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Infant and Early Childhood Mental Health: Definitions, Challenges and Solutions
APA Congressional Briefing on Children’s Mental Health
October 10, 2007
Jane Knitzer, Ed.D.
National Center for Children in Poverty
Mailman School of Public Health, Columbia University
Some Definitions
May be called infant mental health, early childhood mental health, social and emotional health etc. All refer to:
The development of age-appropriate social, emotional and behavioral health in infants, toddlers and preschoolers re:
- managing/regulate emotions (anger, frustration);
- relate to adults and peers (do they turn to or away from adults)
- feel about themselves (do they approach new situation, learning eagerly or not)
Why Invest Early
- Early relationships set the stage for healthy or unhealthy brain development
- Poor early social, emotional and behavioral development predicts early school failure which in turn predicts later school failure
- Early intervention can reduce later higher cost interventions
How Widespread are Early Childhood Mental Health Problems?
An estimated 17% of young children have diagnosable social and emotional disorders according to an epidemiological study of pediatric practices (Angold et al. 2005).
- Mental health disorders can be identified earlier than thought
- In 2002 about 1% of children served in community mental health centers were under age six. (Pottick et al. 2002)
Many more children are exposed to risk factors that increase the odds of poor social and emotional development.
- According to the Early Childhood Longitudinal Study, 10% of all kindergarten children have social and emotional problems that interfere with their functioning,
- Rates three times as high for low-income children (Raver & Knitzer, 2002)
- Young children are being expelled from child care at 3 times the rates of children expelled from k-12, 3-5 times for children of color (Gilliam, 2005)
- Poor social and emotional functioning predicts early school failure which predicts later school failure and more serious mental health problems (Raver & Knitzer, 2005).
The more risk factors, the greater the odds of social, emotional and behavioral challenges BUT developmental research also finds that strengthening protective factors through relationship-based interventions
What Can Help?
Research-informed prevention and early intervention relationship based interventions targeted to parents and other caregivers of young children
- Addressing parental depression (Amerman, 2005)
- Preventive parenting strategies based on clinical knowledge, e.g. Incredible Years (Webster-Stratton 1998)
- Expanding Early Head Start
- Making early childhood mental health consultation available to early childhood programs (Gilliam, 2007)
- Implementing evidence-based curricula to promote improved self-regulatory behaviors and social skills
- Providing evidence-based interventions for higher-risk parents, such as Parent Child Interactive Therapy and trauma-informed infant-toddler therapies
- Family-driven intervention strategies for children with identified disorders
Screening with Follow-up
- Using standardized screening tools for both young children and parents (especially to identify depression) in pediatric practices, obgyn etc.
- Using, and reimbursing for age-appropriate diagnostic tools (e.g. DC0-3)
Criteria for success
- Embedding screening and therapeutic strategies in settings families trust
- Focusing on parents and caregivers to give them the tools to support healthy development
- Increasing awareness about the importance and nature of early childhood mental health issues among the early childhood policymakers, providers and funders
- A well-trained work force
- Tracking impacts as part of the school readiness agenda
Key Policy Implications
Responsive funding streams
- Funding for consultation activities that are NOT targeted to young children with diagnoses but to support caregivers (Technically, indicated client challenge)
- Target funding for children at risk of early school failure by virtue of three or more risk factors (e.g. Foundations for Learning legislation)
- Reimbursement for age appropriate screening and assessment tools and mental health services delivered in early childhood settings
- Better links between adult mental health and early childhood mental health
- Set asides or priority language in child welfare funding streams for improved strategies to meet the mental health and developmental needs of young children, including supporting child welfare investments in evidence-based parenting support strategies.
Current Opportunities
- Make explicit references to young children in the proposed Child and Adolescent Mental Health Resiliency Act of 2007 and the Mental Health in the Schools Act of 2007, as well as NCLB and the Child Health Care Crisis Relief Act.
For more information and detailed citations see: www.nccp.org, contact Dr. Jane Knitzer (Knitzer@nccp.org) or Perry, D., Kaufmann, R & Knitzer, J. Social and Emoitonal Health in Early Childhood. ( 2007). Baltimore, MD. Paul. H. Brookes Publishing Co.
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