) theyfind most challenging in infants and toddlers. Haveparticipants write their responses on sticky notes (onebehavior per sticky note). Let participants know you willcollect the responses (sticky notes) from each smallgroup. Post the sticky notes on chart paper. Read asampling of the sticky notes to the larger group.

C. Slide 12. CSEFEL Definition of Challenging Behaviorfor Children Birth to Five. Each of the bulleted pointscan apply to infants and toddlers as well as preschoolers.Ask the participants if they can think of other aspects of



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Optional Activity A: Building on Strengths (20 minutes)

Offer index cards to participants. Provide 2-3 index cards to each participant. Say toparticipants, “Write a word or a phrase (one per card) that describes a child you care forwho displays challenging behaviors. Think about the really tough, challenging days.When you are done, toss your completed cards to the center of your table to berandomly selected and noted on chart paper.” For example, others who have done thisexercise have come up with words such as “stubborn,” “hyper,” or “cries all the time.”

Collect the index cards and write as many of the listed phrases on chart paper or a whiteboard that you can. Review with participants. Ask participants, “Is there anything thatsurprises you about the list?” or “How does it feel reviewing this list?” You may receiveresponses such as: “It feels gloomy now in here,” or “I did not realize I was lookingnegatively at his behaviors,” or “That’s how I was described as a young child.”

Next, challenge participants to examine the words listed and consider that each andevery one of the words noted could be reframed to be a potential strength. Review thelist again with participants and ask them to replace any “negative” words with words thatidentify a potential strength. For example, “stubborn” might be reframed as “persistent;”“hyper” might be reframed as “curious” or “active;” “cries all the time” might be reframedas “sensitive” or “able to express himself.”

Trainer!s note: To help participants with this portion of the activity, consider asking them,“As you look at this list, are there any words that were used to describe other childrenyou knew or even you when you were little? If yes, is this characteristic an asset orstrength for that child or for you today?”

Once the new, strength-based list has been created, read it out loud. Consider startingby saying, “Young children who display challenging behaviors are …e.g. persistent,sensitive, expressive, etc.”

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challenging behavior that are not listed or covered in thisdefinition. Review how the behaviors listed on the stickynotes may correspond to the definition. Elicit from theparticipants the point that challenging behavior is oftencaregiver specific. In other words, what is challenging toone caregiver may not be challenging to anothercaregiver. Let the group know that specific types ofchallenging behavior will be discussed later in themodule.

Ask participants for examples of how challengingbehavior of infants and toddlers may interfere withlearning and/or engagement in pro-social interactionswith peers and/or adults. Offer participants the followingexamples to support the discussion if needed:

• A baby who is extremely fussy might receive lesspositive attention and physical closeness from adultsand, therefore, become delayed in her socialdevelopment, (i.e., responsive smiling, waving,responding to her name).

• Peers may begin to avoid a toddler who frequentlybites. As a result the toddler who bites may have lessopportunity to learn to play cooperatively or developage appropriate language skills. A parent of a childwho bites may also avoid or limit peer social situationsfor her child.

• A baby who is quiet and hard to engage may be leftalone frequently by caregivers who may not feelconnected to the child.

Summarize the consequences of not addressingchallenging behavior.

(a) When thinking about infants and toddlers, ourconcern centers on the “cost” to the child of continueddistress. Ask the participants what might be the priceor consequence of not addressing challengingbehavior early on. Elicit responses such as:

• the behavior may become habitual, more frequent,and/more difficult to change;

• the behavior may impact the quality of thecaregiving (e.g., a child with challenging behaviormay receive less positive interactions);



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• peer relationships may be impacted (e.g., otherchildren may avoid playing with a child withchallenging behavior);

• other developmental areas may be impacted (e.g., achild may be less able to focus on the other aspectsof learning due to expending energy on emotionalstress or challenging behavior);

• it is more expensive, more intrusive, and lesseffective to intervene later in a child’s life.

(b) Highlight for participants that our problem solvingemphasis is typically on relieving the distress the childmay be experiencing early on.

D. Show Slide 13: Reasons for Challenging Behavior.Share with participants that there are a number ofreasons why children engage in challenging behavior.Some of these include an undiagnosed health problem(e.g., a toddler is not hearing well because of repeatedear infections); a developmental surge (e.g., infant isbeginning to learn to walk); or a developmental problem(e.g., a baby may be overwhelmed by sensory input).

A major influence on the child is the social emotionalenvironment in which he lives and the quality andresponsiveness of important relationships. This includesboth current and past experiences. Exploring recent andpast changes with families is critical to understanding aninfant or toddler’s unique experiences.

We know that experiences such as chronic stress orwitnessing or experiencing abuse can impact babiesnegatively, however, even positive changes such as amove to a new home or an extended visit from a well-loved grandmother can be challenging to an infant ortoddler. Too much excitement or too many changes overa period of time can make it difficult for a very youngchild to maintain a sense of equilibrium. This may resultin behavior that is uncharacteristic of that child or that isa regression to an earlier developmental behavior (e.g.,waking in the night for a baby who has been sleepingthrough the night or toileting accidents for a child whohas previously been fully trained).

Ask participants if they can think of additional reasonsthat may contribute to a child engaging in challengingbehavior. Possible responses may include:



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Temperament: Temperament styles/traits are neithergood nor bad in themselves; what matters is how theenvironment responds to them. Families andteachers who understand and accommodatetemperamental traits will manage more successfully,gradually extending the child’s capacity to cope.

Substance abuse: Substance abuse duringpregnancy can lead to children being born withdevelopmental delays and difficulties with learning,memory, attention, planning, problem-solving,impulsiveness, hyperactivity, problems regulatingemotions, as well as perception and sensoryintegration.

Nutrition: Babies who are malnourished in uteromay be more irritable and unresponsive, and theirbehavior, such as a high-pitched cry, can make themdifficult to care for. They also may have troublehandling stress and focusing their attention.

Parenting practices: Particular parenting practicescontinue to increase the risk of challenging behaviorsas children grow older. When parents are notinvolved with their children, do not respond warmly tothem, and use harsh, inconsistent discipline, childrenmay react with defiant, aggressive, impulsivebehaviors.

Violence: Exposure to violence can affect children’sability to learn, to establish relationships with others,and to cope with stress. Even verbal conflict canupset children, and when it is combined with physicalconflict it can contribute to both emotional problemsand challenging behavior.

E. Slide 14 Activity: Considering Circumstances.Handout 3.4 Considering Circumstances.

(a) Ask each table of participants to create a list ofspecific life circumstances that could negatively affectthe behavior of an infant or toddler in their care.

(b) Then ask them to complete the handout by listingthese circumstances, hypothesize about the child’ssocial emotional experience, the family’s likelyfeelings, and then possible ways to support the youngchild and family. This might include sharinginformation or resources.



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(c) Families and children may have similar feelingsand/or react similarly to very different experiences.Similarly, different families and children may havevery different feelings and behaviors about similar lifecircumstances.

(d) Consider using one example to do with the entiregroup to illustrate how to use the chart.

(e) Elicit responses such as:



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• Poverty/inconsistent income

• Lack of transportation• Poor housing/too many

people/unsafe fromcommunity violence/loss ofhome /frequent moves

• Immigration from anothercountry /speak a differentlanguage/

• Social isolation/poor socialsupport

• Problem with substance use• Domestic violence /abuse• Parents or parent figures

recently divorced orseparated/away in theArmed Services or otherjob/incarceration

• Chronic conflict in thehome/extended family

• Sick parent or sibling• Recent death of important

family member/• Miscarriage• Parent with mental illness/

developmental disability

• Move to a new house• New Sibling• Visit from relatives

Insecure/UnsafeUnregulatedUnnoticedUnacknowledgedLack of controlAbandoned/IsolatedHelplessConfusedWorriedFrightened/Fearful

UnpredictableTiredAnxiousConfused

Angry/frustratedHelplessnessFearfulConfusedDepressed/Self-absorbedIsolatedWorried/anxiousAbandoned

TiredDistracted

Responses to the child inthese circumstance shouldalso include:• Acknowledgement of

distress• Comforting words• Attunement• Help in achieving the

understood intention

Take time to meet with andlisten to parents.

Establish partnerships withcommunity resources thatcould be helpful to familiesin finding housing, help fordomestic violence, mentalhealth services, translators,etc.

Establish a protocol forhow programs will becomeinvolved with difficult familycircumstances; (e.g., onlythe director meets with thefamily about the issue.)

Caregiver may reassurethe family that thesechanges, while welcome,can be stressful for babies.

CircumstancesChild!s Social

EmotionalExperience

Family!s LikelyCaregiver Actions that Could

Possibly Help Support theChild and Family

III. A Relationship Based Approach to ChallengingBehavior (210 min.)

A. Slide 15. A Relationship Based Approach toChallenging Behavior: Examining Behaviors. Welisted young children’s behaviors that are challenging tous. We also discussed the CSEFEL definition ofchallenging behavior which represents behaviors thatare a more serious challenge for a child and extendbeyond typical issues that respond to appropriatesocialization and guidance strategies.



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Optional Activity B: Classroom Considerations Handout 3.3(25 minutes)

Trainer!s Note: To help participants continue to connect with previous module material,consider the following optional activity to further emphasize the importance ofunderstanding environmental circumstances and prevention based strategies.

Ask participants to list challenging behaviors they experience in their classrooms in thefirst column. Next, have each participant complete the middle column, writing one waythey could adapt their classroom practices or environment to help prevent thechallenging behavior. Finally, have participants walk around the room, trying to fill inthe final column by discussing the challenging behavior with others. Use the thirdcolumn to write suggestions from other training participants.

Ask the large group how they think that the information from Module 1 will help themmoving into today!s training. Let them know that the focus of this training is on the manyways that infant-toddler caregivers can further develop and enhance their relationshipswith the infants, toddlers and families they care for, as well as consider additional waysto be intentional about building social emotional skills.

Depending on responses received from participants, consider supplementing thediscussion with the following points:

Caregivers who are intentional about providing responsive care have apowerful influence on the development of positive early relationships.

How a child!s brain functions is a direct reflection of early experiences –experiences matter because they change the way the brain works. Dailycaretaking routines such as holding, rocking, bathing, feeding, dressing,and talking to infants all help create new connections in the brain.

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III. A Relationship BasedApproach toChallenging Behavior(210 min.)

B. The activity we just completed shows how variouscircumstances can impact children’s experiences. Thecircumstances can create intense feelings on the part ofeveryone involved and the young child’s behaviors, orforms of expression, can sometimes be difficult tounderstand and leave caregivers and families feelinghelpless as they try to problem solve to help a youngchild toward well-being and away from distress.

C. Explain to participants that improving an infant’s ortoddler’s behavior requires intervening with the adultswho care for the child. Challenging behavior that isextreme impacts all the infant’s or toddler’s relationshipsincluding, but not limited to the: caregiver, family, andpeer relationships. The approach for addressingchallenging behavior of infants and toddlers is arelational one that addresses the challenges that mayexist within the relationships surrounding and includingthe infant and toddler.

D. Slide 16. Behavior is a Form of Communication. Oneway to frame our thinking about the behavior of infantsand toddlers is to think about behavior as being a formof communication. It may be helpful to encourageparticipants to ask themselves, “What is the meaning ofthis behavior?” or “What is this child trying tocommunicate through his behavior?”

E. Slide 17. Behavior: The Tip of the Iceberg. Askparticipants to picture an iceberg. Encourage them toparticularly focus on the “tip of the iceberg,” the partabove the water. Draw a picture of a large iceberg (or atriangle shape) with a small part of the iceberg (the tip)above water and the majority of the iceberg under thewater line.

a) The challenging behavior is what you see above thewater, (i.e., the tip). The tip shows the behaviorsinfants and toddlers use when they are not able to:

• experience, express, and regulate emotions• form close and secure interpersonal relationships,

and• explore the environment and learn, all• within the context of family, community and culture.



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b) The rest of the iceberg, which is hidden from sightbelow the surface, represents potential needs that arenot being met and skills that need to be developed -what is going on that causes the behavior. Like thelarger portion of the iceberg that is under the surface,the meaning of extreme behavior is often difficult tosee and to understand. Ask participants to identifysome of the key “essential needs” of infants andtoddlers and write their ideas on the chart paper nearthe bottom of the iceberg. This list may include:

• Feeling safe• Ongoing, responsive relationships with one or more

adults• Emotionally responsive social environments• An environment that is matched to the child’s

temperament• Structure and consistency• Good nutrition• Good health• Opportunities for movement• Rest• A sense of belonging within the family and culture• Engaging/stimulating environments

F. Slide 18: Expression of Emotion. When we think aboutthe behavior of infants and toddlers, much of thebehavior considered challenging is behavior thatexpresses strong emotion or little emotion at all. Thebehavior we are talking about is behavior that may betypical for a child’s developmental stage (e.g., tantrums)but it is the intensity, the frequency, or duration of thebehavior that causes it to be challenging to caregiversand that distinguishes it from typical behavior.

G. Slide 19. A 6 month old…. Use the example of a 6-month-old who cries for long periods of time unless he isheld by his caregiver. Ask participants to use thecomparison to the iceberg and ask the followingquestions:

a) What behavior, in this situation, would we considerthe tip of the iceberg? Look for the followingresponse: crying.



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b) Which social emotional skills may the child not havedeveloped or be able to use in this situation? Self-regulation (i.e., ability to self soothe by closing hiseyes, sucking a finger, taking a deep breath (for oldertoddlers.)

c) What might be “underneath the surface”? Look forthe following responses:

• He is scared when he is alone. The child carespace is noisy and frightening to him. (Feeling safe)

• He is lonely. He is held a lot at home because hisfamily believes that an infant should be held closeor perhaps he lives in a large extended familywhere there is always a pair of arms and the floor isnot a safe place for a baby. (Ongoing, responsiverelationships with one or more adults)

• He is sensitive and is anxious about the room noiseand the other children. (Environmental match totemperament)

• He does not feel good and may be getting sick.(Health)

d) Make the point that keeping the concept of theiceberg in mind can be helpful when thinking abouthuman behavior.

e) Our efforts to understand the meaning of thebehavior are the first steps in finding an appropriateresponse to the child. In other words, ourunderstanding of the meaning of the behavior iscritical in devising a strategy to address the situationthat produces the challenging behavior. All behaviorhas a purpose and for young children, thechallenging behavior it is not a form of manipulation.In other words, a young child is not purposefullybehaving in a way that is meant to cause difficulty.

f) It takes time and effort to understand the intent of achild’s communication and then to find new ways tofulfill the need or teach the child other ways tocommunicate his or her needs.



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H. Show Slide 20, Video Clip 3.1.What is the BitingTrying to Tell Us? Consider showing the video segment2-3 times so that participants feel comfortable workingtogether in small groups for activity. Activity: afterreviewing Video Clip 3.1, ask participants to pair up orgather in small groups. Using a blank piece of paper,have participants draw a picture of an iceberg andconsider the following three things:

a) What behavior, in this situation, would we considerthe tip of the iceberg? Look for the followingresponse: biting.

Which social emotional skills may the child not havedeveloped or be able to use in this situation? Look forthe following responses: Self- regulation, problem-solving skills (e.g., turn taking, verbally asking to playwith peer or play with a toy when the peer isfinished).

c) What might be “underneath the surface”? Look forthe following responses:

• He feels frustrated. He sees another child playingwith a toy he would like to play with and acts onwhat he is experiencing at the moment. He doesnot have the language necessary to control asituation, or his attempts at communication are notunderstood or respected.

• He is tired or does not feel good and may be gettingsick. (Health)

• He is feeling stressed. Perhaps his daily routinelooks different or he is lacking interesting things todo.

Debrief as a large group. Point out that observing closelyand taking into account varying circumstances, as wellas what might be going on “underneath the surface,” willhelp caregivers determine the most supportive andappropriate solutions and strategies.

I. Slide 21. Continuum of Emotional Expression. Makethe point that infants and toddlers have two primarystyles of behavior that communicate distress.



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J. Slide 22: Acting-Out Behaviors. The first group ofbehaviors has been termed “Acting-Out Behaviors”.

1. These behaviors have a driven quality that isexpressed either in the intensity, thefrequency, or the duration of the behavior.

2. Read through each of the behaviors one at a time.Ask participants if they have seen these behaviors inchildren in their care and take several comments fromthe group. Ask how these behaviors stand out frombehavior that seems more typical. Ask participants ifthere are other acting out behaviors they think of thatare not listed.

K. Show Slide 23: Social Withdrawing Behaviors. Thesecond group of behaviors is termed “WithdrawingBehaviors” or “Social Withdrawing Behaviors.”(“Withdrawing behaviors” are also sometimes referred toas “internalizing behaviors.”)

1. These behaviors appear intense because the childuses them so frequently or so consistently. A childexhibiting this type of behavior may appear to havegiven up attempting to get his needs met and to havemoved away from interaction with others.Nevertheless the infant or toddler is expressing hisexperience, and it may appear to be a preference.This type of challenging behavior is often overlookedin a busy childcare setting.

2. Read through the behaviors and ask participants ifthey have seen these behaviors and take severalcomments from the group. Ask participants if thereare any withdrawing behaviors not listed.

L. Show Slide 24: Activity: Where Do the Sticky NotesGo? Trainer!s Note: Using participant responses writtenon sticky notes from first part of training, (What IsChallenging Behavior, Slide 11), create two columns ona piece of chart paper. The first column heading shouldread “Acting-Out Behaviors” and the second columnheading should read “Social Withdrawing Behaviors.”Read each sticky note one by one and ask participants ifthe behavior on the sticky note would be considered an“acting-out” or a “withdrawing” behavior. Place the stickynote under the appropriate column heading. Letparticipants know in the next activity they will explore



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acting out behavior and withdrawing behaviors moredeeply. Most times, the acting-out behaviors far outweighthe withdrawing ones because these behaviors getnoticed more often as caregivers often feel the need to“put out those fires”.

Explain to participants that it is critical to pay attentionto the withdrawing behaviors just as much as, if notmore, than the acting out behaviors. Children whodisplay acting out behaviors often get our attention.Children who exhibit withdrawing behavior may easilyfall through the cracks and sometimes are evenconsidered the “good” children because they don’tdemand a great deal of attention. However, thedevelopmental trajectory for children who displaywithdrawing behavior may be even more challengingthan for those who display acting out behaviors (Mash& Barkley, 2003).

M. Slide 25: Activity: Acting Out and WithdrawingBehaviors—Handout 3.5. Provide each table ofparticipants with Handout 3.5. Each table will receiveeither the Birth to 9 months chart or the 8-18 monthchart. Participants will use the scenarios on the chart todescribe what an “acting out” behavior or a “withdrawing”behavior might look like in each of these developmentalelements, within the identified age group. Remindparticipants we are thinking about behaviors that areintense, frequent, and enduring enough to bechallenging.

Ask participants to use Handout 3.5 to note some ideasin response to the question, “What might be going on forthe baby?” Use the “What might be going on for thebaby” section to create more information to the scenarioto explain the child’s behavior. In other words, haveparticipants be creative to come up with circumstancesthat may contribute to the child’s behavior. Hypothesizeabout what the child may be experiencing or needingthat may contribute to his or her behavior.

Trainer!s Note: The infants in these scenarios rangefrom 2 months of age to 18 months of age. While it iscritical to understand that infants under 2 months of agehave acting out and withdrawing behaviors and



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Handout 3.5: Acting Out and Withdrawing BehaviorsModule 3


Young Infants: Birth to 9 monthsDifficulty ExperiencingEmotionsMom has left two month old babyJenna in care for the first time. It!sbeen a rough week so far andshe really misses being close tomom all day.

What might be going on for thisbaby?

Difficulty Expressing EmotionsSeven month old Isaiah sits withtoys in front of him. For a good 15minutes he is really happy andplaying, talking and makingnoises. Isaiah is great at playingby himself for quite some time,but eventually he gets bored anda little bit lonely.


Difficulty Regulating EmotionsFive month old Kayla was born at29 weeks. Right now it is time fora diaper. Her caregiver reportsmost infants are usually calm yetresponsive during this predictableroutine – but it seems to disorientKayla.


Acting Out Behaviors Withdrawing Behaviors

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Handout 3.5

experience emotions, we have not included a scenarioof a child under 2 months of age because typical childcare settings do not usually care for children under 6weeks of age. For the following activity we chose toinclude scenarios of infants up to 18 months becausewe believe the PreK CSEFEL modules have includedscenarios applicable for older toddlers.

The following charts are offered as a guide for thetrainer as possible answers and/or information to elicitdiscussion.

Participants will come up with their own examples; thereare many ways to behave that would demonstrate theissues described. Examples of acting out andwithdrawing behaviors are in bold. Prior to breakinginto small groups consider providing an example or twowith the whole group to demonstrate the activity.



P 3.21Rev. 11/11

Young Infants: Birth to 9 monthsActing Out Behaviors Withdrawing Behaviors

Difficulty Experiencingemotions

Mom has left two month oldbaby Jenna in care for thefirst time. It’s been a roughweek so far and she reallymisses being close to momall day.

What might be going onfor this baby?

Jenna really misses her mom.She is used to her homewhich is quiet with soft lightingand no other baby sounds(like crying). Jenna is far tooyoung to under-stand what isgoing on – she just knows thefeeling of security when momis there and she can’t quiteget that safe feeling with thesestrangers yet.

Possible responses

When mom leaves or at anymoment during the day,Jenna will burst into tearsand scream. She wants tobe held all the time. Thecaregivers can tell that Jennais having an unusuallydifficult time adjusting tochild care.

Jenna seems quiet; shestares into space andsucks on her fingers. Shedoesn!t seem especiallyinterested in anything andrefuses to make eyecontact with any of thecaregivers. She doesn!teven really want to beheld. She doesn!t seem tobe having a very difficulttransition into child care.



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Difficulty Expressingemotions

Seven month old Isaiah sitswith toys in front of him. For agood 7-10 minutes he is reallyhappy and playing, babblingand making noises. Isaiah isgreat at playing by himself forquite some time, buteventually he gets bored anda little bit lonely.

What might be going on forthis baby?

Isaiah is great at playing byhimself for quite some time,but eventually he gets boredand a little bit lonely. Hewould really like his caregiverto come talk and play withhim. Right now he doesn’tknow how to show that heneeds adult attention.

Difficulty RegulatingEmotions

Five month old Kayla wasborn at 29 weeks. Right now itis time for a diaper change.Her caregiver reports mostinfants are usually calm yetresponsive during thispredictable routine – but itseems to disorient Kayla.


Kayla was born prematurelyand seems to have some

When Isaiah becomes boredhe looks around to see who isclose to him, and he catchesthe eye of his caregiver.When he knows she islooking at him he begins tothrow his toys and screams.

Kayla is on the changing tablescreaming as thoughsomeone has hurt her. Shethrashes around making itdifficult to change her. Whenshe is done, and it is time towash her hands, things onlyget worse. She screams fornearly forty minutes afterthe diaper change. Everyonedreads Kayla’s diaperchanges.

Kayla often averts her gaze.She seems to feel no pain.She has very little reaction ifany to the diaper change andto the caregiver’s attempts toengage her. It seems as ifnothing ever bothers hernor does much seem toexcite her or make hersmile. She doesn!t evenreact when other childrenapproach or poke her.

Isaiah seems to becomequiet as he realizes hedoesn’t really want to bewhere he is anymore. Hismuscle tone relaxes and heseems “droopy.” He sitsquietly, no longer makingplayful noises. He makesno eye contact and justseems to be staring off intospace.



P 3.23Rev. 11/11


problems with certain sensoryexperiences like diaperchanges, a caregiver’s touch,bright lights, surprising noises,etc. It is possible that thingsthat would not bother anotherbaby (e.g., diaper changes,bright lights, etc.) mayphysically hurt her. Or itpossible that she isoverwhelmed by stimulationand has little reaction and/orshe disengages.

Difficulty Forming CloseAnd Secure Relationships

Nine month old Aliyah cameto child care six months agoand has very, very slowlycome to have a relationshipwith one caregiver. Thiscaregiver is now absent andmultiple caregivers aresubbing in her place

What might be going onfor this baby?

Aliyah finds it difficult tobond, or attach to acaregiver. With greatpatience and slow, gentlesteps her caregiver has builta relationship of trust withher. While this is wonderful,Aliyah has yet to form a bondwith any of the othercaregivers in her classroom.

When Aliyah’s caregiver putsher down, Aliyah throws herbody back on the matwhere she was placed.She howls and criesforcefully. When caregiversattempt to pick her up andsoothe her she arches herback and turns her headaway, screaming evenmore.

Aliyah will not make eyecontact with any of thecaregivers and she showsvery little emotion (neitherhappy or sad).

*Trainers note: participantsmay ask about autism and/orother significant develop-mental delays. Askparticipants to hold theirconcerns and thoughts untilthe next activity. Letparticipants know that youwill discuss how staff mightrespond in the next activity.In the discussion about howstaff may respond, you cantalk about how responsesmay or may not be differentbased on if a child has adisability or a suspecteddisability.

Difficulty Regulating(continued)



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Difficulty Exploring and learning

Four month old Jackson absolutelywill not tolerate lying on hisstomach during “tummy time.” Hedoes not like to be on his backmuch either. He would prefer to beheld all of the time.


Tummy time may beuncomfortable to Jackson until hegains more muscle control. Hemay prefer being held if he is usedto be held often.

When Jackson’scaregivers put himdown on his tummy heinstantly cries. His facebecomes red, hisbody becomes rigid,and he screams.

If Jackson is not being held,he falls asleep. The childcare environment seems tobe so over stimulating thathe just closes his eyes.

Mobile Infants: 8 – 18 monthsActing Out Behaviors Withdrawing Behaviors

Difficulty Experiencing Emotions

Fifteen month old Jasmine sees herteacher set up the water table, herfavorite activity.

What might be going on for thisbaby?Jasmine really seems to love beingat school, she loves the toys andsometimes enjoys playing with otherchildren. Unfortunately, when shegets excited she expresses it insocially undesirable ways. Or whenJasmine becomes excited shedoesn’t know what to do to engagein even her favorite activities. Shemay become overwhelmed by heremotions and be somewhatimmobilized.

Jasmine runs to thewater table, bangs on it,runs over to her friend,bangs on him, leaveshim screaming, andruns over to thedramatic play area andthrows a plastic chair,narrowly missinganother child. She doesall of this gleefully withno recognition of the trailof tears she leavesbehind her.

Jasmine loves the water table;however, she hovers nearthe table but does notengage in the table. Shestands off to the side andwatches as other childrenbegin to play at the table. Shespends a great deal of timestanding still watchingothers enjoy pouring. Theteachers only know this is herfavorite activity because shealways chooses it. Sheappears to really enjoy thewater table yet she rarelysmiles and even when shedoes put her hands in shedoesn!t look up much orengage the other children.



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Difficulty expressing emotions

Ten month old Josiah’s oldestsister dropped him off thismorning. Usually mom is theone who brings him. Shegenerally stays to chat with theteachers and read him a bookbut today his sister hands him offand leaves, in a hurry to get toher job. He frequently has a hardtime with separation, so momand the caregivers try toschedule the morning routinewith predictable activities everyday. While this helpful, on thedays when the routine isdisrupted Josiah (and everyoneelse) suffers.


Josiah has settled in over thepast few weeks with theintroduction of a morning routinehe can anticipate. When thingschange he is upset, confusedand feels disrupted. Perhapsonce he becomes upset it isextremely difficult for him tosoothe himself and his emotionsare intense and sometimesfrightening even to himself. Orwhen he is upset he shows littlereaction and instead remainsquietly sad. He doesn’t knowhow to express himself in orderto best get his needs met.

Josiah screamsinconsolably for nearlyan hour. He refuses tobe held, crawls to toyshelves to throw things,and causes an intensemorning for thecaregivers and otherbabies.

Josiah watches his sister goand doesn!t react much.Throughout the morning he isunusually quiet. Sometimeshe very quietly whimpers,however, his voice hishardly audible. The teachermay not even notice hiswhimpers if she is not careful.


Difficulty Regulating Emotions

Sixteen month old David cannotseem to adjust to his newclassroom. He has gone from beingthe oldest in a calm, quiet classroomof babies to being the youngest in aroom full of rambunctious toddlers.


David is not just shy or aggressive;he has a very difficult time regulatinghis emotions. He was able tomanage as long as he was in afamiliar, quiet environment but thecomparative chaos of a toddler roomto the infant room has tested hisability to cope.

Difficulty Forming Close andSecure Relationships

Fifteen month old Arabelle has asignificant reaction to anyone newwho comes into her classroom.


Arabelle has spent her life in atransitional housing center forwomen and their children. Thecenter considers child care a choreto be shared by the women likecooking or cleaning, but this hasmeant that when Arabelle goeshome she has a different caregiverevery day. She spends some timewith her mom but mom is veryfocused on improving their lifesituation right now.

David is surprisinglystrong for his age andhe is showing it. He isbiting, hitting andpushing other childrenseemingly withoutprovocation. His face istight and strained. Hehas a difficult timeengaging in any activityfor more than a fewseconds.

David has found a place forhimself in his new classroom,unfortunately it is under atable in the corner of theroom. He is quiet andwithdrawn. If someonecomes near him he pullsback and looks away. Heseems frightened to be thereand the other childrenignore him so he is notforming friendships.



P 3.26Rev. 11/11

When a strangercomes into theclassroom Arabelleruns up to them andthrows herself intotheir arms. She isvery clingy and wantsto be held by anyperson even if shehas never met them.

When a stranger entersArabelle’s classroom,Arabelle moves as faraway from the door asshe can. If a strangercomes very far into theroom Arabelle hidesbehind the rocking chair,looking scared.

After approximately 20-25 minutes, bring participantstogether as a large group to debrief. Encourageparticipants to share some examples of theirresponses. Use the above chart as a guide withsample responses.

N. Show Slide 26: A Relationship Based Approach toChallenging Behavior : Responding to Infant andToddler Distress. When an infant or toddler displays apattern of challenging behavior of either type – actingout or withdrawing - the goal for adults must be tounderstand the child’s experience, respond to his needs,and help him use better strategies to meet his needs.

1. Make the point that it is sometimes easier (moretempting) to react to the behavior, particularly toacting-out behaviors, than to reflect on the meaningof the behavior. The child’s emotion easily stirs upemotion in us. Of course, a quick reaction isnecessary when a child might be about to do harm tohimself or others.

2. When we react, we tend to focus on our ownexperience (e.g., frustration, anger) rather than theexperience of the child (e.g., frightened, lonely).

3. Point out to participants that it is important that theytune in and pay attention to how they feel when achild is exhibiting behavior that they find challenging.Remind participants that behavior that may challengeone caregiver may not necessarily challenge another.



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Difficulty Exploring and Learning

Eighteen month old Cameron haslow muscle tone. She cannot sit upwithout support and tires easily


Cameron may have an undiagnoseddevelopmental disability. She hasdifficulty sitting and is immobile.

Cameron will playwhen toys are broughtto her. When shebecomes tired orfrustrated, she lets hercaregivers know byfalling over, crying andscreaming. She cannotchange positionswithout help.

When left on her own,Cameron would spend hoursstaring at the wall, notinteracting with anything oranyone.

For example, a toddler with a loud voice and exuberantdisposition may be difficult for one caregiver, but notanother, to be around for long periods of time. That isnot what we are talking about here. Rather, we arefocusing on behavior that seems to be having anegative impact on the child’s development and that allcaregivers can agree needs to be addressed.

4. It is worthwhile to keep in mind that an important clueto what the child is experiencing is our own emotionalreactions to the child. For example, if we are frustratedthan it is highly likely that the child is also frustrated.Often our emotions can help us tune in and empathizewith the child’s experience.

5. Show Slide 27: Caregivers and Families Focusingon the Child. When we reflect on the meaning of thebehavior, we are keeping our focus on the child’sexperience. We are more likely to be able to respondwith empathy for his needs and to be more intentionalabout problem solving.

a) The goal for intervention must be to restore thechild’s sense of well being and her developmentalmomentum.

b) We want to use the opportunity to respond in a waythat supports the child’s social emotionaldevelopment and relieves him of the need to use hisemotional energy to tell us something is wrong.

c) When an infant or toddler is constantly feeling stressin his care environment, he uses a tremendousamount of emotional energy to protect himself fromwhat might come next (e.g., some activity or eventthat is confusing, frightening, or otherwiseoverwhelming). Instead, that emotional energy shouldbe spent on developmental growth. It is our job ascaregivers to make sure that happens.

O. Read Slide 28: Responding to Distress. Responses tothe challenging behavior should meet the criteria listed:

• Acknowledge distress (e.g., name the feelings; “Youseem so sad.” Or “You seem so upset.”)

• Offer comfort (e.g. change holding position of an infant;say, “It will be o.k. We’ll help you feel better.”; offercomfort items likely special blankets or pacifers)



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• Be attuned to child’s individualized needs (Explain thatbeing attuned is the ability to understand the child’sunique experience. Being attuned to a child is aboutbeing “at one” or in sync with the child. Give anexample of a teacher who knows Elijah is particularlysensitive to other children’s crying. Before Elijah startsto react to the crying of another child the teacherknowingly approaches Elijah to offer her physicalpresence and comfort to the child.)

• Help the child achieve the understood intention (Helpthe child find another way he can get what he wantse.g., “You want more milk. You can point to the sippycup; you don’t need to throw it”.)

• Be developmentally appropriate (Ensure that thestrategies are appropriate for the individual child’sdevelopmental age. For example picking up a 8 monthold who is crying is appropriate, however, carrying athree year old may be a less developmentallyappropriate first step to soothing a child).

Activity: Handout 3.6: A Different Perspective. Askparticipants to work with a partner and consider some ofthe challenging behaviors they previously identified andlisted in the earlier part of Module 3. For each challengingbehavior, participants need to come up with a new way ofthinking about the behavior. For example, if a participanthad listed “grabs things” as one of the challengingbehaviors they often observed, another way of thinkingabout or reframing this behavior could be, “the child istrying to play with a peer” or “the child doesn’t know yethow to ask for the object.”

P. Slides 29. and Video 3.2.Looking at Behavior that isof Concern. Show Video 3.2 and ask participants whatacting-out and/or withdrawing behaviors they observed(tip of the iceberg). Show Slide 30. Activity: What is MyPerspective. Ask table partners to use Handout 3.7:What is My Perspective? and respond to the questions.Ask the participants to write down as many “I” statementsas they can think of for each individual noted on theirhandout. For example, after question one, “I am Michael.What is my perspective? I felt:,” participants might write, “Iwant to play with her but she wants the same toy I want.”Ask participants to share their statements.



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Handout 3.6 A Different PerspectiveModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H 3.6

A Different Perspective

Challenging Behaviors Observed andExperienced

Learning from One Another:Additional Ideas

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Handout 3.6

Handout 3.7: What is My PerspectiveModule 3


What is My Perspective

I am Michael. What is my perspective? I felt:

I am the child playing with Micheal _______________. What is my perspective? I felt…..

I am caregiver_______________________What is my perspective? I felt……

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Handout 3.7

1. Go on to develop the point that the problem withattempting to develop these “I” statements is that wereally do not have much information about Michael oran understanding about what transpired before thissnapshot in time.

2. Ask participants if they think it might be valuable tosometimes write these “I” statements from theperspective of a child who is troubling them. Askparticipants if they have examples to share about achild in their care? Encourage the group to shareexamples of children’s challenging behavior and thentry to use “I” statements that might speak for thechild’s intention (e.g., for a child who bites the “I”statement might be, “I bite because I don’t know howelse to tell children I’m frustrated and they are in myspace. I want more space.”)

3. Encourage participants at their tables to useHandout 3.8 (Strategies for Responding to Infantand Toddlers! Challenging Behavior) as a guidelineto devise and select some additional possibleresponses to the acting-out and/or withdrawingbehavior observed.



P 3.30Rev. 11/11

Optional Activity C: Who Am I? (25 minutes)

Ask participants to think about a young child in their care who displays challengingbehaviors. Using a blank piece of paper, ask participants to write a couple ofsentences for this child entitled, “Who Am I?” How would this young child describehim or herself?

After participants have an opportunity to write their sentences, ask them to reviewand underline all of the strengths or positive descriptors they used to describe thischild. Next, ask participants, “How did you feel when you underlined the strengths andpositive descriptors?” Encourage participants to share their sentences or theirexperience with the activity with the larger group.

Trainer!s Note: Consider that there may be participants who struggled to identifystrengths. Depending on your comfort level, you may want to ask participants toconsider thinking about someone who might be able to support or encourage them ifthey are struggling to identify strengths and create a positive vision for a young childin their care.

Handout 3.8: Strategies for Challenging BehaviorsModule 3


Strategies for Responding to Infant and Toddlers! Challenging Behaviorand Supporting Infant and Toddlers! Social Emotional Development

Social Emotional Development Goal

Help Child to:Experience, regulate and express emotionsForm close and secure interpersonal relationshipsExplore the environment and learn

All Strategies for Responding to Infant and Toddler Challenging Behavior Should Meet theFollowing Criteria:

Acknowledge distressOffer comfortUse wordsBe attuned to (or in sync with) the child!s individualized needsHelp the child achieve the understood intentionBe developmentally appropriate

Example Strategies:

Systematic strategies• Observe to understand the meaning of the behavior• Track and document frequency, duration, and intensity• Chart time of day behavior occurs• Use self reflection to appropriately respond to behavior• Share reflections/access thoughts and opinions of others• Attempt to understand and empathize with the child!s experience• Monitor progress of social emotional skill development and concerning behavior reduction

Strategies to soothe• Shush (e.g. saying, “shhhhhhhhhh, shhhhhhhh”), white noise (e.g. running a vacuum cleaner, whitenoise machine, or hair dryer)

• Rock• Hold, carry, use slings or carriers to keep child close to one!s body• Hold baby on side or stomach• Outside time, fresh air• Sing• Encourage sucking (pacifier, fingers)• Swaddle• Encourage transitional objects of comfort (e.g. blankets, dolls, stuffed toy, etc.)• Stay calm• Stay physically close

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Handout 3.8

Q. Slide 31. A Relationship Based Approach toChallenging Behavior: Meaning of the Behavior. Ascaregivers, our job is to carefully observe and gatherinformation about a young child and his or her family inorder to eventually generate a hypothesis (our bestguess), test it out, and use what we learn to understandthe meaning of the behavior in question. This processtakes time and thought.

R. Slide 32: Hypotheses.

1. Our immediate job is always how to manage to carefor a child (and other children who are affected)through an episode of behavior that is causingconcern. Our first efforts focus on ensuring the childis safe. We then attempt to help the child developincreased abilities to cope and we foster the child’sabilities to use more acceptable strategies toexperience, express, and regulate emotion; formclose and secure interpersonal relationships; andexplore the environment and learn

2. When the behavior in question is a pattern, we needto figure out its meaning for the child, what needs thebehavior represents (what is the function or purposeof the behavior), and what to do about it. We canwork to cushion ourselves and the child from negativefeelings related to the behavior by establishing thehabit of wondering about the meaning of behavior.This process can help us tap our creativity by leadingus to consider multiple explanations for what might behappening for the child as well as lead to multiplestrategies for dealing with the behavior.

3. Our creativity comes into play when we create ahypothesis, or best guess, about the meaning of thebehavior to the child. We don’t always have access tothe information about what is happening in a home.However, when we hypothesize about why a child isacting the way he or she is (in other words, what themeaning of the behavior is), we are using what weknow about that child to make a guess about why achild responds or behaves as he or she does.



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S. Slide 33. Our Approach. When developing an approachto supporting and guiding young children’s behavior, it iscritical that young children feel safe within secure andcaring relationships. Very young children needresponsive interactions and opportunities to spend timein socially and emotionally supportive environments. Theimportance of caregivers and families meeting theseneeds has been discussed in previous modules. Reviewthe points on the slide with participants.

1. Our approach to responding to challenging behavioris one that it is reflective, rather than reactive.Reflecting on what an experience is like for a youngchild; observing what a child is communicatingthrough his behavior; and deciding what we wouldlike the child to do establishes a process that meets ayoung child’s emotional needs and helps support andteach new skills and behaviors.

2. The focus of this approach is on assisting the child ingetting his needs met rather than eliminating thechallenging behavior.

3. The goal is to assist the child with developmentallyappropriate self-regulation so that the developmentalmomentum is not slowed down or disrupted.

T. Slide 34. Understanding Behavior is the Key. Toprovide the best care for infants and toddlers, caregiversshould try to make sense of the behavior. A reflectiveapproach (as we just discussed) will involve the itemsnoted below. Review with participants the bullet pointson the slide:

• Watch children – careful observation is critical.Previous modules discussed the importance of thestrategy careful observation.

• Behavior is a form of communication -children tell ustheir needs and wants, sometimes throughchallenging behavior.

• Focus on the child. Ask “What is the child trying to tellme?” and “I wonder…”

• Create a best guess (hypothesis) and choosesupportive ways to respond.



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U. Slide 35 and Video Clip 3.3 Katie and Muk. Showvideo clip 3.3 once. Ask participants to then completeHandout 3.9 Infant Toddler ObservationDocumentation while watching the video. Haveparticipants record only what they see and hear. At thispoint, do not have participants try to interpret what thebehaviors mean. After completion of Handout 3.9, askparticipants to share responses with the large group..Possible responses may include:

• Katie uses her hand and arm to slap at her caregiver,Muk, right after she enters the care center with herfather.

• Muk says, “Do you want to go outside, Katie? Okaywe go outside. Right. We go pick apples.” Dad carriesKatie outdoors. Walk toward apple tree.

• Muk pulls branch down toward Katie and her dad.Muk says, “You want to pick it yourself?” Katie cries,“No way, no way!” Dad says, “Okay, okay.” Katieshrieks.

• Katie picks an apple.

• Muk says, “Last week we broke the branch, ‘huh?”Muk reaches for Katie and says, “Okay, here you go,okay.” Katie cries.

• Muk says,”Okay bye-bye daddy. I love you.” Katie’sdad says, “Bye-bye.”

Next, ask participants to form small groups. Display Slide36, Activity: Small Group Discussion. Have participantsdiscuss and respond to the questions noted on the slide.Possible responses to the questions on the slide (thesequestions are also listed below) may include:

• What information did you gather? – see responsesnoted above

• What are the tip of the iceberg behaviors you seefrom Katie? - crying, shrieking, curling her head intocaregiver’s neck, hitting

• What might Katie be trying to tell us? I wonder… -She may be trying to say “I don’t want my daddy toleave.”; or “I worry that my dad is going to comeback.”; or “I don’t quite trust the center yet.”; etc.



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Handout 3.9: Observation DocumentationModule 3


Infant-Toddler Observation Documentation

Date of Observation _______________ Day _________ Time _________ Child!s Initials _________________Child!s Name ______________________________________ Child!s DOB _____________ Age __________Observer!s Name _____________________________ Observer!s Role ______________________________Location of Observation _____________________________________________________________________Adult or other children in the observation by order of appearance (note initials):1 ____________________ 2 ____________________ 3 __________________ 4 ____________________Describe the behavior you observe? (e.g. child turns away from caregiver)

__________________________________________________________________________________________

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__________________________________________________________________________________________

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__________________________________________________________________________________________

__________________________________________________________________________________________

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Handout 3.9

Remind participants that in order to understand andrespond to a young child’s behaviors, we also want toconsider a young child’s development, temperament, andthe environment(s) in which the child spends time.

V. Slides 37 and 38: Questions to Ask About theMeaning of the Behavior. Tell participants that we aregoing to spend some time further discussing the veryimportant process of carefully gathering data to aid inunderstanding and addressing the behavior of aparticular child. It needs to be a systematic andorganized process.

Review bulleted questions with participants. Askparticipants what kinds of data they might need toanswer the questions included on the slides. Forexample ask, “How do you collect data that might helpyou determine what, when, where, how and with whomthe behavior is occurring?” Encourage participants toshare the types of observations, screening,assessments, and data collection they use to gatherinformation about the meaning of behavior. Explain thatcounting how many times a child bites in a day or howlong a baby cries is the only way to really know if thebehavior is improving, staying the same, or gettingworse. Often caregivers or parents may say a behavior,such as crying, happens all the time. However, when it iscarefully timed and tracked patterns may be identifiedsuch as; he cries less after he is fed or he is crying forshorter period of time since the caregivers have beencarrying him in a baby carrier.

Encourage participants to think about how they observe,track, and document their own and other children’sresponses to the child’s behavior. For example, when atoddler grabs a toy from another child, does the childgive up the toy so that the toddler learns that grabbing isan effective way to get a toy. Encourage participants tothink about how they communicate behaviorexpectations to very young children and their families.How do caregivers let the children know what they wantthem to do? In the example of the toddler grabbing toys,how do his caregivers show and teach him how he canget a toy someone else has. The caregivers may alsoshow him how he can ask for help. The caregivers mightalso show and teach the other children what they can dowhen a child grabs a toy from them. The other childrenmight be encouraged to say, “No,” “mine,” “my turn now,”or “I don’t like that”.



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W. Slide 39. and Video Clip 3.4 Muk. Tell participants thatyou are now going to watch another video clip regardingKatie and Muk. After showing the clip, discuss as a largegroup the approaches and strategies used by Muk tobest support Katie and her family. Participants mayidentify the following strategies:

• Muk observes Katie’s behavior and identified patterns(“noticed sometimes she hits”)

• Muk understands child development (understandsseparation anxiety)

• Muk recognizes the influence of Katie being new tothe child care setting

• Muk recognizes Katie’s potential feelings “worry thather parents are going to leave”

• Muk observes Katie’s likes (i.e,. she likes fruit andenjoys picking fruit)

• Muk develops a routine for Katie; recognizes theimportance of doing the same thing each day (Muktalks about using the routine “over and over and over”everyday to provide structure and familiarity)

• Muk references (indirectly) primary caregiving (Muktalks about carrying Katie and helping her each day)

• Muk describes helping Katie to feel safe and secure

• Muk describes an understanding of the family culture(the parents hold children when they feel insecure)

X. Slide 40. and Video Clip 3.5 Observing Michael. Letparticipants know that you will now watch a secondvideo clip of Michael in his care setting. After viewing thevideo clip, participants will have an opportunity to workin pairs or small groups to walk through a responsiveprocess for determining the meaning behind a youngchild’s behavior. Watch Video Clip 3.5 once and askparticipants to create initials for the individuals in thescenario.

a) Show the video a second time and have participantsrecord what happened by again using Handout 3.9Observation Documentation.



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Handout 3.9: Observation DocumentationModule 3


Infant-Toddler Observation Documentation

Date of Observation _______________ Day _________ Time _________ Child!s Initials _________________Child!s Name ______________________________________ Child!s DOB _____________ Age __________Observer!s Name _____________________________ Observer!s Role ______________________________Location of Observation _____________________________________________________________________Adult or other children in the observation by order of appearance (note initials):1 ____________________ 2 ____________________ 3 __________________ 4 ____________________Describe the behavior you observe? (e.g. child turns away from caregiver)

__________________________________________________________________________________________

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Handout 3.9

b) Discuss the observation as a large group and askparticipants to share and comment on theircompleted observation documentation form.

c) Provide participants with a copy of Handout 3.10Getting to Know Michael. Ask participants to readthrough the handout. Using this information, alongwith the observation they just completed, haveparticipants work in pairs or small groups to completeas much of Handout 3.11 Infant Toddler BehaviorReview as possible.

d) Give participants 20- 30 minutes to review, discussand complete Handout 3.11. Debrief as a largegroup.



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Optional Activity D: Review of Collecting and Using Observation to Understand theMeaning of Behavior. Use the following notes to review and discuss the importance ofusing observation.1. Early care and education programs, including those that are home-based, should

have a process in place to gather ongoing observation and documentation ofprogress for each child in care on a regular basis. This may consist of shortanecdotal notes, results of screening measures, information from parents, video ofthe child with adults and peers at different times of day, etc.

2. Observations can be used regularly by staff in group care and by home visitors inconsultation with their supervisor as a part of the staff member’s ongoingprofessional development/supervision. This regularly scheduled time for reflectionon the meaning of children’s behavior can be used to initiate inquiries into thebehavior of a specific child who is exhibiting extreme or confusing behavior.

3. In the case of a child with challenging behavior, additional observations arerequired to collect detailed information.

4. Observations should be initiated quickly so that the child does not have to wait forhelp.

5. Observations should be conducted by more than one person and may include anyperson who interacts with the child. It may be helpful to have observations done bysomeone who does not typically interact with the child but has strong observationskills. It may also be useful for the care provider to do the observation side-by-sidewith a director, a more experienced caregiver, or a mental health consultant or aresource and referral agency.

6. Observations should be done at various times of the child’s day and across multipledays. They should focus on how the child functions in a variety of activities duringthe day with a variety of other people.

7. All documentation should be recorded in a similar way so that the information frommultiple sources can be easily compared and analyzed.

Handout 3.10: Getting to Know MichaelModule 3


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GETTING TO KNOWMICHAEL

Handout 3.10

Handout 3.11: Behavior ReviewModule 3


Infant-Toddler Behavior Review

Child!s Name: _____________________________________ Date of Birth __________ Age ____________

Review Contributors Date of Review _______________________

1._____________________________

2._____________________________

3._____________________________

4._____________________________

Information Gathering

1. What is the behavior of concern?

2. What happens? What are the frequency, intensity and duration of the behavior?

3. When does it happen? Consider writing out daily schedule.

4. Where does it happen?

5. With whom does it happen?

6. How long has the concerning behavior been going on?

7. How does the caregiver feel about the behavior?

8. Has the child had a recent physical? Are there any physical/medical concerns?

9. What happens (right before) before the behavior occurs? What are the triggers?

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Handout 3.11

Y. Make the point that parents are essential to the processof understanding a child’s experience and thinkingthrough how to respond to behavior that is troubling inthe child care setting. This is why it is so important tonurture the relationship with parents from the first daysthe child is in care. A trusting, respectful series ofinteractions over time will allow the child care provider tobring up concerns she has about a child and engage thefull participation of the parent(s) in responding to thedifficulties the child is having. If the provider/parentrelationship is not seen as an important aspect of careand the parent is actively engaged only when there is aproblem, there will be less of a foundation to build on tohelp the child.

Activity: Ask participants to think for a moment about aninstance in which they had a strong relationship with aparent and found it relatively easy to bring up an issue ofconcern with a child. Ask several participants to sharetheir experiences (prompt participants to describe howthey formed the positive relationship with the parent andhow the relationship contributed to their ability to discussbehaviors of concern.) Now ask them to think of aninstance in which they had a concern about a child butdid not feel as comfortable in bringing it up with parents.Why not? Ask for several participants to share theirthoughts.

a) Point out that when there is a child with challengingbehavior in a group setting, parents need to bebrought into the process as quickly as possible. Theymay be asked to observe behavior with a staff personvia video, through an observation window or they mayshare their thoughts through a parent interview.

b) Remind participants that parents may be verysensitive about hearing that their child’s behavior isconsidered challenging by staff. It may be the firsttime a parent is hearing concerns about their child orthey may have repeatedly heard similar commentsand become defensive or “shut down” when acaregiver begins such a conversation. Accepting thatone’s child’s behavior is concerning may take a longtime. Remind participants that sometimes we are justplanting the seed for parents and the ideas andstrategies we share could take a significant while totake root.



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c) On the other hand, parents may be the first to identifya pattern of behavior that is challenging, at least forthem, and to seek help from staff. This probablyindicates the existence of a trusting relationshipbetween the two.

d) Refer the group to Handout 3.12 Talking withFamilies about Problem Behavior: Do!s andDon!ts and take a few minutes to discuss it.

e) Show and discuss Slides 41, 42, and 43, ParentInterview Questions, which list some importantquestions to discuss with family members during oneor more conversations. There will need to be somethought given to which staff member has the mostcomfortable relationship with the family in order todecide who should speak with them. Staff should besensitive to and respectful of cultural issues and tothe impact of culture on parenting behavior,perceptions about behavior problems, andperceptions about the helping professions. Askparticipants if they have questions to add to this listand record them on chart paper. Answers that familymembers provide should be carefully documented,with their permission, and added to the process ofdetermining the meaning behind the child’s behavior.

f) Activity: Ask participants to form pairs. Oneparticipant should role play being the caregiver andthe other the family member. The caregiver shouldthink of a child they care for that has displayedchallenging behaviors. Ask the caregiver to conduct afamily meeting where they share only positiveattributes and strengths about the child for the firstthree minutes of the meeting prior to discussingchallenging behaviors. Remind participants that theirbody language and the way they position themselves(side by side, not across from each other) willinfluence the tone of the interaction. Have participantsswitch roles once finished and go through the sameprocess. Debrief as a larger group. Encourageparticipants to explore the benefits of sharing positiveattributes first. Elicit the point that when positiveattributes are shared first parents may understandthat you are noticing their child’s strengths as well as



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Do

1. Share strengths of child with the family.

2. Let the family know you are feeling concernedand want to do all you can to help their childfeel safe, happy, and successful in your setting

3. Ask the parent if he or she has experiencedsimilar situations and are concerned.

4. Tell the parent that you want to work with thefamily to help the child develop appropriatebehavior and social skills.

5. Tell the parent about what is happening in theclassroom but only after the parentunderstands that you are concerned about thechild, not blaming the family.

6. Offer to work with the parent in thedevelopment of a behavior support plan thatcan be used at home and in the classroom.

7. Emphasize that your focus will be to help thechild develop the skills needed to besuccessful in the classroom. The child needsinstruction and support.

8. Stress that if you can work together, you aremore likely to be successful in helping thechild learn new skills.

Handout 3.12: Do’s and Don’tsModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H3.12

Don’t

1. Begin the discussion by indicating that thechild’s behavior is not tolerable.

2. Indicate that the child must be punished or“dealt with” by the parent.

3. Ask the parent if something has happenedat home to cause the behavior.

4. Indicate that the parent should take actionto resolve the problem at home.

5. Initiate the conversation by listing thechild’s challenging behavior. Discussionsabout challenging behavior should beframed as “the child is having a difficulttime” rather than losing control.

6. Leave it up to the parent to manageproblems at home; develop a plan withoutinviting family participation.

7. Let the parent believe that the child needsmore discipline.

8. Minimize the importance of helping thefamily understand and implement positivebehavior support.

Talking with Families about Problem Behavior:Do’s and Don’ts

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Handout 3.12



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the areas in which the child needs to grow. Pointingout a child’s positive attributes may help parents feelless defensive.

g) Point out that we will be talking more about howparents should be involved when we discuss aprogram protocol for responding to challengingbehavior.

IV. Developing an Individual Support Plan (120 min)

A. Slide 44. Developing an Individual Support Plan:Program Protocol. Make the point that a programneeds to have a protocol in place to address persistentchallenging behavior. Establishing a process or protocolfor helping young children with challenging behavior canhelp ensure that the key people in a young child’s lifeare working together to answer important questions andcreate an understanding that will then lead to aneffective approach with a young child.

B. Slide 45: Program Protocol.1. The protocol should outline clear steps to be followed

in developing a plan to address the behavior. Thiscommunicates the importance of working quickly torespond to the needs of the child.

a) It indicates that the program is concerned aboutchildren and their well being.

b) It helps everyone know what to expect, what theircontribution to the process will be, the sequence ofthe steps in the process, and how decisions will bemade.

c) A protocol establishes the fact that all personsinvolved in the child’s life are included in theinformation gathering and are part of the decision-making process.

d) It documents that there is consent from the familyas well as from the staff who will be implementingthe intervention plan to be developed.

e) The protocol should establish a timeline forimplementing the process and theperson or persons responsible for each step.

f) The protocol should establish a process forregularly reviewing progress, makingchanges in the intervention plan, if necessary, anddeciding when and how a determination will bemade to discontinue or modify the intervention

IV. Developing anIndividual SupportPlan (120 min)

45

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depending on the response of the child to theintervention.

g) The information that is gathered and the decision-making process itself should be consideredconfidential. It will only be shared with the familyand staff directly involved.

2. Slides 46-48: Sample Protocol. Tell participants thatwe will look together at a sample protocol foraddressing challenging behavior in infants andtoddlers. Tell participants that we are going to workwith a case study to practice using the elements of aprotocol. They have a copy of the forms in theirHandouts that they will be using for the case study.

C. Now let’s talk about another very important step in theprocess – building a team. A collaborative team needs tobe assembled. For a center-based program, the teamshould include, at a minimum, the caregiver(s) and thedirector who is in a position to approve additional stafftime and resources. If a program has a mental healthconsultant, s/he should also attend. Other staff may bebrought in to contribute their perspectives. Staff with themost established, trusting relationship with the familyshould be included on the team.

A family child care provider may request support fromthe local resource and referral agency or an infant-toddler specialist to meet with the family.

A home-based program team may include the homevisitor, a supervisor, and the family.

Staff should meet with the family, at the center or athome, to share concerns and learn what familymembers can contribute to an understanding of thebehavior. One or more family member should be invitedto become a full participant on the team that will addressthe behavior.

1. Activity: Slide 49: Potential Team Members and askparticipants to identify what each team member mightbring to the process. Record responses on chart paper.The team should include all relevant people, includingthe bus driver, for example, who is likely to be able toshed light on the child’s behavior during the trip to andfrom the center.

47

48

49

46

2. Make the point that it is very important to determinea convenient time for all parties to come together toreview the information that has been gathered and todevelop a plan that everyone can agree on.

3. In some programs, a mental health consultant will bepart of the team from the beginning. In others, amental health consultant may be brought in if there isnot timely improvement in the child’s behavior or it isclear that the family needs a more intense focus thanthe program can provide.

a) Exactly when a mental health consultant is broughtinto the process will vary from program to program.Having access to a mental health professional hasbeen shown to help reduce child expulsions in care.Public mental health clinics and resource andreferral agencies may be able to provide thatsupport to child care programs when it is notalready part of the program. Mental health providersoffer a third party perspective and have the primaryfocus of understanding the child’s and/or family’sperspective.

b) Slide 50. and Video 3.6 A Full Response toChallenging Behavior. Discuss as a whole groupthe following questions and add comments if theynot brought up:

• Why do you think the parent was willing to acceptthe help of a mental health consultant?

- Staff had already discussed the child’s bitingwith her

- Parent has a trusting relationship with staff

- Parent is experiencing the problem at home

• What did the mental health provider do to learnabout the issue?

- Observed the child in the child care setting

- Met with staff and the parent to hear theirperspectives

• What effect did having a specialist and a supportplan have on staff and parent?



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- Enabled them to consider the meaning of thechild’s behavior

- Helped them notice things about the child thatthey had not noticed before

- Encouraged them to work together as partnersto support the child

• What would you do if you did not have access toa mental health specialist?

- Ask the director, supervisor, or another staffmember to confer with me about the child

- Identify resources in the community (e.g.,mental health center, resource & referralagency) that can be called on for consultation

D. Slide 51: What Goes into a Support Plan whichdescribes the ways in which the intervention or supportplan for the child is developed.

1. After gathering data to see what patterns emergearound the child’s challenging behavior. The supportplan begins with a hypothesis about the behavior andits meaning for the child.



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Optional Activity E: Examining My Own Behavior and Setting Goals (20 minutes)

Ask participants to define and write down a challenging behavior that they themselvesmay exhibit on occasion. Encourage participants to use clear, objective terms. Forexample, “During conversations, I start talking before the other person is finished.” Or,“When I become frustrated at other drivers while in the car, I swear or yell”. Next, askparticipants to consider a different behavior (new skill) to replace the challengingbehavior. For example, “I will wait until the other person has finished speaking before Itake my turn to talk.” Or “I will take three long deep breaths instead of yelling”.

Participants should then identify the steps needed to take to reach the long-termgoal, as well as any possible supports that might be needed. For example, “One -count to three once you feel the other person has finished speaking. Two – repeatback to the person what you heard them say.” Or “Notice when you are becomingfrustrated at another driver or traffic. Think about potential reasons the driver mayhave cut in front of you such as maybe the driver is on her way to the hospital.Practice replacing thoughts of frustration with empathic thoughts.”

2. The team may decide during the first meeting thatthere are some specific changes they would like tomake in the environment (e.g., creating a quiet spacefor that child in the book corner) or the way in whichcaregivers relate to the child (rescheduling a specificstaff member so that she is there to greet the childevery morning).

3. The team may ask the parent to take the child to thedoctor to rule out physical/health problems that maybe contributing to the behavior (e.g,. a persistentearache or allergies.)

4. The team may ask for a developmental andbehavioral assessment if initial attempts to supportthe child are not effective or if the child’s behavior istoo confusing to the team to even plan anintervention.

5. Reference Handout 3.13 The Infant-Toddler ActionSupport Plan as an example of a document that canbe used to identify the specific action steps that needto be taken before the support plan is implemented.

6. The team will need to decide who, what, when, whereand how the support plan will be implemented so thatthe strategies and responses to the child will beconsistent. For example, a two-year-old bites otherchildren in the group and siblings at home. The teambelieves one of the causes of the biting is herfrustration at having to share toys and space withother children all of the time. The family and theprogram staff agree that they will:

• Try to provide protected space and toys for her touse for periods of time

• Notice when she is feeling crowded or stressed• Encourage her to say “no” when she wants other

children to go away• Teach her how to walk away and ask for help• Read books about biting with her• Show her something she can bite such as an apple

slice• Use words such as, “No biting. I know you want to

play with this toy. I’ll help you keep your toy – butno biting. That hurts your friend (sister).”

All of this information should be documented on theplan.



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Handout 3.13: Infant-Toddler Action Support PlanModule 3


Infant-Toddler Action Support Plan

Child!s Name: _____________________________________ Date Plan Developed ____________

Team Members:1 ._____________________________2. _____________________________3. _____________________________4. _____________________________

Parent!s Name______________________________ Signature _____________________________

Behavior Hypothesis (the meaning of the behavior):

Prevention Strategies:

Skill to Develop Strategy to Support Development Person Responsible When

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Handout 3.13

7. The team will need to agree on how each person whointeracts with the child will respond to the behavioronce the support plan is implemented. The responsesection of a support plan should have specificresponses identified for all to refer to so thatconsistency across caregivers is supported. Forexample; when Damon starts screaming when hismother leaves, Judy will hold him and then try tointerest him in an activity. Sara will manage the needsof the other children and will allow Judy to supportDamon until he is involved in play. When he criesagain, Judy will respond immediately and Sara willtake the lead with the other children.

8. The team will need to establish a defined timetableand process for reviewing how the support plan hasimpacted the child’s challenging behavior. The Infant-Toddler Support Plan we are using has a place for ateam to rate the progress of the child at two pointsafter the plan is implemented. If there is no mentalhealth consultant on the team from the beginning,one should be called in if the intensity, frequency, andduration of the behavior is not improving. The teamwill need to determine if further community referralsare necessary to resolve the challenging behavior.

E. A simple protocol which addresses the issues we havenoted will generally be appropriate for use with infantsand young toddlers. A more detailed process such asPositive Behavior Support found in the PreschoolCSEFEL Modules 3a and 3b may be more appropriatefor older toddlers, especially when acting-out behaviorsare the identified problem.

F. Let participants know that the last activity in the day is todiscuss a case study with their colleagues.

1. They are going to work as collaborative groups(teams) to practice a process designed to gain abetter understanding of a child’s behavior and todevise a plan to address the situation.

2. The purpose of the case study activity is to providethem with an opportunity to think about how such aprocess might improve their practice. They should beencouraged to be creative about adapting theprocess so that it is useful to them in their worksetting.



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H. Activity. Slide 52: Case Study Instructions. Askparticipants to divide into groups of 4 or 5 people orgroup together at their table. Within their groups, ask thatthey select the role each would like to play (teacher/s,supervisor, parent/s, mental health consultant, etc.).They will use Handout 3.11 Infant-Toddler BehaviorReview and Handout 3.13 Infant Toddler ActionSupport Plan for this activity as well as Handout 3.14Maria: a Case Study. (Handout 3.15 – TrainerDiscussion Points)

1. Ask each group to read their case study materials,Handout 3.14 and discuss the key information withtheir group.

2. Have participants use Handouts 3.11 Infant-ToddlerBehavior Review and Handout 3.13 Infant ToddlerAction Support Plan to gather information aboutMaria’s behavior and make a plan for supportingMaria. Instruct participants to use the information inthe case study to complete the handouts as best asthey can. If there are questions that they do not havean answer to, instruct participants to note thequestions where they may need to obtain moreinformation. Obtaining more specific information canbe a valuable part of an action plan.

3. Encourage the participants not to move to thehypothesizing and planning stage until they havereviewed all the information. Tell them that their teamcan agree to add data to either the child description orthe observations. They can embellish the context forthe child or the behavior as they wish. The goal is thatonce they have the information identified, they will usethat information to develop the support plan. Give thegroup approximately 30-35 minutes to work on thisactivity.

4. After 30-35 minutes, suggest that the groups move onto the planning step if they have not already done so.Ask that they use the Action Support Plan form toidentify what will need to be done before a plan is putin place to eliminate or reduce the child’s distress.

5. Move among the tables to answer questions andfacilitate team work. Record the time allotted andending time for each section of the activity on chartpaper. Give the groups a 10 minute warning before theend of a section and ask them to wrap up their work.



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Handout 3.14 Observation DocumentationModule 3


MariaMaria is a 16-month-old girl who attends the Happy Elephant Child Care Center. She is new (she began twoweeks ago) to the class of 12 toddlers who range in age from 12 to 24 months. Maria has been biting andhitting the other children in the classroom and none of the efforts to stop her biting have been effective. In themorning Maria runs ahead of her foster mother and quickly grabs toys away from other children. She seemsunaware that another child is playing with the toy. If the other child tugs back on the toy that Maria hasgrabbed, she will bite the child!s arm or hit the child on the head and shoulders. She has also bitten a caregiverwhen the caregiver attempted to intervene. This pattern of behavior may take place several times a day. Boththe biting and hitting are done with intensity and have left bruises and marks on other children and staff. Thecaregivers in the classroom report that they have never had a child who bites as frequently as Maria. When sheis unsuccessful in getting the object that interests her, she collapses on the floor and screams for up to 30minutes at a time. During her tantrums she is inconsolable. She is difficult to hold and she will not allow herselfto be cuddled. Eventually she calms down and is able to be distracted or engaged with an activity or toy. Thestaff at Happy Elephant have told Ms. Carter, Maria!s foster mother, that one of the other parents hasthreatened to withdraw her child if the staff cannot stop Maria from biting. The staff is very concerned abouttheir ability to help Maria.

Information Gathered from Discussion with the FamilyMs. Carter has been Maria!s foster mother for 3 weeks. Ms. Carter is actually a cousin of Maria!s mother. Sheand 3 other family members have agreed to take Maria and her 7 siblings who were removed from the home oftheir mother by Children!s Protective Services because the mother failed to sever her ties to a boyfriend who isknown to traffic in heroin. Maria!s mother was investigated by Children!s Protective Services regarding concernsabout her neglect of her 8 minor children. The condition of the home, the presence of the boyfriend, theimpending birth of another child, and her failure to attend parenting education classes resulted in the removal ofthe 8 children.

Ms. Carter works during the day. She is the single mother of five children of her own. She agreed to takeMaria because the family did not want to see the children go into homes with strangers. Ms. Carter reports thather children are all in school now and she has never had a child that bit others. She is very worried that she willlose this child care placement for Maria. It is convenient and she is able to bring Maria by bus and drop her offon her way to her job in an office a few blocks away from the center.

During the intake interview Ms. Carter is concerned because Maria has used little or no language to date.Her primary communications seem to be grunts, inconsistent babble or screaming and frequent collapses to thefloor if her wishes are thwarted. Ms. Carter notices that Maria watches her when she talks but does not tryeven simple words herself even when she is prompted. Ms. Carter reports that she had talked with thepediatrician about Maria!s lack of language in either her native language or English, but the pediatriciansuggested that they give Maria at least 6 months to adjust to her new environment before “they put her throughan assessment.”

Ms. Carter reports that Maria has had little contact with her siblings since she was placed with her. She hasseen her mother once in the three weeks since she was removed. Her elderly grandmother has come by to visitbut she does not seem to be able to contribute to Maria!s care and she does not have her own car so she hasto be driven over by another daughter. This family is not sure what will happen to all of the children if theirmother does not get them back. Ms. Carter doesn!t know how long she will provide care for Maria. She ishoping her cousin will follow through on the plan worked out with CPS so that she will get her children back.Ms. Carter reports that Maria has few toys at the house but that she does like her blanket and a soft baby doll.Ms. Carter has been leaving both at home during the day. Ms. Carter reports that Maria has not been biting inher home and she doesn!t believe she was biting in her previous day care.

Ms. Carter!s home is busy and Maria has a crib in a room with two older children. Ms. Carter has beenletting her stay up until the other children go to bed and then she puts Maria to sleep in the living room on thecouch, because she will not fall asleep in her crib. Maria is expected to feed herself in her high chair. She eatsslowly with her fingers and still uses a bottle before she goes to sleep.

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Handout 3.14

Handout 3.15 Trainer Discussion PointsModule 3


(For Trainers Use Only/Points to Elicit in Assisting Participants Use the Form with Case Study Maria)

Sample Infant-Toddler Behavior Review

Child!s Name:_____Maria_______ Date of Birth __________ Age____________Review Contributors Date of Review_______________________1. _____________________________2. _____________________________3. _____________________________4. _____________________________

Information Gathering

1. What is the behavior of concern?

Biting, hitting, tantrums, possible delayed language skills

2. What happens? What are the frequency, intensity and duration of the behavior?

Bites and hits several times a day;bites and hits caregivers and other children;biting and hitting is severe (leaves marks and bruises on others and frequent (multiple times a day); tantrumsoccur multiple times a day and are of long duration (approx. 30 minutes)

3. When does it happen? Consider writing out daily schedule.

Frequently;when she wants to play with toys or other childrenWhen caregivers try to intervene*(need more specificity from staff/ a chart of times/daily schedule noting occurrences would be useful) (considerthis as part of Action Support Plan)

4. Where does it happen?

@ child care centerNot at home

5. With whom does it happen?

Other children and caregivers @ child care center

6. How long has the concerning behavior been going on?

Foster mother reports the behavior was not happening in previous care centerWe don!t know much about previous care arrangements or other environmentsBehavior has been occurring since the beginning of starting this class in this center (2 weeks)

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Handout 3.15

6. Bring the large group back together to talk about thecase study and to share and compare their ActionSupport Plans.

7. Ask participants to provide some feedback about theactivity and to report what they found helpful anddifficult. Encourage them to take these materials backto their work settings and continue to use and modifythem.

V. Slide 53 Wrap-up, Reflection and Action Planning(30 min.)

A. Slide 54 Reflection. Offer participants an opportunity toreflect on your time together and the content coveredduring the training. Ask aloud the questions listed on theslide. Pause between each question and ask forfeedback from the larger group.

• What questions do you have about the material wediscussed?

• What insights if any do have about your ownpractices, the children, and/or their families?

• What strategies did you see or hear that might beuseful in your role and work?

B. Slide 55. Handout 3.16. Planning for Change. Reviewthe bullet points on the slide with participants and offertime for completion.

C. Slide 56: Major Messages to Take Home as asummary of the day’s training. Review each message.Ask if participants have others to add.

D. Thank participants for coming and for their attention andparticipation.

E. Ask participants to complete the Evaluation, Handout3.17.



P 3.46Rev. 11/11

53

54

55

56

Location: Date:

Program Affiliation (check one);! Head Start ! Early Head Start ! Child Care ! Other (please list)

Position (check one):! Administrator ! Education Coordinator ! Disability Coordinator ! Mental Health Consultant! Teacher ! Teacher Assistant ! Other (please list)

Please respond to the following questionsregarding this training:

(8) The best features of this training session were….

(9) My suggestions for improvement are…

(10) Other comments and reactions I wish to offer (please use the back of this form forextra space):

Session Evaluation FormModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H 3:1711/11

Please take a moment to provide feedback on the training that you received. Check the box that corresponds inyour opinion to each statement or check N/A if not applicable. Please add any additional comments that youmay have at the bottom of the page. When the survey is completed, leave it with your trainer.

Please put an “X” in the box that best describes your opinionas a result of attending this training…

(1) I can describe the relationship between behavior and thecommunication of distress for infants and toddlers.

(2) I can identify the characteristics of challenging behaviorfor infants and toddlers.

(3) I can describe the key elements of a process for under-standing behavior that is confusing or may be disruptive ofsocial emotional development.

(4) Identify key steps to developing an individual support planfor an infant or toddler.

Strongly Somewhat Somewhat Strongly N/AAgree Agree Disagree Disagree

Handout 3.17

Handout 3.16: Planning for ChangeModule 3


Planning for Change

Whatresources

do you need?

What steps will you take togain confidence in other areas?

In which parts of the Pyramid, Module 3, do you feel mostconfident in as a caregiver? List three things you will do as youconsider ways to create supportive plans for individual children.

Handout 3.16

V. Slide 53 Wrap-up,Reflection and ActionPlanning (30 min.)

References

Butterfield, P., Martin, C., & Prairie, P. (2003). Emotionalconnections: How relationships guide early learning.Washington, DC: ZERO TO THREE Press.

Chazan-Cohen, R., Ayoub, C., Pan, B., Roggman, L.,Raikes, H., McKelvey, Whiteside-Mansell, L. & Hart, A.(2007). It takes time: Impacts of early head start that leadto reductions in maternal depression two years later. InfantMental Health Journal, 28(2), 151-170.

Early Head Start National Resource Center, (2006).Strategies for understanding and managing challengingbehavior in young children: What is developmentallyappropriate and what is a concern? Technical AssistancePaper No. 10. Head Start Bureau, Administration forChildren and Families, Administration on Children, Youth,and Families, U.S. Department of Health and HumanServices. Washington, D.C.

Gladstone, T. & Beardslee, W. (2002). Treatment,intervention, and prevention with children of depressedparents: A developmental perspective. In S.H. Goodman &I.H. Gotlib (Eds.) Children of depressed parents:Mechanisms of risk and implications for treatment. (pp. 277-305) Washington, DC: American PsychologicalAssociation.

Im, J. H., Osborn, C. A., Sanchez, S. Y. & Thorp, E. K.(2007). Cradling literacy: Building teachers! skills to nurtureearly language and literacy from birth to five. Washington,D.C: ZERO TO THREE Press.

Johnston, K., & Brinamen, C. (2006). Mental healthconsultation in child care; Transforming relationships amongdirectors, staff, and families, Washington, DC: ZERO TOTHREE Press.Kostelnik, M., Whiren, A., Soderman, A., Gregory, K., &Stein, L. (2002). Guiding children!s social development:Theory to practice, Fourth Edition. Albany, NY: Delmar.

Onunaku, N. (2005). Improving maternal and infant mentalhealth: Focus on maternal depression. Los Angeles, CA:National Center for Infant and Early Childhood Health Policyat UCLA.



P 3.47Rev. 11/11

Parlakian, R., & Seibel, N. L. (2002). Building strongfoundations: Practical guidance for promoting the social-emotional development of infants and toddlers. Washington,DC: ZERO TO THREE Press.

Sroufe, L., Cooper, R., DeHart, G., & Marshall, M. (1996).Child development: Its nature and course. New York, NewYork: McGraw-Hill, Inc.

Wittmer, D. S. & Petersen, S. H. (2006). Infant and toddlerdevelopment and responsive program planning: Arelationship-based approach. Upper Saddle River, NJ:Merrill Prentice-Hall.

ZERO TO THREE (2005). Diagnostic classification ofmental health and developmental disorders of infancy andearly childhood (revised edition). Washington DC: ZERO TOTHREE Press.



P 3.48Rev. 11/11

Documents

Individualized Intervention with Infants and Toddlerscsefel.vanderbilt.edu/resources/inftodd/mod3/script.pdfIndividualized Intervention with Infants and Toddlers: ... support plan