To truly address the Infant/Early Childhood Mental Health (I/ECMH) needs of our youngest children, we must also recognize and respond to the needs and strengths of the caregiver. A newborn does not live in a bubble, so what impacts a caregiver, will impact their child.

Perinatal mood and anxiety disorders (PMAD) impact many families when a new baby arrives. According to 2020 Mom, symptoms of depression and anxiety occur in up to 20% of mothers, making these conditions the most common complications of pregnancy. Despite their prevalence, PMAD are under-detected by health care professionals, and as a result, many people do not receive proper treatment. When identified early, these symptoms are very treatable, yet when left untreated, they can have devastating impacts. In fact, research indicates that suicide is a leading cause of maternal death.

Many birthing parents only experience PMAD once pregnant or during postpartum and have no history of mental health issues. Therefore, most are only screened for symptoms of depression and not anxiety. Additionally, new parents face countless expectations and judgements about what motherhood should be, and often, many mothers fear being perceived as inadequate in this new role. It is important for providers to proactively discuss PMAD with birthing parents before, during and after pregnancy and normalize the birthing experience, so they are not worried about asking for help.

It’s important to also consider the mental health needs of non-birthing parents. One in 10 fathers experience Paternal Postpartum Depression, and up to 16% of fathers suffer from an anxiety disorder during the perinatal period, according to the National Institute for Children’s Health Quality. In addition, many fathers experience stigma due to feelings about and perceptions of gender and parenting roles, not only felt by the individual, but seen within our society and systems of care.

Moreover, pregnancy, child birth and parenthood bring up powerful conscious and unconscious reminders of childhood issues, which can help or hinder the parent in responding to, caring for and loving their child. Helping parents understand their own strengths and their child’s strengths builds their confidence and supports parent-child interactions.

We know that factors like maternal depression and the mental health of other caregivers, such as grandparents and foster parents, can have an impact on young children’s development. The concepts of attunement, rupture and repair illustrate that mistakes and mismatches will always occur, even in the most secure relationships. But, when repair follows rupture, children learn resilience and that big emotions can be okay. The world, then, appears as a safe place, where disagreements can be resolved, and relationships can be sustained through conflict.

By creating environments where secure attachments can be made, caregivers will help set positive expectations for how children will understand themselves and others and how they will be treated and should treat others.

Given the wide array of circumstances that exist for young children and families, we must be diligent in identifying and providing resources to caregivers that best serve their needs.

This blog post is the third in a series about I/ECMH and this post in particular is in honor of Maternal Mental Health Awareness Month, a time to raise awareness of the common illness experienced by new moms. Thank you to the Postpartum Depression Illinois Alliance for shining light on this important issue. 

States are currently grappling with how to leverage the massive influx of federal funding coming their way through the Coronavirus Aid, Relief and Economic Security (CARES) Act; the Coronavirus Response and Relief Supplemental Appropriations (CCRSA) Act; and most recently through the American Rescue Plan Act (ARPA).

While these funds have focused on stabilizing this essential industry, the various pots of child care funding in ARPA provide a unique opportunity to lay the foundational infrastructure that centers racial equity to transform our child care system as we know it.

In the following process guide, we share a few ideas and guiding questions to help state leaders be strategic and lay the foundation for a more equitable early childhood system that meets the needs of families experiencing the most hardship, particularly families of color, all while facing quick timelines and no promise that this level of federal funding will continue.

The passage of the American Rescue Plan Act (ARPA) represents one the most significant investments in young children and their families in decades. Investments in child care, home visiting, Head Start, health care, housing assistance, mental health services, stable access to food, clean water and other supports for families will go a long way to alleviating many of the challenges and addressing the disparities that the pandemic has only intensified for America’s families.

As systems leaders begin to plan for how to implement these historic investments at the state and community level, there are a number of opportunities to ensure these funds produce the maximum impact for our children and families. We are excited to see many of the priorities in our Policy Agenda included in the legislation, including opportunities to support high-quality early childhood programs and services, build connected and comprehensive early learning systems, and engage families and elevate parent and caregiver voices, which we’ve outlined below.

Quality Programs

Home Visiting Services: States will have the opportunity with the MIECHV funds to improve home visiting methods for virtual or hybrid programming, allow programs to address the intensified needs of families and ensure the workforce receives relevant training and support innovative approaches to family and caregiver engagement.

Individuals with Disabilities Education Act (IDEA): While ARPA includes IDEA funds that are a step in the right direction, the legislation does not come close to providing up to 40 percent of the average cost per student, a commitment Congress made when IDEA was first passed in 1975. These funds will likely be spent on current interventions like professional development, additional technology and supplemental programming to address learning disruptions. While important in this moment, there remains a need for long-term investments in the workforce and increased access to programs.

Community Based Child Abuse Prevention: This funding can be used for a variety of prevention efforts, including home visiting and doula services. While it has long been acknowledged that children and families engaged with the child welfare system benefit from participation in quality early childhood programs, such programs have been significantly underfunded. There needs to be much more attention paid to ensuring more programs are specifically designed and resourced to provide additional supports to families.

Comprehensive Early Learning Systems

Child Care: The child care funding has a mix of one-time investments, a focus on stabilizing the fractured child care industry and a 10-year increase to the mandatory funding for the Child Care & Development Block Grant (CCDBG). These resources present a tremendous opportunity for states to lay down a foundation for a redesigned child care system — one grounded in equitable access and developed in partnership with families and providers. States can use the one-time funds to improve and update data systems, develop family child care networks, contract for supply building in historically disregarded communities and employment status, compensation parity for the workforce, improve subsidy payment rates and policies to be more reflective of the true cost of care, and more reliable revenue.

Elevating Family Voice and the Role of Families

Robust Parental Supports: The paid sick time and family leave payroll tax credits are a small step toward a much needed national family leave policy. Relationships with parents and other caregivers are critical to a baby’s early development and their long-term cognitive, social and emotional development. Enacting public policies that provide parents with paid leave from work to care for their young children helps families begin their journey on a strong foundation of caring, consistent relationships.

The tax credits for families have the potential to cut child poverty in half. Extending these credits beyond the current time frame, as proposed in the American Families Plan, would have a dramatic effect on the lives of young children: Children five years and younger are the population at the highest percentage living in poverty in our country. Additionally, the investments in housing, the extension of Medicaid postpartum health care to 12 months, and the temporary increases to SNAP and WIC should all be made permanent. We know that in order for children to thrive, their families must have access to good nutrition, quality health care, safe and secure housing and clean water.

Centering Parent and Caregiver Voice: As we continue our journey towards ensuring all children have equitable, quality early learning experiences, we must be certain to include the people most significantly affected by either a strong or failing system. Parents and caregivers have the clearest perspective of what families need from their own lived experiences. They know better than anyone how and why programs and policies fall short and what changes would improve outcomes. State leaders must work with families in meaningful ways to ensure these investments truly meet the needs of all children and families, especially those from under-resourced communities.

The early childhood resources and investments in the ARPA are a tremendous step in the right direction. The further increases to early childhood funding proposed in President Biden’s American Families Plan also lend a sense of hope to many of us in the early childhood field. However, there is still much to be done and shortcomings to address. We look forward to helping state and local leaders navigate the complex challenges required to driving systemic change and ensure their prenatal-to-age 5 systems are high-quality and integrated, are resourced to be sustainable, and are designed to serve children and families from historically marginalized communities.

National Policy Team members Mina Hong and Rio Romero-Jurado also contributed to this piece.

Although Infant/Early Childhood Mental Health (I/ECMH) primarily focuses on promoting mental health and prevention, we can lose clarity and honesty when we don’t also look at the needs, challenges and struggles of children and families.

Behavior is how young children communicate and all behavior has meaning. Challenging behavior is a normal part of a child’s development, and as found by the Brazelton Touchpoints Center, shifts at key developmental milestones can offer opportunities to teach children new skills. However, when challenging behaviors are sustained, excessive and/or impacting the child’s daily life, it is important to seek support for intervention that can drive improved outcomes. And, in some cases, a child will receive an appropriate diagnosis.

1 in 6 U.S. children age 2–8 has a diagnosed mental, behavioral or developmental disorder. Yet, 75% to 80% of children in need of mental health services do not receive them. Unfortunately, families often rely on emergency rooms to address children’s mental health needs, where wait times are 8% longer. There are further disparities in access for Black and Latinx children, who are less likely to be diagnosed or treated for mental health conditions and concerns. This is due to inequitable access to services, as well as ongoing stigmas and perceptions of services, among other factors. In fact, psychiatric and behavioral problems among children of color often result in school punishment or incarceration, but rarely mental health care.

Right now, over a year into the COVID-19 pandemic, mental health needs have increased for children and families. There are lower rates of identification for young children with disabilities, difficulties providing services they should be receiving, and many children are experiencing high levels of social and emotional challenges. A survey by Ann & Robert H. Lurie Children’s Hospital of Chicago conducted during the pandemic estimated that 70,000 toddlers and children in Chicago are showing mental and behavioral health symptoms.

The good news? Adverse childhood experiences do not dictate the future of a child. We must be strengths-based in our approach to addressing I/ECMH and focus on protective factors, as well as risk factors. The single most common resilience factor for children is at least one stable and committed relationship with a supportive adult. That adult can be anyone—a parent, a caregiver, a teacher, you.

You don’t have to be a clinician to do I/ECMH work. As we work to bolster the mental health system by reducing the stigma of mental health challenges and improving access to care and close race-based disparities, we need to use a multipronged approach, pulling in a variety of non-traditional providers and supports. Programs, staff and families need to be equipped with the best tools and supports to be able to promote mental health and well-being of all children, intervene when appropriate and provide referrals for targeted treatments.

This blog post is the first in a series about I/ECMH in honor of Mental Health Awareness Month, as we also partner with other I/ECMH organizations, such as the Illinois Association for Infant Mental Health and the Illinois Children’s Mental Health Partnership. 

When one thinks of the phrase “Infant and Early Childhood Mental Health,” they may visualize a baby on a couch babbling to a therapist or wonder if infants and young children even have mental health needs. However, infant/early childhood mental health (I/ECMH) is far more powerful, comprehensive and complex.

As defined by ZERO TO THREE, I/ECMH is the developing capacity of a child from birth to age 5 to form close and secure adult and peer relationships; to experience, manage and express a full range of emotions; and to explore the environment and learn—all in the context of family, community and culture. I/ECMH is an imperative component of early childhood development, and these skills provide a foundation for all other domains of development, such as cognition, speech and language and motor skills.

Many equate I/ECMH with overall social-emotional development or self-regulation. Although, this is not entirely accurate as I/ECMH encompasses the needs and strengths of the child and the primary caregiver, as well as the characteristics of the caregiving relationship.

The early care and learning field can and should approach our work through an I/ECMH lens. This approach is strengths-based and focused on health, not illness; places importance on equity, cultural humility and reflective practice; and understands the importance of brain science and that development happens within the context of relationships. It is critical that the I/ECMH system be comprehensive, coordinated and integrated, and should offer families the supports that reflect the continuum of care needed, from education and prevention to intervention and treatment.

At Start Early, we recognize the importance of I/ECMH in our programs, trainings and professional development offerings. In addition, our Illinois Policy Agenda reflects our commitment to advancing policies that strengthen the I/ECMH system and promote access to the continuum of supports that families with young children need. Some of our policy priorities include:

• Implementing a model of I /ECMH Consultation and trauma supports across early care and learning programs
• Building the capacity of mental health service providers to address I/ECMH
• Establishing routine identification of and referrals for caregiver depression in the perinatal period, including supports for the caregiver and child
• Increasing access to mental health services for families with young children through increased funding for services
• Providing rates to providers that provide parity with physical health care
• Improving access to mental health services provided through services like Early Intervention

At Start Early, we know that the mental health needs of children and families are greater during the ongoing COVID-19 pandemic, and we must prioritize I/ECHMH support now more than ever. I/ECMH is often misunderstood, but it is a simple concept—it is the foundation of all future development, and we all share ownership of helping our children grow.

This blog post is the first in a series about I/ECMH in honor of Mental Health Awareness Month, as we also partner with other I/ECMH organizations, such as the Illinois Association for Infant Mental Health and the Illinois Children’s Mental Health Partnership. 

Tonight, President Joe Biden unveiled the American Families Plan, which includes sweeping federal investments in national child care, prekindergarten and paid family leave, among other priorities. In response, Start Early leaders issued the following statements:

Transformative Investments in Our Youngest Learners Nationwide

“The American Families Plan contains transformative investments in our youngest learners, their families, and the workforce that represent a quantum leap towards a comprehensive early learning system where every family and child has the opportunity to thrive.

The experiences children have during their first five years shape their brains in a profound way, setting them up for lifelong success. We are excited to see our education system expanded to include preschool for 3- and 4-year-olds, supports for families to access high-quality learning and child care, and paid family leave that will help all families begin their journey on a strong foundation of caring, responsive relationships.

Start Early will continue to leverage our expertise in program, policy and research, as well as our decades of work with children, families, the workforce and systems leaders and our efforts to advance equity to help maximize the impact of these historic investments.”

– Diana Rauner, president of Start Early

An Opportunity to Accelerate a Bold Vision for Early Learning in Illinois

“The American Families Plan contains historic investments in our youngest learners, their families and the workforce that create an opportunity to transform our nation’s approach to a prenatal-to-age 5 early learning system.

The Plan will build on the equitable foundations Illinois is already laying through a sweeping package of legislation led by the Illinois Legislative Black Caucus earlier this year. It also offers an opportunity to greatly accelerate the realization of a bold vision for our state’s early learning system, laid out in the recommendations from Governor J.B. Pritzker’s Early Childhood Funding Commission.

Start Early looks forward to bringing these federal opportunities to bear on our work here in Illinois to transform our state’s early learning and care system, beginning in the earliest days of life.”

– Ireta Gasner, vice president of Illinois advocacy & policy at Start Early

Moving Washington State One Step Closer Towards a Comprehensive Prenatal-to-Age 5 Early Learning System

“The American Families Plan contains transformative investments in our youngest learners, their families and the workforce that will move Washington state one step closer towards a comprehensive prenatal-to-age 5 early learning system where every family and child has the opportunity to thrive.

These investments will support the implementation of the Fair Start Act, an historic piece of legislation in Washington state that will advance our early care and education system, making high-quality child care more available and affordable, and provide critical supports to families with young children.

“Start Early will continue to leverage our expertise, our decades of direct work and our efforts to advance equity to inform positive changes for our state’s early learning and care system.”

– Valisa Smith, executive director of Start Early’s Washington State Office

About Start Early
Start Early (formerly known as the Ounce of Prevention) is a nonprofit public-private partnership advancing quality early learning and care for families with children, before birth through their earliest years, to help close the opportunity gap. For nearly 40 years, Start Early has delivered best-in-class doula, home visiting, and Early Head Start and Head Start programs. Bringing expertise in program delivery, research and evaluation, professional development, and policy and advocacy, Start Early works in partnership with communities and other experts to drive systemic change so millions more children, families and educators can thrive.

Weekly Highlights

Legislative Session is Over; Next Up Bill Signings. The Legislature adjourned Sine Die just after 6:00 p.m. on Sunday, April 25th. It was a legislative session to remember! At the press conference following adjournment, Democratic leadership reminded the press of the four goals they brought into the legislative session: 1) economic recovery; 2) COVID response; 3) addressing racial equity; and 4) addressing threats to climate, noting significant progress in each of these areas.

Legislative leaders also emphasized the goal of a safe legislative session, emphasizing that not one legislator or staff contracted COVID, unlike other State Legislatures. Legislators recognized the challenges involved with meeting virtually, but said they hope to maintain some sort of virtual testimony in future years.

What’s Next? Attention now turns to the Governor’s office where the Governor has 20 days (Sundays excluded) to sign and/or veto bills. On Monday, the Governor signed ESHB 1370 relating to Early Learning Facilities and we are expecting the Fair Start for Kids Act to be signed in early May.

Budget Update. After release of budget details on Saturday, both the Senate and House adopted the $59.2 billion 2021-23 biennial budget prior to adjourning on Sunday. The budget contains an additional $10 billion in federal money, spends down the state’s Rainy Day Fund and holds back $1.1 billion in federal dollars to account for unanticipated needs.

State Early WA prepared this summary of key early learning investments. Our rough math shows over $850 million in new operating and capital budget investments. Much of this is federal money and a good portion is one-time for child care stabilization grants ($400 million), but over $300 million is intended to be ongoing.  The goal is for this one-time federal money to be replaced by revenue generated from the new Capital Gains tax. The biggest investments are in our state’s Working Connections Child Care system, with an increase in rates to the 85^th percentile of market rate; reforms to the broken co-payment system; and increases in income eligibility.

Capital Gains on its way to Governor Inslee.  In one of its final actions, the Senate approved the Capital Gains bill, ESSB 5096, on a 25-24 vote on Sunday, sending the bill to Governor Inslee for his expected signature.  On Friday night, a conference committee comprised of three Senators and three House members adopted a compromise that made two key changes to the bill: 1) it created a charitable donations deduction and 2) capped annual distribution to the Education Legacy Trust Account at $500 million with remaining tax proceeds being deposited into the Common School Construction Account.

The compromise kept language stating that the tax is necessary for the support of state government and its existing public institutions. This language could serve to limit the option of a referendum on the ballot to repeal the law.