Healthy Futures: Early Childhood Mental Health Consultation Program

Underdeveloped social-emotional skills and untreated behavioral health challenges can lead children to display disruptive behaviors. As a result, children may have trouble making friends, learning new skills, or may even be expelled from their early learning program. Supporting children that demonstrate these behaviors can be difficult for teachers, especially without adequate support and resources. This can result in teachers experiencing high rates of burnout, and lead to turnover that can be detrimental to early learning programs.

Through Healthy Futures, mental health professionals can provide support to early learning providers. Providers then work with families to address a child’s social and emotional development needs or mental health concerns. In some cases, behavioral health consultants may also work directly with a child and their family and connect them to community-based services through direct referrals.

Children who develop healthy social-emotional skills early on are more likely to have better long-term outcomes as adults. Healthy Futures provides educators with tools for positive social-emotional development in early childhood that enables children to:

• Play and get along with their peers and adults
• Manage stress and overcome challenges
• Learn positive decision-making skills
• Be prepared for school

Healthy Futures helps improve classroom climate, enhances teacher-classroom management skills, reduces child behavioral challenges, and lowers expulsion rates. In fact, in FY22, zero of the 7,571 children served in child development facilities participating in Healthy Futures were expelled. Across the country, over 8,700 three- and four-year-old children are expelled from state-funded preschool and early education classrooms annually. A 2016 report found that exclusionary disciplinary actions, typically suspension or expulsion (which remove a child from their education setting), disproportionately impact children of color and create a racial achievement gap in academic performance as this type of discipline severely restricts opportunities for children to learn and grow in an educational setting. A child suspended or expelled in the early years of their education is more likely to be suspended or expelled again, drop out of high school, fail a grade, or even be incarcerated later in life.

In one evaluation of the program, early learning program directors reported that teachers were more aware of children’s behavioral challenges before they escalated, which allowed them to intervene early and appropriately. Healthy Futures sites have also reported improved child behavior and interactions (children played together better, followed directions more, and were less distracted). Early learning program directors have reported significant improvements in teacher-child interactions and reductions in negative staff behaviors, such as shouting at children.

Healthy Futures is administered by the DC Department of Behavioral Health (DBH). It pairs early childhood mental health consultants with early learning facilities across the District that participate in the child care subsidy program. A majority of sites currently working with Healthy Futures are located in wards 4, 7, and 8. Most sites that participate in the program are traditional child development centers and serve children ages 0 to 5. However, other early learning programs, such as home-based providers, pre-kindergarten spaces, and the District’s Quality Improvement Network (QIN) participate as well.

In FY22, 102 sites participated in Healthy Futures, including 85 child development centers and 17 home-based providers. Healthy Futures specialists provided 65 parent workshops, 384 parent consultations, and 1,354 director consultations. Centers referred 132 children to Healthy Futures for child-specific support and 116 of those families opted in to individual observations and interventions.

The Birth-to-Three for All DC Law requires DBH to expand Healthy Futures to child development centers and home providers that would benefit from the program. DBH has decided to prioritize the expansion to child care facilities that participate in the subsidy program, ensuring that children with the fewest resources have access to Healthy Futures services.

As of FY 2023, Healthy Futures is funded at $4.5 million, including $480,000 of one-time funds that expire at the end of the fiscal year. This funding enables the Department of Behavioral Health to employ early childhood mental health consultants, program supervisors, and administrative program staff. The District’s Office of the Chief Financial Officer (OCFO) estimates that it costs $20,000 per early learning facility to provide a year of mental health consultations. This cost includes consultant and supervisor salaries, travel and office expenses, and program administration.

Fully funding and maintaining Healthy Futures at all eligible early learning facilities will require a recurring annual budget of at least $7 million. It is important for the District to continue to maintain the availability of the Healthy Futures program, as tending to the mental health of families and educators is vital for the well-being of our community. Healthy Futures is undergoing an evaluation by Georgetown University Center for Child and Human Development on the implementation and effectiveness of the program. Evaluating the program will help to assess future investments in Healthy Futures that would allow the program to further deepen, expand, and evaluate its services. It is critical that DC leaders prioritize maintaining all funding of Healthy Futures in the upcoming budget cycle.