THE INFANT MENTAL HEALTH FORUM

By Deborah Roderick Stark, Rachel Chazan-Cohen, and Judith Jerald

Supporting the social and emotional well-being of children is a goal shared by staff of both the preschool Head Start and the Early Head Start programs. In recent years, the country has paid increased attention to the mental health of children. However, most discussions have focused on the school age population and issues surrounding treatment rather than the full continuum needed to support children of all ages—beginning with promotion and prevention and including intervention. Teachers and parents in the Head Start community—and in early care and education settings—report that they struggle to understand and address the mental health needs of very young children and their families, and that they lack the knowledge, skills, and resources within the community to assess and serve children.

Hearing these concerns, the Department of Health and Human Services—under the leadership of the Head Start Bureau and the Commissioner’s Office of Research and Evaluation (CORE), both of the Administration of Children, Youth and Families—held an Infant Mental Health Forum on October 23-24, 2000. The Forum was attended by more than 140 people representing parents; Early Head Start and Migrant Head Start directors, program staff, and home visitors; early educators; training and technical assistance providers; researchers; pediatricians; psychiatrists; psychologists; social workers; Federal partners; and private foundation representatives. The purposes of the Forum were to (1) develop a common understanding of the term “infant mental health”; (2) focus on the role that Early Head Start and Migrant Head Start programs—in collaboration with their community child care and early education partners—play in promoting the social and emotional development of infants and their families; and (3) identify action steps as part of a comprehensive initiative to address infant mental health using Head Start as a leader for the field. (For more details on the meeting and on suggested action steps, see the full report from which this article is excerpted, A Commitment to Supporting the Mental Health of Our Youngest Children: Report of the Infant Mental Health Forum, to be available on the Head Start Web page in the future.)

Defining Infant Mental Health
Charles Zeanah, M.D., a keynote speaker at the Infant Mental Health Forum, defined infant mental health as emotional and social competence in young children who are developing appropriately according to biology, social relationships, and culture. This definition emphasizes the multiple contexts in which infants operate as well as the change inherent in infant development. Normal paths of development within various domains serve as reference points to assess infant competence. Factors that increase the risk of suffering, developmental deviance, or maladaptation create threats to mental health. Discussion at the meeting focused on the context for mental health, including age-appropriate developmental sequence; parental factors; relationships between young children and parents; and factors in the broader family context and environment that affect child development.

Zeanah also addressed the reluctance that many people feel toward using the term “infant mental health” because “infant” is associated with innocence and beginnings, but “mental health” with maladjustment and major mental illness. He argued that the term brings attention to the real suffering and needs of infants and brings to the table a wider array of disciplines and experts to address collectively the problems that families are facing.

Role of Early Head Start and the Child Care Community
The mental health provisions included in the Head Start Program Performance Standards guided discussion to address promotion, preventive intervention, and treatment. Promoting the mental health of infants is central to everything high quality early care and education programs do. These programs continuously build and nurture relationships which support the social and emotional development of infants and their primary caregivers. Teachers interact with infants during feeding and diapering, for example, as well as engage parents in the care of their child. Early experiences with caring adults play an important role in preparing children to explore and learn and set the stage for all future development.

Factors such as maternal depression, domestic violence, poverty, homelessness, and a lack of supports for the family pose challenges to mental health promotion among some Head Start families. These challenges are even more difficult when a child has biological problems such as prematurity, low birth weight, a disability, or a regulatory disorder. The strong relationships programs develop with families enable them to have a unique vantage point to observe problems or the emergence of problems, and to have the trust and respect of families in order to provide or coordinate the help they may need. Thus, program staff need to understand the factors that influence infant mental health and how their work with families can best support mental health and emotional development. Programs will also need to have relationships with other providers in the community who are able to offer more intensive and specialized services.

Early care and education alone cannot provide the range of services needed to support emotional development of infants and their families. Similarly, a small dose of mental health services cannot be the all-healing remedy for those infants and their families who are most challenged. A continuum of services and supports are needed to meet the individual needs of infants and their families over an extended period of time. These services should be provided by those in the community most qualified to offer the particular services and support.

At the Forum, four Early Head Start programs with promising mental health practices presented their models. Three of the programs have social work professionals on staff to serve families, and the fourth uses external consultation in collaboration with a local mental health clinic. Themes that emerged from their presentations were the need to support frontline staff with reflective supervision (see article, Reflective Supervision, on page 34) and the need to establish working relationships with a variety of community network agencies.

Participants at the Forum recognized the challenges of moving forward to address the emotional health of infants and their families, but believe the research and experiences in the field necessitate the development of a more purposeful approach to infant mental health.

Action Steps for Consideration
Forum participants worked in discussion sessions to identify action steps necessary to fully address infant mental health. Their suggestions (the specifics of which are included in the full report) fall within two broad categories: action steps that are specific to Head Start, and action steps that relate to the broader early care and education field. While many participants commented that some of the Head Start specific steps should begin immediately—especially given the role of Head Start as a national laboratory—they recognized that infant mental health transcends Head Start. Efforts should be undertaken to build the capacity throughout the child care and early education field and related health, mental health, and social service professions to increase understanding of early emotional health and appropriate responses. Only then will the nation be able to support the emotional health of all infants and their families. Suggested action steps address the areas of program guidance, public awareness, public policy, professional development, reflective supervision, cross-disciplinary collaboration, financing, research and evaluation, demonstration, and a national agenda on infant mental health. (For more information on action steps, see page 48 of the article, Guiding Principles.)

First Steps
Already, the Administration on Children, Youth and Families is moving forward on suggestions from the Forum. To build on its lessons, the Early Head Start National Resource Center (EHS NRC) will engage in a number of follow-up activities critical to maintaining a sustained focus on this important issue. Activities will include consensus building, training, and dissemination. Within CORE, efforts are underway to encourage relevant research. For example, infant mental health was added as a priority for the Head Start University Partners Grants. Additionally, the Child Care Bureau convened a National Leadership Forum with child care, health, and mental health professionals on March 6, 2001. Importantly, all three units—the Head Start Bureau, the Child Care Bureau, and CORE—have agreed to work together on implementation of all aspects of follow-up to the Infant Mental Health Forum, recognizing that together their efforts will be more effective and reach across the early child care and education field. 

Deborah Roderick Stark is Principle with Stark Consulting. T: 301-889-0430; E: DRS889@aol.com. Rachel Chazan-Cohen is a Social Research Analyst for CORE. Office of Planning, Research and Evaluation, ACF. T: 202-205-8810; E: rccohen@acf.hhs.gov. Judith Jerald is the Coordinator of Early Head Start in the Head Start Bureau. T: 202-205-8074; E: jjerald@acf.hhs.gov.