Early life stress and adverse childhood events can affect the mental and physical health of children. Mental health for young children includes how they understand, express, and manage their feelings and how they create and sustain healthy relationships. Various stressors such as physical abuse, family instability, unsafe neighborhoods, and poverty can cause children to struggle with regulating their emotions and can reduce their social functioning. The COVID-19 pandemic further worsened mental health issues for children and families, and increased the gaps in mental health access by race and socioeconomic status.
Much attention has been dedicated to the urgent mental health needs among young children, but there has been limited focus on identifying practices and programs to prevent mental health difficulties in the first place and to promote positive mental health outcomes. Such efforts are crucial for supporting healthy early childhood social-emotional development and well-being. The Elevating Prevention and Promotion in Early Childhood Mental Health project has identified innovative or exemplary practices across the country that support mental health in young children. We conducted case studies of five organizations with programmatic efforts to improve early childhood mental health. More information on our methodological approach can be found in Appendix A
Innovative or Exemplary Practices in Prevention and Promotion to Support Early Childhood Mental Health
The five case study organizations implement direct services, technical assistance, or systems-level efforts to support early childhood mental health. Based on lessons learned from these efforts, we describe the five key themes (Exhibit 1) that may have implications for other early childhood mental health prevention and promotion efforts.
Theme 1: Prioritizing relationships and collaboration between providers and families and among providers and agencies
A key similarity across all five case study sites is their dedication to prioritizing relationships and collaboration at all levels: between adults and children, between providers and parents or caregivers, among providers, across systems, and within communities. Because children thrive in safe and predictable environments, strong relationships are critical to implementing effective efforts to support mental health in early childhood.5 Strong relationships also help organizations collaborate with communities and other partners. This can lead to a more accurate understanding of a community’s needs, increase transparency on resource allocation, avoid duplication of services, and build the capacity of organizations to offer solutions that match the community context.
- Relationships between adult staff and children. Meaningful relationships between children and caring adults provide the foundation for healthy attachment, emotional regulation, and social interactions and can buffer young children from the adverse effects of toxic stress. The prevention and promotion practices highlighted in the case studies emphasize the importance of adult-child relationships in service delivery. For example, the Whole Child Approach (WCA) at Boys and Girls Club of the Valley (BCGAZ) focuses on creating a secure and supportive environment where children feel comfortable expressing and managing their emotions with peers and trusted adults. As an example, staff members engage in a daily warm welcome routine, ensuring that every child is greeted and can interact with staff. Similarly, Rooted in Relationships (RiR) from the Nebraska Children and Families Foundation (NCFF) helps providers and coaches learn how to cultivate genuine, safe, and positive relationships with children. These practices help nurture secure and supportive relationships, which are fundamental for children’s social-emotional well-being.
- Relationships between providers and parents or caregivers. The Best Starts for Kids (BSK) Infant and Early Childhood Mental Health Strategy (IECMHS) is also intentional in fostering relationships and building trust through service interactions. This helps families feel safe and encourages them to participate more fully in services by creating a space where they feel comfortable sharing concerns related to mental and behavioral health. Providers are then able to teach additional communication and parenting skills that can enhance the caregiver’s ability to promote positive child social-emotional outcomes. Similarly, the Center for Advancing Dyadic Care in Pediatrics (CADP) promotes a dyadic care model that simultaneously nurtures the child-caregiver and provider-family relationships.
- Relationships among providers. Some of the initiatives we examined encourage providers to regularly participate in communities of practice, such as provider networks or learning collaboratives. For example, RiR creates peer support networks for child care providers and coaches to better equip them with the tools needed to support children’s healthy social and emotional development. Supportive environments where positive relationships can flourish can have a cascading effect, benefiting both the providers themselves and ultimately the children and families they serve. CADP invests in building collaborative relationships between behavioral health and pediatric health care providers who work together with families. Through this collaborative approach, providers create welcoming environments and model positive and safe interactions for families.