Infant

1
Infant Toddler Mental HealthAssessment

• Stacey Ryan, LCSW
• Angela M. Tomlin, Ph.D.

2
Objectives

• Participants will be able to
• Discuss the scope of mental health problems in
  young children
• Describe what IMH assessment and treatment is and
  is not
• Explain the importance of social and emotional
  development to other developmental areas

3
Objectives

• Select tools and methods for assessing child
  development, parent-child relationships, parent
  capacity for relationship, and family situations
• Demonstrate beginning knowledge of infant-toddler
  mental health interventions

4
Is Infant Toddler Mental Health Really a Problem?

• Yes!
• Young children do experience problems in social
  emotional competency and even psychopathology
• We are better able to understand and measure
  these problems

5
Why we resist this

• We are too worried about cognitive skills (ready
  to learn)
• Stigma associated with mental health issues
• Myth of childhood
• Our own discomfort with the idea

6
Prevalence

• Best estimates of serious behavior concerns in
  children 2 to 3 years fall between 10 to 15
• Parent and pediatrician report behavior problems
  in 10 of 1 to 2 year olds

7
But wont these problems go away?

• No!
• 37 of 18 mos with extreme behavior/emotional
  problems continue to have problems at 30 mos
• Over ½ of 2-3 with psychiatric d/o still have
  symptoms 2 years out

8
Long Term Effects

• Exposure to poor caregiving, abuse, or domestic
  violence can lead to developmental and mental
  health problems in young children
• Babies, toddlers, and preschoolers can
  demonstrate depression, PTSD, and disruptive
  behaviors

9
The Science of Early Childhood Development

• Babies brains are growing at a phenomenal rate
• The infant brain is experience expectant
• Both positive and negative experiences have
  significant and long lasting effects

10
The Science of Early Childhood Development

• Experience, especially social experiences, change
  the way the brain is shaped and functions
• Babies who experience or witness violence have
  behavioral and physiological changes

11
The Science of Early Childhood Development

• Separation from parents, sometimes sudden and
  usually traumatic, coupled with the difficult
  experiences that have precipitated placement in
  foster care, can leave infants and toddlers
  impaired in their emotional, social, educational
  and physical development (0-3, 2003)

12
So now were thinking

• OK, maybe babies and toddlers can have emotional
  concerns
• And maybe relationship is pretty important
• But there cant be that many babies removed from
  their parents
• Can there?

13
Young Children in Foster Care

• 25 of children in foster care are under 5 years
  old
• 13 of those entering care are under 1 year
• Infants are the faster growing population in
  foster care

14
Young Children in Foster Care

• Once in foster care, babies stay longer than
  other children
• They are more likely to be abused while in foster
  care or when returned to parents
• Reunification of babies placed under 3 months is
  low

15
Young Children in Foster Care

• Of all the children who died from abuse and
  neglect,77 were under 4 years old.

16
MH Challenges in Young Children

• Are real
• Involve a substantial number of babies
• Can be assessed and treated

17
What Infant Toddler Mental Health is NOT

• Babies on a couch
• Talking therapy with toddlers
• Seeing a child without parents
• Bonding therapies
• Developmental therapy

18
What Infant Toddler Mental Health IS

• Based on over 50 years of clinical practice
• Informed by recent brain research findings
• Outcome-based interventions
• A way to understand children in their families

19
Areas to Consider When Assessing Young Children

• Developmental Levels of Infant or Child
• Quality of Important Relationships
• Parent Status (Capacity for Relationship)
• Family Situations

20
Infant Child Development

• A good working knowledge of typical development
  is needed when you assess young children
• You cant tell what is atypical if you dont know
  what is typical

21
Infant Child Development

• Expected order of milestones is knownSkills are
  traditionally divided into 5 areasThere is much
  overlap between the areasUneven development
  across areas is concerning

22
Infant Child Development

• Ways to learn about development
• Have a great memory from college coursework
• Get a child development text
• Watch some babies
• Review some developmental checklists online

23
Infant Child Development

• aap.org
• http//thechp.syr.edu/Developmental_checklist.pdf

24
Infant Child Development

• Cognitive
• Receptive, Expressive, and Pragmatic
  Communication
• Fine Gross Motor
• Social-emotional and behavior
• Adaptive Skills (Self Help)

25
Cognitive Skills

• Thinking
• Problem Solving
• Memory
• Attention
• Imitation

26
Communication

• Use of gestures and facial expressions
• Understanding speech
• Expressive language
• Social or pragmatic aspects of communication

27
Fine Gross Motor Skills

• Use of hands and arms to manipulate objects
• Balance
• Strength and tone
• Walking, running, jumping

28
Social-emotional and behavior

• Eye contact
• Social smile
• Relationships/attachment
• Regulation

• Sleep
• Feeding
• Aggression
• Compliance

29
Self-Help/Adaptive

• Eating
• Dressing
• Participation in grooming
• Toileting

30
Ways development can be atypical

• Global delays in development
• Inconsistent development
• Atypical, unusual behaviorsred flags

31
Red Flags in 6 Month Olds

• Inability to Read Signals
• Persistent Sleep Problems
• Lack of Predictability
• Failure to Imitate Sounds and Gestures
• No Affect, Range of Feelings
• Lack of Stranger Anxiety (8 months)

32
Red Flags 12-18 Month Olds

• No Words
• Persistent Sleep Problems
• Withdrawn
• Excessive Rocking
• Prolonged Fears

• No Separation Distress
• Immobile, Low Activity
• No Social Engagement
• Predominant Anger and Outbursts

33
Red Flags in 18 Months to 3 Year olds

• Eating Problems
• Non Speaking
• Extreme Shyness
• Lack Autonomy
• Failure in Gender Identification

• No Enjoyment in Play
• Poor Problem Solving
• Total Lack of Self Control
• Chaotic Behavior

34
Collecting Information about Infant Child
Development

• Existing records from previous assessments
• Screening and referral
• Single discipline developmental assessment
• Multi or interdisciplinary team assessment

35
Existing recordsUnderstanding test data

• Screening or child find results
• First Steps evaluation/Curriculum based
  assessment
• Normed assessment methods/Clinic or school based

36
First Steps

• Check with the SPOE for the county the child
  lived in before placement to see if there is a
  First Steps E A
• 1/800-441-STEP
• http//www.in.gov/fssa/first_step/

37
Tools Used in First Steps

• Goals of assessment in First Steps is to
  determine if eligible for program and to develop
  intervention plan
• Curriculum-based tools are typically used

38
Tools Used in First Steps

• HELP and AEPS are most common
• Have an associated curriculum
• Are basically a list of skills to be assessed and
  taught
• Sometimes yield age equivalents

39
First Steps Documentation You Can Use

• ED Team Report
• Will indicate developmental levels in 5 areas of
  development
• Will make recommendations for services
• Individual Family Service Plan (IFSP)
• Will explain services that the child will receive
• Includes information about family routines and
  preferences

40
First Steps and CPS

• Indiana now CAPTA compliant
• In other states, the influx of referrals has been
  a problem for Part C
• Some states are using screening tools, then full
  assessment if indicated
• So far, we are not sure what First Steps will do
  with the evaluations in Indiana

41
Clinic School Assessments

• Independent, clinic-based assessments may have
  been completed
• If child is 3 or near 3, a school assessment
  might be available
• School and clinic evaluations often include norm
  referenced tools

42
Clinic School Assessments

• Cognitive
• BSID-3
• DAS
• SBIS-5
• MSID

43
Clinic School Assessments

• Communication
• Rosetti (Caregiver Report)
• Preschool Language Scale-4
• Informal assessments
• AAC

44
Clinic School Assessments

• Adaptive Behavior
• VABS-2
• SIB-R
• ABAS

45
Clinic School Assessments

• Motor Assessments
• Peabody Developmental Motor Scales-2
• VMI

46
Clinic School Assessments

• Social-Emotional and Behavioral
• ITSEA
• BASC
• CBCL

47
Clinic School Assessments

• Autism Assessments
• Developmental History
• ADOS
• Checklists (Gilliam, CARS, MCHAT)

48
What to do if

• No previous developmental assessment??
• Conduct your own developmental assessment
• Get full E A thru First Steps
• Screen and refer

49
Screening Referral

• Screening methods tell you if the child needs
  further assessment in a given developmental area
• Many screening tools use caregiver report
• Do not use social-emotional screener for CPS
  population

50
Suggested Developmental Screening Tools

• Caregiver Report Methods
• Ages Stages Questionnaires
• PEDS
• DOCS
• Direct Assessment of Child
• Denver-II
• Bayley Infant Developmental Screener
• Batelle Developmental Inventory Screening Test

51
Infant-Toddler MSE

• Must understand development
• Good observation skills
• Experience with infants and young children

52
Infant Toddler MSE

• Appearance
• Reaction to Situation
• Adaptation Exploration and Reaction to
  Transitions
• Self Regulation
• Sensory Regulation
• Unusual Behaviors

• Activity Level
• Attention Span
• Frustration Tolerance
• Expression of Aggression
• Muscle Tone and Strength
• Gross and Fine Motor Coordination

53
Infant/Toddler MSE

• Speech and Language
• Thought Processes
• Affect and Mood
• Play
• Cognition
• Relatedness

54
Dos and Donts

• Infants and Toddlers must be evaluated within the
  context of relationships with their primary
  caregivers
• Assessment should always include collaboration
  with parents and caregivers
• Multiple assessments over time are recommended
• Information from Multiple sources is recommended

55
Dos and Donts

• Standardized Instruments May be used
• but not be the sole basis of the Evaluation
• Young Children Should Never be Challenged
• by Separation from Primary Caregivers
• Evaluation should utilize the DC 0-3 system
• along with DSM IV

56
Questions about Developmental Assessment?
57
Assessing Quality of Parent-Child Relationship

• Attachment research and clinical findings
• Tools for assessing relationships
• Suggested observation strategies

58
Relationship Problems vs Mental Health DX

• Do not assume that all of these children will
  have an attachment problem
• Relationship problems and other MH problems can
  co-occur
• Can have MH concern with good relationship

59
Attachment

• Attachment means a specific relationship between
  one child and one adult
• It only refers to a relationship that occurs when
  the adult is in a caregiving role for that child
• Children can have attachment problems that do not
  reach the level of a disorder
• Attachment problems predict problems with future
  relationships

60
Attachment

• Ainsworth/Bowlby introduced the secure/insecure
  attachment paradigm
• These research categories only work loosely in a
  clinic setting

61
Reactive Attachment Disorder

• What it is
• Markedly disturbed and developmentally
  inappropriate social relatedness in most contexts
• Presumed due to pathogenic care (maltreatment,
  lack of consistency)

62
Reactive Attachment Disorder

• Two Patterns
• Excessive inhibition, hypervigilant, highly
  ambivalent behaviors
• Indiscriminate sociability

63
Reactive Attachment Disorder

• Both patterns are know to occur in children who
  have been in foster care and those raised in
  institutional settings

64
Parent-Child Observations

• Most important to have a routine process
• Multiple observations over time are best
• If possible, see parent and child in different
  settings

65
Areas to Observe when Assessing Parent and Child
Interactions

• Attachment Behaviors
• Play Interactions
• Direction/Teaching
• Separation/Reunion

66
Observing Attachment Behaviors

• Does the child seem to feel safe, secure, and
  comfortable? Can the child explore, play with
  toys, interact with the examiner?
• What does the caregiver do to help the child get
  comfortable?
• Can the child and the caregiver share enjoyment?
• How does the child respond when the caregiver
  restricts her?

67
Observing Play Behavior

• Who leads the play?
• Is the play mutual?
• Is the play reciprocal?
• Does the parent provide scaffolding?
• Is the affect positive or negative?
• Is the play sustained?

68
Observing Teaching

• Parent and child most often asked to clean up/Or
  a teaching task
• How does parent explain the task?
• Does child follow instructions?
• How does parent handle refusals?
• Does parent provide scaffolding?
• Emotional tenor of interaction

69
Separation/Reunion

• Parent can be asked to leave room briefly
• Purpose is to elicit attachment behaviors at both
  points
• Avoid if it would be too stressful

70
Clinical Attachment Systems

• DC 0-3 R offers a system of classification for
  young children
• Includes Relationship Classification
• Can help us know what to look for in assessing
  the relationship and interactions between a young
  children and parents

71
DC 0-3R Relationship Assessment

• Overall functional level of child and parent
• Level of distress of child and parent
• Adaptive flexibility of child and parent
• Level of conflict and resolution between child
  and parent
• Effect of the quality of the relationship on the
  childs development DC 0-3R, 2005

72
DC0-3R Tools for Assessing Parent-infant
Relationship

• Parent-Infant Relationship Global Assessment
  Scale (PIR-GAS)
• Relationship Problems Checklist DC 0-3 R,
  2005
• zerotothree.org

73
PIR-GAS

• Used by a clinician to make a judgment about
  relationship classification
• Range from well-adapted to severely impaired
• Need to identify frequency, intensity, and
  duration of problems to classify the problem

74
PIR-GAS

• So not have to know etiology of problems to use
  classification
• Is a seen as a current description of
  relationship that can change

75
PIR-GAS Categories

• Well Adapted
• Adapted
• Perturbed
• Significantly Perturbed
• Distressed

• Disturbed
• Disordered
• Severely Disorder
• Grossly Impaired
• Documented maltreatment

76
Relationship Problems Checklist (RPCL)

• Helps the clinician document the presence or
  absence of problems in a relationship
• Helps support the following descriptors of
  relationship
• Can be used for more than one primary relationship

77
RPCL Areas

• Behavioral Quality of Interaction
• Affective Tone
• Psychological Involvement

78
RPCL

• Overinvolved
• Underinvolved
• Anxious/Tense
• Angry/Hostile

• Verbally Abusive
• Physically Abusive
• Sexually Abusive

79
Underinvolved

• Behavior Quality
• Insensitive/unresponsive to cues
• Does not protect child
• Child appears uncared for

80
Underinvolved

• Affective Tone
• Affect in both partners seems sad, constricted,
  withdrawn, and flat
• To observer, interactions suggest lack of pleasure

81
Underinvolved

• Psychological Involvement
• Parent does not demonstrate awareness of infant
  cues by behavior or in discussion with others
• Parent with history of emotional deprivation or
  neglect

82
Physically Abusive

• Behavioral Quality
• Parent physically harms child
• Parent regularly fails to meet childs basic
  needs

83
Physically Abusive

• Affective Tone
• Reflects anger, hostility, or irritability
• Considerable to moderate tension and anxiety are
  present

84
Physically Abusive

• Psychological Involvement
• Parent exhibits and/or describes anger or
  hostility toward child
• Child may have tendency toward concrete behavior
• Periods of closeness vs distance

85
Additional Parent child tools

• Crowell Procedures
• Parent Child Early Relational Assessment

86
Relationship AssessmentCrowell Procedure

• Free play
• Clean up
• Teaching Tasks
• Separation/Reunion

87
Domains

• Parent
• Emotional Availability
• Nurturance
• Protection

• Child
• Emotional Regulation
• Security
• Vigilance

88
Domains

• Parent
• Comforting
• Teaching
• Discipline
• Structure/Routine

• Child
• Comfort-seeking
• Learning
• Self-control
• Self-regulation

89
Parent Child Early Relational Assessment

• For birth to 5 years
• Parent and child are videotaped during
  interaction in 4 5 minute segments (feeding,
  structured task, free play, and
  separation/reunion)
• Observations are scored on Likert scale

90
Parent Child Early Relational Assessment

• Parent Domains
• Expressed Affect and Mood
• Expressed Attitude Toward child
• Affective and Behavioral involvement with child
• Parenting Style

91
Parent Child Early Relational Assessment

• Infant/Child Domains
• Mood/affect
• Behavior/adaptive ability
• Activity level
• Regulatory capacities
• Communication
• Motoric competence

92
Parent Child Early Relational Assessment

• Parent/Child Dyad
• Affective quality of interaction
• Mutuality
• Sense of security in relationship with parent

93
Questions about Relationship Assessment?
94
Assessing Parent Capacity for Relationship

• Adult Attachment Interview
• Working Model of the Child Interview
• Parenting Stress Index-Third Edition

95
Working Model of the Child

• Structured interview that assesses parents
  internal representations of a their relationship
  to a specific child.
• Parent responds to 19 questions
• Responses are rated and scored
• Overall interviewed is rated as balanced,
  disengaged and distorted.

96
Adult Attachment Interview

• Semi-structured interview that assesses persons
  way of thinking current and past relationship
• Parent status on AAI predicts child security of
  attachment

97
Adult Attachment Interview

• Adult Classification
• Secure/autonomous
• Dismissing
• Preoccupied
• Unresolved/disorganized

• Child Classification
• Secure
• Avoidant
• Resistant/
• Ambivalent
• Disorganized

98
Parenting Stress Index, Third Edition

• Parent checklist 120 items
• Child Domain
• Parent Domain
• Total Stress
• Assess for defensive responding
• Screener available
• Large body of research

99
Parenting Stress Index, Third Edition

• Child Domain
• Distractibility/hyperactivity
• Adaptability
• Reinforces Parent
• Demandingness
• Mood
• Acceptability

100
Parenting Stress Index, Third Edition

• Parent Domain
• Competence
• Isolation
• Attachment
• Health
• Role Restriction
• Depression
• Spouse

101
Parent Evaluations

• Most common Psychiatric Dx
• Depression
• Personality Disorder
• Developmental/MR
• Addictions
• Vocational

102
Parent Psychiatric Evaluations

• Depression and PD can result in significant
  effects on children
• Attachment problems are common
• Behavior concerns are often significant
• Child possibly at risk for developing psychiatric
  dx

103
Cognitive Limitations

• Significantly below average cognitive and
  adaptive skills
• Ranges from mild to profound
• Most individuals with mental handicap who are
  parents are likely to be in the mild to moderate
  range

104
Parenting and Cognitive Limitations

• IQ relates to parenting behavior when below 55-60
• MH in parent increases chances of mental handicap
  in child
• Families with parent with MH are increasing

105
Parenting and Cognitive Limitation

• Need for direct assistance
• Difficulties with transfer of knowledge
• Hard to keep track of multiple issues
• May lack basic academic skills
• Lack of knowledge about children
• Abuse potential unclear

106
Parenting and Cognitive Limitations

• With appropriate supports, most parents with MH
  can learn to be good parents

107
Screening Adults for MH

• Ask about parents school history
• How far did you go in school?
• Were you able to finish school?
• Did anyone in the family receive extra help at
  school?
• Do you remember what kind of help you received
  in school?

108
Screening Adults for MH

• Observe
• Hygiene and dress
• Ability to prepare meals
• Money management
• Tidiness and Cleanliness of Home
• Ability to relate to others

109
Parents with Addiction

• Effects on Family Interactions
• More conflict
• More family problems
• Less structure and discipline
• Increased expectations for child independence
• More physical discipline (boys)

110
Parents with Addiction

• Relation to child abuse
• Child abuse professionals report that substance
  abuse contributes to between ½ and ¾ of child
  abuse
• Alcohol addiction related to physical abuse
  cocaine addiction to sexual abuse
• Children exposed to drugs prenatally are 2-3
  times more likely to be abused or neglected

111
Parents with Addiction

• Children of addicted parents are more likely to
  be in foster care and to stay longer
• Children of addicted parents more likely to be
  depressed, anxious, and have psychiatric
  diagnoses
• Children of addicted parents have more problems
  in school

112
Family Situations

• Strengths
• Weaknesses
• Risk Factors
• Cultural factors

113
Risk Factors

• Poverty
• Domestic Violence
• Community Violence
• Lack of Support
• Reluctance to Accept Help
• Inconsistent Care giving Experiences

114
Risk Factors

• Negative Maternal Attitude Toward
• Pregnancy
• High level of perceived social stress
• Loss of previous child, history of child
  maltreatment
• Young Maternal Age and Single Marital Status
• Marital Discord

115
Cultural Issues

• Always view the cultural framework as a set of
  tendencies or possibilities

116
Cultural shapes beliefs and practices

• What and how a family is
• How children are to behave
• How children are to be treated
• Ideas related to health and disability
• How to relate to professionals
• Communication styles

117
Considering Culture

• Recognize and understand cultural paradigms
• The family as defined by the family has a
  contribution to make in understanding a child
• Demonstrating willingness to learn about
  different cultures helps

118
Results of Child Evaluation

• DSM categories that work
• DC 0-3 R Axis One dx

119

• Should babies and toddlers be Diagnosed?
• If no, how can we bill?
• If yes, what diagnoses can be considered?

120
Psychiatric Diagnoses

• DSM IV TR Diagnoses such as depression, PTSD,
  adjustment disorders, and disruptive behavior
  disorder, NOS can be used
• Some efforts to modify criteria are in progress

121
PTSD

• Items that require verbalization of inner
  experience are revised
• Fewer symptoms required
• Items that involve memory reworded
• Social withdraw replacements feelings of
  detachment
• Temper tantrums added to arousal items
• May have delays, regression, increased fears

122
Depression

• Appear less happy sad irritable angry
• Change in activity
• Problems with appetite and sleep
• Derive less pleasure from play and other
  activities play themes often involve death,
  killing
• Developmental regression in nearly 40

123
Disruptive Behavior Disorders

• Persistent pattern of resistance to caregivers
  (defiant noncompliance)
• Deliberate attempts to annoy caregivers
• Negative emotionality (chronic negative mood or
  emotional dysregulation)
• Aggression
• Deliberate, pervasive, frequent, and severe rule
  breaking
• Poor social competency

124
Psychiatric Diagnoses

• As an alternative DC 0 to 3
• 5 Axis System
• Considers primary dx and relationship status
• Multiple crosswalks to DSM-IV and ICM-9 available
  for billing needs

125
DC 0 to 3

• Axis I Primary Diagnosis
• Axis II Relationship Disorder
• Axis III Medical and Developmental Disorders and
  Conditions
• Axis IV Psychosocial Stressors
• Axis V Functional Emotional Developmental Level

126
Suggested Report Format

• Identifying Information
• Referral Source
• Presenting Issues/Concerns
• Assessment Components and Sources of Information

127
Suggested Report Format

• Family History
• Current Living Arrangements/Concerns
• Developmental Domains
• Present Functioning/Mental Status Exam

128
Suggested Report Format

• Parent Caregiver Interactional Patterns
• Maternal Issues Affecting Child
• Paternal Issues Affecting Child
• Summary/Diagnostic Findings
• Recommendations

129
IMH Interventions

• Core Concepts
• Contributions
• Strategies
• Approaches

130
Core Concepts Regarding Interventions

• Since all areas of development take place within
  the framework of interaction between the infant
  and caregivers the treatment relationship needs
  to always include parents/caregivers (including
  foster parents)

131
Core Concepts for Intervention

• The parents capacity to nurture an infant is
  dependent to a great degree on the support that
  is available as well as the ability to use the
  support available.

132
Core Concepts Regarding Interventions

• Interventions are based on
• The Contribution of the Infant
• The Contribution of the Caregiver
• The Contribution of the Fit
• The Contribution of Stress and Cultural Factors

133
Infant Factors

• Individuality of each Infant
• Temperament Characteristics
• Sensory Functioning

134
Contribution of Caregiver

• Desire for a Child
• Timing of arrival of Child
• Expectations regarding baby
• Perception of child
• The real infant vs. the imagined infant

135
Contribution of the Relationship

• Fit between expectations and reality
• Flexibility in the parent and the infant
• Degree of conflict or disappointment

136
Contribution of Stress Factors

• What is the role of stress within the family
• Understanding cumulative effects of stress
• Dealing with stress may be the first point of
  entry

137
Cultural Factors

• Understanding context so that stereotypes or
  assumptions arent made
• Differences in dealing with feeding, sleeping,
  crying and conflicts.

138
Interventions

• Intervention Strategies include
• Building an Alliance
• Meeting Material Needs
• Supportive Counseling
• Development of Life Skills and Social Support
• Developmental Guidance
• Infant Parent Psychotherapy

139
Building Trust

• Consistency
• Providing Telephone Support
• Observes, Listens, Accepts, Nurtures
• Visits Regularly
• Identifies and Meets Material Needs
• Infant Mental Health
  Services Supporting Competencies Reducing
  Risks

140
Providing for Material Needs

• Facilitates access to community agencies
• Assists with transportation
• Forms alliances with other professionals on
  behalf of family

141
Supportive Counseling

• Observing
• Listening
• Feeling
• Responding

142
Development of Skills and Support

• Develops Social Supports
• Models Problem Solving Skills
• Models Decision Making Skills
• Teaches Problem Solving Processes

143
Developmental Guidance

• Provides Information
• Speaks for Infant
• Encourages Observation and Interaction
• Models Appropriate Interaction
• Encourages Developmentally Appropriate Activities

144
Infant Parent Psychotherapy

• Assists the Parents to Develop new and
  healthier patterns of Interaction
• Identify feelings and put them into words
• Understand reactions, defenses and coping
  strategies
• Form Corrective Attachment Relationship

145
Intervention Methods

• Interaction Guidance
• Infant-Parent Psychotherapy
• Floortime

146
Interaction Guidance

• Susan McDonough, Ph.D. MSW
• For high risk families
• Relationship-based
• Use of videotape
• Focus on positive interaction between parent and
  child

147
Infant-Parent Psychotherapy

• Alicia Lieberman
• Dont Hit My Mommy! A Manual for Child-Parent
  Psychotherapy with Young Witnesses of Family
  Violence

148
Floortime

• Stanley Greenspan, MD Serena Weider, PhD
• Use of play at specific developmental levels
• Play as communication
• Following the childs lead

149
Special Issues for Foster Parents

• Foster parents may have been told not to get too
  close to children in care
• In past, it was believed that it was confusing
  for children to feel too close to foster parents

150
Attachment to Foster Parents

• Now we believe that attachments to foster parents
  should be encouraged
• It can be hard for children to have separations
  from parents
• But the long term effects of no attachments at
  all are more damaging

151
Attachment to Foster Parents

• Foster parents should be encouraged to help the
  child develop a healthy attachment
• The child will be able to extend this attachment
  to birth family, new foster family, or adoptive
  family

152
Ways to Help Foster Parents

• Help foster parents understand that the child
  needs them even when they do not show it
• Understand that rejecting behaviors are old
  coping methods

153
For more on foster care

• Mary Dozier, Ph.D.

154
Reflective Supervision

• Reflective Supervision is clinical supervision
  using a reflective-practice model
• Considered essential in infant-toddler work

155
Reflective Skills

• Listening
• Demonstrating empathy
• Promoting reflection
• Observing the parent-child relationship
• Respecting role boundaries
• Respond thoughtfully
• Understand, regulate, and use ones one feelings

156
Reflective Supervision

• A safe place to process complex situations and
  emotions Linda Gilkerson

157
Components of Reflective Supervision

• Reflection
• Collaboration
• Regular Meetings

158
Questions about Treatment
159
Next steps.

• What do you want to do for follow up?
• Phone consultation?
• Additional Training?
• General vs Case-specific?
• Your Ideas?

160
For Later Questions

• atomlin_at_iupui.edu
• yphrdir_at_cmhcinc.org

161
Infant Toddler Mental HealthAssessment

• Stacey Ryan, LCSW
• Angela M. Tomlin, Ph.D.