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.

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

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

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.

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.

Follow guidance from at least one of these organizations to ensure periodic and accessible maternal screening:

American Academy of Pediatrics

American Academy of Family Physicians

Centers for Medicaid and Medicare Services

American Collect of Obstetricians and Gynecologists

U.S. Preventive Services Task Force

American Society of Addiction Medicine

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.

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

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.

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.

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

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.

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

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.

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.

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

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

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.

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

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

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.

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

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

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 ^®).

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

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.

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.

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

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

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.

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

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

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