1 

June 14, 2022 

To: State, territorial, tribal, and local policymakers and administrators of systems, agencies, and 

programs responsible for young children’s health and well-being, social-emotional development, 

and early learning. 

Subject: Working to ensure that all young children and their caregivers have access to high-quality 

resources that equitably support social-emotional development and mental health. 

Dear Colleagues: 

The U.S. Departments of Health and Human Services (HHS) and Education (ED) are working 

together to ensure that all young children and their caregivers have access to high-quality resources 

that equitably support social-emotional development and mental health. Social-emotional 

development and mental health are foundational for family well-being and children’s healthy 

development and early learning, and are associated with positive long-term health, educational, and 

well-being outcomes. 

Early childhood systems and programs play a vital role in supporting the social-emotional 

development and mental health of children and families. Early childhood systems and programs 

refers to the full range of systems and services that interact with young children and their families. 

This includes early care and education programs, two-generation programs, family support 

programs, and child welfare, social, health and behavioral health service systems. These support 

systems and services are particularly important when children and families experience contexts or 

situations that may overwhelm their ability to cope, including discrimination, the COVID-19 

pandemic, food insecurity, housing instability, and exposure to child abuse and neglect, 

interpersonal and community violence, or other traumatic events. Protective factors such as strong,

trusting relationships with adults and safe, stable family and community environments can help 

develop children’s ability to cope with stress and promote healthy child development. A

comprehensive, equitable, and culturally informed early childhood system is integral to support 

child, family, and community health and well-being. 

HHS and ED believe that early childhood systems should work collaboratively to equip all early 

childhood professionals (i.e., early educators, health providers, and family-support providers) with

the tools to support and promote the social-emotional development and mental health of young 

children and their families. State and local policymakers and administrators of child and familyserving systems, agencies, and programs should ensure equitable access to a continuum of social-
2 

emotional and mental health supports and services for all children. Systems that serve young 

children and their families should work to address family economic insecurity, barriers to 

preventive care, and implementation of evidence-based interventions and services. These systems 

should also address the needs of children and families of color in underserved communities,1

children and families whose first language is not English, children who have experienced 

maltreatment, children with developmental delays and disabilities, children who experience 

homelessness, and families experiencing poverty. 

In service of the above goals, HHS and ED developed four recommendations to complement the 

October 2021 ED report on Supporting Child and Student Social, Emotional, Behavioral, and 

Mental Health Needs. This 2021 report identified seven recommendations to increase the capacity 

of states, districts, schools, programs, and institutions of higher education to provide social, 

emotional, and behavioral health support and improve outcomes for children and students. The ED 

report was developed to assist a wide range of school- or program-based mental health support 

across early childhood, K-12 schools, and higher education settings. In this letter we focus on the 

application of a targeted set of recommendations to the systems and services that work together to 

meet the needs of young children from the prenatal period through age 5 and their families. The 

four recommendations with suggested action steps are:

1. Implement evidence-based practices that support positive social-emotional development and 

mental health for all children and wellness for every caregiver. 

2. Prioritize workforce wellness and enhance workforce capacity to identify and respond to 

children’s and families’ social-emotional and mental health needs. 

3. Leverage policy and funding to increase access to social-emotional and mental health 

support and reduce barriers to access. 

4. Use data to promote equitable implementation and outcomes. 

The joint HHS-ED recommendations included in this letter are intended to set a vision for stronger 

collaboration and coordination across early childhood systems and programs; raise awareness of the 

importance of social-emotional development and mental health for young children; encourage early 

childhood programs and other services and systems that interact with young children and their 

families and caregivers to prioritize access to the full continuum of social-emotional and mental 

health supports and services; and provide resources, guidance, and recommendations on approaches 

that communities, states, tribes, and territories can use to promote and support young children’s 

social-emotional development and mental health. 

Thank you for your commitment to serving young children and families.

1 Based on Executive Order 13985: The term “underserved communities” refers to populations sharing a particular 

characteristic, as well as geographic communities, that have been systematically denied a full opportunity to participate 

in aspects of economic, social, and civic life. See: https://www.federalregister.gov/documents/2021/01/25/2021-

01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government 
3 

Sincerely,

/KH/

Katie Hamm

Deputy Assistant Secretary for Early Childhood Development 

Administration for Children and Families

U.S. Department of Health and Human Services

/KN/

Katherine Neas

Deputy Assistant Secretary

Delegated the authority to perform the functions and duties of the 

Assistant Secretary for the Office of Special Education and Rehabilitative Services

U.S. Department of Education
4 

RECOMMENDATION 1: Implement evidence-based practices that support positive socialemotional development and mental health for all children and wellness for every caregiver.

Universal promotion and prevention strategies help support the development of positive socialemotional skills and mental health in young children. Universal supports may include access to 

preventive care, health and developmental screenings, and enriching early learning activities in 

early childhood care and education settings that build developmentally appropriate skills. Some 

children and families may need additional supports or tailored early interventions to strengthen 

social-emotional skills, including those delivered at home and focused on the early parent-child 

relationship. 

Provide access to preventive care for all children. Preventive health care services enable 

providers to promote children’s well-being, including physical and mental health, and may prevent 

disease later in life. Regular, consistent preventive care can help providers work with families to 

identify concerns early on, provide effective interventions, and reduce the likelihood of negative 

health outcomes (CDC, 2014, Office of the Surgeon General, 2021). Prevention efforts can also 

promote protective factors by providing parent support and supporting early relational health, early 

literacy, and universal social-emotional development. 

Action Steps: 

• Invest in systems and approaches that increase access to preventive, integrated services. For 

example, this roadmap provides strategies and recommendations to increase collaboration 

among the Title V Maternal and Child Health Block 

Grant, home visiting, and early childhood systems 

within states and jurisdictions. Key strategies include 

having a shared vision of an integrated early childhood 

system, aligning funding opportunities, supporting 

cross-system trainings to build collaboration, 

improving family engagement, and engaging the 

community in systems-building efforts. 

• Ensure early childhood systems screen for health 

insurance status and connect children and families to primary preventive care in a medical 

home.

• Amplify whole-family health and mental health promotion supports and preventive 

interventions. Support caregiver mental health and connect parents to behavioral health 

services and supports. 

• Build the capacity of pediatric providers to support children with behavioral health needs 

and connect families to the necessary resources to 

support parental and caregiver behavioral health. 

For example, the Pediatric Mental Health Care 

Access program funds state and regional networks 

of pediatric mental health care teams to provide 

behavioral health focused telehealth consultation, 

training, resources, and referrals to pediatric primary 

care providers. 

Fostering Social and Emotional Health 

through Pediatric Primary Care describes 

evidence-based programs that could be 

applied in pediatric primary care settings to 

support parents in fostering their child’s 

social-emotional development

Examples of Integrating Services

Home visiting programs can consider 

coordinating and co-locating with pediatric 

primary care providers to promote child 

health and well-being. Nutrition and health 

services for young children and families 

can be coordinated across Head Start; 

Women, Infants, and Children program 

(WIC); child care; and food programs.
5 

Conduct routine and comprehensive screening to identify, and respond to, children with 

social-emotional, mental health, or developmental needs. Screening can be conducted and 

coordinated across primary care, early childhood care and education, school, home visiting, or 

community-based settings. 

Action Steps: 

• Review and assess policies around developmental screening to ensure that screening for 

mental health and social-emotional needs are included as part of regular, universal 

developmental screening. These recommendations are consistent with goals and objectives 

outlined in Healthy People 2030. 

o Screen for children’s mental health, caregiver 

mental health, early relational health, and social 

determinants of health. 

o Ensure that providers across settings know what 

screening tools are available, have the training to 

administer those tools, and know who to refer to 

if concerns are identified on screening. 

o Ensure approaches meet the needs of all families 

and communities and are accessible, and 

developmentally, culturally and linguistically appropriate. 

• Develop coordinated, family-centered intake and referral systems that meet whole-family 

needs. 

• Implement the American Academy of Pediatrics’ national health promotion and prevention 

initiative Early Childhood Bright Futures Guidelines in primary care, in coordination with 

community partners. These guidelines provide theory-based and evidence-driven guidance 

for all preventive care screenings and well-child visits.

• Support the implementation of trauma-informed approaches and two-generation approaches.

Implement the full continuum of evidence-based social-emotional supports to equitably meet 

the needs of all young children. 

Action Steps: 

• Support the implementation and dissemination of evidence-based practices. For example, 

Infant and Early Childhood Mental Health Consultation and the Pyramid Model are

evidence-based practices that support young children’s social-emotional and mental health.

• Support early childhood systems in accessing necessary organizational resources, personnel, 

and administrative supports. 

o Leverage and incentivize high-quality, responsive environments.

In primary care settings, a child’s 

health care provider helps parents and 

caregivers to identify their child’s 

developmental milestones and 

monitor whether a child is developing 

on schedule. Learn the Signs Act 

Early helps families to track their 

child’s development and act early if 

they identify concerns.

Program Highlight

ED’s interdisciplinary personnel preparation grant program, Erikson Institute in Chicago, 

Illinois, prepares Developmental Therapy (DT) and Social Worker-Infant Early 

Childhood Mental Health (SW-IECMH) providers to engage in interdisciplinary, 

evidence-based practices to meet the needs of infants and toddlers with disabilities and 

their families. This program provides interprofessional training to DT and SW-IECMH 

scholars, so they gain competencies in child development; early intervention (EI); 

interprofessional, trauma-focused EI; and developmentally informed, relationship-based 
6 

o Work across sectors to build capacity of mental health providers that can support the 

early childhood system, deliver mental health promotion, and provide more intensive 

interventions as necessary.

• Provide implementation supports to enable success and sustainability. For example, this 

Resource Guide for Developing Integrated Strategies to Support the Social Emotional 

Wellness of Children from the Administration for Children and Families’ (ACF) Office of 

Child Care describes key implementation strategies for implementing and delivering 

evidence-based programs and initiatives.

• Include social-emotional development in early childhood care and education quality 

standards.

• Assess and evaluate the implementation of evidence-based models across contexts and 

populations. Strengthen the evidence base of emerging and innovative practices and 

practice-informed, culturally driven interventions.

Support caregiver and family wellness.

Young children’s mental health is greatly influenced by their environments and relationships with 

adults (National Council on the Developing Child, 2010). Caregivers’ own mental health shapes 

their ability to engage in nurturing interactions and use developmentally appropriate practices 

(Smith & Granja, 2021). Environmental and contextual factors also impact the mental health of 

caregivers and children. 

Action Steps: 

• Enhance access to two-generation approaches like Head Start, home visiting, and Project 

LAUNCH that address the needs of parents and children together and build family wellbeing. 

• Prioritize caregiver and family wellness, including support for caregiver mental health and 

prevention of abuse and neglect. Peer support programs can help to connect families 

through shared experience. The Children’s Bureau within ACF developed a Prevention 

Resource Guide that includes tip sheets and other information on promoting protective 

factors and supporting parents and caregivers. 

• Promote access to social and economic supports for families. 

• Develop policies and funding to support access to child care. 

• Raise up parent and caregiver voices to ensure family-centered approaches. Develop parent 

leadership opportunities at planning and policymaking tables, including in all aspects of 

research, program development, and evaluation. Enhance access to peer supports. 
7 

RECOMMENDATION 2: Prioritize workforce wellness and enhance workforce capacity to 

identify and respond to children’s and families’ social-emotional and mental health needs.

The early childhood workforce includes a range of professionals that work together to support 

children and families, including early childhood educators, early interventionists, home visitors, 

health care providers, mental health specialists, child welfare providers, and family support 

professionals. There is a severe workforce shortage of providers equipped to support young 

children’s mental health.2 

Support and promote workforce well-being. 

A healthy, well-compensated, and supported early childhood workforce is critical to ensuring the 

successful implementation of evidence-based mental health promotion strategies and subsequent 

health and well-being outcomes for children and families. Research has shown that quality in early 

childhood education is associated with staff psychological well-being and positive organizational 

climate. 

Action Steps:

• Assess workforce well-being. For example, Head Start recommends that programs 

periodically assess strengths and needs of staff by gathering data directly from both current 

and prospective staff. Programs can also create a Staff Wellness Action Plan that gathers 

information from staff about program strengths and needs around staff wellness. 

• Support a living wage for the early childhood workforce and increase access to health 

benefits and paid family leave. Head Start provides recommendations for programs to 

recruit, train, and retain qualified staff with staffing schedules and benefits that support 

educator well-being, the creation of a culture of belonging, highlighting what drives staff 

motivation, and collaborating with community partners to enrich the early care and 

education workforce. 

• Support and incentivize the development and implementation of wellness programming for 

the early childhood workforce. 

o Promote habits of connection and create and 

normalize habits of physical and mental wellness. 

For example, programs can ensure staff have a 

dedicated space to take breaks and eat meals 

during the day, increase peer-to-peer learning 

opportunities, or encourage staff to incorporate 

physical activity and healthy options into daily 

work routines. 

o Reflective supervision and mental health consultation are supports that can bolster 

well-being and provider capacity. 

• Provide organizational resources to enable the early childhood workforce to be effective. 

Facilities should be well-maintained and in good condition. 

o In schools and early childhood education settings, organizational resources are 

critical to meet the needs of young children. This includes appropriate 

2 White House Fact Sheet. (2022). https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/factsheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-hisfirst-state-of-the-union/ and Child Trends, (2021). https://www.childtrends.org/publications/a-national-agenda-forchildrens-mental-health) 

Example of Workforce Support

As part of their enhanced home 

visiting, Project LAUNCH supports 

home visitors through reflective 

supervision and case consultation and 

provides training on the socialemotional well-being and behavioral 

health of young children and families.
8 

compensation, adequate professional development, sufficient staff capacity, and 

classroom environments that are safe, warm, inviting, and culturally appropriate. 

Absent these organizational resources, educators may experience elevated levels of 

work-related stress that lead to burnout and attrition. 

Invest in workforce preparation and capacity building across the early childhood systems. 

Workforce supports that can bolster the capacity to support and promote children’s social-emotional 

well-being and mental health include high-quality pre-service preparation, in-service professional 

development, coaching, and supervision. Workforce capacity building should be multifaceted and 

cross-sector, inclusive of education, health and mental health, and social services. 

Action Steps: 

• Support equitable access to educational and 

preparation programs through connections 

with local institutions of higher education 

(community colleges, 4-year colleges and 

universities), including minority serving 

institutions. 

• Recruit and support workers from 

underserved communities. 

• Support the development of training and 

technical assistance and facilitate access to 

these professional development 

opportunities. 

o Ensure a sufficient supply of experts 

throughout the state that families and 

providers can call on for support. 

• Increase the diversity of the early childhood 

workforce so the workforce is representative of the children and families served by the early 

childhood system. 

• Support the full range of providers across the early childhood workforce who can respond 

and support mental health (i.e., pediatricians and pediatric health providers, early childhood 

educators, child care providers, home visitors, mental health consultants, child welfare 

providers, behavior specialists, etc.). 

• Encourage data and information sharing across systems and through multidisciplinary teams 

as allowable and work with technical assistance centers to determine what, whether and how 

data may be shared under applicable laws. For example, child welfare providers can help 

identify the social-emotional and mental health needs of young children involved with the 

child welfare system and refer for specialized services as appropriate. Mental health 

consultants can support early childhood providers across settings to increase access to 

preventive social-emotional and mental health services. Medicaid and CHIP programs can 

be used to cover and pay for mental health and substance use services.

Program Highlight

New Hampshire’s State Personnel Development Grant (SPDG)

focuses on improving social-emotional outcomes for preschool 

children with disabilities through the implementation of the 

Pyramid Model (PM) framework. New Hampshire’s efforts 

foster the development of state and local infrastructure to 

implement the PM, including a master cadre of PM trainers and 

coaches, and provide a continuum of supports to ensure 

effective workforce development through preservice programs 

in institutions of higher education (IHEs). Granite State College 

and Plymouth State University have been engaged in 

embedding the PM Framework into their preservice early 

childhood teacher preparation programs since 2019. Their work 

prepares preservice teachers with the knowledge and skills 

needed to enter the workforce prepared to improve the social 

emotional outcomes of young children ages birth to 5 years old, 

including those with disabilities.
9 

Federally funded technical assistance centers and supports

These centers provide technical assistance to grantees or other entities. There are also a number of 

resources and other tools available on the websites for free to everyone. Visit the website for more 

information.

• Center of Excellence for Infant and Early Childhood Mental Health Consultation

• Center to Improve Social and Emotional Learning and School Safety

• Early Childhood Technical Assistance Center

• National Center on Early Childhood Development, Teaching, and Learning

• National Center on Early Childhood Quality Assurance

• National Center on Health, Behavioral Health, and Safety

• National Center for Pyramid Model Innovations

• National Child Welfare Workforce Institute

• National Training and Technical Assistance Center for Child, Youth, and Family Mental Health

• Quality Improvement Center on Workforce Development
10 

RECOMMENDATION 3: Leverage policy and funding to increase access to social-emotional 

and mental health support and reduce barriers to access.

Children and families currently face barriers to accessing mental health supports, including 

complicated and burdensome systems, limited supply of qualified mental health providers, and 

stigma that prevents families from seeking services. State, territorial, tribal, and local policymakers 

and administrators of systems, agencies, and programs can leverage policy and funding to promote 

wellness and support families in meeting their social-emotional and mental health needs. 

Action Steps: 

• Increase understanding of, and appreciation for, mental health and mental health challenges, 

including the use of appropriate language in communications and messaging. 

o Raise up family and community voices to identify solutions that will improve access 

to quality mental health care and strengthen family partnerships. Create and 

highlight opportunities for parent leadership. 

o Access and promote free resources to families and the workforce. 

• Advance coordinated intake and referral systems that 

include mental health screening and supports. 

o For example, family resource centers, 

centralized access points, navigation services, 

and universal home visiting can help families 

get connected to services. 

• Integrate mental health services into non-stigmatized 

settings such as primary care, early childhood 

education, family resource centers, and other 

community-based settings that families go to for 

support. 

• Build capacity and resources to communicate with families for whom English is not their 

first language. 

• Examine existing policies that can contribute to or be harmful to social-emotional and 

mental health. 

o Implement policies to support inclusion and implementation of effective and 

evidence-based social-emotional and mental health practices. Integrate traumainformed care, community-based prevention, and strengths-based approaches into 

programs. 

o Implement policies that address sources of stress for young children and families, 

including those that address poverty and basic needs and promote economic wellbeing. Two-generation programs, wraparound care, peer support programs, and 

access to family-centered substance use treatment and mental health services can 

help to meet family needs.

o Evaluate policies that may lead to harm for children and their families. For example, 

removal from a parent and placement in foster care can be traumatic for both the 

child and parent. States and localities can review policies to ensure that family 

separation is reserved for situations necessary to protect the child’s safety and 

limited in length to reduce further damage to the family’s well-being. 

• Leverage existing funding that support social-emotional mental health and expand funding 

options for social-emotional and mental health services. For example, this guide highlights 

Hub models of coordinated service 

emphasize family-focused service 

coordination and reduce barriers to access 

for families. Hub models can take a “no 

wrong door” approach with streamlined 

intake processes, co-location of partners, 

and joint case management. Some hubs 

also include a case manager or navigator to 

connect families directly to partner 

organizations.
11 

opportunities to support states in leveraging the Title V Maternal and Child Health Services 

Block Grant and Medicaid to promote social-emotional development. 

o Work across sectors to lower costs for mental health care. 

o Use funding to build workforce capacity to support social-emotional well-being and 

mental health.

o Develop and implement policies that provide sufficient reimbursement for dyadic 

interventions and other evidence-based 

interventions. 

o Develop policies that support reimbursement to 

providers for preventive care in the absence of 

formal mental health diagnoses. For example, 

the Family First Prevention Services Act 

provides public child welfare agencies the 

option to receive reimbursement under the Title 

IV-E Prevention Services for eligible children 

and families to access evidence-based treatment and prevention programs in mental 

health and substance use disorder, and in-home parenting supports to support 

families and prevent unnecessary entry into 

foster care. 

• Promote opportunities to coordinate, align, and 

leverage funding from the American Rescue Plan 

Act of 2021 and other COVID-19 relief, including 

for Long COVID, to advance early childhood socialemotional and mental health. 

o Layer and braid funds, to the extent 

allowable under applicable laws, to build a local or statewide (or territory-wide or 

tribal nationwide) infrastructure of social-emotional and mental health supports. 

The Family First Prevention Services Act’s

Toolkit for States aims to help states 

develop a plan for Title IV-E prevention 

services and plan a comprehensive array of 

services to prevent foster care placement by 

braiding Title IV-E prevention services 

reimbursement with Medicaid and other 

funding.

American Rescue Plan Act funds can be used to:

• Hire mental health providers in Child Care 

and Development Fund programs

• Address the early childhood workforce 

shortage

• Expand Pediatric Mental Health Care Access
12 

RECOMMENDATION 4: Use data to promote equitable implementation and outcomes.

High-quality data are critical to help early childhood systems, states, providers, and programs make 

decisions that will ensure families receive needed services and engage in data-driven policy 

decision making. An integrated data system can also help to ensure that programs and services are 

increasing equity and equitable distribution and can identify opportunities to reduce systemic 

barriers that families have faced in accessing high-quality services that promote social-emotional 

well-being and mental health. 

Action Steps: 

• Build the policies and systems that support an early childhood system-wide data 

infrastructure to collect and review program-, provider-, and system-level data around 

positive social-emotional and mental health metrics.

o Facilitate community-driven engagement to support community, family, and 

provider leadership and voice in data system development. Use family engagement 

tools and platforms that generate data.

o Develop and enhance integrated data systems and data infrastructure.

o Develop and promote policies that support data interoperability.

o Share data (when allowable) across systems. ACF has developed a Confidentiality 

Toolkit which provides resources for sharing data across HHS-funded programs. ED 

has developed a crosswalk that identifies confidentiality requirements under the 

Individuals with Disabilities Education Act (IDEA) and the Family Educational 

Rights and Privacy Act (FERPA). 

• Use existing statewide or local data, including publicly available data sets such as the 

National Survey of Children’s Health and the National Survey of Child and Adolescent 

Well-Being, to explore trends in social-emotional 

development and drive future data collection efforts. 

Healthy People 2030 also includes population data that 

can be useful. Engage parents, early childhood leaders 

and workers, and other key stakeholders in these 

discussions.

o Promote community-level data such as the Social 

Vulnerability Index to guide community capacity 

building efforts and meet community needs.

• Enhance data linkages and technology to support 

integrated, family-centered systems. For example, 

universal screening tied to an integrated data system 

could increase family-centered service linkage. In Los 

Angeles County, the Department of Children and Family 

Services developed an electronic referral system to 

increase the Head Start enrollment of children in foster care. 

• Support early childhood education programs in using data to document the needs and 

progress of children, including the identification of key measures and goals to inform 

decisions and track progress.

• Collect and analyze data on relevant indicators and disaggregate data to measure equity. 

Key indicators to advance equity include data that can answer questions related to access to

and quality of services, the experience children and families have in services, and outcomes 

Example of Data Tool

The Well-Visit Planner is a research-based 

online tool and data dashboard that helps 

parents to prioritize their needs and 

concerns in advance of well visits, so 

providers can customize the visits to family 

needs. The tool also provides families with 

information and resources tailored to their 

priorities and needs. Data from the Well

Visit Planner can be used with other 

professionals who work with families to 

provide targeted supports. The Well-Visit 

Planner is available for 4, 6, 9, 12, 15, and 

18-month and 2, 3, 4, 5, and 6-year well 

visits.
13 

for young children. Analysis of the data may suggest possible root causes and structural or 

social determinants of inequities, and the inappropriate or discriminatory use of discipline in 

early childhood education programs and inclusion indicators within early childhood care and 

education.

• Use data to promote accountability and continuous quality improvement.

o The Center for IDEA Early Childhood Data Systems as well the U.S. Department of 

Education provide resources for building integrated data systems and using data for 

quality improvement while protecting privacy as required by the IDEA and FERPA.