Practice to Policy: How Louisiana Revamped Its Approach to 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.

What does quality looks like? How can I be sure a program is nurturing my child and supporting his/her development? 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.
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