PolicyLab

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The first five years of a child's life hold remarkable changes and growth. This period is characterized by rapid brain development, the acquisition of new skills and milestones, and the formation of secure relationships with primary caregivers. These early experiences and relationships lay the groundwork for developing more complex social and emotional skills, which play a crucial role in shaping mental health.

For young children, mental health centers around feeling secure in their relationships with their primary caregivers and using this base of security to facilitate positive interactions with others and effectively manage their emotional experiences and behavior.

We’re highlighting the crucial role of early childhood mental health services and the barriers that families encounter in accessing these services. Below, we discuss the Young Child Program at Children’s Hospital of Philadelphia (CHOP), including comprehensive assessment services and implementation of evidence-based interventions, like the Incredible Years Preschool Parenting Program. Additionally, we offer suggestions for public policy initiatives and community collaboration to improve access and support for mental health services.

Our work is aligned with PolicyLab’s broader early childhood agenda focused on implementing, evaluating and sustaining early childhood behavioral health initiatives. HealthySteps and PriCARE are just two examples of caregiver-focused interventions happening across CHOP.

Access to Early Childhood Mental Health Services

More than 1 in 10 children under the age of 5 experience significant social, emotional, or behavioral challenges that may negatively impact their mental health and well-being. These challenges can manifest as difficulties in forming relationships, coping with emotions, or exhibiting behaviors that are outside of typical developmental expectations. Early identification and intervention are crucial, as these challenges can have long-term effects on a child's ability to succeed in school and develop healthy relationships. Comprehensive mental health services in this age range include support for children and families, as well as connections to early educational settings, helping to address these issues before they escalate and ensuring that children have the best possible start in life.

Despite the clear need for mental health services in the first 5 years of life, access to providers who work with children and their families in this age range can be difficult.

The ZERO TO THREE Policy Center has identified several of these barriers, which include lack of reimbursement for early childhood mental health services, and the availability of specialized training needed to understand the developmental and diagnostic considerations that are unique to this age range and the interventions that are most effective for young children. Further, there can also be a misconception that young children will “outgrow” their challenges, which may result in fewer referrals to mental health services in early childhood.

Providing Mental Health Care for Young Children

As providers in the Young Child Program within the Department of Child and Adolescent Psychiatry and Behavioral Sciences at CHOP, we offer comprehensive early childhood assessment services for families, deliver evidence-based mental health interventions for young children and their families for a range of challenges, and seek to train and prepare the next generation of diverse, multidisciplinary providers specializing in early childhood mental health.

Our team has supported more than 180 families over the past two years through comprehensive assessment services and access to evidence-based interventions for a range of needs.

Piloting the Incredible Years Preschool Parenting Program

As we’ve worked with these families of young children, we recognized several barriers to care, including timely access to services. Group interventions are one way to support multiple families at the same time, which reduces wait times for families. However, the lack of reimbursement for caregiver-mediated group interventions for children with public insurance poses a barrier to their participation. Therefore, we are piloting the Incredible Years Preschool Parenting Program with funding from CHOP’s Office of Community Impact.

Incredible Years is an evidence-based, caregiver-mediated early intervention program tailored for caregivers of young children and supported by over 25 years of research. The Incredible Years program is focused on strengthening caregiver-child relationships and promoting positive interactions, reducing negative discipline strategies for managing challenging behaviors at home, and teaching strategies to enhance young children's social, emotional and language development.

Preliminary findings from this pilot suggest high caregiver satisfaction with the program. Caregivers also indicated that the recommended behavioral strategies are both feasible and acceptable for home implementation. Moreover, caregivers have reported feeling a sense of community and mutual support in the group as they address their children's behavioral health needs and navigate the challenges of existing systems of care.

Advancing Early Childhood Mental Health Services

There is a critical role for public policy in increasing access to early childhood mental health services. As noted above, a lack of reimbursement and limited workforce capacity are consistent barriers. There are payment pathways within Medicaid that can address these barriers and promote a broader mental well-being agenda for young children and their families.

In fact, several states have established financing mechanisms for HealthySteps, an evidence-based dyadic care model for young children, such as Z-codes for psychotherapy for children who do not (yet) have a behavioral health diagnosis. Medicaid could also help to sustain caregiver-mediated group interventions for young children with or at risk for disruptive behavior challenges, like Incredible Years or PriCARE, through mechanisms such as Caregiver Behavior Management Training codes.

It is our hope that Pennsylvania uses levers such as these to support the sustainability of effective mental health care for young children. By addressing existing barriers and promoting accessible care models, we can uplift the mental well-being of young children and their families, paving the way for healthier communities and a brighter future.