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COMMENTARY

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lt is thought provoking to consider Early Head Start (EHS) programming against the
backdrop of the early work of Selma Fraiberg and more recent models promoting infant
mental health (IMH). What journey are we asking EHS staff to embark on? Will they go on
theirjourney alone or be accompanied by at least one trusted companion‘? These are important
questions to ask when considering relationship~based practice and the interface of IMH and S
EHS.
Selma Praiberg established what is believed to be the first Infant Mental Health Program
at the Child Development Project in Ann Arbor, Michigan, in 1972 (Fraiberg, I980). Over 35
years have passed since the first IMH practitioner knocked on a farnily’s door with the offer
of a therapeutic relationship in an effort to respond to an infant and parent believed to be at
risk for developmental and relationship failure. ln recent years, new models have been de-
signed. lmportant examples include Interaction Guidance (McDonough, 2000); Infant-Parent
Psychotherapy (Lieberman & Pawl, 1993; Pawl & Lieberman, l997; Wright, 1986); Circle of
Security (Marvin, Cooper, Hoffman, & Powell 2003); Watch, Wait & Wonder (Cohen et al.,
1999). These models retain core principles trom Fraiberg’s original work: Pay attention to the
infant, the parent, and their early developing relationship from the time you first meet the
family until you say good-bye. Pay attention to past and present relationship experiences,
because they influence the care of the infant “in the moment” and the parent’s experience of
the infant. as well. Pay attention to the developing relationship between parent(s_) and practi-
tioner. lt is this relationship that functions as the instrument for growth and change.
There is now widespread interest in infancy, early parenthood, relationship development,
and the identification of risks and capacities in infancy and early parenthood, as well as
strategies that encourage parental reflection and the reduction of vulnerability in the infant’s
first years. This special issue invites us to consider ways in which infant mental health
principles and practices have been introduced to Early Head Start programs in many commu-
nities across the United States. As always, we are indebted to the practitioners and research
scientists who share their work in hopes that there will be greater understanding across
disciplines and better outcomes for all the infants, toddlers, and families who co
attention
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Direct cot
. 'respondence to: Deborah Weatherston, Ph.D., The Guidance Center, Michigan Association H163
for [O
lnfaOUT
Mental Health, l3lOl Allen Road, Unit 200. Soutligate, Ml 4Sl95; e-mail: tlweatherston(Ffl
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INFANT MENTAL HEALTH -JOUHNA
© 2007 Mich . _ guidance-centerorg
igan Association for Infant Mental Health2-<l6~251 (2007) ni
Published online in Wiley lnterSclence L,(wwwinterscien
Vol. 28(2), . '
DOI: 10.1002/imhj.20t32
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Returiiiiig the Treasr-tr

\NFANT MENTAL HEALTH: PRlNClPLES AND PRACUCE

Selma Fraiberg believed firmly that scientific study about early developinent. was “a treasure
t.hat should be returned to babies and their families as a gift from science” ffraiberg, U980, p.
3). Armed with new understanding, Fraiberg crafted an approach to infants and fairiilies that
was, at the time, revolutionary. As Fraiberg described, “the b21l1_}j,..__€.l»l'tr;l_ parent were, now our
patipiits”’ (Fraiberg, i980, p. "ll. The infants referred today may be premature, underweight,
uinrespoiisive, failing to thrive, or relationship disordered. The parents referred may be ado-
lescent, isolated, unprepared for the care of ababy, depressed, or with histories of unresolved
l o sses, abusive or neglectful care. They ‘ are seen that
together, in the intimacy of their own homes
' ics' where ‘ the infantachmental p "aient s wish (lb/ill)
health lifepractitioner
will be better offers for
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ki t. thantable
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ting
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ters into
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been for him o
What might this practice loo
arent and infant in ver a clinic observehe
a 4- to 6-week thedeveloping
time iperiod, thecapacities IMH ncrete pitaand assistance,
alsoort,theadvo emo-
cacy,
vulner-
beside a p ’ e uently, o ' a.ssessing ' t tervention ' include co
or more tr q 'l while nt and supp i980;
weekly, -it (Fraiberg,
‘ ‘ ' w ith thedtional fami
' y comp
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a relationship d parent pa grams, but
abilities of each. Tra i
lopmental guidance,eded ea by each infant ' an
bility across ll\llH prom
ort deve a y as ne ome varia rolled key to
tional supp , . e may be s ' titioner as
and in t ‘
rant-paren t p sychother p
700?.) Ther , ' nfants an d families lenand pr ipflmm . l of this
atherston, .. . ents to the i . — -~_-.-; * nd earning _
Shirilla 81 We ' en parentts '
many offer rograms most of these compon
emphasize the relationship betwe
ll\/IH p s wrote over 25 y eafi§i"fi'g”51”"Th§:§“x’vinning
‘ll be closely related to_outcome.” la (Fraiberg,rela-
...... Wfgh,W ."l"l"t‘l‘éiil{%.iilEéll'int
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' As Fraiberg ' ' nt and wi V This same of the
successful work.
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Wl9‘8>0, p. 27). lt is the working r
nurtureand respond to the infant appropriately,yypcponsu
tions p allows('each parentlowhaveandeirpress sibilities of early parenthood, umas
thoughts awakenedand feelings
and tointhink the redeeply
rentls)
parent a and inabout core
practitioner
the presence con-
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llic-ts related to unreso
the infant. l\/lost optimally, the working r
curely, fueling each parent's capacity to offer a relationship
infant’s and parent's social and emotional health.
The supervisory or consultation relationship is another hallmark of infant mental health
practice. Most optimally, each ll\/ll-l practitioner meets regularly with a supervisor or consult-
ant, entering into a_ trustingtal relationship
health practice, and
thatult encourages
work.
reduces lt the' within
exploration
theis practitioners
often this
ed lmowledge of personal
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. to what
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acquires the specializ examples in the literat
' ‘ k, Gilkerson
professional responses
a consultation group, that the practitioner
quired for best infant mental health practice. There are many
importance of supervision to the TMH prac-titioner‘s growth (Shahinoon Shano
Eggbeer, 8t Penichel, l995', Heffron, 2005', llaplan-Estrin 8: Weatlierston, 2005)

eallh
lnlanl Mental l-l

lnfant Mental Health Journal DOl lQ.lOQQl'imhl. Published on behalf of the Michigan Association lot
 243 - D. Weatherston

NEW PARTNERS: INFANT MENTAL HEALTH AND EARLY

HEAD START: CAUSE FOR CELEBRATION
A first reading of the papers included in this special issue of the Infant Mental Health Journal
calls for a celebration. Mental health seems to have entered into a partnership with the early
childhood community through Early Head Start. Shared concerns for the optimal social and
emotional development of very young children within family relationships and supportive
environments make infant mental health and Early Head Start a very good fit. The focus on
infancy and early parenthood, coupled with attention to family needs for concrete resources
and emotional support during the first years of a child’s life, suggests an overlapping of
mutual goals. Concern for the training and ongoing supervision of home visitors in Early
Head Start programs echoes practice that leads to competency in Infant Mental Health
(Ml-AIMH, 2002). The observation and assessment of infants and parents together, the use of
working relationships as a context for growth and change, child development goals, a com-
mitment to home visiting, and concerns regarding the mental health of parents are additional
markers of both infant mental health and the Early Head Start programs described in this
la
issue.
\r‘“""'T

Building Capacity and Expanding Service

One might imagine that the infusion of IMH principles and practices into EHS programming
and policies was accomplished easily and swiftly. There is evidence in some of the articles in
this issue that this was the case. Many EHS partnerships were created to provide a focus on
social and emotional health in infancy and early parenthood, reflecting a new commitment to
IMH. Some partnerships (HIPPI Project, Mental Health Mentoring Project, In-Home Nurse-
Interpreter Team) built capacity within EHS programs by training and supervising EHS staff
to provide specialized interventions with a focus on interaction and early relationship devel-
opment for parents and infants enrolled in EHS. Other partnerships (Nurturing Parents, Circle
of Security, Infusion Project) added educational or mental health service components for
infants and families who met specific criteria for treatment and were enrolled in EHS.
Whether building capacity internally or adding to the array of community services avail-
able, all approaches described in this special issue increased attention to infant mental health
and parental mental health issues within EHS staff and EHS communities. They highlighted
the awareness of risk factors that enhance or place infants and toddlers at grave risk for
developmental delays or relationship disorders—-for example, maternal depression, parental
history of abuse and neglect, exposure to trauma, domestic violence, substance use, parenting
distress, or family conflict. These efforts increased the awareness of significant stressors and
risk factors among families in EHS, while maintaining awareness of capacities and
strengths—an important accomplishment when addressing mental health.
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wan,
5 Paradigm. Shifts and Training

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The adoption of principles and practices promoting infant mental health required most pro-
fessionals in the EHS programs mentioned in this special issue to make significant paradigm
shifts: from working with an individual infant or parent in the clinic or center to working
within a relationship context with a parent and cl1ild’t4og_efith_e_r,_ often in the home; liroi1i"'lt'iilil€iiiig
. _.>. . . _ -. . _ __.,.. ....r . .r..|1 _ rr» ... ._

Infant Manta! Health Journal DO] 10.1002/imhj. Published on behalf of the Michigan Association tor Infant Mental Health.
 Returning the ?reasure to Babies - 249

and telling to oLb_s=eryitig, lisftgniphg, and reflecting; from doing for to being with; from observ-
itifgttt't;"i£3§‘“‘i€*5i3iemmg strengths ('5)i”ttié“¥é1?”e7t;e). Another shift included moving from a disci-
plinary specific approach-for leixiiamplle,"H_e'a1'ly childhood education or psychology-—to an
lm@Ydi5¢iP1inaYY OF imnsdiscipiinaliy teiim a.PP.fQ_i?l?1l P.3.Y..¢.h_.Qi.9i%.}’.?. .i_1..L.‘.i-5mg* eaflii
childhood, and social work, to i1ame_fe_vv. A third shift required joint attention to internal
psychological processes and social or economic realities.
These shifts are difficult to make and were addressed primarily through opportunities for
extensive IMH training and consultation. Individual programs offered intensive (weekly or
biweekly) IMH training experiences for EHS staff and opportunities for regularly scheduled,
reflective supervision or consultation with a skilled IMH professional for case conferencing
throughout the demonstration year(s_) (Family Foundations EHS, Pittsburgh; Project HAPPI,
University of Maryland; Pathways to Prevention, Washington, D.C.). Training and consulta-
tion occurred over time, allowing EHS staff to apply their new knowledge -and skills when
working with infants, toddlers, and families and to get continuous, supportive feedback. The
attention to training and consultation allowed EHS staff to begin to fulfill Fraiberg’s intent: to
bring new knowledge and understanding about the importance of infancy and early care to
infants and their families through carefully constructed programs promoting IMH (Shapiro,
Adelson, & Tableman, 1978).
One of the largest training initiatives, the Pathways to Prevention Initiative (Zero to
Three, Washington, D.C-.) deserves special attention. It was designed to address a continuum
of IMH issues within 24 EHS and Migrant and Seasonal Head Start Programs (MSHS) across
the United States. The initiative was funded in response to the urgent needs of EHS/MSHS
staff for training and support in addressing the mental health needs of very young children in
their care. Following a 4-day national training about infancy and infant mental health, each
program worked with an individual IMH consultant for up to 24 hours a month for l0 months,
receiving intensive, supportive on-site consultation for their EHS and community team.
The intent was to build mental health capacity in EHS/MSHS by increasing the knowl-
edge and skills of direct service providers, team leaders, and local mental health providers in
the community. The Pathways model offers an elegant, multidimensional design for the inte-
gration of IMH principles and practices into other large service systems-for example, child
welfare, health, mental health, and early childhood. With extension of the time frame from 1
year to 3 years (time was a significant limitation in the EHS/MSHS project) and more time for
collaboration among all participating partners (minimum of 6 months), this model offers a
significant approach to systems change through intensive IMH training and consultation re-
lationships.
.1--"""""""

Collaboration

The celebration continues as we consider the number of collaborations that were required to
bridge the gap between infant mental health and Early Head Start. Collaborations, like rela-
tionships, take time, energy, and shared passion. It is clear that to be successful, mental health
professionals had to join hands with early childhood professionals. Practitioners had to sit at
the table with research scientists. infant mental health professionals needed to work beside
Early Head Start professionals. Parents and infants had to open their homes to observers and
evaluators. Each participating partner had something t.o contribute and was important to the
success of the whole. This is a valuable lesson for those struggling to infuse infant mental

Infant Mental Health Journal DOI 10.1002/lmhj. Published on behalf oi the Michigan Association for Infant Mental Health.
250 ~ £3. Weatlzersron

health principles and practices into other systems ofearly education, child welfare, health, and
child care. It is tempting to impose principles and practices rather than to partner through
coilaboration with others. The examples in this special issue promote partnership as the most
important ingredient for infusing IMH into other systems of care.

A FINAL WORD AND RECOMMENDATIONS FOR NEXT

STEPS

This is an impressive collection of papers that evokes excitement about the work of EHS in
partnership with IMH. One believes it is possible to have an impact on the social and emo-
tional well-being of infants, young children, and their families through an EHS program that
is enriched by principles and practices identified more particularly with IMH. How might we
“return the treasure to babies" as Selma Fraiberg wished?
One recommendation is to create a national IMH Training Institute in partnership with
EHS under the educational leadership of the national organization Zero to Three and in
consultation with experts from the World Association for Infant Mental Health (WAIMH).
IMH and EHS professionals could apply to attend weeklong institutes throughout the year in
which IMH faculty from across the country would share knowledge about infancy, early
parenthood, attachment. family development, and best-practice skills to enrich services to
EHS families. The IMH Training Institute would integrate theory with best-practice ap-
proaches within an infant mental health framework and offer many opportunities for reflection
within the intimacy of small groups. Trainings could be offered regionally and involve both
IMH and EHS professionals in the planning process.
A second recommendation is an outgrowth of the first. A national IMH Training Institute,
under the leadership of Zero to Three and with WAIMH in a consultant role, could offer core
training to IMH and EHS professionals in the provision of reflective supervision and consul-
tation to individuals and small groups. This could have a dramatic impact on the promotion of
infant mental health in EHS and community programs across the country. Guidance and
support would be provided to participating trainees throughout the year to ensure continuing
growth in the art of reflective supervisory support. This effort would help to build and
maintain a strong and competent infant and family workforce that is skilled in promoting
infant mental health.
In sum, a national IMH Training Institute will allow us to “return the treasure to babies,”
and to their families through a unique partnership between Zero to Three, WAIMH, and Early
Head Start.

REFERENCES

Cohen, i\l.J., Muir, E., Lojakasek. M., Muir, R., Parker, C..l., Barwick, M., et al. (1999). Watch, wait,
and wonder: Testing the effectiveness of a new approach to mother-infant psychotherapy. Infant
Mental Health Journal, 20, 429-451.
Fraiberg, S. (1980). Clinical studies in infant mental health: The first year of life. New York: Basic
Books
Heffron, M.C. (‘2()05). Reflective supervision in infant, toddler, and preschool work. in K. Finello (Ed.),
The handbook of training and practice in infant and preschool mental health (pp. 114-136). San
Francisco: Jossey-Bass.

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 Retiirriing the Treasuri: to Babies ~ Z51

Kaplan-Estrin, M., & Weatherston, D. (2005). Training in the 7 languages of infant mental health.
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McDonough, S. (2000). Interaction guidance: an approach for difficult-to~engage fainilies. In CH.
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Michigan Association for Infant Mental Health. (2002). Competency guidelines. Southgate: Michigan
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Pawl, J., & Lieberman, A. (1997). Infant-parent psychotherapy. In S. Greenspan, S. Wieder, & J.
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Shirilla, J., & Weatherston, D. (Eds). (2002). Case studies in infant mental health: Risk, resiliency &
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Wright, B. (1986). An approach to infant-parent psychotherapy. Infant Mental Health Journal, 7(4),
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Infant Mental Health Journal DOl 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.