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Early Childhood Mental Health

Mental Wellness Begins at Zero

When we think about the phrase “mental health”, we don’t typically think about infants and young children.  Mental health, however, is a concept that applies to everyone.  Mental health refers to the way we think, feel, relate to others, handle stress, make decisions, manage emotions and view ourselves. Mental health problems can occur at any age, even in young children. It is important to remember that children process and respond to stressful situations differently than adults.  Children don’t always understand what they are feeling, and often communicate through their behavior.  What we may perceive as a behavior problem could actually be an indication of a trauma/stress reaction, or an underlying mental health concern such as anxiety or depression.

Early relationships, experiences and environments lay the foundation for mental health across the lifespan. Children who are raised in loving and nurturing environments with attentive and consistent caregivers are more likely to experience a lifetime of mental wellbeing than children who experience chronic stressors such as abuse, domestic violence, and substance abuse. When we experience stress, our bodies respond by releasing stress hormones. In large amounts, stress hormones can impact nerve cell growth. Frequent or prolonged exposure to chronic stress can negatively affect the developing brain and lead to difficulties with emotions, learning, behavior and health.

When young children experience stressful situations, having a healthy supportive relationship with a nurturing adult caregiver helps buffer the impact.  Other helpful strategies include consistent routines, nutritious food, adequate sleep, positive peer relationships, and healthy self-esteem.

Early Childhood Mental Health Development Initiatives

EC-PBIS pyramid

Early Childhood Positive Behavioral Interventions & Supports

What is Iowa EC-PBIS?

Early Childhood-Positive Behavioral Interventions and Supports (EC-PBIS), the Pyramid Model initiative in Iowa, offers early childhood programs a comprehensive, evidence-based approach to promoting social-emotional development and addressing challenging behaviors among young children. EC-PBIS creates nurturing environments for children equipped with supported staff trained to respond to challenging behaviors. This is all for the goal of fostering positive mental health at a young age. Learn more about the Pyramid Model here:

Key Element 1: Training

Explore training opportunities for child care providers and preschools. Trainings are offered in a sequential series to allow providers to gain an understanding on the importance of building relationships with children and families of young children. After training, participants will be able to describe and identify various strategies about environment design, structure transitions, rules, routines, and engaging activities.

To register for a training series your local Iowa Child Care Resource and Referral can provide support for child care providers. Your local Area Education Agency can provide training support for your local preschool program.

View Training Information

Key Elements 2 & 3: Coaching & Data-Based Decision Making

Child Care Centers and Preschools: Ready for a Program-Wide Approach?

Program-wide (cohort) implementation of the Pyramid Model refers to a systemic effort in which an early childhood program/organization enlists the guidance of a coach or leadership team. The program follows steps in implementing the virtues and values of the Pyramid Model across their organization. The coaching team, with representation from program administrators and practitioners, is focused on the ongoing process of supporting the implementation of the Pyramid Model and using data-based decision-making to guide implementation efforts and monitor outcomes. Program-wide implementation might also be called Program-Wide Positive Behavior Intervention and Support (PW-PBIS), Early Childhood Positive Behavior Intervention Support (EC-PBIS) or a Multi-Tiered System of Support (MTSS) to address social, emotional, and behavioral needs.
Programs that have implemented the Pyramid Model through a cohort implementation approach have experienced the following:

  • Reductions in child challenging behavior
  • Increases in children’s social skills
  • Increased satisfaction of program staff and families
  • Reduced turnover in the program
  • Increases in teachers competence and confidence in the support of children
  • Changes in classroom and program climate
  • Sustained implementation of the Pyramid Model

The program-wide implementation process involves four stages and is carefully structured using data-based decision making.

The goals of this stage are to identify the need for change, determine what set of practices are likely to meet that need, decide whether to move ahead with the implementation process, and if so, map out a plan for the work.

  • Programs express interest in doing program-wide adoption of Pyramid Model Practices
  • Program visits a demonstration site
  • Program surveys staff for program-wide implementation buy in 
  • Program engages in collaboration with External Coach
  • Program completes application process

Resources & Tools

The goal of this stage is to build system capacity that will support the implementation of the new practices at the selected sites. Building system capacity requires examining and strengthening the system components necessary to assure success.
Program Leadership Team (PLT) is formed and commits to responsibilities as outlined in Early Childhood Program Wide PBS Benchmarks of Quality (BoQ)

  • PLT attends Program Wide Implementation Leadership Training
  • PLT completes BoQ and action plan
  • PLT plans for time commitment for staff to attend Pyramid Model Practices Training
  • PLT engages in ongoing collaboration with External Coach

Resources & Tools

The goal of initial implementation is to put the new practices in place at selected sites. Site-level Program Leadership Teams (PLTs) guide the implementation process, review data, make decisions, and provide feedback to the SLT on successes and challenges.

  • Program staff participate in Pyramid Model Practices Module training
    • Development and implementation of Program-Wide expectations
  • Sites begin implementation of the evidence-based practices and data collection
  • PLT meet at least monthly with the program coach to:
    • Use the Program Benchmarks of Quality to guide their efforts
    • Use data for internal decision making
    • Share data with State Leadership Team
    • Set up data systems for measuring fidelity of practice by practitioners and child outcomes
    • Structure for ongoing collaboration with family, community, and stakeholders
  • Site practitioner coaches are selected and trained in practice-based coaching
  • Site practitioner coaches are trained in TPOT/TPITOS

Resources & Tools

The goals of full implementation are to assure high-fidelity implementation of practices and achievement of expected outcomes at all initial sites. With a focus on both fidelity and sustainability, all professional development and organizational structures are fully functioning and working together to support practitioners.

  • Leadership team collects, monitors, and reviews data on all relevant processes to ensure implementation fidelity, professional development, coaching support and evidence-based decision making
  • Program Leadership Team represents cultural diversity, meets monthly and has a written implementation plan that is reviewed and updated at every meeting
  • Booster training is provided for internal coaches and classroom teachers
  • Program continues to survey staff buy-in at least annually
  • Equity items on the BoQ addressed with implicit bias training for staff
  • Program designs procedures for developing behavior support plans
  • Program develops staff support plans, including new staff training in the Pyramid model, practice-based coaching is used to assist staff in implementation of the pyramid model with fidelity
  • Information is shared with families and community on an ongoing basis through a variety of formats (e.g., meetings, home visits, newsletters, open houses, websites, etc.)
  • Sites continue to provide data and feedback to PDN and SLT
  • Sites determine whether to become a demonstration site
  • Sites use the BoQ to guide all work; and assessing twice a year
  • Information is shared with families on an ongoing basis through a variety of formats (e.g., meetings, home visits, newsletters, open houses, websites, etc.)

Resources & Tools


The goals of this stage are to increase the number of sites using the selected practices with fidelity, while maintaining the existing implementation sites. By increasing the number of sites across the state, more children and their families will have access to effective interventions and support.

  • Implementation Sites
    • SLT and program coaches continue to provide support and communication with all implementation sites to ensure continued fidelity of implementation and positive child outcomes. If needed, additional training and support is provided to bring a program to fidelity
  • Demonstration Sites
    • Sites continue to train staff and advocate for expansion and use of evidence-based practices
    • Sites continue tours and data collection and reporting to SLT
Apply for 2023-2024 Program-Wide EC-PBIS Implementation

Fill out Application

Other Iowa Early Childhood Mental Health Initiatives

Iowa Association for Infant and Early Childhood Mental Health logo

Iowa Association for Infant and Early Childhood Mental Health

The Iowa Association for Infant and Early Childhood Mental Health (IAIECMH) was established in 2013 for the purpose of supporting Iowa’s early childhood professionals in promoting children’s healthy mental development.  The IAIECMH exists to promote optimal social-emotional development of infants, young children and their families by fostering a competent workforce which values nurturing child/caregiver relationships, and promotes community awareness of the importance of early childhood development.

The IAIECMH is governed by a twelve-member Board of Directors, with diverse representation from mental health, early intervention, parents, students, early care and learning, higher education, state government and public schools.  Key activities of the IAIECMH include implementation of Iowa’s Culturally Sensitive, Relationship Focused, Practice Promoting Infant Mental Health Endorsement process, quarterly newsletters, monthly Reflective Consultation sessions and multiple training events including webinars and in-person workshops.  More information about the IAIECMH can be found at their website.

Project Launch logo

Project LAUNCH

The Iowa Department of Public Health is currently implementing a five-year federal grant called Project LAUNCH. The purpose of this initiative is to support young children’s healthy mental development by focusing on strategies that foster safe, stable and nurturing relationships and positive experiences for children, newborn through age eight. Through Project LAUNCH, Iowa is developing infrastructure to support Infant and Early Childhood Mental Health Consultation, a service that pairs mental health clinicians with direct service professionals such as childcare providers, family support workers and early interventionists. Mental Health Consultation is designed to support direct service staff and build their capacity to promote young children’s healthy mental development. Find more information on the Project LAUNCH website.

Iowa 1st Five logo

Iowa’s 1st Five Healthy Mental Development Initiative

1st Five is a public-private partnership bridging primary care and public health services in Iowa. The 1st Five model supports health providers in the earlier detection of social-emotional and developmental delays and family risk-related factors in children ages birth to five and coordinates referrals, interventions and follow-up. Find more information on the Welcome to 1st Five website.

The Children’s Behavioral Health System State Board

The Children’s Behavioral Health System State Board was established in May of 2019 to serve as a required entity for the Children’s Behavioral Health System. The Children’s Board consists of 1 7 voting members appointed by the Governor. The Board is co-chaired by the Departments of Human Services and Department of Education.

The board’s strategic plan includes topics such as, but not limited to; finding concrete solutions to the unique challenges that exist relating to children’s mental health. Specifically, the Children's Behavioral Health System State Board is initially focusing efforts on:

  • Identification of and establishment of services across the state; 
  • Data and metrics to track services and population data;  
  • Systemization of the assessment tools being used across systems and ages.  
  • The board is learning about how the system is being implemented through the mental health regions and will be providing guidance and advocacy for supporting the referral of and access to services.

Both the adult and children's mental health services are being coordinated in regions across the state.  Learn more about the work and counties within each Iowa region.

Iowa ACEs logo

Iowa ACEs 360

​Adverse Childhood Experiences (ACEs) are traumatic events that can dramatically upset a child's sense of safety and well-being. These events create a toxic level of stress for a child and can lead to lifelong problems with school, work, health, and mental health.

Iowa ACEs 360 is establishing itself as a 501(c)3 organization and is growing its capacity to accelerate impact across the state. Iowa ACEs 360 does not provide direct service, consultation, or referrals for individuals. The focus is on building a network of many leaders who work together and independently to address ACEs.

ACEs are defined in the original ACE Study as physical, sexual, emotional abuse, as well as dysfunction in the home from separation/divorce, mental illness, substance abuse, incarceration, or domestic violence. Factors like systemic racism, poverty, and community violence also increase the likelihood of a child experiencing ACEs and can damage their foundation for future growth. 

The Iowa ACEs 360 is catalyzing a vibrant network to respond to ACEs in Iowa. All efforts are informed by data from the Iowa ACEs report and the Iowa ACEs 360 2019-2022 Strategic Plan.

Lemonade for Life logo

Lemonade for Life

Lemonade for Life was developed as a companion tool and trains professionals working with parents and caregivers on use of the Adverse Childhood Experiences (ACEs) Questionnaire. The goal of the Lemonade for Life program is to help prevent future exposure to ACEs while promoting resiliency and hope.

The Lemonade for Life program helps individuals understand how early life experiences may have long-lasting effects on how they interact in relationships. The training conveys that individuals cannot rewrite the beginning of their story, but they can change how it ends. It is not victim blaming, but rather instills hope and responsibility for change with the individual and is a key stepping stone for self-sufficiency. In this professional training, parenting resources are introduced that guide families to work toward safe, secure and nurturing relationships. The end goal of the program is to prevent exposure to ACEs in the next generation, ending the cycle of abuse and trauma that is all too common.

The Iowa Alliance for Healthy Kids is a group of nonprofit and government agencies committed to improving the social-emotional well-being of young kids in Iowa. The Alliance has teamed up with Sesame Street in Communities to give parents, caregivers, providers, and leaders creative messages and fun tools to promote nurturing relationships within families and to build social-emotional skills with kids. Find opportunities to learn and access resources at