The perspectives of preschool teachers regarding their ability to respond to various crises in the childcare center

Defining a center crisis event

Center crises occur in a variety of different and often sudden ways, including as a result of natural disaster, medical and public health emergencies, and due to various acts of on-campus violence. Some crisis events may be widespread, while others are specific to center site and locality, such as electrical or water outages, student contact with poisonous substances, missing-child emergencies, the rapid spread of illness and disease within a center, or issues of food contamination (Emergency Medical Services for Children, 2016; Field et al., 2017). For the purposes of this study, school crisis events were defined as any emergency which threatened the physical wellbeing of students and staff while on school site, and were allowed to emerge organically during one-on-one interviews with study participants. Because approximately half of all students in the United States are believed to experience some form of school crisis event while in school (Carlton, 2017) and the Western region of the United States presents an ongoing risk of natural disaster with approximately 101 cases since the year 2000 (U.S. Department of Education, National Center for Education Statistics, 2019), it was imperative that this study investigate the perspectives of crisis preparedness by a previously overlooked population of educators: preschool teachers.

The critical role of the preschool teacher during a time of center crisis

Infant and toddler age children are completely dependent upon their caregiver for protection, safety, and effective evacuation during a time of crisis (Bartenfeld et al., 2014; Lai et al., 2018), making all actions taken by the preschool teacher during a time of crisis to be especially critical. Young children may complicate these response actions by behaving unpredictably as a result of confusion or fear surrounding a crisis (Terranova et al., 2015), and because they lack the communication skills necessary to identify themselves to emergency responders, to ask for help, and to express their needs (Fothergill, 2017).

During a major disaster, infant feeding routines must still be reasonably maintained by preschool teachers (Kousky, 2016), and nutrition interventions may be necessary for young children if the crisis takes place over an extended period of time (Pradhan et al., 2016; Tandukar and Guldan, 2017). Due to the sensitivity of their developing organs, young children are also at high risk when exposed to toxins (Bartenfeld et al., 2014; Dziuban et al., 2017; Fothergill, 2017; Hlodversdottir et al., 2018). In addition, infant and toddler bodies contain less fluid in relation to body mass than do adults, making young children more susceptible to dehydration than adults during a time of school crisis (Vega and Avva, 2019). In the case of extreme school crisis events, such as natural disasters, children are more likely to suffer fatal injuries than adults due to their smaller physical size (Kousky, 2016).

Preschool teachers must also take into consideration the long term psychological effect of crises and crisis evacuation procedures upon the coping abilities of young children (Dyregrov et al., 2018; Kousky, 2016; Miller et al., 2017; Scannell et al., 2016; Terranova et al., 2015). Young children are at particular risk for developing early childhood trauma following a school crisis event (Fothergill, 2017; Scannell et al., 2016), making it critical that preschool teachers present themselves in a calm manner during a crisis event, as adult distress is often internalized by the children who observe it (Fothergill, 2017; Lieberman et al., 2018). Magruder et al. (2016) suggested that crisis events and other major traumatic experiences in childhood may result in an elevated risk for alcoholism, drug abuse, and poor health in later adulthood. Thus, preschool teachers must be prepared to make choices during and following a school crisis event that will help to mitigate the possibility of negative developmental effect on the young child.

Possible barriers to effective preschool teacher response during a time of center crisis

During a school crisis event, there are several possible barriers to effective emergency response by preschool teachers. Depending upon the state, student-teacher ratios may be as high as 6:1 for infant classrooms and 12:1 for toddler classrooms (National Center on Early Childhood Quality Assurance, 2015); thus, preschool teachers may be burdened with the task of evacuating several young children with varying levels of mobility. In addition, preschool teachers simultaneously must not only evacuate children, but also evacuate the first aid equipment, breastmilk, infant formula, and diapers needed to effectively care for young children for the duration of the crisis event (DeYoung et al., 2018). Special consideration must also be made to evacuate supplies for children with special needs (Columbia et al., 2019). The need to evacuate such a large amount of critical equipment, along with the children themselves, may be unmanageable for a teacher who is working alone or with very little adult support in a classroom. Also, because a teacher is not able to anticipate the duration of an emergency evacuation situation, the decision of what to take as part of the evacuation may be a point of confusion for the teacher. Possible problems related to the evacuation of appropriate and necessary supplies may be compounded if the preschool teacher is new to the classroom and/or is not yet familiar with the individualized needs of the children.

The present study

Despite the critical role that preschool teachers play during a time of crisis, little is known about the perspectives of preschool teachers with regard to center crisis preparedness. This study if of the first to ask: How do preschool teachers describe the effect of crisis preparedness drills and training on their anticipated ability to handle school crisis events? How do preschool teachers describe their preparedness to handle school crisis events during a time of crisis? How do preschool teachers describe their preparedness to provide medical interventions, psychological interventions, and other support systems to young children and their families during the recoil stage, immediately following a crisis event? And, how do preschool teachers describe the postimpact and recovery and reconstruction measures in place at preschool centers that are intended to aid in community recovery during the weeks and months following a crisis event?

Participant recruitment and demographics

This study investigated the perspectives of school crisis preparedness by 15 preschool teachers working in independently funded childcare centers. Purposive sampling allowed for the author to deliberately select those teachers who met the criteria of providing care to birth to age 5 children while employed in an independently funded childcare center located in the target state, and who previously participated in crisis preparedness drills and training. Participants working in state-funded childcare centers were excluded from this study. This study was granted ethics committee approval prior to participant recruitment.

While all participants in the study self-identified as preschool teachers, it became apparent during interviews that several participants engaged in a dual role within their centers and also acted as center directors. Thus, many of the experiences described by the participants reflected their capacity as both preschool teacher and center director. Noted participant years of experience ranged from 8 to 27 years. Student-teacher ratios in participant classrooms averaged 4:1 for infant and toddler classrooms and 12:1 for preschool and pre-kindergarten classrooms.

Instrumentation

The author was responsible for the writing of all interview protocols, for conducting all phone and virtual interviews, for gathering notes during each interview, and for taping and transcribing all interview recordings. The author ensured that the writing of interview protocols, the language used during participant interviews, and the notes and transcriptions made throughout the study remained objective and unbiased, through the use of reflexive journaling.

Eight interview questions guided the interviews. Interview questions were researcher-produced, and grounded by the integrated model of school crisis preparedness and intervention proposed by Jimerson et al. (2005). According to Jimerson et al. (2005) the preimpact stage of crisis preparedness refers to the period during which educators should train and prepare for the possibility of crisis, while the impact stage takes place during a school crisis event and refers to any immediate acts taken by staff to protect students from harm. The recoil stage, which takes place immediately following a crisis, refers to those acts which are intended to minimize the effect of the crisis event; this might include medical interventions, but also includes those actions which are taken to ensure the psychological safety and security of victims (Jimerson et al., 2005). The postimpact stage refers to a return to normalcy in the days and weeks following a crisis event, with recovery and reconstruction measures being long term and taking place during the months and years following a school crisis event (Jimerson et al., 2005). During recovery and reconstruction, a psychoeducational approach to long term crisis intervention is recommended (Jimerson et al., 2005).

At the beginning of each interview, participants were presented with a list of emergencies that might occur in the childcare center, including: active shooter emergency/intruder, bomb threat, contact with poisonous substances, earthquake, food or water contamination, fire/wildfire, medical emergency, missing child emergency, and rapid spread of illness. Participants were asked to what extent they felt prepared to handle emergencies like the ones listed, but were also encouraged to deviate from the list if they had other personal experiences to share.

Participants were asked to describe how much their ability to handle each of the emergencies had been supported or not supported by the crisis preparedness training and drills in which they had participated at their centers. They were asked to share their personal experiences with crisis in the child care center, to detail emergency response actions that they had learned, and to discuss how each of those response actions contributed to their feelings of being most or least prepared to respond during a time of school crisis. Participants were also asked to discuss how prepared they felt to provide short- and long-term emergency, first aid, medical, and psychological interventions to students. Finally, they were asked to discuss the plans that their center has in place for helping students and their families recover –both immediately, and long term—from a school crisis event.

Design

All interviews were conducted via phone and Zoom virtual platform from the author’s home. Interviews ranged from 25 to 55 minutes. The author began each interview by greeting each participant, providing an overview of the study, and verbally confirming participant consent in the study. Then, each participant was engaged in a series of open-ended, conversational research questions related to their personal experiences with crisis in the child care center. The author concluded each of the interviews by thanking each participant for their time, and providing an approximate date by which they would receive the interview transcript for the purposes of member checking. If a participant appeared to require emotional support as a result of any sensitive information discussed during the interview, they were offered the phone number for the Disaster Distress Helpline, a hotline that provides crisis counseling to those experiencing psychological distress resulting from acts of natural and man-made disaster.

Data analysis plan

Participants were emailed a copy of their transcript for the purposes of member checking. All 15 participants provided written confirmation of the accuracy of their transcripts.

During the precoding stage, the author read through each transcript while journaling impressions related to the tone of the data and regarding any initial similarities and differences noted amongst interviewee data; these observations led to first level coding. Initial commonalities existed in discussions of liability, director discretion when reporting emergency incidents, use of monthly onsite earthquake and fire evacuation drills, and use of books and sing-alongs to help mitigate psychological trauma during a time of crisis. Also noted, were the words: seizure, choking, and lockdown.

During second level coding, each transcript was reread and new similarities were highlighted. Data shared by the majority of the participants exposed concerns related to perceived inadequacies in center crisis preparedness. Second level coding resulted in such repeated words and phrases, as: know your students, keep calm, earthquake drill, fire drill, CPR/first aid training, choking, seizure, allergic reaction, EpiPen, sign in/out logs, and lockdown. Additional topics of discussion included the effect of background experience on perspectives of crisis preparedness, the effect of media reported disasters on center preparedness, the importance of whole-team response during a crisis, and a perceived lack of long term recovery plans following a crisis event. Overall, second level coding resulted in a list of 90 codes, which were than regrouped into 37 categories. Stranger/homeless on-campus, seizure, allergic/allergy, choking, and lockdown were among the most frequent.

Third level coding resulted in a richer understanding of preschool teacher perspectives of school crisis preparedness. Thirty-seven previously identified categories were reduced to five themes. Seizures, choking, allergic/allergy, stranger/homeless on-campus, and lockdown, were discussed by at least six participants each and were categorized under the theme crisis types. Director discretion was also a theme that emerged prominently among codes. The role of the center director in effectively preparing preschool teachers for a crisis event was discussed across several interview transcripts, as coded by role of center director. Further, participants noted director preference with regard to medical supplies and training, crisis communication, and reporting. The theme inadequacies in center crisis preparedness emerged amongst categories as well, revealing several specific vulnerabilities in crisis preparedness training within early childhood centers across the target state. These vulnerabilities were highlighted by the phrases: classroom is not prepared, no outgoing calls, nowhere for the teacher to hide, need drills at different times, and no long term plans. Crisis preparedness training, too, emerged as a major theme across transcripts with codes that indicated routine fire drills, earthquake drills, and first aid/CPR training by preschool teachers working in the target state. Finally, commonalities were considered among the codes of: read books, sing songs, children sensitive to fire alarm, and know your students, which resulted in the theme of mitigating psychological trauma as instinctual response.

Crisis types

In considering common emergencies in the child care center, medical emergencies such as seizures, choking incidents, deep wounds, and allergic reactions, were described in varying levels of severity by several participants. One participant described a choking incident which resulted in death. Choking incidents predominately occurred during lunch times, with hot dogs cited as a food item of particular concern among participants. Allergic reactions were noted during meal times, most often the result of a food allergy. Severe allergic reactions resulted in use of an Epi Pen. Deep wounds often occurred outdoors on the play yard, and resulted in trips to the emergency room for stitches. Seizures also presented as common. Perspectives of crisis preparedness for these common medical emergencies was favorable. Participants expressed confidence in the CPR and first aid training that they had received in preparing them to respond to seizures, choking incidents, deep wounds, and allergic reactions.

Crises situations involving intruder and lockdown emergencies also emerged as common. Participants shared experiences in which an unauthorized person entered their facility, sometimes forcibly so. Frequently, the unauthorized person was described to be homeless or psychologically unstable, resulting in the aid of law enforcement to remove the unauthorized person from the child care center. Also common were discussions of parents who had lost legal custody of their child yet attempted to kidnap their child from the child care center. Six unrelated incidences discussed by participants resulted in center lockdowns. These lockdowns occurred in response to an off-site, yet local, community threat. One participant indicated that center lockdown occurred as a result of a drive-by shooting which took place in front of the child care center. Participant perspectives of preparedness for these emergencies was mixed. Although all participants were confident in their response actions at the time of lockdown, many participants questioned their preparedness to respond effectively if the threat existed on-site rather than in the nearby vicinity.

Director discretion

The theme of director discretion encompasses several different topics discussed by participants, including director authority over 9-1-1 calls, storage of Epi Pens, reporting of choking incidents, access to medical supplies in excess of basic first aid kits, and systems of communication during a time of crisis. Three participants mentioned director control over 9-1-1 calls, administration of Epi Pens, and other emergency response procedures. Teachers were instructed not to call 9-1-1 or administer medical attention or first aid to children; this role was designated strictly for the director. Epi Pens were described as being stored in the office for director and office staff use only. Basic first aid kits were made available in classrooms, but no student-specific medical or emergency supplies were to be stored in classroom, as teachers were not permitted to use these supplies. This perspective was in contrast to the experiences of several other participants who indicated storage of Epi Pens and other medical and emergency supplies inside of the classroom, so as to be readily available to teachers in the event of a medical emergency. Perspectives of crisis preparedness appeared more positive in teachers who had immediate access to Epi Pens and other medical and emergency supplies inside of the classroom, as compared to those who did not.

Director discretion also plays a role in the reporting of emergency incidents. Two participants indicated that choking incidents which required use of the Heimlich maneuver were discouraged from being reported to the parents. In response to being discouraged from reporting a choking incident, one participant shared, “I said no because brain damage could occur. The child was choking. I tried every way to get it [and] the director [said], ‘Don’t even call the parents. It’s fine. There’s nothing going on.’ I couldn’t do that. I called the parents and told the parents, and I actually got in trouble for calling the parents.” Lack of reporting guidelines was associated with negative perspectives of crisis reporting by preschool teachers, specifically following a choking emergency.

The decision to stock classrooms and child care centers with medical and emergency supplies that extend beyond those included in basic first aid kits also appears attributed to director discretion. Four participants described access to an ample amount of supplies, which could be used in the event of a major crisis. These items went beyond requirements of the local licensing agency to include: an automated external defibrillator (AED) to use in the event of cardiac arrest, a portable toilet and toilet paper in the event of loss of plumbing, an ax for use during building collapse, and a box of zip ties, masking tape, and duct tape, stored together for the purposes of constructing temporary shelter. Access to a surplus of emergency and medical supplies within the child care center appears related to positive perspectives of crisis preparedness by preschool teachers in the target state.

Methods of communication during a time of crisis also varied depending upon director discretion. Two participants indicated that phone systems in their classrooms failed to make outgoing calls and were limited to classroom-to-classroom communication only. An additional participant noted lack of a phone system altogether. Poor methods of communication contributed to negative perspectives of crisis preparedness during a time of crisis by preschool teachers who work in the target state.

Inadequacies in center crisis preparedness

Throughout the interviews, participants indicated various inadequacies in center crisis preparedness and in center crisis preparedness plans. One participant noted, “We don’t talk about water contamination. We don’t talk about kidnapping. We don’t talk about threat of violence. I don’t know what I would do if someone [threatening] were to come in [the center]. We don’t talk about any of this. [State/local licensing agencies] push earthquake and fire so much, but that’s pretty much it. Nothing else is really mandated. That’s a bit scary. When taking care of children, that’s a bit scary.” Specific vulnerabilities emerged related to student-teacher ratios, nap time, the applicability of training across various child care settings, and with regard to environmental preparedness. Further inadequacies appear to exist in meeting site-specific crisis needs. Concerns regarding a lack of long-term crisis preparedness plans were also discussed by participants.

Student-teacher ratios during a time of crisis were mentioned briefly by several participants. Perspectives of crisis preparedness when responding to a crisis at the time of emergency appear more favorable by preschool teachers working in centers surrounded by many staff members, than by those participants who are required to respond to a crisis event while alone with their students. The impact of student-teacher ratios thus presents vulnerabilities, especially during mealtimes, nap times, and at the beginning and end of the school day, when fewer teachers are present at the child care center. Three participants shared personal experiences of responding to a crisis situation while alone during nap time; two preschool teachers reported a child having a seizure, and one preschool teacher discussed evacuating a classroom with 12 preschool students during a bomb threat. The vulnerabilities of nap time during a crisis event were echoed by additional participants, who noted the need for crisis preparedness drills that take into consideration all aspects of a young child’s school day.

Participant interviews suggested that considerations need also be made for the applicability of crisis preparedness training across child care settings. Many participants shared concerns related to the physical preparedness of the early learning environment. One participant noted that despite receiving training that requires preschool teachers to close their blinds during an active shooter emergency, some classrooms at the center had blinds that could not be closed. This participant stated, “They’ve been telling us for three years that they’re going to replace our blinds because some of the blinds in our classroom don’t close all the way. They really need to address [this] so that we feel more confident. If we had to go through an [active shooter emergency], we [should] focus on comforting our students instead of worry[ing] that the active shooter is going to walk by our [open] blinds.” Three additional participants questioned the layout of the child care center, noting the effect that their classroom configuration and design would have on their response during an active shooter emergency. These participants expressed concern regarding the visibility provided by large windows in the early childhood classroom and the sturdiness of tables and other furniture during an earthquake.

One participant shared their personal experience of an active shooter emergency while on a field trip, noting inadequacies in crisis preparedness training for off-site threats. Participants who discussed inadequacies in the applicability of crisis preparedness training and in center environmental preparedness for emergencies, shared negative perspectives related to the effectiveness of emergency drills and training on their anticipated ability to handle school crisis events, especially with regard to active shooter emergencies.

Additional inadequacies emerged with regard to site-specific crisis considerations. Four participants expressed concerns regarding the feasibility of safely walking very young children for a mile or more to off-site evacuation locations. An additional participant shared concern with receiving timely guidance from local licensing agencies during a site-specific emergency, stating that “It’s very difficult to get the amount of training or information needed. We had a water outage in our building one year, and we had to move all of our kids into a different area that was not licensed for that age group. I was calling the analyst, and calling the analyst, and trying to figure out what we needed to do. We couldn’t get a response from them about what to do in that situation. I [didn’t] get an answer [until] two days later.” Another participant noted a need for clear direction from state and local licensing agencies regarding such concerns, as: the number of emergency supplies to store on-site per child, checklists for how often to update emergency supplies, and information regarding emergency-specific resources. Overall, interview data suggests a need for better collaboration among state and local licensing agencies with preschool teachers regarding site-specific concerns, so as to strengthen perspectives of crisis preparedness before and during an emergency.

Very few participants discussed with certainty a procedure for long term recovery in the days, weeks, and months following a crisis event, indicating inadequacies in long term crisis preparedness. Participants shared that they would stay with the children to keep them safe and secure until all parents arrived, following a crisis event. However, there appeared no explicitly developed plans for recovery following pick-up of the last child. Overall, there exist negative perspectives of crisis preparedness with regard to plans for long term recovery, as very little attention has been made to creating plans that detail procedures for the days, weeks, and months following a major crisis event.

Crisis preparedness training

Crisis preparedness training within the child care center appears to consist predominantly of monthly fire and earthquake drills, and of completion of CPR and first aid training every 2 years by preschool teachers working in the target state. In considering crisis preparedness training within the child care center, some preschool teachers indicated a need for training beyond that which prepares teachers for fires and earthquakes. The importance of whole-team response and delegated roles during a crisis were discussed as a key factor in successful crisis response. The role of prior background experience was described in conjunction with crisis preparedness training. Concerns regarding the legality of select crisis response actions were discussed, as were concerns that preschool staff may “freeze” during a time of actual school crisis.

All 15 participants shared positive perspectives of CPR and first aid training. Preschool teachers who described responding to common medical emergencies in the child care center discussed the adequacy of CPR and first aid training in preparing them to: clear the area near a child and call 9-1-1 in response to a seizure, provide the Heimlich maneuver to a child who was choking, bandage a deep wound, and administer an Epi Pen to a child during an allergic reaction. Preschool teachers working in the target state also shared positive perspectives of crisis preparedness for fire and earthquakes. However, monthly drills and training which focus solely on fire and earthquakes were deemed inadequate by some. The perspective that state licensing requirements were inadequate in providing guidelines beyond fire and earthquake emergencies emerged across six participant transcripts.

The importance of whole-team response was discussed as a key factor in successful emergency medical response during a time of crisis. Delegated roles appear to contribute to positive perspectives of a preschool teachers ability to handle a school crisis event, whether during a time or crisis or in anticipation of a crisis event. Preschool teachers assigned specific tasks to complete in anticipation of a crisis event detailed with certainty the response actions that they would take during a time of crisis, indicating positive perspectives.

The role of prior training and background experiences were described in conjunction with perspectives of crisis preparedness. Crisis preparedness training unrelated to preschool center preparedness training appears to contribute to positive preschool teacher perspectives of crisis preparedness, in anticipation of a crisis event. Personal prior experience with an emergency also appears to contribute to positive perspectives of preparedness for future events.

Concerns regarding the legality of select crisis response actions were also discussed by participants. In centers where not all staff were required to be CPR certified, questions were posed regarding the legal role of those who were not certified in taking response actions. One participant was fearful that carrying-out an emergency action while not CPR certified could result in legal action being taken against them. Another participant shared an experience in which a child with no prior allergies had an allergic reaction while eating; in response, another child’s Epi Pen was used to provide emergency first aid to the child in need. Participant concerns related to the legality of crisis response indicate a need for crisis preparedness training which supports preschool teacher understanding of the legality of the emergency response actions taken during a time of center crisis.

Participant observations that preschool teachers “freeze” during a time of actual school crisis were also shared. One participant stated that a choking incident resulted in two classroom teachers freezing in shock, and being unable to help. A separate participant shared an incident in which a teacher ran around a center shouting that a child was having a seizure, rather that administering aid to the child. A third participant stated that during a school shooting incident, “An assistant froze, and we had to drag her into the building because she was so frightened that she just froze into place.” Descriptions of preschool teachers who appear unable to effectively respond during an emergency may reflect important considerations in future research related to preschool center crisis preparedness training.

Mitigating psychological trauma as instinctual response

A final theme to emerge across interview transcripts were discussions of instinctual actions taken during a time of crisis and in anticipation of a crisis event, intended to mitigate psychological trauma in children.

Several participants indicated that there exist no clear crisis preparedness guidelines for mitigating psychological trauma in children following a crisis event. However, the natural ability of a preschool teacher to respond to the psychological needs of a child was discussed by several participants, one of whom stated that preschool teachers have, “An inherent understanding of the children and their needs. Most preschool teachers are caring, compassionate, loving people, and those are the people that you want to have around when a child is psychologically having some kind of difficulty. I don’t think there’s any particular training that—I guess you could do some trauma-informed training—but I think preschool teachers already have that. It’s in [the] DNA [of the] preschool teacher.” Participants indicated that children with autism appear particularly sensitive to the sound of a fire alarm during emergency drills. These participants noted taking instinctive response actions to mitigate psychological harm to autistic students during a fire drill, such as providing one-on-one attention and hand holding. Participants shared that they request a parent or aid to be present to support a child with autism during a fire drill, and that they typically forewarn a child with autism of a fire drill so that the child is not surprised by the sound of the alarm. Distracting children as a means to effectively mitigate harm was noted across seven participant transcripts. Most commonly, participants described distracting children with storybooks and song. Overall, perspectives of preparedness for mitigating psychological trauma in students in anticipation of and during a crisis event appear positive in preschool teachers across the target state.