Risk, Reach, and Resources

Today’s research and literature have established the importance of Early Childhood Mental Health (ECMH) to overall health outcomes, educational attainment, and other markers of well-being. Yet this is a relatively recent development.

Colorado, a forerunner in this field, has a long and successful track record of putting the science of ECMH into practice. The state is a known leader across the country for its innovative and collaborative efforts to support early social and emotional development. 

Colorado’s record includes long-standing public investments in ECMH consultation, public and private investments in integrated behavioral health, and success attracting federal dollars to community partnerships focused on ECMH.

Improving ECMH, however, presents a quandary for policy leaders, grant makers, and program directors. The quandary emerges because ECMH is a nascent field. As such, measuring our impact can be elusive. We have not developed, for example, a singular indicator that pinpoints which children might be most at risk. It’s hard to know what to measure and understand when we have made the necessary improvements in promotion, prevention, treatment, and outcomes.

We need to continue to build the foundations that will help us achieve better outcomes by understanding what’s at stake for parents and caregivers, young children, the ECMH workforce, and the policies and organizations that support this work. We need to build the capacity to quantify and qualify the entire ECMH system.

This report represents one of Colorado’s — and the nation’s — first attempts to do just that. It is the first significant step in the creation of a powerful and necessary tool to understand the impact of this field.

However, our findings reveal more questions than answers. How can we better identify the children and families in need of more support? Is there an appropriate number of touchpoints with the ECMH system for all children? What is the right mix of promotion, prevention, and intervention programs that offers equitable opportunities for healthy development? How will we know when we’ve made a sustainable impact? These are questions that remain unanswered.

Our report has limitations and constraints. The scope is limited to a dozen programs that exclusively focus on ECMH and not those with broader goals that might also include social-emotional supports. It is limited by what we can measure today. For example, we did not evaluate Colorado’s clinical behavioral health treatment services or investments from public or private insurance carriers. Data contributions from primary and pediatric care were unavailable in our analysis timeframe. Eventual inclusion of these data will strengthen this work and provide an even more nuanced approach to ECMH risk and reach. 

We also caution that the programs featured here should not be interpreted as an endorsement of them as more effective or valued than other programs. A team of experts identified these programs as having impact expressly on ECMH. They were also able to meet the rigorous data submission requirements established for the current analysis. 

We have assessed risk, reach, and resources across the state. The interpretation of our results will lead to discussion and debate. This discourse has the power to move the field forward.  

We also recognize that specific efforts captured in this report build on a foundation of work decades in the making by many sectors and partners in Colorado. A recent sample of contributions includes but is not limited to:

• 2015 ECMH Strategic Plan (from the Office of Early Childhood)
• LAUNCH Together (inspired by SAMHSA’s Project LAUNCH from a group of ECMH funders)
• The State Innovation Model’s inclusion of pediatric care (from the SIM Office)
• Children’s Hospital Colorado First 1000 Days Campaign
• And many other organizations, programs, and system-strengthening initiatives. 

This report is not only part of this foundation but is also part of a larger vision — that one day we will understand how ECMH impacts health, education and overall well-being; identify where there are gaps in our investments; and enable us to deliver services to all families in need.  

This vision has been nurtured by many in Colorado, and a few exemplary leaders stand out. Jordana Ash, at the Office of Early Childhood, is chief among those. The ECMH Finance Work Group members — including service providers, policy leaders, advocates, funders, and other experts — also have provided significant insight and support. It has been an honor for the Colorado Health Institute to guide this first report.

Years from today, when the next iteration of this report is broader and deeper, we will thank those who envisioned it in the first place. With the release of this report, we are excited to take the first step on that journey.