UMMS Affiliation

Department of Family Medicine and Community Health; Department of Psychiatry

Publication Date


Document Type



Interpersonal Relations; Child Behavior; Social Behavior; Child, Preschool; Child Day Care Centers


Education | Mental and Social Health | Psychiatric and Mental Health | Psychiatry and Psychology


The Together for Kids (TFK) project grew out of two years of work of over 30 childcare, health care, child welfare, and social service agencies concerned about early childhood mental health issues. These concerned constituents, like others across the country, were responding to an increase in the incidence of young children exhibiting challenging behaviors that were resulting in disrupted early childhood classrooms and children being expelled from programs (Grannon et al, 1999; Swanson, 2001).

The importance of addressing the needs of these children at an early stage has been emphasized by a broad array of mental health and childcare professionals. Without appropriate services, these children end up with impaired ability to interact appropriately with family and peers; create family stress; become stigmatized as problem children; fail to develop school readiness skills and behaviors; cause disruptions to other children’s learning, socialization and safety; and contribute to burn out and turnover of preschool teachers (Grannan et al 1999; Shonkoff & Phillips, 2000).

The TFK Coalition collected information from the research literature and from local day care centers about the extent of children at risk in the Worcester area. They found that 3.1% of children in four local day care centers, enrolling over 300 preschool children, were so disruptive they were expelled or would have been if the parents did not voluntarily withdraw them, with an additional 14% identified as at risk of expulsion. They also anecdotally connected the increasing difficulty in managing classrooms with high staff turnover, ranging up to 46% in one year. At the same time, only one Center reported access to early childhood mental health services. Based on this information, the TFK Coalition began to develop an intervention model. The specific focus of the project is on challenging behaviors of preschool children (ages 3 and up) enrolled in childcare centers.


Hennigan, L., Upshur, C. & Wenz-Gross, M. (October, 2003). “First year report: Together for Kids, a project of Community Healthlink, Inc.” Worcester: Health Foundation of Central Massachusetts. Link to report on HFCM website

Journal/Book/Conference Title

Health Foundation of Central Massachusetts