Center of Excellence for Infant and Early Childhood Mental Health Consultation, part of Georgetown University’s Thrive Center

IECMHC in Child Welfare

Children in foster care change placements, schools, and caregivers. Consultation steadies the adults around them so care doesn't become another disruption.

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Holding the People Who Hold the Baby

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Holding the People Who Hold the Baby

Recorded

Neal Horen and child welfare leaders from Arizona and Wisconsin talked about what consultation looks like for caseworkers, caregivers and supervisors.

See the event page

What consultation looks like in child welfare

In child welfare, consultation pairs a mental health consultant with the adults around a young child: caseworkers, court staff, caregivers and the early childhood programs serving children in care. It's a prevention strategy that works through those adults so they can support a child's social and emotional development in their everyday work. It also supports the adults' own mental health because that affects the care they give babies and toddlers.

Project PLAY(opens in a new tab) is the consultation arm of BehaviorHelp, Arkansas's statewide expulsion prevention system. Its team also teaches caseworkers, foster parents, courts, and CASA volunteers why stable, high-quality child care matters for children in foster care.

  • Who the consultant works with

    Consultants work with caseworkers, foster parents, kinship caregivers, CASA volunteers, and the early childhood programs serving children in care.

  • What changes

    Adults learn to read behavior as communication about loss and disruption. The goal is placements and child care enrollments that hold.

  • Where it fits

    Consultation can go first to centers that serve children in foster care. It can also support home visiting programs working with families at risk of deeper involvement with child welfare. Judges, court staff and caseworkers can get training too.

Babies and toddlers are the largest age group in foster care

Babies under 1 are the fastest-growing group in foster care. Many babies and toddlers who come to child welfare's attention already have significant mental health needs, and very few receive services for them.

More than 1 in 3
children entering the child welfare system are birth to 3Source for More than 1 in 3, children entering the child welfare system are birth to 3
34%
of children 12 to 18 months old had clinically significant mental health issues at the time of a maltreatment investigationSource for 34%, of children 12 to 18 months old had clinically significant mental health issues at the time of a maltreatment investigation
2.2%
of babies and toddlers in child welfare identified as needing mental health care receive itSource for 2.2%, of babies and toddlers in child welfare identified as needing mental health care receive it

ZERO TO THREE's 2024 policy brief for states(opens in a new tab) calls consultation a best practice that child welfare agencies can bring in for families and staff with different levels of need. It also says child welfare can't provide every mental health service young children need, and families shouldn't have to enter the system to get them.

ZERO TO THREE, 2024. The 34% and 2.2% figures come from a study of young children investigated by U.S. child welfare agencies (McCue Horwitz et al., 2012).

What the evidence says about its impact

Most of the evidence for consultation comes from center-based early childhood programs.

1 in 4
children referred to Arkansas's Project PLAY had current or past foster care experienceSource for 1 in 4, children referred to Arkansas's Project PLAY had current or past foster care experience
44 of 829
closed Project PLAY cases ended in expulsionSource for 44 of 829, closed Project PLAY cases ended in expulsion
1,195
children in 488 programs were referred to Arkansas's statewide expulsion prevention systemSource for 1,195, children in 488 programs were referred to Arkansas's statewide expulsion prevention system

  • Statewide study

    Foster care raises the risk of expulsion

    In Arkansas's statewide expulsion prevention system, 1,195 children in 488 programs were referred for help. Being in foster care was one of the risk factors for expulsion, and children in foster care were more likely to get a consultant.

    Conners Edge et al., 2021

    Read the study(opens in a new tab)

  • Program report

    Most closed cases ended without an expulsion

    Of 829 cases Arkansas's Project PLAY has closed since BehaviorHelp began, 44 children were expelled. A quarter of referred children had current or past foster care experience.

    Project PLAY annual report, FY24-25

    Read the report(opens in a new tab)

  • National policy brief

    Relationships improve and adult burnout falls

    ZERO TO THREE's 2024 policy brief lists consultation among the prevention services that should be open to all families regardless of their risk of child welfare involvement. It cites improved teacher-child relationships, stronger social skills in children, fewer behavioral issues, and lower burnout and turnover among adults.

    ZERO TO THREE, 2024, citing Boothe Trigg and Keyes, 2019

    Read the brief(opens in a new tab)

  • Read the full evidence

See it in practice

Plan and pay for it

ZERO TO THREE's first suggestion for states is to map infant and early childhood mental health services alongside how families move into and through child welfare. The map should include families who are screened out but may still have significant needs.

Children in care need adults who can hold steady

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