What do I need to know?

This section will equip you with the knowledge, messaging, and talking points to implement an early childhood mental health best practice framework.

What is early childhood mental health?

ZERO TO THREE defines infant and early childhood mental health as the developing capacity of the child from birth to 5 years of age to form close relationships, manage and express emotions, explore the environment, and learn.1 Early childhood mental health is sometimes referred to as social emotional health. Children begin to develop social and emotional competencies early in life.

Mental health provides a foundation of stability that supports all other aspects of healthy development. Children’s ability to thrive begins to take shape prior to birth and is impacted just as much by their social emotional development as it is by their physical development. Practices, policies, and services that promote early childhood mental wellbeing help ensure a child’s success.

The future prosperity of our community depends on the ability to foster the health and wellbeing of the next generation. Early experiences affect lifelong health and learning; young children who experience positive social emotional development and healthy relationships with others are equipped to cultivate the skills and capacities that will enable them to become strong community members.

Early childhood mental health, a term we will use throughout this toolkit to encompass social, emotional, and behavioral health, lays the foundation for children to be able to:

  • Make friends
  • Show empathy
  • Respond to stress
  • Take care of others
  • Resolve conflicts

The quality of support given to babies, toddlers, and preschoolers makes a world of difference for their futures.

Just as the levelness of a table is what makes it functional, the mental health of children is what enables them to function well in all areas of life.

What’s important in Colorado?

Mental Health Colorado worked with early childhood mental health consultants and specialists, home visitors, Early Childhood Councils, and early childhood advocacy experts at the state and national level to develop this toolkit. Here is what they told us about making early childhood mental health a priority, and how to build foundations for a strong future for Colorado.

  • Across all corners of our state, Coloradans want our families and communities to thrive. Colorado prospers when children thrive because they are our future workforce, leaders, and community members.
  • No matter where they live in our state—the plains, mountains, rural areas, or urban centers—children need high-quality support for development.
  • Many communities across Colorado are working hard to reach at-risk populations, reduce barriers to childhood mental health, create consistent coalitions, and secure sustainable funding for early childhood initiatives.

However, many communities still lack:

  • High-quality, affordable child care and early education
  • Early childhood mental health expertise
  • Integrated mental health and physical health care
  • Initiatives that support early childhood social emotional development such as screening and parent/family support

While evidence supports the idea of addressing the mental health of children at an early age, significant barriers prevent many communities from implementing a comprehensive approach to early childhood mental health. Even early childhood partners with robust plans to support early childhood mental health find that community-wide and cross-agency strategies are lacking. Many advocates, families, and professionals recognize the need for mental health improvement but aren’t sure what concrete action steps they can take.

The Early Childhood Mental Health Toolkit was developed as a guide to support Early Childhood Councils, early childhood partners, and early childhood advocates who want to improve community level mental health prevention and intervention. The toolkit provides strategies to support all young children and families, including those who are at risk of mental health problems. It is not a curriculum or a program, but instead a guide for Early Childhood Councils and other early childhood partners to assess how their community work aligns with best practices. Toolkit users will be able to identify their community’s target areas of growth, explore programming suggestions, and identify funding options.

Because there are multiple community organizations and partners that can impact early childhood mental health, this toolkit aims to support Early Childhood Councils who are often in a prime position to strategically organize and implement early childhood mental health initiatives. This doesn’t mean that Councils are the sole users of this toolkit — by also empowering families, early childhood professionals, mental health practitioners, and community members to advocate for better mental health supports for young children, we hope to improve our state’s response to the mental health needs of Colorado’s young children.

Six Steps to Change


Identify someone who can champion early childhood mental health within your community. This could be a parent, early childhood mental health consultant, pediatrician, psychologist, early learning professional, nurse, or anyone else who is passionate about the importance of early childhood mental health.


Determine what services exist and what is lacking or absent. What organizations, agencies, early learning programs, or health care providers are bringing early childhood mental health into focus? What’s working and what are the barriers or service gaps? Read through the What works? section and use our Community Assessment Tool to engage community partners on what services they already provide and what is missing.


After the assessment is complete, identify which best practices:

  • are most needed in the community
  • the community will be willing to implement
  • the community is most passionate about

From there you can choose which best practice to promote in your community.


Share the best practices, the Community Assessment Tool results, and the funding information with members of your community.


Work with your identified community champion to build public will and capacity for implementing the new best practices. Use the What do I need to know? section of this toolkit to share messages and facts about why early childhood mental health matters. Offer to help identify potential short-term and sustainable funding sources within the community using the How can initiatives be funded? section. Identify other community partners, grant opportunities, and other potential funding sources (such as local ballot initiatives or local businesses) that would help finance the best practices in your community.

Follow Up

Once you’ve identified champions, best practices, and funding opportunities, regularly follow up. If you are successful in making changes internally, share these successes with other communities and groups who might benefit.

“The highest rate of return in early childhood development comes from investing as early as possible, from birth through age 5, in disadvantaged families. Starting at age 3 or 4 is too little too late, as it fails to recognize that skills beget skills in a complementary and dynamic way. Efforts should focus on the first years for the greatest efficiency and effectiveness. The best investment is in quality early childhood development from birth to 5 for disadvantaged children and their families.”

– James J. Heckman,
Nobel Prize winner in economics of human development

Join - or Revitalize - the Conversation

Your community may already have an early childhood mental health coalition you could engage in. If you do not have a coalition, it’s possible to form one or to reinforce the importance of early childhood mental health with other coalitions—such as through Early Childhood Councils, school boards, or at workforce development events.

We’ve created key Talking Points to help you talk about the importance of early childhood mental health. This includes data and messages to address funding and policies for early childhood mental health.

Key Concepts

Social emotional screening of young children is an important part of well-child visits and of a comprehensive children’s health system. Sometimes providers need to choose between developmental screening and social emotional screening because of time or reimbursement concerns.

Key Talking Points

Social emotional screening with a standardized tool can identify issues early and provide anticipatory guidance in a child’s mental health development.

Key Strategies

Ensure that primary care practices can conduct at least two social emotional screens for children between the ages of 0 and 3 – without these screens supplanting developmental screenings. This can happen through:

  1. Establishing office routines for social emotional and mental health screening at regular intervals
  2. Bringing developmental and social emotional screenings together as one  independent process
  3. Employing strategies to support mental health in primary care

Key Concepts

Intentional screening for pregnancy-related depression and anxiety in mothers occurs as part of a well-child visit or new mother’s health care follow up.

Universal verbal or written screening using a validated screening tool for alcohol and other drug use occurs during pregnancy, and women with positive screens are provided with a brief intervention and referred for treatment.

Key Talking Points

Depression, anxiety, alcohol, and substance use screenings using validated tools during pregnancy are recommended by multiple national medical entities.

In addition to screenings, states must also cover any medically necessary treatment for children as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Treatment for maternal depression that includes both the child and the parent, such as family counseling, may also be paid for under EPSDT.

Key Concepts

Providing early childhood mental health consultation to early learning and home visiting professionals improves their quality of care and the well-being of the families with whom they work.

Key Talking Points

Mental health consultation can increase overall early learning quality, teachers’ self-efficacy, and teachers’ competence.2

Early childhood mental health consultation is a cost-effective means for infusing mental health services into early childhood settings.3

Key Strategies

Ensure every early learning center, family child care center, and home visiting program has access to an early childhood mental health consultant.

Establish relationships between early learning environments and local early childhood mental health professionals to develop strategies for working together.

Key Concepts

Integration of a child mental health professional in pediatric, family medicine, and other primary health care settings improves accessibility of mental health services for children, which can positively impact children’s social emotional development.

Key Talking Points

Because most children have access to primary care and see primary care practitioners annually, integrated medical and behavioral health care models have a strong potential for improving access to and rates of care for mental health difficulties.4,5

Key Strategies

Engage primary care, mental health providers, and others to collaborate and share information.

Pediatric and mental health collaboration needs to identify and manage emerging problems or symptoms for a child or family not rising to the level of a mental health diagnosis.

Key Concepts

Caregivers’ wellness has a significant effect on their ability to support young children’s mental health.

Key Talking Points

Supportive environments, relationships, and community interventions can help kids exposed to toxic stress counterbalance negative effects and build resiliency.

Investing in intervention and supportive programs to promote parental and caregiver resilience helps kids develop to their full potential.

Maternal mental wellness is critical both during pregnancy and after delivery. Alcohol and substance use during pregnancy can be mitigated with appropriate therapeutic supports; which can prevent issues such as effects of fetal alcohol exposure and neonatal abstinence syndrome.

Key Strategies

Ensure every new parent has access to parenting and caregiver wellness supports, including substance use intervention. Information about these supports can be provided prenatally, upon delivery or adoption, and at periodic intervals during the child’s early years.

All early learning teachers should have opportunities for supporting their own emotional wellness. Administrators can support their teachers and staff by creating these opportunities as a component of professional development, as well as embedding opportunities within the teacher’s day to receive support.

Employ strategies for teacher self-care such as those highlighted here.

Key Concepts

Having trauma-informed practice in early care and in learning settings can provide an antecedent intervention to young children’s traumatic stress

Key Talking Points

More than two-thirds of children in the United States experience trauma (such as abuse or neglect, caregiver substance use, death of a loved one, or community violence) by the time they turn 16. Young children under age 5 are disproportionately exposed to traumatic events and circumstances.6

Key Strategies

Programs should fully integrate knowledge about trauma into policies, procedures, and practices so caregivers can identify and understand signs of trauma and its impact.

Follow the guidance in the National Child Traumatic Stress Network’s Child Trauma Toolkit for Educators for preschool and elementary school students to understand the connections between behavior, mental health, and trauma
and to learn effective ways to support children to manage these experiences.

Key Concepts

Early learning settings are places where social emotional learning can occur and positive solutions to behavioral challenges can be developed

Key Talking Points

Children in early learning settings have opportunities to develop self-confidence, engage in pro-social interactions with adults and peers, learn to effectively communicate emotions, and practice concentration and persistence.7

Key Strategies

Every early learning environment needs to provide intentional opportunities for social emotional learning and for practicing strategies for mental health.

Early learning teachers and directors need access to professional development in child social emotional development.

Key Concepts

The workforce that supports young children and their families must have specific expertise in early childhood mental health

Key Talking Points

Training in early childhood mental health can improve early childhood and educational professionals’ capacity to recognize and address children’s social and emotional health needs. In fact, children in these professionals’ care have shown improved emotional and behavioral regulation and better social skills.8

Key Strategies

All professionals working with young children should be familiar with and meet the requirements for the Colorado Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health (IMH-E ®).

Key Concepts

Young children can’t be categorized diagnostically using tools intended for older children or adults; they need a developmentally relevant diagnostic system.

Key Talking Points

Developmentally based diagnostic systems will allow early childhood mental health providers to recognize and address young children’s social, emotional, and behavioral health earlier and more appropriately.9, 10

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-5) provides a promising practice model for the assessment of infants, young children, and parent-child relationships. However, many health providers are unable to use the DC: 0-5 because of insurance acceptance and electronic health record challenges.

Key Strategies

The DC:0-5 needs to be used intentionally and formally in clinical practices serving early childhood mental health.

Two things need to happen to accomplish this:

  1. Funding is needed to train Coloradans on the DC:0-5. These individuals can then serve as experts and provide further trainings within the state to build the necessary workforce capacity in Colorado.
  2. Electronic health care record systems, including Colorado’s public mental health record system, need to integrate the DC:0-5.

Key Concepts

Quality improvement strategies in early learning settings must consider how teachers and other staff support children’s social emotional and mental health.

Key Talking Points

Early childhood teachers can have a significant impact on children’s wellbeing when they are receiving input about healthy interactions with their students. An 11-state evaluation of pre-kindergarten classrooms showed that high-quality teacher-child interactions predicted increased levels of social skills and lower levels of behavioral problems.11

Key Strategies

Ensure that early learning quality ratings and quality improvement strategies have an intentional focus on caregiver interactions with children, as well as on the classroom environmental factors that impact children’s social emotional development.

Key Concepts

Suspension and expulsion of young children from early learning programs are short-term tactics that perpetuate a cycle of inequality.

Key Talking Points

Across all types of early childhood settings nationally, the average school day sees roughly 250 instances of a preschooler being suspended or expelled.12

Addressing the needs of young children who show behavior challenges is less expensive and more appropriate than removing them from the environment. When teachers are given the supports and the right tools to help children with challenging behavior, they can lower rates of hyperactivity, restlessness, and externalizing behaviors.13

Key Strategies

Implement strategies, guidance, and policies that limit suspension and expulsion of young children and provide resources that support alternative behavioral and social emotional interventions.

1 ZERO TO THREE. Retrieved from https://www.zerotothree.org/resources/110-infantearly- childhood-mental-health August 20, 2018.

2 Alkon, A., Ramler, M. & MacLennan, K. Early Childhood Education Journal (2003) 31: 91.

3 Gilliam, W. S., Maupin, A. N., & Reyes, C. R. (2016). Early Childhood Mental Health Consultation: Results of a Statewide Random-Controlled Evaluation. Journal of the American Academy of Child & Adolescent Psychiatry, 55(9), 754-761. doi:10.1016/j.jaac.2016.06.006

4 Kelleher KJ, Stevens J. Evolution of child mental health services in primary care. Acad Pediatr. 2009;9(1):7-14.

5 Kolko DJ, Perrin E. The integration of behavioral health interventions in children’s health care: services, science, and suggestions. J Clin Child Adolesc Psychol. 2014;43(2):216-228.

6 Bartlett, J., Wilson, A., Moore, K., Redd, Z. (April, 2016). 5 ways trauma informed care supports children’s development. Child Trends. Bethesda, MD.

7 Hemmeter, M. L., Ostrosky, M., & Fox, L. (2006). Social and emotional foundations for early learning: A conceptual model for intervention. School Psychology Review, 35(4), 583.

8 Ritblatt, S. N., Hokoda, A., & Van Liew, C. (2017). Investing in the Early Childhood Mental Health Workforce Development: Enhancing Professionals’ Competencies to Support Emotion and Behavior Regulation in Young Children. Brain Sciences, 7(9), 120. http://doi.org/10.3390/brainsci7090120

9 Egger, Helen L., and Robert N. Emde. “Developmentally sensitive diagnostic criteria for mental health disorders in early childhood: The diagnostic and statistical manual of mental disorders—IV, the research diagnostic criteria—preschool age, and the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood—Revised.” American Psychologist 66.2 (2011): 95.

10 Carter, A. S., Briggs Gowan, M. J., & Davis, N. O. (2004). Assessment of young children’s social‐emotional development and psychopathology: recent advances and recommendations for practice. Journal of Child Psychology and Psychiatry, 45(1), 109-134.

11 Burchinal, M., Vandergrift, N., Pianta, R., & Mashburn, A. (2010). Threshold analysis of association between child care quality and child outcomes for low-income children in pre-kindergarten programs. Early Childhood Research Quarterly, 25(2), 166-176.

12 National Survey of Children’s Health (2016).

13 Gilliam, W.S., Maupin, A.N., and Reyes, C.R. (2016) Early childhood mental health consultation: results of a statewide random-controlled evaluation. Journal of the American Academy of Child & Adolescent Psychiatry. 55 (9), 754–761. http://dx.doi.org/10.1016/j.jaac.2016.06.006