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Executive Summary 13Growing Up Well: Supporting Young Children’s Social-Emotional Development and Mental Health in North Carolina The future of North Carolina’s growth and prosperity depends on our ability to foster the health and well-being of our children. Research shows that wise investments in children and families can lead to future savings, better health, and increased productivity.1 Health in the earliest years— beginning with a mother’s pre-conception health—provides the foundation upon which future development depends. Children with good health and a strong sense of well-being are more likely to grow into adaptable, functioning adults equipped with the kinds of tools needed to contribute positively to their communities.2 Young children’s social-emotional well-being, or mental health, affects how children relate to and interact with others, how they learn, and how well they are able to manage their emotions.3 Children need developmentally appropriate relationships, environments, and experiences during their earliest years to develop a foundation strong enough to support more advanced physical, cognitive, and social-emotional skills.4,5 New scientific evidence from multiple fields, including neuroscience, biology, genetics, and the behavioral and social sciences, confirms that developmental and biological disruptions during the prenatal period and formative years can impair healthy functioning, increase vulnerability to health problems later in life, and change the actual structure of a young child’s developing brain.6,7 Significant adversity in early childhood, including trauma, abuse, living with a parent with a substance use disorder, or being raised in persistent poverty, can cause toxic stress which disrupts a young child’s brain circuitry and other organ and metabolic systems.7 In the absence of protective factors such as nurturing and responsive relationships with caregivers, these disruptions produce changes in the body and brain that lead to lifelong impairments in both physical and mental health. Children exposed to toxic stress have impaired functioning in the areas of the brain that are critical for the development of linguistic, cognitive, and social-emotional skills.8 Impoverished and adverse early experiences, in the absence of protective factors, can lead to difficulty learning, difficulty forming healthy relationships, and lifelong physical and mental health problems.6,7 Further, failure to address these issues at an early age can lead to inordinate expenses to society in the areas of physical health, mental health, education, and criminal justice system expenses. To effectively intervene in order to prevent the short- and long-term effects of toxic stress will require investing in substantial and sustained prevention, promotion, and intervention services. Extensive evidence shows that effective prevention programs, focused on children under 5 years of age, can change the trajectory of children’s lives. Promoting positive social-emotional development among our youngest children is far easier than trying later to solve the problems that can result from lack of attention to mental health during formative years.1,6 A growing body of research shows that investments during early childhood Young children’s social-emotional well-being, or mental health, affects how children relate to and interact with others, how they learn, and how well they are able to manage their emotions.