Concerns about children’s mental and behavioral health have been mounting in recent years. In 2021, the American Academy of Pediatrics joined other national organizations in declaring a national child and adolescent mental health emergency. Symptoms are appearing early in development: nearly 16 percent of children between the ages of 3 and 5 are estimated to have a mental, emotional, developmental, or behavioral health condition. When unaddressed, these conditions can have serious and lasting consequences.

For young children in particular, behavioral health concerns can quickly affect their early relationships and educational experiences. Preschoolers with behavioral health concerns are disproportionately suspended or expelled later in life (PDF), setting them on a trajectory marked by exclusion, isolation, and disproportionate negative attention in school. These experiences contribute to school disruption, poor academic performance, and a greater likelihood of dropping out of school—and even future incarceration, documented by experts as the “preschool-to-prison pipeline.”

Meanwhile, early educators and child care providers are experiencing high levels of stress. They report experiencing challenges when caring for children with mental and behavioral health needs, particularly those who have experienced trauma or who need specialized supports. They’ve also identified a solution that evidence has proven works: early childhood mental health consultation. With more resources and increased scale, consultations could help improve the childhood mental health crisis while stabilizing the child care workforce. 

The child care workforce is stressed, and turnover is high

Research shows that higher emotional distress among child care providers is linked to stronger intentions to leave their jobs. An estimated one in three child care providers across center- and home-based settings are considering leaving their jobs because of various sources of stress, according to a recent national survey. This turnover further destabilizes child care settings, creating cycles where educators, families, and children are left without consistent support. Challenging behaviors can also have spillover effects and disrupt the safe learning experience for other children.

Through interviews and focus groups with more than 50 child care providers across Colorado, along with 14 early childhood professionals supporting quality of care and children in these programs, our research team heard consistent themes: Participants agreed that child care providers often feel unprepared to support children with their mental and behavioral health needs, an issue that can be traced back to lack of training and a lack of resources for teachers in the classroom. Providers may also have limited opportunities to reflect on their own mental health and needs, which can affect how they interpret and respond to child behaviors. 

“They don’t have the proper tools, so they end up using punitive approaches that damage relationships. Once those relationships are damaged, they’re not effective anymore because the kids don’t trust them. And it’s just this cycle that is really hard to break teachers out of. It creates turnover because they don’t ever have time to get that training before they burn out or they’re in survival mode for so long that they have no desire to get that training that’s going to help them be successful… And they leave the field, and the cycle begins again.”—Early childhood professional

Experts and leaders shared that these challenges are acute for home-based providers and for those working in rural areas, who are more likely to work alone, have fewer professional supports, and face geographic barriers to accessing training or resources.

“I’m the cook, I’m the cleaner, I’m the caretaker. I’m the planner, like everything. And so, you forget about those little connection pieces… because you’re focused on everything that needs to be done”—Family child care provider

Colorado shows early childhood mental health consultation is a promising solution

Early childhood mental health consultation is a nationally recognized, evidence-based intervention designed to address exactly these challenges. It pairs child care providers with an expert consultant who visits their care settings and equips them with the skills and knowledge to nurture positive relationships and respond effectively to children’s emotional and behavioral needs. It can be implemented across early childhood settings, including center-based child care, family child care homes, preschools, and other community settings—making it a flexible model for supporting nonparental caregivers.

Consultation offers a unique source of reflective support. For children and families, these services can reduce behavioral concerns, lower the risk of suspension or expulsion, and promote warm and consistent child care experiences.

“Just having someone else’s eyes on that and saying, ‘Here’s some strategies you can use in the classroom to help this child in particular,’ but also they can help the whole class.”—Child care center director

In Colorado, early childhood mental health consultation has been a cornerstone of the state’s early childhood system for more than a decade. In recent years, consultation services have supported thousands of children, teachers, directors, and families across nearly every county in Colorado. Our analyses of program satisfaction surveys from more than 590 participants from across the state show high satisfaction with these services.

Child care providers who received consultation and other professionals in the field reported the following benefits:

• Improved emotional well-being. Providers received practical and emotional support from consultants, improving their confidence, reducing stress, and teaching them how to better support child mental and behavioral health needs.
• More positive classroom environment. Providers learned new techniques, such as trauma-informed approaches and de-escalation methods, and developed new classroom tools, such as cozy corners and calming exercises, to help meet children’s needs. Consultants also helped providers understand the root cause of a child’s behavior, assisting them in responding effectively and minimizing classroom disruptions.
• Increased connections to needed services. Consultants supported providers with recognizing signs of trauma and developmental needs, as well as with connecting children to needed services. They also helped providers engage with families, which bridged communication and made it easier for providers to recommend resources to families.
• Improved child behavior and social-emotional development. With consultation, providers report children had more self-control and coping skills and better understood expectations and how to manage their feelings. Improvements in child behavior were especially apparent when families, teachers, and consultants were all working together.

More resources and evidence are needed to extend the benefits of early childhood mental health consultation

Although consultation is helping many child care providers in Colorado and other states (PDF) better meet children’s mental and behavioral health needs and improve program quality, services are limited and not readily available in every community. Even with Colorado’s robust statewide program, the providers we spoke with cited challenges with scheduling and waiting lists, as consultants are often stretched thin with large caseloads.

States need more resources to expand the reach of early childhood mental health consultation to different types of child care providers. These services have historically gone to child care centers and, as a result, home-based providers may be less aware of consultation. However more than 6 million children nationwide (PDF) rely on home-based child care. Providers in rural areas especially may need targeted outreach to understand the range of supports available to them.

Building the evidence base to show how consultation works in home-based and rural settings is also needed to drive expansion efforts. New evidence should demonstrate which approaches are most effective, identify implementation barriers, and provide guidance for scaling services to reach more children and providers.

Ensuring children have access to mental health services they need to thrive will not only help them in childhood and beyond, but it can also help stabilize the child care provider workforce caring for the next generation.