PowerPoint Presentation - inclusioninstitute.fpg.unc.edu · 4/24/2017 19 References Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in the nursery: A psychoanalytic approach

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Foundations of Infant and Early Childhood Mental Health

Presenter: Jodi Whiteman

2017 Inclusion Institute

Our History

Founded by leading researchers, clinicians, and thinkers in the study of infancy and the early years, ZERO TO THREE is the foremost thought and practice leader in the field of early childhood development.

Copyright © 2017 ZERO TO THREE

A national, nonprofit organization that

informs, trains and supports professionals,

policy makers and parents in their efforts to

improve the lives of infants and toddlers.

Train professionals and build networks of leaders

Influence policies and

practices

Raise public understanding of early

childhood issues


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Levers for Change

Parents


Learning Objectives

• Understand the definition of infant mental health

• Examine the importance of early experiences in supporting infant and early childhood mental health

• Discuss the importance of self-care when working with very young children and families


What does “mental health” have to do with babies?


http://www.google.com/url?sa=i&rct=j&q=babies&source=images&cd=&cad=rja&docid=JjWZagzsbXrfyM&tbnid=Neb0XEzBWlzWJM:&ved=0CAUQjRw&url=http://witandwisdomofanengineer.blogspot.com/2012/12/no-more-babies-no-more-bridges.html&ei=4WRDUf7SMoWy0QGgy4HoAQ&bvm=bv.43828540,d.dmg&psig=AFQjCNErWZKz4gkCWy37STLjLrffLN_ZQQ&ust=1363457631224366

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Definition: Infant Mental Health

The developing capacity of a

child to:

• Experience, regulate and

express emotions;

• Form close and secure

interpersonal relationships;

• Explore the environment and

learn;

All in the context of family,

community and cultural

expectations for young

children (ZERO TO THREE,

2001).


Mental Health Promotion

The Institute of Medicine (IOM) defines Mental Health Promotion as:

“Mental health promotion includes efforts to enhance

individuals’ ability to achieve developmentally appropriate

tasks (competence) and a positive sense of self-esteem,

mastery, well-being, and social inclusion and to strengthen

their ability to cope with adversity.”((National Research Council and Institute of Medicine. 2009. Page 67)


Past Experiences

Temperament/Personality

Current Stressors


Current Stressors

Development/Health

Parent/Caregiver Child

Education

Gender Class

Race

Past Experiences

Stages of Parent

Development


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• Babies are by nature social creatures.

2

• Individual differences are an integral component of babies’ functioning.

3

• Every individual exists in a particular environmental context that deeply affects the person’s functioning.

4

• Interventionists make an effort to understand how behaviors feel from the inside, not just how they look from the outside.

5

• The interventionist own feelings and behaviors have a major impact on the intervention. (Lieberman, 1998)

Underlying Principles of Infant Mental Health (Lieberman, 1988)


Babies are by nature social creatures.


Research informs us that babies are social from the beginning.

• Within 3 days of birth infants can tell the difference between people.

• By 1 month, infants know which characteristics (voice, space, touch) go together with a certain person.

• By 3 months, infants can tell the difference between voices and prefer those that are familiar.

• By 4 months infants begin to form expectations about what their caregivers will be like – gentle and pleasant or upsetting and unavailable.

Photo

© K

iwi

Str

eet

Stu

dio

s


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As babies, the way we are held, talked to, and cared forteaches us about who we are and how we are valued.

Importance of Responsive Relationships


The “Responsive Dance”

When I am distressed are my signals understood and responded to?

What kind of responses can I anticipate?

Will I feel better or worse as a result of the response I get?

Which of the many signals I give get attention, and is it the kind of attention I want?

Lieberman, A., Zeanah, C. ,1995


Definition of Attachment

Attachment is defined as the quality of the relationship. It is the connected, lasting, emotional bonds a child has with a caregiver.

Lieberman & Zeanah, 1995

Attachment is NOT a sudden and magical bond, but rather a slow,

social unfolding that requires the full participation of both parties.Copyright © 2017 ZERO TO THREE

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Why is attachment important?

• Trust

• Learn

• Think

• Cope

• Develop Conscience

• Modulate emotions

• Become self reliant

• Develop future relationships


Attachment Patterns

Attachment Classification Caregiver is… Child’s PatternsChild’s Expectations Over

Time

Secure Sensitive, ResponsiveExplores, seeks comfort when

needed

Needs will be met

consistently

Insecure-Avoidant Distant, disengagedDoes not explore,

shut downNeeds will not be met

Insecure-Ambivalent

Inconsistent (Sometimes

sensitive/disengaged or

neglectful)

Anxious,

Preoccupied with seeking

caregiver’s attention

Unsure of when needs will be

met

Insecure-DisorganizedFrightened/

Frightening

Stereotypic (head banging,

undressing); freezing or

stilling

Confused about how to get

needs met – wants to

approach AND fleeCopyright © 2017 ZERO TO THREE

(Source: Harvard Center on the Developing Child)

Relationships Influence Lifelong Outcomes


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Individual differences are an integral component of babies’ functioning


Past Experiences


Current Stressors


Current Stressors

Development/Health


Education

Gender Class

Race

Past Experiences

Stages of Parent

Development


Current stressors

• Changes in routine

• Violence in the home

• Unavailability or inconsistent availability of caregivers

• Intrusive caregiving

• Environmental stimuli


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Temperament

Temperament refers to the way individuals typically experience and react to their environment.

• Biologically based

• Consistent over time

• Influenced by environment and maturation


Every individual exists in a particular environmental context that deeply affects

the person’s functioning.


Past Experiences


Current Stressors


Current Stressors

Development/Health


Education

Gender Class

Race

Past Experiences

Stages of Parent

Development


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Parent’s State of Mind

• Parent’s sensitivity and responsiveness key influence on child’s pattern of attachment

• Securely attached babies had sensitively responsive mothers

• Insecure-avoidant babies had rejecting and intrusive mothers

• Insecure-resistant babies had under-involved and unpredictable mothers

Prior and Glasser (2006)


Parent/Caregiver’s Past Experiences

In every nursery there are ghosts. They are the visitors from the unremembered past of the parents, the uninvited guests at the christening. Under all favorable circumstances the unfriendly and unbidden spirits are banished from the nursery and return to their subterranean dwelling place. The baby makes his own imperative claim upon parental love and, in strict analogy with the fairy tales, the bonds of love protect the child and his parents against the intruders, the malevolent ghosts.

-Selma Fraiberg (1975, p.387)


Stages of Parent Development (Galinsky, 1987)

Parent Child

Image-Making Stage Prenatal

Nurturing Stage Neonatal and infancy

Authority Stage Toddlerhood

Interpretive Preschool-Adolescence

Interdependent Teen years

Departure College/adulthood


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Parent/Caregiver’s Current Stressors

• Physical Health

• Mental Health

• Poverty

• Quality of Relationships with Other Family/Friends

• Availability of Tangible Support

• Understanding of Child Development

• Experience of Oppression

• FatigueCopyright © 2017 ZERO TO THREE


Parent/caregiver Temperament

Goodness of Fit:

How compatible the demands and expectations of an environment and the people in it are with a person’s temperament, expectations, and other preferences. It also refers to how well an adult can recognize and respond or adapt to a child’s temperament.


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Attachment, Stress, and IECMH

• The quality of the relationship between the parent/caregiver and the child direct impacts how children deal with stress.

• How children handle stress affects overall development, physical and mental health.


What is stress?

Stress is the physical and emotional response a person has to events or experiences.


The function of stress


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Attachment & Brain Development

Attachment relationship facilitates the early growth of coping strategies to deal with novelty and stress

Limbic system plays a primary role in the human stress response

FIGHT, FLIGHT, FREEZE

Caregiving adults help regulate the infant’s maturing limbic system



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Normal life stressors are not dangerous, and can be healthy for a developing brain.

Positive Stress

Examples Having to wait for a moment for a bottle or breast-feeding. Tummy time – reaching for a toy, or learning to roll/crawl.


Children can experience tolerable stress that is time-limited without long-term developmental harm, if they are supported by nurturing, responsive caregiving relationships.

Tolerable Stress


Toxic Stress

Toxic stress refers to the body’s stress response system being strongly activated over time.


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The Long-Term Impacts of Toxic Stress


Interventionists make an effort to understand how behaviors feel from the inside, not just

how they look from the outside.


Behavior Communicates

Behavior

Skill to be developed

Potential unmet need

42Copyright © 2017 ZERO TO THREE

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Challenging Behavior: Any repeated pattern of behavior, or perception of behavior, that interferes with or is at risk of

interfering with optimal learning or engagement in pro-social interactions with peers and adults. (CSEFEL)

Copyright © 2017 ZERO TO THREE 43

The interventionist own feelings and behaviors have a major impact on the intervention.


Calming the Stress Response


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“If providers prioritize self-care, they are giving two gifts—one to themselves and one to the children in their care.”

• (Rice & Groves, 2005, p. 49)


Stress Reduction Techniques

Consider the analogy of the whistling teapot:

What would YOU like to do to reduce your stress?

—Let off steam (vent, de-stress)

—Add water (replenish, relax, and self-care techniques)

—Turn down the heat (reduce or manage the stress)


Breathing Exercise


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Considerations for Intervention


Psychological Development in Early Childhood

Normal Anxieties/Fears• Fear of Loss• Fear of Losing Love and Approval• Fear of Body Damage• Fear of Internal “Badness”

(Behavior vs. Self)• Fear of Strangers


What Works?

Encouraging Parental Motivation Partnerships between parent and interventionist Focus on parent-child relationship Emotional support Home visits


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Evidence-Based Parent-Child Interventions

• Child-Parent Psychotherapy (CPP)

• Circle of Security

• Attachment and Biobehavioral Catch-Up (ABC)


Diagnosis: DC 0-5


Questions?

www.zerotothree.org

[email protected]

Photo © Kiwi Street Studios


http://www.zerotothree.org/

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References

Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in the nursery: A psychoanalytic approach to the problems of impaired infant-mother relationships. Journal of the American Academy of Child Psychiatry, 14(3), 387-421.

Galinsky, E. (1987). The six stages of parenthood. Da Capo Press.

Lieberman, A. F., & Zeanah, C. H. (1995). Disorders of attachment in infancy. Child and adolescent psychiatric clinics of North America, 4(3), 571-587.

Shapiro, V., Fraiberg, S., & Adelson, E. (1976). Infant-parent psychotherapy on behalf of a child in a critical nutritional state. The Psychoanalytic Study of the Child, 31(1), 461-491.

Zeanah, C.H. & Zeanah, P.D. (2001). Towards a definition of infant mental health. Zero to Three, 22, 13-20.

Winnicott, D.W. (1947) `Further Thoughts on Babies as Persons', reprinted in The Child, the Family, and the Outside World. Harmondsworth: Penguin Books, 1964.

Documents

PowerPoint Presentation - inclusioninstitute.fpg.unc.edu · 4/24/2017 19 References Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in the nursery: A psychoanalytic approach