Mental Health Support for Toddlers

By Stephen Simpson, The Texas Tribune

It had only been a year since Estelle Sievert and her wife, Jane, joined the foster care program at SAFE Alliance in Austin when they were introduced to 3-week-old Noah in 2022.

The couple immediately fell in love with their soon-to-be adopted son but knew the future might contain some challenges. The infant’s biological parent had a lifetime of severe mental illness compounded by years of using methamphetamines and PCP that went unaddressed, and studies show that trauma and mental illness can be passed down through generations.

This meant the early stages of this child's life could be the key to ensuring a healthy physical and mental future.

“We wanted to take a proactive approach to parenting to set him up with skills from very early on to identify emotions and validate his feelings,” Sievert said. “Kind of preparing for whatever may come down the line.”

Among the resources the couple found was Austin-based Mainspring Schools, a child care center that has built a nationally recognized mental health program for children as young as infants and toddlers.

Although a focus on mental wellness for infants, toddlers, and kindergarteners started to develop about 30 years ago, a growing number of child care centers, such as Mainspring, are emphasizing mental health as much as literacy in their curriculum — that the ability to express emotions and form relationships is equally crucial to school success as learning to read at an early age.

Additionally, Texas officials — after lagging behind other states such as Arkansas and Colorado for decades — are starting to study the current state of early childhood mental health care in Texas to determine the best way to create a statewide mental health system for the state’s youngest residents — an effort driven in large part by the COVID-19 pandemic.

While the pandemic accelerated incidents of mental health concerns, rates of childhood mental health challenges and suicide had been rising steadily for at least a decade before and have only risen further.

In Texas, more than 500,000 children were diagnosed with anxiety or depression in 2020, an increase of 23% since 2016, according to a 2023 Meadows Mental Health Policy Institute report on child and youth behavioral health.

Seventy-one percent of Texas youth with mental health issues will go untreated, compared with the national average of 61.5%, due in part to a severe shortage of child and adolescent psychiatrists in the state. Jarring statistics like these point to the necessity for early identification and intervention in facilities that touch the most children at very young ages — child care centers.

Mainspring Schools' executive director Colin Denby Swanson, standing, attends a meeting at the child care center in Austin on Sept. 19. Credit: Montinique Monroe for The Texas

In partnership with nonprofits like United Way, grassroots organizations do much of the work in early child care mental health, a feat that has impressed the most ardent supporters of children’s mental wellness.

“You will hear people say, ‘Oh c'mon, it’s just child care,’ but no, it’s so much more. This can alter the direction of these kids' lives,” said Colin Denby Swanson, executive director of Mainspring Schools.

Mental wellness in toddlers

While it’s too early to tell if Noah has inherited mental illnesses, he can become overwhelmed in certain everyday situations. The Sieverts found that a traditional day care setting was too intense for their child.

However, finding a preschool or day care that fits those needs was more complex than expected.

“We learned quickly not all day cares are created equally,” Sievert said.

Mainspring Schools, where Noah has been enrolled in since early 2023, prepares children ages 6 weeks to 5 years old for success in school through early education and mental wellness. This includes specializing in trust-based relational intervention designed to help children who have experienced adversity. Children with these needs often have trouble trusting adults, which frequently leads to perplexing behavior at a young age.

Mainspring Schools tries to address this issue through monthly family dinners and weekly family support nights, where the children and their parents can form a relationship while receiving parenting advice from licensed professionals. The school also has a low child-to-teacher ratio of four to one, allowing for more detailed learning and observation.

“We wanted a program that didn’t use the traditional punitive punishments for children,” Sievert said. “Mainspring School shared the same language that we used at home and understanding of support we felt was needed. We are already seeing the results of this work.”

At 1 or 2 years old, understanding and managing one's behaviors and reactions becomes critical. At 2 to 3 years old, a child with good mental health will continue to interact with people and build healthy relationships, including copying what other people say and do — a primary reason why young children and their parents can benefit from a robust mental wellness program in a child care center, said Barbara Grant Boneta, director of the Success by 6 coalition, a childhood wellness program in Travis County.

“We are almost teaching adults how to allow children to be children again. We are focusing on forming a loving relationship and giving kids time and space to have big feelings and help them label those feelings,” Boneta said.

This is a change to the child-rearing process where literacy and education at an early age were given priority in child care facilities and preschools. Studies have found play and good mental health are just as key to success in school later on in life as much as literacy does.

“The two can go hand in hand,” Boneta said. “It’s one of those things you want to infuse throughout the curriculum.”

The pandemic’s impact

Boneta said trauma-informed care programs like those at Mainspring Schools doesn’t need to be limited to families who have dealt with severe trauma, since the COVID-19 pandemic’s effect on young children is still being studied.

“Families were stressed, and it was a pressure cooker, and children could not form relationships,” Boneta said. “Some of these preschoolers and kindergartners never got to go to a library or gymnastics class before entering elementary school. They missed out on key experiences.”

Children born during the pandemic scored lower in gross motor, fine motor and social-emotional development than before, according to a Columbia University research study. Children with poor or underdeveloped social and emotional skills display more challenging behavior, including anger, withdrawal, anxiety, and aggression.

Additionally, since the onset of the pandemic, fewer toddlers and young children have been receiving early intervention services. Underidentification could increase referrals in elementary schools in the next few years.

Nadine Burke-Harris, a pediatrician and former California surgeon general, met with staff members at Mainspring Schools in Austin on Sept. 19. Credit: Montinique Monroe for The Texas

The pandemic shuttered many child care facilities, making it hard for parents to find programs like Mainspring Schools, said Dr. Nadine Burke Harris, founder of the Center for Youth Wellness and former Surgeon General of California, when she visited Mainspring Schools last month.

In 2023, the University of Texas at Austin’s Texas Institute for Excellence in Mental Health attempted to collect data from state programs and organizations implementing trauma-informed care to infants and early childhood. What they found was that there was no universal understanding of Texas’ approach to delivering infant and early childhood mental health care, meaning it currently looks different from community to community.

“This is precisely the type of program I was talking about when I said there were solutions to adverse childhood trauma, and it can make all the difference in the world,” Harris said. “We need to ask ourselves how we can all play our part as a community because if we address this in our children, we can transform the outcomes of entire communities.”

Texas' progress

The state of Texas is ready to listen. In 2023, the federal government awarded the state $16 million a year until December 2025 to address the gaps in its early childhood system, which were made worse by the COVID-19 crisis.

This has led to a partnership between UT-Austin’s mental health institute and the Texas Workforce Commission to analyze the landscape of infant and early childhood mental health and present recommendations for a state system. The institute’s researchers interviewed 14 states and nine Texas child care stakeholders and conducted two surveys of statewide early childhood programs to determine the best way to create a statewide toddler and early childhood mental health care system in light of the COVID-19 pandemic.

The Texas Legislature also directed the Statewide Behavioral Health Coordinating Council to develop a children’s mental health strategic plan to be published Dec. 1. The plan will cover children from birth through 17 years of age.

These efforts will complement the state’s Early Childhood Intervention program, which supports families with children from birth through 35 months of age who have disabilities or delays in any area of development, including social-emotional development. The program offers counseling, behavior intervention, occupational therapy, social work, specialized skills training and case management.

Although Texas has no statewide effort, many states for decades have used infant and early childhood mental health consultants as a critical component of their continuum of care, especially for children from birth to 5 years old.

Infant and early childhood mental health consultants primarily work in homes or in early childhood education settings with the adults in the young children’s lives to build their capacity to support their child’s healthy social and emotional development — before formalized intervention is needed.

Arkansas has a statewide program established in 2004 and overseen by the University of Arkansas School of Medical Services. The university provides all training and supervision to consultants across the state.

Colorado's Early Childhood Mental Health Consultation program focuses on building a qualified workforce by investing in higher education pathways, such as the Colorado State University School of Social Work’s mental health consultant program.

Connecticut is the national leader in infant and early childhood mental health consultations. Established in 2002, it was the first state to standardize its state program model, which is overseen by a nonprofit organization called Advanced Behavioral Health.

Workforce strain

To achieve a statewide program similar to what other states have created, Texas officials must develop a workforce for this specific field.

The American Academy of Child and Adolescent Psychiatry estimates that the country needs 47 child and adolescent psychiatrists per 100,000 children. In Texas, there are roughly 10 CAPs per 100,000 children, illustrating the dire state of youth mental health services.

“There isn’t a lot of funding available, and you got to be trained in this and have the education around this, and unless you are in a place that can give you that training, it can be hard to get into the industry,” said Boneta.

Meanwhile, child care centers, where many of these youngest Texans can receive mental health services, have struggled since the COVID-19 pandemic.

An empty playground at a day care center in Austin is seen on April 6, 2020. The pandemic forced many child care facilities to close, making it harder for parents to find programs for their kids. Credit: Eddie Gaspar/The Texas Tribune

About one-third of Texas child care centers and homes closed at some point during the pandemic, according to the Bipartisan Policy Center.

This is due to the cost of running a child care facility.

More than 75% of Mainspring’s students receive need-based tuition subsidies or scholarships, but state and federal reimbursements through programs like Early Head Start and the Texas Workforce Commission cover less than half of that amount.

“For a program like Mainspring, the cost is about $2,100 to $2,400 per child per month,” said Swanson, executive director of Mainspring, which has an annual budget of $2.3 million “We rely exclusively on grants and individual giving to support the family services piece.”

The Texas Legislature has attempted to address the child care crisis by allowing cities and counties to exempt specific child care centers from some or all of their property taxes, but local governments have been slow to adopt the exemptions.

In addition to a full property exemption for child care centers, Travis County leaders are allowing voters to determine in November whether to create a 2.5 cent property tax hike to infuse $75 million into child care.

Mainspring Schools, pictured here on Sept. 19, prepares children ages 6 weeks to 5 years old for success in school through early education and mental wellness. Credit: Montinique Monroe for The Texas Tribune

“This is a once-in-a-lifetime opportunity to address child care in our county and support the mental health services needed here,” Aaron DeLaO, vice president of impact for United Way for Greater Austin, said about the tax initiative. “We are on the cusp of being able to address generational trauma in our communities.”

Noah just turned 2 years old this year, and the Sieverts and Mainspring Schools are starting to work on his emotional regulation and finding out how important it is for parents to model behaviors.

For the family, there isn’t an age too young or too old for mental wellness education.

“It makes just as much sense to them as anything else we are telling them at that age,” Sievert said. “So why not start talking earlier about mental health and just identify feelings and how to deal with them?”

For 24/7 mental health support in English or Spanish, call the Substance Abuse and Mental Health Services Administration’s free help line at 800-662-4357. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988.

Disclosure: The University of Texas at Austin has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

This article originally appeared in The Texas Tribune at https://www.texastribune.org/2024/10/09/texas-mental-health-toddlers-preschool/.