Infant Mental Health Training for Child and Adolescent Psychiatry: A Comprehensive Model.

There is growing attention to the importance of infant mental health, defined as recognizing, evaluating, and treating behavioral health symptoms in the first 3 years of life [1]. Currently, there are concerns about overmedication in lieu of comprehensive biopsychosocial treatments with respect to very young children, as well as the realization that more comprehensive services can help in preventing and averting difficulties as children grow older [2–5]. Developmental knowledge about very young children is also important for child psychiatry in treating older children and adolescents as well as understanding early factors that may impact on disorders in adults [6]. Further, infant mental health training and work is multidisciplinary, which provides the opportunity for child psychiatry fellows to learn about multiple systems that may be helpful to the assessment and treatment of young children and their caregivers [7–10]. The importance of training child psychiatry fellows in infant mental health has a long and rich history within child psychiatry [11, 12], pediatrics, and more recently, neuroscience. The theoretical, research, and clinical base was recognized early in child psychiatry as represented in two interesting and informative volumes entitled frontiers of infant psychiatry [13, 14]. In these books, the authors elaborated on major contributions in what was then called infant psychiatry that broadened perspectives on the importance of the early years. More recently, researchers have emphasized the importance of early experiences during pregnancy and in the first years of a child’s life that can have a significant impact on brain development [15]. From a pediatric perspective, the Brazelton Touchpoints Center, based on scientific research and clinical observations of babies and young children, reshaped the field of early child development and the practice of pediatrics. The Touchpoints approach is a systems theory based model of human development that helped to lay the foundation for the infant mental health field [16, 17]. With more of a focus on neuroscience, stress, and brain development, the Center for the Developing Child at Harvard directed by Jack Shonkoff, Professor of Pediatrics at Harvard Medical School, has emphasized that the mission of the universitywide center is to bring credible science to bear on public policy affecting young children, especially those facing adversity [10, 15]. Despite support for infant mental health, current Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for child and adolescent psychiatry do not make specific reference to infants, and only briefly mention the preschool age regarding instruction in normal development. For example, IV.A.6.i states that, “Fellows must have instruction in normal development, including observation of and interaction with normal preschoolers, schoolaged children and adolescents.” Further, IV.A.6k states, without specific mention of infants and young children, that “care for outpatients must include work with some child and adolescent patients from each developmental age group, continuously over time, and whenever possible, for one year’s duration or more” [18]. Likewise, the milestones do not mention the word infant and speak of preschool only one time related to acquiring a customized history (PC1-level 4) [19]. These omissions set a very low bar for accreditation for compliance in this key area of child psychiatry. Child psychiatry training is enhanced by incorporating more educational content on young children, ages 0–3, beyond the minimum, and largely absent, current requirements. This paper provides a * Joy D. Osofsky [email protected]