Early Childhood Mental Health Services

In December 2024, the Commission updated its Strategic Plan for 2025-2030, which will guide the Commission’s priorities and investments. The 2025-2030 Strategic Plan is consistent with the focus and intent of the Children and Families Act, building on what has been learned and accomplished locally and providing a framework for the Commission and the community for how Proposition 10 funds will be strategically invested over the next five years. Central to the success of these investments is a strong foundation that adequately prioritizes early childhood systems and services in San Mateo County.

As outlined in its 2025-2030 Strategic Plan, First 5 San Mateo County is prioritizing partnerships with entities that are achieving both direct impact and positive systemic change. This approach fosters sustainable improvement within agencies and systems, and allows families beyond the direct service reach to benefit. Many of our investments serve present needs as well as examining and improving the underlying systems.

Through this RFP (Early Childhood Mental Health Services), the Commission intends to solicit proposals from qualified agencies and organizations interested in implementing services and strategies that support access to the early childhood mental health service continuum, from preventative social supports for children and families through intensive mental health service delivery.

Desired Outcomes

Successful proposals in response to this RFP will demonstrate that their proposed activities and approach will help F5SMC to achieve the relevant Desired Outcomes in the strategic plan, specifically:

1. Communities provide a safe and healthy environment for young children.

2. Families feel connected to and supported by their community and able to nurture their children’s health and development.

3. Children have healthy relationships and stable attachments to their primary caregivers.

4. Children have access to and are utilizing appropriate health care services to meet their health and developmental needs.

In service of these larger strategic outcomes, F5SMC anticipates that funding this work will positively impact population and participant level indicators such as:

• The percentage of parents reporting difficulty accessing services for their child’s mental, developmental, and/or behavioral health.

• The percentage of parents reporting that they are able to access the services their family needs.

• The percentage of parents reporting confidence in their ability to nurture their children and support their development.

• The number and/or severity of risk factors reported by parents receiving intensive services, such as inadequate food, inadequate housing, depression, domestic violence, and substance abuse.

• The percentage of children ages 0-5 reunified with their families within 12 months of entering out-of-home care.

• The percentage of children ages 0-5 re-entering the child welfare system.

Successful proposers will be required to participate in F5SMC Evaluation Activities, including (but not limited to) administering surveys to program participants as directed by F5SMC staff and evaluation consultants. Surveys will include items assessing the indicators listed above, as well as items associated with other indicators specified in our 2025-30 Strategic Plan.

Strategies & Domains

This RFP is intended to promote healthy children and resilient families by funding agencies providing critical support for young children and their caregivers in San Mateo County through early childhood mental health service delivery. We encourage approaches that: 1) weave together cross-sector partnerships, resources, and services, 2) capitalize on the intrinsic strengths of families by engaging them as equal partners in service delivery, 3) and increase culturally responsive practices.

Areas of Interest

Proposals should demonstrate their ability to design and implement specific approaches and services including but not limited to the following areas:

• Parent-child groups,

• Parent support groups,

• Therapeutic/clinical services including Child-Parent Psychotherapy and other dyadic approaches,

• Sensory regulation/ integration services

• Other services

Proposed strategies must be evidence-based, evidence-informed, or emerging/promising practices .

Funding for this Request for Proposals process is not intended to support the following (although these may be funded through other subsequent procurement processes):

• Early Childhood Mental Health Consultation for childcare or early childcare education providers

• Explicit care coordination or navigation systems as a sole focus of service delivery (though individual navigation and care coordination support paired with other mental health service offerings is allowable)

Target Populations

F5SMC is prioritizing services and approaches that focus on serving the following target populations:

1. Children from birth through age 5 and their caregivers who may have experienced trauma including but not limited to homelessness/housing insecurity or intimate partner violence,

2. Families/caregivers of children ages 0-5 who may be experiencing mental health challenges, isolation, a lack of informal supports, and/or lack of access to services,

3. Children birth through age 5 and their families that are Medi-Cal eligible, as well as those who do not meet economic self-sufficiency in San Mateo County,

4. Culturally, linguistically, and/or geographically isolated families.

Funding Amount and Available Term

First 5 SMC has allocated a maximum of $2,100,000 over 3 fiscal years (2025-26, 2026-27, 2027-28) to meet the goals and objectives detailed in this RFP. This allocation includes $500,000 in Mental Health Services Act funding as a supplement to F5SMC’s Prop 10 contribution.

The suggested maximum amount for each agency to request through this procurement process is $600,000 total or $200,000 per year over the three-year term. We anticipate a highly competitive grants pool so please structure and justify your request accordingly due to limited resources. We encourage requests for lesser amounts when possible.

According to the ZERO TO THREE Infant and Early Childhood Mental Health Task Force , “Infant and early childhood mental health is the developing capacity of the child from birth to 5 years old to form close and secure adult and peer relationships; experience, manage, and express a full range of emotions; and explore the environment and learn—all in the context of family, community, and culture.” Clinical ECMH providers are trained mental health practitioners who focus on the parent-child dyad and have expertise in understanding child development and attachment. In addition to clinical providers, multidisciplinary service providers make up the ECMH landscape, including a range of professionals who work with pregnant and postpartum people and children. These include pediatricians, OBGYNs, nurses, early care and education providers, and occupational and speech therapists. In addition to care providers, key navigational organizations including Help Me Grow, Golden Gate Regional Center, and Special Education Local Plan Area play a role in helping connect children 0-5 with appropriate resources. Collectively, these parties play critical roles in the continuum of care for helping children and families recognize and identify ECMH needs and get connected to appropriate resources and support.

Intervening early to impact children’s health outcomes is inherently an upstream strategy that can mitigate longer-term health challenges and inequitable health outcomes. Creating greater access to quality early childhood mental health and family behavioral health services in San Mateo County is crucial to support the healthy development of our youngest residents.

We know that the groundwork for positive emotional health is laid during pregnancy. After birth, this continues to be developed through caring and safe relationships with a child’s caregivers. Positive mental and emotional health enables children to thrive in all aspects of their life, including their health. However, when children struggle with emotional, mental, and behavioral health concerns, it can lead to more significant health symptoms such as chronic eating, difficulty sleeping, toilet training issues, and dangerous or risky behaviors. According to Zero to Three, between 10-16% of young children in the United States experience mental health conditions, and for babies in poverty this number increases to 22%.

The causes of mental health issues in young children can be due to a number of factors such as environment, trauma, biology, and other adverse childhood experiences (ACEs). ACE scores are highly correlated with future health outcomes and opportunities, including greater risk of nearly every major disease or condition. People with high ACE scores are more likely to die decades before their counterparts with lower ACE scores.

As a result of the COVID-19 pandemic and its many aftereffects, many families continue to struggle in San Mateo County with stress and social isolation. This stress, which is primarily due to economic inequality in the county and social isolation, is particularly profound for families that face low annual household incomes, or middle-income families that may not be able to qualify for certain resources. Preliminary findings from a 2024 survey conducted with 69 parents of children with Medi-Cal eligible children in the County revealed that 34% face housing insecurity, 31% report financial concerns, and 31% experience food insecurity, which are critical stressors for families. Additionally, 24% of parents reported feeling socially isolated. These stressors have ripple effects on children’s mental and emotional well-being. Through the 2024 San Mateo County Early Childhood Mental Health Landscape Scan, data reveals a rise in anxiety among young children, particularly since COVID-19. The rise in anxiety is often misinterpreted as misbehavior, when in reality, these behaviors stem from underlying trauma.

In San Mateo County, we are seeing families facing challenges navigating and accessing the early childhood mental health system, due to a number of barriers. According to the San Mateo County Early Childhood Mental Health Landscape Scan conducted in 2024, these barriers range from eligibility restrictions, to logistical challenges and language access, to high staff turnover that disrupts continuity of care for families. Furthermore, challenges with insurance create another set of limitations for families of young children. Most children in San Mateo County are privately insured. Some private insurance plans do not cover services until high deductibles or out-of-pocket maximums are met, and out-of-pocket costs can be difficult for families to afford and may not be reimbursable. Additionally, providers may be hesitant to share the information required by private insurance companies and are reluctant to contract with them due to concerns over extensive documentation requests and the risk of payment denials or claw backs. These issues further limit access to quality mental health services for children and families.