Early Childhood Mental Health

The earliest years of life are critical to physical, mental, and emotional health in all the years that follow. While a full range of early childhood services is needed to ensure the mental health of our children, community-based, preventive services have a particularly vital role to play. Preventive measures and early intervention can have profound and lasting benefits. Conversely, if left untreated, children's behavioral and emotional problems can increase in severity and require more challenging and far more costly interventions later in life.

Conservative estimates place the number of children with mental health problems at one in 10. Other estimates range as high as one in five. According to the Surgeon General, fewer than 20% of these children receive needed services.

And the problem appears to be increasing. MCC has for several years been hearing from parents, child care providers, and other caregivers that emotional and behavioral problems among young children are increasing in number and severity. Reports of young children who have already experienced multiple expulsions from child care and others who are acting violently toward siblings and other children have become alarmingly more common.

Data support these anecdotal accounts. According to a University of Pittsburgh study, the percentage of pediatric visits by four- to 15-year-olds in which clinicians identified psychosocial problems increased from 6.8% to 18.7% between 1979 and 1996. In Maryland, the number of children with social-emotional problems served by LOCATE: Child Care increased from 293 in FY 2000 to 315 in FY 2007.

The good news is that preventive measures and early treatment can be highly successful -- and cost-effective. The keys are starting early with services and supports and, whenever possible, providing them within the community, in a natural environment such as a home or child care setting. Some behavioral challenges can be resolved with relatively minor adjustments, something as simple as moving a child from a large-enrollment child care program to a smaller one. Other issues may require some form of counseling for children and their parents or special training for the child care provider.

More severe problems will, of course, need progressively more challenging treatment. These forms of treatment, not surprisingly, are vastly more expensive. A recent Colorado study contrasted the $1,020 cost for two days of psychiatric hospitalization with the $987 cost for an entire year of intervention by a behavioral specialist to prevent expulsion from child care. In Maryland, 10 to 20 hours worth of basic consultation services provided by a behavioral specialist working out of a child care resource center costs approximately $250. For a cost of about $5,000 per year, a child can receive outpatient services to prevent the development of serious emotional disturbances at a facility such as Montgomery County's Reginald Lourie Center. Contrast those figures with the following: $35,000 per child per year for therapeutic foster care; $55,000 to $75,000 for a year in a therapeutic group home; and $100,000 to $120,000 for a year in a residential treatment center. But by following the principles of prevention and early intervention, we will help to ensure that problems that can be dealt with early on don't intensify.

The benefits to be gained from community-based mental health services for young children -- in both human and fiscal terms -- are enormous. In the 2002 Session of the General Assembly, legislation was introduced to create a system of such services. MCC supported these bills, which unfortunately did not make it out of committee. However, pilot programs in several sites around the State (including two Office for Child Care-funded projects at the Baltimore City Child Care Resource Center and Chesapeake Child Care Resource Center) have operated for several years. In 2003, the General Assembly enacted legislation requiring OCC to report findings from these pilot projects to the Governor and the General Assembly by the end of 2005. Georgetown University conducted a thorough evaluation of the projects and in its 2005 report documented remarkably positive outcomes for the children and the child care programs involved. Given these outstanding results, the Governor proposed and the General Assembly approved a $1.875 million expansion of early childhood mental health consultation programs in the FY 2007 budget.

Position

MCC should support efforts to put in place more specialized training for providers and to enhance the availability of mental health services for children. Funding for behavioral specialists linked to child care resource and referral centers should be given special consideration.

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