Development of an infant and early childhood mental health service at a tertiary care pediatric hospital: a needs assessment, community case study and logic model creation

Early attachment relationships and positive childhood experiences are foundational to lifelong mental health, yet specialized services for children under six remain critically scarce. This study sought to characterize the service gap in infant and early childhood mental health (IECMH) in Eastern Ontario, Canada, as a first step in developing a logic model to inform creation of a program to support this population. We completed a regional estimation model of IECMH concerns, conducted a semi-structured focus group with community mental health agencies, and administered a survey to pediatric physicians at a regional children’s hospital. Findings from the aforementioned evaluations informed the development of a logic model for a new, responsive, tertiary-level IECMH service. Disruptive behaviours emerged as the most frequently encountered IECMH concern, and respondents identified multiple systemic barriers to accessing care, including insufficient specialist services, prolonged wait times, limited inter-agency collaboration, and a lack of provider awareness and resources. These findings underscored the urgent need to use the logic model to develop a dedicated IECMH clinic, tailored to the unique needs of this vulnerable population. While developed within a Canadian regional context, this framework may serve as a flexible template for other jurisdictions seeking to establish or strengthen tertiary-level IECMH services. Adaptation to local service structures, workforce capacity, and population needs will be essential to ensure feasibility and sustainability. Future evaluation will be necessary to assess implementation outcomes, service utilization, and impact on child and family trajectories.