Rethinking Early Childhood Mental Health Care
At Wayne State University, a cross-disciplinary partnership is advancing a different approach to early childhood mental health — one that begins within pediatric care and challenges how systems are structured to support infants, young children and their caregivers.
The Early Childhood Support Clinic (ECSC) brings together the Wayne State University School of Social Work, the Merrill Palmer Skillman Institute for Child & Family Development and Wayne Pediatrics to deliver integrated, relationship-based care.
The clinic was launched in 2023 with support from the Ethel and James Flinn Foundation, along with Priority Health Total Health Foundation, Blue Cross Blue Shield Foundation, the Community Foundation for Southeast Michigan and Southeast Michigan Perinatal Quality Improvement Coalition. The clinic reflects a growing recognition that early developmental and mental health needs cannot be addressed effectively within traditional service silos.
The effort is led by Dr. Carolyn Dayton, professor of social work at Wayne State University and associate director of the Infant Mental Health Program at the Merrill Palmer Skillman Institute, and Dr. Alissa Huth-Bocks, director of the Institute. Both emphasize that the clinic was designed to meet immediate family needs, prevent future developmental and mental health problems from arising, and test a model that existing systems are not structured to support — particularly when it comes to delivering and sustaining relationship-based care for infants and caregivers.
Expanding access through integrated care
Since its launch, ECSC has served nearly 1,000 infants, young children and their families, most under age 3, by embedding mental health clinicians directly within Wayne Pediatrics.
Rather than relying on families to seek out behavioral health services independently, the model ensures that support is available as part of routine pediatric care. According to Dr. Huth-Bocks, this integration allows clinicians to engage families in real time, often during the same visit in which concerns first emerge.
“We’re located right in the pediatric clinic, so we can literally cross the hallway and connect with families,” she says.
Services include developmental guidance, emotional support, and assistance with concrete needs, as well as coordination across medical, behavioral health and community-based systems. More than half of encounters involve coordination of care, reflecting the complexity of navigating services that are often fragmented and difficult for families to access.
Families may engage with the clinic once or over time, depending on need. Dr. Huth-Bocks indicates that this flexibility is essential, as some concerns can be addressed quickly while others require ongoing support and monitoring.
A dyadic model that challenges system design
At the center of ECSC’s approach is dyadic care — an intervention model that focuses on both the child and the caregiver, as well as the relationship between them.
For infants and toddlers, Dr. Dayton explains, developmental and mental health concerns are inseparable from the caregiving relationship itself. Challenges such as feeding difficulties, sleep disruption or excessive crying can place significant strain on caregivers, particularly in the context of stress, limited resources or perinatal mental health conditions.
“These are the kinds of early problems that, when they begin to affect the relationship, can become much more serious if we don’t intervene,” Dr. Dayton says.
Despite strong evidence supporting dyadic intervention, both Dr. Dayton and Dr. Huth-Bocks emphasize that traditional medical and behavioral health systems are not structured to deliver or sustain this type of care. Current reimbursement models, for example, are typically designed around an individual patient with a diagnosable condition, rather than a caregiver-child pair receiving preventive, relationship-based services.
“We’re working with the parent and the baby together, but the system doesn’t account for that,” Dr. Dayton says.
According to Dr. Huth-Bocks, this disconnect is particularly pronounced for children birth-age 5. While integrated behavioral health models are becoming more common for older children and adults, similar approaches for infants and toddlers remain rare.
“What we’re doing for this age group is almost non-existent,” she says.
Prevention as a systems strategy
The ECSC model is fundamentally preventive, focusing on strengthening early relationships to mitigate the risk of more serious behavioral health challenges later in life.
Dr. Dayton indicates that early intervention can reduce the likelihood and impact of adverse childhood experiences (ACEs), while also supporting healthier developmental trajectories.
“This is prevention through and through,” she says.
The long-term implications are well established in research. Early relational health is associated with improved educational outcomes, better physical and mental health, and greater economic stability across the lifespan. According to Dr. Huth-Bocks, the return on investment is substantial.
“For every dollar you put into this kind of work, you get it back many times over,” she says.
Addressing gaps in pediatric care
ECSC also responds to a practical challenge within pediatric settings. Pediatric providers are often the first point of contact for families with young children, yet they may have limited capacity to address complex mental health concerns without additional support.
Dr. Huth-Bocks notes that this is not a limitation of individual providers, but rather a reflection of how systems are structured. “It’s not a failure of pediatricians—it’s a system issue,” she says.
By embedding mental health clinicians within the pediatric environment, ECSC creates a pathway for early assessment and intervention that would otherwise be difficult to access.
According to both Dr. Dayton and Dr. Huth-Bocks, pediatric providers have responded positively to the model, reporting that it enhances their ability to care for families and expands what can be addressed within a single visit. At the same time, demand continues to exceed capacity.
“The biggest complaint we hear is that there aren’t enough of us,” Dr. Huth-Bocks says.
Advancing policy and sustainability
Beyond direct service delivery, ECSC is contributing to broader efforts to align policy and financing with early childhood mental health practice. The team is engaged in national collaborations focused on expanding Medicaid reimbursement for dyadic care and addressing structural barriers that limit access to preventive services.
Dr. Dayton points to emerging policy changes in other states, including legislation that allows reimbursement for services without requiring a formal diagnosis in very young children, as an important step forward.
At the same time, the field of pediatrics is evolving, with increasing emphasis on early relational health as a core component of child well-being.
A model with implications beyond one clinic
Despite demonstrated impact and growing demand, ECSC currently relies on grant funding, highlighting the broader challenge of sustaining and scaling innovative models within existing systems.
For Dr. Dayton, the long-term goal is clear: a system in which integrated, relationship-based care is standard practice in pediatric settings.
“There’s no reason every pediatric clinic shouldn’t have someone trained to do this work,” she says.
As policymakers and funders consider how to strengthen behavioral health systems, ECSC offers a clear example of both what is possible and what remains to be addressed.
Learn more about the Ethel and James Flinn Foundation.
