Position Statement 46: Promotion of Mental Health during Early Childhood

Mental Health America believes that all children and families should have access to the support they need throughout early childhood to give future generations the best possible start in life. Although diagnosable mental health and substance use conditions are often identified with adolescence, early life, approximately from birth to age eight, is a time of critical brain development that plays a substantial role in establishing predispositions for behavioral health conditions later in life. To ensure that each child has the best chance to live a mentally healthy life, and to reduce overall costs to society, Mental Health America takes the position that all families should have access to high-quality, evidence based:

• Maternity care and pediatric healthcare services that attend to the mental and general health needs of both children and parents;
• Supports for new parents to build skills to promote effective family management and healthy child development;
• Supportive, curated social networks for parents to exchange information, assistance, and encouragement; and
• Child care and pre-school programs that help children to be ready for kindergarten.

Background

Support for healthy early brain development offers a substantial opportunity to promote mental wellbeing later in life. Brain development during this period can promote later mental health in three ways: (1) Building resilience and reducing susceptibility to adverse experiences in the future (2) Shaping healthy cognitive patterns and capacities as well as usual mood and emotional self-regulation, and (3) Beginning behaviors and learning skills that lead individuals to maintain and promote mental wellbeing throughout their lives.[1]

While genetics play a role in early brain development, positive and negative experiences and other environmental factors also play important roles in determining the developmental trajectory. For example, parental mental health or substance use conditions, parental loss, and physical or psychological trauma in childhood have all been associated with the development of mental health conditions later in life.[2] On the other hand, supports and interventions that produce high cognitive, social, and emotional functioning in early life are associated with better mental health, as well as less special education usage and lower rates of arrest.[3]

The critical nature of this early developmental period and the ability to change the later developmental trajectory through effective support requires increased focus and resources. Studies of effective early childhood learning programs, such as the Carolina Abecedarian Project or high-fidelity Head Start programs, have shown reductions in mental health conditions, as well as improvements in mental wellbeing.[4] Conversely, low-quality child care has been demonstrated to have negative effects on children’s mental health.[5]

Many childhood supports are funded and governed by state and local laws. In many areas, there are only limited policies in place to ensure equitable access to evidence-based care. Increased state and local funding and oversight of early childhood programs are critical to improve access, safety and quality. Five federal policies and programs help to support these state and local initiatives: (1) Medicaid and other health care laws, (2) The Child Care and Development Block Grant, (3) The Individuals with Disabilities Education Act, (4) The Head Start Act, and (5) The Every Student Succeeds Act. Note that, while these policies offer a patchwork of supports, there is no guarantee of equitable access to high-quality care and learning opportunities for young children.

(1) Medicaid and other health care laws can extend coverage for maternity care and health care services for new parents and their children. These are further covered in Position Statement 49: Perinatal Mental Health, Position Statement 48: Prevention of Mental Health and Substance Use Disorders in Young People and Position Statement 41: Early Identification of Mental Health Issues in Young People.[6]

(2) The Child Care and Development Block Grant (CCDBG) Act was originally passed in 1990 and has been reauthorized several times since. The CCDBG funds states to offer access to child care services that meet certain health and safety requirements and funds quality improvement activities and coordination for child care and other community service providers.[7]

(3) The Individuals with Disabilities Education Act (IDEA), while best known for requiring school districts to provide and fund Individualized Education Plans (IEPs) as covered in Position Statement 45: Discipline and Positive Behavior Support in Schools, also requires that states provide services similar to an IEP during early childhood (called an Individualized Family Service Plan), which offers limited supports to children with disabilities, including mental health conditions.[8] It does not address children at risk.

(4) Head Start was conceived as part of President Lyndon B. Johnson’s War on Poverty and was most recently reauthorized in 2007 with additional quality standards.[9] The Head Start Act grants funding to state Head Start agencies to administer high-quality early care and education that meets a number of standards. In 2016, the Administration of Children and Families of the U.S. Department of Health and Human Services issued new Head Start program performance standards, which emphasize the use of data for continuous quality improvement.[10]

(5) The Every Student Succeeds Act (ESSA) was the 2015 reauthorization of the Elementary and Secondary Education Act, which provides funding and standards for high-quality and equitable education, as well as related supports.[11] The Infant Toddler program, which serves birth through age two children at risk through state grants, is the primary federal service initiative.[12] Although primarily identified with K-12, the ESSA also contains a number of provisions on funding and standards for preschools.[13]

Taken together, these federal policies are designed to reach every aspect of healthy child development, from health care services to early care and education to specialized supports as needed. Unfortunately, unresolved funding and implementation problems have limited the impact of federal programs, making this far from the reality for many American families.

The Challenges

While many families have access to maternity care and pediatric developmental screenings in early childhood,[14] very few families have access to evidence-based services to support new parents with their child’s cognitive, social, and emotional development.[15] There has been increasing attention to screening for maternal depression,[16] but follow-up remains an issue, despite evidence that maternal depression can be at least partially addressed through pediatric primary care, benefiting the child as well.[17] Substantial litigation also indicates dissatisfaction with the supports provided under the IDEA.[18] It is essential that families at risk have access to parenting supports that have been demonstrated to be effective both in building resilience to mental health conditions and in reducing societal costs over time.

It is crucial that more inclusive federal, state and local programs be developed so that all families have equitable, meaningful access to high-quality early care and early childhood education to significantly improve developmental and mental health outcomes. Unfortunately, research confirms that current early care and education policy does not yet offer adequate subsidies or quality supports to ensure this.[19] This means that every year children across America are put into low-quality early care and education because their parents do not have the resources or tools to access high-quality services. As a result, these children will be more susceptible to mental health challenges later in life. Cost-benefit analyses also confirm that high-quality early care and education, such as high-fidelity Head Start, are cost-saving to society as a whole.[20] Thus, it is in America’s best interest to ensure that every family has access to high-quality early care and education – making a parent’s decision to stay home to care for a child a matter of personal choice, not a financial or safety concern.

Call to Action

Mental Health America calls on policy leaders and advocates to work together to:

• Ensure that evidence-based mental health screening is available to all women during the prenatal and postnatal period, and that infant and child mental health is assessed throughout childhood.
• Ensure that Medicaid and private insurance cover supports and services to parents and young children that mitigate risk factors and build resilience to prevent mental health conditions.
• Advocate for publicly-funded supports to improve parenting skills and promote mental health and wellness for the population at large.
• Ensure that state and federal funding sources provide families with high-quality early care and education in their community or with an adequate subsidy to purchase it. Given the cost-savings that can be realized from high-quality early care and education, innovative financing models, such as wellness trusts,[21] could be used to capture the long-term benefits to pay for the upfront costs.
• Ensure that the five federal programs that support healthy child development are adequately funded and, when reauthorized, clearly delineate the supports to which our youngest children are entitled in pre-school environments.
• Ensure that policies support quality assurance for early care and education services, and that quality is transparent to families. Quality mental health outcomes could be measured in a way similar to that by which cognitive, emotional, and social outcomes are measured in pediatric care,[22] culminating in kindergarten readiness as a final outcome.[23]

Effective Period

This policy was approved by the Mental Health America Board of Directors on March 3, 2017. It is reviewed as required by the Mental Health America Public Policy Committee.

Expiration: December 31, 2022