Author: Deborah Weatherston, PhD, IMH-E®

  • Commentary: All at Sea: A Case Discussion

    Commentary: All at Sea: A Case Discussion

    Jan Proudfoot has given us a great gift – the affirmation of the power of relationship to affect growth and change through the story of a new mother struggling to respond to her baby who she described as strong willed, inconsolable, difficult to feed and unresponsive to people or playthings. Jan’s initial response to the referral was meaningful. She explained, “These problems are so big and I’m so little,” giving us an immediate window into her own feeling of vulnerability as she wondered if she would “know what to do.” She drew on experiences with mentors who had guided her so thoughtfully over many years. She was quietly present, watched and listened carefully, deeply affected by the stories she heard. Her capacity to be emotionally available to Mom and Baby, to witness their interactions and hold their relationship, were strategies that form the bedrock of an infant mental health service. Although in the “assessment and information gathering” phase, Jan’s presence provided a carefully crafted and powerful intervention. After listening intensely to Mom’s stories, she shifted ever so slightly to observe with Mom and wonder aloud about the baby’s experience. This was a carefully paced shift that fueled Mom’s capacity to begin to have empathy for her baby’s difficult entry into the world. Quiet, confident, and very seasoned, Jan worked without hurry, countering the press she felt to teach or to tell Mom what she should do.

    Mum's little boyAs I fell under the spell of the story, gently carried by Jan’s words, I wondered about parallel process, so beautifully illustrated here. Jan, worried about the complexity of the task and if she would know what to do; a new mother, worried about the tasks of motherhood and wondering if she knew how to care for her Baby. Similarly, Jan, observing and listening to Mom so that Mom would observe and listen to her Baby’s cues. Jan, guided in relating to Mom and Baby by the maps her mentors had given her over many years; a new mother, finding a map to guide her in relating to her Baby through her relationship with Jan. Jan nurturing and understanding Mom; Mom nurturing and understanding her Baby.

    Finally, I was enchanted by the use of metaphor. The “ship was off course;” Mom and Baby were “at sea.” Jan’s presence and relationship provided “a map” as Mom and Baby “sailed to sunnier climes.” Simple, yet enormously complex work. Thank you indeed for this great gift.

  • Grass Roots Growth and Change

    Grass Roots Growth and Change

    For many decades, the creative energy of members of the Michigan Association for Infant Mental Health (MI-AIMH) has contributed to the knowledge and understanding of infant mental health principles and practices for thousands of professionals across disciplines in the infant and family field. Beginning with the first infant mental health conference in 1977 and continuing with the publication of MI-AIMH Training Guidelines in 1986, policy papers promoting infant mental health (1985 to 1997), manuals and monographs (1989 to 2015), learning tools (2002 to 2016) and practice DVDs (2012 to 2016), MI-AIMH and its members have made their mark as national leaders, defining and supporting infant mental health.

    In addition to producing materials for professionals and parents to promote relational health, MI-AIMH members developed a set of standards, the MI-AIMH Competency Guidelines®1 (2002), as well as a systematic approach to work force development, the MI-AIMH Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health® (2002), for the infant and family field. Linked to the MI-AIMH Training Guidelines (1986) and professional development indicators identified by the Michigan Department of Education (1996), the standards and plan provide a framework for use across systems and at multiple levels to promote infant mental health. Both provided an extraordinary focus for MI-AIMH for the last 10 years. Experts in the infant and family field recognized the standards and plan as a pathway for best practice and professional recognition in a diverse and rapidly expanding infant mental health field.2,3

    Michigan continued to lead the initiative and by 2013, 13 associations had licensed the MI-AIMH standards and work force plan to support knowledge, skills and reflective practice approaches for the development and promotion of infant mental health in their states. The oversight and quality assurance demands for a small MI-AIMH staff were considerable. The MI-AIMH leadership and leaders in other member states recognized that future strength and growth would require organizational change. The MI-AIMH Board of Directors subsequently engaged in a strategic planning process with knowledge and support from non–MI-AIMH leaders and proposed the creation of a separate organization to manage the endorsement. The organization was incorporated as the Alliance for the Advancement of Infant Mental Health, Inc.® By June 2016, the Alliance® shareholders approved an 11-member Board of Directors, officers, member qualifications and a set of by-laws to govern the organization. What was once a small, grass roots effort developed by MI-AIMH had grown to be a sizable national and international movement, co-lead by MI-AIMH and a new leadership structure, with over 27 infant mental health associations in the United States and one in West Australia.

    US Alliance members mapOf note, MI-AIMH leaders were instrumental in partnering with non–MI-AIMH stakeholders to identify priorities for the new organization that included the following: Sustainability funding for the Alliance®, expansion of the endorsement criteria to recognize those working with children 3 through 5, exploration and advocacy for Medicaid reimbursement of infant mental health services at the state and federal levels, development of training models and higher education programs specific to the competencies, consistent messaging and communication across state associations, building capacity for reflective supervision and consultation in each state and evaluation and research of reflective practice and the endorsement process. These priorities set an ambitious course for the new organization and led to considerable challenge and change for MI-AIMH.

     

    Accomplishments in 2016United Kingdom Alliance Map

    MI-AIMH and Alliance® leaders together coordinated Alliance® activities in 2016 and used distance technology regularly to support and strengthen a sense of community among the IMH leadership across all 27 state associations and Western Australia. Priority projects included:

    • The development of an early childhood mental health endorsement (ECMH-E) specifically for those working in service settings or on behalf of children 3 to 5 years of age and their families
    • The Spanish translation of the Endorsement®, its application system (EASy) and supporting materials to extend this initiative to monolingual Spanish-speaking professionals
    • The completion of the development of the RIOS (Reflective Interaction Observation Scale) to identify core elements of reflective supervision and consultation, under the committee lead of Christopher Watson, PhD, University of Minnesota and with members from Michigan, Indiana, Rhode Island, Connecticut, Texas, Colorado, Kansas and Washington
    • The co-hosting of the 1st Alliance RSC Symposium, in August 2016, at the University of Michigan, Ann Arbor, with over 115 people in attendance
    • A renewed focus on competency-informed training and education that encourages relationship building and reflective practice at the 10th Alliance Board Meeting and Leadership Retreat in Scottsdale, Arizona in October 2016
    • The exploration of ways that states fund infant and early childhood mental health services, examining requirements for Medicaid funding to support and sustain infant-family interventions and treatment services and linking with Zero to Three’s Social Policy network for information exchange
    • The successful funding of research faculty across Michigan universities to evaluate the efficacy of Infant Mental Health Home Visiting (IMH Home Visiting), which is vital for moving the service from a promising practice to an evidence-based practice

    Australia Alliance mapIn summary, MI-AIMH’s creative energy and leadership for over 40 years has led to an explosion of interest and shared commitment in Michigan and across the country to the promotion of early development and relational health, as well as continuing investment in the principles and practices of infant mental health.

    Looking Ahead for MI-AIMH

    What next? MI-AIMH’s leadership capability and creative ingenuity, so effective in the first 40 years, will continue to characterize the organization as new leaders emerge and commit to infant mental health policies and practices in Michigan and the Alliance® becomes a separate entity governing cross-systems and infant mental health work force development and recognition beyond Michigan. The relationship between the two organizations will remain strong. MI-AIMH and Alliance® staff will continue to share space and tasks for the foreseeable future; MI-AIMH members will continue to share leadership responsibilities for the Alliance®. Growth and change will require strong working relationships between the leaders of these two organizations, as well as empathy, support, honesty and flexibility. The goals of both organizations intersect…


    References

    1. Michigan Association for Infant Mental Health (2002/2016). Competency Guidelines®. Southgate, MI: Michigan Association for Infant Mental Health.
    2. Annapolis Coalition, 2007
    3. Weatherston D, Kaplan-Estrin M, Goldberg S. Strengthening and recognizing knowledge, skills, and reflective practice: the Michigan Association for Infant Mental Health Competency Guidelines® and Endorsement® Infant Mental Health Journal. 2009;30:648-663.
  • Honoring Doug: A Lifetime of Commitment to Infants, Children and Families

    Honoring Doug: A Lifetime of Commitment to Infants, Children and Families

    This letter, written by Debbie Weatherston and Sheryl Goldberg, was read on behalf of MI-AIMH at the Davies Memorial Lecture.

    Doug served the Michigan Association for Infant Mental Health and the infant mental health community throughout his long and distinguished service to children and families. While earning his M.S.W. from the University of Michigan in 1979, Doug received clinical training in infant mental health at the Child Development Project where Selma Fraiberg was the director. That experience shaped his commitment – intellectual and heartfelt – to early experiences, the promotion of social and emotional wellbeing, and the unique developmental and relational approach to health through infant mental health. He began his clinical practice in 1980, combining skills as a gifted mental health professional, supervisor, and faculty member at the University of Michigan.
    screen-shot-2016-09-21-at-6-50-29-pmThe Michigan Association for Infant Mental Health – MI-AIMH – benefited from Doug’s extraordinary professional commitments. The organization was so fortunate to have him serve in a leadership capacity for many, many years. Among his most important contributions:

    • He played an important leadership role in the development of the MI-AIMH Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health, beginning in 1999. He gave generously of his time and attention to the creation of this work force system that provides a framework for the infant and family field in over 23 states and West Australia.
    • He was a mainstay in the development of two Reflective Supervision DVD’s, one (2013) for the infant mental health community and a second (2016) for those working as supervisors or consultants in non-mental health infant and early childhood communities
    • He was a member of the MI-AIMH Executive Board of Directors from 2012-2016 where his leadership skills were especially important for participation in the strategic planning process that led to the formal creation of the Alliance for the Advancement of Infant Mental Health, Inc.®.
    • He led MI-AIMH in partnering with the Michigan Department of Human Services in 2014 to develop a Joint Policy, Attachment in Infancy and Best Practice Recommendations for Decision-Making for Infants/Toddlers in Foster Care.
    • He partnered with MI-AIMH for many years in the development and delivery of training. Of note, in 2013, an important grant-funded training series in the art of Reflective Supervision, “ Building and Expanding Reflective Practice in Infant Mental Health.”

    MI-AIMH honored Doug in 2007 with the distinguished Selma Fraiberg Award for his work on behalf of infants, toddlers and families and the promotion of infant mental health. Fitting for him to have been recognized with this award as that is where he began, at the table with Selma Fraiberg and her colleagues.

    In sum, Doug’s presence at so many tables enriched the work of MI-AIMH for decades with his intellect, his clinical understanding, his kindness and his compassion. He was revered by all who worked with him – state policy makers, program directors, trainers, supervisors, clinical practitioners, childcare professionals, nurse family partnership professionals, head start, teachers, infant mental health specialists, members and board members, very young children and families.

    He was an engaging writer, a deep clinical thinker, generous with his gifts and a beloved mentor to so many in the infant mental health community. We honor him today, with gratitude for his very significant contributions to infants, toddlers and families and each one of us.

  • “Nurturing Children and Families: Building on the Legacy of T. Berry Brazelton,” B. Lester and J. Sparrow, Eds. (2010)

    “Nurturing Children and Families: Building on the Legacy of T. Berry Brazelton,” B. Lester and J. Sparrow, Eds. (2010)

    IMG_4001“Nurturing Children and Families: Building on the Legacy of T. Berry Brazelton,” edited by Barry M. Lester and Joshua D. Sparrow, invites readers to reflect on and celebrate the remarkable contributions that T. Berry Brazelton has made to the advance of science and the nurturing of infants, children and their families. The book introduces us to significant concepts that have changed how scientists and practitioners view babies and witness the relational nature of human development over the span of his 50 year career. Most important to mention here: individual differences in infancy and the dynamics of newborn behavior; the infant’s contributions to his or her own course of development; the power of the parent-child relationship to influence health, growth and change; and the importance of shared observation and meaning making in early work with families. Brazelton’s pioneering spirit has transformed practice, inviting pediatricians, nurses, psychologists, social workers, home visitors, early care and education professionals and many others to be open, curious, and thoughtful in their observations, interactions and affective responses to infants and families. Of great importance is Brazelton’s therapeutic stance that has guided generations of parents to feel confident and competent as they cared for their babies in the early years.

    The book is laid out in three separate parts. Part I discusses Brazelton’s accomplishments in terms of behavioral and developmental research. Part II explores innovations in clinical intervention, including a section about infant mental health and the treatment of trauma. Part III discusses the implications of Brazelton’s work for professional development, systems of care, and policy. Chapter by chapter, the book is a masterful collection of writings from among the most respected scientists and clinical leaders in the infant and family field. Each contributor invites readers to think more deeply about early development, relational contexts, and touchpoints for optimal growth and change. What follows is a brief introduction to each part.

    Part I introduces the reader to the transformations in research and practice that are attributed to T. Berry Brazelton. Barry Lester describes existing paradigms that Brazelton challenged and praised the “new lens through which we see and study children based on his scientific contributions.” p. 3. Joshua Sparrow follows with an illuminating chapter in which he examines Brazelton’s transformative ideas about infants and observation, individual differences, culture and development, and collaborative consultation. Part I continues with a focus on advances in fetal and newborn behavior, self-regulatory and relational processes, regression and reorganization in infancy, and neuroscience perspectives on developmental models. The range of topics is stunning, reflecting the depth and breadth of Brazelton’s thinking by colleagues and authors, Kathryn Barnard, Tiffany Field, Daniel Stern, Ed Tronick, Stanley Greenspan, Allan Shore, and Jerome Kagan, to name a few.

    Part II includes discussions of innovative clinical interventions for infants and parents that are relationship based: Touchpoints®, Nurse Family Partnerships (NFP), the care of preterm infants (NIDCAP), the use of the Neonatal Behavioral Assessment Scale (NBAS) to encourage parent-infant interaction. Charles and Paula Zeanah, Joy and Howard Osofsky, Dante Cicchetti and Sheree Toth offer perspectives on infant mental health. They address core concepts that reflect Brazelton’s considerable contributions to our understanding of the field. It is clearly a multidisciplinary field that focuses on strengths; it is relational; it is observational, collaborative and insightful.

    The discussion about “ghosts in the nursery” and angels in this section, written by Alicia Lieberman and William Harris, has particular meaning for the infant mental health community. They align the thinking and work of two important pioneers, T. Berry Brazelton and Selma Fraiberg:

    “Brazelton observed, Fraiberg observed – and both intervened, each as a different segment of the health – pathology spectrum. Brazelton promoted awe, pleasure, and competence in parents who were often seeing the wondrous capacities of their babies for the first time. Through their babies’ responses to them, parents developed a reinforcing sense of self-efficacy. Fraiberg focused on parents whose capacity to connect to the unique individuality of their baby was thwarted by their negative attributions, rooted in their own childhood experiences of having felt unprotected and unloved. Brazelton was working through a lens of optimism, using the baby’s competence to help parents discover their own; Fraiberg was focusing on the mother’s psychopathology, using the baby’s potential to help the mother escape from entrapment in her own past. Together, they created a chiaroscuro that honors the complexity of what Daniel Stern calls ‘the first relationship.’” P. 243-44.

    Their work led to the relationship as a focus for the promotion and practice of infant mental health, a significant shift in the delivery of developmental and clinical services for infants, toddlers and families. We are challenged by the authors in Part III to take the principles of relationship work, so central to Brazelton and Fraiberg, and apply them across disciplines, systems, and organizations to effect continued growth and change through collaboration in this rich and rapidly expanding field.

    Part III contributors discuss the implications of Brazelton’s work across disciplines and systems of care. Libby Zimmerman offers observations about developing the infant mental health workforce; Jayne Singer and John Hornstein discuss Touchpoints® for early care and education providers; Constance Keefer examines early innovations in behavioral/developmental pediatric training. Change is the focus for the concluding chapters. Change in service delivery in a hospital environment is addressed by Myra Fox; improving healthcare service delivery with relationship-based nursing practices is presented by Ann Stadtler, Julie Novak, and Joshua Sparrow; Daniel Pederson and Jack Shonkoff translate the science of early childhood development into policy and practice.

    I turned the last page of this extraordinary collection and drew a deep, reverent breath. What a remarkable man T. Berry Brazelton is. He has contributed so much to shared understanding of the importance of infancy and the power of nurturing relationships to growth, health, and change. Sarah Lawrence-Lightfoot’s concluding reflections are heartfelt:

    “As we honor and learn from the luminous life and work of Berry Brazelton,we take his lessons and make them our own, hearing the echoes of his teachings and giving them our singular voice and commitment. Now is the time. Now is always.” P. 362

    This remarkable collection will enrich every infant mental health professional’s understanding of the legacy of T. Berry Brazelton and his influence on the infant mental health field.

     

    WAIMH Perspectives in Infant Mental Health, Vol. 21(2), June 2013. Reprinted here with permission.