Birth to Three Clinic and Early Childhood Mental Health Program

Dr. Kroupina and Patient

COVID-19 Support for Families With:

Who do we help?

We are the first pediatric program in Minnesota to serve children from birth to age three with high risk histories of toxic stress and we also provide consultations for children up to early school age with high risk histories of toxic stress during the first years of life. These early stressors include multiple hospitalizations; chronic illness; stressful transitions; high-risk to safety and well-being; and/or parents who are struggling with stress themselves.

These children have experienced stressors such as, but not limited to:

  • New medical diagnosis;
  • Difficulty adjusting to new medical needs or diagnosis;
  • Multiple hospitalizations;
  • Chronic illness;
  • Stressful transitions;
  • High-risk to safety and well-being;
  • Parents who are struggling with stress themselves.

A history of toxic stress is often associated with a negative effect on overall development and with an increase in behavioral difficulties such as:

  • Emotional issues, including fear and anxiety;
  • Aggressiveness and impulsivity;
  • Problems with sleep regulation and eating patterns;
  • Developmental concerns in language or socialization.

Having a child with medical needs can be extremely stressful for the entire family. We are located within the department of Pediatrics and work seamlessly with existing medical teams to support families who are experiencing significant stressors surrounding new diagnoses of medical conditions, chronic illness, or problems adjusting to medical conditions. Through our expertise, we are able to support both the child and parent in order to promote the relationship between the two despite continued medical challenges and stressors.

Why Are Our Services Important?

The first three years of life are a sensitive period in a child’s growth and development. In this period, children are particularly vulnerable to the negative impacts of toxic stress on both their physical and mental well-being. Early identification of vulnerable children and timely intervention are critical because during the first years a child’s brain is also uniquely adaptable and capable of developing new brain connections that can help lessen the impact of negative or stressful experiences.

How Do We Help

Our program seeks to intervene in children either at risk for or currently experiencing toxic stress to reverse the deleterious effects and prevent further negative consequences. We support the caregiver by helping them to become an effective buffer to protect the child from stress. We also support parents’ learning of how to read and respond to their child’s signals to foster a more supportive environment for the child to experience and cope with the stressors in their lives.

The relationship between the parent and child during the first three years of life lays the foundation for the child’s lifelong emotional and behavioral well-being. Using the most effective interventions for this age group, we seek to build up and support the relationship between parent and child and promote the child’s neurodevelopment, particularly for children who are at risk.

Our clinical specialists:

  • Evaluate mental health and assess social-emotional development.
  • Develop an individual tailored, comprehensive plan to meet a child’s needs.
  • Coordinate with experts in speech therapy, occupational therapy and other medical specialists.
  • Help parents understand their child’s emotional needs and provide them with techniques for building and promoting security and regulation within their relationships with their child.
  • When necessary, we provide referrals to mental health providers for additional evaluation.

What to Expect?

When you and your child have been scheduled for a diagnostic assessment and evaluation with Dr. Maria Kroupina, PhD. The evaluation includes two to three sessions usually scheduled in successive weeks.

  • The first visit lasts about 90 minutes and consists of: 1: Clinical observations: how your child plays with you, toys, and a new adult (clinician) and how they respond to a series of separations and reunions in a novel environment, and 2: An interview in which you will have the opportunity to discuss your concerns and go over your child’s developmental history.
  • The second visit consists of a developmental assessment lasting 2 hours and overview of the results. Given some children may need more time to finish all of the tasks, a third visit may need to be scheduled.  Based on our evaluation, we will help tailor an intervention plan to your child’s needs.

Given that we work as a team, there will be an opportunity for you to discuss any questions or concerns without your child present. As a pleasant, low-stress experience, your child can stay in the room and play with an assistant while you speak privately with the clinician.


Currently, the ECMHCP is developing their research agenda in early childhood mental health assessment and intervention. Check here in the coming months for news and opportunities for research participants.

Education & Training

The Birth to Three Program trains pediatric residents, students in social work, and international professionals. The Birth to Three Program has also hosted medical students from Maastricht University in the Netherlands for their 18-month clinical research internship.

Early Childhood Mental Health Course

Coursework has been developed to introduce pediatricians and medical specialists working with 0-3 patients to early childhood mental health and development. The course is available in Canvas. Contact program director Maria Kroupina at if you wish to be added to this course.

Recent Events

The Developing Brain and Early Mental Health Initiative - Was held on Friday, December 6, 2019