Supporting Positive Mental Health in Early Childhood

July 24, 2023 | Ramya Dronamraju, Claire M. Rudolph

Supporting positive mental health in early childhood is critical to mental and physical health outcomes later in life. One of the best ways to prevent the long-term effects of adverse childhood experiences (ACEs) is by fostering responsive relationships between caregivers and children. Since early childhood mental health is inextricably linked to caregiver mental health, caregiver mental illness is considered an ACE.

While stress and traumatic events in early childhood are associated with negative mental health status in adulthood, children whose mothers report positive mental health are less likely to develop mental health and behavioral disorders later in life, highlighting the importance of interventions and support for positive caregiver mental health. It’s estimated that approximately 44% of adult depressive disorders could be prevented with the elimination of ACEs.

State, territorial, and freely associated state health organizations have an important role in safeguarding positive mental health in young children and their caregivers. Support for programs and policies that encourage positive mental health in early childhood and provides support for parents and caregivers to have the best chance to improve mental health across the life course. Caregiver and family interventions are critical components of effective mental health therapies for young children.

National Efforts to Improve Early Childhood Mental Health Outcomes

Recent research and headlines about the early childhood mental crisis have spurned national, state, and local action. The federal government issued a recent letter to states, tribes, and jurisdictions outlining a national plan to align state-level coordination across federal funding streams to advance and expand mental health services for children. The letter describes opportunities for states to address the rise in diagnoses of mental illness in children from 3-17 years old, including leveraging the HRSA Title V Maternal and Child Health Services Block Grant, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Community Mental Health Services Block Grant, and the Administration for Children and Families’ Title IV-E Prevention Program. It also suggests states coordinate and fully utilize mental and behavioral health services and programs covered by Medicaid.

SAMHSA’s Infant Early Childhood Mental Health (IECMH) grant program also supports mental health in early childhood. IECMH designs programs that serve children at risk of developing or those showing early signs of having a diagnosis of mental illness to improve mental health outcomes for children from birth through age 12. Strengthening caregiver mental health is an important goal of the IECMCH through multigenerational therapy and other services that aim to strengthen caregiving relationships. From 2019 – 2021 alone, over 9,000 young children and caregivers received evidence-based mental health and related services through IECMH. For more information, health agencies can connect with the national center that provides technical assistance to increase mental health consultations throughout the country.

State Examples

In 2019, in New York state, several state agencies collaborated to create new behavioral health services available for any child aged 0-21 eligible for Medicaid and meeting medical necessity guidelines. These Children and Family Treatment and Support Services were designed to deliver services in the community where it works best for families and children. This approach helps overcome barriers such as access to transportation and childcare for other children. Authorized under Early and Periodic Screening, Diagnosis and Treatment benefit, these services include family and youth peer support, therapy, rehabilitation, and crisis intervention.

Tennessee’s Department of Mental Health and Substance Abuse Services manages the new Behavioral Health Safety Net for Children, which provides mental health services to children aged 3-17 who are uninsured or underinsured for behavioral health conditions. As of 2021, services available include but are not limited to assessment and evaluation for a behavioral health concern, individual and family therapeutic intervention, care management, peer support services, transportation, and psychiatric medication management. Administered through community mental health agencies, participants have access to an outreach coordinator and referrals to other behavioral health payor sources.

In July 2022, Colorado established the Department of Early Childhood to unite Colorado’s early childhood systems and support the health and well-being of all of Colorado’s children, their families, and early childhood professionals. The department supports social-emotional development and mental health through early childhood mental health consultants for providers, parents, and caregivers. The Colorado Early Childhood Mental Health Specialists program focuses on early identification and treatment to help early care providers create environments that support mental health and well-being among children and families. The department also houses the Colorado Early Childhood Mental Health Support Line for parents and caregivers searching for information related to early childhood mental health. It offers videos, print materials, and additional resources to raise awareness and support families’ learning and understanding of mental health.

Recommendations for State and Territorial Health Agencies

  • Recognizing that rates of early childhood mental health disorders have increased in recent years, assess the status of statewide early childhood mental health. Consider looking for county and township-level trends, if possible.
  • Expand child mental health outpatient and crisis services in Medicaid. Gathering data on the effectiveness of these services can help make the case with private health plans to cover similar services and further bolster the mental health system.
  • Engage youth and caregivers in formulating new policy and programming ideas. Ensure that families and caregivers are included in mental health service provision.
  • Encourage collaboration among state agencies and public and private partners to participate in federal early childhood and caregiver mental health programs such as SAMHSA’s Project LAUNCH, Indigenous Project LAUNCH, and IECMH.
  • Work with state Medicaid agencies to promote innovative financing arrangements for early childhood mental health services.

As rates of early childhood and caregiver mental health concerns continue to increase and access to mental health providers is increasingly diminished, health agencies have a responsibility to use available mechanisms to support positive early childhood and caregiver mental health.

This publication was prepared with funding support from the Health Resources and Services Administration's (HRSA) Maternal and Child Health Bureau (MCHB). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA.