Introduction to Early Childhood Mental HealthKathryn Seidler, LMSW Easter Seals Blake FoundationTucson, AZ
A baby alone does not exist. A baby can be understood only as part of a relationship. D.W. Winnicott
Definition of Infant Mental Health. • Developing the capacity of the child from birth to age three to experience, regulate, and express emotions; form close and secure interpersonal relationships; and explore the environment and learn - all in the context of family, community and cultural expectations….Zero to Three IMH Task Force
CORE CONCEPTSOF EARLY CHILDHOOD MENTAL HEALTH 1. Mental health needs of the 0-6 age population challenge and defy our conventional, individual-based thinking about providing therapy
2. Early Childhood Mental Health is FIRST and FOREMOST about RELATIONSHIPS
3. We cannot conceive or consider infants and toddlers outside of the relationships they have with their primary caregivers.
4. Object Relations Theory (Mahler) • Proposes that an internalization of the caregiver occurs within the child’s psyche as a mental representation about self and caregiver, based on the relationship and interactions that occur.
5. Development • Early childhood mental health is understood as a model that is developmental
Periods of Development Early Childhood: 2-6 yrs Prenatal: conception to birth Infancy & Toddlerhood: birth to 2 yrs
5. Development (cont) • Is sequential • occurs in different areas • Is individual • Is inter-related • Moves from simple to complex
5. Development (cont) • “Sensitive Periods” between birth and age 5; children rapidly develop foundational capabilities upon which subsequent development develops • Influenced by biological, environmental and interpersonal sources of resiliency and vulnerability: Nature vs Nurture
5. Development (cont) • Research tells us there is a connection between a child’s early experiences, life-long health and well being established through the development of brain structure in the early years
Growing a Healthy Brain • Nurturing experiences. • Good nutrition. • Intervening early. • Protection. • Taking care of the caregiver.
Pre-natal Development The nervous system begins to develop just before the third week of gestation. Cell creation and movement to the right spots occur during the first five prenatal months. Talking Reasonably and Responsibly about Early Brain Development, University of Minnesota (Eliot, 1999)
Nurture Affects Brain Development • Nurturing touch promotes growth and alertness in babies. • Presence of a secure attachment protects toddlers from biochemical effects of stress. • Abused children pay more attention to angry faces – a reflection of the brain’s response.
5. Development (cont.) • Failure to provide appropriate stimulation, consistent responsive care and opportunities to explore their environment may cause a failure in the development of neural connections and pathways that facilitate essential learning and self-regulating skills
5. Development (cont.) • Exposure to trauma, neglect or severe stress is damaging to the developing brain and may result in learning disabilities, emotional, and behavioral problems
5. Development (cont.) Three Tasks of Early Childhood 1. Emotional Development - negotiating transition from external to internal self-regulation • from birth infants must learn to regulate physiological and emotional functions • emotion, behavior, and attention are highly linked, therefore success in one area can lead to success in another and difficulty in one can lead to difficulty in another
5. Development (cont.) 1. Emotional Development (cont.) • A child’s ability to regulate is deeply embedded in his relationships with others • In dysfunctional homes, emotional demands on the infant can be confusing, conflicting and overwhelming
5. Development (cont.) 2. Cognitive Development - acquiring capabilities that are the foundation for communication and learning • babies are wired to learn • society and parents need to be ready for the competencies with which the child arrives
5. Development (cont.) 2. Cognitive Development • thinking, social interactions, relationships and emotions converge in a powerful way during the second year of life • Quality and quantity of verbal and social stimulation that a child receives will determine the language learning process
5. Development (cont.) 3. Social Development - learning to relate well to other children and forming relationships • secure attachments to caring adults during infancy and toddler years lay the foundation for social relationships • a child’s evolving cognitive, language, and emotional regulations skills play a role throughout social skill and relationship building
5. Development (cont.) • Social Development (cont.) • having positive relationship skills has been found to be a predictor of popularity with peers during the preschool years (Sroufe 1983, 1990) • infants who exhibit ambivalent attachments may develop into unhappy, easily frustrated toddlers and preschoolers (Erikson, Sroufe & Egeland, 1985; Renken et al., 1989)
5. Development (cont.) Social Development (cont.) • Children who are socially competent at the toddler or preschool age have parents who actively help them learn to play • those who appear socially inept often have parents who view social competence as a function of the school system and devalue the importance of social skills
6. Parallel Process • Most parents referred or who seek out infant mental health services have some degree of developmental trauma of their own • A relationship between the worker/therapist and the parent develops first
6. Parallel Process (cont.) • the actions and behavior of the worker toward the parent are geared to acknowledge the unmet developmental needs of the parent • This behavior attempts to created a “holding environment” where the parent may experience a repair and healing of their own unmet developmental needs.
6. Parallel Process (cont.) • The goal is for the parent to learn how to create this “holding environment” for their own child • Another goal is for the developmental trauma of the parent to not repeat itself in the parent/child relationship
A relationship between a parent and IMH specialist can be “therapeutic” or healing even though the reason for the relationship is the needs of the child, family support, early intervention or educational needs.
How do we foster relationships through relationships? • Corrective Emotional Experiences!!! • Fostering the idea of the parent’s “self” in relationship with another • (I am valued, respected, liked!!)
How do we foster relationships through relationships? • Behavior Change - “Now that I know what’s good for my baby or child - I’ll do more because I want to pleased or be liked by my home visitor” • Increased Reflective Function - Ability to think about another’s experience
Emotional Availability • Present and attending to other • Processing other’s behavior • Responding to other’s behavior • Reflection • Timing • Intensity • Affect
7. “Ghosts in the Nursery” • Selma Fraiberg • the parents’ own internalized mental representations of their childhood, caregivers, and affective history • good ghosts / bad ghosts
8. Assessment • Parent/Caregiver Interview • Observation/assessment of parent child relationship and interaction • Standardized Testing • Address parent’s experience with their own caregivers: “Ghosts in the Nursery”
8. Assessment (cont.) • Nurture parent so parent can nurture their child • Link past experiences with current care of infant • Interventions and continued assessment of progress
Infant Mental Health Practice • Promotion • Prevention • Treatment
PROMOTIONSupporting social-emotional health • Home Based Programs • Parent-Child Activities • Enhancing parent-child social-emotional functioning through relationships • Center Based Programs • Continuity of care • Primary caregiving • Social-emotional assessments
PREVENTIONAltering specific family risk conditions, or child-parent risk behaviors • Parent-child interaction guidance • Parent support groups re: discipline • Home visits for depressed parents • Social support to single parents • Linking poor families with services
TREATMENTProviding intervention for specific disorder or problem • Parent-infant psychotherapy • Child play therapy • Couples therapy (esp. w/ spousal violence) • Family therapy • Individual therapy • Substance abuse treatment for parent
IMH Service Delivery Venues • Home visitation • Family support • Family preservation • Early intervention • Child care • Foster care • Parenting education
The Home as a Therapeutic Setting • S. Fraiberg’s “Kitchen Therapy” • Family Turf • Intimacy of home • Potential of trust • Assessment in larger context • Flexibility • Incorporation of family resources
IMH Services in Home-Based ProgramsRationale: Targeting overburdened families • Importance of engaging multi-risk families during perinatal period • Linkage between child maltreatment and adverse psychological outcomes • Evidence re: need for more intensive intervention to address mental health
IMH Services in Home-Based Programs: Strategies • Providing social support as an “antidote” to psychological difficulties • Addressing parental mental health needs through referral process • Engaging in patient-child interactional activities to promote attachment • Exploring parental “ghosts” as a means of addressing child maltreatment
IMH Practice in Home-Based Settings: Parent-Infant Interactional Approach • Incorporate parent-child interaction in each home visit • Reflect on moment-to-moment parent-child interactions • Identify teachable moments in context of parent-child interaction
IMH Practice in Home-Based Settings: Intervention Process Strategies • Increased directives of therapist versus insight work done in talk therapy • Interactive guidance (coaching) • Use of videotape
Intervention Process Strategies (cont.) • Moving beyond play • Developmental guidance in the moment • Unconditional Positive Regard (C. Rogers) • Consistent nurturance/validation
IMH Practice in Home-Based Settings: Staff Issues • Intensive supervision of staff (1Hr/wk) • Regular staff training • Reflective group meetings and case presentations of managers and supervisors • Use of videos in house visits and supervision • Supervisory nurturance of staff
Empathize with parental vulnerability around parenting Connect with parent’s desire to be a good parent Identify and reinforce positive parental behaviors Affirm parent’s special role and relationship with their child Help parent’s find JOY in caring for their child Parent-Infant Mental Health: Promoting Positive Parenting
Promote parental attunement Build on joyful activities Enhance joint attention and involvement Parent -Infant Mental Health:Supporting the “Dance” (D. Stern) • Support parental emotional availability • Encourage affective expression, understanding and sharing