Birth-to-Three Clinic


The goals of the Birth-to-Three Clinic are to:

boy playing with toys

  • Provide mental health evaluation and assessment of social-emotional development
  • Focus on eliminating the gap in services for children ages zero to three
  • Capitalize on the sensitive period of brain development
  • Address multiple risk factors that children with a history of early adversity are facing within their first three years of life
  • Provide therapeutic interventions for parents and children, including guidance and resources for effective parenting

Why focus on children ages zero to three?

A children's environment determines how connections in the brain are built, and the period between ages 0-3 has a lasting impact on brain structure.  This sensitive period is a time when a child's brain is uniquely plastic, and interventions can be most effective.

What is toxic stress response?

Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity - such as physical or emotional abuse, chronic neglect, caregiver mental illness, exposure to violence, multiple hospitalizations, stressful transitions - without adequate adult support.  This kind of prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment well into the adult years.


Clinical Services

Who will benefit from a referral to this clinic?

Children with a history of early adversity/toxic stress in addition to symptoms including:

  • Child does not actively look for help from parents/caregivers
  • Disinhibited social behavior pattern
  • Impaired motivation to explore
  • Decrease in communication skills

Or the child demonstrates an increase in:

  • Behavior problems: frequent meltdowns, tantrums, difficulty controlling emotions or behavior, aggressive behavior toward other people
  • Regulation issues: extensive sleep problems, increased fear and anxiety, easily overwhelmed by environmental stimuli, overly active, frenetic compared to peers


The clinic services will be covered by most insurance.

ProviderMaria Kroupina, PhD, LP, Pediatric Psychologist,

ProviderKathryn Elison, MSW, LICSW, Psychotherapist,

Schedule an appointment: (612) 365-6777

Location: University of Minnesota Masonic Children's Hospital, Discovery Clinic, 2512 Building, 3rd Floor, 2512 South 7th St, Minneapolis, MN 55454


Dr. Kroupina presents at the University of Minnesota's Department of Pediatrics Grand Rounds on January 21, 2015.

Continuing medical education coursework is being developed to introduce pediatricians and medical specialists working with 0-3 patients to early childhood mental health and development.  The course is expected to be available online for pediatricians and medical specialists in fall 2015.  For questions, contact program coordinator Molly McCoy at


Past Events

Toxic Stress and the Impact on the Developing Brain: Informing pediatric practice, assessment and evidence-based interventions.

The Birth to Three Clinic in the Department of Pediatrics is hosting an event to introduce attendees to the impact of toxic stress on the developing brain. Children who have experienced toxic stress arising from medical trauma, absence of sensitive/supportive parenting, and multiple transitions early in life can have negative mental health and physical outcomes as a result of these early experiences. Research tells us that early intervention is best, and there is an emerging field of evidence-based interventions that support optimal social, emotional and cognitive development for this population. We will talk about identification of at-risk children and evidence based interventions with children from birth to three years of age. A major goal is to develop an informed practice based on research in early brain development and toxic stress.

Speakers included:
Maria Kroupina, Director of the Birth to Three Clinic
Jane Ellison, State Trainer for Trauma Informed Child-Parent Psychotherapy (TI CPP)
Kathryn Elison, Psychotherapist in the Birth to Three Clinic

For information or event recording contact Emily Danich at


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.


The Birth to Three Clinic trains pediatric residents, students in social work, and international mental health professionals. BTT also hosts medical students from Maastricht University in the Netherlands during their 18 month clinical research internship requirement.