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The Meaning and Promise of Early Childhood Mental
Health Part I What is ECMH? Mary Claire
Heffron, Ph.D Margaret Rossoff MFT. Department
of Developmental and Behavioral Pediatrics Early
Childhood Mental Health Program Childrens
Hospital and Research Center, Oakland
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What is Infant and Early Childhood Mental Health?

• ? A transdisciplinary collaboration between...
• ? Developmental and Clinical Psychology ?
  Medicine ? Nursing ?
  Neurobiology ? Early Intervention
  ? Social Work ? Education and
  many others
• who share the belief that
• Foundations of the self are formed in the first
  few years of life
• Quality of early relationships is key to and
  shapes all other aspects of development
• Early involvement with a family has long
  lasting effects
• Services are more powerful if they enhance
  family relationships

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Early childhood mental health (ECMH) is

• the social, emotional and behavioral well-being
  of children birth through five and their
  families, including the developing capacity to

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• Experience, regulate, and express emotion
• Form close, secure relationships
• Explore the environment and learn

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An infant or childs mental health is influenced
by

• The physical characteristics and temperament of
  the child
• The quality of the adult relationships in childs
  life
• Caregiving environments
• The community context of the child

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Relationships are central

• Relationships between infant/child and family
  members
• Relationships between child and other caregivers
  such as preschool teachers, childcare providers,
  and extended family members and community
• Relationships between service providers and
  family members

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Early Intervention Services, Child Development
Center, Childrens Hospital Oakland, California
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Working Alliance Home Visitor-Family
Interaction
HOME VISITOR
PARENT
Violating Familys Negative Expectations or
Enhancing Positive Expectations about
Relationships
CHILD/ BABY
Qualities of Parent-Child Interaction
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Early childhood mental health

• Is a shared responsibility across many
  disciplines
• Contains a continuum of services
• promotion of good emotional health
• preventive intervention with at risk
  populations, and
• mental health treatment for families with
  troubled relationships
• Can be integrated into many kinds of services for
  children and families

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Programs that can benefit from incorporating ECMH
services

• Preschools and day care centers
• Early intervention programs for children with
  developmental delays and disabilities
• Medical programs for young children
• Shelters for homeless families
• Programs for families experiencing domestic
  violence
• Programs for women recovering from substance
  abuse
• Social service programs for parents who have
  abused children and for children in foster care
• And.

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Models for inclusion of early childhood mental
health services

• The Lone Rangera mental health specialist to
  whom a program refers families
• The Guidea mental health specialist outside the
  program who consults to program staff
• A Port of Calla mental health specialist on
  staff working with families
• A Fulcruma mental health specialist on staff
  consulting with staff from other disciplines and
  providing direct service
• Alliancea mental health specialist participating
  in a multi-disciplinary team with cross-training

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Principles of ECMH

• Demonstrate concern and empathy
• Acknowledge parents concerns
• Link parents concerns to her/his caring
  about child
• Express empathy for parents perspective
• Ask about parents well-being
• Respect parents right to choose focus of
  work

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Principles of ECMH

• Promote reflection
• Use open-ended questions
• Use questions that encourage parents
  reflection on his/her own feelings
• Use questions that invite parents
  reflection on what child may be experiencing

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Principles of ECMH

• Observe and highlight parent-child relationship
• Speak for the baby
• Acknowledge parent-child connection

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Principles of ECMH

• Respect role boundaries when parents needs are
  outside your field of competence
• Summarize and contain shared information to
  create a sense of understanding, closure and next
  steps
• Acknowledge needs and offer referrals to
  other services

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Principles of ECMH

• Communicate directly about upsets and negativity
• Acknowledge parents feelings
• Keep the door open for further discussion

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Principles of ECMH

• Get support for your own feelings
• Ask yourself reflective questions to
  understand your reactions
• Discuss in supervision

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Features of an Infant Mental Health Approach
Developed by the Consultation and Training Team,
Childrens Hospital Oakland
Relationship focus organizer of
development essential for parent-provider
alliance Empathy, support and understanding Develo
pment of a common language of relationships Meetin
g client at level of need and readiness Infant-par
ent psychotherapy Non-didactic developmental
guidance Flexible interventions Concrete
services Home-based delivery
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• Brief overview of four models of early childhood
  mental health treatment

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Infant-parent psychotherapy (Fraiberg, Lieberman)

• Grounded in psychoanalytic and developmental
  concepts
• Combines psychotherapy of parent, non-didactic
  developmental guidance, support, concrete
  assistance
• Aims to understand how parents experiences shape
  his/her feelings toward, perceptions of and
  behaviors with his/her child

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Infant-parent psychotherapy

• Therapy focuses on both
• parent-child relationships and representations
  and
• parent-therapist relationships and
  representations
• In family sessions, therapist encourages parent
  to interpret childs behavior and imagine childs
  inner world
• Ports of Entry for intervention can be
  behavioral or representational and individual,
  dyadic or triadic

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Watch, Wait and Wonder(Muir, Cohen)

• Conceptual framework includes psychoanalytic and
  attachment constructs
• Works at both behavioral and representational
  levels
• By emphasizing the infant as leading the
  therapeutic activity, creates therapeutic space
  for parent, infant and their relationship

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WWW session format

• Part 1
• Up to 30 minutes is infant-led activity with
  mother told to join baby on floor and observe,
  respond, but not guide or direct
• During this period, therapist neither intervenes
  nor interprets
• Part 2
• Twenty-minute period for therapist-parent
  discussion about parents observations,
  experiences, and reflections during the session

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Interaction Guidance (McDonough)

• Conceptual framework - a synthesis of family
  systems and multigenerational preventive
  intervention models
• Focus on parent-child relationships via
  observable interactions
• Video of parent-child play used to promote
  parents skills in observation and responsivity
• Minimizes authority of therapist

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Circle of Security (Hoffman)

• Grounded in attachment theory, object relations
  and research on early relationships
• 20 week group-based parent education and
  psychotherapy
• Uses edited videotapes of parents interactions
  with their children

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Circle of Security

• Encourages caregivers to
• Increase their sensitivity to childs signals
  both for distance for exploration and closeness
  for soothing
• Increase ability to reflect on self and child
• Reflect on past experiences that affect patterns
  with their children