The mental and behavioral health needs among young children in the US have increased markedly over the past decade. Early childhood mental health refers to a child’s ability to manage feelings, form secure relationships, and confidently engage in learning and play—skills that are foundational for healthy development. Positive mental health is more than the absence of behavioral problems and mental health issues like anxiety and depression; it also reflects the presence of social-emotional strengths like emotional regulation and resilience.

Why This Matters

Early educators cultivate responsive, nurturing relationships that support emotional security and build confidence, which is central to children’s development. Nearly 60 percent of US children ages 5 and younger spend time in nonparental care settings, and access to sensitive, supportive, and skilled caregivers in these settings can meaningfully shape their early behavioral health. However, relationships between children and nonparental caregivers in child care settings can be disrupted when caregivers lack the training or support needed to understand, identify, and address children’s emerging needs.

This brief is meant to deepen the evidence base of child mental and behavioral health needs and the challenges child care providers face in trying to meet those needs. It provides recommendations to improve consultation and identifies the resources needed to support child mental and behavioral health, based on insights from consultative roles (CRPs) in early childhood, who have firsthand experience.

What We Found

Focus groups with 52 child care program directors and educators (referred to generally as “child care providers” in this brief) and interviews with 15 CRPs in Colorado surfaced the following key themes about young children’s mental and behavioral health:

• Participants reported observing a high degree of externalizing behaviors (e.g., hitting, kicking, biting, and other outward aggressions) that negatively impacted the learning environment, followed by internalizing behaviors (e.g., anxiety and withdrawal).
• Participants held differing perspectives on the child care settings in which children may be more likely to have behavioral challenges. Some perceived differences by child subgroups, such as observing that children of different age groups present unique challenges as their needs change across developmental stages.
• Participants said child care providers experience a range of challenges in meeting children’s mental and behavioral health needs, including a lack of accessible training, tools, space for reflection, and support for their own mental health needs.
• Participants mentioned that more training, access to infant and early childhood mental health consultation, awareness of mental health, and parent education are resources needed to better support children's mental and behavioral health.

How We Did It

Between February and June 2025, the Urban research team conducted 24 virtual focus groups with 52 Colorado child care program directors and educators in center- and home-based programs and 15 interviews with CRPs. The research team asked directors and educators about the mental and behavioral health needs of children in their care, perceived benefits of early childhood mental health consultation (ECMHC), the mediating effects of consultation, their relationship with the consultant, and what additional supports and/or resources are needed to improve ECMHC. The research team asked CRPs about their role, the mental and behavioral health needs of children, challenges in meeting those needs, experiences working alongside consultants, perceived benefits of ECMHC, needed resources, and suggestions for improving ECMHC. Focus groups and interviews were recorded with permission, and recordings were fully transcribed and coded following a thematic coding scheme in NVivo.