Expanding Early Childhood Mental Health Services: An Example in California

Relationship-based early interventions are recognized as important interventions in supporting and regulating parent-child interactions and improving developmental outcomes. However, it is uncommon for programs in the public mental health system to serve children under five, particularly by addressing the risk factors that impact the quality of the parent-child relationship. The current study sought to address this gap, and was carried out as part of a quality improvement effort in California to extend services to children 0-5 and their families in eight rural and urban counties. We examined the effects of a relationship-based intervention in a public mental health setting for young children (M age = 34.7 mo.) and their parents (N = 45). Children in this sample had been identified with a DC 0-3 and DSM IV-TR diagnosis, but were not previously served in the California public mental health system. Families self-identified multiple risk factors including substance abuse, mental health problems, low income and domestic violence. County mental health providers received training in dyadic treatment approaches including recognition of parenting strengths, reciprocal cueing between child and parent and enhancing parental perceptions of positive emotions. Additionally, infant mental health specialists provided weekly reflective supervision and consultation.

At the conclusion of the intervention period (M = 22 sessions), families reported significantly fewer ecological risks (e.g., serious mental health issues, limited parenting skills, major stressors in the family), as well as significant decreases in parental distress on the PSI. The percentage of parents in the clinical range declined from 41%-25%, p < .05. Furthermore, fewer children were identified as at-risk for developmental problems on the ASQ in all five domains, and children’s functional adaptation (measured by the C-GAS) significantly improved (p < .001). Finally, changes in children’s C-GAS scores were partially accounted for through changes in service coordination, total risks and family resources and support, F (3, 41) = 2.84, p < .05.

The evidence from this study indicates that families can benefit substantially from relationship-focused interventions, as a component of the continuum of care that is offered through specialty mental health settings. Notably, ecological conditions and changes in the coordination of services have significant impacts on children’s development. These findings suggest that providers need the training necessary to offer quality relationship-based programming and should be encouraged to move away from stratified services that serve only specific developmental or mental health concerns.