Child Law Practice
Vol. 24 No. 9
thing—staying clean and sober,maintaining adequate housing, andworking—but is derailed by theiraddictions? This child does not seeaddictions or sobriety. This childsees mom or dad becoming un-available to them.Infant mental health assess-ments provide opportunities to seethe world through the eyes of thechild. They assess how the child isresponding to their environment,how they are developing, whatkinds of problems they may be ex-periencing, and how supportivetheir caregiving relationships are.They allow us to explore what isgoing on with that baby and an-swer questions such as:
How is this child beingimpacted?
What might this mean for thefuture?
Will this child be at risk?
What is the baby’s experience of the situation?
Can that baby seek and findcomfort with the availablecaregivers?
Are current experiences impact-ing development and growth?
What protective factors are inplace for this child?
In what kinds of cases are infantmental health assessmentsuseful?
Separation from PrimaryCaregiver(s).
Any case whichinvolves a young child possiblyseparating from a primarycaregiver should, at minimum,involve a consult and may requireboth an infant mental health assess-ment as well as ongoing monitor-ing. Separations, even if temporaryand done with the best of inten-tions, can bring about grief andmourning that without adequatesupport can lead to extreme sad-ness and withdrawal. These couldinclude:
divorce cases that are initiated inpregnancy or in a child’s firstthree years of life,
cases involving termination of parental rights,
cases involving incarceration of aprimary caregiver,
cases wherein a caregiver entersresidential rehabilitation.
An infant mentalhealth consultation or assessment isrecommended with any case involv-ing exposure to domestic or commu-nity violence or other traumaticevents. Babies can and do developtraumatic stress responses includingre-experiencing of traumatic events.Contrary to popular belief, babies doremember—though not in the sameways that we think of rememberingas adults. A variety of events, includ-ing hospitalization, may be experi-enced by the very young child astraumatic. However, no two childrenexperience or respond to the sameevent, even a traumatic one, in thesame way. Assessment allows us toexplore how an event has impactedan infant or toddler.
Any depen-dency case involving the placementof an infant or toddler (0-3) outsidethe care of their primary attachmentfigure warrants an assessment.Removing a child from her home is atraumatic experience for that child,even if it is for excellent reasons.Infants and young children can anddo attach to multiple caregivers, butthey rely—physically and psycho-logically—on a primary attachmentfigure. Removing a child from hisprimary attachment figure equalsplunging him into the unknown; it isscary and overwhelming even if thechild already has, or can develop, atrusting and loving relationship withthe alternate caregiver. Primaryattachment figures are not inter-changeable. Losing one during theearly years means the young childwill experience abandonment, evenwhen it is in the best interests of thechild. Assessment helps us considerhow the experience of removal, andsubsequent placement, impacts thechild and what can be done toprovide support through thesechanges.
Red Flag Behaviors.
Assessmentsare also useful in cases wherecaregivers report seeing “red flags”around the child’s development orbehavior. For example, babies oftenshow us they are distressed throughtheir eating, sleeping, elimination,and with aggression in their relation-ships. It is common to see develop-ment become delayed or even gobackwards with children who areexperiencing mental health issuesand no intervention. An assessmenthelps to identify how a child’sexperiences are impacting hisoverall developmental progress andwell-being (see sidebar, p. 138).
Who typically conducts theassessment? What qualificationsshould the evaluator have?
Infant Mental Health Training.
The evaluator should have hadspecific training in
infant mentalhealth, not just child development
.Training in infant mental healthshould be substantial, includingfocus on infant development,parent-child relationships, emotionalfunctioning, pathology, diagnostics,assessment, and intervention. Anincreasing number of states havetraining programs and infant mentalhealth centers such as our Center onInfant Mental Health and Develop-ment at the University of Washington’s School of Nursing.The mission of these programs is toprovide education and clinicaltraining on the unique needs andcircumstances of the youngest of children (see the Resources sidebarfor details). Because they cannot tellus their story, infants and youngchildren can be one of the mostchallenging and difficult popula-
(Continued from front page)