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Journal of Child and Adolescent Psychiatric Nursing
ISSN 1073-6077
Commentary
Education and Endorsement in Infant Mental Health In her classic book, Clinical Studies in Infant Mental Health, Selma Fraiberg and her colleagues (Fraiberg, 1980) laid the foundation for the interdisciplinary field of Infant Mental Health. Like other clinicians and researchers in the 1960s, including Bowlby, Ainsworth, and Brazelton, Fraiberg was deeply influenced by both her clinical work with parents and very young children who had experienced significant social and emotional deprivation, and her psychoanalytic training. She supported the integration of scientific knowledge with ongoing therapeutic practice, as highlighted in the following quote,“Today, we are in possession of a vast scientific treasure acquired through the study of normal and deviant infants, a treasure that should be returned to babies and their families as a gift from science” (Fraiberg, 1980, p. iii). Beginning in the early 1970s, Fraiberg directed the Child Development Project, an interdisciplinary training program at the University of Michigan, with the goal of developing better assessment tools and treatment modalities for infants with attachment disorders. She and her colleagues coined the phrase infant mental health (IMH) (Weatherston, KaplanEstrin, & Goldberg, 2009), and developed the IMH model, which at the time was a new modality of seeing parents and infants together, primarily in their homes. In this model, she and her interdisciplinary team focused on the developmental capacities of the infant, the developing parent–infant relationship, and the parent’s early and often traumatic childhood experiences. Following an in-depth assessment of infant development and the parent–infant relationship, practitioners provided mothers with resources, emotional support, developmental guidance, and, as needed, infant–parent psychotherapy. The work relied on a strong therapeutic alliance that offered parents opportunities to observe their infants, to think deeply about their infants and their early parenting role, and to share their feelings openly within a secure base of support. For more information about the current state of science in IMH, see Zeanah (2009).
tions to support preterm infants and infants with emotion regulation problems; and relationships between trauma and neurobiological outcomes. However, it is beyond the scope of this article to discuss these contributions in depth. Among nurses, Kathryn E. Barnard has had the most notable long-term impact on the field of IMH. In the 1970s, Dr. Barnard initiated research that integrated knowledge of early child development into clinical practice, and developed methods for assessing interaction patterns of young children and their parents (NCAST Teaching and Feeding Scales). Focusing on infants who were at risk for failure to thrive and developmental delays, she identified the importance of parent–child interaction as a predictor of cognitive and language development, and postulated the Parent–Child Interaction Model, a middle range theory, to explain this relationship. Today, nurses and other professionals worldwide use the NCAST Teaching and Feeding Scales (now known as the Parent–Child Interaction Scales) in their clinical work and research (NCAST, 2015). In honor of her pioneering work to improve the physical and mental health of infants and young children, in 2002, Kathryn Barnard received the Gustav O. Leinhard Award from the Institute of Medicine (IOM, 2013). It is fitting that Dr. Barnard shared this award with Dr. T. Berry Brazelton who also worked tirelessly to help professionals and families understand and facilitate the developmental capacities of infants and young children.
Nursing and Graduate Education Programs in Infant Mental Health An Internet search revealed several graduate certificate or degree programs in IMH at universities or institutes in the United States. However, given the page limitations of this article, only programs known to be offered through Schools of Nursing will be discussed here.
Nursing and Infant Mental Health
A Graduate Certificate Program
While nurses do not constitute the majority of professionals in the field of IMH, the research of many nurses has contributed to the evidence base for the field, especially in the realm of understanding pregnancy and postpartum outcomes, including perinatal depression; the role of the family environment in health and infant developmental outcomes; interven-
In 2001, the Barnard Center for Infant Mental Health and Development was opened at the University of Washington School of Nursing in Seattle. The Center conducts research and provides many training programs, including community-based Promoting First Relationships training that is based on Barnard’s Parent–Child Interaction Model. Since 2009, the Center has offered the university-based Irving B. Harris Graduate Certificate Program in Infant Mental Health.
doi: 10.1111/jcap.12112
Journal of Child and Adolescent Psychiatric Nursing 28 (2015) 65–67 © 2015 Wiley Periodicals, Inc.
65
Commentary
This certification is housed under the larger umbrella of the Graduate Certificate Programs in Advanced Practice Nursing and provides interdisciplinary training in the field of infant mental health (Barnard Center for Infant Mental Health and Development, 2015). Information about the certificate program can be found at http://www.nursing.uw.edu/ centers/barnard-center-infant-health-development. The Washington Association for Infant Mental Health plans to implement IMH endorsement in spring of 2015. Information about that endorsement process is available at http:// www.wa-aimh.org/endorsement. A Graduate Degree Program In the 1980s, the Wayne State University in Detroit, Michigan, established one of the first graduate certificate programs in IMH in the United States. Consistent with the movement toward evidence-based clinical practice, that program has evolved into a Dual-Title Degree in IMH that is offered collaboratively by the Merrill Palmer Skillman Institute, the College of Nursing, School of Social Work, College of Education, and Department of Psychology. Many of Fraiberg’s core beliefs can be seen in this interdisciplinary program that provides graduate students with many opportunities to learn about infant development, infant and parent assessment, family observation, attachment and trauma, and attachment-based treatment modalities. Graduates of this program specialize in either research or clinical work, and receive the degree from their discipline with a dual title in IMH (e.g., PhD in Nursing and IMH). Beginning in 2012, students from nursing, social work, and education enrolled in the DT-IMH program. For each discipline, the program is configured somewhat differently. However, all students must complete a set of five courses. The three “core” courses focus on IMH theoretical foundations, assessment and screening, and intervention. Two additional courses are focused on infant behavior and development. These courses address the importance of development within the context of relationship and explore issues that will support or be a barrier to early relationship development. All program content is aligned with the Michigan Association for Infant Mental Health (MI-AIMH) Competency Guidelines® and the MI-AIMH Endorsement® (Michigan Association for Infant Mental Health, 2002, 2011). Both are described in the next section of this article. In addition to these required courses, a student’s clinical placement or research project must focus on a topic related to IMH. For nurses, the PhD dissertation or DNP project must be focused on a topic that enhances the science or clinical practice of nursing and IMH. Due to the broad scope of practice within advanced practice nursing specialties like PMH, NNP, and PNP, numerous clinical issues can be explored. By focusing on parent–infant interaction, interfamily relation66
ships, and the developmental and mental health needs of infants, toddlers, and families, nurses can better understand and provide care to vulnerable infants and their families. Information about the Dual-Title Degree in IMH can be found at http://www.mpsi.wayne.edu.
Endorsement in Infant Mental Health One of the challenges faced by the interdisciplinary field of IMH is the issue of credentialing practitioners from such a wide range of disciplines. From 1996 to 2001, a group of MI-AIMH members identified the need to credential IMH professionals. They developed and refined a comprehensive set of competencies and a procedure for endorsement (Weatherston et al., 2009). The MI-AIMH Competency Guidelines® and the MI-AIMH Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health® were published in 2002, and revised in 2011 (Michigan Association for Infant Mental Health [MI-AIMH], 2002, 2011). The competencies cover eight core areas: theoretical foundations; law, regulation, and agency policy; systems expertise; direct service skills; working with others; communicating; thinking; and reflecting (Weatherston et al., 2009, p. 652). To successfully achieve endorsement through MI-AIMH, applicants must demonstrate mastery of content in each of the core areas. Based on the competencies, IMH professionals from multiple disciplines are endorsed at one of four levels: infant family associate (Level I); infant family specialist (Level II); infant mental health specialist (Level III); or infant mental health mentor (Level IV) (Weatherston et al., 2009). Endorsement “verifies that an applicant has earned an educational degree (as specified for each level); participated in specialized inservice trainings; worked with mentors who support reflective practice; and acquired knowledge promoting culturally sensitive, relationship-based service to infants, toddlers, parents, caregivers and families” (Weatherston et al., 2009, pp. 656–657). Applicants at Levels III and IV must also pass an examination. As of 2014, over 1,300 individuals have earned endorsement, close to 550 are “in process,” and 19 states and 1 region in Australia are using the MI-AIMH Competency Guidelines® and Endorsement® to promote policy, practice, training, and research in infant mental health. In addition, several other countries outside the United States are strongly considering licensing the use of the MI-AIMH endorsement system (D. Weatherston, personal communication, March 16, 2015). Infant mental health is a growing interdisciplinary field focused on fostering the optimal development of infants and young children through supporting relationships between children and their parents/caretakers. Nurses have and will continue to contribute to the field of IMH as clinicians, eduJournal of Child and Adolescent Psychiatric Nursing 28 (2015) 65–67 © 2015 Wiley Periodicals, Inc.
Commentary
cators, and scientists. We invite you to join us in this interdisciplinary field to promote the mental health of infants and young children.
IMH Resources Michigan Association for Infant Mental Health: www.miaimh.org. World Association for Infant Mental Health: www.waimh.org.
Acknowledgements The authors thank Deborah J. Weatherston, Executive Director, Michigan Association for Infant Mental Health (MIAIMH), for her assistance in confirming the accuracy of the information about the endorsement process. Judith Fry McComish, PhD, RN, IMH-E (IV), FAAN Associate Professor College of Nursing Wayne State University Detroit, MI, USA Carla Caringi Barron, LMSW, IMH-E(IV) Clinical Coordinator, Infant Mental Health Program Merrill Palmer Skillman Institute Wayne State University Detroit, MI, USA Ann Michele Stacks, PhD IMH-E (IV) Director, Infant Mental Health Program
Journal of Child and Adolescent Psychiatric Nursing 28 (2015) 65–67 © 2015 Wiley Periodicals, Inc.
Merrill Palmer Skillman Institute Wayne State University Detroit, MI, USA Author contact: [email protected], with a copy to the Editor: [email protected]
References Barnard Center for Infant Mental Health and Development. (2015). Information about the Barnard Center. Seattle, WA: Author. Retrieved from http://www.nursing.uw.edu/centers/ barnard-center-infant-health-development Fraiberg, S. H. (1980). Clinical studies in infant mental health: The first year of life. New York: Basic Books. Institute of Medicine. (2013). Gustav O. Lienhard award. Retrieved from www.iom.edu/Activities/Quality/Lienhard.aspx Michigan Association for Infant Mental Health. (2002, 2011). Competency Guidelines: MI-AIMH Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health. Southgate, MI: Author. NCAST. (2015). NCAST Programs: Promoting nurturing environments for young children. Seattle, WA: Author. Retrieved from http://www.ncast.org Weatherston, D. J., Kaplan-Estrin, M., & Goldberg, S. (2009). Strengthening and recognizing knowledge, skills, and reflective practice: The Michigan Association for Infant Mental Health Guidelines and Endorsement Process. Infant Mental Health Journal, 30, 649–663. doi:10.1002/imhj.20234 Zeanah, C. H. (2009). Handbook of infant mental health (3rd ed.). New York: The Guilford Press.
67
Copyright of Journal of Child & Adolescent Psychiatric Nursing is the property of WileyBlackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Journal of Child and Adolescent Psychiatric Nursing
ISSN 1073-6077
Commentary
Education and Endorsement in Infant Mental Health In her classic book, Clinical Studies in Infant Mental Health, Selma Fraiberg and her colleagues (Fraiberg, 1980) laid the foundation for the interdisciplinary field of Infant Mental Health. Like other clinicians and researchers in the 1960s, including Bowlby, Ainsworth, and Brazelton, Fraiberg was deeply influenced by both her clinical work with parents and very young children who had experienced significant social and emotional deprivation, and her psychoanalytic training. She supported the integration of scientific knowledge with ongoing therapeutic practice, as highlighted in the following quote,“Today, we are in possession of a vast scientific treasure acquired through the study of normal and deviant infants, a treasure that should be returned to babies and their families as a gift from science” (Fraiberg, 1980, p. iii). Beginning in the early 1970s, Fraiberg directed the Child Development Project, an interdisciplinary training program at the University of Michigan, with the goal of developing better assessment tools and treatment modalities for infants with attachment disorders. She and her colleagues coined the phrase infant mental health (IMH) (Weatherston, KaplanEstrin, & Goldberg, 2009), and developed the IMH model, which at the time was a new modality of seeing parents and infants together, primarily in their homes. In this model, she and her interdisciplinary team focused on the developmental capacities of the infant, the developing parent–infant relationship, and the parent’s early and often traumatic childhood experiences. Following an in-depth assessment of infant development and the parent–infant relationship, practitioners provided mothers with resources, emotional support, developmental guidance, and, as needed, infant–parent psychotherapy. The work relied on a strong therapeutic alliance that offered parents opportunities to observe their infants, to think deeply about their infants and their early parenting role, and to share their feelings openly within a secure base of support. For more information about the current state of science in IMH, see Zeanah (2009).
tions to support preterm infants and infants with emotion regulation problems; and relationships between trauma and neurobiological outcomes. However, it is beyond the scope of this article to discuss these contributions in depth. Among nurses, Kathryn E. Barnard has had the most notable long-term impact on the field of IMH. In the 1970s, Dr. Barnard initiated research that integrated knowledge of early child development into clinical practice, and developed methods for assessing interaction patterns of young children and their parents (NCAST Teaching and Feeding Scales). Focusing on infants who were at risk for failure to thrive and developmental delays, she identified the importance of parent–child interaction as a predictor of cognitive and language development, and postulated the Parent–Child Interaction Model, a middle range theory, to explain this relationship. Today, nurses and other professionals worldwide use the NCAST Teaching and Feeding Scales (now known as the Parent–Child Interaction Scales) in their clinical work and research (NCAST, 2015). In honor of her pioneering work to improve the physical and mental health of infants and young children, in 2002, Kathryn Barnard received the Gustav O. Leinhard Award from the Institute of Medicine (IOM, 2013). It is fitting that Dr. Barnard shared this award with Dr. T. Berry Brazelton who also worked tirelessly to help professionals and families understand and facilitate the developmental capacities of infants and young children.
Nursing and Graduate Education Programs in Infant Mental Health An Internet search revealed several graduate certificate or degree programs in IMH at universities or institutes in the United States. However, given the page limitations of this article, only programs known to be offered through Schools of Nursing will be discussed here.
Nursing and Infant Mental Health
A Graduate Certificate Program
While nurses do not constitute the majority of professionals in the field of IMH, the research of many nurses has contributed to the evidence base for the field, especially in the realm of understanding pregnancy and postpartum outcomes, including perinatal depression; the role of the family environment in health and infant developmental outcomes; interven-
In 2001, the Barnard Center for Infant Mental Health and Development was opened at the University of Washington School of Nursing in Seattle. The Center conducts research and provides many training programs, including community-based Promoting First Relationships training that is based on Barnard’s Parent–Child Interaction Model. Since 2009, the Center has offered the university-based Irving B. Harris Graduate Certificate Program in Infant Mental Health.
doi: 10.1111/jcap.12112
Journal of Child and Adolescent Psychiatric Nursing 28 (2015) 65–67 © 2015 Wiley Periodicals, Inc.
65
Commentary
This certification is housed under the larger umbrella of the Graduate Certificate Programs in Advanced Practice Nursing and provides interdisciplinary training in the field of infant mental health (Barnard Center for Infant Mental Health and Development, 2015). Information about the certificate program can be found at http://www.nursing.uw.edu/ centers/barnard-center-infant-health-development. The Washington Association for Infant Mental Health plans to implement IMH endorsement in spring of 2015. Information about that endorsement process is available at http:// www.wa-aimh.org/endorsement. A Graduate Degree Program In the 1980s, the Wayne State University in Detroit, Michigan, established one of the first graduate certificate programs in IMH in the United States. Consistent with the movement toward evidence-based clinical practice, that program has evolved into a Dual-Title Degree in IMH that is offered collaboratively by the Merrill Palmer Skillman Institute, the College of Nursing, School of Social Work, College of Education, and Department of Psychology. Many of Fraiberg’s core beliefs can be seen in this interdisciplinary program that provides graduate students with many opportunities to learn about infant development, infant and parent assessment, family observation, attachment and trauma, and attachment-based treatment modalities. Graduates of this program specialize in either research or clinical work, and receive the degree from their discipline with a dual title in IMH (e.g., PhD in Nursing and IMH). Beginning in 2012, students from nursing, social work, and education enrolled in the DT-IMH program. For each discipline, the program is configured somewhat differently. However, all students must complete a set of five courses. The three “core” courses focus on IMH theoretical foundations, assessment and screening, and intervention. Two additional courses are focused on infant behavior and development. These courses address the importance of development within the context of relationship and explore issues that will support or be a barrier to early relationship development. All program content is aligned with the Michigan Association for Infant Mental Health (MI-AIMH) Competency Guidelines® and the MI-AIMH Endorsement® (Michigan Association for Infant Mental Health, 2002, 2011). Both are described in the next section of this article. In addition to these required courses, a student’s clinical placement or research project must focus on a topic related to IMH. For nurses, the PhD dissertation or DNP project must be focused on a topic that enhances the science or clinical practice of nursing and IMH. Due to the broad scope of practice within advanced practice nursing specialties like PMH, NNP, and PNP, numerous clinical issues can be explored. By focusing on parent–infant interaction, interfamily relation66
ships, and the developmental and mental health needs of infants, toddlers, and families, nurses can better understand and provide care to vulnerable infants and their families. Information about the Dual-Title Degree in IMH can be found at http://www.mpsi.wayne.edu.
Endorsement in Infant Mental Health One of the challenges faced by the interdisciplinary field of IMH is the issue of credentialing practitioners from such a wide range of disciplines. From 1996 to 2001, a group of MI-AIMH members identified the need to credential IMH professionals. They developed and refined a comprehensive set of competencies and a procedure for endorsement (Weatherston et al., 2009). The MI-AIMH Competency Guidelines® and the MI-AIMH Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health® were published in 2002, and revised in 2011 (Michigan Association for Infant Mental Health [MI-AIMH], 2002, 2011). The competencies cover eight core areas: theoretical foundations; law, regulation, and agency policy; systems expertise; direct service skills; working with others; communicating; thinking; and reflecting (Weatherston et al., 2009, p. 652). To successfully achieve endorsement through MI-AIMH, applicants must demonstrate mastery of content in each of the core areas. Based on the competencies, IMH professionals from multiple disciplines are endorsed at one of four levels: infant family associate (Level I); infant family specialist (Level II); infant mental health specialist (Level III); or infant mental health mentor (Level IV) (Weatherston et al., 2009). Endorsement “verifies that an applicant has earned an educational degree (as specified for each level); participated in specialized inservice trainings; worked with mentors who support reflective practice; and acquired knowledge promoting culturally sensitive, relationship-based service to infants, toddlers, parents, caregivers and families” (Weatherston et al., 2009, pp. 656–657). Applicants at Levels III and IV must also pass an examination. As of 2014, over 1,300 individuals have earned endorsement, close to 550 are “in process,” and 19 states and 1 region in Australia are using the MI-AIMH Competency Guidelines® and Endorsement® to promote policy, practice, training, and research in infant mental health. In addition, several other countries outside the United States are strongly considering licensing the use of the MI-AIMH endorsement system (D. Weatherston, personal communication, March 16, 2015). Infant mental health is a growing interdisciplinary field focused on fostering the optimal development of infants and young children through supporting relationships between children and their parents/caretakers. Nurses have and will continue to contribute to the field of IMH as clinicians, eduJournal of Child and Adolescent Psychiatric Nursing 28 (2015) 65–67 © 2015 Wiley Periodicals, Inc.
Commentary
cators, and scientists. We invite you to join us in this interdisciplinary field to promote the mental health of infants and young children.
IMH Resources Michigan Association for Infant Mental Health: www.miaimh.org. World Association for Infant Mental Health: www.waimh.org.
Acknowledgements The authors thank Deborah J. Weatherston, Executive Director, Michigan Association for Infant Mental Health (MIAIMH), for her assistance in confirming the accuracy of the information about the endorsement process. Judith Fry McComish, PhD, RN, IMH-E (IV), FAAN Associate Professor College of Nursing Wayne State University Detroit, MI, USA Carla Caringi Barron, LMSW, IMH-E(IV) Clinical Coordinator, Infant Mental Health Program Merrill Palmer Skillman Institute Wayne State University Detroit, MI, USA Ann Michele Stacks, PhD IMH-E (IV) Director, Infant Mental Health Program
Journal of Child and Adolescent Psychiatric Nursing 28 (2015) 65–67 © 2015 Wiley Periodicals, Inc.
Merrill Palmer Skillman Institute Wayne State University Detroit, MI, USA Author contact: [email protected], with a copy to the Editor: [email protected]
References Barnard Center for Infant Mental Health and Development. (2015). Information about the Barnard Center. Seattle, WA: Author. Retrieved from http://www.nursing.uw.edu/centers/ barnard-center-infant-health-development Fraiberg, S. H. (1980). Clinical studies in infant mental health: The first year of life. New York: Basic Books. Institute of Medicine. (2013). Gustav O. Lienhard award. Retrieved from www.iom.edu/Activities/Quality/Lienhard.aspx Michigan Association for Infant Mental Health. (2002, 2011). Competency Guidelines: MI-AIMH Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health. Southgate, MI: Author. NCAST. (2015). NCAST Programs: Promoting nurturing environments for young children. Seattle, WA: Author. Retrieved from http://www.ncast.org Weatherston, D. J., Kaplan-Estrin, M., & Goldberg, S. (2009). Strengthening and recognizing knowledge, skills, and reflective practice: The Michigan Association for Infant Mental Health Guidelines and Endorsement Process. Infant Mental Health Journal, 30, 649–663. doi:10.1002/imhj.20234 Zeanah, C. H. (2009). Handbook of infant mental health (3rd ed.). New York: The Guilford Press.
67
Copyright of Journal of Child & Adolescent Psychiatric Nursing is the property of WileyBlackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
