Infant and early childhood mental health consultation (IECMHC) is a service used in child care and early education—and in other naturalistic settings such as home visiting, early intervention, and primary care—to promote healthy social-emotional development for children. Mental health consultants help early educators promote social-emotional development and prevent (or reduce) challenging behaviors. IECMHC is one of several strategies in a continuum of mental health supports available to child care and early education, including program-wide social-emotional training models (e.g., Pyramid Model), developmental screening for social-emotional skills, and referral to mental health treatment services.
IECMHC is recognized by the Association of Maternal and Child Health Programs (AMCHP) as a national best practice, associated with positive outcomes when implemented to fidelity with core components of effective IECMHC (e.g., qualified consultants who prioritize consultative relationships, apply evidence-informed strategies, and define program structure, design, and activities). These positive outcomes have been found across multiple levels, including:
- Children—e.g., increased social-emotional skills, reduced behavioral concerns and suspensions/expulsions
- Professionals—e.g., enhanced knowledge and skills to address challenging behaviors and promote social-emotional development, improved child-professional relationship quality
- Programs—e.g., improved climate, adoption of program-wide mental health promotion practices
- Families—e.g., access to mental health supports, improved communication with child care and early education professionals
Despite its promise and increasing implementation in states, IECMHC is not adequately being adapted, implemented, and tested in home-based child care (HBCC) settings (see box). Most research and evaluation studies of IECMHC focus on center-based or combined center/home-based samples and rarely evaluate models specifically for HBCC. HBCC is the largest nonparental care arrangement in the United States, serving over 12 million children—especially very young children, rural families, and families with low incomes. Despite their prevalence and critical role in child care, unlisted HBCC providers are typically ineligible for state or local IECMHC funds.
Home-based child care (HBCC) vs family, friend, and neighbor care (FFN)
Home-based child care (HBCC) is an umbrella term that includes both individuals who are listed and those who are unlisted through state or other regulated systems. Listed providers are paid directly by families or through subsidies and can be licensed, certified, or registered with a state. Unlisted providers are typically not known to state and local systems and can be paid or unpaid. Family, friend, and neighbor (FFN) care is another form of home-based care; these individuals are typically exempt from licensing and regulations and can be paid or unpaid.
Below, we outline five key considerations for an HBCC-specific mental health consultation framework.[1] We hope this work contributes to a small but growing call to action for tailored mental health supports for HBCC.
- States should expand funding for, and conduct outreach to, all types of HBCC programs—including FFN, who are often ineligible for state- or locally funded mental health consultation. Although most states offer some form of IECMHC to early educators, the funding is braided and blended and typically restricted to licensed programs. Several states are pursuing legislated funding or other funding strategies to support IECMHC expansion. Even when HBCCs are eligible to receive state IECMHC services, they are less often connected to consultation services than center-based programs, instead relying primarily on one-time or short-term trainings or workshops. Potential challenges to HBCC educators engaging in mental health consultations include lack of awareness of program availability, eligibility restrictions, waitlists for services, or poor fit with program needs.
- Mental health consultation frameworks should be specified for HBCC-specific adaptations and consultants should receive specific training and gain field experience delivering services to home-based programs. For example, HBCC programs often serve mixed age groups, from infancy to middle childhood. Mental health consultation for HBCC must expand existing IECMHC approaches to include strategies for older children attending before- and after-school care or summer care, along with strategies for implementing mental health and behavior intervention practices in mixed-age instructional settings. HBCC programs are also more likely than center-based programs to serve infants and toddlers, which requires specialized consultant expertise for social-emotional development promotion. Consultants should be trained in child development from infancy through middle childhood and have experience delivering consultation for a wide age range of children in mixed-age settings.
- Mental health consultation frameworks should incorporate HBCC educators’ preference for informal, trusted networks and flexible, individualized mental health consultation approaches that prioritize relationships. FFN educators rely heavily on word-of-mouth networks when deciding whether to engage in services and may mistrust formal systems, including mental health consultation. In our outreach to two HBCC advisory groups, leaders shared that HBCC has a strong relationship focus in service delivery and would like to see a similar approach used for mental health consultation. This feedback aligned with findings from the FFN study, where FFN educators recommended a flexible, informal approach to mental health consultation where educators build consistent relationships with consultants, rather than a consultative approach that is prescriptive or feels investigative. States should partner locally with trusted sources of information such as family child care networks or peer leaders when conducting mental health consultation outreach and enrollment.
- Mental health consultation models for HBCC must explicitly focus on educator well-being and acknowledge the unique aspects of a home-based work environment, in addition to child and family well-being. Recent results from national survey data (the RAPID survey) show that half of early educators experience high levels of anxiety and depression. HBCC educators may be particularly vulnerable to stress and social isolation; research suggests they often work alone for long hours, may lack consistent opportunities to connect with other adults throughout the day, and report high financial burden.
- To increase knowledge about effective mental health consultation in HBCC settings, federal, state, and foundation funders should invest in HBCC-specific research and incorporate funding for evaluation into appropriated and grant funding opportunities. Despite high demand for mental health supports and the high prevalence of HBCC in the United States, there is little literature or documented evaluation of mental health consultation adaptation, acceptance, and outcomes in HBCC, and our literature scan and expert outreach turned up only a handful of published studies and reports. When HBCC educators are included in IECMHC research, they are rarely examined separately from center-based educators or programs.
Home-based child care is a common and preferred care arrangement for millions of children and families in the United States. Mental health consultation is an effective service for promoting healthy social-emotional development and reducing behavioral challenges in child care settings, but the field lacks an articulated framework for mental health consultation in HBCC and many HBCC programs are ineligible for funded mental health consultation services. Supporting HBCC through tailored mental health consultation services is an important strategy for promoting positive behavior, social-emotional skills, and educator well-being. States and funders should work to advance HBCC-focused mental health consultation approaches and expand eligibility and outreach to all HBCC.
Child Trends provides strategic planning, consultation, and research and evaluation services to home-based child care programs and local/state organizations and governments. If your program or organization is interested in partnering with Child Trends, contact Rebecca Vivrette at rvivrette@childtrends.org. We would like to thank the experts who provided additional published resources and evaluation reports to inform this brief, as well as the workgroup of HBCC leaders at Home Grown and the National Center on Early Childhood Quality Assurance (NCECQA) who provided important feedback and insights into the development of the considerations outlined in this brief.
Footnote
[1] These considerations were developed through a brief literature scan on mental health consultation in HBCC. Given the lack of available published studies and frameworks, we also include research reports obtained via outreach to experts in the field. Lastly, we conducted an informal group interview with an advisory group of HBCC educators to obtain additional insight and context for developing these considerations. These considerations are not intended to be exhaustive, but to reflect the most consistent points identified in the literature, reports, and interviews; we hope to use these learnings to continue the conversation on expanding mental health supports for HBCC in the United States.
Suggested citation
Vivrette, R. (2026). Five considerations for developing a mental health consultation framework for home-based child care. Child Trends. DOI: 10.56417/8686i3314w