Penfield’s Early Pathways Named Among the Most Effective Treatments in the Country for Infant and Early Childhood Mental Health 

A new international review of the scientific evidence singles out Early Pathways, developed and delivered right here in Wisconsin, as one of only two dyadic therapies proven effective for children ages 0–6 already experiencing clinical mental health symptoms. 

When a toddler is struggling with aggression, anxiety, or the aftermath of trauma, parents and pediatricians need to know that the help they’re being offered actually works. A newly published scoping review in Child and Adolescent Psychiatry and Mental Health, the peer-reviewed journal from BioMed Central, gives Penfield Children’s Center’s Early Pathways program exactly that kind of validation, and on a national stage. 

The review, conducted by researchers affiliated with the Children’s Hospital of Eastern Ontario (CHEO) and the University of Ottawa, set out to answer a deceptively simple question: of all the “dyadic,” relationship-based therapies designed to strengthen the bond between young children and their caregivers, which ones actually hold up as treatments, not just prevention, for children who are already showing clinical symptoms? 

The researchers began with 33,960 studies identified across five major databases and years of hand-searching. After rigorous screening, only 62 studies met the bar for inclusion, spanning eight distinct treatment models used around the world. 

Two rose to the top. 

Early Pathways: One of Two Models with the Strongest Evidence Base 

Alongside Parent-Child Interaction Therapy (PCIT), Early Pathways (EP) was identified as one of the two interventions with the most robust published evidence for treating young children’s mental health symptoms and the only one of the two developed and based entirely in Wisconsin. 

Here’s what the review found, drawing on eight separate studies of Early Pathways involving more than 1,000 children: 

• Consistent, statistically significant improvements in children’s emotional and behavioral functioning, sustained at 4–6 week follow-up. 

• Particular strength in reducing aggression and anxiety, two of the most common and most disruptive symptoms clinicians see in this age group. 

• Three of the program’s randomized controlled trials used intention-to-treat analysis, a gold-standard statistical approach that minimizes bias, a distinction most studies in the review did not achieve. 

• Successful adaptation for African American and Latino families, and, more recently, for children experiencing early childhood PTSD, evidence that the model can flex to meet the needs of diverse communities. 

• A theoretical foundation that blends attachment theory, cognitive-behavioral therapy, and social learning theory, allowing therapists to work simultaneously on the parent-child relationship and the specific behaviors a family is struggling with. 

The reviewers were also candid about where the field, including EP, still needs to grow: most studies to date have come from a single research team, long-term outcomes beyond a few months are still being established, and attrition (particularly in waitlist comparison groups) remains a challenge shared across nearly every intervention in the review. Penfield sees this not as a caveat to downplay, but as the next chapter to write, and an invitation for continued investment in outcomes research. 

Why This Matters 

For families, this means the home-based, parent-child support they receive through Early Pathways isn’t just compassionate care. It’s a model now recognized in international scientific literature as genuinely effective medicine for the developing brain. 

For clinicians and pediatric partners, it means a trusted referral: Early Pathways is one of only two dyadic interventions clinicians nationally can point to with confidence when a young child needs more than prevention. They need treatment. 

For funders and community partners, it means an investment in Early Pathways is an investment in a program whose results are holding up to the highest standards of independent, international scientific scrutiny, not just Penfield’s own reporting. 

“For families, providers, and communities, it matters deeply that Early Pathways is not only compassionate and relationship-centered but backed by strong evidence that it works. This recognition affirms what we have seen in Milwaukee homes for years: when young children and caregivers receive the right support early, healing is possible and outcomes improve. We are motivated by that evidence to make Early Pathways available more widely, and the launch of our Training & Certification Institute is an important step toward equipping more professionals and communities to bring this proven model to the children and families who need it most.”

— Polina Makievsky, President & CEO, Penfield Children’s Center

 “Early Pathways reflects that a community-based agency and university can collaborate to develop and offer effective interventions for children and their families. Marquette is proud to partner with an agency doing this level of trauma and mental health intervention for Milwaukee’s youngest children and their families.”

— Alan W. Burkard, PhD, Professor, Department of Counselor Education and Counseling Psychology 

About Early Pathways 

Early Pathways is a home-based, parent-child mental health intervention for children from birth to 72 months. The Early Pathways treatment model was developed by Dr. Robert Fox and Marquette University faculty and was built upon the STAR Parenting model. Penfield Children’s Center acquired the model in 2020 and is responsible for its delivery and evaluation. Rooted in attachment theory, the program pairs therapists with families in their own homes to build caregiving skills, emotional connection, and behavioral strategies that help children heal and thrive. Early Pathways has served families across Milwaukee for years and continues to be refined and studied as a national model for infant and early childhood mental health care. 

About Penfield Children’s Center 

Penfield Children’s Center is a Milwaukee-based nonprofit dedicated to ensuring children have positive early experiences from pregnancy through age 5, when the foundations for lifelong development are established. Penfield serves children and their families through a comprehensive continuum of early education, early intervention, pediatric therapy, autism services, and infant and early childhood mental health programs. 

As the co-developer of the Early Pathways model, Penfield has helped advance a developmentally informed approach to infant and early childhood mental health that supports young children and their caregivers together. Building on the model’s growing recognition, Penfield is in the early stages of launching a national training and certification institute to equip clinicians across the country to implement Early Pathways and expand access to developmentally appropriate mental health services for young children and their families. 

Source: Matheson K, de Schaetzen C, Li A, et al. Dyadic attachment-based therapies for infants and young children with mental health problems: a scoping review. Child and Adolescent Psychiatry and Mental Health. 2025;19:124. https://doi.org/10.1186/s13034-025-00981-7