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Take Me To EVENTS page

Practice to Policy: How Louisiana Revamped Its Approach to Preschool

Child working on a project at preschool

By Sherryl Heller, PhD (Associate Professor, Tulane University School of Medicine) and Allison Boothe, PhD (Assistant Professor, Tulane University School of Medicine

Preschool expulsion is both detrimental and prevalent. The good news is that we can prevent preschool expulsion through a process called early childhood mental health consultation (ECMHC). Now the question becomes “How do we do it?” Many states have ECMHC programs producing positive outcomes (e.g., Arizona, Arkansas, Connecticut, and Louisiana). All found creative means to fund their programs (e.g., the Child Care and Development Block Grant, tobacco taxes, and private foundations). Louisiana opted to incorporate ECMHC into its quality rating and improvement system.

Selecting a child care center can be a daunting task for any parent.

  1. What does quality looks like?

  2. How can I be sure a program is nurturing my child and supporting his/her development?

  3. Can I afford a quality program?

The Tulane Institute of Infant and Early Childhood Mental Health was concerned about the lack of quality child care options available in the Louisiana. The Institute’s staff was frustrated with the multiple expulsions of many of the children with whom they worked (i.e., foster children, children with developmental challenges). They worried about how often those expulsions increased the behavior problems of these already vulnerable children.

In response to this concern, the Institute approached state policy makers, many of whom were well intentioned, but unaware of the degree of inadequate care in many of the state-funded programs. In 2003, the Institute arranged a series of visits for state leaders to publicly funded child care settings. Afterward, the leaders were overwhelmed with the lack of quality care for kids, making statements like:

“There was so much noise and chaos that I can’t stop shaking,”


“The children had nothing to do but watch television.”

They began to understand how important quality child care is and how lacking it was in their own backyard.

After Hurricanes Katrina and Rita, state planners made sure to include the rating system in the rebuilding effort. In partnership with early education providers, they developed a Quality Rating and Improvement System for child care . This rating system made the social and emotional needs of children a focus of the model (see and made ECMHC the primary means to improve the quality of child care for the future. State policymakers developed legislation for a state tax credit system to help offset the cost of increasing quality.

Based on input from other ECMHC programs around the country, the Institute designed a model tailored to the particular needs of Louisiana (see Heller et al., 2011). All centers participating in the quality ratings system could access ECMHC services, free of charge. Regional non-profit agencies employed the mental health consultants allowing the ECMHC program to gain champions throughout the state and localize the provision of services. This effort is unique in that quality improvement and early childhood mental health consultation work hand in hand to enhance the healthy development of all children in our state.

More recently school readiness has become the focus of many Quality Rating Systems. The current challenge is to ensure that when we assess very young kids for school readiness and developmental progress, we give appropriate attention to their social and emotional development. The threat is that the focus on school readiness may push child care centers to overly emphasize cognitive skills, such as knowledge of numbers and letters, and neglect kids’ social and emotional needs which are just as important for school readiness. Research shows that preschool children with appropriate social skills and emotional regulation are better prepared for school, are more likely to succeed, and less likely to get expelled.

Recently, the Department of Health and Human Services (HHS) announced an investment of $4 million dollars to support practices, such as ECMHC, that reduce expulsion and suspensions in early learning settings. Partners outside the government have also committed to support social emotional and behavioral development of our youngest children, such as the American Academy of Pediatrics, the Irving Harris Foundation, and the Robert Wood Johnson Foundation. Furthermore, HHS and the Department of Education released a joint policy statement with recommendations to reduce expulsion and better support children’s healthy social-emotional and behavioral development. The research is clear: with ECMHC as a support to early learning centers, we will decrease expulsions and increase our kids’ healthy social emotional development, contributing to better school readiness for ALL our children.


Boothe, A. B., & Nagle, G. A. (2013). A Quality Start in Louisiana: Early Childhood Mental Health Consultation as a Primary Support in a Statewide Quality Rating and Improvement System. Journal of Zero to Three, 33 (5), 45-51.

Bowman, B., Donovan, M., Bums, S. (Eds.), & the Committee on Early Childhood Pedagogy of the National Research Council. (2000). Eager to learn: Educating our preschoolers. Washington, DC: National Academy Press.

Harms, T., Clifford, R. M., Cryer, D. (2005). Early Childhood Environment Rating Scale-Revised Edition. New York: Teachers College. Harms, T., Cryer, D., & Clifford, R. M. (2006). The Infant/Toddler Environment Rating Scale-Revised Edition. New York: Teachers College Press.

Heller, S. S., Keyes, A., Boothe, A., Nagle, G., Sidell, M. & Rice, J. (2011). Evaluating the Impact of Mental Health Consultation on Early Childhood Teachers’ Efficacy and Competence. Infant Mental Health Journal, 32 (2), 143-164.

Report of the Advisory Council on Child Care & Development Block Grant, (2005). Retrieved from

Shonkoff, J.P., & Philips, D.A. (Eds.). (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.


Sherryl Scott Heller, PhD, a licensed psychologist, is currently an Associate Professor in the department of Psychiatry and Behavioral Medicine at Tulane University School of Medicine and a member of the Tulane Institute of Infant and Early Childhood Mental Health. Dr. Heller currently directs the Fussy Baby Network New Orleans and Gulf Coast home visiting program. Dr. Heller provided mental health consultation to child care setting throughout her graduate career. In 2000 Dr. Heller was one of 19 Infant Mental Health consultants selected nationally to consultant to Early Head Start programs. Dr. Heller worked with the YWCA East Baton Rouge EHS program serving adolescent mothers and continued to provide consultation and training for several years after the Pathways program ended. For several years Dr. Heller served as the research director for the Louisiana Quality Start Mental Health Consultation to Childcare Centers Program and continues to provide reflective supervision to mental health consultants working in this state-wide program. Dr. Heller also provides early childhood mental health consultation to publically funded kindergarten programs. Dr. Heller has presented regionally and nationally on early childhood mental health consultation and reflective practice to organizations such as Zero To Three National Training Institute, Head Start National Research Conference, Louisiana Infant Mental Health Association, Washington DC Department of Behavioral Health, and Philadelphia Health Federation.

Allison Boothe, PhD, is a clinical psychologist and assistant professor in the department of psychiatry and behavioral sciences at Tulane University School of Medicine and a member of the Tulane Institute of Infant and Early Childhood Mental Health . She is director of the Louisiana Quality Start Mental Health Consultation to Childcare Centers Program and the Cornerstone Mental Health Consultation Program, which provides consultation to elementary schools in New Orleans. She completed a post-doctoral fellowship in Infant and Early Childhood Mental Health at Tulane. Dr. Boothe received her Ph.D. from the University of Alabama in child and adolescent clinical psychology.  She holds two master’s degrees-one in child and adolescent clinical psychology from the University of Alabama and one in marriage and family clinical psychology from Pepperdine University. She graduated from Louisiana State University with a B.S. in Psychology. Dr. Boothe co-developed the Louisiana early childhood mental health consultation model (ECMHC), which focuses on supporting young children’s social-emotional development in the context of early education environments. Dr. Boothe has been asked to consult with many states as they develop their ECMHC program, and she has been invited to speak about the Louisiana ECMHC model to many national groups including the QRIS National Learning Network, The American Academy of Pediatrics, and the US Office of Family Assistance.

Image source: Flickr user Barnaby Wasson via Creative Commons

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