CLINICAL INTERVENTIONS TO ENHANCE INFANT MENTAL HEALTH: A Selective Review

The National Center for Infant and Early Childhood Health Policy supports the federal Maternal and Child Health Bureau and the State Early Childhood Comprehensive Systems Initiative by synthesizing the policy relevance of important and emerging early childhood health issues, conducting policy analysis on systems-building and programmatic issues, and disseminating the latest research findings to increase the visibility of early childhood policy issues on the national agenda. The rapid growth of research showing the profound impact of early caregiving experiences on a child's early and later social, emotional, behavioral, and cognitive development has generated enormous interest in the development of interventions that strengthen the parent-infant relationship. Because parents and infants have a variety of needs, and service sectors vary in the types of services they provide (Zeanah et al, 2000), a continuum of infant mental health (IMH) services is necessary. Considerable variability in the current delivery of interventions exists, and includes: ■ Severity of problem (e.g., no problem/prevention, parenting or family problems, severe child behavior/emotional problems). Nevertheless, there are overarching goals across the continuum of services: 1. To enhance the ability of caregivers to nurture young children more effectively; 2. To expand the ability of non-family caregivers to identify, address, and prevent social-emotional problems in early childhood; and 3. To minimize or avert suffering, and ensure that families in need of more intensive services can obtain them. The unique focus of infant mental health interventions is most often the caregiver-infant relationship, rather than the traditional approach of focusing specifically on the child or caregiver. Because a relationship approach to assessment and treatment is new, the development of evidence-based approaches is still in its own infancy. Furthermore, as described by Shonkoff and Phillips (2000), there are a number of challenges in developing the evidence-base for infant mental health interventions (Exhibit One). Few interventions approach state of the art methodology to determine their short-and long-term effects (e.g., randomized controlled trials), but a number of promising approaches have shown significant improvements on social-emotional development and/or parent-infant relationships. This brief describes selected programs that represent current approaches in infant mental health. This is not an exhaustive review; rather, illustrative programs are selected that: a) Focus on the parent-infant relationship as a target of intervention. b) Have been implemented in primary, focused, or tertiary care settings, with low to high risk families. c) Demonstrate evidence of short or long term improvement in parent-infant relationships. Infant Mental …