Consultation to the court in infant/toddler custody cases

This paper describes a special component of an infant mental health program wherein infants are referred by the Department of Social Services for assessment and treatment. The infants in these cases are frequently in foster care and under court supervision for abuse and neglect. This paper describes the special role of the infant mental health specialist in establishing a working alliance with the family and in providing consultation to the Department of Social Services and the court. Note is made of the role of the infant mental health specialist within the legal system.     

Parents' perceptions of their infant's day care experience

Parents of infants who had been enrolled in a day-care center were asked to evaluate their day-care experience as well as their children's current development status. In general, parent evaluations provided strong support for day care as an effective means of supplementary infant care. When dissatisfaction with day care was expressed, it focused on matters pertaining to infant health, physical resources of the center, parent involvement in center activities, and caregiver-infant ratios. Parents perceived their children to be advanced in competence skills relative to their peers. With few exceptions, parents viewed group day care as the most desirable type of supplementary infant care, but only if high-quality staff and programs could be assured.     

Meeting the emotional needs of infants and toddlers in foster care: The collaborative mental health care experience

This paper describes a partnership between an infant mental health consultation program and child welfare authorities, with a special focus on the use of a consultation model to support infants and toddlers in foster care. The authors describe a model of practice that incorporates the transactional model with a developmental perspective to help foster parents understand and address the emotional needs of these children. The clinical implications section reviews strategies for addressing attachment and relationship disturbances, promoting self‐regulation, and enhancing social competence in infants and young foster children.     

Home-based early intervention: Emerging purposes,intervention approaches,and evaluation strategies

Infant and toddler home visiting programs constitute an important subgroup within the rapidly growing field of early intervention. Scores of such programs have been implemented by health, educational, and mental health agencies during the past decade. Recent reviews have reported on home-based early intervention for specific populations, such as biologically impaired infants or infants from economically disadvantaged families. Other reviews have focused on the effects of home-based early intervention in particular outcome domains, such as I.Q., or infant health. In this review the author draws together the information emerging from partial reviews and specific program reports in order to describe the full range of purposes and strategies encompassed by home-based early intervention and to draw inferences about its potential to enhance infant health and development and broader family functioning.     

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

Effecting 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.     

Opportunities in public policy to support infant and early childhood mental health: the role of psychologists and policymakers

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants, toddlers, and young children have come to the forefront of thinking as children need a "voice" to advocate for their support and care. This article (a) highlights several important policy areas that support the social-emotional development of very young children and (b) gives examples of current policy accomplishments and challenges. The article offers a policy agenda to promote the mental health of infants and young children and suggests ways that psychologists can engage with policymakers to promote policies that foster infant mental health, including contributing to the knowledge base that informs policy decisions, educating the public and policymakers about early childhood development and mental wellness, forming community partnerships to identify and address infant mental health risks, and participating in the development of policy recommendations that improve access to evidence-based practices in infant mental health.     

Minor illness and social behavior of infants and caregivers

Fourteen infants attending day care were observed during the first year of life when well and during acute minor illnesses. Comparisons of behavior during 46 afebrile illnesses and a like number of well observations revealed no differences in infant or caregiver behavior. During 24 febrile illness observations, however, infants moved less, contacted toys less, were in closer proximity to teachers, cried more, and looked at teachers more. During a subset of these febrile illnesses, in which teachers recognized that infants were ill, teachers vocalized, gave toys, looked at, touched, held, and fed infants more than when infants were well. Analysis of teacher behavior during infant crying demonstrated that infant cries played an important role in eliciting social responses from teachers during febrile illness. These results suggest that both caregiver perception of illness state and illness-induced changes in infant behavior contribute to increased sociability by caregivers during acute febrile illness.     

Group CBT for Externalizing Disorders in Urban Schools: Effect of Training Strategy on Treatment Fidelity and Child Outcomes

Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C +) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C +. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C + delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C + resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.     

A randomized control trial of integrated care for families managing infant colic

This article presents a randomized clinical trial examining the effectiveness of a unique model of integrated care for the treatment of infant colic. Families seeking help for infant colic were randomized to either the family‐centered treatment (TX; n = 31) or standard pediatric care (SC; n = 31). All parents completed 3 days of Infant Behavior Diaries (Barr et al., 1998) and the Colic Symptom Checklist (Lester, 1997 ), Beck Depression Inventory (Beck & Steer, 1984 ), and Parenting Stress Index 3rd ed.‐SF (Abidin, 1995 ). TX families were seen three times by a pediatrician and a mental health clinician within 1, 2, and 6 weeks of baseline data. TX families received individualized treatment plans addressing problem areas of sleep, feeding, routine, and family mental health. SC families were seen only by their own healthcare provider. All families were visited at home by a research assistant to retrieve data at 2, 6, and 10 weeks after baseline. Family‐based treatment accelerated the rate of reduction of infant crying faster than did standard pediatric care. Infants in the TX group had more hours of sleep at 2 weeks posttreatment and spent less time feeding at 2, 6, and 10 weeks posttreatment than did SC infants. Results indicate that individualized family‐based treatment reduces infant colic more rapidly than does standard pediatric care.     

Infant care from infants' viewpoint: the views of some professionals

Debate about infant care tends to focus on still unresolved questions about whether or not day care is harmful, while research studies often confine care options to an unrealistic axis of choice between group care and mother care. Research that delineates constituents of day care quality in relation to measurable outcomes for different groups of children is urgently needed and should be based on a broader view of infant care options. A postal opinion survey sought the confidential views of members of an international organization of infant mental health professionals as to the kinds of care they considered likely to be best for infants from birth to 36 months, assuming that all types of care were of equally high quality and availability. Surprisingly lengthy periods of care by mothers were consistently endorsed; fathers were almost entirely disregarded as principal or joint caregivers; all forms of family care were endorsed over all forms of purchased care, but all forms of individual care were preferred to full-day group care for all age groups and to half-day group care up to the age of 2. The patterns of care judged by these respondents as likely to be best for infants are very different from those which most infants experience now, and from those which policy- and opinion-makers, practitioners and parents aspire, publicly at least, to provide for infants in the future. ©1997 John Wiley & Sons, Ltd.     

The effect of neonatal temperament on caregiver behavior in the newborn nursery

The research was conducted to determine whether temperamental characteristics of neonates influence caregiver behavior as early as the second day of life. Visual attentiveness, activity, and irritability of 28 healthy newborns were rated during six 30-minute sessions. Derived scores represented the infant's behavior during the total observation time and during specified caretaking activities. Several categories of nurturant behaviors and types of comments directed toward each infant by nurse-caregivers were coded during independent sessions. Variations in caregiver behavior were shown by Pearson correlations to be related to independently assessed differences among neonates. Alert babies received the most nurturant and social contact; active infants received the least contact, but the most comments that reflected concern about their health; irritable infants were soothed most. The data clearly suggest that emerging infant temperament plays a role in shaping the caregiving environment by the second day of life.     

Suicide survivors' perceptions of the treating clinician

Seventy-one suicide survivors were surveyed about their perceptions of the clinicians who were treating their loved one at the time of death. Survivors provided information regarding their perceptions and attitudes toward clinician behaviors before and after the suicide and their perceptions of helpful and troubling aspects of clinician behaviors. Results indicated that survivors share a number of common opinions regarding the mental health care providers treating their loved ones. Several differences existed between survivors who consider lawsuits against mental health care providers versus those who do not. The implications of these findings for clinical practice, legal issues, surviving suicide, and future research are discussed.     

Employment and Roles of Counselors in Employee Assistance Programs

The authors studied employment and roles of master's-level counselors in employee assistance programs (EAPs) and the services offered by different types of EAP organizations. The study focused on programs, workshops and seminars: assessment; counseling; consultation; and evaluation and marketing services offered by EAPs. Master's-level counselors were found to be similar to those with Master's of Social Work (MSW) degrees in employment rate and percentage of EAP staff. Both groups were the most frequently employed and constitute the greatest percentage of the professional mental health staff in EAPs. Also, counselors were found to be involved in all of the service areas studied within each type of EAP. Differences in counselors' roles among EAP types are discussed.     

Pastoral consultation through a community Mental Health Center

Conclusion Pastoral consultation through a mental health center in Kansas has been a beneficial experience for participating clergymen and the mental health center staff. This consultation has provided interested clergymen an opportunity to learn effective ways of serving parishioners through the church. The clergymen and mental health center staff have also begun to realize the mental health implications of religious resources, as well as ways in which ministers and the mental health center staff can effectively work together in serving troubled individuals within the local community. Pastoral consultation may become a means through which other community mental health centers and local clergymen can form meaningful professional relationships. The continuance of a pastoral consultation program over a longer period of time is needed to determine its possibilities and liabilities for assistingA report of one aspect of a special study project on Community Clergy and Mental Health, made possible by a grant from W. Clement Stone to the Menninger Foundation.     

Development of parenting self‐efficacy in mothers of infants with high negative emotionality

Maternal parenting self‐efficacy (PSE) is a potential target for infant mental health interventions because it is associated with a number of positive outcomes for children and mothers. Understanding the development of maternal PSE under conditions of increased parenting stress, such as parenting an infant who is easily distressed and difficult to soothe, will contribute to providing more effective interventions. This study examines the development of maternal PSE in mothers of infants with high negative emotionality (NE). The Neonatal Behavioral Assessment Scale (NBAS; T. Brazelton, 1973 ) was administered twice to 111 infants to select a sample of irritable (n = 24) and nonirritable (n = 29) infants for a prospective study comparing the development of PSE in mothers of infants differing in neonatal NE. Consistent with our hypotheses and previous research, at 8 weeks' postpartum, mothers of irritable infants have significantly lower domain‐specific PSE than do mothers of nonirritable infants. Contrary to our predictions, mothers of irritable infants exhibit a significant increase in domain‐specific and domain‐general PSE from 8 to 16 weeks' postpartum. The implications of these results for infant mental health screening, infant mental health interventions, and research on self‐efficacy theory are discussed.     

Infant communication and the mother–infant relationship: The importance of level of risk and construct measurement

Infants' emerging communication skills are understood to be associated with the maternal relationship, particularly for children experiencing high levels of social risk. This study attempts to determine the extent to which this association is influenced by (a) the mental health risk of the dyad and (b) different operational definitions and measurement of both the dyadic relationship and the construct of “communication.” Ninety‐six infants (10–30 months) and their mothers were recruited: A total of 46 were at‐risk dyads referred to a mental health clinic for relationship‐based emotional and/or behavioral difficulties, and 50 were nonrisk dyads not seeking mental health services and served as a normative reference or comparison group. Several factors were assessed: (a) developmental competence, (b) maternal psychopathology, (c) quality of mother–infant interaction during play, (d) attachment security classification, (e) prelinguistic and social‐affective communication, and (f) linguistic communication. In all infants studied, the quality of mother–infant interaction during play, rather than the attachment security classification, was associated with infants' prelinguistic and social‐affective communication abilities, but not with linguistic communication. Different aspects of mother–infant interaction predicted prelinguistic communication for clinic and comparison infants whereas only infant age predicted linguistic communication. All infants displayed communication abilities in the normal range, but the statistically poorer performance demonstrated by clinic‐referred infants could become clinically meaningful in later childhood. Best practices should include communication screening of infants presenting with attachment problems and screening for relational difficulties in infants presenting with communication delays. ©2004 Michigan Association for Infant Mental Health.     

A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children

A system of care for abused and neglected infants and young children should adopt a comprehensive perspective, with mental health considerations systematically incorporated into policies and decisions affecting children and their families. Children age birth to 5 years have disproportionately high rates of maltreatment, with long-term consequences for their mental and physical health. Research on normal development and developmental psychopathology has shown that early development unfolds in an ecology of transactional influences among biological, interpersonal, and environmental domains. Psychologists should collaborate with other early intervention disciplines to create systems of care based on an ecological-transactional model of development that includes early mental health principles in order to serve the needs of these young children. Didactic courses, practicums, and internships in infant and early childhood mental health should become integral components of undergraduate and graduate curricula in psychology in order to build capacity to achieve this goal. Recommendations are offered for systemic change by integrating infant and early childhood mental health principles into existing systems of care for young children and their families.     

An Existential Perspective of Body Beliefs and Health Assessment

Successful health assessments are ongoing and rely on a clinician/client interaction, which is influenced by both the client’s and the clinician’s beliefs about their bodies. These beliefs about the human body arise out of religious and cultural contexts. Theories often explain cultural context by comparison of differences and similarities between the client and the clinician and/or between the client and the dominant culture. This approach can carry a bias inherent in the comparison to dominant beliefs held by those with the most power and economic advantage. The author suggests an existential approach in which client and clinician bodies interact each as adept, autonomous individuals with a conglomerate of beliefs about body and health.The author is an Interdisciplinary PhD candidate in Music Therapy and Health Psychology at the University of Missouri-Kansas City Conservatory of Music. Her research goals include the interrelationship of music, spirituality, and cardiovascular health. She is a Board Certified music therapist and has served in that capacity since 1980 in mental health facilities, hospice, and private practice.