Approaches to intervention in infant mental health

Approaches to intervention in infant mental health Interventions in the infant period have the core aim of promoting infant development and motivating infant potential. Interventions may occur or be targeted at multiple levels of the individual, family and social system. For example the focus may be the infant individually, the infant–parent relationship, the family, the social group or community, or broad-based population approaches that support infants and families. Interventions may be preventive and aimed at reducing potential developmental problems in high-risk situations, or may be focused on infants already experiencing developmental difficulties. A comprehensive program for infant mental health involves support across the community for parenting and early childhood, preventive interventions and targeted services for high-risk infants and parents. Interventions focused on the infant Clearly when an infant has specific developmental or medical problems, aspects of any clinical intervention with the infant and family need to acknowledge and address these issues, while also supporting the caregivers in their interactions with the health system and helping them adapt to the particular needs of their baby. As quoted at the start of this book, the paediatrician and psychoanalyst Donald Winnicott is famously reported to have said, ‘There is no such thing as a baby…if you set out to describe a baby, you will find you are describing a baby and someone. A baby cannot exist alone, but is essentially part of a relationship’ (1964/1978, p. 88). His contemporaries and subsequent writers have not always agreed with him, in that there is more ready acknowledgement of the infant as an active participant in his own destiny from the first moments after birth. Approaches to intervention based on the transactional model (Sameroff & Fiese, 2000) suggest the ‘three Rs’ of early intervention—remediation, redefinition and re-education. Remediation is an approach to intervention focused primarily on facilitating changes in the child with the aim of improving the infant–caregiver relationship. It can form part of an overall intervention
strategy. For example, infants who have had repeated intrusive medical
procedures may benefit from gentle touch and interactions that provide them
with a new experience of physical contact and ‘being with’ another, enabling the
infant to be more responsive to parental touch and interaction. This allows
parents who may have become anxious, or felt incompetent in interaction with a
sick or easily overstimulated baby, to see their infant behaving in a different way,
and to approach him in a new way (Field et al., 1986; Als, 1992).
Abused babies and toddlers may also benefit from individual therapy as part
of supporting their transition to a new caregiving environment. As children get
older and develop their own inner world and more established patterns of
behaviour, the argument for individual intervention increases, as individual
therapy to address maladaptive behaviours may support the development of new
relationships with foster or alternative caregivers. Therapeutic support at an
interactional or family level may also be indicated. Whatever therapeutic
interventions are provided for an infant and his caregivers, the overall focus
must be developmentally informed and sensitive to the young child’s need for
continuity in his relationships with sensitive, responsive adults.
Interventions for the infant–parent relationship
There are a range of approaches to therapeutic intervention in the infant–parent
relationship (Sameraff, McDonough & Rosenblum, 2004). Infant–parent
therapies can be understood as working across both the domains of observed
behaviours and interactions between infant and parent, and their existing and
developing internal representation of relationships. A number of these therapies
used video-taped interactions of infant and parent, then replayed and examined
them to enable the parents to reflect on and gain new knowledge about
themselves and their infant.

Interventions for the family
Family approaches to intervention acknowledge the interconnectedness of
family members and their inevitable impact on each other. The arrival of a new
infant in a family requires adjustment by everyone, including existing siblings
and extended family. Critiques of dyadic approaches to infant–parent work
suggest that exclusion of the father or other siblings, for example, denies the
significance of the wider family context, with excessive focus on parent (usually
mother) and infant alone. The nature of the presenting problem and the family
structure and constellation should inform decisions about who is involved in
therapeutic interventions.

Group therapies
Group work can be undertaken with infants and parents, either with a psychoeducational
or a more experiential and therapeutic focus. This enables new
parents to learn from each other and from other infants in the group about
themselves, their own infant and approaches to parenting. New parents groups
are an example of community–based groups, but group programs are also
offered to higher risk groups such as families with infants with prematurity or
other medical problems or parents who have suffered perinatal mental illness.
Population-based and targeted interventions
Some services and programs are offered to all new parents independent of their
particular needs or risk factors. Sometimes they include a screening or
identification process of families with risk factors, which may indicate they
would benefit from more targeted or intensive intervention. Examples include
universal home-visiting programs, sometimes staffed by trained volunteers, with
extra visits or professional supports offered to families and infants at risk.
Clinicians working with infants and families need to be aware of the range of
services and facilities in their area, and to advocate for the provision of trained
staff with specialist expertise if an adequate range of interventions and supports is not available.