By Elizabeth Aguilera for CalMatters

While California has committed billions of dollars to support the mental health of K-12 students, little has been specifically dedicated to children 5 and younger.

Advocates say it’s a need that needs to be addressed, and they are asking Gov. Gavin Newsom to set aside $250 million in the state budget to support the mental health of infants, toddlers, preschoolers and their parents and caregivers.

Kids under 5 account for almost a quarter of all Medi-Cal recipients under 21 but do not receive a proportionate share of health and mental health care compared to older youth, according to Children Now, an advocacy organization focused on the health and welfare of California’s children. At least 43% of those children under 5 have experienced at least one adverse childhood experience. These experiences — including violence, abuse or neglect — have been connected to chronic illnesses later in life and death.

“They are very cute and adorable so people don’t see any needs besides feeding and clothing them at this age,” said Lishaun Francis, director of behavioral health for Children Now. “Because they can’t speak about their needs, they can’t say ‘This is making me sad’ or ‘This is not a healthy attachment relationship.’ They can’t express themselves so we take for granted what they need.”

Children Now, along with more than 400 organizations, sent a letter to Newsom asking for $250 million over four years to fund organizations that provide mental health support for mainly low-income infants and toddlers and their families. Advocates say providing support services early helps prevent children from experiencing adverse events, and if they have gone through trauma already it can help them heal and process. 

The money would also support training for child care providers and other caregivers to ensure they have the skills to help prevent traumatic experiences. Those skills include providing a nurturing relationship with children and helping a child cope with trauma. 

These needs have increased during the pandemic as children have experienced isolation, family stress over finances and housing, and possibly lost a parent or loved one to COVID-19.

Because infants and toddlers can’t express their feelings the way an older child might, there is a perception they don’t register stressful or traumatic events the same way older children might.

But young children do experience anxiety, stress, sadness and other emotions related to trauma and they rely on their caregivers to help them make sense of it all, said Dr. Chelsea Lee, a specialist in infant and early childhood mental health at the UC Davis CAARE Center, a mental health clinic serving children who have experienced trauma and abuse.  

If those experiences are not addressed or prevented early on, a child’s future may be marked by angry outbursts, bad grades and the inability to have a relationship or keep a job, experts said.

“The first five years are crucial for setting the foundation for functioning across the lifespan up to teenage years, adolescence, adulthood and everything,” Lee said. “Early caregiving experiences and nurturing relationships are very important for little kiddos.”

Last year, California launched the $4.4 billion Children & Youth Behavioral Health Initiative to redesign behavioral support for kids. But the initiative doesn’t directly address the needs of children younger than kindergarten age. 

“We are essentially asking the state not to forget about very little kids, infants and toddlers,” with the current funding request, Francis said. 

Putting resources into early intervention is vital for the health and safety of future populations, said Kelly Morehouse-Smith, director of family well-being for the Child Care Resource Center, which operates a home-based family support program in Los Angeles. If there is no intervention or support, issues like aggressive behavior or isolation show up in school and often impact learning, she said. 

“Trauma doesn’t just stay in 0 to 5, it manifests throughout someone’s lifetime,” Morehouse-Smith said. “If you don’t address it at all then the child hasn’t processed the trauma, doesn’t learn coping skills and what we see are behaviors that impact the school setting, social settings and family relationships.”

That is why Elizabeth Lomeli, a para-educator for the Child Care Resource Center  who does home visits with families, worries about her own daughter. When her 8-year-old daughter Gisselle was around 4 she witnessed a lot of infighting among her extended family. Lomeli could not find resources for her daughter until she started school. It took three years for Gisselle to begin therapy. 

“It impacted her as she was growing — she was very insecure about her being able to do things and was worried about other people,” Lomeli said. “If she had received these services when she was young she would have had that confidence and received that independence.”

Infants and toddlers are unique in how they show stress and trauma, and because they are so young the outreach takes a two-generational approach, Francis said. Parents and caregivers are part of the formula for ensuring young children are healthy, safe and nurtured, she said.

The training also helps adult caregivers by giving them tools to help them deal with their own stress. It helps them understand childhood milestones so they know why their baby is crying or what their toddler is able to do and helps connect families with other resources they might need. The ultimate goal, Francis and others said, is to provide support and training that prevents adverse events from happening to children in the first place.

“If families have the skills and training and access to resources, it can reduce the incidences of abuse and neglect,” said Deborah Kelch, interim executive director of First 5, which is also advocating for the money. “It has a strong prevention component by helping the adults be there for children the best way they can.”

Two years ago the state launched the Aces Aware Initiative, which includes training doctors, especially those who treat Medi-Cal patients, to screen kids and adults for adverse childhood experiences. Since then, 500,000 children and adults have been screened and 62% indicate they experienced at last one adverse childhood experience. These experiences are considered potentially traumatic events and exposures children go through. They include physical or sexual abuse, physical or emotional neglect and household dysfunction such as divorce, substance abuse or an incarcerated loved one.

The advocates and some legislators are lobbying the Newsom administration to include the money in the revised budget, which is expected in May.

Democratic Sen. Josh Newman of Brea agreed the state has not focused enough attention on the mental health of the youngest children. As an added benefit, he said the state could save money in the long run by helping young children directly instead of later on when their challenges are more severe. 

“You can put a kid on the right path early and you end up with a healthy child and a productive citizen,” said Newman, who serves on the Senate Special Committee on Pandemic Response. “If we don’t do that we end up with fewer productive and healthy people.”