This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

When infants and very young children experience mental health issues, it looks very different from how adults experience those same issues.

"When we think about the mental health of adults, we immediately think about things like depression [or] anxiety," explains Danielle Rice, workforce development specialist with the Michigan Association for Infant Mental Health.

In infants and toddlers, mental health needs might manifest as social and emotional developmental delays. In children aged 3 to 5, mental health issues might manifest as either behavior problems or extreme independence.

"These children become really, really independent and want to do things on their own because they don't trust that adults can meet their needs," Rice says. "When we're thinking about infants and young children, what they really need is consistent caregiving, a caregiver who's going to respond to their needs consistently in an appropriate, sensitive way. And if they don't have that, we start to see some of these other delays in their social and emotional development."

For African-American children, especially little boys, these mental health needs can result in suspension or expulsion from daycare and preschool at a much higher rate than other children — partially because of behavioral problems but also because implicit biases cast them as being prone to "bad" behavior. This not only sets the child up for academic failure later on but also puts working parents in a bind as they have to find other child care for their kids.

"These children are really looking for connection," Rice says. "We need to look at how can we implement strategies to really help these children get the connection that they need to get their needs met, instead of making this big leap to ‘Let's just kick them out.’"

The Michigan Department of Health and Human Services (MDHHS) has one such strategy. Its Infant and Early Childhood Mental Health Consultation (IECMHC) program sends trained early childhood consultants to daycare settings and preschools to help caregivers better meet the social and emotional needs of the children in their care.

"The strategies can sound really simple, but to implement them every day, day in and day out, can be challenging," says Gillian Ogilvie, MDHHS IECMHC coordinator. "Some of these things are really getting on a child's level, meaning physically you are eye to eye with them and you're giving either a direction or using active listening and labeling their emotions."

"Really able to help"

A prevention-based intervention teaming mental health professionals with early care and education providers and families, IECMHC improves adults’ ability to positively develop children’s social, emotional, and behavioral health from birth through age 5. With many parents working 40 or more hours a week, daycare providers and early childhood educators are instrumental in ensuring that these needs are met. Great parenting during the evenings and weekends is not enough.

"The consultants are really able to help early childhood educators and care providers begin to understand the needs of the child, especially the small child," Rice says. "They help them to think about, 'What are this child's strengths? What are the areas of growth and potential for this child? And how can the child care provider support this child in getting their needs met?'"

IECMHC offers two main services. One is direct consultation within a child care setting that focuses on a particular child or family having behavioral or socio-emotional struggles.

"With the child-family focus cases, our highest rate of referrals are related to aggression and lack of self-regulation," Ogilvie says. "With young children, we're expecting to see some temper tantrums and some acting out because kids are learning how to verbalize their emotions and their needs and wants. But we're talking about kids that are really, really struggling and having intense responses to typical daily stresses."

Consultants also offer programmatic advice.

"We come in and work with the director and the teachers around policies and protocols that support socio-emotional development and also staff wellness," Ogilvie says. "We're really seeing a lot of high stress levels, burnout, and folks leaving the child care sector as a profession because things have been so, so challenging over the last few years since COVID."

IECMHC also provides community trainings and connection. Consultants offer sessions on socio-emotional development and other topics to child care providers, parents and family members, and other caregivers.

"This really helps build the entire system for early childhood," Ogilvie says. "We love being able to be community-specific. The consultants really have their finger on the pulse of what is needed in their communities. We do a variety of assessments to measure change in both the children, if a child is identified for focus, and the program quality."

IECMHC specifically addresses the relational component between the care provider or preschool teacher and the children in their care. The result is more responsive caregiving, less stress, and more children who are developmentally on track — able to get along with their peers and demonstrate self-regulation.

"For our programmatic referrals, we're seeing a lot of programs reaching out, honestly, just wanting to be able to promote socio-emotional development for all the kids in their care for the birth-to-6 age range," says Tina Jones, MDHHS early childhood mental health coordinator. "The other thing that we get a lot of referrals around is difficulty with transitions, going from a circle-time activity to snack time to outdoor time. Any time something is changing, there can be a lot of difficulty in a classroom or in a child care setting."
 
Looking to expand in Michigan

IECMHC currently serves 27 of Michigan’s 83 counties, with hopes to expand. The initial focus has been on underrepresented and under-resourced counties, specifically Wayne, Genesee, Muskegon, and Saginaw counties, as well as counties in the Upper Peninsula. An initiative in collaboration with the Michigan Health Endowment Fund and the Indigo Cultural Center is sponsoring focus groups that will provide feedback on how the program can refine the model and infuse more equity into the curriculum.

"With those surveys and focus groups, we did learn that some folks weren't aware of the services or that there's stigma around receiving services that prevented them from engaging in them or reaching out for help," Jones says.

IECMHC works because the consultants go above and beyond sharing evidence-based information. They also build relationships with the child's care provider, teacher, or caregiver. The program encourages and challenges caregivers, teachers, and child care providers to think about each child’s needs, draw upon the child’s strengths, and implement strategies that improve that child's development over time.

"Once that child care provider has this experience of a secure relationship where their needs are getting met, they're able to meet the needs of the children that they're working with," says Mary Ludtke, MDHHS evidence-based practice and grant development section manager. "I just really love that the program is relationship-based. It thinks about children in the context of their relationships, which is so important, because that's how they grow and develop."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photo by Stephen Smith.