Looking ahead

A primary interest of the field of infant mental health is in the early conditions that place infants at risk for less than optimal development. The fundamental problem of what constitutes normal and abnormal development is now a focus of developmental psychology, infant psychiatry, and developmental neuroscience. In the second part of this sequential work, I present interdisciplinary data to more deeply forge the theoretical links between severe attachment failures, impairments of the early development of the right brain's stress coping systems, and maladaptive infant mental health. In the following, I offer thoughts on the negative impact of traumatic attachments on brain development and infant mental health, the neurobiology of infant trauma, the neuropsychology of a disorganized/disoriented attachment pattern associated with abuse and neglect, trauma-induced impairments of a regulatory system in the orbitofrontal cortex, the links between orbitofrontal dysfunction and a predisposition to posttraumatic stress disorders, the neurobiology of the dissociative defense, the etiology of dissociation and body–mind psychopathology, the effects of early relational trauma on enduring right hemispheric function, and some implications for models of early intervention. These findings suggest direct connections between traumatic attachment, inefficient right brain regulatory functions, and both maladaptive infant and adult mental health. ©2001 Michigan Association for Infant Mental Health.

Despite knowing the importance of the early detection of adverse experiences, mental health disorders beginning or occurring during early childhood can be difficult to recognize. To address this gap, this manuscript describes the care of a parent-child dyad utilizing the nursing process in an illustrative case. This illustrative case provides a scenario that includes the early detection of infant mental health (IMH) in primary care with referral to a psychiatric mental health advanced practice nurse (PMHNP) and highlights how integrative care with PMHNP can facilitate the use of the nursing process to promote optimal early childhood growth and development and prevent long-term mental health problems. The collaboration between the primary care provider and PMHNP in addressing a common diagnosis observed in IMH (i.e., feeding disorder) where a 6-month-old infant presented with poor weight gain due to detached parenting, secondary to maternal depression, resulted in early infant-parent intervention that reduced maternal depression and normalized infant growth. The screening of IMH in pediatric primary care promotes early referral and collaboration with the PMHNP to address IMH problems to promote optimal growth and social-emotional development in early childhood.

BackgroundApproximately 10%-15% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel’s attitudes to perceived usefulness of internet-based interventions.ObjectiveThe purpose of this study was to examine health professionals’ perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful.MethodsBetween May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: “How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?” The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often).ResultsThe participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006).ConclusionsInternet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support.

PurposeDespite the long-established importance of infant mental health, internationally this has not been mirrored in the provision of infant mental health services. Within Scotland in the UK, there has been significant recent government investment in developing infant mental health services. However, existing research identifies a massive knowledge and skills gap that could create barriers to implementation. This study aims to use qualitative methods to consider the views of relevant professional stakeholders on education and training within infant mental health.Design/methodology/approachThe authors completed semi-structured interviews with 14 professional stakeholders working in a health board in Scotland. This study used purposive sampling to include a broad range of professionals across health and social care services and analysed the resulting data using Braun and Clarke’s (2006) methodology. This study adopted a reflexive stance throughout, including the research team interviewing each other as part of the process.FindingsWithin the theme of education and training, we identified four sub-themes. These included roles for public health and societal education, training for parents, training for professionals and increasing professionals’ experience of infant mental health.Originality/valueThe issues identified are relevant in any area of the UK or internationally in considering the role of education and training in developing and maintaining new infant mental health services. Further research with families and with wider groups of professional stakeholders would be of further benefit.

This review explores the concept of infant mental health and its relevance to the African context. Infant mental health refers to the capacity of infants (0-3 years) to regulate emotions, form secure relationships and explore their environment. It is crucial for neurological development, mental maturity, and cognitive capacity. The field of infant mental health started with developmental psychology but has evolved in its multidisciplinary approach to the mental healthcare of newborns. Classificatory systems of mental disorders have expanded to include infant mental disorders. Awareness of this discipline is rising due to advocacy and research. Research started in Europe, but also began quite early in Africa, with the attachment studies of Mary Ainsworth. Africa has unique cultural factors that promote infant mental health, such as communal living and practices like carrying infants. However, some cultural beliefs/practices may be detrimental. Research is limited but institutions such as the Centre for Child and Adolescent Mental Health are bridging the research gap. Infant mental health is essential for healthy development and Africa needs culturally sensitive approaches to promote it. Strengthening policies, existing structures, and research output will help drive progress in this field.

The perinatal period is a time of great vulnerability for many women, in particular those with a range of psychosocial vulnerabilities and mental health risk factors. This paper outlines the psychosocial and mental health profile of consumers and their partners of a perinatal and infant mental health (PIMH) service in Australia. To establish the consumer profile, we analysed client vulnerabilities and demographical information maintained over a 6-year period for 406 consumers. Consumer information, including mental health problems, psychosocial vulnerabilities and demographical information, was entered into a standalone database by the allocated clinicians upon service allocation and throughout treatment. The women accepted by PIMH presented with an average of nine different vulnerabilities. Frequently endorsed risk factors included depression (72.66%), anxiety (71.43%), comorbid depression and anxiety (58.13%), self-harm (past, 7.88%, present, 16.26%), a history of family mental health issues (39.66%), childhood trauma (57.88%), limited support (68.84%), relationship conflict with partners (38.92%) and financial stress (47.29%). The women's partners also presented with a range of vulnerabilities, in particular childhood trauma (34.11%) and mental health issues (30.81%). This study contributes to our understanding of the profile of vulnerable women in the perinatal period, and in particular contributes to the literature by highlighting that in addition to depression, anxiety, self-harm and trauma are also significant in PIMH service delivery.

64.2 TEACHING ADULT PSYCHIATRY RESIDENTS ABOUT PERINATAL MENTAL HEALTH

In this article, foundational ideas for investing in infant mental health as well as institutionalised children are explored. In infant mental health, there are three foundational ideas (1) stressful life experience can harm brain development during pregnancy and in the first months of life; (2) the parent-infant relationship can moderate at least in part the effects of this stress; (3) nurses and other health workers can support the infant-parent relationship and in that way promote healthy development of the child and of the adult the child will become. The author, Alexander Harrison, describes a model to support the parent-infant relationship in the form of training in infant mental health offered by a non-profit, Supporting Child Caregivers (SCC) to nurses and other health workers. In addition to the training, an SCC team is exploring the development of ‘nudges’, strategies to encourage the sustainability of the training. In working with institutionalised children, Monisha Nayar-Akhtar describes problems that are encountered in the care of the children and proposes alternative ways of viewing the care and management of these children. Drawing from cultural and social theorists, these ideas while acknowledging the insights provided by attachment theory, offer socio and culturally informed ideas that broaden our understanding of working with institutionalised children in the South Asian regions of the world.

Infant Mental Health relates to how well a child develops socially and emotionally from birth to age three. There is a well-established link between parent-infant relationship quality, Infant Mental Health, and longer-term social and emotional development there is a lack of evidence-based interventions that support the parent-infant relationship and/or protect against poor Infant Mental Health. Little Minds Matter is a specialist Infant Mental Health service developed in Bradford (UK) to support parent-infant relationships by providing training and consultation for professionals and direct clinical work to families. The successful implementation of this intervention depends upon how well it becomes embedded within, or integrated into, the early years system. For the purposes of this study, the early years system includes health, social and education services that support child health and development from conception to primary school entry at age five. This study protocol aims to apply a systems approach to evaluate this service and provide a perspective on the process of embedding a complex service within a healthcare system. Multiple methods will be used to investigate embeddedness within the wider early years system. Routinely collected quantitative data about the service will be used to develop a system map showing interaction with related services. Qualitative data will be collected at two time points through interviews with individuals involved in the design and provision of the service, and professionals working within the early years system. Framework analysis will be used to analyse the data inductively and deductively within a systems approach. The findings from this study will provide evidence to inform the ongoing implementation of the service for providers and commissioning bodies. Exploring the application of a systems approach in this clinical context will have application more broadly for researchers evaluating complex interventions and services within a wider system.

Much clinical work in infant mental health includes working with families of young children involved in the complex arenas of the legal and child protection systems. These systems have their own distinctive languages, cultures, and values, but they share a concern with clinicians about the best interest of the child. This special issue explores selected topics in this area, calling attention to research, policy, and clinical issues in forensic infant mental health. The purpose of the issue is to stimulate additional thinking and additional scholarly attention to these vital issues that have such importance for families around the world.

The promotion, protection and restoration of mental health are foundational to healthy communities. However, most mental health services in Canada, already underfunded in comparison to hospital-based medical-surgical programs, continue to be focused on providing reactive acute care. Mental health problems in later life often have their roots in the prenatal, infancy and early childhood life periods, and considerable evidence has accumulated about the effectiveness of interventions during this period of time. Although public health nurses (PHNs) play a leadership role in Canada in developing and providing programs that promote mental health in the early years, much of this work is largely invisible. This paper describes the concept of infant and early childhood mental health, identifies key national policies, and explores the role of PHNs in supporting mental wellness for infants and families, in keeping with health equity and Indigenous perspectives. Canadian practice exemplars are provided to highlight the value of investing in the promotion of infant and early childhood mental health.

The concept of infant mentally health is generally not well known in communities and in those who provide care for young children. A plea is made for greater awareness of the importance of the early care-giving environment through improved training of health care workers on all levels.

Mental Health, Intervention and Prevention

BackgroundInfant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security–Parenting (COS-P), currently being conducted in Denmark.Methods/designIn a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU) in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2–12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (N = 314), who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline) and at follow-up when the child is 12–16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing.DiscussionThe potential implications of the experimental evaluation of an indicated brief group-based parenting educational program to enhance parental sensitivity and attachment are discussed.Trial registrationClinicalTrials.govID: NCT02497677. Registered July 15 2015

ForWhen is an Australia-based national navigation service aimed at helping parents and carers navigate the perinatal mental health service landscape and connect them with appropriate support and clinical services. The current study forms part of a mixed-methods evaluation of the ForWhen program. Semi-structured interviews were conducted with ForWhen navigators during the early design and implementation phases of the service. Results were used to characterise the ForWhen navigator activities and responsibilities, identify navigator core competencies, and examine facilitators and barriers to successful implementation of a large-scale navigation program for perinatal and infant mental health. Further research will be crucial for evidencing the utility and potential of navigation models in addressing identified issues with access to treatment for perinatal and infant mental health issues.