Brain science

Q&A: A researcher who’s seeking nimble interventions for toxic stress

PHOTO: ZEISS Microscopy, Creative Commons

When children endure toxic stress, it can have lifelong impacts on their health, education and well-being. Dr. Philip A. Fisher, professor of psychology and research scientist at the Prevention Science Institute at the University of Oregon, believes traditional evidence-based interventions are too cumbersome and expensive to replicate widely. He argues that researchers, program developers and policymakers must become more flexible and innovative in finding ways to mitigate the effects of toxic stress.

Dr. Fisher spoke Thursday evening at the annual Community Lecture Series hosted by the Marsico Institute for Early Learning and Literacy at the University of Denver. This Q&A, which has been edited for length and clarity, took place earlier in the day.

Q: How did you get interested in the topic of toxic stress?

Dr. Phillip A. Fisher, senior scientist at the Oregon Center for Social Learning.
Dr. Philip A. Fisher

A: In high school, I started volunteering in a residential treatment center for severely emotionally disturbed kids. I worked at summer camps for troubled kids during college.

What I continued to encounter were these things that really didn’t have adequate explanations. So, why were so many of the kids we were working with from disadvantaged communities, from poor backgrounds? Sure, kids who don’t have opportunities don’t do as well, but it didn’t really explain why there were the specific kinds of issues that we saw in these kids.

The models that were out there…mostly consisted of assigning labels to kids. You have conduct disorder. You have attention deficit disorder. They didn’t say much about what was going on.

Q: What is toxic stress?

A: It has to be put out there first and foremost, not all stress is toxic…We know that some stress is probably not a bad thing. It actually can help make people stronger.

In early childhood what [toxic stress] really means is prolonged activation of these bodily systems…that are designed to help us respond to stress, in the absence of any kind of supportive care.

If there’s a lot of distress that a child or infant is experiencing—they’re hungry, they’re tired, they’re scared—and it happens consistently over long periods of time and there’s no caregiving adult present—somebody to help buffer the child from the experiences of stress—that’s when things move from tolerable to toxic.

Q: How does toxic stress manifests itself in children?

A: Kids become much more sensitive to stress in their lives. So, when they experience stress, they tend to function more poorly. We see that not only in terms of their ability to concentrate and focus in class but also health vulnerabilities. They’re more likely to get sick. They’re more likely, over their life span, to have problems with things like diabetes, heart disease and obesity.

It’s also increasingly clear that toxic stress really does have the potential to disrupt the architecture of the developing brain…so (kids who experience) significant toxic stress, of some types, have more difficulty with self-control. In a classroom setting, they tend to be more impulsive. They tend to be the ones more likely to lash out or do things not consistent with the rules. They have a hard time shifting their attention flexibly from one thing to another.

Q: What are the implications of toxic stress for educators tasked with helping children achieve academically?

A: The first thing is just to understand that those kids aren’t (misbehaving) because they’re troublemakers or they’re willfully disobeying you. One of the things that’s become clear from our research is that those kids just don’t process information very well.

(If kids are) doing something that’s not what they’re supposed to be doing, corrective feedback might not be getting through. That’s one of the reasons…having more individualized support for the child, making the signals really clear to them, can be really, really helpful.

Q: You’ve talked about developing flexible, low-dose programs that help with toxic stress. Why is that important?

Where we started developing programs that helped to offset toxic stress, they were large, expensive programs. What I’ve become convinced in the last 10 years is that we’re not going to have impact at scale if that’s all that’s available. It’s just not going to happen.

We have to get a lot smarter about…cutting to the core of what needs to happen most. It’s not like the system’s broken and we should throw it out, but we need to augment what’s out there with other ways of approaching of knowledge development…We have to be committed to a broad array of strategies, and a process of learning about them in a much more rapid-cycle way.

I think school is the perfect innovation platform…If you engineer things properly, then each year can be a new opportunity to gather information, to figure out what’s working and for whom…and for those for whom it’s not, to engineer new approaches.

Q: Right now, what do you consider the most promising interventions for dealing with toxic stress?

A: The majority of the ones that are out there, they’re at a point where there’s good proof of concept. One of the hallmarks of the toxic stressors that we’re talking about is that kids don’t really learn good cause and effect.

A baby crying (will think), “Maybe somebody’s going to come pick me up. Maybe they’re not. Maybe if they pick me up, they’re going to shake me. Maybe they’re not.” That whole learning process really goes sideways.

The things that…help turn that around are things that make it very clear to the child that the environment is consistent, predictable and responsive, and then also warm and nurturing.

Q: You’ve described healthy interactions between children and caregivers with a tennis analogy, “serve and return.” What is that?

A: We define serve and return very precisely. It’s an instance in which the child initiates some action, either puts the focus of their attention on the adult or something else in their immediate environment and the adult shares the child’s focus of attention and (responds).

(A serve) could be the child fussing or that they’re delighted. It could be that they’re gazing at something. It could be that they’re pointing to something and saying what it is. The return of the serve is really what’s critical.

Q: What is the video coaching program, Filming Interactions to Nurture Development, or FIND,  you’ve helped develop?

A: It involves basically showing people, using video, instances of themselves engaged in “serve and return” with the children they’re taking care of. Showing people instances of themselves doing this is a profound experience…because they’re seeing something that is the building block of healthy brain development.

What we think is different about this is were not coming from a place of people need to do something they don’t know how to do and therefore we have to instill new skills. I think that’s one of the reasons our existing programs are so costly and cumbersome. They come from the starting point of people are deficient in something and we have to start from the ground up.

Planning mode

As lawmakers consider major preschool expansion, Colorado providers want more than just extra seats

PHOTO: Ann Schimke

With Gov. Jared Polis’ proposal for the biggest expansion of Colorado’s state-funded preschool program in its 30-year-history, many early childhood educators are cheering the possibility of 8,200 new preschool slots for at-risk children.

But they’re also asking hard questions about how providers will find the staff and space to create new preschool classrooms, and whether state leaders will reshape the program to broaden its reach and intensity. Suggestions from the field include expanding the definition of at-risk, accepting more 3-year-olds, offering more full-day slots, and rewarding top-rated providers with more money.

These discussions echo debates about preschool quality and access nationally as more state leaders prioritize early childhood education, and as public preschool programs from New York to California attempt massive scale-ups.

Research shows that early childhood programs can produce huge long-term gains for children, particularly those from low-income families. But there’s a caveat: The programs must be high-quality.

In Colorado, Polis’ preschool proposal hinges partly on his plan to offer free full-day kindergarten statewide. That’s because 5,000 of the new preschool slots would be funded with money currently earmarked for full-day kindergarten through a special pool of flexible early education dollars. Lawmakers likely won’t make final decisions on the full-day kindergarten and preschool expansion plans until late spring.

In the meantime, preschool providers are weighing the pros and cons.

One of them is Lynne Bridges, who runs a highly rated preschool designed to look like an old schoolhouse in downtown Pagosa Springs in southwest Colorado. It’s called Seeds of Learning and serves children from tuition-paying families and about two-dozen preschoolers who qualify for public dollars through the Colorado Preschool Program.

While Bridges is thrilled with Polis’ support for early childhood education, she’s frustrated, too, that the state’s preschool program doesn’t recognize top programs like hers with extra funding.

“It’s almost like this high-quality program I’ve created …. It’s my burden,” she said.

Bridges’ program holds a respected national accreditation and also has a high rating from the state through its Colorado Shines rating system. She fundraises constantly to fill the gap between her government allotment and the cost of providing preschool for her at-risk kids — the ones she said have the most to gain from a high-quality program.

“There’s only so much money to be had in a rural community,” Bridges said. “This shouldn’t be me laying awake at night trying to help these families.”

The $111 million Colorado Preschool Program serves about 21,000 preschoolers statewide — most of them 4-year-olds in half-day slots — as well as 5,000 kindergarteners in full-day programs. Most of the program’s slots are offered in public school classrooms, though some are in community-based facilities.

On average, providers get about $4,100 per state preschool slot, though the amount varies based on a district’s size, share of low-income students, and cost of living.

Jennifer Okes, chief operating officer at the Colorado Department of Education, said the state’s finance formula allocates preschools half per student of what’s earmarked for first- through 12th-graders.

That formula doesn’t account for preschool quality, she said.

“I guess you could take preschool funding out of [the Public School Finance Act] and fund it separately. That would be a big statutory change.”

A separate state program that provides subsidies to help low-income families pay for child care works the way Bridges wishes the Colorado Preschool Program did, but it’s governed by a different state department and set of rules.

Leaders in the suburban Westminster school district north of Denver, where three-quarters of preschoolers are funded through the Colorado Preschool Program, said Polis’ proposal fits with the district’s own plans to expand early childhood options.

“I’m all for it,” said the district’s Early Childhood Education Director Mat Aubuchon, of the state preschool expansion. “I’m just curious what latitude we’ll get as districts.”

Aubuchon said if the state funds more slots, he hopes more can be merged to create full-day preschool slots. Currently, state rules allow only a small fraction of slots to be combined.

In addition, he wants more leeway in the state’s primary eligibility criteria, which gives preference children from low-income families, those in unstable housing, or who have speech or social difficulties, among other factors.

“I would like to see a little bit more pre-academic stuff in there,” said Aubuchon.

For example, children likely to be at risk for later reading struggles, based on results from a pre-reading assessment, should be given greater consideration, he said.

Aubuchon said if Polis’ plan comes to fruition, he’d like at least 100 to 150 more state preschool slots — maybe more if districts get additional flexibility to make full-day slots. He said the district will likely be able to find space for additional preschool classrooms.

Christy Delorme, owner and director of Mountain Top Child Care in Estes Park in northern Colorado, would like more state preschool slots, too.

She knows some commercial child care centers aren’t happy about Polis’ preschool expansion plan “because it takes away those paying slots,” but said she thinks it’s a good idea.

“Most parents can’t afford child care,” she said. “The more kiddos we can get into early education programs the better off our society will be.”

Delorme doesn’t have the room for a new classroom at Mountain Top, but like Aubuchon, wants the option to create full-day slots for the children she’s already serving. Currently, the 10 children in half-day slots funded by the Colorado Preschool Program rely on scholarships from a local nonprofit to stay at Mountain Top all day. If they become eligible for full-day state slots, that scholarship money could be rerouted to at-risk 3-year-olds,

One challenge that many preschool providers will face if there’s a sudden influx of new state-funded preschool slots will be hiring qualified staff for new classrooms.

That very problem is what led Bridges, of Seeds of Learning in Pagosa Springs, to cut her program down from four classrooms to three a few years ago. Turnover was high and she couldn’t find reliable substitutes.

With the switch to three classrooms, she also raised wages. Today, a lead teacher with a bachelor’s degree makes about $22 an hour, competitive pay in a community where her workers sometimes used to leave for jobs at the local Walmart. Today, Bridges has no problem with turnover.

Delorme, whose teachers start at $15 to $17 an hour, agreed that the field’s low pay makes it tough to find qualified staff.

“Education in general, it’s hard to recruit, but does that mean I wouldn’t want to expand my program because of that?” she said. “No.”

Race for mayor

How to help Chicago’s younger learners? Mayoral frontrunners skip a chance to say.

PHOTO: Stephanie Wang

The challenge of mending and strengthening Chicago’s network of care and education for its youngest residents defies instant solutions, but four candidates for mayor agreed Monday on one point: The city needs to care for its child care centers rather than imposing more burdens on them.

And the city should include those crucial small businesses, which often anchor neighborhoods, in its growing pre-kindergarten system.

Related: Why Rahm Emanuel’s rollout of universal pre-K has preschool providers worried

At a forum Monday at the University of Chicago on the topic of early childhood education, candidates addressed how city government can stitch together a stronger early learning system. Chicago’s mayoral election is Feb. 26.

Chicago is in the first year of a four-year universal pre-kindergarten rollout, and the city’s next mayor will determine much of the fate of the program. About 21,000 children have enrolled out of an estimated 45,000. And cost estimates are now north of $220 million, much of it federal and state money earmarked for early childhood expenditures. But the mayor can direct how that money is spent.

The forum attracted four candidates: former federal prosecutor Lori Lightfoot, former Chicago schools CEO Paul Vallas, state representative and former teacher La Shawn K. Ford, and John Kozlar, a University of Chicago graduate who, at 30, is the youngest candidate in the race.

Four candidates considered front-runners — Toni Preckwinkle, Susana Mendoza, Bill Daley and Gery Chico — didn’t attend. Nor did six more of the 14 candidates.

All of the mayoral candidates who answered said they would continue to support Chicago’s universal pre-K expansion but did not specify how.

The event was organized by Child Care Advocates United, a statewide alliance of child care providers who banded together four years ago when the state budget crisis was forcing many providers and child care agencies to cut back or close.

The central topic of conversation was how city government can build a stronger early learning system. Several questions revolved around issues faced by for-profit and nonprofit day care owners and preschool operators who are facing teacher shortages, budget pressures, and a churn of students. Some advocates say Chicago’s rollout of universal pre-K has made a operating a difficult business even more tenuous, as they lose children and revenue to Chicago Public Schools.

A Chalkbeat analysis of data published last week showed that public school preschool programs are at 91 percent capacity, while one in five seats at community-run preschools and centers is empty.

The candidates Monday offered different suggestions for alleviating the pressure.

Related: Care about schools? Read Chalkbeat Chicago’s voter guide to the mayor’s race. 

“We have to end this fight between Chicago Public Schools and (community) providers. It is killing an industry,” said Ford, a state legislator who described the budget pressures many providers faced under former governor Bruce Rauner, when Illinois did not pass a budget for more than two years.

A September report from the Illinois Department of Children and Family Services, which tracks openings and closures among licensed daycare facilities, shows a loss of 3,400 licensed facilities statewide from 2010 to 2018.

“Chicago Public Schools cannot do (preschool) cheaper, and it cannot do it better,” said Vallas, also a former budget director for the city of Chicago, who has put out a detailed prenatal-to-preschool platform that starts with universal prenatal care and a detailed menu of services and supports for children birth to age 5.

“The challenge with the universal pre-K program that Rahm Emanuel and (schools chief) Janice Jackson rolled out is that there was no engagement with community-based providers,” said Lightfoot, who questioned the timing of the May 2018 announcement just weeks before a Chicago Tribune series cast a spotlight on a pattern of mishandling student sexual abuse cases in the K-12 system. “This program was ill-conceived and rolled out in spring to be a distraction to the sex assault investigation about to be unveiled by the Tribune.”

At the forum, held in the auditorium of the Logan Center for the Arts at the University of Chicago, Vallas also spoke about creating incentives to entice more prospective teachers into the field, including grow-your-own programs that target parents.

He also described a system of startup grants and opportunity zones that would make it easier for new businesses to take root and tax breaks for providers who serve a variety of children well.

Ford advocated pressuring state legislators to increase reimbursement rates to providers, which could be used to increase teacher pay, and setting aside tax-increment financing, or TIF, dollars for early childhood businesses. And Lightfoot talked about converting some of the schools that Chicago has closed into job training and early childhood centers.

“The policy that has been rolled out is not equitable and not sustainable,” she said of Chicago’s universal pre-K rollout. “We need to work in partnership with our communities.”

Are you ready to vote on Feb. 26? Find everything you need at Chi.vote, a one-stop shop for the Chicago election — Chalkbeat Chicago is a partner.