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Substance Abuse and Mental
Health Services Administration
(SAMHSA)
Expert Convening on
Infant and Early Childhood Mental
Health Consultation
September 11 -12, 2014
SAMHSA Headquarters
Rockville, MD
Infant and Early Childhood Mental Health
Consultation (IECMHC) is an intervention for
promoting the social, emotional, and
behavioral well-being of young children and
their families in early childhood settings.
While a number of individuals and
organizations have been working to
advance the field, experts have had few
opportunities to come to consensus about
how to define and operationalize IECMHC
and to discuss the state of the field with
federal leaders. In the fall of 2014, the
Substance Abuse and Mental Health
Services Administration (SAMHSA) convened
a 1.5-day meeting of national experts on
IECMHC to provide a forum for beginning to
explore these issues.
SAMHSA has long been a supporter of
IECMHC; for example, through the
development of a monograph on Early
Childhood Mental Health Consultation (see
References & Resources section below), and
through Project LAUNCH: SAMHSA's early
childhood wellness promotion initiative
(http://www.healthysafechildren.org/grante
e/project-launch). In recent years, this
commitment has been reinforced by strong
evidence of the lifelong health and
behavioral health consequences of early
adversities experienced by young children,
and the potential for IECMHC to mitigate
these negative impacts and to promote
positive behavior and school readiness.
SAMHSA organized this Expert Convening to
chronicle advances in the implementation,
evaluation and funding of IECMHC and to
join with national experts and federal
partners in charting a way forward.
On the first day of the convening, the Expert
Group’s aim was two-fold: first, to reach
consensus on the definition, key elements,
and core competencies of IECMHC; and
second, to identify effective IECMHC
approaches that would inform a dialogue
with federal leaders.
On the second day, the group met with
federal leaders to share points of consensus
and to solicit input on next steps for the field.
The convening focused on IECMHC in early
care and education and home visiting.
Although IECMHC occurs in a variety of
settings, narrowing the scope of the
conversation was necessary to allow
adequate time for the Expert Group to
achieve its objectives. Moreover, the
majority of research to date that has shown
beneficial outcomes of IECMHC has been
conducted in the context of early childhood
education and home visiting programs.
Nevertheless, the Expert Group agreed that
future efforts should consider IECMHC across
Definition of IECMHC
Infant and Early Childhood Mental Health
Consultation is a multi-level preventive
intervention that teams mental health
professionals with people who work with young
children and their families to improve their social,
emotional, and behavioral health and
development.
IECMHC builds the capacity of providers and
families to understand the powerful influence of
their relationships and interactions on young
children’s development. Children’s well-being is
improved and mental health problems are
prevented and/or reduced as a result of the
MHC’s partnership with adults in children’s lives.
IECMHC includes skilled observations,
individualized strategies, and early identification
of children with and at risk for mental health
challenges.
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multiple service settings; for example, primary
care and child welfare.
What is IECMHC?
IECMHC is a preventive intervention for
promoting young children’s social,
emotional, and behavioral health in early
childhood settings. The cornerstone of
IECMHC is a collaborative relationship
between the Mental Health Consultant
(MHC) and the adults who care for young
children (e.g., parents and other family
members, early childhood educators, home
visitors).
Rather than offering therapeutic services
directly to a child or to a family, the MHC
works in partnership with the child’s
caregivers to increase their capacity to
support children’s social and emotional
development. The MHC helps caregivers
learn to identify, understand, and address
the needs of children at risk for mental health
problems as early as possible. In addition,
the MHC works with the adults in children’s
lives to consider how their own attitudes,
beliefs, and actions affect their relationships
with children and with other caregivers, and
how to change their behavior in ways that
lead to more optimal outcomes for young
children. In turn, caregivers are better able
to address issues as they arise rather than
waiting until more serious problems emerge
(e.g., preschool expulsion).
IECMHC is an interdisciplinary field
representing diverse voices and
perspectives. Accordingly, SAMSHA
assembled experts from a wide range of
backgrounds to identify points of consensus
on the definition, core elements, and core
competencies of IECMHC. The convening
included leaders from both public and
private sectors: federal and state agencies,
research and policy institutes, colleges and
universities, medical centers, mental health
agencies, early childhood programs, and
non-profit organizations.
What is the definition of IECMHC?
The Expert Group began their discussion
about IECMHC by noting the need for a
common definition that is widely accepted
and shared by multiple stakeholders. They
defined IECMHC as an intervention that
teams mental health professionals with the
people who care for young children to
improve the social, emotional, and
behavioral development of children and
their families. The Expert Group’s definition
emphasizes that IECMHC is:
• Preventive – stops social, emotional,
and behavioral challenges in young
children from occurring or becoming
worse
• Multi-level – addresses young
children’s mental health needs by
mobilizing the collective resources of
families, staff, programs, and
communities
• Relationship-based – recognizes the
critical role of positive relationships –
between parents and children and
among the caregivers in children’s
lives –for supporting healthy child
development
• Capacity-building – increases the
ability of early childhood staff and
programs to address the mental
health needs of young children
The Expert Group noted that a hallmark of
IECMHC is that it is a process of building the
capacity of early childhood staff and
families to understand the powerful influence
of their relationships and interactions on
young children’s development. As a result of
the MHC’s partnership with the adult in
children’s lives, children’s well-being is
improved and mental health problems are
prevented and/or reduced. Specific
strategies for accomplishing these aims
include skilled observations, individualized
services, and early identification of children
with and at risk for mental health challenges.
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While the group came to consensus on the
definition, they acknowledged that further
refinement may be needed.
What are the Core Elements of
IECMHC?
IECMHC encompasses a broad array of
strategies implemented at multiple levels –
the child, the family, the provider, the
program, and the community. The Expert
Group reviewed the full range of strategies in
early education and home visiting programs
and identified four core elements of IECMHC:
1. Infant/Child/Family Focused Mental
Health Consultation – The MHC helps
caregivers understand and address a
specific concern about a child or a family
(e.g., by assisting caregivers in
developing and implementing a plan to
address a child’s aggressive behavior or
a parent’s harsh discipline).
2. Provider Focused Mental Health
Consultation – The MHC works with early
childhood staff to improve the quality of
care they offer to children and families
(e.g., by helping providers develop the
skills to manage life stress while at work or
to maintain a high quality classroom
environment).
3. Program Focused Mental Health
Consultation – The MHC partners with
directors and other program leaders to
develop policies and practices that
support children’s mental health (e.g.,
working with program leaders to develop
policies and procedures to prevent
preschool expulsion or address a parent’s
depression).
4. System & Community Focused Mental
Health Consultation – The MHC
collaborates with community providers
and systems to meet children’s mental
health needs (e.g., by offering a training
at a community agency or by
coordinating care among community
providers who work with a particular
family).
What are the Core Competencies
for Mental Health Consultants?
Our capacity to realize the benefits of
IECMHC rests in large part upon developing
and maintaining a well-qualified workforce
of MHCs. The current scarcity of trained
MHCs is a serious impediment. Experts
agreed that an essential first step in
developing a well-qualified workforce is to
establish consensus on the competencies
MHCs need to provide effective IECMHC.
The Expert Group noted that well-qualified
MHCs come from a variety of disciplines but
must have formal training and licensure and
possess knowledge and skills in multiple
domains. These include but are not limited
to:
• Mental health (assessment and
treatment)
• Infant and early childhood health and
development
• Early childhood providers and programs
• Consultative stance
• Culture of providers, children, and
• families
• Community organizations and resources
• IECMHC models
MHCs must develop an understanding of the
social and emotional strengths and needs of
providers, children, and families within a
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particular program and community so that
consultation can be tailored to meet the
needs of those particular groups. They also
need to possess knowledge and skills in
infant and early childhood health and
development, consultation, and early
childhood settings. Further, they must
develop a deep understanding and
appreciation of the cultures, systems, and
communities in which young children and
their families live. Because MHCs often serve
as a resource to the community on social,
emotional, and behavioral issues in early
childhood (e.g., by providing referrals and
training), they also need to be familiar with
community resources and to build
partnerships with community organizations
that work with young children and their
families. Finally, MHCs must have training in
effective models of IECMHC.
What is the evidence of the
effectiveness for IECMHC?
The U.S. has increased its investments in
young children and their families in response
to clear and growing evidence showing that
the early years set the foundation for lifelong
individual health and development.
Concurrently, policymakers are demanding
evidence on intervention effectiveness to
help guide decisions about how to allocate
federal, state, and local funding. Therefore,
IECMHC stakeholders must make a
compelling case that IECMHC will yield a
good return on investment.
The Expert Group reviewed existing research
on IECMHC and concluded that there is
strong evidence that IECMHC works.
Research and evaluation findings offer
compelling evidence that:
IECMHC improves social, emotional, and
behavioral outcomes for young children.
IECMHC has major benefits to early
childhood providers and programs.
IECMHC that incorporates Core Elements
and Competencies is associated with a
decrease in children’s behavior problems,
prevention of preschool suspension and
expulsion, enhanced parent-child
relationships, and a reduction in missed
workdays among parents.
The Consultative Stance
MHCs build the capacity of early childhood
programs to promote children’s mental health
through the use of a consultative stance – an
approach that conveys to staff, families, and
programs that supporting children’s mental
health is a shared responsibility. The MHC avoids
the role of the “expert” and works collaboratively
with caregivers to understand children’s behavior
and to identify and implement strategies that
meet children’s social and emotional needs.
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Research shows that IECMHC also has
benefits for early childhood education (ECE)
providers, including improved skills in
teaching children about feelings and in
behavior management, increased program
fidelity, and better program outcomes, such
as improved teacher-child interactions and
classroom climate.
Less research has been done on IECMHC in
home visiting, but initial findings suggest that
providers show improvements in family
engagement, amount of program
participation (dosage), and home visitor
retention.
In addition, IECMHC is associated with
positive program level outcomes, such as
more supportive prevention policies,
increased access to reflective supervision for
staff, reduced stress, burnout, and turnover
among program staff, and fewer expulsions
and improved school readiness among
children.
Finally, system level outcomes of IECMHC
include increased developmental screening,
referral, and follow-up, early identification of
mental health problems, and more
appropriate referrals of young children and
their families to specialized services.
Next Steps for the Field of IECMHC
On the second day of the convening, the
Expert Group met with federal partners,
including leaders from SAMHSA, the
Administration for Children and Families, the
Health Resources and Services
Administration, the Office of the Assistant
Secretary for Planning and Evaluation, and
the U.S. Department of Defense. The second
day of the convening provided an
opportunity for experts to share points of
consensus and the evidence of IECMHC’s
effectiveness with federal leaders, as well as
a dialogue about the needs of programs
they oversee, including child care, Early
Head Start, and home visiting initiatives.
Together, national experts and federal
leaders identified critical next steps for the
field to address the nation’s need for
IECMHC and to scale up successful
implementation. In particular, the Expert
Group highlighted the following:
IECMHC supports caregiver well-being and
acts as a powerful mechanism for ensuring
the social, emotional, and behavioral
development of young children.
IECMHC has the potential for having a
“multiplier effect” – partnerships between
MHCs and the adults in children’s lives
have beneficial reverberations
throughout caregiving systems (e.g.,
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immediate and extended family
members, child care providers,
community providers), including benefits
for young children, families, providers,
programs, and communities. Providers
can then apply the skills and knowledge
they acquired through IECMHC to their
work with other children and families in
the future.
IECMHC is a preventive approach that is
relatively free of a “mental health”
stigma.
After receiving feedback from federal
leaders, several critical and urgent next steps
for the field of IECMHC emerged:
1. Communication - Further refine the
definition of IECMHC and clearly
articulate its unique value within the
existing system of care that supports
young children and their families. Solicit
input from the broader field on optimal
strategies for communicating with
stakeholders about IECMHC’s distinct
contribution to child and family well-
being.
2. Core competencies – Adopt a consistent
set of standards for the competencies of
MHCs to ensure that training and
credentialing lead to a well-qualified
workforce.
3. Training – Expand opportunities for
training to develop a workforce that is
prepared to carry out effective IECMHC
and has the capacity to scale
implementation to meet the need.
4. Model development – Fully develop and
manualize models of IECMHC to facilitate
implementation and replication in early
childhood programs, and to support state
system infrastructure.
5. Sources of funding – Identify potential
funding streams at the community, state,
and federal level – both existing and new
– to obtain sufficient funds to implement
IECMHC across programs serving young
children and their families.
6. Research and evaluation – Conduct
further research and evaluation to
determine the precise amount (dosage)
needed to achieve IECMHC’s intended
results, and to ensure that the strategy
can be standardized, replicated, and
scaled up. Publish research findings in
peer-reviewed literature.
7. Policies – Partner with stakeholders at the
state level to establish policies that
support widespread implementation of
IECMHC and, in turn, lead to better
outcomes for young children and their
families.
Conclusion
The SAMHSA Convening on IECMHC
facilitated a consensus among experts on
critical aspects of IECMHC, including its
definition, core elements, and core
References & Resources
1. Cohen, E., & Kaufmann, R. (2005). Early childhood
mental health consultation. DHHS Pub. No.CMHS-
SVP0151. Rockville, MD: Center for Mental Health
Services, SAMHSA.
2. Gilliam, W.S. (2008). Implementing policies to reduce
the likelihood of preschool expulsion. FCP Policy Brief
No 7. New York, NY: Foundation for Child
Development.
3. Goodson, B.D., Mackrain, M., Perry, D.F., O’Brien, K., &
Gwaltney, M.K. (2013). Enhancing home visiting with
mental health consultation. Pediatrics, 132(Suppl 2),
s180-S190.
4. Hepburn, K.S., Perry, D. F., Shivers Marie, M.E., &
Gilliam, W. S. (2013). Early childhood mental health
consultation as an evidence-based practice. Zero to
Three, 33(5), 10 -19.
5. Johnston, K., & Brinamen, C. (2006). Mental health
consultation in child care: Transforming relationships
among directors, staff and families. Washington, DC:
Zero to Three.
6. The RAINE Group (2014). Early childhood mental
health consultation protects and maximizes our
national investment in early care and education.
Phoenix, AZ: Southwest Human Development.
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competencies. In addition, the convening
brought together experts and federal
leaders to discuss the state of the field and
to identify important next steps. Together,
federal leaders and experts concluded that,
to advance IECMHC, the field will need to
clearly communicate its benefits, increase
training opportunities, facilitate widespread
adoption of core competencies, identify
funding sources, conduct additional
research and evaluation, and further
develop specific models. The work of the
convening further clarifies and accentuates
the importance of IECMHC as a strategy for
improving and sustaining positive
organizational, provider, family, and child
social-emotional health and well-being.
EXPERT CONVENING PLANNING COMMITTEE
Catherine Ayoub, Associate Professor, Harvard Medical
School; Director, Research and Evaluation Brazelton
Touchpoint Center, Boston, MA; Roxane Kaufmann,
Director of Early Childhood Policy, Georgetown
University Center for Child and Human Development,
Washington, DC; Jennifer Oppenheim, Lead, Project
LAUNCH, Substance Abuse and Mental Health Services
Administration; Deborah Perry, Associate Pr ofessor ,
Georgetown University Center for Child and Human
Development, Washington, DC.
EXPERTS
Jordana Ash, Early Childhood Mental Health Director,
Colorado Office of Early Childhood, Denver, CO;
Catherine Ayoub, Associate Professor, Harvard Medical
School; Director, Research and Evaluation Brazelton
Touchpoint Center, Boston, MA; Liz Bicio, Director, Early
Childhood Consultation, Partnership and Early
Childhood Programs, Advanced Behavioral Health,
Inc., Middletown, CT; Linda Delimata, Consultation
Coordinator, Illinois Children’s Mental Health
Partnership, Chicago, IL; Walter Gilliam, Assoc iate
Professor of Child Psychiatry and Psychology and
Director, Edward Zigler Center in Child Development
and Social Policy, Yale University Child Study Center,
New Haven, CT; Kadija Johnston, Director of the Infant-
Parent Program, University of California, San Francisco,
CA; Roxane Kaufmann, Director of Early Childhood
Policy, Georgetown University Center for Child and
Human Development, Washington, DC; Mary
Mackrain, Project Director, Learning & Teaching
Division Education Development Center, Inc.,
Birmingham, MI; Kevin O'Brien, Manager, Milwaukee
Mental Health Consultants, Family Therapy Training
Institute, Milwauke, WI; Deborah Perry, Assoc iate
Professor, Georgetown University Center for Child and
Human Development, Washington, DC; Paul Spicer,
Professor, University of Oklahoma, Norman, OK.
SAMHSA
Ingrid Donato, Chief, Mental Health Promotion Branch,
Center for Mental Health Services (CMHS); Rebecca
Flatow, Public Health Analyst; William Hudock, Senior
Advi sor, CMHS; Larke Huang, Senior Advisor on
Children and Families; Jennifer Oppenheim, Lead,
Project LAUNCH; Tara Parra, Public Health Advisor,
CMHS; Melodye Watson, Public Health Advisor, CMHS;
Ekaterina Zoubak, Public Health Advisor, CMHS.
FEDERAL PARTNERS
Katherine Beckmann, Senior Policy Analyst, ACF,
USDHHS, Washington, DC; Kiersten Beigel, Family and
Community Engagement Lead, ACF , USDHHS,
Washington, DC; Marco Beltran, Health Lead, ACF,
USDHHS, Washington, DC; Barbara Hamilton, Early Care
and Education Specialist/ECCS Project Officer,
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Maternal and Child Health Bureau, HRSA, USDHHS,
Rockville, MD; Ann Linehan, Acting Director of the
Office of Head Start, AC F, USDHHS, Washington, DC;
Shantel Meek, Senior Policy Advisor for Early Childhood
Development, ACF , USDHHS, Washington, DC; Shannon
Rudisill, Assoiciate Deputy Assistant Secretary for Early
Childhood Development, ACF, USDHHS, Washington,
DC; Linda K. Smith, Deputy Assistant Secretary and
Inter-Departmental Liaison for Early Childhood
Development, ACF , USDHHS, Washi ngton, DC; Barbara
Thompson, Director, Office of Family Policy/Children
and Youth, Office of the Secretary of Defense, Military
Community and Family Policy, US Department of
Defense, Washington, DC; Pamela Trivedi, Office of the
Assistant Secretary for Planning and Evaluation (ASPE),
USDHHS, Washington, DC; Tatiana Tucker, Office of
Child Care, ACF , USDHHS, Washington, DC; David Willis,
Director, Division of Home Visiting and Early Childhood
Systems, Maternal Child Health Bureau, HRSA, USDHHS,
Rockville, MD.
INVITED GUESTS
Amy Hunter, Assistant Prof essor, Georgetown University
Center for Child and Human Development,
Washington, DC; Lynn Kosanovich, Senior Regional
Director, Healthy Families America, Prevent Child
Abuse America, Chicago, IL; Vicky Marchand, Early
Childhood Consultant, Center for the Study of Social
Policy, Washi ngton, DC; Matthew Melmed, Executive
Director, ZERO TO THREE, Washington, DC; Jennifer
Ng’andu, Program Officer, Robert Wood Johnson
Foundation, Princeton, NJ; Cindy Oser, Senior Policy
Analyst, ZERO TO THREE, Washington, DC.
FACILITATOR
Elizabeth Waetzig, Consultant, Change Matrix, South
Bend, IN.
WRITERS
Lead Writer: Jessica Dym Bartlett, Research Associate,
Harvard Medical School, Project Director, Research
and Evaluation, Boston Children's Hospital, Boston, MA;
Catherine Ayoub, Associate Professor, Harvard Medical
School; Director, Research and Evaluation Brazelton
Touchpoint Center, Boston, MA Jennifer Oppenheim,
Lead, Project LAUNCH, Substance Abuse and Mental
Health Services Administration; Deborah Perry,
Associ ate Professor, Georgetown University Center for
Child and Human Development, Washington, DC.
Disclaimer
The views, opinions, and content expressed herein are
the views of the convening experts and do not
necessarily reflect the official position of SAMHSA or
HHS. No official support of or endorsement by SAMHSA
or HHS for these opinions or for the instruments or
resources described are intended or should be
inferred. The guidelines presented should not be
considered substitutes for individualized client care
and treatment decisions.
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