Mental health issues span gender, race, religion and age.
Over the years, mental health professionals have worked to include children in their consideration of mental health struggles, with the American Academy of Pediatrics declaring a national emergency in child and adolescent mental health in 2021.
So why are infants and toddlers — the most vulnerable members of our society — left out of the conversation?
“I think there’s a misunderstanding that family stress and trauma and things that are happening in the world in general don’t affect babies, but it really does,” said Lisa Cloninger, director of Mecklenburg County Public Health’s Children’s Developmental Services Agency (CDSA). “Anything that impacts the grown-ups impacts the child.”
In order to aid in an underserved population’s mental health needs, the CDSA launched its new Infant and Early Childhood Mental Health program in September.
CDSA is an early intervention agency, part of the statewide Infant-Toddler Program (NC ITP) that supports families with children aged from birth to 3 years old who experience developmental delays or show signs of an established condition, per NC ITP policy.
Cloninger saw families struggling with their child’s social and emotional needs but not meeting the requirements for services within CDSA because their child did not have a developmental delay.
The new Infant and Early Childhood Mental Health program, according to Cloninger, was born of the needs that those families faced.
“Some of the families aren’t eligible [for CDSA], but we know they still need help and there’s not anywhere to send them in the community to get that,” she told Queen City Nerve. “So we decided to build it ourselves.”
Using American Rescue Plan Act grant funding, CDSA established its free program focused on mental health services to reduce the impact of traumatic events on the birth-to-3-year-old population.
Why do babies need mental health care?
A child’s sense of security and attachment toward their caregiver indicates good mental health in infants and toddlers, says IECMH licensed clinician Tachina Hardy.
“Forming secure attachment with their caregiver(s) is essential for infant and toddlers’ development,” Hardy said. “Being able to regulate their emotions and the ability to express their needs are all signs of good mental health.”
When children are unable to regulate their emotions in infancy, it can be later associated with motor, language and cognitive delays, behavioral problems and ongoing parent-child relationship difficulties, according to ZERO to THREE (ZTT), a nonprofit organization dedicated to ensuring babies and toddlers have a strong start in life.
According to the organization, between 10-15% of young children experience mental health conditions like PTSD and anxiety.
The more than 1 million neural connections formed each second from birth to 3 mold babies’ future social-emotional and cognitive functioning, leaving them vulnerable to early mental health struggles.
Cloninger echoed the impact the early childhood experiences have on a child’s brain development, saying they can shape how a child reacts to other people and their environment and how they feel about safety.
“Research has consistently found that securely attached children experience better relationships with their parents and peers, heightened optimism, stronger self-esteem and enhanced problem-solving abilities,” ZTT reported.
“Conversely, adverse experiences such as neglect, abuse, or trauma can have negative effects on a baby’s mental health, potentially leading to issues like anxiety, depression, and behavioral problems throughout childhood, adolescence and even adulthood,” the organization continued.
Clinicians like Hardy follow the same early intervention design as CDSA to decrease the likelihood of trauma and behavioral side effects later in life.
Much of that intervention begins with the child’s guardians.
“That’s a lot of what our services are,” Hardy said. “We’re there to work with the kid but we’re also there to support the parents in working with their kid and managing their behaviors and also helping the child learn how to manage their own behaviors.”
The program can help with issues that include feeling overwhelmed with being a new parent; helping families support their child with regulating emotions and behavior; ongoing significant stress due to divorce, substance use or domestic violence at home, and other concerns.
Dealing with difficult events such as loss of a loved one, frequent moves or changes in caregivers, scary events such as break-ins, car accidents, or community violence can also be triggering.
“When dramatic changes occur in the life of a baby or young child, they are affected,” said Tamikia Greene, assistant public health director with Mecklenburg County. “We want to help that child and that family with the needed mental health services. Babies and young children may not be able to tell you what’s wrong, but they feel it and it shapes their growth. We want to help our community with this new service.”
Based on a given family’s needs, as established in an initial, virtual visit conducted by licensed clinicians, the program uses two different approaches to address concerns: traditional infant and early childhood mental health strategies as well as attachment and biobehavioral catchup, known as ABC.
Because they are so young, children below the age of 3 may find it difficult to navigate their emotions, Hardy said.
“Kids may not be understood because they don’t have the words to be understood.”
Traditional IECMH strategies for infants and toddlers curb communication and developmental difficulties by teaching them how to regulate and express their emotions, form close relationships with other people and explore their environment, Cloninger said.
In ABC — a short-term, evidence-based IECMH modality — clinicians take on the role of “parent coaches” to teach guardians how to nurture their child and follow the child’s lead in addressing their concerns.
Clinicians also work with families inside their homes, using ABC to redirect parents’ interactions with their children through “in-the-moment commentary” to promote a secure parent-child attachment style.
“We’re not there to say, ‘Oh, you’re doing this wrong,’” Hardy said. “We’re there to encourage you in what you’re doing and to add to your toolbox as a parent.”
Eligibility and getting started
The IECMH program’s eligibility criteria are not as stringent as CDSA’s.
If a family resides in Mecklenburg County and has a child aged 3 or under, they are eligible for the program.
Families can visit IECMH’s CDSA page to complete the referral form necessary for eligibility.
A referral from a doctor, friend or one’s self will lead to the initial, virtual visit to discuss a family’s needs. Cloninger said using yourself as a referral will not impact your chances of getting accepted into the program.
Following the initial visit, families receive a thorough assessment with a clinician, social worker or psychologist to get an in-depth understanding of the child and how best they can be supported.
Hardy emphasized that the program may not ensure the child won’t need therapy moving forward, but it does serve as a beginning step to raise parental awareness of what is going on with their children.
“We can really prevent a lot of challenges for the family and for the child ongoing and maybe prevent as many children needing mental health services … in the future,” Cloninger added.
If a family still requires services after their child ages out of the program, they will be connected to providers in the community.
The IECMH program ensures Cloninger and Hardy’s sentiment stressing the importance of positive interactions and developmental support for overlooked tots does not fall through the cracks.
“I think we just have so much more information now about human development and how sensitive of a time it is in infancy and toddlerhood,” Cloninger said.
“We just have this opportunity now to intervene so early and really change the trajectory of a child and family’s life.”
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