Wellness in Early Childhood

Mental health includes the development of the skills and abilities that help children succeed in both school and life, from self-control to building connections with others. For young children, supporting good mental health for a lifetime means supporting families.

Mental health skills are the building blocks for a bright future. When babies and toddlers experience nurturing, responsive relationships with their caregivers, they are more likely to grow into healthy children and adults. Supportive, resilient communities provide the context for these healthy relationships. Evidence shows that children are more likely to be ready for school, experience academic success, higher graduation rates, and enter the professional world as adults with strong capacities for life-long learning and relating to others. These children grow into the leaders of a resilient and thriving North Carolina.

Adverse childhood experiences (ACEs) such as persistent poverty, abuse and neglect, parental substance abuse, and maternal depression can create toxic stress for children. Extensive neuroscience research demonstrates that toxic stress can damage children’s brain architecture and increase the likelihood that significant mental health problems will emerge during childhood (Center on the Developing Child, Harvard University).

In North Carolina, too many of our youngest children are experiencing significant adversity:

• Young children are the members of our community most likely to be living in poverty. Nearly half of children 0-5 (49 percent) live in poor or near-poor families. For children of color, these numbers are worse: with 75 percent of Latinx children 0-5, and 67 percent of African American children 0-5 are living in low-income homes, compared to 40 percent of white children 0-5.
• The opioid epidemic is hitting our communities hard. Three North Carolinians die from opioid overdose each day – many leaving children behind. As a result, increasing numbers of young children are entering and lingering in foster care without permanent connections to caregivers and family.
• Young children experience high rates of family violence, such as child abuse and domestic violence. In 2019, more than 22,000 children 0-5 were investigated by Child Protective Services for maltreatment.

The impact of these adverse experiences on children’s short- and long-term mental health is clear:

• An estimated 91,000 children ages 0-5 have mental health problems so severe they have trouble functioning.
• One in five North Carolina students will report a mental health disorder in any given year.
• The number of young people who die by suicide in North Carolina has doubled since the beginning of the decade. Fifty-six young people died by suicide in 2020 in North Carolina. Suicide is the second leading cause of death for young people ages 10-17 in our state.

EarlyWell was launched in the Fall of 2019 as the NC Initiative on Young Children’s Social Emotional Health. EarlyWell’s goals are to develop and implement:

• A comprehensive, shared vision of an Infant and Early Childhood Mental Health system in North Carolina. A shared understanding of how the Infant and Early Childhood Mental Health System connects with and is supported by Medicaid’s standard and tailored plans.
• A set of shared metrics to define and measure our state’s progress in improving young children’s mental health outcomes and in building the systems to serve them
• A set of strategies defined in a four-year Infant and Early Childhood Mental Health Action Plan which includes policy change, funding changes, practice changes, collaboration development, and other steps needed to improve measurable outcomes.
• A working body of decision-makers and experts who will provide leadership for the Initiative. This group will oversee implementation of the Action Plan. It includes health providers, state agencies, managed care companies, LME-MCOs, researchers, policy makers, and advocates who are working on various efforts to promote young children’s mental health.

The work will be implemented with the following guiding principles:

• Build on the excellent planning work already completed in multiple state initiatives, including:
  • The NC Institute of Medicine Task Force on Infant and Early Childhood Mental Health (IECMH);
  • Pathways to Grade-Level Reading Framework;
  • The Zero to Three NC Workgroup’s Recommendations for IECMH;
• Focus on racial and ethnic equity. While all children face challenges in reaching their full potential, children of color bear a heavier burden with regard to family stressors and toxic stress. Racism, poverty, unrecognized trauma, and violence are more likely to affect the relationships children of color have with their caregivers and their communities. A focus on equity is essential to making any measurable improvement in young children’s mental health outcomes in North Carolina.
• Advocate for change. Plans are necessary but insufficient in and of themselves to create real systems change in and of themselves. We will advocate for the legislative support, administrative support, provider support, and family support needed to ensure that the policy and program changes in the Action Plan actually take place.