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Two studies evaluated a Therapeutic Nursery Program (TNP) integrated into Head Start centers aimed at reducing the impact of risk and increasing protective factors related to mental health outcomes in the child, family, and environment. Teachers and parents ident@ed dilferent sets of behavior problems in children referred to the TNF: suggesting the need to target internalizing as well as externalizing driqculties. The TNP services appeared successful in increasing adjustment and forging family alliances with teachers.Poverty and the increasing environmental stressors associated with poverty place Head Start children at greater risk for the development of negative mental health outcomes such as excessive externalizing (i.e., aggressive, defiant, and disruptive behavior) and internalizing (i.e., anxious, withdrawn, and depressed behavior) symptoms, delayed academic achievement, family conflict, or poor peer relationships. Reviews of the success of early preventative interventions designed to facilitate the transition to the social world of the preschool classroom, emphasize the need to embed the mental health perspective more fully into Head Start programs through a more conspicuous, active but culturally-sensitive presence in classroom activities, family programs, and staff development and strategic planning activities. Integration also takes the form of a more collaborative stance in the creation of interventions and closer links with community resources. The literature also indicates that early interventions carried out in the classroom and with the family have positive effects in both preventing later problems and in reducing the level of high-risk behaviors in identified children.

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