EARLY

HEAD

START

NATIONAL

RESOURCE

CENTER

Responding 

to the 

Mental Health Needs 

of Infants, 

Toddlers 

and Families

U.S. Department of Health and Human Services

Administration for Children and Families 

Administration on Children, Youth and Families 

Head Start Bureau 

Prepared by 

Early Head Start National Resource Center @

ZERO TO THREE

EARLY HEAD START

Program Strategies 

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

Introduction

E

ach year, the Early Head Start National Resource Center (EHS NRC) invites Early Head Start (EHS) and

Migrant and Seasonal Head Start grantees to share their experiences in meeting the challenges of planning

and carrying out high-quality services for expectant parents and families with infants and toddlers. This

report highlights how 10 programs respond to the mental health needs of infants, toddlers, and their families. Each of

the programs in this publication responded to a questionnaire (see appendix A) that was mailed to every grantee.

The programs, primarily selected according to the depth and breadth of their responses, were also chosen to illustrate

the diversity of programs as they strive to meet the unique needs of families in many different communities.

The opening section of this report discusses the meaning of infant mental health and what is involved in responding to

the mental health needs of very young children and their families. We explore the Head Start Program Performance

Standards as they relate to mental health services and describe a continuum of mental health services from promotion

to treatment. The closing discussion considers staff training and supervision as well as the management systems that

are necessary to provide effective services.

The information in this report compliments a larger initiative from the Head Start Bureau to address the mental

health of infants, toddlers, and their families. In October of 2000, the Administration on Children, Youth and Families

convened an Infant Mental Health Forum attended by more then 140 individuals representing parents; EHS and

Migrant Head Start grantee directors and program staff; training and technical assistance providers; researchers; 

pediatricians; psychiatrists; psychologists; social workers; federal partners; and private foundation representatives.

The purpose of the forum was to:

 Develop a common understanding of the term “infant mental health;”

 Focus on the role that EHS and Migrant and Seasonal Head Start programs – in collaboration with their 

community early care and education partners – play in promoting the social and emotional development of infants

and their families; and

 Identify action steps that should be a part of a comprehensive initiative to address infant mental health using

Head Start as a leader for the field.

1

Early Head Start

Program Strategies: 

Responding to the Mental Health Needs of Infants,

Toddlers and Families
E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

Introduction

E

ach year, the Early Head Start National Resource Center (EHS NRC) invites Early Head Start (EHS) and

Migrant and Seasonal Head Start grantees to share their experiences in meeting the challenges of planning

and carrying out high-quality services for expectant parents and families with infants and toddlers. This

report highlights how 10 programs respond to the mental health needs of infants, toddlers, and their families. Each of

the programs in this publication responded to a questionnaire (see appendix A) that was mailed to every grantee.

The programs, primarily selected according to the depth and breadth of their responses, were also chosen to illustrate

the diversity of programs as they strive to meet the unique needs of families in many different communities.

The opening section of this report discusses the meaning of infant mental health and what is involved in responding to

the mental health needs of very young children and their families. We explore the Head Start Program Performance

Standards as they relate to mental health services and describe a continuum of mental health services from promotion

to treatment. The closing discussion considers staff training and supervision as well as the management systems that

are necessary to provide effective services.

The information in this report compliments a larger initiative from the Head Start Bureau to address the mental

The EHS NRC gratefully acknowledges

all the EHS grantees who answered our

questionnaire on the topic of responding to

the mental health needs of infants and 

toddlers and their families. The following

programs are profiled in this document.

Astor Early Childhood Programs

50 Delafield Street

Poughkeepsie, NY 12601

845-452-4167

Lenore Strocchia-Rivera, Mental Health 

Coordinator/Clinical Director

Elizabeth Colkin, Program Director

Community Action Commission of 

Santa Barbara County, California

5681 Hollister Avenue

Goleta, CA 93117

805-964-8857

Thesa Carpenter, Infant-Toddler Supervisor

Mattie Gadsby, Health Advisor

Emma Posadas-Espinoza, Licensed Clinical Social Worker

Early Head Start Family Center of Portland

911 N. Skidmore

Portland, OR 97217

503-236-938

Cynthia Wells, Executive Director, Early Head Start 

Family Center of Portland

Barbara Brady, Program Manager, Early Childhood Mental 

Health Program of Multnomah County Department of 

Community and Family Services

Patricia Navin, Health Manager, Early Head Start Family 

Center of Portland

Irene Finley, Mental Health Consultant, Multnomah 

County Department of Community and Family Services

Hope Street Family Center

California Hospital Medical Center

1401 South Grand Avenue

Los Angeles, CA 90015

213-742-6385

Cecilia Samartin, Mental Health Coordinator

Sherrie Segovia, Social Services Coordinator

Marta Schmidt-Mendez, Child Development Coordinator

Vickie Kropenske, Director

2
Lincoln Action Program

210 O Street

Lincoln, NE 68508

402-471-4515

Sue Hinrichs, Early Head Start Director

Mary Fran Flood, Head Start Mental Health Consultant

Corrie Davies, Clinical Psychology Extern

Panhandle Community Services

3350 10th Street

Gering, NE 69341

308-635-3089

Charlene Mahnke, Director of Child Development Programs

Donna DeForge, Mental Health Coordinator 

Joan Yekel, Assistant Early Head Start Director

Beth Grass, Infant/Toddler Specialist

PEACE, Inc., Early Head Start

808 N. McBride Street

Syracuse, NY 13203

315-470-3370

Regina Canuso, Health/Mental Health Coordinator

Redlands Christian Migrant Association

402 W. Main Street

Immokalee, FL 34142

941-658-3571

Karen Budnick, Social Service/Mental Health Specialist

Norma Ramirez, Area Coordinator

Upper Des Moines Early Head Start

101 Robbins Avenue

Box 519

Graettinger, IA 51342

712-859-3885

Julie Edwards, Family Development Manager

Mary Jo Madvig, Director

Youth in Need, Inc.

1200 Continental Drive

Wentzville, MO 63385

636-332-0265

Bob Bertolino, Senior Director of Clinical Training and 

Early Childhood Clinical Services

We also acknowledge and thank the

following individuals who served as

part of the work group to review and select

questionnaire responses.

Region 4 Head Start Quality Improvement Center for

Disability Services

Helen Keith, 

Former Infant Toddler Specialist

Region 6 Head Start Quality Improvement Center for

Disability Services

Judy Wilgren, 

Infant Toddler Specialist

Region 7 Head Start Quality Improvement Center

Alice Eberhardt-Wright, 

Infant Toddler Specialist

Early Head Start National Resource Center @ ZERO TO THREE

Jennifer Boss, Senior Program Associate

3

Astor Early Head Start, Poughkeepsie, NY
E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

4

WHAT IS INFANT MENTAL HEALTH?

The term infant mental health conveys widely 

different meanings for the varied professionals

who use it. The term seems to have as many 

different definitions as there are disciplines concerned

about the mental health needs of infants and toddlers

and their families. Each discipline—education, psychology,

psychiatry, social work, early intervention, and others—

draws on its own history and roles to define what the

term represents and to clarify what supporting infant

mental health implies. The words mental health often

evoke negative images of mental illness, images that

many people feel distinctly uncomfortable associating

with babies. In this publication, we will explore how

“meeting the mental

health needs” of babies

and families is interpreted in the context of

Head Start, and we will

share promising strategies

used by Head Start 

programs serving infants

and toddlers around the

country.

Infant Mental Health from the Eyes of the Baby

Broadly speaking, infant mental health is healthy social

and emotional development. What do we want for the

babies in our care? What do emotionally healthy infants

look like? These are simple questions with complicated

answers that are deeply rooted in culture and in one’s

own life experiences. 

Some of the characteristics that might come to mind

include

 loving and secure relationships;

 resilient physical and emotional health; and

 physical and emotional environments that support

infants’ capacities and that challenge them 

appropriately.

Infant mental health is a complex topic because babies

and toddlers have unique developmental characteristics

and are utterly dependent on the adults in their lives.

Infant and toddler development is exceptional because

each area of their development is closely influenced by

every other area. Thus, one cannot discuss the mental

health of infants without also considering the influence

of cognitive skills, motor abilities, language, sensory 

systems, and so on. Moreover, because infants are 

completely dependent on their adult caretakers, infant

mental health also involves fundamental concerns with

the quality of the child’s relationships to his or her primary

caregivers. Variables such as the caregivers’ mental

health, temperament, and life circumstances have a 

profound effect on the child. Likewise, the individual

Early Head Start

Program Strategies: 

Responding to the Mental Health Needs of Infants,

Toddlers and Families

I

started Home Based when I was 

pregnant with my first son, Octavio.

J.D. was my home visitor. She gave me a

lot of information about children birth

to 1 year and how to take care of 

yourself before and after childbirth.

After my 16th B-day and Octavio was 6

weeks, I went to Center Based. In

Center, J.Y. and B.G. gave me lots of

information about brain development

and parenting skills. The EHS program

teachers and other parents have helped

me out through the good and bad

times. In a way, I guess you could say

we’re kind of like a big family. Learning

new stuff everyday, communicating

with one another. Staying focused on

our goals. Becoming a better parent.

Helping others with their problems.

16-YEAR-OLD MOTHER, 

Panhandle Community Services EHS
5

characteristics and temperament of the child influence

the caregiving relationship. Given this complexity, effective mental health services for infants, toddlers, and

their families require a multifaceted approach that is

integrated with all program services.

ZERO TO THREE Task Force on Infant Mental

Health

In the spring of 2001, ZERO TO THREE created an

Infant Mental Health Task Force to capitalize on the

rapidly expanding national interest in all aspects of

infant mental health and on ZERO TO THREE’s rich

history of leadership in this area. 

The work of the task force includes the following

objectives:

 Promotion, prevention, and intervention-treatment

strategies and practice

 Training and professional development

 Systems development, policy creation, and funding

 Public awareness and advocacy

The task force has developed the following draft 

definition of infant mental health and the explanatory

comments that follow it:

Infant mental health is the developing capacity of the child

from birth to three to: experience, regulate, and express

emotions; form close and secure interpersonal relationships;

and explore the environment and learn—all in the context

of family, community, and cultural expectations for young

children. Infant mental health is synonymous with healthy

social and emotional development.1

The definition’s phrase “developing capacity” reminds

us of the extraordinarily rapid pace of growth and change

in the first three years of life. Both a newborn and a

three-year-old experience intense feelings and are active

partners in their relationships with adults, but the differentiation and complexity of a young child’s emotional

and social development increase markedly over time.

Because every child is a unique blend of characteristics,

infants’ and toddlers’ developmental pathways will

reflect not only their individual constitutional differences but also the contributions of their caregiving

environments.

As infants and toddlers “come to experience the full

range of human emotions,” they initially depend on

adults to help them “regulate their interaction, attention, and behavior” as they experience emotion. The

young child’s increasing ability to self-monitor contributes to the emotional regulation that is a sign of

mental health.

Through “relationships with parents and other caregivers,” infants and toddlers learn what people expect of

them and what they can expect of other people. “Nurturing, protective, stable, and consistent relationships are

essential to young children’s mental health.” Thus, the

state of adults’ emotional well being and life circumstances profoundly affects the quality of infant-caregiver

relationships.

The drive to “explore and master one’s environment is

inborn in humans.” Infants’ and toddlers’ active participation in their own learning and development is an

Upper Des Moines Early Head Start, Spencer, IA

1– The draft definition from the ZERO TO THREE Task Force on Infant Mental Health is not yet published.
important aspect of their mental health, as is their ability

to adapt to and cope with the environment. Infants and

toddlers “share and communicate feelings and experiences” with significant caregivers and other children. A

developing sense of oneself as “competent to engage in

relationships and to act in the world” is an important

aspect of infant mental health.

“Culture influences every aspect of human development,” including how infant mental health is

understood; adults’ goals and expectations for young children’s development; and the child-rearing practices that

parents and caregivers use to promote, protect, or restore

infants’ and toddlers’ mental health.

Head Start’s Program Performance Standards

The Head Start Program Performance Standards describe a

comprehensive array of supports and services related to

mental health (see appendix B), including prevention,

assessment, and early identification of mental health

problems; professional mental health consultation; and

delivery of mental health services. 

The Performance Standards also recognize social and 

emotional needs that are specific to infants and toddlers:

Grantee and delegate agencies must support the social and

emotional development of infants and toddlers by promoting

an environment that encourages the development of selfawareness, autonomy, and self-expression; and supports

the emerging communication skills of infants and toddlers

by providing daily opportunities for each child to interact

with others and to express himself or herself freely. 2

It is important to note that, although specific regulations concerning child mental health are described in

one section of the Performance Standards (45 CFR 1304.24),

many additional regulations that are directly linked to

healthy social and emotional development are located

throughout the Performance Standards. 

Examples include the following:

 The regulations governing group size and teacher-tochild ratios in center-based settings recognize the

importance of close, nurturing relationships for infants

and toddlers.

 The requirements for family collaboration and partnership recognize the critical effect of the parent-child

relationship in all aspects of the EHS program.

 Health and safety guidelines ensure that the physical

environment promotes the child’s wellness and that

the child’s ongoing health status is monitored.

Many additional regulations ensure that the promotion

of mental wellness and the prevention of mental health

problems occur throughout the delivery of the Head

Start program.

THE PRACTICE OF INFANT MENTAL

HEALTH: PROMOTION, PREVENTION

AND TREATMENT

The field of infant mental health is relatively new, and

those who identify themselves as infant mental health

practitioners are rare. 

Yet, many professionals interact with very young 

children in their daily work and are concerned about

the same things that a practitioner of infant mental

health is concerned about, including:

 the quality of the relationships between children and

their parents;

When I first had my son, Jacob, it was really hard. I really did nothave anyone to help me. When I was pregnant I read child

magazines and stuff about child development but I really did not

understand it. Then when I came to the program, EHS, I talked to J.,

and B., and other parents about many things I did not understand,

not just child development. They were a really good support too.

They have really helped me to become a mature parent.

17-YEAR-OLD MOTHER, 

Panhandle Community Services EHS

6

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

2– Head Start Performance Standards, 45 CFR 1304.21 (b)(2)(i-ii)
 characteristics of the family (e.g., single parents, teenparents, substance abuse) or environment (homelessness,

violent communities) that put children at risk for 

current or later problems;

 resilience and vulnerabilities in individual children;

 mental illness or disorders such as depression or 

behavior problems; and

 community supports and services for children 

and families.

The above list is by no means comprehensive but illustrates the diversity within the field of infant mental

health and among the professionals who may be working

with children and families. The practice of infant mental

health can be thought of as involving a continuum of

services encompassing the promotion of mental wellness,

the prevention of mental health disturbances and identification of mental health needs, and the delivery of

services to treat mental health problems.

Common Themes

The EHS programs responding to our survey revealed

the following issues as some of the common mental

health challenges faced by families in EHS:

 Depression, both clinical and post-partum

 Substance abuse

 Parental stress from economic issues, or violence in

their communities

 History of unresolved grief or loss

 Attachment issues

between children and

parents

 Parents with developmental delays

 Domestic violence

 Immigration

 Parental and familial low self-esteem 

 Relationship stressors

 Parental understanding of child development 

 Conflict between cultural childrearing practices and

“expert” opinions on appropriate practices

 Child behavior problems

The programs also described some of the following

strategies for meeting these challenges:

 Strengthening a focus on promotion and prevention

activities

 Hiring mental health professionals on staff

 Utilizing mental health consultants in a variety of

roles such as conducting observations, training staff,

case consultation, or crisis intervention

 Developing partnerships with university training programs that provide services through trainees in fields

such as psychology, psychiatry, or counseling

 Collaborating with local service providers in the area

of mental health for services such as helplines or crisis

intervention

Within this report, various EHS programs working in

diverse communities with different program models

describe their philosophies and approaches to mental

health services. The program descriptions reveal great

diversity in the approaches they take to deliver mental

health services; however, some common themes emerge

from all of these programs. 

Consider these themes as you read about these unique

EHS programs:

 The quality of the parent-child relationship is the

most important aspect of infant mental health promotion, prevention, and treatment.

 Infant mental health services begin prenatally, recognizing that the mental health of the expectant mother

is where infant mental health really begins.

7

Upper Des Moines

Early Head Start,

Spencer, IA
Astor Early Childhood Programs

I

nfant mental health is defined in 

our program as the attainment of a

healthy parent-child bond. 

Anything, whether constitutional variables of the infant

or mental health issues of the mother or father, that

appears to interfere with the parent-child bond is dealt

with early on because our approach is one of wellness

and prevention.

A mental health professional is assigned to each EHS

center, except in our largest center (Poughkeepsie, NY)

where we have the equivalent of two full-time mental

health professionals and one predoctoral psychology

intern. The mental health professional practices reflective

supervision on a weekly basis with the parent-infant 

educators, either individually or in small groups. Any

concerns that a parent-infant educator has about a child

on her caseload is addressed during reflective supervision;

if mental health expertise is requested, then a referral is

generated and a formal consultation is begun. Any 

information such as observations and Denver II 

Developmental Screening Instrument results that may

have already been gathered by the parent-infant educator are shared with the mental health professional. If a

child appears significantly delayed in any developmental

area, then he or she is referred to the local Early 

Intervention (EI) Program. Any treatment services

offered through EI are designed to support the parent-child

relationship and to provide the least amount of disruption

to the child’s routine at home or at the center.

In general, a strong positive correlation exists between

the mental health of parents and those of their children.

Thus, a family systems approach is customary to 

understand mental health problems and their solutions.

Astor Early Childhood Program, Poughkeepsie, NY

 Parent and family involvement occur at all levels of

mental health promotion, prevention, and treatment

and are sensitive to cultural and familial beliefs and

values.

 Mental health services are integrated into all program

services and require a multidisciplinary approach to be

effective.

 Collaboration with community providers such as mental health organizations and county and state programs

ensures that families receive the comprehensive services necessary for high-quality care. Part C Early

Intervention programs are particularly important for

the early identification of mental health needs and

should be full partners in mental health services for

families with infants and toddlers.



8

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families
However, we also believe that many of the difficulties

encountered by our parents can be overcome by ongoing

assessment of and education about the child’s socialemotional development. Monthly, parent-infant educators

use the Denver II Screening Instrument to determine

whether personal-social skills are emerging within normal

age limits. Second, they carry out socioemotional 

curriculum activities during every home or center visit,

drawing from the Hawaii Curriculum and Partners for a

Health Baby Curriculum. Handouts and educational

booklets are distributed and explained during home visits.

Finally, parent-infant educators are trained to watch for

signs of depression in infants, toddlers, mothers, and

mothers-to-be.

Community Action Commission of Santa Barbara

Our program has a unique 

contract and collaboration with Santa

Barbara County Alcohol Drug and Mental

Health Services and the Children and Families Commission of Santa Barbara County.

We have four full–time, on-site mental health practitioners (Licensed Marriage and Family Therapists and

Licensed Clinical Social Workers) who are county

employees. Through our referral system, the mental health

practitioners are available for consultations, clinical observations, assessments, and treatment. They also have been

available to consult in person and on the telephone with

the EHS staff as well as with site supervisors and lead

caregivers at respective centers. In addition, the mental

health practitioners are available to dialogue informally

with parents and have provided consultation to EHS

staff members who are engaged in the delivery of 

home-based services.

We have discovered that the “goodness of fit” of our 

program philosophy with EHS personnel, and the mental

health practitioner is critically important. In fact, it is

now even more critical than usual because the concept

of infant mental health is not widely understood or

embraced, even among mental health professionals who

have been working with other populations. The concept

of goodness of fit expects that personnel have the ability

to work within “Head Start culture” and the flexibility to

expand clinical services beyond the traditional office visit.

An understanding of poverty and its effects on children

and families is also necessary. Goodness of fit involves an

interest and willingness to learn about cultural issues and

intergenerational issues related to immigration and the

family.

Early Head Start Family Center of Portland

We approach meeting the mental

health needs of infants, toddlers, and

their families as well as of pregnant women

by collaborating with systems rather than

by providing mental health services in 

isolation. The Early Childhood Mental Health 

(ECMH) Program of Multnomah county contributes the

services of a mental health consultant who provides both

direct service and consultation to children and families

as well as to the staff of the center. The consultant

receives clinical supervision, psychiatric consultation,

and ongoing early childhood mental health training

through the county’s ECMH services. In this manner,

the center and county systems maximize administrative

resources. Both contribute not only their own staff and

expertise but also their combined networks in the childcare,

education, social services, health care, and mental health

communities.

Mental health services are integrated into the EHS

center’s approach to allow staff members to meet parents

where they are as partners and to be responsive to their

cultural and community environments. Making the 

mental health consultant and our outreach efforts visible

is key to carrying out our approach. Parents access services

in many ways. They could be introduced to the mental

health service component through their Family Resource

9
Team. With the parents functioning as the lead partner,

the team determines when to confer with internal and

external resources, including the mental health consultant.

The mental health consultant works with early childhood care and education staff members as well as with

health, special education, and other social service supports,

focusing on strengths and building the program’s overall

capacity to care for all children. The mental health 

consultant becomes more visible by interacting with 

parents and staff members in the classrooms. They share

information and experiences from their various 

perspectives on topics that emerge in the day-to-day

experiences. The consultant provides more formalized

training at parent meetings in the centers, parenting

classes, and home-based group socialization settings.

One mental health consultant is assigned to the Early

Head Start Family Center. The position provides a range

of services involving consultation, direct service, training,

program development, and county administrative

responsibilities. The partnership between the county and

the center is monitored by the health manager of EHS.

The administrators of both systems jointly develop 

program needs and priorities that they carry out and

review regularly.

At any moment in the day, the consultant could be

conducting case consultation for clients or consultees or

administrative consultation for programs or consultees. 

The mental health consultant works in the on-site

model to provide primary and secondary prevention

services as well as early intervention services that

include the following:

 Classroom observation of an individual child

 Family mental health consultation

 Mental health screening, assessment, or both

 Mental health treatment services

 Family Resource Team consultation

 Community information and referrals

 Coordination with community service providers

 EHS staff consultation

 Classroom observation related to EHS Performance

Standards—screening and classroom competencies

 Administrative consultation for program planning

 Staff training (individual, group, or both)

 Parent training (individual, group, or both)

Hope Street Family Center

I

nfant mental health at the Hope Street

Family Center is everybody’s business. It

is an integral component of service delivery

that is woven throughout the various 

program components so all members of the

team, regardless of professional background,

are part of the mental health team. 

Within the context of fostering the wellness of the entire

family, interventions focus on the relationship between

the primary caregiver and the infant, are sensitive to 

culture, and are tailored to address specific family and

individual needs.

Ours is an ecological approach that strives to understand

the infant within the context of his or her family, 

community, and culture. Although the program retains

two full-time staff members with advanced degrees in

psychology, the responsibility for maintaining a therapeutic

and encouraging environment for clients is shared

among all members of the team. In this way, multidisciplinary staff members with backgrounds and training in

health, mental health, education, social work, and child

development are instrumental in the planning and 

delivery of mental health interventions. The mental

health staff provides leadership and focus with respect to

these interventions but is by no means the exclusive

provider of these services. Aside from traditional modes

of intervention such as group, family, and individual

therapies as well as psychological and developmental

assessments, other components of the program such as

the center-based literacy program, the after-school youth

center, and the on-site continuation high school are 

frequently used as part of the mental health intervention

plan for families and individuals.

10

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families
The therapeutic relationship established between the

home visitor and the primary caregiver is the foundation

on which effective mental health and case management

interventions depend. Finding and retaining professional

home visiting staff members with the aptitude and 

interest to refine their interpersonal and clinical skills is

critical to the multidisciplinary team approach used for

mental health intervention. Whenever possible and

appropriate, referrals are made to outside mental health

agencies; however, the team-based approach is maintained,

and outside providers become part of an integrated plan

for mental health intervention rather than sole providers

of the mental health intervention.

Lincoln Action Program

The Lincoln Action Program (LAP)

Early Head Start program views mental

health for infants within the context of the

child’s family and culture. The program cultivates

the following hallmarks of mental health for the infants

and toddlers in its program: developmentally appropriate

emotional expression and regulation, positive relationships with primary caregivers (and, eventually, with peers),

and developmentally appropriate behavior management.

To foster the mental health of EHS participants, the

program focuses on four primary areas: (1) comprehensive assessment of risk and protective factors within the

family and community, (2) strategies that include intensive case management and child development services 

to prevent infant-toddler mental health problems, (3)

individualized assessment of emotional and behavioral

strengths and needs for all program participants, and (4)

intervention for existing infant-toddler emotional and

behavioral problems. EHS family advocates use information from the community assessment to identify

sociodemographic factors such as low-income, housing,

access to medical care, transportation, and child care

that are likely to affect participant families. The family

advocates provide individualized case management and

child development services through their weekly visits

with infants, toddlers, and their parents. Using program

curricula, the family advocates provide information and

support to parents that focuses on child needs and

strengths and that helps parents to prevent a range of

emotional, behavioral, and social problems.

Panhandle Community Services

Mental health services for infants and

toddlers totally revolve around the

relationships and interactions they have

with their parents and other caregivers. 

Our definition of infant mental health depends on the

parent-caregiver and the infant being in harmony. The

parent-caregiver provides consistent, responsive, nurturing care, and as a result, the infant learns to regulate himor herself and achieves positive social and emotional

development.

Therefore, our philosophy about infant mental health

is that everything one does with the infant will affect his

or her mental health. The infant’s physical health and

nutrition as well as the parent’s involvement and social

service needs all affect the infant’s mental health or wellness. One cannot look at the infant alone but also must

11

Panhandle

Community

Services,

Gering, NE
consider the parent and help the parent meet his or her

own needs.

Infant mental health services also require professionals

to advocate for the infants, toddlers, and parents by

speaking and negotiating for the infant or toddler or 

parent on behalf of the relationship and service needs.

These service needs may include childcare, early 

intervention, relocations, child welfare, and health care.

Issues related to attachment, separation, transition, family

trauma, abuse, neglect, abandonment, and death in the

family may also be explored and expressed in relation to

infant mental health services.

Our classrooms practice the primary caregiver system

in which one staff person is assigned to be the primary

caregiver for three to four infants. This system helps the

infant feel emotionally safe. The caregiver understands

the infant’s needs and temperament through regular contact and by gathering information from the parent about

the infant. In addition, the caregiver shares information

about the infant with the parent. In our classrooms, the

same caregivers stay with the infants for the first three

years of childcare. Staff members move with the children

as they advance to different rooms instead of transferring

the children to both new caregivers and different rooms.

This practice helps infants, toddlers, and parents to build

trust and security.

Mental health needs of very young children and their

families must be addressed on a continual basis. Our EHS

families on the whole are under much stress. When the

parents are under stress, the infants and toddlers also feel

this stress. Staff members must carefully observe these

family members so the appropriate services and referrals

can be coordinated in a timely manner.

PEACE, Inc.

PEACE, Inc., Early Head Start has a

strong commitment to mental health

and incorporates mental health principles

and strategies into its comprehensive program for pregnant women and for families

with children from birth to three. 

Our philosophy supports a holistic approach that optimizes child development by incorporating positive

strategies throughout the program to improve mental

health functioning of parents and children.

PEACE, Inc., Early Head Start enrolls predominantly

low-income, high-risk families, whose multiple life challenges make them vulnerable to mental health

difficulties. Our enrollment sites include two drug rehabilitation programs and a prison, and many of the families

who enter our program through these sites eventually

make the transition into our home-based or center-based

slots. These families carry additional burdens because of

their backgrounds with drug addiction, prison, or both.

These additional burdens often exacerbate existing 

stressors, which further jeopardize their mental health.

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

PEACE, Inc., Early Head Start, Syracuse, NY
Recognizing that our families are experiencing 

significant stress, which affects their mental health, our

program works to improve parent mental health through

a variety of mental health strategies, including improving

the parent-child relationship, which is critical to a child’s

positive mental health functioning. The program’s 

preventative, strength-based, child-development-focused,

and family-centered interventions respect and help 

promote healthy contexts for development.

PEACE, Inc., Early Head Start maintains a deep 

commitment and a multifaceted approach to meeting the

mental health needs of infants, toddlers, and their families

as well as of pregnant women. A certified psychiatric

clinical nurse specialist (CNS) is employed full time as

the program’s health and mental health coordinator. This

joint position demonstrates our philosophy that health

and mental health are connected and reciprocal. The 

psychiatric CNS plays many roles in carrying out the

mental health program. She provides psychotherapy to

the parents, the parent-child dyads, and the families who

are enrolled. In addition, she trains center-based and

home-based staff members in how to “red flag” mental

health issues and how to recognize and respond to 

emergency situations. She also provides support and

supervision on mental health issues that arise when 

working with challenging situations.

Several protocols are in place to help implement the

mental health portion of the programs:

 A depression screening tool, the Center for

Epidemiological Studies Depression Scale.

 Mental Health Alert protocol for staff to alert the 

psychiatric CNS of a mental health need.

 Emergency and crisis counseling phone numbers for

use when EHS staff are not available.

 Emergency protocols for staff to follow in crisis 

situations.

 Mental health release information to share 

information within confidentiality guidelines.

 Newborn assessment, including the parent-child 

relationship.

In addition to the above protocols, the psychiatric

CNS does presentations on stress management, relaxation,

and parent-child relationships for staff, EHS parents

meetings, and socializations.

The psychiatric CNS leads a monthly Mental Health

Advisory Group comprised of mental health, 

developmental and maternal-child professionals in the

community. This group was originally created to help the

EHS program develop its mental health component and

has evolved into a peer supervision and resource group

with includes mental health staff from Head Start.

Upper Des Moines Opportunity, Inc.

The Upper Des Moines Opportunities,

Inc., EHS program believes infant 

mental health is at the foundation of services

to children and families. Infant mental health is

assessed within the context of the child’s environment

and his or her responsive relationships. EHS personnel

use the strengths-based approach to assist families in

accessing the resources they need. In accordance with

the directive from the national Head Start Bureau, the

program’s ultimate goal is to assist children in dealing

effectively not only with the present environment in

which they live but also with later responsibilities they

may have in school and life. To achieve this goal, EHS

has woven strategies to ensure infant mental health into

every aspect of the program. Because infant mental

health directly affects the development and resources 

of the child and the family, the program individualizes

services for each family.

To ensure that families who are expecting or who have

young infants are offered a quality, comprehensive program

at such a critical time, the health services manager, a

registered nurse, plays an instrumental role in the 

13
Assessment for the early identification of mental

health needs is another aspect of prevention. Assessment

occurs through formal processes, such as screening instruments and diagnostic evaluations, and through informal

procedures, such as classroom observations or conversations with caregivers about children’s behavior. Training

in this area can help staff members to hone their 

observation skills and their ability to communicate with

parents about sensitive issues. Keep in mind that before

findings from assessments can be used to address any

identified needs, the Performance Standards, require 

consultation with a mental health or child development

professional. 

Treatment. Strong community collaborations involving

mental health services ensure that staff members can

make an array of services available to families. Help staff

members to recognize not only their own professional

limits in meeting the mental health needs of children

and families but also the situations in which they may

need to seek help from mental health professionals.

The following programs illustrate how a variety 

of approaches are necessary for a comprehensive 

professional development plan.

STAFF TRAINING AND SUPERVISION

S

taff members need a variety of training and 

professional development experiences to better

understand social and emotional development

and the mental health needs of infants, toddlers, and

families. Every point along the continuum of mental

health services (promotion, prevention, and treatment)

described in the previous section has implications for

staff training.

Promotion. During the course of a typical day, staff 

members—perhaps, without even knowing it—do many

things that promote the mental health of children and

families. You can help staff members to recognize what

they already do in their everyday interactions with 

children and families that supports emotional well being,

for example, providing unhurried time for children to

play or explore their surroundings, maintaining regular

and consistent caregiving routines, and offering wellbalanced meals and opportunities for rest.

Prevention. The timely delivery of comprehensive, 

high-quality services to the children and families in your

program helps to prevent mental health problems. This

assistance might include helping families to access needed

services such as food stamps or housing assistance;

encouraging family literacy or job skills; providing quality

child care to the children of working parents; and most

importantly, nurturing the positive relationship between

children and their parents.

program’s service delivery model. The nurse makes monthly

home visits to pregnant women and their families and to

families with young infants until the infant is four

months of age or as needed thereafter. In particular, the

nurse assesses and monitors maternal depression, providing

referrals and follow-up services as needed. The nurse 

also offers a special socialization group designed for 

parents-to-be and parents of newborns up to four months

of age. This group, Baby Time, focuses on the issues of

prenatal, postnatal, and infant care. It provides an 

opportunity for men and women to support one another

and grow in their understanding of this vitally important

time in their child’s life, a time that is critical for 

encouraging bonding and attachment.



14

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families
attachment, behavior guidance with toddlers, anger 

management, domestic violence, and child abuse and neglect.

Upper Des Moines Opportunity, Inc.

Ongoing staff development is a priority

in the EHS program. EHS continually

develops a trusting, responsive work 

environment among coworkers in which

training needs are identified and fulfilled. 

Individual goals and training plans as well as reflective

supervision are used to identify training needs for each

employee. A certified trainer on the EHS staff trains all

personnel in the WestEd Program for Infant/Toddler

Caregivers on a monthly basis. Staff members are kept

abreast of educational conferences, which they are

encouraged to attend. Any members who attend continuing education forums provide training to their peers

afterward. Personnel are encouraged to continue their

education, and assistance is provided for this purpose.

The Head Start training guides provide additional guidance.

Program-specific training needs are accessed through 

professional development personnel at the regional Quality

Improvement Center. Training needs that are identified

statewide are addressed through the networking meetings

of the Iowa State Early Head Start program.

15



Lincoln Action Program

Mental health consultants from the

University of Nebraska have designed

a curriculum, Child Development in a 

Family Context, for family advocates and

EHS managers. This curriculum provides didactic

and experiential training related to promoting emotional,

social, and behavioral competence in infants and young

children. Monthly training sessions address normal 

psychological development, family risk and protective

factors, and mental health disorders of infancy and 

childhood. In addition to these regular monthly sessions,

consultants provide annual training to the EHS staff on

risk assessment and suicide intervention as well as on

establishing appropriate boundaries and professional 

relationships with EHS families.

Panhandle Community Services

Staff members are provided training

through various modes: all-staff, inservice sessions; small-group cluster training;

center or home-visit observation and 

feedback; monthly meetings; individual

consultations; community training events;

and conferences,videos, books, articles, and 

handouts. Some of the mental health topics that are

offered to the staff include mental wellness, social and 

emotional development, stress management, bonding and

Upper Des Moines Opportunity, Inc., Spencer, IA

PEACE, Inc., Syracuse, NY
Home visitors primarily use the following educational

materials to strengthen parent knowledge with respect to

the social-emotional domain: Partners for a Healthy

Baby Curriculum by Florida State University; the Parents

as Teachers Born to Learn curriculum; and the March of

Dimes Baby and You curriculum. Staff members are

encouraged to access mental health resources such as 

the Mental Health Took Kit on the Web site of the

Head Start Information and Publications Center and 

the training offered through the HeadsUp Network.

A variety of regional training opportunities are open

to all staff members and provide a time to learn and 

network with fellow service providers. The Head Start

Birth–5 program conducts in-service events and training

as a part of the continuing education plan. An annual

child abuse prevention conference takes place in the

community. Staff members are also able to attend 

conferences sponsored by the Iowa Association for the

Education of Young Children and by Iowa’s Child Care

Congress.

Youth in Need, Inc.

The Youth in Need (YIN) EHS mental

health program is comprehensive. 

Its staff includes one doctoral level and three master’s

level clinicians who provide a continuum of services

from prevention to identification to treatment. 

Their credentials are as follows:

 Clinical Director, PhD in Marriage and Family

 Therapist/Area Manager, MA in Counseling 

(two clinicians)

 Therapist/Area Manager, MSW in Social Work

In addition to the core clinical staff, the YIN EHS staff

includes two full-time registered nurses (RNs) who 

provide education and support to families and pregnant

women. They address issues related to maintaining

healthy lifestyles, avoiding substance abuse, and 

developing nurturing relationships with their very young

children. These services are provided through individual

meetings, community and school-based groups, and 

educational materials and pamphlets.

Professional development experiences are available to

the program staff through quarterly “all-staff” trainings,

weekly team staffings at each program site, weekly 

supervision sessions for individuals and immediate 

supervisors, open-door consultations, and community

workshops and continuing education.

Quarterly trainings. Quarterly trainings for the staff

include lectures, small group exercises, role plays, and

question-and-answer segments. Staff members are 

consulted in advance to gather their ideas for training 

on mental health. Therefore, training topics include staff

members’ ideas as well as areas related to personal and

professional growth. 

Past and future training topics include the following:

 Identifying signs of neglect as well as physical, sexual,

and emotional abuse

 Identifying signs of substance abuse

 Forming respectful, collaborative relationships with

families

 Working with “multiproblem” families

 Managing stress

 Managing crisis situations

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

16

Panhandle Community Services, Gering, NE
Weekly team staffings. Team staffings allow staff 

members to gather in smaller groups to discuss their 

families and to generate ideas that may assist in resolving

problems. Members of the clinical team often lead these

weekly meetings. 

The meetings are also used to accomplish the following:

 Train the staff on mental health issues

 Share information among staff members

 Give program and agencywide reports and updates

 Discuss new or revised policies and procedures

 Debrief crises or situations

 Provide team-building as well as personal growth

activities and exercises

 Process daily, weekly, and monthly events

Individual supervision sessions. These sessions can be

conducted by either a group of clinical staff members or

by a single member of the clinical team. They provide a

context for further training. Each clinician experiences

face-to-face supervision one hour per week. 

Supervision is a reflective process during which 

clinicians can achieve the following:

17

The Mental Health Needs of Staff Members

Intensive work with very young children and families is

emotionally and physically demanding. The work is especially difficult when children and families are suffering.

Staff members must pay attention to their own emotional

well-being to be able to sustain the kind of relationships

that are necessary to provide effective services.

Reflective supervision is one way to support staff 

members as they manage the challenges of this work. All

staff members can benefit from the practice of reflective

supervision. Reflective supervision involves collaborative

relationships between staff members and their supervisors

that provide regular opportunities to reflect on one’s own

work. Ideally, reflective supervision provides a safe 

environment for a staff member to openly discuss challenges

or negative feelings, recognize achievements, brainstorm

ideas, and get the resources that he or she might need to

work effectively with families.

The following programs share their experiences of 

supporting mental health needs of staff members.

 Process emotional reactions and responses

 Discuss their work with children and families

 Explore options for treatment

 Clarify one’s role and goals

 Generate solutions to problems

 Discuss theoretical approaches

 Plan staff development for individuals

 Manage crisis situations

 Discuss potential referrals

 Mediate intrastaff conflict

 Conduct individualized training

 Conduct performance reviews and evaluations 

(self or supervisory)

 Process daily, weekly, and monthly events

 Debrief crises and other situations

Open-door consultations. 

An “open-door policy” allows clinical staff members to

provide face-to-face or telephone guidance as needed.

Community seminars and trainings. 

These trainings may be local or national and often

include specific break-out segments or at least 

components that focus on topics related to mental health.

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

Community Action Commission of Santa Barbara

We recognize that the work environment

can either support mental health or

derail it. Thus, we strive to provide a predictable and

stable work environment through healthy management

systems that consistently provide staff members with the

information and tools they need to confidently do their

work to the highest of their abilities.

The mental health practitioner has been available to

assist with acute client crises that have left emotional

residual for EHS personnel. Assistance has included 

consultation, crisis intervention, debriefing, and recommendations for action plans, all of which have enhanced

management’s sensitivity and response to EHS employees.

The practitioner also assisted staff members in responding

sensitively to parent concerns in the EHS community

while maintaining confidentiality. Save a Valuable

Employee (SAVE) is an agency benefit that provides

individual staff members with three free counseling 

sessions. It is confidential. In addition, the EHS team has

identified reflective supervision and reflective practices

as goals, which they have also fulfilled.

Hope Street Family Center

The prevention of burn out and other

stress-related problems for staff 

members is an important concern, and 

special care is taken to hire personnel who

have the fortitude and sensitivity to work

effectively with families under a variety of

potentially stressful circumstances.

Weekly reflective supervision that maintains a collaborative, solution-focused tone is the primary manner in

which the mental health needs of staff members are

addressed. During this process, staff members are gently

encouraged to explore feelings and attitudes as they

relate to their work with families and to use the support

available to them within the team or broader organization

if needed. It is incumbent on the members of the 

leadership staff to provide a working atmosphere that is

safe for this insight-oriented approach and one in which

professional boundaries and relationships are clearly

defined. Guiding principles that assist in achieving this

end include maxims such as “There are many right ways

to get the job done,” “Learning from mistakes is a mark

of professionalism,” “Mutual respect is essential to team

work and collaboration,” and “All ideas have merit.”

The hope is that these principles, while offering support

to staff members, also will significantly enhance relationships that staff members establish with their clients.

In the rare case where these strategies are not sufficient

to address particular mental health concerns for individuals,

the EAP program refers individuals to the appropriate

professional services. Administrative and clinical 

supervisors provide follow-up as deemed 

necessary. Just as the mental wellness of parents affects

the quality their children’s lives, the mental wellness of

staff members affects the quality of work they achieve 

in partnership with their clients.

Redlands Christian Migrant Association

We address the mental health needs of

staff members in a variety of ways.

One way is through our social service/mental health 

specialist, who travels to all the areas and presents on

our employee assistance program known as “Life Balance,”

which is marketed by Ceridian Corporation. Life Balance

offers an array of services such as telephone counseling—

available at all times—for any life issue that may cause a

staff person to fell stressed, overwhelmed, or just in 

need of information or advice. This service is offered in

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

18



Upper Des Moines Opportunity, Inc., Spencer, IA
English or Spanish. Life Balance offers tips on audiotape,

a library-by-mail service, extensive educational materials,

on-line services, formal seminars, and research or referral

services. Additionally, we pursue ongoing communication

with program managers, provide training at area meetings,

include Life Balance inserts in payroll envelopes, supply

updated program communication in the agency newsletter,

and distribute promotional materials such as pencils and

magnets that provide reminders to staff members. We

have found that members of our staff learn in a variety 

of ways. Reinforcement, consistency, and fun are key to

long-term change and positive mental health.

Other initiatives include sponsoring a mental health

and wellness day for the staff at the end of the program

year. In designated areas throughout the state, staff 

members were invited to attend this special day, which

took place at a local or regional hospital. The focus is on

the mind-body connection, prevention, education, and

the importance of nurturing and taking care of our bodies.

Another initiative was to have guest speakers present on

the theme of health and wellness at local area meetings.

Our goals are to promote education, prevention, and

awareness and to continually remind the staff of the

important and lasting value of wellness. Ultimately, we

are responsible for our physical and mental health.

MANAGEMENT SYSTEMS TO SUPPORT INFANT

MENTAL HEALTH SERVICES

Management systems for mental health services provide

a framework for planning, communications, tracking and

record keeping, and self-assessment efforts. Because 

mental health services, as described above, are woven

throughout program practices and services, it is particularly important that these management systems be well

thought out and carefully carried out.

Planning. Planning for mental health services begins

with the community assessment. What mental health

issues confront children and families in your community?

You may, for example, discover high rates of maternal 

depression, substance abuse, or community violence. By

identifying some of these issues in advance, you then can

prepare staff members to work with families around these

issues and develop community partnerships with agencies

who are knowledgeable about addressing these needs. In

addition, you could also encourage professionals in these

areas to become representatives on the Health Services

19

Youth in Need, Inc.

I

ncluded in the overall mental health 

program for YIN EHS is the importance

of addressing the mental health needs of

staff members. Just as the families we work with

need ongoing emotional support and resources, so do

members of the staff. Therefore, whether in individual or

group meetings, staff members are always provided with a

warm, comfortable climate where they are encouraged to

share their thoughts, ideas, and concerns. To further 

promote mental health and well-being for staff members,

the YIN EHS program maintains an “open-door policy”

that allows staff members to talk with the clinical staff as

needed. If staff members request further services, they

can be referred to community resources. Other forms of

support are also offered, including staff support groups,

retreats, and social gatherings.

Because supporting the mental health of staff members

involves a continuum of services from prevention to

referral and intervention, a mental health resource 

collection has been established. This collection includes

printed information on how to manage personal mental

health and a list of resources with information on a variety

of different services that include but are not limited to

support groups, counselors (individual, couple, family,

and group), and activities related to mental health.

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

Advisory Committee, a strategy that could enhance

guidance to your program.

Communications. The issue of confidentiality is 

paramount when it comes to mental health issues. Our

society places a stigma on mental illness, so particular

care must be taken to protect the privacy of children and

families who are receiving mental health services.

Communication systems should include confidentiality

guidelines that determine who should know what kind of

information and under what circumstances. Everyone

involved should understand these guidelines.

Tracking and record keeping. Because many mental

health services will be provided by community partners,

the systems used for referral and follow-up should ensure

that services are rendered in timely fashion and that the

families’ needs are being met through those services.

Tracking systems should also monitor any additional

needs or concerns that arise. Careful record keeping,

within the established confidentiality guidelines, 

provides staff members with a way to monitor individual

progress and program self-assessment.

Self-assessment and continuous improvement. 

Ongoing evaluation of mental health services for children

and families is one component that ensures the overall

effectiveness of the program. Both formal and informal

methods of gathering information about the success of

the program contributes to the quality of the services;

includes information from the spectrum of promotion,

prevention, and intervention activities; and should

include feedback from families.

The following EHS programs describe a variety of 

management systems and procedures related to their 

mental health services.

Early Head Start of Portland

We have a continuous quality improvement process to communicate and

assess the mental health component of our

center. The executive director of the EHS center

meets regularly with the program manager of the Early

Mental Health Program. Mental health is part of the

Health Services Management system. The health manager

is the direct service link between the two systems, 

monitoring and prioritizing service needs of the program

with the consultant. Once each quarter, the health 

manager and the consultant together with the administration review the mental health delivery system of the

center. The consultant and the health manager meet

monthly to review both program and family needs and to

determine other communication needs with the center

and its external partners. They also meet monthly with

the multidisciplinary team with respect to case-specific

and site-specific issues.

Data collection and assessment efforts provide another

feedback loop. The center’s information systems manager

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families



developed a mental health database that tracks 

quantitative and outcome data for services provided by

the mental health consultant. These data are reported

monthly to both the center and the county. The center

20

Upper Des Moines Opportunity, Inc., Spencer, IA
participates in an annual external evaluation process,

which includes the mental health service component.

The county also has an evaluation process that includes

data from the center’s staff, administration, and families.

The consultant’s performance is assessed through the

feedback from these systems and through clinical supervision. The consultant receives weekly supervision in

various forums to review treatment services, which are

tracked through the clinical service standards of the

county, state, and federal mental health requirements.

These systematic processes allow us to respond promptly

to the changing needs of our children and families. 

Communication across the various systems provides a

broader range of more thoughtful input to the planning

process. Thus, children and families benefit by receiving

seamless services that are well coordinated and integrated

across this network of systems. Services are flexible and

nontraditional, occurring in the natural settings of the

child and family. Children and families have access to a

full spectrum of high-quality mental health services for

prevention and intervention through a family-friendly,

child-centered, community-based, and integrated service

delivery model. Families provide input through the formal

evaluation processes, and they regularly have access to all

of these systems to provide input and direction.

Hope Street Family Center

The management team at the Hope

Street Family Center includes mental

health professionals and professionals from

other disciplines. With mental health staff members

in leadership roles, both clinical and administrative 

concerns relating to mental health receive ongoing 

consideration in the overall planning of services for families. As mentioned above, mental health staff members

participate as coleaders of weekly case conferences, unit

meetings, and coordinating meetings, so mental health

service planning for infants, toddlers, and pregnant

women is a central rather than ancillary process. Thus,

the mental health staff along with staff members from

other disciplines develop an intimate understanding of

programmatic issues that affect service delivery, an

understanding that is often difficult to achieve by relying

on outside consultants alone.

Documentation, including MIS that tracks mental

health interventions and internal charting, helps staff

members to maintain a focus on family relationships and

on more pressing mental health concerns. Internal

monthly documentation reviews strengthen the staff

members’ awareness of mental health issues for families

and their ability to plan interventions using the 

multimodal team approach described above. Similarly,

self-assessment instruments and processes provide a

framework for understanding how mental health, family

relationship issues, psychosocial stresses, and effectiveness

of mental health planning and interventions are critical

to the overall functioning of the program.

Panhandle Community Services

Our program has many systems in place

to support mental health services, systems that the director, management team,

infant-toddler teachers, and home visitors

are committed to using. Training is a priority, and

as result, we have a well-trained staff. Each staff member

is required to attend 40 hours of training during the year,

and many of the training opportunities revolve around

21

Upper Des Moines Opportunity, Inc., Spencer, IA
E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

mental health topics.

The management team meets two times a month, and

the core EHS staff meets weekly. Planning, consultation,

and assessment are ongoing during these meetings. The

program tries to use a mental wellness approach with its

staff and families. Therefore, the staff discusses not only

stress prevention strategies but also wellness information.

Meeting notes are recorded and kept in a notebook for

staff members to read if they could not attend a meeting.

Documentation is done using (a) the mental health

screening form, family partnership agreement, and goal

sheets and (b) the social service contact sheet, observation

forms, and home visit plans. Mental health services and

issues are addressed in the ongoing self- assessment efforts.

Redlands Christian Migrant Association

One of the unique attributes of the 

Redlands Christian Migrant Association

(RCMA) management system is the 

structure itself. RCMA is deeply committed to 

hiring from the community from which it serves. This

commitment goes beyond the classroom. Center management, regional management, and the management team

blend the knowledge base of degreed professionals with

the real-life knowledge of nondegreed professionals who

are working their way toward degrees. How does this 

philosophy support mental health services? The answer

lies in the very way that this philosophy supports all

other comprehensive services to all children. The practice

of hiring and developing staff members from the 

community links the needs of the community directly to

the plan to address those needs. Staff members whose

roots are in the community have greater success in working with parents to support the positive development of

a child’s mental health because those staff members possess

a built-in understanding and empathy for the many 

challenges their families face. The degreed professional’s

job is to tap into this understanding, learn from it, and

offer academic knowledge to support the shared goals of

parents and the program.

Communication is a large part of supporting the 

mental health needs of infants and toddlers. The Health

Advisory Committee meets three times each year to

review current issues related to the health, safety, and

mental health of children. This committee comprises a

diverse group of health and social service providers who

have played an integral role in making recommendations

to strengthen the delivery of services in this area. Regularly

scheduled EHS meetings bring the center’s teams together

with management to analyze and assess program needs as

they relate to children and families. The center’s team

staffings are conducted on each child or family to foster a

well-rounded approach to supporting individual children

and families. The primary mode of record keeping is

through the individual family folder. Head Start Family

Information System (HSFIS) and health data tracking

are used to stay up to date on health and screening 

service delivery.

Youth in Need, Inc.

The clinical director provides oversight

of the Mental Health Program. The EHS

program director supervises the clinical director. Decisions

with respect to planning for the Mental Health Program

involve the program director, the clinical director, and

the clinical staff. Input from other systems directors (of

education, health, nutrition, transportation, etc.), the

program staff (home visitors, center family specialists,

teachers, etc.), parents (Policy Council, etc.), and 

community members (Division of Family Services, 

partners, etc.) is also obtained and is included in any

programmatic decisions.

Record keeping involves saving and organizing clinical

assessments, documentation notes, and summaries. All

documentation is consistent with a strengths-based 

philosophy. This information is kept in client files and is

monitored by the clinical director. Self-assessment 

procedures are in place to evaluate the effectiveness of

the services provided and to determine whether the

needs to very young children and families are being met.

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families



22
CONCLUSION

At the heart of infant mental health is the quality of the

relationship between babies and their parents. Perhaps

the greatest opportunity for infant mental health practice

in EHS is in the everyday interactions among parents,

children, and the EHS staff. Because of the comprehensive

nature of their program, EHS staff members have a

unique opportunity to provide intensive, ongoing mental

health support to families, support that can truly make a

difference. Regular routines, for example, feeding, 

playing, arriving, and departing, provide the most fertile

times to work with parents to strengthen the relationships

they have with their children. With professional mental

health consultation and community collaboration, EHS

programs have the tools to fully respond to the mental

health needs of infants, toddlers, and families.

Upper Des Moines Early head Start, Spencer, IA

Astor Early Childhood Programs, Poughkeepsie, NY Redlands Christian

Migrant Association,

Immokalee, FL

Upper

Des

Moines

Early

Head

Start,

Spencer,

IA

Astor Early Childhood Programs, Poughkeepsie, NY
Appendix A

EARLY HEAD START PROGRAM STRATEGIES:

RESPONDING TO THE MENTAL HEALTH NEEDS

OF INFANTS AND TODDLERS

The Early Head Start National Resource Center (EHS

NRC) collects and disseminates information on issues of

critical importance to the EHS community. Each year the

EHS NRC invites EHS grantees to participate in this

unique opportunity to share their strengths with each

other. As new EHS programs are being developed around

the nation, the knowledge and experience of existing

grantees is an invaluable resource for others to learn from.

The EHS NRC will choose, based on the depth and

breadth of the responses to the questions below, a select

number of EHS programs to profile in the third edition

of Early Head Start Program Strategies, a series of reports

illustrating the diverse and unique approaches of Early

Head Start programs around the country. The previous

editions in this series focused on staff development, and

socializations for infants and toddlers in the home-based

program option. To order these and other EHS NRC

publications, contact the Head Start Information and

Publications Center at 703-683-2878 or visit the EHS

NRC Web site at www.ehsnrc.org.

Please complete the following questions in as much

detail as needed to adequately convey your approach to

addressing the mental health needs of infants and 

toddlers in Early Head Start. Average length of

response is 5 pages total. Grantees are encouraged to

share this with delegate agencies. We request that each

Grantee only submit one survey.

Write your response on a separate paper and number

according to the question you are responding to. Please

write in complete sentences.

Please send your responses electronically by email

attachment or on disk. Send to the attention of: 

Stefanie Powers, ZERO TO THREE, 2000 M St.

NW, Suite 200, 20036. Email

s.powers@zerotothree.org. Phone 202-638-1144 if you

have any questions. RESPONSES ARE DUE BY

MARCH 9, 2001.

Please include a cover page with your name, title,

phone number, fax number, name of the Grantee, and

mailing address.

If possible, include photos of your EHS program. You

must complete and send a photo release form for each

picture. These photos will be used to illustrate the

EHS Program Strategies publication, and will be kept

on file for future EHS NRC publications.

A. Mental Health Services for Infants and Toddlers

The term “infant mental health” has been defined in a

variety of ways and is understood in different ways in 

different settings and across different disciplines. In the

questions that follow, we focus on mental health broadly to

include all the experiences necessary to support the optimal

physical, cognitive, emotional, and social development of

infants and toddlers in the context of their family.

1. What does Infant Mental Health mean in your 

program? What is your definition of infant mental health

and your philosophy of responding to the mental

health needs of very young children and their families?

2. Please describe your approach to meeting the 

mental health needs of infants, toddlers, their families,

and pregnant women. (Your approach may include a

range of activities or experiences, for example: having

a mental health specialist on staff; practicing reflective

supervision with staff; using observations and developmental assessment; developing a community collaboration for substance abuse treatment; planning child

development experiences that support the parent-child

relationship, etc.)

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

24
3. How do you view the relationship between the

mental health needs of parents/guardians and the 

mental health of their children? How do you address

this in your approach to service delivery?

4. What are the biggest mental health issues you

encounter when providing services to families with

infants and toddlers? 

5. How do your developmental screening and ongoing

assessment processes include a focus on the social and

emotional development of children, and on the mental

health issues of infants, toddlers, pregnant women, and

families?

6. What are the biggest challenges in meeting the 

mental health needs of children and families? What

strategies have you developed to address those challenges?

B. Community Resources

1. What kind of mental health resources are available

in your community for families with infants and 

toddlers and pregnant women? How do families access

such services? Describe any community partnerships

for mental health services.

2. Do you use a Mental Health Consultant? In what

capacity (describe all the ways this individual provides

consultation for your program)? Where did you locate

this individual and what is their educational and 

experiential background? Approximately how often do

you use a mental health consultant (i.e. number of

days per month or hours per week).

C. Staff Training and Supervision

1. What kind of professional development experiences

are available for all staff on the topic of mental health?

2. How do you address the mental health needs of staff?

D. Management Systems

1. What management systems (planning, communications, governing bodies, record-keeping, reporting, and

self-assessment) are in place to support mental health

services for infants and toddlers? Please describe how

these systems operate to systematically meet the mental

health needs of infants, toddlers, pregnant women, and

families in your program.

25

Upper Des Moines Early Head Start, Spencer, IA
Appendix B

HEAD START PERFORMANCE STANDARDS

RELATED TO MENTAL HEALTH

The following summary of the Head Start Program 

Performance Standards related to mental health was 

published in Chazan-Cohen, R., Jerald, J., & Stark, D.

(2001), A commitment to supporting the mental health

of our youngest children, Zero To Three, 22(1), 6.

Head Start embraces a vision of mental wellness. Head

Start Performance Standards focus on the effective and

timely delivery of services to the people (parents and

staff) most directly involved in addressing the mental

health needs of children.

The objective of the Performance Standards related to

child mental health (45 CFR 1304.24) is to build 

collaborative relationships among children, families,

staff, mental health professionals, and the larger 

community, in order to enhance awareness and 

understanding of mental wellness and the contribution

that mental health information and services can make to

the wellness of all children and families.

Grantee and delegate agencies must work collaboratively

with parents by:

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

26

1. soliciting parental information, observations, and

concerns about their child’s mental health;

2. sharing staff observations of their child and 

discussing and anticipating with parents their child’s

behavior and development, including separation and

attachment issues;

3. discussing and identifying with parents appropriate

responses to their child’s behaviors;

4. discussing how to strengthen nurturing, supportive

environments and relationships in the home and at

the program;

5. helping parents to better understand mental health

issues; and

6. supporting parents’ participation in any needed

mental health intervention.

Grantee and delegate agencies must secure the services

of mental health professionals on a schedule of 

sufficient frequency to enable the timely and effective

identification of and intervention in family and staff

concerns about a child’s mental health; and

Mental health program services must include a 

regular schedule of on-site mental health consultation 

involving the mental health professional, program 

staff, and parents on how to:

Upper Des Moines Early Head Start, Spencer, IA
1. Design and implement program practices responsive

to the identified behavioral and mental health 

concerns of an individual child or group of children;

2. Promote children’s mental wellness by providing

group and individual staff and parent education on

mental health issues;

3. Assist in providing special help for children with

atypical behavior or development; and

4. Utilize other community mental health resources,

as needed.

Head Start Performance Standards concerning accessing

community services and resources (45 CFR 1304.40 [b])

require grantee and delegate agencies to work collaboratively with all participating parents to identify and

continually access either directly or through referrals,

services and resources that are responsive to each family’s

interests and goals, including education and other 

appropriate interventions, including opportunities for

parents to participate in counseling programs or to

receive information on mental health issues that place

families at risk, such as substance abuse, child abuse and

neglect, and domestic violence.

Performance Standards related to parent involvement

in health, nutrition, and mental health education (45

CFR 1304.40[f]) specify that grantee and delegate

agencies must ensure that the mental health education

program provides, at a minimum:

 a variety of group opportunities for parents and 

program staff to identify and discuss issues related to

child mental health;

 individual opportunities for parents to discuss mental

health issues related to their child and family with 

program staff; and

 the active involvement of parents in planning and

implementing any mental health interventions for

their children.

Performance Standards (45 CFR 1304.40 [c]) require

EHS grantee and delegate agencies serving pregnant

women to assist them to access comprehensive 

prenatal and postpartum care, including mental health 

interventions and follow-up, including substance abuse

prevention and treatment services, as needed.

Source:

U.S. Department of Health and Human Services,

Administration for Children and Families, Administration on

Children, Youth and Families, Head Start Bureau. Head

Start program performance standards and other regulations.

45 CFR Parts 1301-1306, 1308, and guidance.

Washington, DC: U.S. Department of Health and Human

Services.

27 Astor Early Head Start, Poughkeepsie, NY

Redlands Christian

Migrant Association,

Immokalee, FL
Appendix C

RESOURCES FOR MENTAL HEALTH SERVICES

Cohen, E., & Kaufman, R. (2000). Early childhood mental

health consultation. Washington, DC: Georgetown

University Child Development Center.

Department of Health and Human Services. (2000). Report of

the Surgeon General’s conference on children’s mental health:

A national action agenda. Washington, DC: Author.

Donahue, P., Falk, B., & Provet, A.(Eds.). (2000). Mental health

consultation in early childhood. Baltimore: Paul H.

Brookes.

Fenichel, E. (Ed.). (1992). Learning through supervision and

mentorship to support the development of infants, toddlers,

and their families: A sourcebook. Washington, DC: ZERO

TO THREE.

Fenichel, E. (Ed.). (2001). Infant mental health and Early

Head Start: Lessons for early childhood programs. ZERO

TO THREE, 22(1).

Florida State University Center for Prevention and Early

Intervention Policy. (1999). Partners for a healthy baby home

visiting curriculum for expectant families. Tallahassee, FL:

Author.

Florida State University Center for Prevention and Early

Intervention Policy. (2000). Florida’s strategic plan for infant

mental health. Tallahassee, FL: Author.

Head Start Information and Publication Center. (2001). 

Mental health tool kit [On-line resources]. Available at

www.headstartinfo.org.

Healthy Child Care New England. (2000). Relationships,

resiliency, and readiness: Building a system of early care and

education mental health services. Brewster, MA: Author.

Hernandez, M., & Isaacs, M. (1998). Promoting cultural 

competence in children’s mental health services. Baltimore:

Paul H. Brookes.

Lerner, C., & Dombro, A. (2000). Learning and growing 

together: Understanding and supporting your child’s 

development. Washington, DC: ZERO TO THREE.

Mann, T. L. (1997). Promoting the mental health of infants and

toddlers in Early Head Start: Responsibilities, partnerships,

and supports. Zero To Three, 18(2), 37–40.

March of Dimes Birth Defects Foundation. (1994). 

Babies and you: A prenatal health promotion program. 

Wilkes-Barre, PA: Author.

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

28

Panhandle Community Services, Gering, NE
March of Dimes Birth Defects Foundation and the National

Coalition of Hispanic Health and Human Service

Organizations. (1995). Comenzando bien: A prenatal 

education program for Hispanic Women. White Plains, NY:

Author.

Mister Rogers’ Neighborhood Child Care Partnership. (1998). 

What do you do with the mad that you feel? Helping children

manage anger and learn self-control: A training workshop for

child care providers and others working with young children. 

Pittsburgh: Family Communications.

Osofsky, J. D., & Fitzgerald, H. E. (Eds.). (2000). World

Association of Infant Mental Health handbook of infant

mental health. New York: John Wiley.

Parlakian, R. (2001). Look, listen, learn: Reflective supervision

and relationship-based work. Washington, DC: 

ZERO TO THREE.

Parlakian, R. (2001). The power of questions: Building quality

relationships with families. Washington, DC: 

ZERO TO THREE.

Parlakian, R., & Seibel, N. L. (2001). Being in charge: Reflective

leadership in infant/family programs. Washington, DC:

ZERO TO THREE.

Porter, L. (1999). Young children’s behavior: Practical

approaches for caregivers and teachers. Baltimore: Paul H.

Brookes.

Powers, S., & Lerner, C. (2000). Learning and growing together

tip sheets: Ideas for professionals in programs that serve

young children and their families. Washington, DC: 

ZERO TO THREE.

Rafanello, D. (1999). Partnerships to promote mental health. 

Healthy Child Care America, 3(4), 10–11.

Shonkoff, J. P., & Phillips, D. A. (Eds.). (2000). From neurons

to neighborhoods: The science of early childhood 

development. Washington, DC: National Academy Press.

U.S. Department of Health and Human Services. (1996). 

Promoting mental health. Washington, DC: Head Start

Information and Publications Center.

U. S. Department of Health and Human Services. (2000). 

A commitment to supporting the mental health of our

youngest children: Report of the infant mental health forum. 

Washington, DC: Author.

WestEd and the California Department of Education. (1990).

The Program for Infant Toddler Caregivers. Sacramento,

CA: Author.

Zeanah, C. H. (Ed.). (2000). Handbook of infant mental health

(2nd ed.). New York: Guildford.

ZERO TO THREE. (1994). Diagnostic classification of mental

health and developmental disorders of infancy and early 

childhood. Washington, DC: Author.

29
Notes:

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

30
Notes:

31
Notes:

E ARLY H EAD S TART P ROGRAM S TRATEGIES Responding to the Mental Health Needs of Infants, Toddlers and Families

32
4

EARLY HEAD START

Program Strategies: 

Responding to the 

Mental Health Needs of Infants, 

Toddlers and Families

This document was developed by the Early Head Start National

Resource Center (EHS NRC) @ ZERO TO THREE in collaboration

with the Head Start Bureau. The contents of this paper are not 

intended to be an interpretation of policy.

Photo disclaimer:

The children and families appearing in the photographs in this 

document are for publication purposes only and are not being portrayed

as receiving mental health services. Mental health confidentiality 

regulations forbid the unauthorized disclosure of client information.

Early Head Start National Resource Center @ ZERO TO THREE 

2000 M Street, NW, Suite 200 

Washington, DC 20036-3307 

Phone:202-638-1144 

Fax: 202-638-0851 

www.ehsnrc.org 

Funded by contract #105-98-2055

U. S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth, and Families

Head Start Bureau

EARLY

HEAD

START

NATIONAL

RESOURCE

CENTER
EARLY HEAD START NATIONAL RESOURCE CENTER

Early Head Start National Resource Center @ ZERO TO THREE