The youngsters enrolled in the preschool program at Cincinnati (Ohio) Children’s Medical Center are not your ordinary kids. Everyone is a victim of serious abuse or neglect.

The Therapeutic Interagency Preschool (TIP) program uses psychiatrists, mental health, speech, and occupational and physical therapists from Cincinnati Children’s, teachers from the Head Start program run by Hamilton County Educational Services Center (ESC) and caseworkers from Hamilton County Family and Children’s Services. It has helped abused children heal for 27 years.

 “We take a lot of children who are at risk and move them toward being more resilient and functioning well,” says Jane Sites, the program’s founder and director at Cincinnati Children’s.

The program enrolls about 65 children in morning and afternoon classes year-round at the hospital – although many children stay longer. There is a waiting list of about 35 children for the program, which also has after-school classes for older students.     

County caseworkers refer children to TIP. These are children who have been beaten or burned, sexually assaulted or otherwise mistreated by mentally unstable or drug-addicted parents. Often, the manifestations of their trauma turn into anger, aggression, sadness, despair and depression.

“It is a unique population of children who require the intensity of services that Cincinnati Children’s can provide,” says Irene Schaeffer, Hamilton County ESC’s special educational services supervisor. “These are the kids who wouldn’t make it in kindergarten. They would be expelled or placed in an outpatient behavioral treatment program without this early intervention.”

TIP combines standard Head Start curriculum with clinical and mental health services. Speech therapists work on language skills. Occupational and physical therapists work on motor skills in sessions that can take place in a classroom, playground, garden or lunchroom on the hospital’s grounds. Children and their families also meet weekly with mental health professionals.

The clinical and mental health services are woven into the children’s daily activities. Therapists make their work look like play in helping children understand and navigate a difficult life.  

For example, planting a seed in the garden, watering the seedling and nurturing the young plant as it grows can be a profound experience for a child who has never been nurtured by a parent. Children who can’t form healthy relationships with adults or other children may form strong emotional bonds to plants in TIP’s garden, Sites says.

“It’s so beautiful to watch how protective they are over their tomato seed and plant and make sure squirrels don’t come in. It is the beginning of resiliency and coping,” she says.

It may not look like therapy to a family or child, but it is, says Moira Weir, director of Hamilton County Job and Family Services. “We are not just sitting in a therapist’s room and talking,” she says. “We do different kinds of activities that get kids interested and engaged, as well as parents.”

In TIP’s nurturing environment, Sites says the children make significant strides. Children who participate in TIP for one year make the most developmental progress of any preschoolers in the county’s Head Start program, she says.

“Don’t ask what is wrong with the child,” Sites says. “Ask what has happened to the child. That is the critical difference.”

She stresses that it’s important to reach abused children at an early age, which is why TIP last year began a program called Baby TIP for children up to three years of age.

When the partners launched TIP 27 years ago, Sites says little was known about the psychological effects of abuse on children. “We didn’t think enough about developmental issues or know what reactive detachment disorder, or PTSD, or bipolar looks like when it starts to express itself at age 4 or 5,” she says.

The partners say the hospital’s and county agencies’ commitment to working collaboratively by pooling resources and integrating services is key to TIP’s success.

“Effective partnerships require people to put their personal agendas aside and say, ‘what can we as a team to do solve this problem,’” says Weir. “Everyone involved in TIP cares deeply about these children.”