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Issue Brief 63 - Infant and Early Childhood Mental Health: Building a Statewide System of Professional Endorsement®

September 13, 2018issue brief banner.png

Infant and Early Childhood Mental Health

Building a Statewide System of Professional Endorsement®


Professionals who care for young children play an important role in promoting social-emotional development, positive mental health, and relational health, as well as identifying problems early and connecting young children to intervention and treatment services when necessary. Unfortunately, most pre-professional education and training programs lack specific courses or modules related to infant and toddler mental health, and many professionals lack the critical skills needed to work with very young children. Many states, including Connecticut, are taking steps to ensure that professionals working with infants, toddlers, and their families are well-trained to promote optimal mental health, promote preventive strategies, and facilitate linkage to early intervention or treatment.

Attention to the Mental Health of Young Children is Critical for their Healthy Development

Infant and early childhood mental health is defined by the Zero to Three Infant Mental Health Task Force Steering Committee as a young child’s capacity to regulate and express emotions, form close and secure relationships, safely explore their environment, and learn. Young children develop these capabilities within the context of their family, environment, community, and culture, as well as through relationships with their primary caregivers. Infants and toddlers who develop healthy and strong social and emotional competency are better prepared for school and have healthier and more prosperous lifelong outcomes.

Professional Endorsement® for Infant and Early Childhood Mental Health Ensures a Skilled Workforce

The Connecticut Association for Infant Mental Health (CT-AIMH) is a statewide non-profit professional organization dedicated to advancing the infant and early childhood workforce by ensuring professionals are trained in the most current scientific advances in child development, infant mental health principles, and relationship-based practices. In 2010, CT-AIMH, with support from the Children’s Fund of Connecticut (CHDI’s parent organization), the Connecticut Head Start State Collaborative Office, and others, purchased the license from the Michigan Association of Infant Mental Health to provide the Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health®. Also holding the Endorsement® license are 28 other state IMH associations, Western Australia, and Ireland that together are members of the Alliance for the Advancement of Infant Mental Health (Alliance).

Since obtaining the license in 2010, CT-AIMH has built a statewide competency system known as the CT-AIMH Endorsement®.The system provides professional development through training and education programs with a goal of building a more skilled workforce. Becoming endorsed demonstrates that an individual has completed specialized education, related work, in-service training, and reflective supervision/consultation experiences that have led to competency in the promotion and/or practice of infant or early childhood mental health. The credential does not replace licensure or certification, but is meant as evidence of a specialization in the promotion and practice of infant mental health within each professional field, such as child development, early care and education, pediatrics, psychiatry, psychology, social work, and others. To date, 56 professionals in Connecticut are endorsed in Infant Mental Health through this system.

Expanding Endorsement® from Infancy to Early Childhood Will Improve Connecticut’s Workforce

In 2017, recognizing that there are also many professionals working with children ages 3 to 6, the Alliance, with help and guidance from a national workgroup, developed an early childhood mental health endorsement for those who work with older children. The Competency Guidelines® were retitled to reflect the extension of the program to professionals who work with children prenatal to 6 years old and their families, and is now called the Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant and Early Childhood Mental Health®.

CT-AIMH is now conducting a pilot project to endorse professionals who work with children ages 3 to 6 and whose work will benefit from extended training in infant and early childhood mental health principles. To date, three providers have earned their Early Childhood Mental Health Endorsement®, and three others are in process. CT-AIMH plans to revise deployment of the endorsement program based on lessons learned during the pilot and offer the Early Childhood Mental Health Endorsement to professionals in 2019.

Additional Support will Advance Professional CT-AIMH Endorsement® in Connecticut

Connecticut agencies and stakeholders have taken several steps to build a more competent infant and early childhood workforce. Examples include: increasing support for reflective supervision/consultation groups in Birth to Three and home visiting programs; committing to having at least one endorsed infant mental health professional on staff for every Birth to Three operated program; and providing a bi-annual infant mental health training series for child welfare and Head Start staff through a partnership with Head Start, the Department of Children and Families, and CT-AIMH. While these measures are expanding the capacity of the early childhood workforce in Connecticut to address the socio-emotional needs of young children, additional actions can advance and sustain a statewide system of professionals who are endorsed and credentialed in infant and early childhood mental health. 

Recommendations for Connecticut include:

  • Increase public funding to support endorsement activities, including funding for:
    • infant and early childhood mental health training;
    • release time for staff to attend training;
    • reflective supervision/consultation;
    • deployment of a university-level, cross-discipline, Faculty Infant Mental Health Training Institute, with accompanying materials.
  • Ensure that all State and/or public agencies serving the most vulnerable children and their families have infant/early childhood mental health endorsed staff in every region.
  • Follow Michigan’s practice requiring Endorsement® in infant and early childhood mental health for practitioners who bill Medicaid for mental health services provided to infants and toddlers. Additionally, Medicaid and commercial insurers should pay for infant and early childhood mental health services delivered to young children birth to 6 years who show signs of risk (without a diagnosis) if delivered by a professional holding the Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant and Early Childhood Mental Health®. 
  •  Require state institutions of higher education to include infant and early childhood mental health competencies in their infant, young child, and family related courses (e.g., nursing, social work, education, psychology) and/or supportan Endorsement® requirement to develop a pipeline of professionals who can pursue endorsement within their careers. Use the Faculty Infant Mental Health Training Institute to help faculty across disciplines to incorporate infant mental health into existing courses.

This Issue Brief was prepared by Abby Alter, Senior Associate for Early Childhood Initiatives at Child Health and Development Institute, and Heidi Maderia, Executive Director of the Connecticut Association for Infant Mental Health. To learn more about Endorsement®, please visit To learn more about the infant mental health workforce, read "The Infant Mental Health Workforce: Key to Promoting the Healthy Social and Emotional Development of Children," or contact Abby (Email:; Phone: 860-679-8788).