Minnesota Infant Mental
Health Services Feasibility Study
Executive Summary
In response to the critical need for mental health services
that support families with infants and toddlers, the Minnesota
State Early Intervention Team selected CEED, the Center for Early
Education and Development in the College of Education and Human
Development at the University of Minnesota, to conduct a
Feasibility Study on an Infant Mental Health Services Framework
for the State of Minnesota. The Early Intervention Team is
comprised of representatives from the Minnesota Departments of
Health, Human Services, and Children, Families and Learning who
work together on cross-agency initiatives that coordinate
programs serving young children and their families.
To accomplish this study, CEED convened an interdisciplinary
Consultant Team consisting of community experts representing a
variety of fields and perspectives, including parents. Data for
the study was gathered by means of a paper survey sent to parents
and representatives from a variety of professional fields across
the state, a series of focus groups held in five diverse
Minnesota communities, and interviews with parents and key people
in pivotal positions who serve families. In addition, the
Consultant Team and CEED reviewed what infant mental health
services are currently in place in Minnesota and what service
delivery models exist in other states. The recommendations in
this report are a result of this process.
A Definition of Infant Mental Health
In spite of its tremendous importance and the great strides in
theory and research in recent years, there is, as of yet, no
single agreed-upon definition of infant mental health. For the
purposes of this study the following definition of infant mental
health was developed by the Minnesota Infant Mental Health
Feasibility Study Consultant Team.
Infant mental health is the optimal growth and
social-emotional, behavioral, and cognitive development of the
infant in the context of the unfolding relationship between
infant and parent.
Guiding Principles
These guiding principles form the underlying foundation in the
creation and coordination of infant mental health services. They
provide the base for the recommendations in this report.
1.) All infants and families will have community support that
promotes the development of healthy families and children,
including access to services that promote infant mental health at
a level responsive to their needs.
2.) Infant mental health services will recognize that the
optimal development of the infant and toddler occurs within the
context of relationships—especially the relationship between
parent and child.
All the
systems and agencies that work with families of infants need to
be providing infant mental health services in some capacity...to
help parents build a healthy relationship with their child.
--- Family
Support Program Administrator
3.) Infant mental health services will recognize the need to
be sensitive to and to support parents so that they may in turn
nurture their infants.
4.) Infant mental health services will be based on a
multidisciplinary perspective and practice that utilizes the
expertise of many disciplines combined with principles of infant
mental health. (Contributing perspectives include medicine,
nursing, public health nursing, psychiatry, psychology, social
work, education, child care, parent education, occupational
therapy, physical therapy, and speech and language therapy.)
5.) All persons working with infants and their families must:
know the stages of normal infant development; be able to
recognize relationship and separation issues; and incorporate an
approach that supports the parent-infant relationship into their
practice.
6.) The legal and protective systems that interface with
infants and toddlers will operate with well-informed policies and
procedures that protect and optimize infant mental health needs.
Professionals in the area of child protection, guardians ad
litem, judges, referees, attorneys, foster parents, and mental
health personnel who are involved in court recommendations for
very young children will have a thorough knowledge of infant
mental health needs to inform their judgments and decisions. In
addition, attorneys, referees, and judges who make custody and
visitation recommendations will create recommendations that
enhance infant mental health.
Criteria for Effective Service Delivery
The following criteria, based on research and successful
service delivery models already in existence, identify effective
infant mental health services and reflect what the Consultant
Team believes to be the crucial components of "effective
practice" in the field of infant mental health.
1.) Infant mental health services will be based on the
family’s strengths as well as its needs.
2.) Service providers will strive to be both sensitive and
responsive to the unique qualities, values and culture of each
family and its community.
3.) Service providers will form collaborative relationships
with families, listening and learning from each other as they all
seek to provide what is best for the child.
4.) For families receiving services from multiple providers,
infant mental health services will be provided by one of the
providers (either an infant mental health specialist or a
professional from another discipline) who will establish a
significant relationship with the family, thereby forming and
maintaining ongoing, consistent support to the family. In
situations where infant mental health services are provided by
another provider, the infant mental health specialist may act as
consultant.
5.) For infants and families with multiple needs, a
coordinated service plan will be developed to eliminate
fragmentation and duplication of services.
6.) Infant mental health services will be provided in settings
that are most accessible to families. In the case of infants and
families with multiple needs, all services will be provided in
one setting (home, school, child care, Head Start, etc.)
determined in consultation with the family.
7.) Services often will be offered on a long-term, rather than
time-limited, basis in order to foster, reinforce, and
consolidate learning and changes toward the goal of infant mental
health.
8.) To ensure the delivery of quality infant mental health
services, professionals will have ongoing access to training and
consultation.
9.) Professionals providing intensive infant mental health
services will have sufficiently small caseloads to meet with the
family at least once per week, and more often if the family is in
crisis.
10.) Infant mental health services will be planned, developed,
and provided within existing, effective service delivery systems.
11.) The effectiveness and efficiency of infant mental health
services will be determined on an ongoing basis. The results will
be used to improve services.
RECOMMENDATIONS
The Minnesota Infant Mental Health Feasibility Study
Consultant Team recommends that infant mental health services be
identified and organized as a continuum of activities divided
into five broad areas (see diagram 1):
1.) public awareness
2.) education and support
3.) screening
4.) assessment and intervention
5.) training and consultation
I. Public Awareness
It is recommended that state agencies and local communities
take a leadership role in increasing public awareness of infant
mental health issues.
II. Education and Support
It is recommended that state agencies and local communities
take a leadership role in providing education and support for
families with infants and toddlers to foster the development of
healthy parent/child relationships.
III. Screening
A. It is recommended that Minnesota provide universal
screening for newborns and their parents to identify families
that need services.
There is a
great need to educate people about mental health issues and to
eliminate the stigma attached to mental health treatment.
Barriers to providing infant mental health services (include)
parents who don't understand that they have issues that need to
be addressed and who don't understand the needs of their child...
--- Program
Administrator
B. It is recommended that screening be conceptualized
as an ongoing, multidisciplinary, developmental process that
begins in the prenatal period and extends through the preschool
years.
IV. Assessment and Intervention
A. It is recommended that communities establish procedures for
assessment of the parent/child dyad to establish needs and to
guide referrals.
B. It is recommended that moderate level intervention be
available in all Minnesota communities to support families
experiencing circumstances and vulnerabilities associated with
risk to an infant's mental health.
C. It is recommended that intensive intervention be provided
to Minnesota families whose infants are at high risk or who
already are experiencing problems or disorders that may indicate
impaired mental health.
I think that
there is a real problem that is getting worse with the financial
restraints of health care...the real bind of needing to see more
patients and getting paid less for it...and I think we deal more
and more with crisis issues. A well child checkup should be
80-90% about anticipatory guidance and dealing with the
behavioral and emotional issues of children and families...I
don't know that pediatricians have time to do that or even have
the skills to do that. I see a big need for more resources.
-- Pediatrician
V. Training and Consultation
It is recommended that state agencies in Minnesota collaborate
on developing and maintaining an Infant Mental Health Network of
specialists throughout the state.
CONCLUSION
The mental health of infants and toddlers, established and
maintained by nurturing environments and interactions with their
primary caregivers, is of crucial importance to all of us. It
sets the stage for children to learn and to succeed in life.
Infant mental health services play a large role in addressing the
changing needs and circumstances under which families are raising
their children in today’s world. The needs of families are
very real, and the manner in which we meet them will contribute
to the future of our society. In a very basic way, infant mental
and physical health is the foundation of each new generation. A
coordinated system of services to support good
health—physical and mental—will help insure that this
foundation is solid.
Minnesota has a rich tapestry of services for children and
families that can, if coordinated within the framework of a
statewide service system, provide much of the form and substance
required for quality infant mental health services. The
recommendations in the Feasibility Study Report propose to
guarantee that Minnesota parents have the education and support
needed to be successful— and that when parents and families
have problems, there will be services in place and accessible to
them so that their children can be raised in a nurturing
environment with caring, responsive caregivers.
WE ASKED A NUMBER OF
people in varying roles from across the state to share their
reactions to the findings of the Infant Mental Health Study.
Following are responses from some of those program administrators
and practitioners.
Serving All Families is
Positive Direction
by Joann O'Leary
Parent-Infant
Specialist
Abbott Northwestern Hospital
Minneapolis
The recently published
Minnesota Infant Mental Health Feasibility Study is a long
overdue, comprehensive summary of what is needed for families and
children here in Minnesota. Having been in the field of early
intervention in different capacities for the last thirty years, I
was very impressed with the work and recommendations put forth.
Throughout the
documentation three things stood out for me: relationship based
intervention, services that begin prenatally (actually
preconception as one looks at curriculum development for
elementary and secondary school students) and interdisciplinary
collaboration.
Two other positive
aspects of the recommendations are that all families would be
served in some capacity with the universal screening and that
there would be various entry points.
It has been my dream to
have an infant mental health specialist interwoven into programs
in all the different roles I have had. I believe this model would
work because the person(s) would be seen as part of the team,
parents wouldn’t have to feel separated out if they needed
more help and staff would see them as a resource, collaborating
with them daily.
Thank you for the hard
work and excellent outcome.
Community, Communication
and Collaboration
by Louis Alemayehu
Executive Director
Cultural Beginnings
St. Paul
I was really fascinated,
affirmed and encouraged by the Feasibility Study that examined
Minnesota’s capacity for providing mental health services to
infants and toddlers and their families. We at Cultural
Beginnings are really struggling as a project that operates out
of a different paradigm (than one) that is linear and hierarchic.
Our process has more to do with the social values of villages in
Wales, Italy, Senegal, Pakistan, the Philippines and rural
Minnesota of 40+ years ago.
This study affirms the
need for community, communication and collaboration amongst
parents, policy makers and service providers. It made me think of
the book The Careless Society in which John McKnight
questions what happens when we professionalize compassion and the
authentic function of extended family and community. There is no
way for professionals to really do the work of community, but can
professionals have an important role in supporting the health and
vitality of community? I think they can if they can understand
and bond with communities of all descriptions.
One of the things that
has made the work of Cultural Beginnings successful is its
dependence upon collaboration. In many instances, we have made
the decision not to compete with agencies for "clients"
to do our work. Instead, we have tried to understand the needs of
our communities and to connect our communities to the resources
available. The focus has been on bringing resources to the
families and communities and not fighting over territory.
Families get lost in the dust of conflict, which is not about the
needs of children, families and community. There is no substitute
for community and cooperation.
One of the things that
gets lost in much of our work in the helping professions is that
culture is at the very center of family life. In this country, we
pay little attention to the whole drama of assimilation.
Assimilation is not always bad. When it happens, it should be a
thoughtful, measured process which also continues enduring,
life-giving values that then get translated into different forms
of cultural expression. In the United States, as our cultural
ties have deteriorated, so have our family relationships. As our
families have deteriorated, so have our communities. To nurture
children from birth to 4 years old is a cultural process of
family, extended family and community. If we could all do our
work in ways that affirmed that process, I believe we could
slowly turn this ship around and head away from the current
social storm. It would be very useful to remember the words of
writer Wendell Berry, who said, "The first unit of health is
community."
We have a
lot of pressure to place kids in special education due to
adjustment problems that would be better treated by mental health
professionals.
--
Feasibility Study Survey Respondent
Early Brain Development
and Relationships
by Renee Piprude
Public Health Nurse
Cass County Public Health Division
Walker
Thank you for allowing me the opportunity to respond to the
recently completed Feasibility Study. I am a Public Health Nurse
for Cass County and work in the field of maternal-child health.
In addition to working directly with mothers, infants, and
children, I also work in the WIC (Women, Infant, Child) nutrition
program, and CTC (Child and Teen Checkup) program.
Recent research into early brain development suggests that the
first three years are crucial to a child's growth and
development. Babies thrive in a responsive and nurturing
environment. If babies have a strong and secure relationship with
a caring adult, they grow up with a healthier self-concept and
are better equipped to handle the stress of life. How a brain
develops depends not just on the genes you are born with but also
the positive experiences you have.
Our agency has a strong commitment to families with young
children in Cass County. In addition, we recognize the importance
of universal screening for newborns and their parents and have
applied for the Minnesota Health Beginnings Grant: a universally
offered home visiting program for all pregnant women and families
with newborns. All families can benefit from individually
tailored information and support around the time of birth.
Furthermore, research has proven that the positive effects of
home visiting can persist over time, affecting long term child
and family outcomes.
It seems
that now services may be available to families at risk of abuse
or with an identified special education delay. Too many families
don't fit into either mold and so are denied access to these
services. Also, many insurance plans don't cover mental health
services. Families can't afford them out-of-pocket and yet don't
meet the financial criteria for funding assistance.
--
Feasibility Study Survey Respondent
Cass County is fortunate in that we are rich in collaborative
efforts. We have recognized the importance of people from all
disciplines "coming together at the table" in order to
provide services to families with young children, thereby
avoiding duplication and gaps. The high level of interagency
collaboration has had one major beneficial effect. From social
workers to public health nurses, school district personnel to
tribal service providers, people who work together have come to
know each other personally and to appreciate and value what each
other can do.
Our Cass County/Leach Lake Reservation Children's Initiative
is an affiliation of county and tribal agencies, schools,
community organizations and private citizens which has organized
as a non-profit, tax exempt corporation for the purpose of
helping communities build strong families. We are part of the
Minnesota Children's Initiative, a four-member partnership that
includes St. Paul/Ramsey County, Becker County, and the State of
Minnesota. The Children's Initiative is primarily funded by state
and federal grants, Cass County and area school district tax levy
dollars.
The Initiative is both a Children's Mental Health
Collaborative and a Family Service Collaborative. Their
philosophy is to identify the mental health needs of children,
develop comprehensive services unique to each child within the
least restrictive environment, and to establish strong
coordination mechanisms across agencies to assure a collaborative
services system for children.
The Collaborative Board has established five local family
resource centers and councils. Each family center is flavored by
the needs of the community it serves. Their common purpose is to
serve as vehicles for addressing the problems and stresses that
today's families and children face. The Initiative strongly
encourages community members to become involved in the mission.
In the six years since Cass County and the
Leech Lake Reservation began a collaborative effort called the
Children's Initiative, things have quietly but steadily changed
for the better for families, infants, and children county-wide.
There is a great need for stable funding
sources and commitment to maintenance of a program, not just
start-up money for innovation.
--from an interview with a Program Manager
Trust and Training—
A
Successful Combination on the Reservation
by Teri Sanns
Early Childhood/Special Education Speech Clinician
Cass Lake Elementary School
Cass Lake
On a very general level I noted now my own awareness of infant
mental health has been enhanced by participation in the
Feasibility Study process. Beginning with the completion of the
survey two summers ago, my vision of mental health has gone from
basically not recognizing it as a viable issue to my current
perception of it as the necessary underlying element in
development across all areas. My interest in this area was
precipitated by my participation in this study and has led to a
heightened interest in some of the brain research findings that
have come out recently. I am grateful that I have been focused in
this direction.
Some specific reactions to the report follow:
The discussion of risk factors and protective factors is so
important and everyone working with families of infants should be
aware of these. In our community we have examples of families who
have one or many of these problems (maternal depression in
particular) sometimes coupled with chemical dependency. Training
in these factors and good referral sources are needed for many
professionals.
The concepts of "seamless services," avoiding
duplication of services and minimizing the number of different
service providers are very important here on the reservation.
This is a place where trust is earned over a long period of time
and "less is more." It is sometimes rare if one, let
alone four or five providers, can establish a relationship with a
family. We always keep a case manager with a family when more
than one child from the family is receiving services whenever
possible. It is important for continuity to be able to move from
one level of services to another while maintaining the rapport
because periodic crisis is to be expected with many families.
With regard to the provision of services in the home setting,
this is an area that has been difficult here. Many of our
families strongly resist home visits. Often parents will dodge
services completely to avoid home visits. I assume it is for
cultural reasons and have not had much luck in dealing with this
issue. I only know that we have a much better rate of
participation from families when we offer them a center based
service option.
I was keenly interested in the recommendation about the
development of graduate level training in infant mental health. I
would consider seeking some type of training like this if it were
available to me and geographically feasible.
The data on cost and cost savings was interesting. All of us
who have worked in Special Education for a number of years know
this information on an instinctive level. I have never thought
about the cost in terms of medical or legal expense.
I like the elements of the recommendations that stress that
services should be available for all families. Often services are
geared toward families of children with a diagnosed handicap or
families with poverty issues. Although we sometimes hold
stereotypes of which families may need infant mental health
services, I believe that there are families from all walks of
life who can benefit from these services.
I look forward to changes as a result of this process in the
future.
NEXT STEPS
The next steps following the completion of the Minnesota
Infant Mental Health Services Feasibility Study will be guided by
the Infant Mental Health Work Group, an interdisciplinary team
that has been meeting since 1995. The Work Group is comprised of
state department staff and local community representatives. Ideas
under consideration by the Work Group include facilitating the
revitalization of the Infant Mental Health Association of
Minnesota, a nonprofit organization founded by Joann O'Leary and
Jolene Pearson, and contracting with CEED to work with two
Minnesota communities to determine ways that training and service
coordination can be realized on the local level.
Meanwhile, discussions are going forward in the Departments of
Human Services and Children, Families & Learning as to what
should be done next to begin implementation of the Study
recommendations. The contact for the Work Group is Sue Benolken
at the Department of Human Services who, along with Michael
Eastman at Children, Families & Learning, has facilitated the
progress made thus far.
For more information about the Minnesota Infant Mental Health
Services Feasibility Study, contact: Christopher Watson,
Coordinator CEED
1954 Buford Avenue, Suite 425, St. Paul, MN, 55108;
tel: 612/625-2898 - fax:612/625-6619 via e-mail at
watso012@umn.edu
From a public policy point of view, the
short-sighted emphasis on tax reduction and cost control, as
opposed to investment in the well-being of infants, has a huge
effect on providing needed services.
--from an interview with a Hospital
Psychologist
Minnesota Infant Mental
Health Services
Feasibility Study
Principal Investigator
Christopher Watson, M.S.J., M.F.A.,
Coordinator
CEED, Center for Early Education and Development
College of Education & Human Development
University of Minnesota
Interdisciplinary Consultant Team
George Abrahams, Ph.D.
Licensed Psychologist specializing in children,
adolescents and families
Rochelle Barsuhn
Parent Representative
Barbara Belzer, M.S.W., M.S.
Licensed Independent Clinical Social Worker
Fraser Child & Family Center
Martha Cramer
Educational Program Coordinator
Birth to Three Early Childhood Special Education Program
Carver County
William Brooks Donald, M.D., M.P.H.
Pediatrician and Member of the Maternal and Child Health
Advisory Task Force of the Minnesota Department of Health
Betty Flanigan, O.T.R., M.P.H.
Hennepin County Community Health Department
Sandra Hewitt, Ph.D.
Licensed Psychologist specializing in cases of child abuse
Linda Olson Keller
Consultant, Minnesota Department of Health
Jolene Pearson, M.S.
Parent Infant Specialist, Early Childhood Family Education
Susan Schultz, Ph.D., M.P.H.
Licensed Psychologist specializing in children,
adolescents and families
|
Winter 1999,
Volume 26, Issue 1