Early Actions for Long-Term Resilience: Pathways to Strong and Resilient Mental Health for Infants and Young Children

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Part 4 of Guidance for Advancing Action Along NC Pathways To Grade-Level Reading

Here is the fourth of our five-part Pathways to Grade-Level Reading Policy and Practice Action Toolkit to provide guidance for how policymakers, advocates, community non-profits, the business community, and other stakeholders can work together to move us closer to the goal of all North Carolina’s children reading on grade-level by third grade. This Toolkit also highlights organizations and initiatives across the state that are already taking action to move the needle forward. 

Explore Part 1, Part 2, and Part 3 of the Toolkit. Read on to preview the actions that are the focus of each Toolkit. 

The guidance in this fourth part of the toolkit prioritizes prevention by attending to infant and early childhood mental health. Pathways laid out the importance of young children’s social and emotional health and facilitated the development of what is currently known as the EarlyWell Initiative, which has focused on centering family voices and racial equity in the policy process. Their reports provide insight into what families need and want from North Carolina’s mental health ecosystem for babies and young children. 

Infant and early childhood mental health includes developing capacity of the child from birth to five years old to express the following competencies in the context of family, community, and culture:

  • Form close and secure adult and peer relationships;
  • Experience, manage, and express a full range of emotions; and
  • Explore the environment and learn.


These are skills that are built in the early years through relationships with nurturing, consistent, and responsive caregivers. This means that infant and child mental health requires attending to parents, particularly maternal mental health

Children who grow up with parents struggling with poor mental health are less likely to develop strong emotional and behavioral regulation, which has been associated with several adolescent and later life mental disorders such as depression, bipolar disorder, borderline personality disorder, and substance-abuse disorders.  

There is urgency to addressing infants’ and young children’s mental health because although people are capable of psychological recovery at any age, the CDC reports that among children exhibiting behavior challenges, more than 1 in 3 also had anxiety, and about 1 in 5 also had depression. Preventing and intervening early to identify the underlying cause are critical components of ensuring that treatable conditions don’t become life-long burdens. 

It is important that we broaden our understanding of preventive mental health interventions to include economic supports. The negative effects of poverty on children’s development can be alleviated by investing in public policies that either reduce poverty, or reduce the impacts of poverty. Such policies include addressing housing, food, health care, and safety, while facilitating education and professional training.  

Direct provision of infant and young child behavioral and mental health care is hampered by the scarcity of trained infant and early child mental health professionals. This is particularly true for rural communities. According to the UNC School of Medicine, in many rural North Carolina communities, there simply aren’t any pediatric mental health professionals, forcing families to drive hours away from home for their child to receive care from a provider outside of their community. In more than 68 of North Carolina’s counties, there is no child and adolescent psychiatrist available. The ARCh Project is a comprehensive statewide initiative that is directly addressing this barrier to care. 

The ARCh Project was launched in 2022 by North Carolina’s Center for Child & Family Health, in partnership with state agencies and nonprofit institutions, to build a robust workforce in the state focused on young children’s mental health. Over a five-year period, the project will:

  • Expand mental health consultation to pediatricians and early interventionists;
  • Support the development of a statewide childcare consultation model;
  • Increase equitable access to infant and early childhood mental health endorsement; and
  • Provide training and supervision to professionals across the state in a wide range of infant and early childhood mental health topics.

The ARCh Project aims to achieve these outcomes by connecting regions and places to spread resources, and connect the different sectors (including but not exclusive to childcare, pediatrics, treatment, and early intervention) to share and expand knowledge of infant and early childhood mental health.

Additional Policy Areas for Strong Early Childhoods

This toolkit highlights five policies to ensure that parents and their young children can be resilient and thrive, even in the face of adversity. These include:  

  • Address Barriers in Health Insurance Coverage of Infant & Early Childhood Mental Health Services to Ensure Adequate Benefits 
  • Create a Mental Health Professional Development System to Recruit and Retain Infant and Toddler Mental Health Clinicians 
  • Increase Professional Development in Mental Health Treatment for Pediatricians and Family Physicians
  • Integrate Mental Health Providers with Pediatric and Other Primary Care Practices
  • Expand the NC Child Treatment Program

What is Pathways for Grade-Level Reading?

The Pathways for Grade-Level Reading aims high and is driven by a bold vision:

All North Carolina children, regardless of race, ethnicity, or socioeconomic status, are reading on grade-level by the end of third grade, and all children with disabilities achieve expressive and receptive communication skills commensurate with their developmental ages, so that they have the greatest opportunity for life success. 

Toolkit Part 1 (access here) 

Toolkit Part 2 (access here)

Toolkit Part 3 (access here) 

Toolkit Part 4 (current toolkit)  

  • Address Barriers in Health Insurance Coverage of IECMH Services to Ensure Adequate Benefits
  • Create a Mental Health Professional Development System Focused on Infant and Toddler Clinicians 
  • Expand the NC Child Treatment Program
  • Increase Professional Development in MH Treatment for Pediatricians and Family Physicians 
  • Integrate Mental Health Providers with Pediatric and Other Primary Care Practices

Toolkit Part 5 (to be released April 2024) 

  • Use Data to Track Community Needs and Service Provision 
  • Screen Children and Families for Social Determinants of Health and Connect them to Appropriate Services
  • Expand Maternal Depression Screening and Treatment
  • Invest in Two-Generation Interventions
  • Include At-Risk Children in Early Intervention

Keep in Touch with NCECF and Support Our Work

Learn more about the Pathways Action Map and consider adding your work to the map! Share it with others in your network and community, whose work you think should be spotlighted. We want to utilize the Map as a resource to build awareness of innovation, make connections, and identify gaps and opportunities that can help guide policy making, advocacy, funding, and capacity building.

If you have any questions, or would like a guided tour of the Pathways Action Map, please contact us. We’d love to hear your ideas on how to continue to utilize this tool to support the success of all North Carolina children.

Please be sure to subscribe to our biweekly newsletter and consider making a donation today to continue a strong 2024 by helping us transform the lives of North Carolina families, from their earliest days, while also supporting a small growing, family-friendly team. 

The NC Early Childhood Foundation is driven by a bold – and achievable – vision: Each North Carolina child has a strong foundation for life-long health, education, and well-being supported by a comprehensive, equitable birth-to-eight ecosystem. We build understanding, lead collaboration, and advance policies to ensure each North Carolina child is on track for lifelong success by the end of third grade.