Exclusionary discipline practices differentially harm young children of color. As early childhood education systems seek to close these gaps to ensure all young children have access to high quality early learning experiences, the field requires more evidence-based approaches that can be scaled and replicated. Infant and early childhood mental health consultation (IECMHC) has been associated with lower rates of preschool expulsion; but the field lacks clear guidance on the essential elements of high quality IECMHC. Without such guidance, researchers cannot build a credible evidence base for the causal link between IECMHC and exclusionary discipline. An interdisciplinary research team, with support from the national Center for Excellence in IECMHC, led a consensus-building process to identify the essential activities of IECMHC as implemented across settings. The three-stage Delphi Process resulted in a list of five essential elements and 26 activities that define IECMHC and make concrete its emphasis on relationships and equity. This greater clarity around the activities of IECMHC can help inform future research and evaluation, as well as workforce and professional development.

Infant and Early Childhood Mental Health Consultation (IECMHC) is an evidence-based service in which consultants build capacity for early childhood professionals and programs to promote the social-emotional development of infants and young children. This paper describes the current state of the evidence for IECMHC, mapping the evidence to a new theory of change from the Center of Excellence (CoE) for IECMHC. There is a substantial literature base regarding the effects of consultation on outcomes for infants and young children; yet the evidence for consultation’s specific mechanisms of change, moderators of impact, and reductions in disparities have been understudied. The authors identify gaps in the scholarly literature, articulate next steps for research, and conclude with a call to action for IECMHC researchers to expand rigorous studies to the range of settings in which IECMHC is implemented and to center social justice in the research questions, methods, and dissemination.

Objective: Parents and young children in low-income communities have compounding risk factors for their health and mental health, and integrated primary care has been identified as an effective approach for embedding needed auxiliary supports. Less is known about how primary care clinicians-who are key organizational drivers for integrated primary care-perceive the impact of this support on themselves and their clinics. Method: This study used a qualitative approach to gather clinicians' perceptions of how HealthySteps (one approach to integrated care for young families) impacted their functioning and their clinic in an urban low-income community. Results: Thematic analysis of clinician interviews resulted in four themes. Clinicians opined that HealthySteps reduced their stress, eased their workload, and supported their job satisfaction in a setting where most families had significant psychosocial risk factors. They highlighted components of HealthySteps perceived to be the most impactful (e.g., tangible supports for families, connection to community services) and highlighted its role in improving relationships with families and case conceptualization. Conclusions: Recommendations are provided to leverage clinician voices to advocate for integrated primary care.

This paper focuses on outcomes for Infant and Early Childhood Mental Health Consultation (IECMHC) provided to early education teachers as part of a tiered statewide expulsion prevention initiative. In a sample of 360 children (83.3% male, 66.6% White, 88.1% with clinically elevated externalizing behavior at baseline) at risk for expulsion, outcomes from consultation are described, including expulsion outcomes and changes in child behavior. Multiple regression was used to explore the role of teacher engagement in the IECMHC process on child-level behavioral outcomes. Of the referred children receiving IECMHC, 3.9% were expelled. From pre- to posttest, teachers reported significant reductions in behavior concerns (both frequency and the perception of the behaviors as “problematic”) and expulsion risk (based on teacher perception of child behavior). Teacher engagement in the IECMHC process was a robust predictor of change in child outcomes, with greater engagement associated with improvements in child behavior problems and prosocial skills.

Infant and Early Childhood Mental Health Consultation (IECMHC) is a preventative, capacity-building intervention in which mental health professionals partner with early childhood professionals to indirectly improve the environments and relationships that young children experience. Prior research has demonstrated that IECMHC is associated with positive outcomes for children, teachers, and classrooms. Over the past decade, IECMHC implementation and research have expanded, warranting an updated review. The current paper provides an update of the IECMHC evidence base. Included studies (n = 16) were systematically gathered, screened, and coded for context, intervention characteristics, methods and measures, outcomes across ecological levels, and alignment with the IDEAS Impact Framework's guiding questions. Our analysis replicates prior reviews, describing the positive impact of IECMHC on outcomes such as child externalizing behavior, teacher self-efficacy, and teacher-child interactions. Beyond updating prior reviews, this analysis describes emerging, nuanced findings regarding the mechanisms of change and the differential impact of IECMHC. We augment our review with descriptions of evaluations that did not meet our inclusion criteria (e.g., IECMHC in the home visiting context, unpublished evaluation reports) to provide context for our findings. Finally, we provide policy and practice implications and articulate an agenda for future research.

In recent decades, there has been considerable public interest and policy action regarding the issue of exclusionary discipline from early care and education (ECE) settings. While numerous states have pursued legislation to address this practice, the legislation has received scarce empirical attention. Using a qualitative approach, the current study investigated state legislation addressing ECE exclusionary discipline (13 bills from 12 states as of January 2019) based on an existing policy framework with the following domains: Motivating Rationale, Population, Alternatives and Practices, Accountability, Personnel Development, and Financing. The majority of bills recommended reducing or banning the use of expulsion in publicly funded preschools, and many bills offered alternative responses to expulsion, ranging from general responses (e.g., behavioral supports) to specific responses (e.g., early childhood mental health consultation). There was variability in the extent to which bills outlined recommendations for accountability, such as data tracking, and financing or recommended alternative responses. Based on our review of the legislation, the following recommendations were identified to support future legislative advances for this issue: identify developmentally-appropriate, evidence-based practices that curtail exclusionary discipline as well as its disproportionate impact on young boys of color; expand the scope of the legislative protections; incorporate mandates related to funding and enforcement; collect data; and include stakeholders when crafting and evaluating legislation.

Young children's social-emotional development is powerfully shaped by their early environments, which for many includes early childhood education (ECE). Infant and Early Childhood Mental Health Consultation (IECMHC) pairs teachers and infant and early childhood mental health (IECMH) consultants to promote teachers' capacity to foster positive social-emotional development in ECE. Although the outcomes of IECMHC have been well studied, little research has investigated how this model leads to changes for teachers and children. According to theory, the quality of the relationship between teachers and IECMH consultants, termed consultative alliance (CA), is a key mechanism of change. This study analyzed the role of CA on 6-month outcomes of IECMHC in a sample of 316 children, 289 teachers, and 62 IECMH consultants. Results from multilevel models suggested that stronger CA predicted greater improvements in teacher-child closeness and teacher-rated child attachment behaviors. In addition, a strong CA was related to greater improvement in classroom climate, teachers' self-efficacy, and teachers' perceptions of their jobs. This study upholds the centrality of relationship-building and parallel process in mental health consultation, and by advancing understanding of the mechanisms of change for IECMHC may provide salient implications for policy and practice.

Young children of color-especially boys-are at disproportionate risk for suspension and expulsion from early care and education settings. Infant and Early Childhood Mental Health Consultation (IECMHC) is an approach associated with lower than expected expulsion rates, but the mechanisms through which it may influence preschool expulsion are unknown. This paper reflects on the parallels between IECMHC and interventions created to reduce implicit bias. Based on interviews with leaders in IECMHC practice, implementation, and evaluation, a theoretical framework was created to articulate how IECMHC is hypothesized to affect expulsion by first reducing the influence of implicit bias on disciplinary decisions. Implications for practice and research are provided.