Infant Mental Health Approach Research Articles

An exploration of staff experience and participation in a perinatal and infant mental health network group.

Infant mental health (IMH), an area which focuses on the social and emotional development of infants in the context of the parent-infant relationship, has become an increasingly prominent field of both research and clinical practice worldwide. IMH network groups are initiatives which aim to facilitate continuous learning in the IMH approach, provide an opportunity for case discussion and encourage reflective practice. This study aimed to explore the experiences of staff working within an adult mental health (AMH) service and their participation in a perinatal IMH network group (PIMH-NG). This study had a qualitative research design and the data were collected using a focus group methodology. Participants were recruited from a PIMH-NG which aimed to provide staff working within an AMH setting with the opportunity for continuous development of IMH knowledge. The data were analysed using thematic analysis. The data gathered from the focus group indicated that staff participating in a PIMH-NG enhanced their clinical skill, reflective practice and supported the dissemination of IMH knowledge throughout their respective teams. The PIMH-NG facilitated this work by providing the opportunity for continuous learning, reflective group discussion and ongoing peer support. The findings of this study indicate that incorporating elements of an IMH model into AMH services can be beneficial for staff, service users and overall service deliveryand development. These findingsmay be used to develop the structure and content of future network groups of this nature.

The Michigan infant mental health home visiting model.

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent-child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.

Cultural adaptation of an intervention to prevent postnatal depression and anxiety in Chilean new mothers

ABSTRACT Objective: The aim of this study was to culturally adapt What Were We Thinking (WWWT), an Australian psychoeducational intervention to prevent symptoms of depression and anxiety among first-time mothers, to be used in the Chilean primary health system. Background: Mental health symptoms are common in first-time mothers. Despite the availability of effective screening and referral in the Chilean primary health system, very few women access treatment due to diverse barriers. This highlights the importance of using a preventive approach. The evidence that culturally-adapted, evidence-based preventive programmes can reduce maternal mental health problems supports the development of this study. Methods: WWWT materials were translated into Spanish. Cultural Adaptation and field testing were conducted following the Cultural Adaptation Model. Results: Modifications to the intervention included adding an explicit infant mental health approach, a simplification of written information, and changes in the number and duration of the sessions. The adapted version of WWWT was considered understandable and relevant for local perinatal mental health specialists, new mothers and their partners. Conclusion: The Spanish version of WWWTis a culturally sensitive intervention, its potential for effective use in the Chilean context warrants further investigation. Limitations and implications for future studies are discussed.

Reflective Capacity: An Antidote to Structural Racism Cultivated Through Mental Health Consultation.

ABSTRACTEffecting a paradigm shift from “reproductive health” to “reproductive justice” within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant‐Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use‐of‐self in patient–provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well‐being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice.

Child-Parent Psychotherapy with Infants Hospitalized in the Neonatal Intensive Care Unit.

Hospitalization in the Neonatal Intensive Care Unit (NICU) is a stressful and potentially traumatic experience for infants as well as their parents. The highly specialized medical environment can threaten the development of a nurturing and secure caregiving relationship and potentially derail an infant's development. Well-timed, dose-specific interventions that include an infant mental health approach can buffer the impact of medical traumatic stress and separations and support the attachment relationship. Many psychological interventions in the NICU setting focus on either the parent's mental health or the infant's neurodevelopmental functioning. An alternative approach is to implement a relationship-based, dyadic intervention model that focuses on the developing parent-infant relationship. Child-parent psychotherapy (CPP) is an evidence-based trauma-informed dyadic intervention model for infants and young children who have experienced a traumatic event. This article describes the adaptation of CPP for the NICU environment.

Infant Mental Health and Family Mental Health Issues

This article examines common parental responses to the experience of having a medically fragile infant in the intensive care unit, which are compounded by parental mental health issues, and may result in a disrupted parent-preterm infant attachment. The importance of an interdisciplinary team with a strong infant mental health approach is described.

Infant Mental Health in Prenatal Care

Pregnancy is a time of profound physical and psychological change. It marks the transition to parenthood and the beginning of the infant-parent attachment, which is critical for the infant's future mental health. We describe obstetric practices that utilize an integrated infant mental health approach. Integrated infant mental health models in prenatal care emphasize the importance of the maternal fetal relationship, both from a medical as well as a relational perspective. Professionals using an infant mental health informed approach during the course of obstetric care have an opportunity for promotion of the relationship between the mother and her baby and, if needed, can intervene at the earliest possible time, minimizing the psychological vulnerability of the prenatal period.

Implementation of the PICCOLO in Infant Mental Health Practice: A Case Study

ABSTRACTThis case study examined the integration of the PICCOLO tool within home‐based services using an infant mental health approach with a family at risk. The tool was identified as best practice in Michigan and fits well with basic infant mental health theory. A narrative case example shows the use of the tool with a family and in supervision. Some of the benefits of using the PICCOLO within an infant mental health approach include (a) fostering a paradigm shift in multiple relationships from a deficit model toward a focus on strengths, (b) promoting efficacy and a positive outlook in parents, (c) documenting the impact of services on the parent–infant relationship, (d) providing a concrete structure for developmental guidance and strategies for using existing strengths to drive interventions, (e) allowing better sensitivity to unique strengths in families with children with special needs, (f) increasing observation skills and reflective capacity for the therapist.

Therapeutic play within infant-parent psychotherapy and the treatment of infant feeding disorders.

This clinical article presents an infant mental health approach to the treatment of feeding disorders in infants and toddlers that involves the infant-parent psychotherapist directly working with the infant's representations within infant-parent psychotherapy sessions. The treatment is informed by an assessment of the infant's emotional development, subjective experience, and the dynamics of the infant-parent relationship. This model involves therapeutically using play and words with infants and draws upon concepts from D.W. Winnicott and attachment theory as well as principles from the psychodynamic treatment of posttraumatic stress disorder in infants. The model was developed from clinical work over 2 decades in a tertiary pediatric hospital with infants who presented with feeding disorders ranging from breast or bottle refusal, refusal to wean onto solids, feeding aversion, tube dependency, and failure to thrive.

Professional Development Through Reflective Consultation in Early Intervention

The fields of special education/early intervention and infant mental health are moving closer, as practitioners find common ground in understanding and intervening to support vulnerable infants and toddlers. The importance of the impact of relationships on all developmental domains has been brought to the foreground. This includes relationships between parent and interventionist, as well as parent and child. Ongoing professional development in the form of reflective consultation supports the work of interventionists by fostering reflective functioning and facilitating a greater understanding of the impact of interactions and emotions in their work with families. This may lead to a broader and deeper range of intervention approaches and a better choice of intervention based on a better understanding of individual and family needs. This article describes a collaborative pilot project that integrates an infant mental health approach to support early interventionists within a special education system. The project supported the services of an infant mental health consultant to facilitate ongoing reflective consultation for 2 home-based school district teams working in an urban community. Data were collected to explore the effects of reflective consultation in supporting early interventionists, decreasing burnout, and increasing skills needed to work with diverse families. As a result of this project, the participants advocated for use of district professional development funds to continue reflective consultation with the consultant.

W06-01 Diagnosis, classification and treament of psychopathology in infants and toddlers: Incorporating an infant mental health approach

Aims:This workshop will present a theoretical framework to conceptualize early childhood behavior problems in the context of the early parent-child relationship, and will demonstrate how this relational framework can be used to diagnose, classify, and treat child behavior concerns in children under the age of five.Background:There is increasing evidence to suggest that a significant number of very young children manifest signs of early psychopathology, and that behavioral problems that emerge early are likely to persist, and warrant further assessment and intervention. One of the challenges to identifying early psychopathology in young children is how to diagnose and classify early behavioral disturbances using a developmental and relational framework.Methods:This presentation will describe an “infant mental health approach” to diagnose and intervene with young children with behavioral concerns. This comprehensive model of behavioral assessment incorporates an assessment of the parent's perceptions of the child, observations of dyadic interactions, and utilizes a developmental context to diagnose, classify and treat early behavioral concerns in children under the age of five. Using the DC 0-3R, this model will highlight how an understanding of child behavior in the context of the parent-child relationship can be a helpful framework to diagnose and treat early behavioral disturbances in children under the age of 5. Participants will learn how to identify vulnerabilities in the parent-child relationship, how to diagnose and conceptualize early psychopathology in young children, and how to formulate interventions to support dyads at risk.

Finding Kirk's Words: An Infant Mental Health Approach to Preschool Intervention

Three-year-old Kirk arrived for his 1st day of preschool in November. Initially reluctant to let his parents leave, Kirk suddenly accepted their goodbyes and assumed a space near the library area. Staring past everyone, Kirk's eyes appeared vacant and fixed straight ahead. Occasionally his gaze would shift in response to a loud noise or someone's sudden movement. However, Kirk maintained the same blank expression and a rigid posture. As these early days turned to weeks, Kirk sustained the same blank gaze, flat facial expression, and rigid posture throughout the 4-hour preschool day. When he was calm enough to engage in an activity, it was almost exclusively solitary play, and Kirk had begun to growl at children who approached him directly. In addition, none of the staff had heard Kirk speak. There were grunts and growls, pointing and gesturing, but never a word spoken to his classmates or teachers. Interestingly, early conversations with Kirk's parents revealed that unlike the preschool environment, home was a place where Kirk spoke freely.