Infant Mental Health Consultation: A Wise Investment Of CCDBG Dollars

The new Child Care and Development Block Grant (CCDBG) funding represents an enormous opportunity to improve access to and quality of child care for infants, toddlers, their families, and the teachers and programs that work with them. With funding from the Pritzker Children’s Initiative, a project of the JB and MK Pritzker Family Foundation, the BUILD Initiative is organizing a series of webinars and blogs in partnership with ZERO TO THREE and the Center for Law and Social Policy for state policy leaders, decision makers and advocates.

By Myra Jones-Taylor, Chief Policy Officer, ZERO TO THREE

I recently spent a day visiting with Early Head Start (EHS) teachers and infant early childhood mental health (IECMH) clinicians at Starfish Family Services in Inkster, Michigan, just outside of Detroit. I was there to learn how the 55-year-old organization integrates IECMH consultation into each of its early learning classrooms, which serve children between the ages of six weeks to five years old.

A veteran EHS teacher seated next to me said to the group, “When David toddled in this morning, I could tell he was in the back seat. I was tired and probably getting close to being in the back seat myself, but I knew I had to connect with him and give him what he needed if I wanted to avoid having him end up in the trunk.” The school’s IECMH clinician registered the look of horror on my face and quickly said to me, “We should probably stop here and tell you why she’s talking about babies in the trunk of a car.”

Relieved, I listened as she explained how they use the car as an analogy for the brain. The front seat of the car is the prefrontal cortex. Ideally, children will spend most of their day there because that is the place in the brain where learning takes place. The back seat is the limbic system. As the site of heightened emotion, it is responsible for the times when children are most attuned to their feelings. When children are there, they crave connection and need to be comforted and reassured. Once the need for comfort is satisfied, children are more capable of making their way to the front seat. The trunk is analogous to the fight or flight impulse in the brain and the place you want children to avoid. When children are in the trunk, their immediate need is for safety. Attempting to rationalize or comfort children when they are in the trunk will only intensify their behavior, not improve it.

Starfish adopted the car analogy to create a common language among early learning teachers, IECMH clinicians, and families. The organization realized teachers and clinicians work with the same children and families, many of whom are in crisis or experiencing great adversity, but only the clinicians had the advantage of trauma-informed training to address those challenges. The organization decided to make IECMH and trauma-informed care a top priority and trained all early learning staff in Trauma Smart, a program of Crittenton Children’s Center in Kansas City, Missouri. Trauma Smart’s approach bridges the gap among IECMH clinicians, early learning teachers, and families. In fact, Trauma Smart first created the car-as-brain analogy several years ago after also recognizing the need for shared understanding of mental health across the early childhood field. Today, every teacher at Starfish has been trained in the program, and an increasing number of mothers and fathers have participated in programming featuring the caregiver curriculum.

What is IECMHC?

Infant Early Childhood Mental Health Consultation (IECMHC) is a preventative intervention that places IECMH consultants in early childhood settings to build social-emotional competence of the adults working with children in these settings. Consultants also partner with families to address a child’s individual needs and/or provide information, training, and resources to all families. These consultants come from a variety of disciplines – social work, psychology, psychiatry, marriage and family therapy, and counseling. They typically have a minimum of a master’s degree in a mental health field and have deep knowledge of child development, infant and early childhood mental health, relationship-based approaches, and evidence-based practices. According to Cohen and Kaufmann (2005),”Early childhood mental health consultation aims to build the capacity (improve the ability) of staff, families, programs, and systems to prevent, identify, treat, and reduce the impact of mental health problems among children from birth to age 6 and their families.” While this holistic approach of building capacity of a young child’s caregivers and families may depart from traditional one-on-one therapeutic mental health services, it is a core principle of infant mental health. When states tap CCDBG for IECMHC, the services come at no cost to the program or the family. The delivery of services can be child-focused, classroom-focused, or program-focused consultation.

Why is IECMHC Important?  

IECMHC builds the capacity of providers and families to understand the powerful influences of infant and toddler relationships, interactions, and environments on the development of babies.  Infant-toddler well-being is promoted and mental health problems are prevented or reduced as a result of the consultant’s partnership with adults in young children’s lives. It can also promote emotional and other important skills for infants and young children.

An emerging evidence base demonstrates the range of outcomes that can result from the delivery of IECMHC. In light of so much promising evidence, there is need for more research focused specifically on child-level outcomes for infants and toddlers. It has been linked to improvements in teacher-child interaction and classroom climate, reductions in children’s problem behavior and increases in their social skills, prevention of expulsion including among young children of color, less work missed by families, lower parenting stress, and decreases in teachers’ stress and rates of turnover.

IECMHC in Use

Starfish is one of numerous programs around the country that embed IECMHC in early learning programs to promote strong social-emotional health in young children. All Our Kin, an organization that leads staffed family child care networks in Connecticut and New York, has also recognized the importance of connecting IECMH consultants and training to its family childcare providers. All Our Kin currently embeds IECMHC in its family child care programs that are also part of the Early Head Start-Child Care Partnerships (EHS-CCP). Providers receive observations from IECMH clinicians at least once a year and may have additional observations to address the needs of individual children. Beginning this year, EHS-funded All Our Kin providers will also be able to take part in reflective supervision, a fundamental component of IECMH practice.

While IECMHC is a core part of All Our Kin’s prevention model, the organization’s relationships with the IECMH community was instrumental in helping families cope in the wake of a recent tragedy. In early July 2018, a father of one of the children participating in EHS was shot and killed. The trauma of the loss was compounded by the fact that the slain father was also the grandson of the EHS family child care provider. Almost immediately, All Our Kin connected with IECMH clinicians in the community to provide more intensive supports for the family who lost their father and grandson, as well as for all the children and families in the program. Leaders of the organization told me their existing relationships with IECMH consultants in the community allowed the family to access services immediately and ensure a trauma-informed plan was in place to support children and families as soon as the program reopened.

Funding IECMHC

Both All Our Kin and Starfish help us see the power of IECMHC but, when we look at the financing for the work, it gets very complicated. All Our Kin relies on EHS-CCP funds and thus its IECMH work is limited to the providers who are part of that particular initiative. Starfish relies on a complicated funding system that includes Medicaid reimbursement and a lot of private fundraising to cover their IECMHC costs. We know countless other programs across the country would also like to provide IECMHC but competing demands on resources prevent them from doing so. My hope is that this year’s historic increase in the Child Care and Development Block Grant (CCDBG) will finally empower programs to use their quality set-aside dollars to provide this critical component of quality early learning for infants and toddlers.

Using CCDBG Funds for Infant-Toddler Settings

Many early learning providers have looked to the mental health provisions of the reauthorized CCDBG to reduce preschool expulsions and suspensions; however, it is important to remember these funds can also be used to support infant-toddler early learning settings. The integration of IECMH in child care for infants and toddlers is not just permissible through CCDBG: it is essential for optimal learning and development, particularly for children who experience toxic stress. The benefits of IECMHC begin in the infant and toddler period, and the common rationale for providing IECMHC in preschool classrooms (reducing suspensions and expulsions) applies in classrooms serving children under the age of three as well. As shocking as it may seem, there is evidence of expulsion of toddlers from early childhood programs.

Recommendations to States for Improving IECMHC

1. Create awareness campaigns to acquaint providers, parents, and caregivers with the topic of IECMHC, introduce it them as a resource, and inform them of its potential impact.
2. Invest in IECMHC as part of the child care delivery system.
3. Build the IECMHC workforce by offering incentives to colleges, universities, and IECMH training programs to prepare IECMHC professionals.
4. Strengthen the IECMHC workforce and ensure quality of services by creating policies that encourage hiring IECMHC professionals with infant and early childhood mental health endorsement or credentialing.
5. Leverage funding (federal, state, community, private, Tribal, territorial) to implement statewide IECMHC services in child care, as well as other programs and settings serving young children and their families, such as early intervention, foster care, primary care, and home visiting.

Moving Forward

At its core, IECMHC is focused on prevention, supporting the positive social and emotional growth of infants and toddlers. It’s not primarily a “treatment” strategy but a support and prevention approach. So, while we focus on IECMHC in a child care context here, it can and should be part of other service systems where young children are, including foster care, substance abuse treatment, etc. It presents an opportunity to promote social and emotional well-being for infants and young children, reduce stress and improve skills of the child care workforce, and can also serve as a link to the more intensive mental health services families may critically need. As states continue to create, implement, and expand IECMHC services, the potential exists to transform the approach to mental health for young children and their families – and to redefine the components of a systems-approach to child care.

Watch our August 6 webinar archive, Reaching Out: Using Consultants to Support Best Practices in Infant-Toddler Child Care Recording | Presentation

Additional resources:

• https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children
• https://www.zerotothree.org/resources/1952-infant-and-early-childhood-mental-health-consultation-a-briefing-paper  
• https://www.samhsa.gov/sites/default/files/programs_campaigns/IECMHC/financing-guidance-infant-early-child-mental-health-consult.pdf
• https://www.samhsa.gov/iecmhc/toolbox
• https://gucchd.georgetown.edu/products/FINAL%20formatted%20executive%20summary.pdf