Module 5: Risk Factors and Community Referrals

Module 5: Risk Factors and Community Referrals

girl looks at camera

Although many prevention and best practice strategies were shared in modules 2-4, there are times when early childhood mental health consultants and the other adults in a child’s life are worried about a child’s behavior and prevention strategies are not warranting positive change. Sometimes further assessment and referral are necessary to help families and children get the support they need. Some social and emotional risk factors that should be carefully observed and discussed include:

  • Little or no eye contact
  • Frequent and long-lasting fussiness or irritability
  • Unsmiling or withdrawn behavior
  • Little or no preference for familiar adults
  • Extreme, frequent and long-lasting tantrums that impede on learning and relationship building
  • Lacks curiosity
  • Sleeping too much or too little
  • Troubles with eating/feeding- too much or too little
  • Shows a regression in language, for example stops cooing and babbling.

In addition, for toddlers and preschoolers:

  • Unable to use toys in imaginary ways
  • Often seems sad or worried
  • Fails to listen or respond
  • Rarely uses words to express feelings
  • Seems unable most of the time to control feelings

An important role of the early childhood mental health consultant is to be knowledgeable about community services and how to access them when risk occurs. In a national cross-site study of effective early childhood mental health consultation programs, 69% of consultants reported making at least monthly referrals to other community resources for early care and education providers and 72% reported making at least monthly referrals for families (Duran et al., 2009). Information on community-based services should be readily available to families, and consultants can help gather that information for caregivers and adults. It is important for consultants to be well informed of the array of community services available for young children. This includes knowing the eligibility criteria for the services, what services are provided, who the service contact is, costs involved, and steps for accessing services. Children can be susceptible to a wide range of behavioral and developmental risks, so it is important to have a diverse and expansive list of referral sources. This knowledge will expedite getting children and families to the appropriate source. Some possible resources to consider are:

  1. Early care and education
    • Early Head Start
    • Head Start
    • School Readiness Programs
    • Other child care or education settings
  2. Early intervention and special education
    • Part C
    • Special education
    • Local schools
    • Other
  3. Children’s mental health services
    • Home-based services
    • Infant mental health (if separate from home-based)
    • Wraparound
    • Child case management
    • Family therapy
    • Specialty services (e.g., Children’s Mood Disorder Program)
    • Other
  4. Adult mental health and substance abuse services
    • Assessment
    • Individual counseling
  5. Other community services and supports
    • Child Care Resource and Referral
    • Primary health care provider/pediatrician
    • Developmental pediatrician
    • Neurologist
    • Public health (e.g., lead or fetal alcohol screening, Children’s Special Health Care Services Program, etc.)
    • Occupational therapist
    • Physical therapist
    • Speech/language therapist
    • Department of Human Services (e.g., cash assistance, child care subsidy, etc.)
    • Domestic violence program
    • Parent education and support services (e.g., divorce group)
    • Infant massage
    • National and state associations/resource centers


  1. Do you have knowledge of state and local resources that families can access when in need of additional services? If not, how might you go about accessing this information?
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This product was developed [in part] under grant number 1H79SM082070-01 from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.