Improving Treatment for Drug-Exposed Infants
Treatment Improvement Protocol (TIP) Series 5

Transition to the Preschool Period

Transition from the toddler to preschool period should involve careful planning and preparation with the mother and child to ensure compliance with the new program. Early intervention and developmentally based parent-child and early childhood programs should continue to provide services within a family-centered model, and should feature low child to teacher ratios of 4:1 for multirisk children. In addition, class size should remain small, with no more than eight children and two teachers per classroom. Lower ratios and small class size ensure that the children receive the individualized attention critical to their educational development.

To deal adequately with the complex problems of multirisk children in a school setting:

1. Needed therapeutic services should be provided:
   • Speech and language services
   • Physical therapy
   • Occupational therapy
   • Play therapy.
2. Teachers should be provided with training to:
   • Understand addiction issues in general.
   • Understand women's addiction issues and family systems.
   • Understand cultural and racial factors in the family's background.
   • Recognize behavioral cues in individual children to promote the child's self-regulation.
   • Provide a consistent, predictable, well-structured environment to promote the child's self-regulation.
   • Plan for transitions to promote the child's self-regulation.
   • Address issues relating to addiction, abuse, and violence.