Across the country, states are making progress in expanding Infant and Early Child Mental Health Consultation (IECMHC). IECMHC is a prevention-based approach that pairs a mental health consultant with early childhood professionals across different early care and education settings (incl. home visiting, early intervention, child care, Pre-K, Head Start) to support their capacity to foster the healthy social-emotional development of babies and young children. There is strong evidence that IECMHC improves outcomes for children, families, and the workforce.  

Based on a recent national scan (Dec 2024–Mar 2026), at least 35 states and territories are implementing some form IECMHC. While this progress should be celebrated, system leaders need to understand that IECMHC is only one component of a comprehensive, statewide IECMH approach to addressing social-emotional and mental health outcomes for babies and young children. A comprehensive IECMH system requires collaboration and alignment across multiple programs, agencies, and funding streams to address the full continuum of IECMH promotion, preventive-intervention, and treatment services.  

Drawing on takeaways from interviews with system leaders in three states that have made significant progress in building comprehensive IECMH systems, this piece lays out what states can do to build a comprehensive IECMH system that supports the healthy social-emotional development and mental health of young children in the context of secure, nurturing relationships with parents and caregivers.  

Why Early Relational Health and IECMH Matter  

Policymakers, early childhood leaders, and families are increasingly aware of the importance of early relational health and that safe, stable, and nurturing interactions between caregivers and young children provide the foundation of healthy development. 

At the same time, states are grappling with the profound impacts of Adverse Childhood Experiences (ACEs), Trauma and Toxic Stress— all of which can disrupt the parent-child relationship and derail healthy development if left unaddressed. 

ZERO TO THREE  defines Infant and Early Childhood Mental Health (IECMH)  as “developing capacity of the child from birth to 5 years old to form close and secure adult and peer relationships; experience, manage, and express a full range of emotions; and explore the environment and learn—all in the context of family, community, and culture”.  

Given the comprehensive nature of IECMH, a continuum of supports and services are needed to promote the healthy social-emotional development and mental health of babies and young children within the context of relationships with parents and other caregivers. This includes: 

• Promotion of healthy social and emotional development and mental health for all infants and young children through materials and training that are targeted to parents, early care and education professionals, and others working with young children.  

• Preventive-intervention services for families who are experiencing levels of stress and challenges that may increase their young child’s risk of developing social-emotional or mental health problems. This includes home visitors and early intervention professionals supporting the parent-child relationship, parenting groups, and IECMH consultation for early care and education professionals. Early childhood professionals can also be supported in their work with families of young children through ongoing reflective supervision/consultation (RS/C). 

• Treatment services that address the parent-child dyadic relationship, when their interactions are determined to have a negative effect on the mental health of the young child (e.g. abuse and neglect, parental mental health, domestic violence, etc.) that are provided by clinical mental health professionals who utilize evidence-based dyadic clinical treatments. 

What a Comprehensive IECMH System Requires 

To build a coherent statewide IECMH system, states must move beyond isolated programs and services and instead build effective IECMH infrastructure systems in which governance, data, funding, professional development, and aligned policies – work together to promote high‑quality and equitable statewide IECMH services and supports.  States are at various stages of building comprehensive IECMH systems. Forty-five states have participated in ZERO TO THREE’s IECMH Financing Policy Project (FPP), which has supported cohorts of state teams each year since 2016. Building a comprehensive state IECMH system includes: 

1. Establishing IECMH Governance

A statewide IECMH system requires governance structures that enable the state to set and align programming and policy around a clear vision, provide accountability, and facilitate coordination across programs, agencies, and funding streams. Addressing statewide governance for IECMH is key for building a statewide IECMH system. State approaches to enhancing IECMH governance may include: 

• Designating a lead agency,  
• Funding a full‑time IECMH policy position, and  
• Establishing an ongoing cross‑sector IECMH advisory body. 

Alabama, Georgia, and Washington, all of which have made significant progress in building comprehensive IECMH systems, illustrate the variety of governance models that can support effective IECMH system governance. 

2. Data That Drives Decisions

States should use available data from early childhood programs, Medicaid, child welfare, and existing IECMH services, as well as population demographics, to understand needs, identify gaps, and plan for equitable access. Washington State Health Care Authority , for example, uses a range of data and qualitative focus group data from a statewide listening tour to support planning and outcomes reporting. https://www.hca.wa.gov/assets/program/iechm-statewide-tour-report-2024.pdf 

3. Sustainable Funding

States should map current funding sources utilized and examine how to maximize federal, state and philanthropic funding sources to expand IECMH services and infrastructure supports,  including: 

• Medicaid – In February 2026 the Centers for Medicare and Medicaid Services (CMS) released the State Medicaid & CHIP Toolkit for Children’s Behavioral Health Services and the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Requirements, which includes strategies to cover IECMH services and encourages states to allow behavioral health services to be provided without a formal behavioral health diagnosis. 

• State legislative appropriations – to fund IECMH system infrastructure and supports and fund services across the IECMH promotion, preventive-intervention and dyadic treatment continuum. 

• Private insurance – to cover dyadic treatment through working with their state insurance agency to examine potential coverage of IECMH services as an “Essential Health Benefit” under the Affordable Health Act (ACA). 

• Federal early childhood program funding – Some early childhood programs utilize a preventive-intervention approach to support healthy social-emotional development and strong parent-child relationships, including early intervention (Part C); home visiting; and Head Start/Early Head Start. 

• Federal grants – such as the Preschool Development Grant – Birth to Five (PDG B-5), that, similarly to a philanthropic funding, can be utilized to fund time limited infrastructure / systems projects. 

• Philanthropic funding – for short term funding of system projects including assessments of the current IECMH systems infrastructure (including funding), strategic planning, convening of key partners, as well as professional development and public awareness campaigns. 

4. A Trained and Supported Workforce  

State IECMH systems must develop higher education and professional development opportunities to support the capacity of early childhood and mental health professionals and sustain an adequate statewide workforce. States can strengthen workforce capacity by: 

• Promoting Endorsement – developing policy or guidance that either encourages or requires IECMH endorsement from the state Associations for IMH (AIMH). Endorsement creates shared statewide standards and framework for IECMH competencies and supports the capacity of early childhood and mental health professionals. The Alliance for the Advancement of Infant Mental Health Pathways for Endorsement table includes the education, work experience, training, reflective supervision, and other requirements at the different levels of endorsement. 

• Developing Training on trauma informed care / adverse childhood experiences (ACEs) – training widely across programs about the impact of early childhood trauma / adverse childhood experiences (ACEs) and how organizations can implement a trauma informed approach.  

• Promoting Diagnostic Classification (DC:0-3) training through ZERO TO THREE at the general and clinical levels to promote understanding and capacity to make mental health diagnosis for infants and young children and their families. 

• Providing Dyadic Therapy training and certification for mental health clinicians in Evidenced Based therapies and promising practices.   

5. Policies That Align Systems 

Practices that support integrated IECMH systems, such as screening, referral, professional qualification, staff training, and adoption of evidence-based practices, can be incorporated into policies and program standards across early care and education programs, Medicaid, and child welfare. 

6. Communication That Builds Public and Professional Awareness 

States should develop a communications and public awareness strategy that includes:  

• A unified campaign to promote IECMH through print media (articles, posters, developmental materials), electronic media (websites, blogs), and social media targeted to families, early childhood and mental health professionals, other professionals working with young children and their families, and the general public. 

• Communication to mental health and early childhood professionals regarding professional development and endorsement opportunities. 

• Providing information broadly on the impact of trauma, ACEs, and the importance of early relational health and social-emotional development and when, how, and where to make referrals. 

Steps States Can Use to Build a Strong IECMH System

While each state highlighted here took a different pathway to building a statewide IECMH system, commonalities in their experience suggest some key steps that states can use to build a coherent statewide IECMH system: 

1. Convene a Statewide IECMH Taskforce / Workgroup 

Bring together parents, providers, state agencies, the state AIMH, legislators, advocacy, and philanthropic organizations to analyze data, inform strategic direction and priorities, and advise on policy development. 

2. Conduct a Statewide Needs Assessment

Map current IECMH services, funding, workforce capacity, training, and communication efforts to assess the strengths and resources that the state can build upon, as well as challenges and gaps to be addressed. A statewide IECMH systems review should include: 

• Analyzing currently available quantitative data. 

• Collecting data through surveys, interviews and focus groups. 

• Reviewing documents – reports, policies, statutes. 

• Developing a report that synthesizes the data and information gathered and that identifies gaps and strengths. 

3. Engage in Strategic Planning  

Use the findings to set a shared vision, establish SMART goals, and develop actionable strategies with timelines, responsibilities, and performance indicators. 

Building Comprehensive, Sustainable IECMH Systems – A Call to Action for States 

To truly support early relational health and improve mental health outcomes for young children, states must build coordinated, adequately funded, and sustainable IECMH systems that span promotion, preventive-intervention, and treatment, with IECMHC as one important component of that system. 

Through strategic and comprehensive approaches to IECMH governance, data, funding, workforce development, policy alignment, and communication, states can create systems that support families and the workforce to promote healthy social-emotional development and mental health for every infant and young child through strong, nurturing relationships.