Author: Joan Shirilla, LMSW, IMH-E® (IV)

  • Letter from past Infant Crier Editor Joan Shirilla, LMSW, IMH-E®

    Letter from past Infant Crier Editor Joan Shirilla, LMSW, IMH-E®

    Infant mental health home visiting — as well as the Michigan Association for Infant Mental Health (MI-AIMH) — evolved from a request by Selma Fraiberg to the director of the Michigan Department of Mental Health (MDMH) in 1972 to fund graduate students to train in the developing Child Development Project in Ann Arbor. Betty Tableman, then a MDMH staff person who later became the Director of Prevention Services, suggested that staff already employed by Michigan community mental health agencies be funded to carry out the new intervention instead. 

    In 1973, six clinicians from CMH agencies across the state formed the first training group, meeting bi-weekly in Ann Arbor under Fraiberg, Vivian Shapiro, and Edna Adelson’s guidance to learn about the infant-parent dyad.  Their work was based on Fraiberg’s intervention with blind children and their families. The work was complex and challenging, and the trainees asked for and received a second year of training.  They took their skills back to their home communities and found that their work had deepened; relationships between infants and parents changed, and development improved while their hunger to learn more increased. 

    The trainees were on fire with their knowledge and wanted to follow Fraiberg’s dictum to “share what they were learning about mothers and babies with their colleagues.” They formed the Michigan Association of Infant Mental Health in 1977 and hosted its first conference with T. Barry Brazelton as the plenary speaker with more than 800 people attending. Wanting to continue to share the developing knowledge and information about service delivery in the state, the Infant Crier was born, again, under the leadership of Betty Tableman, who served as the first editor. Consider that at the time, there was no internet, no email, and no email blasts.  Rather than checking your voice mail, text, or twitter, you would look in your office mailbox for messages taken by department secretaries.  Reading the Infant Crier, which arrived in your mailbox rather than your inbox, became an important way to learn about this growing field and to connect with others sharing your interest and dedication promoting secure attachment relationships for very young children.

    Looking back, we see Betty’s hand in Infant Crier articles that focused on social policy, news clips and emerging clinical content. Deborah Weatherston followed as editor from 1998-2009.  Under her editorial direction, the Infant Crier became a more clinically focused tool to share knowledge, personal reflections, and social policy. It connected those working with infants, very young children, and their families, across disciplines, from across the state and gradually across the country and world. The Infant Crier became a treasured publication to help develop and nurture understanding of infant, young child, and family development, attachment, and relationship-based work. 

    As Debbie transitioned to MI-AIMH’s first Executive Director, Joan Shirilla served as the Associate Editor, beginning in 2002 through 2009. Articles from leaders in the field, such as Barry Wright, Ph.D., Doug Davies, Ph.D., Michael Trout, M.A., Julie Ribaudo, LMSW, and many others shared didactic information and personal reflections about the complex world of very young children and their families. Jeri Lea Lentini, LMSW, also served as co-editor for several years, sharing her wisdom and clinical expertise. She was followed by Jennifer DeSchryver, Psy.D., who served as editor, bringing with her extensive clinical insight and editing skills.

    Joan stepped in as Infant Crier editor in 2013, sharing it for two years with Kerry Baughman, who moved the publication to its more updated online format, making the Infant Crier more accessible and less costly. 

    In 2020, the leadership of the Infant Crier transitioned to Danielle Davey, LMSW, and Kristyn Driver, LMSW, both highly skilled and seasoned IMH clinicians and supervisors. Their passion for the field is apparent in their work and they are eager to provide a platform for both seasoned and new clinicians to share their work and reflections. They are committed to reflecting best practice in the Infant Crier, to offer a deeper exploration of issues of diversity, equity and inclusion in Infant Crier articles. We are excited to introduce our talented new editors and look forward to Infant Crier articles that continue to help us grow as clinicians and people.

    Reference

    Tableman, Betty. Reflections on MI-AIMH’s History. Reflections from the Field. 2017. 11-13. 

  • Doug Davies: His Enduring Contribution to the Social Work and Infant Mental Health Field

    Doug Davies: His Enduring Contribution to the Social Work and Infant Mental Health Field

    screen-shot-2016-09-21-at-6-52-50-pmDoug Davies, M.S.W., Ph.D., was a beloved colleague, mentor and friend to many in the infant mental health community. He was a Lecturer at the School of Social Work, University of Michigan, had a private practice, and was a MI-AIMH board member for many years. After his retirement from the University of Michigan, he continued to write, provide individual and group reflective supervision, and train infant mental health and early childhood staff in Michigan, Alaska, Virginia and California. His ability to listen deeply helped each of us understand young children, their families, and ourselves better, becoming not only better therapists but better human beings. He provided listening without judgement, genuine compassion, and support that serve as a model we carry within us. We miss him dearly but he was a secure base we have internalized. His felt presence continues with us in our work and in our lives.

    A Doug Davies Memorial Lecture was held at The University of Michigan School of Social Work on June 24, 2016.  The following are excerpts from speakers, Julie Ribaudo, LMSW, IMH E®, and John Bennett, LMSW,  given at that memorial. John and Julie offered personal comments about Doug, and Julie shared the beginning of a chapter written by Doug in the days preceding his death. Doug’s editors at Guilford Press had requested that he write a chapter on toxic stress and one on adolescents for a 4th edition of his text, Child Development (Davies, D. (2011). New York: The Guilford Press). Although initially not sure he wanted to commit the time to write 2 new chapters, Doug agreed, wanting to make complex scientific research easier to understand. He was excited about making information more accessible to clinicians, knowing that a better understanding of complex reactions to trauma would help make better therapists and would ultimately result in better services and outcomes for young children and families impacted by trauma.


    Comments from John Bennett, Doug’s First Clinical Supervisor

    “I was Doug’s first Infant Mental Health supervisor, and he was my first supervisee. About a year later, we wrote a paper together: “Intervention and Adaptation in the Third Year: The Mother-Child Dialogue.” That was about 40 years ago. We spent those 40 years as colleagues in the Child Psychiatry Division of the University of Michigan Department of Psychiatry, as office partners in private practice, and, most importantly, as friends. We talked with each other between clients and met once a month for dinner and drinks. We traded stupid jokes, talked about our childhoods and our current lives, our children, and his grandchildren. Unfortunately both of my grandchildren were born in the year following his death, but I’m sure he would have been as happy to listen to those stories as I was his. We regaled each other about being Irish — the random, existential, metaphysical (and somewhat inebriated) views of life lived. We also talked about the new ideas we were discovering — the latest being arousal moderation, brain networks, and metabolic aspects of mental and emotional functioning in childhood, among many others. This would be serious stuff, and then we would get carried away and end up like Moose and Squirrel. It was a great friendship that covered lots of territory. When he retired from the School of Social Work, I was surprised, after hearing all the praise, and how people were not going to be able to get along without him, etc., to hear the Dean end the ceremony by announcing that Doug would continue on doing essentially what he had done prior to his “retirement.” I caught him afterwards and told him how I thought it was such a dirty little Irish trick to say he was retiring, get people to say all those nice things, then go on working just like he’d done before. Doug assured me (with his glinty little Irish wink) that he didn’t know this would happen when he announced his retirement. When he died, and we had the memorial in Kalamazoo, I was hoping he would be hiding off-stage somewhere and come laughing and popping out from behind the curtains just after all the nice things had been said… but not this time. What a nice guy to have as a friend. I still miss him.”


    Julie Ribaudo’s Lecture

    “Doug approached his work with intellectual rigor, curiosity, and with a healthy respect for the magnitude of the messages he sought to convey.  Because of that, he often wrote out entire lectures.  While it could stem, on the face of it, boring to be read to (unless you are a young child with an animated parent!), listening to Doug was never boring.  I heard him enough times that he would joke with me that I should leave because I had heard his material before.  I never did and I never regretted it.  It is a great honor and with deep respect for his profound gifts that I am going to read from Doug’s last written contribution to the field of social work and to the lives of children and their families.”

    This first section comes from Child Development, 3rd edition. It is included to provide a context for the new text and to show where Doug intended the new information to be placed.*

    *Editor’s note

    In recent years, the effects of prolonged stress on the [hypothalamus-pituitary-adrenal (HPA)] system has been re-named “toxic stress.” “Toxic stress is the extreme, frequent, or extended activation of the stress response, without the buffering presence of a supportive adult.” Created by ongoing severe environmental stressors such as chronic trauma, abuse, and neglect, “toxic stress” is an internal response to even mild stressors that has been shaped by trauma over time. It is a biological adaptation to frequent experiences of threat and high arousal. “One of the primary consequences of early life toxic stress is HPA dysregulation, as the developing neuroendocrine system is chronically pressed into action.”

    The constant secretion of cortisol in response to toxic stress also weakens the immune system. Young children become more susceptible to allergens, which are move prevalent in poverty environments. Young children exposed to toxic stress are much more likely to develop asthma.

    Stress Response Systems

    The function of biological stress response systems is to secrete hormones and neurotransmitters that provide adaptive responses to external stressors and to modulate internal stress. The limbic system, specifically the amygdala, is responsible for recognizing threat and mobilizing reactions to it; it is the brain’s “alarm system.” When the amygdala signals a threat, the [HPA] system secretes and releases neurohormones called catecholomines, which in turn trigger increases in the amount of cortisol in the bloodstream. Catecholomine release underlies the familiar “fight-or-flight” response, in which the individual’s alertness, concentration, appraisal of the environment, and physical energy intensify in the face of danger.

    “Here, I can see Doug looking up, clearing his throat, and ad-libbing just a tad to say, “Here I am thinking of…”  He was always generous in sharing his thinking process with us.”

    …When faced with threat, the stress response system focuses brain activity on dealing with the threat and temporarily inhibits other functions. Animal studies have shown that the release of cortisol promotes the freeing of energy, so that the individual can take action, but at the same time suppresses the immune system, physical growth, and emotions and memory. The hippocampus, a brain area that plays a central role in learning and memory, can atrophy if it is bombarded by high concentrations of stress hormones, resulting in memory impairments.

    The following section begins Doug’s work on Edition IV.

    Epigenetics refers to alterations in the ways genes express themselves in response to changes in biochemical processes. These biochemical changes are in turn caused by environmental influences. The underlying structure of the genes does not change, but their “expression” — the way they regulate functioning — does change. Changes can go in the direction of a well-regulated HPA system when the child receives consistent supportive and protective care by adults; or enduring characteristics of HPA dysregulation, generally in the direction of hyper reactivity, are the likely result of ongoing, unbuffered exposure to toxic stress. When a young child is exposed to toxic stress over time, the constant secretion of the stress hormones cortisol, norepinephrine, and epinephrine leads to epigenetic changes in the HPA system. This is the process underlying over-arousal and reactivity to triggers and mild stressors we observe in chronically-traumatized children.

    “Here we see Doug’s sheer brilliance in listening to and probing the meaning of aggressive behavior of young children exposed to violence.  Even before the benefit of brain science to substantiate aggression as often reactive, Doug knew to listen and observe very carefully – with the aim of understanding and helping a child gain distance, psychologically, from what they had endured, and locating the trauma in the past rather than in the present.  Profoundly empathic, he also worked compassionately with parents, teachers, and other professionals to understand the child as well.  He taught the rest of us to do the same.”

    To understand  the developmental costs of toxic stress, it is useful to define allostasis, a recent concept that captures the “active process of adaptation” in response to stress.

    Allostasis is defined as “maintaining stability through change.” It is “a fundamental process through which organisms actively adjust to both predictable and unpredictable events.” In animals, including humans, allostasis regulates the individual’s ongoing relationship to environmental stress through complex interactions of the nervous, endocrine, and immune systems. In the face of stress or threat — physical or psychological danger, or illness, as examples — these systems work together to promote the best possible adaptation to the environment and survival. In the face of danger, the brain and nervous system appraise the threat and prepare for action, the endocrine system secretes hormones that support action and endurance, and the immune system mobilizes an inflammation response in case of injury.

    “Allostatic load,” or overload, refers to how hard these systems have to work to maintain adaptation. In conditions of chronic stress, such as child maltreatment in early childhood, the process of allostasis operates at high levels in order to protect the individual. However, these ongoing mobilizations of regulatory, internally-based protective processes become shaped, or “biologically embedded,” by constantly responding to threat: “When activated chronically and out of context, allostasis ceases to be adaptive and thus may promote disease as maltreated individuals age.” Neurobiological research has shown a number of developmental and health downsides of allostatic overload in early childhood. These include alterations in brain architecture and function. For example, maltreated children as adults show smaller prefrontal cortex volume. The prefrontal cortex houses the brain’s executive functions, including planning, attention, and impulse-control and decision-making. Neuropsychological testing of maltreated, traumatized children shows deficits in all these functions compared to normal children (Beers & De Bellis, 2002) . To the extent that these deficits become embedded, the child’s capacity for learning and flexible responses to the environment will be compromised as development proceeds. The costs of an overactive endocrine system, specifically the HPA axis, have been documented in the biology of trauma literature. Over secretion of cortisol and other stress hormones in response to chronic threat leads to an overactive and more-easily triggered stress response. Behaviorally, this translates to hyperarousal, hypervigilance, overreactions to even minor stressors, and tendencies to “act without thinking” based on fear and anxiety. When the immune system responds to threat by increasing inflammation levels, the body is preparing to fight physical injury. Children and adults with histories of maltreatment show elevated inflammation levels. Increased baseline inflammation levels disrupt the body’s ability to develop acquired immune response and lead to later vulnerability to inflammatory diseases such as rheumatoid arthritis, fibromyalgia, and chronic fatigue syndrome.

    To summarize, while early allostatic adaptations to adversity by the nervous, endocrine, and immune systems promote short-term protection and survival, these same adaptations program biological responses in all three systems that are detrimental to development and physical and mental health in the long term.

    “Although Doug’s last written words leave us wishing for more, they remind us how much we learned from him. His last writing is a further contribution to his enduring legacy and his capacity to help us strive for excellence and deeper understanding. He knew, and taught us to stay confident too, that through understanding, we would become more compassionate, kinder and better able to support young children and their families. Sometimes we hear sanitized versions of someone when they have died. With Doug, no sugarcoating is needed. He was simply good – through and through.”


    References

    Beers, S. R. & De Bellis, M. D. (2002). Neuropsychological function in children with maltreatment-related posttraumatic stress disorder. American Journal of Psychiatry, 159, 483-486.

    Danse, A. & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology and Behavior, 106, 29-29.

    McEwen, B. S. (2012). Brain on stress: How the social environment gets under the skin. Proceedings of the National Academies of Science of the United States of America, 109,  17180-17185.

    McEwen, B. S. & Wingfield, J. C. (2003). The concept of allostasis in biology and biomedicine. Hormones and Behavior, 43, 2-15.

    Steptoe, A. Hamer, M., & Chida, Y. (2007). The effects of acute psychological stress on circulating inflammatory factors in humans: A review and meta-analysis. Brain, Behavior, and Immunity, 21, 901-912.

    Tarullo, A. R. & Gunnar, M. R. (2006). Childhood maltreatment and the developing HPA axis. Hormones and Behavior, 50, 632-639.

  • THANK-YOU, Kerry Baughman, Infant Crier Co-Editor

    THANK-YOU, Kerry Baughman, Infant Crier Co-Editor

    Kerry Baughman is stepping down as Co-Editor of the Infant Crier as she assumes new responsibilities as Director of Northwest Michigan Community Action Agency’s (NMCAA) 10 county Head Start and Early Start program.

    Kerry BUnder Kerry’s leadership, the Infant Crier changed from a paper document to an online edition making it immediately accessible to readers and providing a more interesting and appealing newsletter. She developed a year-long theme focusing on infant mental health research in Michigan, the first time this was a focus in the Infant Crier. Her technical skills, editing, thoughtful reflection and attention to detail have resulted in outstanding issues over the last 3 years.

    Kerry is an active member of MI-AIMH, serving as President of the NW Michigan Association for Infant Mental Health since 2013 and previously serving as the NW MI chapter representative to the MI-AIMH board. She was also an active member of the NW MI IMH Training Consortium. She has been a home visitor, Great Start Collaborative Coordinator, and, for the past 7 years, Manager of NMCAA’s Early Head Start program. Her commitment to promoting early developing relationships, staff training and endorsement, and reflective supervision make her an outstanding choice for her new responsibilities. Although we will miss her skill and leadership for the Infant Crier, it is exciting that she will continue to promote infant and early childhood mental health across northern Michigan.

  • Michigan Association for Infant Mental Health (MI-AIMH) Welcomes New Officers

    Michigan Association for Infant Mental Health (MI-AIMH) Welcomes New Officers

    Michigan-Association-for-Infant-Mental-Health

    The MI-AIMH Board of Directors is very pleased to welcome Cathy Liesman, Ph.D., IMH-E (IV) as President and Rosalva Osorio, L.M.S.W., IMH-E (III), as Vice President of the Michigan Association for Infant Mental Health Board.

    Cathy is currently the Chief Operating Officer at Development Centers, Inc. (DCI) in Detroit and has had administrative responsibilities at DCI since its founding in 1983. She has a Ph.D. in Psychology and is endorsed at Level IV-Policy Mentor. Cathy has served on the MI-AIMH Board of Directors for 20 years as President, Social Action Committee Chair and Treasurer. She was the recipient of the Betty Tableman Award in 2001 for her advocacy work and has cherished her connections to her many MI-AIMH colleagues throughout her career.

    Cathy describes advocating for relationship-based work, services for young children and MI-AIMH as her avocation. Her skills in relationship-based work extend from relationships with families to working within and across systems as she has supervised, secured grants, developed programs and successfully advocated for children and families. She helped to grow Development Centers, Inc. into the comprehensive agency that it is today serving over 11,000 persons and their families each year in mental health, vocational, Head Start and prevention programming.

    She is very excited about serving as MI-AIMH’s president as she believes that MI-AIMH has a critical role in workforce development and support of the professionals in multiple disciplines who work with very young children and their families. She sees MI-AIMH as a “wonderful vehicle” for the collaborative work of cross-system advocacy for best practice and services for very young children and their families. Cathy is excited about the talent of current board members who bring a diversity of skill, talent and discipline. She explains that each person’s skills are needed to continue to move MI-AIMH forward with the refining of MI-AIMH within Michigan as well as the promotion of the national organization, the Alliance for the Advancement of Infant Mental Health.  Cathy believes it is important for individuals to be ambassadors of MI-AIMH and relationship-based work. “It is the depth of who we reach as individuals that makes our work so far reaching.”

    As the current president Cathy offers stability, knowledge of organizations and a commitment to continue to work for the growth accomplished by the staff and board.

    Rosavla Osorio is a Clinical Director at The Children’s Center, one of two contracted providers of Detroit-Wayne Mental Health Authority dedicated solely to children’s services. Prior to her current position she was Program Supervisor for Infant Mental Health Services at Southwest Counseling Solutions, where she “fell in love with infant mental health.” Rosalva earned a Masters of Social Work at the University of Michigan and is endorsed at Level III, Infant Mental Health Specialist.

    She greatly appreciates the reflective process in infant mental health as a way for clinicians to learn about themselves and be a “tuning fork” for families with very young children.  She describes a family she worked with for 3 years that helped her understand and value infant mental health. She recalls the joy the family experienced when their medically fragile young child learned to sit up and then walk. His mom, who initially felt defeated and inadequate, came to see herself as competent and important to her toddler. Rosalva wants to help other young children and their families find joy together.

    Rosalva explains that she experienced “ghosts” from her family of origin and that the birth of her daughter, Isalia, now 12, was an opportunity to grow and change to become better.  She understood that being a young mother would be hard but wanted to be her best for Isalia. “She is my biggest piece of artwork, my biggest joy.” She has been intentional and reflective in her parenting and acknowledges that this is an important part of infant mental health work.  She is grateful to Jennifer DeSchryver, Psy.D., who served as consultant when Rosalva was at Southwest Counseling Solutions. She saw Rosalva’s talent and passion and recommended her for a board position.

    Rosalva believes that each of us has talent to bring to the infant mental health field. “I get so passionate about being a change agent,” she stated, “so I speak up. People see things in me that I didn’t see in myself.”   She recalls being intimidated when she joined the board 3 years ago, yet finding it “humbling and an honor” to work with people she admired. She soon realized that “we are all human and all learning.”  She believes being a part of change is about creating relationships and hopes that other MI-AIMH members will step out of their comfort zone to advocate on behalf of infants, toddlers and their families. She is excited to continue to move MI-AIMH forward wanting it to be the first place that everyone goes to for information about infants, toddlers and their families. Rosalva will serve for one year as Vice President and then move into the MI-AIMH Presidency.