Caring for Our Children (CFOC)

Chapter 1: Staffing

1.6 Consultants

1.6.0 Infant and Early Childhood Mental Health Consultants

COVID-19 modification as of May 21, 2021 



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:

  1. Training, expertise and/or professional credentials in mental health (e.g., psychiatry, psychology, clinical social work, nursing, developmental-behavioral medicine, etc.);
  2. Early childhood development (typical and atypical) of infants, toddlers, and preschool age children;
  3. Early care and education settings and practices;
  4. 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:

  1. Developing and implementing classroom curricula regarding conflict resolution, emotional regulation, and social skills development;
  2. Developing and implementing appropriate screening and referral mechanisms for behavioral and mental health needs;
  3. Forming relationships with mental health providers and special education systems in the community;
  4. Providing mental health services, resources and/or referral systems for families and staff;
  5. Helping staff facilitate and maintain mentally healthy environments within the classroom and overall system;
  6. Helping address mental health needs and reduce job stress within the staff;
  7. Improving management of children with challenging behaviors;
  8. Preventing the development of problem behaviors;
  9. Providing a classroom climate that promotes positive social-emotional development;
  10. Recognizing and appropriately responding to the needs of children with internalizing behaviors, such as persistent sadness, anxiety, and social withdrawal;
  11. Actively teaching developmentally appropriate social skills, conflict resolution, and emotional regulation;
  12. Addressing the mental health needs and daily stresses of those who care for young children, such as families and caregivers/teachers;
  13. 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:

  • Follow guidance from your state and local health department as well as your state child care licensing agency.

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:

  • Changes in families routines (e.g., physical distance from family, friends, worship community)
  • Disrupted learning environments (e.g., virtual learning environments, technology access)
  • Disrupted health care access (e.g., missed well-child and immunization visits, limited access to mental, speech, and occupational health services)
  • Missed significant life events (e.g., important events/celebrations, vacation plans, and/or milestones)
  • Lost security and safety (e.g., food insecurity and housing, increased exposure to violence and online harms, threat of physical illness and future uncertainty)

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:

  • Individual and group staff consultation to guide their work with children and families
  • Child and family consultation and connect to resources and services as needed
  • Timely staff trainings virtually

    Consider alternatives to IECMHCs  onsite consultation and schedule other methods for delivering services:

  • Use Virtual video visits or phone to review child social and emotional health needs, address health and safety issues and any training needs
  • Plan outdoor visits, if weather allows, using face mask and physical distancing

Refer to the COVID-19 modifications in CFOC Standard Daily Staff Health Check when on site visits are essential.

Additional Resources:

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.
Early Childhood Learning and Knowledge Center. Head Start Heals Campaign
American Academy of Pediatrics. Guidance Related to Childcare During COVID-19


As 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).
Access 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.
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Child Care Health Consultants Early Childhood Education Consultants
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Gilliam, W. S. 2007. Early Childhood Consultation Partnership: Results of a random-controlled evaluation. New Haven, CT: Yale Universty.
  10. American Academy of Pediatrics, Committee on School Health. 2003. Policy statement: Out-of-school suspension and expulsion. Pediatrics 112:1206-9.
  11. 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.

COVID-19 modification as of May 21, 2021