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IntroductionAimsMethodResultsConclusionThe quality of the early child–caregiver relationship plays a crucial role in shaping a child’s development. In response to the lack of early intervention provisions for 2–5 year olds, the Leeds Infant Mental Health Service increased their offer to support children up to their fifth birthday (and their caregivers), where relational difficulties impact upon the child’s emotional wellbeing.This paper aims to evaluate the effectiveness of the direct therapeutic work (named ‘Understanding Your Toddler’; UYT), in promoting the child–caregiver relationship.Nineteen families were accepted for UYT, where there was motivation and emotional availability to consider change within the relationship. Thirteen families engaged in the work. The UYT offer adopted a three session, home-visiting model, drawing upon several therapeutic approaches. A two-phased mixed methods design was adopted. Phase I analysed quantitative changes within the relationship. Phase II qualitatively evaluated families and professionals’ experiences of UYT.Paired t-tests and Wilcoxon signed rank analyses illustrated significant differences pre and post UYT in caregiver: goals, confidence, perceptions and feelings of irritation. No significant differences were found in caregiver feelings of warmth. Themes from interviews suggested that the strengths-based approach was valued, and that video work supported caregivers to ‘see the world from their (toddlers’) point of view’.This evaluation contributes to the limited evidence evaluating the efficacy of child–caregiver interventions in practice. Despite the small sample, the UYT model provides a helpful framework (applicable to clinical contexts) to foster early relationships and emotional development of young children. [ABSTRACT FROM AUTHOR]

Aims/BackgroundDesign/MethodsResultsConclusionWe aimed to adapt, pilot and explore experiences of receiving and delivering the video feedback intervention for positive parenting (VIPP) for 2 to 6 month old babies, mothers experiencing moderate to severe perinatal mental health difficulties and perinatal mental health clinicians.The VIPP intervention was adapted to include developmentally appropriate activities and developmental psychoeducation for 2 to 6 month olds, alongside psychoeducation on emotion regulation, and then piloted in 14 mothers experiencing moderate to severe perinatal mental health difficulties (registration ISRCTN64237883). Observational and self-reported pre-post outcome data on parenting and parent-infant mental health was collected, and post-intervention qualitative interviews were conducted with participating mothers and clinicians.Consent (67%), intervention completion (79%) and follow-up rates (93%) were high. Effect sizes on pre-post outcome measures indicated large improvements in parenting confidence and perceptions of the parent-infant relationship, and a medium-size improvement in maternal sensitivity. In qualitative interviews, clinicians and mothers described how mothers’ initial anxieties about being filmed were allayed through receiving positive and strengths-focussed feedback, boosting their self-confidence, and that the video feedback facilitated identification of young babies’ subtle behavioural cues and moments of mother-infant connection. Streamlining the information provided on maternal emotion regulation, and allowing increased use of clinical judgement to tailor intervention delivery, were suggested to optimise intervention feasibility and acceptability.It is feasible and acceptable to implement VIPP with very young babies and their mothers experiencing perinatal mental health difficulties. A fully powered randomised controlled trial is required to establish intervention efficacy. [ABSTRACT FROM AUTHOR]

Prior to the COVID-19 pandemic, parent–infant psychotherapy (PIP) was routinely offered face-to-face to mothers and babies attending a UK community perinatal mental health service. The pandemic necessitated the rapid transfer of PIP to a virtual platform to continue delivery at time of increased vulnerability for mothers and babies. This service evaluation sought to evaluate this novel method of delivery, of which, the processes and outcomes were unknown. The findings demonstrated that virtual PIP (vPIP) is impactful and accessible for mothers and their babies, with statistically significant improvements found in maternal mental health and postpartum bonding. Furthermore, interpretative phenomenological analysis (IPA) of interviews exploring the experience and meaning for mothers and babies engaging in vPIP, illuminated the complex therapeutic processes underlying the positive clinical outcomes. In conclusion, this small-scale service evaluation demonstrated that, despite the frustrations and anxieties of working online, mothers in our sample found the overall experience of vPIP to be positive, and to result in real-world differences for them and their babies. [ABSTRACT FROM AUTHOR]

Infant mental health is a new field in southern Africa. Some of its premises do not mesh neatly with local social forms and cultural precepts. Infant observation is a key element in the training of students in the only M. Phil programme on infant mental health in Africa. During training, students raised concerns about the model. Seminar discussions generated rich data about their efforts to secure an observational stance true to both the observational model and local relational practices. An anthropologist attended the seminars at which students reported on their weekly infant observations. Discussions were recorded and key themes identified. The anthropologist's 'second-order witnessing' enabled careful reflection on the experience of learning to be an observer and observed. The article considers the process of finding an observational stance both epistemologically and practically in the socio-centric worlds of southern Africa, and reflects on the experiences of being observed from the points of view of the caregivers and infants. It demonstrates that despite the model's presumption of distance, observers become significant persons in the life of the family. Through close attention to how received models settle in practice, we can derive important questions about epistemological conflicts and productive intersections. [ABSTRACT FROM AUTHOR]

As part of work to develop Infant Mental Health services and systems in Scotland, the authors embarked on a project to facilitate the voices of babies and young children in our work, in the appraisal and evaluation of that work and in the design and development of our services. Our Best Practice Guidelines provide guidance on how to take account of infants' views and rights in all encounters they may have with professionals in statutory or third sector services, or in public spaces, such as shops, libraries or galleries. The Infant Pledge details what babies and young children should expect from adults. In this paper, we will describe theoretical considerations underpinning this initiative and also place the work in the context of relevant policies and legislation, including the UNCRC. [ABSTRACT FROM AUTHOR]

Infants' experience of the early caregiving environment is fundamental to the development of positive social and emotional functioning. The Leeds Infant Mental Health Service was established to provide early intervention to infantsunder two and their caregivers, where there are concerns about the attachment relationship. This paper describes preliminary data to evaluate its effectiveness. Improved parent-infant relationships and parental well-beingare achieved by asmall multidisciplinary workforce through direct therapeutic work with infants and their caregivers and by up-skilling other professionals who are in contact with infants, through specialist training and consultation. Launched in 2012, the service has trained over 2500 professionals.Over 500 reflective case discussions and 200 case consultations have been delivered to practitioners, many of whom work with vulnerable infants. Ascreening tool has been developed to enable health visitors to identify infants at risk of developing poor attachment relationships with their caregivers. Direct therapeutic work has been completed with over 531 families, the majority (71%) before the infant was 6 months old. Caregivers and professionals are positive about the service. The model represents a clinically and cost-effective way to deliver city-wide infant mental health provision. Future research is needed on effectivess, particularly long-term outcomes. [ABSTRACT FROM AUTHOR]

This study examined changes in parental reflective functioning (PRF) among mothers enrolled in Infant Mental Health-Home Visiting (IMH-HV) and explored whether parental risk, treatment dosage or therapist experience predicted change in PRF. Participants included 75 mothers and their children who were enrolled in IMH-HV delivered by Community Mental Health therapists. Results indicated significant improvements in PRF from baseline to 12-months. Maternal demographic and psychosocial risk, therapist experience and treatment dosage were not directly associated with changes in PRF. However, Mothers who received more treatment sessions from therapists with six or more years of experience demonstrated the greatest improvements in PRF, while mothers who received more treatment sessions from therapists who had been practicing IMH for less than 15 months showed a decline in PRF. Therapists working with very high-risk families may need specific training and ongoing reflective supervision over a period of years to promote improvement in PRF. [ABSTRACT FROM AUTHOR]

This article reviews the evolution of a newborn through the first year of life and the potential impacts of COVID-19 on the infant, parent, and the parent-infant relationship. Babies grow in the context of relationships, and the quality of those relationships affects the physiological and psychological organization of the baby. Precisely because each baby is a being with unique biology, temperament, and ways of experiencing, feeling, and learning, much is to be discovered and understood about them. The baby's wordless communications require their parents to intuit, infer, hypothesize, and experiment as parents come to know the needs of their baby. As we walk alongside parents who struggle to come to know their infant – even as the infant is coming to know them – we are required to have conceptual knowledge of how a newborn becomes a fully awakened infant. Under typical conditions, the birth of a firstborn baby presents a caregiving challenge and developmental opportunity for the emerging parent. Environmental context can serve to support or interfere in the success of the adjustment. This paper will explore some theoretical underpinnings that contribute to infant and parent well-being and the possible impact of being born during the COVID-19 pandemic. Also considered will be the undue burden of families bearing the weight of economic inequities, oppression, and structurally supported racism. This article will explore the influence of parental perception, the development of attachment relationships, and how that is influenced by and influences infant communication. Finally, it will suggest ways that psychotherapists seeing individuals who are parents can hold the infant in mind as they work to understand and respond to their adult clients navigating the impacts of this pandemic. [ABSTRACT FROM AUTHOR]

Infant mental health (IMH) as an interdisciplinary field relies on relationships to heal past trauma and promote secure parent-infant attachment. Stress related to performing IMH work has gained more attention in workforce development/well-being literature. Yet, IMH workforce engagement in self-care practices to manage work stress is left unexplored. This qualitative investigation examines a purposive sample (N = 21) of clinical IMH practitioners in two U.S. states to answer the following research questions: a) What self-care practices do clinical IMH practitioners perform? b) Do clinical IMH practitioners rely on reflective supervision as a professional self-care practice? Data include: a) open-ended interviews with clinical IMH practitioners and b) an inventory measuring burnout. Results indicate that on average, the sample reported moderate to high levels of burnout. Yet the majority of the sample engaged in personal and professional self-care practices to manage work-related stress. Saturation of themes: a) heavy reliance on individual coping, b) reflective supervision is insufficient on its own, c) organizational supports may facilitate engagement in self-care and d) competing care demands impede self-care; suggests that individual engagement in self-care outside of work, may not sufficiently manage work-related stress in this group of social service professionals. Highlighted themes offer an ecological framework for considering the interplay between individuals and organizations in promoting IMH workforce well-being. Recommendations for systematic investigation of the role individuals and organizations play in promoting self-care practice and well-being in the broader IMH workforce, employing quantitative methods of inquiry are discussed. [ABSTRACT FROM AUTHOR]

The lack of robust evaluation of training outcomes has been noted within the delivery of Health & Social Care across the UK. The impact on adult mental health of poor emotional care during infancy and early childhood has also been highlighted by the relatively recent advancements in neuroscience. This study used pre- and post-testing to assess practice across three key domains. The gains observed in staff knowledge and confidence post-training are directly attributable to the training: p <.001 (Knowledge Scores) and p =.001 (Self-Efficacy Scores). Key findings also indicate that Infant Mental Health (IMH) training has potential to encourage staff in Adult Services to take more ownership of a family focused agenda and that current service provision struggles to meet the needs of high-risk infants. With a clear focus on robust methodology, this study measures IMH training outcomes on a multi-professional basis across Adult Mental Health and Children's Services within one Health & Social Care Trust (NI). The findings also add to our understanding of the interface between social work and other services who seek to support families with complex needs. [ABSTRACT FROM AUTHOR]

Selma Fraiberg, a social worker and psychoanalyst, is best known for her classic volume, The Magic Years, and her pioneering work in infant mental health. In this article, her multi-faceted professional career will be explored. Beginning with her thoughts about social work and psychoanalysis as an undergraduate, I discuss her professional education and the influence of three refugee analysts from Vienna before outlining her diverse contributions to group work with children and adolescents, agency-based psychotherapy with children, and clinical research on the development of blind children. Finally, I discuss the evolution of her theoretical perspectives and the impact of her legacy nearly 40 years after her death. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine associations between maternal mentalization, interactive behavior, and child symptoms in families in which mothers suffer from interpersonal violence-related posttraumatic stress disorder (IPV-PTSD). Fifty-six mothers and children (aged 12–42 months) including mothers with a diagnosis of IPV-PTSD were studied. Mentalization was measured by the Parental Reflective Functioning (PRF) Scale. Interactive behavior during free-play was measured via the CARE-Index. Child symptoms were measured by the Infant-Toddler Social and Emotional Assessment (ITSEA). Data analyses included non-parametric correlations and multiple linear regression. Results showed that lower IPV-PTSD and higher Maternal Reflective Functioning (MRF) were related to greater maternal sensitivity. Lower MRF and greater controlling behavior were related to child dysregulation. MRF was found to be lower in the subgroup of IPV-PTSD when the child's father was the perpetrator of IPV. Both MRF and interactive behavior are thus likely to be important targets for intervention during sensitive periods of early social–emotional development. [ABSTRACT FROM AUTHOR]

Clinical infant mental health interventions with brain-injured mothers and fathers and their infants is scarcely described in the literature. Further elaboration of this work is required and this paper seeks to add to that literature. This is a single case report describing home-visiting clinical work with a mother with an acquired brain injury focussing on her relationship with her infant over more than 2 years. A range of interventions including family support, developmental guidance, video-replay and holding a reflective stance were delivered throughout the 2-year period. The mother reported that her relationship with her son improved though sometimes strong feelings of ambivalence towards her son remained. Participation in psychological therapy resulted in the mother experiencing significant emotional fatigue. Clinicians should be aware of this possible emotional toll on the person with a brain injury. The relative contributions of the parent's social and emotional experience prior to the acquired brain injury, the effects on the functioning of that injury and the interplay between these factors should be considered. Interventions should be informed by each family's individual needs, begin early in life and a mix of behavioural and psychological interventions may be desirable. The experience of a very young child must also be held in mind. [ABSTRACT FROM AUTHOR]

Background: An infant's development is closely linked to the relationship they have with their parents. Parenting stress, affective disorder, and an upbringing with substance-abusing parents can affect parenting quality and increase the risk of children developing behavioral, mental and social problems. The overall aim of the study was to investigate how parents of children attending an outpatient Infant Mental Health (IMH) unit rate their own psychological health and parenting stress, and to explore predictors of parenting stress. Methods: The sample comprised 197 parents, 129 mothers and 68 fathers, referred with their infant/toddler to an outpatient IMH unit for interplay treatment. On admission, the parents completed self-report questionnaires concerning their own mental health problems and parenting stress. Results: The mothers reported significantly more psychiatric symptoms and parenting stress than the fathers. Fathers with substance-abusing parents had often experienced divorce in the family of origin, had a low level of education, and had often experienced trauma. Depression was a predictor for parenting stress for both mothers and fathers. Conclusion: The parents' situation was strained, presenting a variety of psychiatric symptoms and high levels of parenting stress, making assessment of parental health before starting treatment important. The mothers' situations were more serious compared with the fathers', and for both parents depression was a significant predictor for parenting stress. To increase the chances of a positive treatment outcome for the child, both parents should be included in the treatment. [ABSTRACT FROM AUTHOR]

This paper follows the journey of a young black woman as she enters motherhood during treatment in psychoanalytic parent-infant psychotherapy with a black female therapist. The impact of the mother's early trauma on the developing parent-infant relationship is explored through the theme of being seen. Transference and countertransference phenomena are examined. There is a particular focus on the mother's race, sexuality and gender and their impact on her growing son. Winnicott's attention to the use of black in the consulting room is drawn upon, to open up a discussion about some of the clinical implications regarding sameness in therapist and patient, both being black and female. Finally, the practice of video-recording sessions and what this elicits in the countertransference is also explored, providing another perspective to the theme of being seen. [ABSTRACT FROM AUTHOR]

Reflective supervision has been promoted as essential to the practice of infant and early childhood mental health. The authors employed a qualitative program evaluation of a four-month reflective supervision training, using focus groups with 34 supervisors from 26 publicly funded infant and early childhood mental health programs. Participants reported the training to be effective and impactful, particularly experiential components. Barriers to implementation included lack of buy-in from administrators, isolation when others in the agency were not familiar with the model, and job demands. Recommendations include adding a collective participation approach to training within agencies to support dissemination and sustainability. [ABSTRACT FROM AUTHOR]

Cultural sensitivity is fundamental to relationship-based interventions where professionals meet with children and families in their homes, neighborhoods, and communities. Understanding how we are different from others and how to engage in meaningful relationships despite those differences is important at all levels of human interaction. Professionals who provide relationship-based intervention benefit from supervision aimed at enhancing their capacity for reflection. Reflective supervision has become a powerful training technique to support the professional's capacity to think deeply about their work with vulnerable infants and families. This article will consider the impact of diversity upon the developing relationship between the reflective supervisor and supervisee. Through use of a supervisory vignette, this article will consider how cultural differences can pose a barrier to the full incorporation of the reflective experience within infant mental health work and professional growth. The authors posit that reflective supervision can support cultural sensitivity, relationship building, professional growth, and positive infant and family outcomes. [ABSTRACT FROM AUTHOR]

Maternal and child mental health disparities exist in the United States among people of color and people with low socioeconomic status. Adverse maternal and child mental health has short- and long-term consequences for both mothers and children. The persistent and intergenerational nature of maternal and child mental health disparities reflect an important social justice issue to which social workers must respond. The infant mental health framework can guide social workers in understanding and addressing these disparities. This framework provides a useful lens through which practitioners can understand and support the context and development of caregiver-infant dyads. This manuscript reviews maternal and child mental health disparities, provides an overview of the infant mental health framework, and describes implications for the social work practice. With roots in the social work profession and emphasis on human development within social context, the infant mental health provides insight to social work practitioners, scholars, and educators. [ABSTRACT FROM AUTHOR]

The practice of infant mental health (IMH) has evolved from a combination of theoretical frameworks focused upon early relationships and the complex interplay between individuals and their internal and external worlds. The main components of IMH practice: developmental guidance; emotional support; parent–infant psychotherapy; concrete support; and advocacy, demonstrate a connection between psychoanalytic theoretical frameworks and social work values and forms the basis of practice for IMH therapeutic programmes. This paper will trace the theoretical roots of IMH practice and utilise a clinical case example to illustrate the ways in which insights from object relational, self psychological and attachment theories are integrated into IMH home visiting practices. [ABSTRACT FROM AUTHOR]

A short account of a recent pilot project taking place in Kiev describing some factors that are contributing to the developing interest in Infant Observation and infant mental health amongst clinicians in Ukraine, and their determination to build resources for the future of children growing up in an environment of pervasive uncertainty. [ABSTRACT FROM PUBLISHER]

Identification of developmental delays, behavioral concerns, and social-emotional problems in very young children allows pediatricians and parents to determine appropriate treatment early in the child's development. If left untreated, many of these delays may hinder the child's developmental growth and functioning. However, there is limited research on pediatricians' experiences with developmental screening tools and on perceived barriers to conducting developmental surveillance for children ages 0 to 5 years. An online survey examined the awareness and experience of a purposive sample (N= 100) of Florida pediatricians with developmental surveillance, screening tools, and reliance on other sources of information in the screening of very young children. Statistical significance was noted in that more pediatricians (94%) who had heard or read about developmental surveillance updated the developmental history compared with those who were not familiar (79%) with the concept of developmental surveillance. Significance was also noted for the physicians' awareness of developmental surveillance and reliance on the opinions of mental health professionals during the developmental screening process. The authors include implications for research, training, and advocacy related to the identification of developmental delays and parental satisfaction with pediatric visits. [ABSTRACT FROM PUBLISHER]

The paper describes the genesis, construction and preliminary reliability testing of the Parent−Infant Relational Assessment Tool (PIRAT). PIRAT is a clinical assessment tool for the identification of risk in the early parent−infant relationship. The rationale was to design a flexible, reliable measure that would enable professionals working with infants and their caregivers to assess the parent−infant relationship as it appears in the consulting room, clinic or home environment and to pinpoint areas of concern at the earliest possible opportunity. The measure was developed in the Parent–Infant Project at the Anna Freud Centre and a subsequent study was undertaken to establish whether it could be successfully transferred to healthcare professionals for use in their workplace settings. A reliability study was conducted with a panel of health professionals, including midwives, health visitors, child protection social workers and clinical psychologists, using videotapes of their consultations in the home or clinic with mothers and infants of 0−2 years old. The results demonstrate good interrater reliability for the 10 participants in the study. Verbatim excerpts from the training sessions are included to elucidate the process of training and the ways in which participants engaged with and embedded the measure into their practice. [ABSTRACT FROM PUBLISHER]

This article describes the author's experience at a child-care centre whose staff focused on the achievement of developmental milestones and the cognitive development of infants, but with minimal attention paid to their internal lives. The author elucidates the complexity of clinical work in non-clinical settings and demonstrates how a psychoanalytic perspective along with an understanding of formal consultation helped her address barriers to clinical work. The establishment of a collaborative consulting relationship with a teacher of one of the infant classes enabled the author to intervene with some of the infants, and helped the teacher to gain an understanding and appreciation of infant mental processes. Specific interventions are described. [ABSTRACT FROM AUTHOR]

Background: The parental functioning and its influence upon infant mental health development have been extensively studied but there are few clinical studies investigating less severe psychiatric problems among mothers and fathers in the same family. Aim: This study focuses on the emotional well-being of mothers and fathers who bring their infants to an Infant Mental Health Clinic. Methods: The studied sample is comprised of 63 families with 0-47-month-old infants where the mothers completed the Center for Epidemiological Study-Depression Scale (CES-D), including 43 families in which the CES-D was completed by both parents. In 44 families, the mothers also filled in the Swedish Parental Stress Questionnaire (SPSQ), including 32 where the SPSQ was completed by both parents. The children were independently classified with the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3). Results: Altogether, 54% of the mothers and 11% of the fathers reported depressive symptoms above the CES-D clinical cut-off. Self-rated depressive symptoms and parental stress were strongly related. The mothers' self-rated depressive symptoms were associated with the severity of their infant's problems, but the association was not specific to the DC 0-3 Axis I classification. The mothers' stress level was marginally related to DC 0-3 Axis II relationship classification. Conclusion: The results indicate that the inclusion of systematic parental self-ratings in infant mental health assessments could add clinical information facilitating the planning of family oriented interventions. [ABSTRACT FROM AUTHOR]

Children who are receiving services for abuse and neglect are likely to have reduced developmental levels and are less prepared for success in school as a result. The progress of 144 children receiving services from The Children's Home Society of Florida was tracked with half being randomly assigned to a control group and half to an experimental group receiving enhanced infant mental health oriented case management services from two social work professionals in each of two locations in Tallahassee and West Palm Beach Florida. Those receiving enhanced case management showed significantly higher results in the following areas: more visits with their parents (for those removed from the family home), more service referrals, more completed assessments for services, more services based on the assessments they received, and more success in completing goals of treatment for which they were referred. Their parents had more contact with professionals to whom they were referred and had more success in completing goals of the treatment for which they were referred. Children who received intensive case management also showed improvement in their developmental skills related to problem solving from inception to completion of services. Implications for further research are considered. [ABSTRACT FROM AUTHOR]

Despite the abundance of research on attachment and on the effects of separation, very little research examines the actual processes of separation occurring daily when mothers leave their children (age 6-18 months) in out-of-home group care. In the current study, this everyday process of separation was observed for three months (September-November), starting with the first day in daycare. Typical patterns of mother-child, mother-child-caregiver, mother-caregiver and child-caregiver interactions were identified, each including behaviours that could either relieve or aggravate stress. Separation processes initiated by the mother that included repeated patterns of ceremony and ritual were identified as reducing stress. In addition, infants and toddlers who cried more following separation received more attention distracting responses, whereas those who cried less received more empathic responses. More crying was observed when mothers remained to talk to the caregiver after separation. [ABSTRACT FROM AUTHOR]

The primary aim of this article is to give a theoretical and empirical background for clinical interventions in family-oriented treatment for substance use disorders. The article refers to an ongoing research project, which is based on the concepts of mentalization and parental reflective functioning. Theory of mentalization and attachment theory is explored as explanatory tools of both addictive problem and risk/resilience factors in offspring. Mentalization is defined as the competence to envision mental states in self and others and to understand behaviour in terms of mental states. Substance use is discussed as clinical expressions of impaired mentalizing skills and disorders of state- and affect regulation. Parental reflective function particularly refers to parents' competences to interpret the mind of their own infant or child. Parental reflective functioning, as 'minding the baby', promotes sensitive care, which again serves to protect the infant and the immature brain from potentially dangerous stress and physiological arousal. Substance use often makes the parent 'absent-minded' and thus imposes a risk of impaired interactions between caregivers and the extra vulnerable substance exposed child. Without a lifeline to the caregivers' mind, the development of self regulation and social competences is endangered. High-risk families need substantial support to break the burden of intergenerational transmission of internal representations of caregiving experiences, and to promote good enough care for the infant. The mentalization-based treatment programs (MBT) briefly outlined here, propose a long-term multidisciplinary treatment and follow-up. [ABSTRACT FROM AUTHOR]

This paper explores the notion of a GP practice as a 'secure base', suggesting that greater attention could usefully be paid to the importance of attachment relationships in primary care. If professionals feel secure and respected within 'the practice' then 'the practice' itself is more likely to be able to function as a 'secure base' for its patients. It is suggested that this concept could be developed further to provide a conceptual framework for practices to examine their function as therapeutic organizations. A short resume of John Bowlby's attachment theory is outlined. Illustrations are given of how different attachment styles - secure, avoidant, ambivalent or disorganized - might affect patient care. A case of a mother (with postnatal depression) and her infant is considered in detail to illustrate the value of early intervention in a mother-infant relationship. Professionals are also attached to the practices where they work and the author reflects on his own retirement from being a GP (after 35 years). Finally, the paper describes another case - of a patient who was able to relive, and possibly repair, some of her earlier traumatic childhood separations through her relationship and parting from her GP as retirement approached. [ABSTRACT FROM AUTHOR]

'Infant led' and 'child led' interventions designed to address the affects related to familial violence honour a 'child up', rather than a 'parent down' approach to dyadic work. The capacity to form healthy attachments is largely developed within early childhood. Relational disruption resulting from familial violence threatens to impair healthy attachments and the subsequent neurodevelopmental sequences involved in affect modulation. Two innovative mental health group work interventions within the Western Region of Metropolitan Melbourne work to enhance the attachments of infants and mothers, and children and mothers/carers affected by family violence. [ABSTRACT FROM AUTHOR]

Background. As a proposed risk factor for infant and child development, maternal history of abuse has been a frequent target of investigation. However, there have been no controlled studies about the impact of maternal history of abuse on the medical course of pregnancy, the peri- and postnatal period. Method. All women with a newborn child were contacted by mail and presented with the Childhood Trauma Questionnaire (CTQ). The index group (n = 58) was formed by women who scored above the cutoff for moderate or severe abuse and compared to a control group (n = 60) with regard to pre,- peri-, and postnatal complications as documented in the patient charts. Results. The results show that women with a history of abuse have significantly more prenatal medical complications and infant medical complications in the post- but not perinatal period. Conclusions. Maternal history of abuse significantly impacts the medical course of delivery and the puerperium. Given the prevalence of abusive experiences, this finding is highly relevant from a preventive point of view. [ABSTRACT FROM AUTHOR]

Early intervention providers (957) were asked about their comfort level with and interest in training in infant mental health (IMH) topics including attachment, behavior and regulation/adaption, and whether they worked with families who needed information in these areas. Results indicated that providers continue to grow in understanding of these core IMH topics and that they continue to recognize the importance of training in these areas for themselves and families. Significant differences were found by provider type, level of experience and minority status. Both minority and less experienced providers were most interested in learning more about IMH topics. [ABSTRACT FROM AUTHOR]

If reunification of a biological family is a reasonable goal in a foster care case involving infants and toddlers, relational therapies may be the psychotherapeutic treatments most indicated. Working within the context of the family relationships addresses many of the perils of contemporary foster care for children in the earliest years of life, including lengthy stays and loss of supportive family bonds. A "best practices" research program-Families in Transition (FIT)--is described which uses court-ordered family visitation sessions as an opportunity for relational assessment and interventions. [ABSTRACT FROM AUTHOR]

This is a short description of a piece of research that compared and contrasted the way in which different caregivers described their infants and the relationship between the pair of them. The original study was based on a clinical sample of five mothers who all had been seen for infant-parent psychotherapy and one other, where there had been no problems, as a control; but for reasons of space only three examples are presented here. The transcripts of all the interviews were examined and coded to discover how often, and in what way, the internal and external worlds of infant and mother were acknowledged. [ABSTRACT FROM AUTHOR]

This review explores diverse theories that provide the basis and rationale for infant mental health, a relatively new service designed to reduce social and emotional disturbances in infancy and early parenthood. Psychoanalytic theory, attachment theory, social and contextual theories, developmental theories and the work of Donald Winnicott and Daniel Stern contribute to the fundamentals of infant mental health practice, increasing the understanding of development in early childhood and the power of relationships in defining a context for social and emotional growth. Infant mental health practice influences psychotherapeutic change in early parenthood and the possibility of attachment security in early infancy. [ABSTRACT FROM PUBLISHER]

Aim: To add to our knowledge concerning the key elements involved in the individual's experience of growing up with substance abusing parents and the resulting challenges this involved for their own parenthood. Methods: In-depth interviews were conducted with 19 parents who had participated in a mental health intervention programme. All had experienced substance abusing parents in their family of origin. Qualitative content analysis was used to analyse the data. They also completed a self-report questionnaire assessing their attachment style. Result: Participants reported a high incidence of emotional abuse and neglect coupled with inadequate support from the community. Their own parental role was influenced by high parental stress and a majority had an insecure attachment style. Conclusions: All participants had experienced a very difficult childhood which was reinforced by the fact that they received little support from society. Their childhood experience and the resulting challenges that this created in their own parenting role could negatively influence their own children's ability to form a secure psychosocial development. It is therefore important to develop instruments that can help to identify children who were raised in misuse families in order to accommodate the transgenerational effects of growing up with substance abusing parents. [ABSTRACT FROM AUTHOR]