In 2019 and in partnership with the North Carolina Early Childhood Foundation, NC Child launched EarlyWell, an initiative designed to understand and improve the landscape surrounding infant and child mental health in North Carolina. Over the past three years, the EarlyWell team has worked to convene families, caregivers, and grassroots and grass tops leaders across the state to unearth challenges and opportunities to enrich our state’s child mental health ecosystem. On October 5th, EarlyWell unveiled the first wave of policy priorities that the initiative’s growing coalition will work to advance over the next two years.
I sat down with our EarlyWell director, Morgan Forrester Ray, to talk a little more about where EarlyWell has been and what the next phase of the initiative’s work looks like.
Q: How did EarlyWell come about?
Morgan: I think the field of children’s mental health has come a long way in the past 10 years, and as a state, I think we’ve been really good about expanding our knowledge and understanding of that landscape. There was this huge body of work for several years called the Pathways to Grade Level Reading, and it really focused on what a child needs to be at grade level reading by third grade. One of the big things this work found was the importance of early relational health and mental health had on a child’s ability to read at grade level. So, in 2019, we really zeroed in on the mental health component and through a partnership with the North Carolina Early Childhood Foundation and through funding from The Duke Endowment, we launched the EarlyWell Initiative.
Q: What are some misconceptions people tend to have about infant and early childhood mental health?
Morgan: I think the biggest misconception people have about child mental health is that they think it doesn’t exist. A lot of times when people think about mental health, the image that comes to mind is laying on a therapist’s couch and talking about their challenges, and it’s hard to reconcile that image with what child mental health actually looks like. When we talk about child mental health, we’re not talking about going to a therapist’s office, we’re talking about behavioral challenges like bedwetting, sleep regression, and attachment issues. We know that infants and toddlers don’t exist in a vacuum, and their mental health does have a link to the health of their caregivers—so child mental health isn’t singularly focused on a child, it’s also focused on supporting the adults in their lives.
Q: Who did EarlyWell engage with throughout this process? Why was it important to engage these different groups?
Morgan: From the start, EarlyWell was really focused on bringing together people from all levels of the child mental health ecosystem. We engaged system leaders, and people and organizations who had been working on this issue at a high level for years. We also engaged government partners and other champions of child mental health at the statewide level. We never wanted to close ourselves off to anyone who cared about this issue, so we were really diligent in making sure there was an open door. Most importantly, I think, is that we engaged families and family-serving organizations directly. There was no way we could’ve gained any insight or speak with any credibility on child mental health without centering family voices.
Q: Can you tell me a little more about why centering family voices was so crucial to this project?
Morgan: As a coalition, and as folks who have opportunities to make changes, we knew we needed to make sure that families and caregivers had a voice and were listened to in the process because we must make changes that make sense for them. Additionally, there’s such a strong link between children’s mental health and the mental health of the adults in their lives, and if we didn’t hear from adults about how they influence and are influenced by the mental health ecosystem, we would’ve had a really narrow perspective. Consider, too, that a lot of EarlyWell’s work happened during the pandemic, and by centering parents and caregivers, we were able to learn so much more about how the pandemic was affecting children and how those shockwaves would continue to affect children and adults.
Q: EarlyWell just hosted a retreat where it unveiled the first wave of policy priorities to a group of 100 community stakeholders. What are some of your takeaways from this event?
Morgan: I think the first four years of EarlyWell’s work felt more like a think tank. We were fact finding, information sharing, and really planning and developing a set of recommendations that will transform infant and child mental health. At the launch event, I think we really pivoted and felt more like a coalition. We’re all in this together and we can start to move these policies forward. There’s a lot of enthusiasm around this work, and I think my biggest takeaway from the event is that all the energy is coming from people who are passionate about this work and are ready to seize the moment and create real change for children and families in North Carolina. We built these relationships, we can lean on each other, and now we’re rolling up our sleeves to get it done.
Q: If someone hasn’t been involved in EarlyWell before, are they able to get involved now? And if so, what does that involvement look like?
Morgan: We have six policy priorities we’re focusing on through 2025, and that means there’s a lot of ground to cover—so if someone feels really passionate about child mental health, we’d love to welcome them to our coalition. What I really want to highlight here is that anyone can get involved in EarlyWell, no matter their level of experience. For example: If you’ve never considered yourself an advocate but you feel passionately about expanding access to doula and group prenatal care or strengthening the child mental health workforce, there’s a place for you in EarlyWell, and you can engage with the work on a level you feel comfortable with.
If you are interested in learning more about EarlyWell or getting involved, you can read about our policy priorities on the EarlyWell page of our website and you can join the EarlyWell listserv for updates on the coalition and opportunities to get involved. For additional information, please contact NC Child Health Policy Manager Hannah Preston at hannah@ncchild.org.