The Evidence Base for How and Why Infant and Early Childhood Mental Health Consultation Works


What is IECMHC?

Infant and Early Childhood Mental Health Consultation (IECMHC) is an evidence-based service in which a mental health professional builds the capacity of early childhood professionals and programs to improve the social-emotional development of infants and young children and enhance equity in early childhood settings. These mental health professionals, referred to as IECMH consultants, have expertise in early childhood and indirectly help young children by partnering with the adults who care for them. IECMH consultants adopt a “consultative stance” which defines how they approach all activities of consultation. The consultative stance, as defined by Johnston & Brinamen (2006), refers to how consultants prioritize the formation of strong, empowering, equitable relationships in their role, embodying tenets such as “wondering instead of knowing” and “avoiding the position of the sole expert”. Within the context of a trusting relationship, the early childhood professional explores their relationships with young children, practices new ways of interacting with them, and develops confidence in supporting how the individual addresses challenging behaviors.

IECMHC – also referred to in this article simply as “consultation” – is not therapy for children, families, or professionals. It is also not the same as coaching; although the two are complementary preventative services, IECMHC does not use predefined goals or strategies with consultees, and the consultants bring significant infant mental health expertise to their roles (NAEYC, 2011). Broadly, consultation programs are defined by their infrastructure, consultant workforce, and high quality services; beyond that, consultation is unique in its focus on non-directive, capacity-building relationships which lead to indirect effects on children and families. It is rooted in the principles of Infant Mental Health and relational health, which center relationships as agents of change and emphasizes cultural and other contextual influences as essential to understanding a child or dyad (Frosch et al., 2021; Zeanah & Zeanah, 2019). Consistent with these theories, IECMHC is grounded in the recognition of how individual characteristics, developmental stage, and relationship quality are inextricably linked, and parallel processes (supervisor-consultant, consultant-provider, and provider-parent/child relationships) are intentionally invoked to promote positive outcomes (Frosch et al., 2021; Zeanah & Zeanah, 2019). As a multilevel service, consultants seek to understand the intersecting levels of influence on a child, family, early childhood professional, and/or program, (e.g., organizational climate, cultural considerations, parent engagement) and to build upon strengths across these levels.

IECMHC has been implemented in a variety of settings such as early childhood education (ECE), home visiting, child welfare, family friend and neighbor (FFN) care, Part C/early intervention services, and primary care. IECMHC programs vary based on the setting and individual models may evolve over time. Nevertheless, an overarching framework articulates the core elements of an IECMHC program: a solid program infrastructure, highly-qualified consultants, and high-quality services (Duran et al., 2009). These core components of an IECMHC program – paired with readiness for change, positive relationships, and positive interactions – contribute to IECMHC’s positive outcomes for children, families, professionals, and programs. Key distal outcomes for IECMHC include improved early childhood professional skills and confidence in supporting early childhood mental health; programmatic improvements to support a positive climate; increased social-emotional skills and reduced externalizing behaviors in infants and young children; and reduced child suspensions and expulsions from ECE programs. Beyond these overall effects, IECMHC is intended to reduce disparities in these outcomes in early childhood programs and settings, both by providing additional supports to programs and children affected by poverty, discrimination, and other stressors and by building providers’ awareness of their own biases.


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