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Behavioral Health


The first 3 to 5 years of a child’s life are some of the most important from a developmental standpoint. Young children are exposed to a veritable storm of information and expected to successfully adapt to overwhelming new experiences. It can be a frustrating time and a wonderful time for both young children and their caregivers. The children in your care may be challenged by issues such as separation anxiety, aggression, excessive attention-seeking, and other behaviors that you may not know how to address.

Snohomish Health District Child Care Health Outreach Program offers the consultation services of a Behavioral Health Specialist (BHS). The BHS is available to consult with child care providers about behavioral health related concerns in their child care home or facility. For example, the BHS can give information about:

  • helping child care staff address challenging behaviors
  • general strategies and interventions for children with mental health diagnoses and/or other behavioral/developmental challenges
  • modifying classroom setting or practices to prevent, manage, or re-direct challenging behaviors
  • training on Adverse Childhood Experiences (ACEs), trauma-informed approaches to care, and resilience work
  • resources and referrals within the community
  • targeted intervention recommendations for an individual child (requires signed authorization from parent/guardian of child)

* The Behavioral Health Specialist does not provide mental health diagnoses or ongoing mental health treatment.

Five Universal Practices to Prevent Challenging Behaviors

Did you know that most challenging behaviors can actually be prevented? In Prevent-Teach-Reinforce for Young Children (PTR-YC), the book authors write, “There is much that can be done in the realm of universal strategies that can promote resilience and prevent the emergence of social and emotional difficulties.” The term “universal strategies” refers to classroom-wide practices that have an effect on everyone present. Implementing these universal strategies helps you create a high quality environment that reduces the chances of experiencing challenging behavior. Take a look at the five universal strategies below and notice which practices you are already using and which practices you can implement as soon as possible.

  1. Use a 5:1 ratio of positive to negative/neutral attention. It’s important that you are careful to recognize when children behave appropriately. If they are only given attention when they are exhibiting unwanted behaviors, they will exhibit more of those behaviors. Be sure all children receive at least five positive interactions with teachers for each negative interaction.
  2. Use predictable and comprehensible schedules and routines. The more predictable the environment, the safer a child feels. Your schedule should be explained to children and any changes should also be discussed with children. Otherwise, the schedule is not predictable enough to be a prevention aid.
  3. Use routines within routines to heighten predictability. PTR-YC provides the example of a daily circle time built into the schedule. To be a prevention aid, the circle time should also have routines within that activity, such as a song sung each time as the children find their seats.
  4. Teach behavioral expectations directly. Teachers often assume that misbehavior is intentional noncompliance, when in reality, the child has not been taught exactly and explicitly how to behave. Children should be taught the specific behavioral expectations for each activity and routine that is performed throughout the day.
  5. Teach peer-related social skills. These include sharing, taking turns, and other activities that require interaction. Children need to be taught how to function in these situations. Social skills are complex and often frustrating for young children to master. They need lots of instruction and practice throughout the entire day.


Dunlap, G., Wilson, K., Strain, P., & Lee, J. K. (2013). Prevent-Teach-Reinforce for young children: The early childhood model of individualized positive behavior support. Baltimore, MD: Paul H. Brookes.

Assessment and Additional Support

The Snohomish Health District’s Children with Special Health Care Needs program offers federal and state-funded support to families for a range of health problems, including chronic behavioral and developmental concerns. You can download their brochure here: Children with Special Health Care Needs Program Brochure.

How the program helps parents of children with special needs:

  • Assessing children’s needs
  • Educating and counseling parents
  • Linking families to health care and community resources

To learn more about the program and refer yourself or others, call (425) 339-8652.

Helpful Resources




Contact us

Child Care Health Outreach

General Questions: 425.252.5415

Communicable Disease Reporting: 425.339.5278

For general questions or information:

To submit class materials or register for a class:


Bonnie Decker

Public Health Nurse

Phone: 425.339.5228


Micha Horn
Environmental Health Specialist

Phone: 425.339.8712


Alexandria Deas
Behavioral Health Specialist

Phone: 425.339.3535 


Katy Levenhagen
Nutrition Consultant

Phone: 425.252.5407


Did you know?

The Snohomish Health District's Child Care Health Outreach Program has disease fact sheets on 26 different illnesses commonly found in child group care settings.