Mental Health in All Places:
Supporting the Social-Emotional Wellbeing of Young Children
For young children to thrive, we must support their social-emotional health—and the social-emotional health of those who care for them—in home, child care, and health care settings.
Why It matters
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What can California do?
Increase wage replacement in California’s Paid Family Leave program to 90%.
Expand home visiting through Medi-Cal managed care plans.
Support front-line child care workers’ mental health.
Invest in Early Childhood Mental Health Consultation to train child care providers to support the mental health of children.
Create a Medi-Cal dyadic care benefit to improve mental health care for children and parents.
Provide continuous Medi-Cal coverage for children up to age 5, and for birthing persons to 12 months postpartum.
Support trauma-informed communities that address and prevent Adverse Childhood Experiences and toxic stress.
Solutions: In Detail
In the home
Paid Family Leave
The ability to bond with a new child is shown to improve maternal and child wellbeing, which can have lifelong benefits, including helping to reduce infant mortality, premature birth, and maternal stress. Paid Family Leave (PFL) is meant to allow caregivers to bond with a new child and still meet their financial obligations. However, since PFL only provides 70% wage replacement for low-wage workers, the program is out of reach for Californians who need most of their income to meet basic needs. Low-wage workers, in particular, need a wage replacement rate of 90% in order to make ends meet. This is a matter of equity, as low-wage workers are more likely to be people of color, women and immigrants, populations who already face health disparities due to systemic racism, sexism and xenophobia.
For these reasons and more, First 5 supports AB 123 (Gonzalez), which would increase wage replacement to families using PFL to 90%. For more information, read our support letter.
Home visiting programs can play an important role in supporting primary caregiver mental health and the bond between a parent and child. Home visiting models connect new and expecting parents with a designated support person, such as a nurse or community health worker, who
meets with them in their home or another preferred location on a voluntary basis. Services often include various screenings, including screening for depression, case management, and family support or counseling. Home visitors also provide a wide array of referrals for families, including to mental health services for parents who screen positive or present with depressive symptoms. Home visiting is associated with many improved outcomes for families including positive parenting practices, improved parent and child health, reductions in child maltreatment, and improved child development. Home visiting also can help alleviate the intergenerational transmission of trauma by building positive and healthy attachments between parents and their children. Yet, less than one-third of California children ages 0-2 years who would likely benefit from home visiting actually receive it.
First 5 and many of our partners are calling on California leaders to launch a pilot program to expand home visiting through Medi-Cal managed care plans. Ensuring that more of California’s most marginalized families can access the resources that they need to thrive can prevent costly negative mental health outcomes and save taxpayer dollars down the road. Prioritizing expansion of home visiting through Medi-Cal can leverage federal resources, as federal guidance has made clear that Medicaid may be used to finance core components of home visiting, yet California has not taken full advantage of this opportunity. Expansion via Medi-Cal will also increase access to home visiting for historically underserved families and children in Black and Latinx communities. Read more here.
In Child Care
Supporting child care workers’ mental health
Just as the mental health of family caregivers is important for children’s mental health, so is the wellbeing of other caregivers who spend significant time with young children. As essential workers on the front lines during the COVID-19 pandemic, California’s child care workers have been under enormous, extended stress due to fear of contracting COVID-19 at work, the need to implement costly and complex safety precautions, threat of unemployment or underemployment, and concern about the wellbeing of children in their care. In addition, most child care providers are women of color, whose own families have been disproportionately affected by COVID-19. It is imperative to recognize and address the mental and emotional toll that child care providers have experienced, and continue to experience, from working through a pandemic. Furthermore, it’s important to realize that child care work is stressful, in no small part due to low wages for work that involves great responsibility. Pre-pandemic, 28% of child care providers reported their mental health was “not good” on half or more of the prior 30 days. As the pandemic lifts and more children return to child care facilities, experts anticipate an uptick in anxiety, sadness, and acting out among children due to yet another transition. It’s critical that we boost mental health support for our essential, front-line child care workers as they navigate the emotional demands of the children they care for, in addition to their own.
Early Childhood Mental Health Consultation
Early Childhood Mental Health Consultation (ECMHC) brings together mental health professionals with people who work with young children, like child care providers, and their families to improve children’s social, emotional, and behavioral health and development. ECMHC includes skilled observations, individualized strategies, and early identification of children with and at risk for mental health challenges. The ECMHC model has been found to be effective in reducing suspensions and expulsions from early care and learning settings, which disproportionately affect children of color
California must create opportunities to support ECE providers in identifying and addressing mental health issues and behavior concerns in children as early as possible and offer critical buffering supports, which will reduce the need for costly crisis intervention later and throughout a child’s life. First 5 urges the state to dedicate $112 million over three years to expand Early Childhood Mental Health Consultation and Trauma-Informed Care to support child care providers in addressing the mental health needs of children. More information is here and here.
Dyadic care refers to serving both the parent and child together as a dyad in order to support mental health and healthy child development. Dyadic care that takes place within pediatric settings can help identify depression, provide referrals to services, and coach the parent-child relationship. Dyadic care has been found to improve outcomes for parents and children by strengthening parent-child relational health and overall family wellbeing, in addition to mitigating the impact of early adverse experiences.
In California, the prevalence of dyadic care is modest because there is no sustainable, broadly- available funding source. First 5 supports creating a dyadic care benefit financed by Medi-Cal to improve preventative care for children, address social-emotional needs, and support maternal mental health. With family therapy now a covered Medi-Cal benefit for children, there is an immediate opportunity for the State to fully reimburse evidence-based dyadic care models in Medi- Cal. Making these services specifically allowable in Medi-Cal would allow the state to increase access to these services among critical populations, as well as save money in the long term by ensuring prevention and early intervention for families before concerns become more expensive to treat. To ensure a new dyadic care benefit is fully utilized, we also support dedicating funds for technical assistance to pediatric practices so they can build evidence-based models that strengthen the parent-child bond and the social-emotional development of children into their standard of care. Read more here and here.
Continuous Medi-Cal eligibility
Having reliable and continuous health care coverage is critical for accessing mental health supports, and such support is critical in the year after giving birth, when one in seven mothers experience postpartum depression. COVID-19 has underscored the need for extended coverage, with increased isolation and stress taking a toll on maternal and child physical and mental wellbeing.
Nearly half of births in California are covered through Medi-Cal, yet existing Medi-Cal coverage extends to just 60 days for postpartum individuals and from birth to age one for children. First 5 supports extending postpartum coverage to 12 months for birthing persons, and up to age five for young children, through the 2021-22 budget. Doing so would help improve California’s incredibly low rates of preventive services and achieve health equity for young children and mothers, given that communities of color are experiencing the impacts of the pandemic disproportionately, and Medi- Cal serves primarily families of color. Read our sign-on letter here.
Adverse Childhood Experiences
Young children need supportive community environments, as well as supportive family environments, to foster their social-emotional wellbeing and prevent Adverse Childhood Experiences (ACEs). Trauma-informed practices and systems that work across sectors and spaces are critical to the work of preventing and mitigating ACEs. Addressing ACEs in communities requires that we unearth and call out racism in all its embedded places and forms; urge policy leaders to address the root causes of inequities; and work toward community environments that are healthy and safe, and provide access to lifelong learning, education and employment; opportunities to connect with one another; and shared economic security and mobility. We support the California Surgeon General’s goal of transforming outcomes for our young children by engaging a cross-sector approach to cutting the burden of ACEs and toxic stress in half in a generation, as well as her recommendations for how to do so.