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“It’s OK, I’m Fine” : Lessons Learned by Young Children who Experience Infant Mental Health Interventions Cheryl Pratt,

“It’s OK, I’m Fine” : Lessons Learned by Young Children who Experience Infant Mental Health Interventions Cheryl Pratt, PhD Linda Schwartz, PhD. Infant Mental Health. Infants and toddlers develop emotionally and socially within the context of their primary relationship.

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“It’s OK, I’m Fine” : Lessons Learned by Young Children who Experience Infant Mental Health Interventions Cheryl Pratt,

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  1. “It’s OK, I’m Fine” :Lessons Learned by Young Children who Experience Infant Mental Health InterventionsCheryl Pratt, PhDLinda Schwartz, PhD ©Children's Research Triangle, 2007

  2. Infant Mental Health Infants and toddlers develop emotionally and socially within the context of their primary relationship ©Children's Research Triangle, 2007

  3. Definition of Infant Mental Health Infant Mental Health is the Appropriate Unfolding of: Emotional Regulation Interpersonal Relationships Exploration of the Environment within the context of the Family ©Children's Research Triangle, 2007

  4. Infant Mental Health • Is based on the understanding that infants and young children do not exist in isolation, but rather develop and experience the world within the context of relationships and environments. ©Children's Research Triangle, 2007

  5. Infant Mental Health • Each infant and young child has unique social and emotional needs. An appropriate response to these needs provides the opportunity for healthy development ©Children's Research Triangle, 2007

  6. Infant Mental Health The Parent/Infant/Child Relationship should be the central focus in helping to foster the healthy development of the PSE child ©Children's Research Triangle, 2007

  7. Model ©Children's Research Triangle, 2007

  8. Secure Attachment • This is of crucial importance to the child’s psychological development—and that a warm, sensitive, responsive, dependable interaction is the key ingredient in developing secure attachments ©Children's Research Triangle, 2007

  9. The parent’s internal working model of attachment is based on his/her early experiences along with particular infant development characteristics. ©Children's Research Triangle, 2007

  10. Functions of Attachment • Allows child to develop a sense of trust, safety and security • A secure base can mitigate future challenges, stressors • Provides a foundation for subsequent intimate relationships ©Children's Research Triangle, 2007

  11. Barriers to Healthy Attachment • Separation from caregiver • Prenatal substance exposure • Intense pain that cannot be removed by the parent • Neglectful or abusive parenting • Temperament ©Children's Research Triangle, 2007

  12. Attuned Parent-Child Interaction Builds the • Right Hemisphere • Research has shown that the right hemisphere is dominant for: • Attachment functions • Self-regulation and survival ©Children's Research Triangle, 2007

  13. Non-conscious processing and communication of social and emotional information The organization of the most comprehensive and integrated map of the body state available to the brain ©Children's Research Triangle, 2007

  14. Just as the left brain communicates its • states to other left brains via conscious • linguistic behaviors, so the right brain nonverbally communicates its unconscious states to other right brains that are tuned to receive these communications ©Children's Research Triangle, 2007

  15. Adult Attachment as it Affects the Attachment of the Child • A parent’s coherent autobiographical narrative is the best predictor of secure attachment with their child • Interpersonal neurobiology-the non-verbal aspects of the way a parent relates to her child ©Children's Research Triangle, 2007

  16. Therapeutic Interventions • Experiential Therapies • Family System Therapy • Parent Psycho-education • Insight Oriented Therapy • Behavior Management ©Children's Research Triangle, 2007

  17. Experiential Therapies • Self-regulation www.alertprogram.com • Narrative therapy www.familyattachment.com ©Children's Research Triangle, 2007

  18. Family Systems Treatment • Focus on parent’s own attachment history • Model healthy limits, boundaries and structure • Parents are encouraged to join support groups ©Children's Research Triangle, 2007

  19. Family Systems Treatment (con’t) • Treatment team and parents create a strong and unified collaborative alliance • Help parents develop positive working relationships with resources in the community ©Children's Research Triangle, 2007

  20. Parent Psycho-education • Effects of problematic attachment histories on development • Developmental expectations • Parenting skills for the attachment-resistant child • Advocating for services ©Children's Research Triangle, 2007

  21. Insight Oriented Therapy • Treatment individually for the foster parent, adoptive parent, or biological parent • Decision based on cognitive and mental health abilities of the adult • Assess adults internal working model of attachment ©Children's Research Triangle, 2007

  22. Behavior Management • Parenting classes/curricula • Issues-quality and appropriateness of the curriculum for special needs children • Use of behavioral logs, role modeling, 1:1 therapy, videotaping, etc. ©Children's Research Triangle, 2007

  23. Infant Mental Health Interventions • Concrete Support Services • Brief Crisis Intervention/Problem Solving • Developmental Guidance • Parent-Child Interaction Guidance • Infant-Parent Psychotherapy ©Children's Research Triangle, 2007

  24. Parent Child Interaction Guidance • Developed by Dr. Susan McDonough School of Social Work and Center for Human Development at University of Michigan • Goal is to promote and nurture the care-giving relationship ©Children's Research Triangle, 2007

  25. Defining Treatment • Family Defines the Problem • Family Defines Intervention Success ©Children's Research Triangle, 2007

  26. Interventionist’s Role • Offer Assistance in Helping the Family Define the Problem • Enhance Parent-Infant Interaction through modeling, coaching, and video feedback • Monitors Treatment Progress ©Children's Research Triangle, 2007

  27. Treatment Process • Assessment of the infant, family, home environment and cultural context • Family engagement process • Treatment implementation • Monitoring treatment progress • Evaluation of treatment efficacy ©Children's Research Triangle, 2007

  28. Using Videotape Feedback • Provides salient feedback • Increases awareness of family interactions • Emphasizing instances of positive parenting, acceptance of negative family feelings, and providing new perspectives through discussion of concrete behaviors ©Children's Research Triangle, 2007

  29. Concern Parents over-reliance on modeling behaviors ©Children's Research Triangle, 2007

  30. Infant-Parent Psychotherapy • Developed by Selma Fraiberg to address mental health problems in infants from birth to three years of age • The theoretical target (Stern) is the web of mutually constructed meanings in the infant-parent relationship ©Children's Research Triangle, 2007

  31. The primary therapeutic focus involves the uncovering of unconscious links between the parent’s psychological conflicts and parenting practices that are gravely mis-attuned to the baby’s needs and derail the infant’s normative development. ©Children's Research Triangle, 2007

  32. Basic Premises • Because behavioral patterns are not internalized as part of the personality structure before the age of 3 years, infants and toddlers can regain their momentum toward normal development when they are no longer the recipient of maladaptive parenting practices ©Children's Research Triangle, 2007

  33. Because profound personality changes occur throughout the lifespan this perspective forms the basis for relational approaches to psychotherapy for children and with adults ©Children's Research Triangle, 2007

  34. Mental Health problems in infancy and early childhood, regardless of their etiology, need to be addressed in the context of the child’s primary relationship, because the child’s sense of self unfolds and is sustained by these relationships ©Children's Research Triangle, 2007

  35. Mental Health risk factor in the first 5 years of life operate in the context of transactions between the child and his/her social environment, including family, neighborhood, community, and the larger society ©Children's Research Triangle, 2007

  36. Childrearing mores and parenting practices are deeply held, often unconscious cultural values about who is a worthy human being and which characteristics should be encouraged and discouraged in raising a child ©Children's Research Triangle, 2007

  37. Therapeutic Themes • Ghosts in the Nursery • Supporting Affective Attunement • Assessing the Child’s and Parent’s Contribution to the Relationship and Dyadic Functioning ©Children's Research Triangle, 2007

  38. Intergenerational Transmission of Psychopathology • Ports of Entry in Infant-Parent Psychotherapy • The Therapeutic Relationship as the Matrix for Treatment ©Children's Research Triangle, 2007

  39. DIR Model • Developmental Individual-Difference Relationship Based Approach • Developed by Serena Weider Ph.D. and Stanley Greenspan M.D. ©Children's Research Triangle, 2007

  40. Developmental= Greenspan’s 6 Stages of social Emotional Development • Individual-Difference= the unique way a child processes information • Relationship Based=learning and facilitating relationships that enable a child to progress in his/her development ©Children's Research Triangle, 2007

  41. Stages of Functional Emotional Developmental Capacities • Stage One: Regulation and Interest in the World First few months of life • Stage Two: Engaging and Relating 2-6 months • Stage Three: Intentionality and Two-Way Communication 6-9 months ©Children's Research Triangle, 2007

  42. Stage Four: Social Problem-solving, Mood Regulation, and Formation of a Sense of Self 9-18 months • Stage Five: Creating Symbols and Using Words and Ideas 18-30 months • Stage Six: Emotional Thinking, Logic, and a Sense of Reality; 2 ½ years-4-5 years ©Children's Research Triangle, 2007

  43. Stage Seven: Multicausal and Triangular Thinking; early school years • Stage Eight Gray-Area, Emotionally Differentiated Thinking; later school age through adolescence • Stage Nine: A Growing Sense of Self and Reflection on an Internal Standard; puberty, early adolescence ©Children's Research Triangle, 2007

  44. Stages of DIR Intervention • Stage One: Facilitate Shared Attention and Regulation • Stage Two: Facilitate Engagement and Relating • Stage Three: Facilitate Purposeful Emotional Interactions • Stage Four: Facilitate Shared Problem-Solving • Stage Five: Facilitate Creating Ideas ©Children's Research Triangle, 2007

  45. Floortime • First Goal-Follow the Child’s Lead While Challenging the Child at the Same Time • Second Goal- Bring the Child into a Shared World • Creating Learning Environments: Floortime: All the Time and Everywhere ©Children's Research Triangle, 2007

  46. Other Curriculum Interventions • Circle of Security Intervention -20 week group based parent intervention program designed to alter the developmental pathway of at-risk parents and their children • PIPE curriculum used in Early Head Start where the emphasis is on the relationship and parenting skills to facilitate normal development in children 0-3 ©Children's Research Triangle, 2007

  47. STEEP (Steps Toward Effective, Enjoyable Parenting) a preventive intervention program for expectant parents and continues over the child’s first year of life • David’s Olds Public Health Home Visitor’s Program • Wait-Watch- and Wonder Program ©Children's Research Triangle, 2007

  48. Do-Watch-Listen-Say: Social and Communication Intervention for Children with Autism (Kathleen Ann Quill) • PCIT-Dr. Sheila- Eyberg-2-7 years of age based on operant theory, traditional child psychotherapy, and early childhood development ©Children's Research Triangle, 2007

  49. Parent Group at CRT • Provision of safe holding and facilitating environment for both the parent and child • Goal to build trust and strengthen relationships • Provide empathetic and supportive experiences ©Children's Research Triangle, 2007

  50. Explore how past relational dynamics influence interpersonal relationships • Use of maternal/parental reflective functioning (Fonagy, Target and Steele) • Slade’s “keeping the baby in mind” ©Children's Research Triangle, 2007

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