Infant and Toddler Mental Health Summer Institute A summary report

What was it? Partnership with IAITMH, Sunny Start and Department of Mental Health Intense training opportunity Three sessions over a five day period Networking opportunity Goal was to reach out to more mental health professionals and therefore increase the workforce capacity/ resources for families Partnership with IAITMH, Sunny Start and Department of Mental Health Intense training opportunity Three sessions over a five day period Networking opportunity Goal was to reach out to more mental health professionals and therefore increase the workforce capacity/ resources for families

Session One – July 9 Mental Health Diagnosis in Young Children with Janice Katz, PhD ½ day session Highlighted diagnostic criteria in the DC 0-3 Participants received a copy of DC: 0-3R CANS 0-5 with Stacey Ryan, LCSW ½ day session Highlighted the CANS tool and its use in Indiana Mental Health Diagnosis in Young Children with Janice Katz, PhD ½ day session Highlighted diagnostic criteria in the DC 0-3 Participants received a copy of DC: 0-3R CANS 0-5 with Stacey Ryan, LCSW ½ day session Highlighted the CANS tool and its use in Indiana

Session Two – July Interaction Guidance (IG): Dyadic Treatment for High Risk Families with Susan McDonough, PhD IG is a structured format based on systems theory along with infant mental health concepts. Videotape is used to support change in parent-child interactions IG is an evidenced-based intervention strategy Each participant received a copy of Treating Parent-Infant Relationship Problems Interaction Guidance (IG): Dyadic Treatment for High Risk Families with Susan McDonough, PhD IG is a structured format based on systems theory along with infant mental health concepts. Videotape is used to support change in parent-child interactions IG is an evidenced-based intervention strategy Each participant received a copy of Treating Parent-Infant Relationship Problems

Session Three – July Dialectical Behavior Therapy (DBT) for High Risk Parents with Janet Dean, LCSW DBT is an evidence-based treatment for individuals with personality problems, characterized by low reflective functioning, difficulty with self-regulation, and reduced tolerance for stress Each participant received a copy of Early Intervention with Multi-Risk Families Dialectical Behavior Therapy (DBT) for High Risk Parents with Janet Dean, LCSW DBT is an evidence-based treatment for individuals with personality problems, characterized by low reflective functioning, difficulty with self-regulation, and reduced tolerance for stress Each participant received a copy of Early Intervention with Multi-Risk Families

Participant Data Total 75 participants over the five days Session 1 – 50 total participants Session 2 – 52 total participants Session 3 – 41 total participants 27 participated in all five days of the institute 22 different centers/organizations represented 26 different communities represented Total 75 participants over the five days Session 1 – 50 total participants Session 2 – 52 total participants Session 3 – 41 total participants 27 participated in all five days of the institute 22 different centers/organizations represented 26 different communities represented

Evaluation Comments Session One Now I know what to do for early mental health assessments that DCS asks me to do. Also, our facility is now using the CANS for all our child intakes. I plan to start using the DC: 0-3 diagnostic criteria and crosswalk with my reports and treatment with infants and toddlers. Now I know what to do for early mental health assessments that DCS asks me to do. Also, our facility is now using the CANS for all our child intakes. I plan to start using the DC: 0-3 diagnostic criteria and crosswalk with my reports and treatment with infants and toddlers.

Evaluation Comments Session Two I will be less clinical. I love the way this is strength based and goes where the client is. This gave me permissive to focus more on the client: less on the illness. I will increase my practice age range. I really want to try the video thing and I plan to be more observant and make snap shots of the positive things parents and children are doing to build better relationship. Because of this training will feel more comfortable serving younger children. Prior to this session would not have considered seeing 0-2 year old. Learned a lot about use of self I will be less clinical. I love the way this is strength based and goes where the client is. This gave me permissive to focus more on the client: less on the illness. I will increase my practice age range. I really want to try the video thing and I plan to be more observant and make snap shots of the positive things parents and children are doing to build better relationship. Because of this training will feel more comfortable serving younger children. Prior to this session would not have considered seeing 0-2 year old. Learned a lot about use of self

Evaluation Comments Session Three I'll be much more mindful and less intense. Will work more with infant ages (0-3). I would like to try to be more aware of structure, being in the moment, less focused on change. I will begin to develop services for Infant toddler mental health in my community mental health center. I'll be much more mindful and less intense. Will work more with infant ages (0-3). I would like to try to be more aware of structure, being in the moment, less focused on change. I will begin to develop services for Infant toddler mental health in my community mental health center.

What We Learned Participants appreciated attention and focus on learning environment and materials Providers want to serve this population Providers want more information to successful partner with children and famiilies Useful techniques for infant and toddler mental health interventions Participants appreciated attention and focus on learning environment and materials Providers want to serve this population Providers want more information to successful partner with children and famiilies Useful techniques for infant and toddler mental health interventions

Why a Relationship Approach? Infant behavior cannot be viewed apart from the childs relationships During infancy the most important relationships are with the primary caregivers Caregivers have relationships with their social context; extended family, friends, cultural and spiritual networks Infant behavior cannot be viewed apart from the childs relationships During infancy the most important relationships are with the primary caregivers Caregivers have relationships with their social context; extended family, friends, cultural and spiritual networks

Origins of Interaction Guidance Created specifically for families who were not successfully engaged in mental health treatment or refused referral Incorporated principles of family systems and dynamic theory, the use of video technology and brief psychotherapy practice to address parent-infant relationship problems Created specifically for families who were not successfully engaged in mental health treatment or refused referral Incorporated principles of family systems and dynamic theory, the use of video technology and brief psychotherapy practice to address parent-infant relationship problems

How we can partner with families who dont want our help Listen to how others have treated them without trying to explain, clarify, defend, or instruct Acknowledge and legitimize their feelings of betrayal, mistrust and disappointments Ask, rather than assume, that they believe you can be helpful Listen to how others have treated them without trying to explain, clarify, defend, or instruct Acknowledge and legitimize their feelings of betrayal, mistrust and disappointments Ask, rather than assume, that they believe you can be helpful

Where to Begin? Therapeutic Port of Entry Treatment approach matches Familys needs & capabilities at this point in their family life cycle Therapeutic Port of Entry Treatment approach matches Familys needs & capabilities at this point in their family life cycle

Interaction Guidance Relationship focused Interaction as: Early focus of intervention Reflection of representation Egalitarian therapeutic relationship Replay and reflection of interactions inviting alternative family perspective Time-limited piece of work with follow-up and referrals Relationship focused Interaction as: Early focus of intervention Reflection of representation Egalitarian therapeutic relationship Replay and reflection of interactions inviting alternative family perspective Time-limited piece of work with follow-up and referrals

Why pay attention to family and relationship? Insights from the field of neurodevelopment: Bruce Perry There is no more effective neurobiological intervention than a safe relationship. It changes the brain. Insights from the field of neurodevelopment: Bruce Perry There is no more effective neurobiological intervention than a safe relationship. It changes the brain.

Three Important Discoveries Safety in relationship precedes the ability to… Be reflective; which precedes the ability to… Be Flexibly Responsive to ones situation and environment Safety in relationship precedes the ability to… Be reflective; which precedes the ability to… Be Flexibly Responsive to ones situation and environment

Therapeutic approaches facilitate: Integration Acceptance Safety Working with resistance/ambivalence Change Reflective functioning Integration Acceptance Safety Working with resistance/ambivalence Change Reflective functioning

About change Any theory of change must incorporate: Establishment of safe and trusting relationship Gain new information and experience across domains of cognition, emotion, sensation, and behavior The simultaneous or alternating activation of neural networks that are not integrated or dissociated Any theory of change must incorporate: Establishment of safe and trusting relationship Gain new information and experience across domains of cognition, emotion, sensation, and behavior The simultaneous or alternating activation of neural networks that are not integrated or dissociated

About change: Theres more… Moderate levels of emotional arousal alternating with periods of calm and safety The integration of conceptual knowledge with emotional and sensory experience through narratives that are co-constructed with the therapist Skills to help continue integration outside of the therapeutic relationship Moderate levels of emotional arousal alternating with periods of calm and safety The integration of conceptual knowledge with emotional and sensory experience through narratives that are co-constructed with the therapist Skills to help continue integration outside of the therapeutic relationship

Whats next? Create a listserv to foster communication among those who attended the Institute The Social and Emotional Training and Technical Assistance Committee is surveying providers to learn what training is currently available that addresses identified competencies Review of data to identify needs Develop plan to address training needs to further expand early childhood mental health resources Create a listserv to foster communication among those who attended the Institute The Social and Emotional Training and Technical Assistance Committee is surveying providers to learn what training is currently available that addresses identified competencies Review of data to identify needs Develop plan to address training needs to further expand early childhood mental health resources