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The Infant Toddler Mental Health Coalition of Arizona

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Frequently Asked Questions


What is involved in the Endorsement® process?
  1. Register on the Endorsement Application System (EASy), which involves submitting preliminary information and paying the EASy registration fee
    • When registering on EASy, it is strongly recommended that you register using a personal email address (e.g., Gmail, yahoo, Hotmail, etc.). Employer email servers often block messages sent by EASy
  2. EASy applicants must have a current membership with ITMHCA or another IMH association
    • ITMHCA memberships run on a calendar year. Any 1-year membership purchased before October 1st will expire December 31 of the same year. Any 1-year membership purchased after October 1st will expire December 31 of the following year. For example, a 1-year membership purchased on August 1, 2020 will expire on December 31, 2020. A 1-year membership purchased on October 10, 2020 will expire on December 31, 2021. There are no exceptions that can be made to this rule.
    • EASy applicants with memberships in associations other than ITMHCA must provide documentation in writing to of their membership in another Infant Mental Health Association
  3. EASy will email you a username and password
  4. Build your professional application, including work, in-service training and supervisory experiences. This reflects your capabilities within the infant, young child and family field
  5. You will be asked to list the names and email addresses for the 3 individuals who will complete reference rating forms on your behalf. EASy will send an email to each reference rater; the whole process is done electronically. Please ask your reference raters for a personal email address so they will receive the secure link to complete the form on EASy
  6. Once your application is complete you may "Submit" by clicking the button that appears on your EASy dashboard. This includes paying the Endorsement Processing Fee
  7. Applications are reviewed quarterly. Check the Announcements section on the login page for EASy to see when the next review will take place
  8. Infant Family Associate and Infant Family Specialist applicants receive an Endorsement® decision after at least one trained reviewer, who has earned Endorsement®, examines and approves the application
  9. Infant Mental Health Specialist and Infant Mental Health Mentor applicants move on to the written Endorsement® exam after at least one trained reviewer, who has earned Endorsement®, examines and approves their application. ITMHCA offers the written exam once or twice a year. Check our Calendar to see when the next exam will take place

How do I ask for help while completing the Endorsement® process?

If you have questions while in EASy, select the "Support" button in the upper right-hand corner. Applicants can indicate whether the issue is technical or related to the Endorsement® process. There are also Comment boxes within every tab of the Endorsement® application where applicants can ask questions or leave remarks. If you have other questions, unrelated to EASy, email the Endorsement Coordinator.

How long does it take to apply for Endorsement®?

ITMHCA requires that applicants register on EASy a minimum of 4-weeks before an intended submission date. This ensures enough time for receipt and upload of transcripts, completion of reference ratings, and thorough entries related to applicant's specialized work, in-service training, and RSC experiences.

Most applicants spend an average of 6-12 months completing their Endorsement® application. That said, this depends largely on applicants' work, supervision, and training experiences in addition to the Endorsement® category for which they are applying.

How much does Endorsement® cost?

The costs for Infant Specialist and Infant Mentor are in line with credentialing fees that have been established by other professional organizations, e.g. CDA (Child Development Associate) and ACSW (Accreditation for Certified Social Workers). The credentialing fees support the overhead costs of the ITMHCA Endorsement® and allow us to have applications and exams carefully reviewed.

Fees Associated with ITMHCA Endorsement®

 ITMHCA MembershipEASy RegistrationEndorsement Processing
Infant Family Associate$60$15$25
Infant Family Specialist$60$20$100
Infant Mental Health Specialist$60$25$200
Infant Mental Health Mentor$60$25$300

Infant Family Associate

Infant Family Specialist

Infant Mental Health Specialist

Infant Mental Health Mentor

What happens after I submit my application for review?

All applications are carefully reviewed by at least one trained application reviewer who has earned Endorsement®. The application reviewer will examine your official transcripts, reference rating forms, and qualifying specialized work, in-service training, and RSC experiences. Then they will make a recommendation about whether to recommend your application for Endorsement®, to approve you to sit for the Endorsement® exam, or may suggest that you pursue further work, training and/or RSC experiences and then have your application be re-reviewed after a period of time.

Why should I earn Endorsement®?

Neurons to Neighborhoods (Shonkoff and Phillips, 2000) and Transforming the Workforce for Children Birth through Age 8: A Unifying Foundation (2015) report there is a critical shortage of well-trained professionals who have knowledge, skills and supervised work experience to promote healthy social and emotional development, and to intervene and treat serious early childhood mental health problems.

By engaging in Endorsement®, you will:

  • Grow and develop as a professional in the rapidly expanding infant, young child and family service field
  • Be recognized by employers and peers for having attained a category of competency in culturally sensitive, relationship-based practice that promotes infant and early childhood mental health
  • Become a part of one of the first and most comprehensive international efforts to identify best practice competencies at multiple levels and across disciplines and to offer a pathway for professional development in the infant and family field.

What benefit is there if I have earned a graduate certificate in infant mental health?

Graduates from a college or university program or post-graduate certificate program in infant mental health must submit documentation of completion of the program, such as a copy of diploma or certificate. Certificate holders may find that their course work has documented their competency in all of the knowledge and skill areas under Theoretical Foundations and Direct Service Skills as defined for Infant Family Specialist or Infant Mental Health Specialist. The approved competencies vary from program to program.

  • Although most of the competencies are documented by the completion of a university-based certificate in infant mental health, certificate holders who apply for Endorsement® must still include at least 30 hours of specialized in-service training

How do I indicate that I have earned the Endorsement®?

The Infant Mental Health Endorsement® (IMH-E®) marks indicates that a person has earned Endorsement®. Use of the registered trademark is important (whenever possible) to distinguish from other systems of "endorsement."


    Jane Doe, IMH-E®
    Infant Family Associate

    John Doe, BSW, IMH-E®
    Infant Family Specialist

    Jane Doe, MSW, LMSW, IMH-E®
    Infant Mental Health Specialist

    John Doe, MA, IMH-E®
    Infant Mental Health Mentor – Clinical

 Reflective Supervision/Consultation

Am I only able to include RSC hours from those who are trained in RSC?

RSC that meets criteria for Endorsement® must come from an individual who has earned Endorsement® as an Infant Mental Health Specialist or Infant Mental Health Mentor-Clinical. A lot of clinical supervision is reflective, but perhaps not all is from a specialist in infant and early childhood mental health. The only exception is for applicants who are pursuing Infant Family Specialist and are Bachelor's prepared; they can receive qualified RSC from someone who is an Infant Family Specialist AND is Master's prepared.

How do I count reflective consultation?

Many individuals do not have a direct supervisor who has earned Endorsement®, however, they do receive RSC from a consultant who is endorsed. If your team meets with an endorsed consultant, you can count the hours of time that you spend with the consultant, even if you are not the identified presenter. For example, if you meet and participate in case consultations once a month for two hours, you will have 24 hours of RSC that meets criteria for Endorsement®.

Should I include all sources of reflective supervision (i.e. program supervisor, reflective supervisor, reflective consultant etc.)?

If all of those sources meet criteria for Endorsement®, you may include them all as long as the majority of the required clock hours were provided by just one or two supervisors/consultants.

As in relationship-focused practice with families, RSC is most effective when it occurs in the context of a relationship that has an opportunity to develop by meeting regularly with the same supervisor/consultant over a period of time. Therefore, ITMHCA expects that Endorsement® applicants will have received the majority of their hours (24 clock hour minimum for Infant Family Specialist and 50 clock hours for Infant Mental Health Specialist and Infant Mental Health Mentor-Clinical) to come from just one source with the balance coming from no more than one other source.

Some applicants may have special circumstances, e.g. if the program supervisor changed or if the applicant moved positions. Exceptions regarding the number of RSC providers should be discussed with the Endorsement Coordinator.

I have a co-worker who has earned Endorsement® as an Infant Mental Health Specialist. Can s/he provide the hours of reflective supervision I need for Endorsement®?

Peer supervision (defined as colleagues meeting together without an identified supervisor/consultant to guide the reflective process), while valuable for many experienced practitioners, does not meet the RSC criteria for Endorsement®. The provider of reflective supervision is charged with holding the emotional content of the cases presented. The ability to do so is compromised when the provider is a peer of the presenter. Unnecessary complications can arise when the provider of reflective supervision has concerns about a peer's ability to serve a particular family due to the peer's emotional response AND the provider and peer share office space, etc.


I have attended well over 30 hours of in-service training; should I submit every in-service training I've ever attended?

You will include as many hours of relationship-based in-service training and/or continuing education as necessary to document that the competencies (as specified in Competency Guidelines®) have been met.

You will list which specific knowledge/skill areas are covered at each training, e.g., attachment, separation and loss; cultural competence; etc. For a training to count toward Endorsement® at least one competency must have been covered. It is important to remember that Endorsement® reflects training specialization in the promotion of culturally sensitive, relationship-based practice promoting social and emotional well-being in the first years of life or infant and early childhood mental health.

Although the minimum requirement is 30 hours of in-service training, we expect Endorsement® applicants to document that they have achieved competency in almost all of the knowledge/skill areas via their college course work, on-the-job training, in-service training opportunities, and reflective supervision/consultation.

To demonstrate that the full range of competencies have been covered:

  • Most IFA applicants submit an average of 40 hours of in-service training experiences
  • Most IFS applicants submit an average of 50 hours of in-service training experiences
  • Most IMHS applicants submit an average of 75 hours of in-service training experiences
  • Most IMHM applicants submit an average of 75 hours of in-service training experiences

How do I know when my EASy application demonstrates enough to show a competency area has been met?

This varies greatly depending on many factors including how long ago you took college courses, how specific the course or training is to infant and early childhood mental health, number of hours, etc. That said, you can use the Competencies page of your EASy application to help you determine this. This page is intended to be used as a "self-study" to help you assess your education and in-service training experiences and determine what additional specialized training might be necessary to meet the competencies and earn Endorsement®. You are encouraged to review this "self-study" with an advisor, endorsed colleague, supervisor, mentor, or provider of RSC before submitting your Application as an informal review. Someone who has been through the Endorsement® process themselves will have important and beneficial feedback to share with you!

At least one trained application reviewer will carefully examine all the material in your application including college transcripts, in-service training record, and reference rating forms. An application reviewer will be looking most closely at the competency areas under Theoretical Foundations, Direct Service Skills, and Reflection. For the areas of Theoretical Foundations (including pregnancy and early parenthood; infant/very young child development and behavior; attachment, separation, trauma, and loss; cultural competence; etc.) and the areas of Direct Service Skills (including observation and listening; screening and assessment; etc.) competency must be documented by course work and/or in-service training. That is, work experience alone is not enough to document competency in areas such as attachment, separation, trauma, and loss or screening and assessment.

How far back can I go when including trainings that meet criteria for Endorsement®?

There is no limit on how long ago the training was attended to be counted toward requirements. Some applicants may have been in the field for many years and are encouraged to include all the trainings that have shaped their practice in infant, early childhood-family work. However, it is not necessary to submit a comprehensive list of every training ever attended. The list should reflect a balance of breadth and depth across the competencies and the promotion of infant and early childhood mental health.

Are only ITMHCA sponsored trainings eligible for Endorsement®?

The training does not need to be sponsored by ITMHCA to be eligible to count toward your minimum for Endorsement®. In fact, many trainings that you attend for professional licensing or agency requirements may also qualify for Endorsement® (e.g. an ethics training for social workers, Part C training about family-centered planning, or doula training, to name only a few).

A specialized training that is eligible for Endorsement® should meet the following criteria:

  1. Is culturally sensitive, relationship-focused and promotes infant and early childhood mental health
  2. Relates to one or more of the knowledge/skill areas in the Competency Guidelines®
  3. Is specific to the Endorsement® category for which you are applying

Are there any in-service trainings, conferences or courses that are mandatory while working toward Endorsement®?

No, however, we strongly recommend that you carefully review the Competency Guidelines® to identify the knowledge/skill areas for the Endorsement® category for which you are applying. We expect applicants to document competency in these areas either through college course work, on-the-job training, in-service training opportunities, and RSC. It is important to seek out in-service training/conference offerings that will fill in any competency gaps you might have. Some skill areas (such as empathy and compassion, self-awareness) will be documented in the three reference ratings that you will include with your application.

Trainings that might not meet criteria would be focused primarily on school-aged children, adolescents or the elderly.


What is the difference between the specialized work experiences that meet criteria for Infant Family Specialist and Infant Mental Health Specialist?

Infant Family Specialist work experience is typically broader and encompasses many of the ways that applicants might work with the families of infants and toddlers including case management, Part C service coordination, home visiting, parent education, and family support.

Infant Mental Health Specialist work experiences include the following interventions: advocacy, developmental guidance, emotional support, concrete assistance, and parent-infant/very young child relationship-based therapies and practices (e.g. Infant Parent Psychotherapy). These therapies and practices are intended to explore issues related to attachment, separation, trauma, and unresolved losses as they affect the development, behavior and care of the infant/very young child. Competence as an IMHS builds with supervised work experience over time with services delivered to the families of infants and toddlers that are relationship-focused and culturally sensitive with an emphasis on examining the role of relationships in reflective supervision.

I am Bachelor's prepared and work in an infant/toddler classroom. I receive reflective supervision regarding the infants/toddlers and their families. Do I qualify for Infant Family Specialist?

ITMHCA does not count classroom experience toward the specialized work experience requirement for Infant Family Specialist mainly because, while a focus on social emotional development is one of the roles, it is not the primary role of an infant/toddler teacher. Quality early care and education settings certainly use opportunities in the daily routine to promote social and emotional development, but are also charged with feeding, diapering/toileting, care, safety, and curriculum development that promotes all domains of development. The primary work of most early care and education settings is not supporting the relationships that surround the infant/toddler. It is our hope that early care and education providers, especially those who pursue and earn Endorsement®, do work with infant and early childhood mental health principles in mind, which is why the competencies that are required for Infant Family Associate are nearly identical to those required for Infant Family Specialist. Experience in an early care and education setting is valuable and can be counted toward meeting the requirements for Endorsement® as an Infant Family Associate.

Does work experience with pregnant women and families count towards the work experience requirement for Infant Family Specialist and Infant Mental Health Specialist?

Yes, work with pregnant women and families does count towards the required work experience for IFS and IMHS. However, the applicant's work experience must ALSO include work with infants, toddlers, and their families.


What is the format of the exam?

There are two parts to the Endorsement® exam.

Part One (60 Multiple Choice Questions – 90 minutes)
The multiple-choice, or quantitative, section is primarily focused on infant and early childhood mental health knowledge specific to work with infants, young children, and their families. Most questions will be related to direct service, but there will be some questions related to reflective supervision/consultation, policy, and research. The multiple-choice section is the same for all Specialist and Mentor applicants. Knowledge gained through course work, specialized in-service training, and self-study will be most useful in this section of the exam. IMH-E® applicants are expected to have knowledge on pregnant women, infants, young children (up to age 3), and families.

Part Two (Vignettes – 90 minutes)
The qualitative section will ask for responses to vignettes. This section is intended to measure the applicant's capacity to apply their knowledge of IECMH principles into practice and to demonstrate a reflective, relationship-based approach. While all of the competency areas are important, the ones under the Reflection, Thinking, and Working with Others domains are important to the qualitative section for Specialists and Mentors - Clinical.

The Administration domain is the primary focus of the Policy exam. Policy applicants are asked to demonstrate a capacity to promote IECMH principles and practices within and across systems.

The Research and Evaluation domain is the primary focus of the Research/Faculty exam. In the Research/Faculty exam, one scenario is more specific to teaching; the other scenario is more specific to empirical research. Research/Faculty applicants will demonstrate a commitment to IECMH principles and practices related to research or course planning and instruction. To learn more see the What to Know About the Endorsement® Exam.

What primary topics are covered in the multiple-choice portion of the test?

The multiple-choice questions are related to the knowledge and skill areas of the competencies as indicated in the Competency Guidelines®, such as:

  • Attachment separation, trauma, grief, and loss
  • Pregnancy, infant and young child development and behavior
  • Relationship-based therapeutic practice
  • Infant mental health screening and assessment
  • Disorders of infancy/early childhood
  • Cultural competence
  • Reflective practice

How should I study for the exam?

Studying for the test will vary from person to person. If you are currently engaged in relationship-based practice with infants, young children, and their families, receive reflective supervision and have consistently updated your knowledge and skills through specialized in-service training or enrollment in university or college course work specific to infancy, early parenthood and infant and early childhood mental health, you will most likely be very well prepared. If you have not engaged in a great deal of clinical practice or attended in-service trainings or university-based coursework specific to the promotion of infant and early childhood mental health, you will likely find the exam challenging. To learn more, see the Exam Preparation Resource List.

What happens if I do not pass the exam?

A passing score on Part 1 (multiple choice) of the exam is 80%. Applicants who receive a score of less than 80% will be invited to take the exam again in one year. In order to carefully protect the exam materials, applicants will not receive specific feedback related to the questions missed on Part 1. Applicants who do not receive a passing score on Part 2 (response to vignettes/scenarios) will be provided specific feedback based on exam reviewers' remarks. Those applicants will be invited to take the exam again in one year.


In order to renew Endorsement® annually, the following is required:

  • On-going membership in ITMHCA or another IMH Association
  • 15 clock hours of training related to culturally sensitive, relationship-focused practice promoting infant and early childhood mental health. If you are a provider of RSC, at least 3 hours of the 15 hours required need to be about the provision of RSC
  • It is strongly recommended that all IMHS and IMHM-C endorsees participate in ongoing reflective RSC

*NEW* beginning in 2023 (for renewals processed by the February 2024 deadline), those holding Endorsement® as Infant Family Specialist, Infant Mental Health Specialist and Infant Mental Health Mentor-Clinical will also need to meet the following requirement for annual renewal:

  • Receive a minimum of 12 hours of RSC annually (group or individual; in-person or distance technology)
  • Provider of RSC must be endorsed as an IMHS or IMHM-C. Exception: IFS endorsees who are Bachelor's prepared may count RS/C received from other IFS endorsee's who are Master's prepared.

For questions about Endorsement® please email