Infant mental health home visiting therapists’ reflective supervision self-efficacy in community practice settings

In recent years, there has been an increase in the research on reflective supervision, including the development of tools designed to measure reflective practice in the context of reflective supervision. The Reflective Supervision Self-Efficacy Scale for Supervisees (RSSESS) is a self-report measure that has been used in previous evaluations and is designed to assess perceived reflective practice self-efficacy for Infant Mental Health-Home Visiting (IMH-HV) therapists. Properties of the RSSESS including factor structure and reliability are explored in a first study that lays the foundation for the use of the RSSESS in an IMH-HV evaluation in the State of Michigan. IMH-HV therapists completed the RSSESS at 4 time points over a 12-month period and also completed a Clinician Profile Form that included questions about their IMH background and their work experience, including job satisfaction and burnout. Results indicated that the RSSESS is a reliable tool to measure change in reflective practice skills. IMH-HV therapists demonstrated growth in their use of reflective practice skills with families and their observational skills over the 12-month period. In addition, results indicated correlations between reflective supervision self-efficacy and job satisfaction as well as burnout.     

Community-delivered infant–parent psychotherapy improves maternal sensitive caregiving: Evaluation of the Michigan model of infant mental health home visiting

The current study evaluated the effectiveness of a home-based psychotherapeutic Infant Mental Health Home Visiting (IMH-HV) intervention for enhancing parenting sensitivity; a secondary aim was to evaluate whether the use of video feedback was associated with greater treatment response. Participants were N = 78 mothers and their children (age at entry ranged from prebirth to 24-month old (M = 9.8, SD = 8.4), who were initiating IMH-HV services with community mental health-based therapists (N = 51). Dyads were assessed during extended home visits via standardized interviews and observational and questionnaire methods within the first month of treatment (baseline), and again 6 and 12 months thereafter. Following each of these extended home visits, study evaluators completed a standard Q-sort to capture observations of maternal sensitivity during the visit. Therapists completed fidelity checklists used to derive the total number of IMH-HV sessions received (i.e., dosage) and frequency with which therapists provided video feedback. Results indicated a dose–response relationship between number of sessions and maternal sensitivity, and that video review with parents independently contributed to improved maternal sensitivity. Discussion focuses on the effectiveness of this community-based psychotherapeutic home visiting model for enhancing parenting, as well as the value of video feedback as a specific therapeutic strategy.     

Infant mental health home visiting therapists’ fidelity to the Michigan IMH-HV model in community practice settings

Implementation research suggests that fidelity to a therapeutic model is important for enhancing outcomes, yet can be difficult to achieve in community practice settings. Furthermore, few published studies have reported on characteristics of treatment fidelity. The present study examined fidelity to the Infant Mental Health Home Visiting (IMH-HV) model among 51 therapists with a range of experience practicing in community settings across the state of Michigan. IMH therapists completed fidelity checklists after every session with participating families to track use of 15 treatment strategies central to the IMH-HV model across the 12-month study period. Results indicated that the most commonly endorsed components utilized in home visits were developmental guidance and infant–parent psychotherapy, followed by the provision of emotional support. Use of IMH-HV components did not vary over time for the entire sample; however, patterns of strategies used showed somewhat more variability among more experienced therapists and when serving higher risk families. Findings demonstrate that IMH-HV therapists report a range of adherence to the model in community settings, with greatest fidelity to several model core components. Ongoing training in the flexible use of all core strategies may further enhance fidelity and contribute to positive outcomes for caregivers and their children receiving IMH-HV services.     

Postnatal mental health and mothers’ processing of infant emotion: an eye-tracking study

ABSTRACT

Background

Postnatal mental illnesses are associated with less maternal sensitivity. Differences in how mothers with and without mental illness process infant emotions could explain this. People with mental illness in non-perinatal populations show certain processing patterns when viewing emotional faces, but it is not clear whether these patterns are present in mothers.     

Mothers’ self-reported emotion dysregulation: A potentially valid method in the field of infant mental health

In the current study, we evaluated the extent to which mothers reported emotion dysregulation on the Difficulties with Emotion Regulation Questionnaire (DERS) (a) converged with physiological indices of emotion dysregulation while parenting, (b) correlated with maternal sensitivity, and (c) predicted infant attachment disorganization and behavior problems in a sample of 259 mothers and their infants. When infants were 6 months old, mothers’ physiological arousal and regulation were measured during parenting tasks and mothers completed the DERS. Maternal sensitivity was observed during distress-eliciting tasks when infants were 6 and 14 months old. Infant attachment disorganization was assessed during the Strange Situation when infants were 14 months old and mothers reported on infants’ behavior problems when infants were 27 months old. Mothers who reported greater emotion regulation difficulties were more physiologically dysregulated during stressful parenting tasks and also showed lower levels of maternal sensitivity at 6 months. Mother-reported dysregulation predicted higher likelihood of infant attachment disorganization and more behavior problems. Results suggest that the DERS is a valid measure of maternal emotional dysregulation and may be a useful tool for future research and intervention efforts aimed toward promoting positive parenting and early child adjustment.     

The impact of identity leadership on team functioning and well-being in team sport: Is psychological safety the missing link?

The purpose of this study was to investigate the role of psychological safety in explaining the impact of identity leadership on team performance and athlete well-being. Adopting a cross-sectional survey design, 289 handball players rated the identity leadership skills of their coach, their captain, and the informal leaders in the team, as well as various performance- and well-being-related measures. Structural equation modelling (controlling for the nested structure of our data) revealed that by demonstrating identity leadership, coaches, captains, and in particular informal athlete leaders, all had a unique contribution in strengthening their team members’ identification with their team. By this shared sense of ‘us’, athletes felt psychologically safe in their team to speak up, provide input, and take risks. In line with our hypotheses, this sense of psychological safety acted as a mediator between identity leadership and two subsequent pathways: (1) a team-oriented pathway in which psychological safety inspired good teamwork, which fostered team resilience and, in turn, enhanced athletes’ satisfaction with their team’s performance; and (2) an individual-oriented pathway wherein psychological safety buffered against athletes’ burnout, thereby enhancing their health. In addition to these pathways mediated by psychological safety, the informal leaders directly influenced the performance pathway (with total effect sizes being 10 times larger than those of coaches and team captains), whereas coaches had a direct influence on the health pathway (with total effect sizes being three times larger than those of informal leaders and captains). Given the often-underestimated importance of the informal leaders, sport teams can be recommended to adopt a structure of shared leadership in which team members are encouraged to engage in identity leadership. In conclusion, we found that by nurturing a shared sense of ‘we’ and ‘us’ within the team, leaders are able to foster a psychologically safe environment, which in turn paves the way for an optimal team functioning and a healthier team.     

Optimism and pessimism in the context of health: bipolar opposites or separate constructs?

One difficulty plaguing research on dispositional optimism and health is whether optimism and pessimism are bipolar opposites or constitute distinct constructs. The present study examined the Life Orientation Test to determine whether the two-factor structure is explained by method bias (due to measurement) or substantive differences. The authors compared three measurement models: bipolar, bivariate, and method artifact. Optimism and pessimism emerged as distinct constructs due to substantive differences. The authors also considered the validity of optimism and pessimism, examining their relations with psychological and physical health outcomes. Optimism and pessimism were more similar in relation to psychological health than to other health-related behavior or physical health outcomes. However, a strongly interpretable pattern for the relation of optimism and pessimism to the health outcomes did not emerge. Further research may benefit from considering optimism and pessimism as bivariate and also should consider the conceptual components and behavioral mechanisms specific to each variable.     

The illusion of mental health: in the mind of which beholder?

We reference self-ratings and clinician ratings of childhood anxious symptoms to a third data source well delineated with regard to the pathophysiology of anxiety. A total of 36 children with anxiety disorders and other children were administered yohimbine, an alpha-sub-2-adrenoreceptor antagonist, in response to which anxiety-prone children have blunted output of growth hormone. We assessed neuroendocrine reactions. In general, participants who claimed anxiety that was unconfirmed by clinicians displayed anxiotypic neuroendocrine profiles, whereas those who denied anxiety detected by clinicians did not, suggesting self-report may have had the advantage over clinician ratings in some instances. Nuanced and contextualized conclusions in this area of work are needed. In response to the question "the illusion of mental health: in the mind of which beholder?," we answer "it depends on the sample and the syndrome under study."     

‘At home in the uncanny’: Freud's account of das Unheimliche in the context of his theory of religious belief

This paper serves as an exploration of Freud's comment that one of the functions of religious belief is to make humanity feel ‘at home in the uncanny’ (heimisch im Unheimlichen). The first section examines the context of Freud's comment within The Future of an Illusion. Attention is then shifted to Freud's essay on ‘The ‘‘Uncanny’’’, and to his conclusion that the ‘uncanny’ is the name for everything that ought to have remained secret and hidden but has come to light. A number of interpretations of the ‘at home’ remark are discussed, and it is suggested that religion might fruitfully be viewed as an attempt to come to terms with humanity's ‘transcendental homelessness’.     

Caregiving representations in war conditions: Associations with maternal trauma,mental health,and mother–infant interaction

Risk features in mothers’ caregiving representations remain understudied in dangerous environments where infants most urgently need protective parenting. This pilot study examines the feasibility of a novel coding system for the Parent Development Interview (PDI) interview (ARR, Assessment of Representational Risk) in assessing 50 war-exposed Palestinian mothers’ caregiving representations. First, we explored the content and structure of risks in the representations. Second, we examined associations between the high-risk representations, mothers’ pre- and postnatal exposure to traumatic war events (TWE), depressive and post-traumatic stress disorder (PTSD) symptoms, and self-rated emotional availability (EA) with their 1-year-old infants. Following three dimensions of high-risk caregiving representations were identified: self/dyadic dysregulation, unavailable, and fearful. Mothers’ prenatal depressive symptoms were associated with dysregulating and fearful representations, and their postnatal PTSD with fearful representations. TWE were not associated with the high-risk representations. Moreover, mothers of boys reported more fearful representations, and mothers with financial difficulties reported more unavailable representations. TWE and high-risk representations were not associated with EA. However, qualitative analysis of the representations indicated risks in the mother–infant relationship. Further, older mothers and mothers with postnatal PTSD reported lower EA. Cultural variance in caregiving representations and the use of self-report measures among traumatized mothers are discussed.     

Leaving home or still in the nest? Parent-child relationships and psychological health as predictors of different leaving home patterns

In this study, the author examines the patterns of leaving home in a sample of 93 participants and their parents. The quality of parent-child relationships, psychological symptomatology in adolescence and young adulthood, and attachment representation were assessed longitudinally from mid-adolescence to young adulthood. Attachment representation, adolescent autonomy, and parent-adolescent conflict were found to be important predictors of the timing of leaving home. In-time leavers were more securely attached and had been granted high autonomy during adolescence, compared with participants who had left home later or had returned to reside in the family home. Young adults with nonnormative leaving home patterns also showed higher percentages of insecure attachment representations and lower percentages of involvement with a romantic partner. Participants residing with their parents were, according to their parents' perceptions, less psychologically healthy.     

Coconstructing Mother–Infant Distress: The Microsynchrony of Maternal Impingement and Infant Avoidance in the Face-to-Face Encounter

This article takes a new look at the self-experience of creative artists. A five-step model of the creative process is put forth: preparation, inspiration, realization, completion, and objectification. The vicissitudes the creative self undergoes in each step are described, as well as the selfobject experiences needed to sustain the self through each phase. Of particular interest in this regard are the roles of the “muse” and of the artistic community. The article then describes three pathologies that the creative self is particularly prone to: addictions, vertical splits, and depression/isolation. The article concludes with a case example of a female patient who brought her paintings and stories into therapy.     

Does parental autonomy support mediate the relation between parent and infant executive function? A study of mothers and fathers in the Netherlands and China

Parenting skills, such as Autonomy Support (AS), have been proposed as a potential mechanism explaining the intergenerational contiguity of Executive Function (EF). However, few studies have focused on mothers and fathers among non-Western families. The current study investigated the role of maternal and paternal AS in the relation between parental EF and infant EF at 14 months of age among 123 Dutch and 63 Chinese first-time mothers and fathers and their infants. Multiple-group structural equation models were built for mothers and fathers separately with country as a grouping variable. Results showed that parental AS did not mediate the relation between parent EF and infant EF at 14 months. Mean-level differences were found in parental AS, maternal EF, and infant inhibition across countries, while no country differences were found in the relation between parent EF, AS and infant EF. Our findings suggested that individual differences in early EF may not be stable enough to be reliably predicted from parental factors across the Netherlands and China.     

Addressing the needs of new mothers in a multi-cultural setting: an evaluation of home visiting support for new mothers – Mom to Mom (Negev)

This study evaluated the Mom to Mom (M2M) program operating in the Negev region of Israel, an area with a high proportion of immigrants. M2M helps women cope with the first year of parenting through home visits of volunteer mothers. Specific objectives were to evaluate (1) Participants’ motivations for joining M2M; (2) Gains from participation; and (3) The effect of participation on post-partum depression (PPD). Three stages included (1) Analysis of demographics of all 440 mothers in M2M; (2) A telephone survey of 51 mothers to assess gains from participation; and (3) 137 mothers filled out the Edinburgh Post-Natal Depression Scale (EPDS) and were followed for one year. Most mothers in M2M were first time mothers, with a high rate of perinatal complications (54.4%) and positive EPDS scores (38.7%). Two major reasons for participation were being an immigrant and having low income. The greatest gains from home visits were increased self-confidence, improved parenting skills and communication with the partner. Seventy-nine percent of mothers with PPD symptoms were functioning at work and at home after a year from joining the program. Our findings suggest that M2M has the capacity to address challenges in the post-natal period among women from diverse cultures.     

Can the home environment promote resilience for children born very preterm in the context of social and medical risk?

Relationships between the home environment and early developmental outcomes were examined in 166 children born very preterm in one tertiary maternity hospital to explore whether a more optimal home environment could promote resilience. In particular, we explored whether this effect was apparent over and above social risk and children's biological risk, as measured by cerebral white matter abnormality (WMA) evaluated using magnetic resonance imaging (MRI) at term-corrected age and length of hospital stay (LOS), and whether the effect of the home environment differed according to WMA. The home environment and social-emotional outcomes were assessed at 2years' corrected age using the Home Screening Questionnaire (HSQ) and the Infant-Toddler Social and Emotional Assessment (ITSEA). Children's cognitive and motor development was assessed using the Bayley Scales of Infant Development II. A more optimal home environment was associated with better cognitive and social-emotional development after adjusting for social risk, WMA, and LOS. Neonatal cerebral WMA moderated the relationship between the home environment and dysregulation problems only, such that the home environment had less effect on dysregulation for children with mild or moderate to severe WMA. The need to support parents to create an optimal home environment is discussed.     

The “Jewish Knight” of Slobodka honor culture and the image of the body in an Ultra-Orthodox Jewish context

Scholarship on Ultra-Orthodox Jewish thought has traditionally assumed that the views of these communities derive from a struggle against the Jewish Enlightenment and Zionism, as well as against any values they identify as “modern.” This article challenges that assumption. Beginning with an examination of Ultra-Orthodox sources that present an image of the religious leader as the “ideal Jew,” the author then focuses on sources concerning the founder of the Slobodka Yeshiva in Lithuania. This rabbi intended his students to internalize “modern” norms found in the European honor culture of his time, while translating them into the language of Jewish Ultra-Orthodoxy. The author chooses to present his argument by tracing the image of the body in the Slobodka method, since it is precisely through the nexus of the body that Ultra-Orthodox Judaism was segregated from general European society and culture.     

Neuromuscular control of posture in the infant and child: is vision dominant?

This study explored the effects of vision and maturation on the characteristics of neuromuscular responses underlying balance control in both seated and standing children of five age groups (3 1/2-5 months, 8-14 months, 2-3 years, 4-6 years, and 7-10 years). A platform was used to unexpectedly disturb the child's balance in the anterior or posterior direction. Responses of the leg, trunk, and neck muscles were recorded using surface electromyograms. Vision was not required for the activation of these responses in any of the age groups tested. However, comparison of the muscle response latencies of standing children to posterior platform translation in the two visual conditions showed a significant reduction in latency for neck flexors in the 2- to 3-year-olds with vision removed and ann increase in the total number of monosynaptic reflexes. No reduction in latency was found in the older age groups. The hypothesis of a shift from an early long latency visual dominance to a shorter latency proprioceptive one during childhood is discussed. Postural control showed a cephalo-caudal developmental gradient with postural responses appearing first in the neck, then trunk, and finally, legs, as children developed from 3 to 14 months of age. A wide variety of response patterns was seen in the 3- to 5-month-olds, indicating that postural responses are not functional prior to experience with stabilizing the center of mass.     

Infant directed speech and the development of speech perception: Enhancing development or an unintended consequence?

Infant directed speech (IDS) is a speech register characterized by simpler sentences, a slower rate, and more variable prosody. Recent work has implicated it in more subtle aspects of language development. Kuhl et al. (1997) demonstrated that segmental cues for vowels are affected by IDS in a way that may enhance development: the average locations of the extreme “point” vowels (/a/, /i/ and /u/) are further apart in acoustic space. If infants learn speech categories, in part, from the statistical distributions of such cues, these changes may specifically enhance speech category learning. We revisited this by asking (1) if these findings extend to a new cue (Voice Onset Time, a cue for voicing); (2) whether they extend to the interior vowels which are much harder to learn and/or discriminate; and (3) whether these changes may be an unintended phonetic consequence of factors like speaking rate or prosodic changes associated with IDS. Eighteen caregivers were recorded reading a picture book including minimal pairs for voicing (e.g., beach/peach) and a variety of vowels to either an adult or their infant. Acoustic measurements suggested that VOT was different in IDS, but not in a way that necessarily supports better development, and that these changes are almost entirely due to slower rate of speech of IDS. Measurements of the vowel suggested that in addition to changes in the mean, there was also an increase in variance, and statistical modeling suggests that this may counteract the benefit of any expansion of the vowel space. As a whole this suggests that changes in segmental cues associated with IDS may be an unintended by-product of the slower rate of speech and different prosodic structure, and do not necessarily derive from a motivation to enhance development.