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 October 10, 2022.

Standard was last updated on September 13, 2022.

After reading the CFOC standard, see COVID-19 modification below (Also consult applicable state licensure and public health requirements).

Early care and education programs should find and work with qualified infant and early childhood mental health consultants (IECMHCs) to help create environments that promote social-emotional development and health in early childhood, to help with behavioral concerns, and to lower staff stress.

Programs should find and work with IECMHCs who:

  • Have professional credentials and expertise in early childhood development and child mental health such as psychiatry, psychology, developmental-behavioral pediatrics, clinical social work, or nursing
  • Work well with children, families, and program staff from different racial, ethnic, and cultural/language backgrounds
  • Have an understanding of infants and young children who have developmental delays or disabilities
  • Are experienced in trauma-informed care of young children and families
  • Are familiar with early care and education policies, practices, and regulations
  • Can partner with program directors, staff, and families, and work together with professionals of other disciplines

Programs should expect an IECMHC to share or help develop:

  • An assessment of the program’s needs, strengths, and areas for improvement in mental health
  • Policies on child, family, and staff mental health
  • Individual observations of children and staff to assess children’s development, behavior, and related needs
  • Resources for teaching children about understanding their feelings, emotional regulation (managing or expressing their emotional responses effectively), coping strategies, conflict resolution, empathy, and social skills
  • Connections and/or referrals to community mental health providers and special education systems or resources
  • Resources to understand the mental health needs of specific children or families
  • Collaboration for screening or referral of children to early intervention services and/or local providers
  • Lists of community resources for families and staff who may need mental health support

Program staff should work with an IECMHC to develop the following skills:

  • Create and keep up healthy social-emotional environments and relationships in the program and with families
  • Understand and support staff to manage children’s challenging behaviors (such as aggression and tantrums) as well as internalizing behaviors (such as anxiety and depression), and how to respond appropriately
  • Recognize and respond to the needs of children who are sad or anxious, avoid others, or harm themselves
  • Partner with staff to make sure children with developmental delays and disabilities are included safely and meaningfully in all activities and experiences, within the scope of the mental health consultant’s expertise
  • Approach families about behavioral or mental health concerns for their children
  • Recognize the daily stressors and mental health needs of families and staff
  • Respond appropriately to child, family, or community crises (such as serious illness, homelessness, substance abuse, divorce, deaths, or natural events like tornados, floods, wildfires)
  • Understand staff’s obligations and required actions as mandated reporters
  • Identify and address staff’s work-related stress, responses to stress, and self-care needs 

Early care and education program leadership/staff and IECMHCs should meet regularly to discuss program needs and talk about concerns for children’s development and behavior. 

COVID-19 modification as of October 10, 2022:

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:

  • Disrupted learning environments
  • Disrupted health care access (e.g., missed well-child and immunization visits, limited access to mental, speech, and occupational health services)
  • 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 to 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

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

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

Infant and early childhood mental health is essential to develop many life skills. 1-4 Many children learn these skills in early care and education settings.5–6 For example, children learn to take turns, wait for rewards, and respond to challenges and frustrations. However, many factors can interfere with this learning.

Many children have adverse childhood experiences early in life such as child abuse, domestic violence, homelessness, parental substance abuse, and racism.7–9 Greater exposure to these experiences often results in behaviors that lead to a child’s suspension or expulsion from early care and education programs.10 Staff may be aware of adverse experiences or see signs of a child’s distress such as acting out, persistent sadness, anxiety, or withdrawal from others.11 With training on trauma-informed practices, teachers can help lower the harmful effects of stress on children; this training creates safe, trusting environments for learning and forming relationships.12 Staff can help to identify children and families who may need referral for mental health care.

When children’s emotional struggles turn into challenging behaviors, they can disrupt group activities. These events may raise staff stress, sometimes causing harsh responses.13,14 Unintentional prejudices result in more suspension or expulsion of children with disabilities, children with behavioral challenges, and children of color.15–19 Program staff need strategies to effectively lower and deal with challenging behaviors. They also need to be more aware of their own experiences and biases, and have ways to recognize and lower their stress levels.

Infant and early childhood mental health consultation is an evidence-based strategy that has helped early educators address complex issues for better outcomes for children, families, and staff.20 Qualified consultants can work with a program, classroom, and individual children and families. Consultants can help form policies for child supervision, discipline, suspension/expulsion, preventing and reporting child abuse and neglect, inclusion of children with disabilities, confidentiality of records, and staff wellness, and help staff follow the policies. They can share lessons and classroom strategies to promote development of essential social-emotional skills, reduce challenging behaviors, and eliminate expulsions. They can also build a program’s capacity to identify and support the mental health needs of individual children, families, and staff. 13, 18, 21-23  An ongoing relationship with a consultant is strongly recommended for shared understanding and trust.24,25


Programs may find qualified consultants by contacting local mental health and behavioral care providers (e.g., child clinical and school psychologists, licensed clinical social workers, child psychiatrists, developmental pediatricians, qualified health care providers). Some state, local, tribal, or territorial child care licensing, early education, or human service agencies may keep lists of qualified mental health consultants. Local colleges and universities may be able to help find graduate school professionals-in-training (trainees). The cost for trainees may be lower than for community professionals, but turnover is likely to be higher as trainees complete their studies. To make sure someone can provide the services, ask about credentials and experience (or ongoing supervision for consultants-in-training). This includes asking about up-to-date professional licensure and certifications, types of services, frequency of contact, and the cost. 

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Additional Qualifications for Caregivers/Teachers Serving Children Birth to Thirty-Five Months of Age Child Abuse and Neglect Education Child Care Health Consultants Early Childhood Education Consultants Specialized Consultation for Facilities Serving Children with Disabilities Stress Management for Staff Coordinated Child Care Health Program Model Monitoring Children’s Development/Obtaining Consent for Screening Helping Families Cope with Separation Methods of Supervision of Children Discipline Measures Preventing Expulsions, Suspensions, and Other Limitations in Services Using Physical Restraint Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation Care for Children Who Have Experienced Abuse/Neglect Written Policy on Confidentiality of Records Documentation of Child Care Health Consultation/Training Visits Release of Child’s Records Support for Consultants to Provide Technical Assistance to Facilities
  1. Whitebrook M, McLean C, August LJE, Edwards B. Early childhood workforce index 2018. Berkeley, CA: Center for the Study of Child Care Employment, University of California, Berkeley; 2018. Accessed August 26, 2021.

  2. Hammer D, Melhuish E, Howard SJ. Do aspects of social, emotional and behavioural development in the pre-school period predict later cognitive and academic attainment?. Aust J Educ. 2017 Nov;61(3):270-287.
  3. HammerD, Melhuish E, Howard SJ. Antecedents and consequences of social–emotional development: a longitudinal study of academic achievement. Arch Sci Psychol. 2018;6(1):105.

  4. Robson DA, Allen MS, Howard SJ. Self-regulation in childhood as a predictor of future outcomes: a meta-analytic review. Psychol Bull. 2020;146(4):324-354. doi:10.1037/bul0000227

  5. Qi CH, Zieher A, Lee Van Horn M, Bulotsky-Shearer R, Carta J. Language skills, behaviour problems, and classroom emotional support among preschool children from low-income families. Early Child Dev Care. 2020;190(14):2278-2290.

  6. Berry D, Blair C, Willoughby M, Garrett-Peters P, Vernon-Feagans L, Mills-Koonce WR, Family Life Project Key Investigators. Household chaos and children’s cognitive and socio-emotional development in early childhood: does childcare play a buffering role?. Early Child Res Q. 2016;34:115-127.

  7. National Scientific Council on the Developing Child. Establishing a level foundation for life: mental health begins in early childhood: Working Paper 6. Updated Edition. Published December 2012. Accessed February 21, 2022.
  8. Giano Z, Wheeler DL, Hubach RD. The frequencies and disparities of adverse childhood experiences in the U.S. BMC Public Health. 2020;20(1):1327. doi:10.1186/s12889-020-09411-z

  9. Merrick MT, Ford DC, Ports KA, Guinn AS. Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states. JAMA Pediatr. 2018;172(11):1038-1044. doi:10.1001/jamapediatrics.2018.2537

  10. Zeng S, Corr CP, O’Grady C, Guan Y. Adverse childhood experiences and preschool suspension expulsion: a population study. Child Abuse Negl. 2019;97:104149.
  11. Cummings KP, Swindell J. Using a trauma-sensitive lens to support children with diverse experiences. Young Except Child. 2019;22(3):139-149.
  12. Bartlett JD, Smith S. The role of early care and education in addressing early childhood trauma. Am J Community Psychol. 2019;64(3-4):359-372.

  13. Silver HC, Zinsser KM. The interplay among early childhood teachers’ social and emotional well-being, mental health consultation, and preschool expulsion. Early Educ Dev. 2020;31(7):1133-1150.

  14. Zinsser KM, Zulauf CA, Das VN, Silver HC. Utilizing social-emotional learning supports to address teacher stress and preschool expulsion. J Appl Dev Psychol. 2019;61:33-42.

  15. Zeng S, Pereira B, Larson A, Corr CP, O’Grady C, Stone-MacDonald A. Preschool suspension and expulsion for young children with disabilities. Except Child. 2021;87(2):199-216. doi:10.1177/0014402920949832

  16. Davis AE, Perry DF, Rabinovitz L. Expulsion prevention: framework for the role of infant and early childhood mental health consultation in addressing implicit biases. Infant Ment Health J. 2020;41(3):327-339. doi:10.1002/imhj.21847

  17. Hooper A, Schweiker C. Prevalence and predictors of expulsion in homebased child care settings. Infant Ment Health J. 2020;41(3):411-425.

  18. Miles E, Stoker J, Senehi N, et al. Suspension and expulsion in Colorado early care and education settings: child, program, and communitylevel predictors. Infant Ment Health J. 2021;42(6):767-783.

  19. Stegelin D, Leggett C, Ricketts D, Bryant M, Peterson C, Holzner A. Trauma-informed preschool education in public school classrooms: responding to suspension, expulsion, and mental health issues of young children. J Risk Issues. 2020;23(2):9-24.

  20. Trivedi P, deMonsabert J, Horen N. Infant and early childhood mental health consultation: overview of research, best practices, and examples. Published 2021. Accessed February 22, 2022.
  21. Conners Edge NA, Kyzer A, Abney A, Freshwater A, Sutton M, Whitman K. Evaluation of a statewide initiative to reduce expulsion of young children. Infant Ment Health J. 2021;42(1):124-139.

  22. Centers for Disease Control and Prevention. Coughing and sneezing. Web site. Last reviewed April 22, 2020. Accessed November 3, 2021.

  23. Gilliam WS, Maupin AN, Reyes CR. Early childhood mental health consultation: results of a statewide random-controlled evaluation. J Am Acad Child Adolesc Psychiatry. 2016;55(9):754-761. doi:10.1016/j.jaac.2016.06.006

  24. Davis AE, Barrueco S, Perry DF. The role of consultative alliance in infant and early childhood mental health consultation: child, teacher, and classroom outcomes. Infant Ment Health J. 2021;42(2):246-262. doi:10.1002/imhj.21889

  25. Vuyk MA, SpragueJones J, Reed C. Early childhood mental health consultation: an evaluation of effectiveness in a rural community. Infant Ment Health J. 2016;37(1):66-79.


COVID-19 modification as of October 10, 2022.

Standard was last updated on September 13, 2022.