Policy Resource

New ZERO TO THREE Report: How States are Nurturing Change in Infant-Early Childhood Mental Health Policies

Jun 18, 2013

Last month, the Policy Center released the next paper in this series, Nurturing Change: State Strategies for Improving Infant and Early Childhood Mental Health.

For most people, the term infant-early childhood mental health (I-ECMH) can be somewhat shocking or at least puzzling. Some people might tend to think that babies and young children don’t have the same emotional responses as adults to their environments and relationships. Yet, mental health and wellbeing is an intrinsic part of infancy, and we need to promote healthy social and emotional development, starting with babies. This promotion includes helping children experience, regulate, and express emotions; form close and secure interpersonal relationships; and explore their environment and learn- all of which are skills we need to thrive in school and life.

Infants and toddlers can and do experience intense emotions such as pain and sadness. Moreover, mental health and developmental disorders, including depression, anxiety, and ADHD, can and do begin to manifest in the first years of life. As development progresses, difficult behaviors and emotions that are left untreated often compound and become ingrained. But early intervention can yield promising outcomes, placing children back on a path to wellbeing.

A focus on infant and early childhood mental health (I-ECMH), which provides critical grounding for later mental health, relationships, and school success, has been a central focus of ZERO TO THREE’s work since its inception over 30 years ago. Last year, the ZERO TO THREE Policy Center released Making It Happen: Overcoming Barriers to Providing Infant-Early Childhood Mental Health, which discussed common barriers to providing I-ECMH services and issued federal policy recommendations to address them.

Last month, the Policy Center released the next paper in this series, Nurturing Change: State Strategies for Improving Infant and Early Childhood Mental Health. This new resource highlights promising strategies from 6 states—California, Florida, Louisiana, Michigan, Ohio, and Wisconsin—that have overcome barriers identified in Making It Happen. In addition to highlighting compelling and varied examples of state-level work in I-ECMH, Nurturing Change also provides strategic questions for states and makes recommendations for state policymakers.

Although research estimates that 10-14% of children age 0-5 experience emotional or behavioral disturbances, access to quality mental health care by providers trained in I-ECMH can be scarce. Why?

  • Many providers have difficulty getting reimbursed for I-ECMH services.
  • Eligibility requirements and diagnostic issues continue to prevent many young children from receiving the services they need.
  • Too few providers have adequate training in I-ECMH.
  • And I-ECMH services are not incorporated into the systems that currently serve young children and their families. And while that all sounds like bad news for babies in need, several states have implemented strategies to overcome these barriers:

  • Wisconsin is building a statewide, comprehensive, integrated I-ECMH system. *Michigan has developed competencies and an endorsement system for I-ECMH professionals that are being adopted by 14 other states.

  • Florida developed and adopted a user-friendly crosswalk to translate diagnoses between the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R) and other diagnostic manuals.

  • California uses Medicaid funding to reimburse providers for dyadic therapies, which treat infants and their caregivers in the context of their relationship.

  • Louisiana is integrating I-ECMH principles into their broader early childhood system so that caregivers and providers will be able to identify appropriate resources and referrals.

  • Ohio includes screening for maternal depression in its statewide home visiting system.

These are just a few examples of the work being done at state and local levels to nurture change for infants, toddlers, and families with I-ECMH needs. You can learn more about these and other promising state strategies in Nurturing Change: State Strategies for Improving Infant and Early Childhood Mental Health.

  • Author

    Patricia A. Cole

    Senior Director of Federal Policy


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