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In this discussion, after a few general comments, I will propose a systems reading of the intervention so elegantly described by Kaija Puura. I will draw parallels between the therapeutic and the family groups as framing-developing systems and formalize the steps taken by the family toward healing under the influence of the therapist's team.

The focus of this paper is on the development and evaluation of an intervention model for Florida's Infant and Young Child Mental Health Pilot Program, designed to identify families with children at risk for abuse and neglect, and to provide clinical evaluation and treatment services. The evaluation model, intervention strategies, and results presented in this paper are all part of the Florida pilot project developed as a response to the recommendations of the state's Strategic Plan for Infant Mental Health. Funded by the Florida legislature, the 3-year, multisite pilot was designed to provide earlier identification, better evaluation, and more effective treatment services for high-risk children under the age of three. The target population was children either at risk for out-of-home placement due to abuse and neglect, or those already in the child welfare system or adjudicated dependent by the state. The goals of the pilot project were: 1) to reduce the occurrence and re-occurrence of abuse and neglect; 2) to enhance the child's developmental functioning; 3) to improve the parent-child relationship; 4) to increase expeditious permanency placements; 5) to develop a model for intervention and treatment that could potentially be replicated in different sites; and 6) to document the components of a quality infant mental health intervention model and evaluate its effectiveness.

This article provides an overview of a training and consultation program aimed at enhancing the capacity of Early Head Start (EHS) and Migrant and Seasonal Head Start (MSHS) programs to address infant mental health issues from a promotion, prevention, and treatment perspective. This program was implemented by the Early Head Start National Resource Center (EHS NRC), operated by ZERO TO THREE. The EHS NRC is funded by the Head Start Bureau to provide a diverse array of training and technical assistance support services to Early Head Start programs throughout the country. In the fall of 2001, ZERO TO THREE was funded to design and implement the Pathways Initiative. While ZERO TO THREE was not funded to test the efficacy of the Pathways Initiative as a research intervention similar to other papers described in this special issue, we worked creatively to identify resources that allowed us to engage an external evaluator to look at both process and outcome measures. This paper describes the consultation program, evaluation activities, and key lessons learned.

Perinatal mental illness is a known risk to maternal-infant attachment and healthy infant development. Mothers experiencing complex mental health issues in the first year following birth are less likely to become involved in parenting programs or day stay interventions because of their mental health difficulties and perceived stigma. Currently, most perinatal day or group treatment programs only include the mother and not their infant. This paper describes "Together in Mind," a perinatal and infant mental health day program developed by the Queensland Centre for Perinatal and Infant Mental Health, targeting mothers with moderate to severe mental illness and their infants under 12 months. The service model was a 6-week, 1 day per week psychoeducation intervention. Psychoeducational material and support were provided across each day session by an adult perinatal mental health clinician, an infant mental health clinician, and a child health nurse working in collaboration. The program was trialed across seven Hospital and Health Service sites in Queensland, Australia, during 2016-18. In total, 24 group day programs were delivered with 84 mothers and their infants. Pre and post intervention quantitative measures and a post-program qualitative survey about participant satisfaction were collected. Statistically significant improvements in all quantitative measures showed a large to medium effect size on the: Health of the Nation Outcome Scale (HoNOS) (d = 0.82; p .000); Depression, Anxiety and Stress Scale (DASS-21) (d = 0.5; p .000); Karitane Parenting Confidence Scale (KPCS) (d = 0.63; p .000); Maternal Postnatal Attachment Scale (MPAS) (d = 0.49; p .000), Ages and Stages Questionnaire: Social-Emotional (6 months) (d = 0.83; p .000). The results indicate collaboration and early intervention contributes to strengthening the emerging development of the maternal-infant relationship within the context of complex maternal mental health issues.Con frecuencia se excluye a las madres perinatales con asuntos de salud mental severos y complejos de programas de apoyo a la crianza, lo cual presenta un riesgo para la relación materno-infantil y el desarrollo saludable del infante. El Centro de Queensland para la Salud Perinatal y la Salud Mental del Infante puso a prueba ‘Juntos en la Mente,’ un programa perinatal y de salud mental infantil de un día con énfasis en madres con salud mental entre moderada y severa e infantes de menos de 12 meses. La colaborativa intervención la llevaron a cabo 3 servicios públicos de salud mental y de salud infantil a lo largo de 7 lugares de Servicio de Hospital y Salud en Queensland, Australia, durante 2016-18. En el período de 2 años, se trabajó con 24 grupos de 6 semanas de duración y con 84 madres que completaron las medidas cuantitativas de pre- y post- intervención, así como encuestas posteriores al programa para reportar la experiencia de las participantes. Se dieron mejorías estadísticamente significativas en todas las medidas cuantitativas, lo cual muestra un efecto de tamaño entre grande y mediano: La Escala de Resultados de Salud de la Nación (HoNOS) (d = 0.82; p.001); Escala de Depresión, Ansiedad y Estrés (DASS-21) (d = 0.5; p.001); Escala Karitane de Confianza en la Crianza (KPCS) (d = 0.63; p.001); Escala de Afectividad Materna Postnatal (MPAS) (d = 0.49; p.001), Cuestionario de Edades y Estados: Socio-Emocional (6 meses) (d = 0.83; p.001). Los resultados sindican intervenciones tempranas colaborativas refuerzan el naciente desarrollo de la relación materno-infantil dentro del contexto de los complejos asuntos de salud maternos.Les mères périnatales avec des problèmes graves et complexes de santé mentale sont fréquemment exlues de programmes de soutien au parentage posant ainsi un risque à la relation maternelle-nourrisson et au développement sain de l'enfant. Le Centre de Queensland (en Australie) pour la Santé Mentale du Nourrisson a mis en place un programme ‘Together in Mind’, un programme de santé mentale périnatale et du nourrisson de jour ciblant les mères ayant des maladies mentales modérées à sévères avec des nourrissons de moins de 12 mois. L'intervention collaborative a été offerte par trois services publics de santé et de santé mentale de l'enfant au travers de 7 hôpitaux et sites de service de santé à Queensland en Australie entre 2016 et 2018. Durant cette période de deux ans 24 groupes de durée de 6 mois ont été formés avec 84 mères remplissant des mesures qualitatives pré-intervention et post-intervention et des questionnaires à la fin du programme, relatant l'expérience de la participante. Nous avons trouvé des améliorations statistiquement importantes dans toutes les mesures quantitatives, montrant une taille d'effet de grande à moyenne: Echelle de Résultat de Santé de la Nation (HoNOS) (d = 0,82; p,001); Echelle de Dépression, Anxiété et Stress (DASS-21) (d = 0,5; p,001); Echelle Karitane de Confiance de Parentage (KPCS) (d = 0,63; p,001); Echelle d'Attachement Maternel Postnatal (MPAS) (d = 0,49; p,001), le Questionnaire Âges et Étapes Socio-Émotionnel (6 mois) (d = 0,83; p,001). Les résultats indiquent que l'intervention précoce collaborative renforce le développement qui pointe de la relation maternelle-nourrisson dans le contexte de problèmes de santé mentale complexe.Evaluation einer kollaborativen Gruppenintervention für perinatal moderat bis schwer psychisch erkrankte Mütter mit ihren Säuglingen in Australien Mütter in der perinatalen Phase mit schweren und komplexen psychischen Problemen sind häufig von unterstützenden Elternprogrammen ausgeschlossen, was ein Risiko für die Mutter-Kind-Beziehung und die gesunde Entwicklung des Kindes darstellt. Das Queensland Center für perinatale und kleinkindliche psychische Gesundheit testete „Together in Mind“, ein Tagesprogramm für perinatale und kindliche psychische Gesundheit, das sich an moderat bis schwer psychisch erkrankte Mütter mit Säuglingen unter 12 Monaten richtet. Die kollaborative Intervention wurde im Zeitraum 2016-2018 von 3 öffentlichen Diensten für psychische und Kindergesundheit an 7 Standorten von Krankenhäusern und Gesundheitsdiensten in Queensland, Australien, durchgeführt. Innerhalb dieses Zweijahreszeitraums nahmen 24 Gruppen mit 84 Müttern über 6 Wochen an der Intervention teil. Vor und nach der Intervention wurden quantitative Maße erhoben und Umfragen durchgeführt, in denen die Erfahrungen der Teilnehmenden erfasst wurden. Bei allen quantitativen Maßen gab es statistisch signifikante Verbesserungen mit großen bis mittleren Effektstärken: Health of the Nation Outcome Scale (HoNOS) (d = 0,82; p0,001); Depressions-, Angst- und Stressskala (DASS-21) (d = 0,5; p0,001); Karitane Parenting Confidence Scale (KPCS) (d = 0,63; p0,001); Mütterliche postnatale Bindungsskala (MPAS) (d = 0,49; p0,001), Ages and Stages Questionnaire: sozial-emotional (6 Monate) (d = 0,83; p0,001). Die Ergebnisse zeigen, dass eine frühzeitige kollaborative Intervention im Kontext mütterlicher komplexer psychischer Erkrankungen die Entwicklung der Mutter-Kind-Beziehung stärken kann.オーストラリアにおける中程度から重度の周産期精神疾患を持つ母親及びその乳幼児に行った協働グループ介入の評価 重篤で複雑なメンタルヘルスの問題を抱える周産期の母親は、子育て支援プログラムからの対象から除外されることが多く、母子関係や乳幼児の健全な発達にリスクをもたらしている。Queensland周産期乳幼児精神保健センターが「Together in Mind」という、12か月未満の乳児のいる中程度から重度の精神疾患を持つ母親を対象とする周産期乳幼児精神保健デイプログラムを試みた。2016年から2018年にかけて、オーストラリア、クイーンズランド州の7つの病院と保健サービの拠点に、3つの公立の精神保健と児童精神サービスによる協働介入が提供された。2年間で、24のグループに対して6週間ずつ介入し、84人の母親に介入前と後の定量測定を実施し、プログラム後には参加者の経験が報告された。すべての定量測定に大から中等サイズの統計的に有意な効果が見られた。すなわち、国民健康成果尺度 (HoNOS) (d = 0.82; p.001) 、抑うつ・不安・ストレス尺度 (DASS-21) (d = 0.5; p.001) 、カリタン子育て信頼尺度 (KPCS) (d = 0.63; p.001) ; 母親の産後アタッチメント尺度 (MPAS) (d = 0.49; p.001) 、年齢と段階アンケートである社会的-感情的 (6か月) (d = 0.83; p.001) である。複雑な母親のメンタルヘルスの問題という観点からみると、新たな母親-乳幼児関係の発達が早期共同介入により高められる事を調査結果が示している。.患有严重和复杂心理健康问题的围产期母亲经常被排除在协助育儿项目之外, 这对母婴关系和婴儿健康成长构成了风险。昆士兰州围产期和婴儿心理健康中心试行了“共同铭记”计划, 这是一项针对携带12个月以下婴儿并患有中度至重度心理疾病的母亲的围产期和婴儿心理健康日计划。在2016-18年间, 澳大利亚昆士兰州的3家公共心理健康和儿童卫生服务机构对7家医院和卫生服务点实施了协作干预。在2年的时间里, 将84位母亲分24个小组进行了为期6周的干预活动, 完成了干预前和干预后的定量测量, 并完成了旨在报告参与者经历的项目后调查。从统计学上看, 所有量化指标都有显著改善, 呈现出大幅到中幅的影响效果:国民健康状况量表 (HoNOS) (d = 0.82; p.001); 抑郁、焦虑和压力量表 (DASS-21) (d = 0.5; p.001); Karitane育儿信心量表 (KPCS) (d = 0.63; p.001); 产妇产后依恋量表 (MPAS) (d = 0.49; p.001), 年龄与发育进程问卷:社交情感 (6个月) (d = 0.83; p.001)。研究结果表明, 在复杂的产妇心理健康问题背景下, 协作性的早期干预可以加强母婴关系的产生和发展。.تقييم تدخل جماعي تعاوني للأمهات المعرضات للمرض النفسي في الفترة المحيطة بالولادة وللرضع في أستراليا كثيراً ما يتم استبعاد الأمهات اللاتي يواجهن مشاكل حادة ومعقدة في الصحة النفسية في الفترة المحيطة بالولادو من برامج الرعاية الوالدية الداعمة التي تشكل خطراً على العلاقة بين الأم والرضيع وعلى نمو الرضيع النفسي. قام مركز كوينزلاند للصحة النفسية للرضع بتقييم برنامج “معاً في الذهن”، وهو برنامج يوم للصحة النفسية في الفترة المحيطة بالولادة والرضيع يستهدف الأمهات المصابات بمرض نفسي متوسط إلى شديد ولديهن رضع دون سن 12 شهراً. تم تقديم هذا التدخل التعاوني من خلال 3 مؤسسات عامة للصحة النفسية وصحة الطفل في 7 مواقع للمستشفيات والخدمات الصحية في كوينزلاند، استراليا، خلال الفترة 2016-2018. وفي فترة السنتين، تم تشكيل 24 مجموعة من 6 أسابيع والتي اشتملت على 84 أم أكملن القياسات الكمية القبلية والبعدية، واستبيانات بعد البرنامج التي تناولت تجربة المشاركين. أظهرت النتائج تحسنات ذات دلالة إحصائية في جميع المقاييس الكمية التي تبين حجم تأثير كبير إلى متوسط: مقياس نواتج الصحة العامة HoNOS (d = 0.82, p.001) ؛ مقياس الاكتئاب والقلق والتوتر 21-DASS (d = 0.5; p.001) ومقياس كاريتين لثقة الرعاية الوالدية KPCS (d = 0.63; p.001) ؛ ومقياس التعلق الأمومي ما بعد الولادة MPAS (; p.001d = 0.49) و استبيان الأعمار والمراحل: اجتماعي - عاطفي عند 6 شهور (d = 0.83; p.001) .وتشير النتائج إلى أن التدخل المبكر التعاوني يعزز النمو الناشئ للعلاقة بين الأمهات والرضع في سياق قضايا معقدة تتعلق بالصحة النفسية للأم.

The aim of this paper is to evaluate the case for preventive interventions in infancy aimed at the reduction of childhood psychopathology. The paper considers the terminology of prevention and the case for prevention in infancy. It is argued that increased knowledge concerning the developmental pathways involved in many psychological disorders opens the door to prevention initiatives. An overview of recent prevention trials is provided and the implications from treatment evaluation studies are explored. The case for prevention of conduct disorders is taken as an illustration of the potential for interventions in infancy. A developmental model of conduct disorder implicates a vicious cycle of parent- child inter- actions, a process that may arguably be preempted by early intervention. Three modalities are considered in detail: parent training; enhancement of attachment security; and (c) the facilitation of (a) early (b) the the development of reflective function. Studies in each of these areas are reviewed. The paper concludes that increased emphasis on the prevention aspect of infant mental health interventions is justified and desirable.

This paper describes a pregnancy and infant/parent program that was developed to provide comprehensive mental health services to families with children under 3 years of age. Because either the infant or parent can be the identified patient, we are able to treat families who define their problems in a variety of ways. The program has four basic premises: (1) the mental health of all family members should be addressed, (2) treatment of family members should be provided with minimum fragmentation of services, (3) the treatment plan must be individualized for each family, and (4) modes of therapy must be changed as the needs of the family change over time. This paper presents the rationale and techniques necessary for integrated services to families with children under 3 years of age. Two cases are presented: one with the infant as the identified patient, and one with the mother as the identified patient. Cet article decrit un programme grossesse et enfadparent developpe pour offrir des services complets en matiere de medecine mentale a des familles ayant des enfants de moins de trois ans. Puisque l'enfant ou le parent peuvent tout aussi bien ětre le patient identifie, nous avons pu traiter des familles qui definissent leurs problemes de facons tres variees. Le programme part de quatre hypotheses fondamen-tales: 1) il faut aborder la sante mentale de tous les membres de la famille, 2) on devrait traiter les mem-bres de la famille avec une fragmentation de services minimum, 3) le traitement doit ětre individualise pour chaque famille, et 4) les modes de theapie doivent ětre changes a mesure que les besoins de la famille evoluent avec le temps. Cet article presente le raisonnement et les techniques necessaires pour offrir des services integres a des familles ayant des enfants de moins de trois ans. Deux etudes de cas sont presentees: l'une avec un enfant en tant que patient identifie et l'autre avec une mere en tant que patiente identifiee.

Parenting very young children in the context of military service, deployment separations, and war-related trauma can be challenging for many families. Female active duty personnel represent one of the fastest growing segments of the military, and recent policy changes have led women to pursue serving in combat positions at much higher rates. While not much is known about service member mothers, some studies have shown that they experience significant symptoms of distress, depression, and anxiety during the deployment cycle, feelings of disconnection from family during reintegration, and higher rates of childhood trauma histories than their male counterparts. Service member mothers who experience the combined stressors of deployment separation, combat exposure, and adverse childhood experiences-a triple threat-may be at serious risk of posttraumatic stress and depressive symptomatology, which can negatively influence the quality and nature of their parenting and parent-child relationships. This case report describes the participation of a young single service member mother and her preschool-aged daughter in a home-based, reintegration program designed for military families with very young children (ages 0-5). The paper illustrates how this relationship-based, reflective parenting intervention was effective in increasing the mother's sense of competence in her parenting and strengthening the parent-child relationship.Criar a niños muy pequeños en el contexto del servicio militar, las separaciones debido a asignaciones militares de trabajo y el trauma relacionado con la guerra pueden representar un reto para muchas familias. Las mujeres, como miembros del personal activo con asignaciones militares, representan uno de los segmentos que aumentan más rápidamente dentro del campo militar, y los cambios recientes en las regulaciones han llevado a las mujeres a dedicarse al servicio en posiciones de combate en porcentajes mucho más altos. Aunque no mucho se sabe acerca de las madres que son miembros del servicio militar, algunos estudios han mostrado que ellas experimentan síntomas significativos de angustia, depresión y ansiedad durante el ciclo de asignación militar de trabajo, sentimientos de desconexión de la familia durante la reintegración, y más altos porcentajes de historias de trauma en la niñez que sus compañeros varones. Las mujeres en el servicio militar que experimentan la combinación de factores de estrés por la separación debido a la asignación de trabajo, el estar expuestas al combate, y las adversas experiencias de la niñez - una triple amenaza - pudieran encontrarse bajo un serio riesgo de estrés postraumático y sintomatología depresiva lo cual puede influir negativamente la calidad y naturaleza de la crianza y las relaciones progenitor-niño. Este reporte de caso describe la participación de una madre joven soltera miembro del servicio militar y su hija de edad prescolar dentro de un programa de reintegración con base en el hogar diseñado para familias militares con niños muy pequeños (edad 0-5). El ensayo ilustra cómo esta intervención de crianza con reflexión con base en la relación afectiva fue eficaz en lograr aumentar el sentido de competencia de la madre en cuanto a la crianza y fortalecer la relación progenitor-niño.Le parentage de très jeunes enfants dans le contexte du service militaire, des séparations de déploiement et du trauma lié à la guerre peut s'avérer difficile pour bien des familles. Les femmes des forces armées représentent l'une des segments à la croissance la plus rapide des forces armées américaines et des changements politiques récents aux Etats-Unis ont amené les femmes à s'intéresser aux positions de combat à des taux beaucoup plus élevés qu'auparavant. Bien qu'on sache peu de choses sur les mères dans les forces armées, certaines études ont montré qu'elles font l'expérience de symptômes importants de détresse, de dépression et d'anxiété durant leur cycle de déploiement ainsi que de sentiments de déconnexion de la famille durant leur réintégration, et font preuve d'une incidence d'histoire de trauma de l'enfance bien plus élevée que leurs contreparties hommes. Les mères dans les forces armées qui font l'expérience d'une combinaison de facteurs de stress comme la séparation du déploiement, l'exposition au combat, et des expériences adverses de l'enfance - une triple menace - peut être à risque sérieux de stress post traumatique et d'une symptomatologie dépressive qui peut influencer la qualité et la nature de leur parentage et des relations parent-enfant de manière négative. Cette étude de cas décrit la participation d'une mère des forces armées jeune et célibataire et sa fille d’âge préscolaire dans un programme de réintégration à domicile pour les familles de militaires avec de très jeunes enfants (âges 0-5). Cet article illustre la manière dont cette intervention réflective, basée sur le parentage, était efficace pour l'augmentation du sens de compétence et confiance en son parentage de la part de la mère ainsi que pour le renforcement de la relation parent-enfant.Die Erziehung von sehr jungen Kindern im Kontext von Militärdienst, einsatzbedingten Trennungen und Kriegstraumata stellt für viele Familien eine Herausforderung dar. Weibliches Personal im aktiven Dienst ist eines der am schnellsten wachsenden Segmente des Militärs. Jüngste politischen Veränderungen haben außerdem dazu geführt, dass Frauen vermehrt in Kampfpositionen eingesetzt werden. Noch ist wenig über Mütter im Militärdienst bekannt, aber einige Studien haben gezeigt, dass sie in höherem Maße als ihre männlichen Kollegen Symptome von Not, Depression und Angst während des Einsatzzyklus sowie fehlende Verbundenheitsgefühle zu ihren Familie während der Reintegration erleben. Außerdem zeigen sie eine höhere Rate an Traumatisierung im Kindesalter auf. Mütter im Militärdienst, die die kombinierten Stressoren von einsatzbedingter Trennung, Kampf-Exposition und negativen Kindheitserfahrungen - eine dreifache Bedrohung - erleben, könnten einem ernsthaften Risiko von posttraumatischem Stress und depressiven Symptomen ausgesetzt sein, was die Qualität und die Art ihrer Erziehung und Eltern-Kind-Beziehungen negativ beeinflussen könnte. Dieser Fallbericht beschreibt die Teilnahme einer jungen alleinstehenden Mutter im Militärdienst und ihrer Tochter im Vorschulalter an einem häuslichen Reintegrationsprogramm für Militärfamilien mit sehr jungen Kindern (0-5 Jahre). Der Artikel veranschaulicht, wie diese beziehungsbasierte, reflektierende Erziehungsintervention wirksam dazu beigetragen hat, das Kompetenzgefühl der Mutter in ihrer Erziehung zu erhöhen und die Eltern-Kind-Beziehung zu stärken.戦時派遣後の乳幼児の子育て:事例報告 兵役や、派遣による分離、戦争に関連したトラウマの文脈における乳幼児の子 育ては、多くの家族にとって非常に難しいものになりうる。女性の戦地要員は、 軍隊の最も速く成長している区分のひとつで、最近の方針転換で、はるかに高い 割合で女性が戦闘陣地での業務に従事することとなった。軍人母親についてはあ まりよく知られていない一方、いくつかの研究は、彼らが現地派遣中に苦悩、抑 うつ、不安の深刻な症状、社会復帰中に家族からの断絶の感情、そして男性の同 僚よりも高い割合での小児期のトラウマの歴史を体験していることを示している。 派遣による分離、戦闘曝露、子ども時代の逆境的体験−3つの脅威−を体験した 軍人母親は恐らく、彼らの子育て、親子関係の質や特徴に否定的な影響を与えう る、外傷後ストレスや抑うつ症状の深刻なリスク状態にあるのであろう。本事例 報告は、若いひとり親の軍人母親と彼女の幼児期の娘が、乳幼児(0歳から5歳)の いる軍人家族のためにデザインされた再統合プログラムに参加したことについて 述べている。本論文は、いかに、この関係性をベースとした、子育てを内省する 介入が母親の子育てに関する能力を高め、親子関係を強化するのに効果的である かを示している。.在服兵役、部署分离和有战争创伤的背景下养育非常年幼的儿童对许多家庭来说是一项挑战。女性现役人员是军队中增长最快的部分之一, 最近的政策变化导致女性在战斗岗位上服役的比例更高。虽然对军人母亲的了解不多, 但一些研究表明, 她们在部署周期中会出现明显的痛苦、抑郁和焦虑症状, 在重返社会时会感到与家庭脱节, 子女创伤史的发生率高于男性军人。经历过部署分离、战斗暴露和不良童年经历 (三重威胁) 等综合压力源的军人母亲, 可能面临严重的创伤后压力和抑郁症状的风险, 这可能会对养育、亲子关系的质量和性质产生负面影响。本病例报告描述了一位年轻的单身军人母亲和她的学龄前女儿参加的一项家庭为本的重返社会方案, 该方案是为有年幼儿童 (0-5岁) 的军人家庭设计的。本文阐述了这种基于关系的反思性养育干预对提高母亲的养育能力和加强亲子关系的有效性。.الرعاية الأمومية لصغار الآطفال في وقت نشر القوات أثناء الحرب: تقرير حالة تمثل الرعاية الوالدية للأطفال الصغار جدا في سياق الخدمة العسكرية ونشر القوات والصدمات المتعلقة بالحرب تحديا لكثير من الأسر. وتمثل الموظفات العاملات في الخدمة الفعلية واحده من أسرع القطاعات نموا في الجيش ، وقد أدت التغييرات الاخيره في السياسة العامة إلى استمرار النساء في الخدمة في مواقع قتاليه بمعدلات اعلي بكثير. وفي حين لا يعرف الكثير عن الأمهات الأعضاء في الخدمة ، فقد أظهرت بعض الدراسات انها تعاني من اعراض كثيرة من الكرب والاكتئاب والقلق خلال دوره نشر القوات ، والشعور بالانفصال عن الاسره اثناء إعاده الإدماج ، وارتفاع معدلات الصدمات الطفولية عن نظرائهم الذكور. الأمهات الأعضاء في الخدمة الذين يعانون من هذه الضغوط المجتمعة من حيث انفصال القوات ، والتعرض للقتال ، وتجارب الطفولة السلبية-مما يمثل تهديد ثلاثي-قد يكونوا في خطر شديد من الإجهاد ما بعد الصدمة وأعراض الاكتئاب التي يمكن ان تؤثر سلبيا علي نوعيه وطبيعة الابوه والامومه والعلاقات بين الوالدين والطفل. ويصف هذا التقرير مشاركه أحد عضوات الخدمة من الأمهات وابنتها في سن ما قبل المدرسة في برنامج لأعاده الإدماج في المنزل مصمم للأسر العسكرية التي لديها أطفال صغار جدا (الذين تتراوح أعمارهم بين 0-5). وتوضح الدراسة كيف ان هذا التدخل القائم علي العلاقة للرعاية الوالدية التأملية كان فعالا في زيادة إحساس الأم بالكفاءة في الرعاية الوالديه وتعزيز العلاقة بين الوالدين والطفل.

The experience of touch is critical for early communication and social interaction; infants who show aversion to touch may be at risk for atypical development and behavior problems. The current study aimed to clarify predictive associations between infant responses to tactile stimuli and toddler autism spectrum, internalizing, and externalizing behaviors. This study measured 9-month-old infants' (N = 561; 58% male) avoidance and negative affect during a novel tactile task in which parents painted infants' hands and feet and pressed them to paper to make a picture. Parent reports on the Pervasive Developmental Problems (PDP), Internalizing, and Externalizing scales of the Child Behavior Checklist were used to measure toddler behaviors at 18 months. Infant observed avoidance and negative affect were significantly correlated; however, avoidance predicted subsequent PDP scores only, independent of negative affect, which did not predict any toddler behaviors. Findings suggest that incorporating measures of responses to touch in the study of early social interaction may provide an important and discriminating construct for identifying children at greater risk for social impairments related to autism spectrum behaviors.

The young child's mental representations convey a wealth of information about his/her early moral and emotional construction of reality. The MacArthur Story Stem Battery (MSSB) is a unique, child-friendly tool for assessing socioemotional development in young children (3–6 years). The technique provides incomplete stories (stems), which are completed by the child using their own verbalizations and actions with doll figures. A sensitive examiner scaffolds appropriate boundaries for the task. The MSSB has demonstrated adequate psychometric properties and initial studies suggest the MSSB can tap important prosocial competencies as well as features indicative of psychopathology and distress. The MSSB has been translated and used in a number of countries across the world, in part due to the measure's clinical utility to quickly assess children at the level of representation. Current innovations reviewed emphasize the use of the MSSB for assessment in clinical and at-risk populations. A table summarizing key clinically relevant articles on the MSSB is referenced throughout the paper.

This paper describes a partnership between an infant mental health consultation program and child welfare authorities, with a special focus on the use of a consultation model to support infants and toddlers in foster care. The authors describe a model of practice that incorporates the transactional model with a developmental perspective to help foster parents understand and address the emotional needs of these children. The clinical implications section reviews strategies for addressing attachment and relationship disturbances, promoting self-regulation, and enhancing social competence in infants and young foster children.

In this paper we focus on the first wave of outcomes in a pilot phase randomized control trial of a home-based intervention for infants and their families, Minding the Baby® (MTB), an interdisciplinary, mentalization-based intervention in which home visiting services are provided by a team that includes a nurse practitioner and a clinical social worker. Families are recruited during mother's pregnancy and continue through the child's second birthday. Analyses revealed that intervention families were more likely to be on track with immunization schedules at 12 months, had lower rates of rapid subsequent childbearing, and were less likely to be referred to child protective services. In addition, mother-infant interactions were less likely to be disrupted at 4 months when mothers were teenagers, and all intervention infants were more likely to be securely attached, and less likely to be disorganized in relation to attachment at one year. Finally, mothers' capacity to reflect on their own and their child's experience improved over the course of the intervention in the most high-risk mothers.

The Early Head Start Research and Evaluation Project, a random-assignment evaluation, found a broad pattern of positive impacts for children and families. However, there were no program impacts on depression or use of mental health services by the time children reached age 3, at the end of the Early Head Start (EHS) program. This paper presents recent findings from the follow-up study in the spring prior to the children entering kindergarten, when a positive program impact emerged for reducing maternal depression. Results show that earlier program impacts on children and parents (when children were 2 and 3 years of age) mediated, or led to, the delayed impact on maternal depression. The combination of the most promising child factors accounted for over 57% of the later impact on depression, while the most promising parent factors accounted for over 35% of the later impact on depression. Implications for EHS programs are discussed.

The development of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3; Zero to Three: National Center for Clinical Infant Programs, 1994) has been an important step in the field of infant mental health. In this paper, we propose some additions to the existing classification system. These additions include the development of criteria for infant, toddler, and family strengths, and the development of criteria for symptomatology that represents risk for disorder, but not fully manifest disorder. These additions will give DC: 0-3R greater potential for use in the primary health care of children, thereby increasing the system's utility in diagnosing and preventing infant mental health problems.

This paper examines the effect a chronic medical illness can have on the attachment pattern of young children and discusses ways in which specific clinical interventions may assist families and the medical personnel in maintaining adequate attachment patterns in such children. Three cases of infants and toddlers showing signs of a severe attachment disorder are reported and their response to intervention presented.

Despite the frequent use of the term and although it is a key notion in evaluation, infant depres- sion remains poorly defined and assessed since the initial work of Rene Spitz. This paper reviews recent aspects of infant depression related to classification, issues in infancy, attachment disorders, relationship disorders, ma- ternal depression, failure to thrive and protein energy malnutrition. The actual scope of depression might include some aspects of protein energy malnutrition, a frequent and severe disease in tropical and developing countries, and some aspects of failure to thrive as observed in some multi-problem families in western countries. There might be a continuum between withdrawal reaction and infant depression. Withdrawal reaction is observed in various organic or psychopathological conditions, and could be used as an alarm symptom to screen infants in well-baby clinics. Infant depression is difficult to recognize, and delay in its recognition may have important de- velopmental consequences.

In this paper, neurological issues for the stimulant drug-exposed neonate are reviewed. The experiences in adult users are reviewed, and the applicability to neonatal studies is identified. Structural abnormalities are described, and the possible mechanisms of injury are reviewed. The biochemical systems altered by these drugs are described with the possible behavioral outcomes. Neurophysiological measures showing drug effect are described as evidence of acute intoxication on ischemia. This article lays out the possible neurological bases for the descriptions of altered behavior in early infancy and beyond after prenatal stimulant drug exposure. Les problemes neurologiques pour les nouveau-nes exposes aux stupefiants sont ici examines. Les experiences chez les utilisateurs adultes sont passees en revue et les applications possibles pour les etudes neonatales son identifiees. Les anormalites structurales sont decrites et les mecanismes envisageables de lesion sont examines. Les systemes biochimiques alteres par ces drogues sont examines avec les evntuelles consequences en matiere de comportement. Des mesures neurophysiologiques montrant l'effet de la drogue sont decrites comme preuve d'intoxication severe d'ischemie. Ce travail pose les base pour les descriptions de comportement altere ou la guerison durant la petite enfance apres une exposition prenatale aux stupefiants.

Cocaine and crack belong to a broad category of agents that act primarily as central nervous system stimulants at the level of the monoaminergic neurotransmitter system (dopamine, norepinephrine, and serotonin). These neurotransmitters are involved in the regulation of a number of basic psychological functions including attention and arousal and play a crucial role in the defining of brain structure and neuronal formation. This paper outlines what is currently known about the direct effects of cocaine on the mature and developing central nervous system. Three general points are reviewed: (1) Cocaine has differing effects on structural and functional brain development throughout gestation (e.g., there is not a single, all or none effect); (2) No one area of the brain is singularly affected. Areas related by the monoaminergic system are differentially influenced and affecting one area may result in a functional change in another; and (3) Because substantial brain growth, synaptic formation, and remodeling occur in the first months after birth, ongoing postnatal exposure to cocaine also carries risk for direct effects on brain function. Understanding the developmental neurobiological effects of cocaine provides data to guide studies in infants and young children of how prenatal cocaine exposure may contribute to specific, biologically based areas of neurological vulnerability that will be expressed behaviorally and developmentally in the first 3 to 5 years of life.

The aim of this work was to identify ways of objectifying the course of mothers' represen tations of their babies and themselves as mothers during pregnancy and the postpartum period. A sample of 51 women attending a Family Guidance Clinic for psychoprophylaxis courses was studied using semistruc tured interviews that were administered in the 7th month of pregnancy and on the 5th day and in the 4th month postpartum. This paper describes a method for classifiying themes identified in the mothers' representations of the baby and of the self-as-mother as wish-organized, defense-organized, fear-organized, or disorganized. This classification derives from the presumed clinical function of the narrative themes in the mothers' representational world. Themes about the baby and about the self-as-mother were primarily fear-organized at the 7th month of pregnancy. On the 5th day postpartum, there was no prevailing thematic organization. At 4 months postpartum, representations of the baby were primarily fear-organized and almost never disorganized. We speculate that themes about the baby and the self-as-mother that are disorganized may have negative prognostic significance.

Infant sleep problems have become prevalent as complaints of parents to clinicians during the first 2 years of the child's life. This paper reviews (1) identification of multiple etiological sources for infant sleep problems from a systems perspective, (2) the assessment of sleep disturbances, and (3) the applica- tion of intervention methods to the appropriate component of system dysfunction. These areas are reviewed by integrating research findings with clinical vignettes from our practice as pediatric sleep clinicians. RgSUME: Les probltmes du sommeil infantile sont parmi des problemes repandus dont les parents font part aux cliniciens durant les deux premieres annees de la vie de l'enfant. Cet article passe en revue (1) I'identification de multiples sources etiologiques pour les problemes du sommeil infantile dans une perspective de systeme; (2) l'evaluation des troubles du sommeil; et (3) l'application de mtthodes d'intervention au composant approprie de disfonction du systeme. Ces domaines sont passes en revue en intkgrant des resultats de recherches avec des vignettes cliniques de notre cabinet de cliniciens pediatres spkcialises dans les troubles du sommeil.

Developmental psychopathology focuses on developmental aspects of pathology as well as individual patterns of adaptation and maladaptation. Adaptation involves the resolution of earlier issues, with successful resolution facilitating adaptation and earlier developmental failures increasing the likelihood of future problems. The study of developmental psychology provides knowledge about normal processes in order to better understand psychopathology as well as groups at high risk for having problems over time. The project described in this paper focuses on applied psychoanalysis using psychoanalytic knowledge and theory in the context of an intervention project involving observational research. A case description of an adolescent mother and her child will be presented to illustrate issues about problematic development in a child first observed as part of the research project and later referred to a therapeutic nursery. The case will be discussed in relation to two questions: (1) Is it possible to define and evaluate manifestations of disturbance early in life that result in definable psychopathology at school age? (2) To what extent can the self-righting capacity of the child or environmental intervention compensate in correcting the developmental process?

This paper deals with the influence of maternal representations during pregnancy on the subsequent mother-infant relationship and the infant's style of attachment at 1 year of age. Psychoanalytic thinking, beginning with Freud to the most recent contributions, has considered the great importance of the mental dynamics between parents and children to which empirical research according to Bowlby's theoretical perspective has contributed. The current research project was planned in order to study the intergenerational processes. Starting during pregnancy, the woman was interviewed specifically to study maternal representations of herself as a mother and of the future baby. When the child was 1 year old, the style of attachment was studied during the Ainsworth Strange Situation paradigm and, at the same time, the mother was given the Adult Attachment Interview. Case studies are presented to illustrate, from the clinical point of view, the mental dynamics during pregnancy and the influence on the style of attachment of the baby. The clinical implications are discussed especially in terms of the fantasies in pregnancy and their relevance for the subsequent mother-infant relationship.

Infantile colic is at the same time exasperating and also fascinating and gratifying. This is the point of view of a pediatric practitioner and researcher with over three decades of practical experience. Colic is exasperating because of the unpleasantness of the extensive crying and because of the inadequacies of much of the existing research and writing on the subject. It is fascinating for the researcher and observing clinician because it probably represents the earliest known example of a behavior problem resulting from a stressful parent-child interaction. It is gratifying because of the opportunity for successful clinical intervention to help distressed families. This paper summarizes the evidence supporting these points and suggests ways to solve some of the remaining problems. No new data are introduced; rather, this is an attempt to put what is already known into a more useful perspective.

Our understanding of the etiology, pathophysiology, sequelae, incidence, and management of colic is hampered by the absence of a standard definition and accepted clinical criteria for colic. In this paper we distinguish colic from excessive crying and offer a set of criteria that can be used in clinical practice to determine if an infant has colic or excessive crying. We also discuss differences between colic and excessive crying from a developmental perspective, including biological and transactional components. We conclude that many components have long-term consequences for the parent-infant relationship, and we briefly consider some directions for colic management.

“Colic” is an ill-defined but common complaint typically thought to be a sign of an underlying disease process or a clinical entity distinct from the crying that characterizes normal infants. In this paper, an alternative hypothesis is suggested. The general argument is that colic represents the upper end of the spectrum of the crying activity of normal infants. However, it is not the case that all aspects of crying will be increased; rather, that the “excessive” crying in colic is due specifically to prolonged bouts of otherwise normal crying. The results of three studies in normal infants are presented to support this argument. Together, the results support the concept that the crying typical of normal infants reflects a biological predisposition to cry, which is nevertheless affected by sufficiently large changes in the caretaking environment, and that these caretaking changes preferentially affect bout length. If so, then the key to “colic” may be in understanding how biology and behavior interact to produce, not just crying, but prolonged crying bouts.

This paper discusses the Ford Foundation's Child Survival/Fair Start Initiative, under which Ford has sponsored community-based strategies to improve pregnancy outcomes and infant health and development, through parent support, education, and service brokerage. We present an overview of the general Child Survival/Fair Start strategy and then examine in detail emerging lessons in two areas: The influence of specific patterns of family support needs on local program priorities and emphases and the nurturance and work of the lay home visitors.

This paper deals with the mental health aspects of infant day care emphasizing that mental health input into the design, implementation and ongoing supervision/evaluation of the majority of day care programs is minimal at the present time. The author proposes the following three criteria by which the adequacy of mental health input in a day care program could be judged: 1) ongoing mental health consultation to the caregiver staff on a weekly basis and by the same clinician(s), 2) assignment of primary caregivers to the infants, 3) periodic naturalistic observations of the infants to be recorded and discussed by the caregivers. The author postulates that consultation to the caregiver staff of infant day care programs represents the opportunity to establish a new frontier of prevention. Therefore, the mental health profession should consider it a goal that every infant day care setting would have a mental health clinician as a consultant. The methods, preventive functions and manpower aspects of such consultation work is discussed.

This paper describes programs developed in response to the dramatic rise in adolescent pregnancies and births during the past 15 years. In the main, these programs are targeted to reduce pregnancies among the teen population, as well as to teach teen mothers positive parenting and health care practices. The emphasis on parenting skills arose due to the fact that low-birth-weight and premature children tend to occur in large numbers in teen populations and that these children are at risk for child abuse and neglect. Primary prevention programs are designed, e.g., within school clinics that dispense contraceptives, and are among the most successful of the newer movements in the field. Greater attention currently is given to the teen father. An ideal program is presented and recommended for widespread adoption because the United States continues to experience large numbers of adolescent pregnancies.

Representation-oriented brief psychotherapy with mother-infant dyads is used to examine correspondences between maternal behaviors and maternal representations of her infant. A single case study is presented to illustrate how one can objectify interactional variables that may correspond behaviorally to underlying maternal mental representations. This paper presents the results of a collaboration that focuses on the process of enacting fantasy via the domain of behavior. Attention is drawn to interacted themes that are enacted versions of representational themes. Enacted themes are pathogenic in behavioral terms for the infant. Five themes are identified in the case material. Changes in the mother's representations affect both the mother-infant relationship and the infant's functioning.

Rapid changes in family life have created enormous challenges and pressures on developing families - divorce, two working parents, disappearance of the extended family, unclear cultural values for our children's future, poorly defined support systems for stressed families, inadequate substitute care when both parents work-all contribute to an anxious atmosphere for young families. Parents who must return to work „too early” (and we have no established standards yet for what this means to either child or adult development) seem to grieve about the loss of the relationship with the developing child. They may even set up defenses against making a strong and painful attachment. They may not become involved in the child's development in a way that will foster their own development as nurturing adults. The grieving and the necessary defenses against it are predictable and must be mitigated in order to foster nurturing adults within the family. Children must be provided with caring, intensely involved adults in order to assure their optimal future development. We must provide them and their parents with adequate substitute care. This paper suggests adjustments at the industrial level that must be made to foster parental involvement and to assure positive outcomes for future generations.