Ashton was a toddler carrying more than his years.
His early life included exposure to prenatal substances and domestic violence, time in resource care, reunification with caregivers, and periods of housing and food insecurity.
Each experience left an imprint on Ashton, who has complex developmental and behavioral health needs.
The KidSTART program at Rady Children’s Hospital-San Diego is designed for stories like his to meet young children and their caregivers early, before concerns compound. The program serves children from birth to five years and brings together developmental services and mental health care into a single coordinated model based on the unique needs of the child and family.
“The early years form a real foundation for how children go on to navigate the world,” said Kristen Sylvester, manager of the KidSTART Clinic. “We can support families and help shift the trajectory.”
When Ashton first entered KidSTART programming, he didn’t join other kids at the table for play and learning. Instead, he crawled underneath it.
Group settings were hard. He didn’t follow routines or respond to social cues. He struggled with speech and feeding. He went from calm to overwhelmed without warning.
The challenges were already beginning to stack.
At the same time, his mom was navigating her own substance abuse recovery, parenting stress, and uncertainty about how to support him.
For Ashton, changing the trajectory meant starting not just with his developmental and mental health needs, but with the caregiver at the center of his world.
Caring for caregivers
The KidSTART program operates two components: the KidSTART Center, which provides developmental services such as speech, behavior, and occupational therapy and care coordination, and the KidSTART Clinic, which focuses on mental health care for both kids and their caregivers.
Rather than splintering care across settings, teams work side by side to reduce fragmentation and ease the burden on families.
“It is essential to have caregivers understand and be involved in treatment for their young children,” said Natalie Elms, manager of the KidSTART Center. “We help break down barriers for caregivers and deliver services in a way that is engaging and accessible for them.”
Children are referred to the program from multiple sources, including pediatric health care providers, child welfare, community programs, and early childhood partners.
When Ashton was referred to KidSTART, his referral was carefully reviewed in a weekly meeting between leaders from the KidSTART Center and the KidSTART Clinic. During the triage meeting, the child’s needs are discussed and then next steps are determined, which often includes a comprehensive developmental evaluation, a mental health assessment, or both.
For Ashton, the care plan included multiple services along with support for his mother.
While he participated in group-based developmental services, his mom joined a caregiver group facilitated by a social worker. That group discussed strategies being used with their children, and how to bring those into daily life.
Most of KidSTART’s mental health interventions are dyadic, meaning caregivers and kids participate together. The goal is to strengthen relationships and support caregivers as partners throughout the journey.
“For the change to really permeate into a child’s life, you need their most important people there to carry it out of the treatment room,” Sylvester said. “A lot of our modalities are focused on the child and the caregiver and their relationship.”
Supporting families upstream
Early childhood is a period of rapid growth. Nearly 90% of neural connections form by age 5. Emotional regulation, communication, and attachment begin developing in the first year of life.
“This is the time when kids are developing the fastest,” Sylvester said. “It’s also the time when mental health and development are so intricately linked that they really have to be addressed together. A small intervention can have a big result.”
Children often enter KidSTART with overlapping concerns like developmental delays, trauma exposure, prenatal substance exposure, medical concerns, and food or housing insecurity. Without coordinated care, these factors can blur diagnostic clarity and make it difficult for care teams to understand what a child truly needs.
“If a child has a traumatic experience, the way they communicate is going to change depending on their developmental stage,” Elms said. “If we’re going to be able to understand the impact, we need to work together so we can get ahead of potential symptoms.”
KidSTART operates as a transdisciplinary team. Occupational therapists, speech-language pathologists, behavior specialists, mental health clinicians, social workers, parent care coordinators, psychologists, psychiatrists and a developmental behavioral pediatrician collaborate regularly to align goals and create one clear path for families. Parent care coordinators with lived experience also help caregivers work toward their goals and navigate community and school resources.
This approach is not only more effective for kids, but also reduces stress for caregivers, whose own mental health directly influences child outcomes.
“Supporting caregiver mental health is critical to treating kids with anxiety and attachment concerns,” Sylvester said. “Caregivers are often under enormous amounts of stress and helping them cope promotes their ability to support their children.”
Rebuilding safety and confidence
As part of his care, Ashton participated in child-parent psychotherapy treatment. This approach helps caregivers and children process difficult experiences together and regain a sense of safety.
“The work focuses on the parent and child understanding past traumatic events and making meaning together of them,” Sylvester said. “It opens up communication so there aren’t forbidden or scary things that don’t get talked about.”
A key element of the care was restoring the caregiver’s role. Ashton’s mother strengthened her confidence and began efforts to repair the impact of their earlier separation. Those past experiences were no longer unspoken.
“It lays the groundwork so that as a child gets older and begins to understand and have more questions, they can talk about it openly,” Sylvester said. “That becomes a protective factor for later maternal health.”
Progress came gradually through coordinated services and ongoing caregiver support.
Ashton began to tolerate group activities. He learned how to successfully participate in routines. His confidence grew.
His mom had more understanding, parenting strategies and tools, and reassurance. She felt prepared to advocate for services and support Ashton through his transition to school.
A turning point
By the end of the program, Ashton no longer hesitated at the doorway when he arrived for KidSTART services.
In his transdisciplinary group therapy sessions, Ashton sat in his spot, took his shoes off like the other children, and was excited to participate in the obstacle course, art activities, and circle time.
When he noticed the child seated next to him was unsure of what to do, Ashton offered a friendly smile and showed him how to raise his hand to request a turn.
It was a small moment, but it captured what KidSTART staff hope to build long before a child enters school.
“It was so dramatically different from when he started and beautiful to see his developmental and social skills emerging,” Elms said. “He was confident in his skills and the social understanding of how to be a friend, to be a helper to his little neighbor.”
The six-to-18-month program plans for discharge and transitions early. In Ashton’s case, plans began months ahead to connect with school district services and continue speech therapy in a group setting elsewhere at the hospital. This approach prepared Ashton — and his mom — for his next chapter.
“We support in a way that sets children and their families up for success, rather than waiting until the child enters kindergarten struggling,” Elms said. “It’s giving them what they need from the beginning.”
Using common language
What made Ashton’s progress possible wasn’t just early intervention; it was the way care focused on strengths alongside needs.
The KidSTART program is guided by the HOPE (Healthy Outcomes from Positive Experience) framework, which emphasizes relationships, environments, engagement, and emotional growth for children and families.
At the clinical level, HOPE helps caregivers understand what is working in a child’s life and how positive relationships and support contribute to a child’s development.
“The building blocks tie what life is like in the real world,” Sylvester said. “Having an explicit framework is so helpful to break out of the hospital walls and ensure we’re touching all parts of somebody’s life to support them.”
HOPE also functions as a common language across San Diego’s early childhood ecosystem, including community partners and child welfare and social service providers.
“It’s a beautiful common language for us to have across organizations,” Elms said. “To be able to take this strength-based approach is important to build trust in providers and systems again.”
Strengthening futures
Now in its 15th year, KidSTART serves about 300 children annually. The program, now funded in partnership with the County of San Diego Behavioral Health Services, tracks developmental progress, caregiver well-being, and placement stability. More than 98% of participants have maintained the child’s home and school placements.
The need for the program is both urgent and hopeful.
“There’s no shortage of kids that need services,” Sylvester said. “But more people are recognizing children’s needs sooner. We’ve provided a place where caregivers feel comfortable because their child is being helped and they can engage in their own supports.”
That supportive environment depends on a model that prioritizes collaboration and opportunities to intervene more effectively.
“It’s absolutely critical to build the infrastructure to have a high degree of consultation across teams,” Elms said. “When you have a caregiver who has their own set of challenges, it’s impossible for a child to make as great of gains without that level of coordination and collaboration.”
And for Ashton and his mom, the early support from age 4 to 5 didn’t just change the trajectory of their relationship — it reshaped what was possible before he ever walked through a classroom door.
