Infant and Toddler Mental Health Summer InstituteA summary report

What was it?Partnership with IAITMH, Sunny Start

and Department of Mental Health Intense training opportunityThree sessions over a five day periodNetworking opportunityGoal was to reach out to more

mental health professionals and therefore increase the workforce capacity/ resources for families

Session One – July 9Mental Health Diagnosis in Young

Children with Janice Katz, PhD½ day sessionHighlighted diagnostic criteria in the

DC 0-3Participants received a copy of DC: 0-3R

CANS 0-5 with Stacey Ryan, LCSW½ day sessionHighlighted the CANS tool and its use in

Indiana

Session Two – July 10-11 Interaction Guidance (IG): Dyadic Treatment

for High Risk Families with Susan McDonough, PhD

IG is a structured format based on systems theory along with infant mental health concepts. Videotape is used to support change in parent-child interactions

IG is an evidenced-based intervention strategy

Each participant received a copy of Treating Parent-Infant Relationship Problems

Session Three – July 12-13 Dialectical Behavior Therapy (DBT) for

High Risk Parents with Janet Dean, LCSW DBT is an evidence-based treatment for

individuals with personality problems, characterized by low reflective functioning, difficulty with self-regulation, and reduced tolerance for stress

Each participant received a copy of Early Intervention with Multi-Risk Families

Participant DataTotal 75 participants over the five

daysSession 1 – 50 total participantsSession 2 – 52 total participantsSession 3 – 41 total participants27 participated in all five days of the

institute22 different centers/organizations

represented26 different communities represented

Evaluation CommentsSession One

Now I know what to do for early mental health assessments that DCS asks me to do. Also, our facility is now using the CANS for all our child intakes.

I plan to start using the DC: 0-3 diagnostic criteria and crosswalk with my reports and treatment with infants and toddlers.

Evaluation CommentsSession Two

I will be less clinical. I love the way this is strength based and goes where the client is. This gave me permissive to focus more on the client: less on the illness.

I will increase my practice age range. I really want to try the video thing and I plan to

be more observant and make snap shots of the positive things parents and children are doing to build better relationship.

Because of this training will feel more comfortable serving younger children. Prior to this session would not have considered seeing 0-2 year old.

Learned a lot about use of self

Evaluation CommentsSession Three

I'll be much more mindful and less intense.

Will work more with infant ages (0-3).

I would like to try to be more aware of structure, being in the moment, less focused on change.

I will begin to develop services for Infant toddler mental health in my community mental health center.

What We LearnedParticipants appreciated attention

and focus on learning environment and materials

Providers want to serve this population

Providers want more information to successful partner with children and famiilies

Useful techniques for infant and toddler mental health interventions

Why a Relationship Approach?

Infant behavior cannot be viewed apart from the child’s relationships

During infancy the most important relationships are with the primary caregivers

Caregivers have relationships with their social context; extended family, friends, cultural and spiritual networks

Origins of Interaction Guidance

Created specifically for families who were not successfully engaged in mental health treatment or refused referral

Incorporated principles of family systems and dynamic theory, the use of video technology and brief psychotherapy practice to address parent-infant relationship problems

How we can partner with families who don’t want our

helpListen to how others have treated

them without trying to explain, clarify, defend, or instruct

Acknowledge and legitimize their feelings of betrayal, mistrust and disappointments

Ask, rather than assume, that they believe you can be helpful

Where to Begin?

Therapeutic “Port of Entry”Treatment approach matchesFamily’s needs & capabilities

at this pointin their family life cycle

Interaction GuidanceRelationship focused Interaction as:

Early focus of interventionReflection of representation

Egalitarian therapeutic relationshipReplay and reflection of interactions

inviting alternative family perspective

Time-limited “piece of work” with follow-up and referrals

Why pay attention to family and relationship?

Insights from the field of neurodevelopment:Bruce Perry

“There is no more effective neurobiological intervention than a safe relationship.”

“It changes the brain.”

Three Important Discoveries

Safety in relationship precedes the ability to…

Be reflective; which precedes the ability to…

Be Flexibly Responsive to one’s situation and environment

Therapeutic approaches facilitate:

IntegrationAcceptanceSafetyWorking with

resistance/ambivalenceChangeReflective functioning

About “change”Any theory of change must

incorporate:Establishment of safe and trusting

relationshipGain new information and experience

across domains of cognition, emotion, sensation, and behavior

The simultaneous or alternating activation of neural networks that are not integrated or dissociated

About change: There’s more…

Moderate levels of emotional arousal alternating with periods of calm and safety

The integration of conceptual knowledge with emotional and sensory experience through narratives that are co-constructed with the therapist

Skills to help continue integration outside of the therapeutic relationship

What’s next? Create a listserv to foster communication

among those who attended the Institute The Social and Emotional Training and

Technical Assistance Committee is surveying providers to learn what training is currently available that addresses identified competencies

Review of data to identify needs Develop plan to address training needs

to further expand early childhood mental health resources