PERSPECTIVE: A Needed Credential to Advance Infant and Early Childhood Mental Health

by Abby Alter and Heidi Maderia 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 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.

A System of Professional Endorsement is Improving Connecticut’s Workforce

The Connecticut Association for Infant Mental Health (CT-AIMH) purchased a license in 2010 from the Michigan Association of Infant Mental Health to provide the Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health®. The license was purchased with support from the Children’s Fund of Connecticut, the Connecticut Head Start State Collaborative Office, and others. Since obtaining the license, CT-AIMH has built a statewide competency system known as the CT-AIMH Endorsement® for providers caring for children up to age 3. The system provides professional development through training and education programs with a goal of building a more skilled workforce.  In 2017, with help and guidance from a national workgroup, the endorsement system was expanded to include professionals working with children from 3 to age 6.

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 and/or early childhood 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, and three providers have earned the Early Childhood Mental Health Endorsement® (currently in its pilot phase). CT-AIMH plans to revise the endorsement program based on lessons learned during this pilot, and offer the Early Childhood Mental Health Endorsement® to professionals in 2019.

Additional Measures to Build a More Competent Infant and Early Childhood Workforce

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 social and emotional needs of young children, more can and should be done. 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.
  • 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 support an 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.

These additional actions can advance and sustain a statewide system of professionals who are endorsed and credentialed in infant and early childhood mental health. In that way, we can best promote optimal mental health and preventive strategies, and facilitate, as needed, early intervention or treatment.


Abby Alter is Senior Associate for Early Childhood Initiatives at the Child Health and Development Institute, and Heidi Maderia is Executive Director of the Connecticut Association for Infant Mental Health. To learn more, visit or read "The Infant Mental Health Workforce: Key to Promoting the Healthy Social and Emotional Development of Children."  This article was adapted from an Issue Brief developed for Child Health and Development Institute of Connecticut, Inc, a catalyst for improving the health, mental health and early care systems for children in Connecticut.