Editor's Note: Children's earliest experiences—both positive and negative—impact their brain formation and in turn their social and emotional, physical, cognitive, communication, and sensory and motor skill development. Recognizing the tremendous opportunities—and risks—associated with this critical period of brain development, policymakers are increasingly investing in what experts call "infant and early childhood mental health" (I-ECMH). In a new policy brief for ZERO TO THREE, summarized below, Manatt Health explains what I-ECMH is, documents why investments in I-ECMH matter, and identifies specific actions that state policymakers should take to support the healthy development of young children. Click here to download the full brief free.


What Is I-ECMH?

In the first three years of life, a child's brain grows faster than any other time, charting the course for all areas of brain development. Promoting an optimal environment for brain growth is paramount to influencing healthy development. Conversely, negative early experiences, often referred to as adverse childhood experiences (ACEs), have long-lasting impacts on health outcomes, educational performance and even criminal justice involvement throughout children's lives. Understanding that children's earliest experiences matter, policymakers are increasingly focused on I-ECMH, defined as the capacity of a child from birth to five to:

  • Experience, express and regulate emotion;
  • Form close, secure interpersonal relationships; and
  • Explore his/her environment and learn, within the context of family and cultural expectations.

Experts regard I-ECMH as a cornerstone to healthy, lifelong development. Fortunately, I-ECMH can be positively impacted through a continuum of targeted strategies focused on promotion, prevention and treatment:

  • Promotion—strategies aimed at encouraging positive I-ECMH development, such as public awareness campaigns and help lines.
  • Prevention—services seeking to identify risk factors, mitigate the effects of ACEs and intervene in child/caregiver dynamics that threaten healthy development, such as parenting education and home health visits.
  • Treatment—evidence-informed services and supports to address mental health disorders directly, such as child-parent psychotherapy or parent-child interaction therapy.

Why Is I-ECMH Important?

I-ECMH is directly linked to the formation of a child's brain architecture. If not addressed in early childhood, I-ECMH disorders have implications for all facets of adulthood. Research has documented the impacts of ACEs and mental health problems in childhood across multiple dimensions:

  • Physical and behavioral health. Children's exposure to ACEs has been shown to impact long-term physical and mental health outcomes and substance use. Researchers have documented a direct relationship between the number of ACEs and the likelihood of having heart disease, cancer, chronic bronchitis or emphysema, hepatitis or jaundice and skeletal fractures in adulthood, even in the absence of health-compromising behaviors, such as smoking. Adults who experienced four or more ACEs are at significantly increased risk of depression, suicide attempts, alcoholism and illegal drug use.
  • School readiness and educational attainment. Success in school is strongly linked to healthy social and emotional development. For children who experience ACEs, school readiness and educational attainment are often negatively impacted.
  • Juvenile justice involvement. ACEs also contribute to juvenile delinquency, increasing children's risk of juvenile arrests and felony charges.
  • State spending. The Centers for Disease Control and Prevention estimates that childhood abuse and neglect result in a lifetime cost of more than $200,000 per child, amounting to approximately $124 billion in total lifetime costs as a result of new child maltreatment cases in the U.S. each year.

What Can Policymakers Do to Advance I-ECMH?

To strengthen I-ECMH policy and support the healthy development of children, policymakers should take the following actions:

  1. Establish cross-agency I-ECMH leadership. To ensure coordination and accountability and drive a statewide I-ECMH strategy, the state should designate an accountable person or team to develop I-ECMH policies, make programmatic and funding recommendations, manage implementation and monitor progress.
  2. Ensure Medicaid payment for I-ECMH services. Since nearly 50% of children under six years old receive healthcare coverage through Medicaid or the Children's Health Insurance Program (CHIP), states should leverage Medicaid payment to support I-ECMH prevention and treatment services for children and their families.
  3. Invest in prevention through mental health consultation. An early childhood mental health consultation system—in which a consultant with mental health expertise works collaboratively with programs, their staff and families to improve their ability to prevent and identify mental health issues among children in their care—helps reduce problem behaviors in young children and promotes positive social and emotional development.
  4. Train the workforce on I-ECMH. Embedding I-ECMH educational and competency standards in mental health, social work, healthcare and early childhood education professionals' training, coursework and ongoing professional development provides opportunities to build a workforce that understands I-ECMH and is prepared to identify situations that threaten children's healthy development.
  5. Raise public awareness of I-ECMH. Developing public health campaigns, educational materials and other efforts can help build public awareness of the importance of I-ECMH. States should conduct public awareness campaigns, develop and distribute parent educational materials, encourage public-private partnerships with local foundations, and host learning collaboratives with stakeholders to share best practices and address barriers to advancing I-ECMH goals.


Implementing the actions outlined above will position states to have a meaningful impact on the lives of young children, their families and communities.