The Impact of California's Mental Health Service Provider Shortage: Inequitable Access to Infant and Early Childhood Mental Health Services

Brief

The first five years of life mark a critical time for early childhood development. Early experiences and relationships with caregivers shape the architecture of a developing brain and lay the foundation for mental health across an individual’s life. Despite the importance of mental health in the early years, the mental and behavioral health needs of infants, toddlers, and young children are often overlooked. Only in recent years has California and our state leaders started to acknowledge that very young children can suffer from mental health concerns, that their wellness is dependent on their caregivers’ wellness, and looked for ways to treat mental health concerns in the first years of life.

As California has started to more prominently acknowledge infant and early childhood mental health (IECMH) it has also made significant strides in increasing investments and launching initiatives in mental health for children. However, many of these investments are focused on older children. Furthermore, recent changes in mental and behavioral health funding through Proposition 1 and the Mental Health Services Act may soon impact the availability of community-based prevention and early intervention services for young children. The state must do more to ensure we meet the mental health needs of California’s youngest.

An important component of improving access to mental health services for young children is addressing the mental health provider workforce shortage impacting the nation and our state. This shortage is particularly acute for providers serving specific sub-populations of California children, such as children in Medi-Cal, infant and toddlers, and for providers that are cultural and linguistically relevant for the diverse population of children in the state. These challenges exacerbate existing health disparities, putting our most vulnerable children at an even greater disadvantage.

To address these challenges and prioritize the mental health needs of infants, toddlers, and young children, this brief poses several key recommendations for state leaders:

1. Embed basic training of IECMH for all individuals who have contact with children, such as early care providers and community health workers, through grants to employers and educational institutions.
2. Collect more robust data on IECMH providers across the state to more accurately assess the shortage of licensed and non-licensed IECMH providers.
3. Increase Medi-Cal reimbursement rates for all IECMH providers, especially for non-licensed community-based supports such as community health workers.
4. Expand investments in IECMH to increase the ways Medi-Cal members with toddlers and young children can access IECMH services, including but not limited to creating new Medi-Cal benefits focused on IECMH providers and developing new grants programs focused solely on the prenatal to five population.
5. Proactively invest in mental health programs specifically for the birth to 5 population and the providers who serve them.

These recommendations aim to address the critical shortage of IECMH providers, improve access to mental health services for families with young children, and reduce the inequitable impacts of the current system. The success of California’s mental health investments for infants and young children rests on having a culturally relevant workforce who can meet this population’s needs. By investing in the IECMH workforce and prioritizing the mental health needs of infants and young children, California can take significant steps towards building a more equitable and supportive mental health system that sets kids up for success during their most vulnerable time.