Keana Reece found navigating between health and education systems overwhelming when it came to meeting the needs of her 4-year-old, Tyran. He is now enrolled at The Primary School East Bay, where they posed on Oct. 13, 2021. (Julia McEvoy/KQED)
Keana Reece always makes sure she is last in line when she drops off her 4-year-old son, Tyran, at preschool, so she can minimize the trauma of handing him off to his teacher. As she leads him in by the hand, she gives him the pep talk.
“Remember: My name is Tyran. I am loved. I am worthy. And I'm highly intelligent. Got it?”
Tyran has nonverbal autism, so Reece has come to intuit his every gesture and sound. Early signs of autism can appear in children during their first two years of life, with some children becoming verbal as they grow older. Reece is wearing her “I Love Someone With Autism” T-shirt as she walks up to the classroom door.
“You know the drill. Big boys on one side of the door, mommies on the other,” Reece tells him. Tyran starts to cry as he’s led in, and Reece turns away. "This is the hardest part of my day," she admits.
Reece brings her son here in the afternoons to a special education preschool at the Hayward Unified School District’s Student Information and Assessment Center (SIAC). But she often feels like it's hard to get the school to respond to what she knows is best for her son.
“I talk to the teacher maybe two minutes a week. They take him in. They bring him out. I don't know what he's learning. I don't know anything,” Reece said.
When the Hayward school district seemed to give her the runaround on buying a new electronic PECS board — a speech tablet that would make it easier for Tyran to communicate — she saved up and sacrificed to buy one herself.
When she learned the preschool wouldn’t do inclusion, where Tyran could be with children who did not have disabilities, she began looking for one that would.
“It's disheartening because I know who he is, I know what he's capable of. When I look at him, I see greatness,” she said.
“It's a ton of work, but it's either do the work or let him fall under the bridge. It's the educational system. I just don't know how to navigate the system, and it's overwhelming.”
That kind of stress can take a toll.
“I was so involved in Tyran and making sure our time was together and making sure the house was together, making sure my husband was together. That Keana was falling by the wayside, and some days it was four or five o'clock and I realized I hadn't eaten anything all day,” she said.
Parenting during the pandemic has been rough on a lot of families. According to research done by Frontiers in Psychiatry, parents reported increased stress due to difficulty in parenting, with 1 in 5 reporting high stress over the course of the pandemic. Children's resulting social and emotional issues have been showing up inside school classrooms. But while billions in pandemic tax dollars have been allocated to help schools with kids’ mental health, little has been done for parents.
It took Reece finding a new preschool to get the help she needed.
Reece has a trusting relationship with her pediatrician at the Kaiser Hayward-Sleepy Hollow medical clinic. So when she got an email from him about a new public preschool that Kaiser physicians were helping design, she was intrigued.
What she found was a place where she would get to be part of Tyran’s education, and where school staff would treat her as an equal partner. They would also give her a personal coach who would check in with her biweekly.
“If there's something at school that I just can't talk to the teacher about or I don't know who to go to, I can call Diane,” said Reece. “‘Hey, this is my problem, what do I do?’ And if it's something that I just can't bring up, she'll say, ‘I'll talk to them.’ So by the time they come to me, the issue was already brought out and the awkwardness of the situation has been taken away. It is pretty amazing.”
The publicly funded preschool, called The Primary School East Bay, costs Reece nothing. The school prioritizes families who qualify based on income and enrolls them on a rolling basis when spots are available. Reece can also still keep Tyran in the traditional public school special education class in the afternoons, giving her full-day preschool. This allows her to keep her payroll job at the city of Oakland, though it means shuttling Tyran between schools during her lunch hour.
There was something else about this new school that appealed to her: It would have Kaiser medical staff on campus twice a week.
Inside the school, Dr. Paul Espinas points out two medical assistants and a nurse, all Kaiser staff, working outside at tables in the school’s grassy playground. Espinas is a Kaiser pediatrician and medical director at the preschool, which means he meets weekly with school staff to coordinate care for kids and their families.
“We should honor the work that school nurses have done in the area. We should honor the work that our school-based health clinics have done. But I feel like a lot of families are still trapped, trapped ping-ponging between different organizations within their community,” said Espinas.
Espinas had seen parents struggling to navigate the health care system, describing times when he’d screen a child for a developmental issue and make a referral, and the parent wouldn’t follow up.
“And if they don't make it, and I see them a year later still needing speech therapy or the speech, the speech problems are worse. Like, I feel like that's a systems fail on our part,” said Espinas.
Espinas says the clinic’s doctors work directly with teachers at the school to help parents schedule appointments, make sure families bring kids in for vaccines, or get the asthma medication they need. He said the teachers’ role in helping reach out to parents is pivotal, and called the intensive team effort unique.
“If we get this model right, other systems hopefully will replicate it. Other Kaisers, other big health systems,” said Espinas.
Reece says the coordination takes stress off her. “I don't have a medical background and I don't have an educational background, either,” she said.
When teachers at Hayward’s district-run preschool sends her to Tyran’s pediatrician to get more information about what Tyran needs, by the time she gets back to the school with the information, she has it confused. She said, "I have answers, but I'm sure they're not as accurate as my Kaiser physician saying, 'I'll let the school know.'"
Because Kaiser staff communicate directly with The Primary School East Bay, now when Reece shows up at the school, teachers already have information her doctor has sent them, and she can sit down with staff to discuss next steps to best assist Tyran.
Teachers are also benefiting.
“Remember last year during COVID? I didn't necessarily have to come up with a health plan. Our on-site doctor did,” explained Denise Laney, lead teacher at the school.
“As a teacher, I have had students come into my classroom with not the appropriate attire for the weather. I've had students that come in complaining of hunger. I've had families say, 'Hey, I know that my student needs glasses, but I can't afford it.' I know that someone's been complaining, their tooth hurting, but I'm not sure what to do, and we have resources for all of that.”
Having health care staff on site also allows these early childhood educators to remain focused on teaching and creating a respectful way of including and engaging parents in how to best support their kids.
“So that we really are able to learn to not just assume things, but to ask a lot of open-ended questions,” said Natasha Hall-Sevilla, manager of parent wellness coaching. “To really learn and understand what our families are going through so that we can change ourselves, and change how we show up for families.”
All this can mean extra hours for teachers. But Laney says teachers like her are getting paid more than the norm for early childhood educators who have long complained about being undervalued.
There are only 48 children enrolled in The Primary School East Bay — three classrooms each with two teachers and a total staff of 15. So far, the estimated cost of the state-funded preschool is about $20,000 per child, with some of that coming from philanthropy.
While there are other schools nationwide educators cite as the models they used to develop The Primary School East Bay, including the privately funded The Primary School in East Palo Alto, the East Bay school operates using state tax dollars. As it adds grades, it hopes to prove this kind of intensive wraparound support for families with public funding.
California is investing a historic $3 billion over the next five years to expand the community schools model. The goal is to make high-poverty schools into one-stop shops, serving students' social and emotional needs and, by extension, the needs of their families. The state is investing an additional $1 billion to help schools provide mental health services through partnerships with community health organizations.
Courtney Garcia oversees both The Primary School locations, and says public systems are not currently set up for different agencies to coordinate seamlessly and in a family-centered way, which complicates caregivers’ lives.
“Parents really express, many of them, isolation, overwhelm and so many stressors that can make it really difficult for them to reach out and seek help, can make it difficult for them to overcome barriers to accessing resources that are there to serve their child and to serve their family in many cases,” Garcia said.
Garcia points out that for children and families in Alameda who qualify for Medi-Cal, only 43% of children are having their annual preventive checkups. At The Primary School East Bay, 100% of students have had those checkups in the past year.
Kaiser Permanente calls this integrated care between its medical staff and the school staff promising, though it wouldn’t say what share of the costs it was carrying. If Kaiser Permanente, one of California’s largest health care providers, were to supply medical staff to public schools, it could be a game changer.
This kind of coordination between her local health clinic and her school does take some stress out of Reece’s life, but not all of it.
When things get overwhelming, she turns to the parent coach hired by the school to focus on her well-being. The coach works with 40 to 50 parents. Hall-Sevilla, the parent coach coordinator, says coaches work on parent wellness, nutrition and stress management.
“And I'll say, 'Oh, my gosh, it sounds like you are really stressed out. I can hear and sense the stress in your voice. Would you be OK to take a breath with me?' And so we stop and we take a deep breath, and then they're able to continue on,” she said.
Coaches also guide parents and guardians toward reaching their own goals, checking in every two weeks. Reece and other parents also are part of a monthly wellness group of parents who support one another.
Before they found The Primary School East Bay, Reece and her husband talked about her homeschooling Tyran, even though it would have meant giving up her job. They both decided Tyran’s needs have to come first.
“In my mind now, I don’t care if he's autistic, he's still going to grow up, he's still going to get married, he's still going to have kids … he's still, you know, he's still going to be a force to reckon with in this world,” she said.
Reece has worked hard to get Tyran into the right preschool where she believes he can thrive.
Now she just has to find the right place for him to go to kindergarten.