Chapter 1: Staffing
18.104.22.168: Infant and Early Childhood Mental Health Consultants
*STANDARD UNDERGOING FULL REVISION*
After reading the CFOC standard, see COVID-19 modification below (Also consult applicable state licensure and public health requirements).
A facility should engage a qualified infant and early childhood mental health consultant (IECMHC) who will assist the program with a range of early childhood social-emotional and behavioral issues and who will visit the program at minimum quarterly and more often as needed.
The knowledge base of an IECMHC should include:
- Training, expertise and/or professional credentials in mental health (e.g., psychiatry, psychology, clinical social work, nursing, developmental-behavioral medicine, etc.);
- Early childhood development (typical and atypical) of infants, toddlers, and preschool age children;
- Early care and education settings and practices;
- Consultation skills and approaches to working as a team with early childhood consultants from other disciplines, especially education and child care health consultants, to effectively support directors and caregivers/teachers.
The role of the IECMHC should be focused on building staff capacity and be both proactive in decreasing the incidence of challenging classroom behaviors and reactive in formulating appropriate responses to challenging classroom behaviors and should include:
- Developing and implementing classroom curricula regarding conflict resolution, emotional regulation, and social skills development;
- Developing and implementing appropriate screening and referral mechanisms for behavioral and mental health needs;
- Forming relationships with mental health providers and special education systems in the community;
- Providing mental health services, resources and/or referral systems for families and staff;
- Helping staff facilitate and maintain mentally healthy environments within the classroom and overall system;
- Helping address mental health needs and reduce job stress within the staff;
- Improving management of children with challenging behaviors;
- Preventing the development of problem behaviors;
- Providing a classroom climate that promotes positive social-emotional development;
- Recognizing and appropriately responding to the needs of children with internalizing behaviors, such as persistent sadness, anxiety, and social withdrawal;
- Actively teaching developmentally appropriate social skills, conflict resolution, and emotional regulation;
- Addressing the mental health needs and daily stresses of those who care for young children, such as families and caregivers/teachers;
- Helping the staff to address and handle unforeseen crises or bereavements that may threaten the mental health of staff or children and families, such as the death of a caregiver/teacher or the serious illness of a child.
COVID-19 modification as of May 21, 2021
In response to the Centers for Disease Control and Prevention’s COVID-19 Guidance for Operating Early Care and Education/Child Care Programs, it is recommended that early childhood programs:
Infant and early childhood mental health consultants (IECMHCs) can support recovery and reduce harm from the social, emotional, and mental health challenges children and families face during COVID-19, such as:
Refer to the Centers for Disease Control and Prevention’s COVID-19 Parental Resources Kit:
Ensuring Children and Young People’s Social, Emotional, and Mental Well-beingto support children and families with these challenges.
Use IECMHCs to deliver:
Refer to the COVID-19 modifications in CFOC Standard 22.214.171.124: Daily Staff Health Check when on site visits are essential.
Center of Excellence for Infant and Early Childhood Mental Health Consultation. COVID-19 and Infant and Early Childhood Mental Health Consultation (IECMHC): How to Provide Services When Everything Is Different
Center for Early Childhood Mental Health Consultation. https://www.ecmhc.org/
RATIONALEAs increasing numbers of children are spending longer hours in child care settings, there is an increasing need to build the capacity of caregivers/teachers to attend to the social-emotional and behavioral well-being of children as well as their health and learning needs. Early childhood mental health underlies much of what constitutes school readiness, including emotional and behavioral regulation, social skills (i.e., taking turns, postponing gratification), the ability to inhibit aggressive or anti-social impulses, and the skills to verbally express emotions, such as frustration, anger, anxiety, and sadness. Supporting children’s health, mental health and learning requires a comprehensive approach. Child care programs need to have health, education, and mental health consultants who can help them implement universal, selected and targeted strategies to improve school readiness in young children in their care (1-5). Mental health consultants in collaboration with education and child care health consultants can reduce the risk for children being expelled, can reduce levels of problem behaviors, increase social skills and build staff efficacy and capacity (1-11).
COMMENTSAccess to an early childhood mental health consultant should be in the context of an ongoing relationship, with at least quarterly regular visits to the classroom to consult. However, even an on-call-only relationship is better than no relationship at all. Regardless of the frequency of contact, this relationship should be established before a crisis arises, so that the consultant can establish a useful proactive working relationship with the staff and be quickly mobilized when needs arise. This consultant should be viewed as an important part of the program’s support staff and should collaborate with all regular classroom staff, administration, and other consultants such as child care health consultants and education consultants, and support staff. In most cases, there is no single place in which to look for early childhood mental health consultants. Qualified potential consultants may be identified by contacting mental health and behavioral providers (e.g., child clinical and school psychologists, licensed clinical social workers, child psychiatrists, developmental pediatricians, etc.), as well as training programs at local colleges and universities where these professionals are being trained. Colleges and universities may be a good place to find well-supervised consultants-in-training at a potentially reasonable cost, although consultant turnover may be higher.
TYPE OF FACILITYCenter, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS126.96.36.199 Child Care Health Consultants
188.8.131.52 Early Childhood Education Consultants
- Brennan, E. M., J. Bradley, M. D. Allen, D. F. Perry. 2008. The evidence base for mental health consultation in early childhood settings: A research synthesis addressing staff and program outcomes. Early Ed Devel 19:982-1022.
- National Scientific Council on the Developing Child. 2008. Mental health problems in early childhood can impair learning and behavior for life. Working Paper no. 6. http://developingchild.harvard.edu/library/reports_and_working_papers/working_papers/wp6/.
- Perry, D. F., M. D. Allen, E. M. Brennan, J. R. Bradley. 2010. The evidence base for mental health consultation in early childhood settings: A research synthesis addressing children’s behavioral outcomes. Early Ed Devel 21:795-824.
- Perry, D. F., R. Kaufmann, J. Knitzer. 2007. Early childhood social and emotional health: Building bridges between services and systems. Baltimore, MD: Paul Brookes Publishing.
- Perry, D. F., M. C. Dunne, L. McFadden, D. Campbell. 2008. Reducing the risk for preschool expulsion: Mental health consultation for young children with challenging behaviors. J Child Fam Studies 17:44-54.
- Committee on Integrating the Science of Early Childhood Development, Board on Children, Youth, and Families. 2000. From neurons to neighborhoods. Ed. J. P. Shonkoff, D. A. Phillips. Washington, DC: National Academy Press.
Gilliam, W. S. 2005. Prekindergarteners left behind: Expulsion rates in state prekindergarten programs. Foundation for Child Development (FCD). Policy Brief Series no. 3. New York: FCD. http://www.challengingbehavior.org/explore/policy_docs/prek
- Gilliam, W. S., G. Shahar. 2006. Preschool and child care expulsion and suspension: Rates and predictors in one state. Infants Young Children 19:228-45.
- Gilliam, W. S. 2007. Early Childhood Consultation Partnership: Results of a random-controlled evaluation. New Haven, CT: Yale Universty. http://www.chdi.org/admin/uploads/5468903394946c41768730.pdf.
- American Academy of Pediatrics, Committee on School Health. 2003. Policy statement: Out-of-school suspension and expulsion. Pediatrics 112:1206-9.
Duran, F., K. Hepburn, M. Irvine, R. Kaufmann, B. Anthony, N. Horen, D. Perry. 2009. What works?: A study of effective early childhood mental health consultation programs. Washington, DC: Georgetown University Center for Child and Human Development. http://gucchdtacenter.georgetown.edu/publications/ECMHCStudy
COVID-19 modification as of May 21, 2021