Delivering effective psychological therapies and interventions for infant mental health
Infant Mental Health (IMH) underpins the social and emotional wellbeing and development of children in the earliest years of life. Promoting positive early relationships is central to good IMH. Early interactions and relationships are important for healthy brain development and lay the foundation for lifelong mental and physical health and wellbeing. Persistent problems in early relationships and emotional development for babies and young children can significantly impact a range of later outcomes associated with long term costs to individuals, families, communities and society.
This Good Practice Guidance for Practitioners and Services, outlines the core principles that underpin the effective delivery of IMH support, interventions and services. Key to these principles is Getting it right for every child (GIRFEC). GIRFEC is the National Practice Model in Scotland which provides a common framework and language for all those working with infants, children and families. Its principles reflect the United Nations Convention on the Rights of the Child and lift up the importance of being child-focused, understanding the wellbeing of a child in their current situation, tackling needs early and joined-up working. Good practice at all levels of support and intervention should be embedded within GIRFEC principles and values and take a rights-based approach. See the Voice of the Infant: best practice guidelines and infant pledge - gov.scot (www.gov.scot) for guidance on how to take account of infants’ views and rights in all encounters they may have in statutory or third sector services or in public spaces. The term ‘voice of the infant’ is used to convey that babies have their own minds and have things to communicate from birth.
Infant mental health describes babies and young children’s capacity to experience, regulate and express emotions, form close and secure relationships, and explore and learn about their environment. Positive IMH is created and supported primarily through the development of sensitive, warm, and responsive early relationships between the child and key caregivers. There is no such thing as a perfect relationship. There are many kinds of early relationship experience, influenced by culture and values, which may look very different, but can all be ‘good enough’ to support positive IMH.
Evidence-based interventions are supported by rigorous testing and the latest and best available research evidence. Delivery of evidence based IMH interventions provides young children and families in need of additional support with care that has been demonstrated to improve outcomes.
The baby’s brain is developing rapidly during pregnancy, and changing in response to maternal circumstances, experiences, and behaviours. Nurturing relationships begin before birth, and there are a range of protective and risk factors that can impact how a parent feels about their unborn baby and starts to bond with them. Early identification is critically important in IMH, and during pregnancy it is possible to recognise and support parents who may struggle in developing their relationship with the baby. Pregnancy is a window of opportunity for change for parents and babies as parents wish to give their baby a good start in life.
Many things can get in the way for a parent and baby trying to build a healthy and secure relationship. This can include parent factors such as a parent’s own experience of being parented or their own mental health difficulties, trauma, substance misuse, environmental factors, separations, as well as differences or difficulties affecting a baby’s development and functioning.
IMH needs can present in a range of ways across areas of development and functioning. There can be ‘noisy’ indicators e.g., sleeping difficulties, and ‘quiet’ indicators e.g., compulsive, or compliant patterns of behaviour in interaction with parent. Babies and young children can learn to outwardly communicate something different to how they feel inside. Read how this can present in a case vignette based on the work of the GIFT team in Glasgow GIFT case vignette.
Struggles in relationships between parents and their young children are universal. Difficulties that cause concern about IMH may be experienced differently by different people. Parents and practitioners have distinct perspectives and may therefore worry to varying degrees about the infant and the parent infant relationship. Worries expressed by a parent should be taken seriously. Sometimes the parent or caregiver does not express concern themself, however, infant focused observation and assessment identifies risks to IMH and wellbeing. Babies whose emotional wellbeing is in crisis can sometimes be overlooked. Practitioners in contact with babies and young children should be able to recognise indicators of concern and know how to respond. It is important to take an infant centred approach to develop an understanding of the baby’s lived experience. This case vignette highlights the experience of postnatal depression through the eyes of the infant PMHT case vignette.doc.
Experience of perinatal mental health, trauma or addiction difficulties is closely connected to IMH and where there are these difficulties it is always important to consider what this means for the baby and the parent infant relationship. However, IMH and perinatal mental health are different. Problems in the parent infant relationship can exist due to a range of factors and can develop where there are no concerns about perinatal mental health. Similarly, positive IMH can exist in the context of perinatal mental health difficulties.
There are a range of conditions that can make it harder for parents to protect, support and promote their relationship with their young child such as domestic abuse, poor housing, or living in poverty. The impact of adversities on a young child’s wellbeing and development will vary depending on the strength and security of their relationship with a parent.
It is important to be aware of local context and the services that are available across all types of practice who support parents and caregivers to promote positive relationships with their babies and young children. Read about the powerful impact services in the community can have in supporting parent infant relationships and family wellbeing Home-Start case vignette.docx.
Parents and caregivers will have different preferences for how they access additional support, based on their circumstances, needs or previous experience. It is important that consideration is given to individual choice in terms of the way the intervention is delivered e.g., online or face to face, group or one to one. Providing a sense of choice and control, empowerment, collaboration, trust, and safety are important ways in which practitioners can offer trauma informed care. More information on training and education resources to support trauma informed practice can be found here.
Related policies:
The Best Start: A five year forward plan for maternity and neonatal care in Scotland
The vision for maternity and neonatal services across Scotland is one where all mothers and babies are offered truly family centred and compassionate care, recognising their own unique circumstances and preferences. Care is individualised with strong multi-professional links, ensuring a strength based, trauma informed, safe, compassionate service for all. Continuity of midwifery carer throughout the routine maternity journey and keeping mothers and babies together, reduces anxiety, helps to build effective relationships and supports a strong foundation for optimal parenting including a focus on bonding and attachment, parenting skills and resilience.
The Universal Health Visiting Pathway presents a core home visiting programme to be offered to all families by Health Visitors in Scotland as a minimum. It is founded on the following principles:
- Promoting, supporting, and safeguarding the wellbeing of children
- Person-centeredness
- Building strong relationships from pregnancy
- Offering support during the early weeks and planning future contacts with families
- Focusing on family strengths, while assessing and respectfully responding to their needs