Head Start programs embrace a vision of mental wellness for children, families, and staff. They make it a priority to increase understanding of mental health and provide access to a range of mental health information and services. Executing this vision requires collaborative relationships among children, families, staff, mental health professionals, and the larger community.

Social and emotional wellness is a foundation for health, mental health, and resilience. As young children grow, their early emotional, social, and relational experiences can affect the development of their brains. Children who are more socially competent have better learning outcomes and tend to form stronger relationships with teachers and peers. Children with less developed social skills often struggle in their relationships and academically. Early childhood mental health affects education, employment, criminal activity, substance use, and mental health outcomes in adulthood.

Key Terms

• Mental health: A state of well-being in which an individual realizes their own abilities and can cope with the normal stresses of life, work productively and fruitfully, and contribute to their community.
• Behavioral health: The state of health related to emotions and behaviors that affect overall well-being. Behavioral health care refers to the prevention, diagnosis, and treatment of mental and substance use disorders, life stressors and crises, and stress-related physical symptoms.
• Early childhood mental health: The social, emotional, and behavioral well-being of young children — including developing the capacity to experience, regulate, and express emotions, to form close and secure relationships, to explore their environments, and to engage in age- and stage-appropriate learning — in the context of family, community, and cultural expectations.
• Optimal behavioral health outcomes: The state in which everyone has a fair opportunity to attain their highest level of mental health and wellness. Achieving optimal behavioral health outcomes requires that high-quality and affordable behavioral health services and supports are provided for all populations, including those who have experienced challenges in getting care including persons with disabilities; persons who live in rural areas; and persons affected by persistent poverty.
• Social and emotional development: A child’s growing ability to regulate emotions, attention, and impulses and to slowly build an inventory of social skills that allow them to engage successfully with peers for play and problem-solving. Ongoing and successful development of social and emotional skills in the early years is linked to higher-order cognitive functioning and school readiness.
• Adverse childhood experiences (ACEs): Stressful or traumatic events, such as abuse and neglect in the early years of life, witnessing domestic violence, or growing up with family members who have substance use disorders. ACEs are strongly related to the development of a wide range of health problems throughout a person’s lifespan.
• Trauma-informed care: A service delivery approach focused on an understanding of and responsiveness to the impact of trauma. It promotes positive outcomes by emphasizing physical and emotional safety and enhances well-being by helping individuals define their own needs and goals to make choices about their care and services.
• Resilience: An individual’s developed capacity to cope with stress and adversity, enabling them to bounce back from difficult experiences and return to effective functioning.

The mental health of young children is also linked to the well-being of the people who care for them. For this reason, Head Start programs also support the mental health of their caregivers, including family and program staff.

Health managers may oversee mental health services, working with a mental health manager, consultants, or other partners to make sure the program meets mental health standards. These partners might include social workers, psychologists, and mental health counselors. Based on how a program has designed its mental health services, it may offer services in the program or connect children, families, and staff to services in the community.

This chapter explores mental health concepts and reviews children’s developmental milestones related to mental health. It covers the role of the health manager and provides examples of how the Head Start program can collaborate with a mental health consultant to deepen mental health support. This chapter also addresses how programs can offer trauma-informed care, services to address depression and substance use disorder, and mental health and wellness training.

Social Determinants of Health Considerations

According to Healthy People 2030, the social determinants of health (SDOH) are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Lack of access to social, economic, and environmental resources can lead to behavioral health concerns, including mental health issues and substance use disorders.

To improve mental health outcomes, the Head Start program is committed to helping families and staff have access to high-quality culturally and linguistically responsive behavioral health care. The program is also committed to addressing negative SDOH factors, such as isolation, unemployment, ACEs, unsafe or unstable housing, and food insecurity.

While mental health symptoms and disorders (e.g., depressive symptoms or depression) are common and widespread, rates are higher among certain underserved populations, especially those that experience poverty or live in rural and under-resourced communities. People in these communities face significant obstacles to getting access to and using high-quality mental health care. Head Start programs are well situated to combat this lack of access by helping children, families, and staff connect with high-quality providers of needed mental health services. A health manager can help arrange for and support the partnerships to achieve this goal.

Head Start Health Services Competencies

O-4 K Understand the general principles of health and wellness, including promotion, prevention, early identification, and intervention.

O-8 S Assist children and families to address challenges that affect their well-being, promote resilience, and strengthen protective factors.

CFH-2 Acknowledge the importance of safe, responsive, and nurturing relationships for healthy social and emotional development.

CFH-3 K Be familiar with early childhood developmental milestones including cognitive, motor, language, and social and emotional.

CFH-4 K Be aware that maternal and family health and wellness beginning with preconception influence health across the lifespan.

CFH-7 K Understand how toxic stress and adverse childhood experiences influence health and development.

CFH-17 S In collaboration with the program’s mental health consultant and families, promote children’s social and emotional well-being, assess risk, and make appropriate referrals for children with mental health concerns.

CFH-18 S In collaboration with the program’s mental health consultant, assess risk and make appropriate referrals for families living with challenges such as domestic violence, child abuse and neglect, substance use, depression (especially for prenatal and postpartum women), and other mental health issues.

EF-3 K Be familiar with strength-based communication strategies such as super listening and motivational interviewing.

EF-4 S Develop and sustain trusting relationships with families.

L-3 K Know how to access and use external health resources, including technical assistance providers, health consultants, and state, Tribal, and community agencies.

L-9 S Demonstrate responsive program management practices (e.g., collaboration, communication, meeting facilitation).

L-15 S Promote staff wellness, including stress management, injury and illness prevention (e.g., staff immunizations), and healthy active living.

L-16 S Establish partnerships with local health care providers to support the health needs of children and families and promote healthy communities.

Performance Standards Related to Mental Health and Wellness

• Child mental health and social and emotional well-being, 45 CFR §1302.45
• Family support services for health, nutrition, and mental health, 45 CFR §1302.46
• Child screenings and assessments, 45 CFR §1302.33
• Suspension and expulsion, 45 CFR §1302.17
• Family partnership services, 45 CFR §1302.52
• Staff health and wellness, 45 CFR §1302.93(b)
• Community partnerships and coordination with other early childhood and education programs, 45 CFR §1302.53(2)(a)

Last Updated: April 21, 2025