Helping families get support for stress, depression, anxiety, trauma, substance use, and other mental health conditions promotes healing and recovery. Mental health treatment is important, and it works. Receiving treatment soon after noticing a concern works better than waiting.

What is early childhood mental health?

Early childhood mental health is the ability of infants and young children to form close and secure relationships and manage and express a full range of emotions. It is the foundation of healthy development.

Family, community, and culture influence mental health in young children. The mental health of caregivers also influences children’s mental health and well-being.

This resource suggests ways to make referrals for children and families to mental health treatment. It has tips for finding mental health providers in your community, developing partnerships with them, and referring families to their services.

Head Start Programs Offer a Range of Mental Health Support

Head Start programs are a wonderful opportunity to support infant, early childhood, and family mental health. They offer a full, integrated approach to early childhood mental health. The Head Start strategies for supporting mental health achieve these goals:

• Promote mental health
• Prevent mental health concerns from developing
• Find mental health concerns early
• Make referrals for mental health treatment when needed

Mental Health Consultation in the Program Promotes Mental Health and Well-being

Head Start programs support infant and early childhood mental health by offering mental health consultation (MHC) (45 CFR § 1302.45(a)(3)(4),(b)(1–6)). MHC is an evidence-based approach that connects mental health professionals with people who work with young children. MHC helps adults promote the social and emotional development of young children. Mental health consultants help staff learn ways to teach children about feelings, build regulation skills, solve problems, and make friends. Mental health consultants might also help design program practices to support social and emotional development, help address behavioral concerns and educate about mental health.

For more information about MHC, see Understanding Mental Health Consultation in Head Start Programs.

MHC is an important part of the range of mental health services offered by Head Start programs. And some children and families may also need direct therapy from mental health providers outside the program. Head Start programs can help connect families with appropriate providers.

Partnerships with Mental Health Providers

Developing partnerships with mental health providers in the community is the most helpful way to refer families to therapy or other mental health services. Learning about local mental health providers and the type of service they offer can help you find the best providers for families.

Follow these tips to find mental health professionals in your community:

• Ask health care providers you already work with (e.g., your mental health consultant, pediatricians, or members of your Health and Mental Health Services Advisory Committee) for suggestions.
• Contact local, state, and national organizations for suggestions, such as:
  • Substance Abuse and Mental Health Services Administration
  • Local community mental health agencies, mental health centers, or hospitals
  • State officials such as a children’s mental health director, liaison to the state chapter of licensed psychologists, or a liaison in the Office of Special Education
  • Department leaders at universities for social work, psychiatry, psychology, and special education
  • Local chapters of National Association for Social Workers or American Psychological Association

After you have a list of mental health providers in your community, contact them to learn more about the type of clinical services and specialties they offer and whether they serve children. Some of these providers might also be a good fit for your Health and Mental Health Services Advisory Committee.

Some local mental health providers might not be familiar with Head Start programs. Consider offering opportunities for them to learn more, and then find ways to strengthen your partnership. Tips include:

• Invite mental health providers to your facility to get to know the program.
• Work together with partner agencies to inform mental health providers in the community of the needs of Head Start families. Ask mental health providers to host or attend events at your program so families can meet them.

Education and Professional Certification

There are many types of mental health professionals. Usually, mental health providers have at least a master’s degree in a human services field with certification or licensure from a state board. Common examples of mental health professionals are counselors, marriage and family therapists, psychologists, social workers, and psychiatrists. Many of these professionals call themselves therapists.

Questions You Can Ask Mental Health Providers to Learn More About Them

• How do you usually work with families?
• What is your training or experience with young children and families?
• How do you support family diversity related to family composition, language, culture, and financial situation?
• What are your fees, and do you accept insurance or offer sliding-scale payments?
• What hours are you open?
• Is your office near public transportation?
• Is your office accessible for people with mobility challenges?
• Do you do home visits?
• Is there a waiting list?
• Whom should I contact for referrals?
• Do you offer a free phone consultation?

Experience and Approach of Mental Health Providers

Mental health providers often have a specialty in areas like depression, behavioral concerns, trauma, or substance use. Services are more likely to help if the provider has experience with the specific challenge the family has.

When learning about providers, find out about their approach or “orientation.” This is how they work with people. An approach could be teaching new strategies, using art therapy, focusing on family relationships, or many other methods.

Keep a list of the languages they speak, and their specialty with groups of people (e.g., immigrant and refugee families, LGBTQIA2S+ people, expectant families, people with disabilities, and families with certain racial, ethnic, or cultural backgrounds). A list of providers’ specialties, approaches, and characteristics helps you connect families with providers who best match their needs.

Supportive Qualities in a Mental Health Provider

Families should feel supported and respected by their mental health provider. Important qualities to look for include:

• Clear communication: Can they explain things well and work with families to make decisions?
• Positive outlook: Do they focus on what families are good at and offer hope?
• Flexibility: Are they available when it’s convenient for families?
• Reliability: Do they show up on time and answer messages promptly?
• Being open-minded: Do they practice without judgment? Do they notice when they are not meeting families’ needs and change their approach? Do they ask for help or learn more things to give the best care?

Making Referrals for Mental Health Services

Once you know the mental health providers and services in your community, you can help families find the right support when they need it.

Preparing to Make a Referral

Choose the right staff member to help the family with the referral. Referrals work best when one staff member helps the family from start to finish. Think about who knows the family well and can offer the most support for their needs. You can discuss and decide this during a team meeting with everyone in the program who supports the family. When deciding who is the best person to support the family, ask these questions:

• Who has the best relationship with the family? Families are more likely to trust a referral from someone they trust and know well.
• Who understands and respects the family’s culture, beliefs, and values? This staff member is more likely to refer the family to a provider who is a good fit.

Guiding Families Through the Referral and First Visits with a Warm Handoff

The next step is making the referral. A warm handoff is when a staff member personally introduces a family to a trusted provider. This type of handoff is more likely to make a family feel supported, and it works better than just giving a family a phone number to call.

You can help make the first visit successful by following these strategies:

• Find out why the family is looking for mental health services. Starting mental health services can be uncomfortable or scary, so it is important to talk about it openly. To avoid confusion, make sure everyone has a shared understanding of the family’s goals.
• Call the mental health provider to let them know you will be referring a family. Keep the family’s information private unless they have given written consent to share it.
• Some families might prefer to contact the provider themselves, so it is helpful to explain the steps they can expect to follow. For example, you might say “First you call the Community Health Center, then ask for Ms. Jones. She will ask you some questions to begin the intake process.” These steps will be different for different providers.
• Offer to stay near the family during the first call to answer questions or to help in other ways.
• Make sure the family has privacy. If they’re making the call from the Head Start program, make sure they have a private room.
• Ask the family if they want other support. Offer to go with them on their first visit, arrange transportation, or meet them afterward.
• Ask the family if they would like to sign a release of information form that allows the program to contact and share information with the mental health provider.
• Plan to check in with the family over the next few weeks. This can be in person or over the phone to see how things are going and to help with any issues.

Reducing Barriers to Mental Health Care

Families may hesitate to go ahead with a referral for several reasons. These include shame about mental health, cultural beliefs about mental health treatment, concerns about how to pay for services, transportation challenges, and long waiting lists or delays. Discussing economic, transportation, and cultural barriers during the referral process is best practice. Use these ways to discuss common barriers to getting mental health services:

• Help families sign up for insurance and review coverage for mental health services together (45 CFR § 1302.46(b)(2)(i)).
• Find local providers who offer sliding scales or other affordable ways to pay.
• Find programs that offer home visits.
• Find grant funding, or team up with a local business, to offer funds for gas or public transportation.
• Confirm what languages the providers speak.
• Think about using a mental health interpretation service that can partner with providers.
• Ask for a recommendation for another local provider if waiting lists are long.
• Explore virtual services for mental health.

Checklist for Guiding the Referral Process for Children and Families
As the staff member guiding the family through the referral, I have:

• Agreed with the family on why the referral is being made
• Found appropriate mental health providers based on the family’s needs
• Asked the family about possible barriers (e.g., cost, transportation, schedule)
• Discussed family concerns or worries about the referral
• Discussed and received written consent from the family to share information with the mental health provider
• Contacted the mental health provider to let them know I am referring a family, and I shared information (with family consent), such as reason for referral, background, history, strengths and culture of the family, and challenges the family might have in getting care
• Followed up with the mental health provider to confirm they received the documents
• Asked the family how they would like me to support them (e.g., being near when they make their first appointment and going to the first appointment with them)
• Made a follow-up plan to check in with the family and support their ongoing care

Conclusion

Referrals are an important part of Head Start mental health services. When Head Start staff plan carefully to develop strong partnerships with mental health professionals, support families through the referral process, and follow up to make sure the service met their needs, it is more likely that children and families will receive the support they need to thrive.

Last Updated: January 16, 2025