Changing the Trajectory of a Mental Health Crisis: It’s Time New Jersey Makes Infant Mental Health a Priority

Over the past two years, the nation has seen an increase in rates of mental health concerns among children, exacerbated by the COVID-19 pandemic and racial inequities. In response, a National State of Emergency in Children’s Mental Health was declared by the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA).

Sounding the alarm is an important first step to addressing mental health challenges among children and adolescents and stopping the growing crisis. As we work to better understand and address the impact of the pandemic on the mental health of children, it is critical to acknowledge that infants and toddlers have mental health needs as well. Despite babies being among the most vulnerable, their needs are almost always the last to be noticed.

Why Should We Be Concerned About Babies’ Mental Health?

Infant and early childhood mental health (IECMH) often went unaddressed prior to the pandemic but it has become an even greater concern now, since babies born during the pandemic are likely to experience higher levels of mental health needs. As a result of the health crisis, many parents experienced increased stress from financial hardship, food insecurity, social isolation and trauma from the loss of family and friends, impacting their capacity to support their young one. In addition, the traditional support systems for babies and their families were disrupted by the pandemic, putting the mental health of infants at risk.

And all of this is taking place at a critical time of a babies' brain development.

Research tells us that stress and trauma can impact healthy growth and development. Fortunately, providing supports that nurture strong relationships with loving, consistent and trusting caregivers can help. But when parents are also experiencing increased stress, it can be challenging for them to provide the support their babies need.

The Impact of COVID-19 on Mental Health

Parents of young children report higher levels of concern about their children’s social development.¹ To capture the depth of the emotional toll that tangible hardship takes on families, the RAPID-EC survey, conducted by the University of Oregon, measured emotional distress in adults (depression, anxiety, stress, loneliness) and children (fearfulness/anxiety, fussiness/defiance) experienced throughout the pandemic. Results from the survey highlight the material hardships many families experienced such as difficulty paying bills, basic food needs, housing and utilities. It also revealed a steady association between the increase of material hardship and the increase in emotional distress in both parents and children. Over the course of the pandemic, the survey has shown one in four households with young children, sometimes as many as one in three, experienced material hardship, which also affected family well-being.²

The connection between material hardship and emotional distress is associated with a higher mental health risk for historically marginalized families. Black and Latino families experience significantly higher rates of material hardship than white families, including those at middle- and upper-income levels. Social isolation emerges as the primary challenge for white families, while the challenge to meet basic needs persist for Black families.³ Pervasive and systemic racism adds an additional toll.

IECMH Services in New Jersey

A key barrier influencing the mental health crisis is access to services, particularly for families with low incomes. Often, families in general are unaware that they can even access mental health services for their young child. And if they do, finding a mental health provider can be time consuming and difficult, especially for parents who are stressed and have many other responsibilities. Additionally,there are not many mental health providers that provide services to very young children, leaving parents with little to no options.

Another complication to receiving mental and behavioral health treatment or services for those receiving benefits under NJ FamilyCare, New Jersey's publicly funded health insurance program which includes Medicaid, is that there must first be a diagnosis. This can prevent families from accessing services until the need is significant. Requiring a diagnosis to receive services can be stigmatizing and deter many from even seeking treatment. At a time when many families and children are experiencing mental health needs, New Jersey should be making it easier - not harder - for families to access services as early on as possible.

Promising Solutions

IECMH advocates in New Jersey have proposed a solution to create a preventative behavioral health benefit under NJ FamilyCare for children. This benefit would allow individual or family therapy for children without requiring a formal behavioral health diagnosis, reducing the stigma of receiving mental health services. As data has shown, there are many risk factors that can impact mental health, from food and housing insecurity, to other family stressors. By identifying these factors and providing treatment or supportive services as soon as possible, more significant mental and behavioral health concerns can be prevented.

Another option is implementing the HealthySteps program statewide. HealthSteps is an evidence-based model being piloted in New Jersey that uses an integrated pediatric primary care approach to meeting families where they are. This initiative takes advantage of the pediatric office as the universal touchpoint for families (99.3% of New Jersey mothers reported that they took their new infant to their well-baby checkup in 2015). A HealthySteps Specialist, usually a licensed behavioral health provider, is placed in a pediatric office to address family needs and connect families to services and resources. This removes the burden from parents to navigate an often complicated mental and behavioral health system. However, the HealthySteps program is currently only available in three communities in New Jersey. The state should expand the HealthySteps program so that more families are able to benefit.

Time to Make Infant Mental Health a State Priority 

Families and caregivers need easily accessible support to promote the health and well-being of their children. The pandemic increased the amount of stress and anxiety beyond what already accompanies parenthood. The negative impact parents’ stress has on a child’s healthy development must be addressed in addition to the challenges of accessing services. IECMH needs went unmet for young children even prior to the pandemic. And as we emerge, the impact these past two years have had on mental health will not just disappear. New Jersey must strive to make access to infant mental and behavioral health services a priority.