Author: Sheryl Goldberg, LMSW, ACSW, IMH-E (IV)

The short answer to this question is, “Intention and Attention”. The rest of this message will offer you information to reflect upon related to our growth process.

Our Chosen Definition of Diversity

MI-AIMH strengthens and supports a diverse infant and early childhood mental health-informed workforce, engaging professionals who represent many different cultures, ethnicities, disciplines and service communities. These professionals support pregnant women, infants, toddlers, young children and families in a variety of ways, integrating I-ECMH principles in their work with families.  Because we believe that it is important that we direct our workforce development activities towards this broad expanse of individuals and organizations that touch the lives of families during this sensitive period, we feel an equally broad definition of diversity is required.

The challenge that we acknowledge is that it is difficult to “go deep” in any one priority area when we are so broad in our attention.  There is no doubt that we have many miles ahead in this journey, nor that we have laced up our sturdy walking shoes to travel down the path.  In reflecting upon where we have been, where we are now, and where we are going, I hope we can notice and mark the milestones achieved and power ahead to reach those before us.

The Evolution of IMH Workforce Development Efforts

Founded in 1977, MI-AIMH was born from Selma Fraiberg’s pioneering infant mental health work recognizing the critical importance of the infant-parent relationship to all learning and development. Over time, MI-AIMH has translated her model of “therapy around the kitchen table” into a comprehensive, practical framework for infant and family professionals, which has guided the IMH home visiting model in our public community mental health services system in Michigan.  The attainment of Medicaid funding to support this treatment by MI-AIMH Endorsed mental health clinicians has resulted in tremendous growth of IMH treatment services for high risk families who are pregnant or parenting infants and young children.  However, other professionals also spend many hours with very young children and work with families who are pregnant or parenting birth to six year olds, and we want them to use our resources and expertise to support relationship-focused, reflective practices aligned with infant mental health competencies.

Our relationships with other important systems serving infants, young children and families over the years have continued to inform understanding about the importance of an IMH informed workforce to the well-being of those we serve.  Endorsed professionals now represent the broad array of service delivery systems to this population, even though the majority are still providing infant and early childhood mental health services in CMH programs.

Our framework to guide understanding and attainment of competency, the MI-AIMH Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant and Early Childhood Mental Health® developed in 2002, reflects the diversity of practitioners in terms of their professional roles and practice settings.  The competencies upon which this was built are what we have focused our training programs on ever since.

Specific to cultural diversity, all of our training events intend to integrate this perspective into the didactic and reflective components of the programs.  Sometimes we have been more successful than others in these efforts, and current vetting of potential training emphasizes this as a focus.  We have also developed and delivered training over the years wholly devoted to issues related to culture, relationship support across difference, and identity self-awareness.  In the last several years we have offered memorable stand-alone events and MI-AIMH Conference presentations from diverse trainers on topics such as historical trauma, hair-combing interactions, third space, the Irving Harris diversity tenets, reflective supervision where there is racial difference between supervisor and supervisee, and more.

Coming up in 2018 and 2019, we will have a repeat offering of “Climbing Mountains, Building Bridges” (an important training offered over the last few years), and two major events built to deepen our competency in providing culturally sensitive relationship-focused work:  The Explorations in Development 2-day conference offered in collaboration with Wayne State University’s Merrill-Palmer Skillman Institute IMH Dual Title Program and Healthier Urban Families Program this fall will examine the role of culture, power and privilege in seeking and utilizing early intervention and early childhood mental health services.  Our 2019 MI-AIMH Biennial Conference in May is entitled Relationships Heal: The Transformative Power of Connections, which will reflect many aspects of our work through a cultural lens.

Building More Diverse IMH Leadership

Competency-based training leading to Endorsement will always be one of our key strategies for building strong infant-family professionals.  This is our primary mission, but it is not enough to address the needs in our field to open pathways that will result in more culturally diverse leaders.  We are attending to this both within MI-AIMH and within the global organization we are a part of, the Alliance for the Advancement of Infant Mental Health®.  Here are a few important examples of intention and attention to this area of need:

• MI-AIMH’s Board and Liaison roster now reflects more racial diversity than ever in its officers, committee leadership, and representatives
• The EASy application system for Endorsement® has been translated into Spanish for the IFA and IFS categories thanks to grant support from our Alliance partner, the Oregon Infant Mental Health Association, Colorado’s Project LAUNCH, and Connecticut’s HSSCO. Further efforts are underway to support translation at the IMHS and IMHM categories, as well as to hire a Spanish speaking Endorsement Coordinator to work with potential applicants across the country
• The next Annual Reflective Supervision/Consultation (RSC) Symposium that will be in Colorado in August will continue to provide an in-depth opportunity to build reflective supervision expertise and leadership. I have had the privilege of being on the planning committee as an Alliance Board member. Entitled “Mining the Depths: An Exploration of Equity Through the Reflective Process”, we intend to immerse attendees in considering the impact of race and equity on the important relationship for learning that RSC offers.
• The Alliance drafted a Call to Action document for all member IMH associations on Diversity, which will be published in our next Crier issue
• MI-AIMH is exploring the feasibility of joint grant-seeking with Wayne State University/Merrill-Palmer Skillman Institute to offer Diversity Fellowship experiences once again

It is with great humility that I ask you to celebrate what we all have accomplished thanks to the many voices and hours of intentional attention to the issues at hand AND to stay engaged as we continue to find our way forward together.

“So, what is Reflective Supervision or Consultation, anyway?” I am asked, yet again.  I take a deep breath and orient myself to whom I am speaking.  A mental health clinician unfamiliar with early childhood mental health?  Someone who offers early care, education, or support services of a different kind?  Is it a program supervisor or administrator?  Someone who is responsible for workforce development policy and who needs to know what value reflective practices, including supervision or consultation, can offer to their system?  Is it a student or new staff person?

My answer will be slightly different for each of these individuals because they each come to that question from a unique place.  However, a brief dilemma statement can help move the conversation forward to get a glimpse into what reflective supervision/consultation (RS/C) is and how it might be important to enhancing the quality of service they offer.

Here are a few good ones:

*A new staff person appears uncomfortable speaking with a parent about their baby’s observable atypical development.
*An experienced staff person is having difficulty engaging a particular family.
*A clinician who has worked with older children and their families is now working in an infant mental health (IMH) program; she is observed picking up the baby to play when she walks into one of her families’ homes and launching into conversation with the parent about whether the agreed upon time for parent-infant play was spent since she was last there.
*An infant/toddler caregiver feels overwhelmed by a toddler who refuses to stop hurting other children in her care.
*A supervisor has a staff person who is extremely inconsistent in meeting with him.

You might find yourself easily able to see how these dilemma statements could be used to engage in a dialogue that sheds light on how RS/C addresses the issues of relevance.  Each of them is a real practice example of an opportunity to engage in mutual exploration, to clarify experiences and perspectives, and to uncover possibilities for further focus.

Let’s now consider aspects of RS/C that can inform any responses you might offer:

1. What do we mean when we talk about RS/C?
2. What are its core processes?
3. Why do we believe it is so important to the provision of quality relationship-based services to infants, toddlers, and families, as well as to the growth and health of the professional?
4. How do we use this important relationship process to manage all that there is to balance? In RS/C we try to balance:

*Attention to the self with attention to the work,
*Attention to the supervisory relationship, with the practitioner-family relationship, with the parent-baby relationship (to what each partner brings to those relationships), and the weird thing we call “parallel process” by which one influences all the others,
*Attention to what is there, what is missing, and to whether all perspectives are represented,
*Attention to emotions stimulated and to thoughts that emerge to be explored,
*Attention to noticing and holding the experience that is there, and also to help support openness to explore what we do not know yet.

What do we mean when we talk about RS/C?

Without citing the literature here, I will summarize by saying that it is a collaborative relationship for learning and support that requires true participation between supervisor and supervisee or consultant and consultee(s).  Its most basic expectations are that it:

*Is safe and mutually respectful,
*Is consistent and frequent enough to create continuity and familiarity,
*Pays attention to the emotional experience and thoughts of the supervisee,
*Pays attention to all of these relationships — supervisor and practitioner, practitioner and family, parent/caregiver and very young child,
*In addition to helping supervisees increase their understanding about a family or dilemma in their work, it provides a “holding environment” within which they can tolerate a bit of ambiguity (and sometimes anxiety or other difficult feelings) long enough to be curious, to be open, and to notice and explore what might be observed in the baby, caregiver, and self.

It may or may not be obvious, but BOTH supervisor and supervisee must be willing to engage in this way.

What are the core processes in RS/C?

We are learning to tease these apart now through various research efforts taking place across the country.  Observable elements of RS/C are being codified in a tool under current development by Christopher Watson, Ph.D., along with colleagues at the University of Minnesota and others working in states who have purchased a license to use the MI-AIMH Endorsement ®.  This tool, called the Reflective Interaction Observation Scale (RIOS), seems to capture the core processes quite well.

The first core process is the mutual attempt to Understand the Story that is being presented about the baby, family, and the work with them, in a way that looks beyond a superficial presentation and considers the influence of history and current contexts.  A supervisor and supervisee hope to avoid rushing to judgment as they try to get the best handle on what is happening in order to figure out where they are and what to do next.  This can be one of the hardest things to do in the push to solve the problem, allowing us to move away from the feeling of confusion or the discomfort of not knowing.

The ability to understand and use Parallel Process is another important element in RS/C.  In IMH, we believe that the most therapeutic thing about what we do is the relationship we offer.  We believe that this is true whether we are IMH practitioners acting as therapists or as IMH-informed practitioners working in other systems or disciplines.  We hope that the quality of the relationship that the practitioner offers to the family is a new experience that can be taken in by the caregiver and the baby as a source of regulation, consistency, acceptance, appreciation, curiosity, etc., and that the caregiver, having been really seen in this way by the practitioner, will be more able to do this for their very young child.

How can a practitioner do this for a caregiver in a consistent, genuine way if they do not experience this “being seen” and accepted when vulnerable, when clear and strong, when sad or anxious, or when not knowing?  Short answer, I do not think they can.  The supervisor/consultant’s offer of this relationship to the supervisee makes it more possible for him or her to be with the caregiver and very young child in a unique way through this parallel process.  It allows them to also use observations about the affective experience at the level of the supervisor and/or supervisee to tell them something about the affective experience of baby and family members.

This adds a layer of quality that goes above and beyond diagnostic formulation and carrying out well-designed treatment plans.  This wondering about the effects of relationships upon relationships helps inform the work.  The RS/C relationship should help the supervisee pay attention to his or herself in the work in order to increase use of self.

Holding the Baby in Mind is the next element.  We all naturally tend to gravitate toward a particular interactive partner in our observations and perspectives.  When families or other caregivers are particularly overburdened, or supervisees are overwhelmed by worries, either in their own lives or in response to what the caregivers present, it is easy to lose sight of the baby.  Is it too overwhelming to wonder how the baby experiences these things?  Is it too sad or frightening?  What does the baby bring to the equation?  What does the baby mean to the caregiver?

The baby as an interactive partner tells us much about what is important in the work with a family.  A supervisor/consultant may have to notice when there are little observations or curiosity about the baby in his/herself, or in the supervisee, and engage in gentle inquiry about this.

The Working Alliance is the term used to describe some of the other characteristics of great import to the RS/C process.  This is something that has to be built.  I think it starts most hopefully with assuming best intent of the other on the part of both supervisor and supervisee.  This is easier said than done sometimes – because of past relationships or the lack of confidence of a new supervisor or of a new supervisee, or of mismatch in style, personality, training, or cultural expectations.

Just as is true in a new practitioner-family relationship, trust and safety have to be grown and tested in order for real comfort to emerge.  A pair will have to negotiate how to set their agenda and goals, what the expectations of each other are, how to use their time, and ask for information.  They will celebrate accomplishments. They will have to sort through many experiences — of observing and wondering together, of sitting with silence, of not knowing when the pressure to know feels urgent, or of inquiring about what might be missing. They will need to acknowledge their own feelings as they emerge in order to better understand what is happening in the work and be willing and able to manage intense feelings.  They will have to learn how to repair when there are mis-attunements or misunderstandings and to learn and try out new skills. It is a developmental process for each supervisee and supervisor, for each RS/C relationship, and even within that, perhaps for each new type of dilemma.

So, we come full circle as we have looked at these core processes, or elements, and all there is to balance to this final question – Why is RS/C so important to the provision of quality relationship-based services, as well as to the growth and health of the professional?

This is the vehicle for truly supported learning where relationship affects relationship, and where competencies — theory and knowledge and skills and reflection — can be tried out in a supported way.  Supervisees do this with the help of the supervisor, parents and other caregivers do this with the help of the practitioner, and babies do this with the help of those who care for them.  None of us learn from experience alone, rather it is the reflection on experience that teaches.

 

Reference

Watson, C., Gatti, S., Harrison, M., & Hennes, J. (2014). Reflective supervision and its impact on early childhood Intervention. In Advances in Early Education and Day Care: Early Childhood and Special Education, Vol. 18. (Eds. E. Nwokah & J. Sutterby). Emerald Group Publishing:  United Kingdom. pp. 1-26.