A new report recently published in the New England Journal of Medicine shows a downward trajectory in severe mental health issues for children between the ages of 6 and 17. On the surface, this is good news. Yet on the flip side, the study also reveals a troubling pattern of young people without access to mental health treatments from which they can truly benefit.
Lost in the narrative completely are the youngest set of children -- specifically infants and toddlers. With preschool expulsion rates at more than three times the expulsion rate of students in kindergarten through 12th grade, it's clear that the mental health needs of infants and toddlers can no longer be overlooked. It's time we took a serious look at infant and early childhood mental health and strategies to prevent mental health problems before they start.
Consider the experience of one mom and her child care provider:
Christine arrived at her sons' child care center feeling anxious. The child care director had asked Christine to meet with the center's "social-emotional" consultant. The consultant, Mr. Lee, shared that her boys' teacher wanted to build a good relationship with the boys and needed some help understanding how to do it. The teacher wanted them to be safe and happy and felt her efforts were just not working.
Mr. Lee explained that his job was to support everyone working together to figure out what the boys were trying say through their behavior. Mr. Lee asked Christine some difficult yet thoughtful questions about what her boys were going through and why they might be acting out. Christine was able to reflect on the fighting had they had recently seen and heard between herself and their dad. Christine, Mr. Lee and the boys' teacher met every week to share thoughts and ideas for the boys. The teacher was able to spend some more one-on-one time with the boys, and Christine was able to talk with her sons about what they were seeing and hearing at home. Christine felt not only a sense of safety with this team who supported her and her children, but also hope - something that had not been there in a long time. (Adapted from Ash, Mackrain, & Johnston , Early Childhood Mental Health Consultation: Applying Central Tenets Across Diverse Practice Settings. Zero to Three, 33(5), p.30).
Christine's sons might have been just another statistic in the preschool expulsion scenario. But thanks to targeted and proven models designed to address underlying issues that drive certain behaviors, she and her sons benefited from services and techniques designed specifically to meet their particular needs.
It is estimated that between 9.5 percent and 14.2 percent of children age birth to 5 experience an emotional or behavioral disturbance. This means that the many people who interact with young children on a daily basis play an important role to play in helping children feel safe, secure, and cared for. Most importantly, when children are struggling with social-emotional challenges, they can ensure that these issues are identified as early as possible - ideally within the first three years of life. Research demonstrates that early prevention and treatment of mental health disorders is much more beneficial and cost-effective early in life, rather than attempting to mitigate their effects on health and learning later in life.
So how do we bolster positive mental health in young children and ensure that challenges are detected early? The key is to integrate mental health prevention services into the settings where children spend their time -- at home, child care or the doctor's office. Here is how we can ensure this happens:
• Educate parents and caregivers about social and emotional development. Parent and caregivers know their own child best. They are often the first to notice if their young child's behaviors, moods, or intensity are different than usual.
• When mental health concerns exist for young children, link parents to early intervention programs in the community that are adequately prepared to screen for and treat social-emotional difficulties in a two-generation, dyadic fashion. Engage parents as partners in the intervention effort since therapists may spend an hour with the child each week, but parents are there day-in and day-out.
• Screen parents for depression. Parents who are experiencing depression may be unable to provide their children with the responsive care they need to feel safe, secure, and loved. Supporting parents' mental health is another way of supporting young children's mental health.
• Help pediatricians support infant and early childhood mental health. A child's pediatrician is often the first person a parent turns to when their child is physically sick and he or she should also be a key resource when a parent is worried about their young child's mental health. Programs such as Healthy Steps help pediatricians be that resource.
• Ensure that child care providers are prepared to promote and support healthy social and emotional development. Second only to immediate family, child care is the setting in which early childhood development unfolds. It is critical that child care providers are knowledgeable regarding early childhood mental health so that they are able to support young children's social and emotional development and address challenging behavior in a positive manner.
• Integrate mental health prevention strategies into other programs that serve young children and their families. Home visiting programs match at-risk parents and their children with trained providers such as nurses, social workers or paraprofessionals who met regularly with the families through home visits to provide support and education. Home visiting programs across the country are integrating mental health prevention strategies into their programs and linking children and families with needed services.
• Implement early child care mental health consultation and other promotion/prevention models. Project LAUNCH, a federal program that aims to promote the wellness of young children birth to 8 by addressing the physical, social, emotional, cognitive and behavioral aspects of their development, has sites throughout the country which demonstrate a variety of effective early child care mental health consultation and other promotion/prevention models.
Preventing mental health problems means starting in the earliest years of life to promote healthy social and emotional development. Children begin to learn important life skills in infancy, skills like communicating their needs, expressing and not being overwhelmed by their emotions, building self-confidence, making friends and getting along with others. The key to preventing mental health problems is to identify and address concerns as soon as possible, and to support those who surround young children. There are ways to identify mental health problems in young children, and to effectively treat them. Parents, pediatricians, home visitors and child care providers can be the "first responders" to mental health concerns. Catching problems early, and intervening before they become more serious, will provide the best chance of helping all young children succeed and lead healthy, happy lives.
This blog post is the second in a three-part series exploring the mental health needs of very young children. Click here to read the first post on promotion of infant and early childhood mental health and stay tuned for a future post on effective treatment for those with diagnosed mental health disorders.
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