Early childhood mental health consultation (ECMHC) is emerging an as evidence-based intervention for supporting young children’s social/emotional development and addressing challenging behaviors. Over the last decade, the following research and practice guided definition has taken shape:

A problem-solving and capacity-building intervention implemented within a collaborative relationship between a professional consultant with mental health expertise and one or more caregivers, typically an early care and education provider and/or family member. Early childhood mental health consultation aims to build the capacity (improve the ability) of staff, families, programs, and systems to prevent, identify, treat and reduce the impact of mental health problems among children from birth to age 6 and their families. (Adapted from Cohen & Kaufmann, 2000)

There are several key elements of this definition that are important to tease out, which help to clarify the central characteristics of ECMHC and highlight commonalities and differences between ECMHC and other mental health strategies and interventions.

Early childhood mental health consultation is…

• Focused on early care and education settings. ECMHC is focused on providing services that benefit infants and young children who are in early care and education settings, including Head Start/Early Head Start programs, child care centers and family child care homes.
• Indirect and capacity-building. ECMHC seeks to promote positive outcomes for infants and young children by helping caregivers (i.e., family members and early care and education providers) develop the attitudes and skills necessary to effectively support the social and emotional development of the young children in their care. The emphasis on capacity-building also extends to the overall early care and education program, with a focus on strengthening the program’s ability to create nurturing environments that foster mental wellness among children, families and staff.
• Collaborative and relationship-based. A hallmark of ECMHC is the focus on collaboration between the mental health consultant and caregivers (including early care and education providers and family members). This collaboration is critical to developing and implementing feasible and appropriate strategies. Building strong, positive relationships between and among these key stakeholders is an essential component of achieving meaningful collaboration and, ultimately, effective consultation.
• Delivered by professional consultants with mental health expertise. The ultimate goal of ECMHC is to promote optimal mental health among infants and young children in early care and education settings. Thus, consultants delivering ECMHC services must have a strong foundation in infant and early childhood mental health.

• Attentive to prevention, promotion and intervention. ECMHC seeks to support optimal mental health for all young children — not just those identified with mental health challenges. This holistic approach requires that consultation activities address the full spectrum of young children’s mental health needs, from promotion of healthy social/emotional development to prevention of mental health problems to early intervention for young children demonstrating challenging or troubling behaviors.
• Based on knowledge of effective early childhood practices. To optimize outcomes for young children and their caregivers, consultants must be well-versed in effective practices focused on a range of early childhood issues (e.g., managing behavior, addressing trauma, fostering attachment).
• Family-centered. Engaging families is an essential component of ECMHC, as they know their children best and have a monumental impact on children’s mental wellness through their own behaviors. Families are critical partners in developing strategies that are well-attuned to the child and family’s strengths, needs and preferences. Using a family-centered approach increases the likelihood that family members will support implementation of strategies at home, thus strengthening the overall impact of consultation.
• Culturally and linguistically competent. As noted above, ECMHC is inherently collaborative and, as such, requires the formation of strong, positive relationships between and among those who will be involved in consultation efforts. In order to establish these critical relationships — and deliver appropriate services – consultants must explore and gain a firm understanding of consultees’ cultures, including ethnic, racial, linguistic, socioeconomic, education and religious aspects. Further, consultants must reflect on how their own culture impacts their approach to service delivery and reconcile this individual perspective with the collective culture of all of those involved in the consultation.
• Strengths-based. Another important element of ECMHC, which supports relationship-building and the provision of effective services, is the use of a strengths-based approach. By developing strategies that build upon the abilities and positive qualities of the children, families and early care and education providers involved in consultation, consultants not only increase the likelihood that recommended strategies will be embraced but they also provide a model for best practice service delivery.
• Reflective. ECMHC is unique in its emphasis on reflective practice. Instead of approaching each situation with pre-conceived notions of what to do, consultants constantly reflect on what they are hearing and seeing in order to set an appropriate course for intervention. Consultants also strive to help consultees become reflective by modeling this practice and promoting reflective thinking (for example, encouraging caregivers to consider why a child may be exhibiting a certain behavior).

It is worth noting the close alignment between ECMHC’s defining characteristics and Head Start’s principles regarding children’s mental health:

• Support for a comprehensive approach to promoting children’s social and emotional development
• Recognition that parents are their children’s most important teachers, and therefore parents should be involved in classroom and service decisions
• Recognition that parents and staff are best equipped to help address a child’s mental health when their own mental health needs are met
• Recognition that children’s and families’ mental health needs are best addressed when they are identified early on (Hunter & O’Brien, 2009).