Editor’s note: This essay is an entry in Fordham’s 2021 Wonkathon, which asked contributors to address a fundamental and challenging question: “How can schools best address students’ mental health needs coming out of the Covid-19 pandemic without shortchanging academic instruction?” Click here to learn more.
Sound childhood mental health is the foundation of stability that supports academic success in school. Investing in the mental health of K–12 students is much needed, but by the time a child reaches kindergarten, many mental health issues have already emerged and begun to cause problems, setting some children on a course for academic failure. Waiting to invest in children’s mental health at school age is a missed opportunity, nor is such a plan the most cost effective public policy.
It is during the first five years of a child’s life when their brains are developing the most rapidly. By age six, the brain has already reached 95 percent of its peak size. Children under age two are at an especially critically sensitive time developmentally because they are at the height of neuroplasticity and greatly benefit from developmentally stimulating experiences and positive caregiver interactions. Investments in early childhood mental health supports and the programs, such as quality child care which can deliver these services available to families, is crucial to a child’s successes in school and in life (Institute of Medicine, 2000).
One such program is Infant and Early Childhood Mental Health Consultations (IECMHC). IECMHC builds the capacity of the adults caring for children as well as addresses the challenging behaviors some young children face. IECMHC is a prevention- and relationship-based approach that pairs a mental health consultant with the adults who work with infants and young children in the natural settings where they learn and grow, including child care, preschool, and the home (Center for Excellence for IECMHC, 2017, 2020; SAMHSA, 2014). Implementation varies depending on the population, need, and local infrastructure, but the goal remains the same: healthy children and healthy families.
In Maryland, IECMHC is funded by the Maryland State Department of Education and happens in a number of settings. Child care providers can access mental health consultation through the statewide network of Child Care Resource Centers. These centers also train providers to identify symptoms of mental health problems that young children may exhibit. For example, providers know how a child gets along with others and will notice if they’re isolating themselves from the rest of the kids. They may also notice if they aren’t listening to instructions or are being overly aggressive. Then a mental health specialist and the provider will work with the child and their parents to solve problems together. The mental health consultants also work with child care program directors and teachers to advise about universal program and classroom strategies that promote social emotional well-being for all children.
IECMH consultants also visit Early Head Start Centers and spend time in classrooms. They observe and interact with children, providing direct support. But perhaps even more importantly, they support the teachers in planning for lessons and needed developmental supports. In addition, Maryland funds a network of Family Support Centers, which also support the emotional needs of families. They offer developmental screenings for children and employ the Strengthening Families Framework to support parents, along with early childhood mental health services.
The IECMHC model in Maryland relies on the National Pyramid Model (NPM). NPM is a framework that promotes the social and emotional development and school readiness of young children from birth through age eight and has been found to help teachers improve social, emotional, and behavioral outcomes for children (Hemmeter, 2016). Training, coaching for staff, and the implementation of a program-wide positive behavior support in early childhood programs though the NPM approach provides a tiered intervention framework of interventions for promoting social, emotional, and behavioral development of infants and toddlers who are indicated for services related to delays or concerns with development. This model aligns with school-aged Positive Behavior Intervention and Supports (PBIS), applied broadly throughout the school system within Maryland.
When society invests in programs like these we not just investing in children. We are making a down payment on the well-being of the entire country for decades to come. For example, Nobel Laureate in economics James Heckman finds a 13 percent return on investment for high-quality, birth-to-five early education in the form of improved life outcomes such as higher school graduation rates, better long-term physical and mental health, greater earning potential as adults, and reduced likely hood of substance misuse. Society as a whole sees reduced social spending due to less crime, less unemployment, and less drug and alcohol dependency (Heckman, 2016).
Other research finds equally significant positive outcomes stemming specifically from early childhood mental health programs and interventions. Dr. Walter Gilliam of Yale University found improved teacher-rated child behavior, improved classroom climates, increases in teacher-reported developmentally appropriate knowledge, as well as increased job satisfaction and reduced stress for the teachers themselves (Gilliam, 2006; 2007; 2014).
Further research supports these findings by demonstrating positive outcomes for children, increased quality of teacher-child relationships, and improved early childhood classroom settings (Brennan, et al., 2008; Connors-Burrow, 2013; Gilliam, 2016). A 2009 systematic review also found that improved child behavior was a consistent outcome of IECMHC (Perry et al., 2010). In Maryland, annual statewide data collection has also shown improved child, family, and classroom-level outcomes while teacher- and parent-rated child behavior has improved, too (Latta et al., 2021; Wasserman, et al., 2020; Andujar, et al., 2019; Candelaria, et al., 2018).
For far too long, preschool suspension was a common occurrence. So common that the Maryland Legislature recently made it unlawful to expel children enrolled in publicly funded pre-kindergarten programs (COMAR, 2017). Instead, a greater emphasis has been placed on providing early childhood teachers with the tools needed to address mental health problems, which are at the root of a child’s misbehavior. Gilliam’s research lends credence to this approach.
Gilliam uncovered disparities in the experiences of young children of color and children from other marginalized communities in early childhood settings, especially around rates of suspension and expulsion (U.S Department of Education Office for Civil Rights, 2014; Gilliam, 2016). IECMHC is linked with reducing those rates (Perry et al., 2008; Gilliam & Shahar, 2006) by impacting early childhood professionals’ beliefs, attitudes, and practices to support more effective caregiving for all children. The proof is in the numbers. Among sites in Maryland that receive IECMHC, formally identified preschool expulsions rates have been low among children receiving this service: 3–5 percent in 2018–20 (Latta et al., 2021, Wasserman, et al., 2020; Andujar, et al., 2019; Candelaria, et al., 2018).
For children who are trauma-exposed, the need is even more urgent. Toxic stress or other adverse childhood experiences (ACEs) have long-term impacts on developing brains. The National Survey of Children’s Health found that just under half of the children in the United States have lived through at least one traumatic experience, such as losing a parent to divorce, abandonment, or incarceration; witnessing or being a victim of violence; experiencing neglect; living with a parent suffering from addiction or mental illness; or living in a family that faces economic hardship. Sadly, the generational impacts of poverty and other ACEs means that many parents experiencing the negative emotional effects of trauma often have had limited exposure to strategies to promote attachment and resilience in their own children. The Covid-19 pandemic has only exacerbated emotional problems of young children in Maryland. At the same time, Maryland’s early childhood workforce is facing a dramatic economic crisis caused by low enrollments.
Mental illness is treatable and manageable, and often preventable. More investments are needed to strengthen existing programs, fill existing gaps, reduce stigma, foster innovation and research, and break down barriers. Invest earlier, and collectively and we will reap the benefits earlier, throughout a child’s academic career and life. Otherwise, the K–12 school system, and then our society at large, will bear the brunt of these problems if help does not arrive soon for our youngest children.
AMHSA (Substance Abuse and Mental Health Services Administration (2014). Expert Convening on Infant and Early Childhood Mental Health Consultation. https://www.samhsa.gov/sites/default/files/programs_campaigns/IECMHC/ie…- expert-convening-summary.pdf
Andujar, P., Fry, J., Wasserman, K., & Candelaria, M. (2019). Maryland’s infant & early childhood mental health consultation project: 2019 legislative brief. The Institute for Innovation and Implementation. https://create.piktochart.com/output/35764480-md-iecmhc- project-1-25-2019
Brennan, E. M., Bradley, J. R., Allen, M. D., & Perry, D. F. (2008). The evidence base for mental health consultation in early childhood settings: Research synthesis addressing staff and program outcomes. Early Education and Development, 19(6), 982-1022. https://doi.org/10.1080/10409280801975834
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Center of Excellence for Infant and Early Childhood Mental Health Consultation. (2020). Infant and early childhood mental health consultation—Competencies. http://www.iecmhc.org/documents/IECMHC-competencies.pdf.
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Latta, L., Afkinich, J., Sweeney-Wasserman, K., Kane, A., & Candelaria, M. (2021). Maryland’s infant & early childhood mental health consultation project: 2020 legislative report. The Institute for Innovation and Implementation. https://earlychildhood.marylandpublicschools.org/system/files/filedepot/19/legislative_brief_fy2020_3.pdf
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