IECMHC in Early Intervention
Early intervention teams are asked to support a child's social and emotional development alongside speech, movement and learning. Many do it without a mental health professional on the team. Consultation gives them one.
Join the early intervention roundtable
Upcoming 2:30 to 4pm ET
Neal Horen and early intervention leaders from Alabama, Illinois and Wisconsin share how states are building consultation into Part C. Run with the Infant Toddler Coordinators Association (ITCA), for Part C lead agency staff, regional and county EI leaders, and state and national TA providers.
- How consultation helps EI providers support social and emotional development
- How reflective consultation helps EI providers feel supported and stay
- How Alabama, Illinois and Wisconsin are building IECMHC into Part C
What consultation is in early intervention
A mental health consultant works alongside the people who serve infants and toddlers with developmental delays and disabilities. That way, a child's social and emotional development gets the same attention as speech, movement and learning. It isn't therapy. It works through the adults around the child, and it fits inside Part C as it already runs. We explain how consultation fits the wider early childhood system(opens in a new tab).
Who the consultant works with
Consultants work with service coordinators, early interventionists, therapists and program leaders. The work happens in case consultation, reflective sessions, training and joint visits.
What changes
Providers read social and emotional development with more confidence, respond to it, and know where to turn when a family needs more.
Where it fits
Consultation fits inside Part C. Social or emotional development is one of the five domains(opens in a new tab) every state evaluates. Positive social and emotional skills is one of the three child outcomes(opens in a new tab) every state reports.
The gap it fills
- 463,000
- infants and toddlers received early intervention in 2023Congressional Research Service for 463,000, infants and toddlers received early intervention in 2023 (opens in a new tab)
- 13 states
- require infant mental health expertise on the evaluation teamThe 50-state survey for 13 states, require infant mental health expertise on the evaluation team (opens in a new tab)
- 48 states
- named a lack of qualified providers as a top challenge in serving eligible familiesGAO, 2023 for 48 states, named a lack of qualified providers as a top challenge in serving eligible families (opens in a new tab)
- Most
- early intervention practitioners get no training outside their own disciplineGeorgetown, 2025 for Most, early intervention practitioners get no training outside their own discipline (opens in a new tab)
What happens when a provider asks for help
These five steps follow how Alabama, Illinois and Texas run it.
A concern surfaces
A screening at intake, a parent's worry or a provider's own observation points to something social or emotional.
The provider asks
A short request goes to the consultant. In Alabama any early intervention team member can use one form(opens in a new tab) for the whole state.
They think it through together
The consultant and the provider talk through what may be happening for this child and family and what to try next. Sometimes the whole team does this in a meeting.
The family stays in charge
With the family's consent the consultant can join a visit or help shape IFSP outcomes. The provider keeps the relationship.
More help when it's needed
If a child or parent needs treatment, the consultant helps the team make the referral. In Alabama that shows up on the IFSP as a non-EI service.
It works at three levels
- See how Texas ran it(opens in a new tab)
Child and family
A provider brings a child to consultation when a screening, a parent's worry or their own observation points to a social or emotional concern. With the family's consent, the consultant can join a visit and help shape the family's IFSP outcomes. The consultant can also say when a referral for treatment is the right next step.
- See how Wisconsin embedded it(opens in a new tab)
Provider and team
The consultant gives the team reflective space and brings case consultation into team meetings. Training is built around what providers need to know, such as reading an infant's cues or supporting a parent who is still absorbing a diagnosis.
- See Alabama's model(opens in a new tab)
Program and system
Program leaders get reflective consultation of their own and programmatic consultation on policies and practices. At the state level, a structure can make consultation available to every early intervention team. Alabama offers it statewide.
What's the difference between consultation and reflective supervision?
Consultation includes reflective supervision and adds to it. Both matter in early intervention.
Reflective supervision asks
How is this work, and these situations, affecting you, your relationships and your practice?
Consultation adds
What may be happening here developmentally, relationally, emotionally or behaviorally? How can we respond in ways that help the relationship, the child and their family, and us?
What the evidence says about its impact
The peer-reviewed research(opens in a new tab) on consultation comes from early care and education and home visiting. In early intervention the evidence comes from state pilots and program evaluations, and it points the same way.
- 2.28 to 4.09
- Illinois service coordinators' satisfaction with their work with families (5-point scale) after a year with a social-emotional consultantSource for 2.28 to 4.09, Illinois service coordinators' satisfaction with their work with families (5-point scale) after a year with a social-emotional consultant (opens in a new tab)
- 18 of 39
- self-assessment items showed significant gains in providers' confidence with social-emotional concernsUniversity of Wisconsin, executive summary for 18 of 39, self-assessment items showed significant gains in providers' confidence with social-emotional concerns (opens in a new tab)
- 4%
- of children in a national Part C study qualified because of a social or behavioral problemNCCP, 2020 for 4%, of children in a national Part C study qualified because of a social or behavioral problem (opens in a new tab)
- 32%
- of families said they often had a hard time figuring out what to do about their child's behaviorNCCP, 2020 for 32%, of families said they often had a hard time figuring out what to do about their child's behavior (opens in a new tab)
A consultant at the front door changes what gets seen
Illinois added a social-emotional consultant to three early intervention intake offices serving 1,600 children. Before the pilot the offices flagged 9% of children for social-emotional concerns while providers saw 24%. After the pilot, intake flagged 22%. Before the pilot, two thirds of service coordinators had reflective supervision rarely or never. After it, all of them had it monthly. Their satisfaction with the work rose from 2.28 to 4.09 with no change in caseloads. The state funded a statewide rollout at about $1.5 million a year against a $115 million program. There was no control group.
Providers gain confidence, and parent and child interactions improve
For 14 months, Wisconsin embedded consultants in 5 Birth to 3 programs and ran a statewide referral line. On a 39-item self-assessment, providers' confidence and skill in social and emotional work rose significantly in both groups. In the embedded programs, video ratings showed significant gains in parents' sensitivity, babies' positive mood and social skills, and how well parent and baby responded to each other. Parents reported significant growth in their child's social and emotional skills. There was no control group, so the results are promising but not proof.
Providers learn what infant mental health is and where to get help
In 2023, Texas piloted remote consultation with 8 of its 41 early intervention agencies. Each agency's hours were set by its enrollment. Providers reported a better understanding of what infant mental health is and where to get social and emotional support for children and families. 60 of the 72 requests came from early intervention specialists. The state has since carried the work into 11 high-need counties.
Providers report the gains year after year
In Louisiana's Lafayette region, a master's-level consultant and a child psychiatrist have supported early intervention providers since Project LAUNCH. In annual surveys, providers say they are better able to spot and meet young children's mental health needs and to get them intensive services. They also focus more on the parent and child relationship.
Social and emotional problems get in the way of other gains
A study of 1,055 children in Part C found that social, emotional, and behavioral problems get in the way of learning during early intervention. Delays in social and emotional skills do too. The authors conclude that services should target them to improve developmental outcomes. Toddlers with language delays show more of these problems than their peers.
Chavez et al., 2024, Early Childhood Research Quarterly
The people carrying this work are stretched thin
48 states told the Government Accountability Office that a lack of qualified service providers is one of their top challenges. Wisconsin's evaluators saw the same thing up close: high caseloads and deadlines stretched Birth to 3 providers thin. Consultation reaches the people already in the job.
GAO, 2023
The wider evidence points the same way
Most of the research comes from early care and education. There, consultation is linked to less acting-out behavior in children, more confidence and less job stress for adults, and fewer requests to expel. The 2022 review of that decade of research notes early intervention had not yet been evaluated in peer-reviewed studies.
Read the full evidence
See it in practice
- Wisconsin's Birth to 3 Pilot (opens in a new tab)Five programs embedded a consultant and a statewide line took referrals. The page carries the evaluation and eight recommendations for a statewide model.
- Alabama's Early Intervention Handbook (opens in a new tab)How consultation runs in three tiers as a statewide service for every early intervention team. It includes the request form.
- Consultation in Texas Early Childhood Intervention (opens in a new tab)A short outreach video shows what consultation looks like inside an ECI program. The same page holds the state's sustainability plan.
- The Texas Program Manual (opens in a new tab)Statewide standards for consultation across child care, home visiting, early childhood intervention and pediatric settings. A companion guide comes with it.
- Policies and Practices for Part C (opens in a new tab)The ECTA Center developed this briefing paper with ITCA, the Center of Excellence and other partners. It includes state spotlights and a planning tool.
- Two Webinars on IECMH in Part C (opens in a new tab)One session covers screening, assessment and eligibility, the other practices and services. Georgetown, NCPMI and ZERO TO THREE presented with ECTA.
- The 50-State Survey (opens in a new tab)Part C coordinators reported on screening, evaluation teams, consultation and financing. The report describes the Illinois and Louisiana models in detail.
- Three Vignettes (opens in a new tab)The Georgetown team shows how early intervention and mental health work together at the family, classroom and system level.
- Consultation and Pyramid Model Coaching (opens in a new tab)The crosswalk shows what each approach does, where they overlap and how programs can use both. Early intervention is one of the settings it covers.
- Reflective Supervision Info Sheet (opens in a new tab)A guide to reflective supervision for supervisors.
Plan and pay for it
States that fund consultation pay for it in different ways. Illinois used Part C and general revenue. Texas and Wisconsin used pandemic relief and preschool development funds. Alabama's mental health department offers it at no charge(opens in a new tab) to early intervention, pre-K and pediatric practices.
- Logic Model Template (opens in a new tab)Build your own logic model using guiding questions for each part.
- Financing IECMHC (opens in a new tab)Questions and answers on the funding streams states use for consultation.
- Illinois's Approach (opens in a new tab)Illinois used Part C and general revenue funds to place a consultant at every early intervention intake site. The brief sets out the lessons learned.
- Program Manual Planning Document (opens in a new tab)A guide to writing your own consultation program manual. It includes sample language for early intervention.
Bring it to your early intervention program
You don't need a funded position to bring consultation into your program.
Three ways in
- Train your own staff: build consultation capacity inside your program with the Practical Certificate. Early interventionists already enroll.See the Practical Certificate
- Get consultation now: Georgetown consultants work with your staff virtually, starting within days.See Virtual Consultation
- Design your system: we help you plan and build a system of consultation support.See Technical Assistance