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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]

Dyadic interventions targeting maternal mental health and the mother‐infant relationship in the perinatal period are critical due to the potential consequences of perinatal mental illness and relational disturbance for the mother, the infant, and their family. This paper describes the Pregnancy to Parenthood (P2P) model of care, a dyadic mother‐infant community‐based program designed to support vulnerable families in Western Australia in the context of an identified need to build workforce capacity. A pragmatic service evaluation study was conducted by analyzing routine clinical data collected from 105 dyads who completed pre‐ and post‐intervention measures, including the Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS), and the Mother Object Relations Scale‐Short Form (MORS‐SF). Reliable change index and cut‐off analyses indicated a clinically reliable pre‐post reduction in perinatal depressive and anxiety symptoms for 71% and 68% of the sample, respectively. Significant pre‐post improvements with medium effect sizes (r = −.46, r = −.32) were found for caregiving representations on the MORS‐SF, suggesting representations became more balanced. These results provide provisional evidence that the P2P model of care may be effective in improving maternal mental health and caregiving representations. Further research is required to evaluate the efficacy of P2P in relation to enhancing family well‐being, and to inform policy and mental health service development. [ABSTRACT FROM AUTHOR]

Infant Mental Health Home Visiting (IMH-HV) is a needs-driven, relationship-based home visiting intervention with demonstrated positive outcomes for parents and young children. Prior research found that higher therapeutic alliance (TA) was associated with improved program retention and provider race affected TA and retention for clients. The objective of this quality improvement project was to inform improvements to IMH-HV provider trainings to better prepare providers to effectively engage and support diverse families. Focus groups or individual interviews were completed with 18 providers and 7 clients (parents/caregivers). Participants self-selected into one of three groups offered separately to providers and clients: White identifying, Black identifying and Non-Specified identity groups. A racially diverse, interdisciplinary team facilitated focus groups and interviews and conducted thematic analysis of the data. Analysis identified barriers and opportunities for effective engagement of clients: when providers and clients are of different racial/ethnic backgrounds, provider attempts to forge a connection may make families feel 'othered'; providers may not see their racial identity as salient, yet it influences their practice and the establishment of rapport with families; patience, tolerating discomfort, and allowing a family to determine whether the provider can be trusted are key. Effective IMH-HV practice with clients of diverse backgrounds requires a high level of self-understanding on the part of providers. Enhancing training to promote deeper consideration of both the perspectives of diverse clients and the salience of one's own identity has potential to reduce barriers to TA, improve program retention, and address health disparities. Significance: Therapeutic alliance, or the working relationship between parents and infant mental health home visitors, is associated with program retention. Differences between white and Black/African American home visitors' ratings of therapeutic alliance with their clients suggest that white home visitors may feel less equipped to work with families from diverse backgrounds. This report adds to understanding of barriers to therapeutic alliance within the context of IMH-HV in Michigan. Findings can be applied to improve IMH-HV training and better prepare home visitors to engage and support diverse families. [ABSTRACT FROM AUTHOR]

Inpatient parent–infant psychiatric units (PIUs) are considered "gold standard" for treating maternal mental illness, with well‐documented positive outcomes for mothers. However, little research addresses outcomes for infants in these units, who often face significant developmental and socio‐emotional adversity. This pilot study aimed to evaluate the characteristics and progress of an Australian PIU population, focusing on the impact of PIU admission on infant outcomes. Over 3 months, 31 consecutively admitted mother–infant pairs (dyads) were assessed through interviews, observations, and standardized measures to evaluate maternal and infant characteristics and progress from admission to discharge. Maternal well‐being and the mother–infant relationship improved. Infants exhibited high levels of physical (29%) and developmental concerns (80.6%). 22.6% receiving an Axis I infant mental health diagnosis. Infant socio‐emotional responsiveness improved significantly, as measured by the modified Alarm‐Distress Baby Scale, indicating a positive impact of PIU admission. The small sample size and reliance on clinician‐observed measures limit the generalizability of the findings. PIU infants are particularly vulnerable, and PIU admission may ameliorate socio‐emotional responsiveness. Further research with larger samples and extended follow‐up is needed to determine the most effective intervention strategies during and after PIU admission to maximize benefits for these infants. [ABSTRACT FROM AUTHOR]

Parenting has been found to be highly contextually and culturally determined and there have been calls to research parenting within culture as it is lived. Due to changing social and economic factors, middle-class South African mothers face unique challenges in relation to the navigation of culture and class in child-rearing. Foregrounding the complexity of acculturation, this paper uses social constructionist theory in the analysis of maternal narratives and responses to video-recordings of their interaction with their infants, of a group of middle-class South African mothers from various cultural and racial groups, with an aim to understanding how mothering is changing amongst middle-class South African mothers. The findings suggest that acculturation is complex and influenced by a combination of socioeconomic status, geographical location, contact with other cultural groups and personal emotional experiences of having been parented within a particular culture. [ABSTRACT FROM AUTHOR]

The COVID-19 lockdown affected children, especially those with autism spectrum disorder, due to the disruption in rehabilitation and educational activities. We conducted a cross-sectional study of 315 preschool-aged children, 35 of which had autism, to investigate this impact. A questionnaire was administered to explore socio-demographic status, familiar/home environment, and COVID-19 exposure. The clinical features of autistic subjects were also examined. Seven variables were considered to describe the effect of pandemic: Remote learning, Behavior changes, Home activities, Sleep habits, Night awakenings, Physical activity, Information about the virus. The lockdown had a significant impact on Remote learning, Behavior changes, and Information about the virus in participants with autism. Moreover, we found a worsening in repetitive movements, echolalia, restricted interests, and aggressive behaviors. [ABSTRACT FROM AUTHOR]

Background: Early relational health (ERH) interventions can buffer toxic stress and improve the developmental trajectories of neonatal intensive care unit (NICU) infants. Purpose: The purpose was to examine the current state of the science related to multimodal, dyadic ERH interventions implemented in the NICU setting in the United States and identify gaps in the current literature. Data Sources: PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo were searched in November 2022 and November 2023 for original studies and conference proceedings from 1970 to present in the English language. Gray literature searches were performed in February 2023 and December 2023. Study Selection: English language, original research, with a focus on multimodal, dyadic ERH interventions that took place primarily in a NICU in the United States were included. Outcome measures could be related to implementation, relational health, or physical and/or mental health outcomes of parent and/or infant. Eighteen of 2021 reviewed articles met the inclusion criteria. Data Extraction: Data were extracted for author, year, intervention, purpose, methods, sample, paternal inclusion, dyadic components, non-dyadic components, and major outcomes/results and distilled for study characteristics, multimodal, dyadic intervention characteristics, and outcome measures. Results: Several multimodal dyadic interventions exist to aid ERH in the NICU, providing evidence of improved outcomes for infants and families. More research is required using higher sample sizes and replication studies. Implications for Practice and Research: ERH interventions show promise in improving neurodevelopmental, behavioral, and maternal mental health outcomes and should be considered for implementation into NICU services. [ABSTRACT FROM AUTHOR]

Introduction: Early childhood development is a strong predictor of long‐term health outcomes, potentially mediated via epigenetics (DNA methylation). The aim of the current study was to examine how childhood experiences, punitive parenting, and an intergenerational psychotherapeutic intervention may impact DNA methylation in young children and their mothers. Methods: Mothers and their infants/toddlers between 0 and 24 months were recruited at baseline (n = 146, 73 pairs) to participate in a randomized control trial evaluating the effectiveness of The Michigan Model of Infant Mental Health Home Visiting (IMH‐HV) parent–infant psychotherapy compared to treatment as usual. Baseline and 12‐month post‐enrollment data were collected in the family's home and included self‐report questionnaires, biological saliva samples, home environment observation, video‐taped parent–child interaction, and audio‐recorded interviews. Saliva DNA methylation was measured at the genes, nuclear receptor subfamily 3 group C member 1 (NR3C1), solute carrier family 6 member 4 (SLC6A4), brain‐derived neurotrophic factor (BDNF), and the genetic element, long interspersed nuclear element‐1 (LINE1). Results: For mothers, baseline methylation of BDNF, SLC6A4, NR3C1, or LINE1 was largely not associated with baseline measures of their childhood adversity, adverse life experiences, demographic characteristics related to structurally driven inequities, or to IMH‐HV treatment effect. In infants, there were suggestions that methylation in SLC6A4 and LINE1 was associated with parenting attitudes. Infant BDNF methylation suggested an overall decrease in response to IMH‐HV psychotherapy over 12 months. Conclusions: Overall, our findings suggest that the epigenome in infants and young children may be sensitive to both early life experiences and parent–infant psychotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Clinical services require feasible assessments of parentinfant interaction in order to identify dyads requiring parenting intervention. We assessed the reliability and predictive validity of two observational tools and tested whether briefer forms could be identified which retain acceptable psychometric properties over short observation periods. Methods: A stratified high-risk community sample of 250 mother-infant dyads from The Wirral Child Health and Development Study completed 7-min playbased interaction at 6-8 months. Film-footage was independently coded by two trained raters using PIIOS and NICHD-SECCYD systems. Incremental predictive validity was assessed from 3, 5 and 7 min observation to attachment outcomes (Strange Situation; 14 months) and infant mental health (BITSEA; 14 and 30 months). Results: Excellent inter-rater reliability was evident at code and subscale level for each tool and observation period. Stability of within-rater agreement was optimal after 5 min observation. ROC analysis confirmed predictive (discriminant) validity (AUCs >0.70) to top decile age 2 mental health outcomes for PIIOS total score and a brief 3-item composite from NICHD-SECCYD (sensitivity, intrusiveness, positive regard; NICHD-3), but not to attachment outcomes. Logistic regression showed dyads rated at-risk for externalizing problems using NICHD-3 were also at significantly higher risk for insecurity at 14 months (OR = 2.7, p = 0.004). Conclusion: PIIOS total and NICHD-3 ratings from 5 min observation are both reliable and valid tools for use in clinical practice. Findings suggest NICHD-3 may have greater utility due to its comparative brevity to train and code, with suitability for use over a broader developmental time frame (3-24 months). [ABSTRACT FROM AUTHOR]

Reflective practice (RP) is a core component of infant mental health (IMH); however, there is limited published empirical research on IMH practitioner experiences of RP. This two‐stage, qualitative, multimodal study explored Irish IMH practitioners' experiences of RP spaces. Visual and verbal data from seven individual interviews and a participatory arts‐based focus group with seven participants (eight participants in total, all white Irish females) were analyzed using Interpretative Phenomenological Analysis. Five group experiential themes (Just get on with it; What should I be bringing to this space?; Who are my "hands"?; Taking a step back; and You go in heavy and you come out light) were generated by the analysis. These were used to construct a developmental and experiential model of learning in an RP space. The themes portray how a practitioner's RP experience can change over time: influenced by prior experiences and practice development stage, practitioners move from initial uncertainty, anxiety, and perceived pressure in a busy workload to developing the trust and ability to be vulnerable in an RP space. Through relationships (supervisor/facilitator or group members), a shared safe space can be created, which addresses practitioners' needs for containment, allowing for experiential learning through a process of transformational moments. [ABSTRACT FROM AUTHOR]

Abstract Background Family psychosocial challenges during the early years of a child’s life are associated with later mental and physical health problems for the child. An increased psychosocial focus on parents in routine child developmental assessments may therefore be justified. Methods Participants in this qualitative study included 11 mothers and one parental couple (mother and father) with children aged 9–23 months. Participants were recruited to Project Family Wellbeing through their general practice in Denmark. Twelve interviews were conducted, transcribed and analysed with a deductive approach. The topic guide drew on the core components of the Health Belief Model, which also served as a framework for the coding that was conducted using thematic analysis. Results Results are presented in four themes and 11 subthemes in total. Parents welcome discussion of their psychosocial circumstances during their child’s developmental assessments. Clinicians’ initiatives to address psychosocial challenges and alignment of parents’ and clinicians’ expectations may be required to allow this discussion. A flowing conversation, an open communication style and a trustful relationship facilitate psychosocial discussion. Barriers included short consultation time, concerns about how information was used and when parents found specific psychosocial aspects stigmatising or irrelevant to discuss. Conclusion Enquiry about the family’s psychosocial circumstances in routine developmental assessments is acceptable among parents. Alignment of clinical and parental expectations of developmental assessments could facilitate the process. Future research should examine the predictive validity of the various components of developmental assessments. Trial registration This is a qualitative study. The study participants are part of the cohort from Project Family Wellbeing (FamilieTrivsel). The project’s trial registry number: NCT04129359. Registered October 16th 2019.

I think back to sitting in the warm dark, an amber glow in the corner of the room and the gentle rise and fall of breath following breath, snuffle, stretch, toe curl, sigh. I remember drifting in the peace of my infant observation, wondering what I was doing as I began the journey to becoming a play therapist. The learning from these surprising, provocative and informative infant observations has remained a deeply important foundation in my work. Fourteen years later, as a play therapist often working together with parents and infants, I remain fascinated by the possibilities that working through play therapy in the very early years can bring to relational and transformational change. This exploration brings together the story of this work to share and learn from together. [ABSTRACT FROM AUTHOR]

Background: Family psychosocial challenges during the early years of a child's life are associated with later mental and physical health problems for the child. An increased psychosocial focus on parents in routine child developmental assessments may therefore be justified. Methods: Participants in this qualitative study included 11 mothers and one parental couple (mother and father) with children aged 9–23 months. Participants were recruited to Project Family Wellbeing through their general practice in Denmark. Twelve interviews were conducted, transcribed and analysed with a deductive approach. The topic guide drew on the core components of the Health Belief Model, which also served as a framework for the coding that was conducted using thematic analysis. Results: Results are presented in four themes and 11 subthemes in total. Parents welcome discussion of their psychosocial circumstances during their child's developmental assessments. Clinicians' initiatives to address psychosocial challenges and alignment of parents' and clinicians' expectations may be required to allow this discussion. A flowing conversation, an open communication style and a trustful relationship facilitate psychosocial discussion. Barriers included short consultation time, concerns about how information was used and when parents found specific psychosocial aspects stigmatising or irrelevant to discuss. Conclusion: Enquiry about the family's psychosocial circumstances in routine developmental assessments is acceptable among parents. Alignment of clinical and parental expectations of developmental assessments could facilitate the process. Future research should examine the predictive validity of the various components of developmental assessments. Trial registration: This is a qualitative study. The study participants are part of the cohort from Project Family Wellbeing (FamilieTrivsel). The project's trial registry number: NCT04129359. Registered October 16th 2019. [ABSTRACT FROM AUTHOR]

This article explores the 'ways of being' (Pawl, 1994) that promote an alliance between the parent and provider and illuminates the concept of 'parallel process', otherwise known in Infant Mental Health (IMH) work as the platinum rule, 'Do unto others as you would have others do unto others' (Pawl, 1994:23). Parallel process illuminates the interconnected nature of providing for a parent what we hope parents can provide for their infant (Weatherston & Ribaudo, 2020). Often, parents who struggle the most to provide for their infant's emotional and relational needs have not had reliable experiences of their own needs being met. By offering emotional containment and care, practitioners across a spectrum of perinatal services can be a source of healing and, thus, therapeutic. [ABSTRACT FROM AUTHOR]

Abstract Introduction Early childhood development is a strong predictor of long‐term health outcomes, potentially mediated via epigenetics (DNA methylation). The aim of the current study was to examine how childhood experiences, punitive parenting, and an intergenerational psychotherapeutic intervention may impact DNA methylation in young children and their mothers. Methods Mothers and their infants/toddlers between 0 and 24 months were recruited at baseline (n = 146, 73 pairs) to participate in a randomized control trial evaluating the effectiveness of The Michigan Model of Infant Mental Health Home Visiting (IMH‐HV) parent–infant psychotherapy compared to treatment as usual. Baseline and 12‐month post‐enrollment data were collected in the family's home and included self‐report questionnaires, biological saliva samples, home environment observation, video‐taped parent–child interaction, and audio‐recorded interviews. Saliva DNA methylation was measured at the genes, nuclear receptor subfamily 3 group C member 1 (NR3C1), solute carrier family 6 member 4 (SLC6A4), brain‐derived neurotrophic factor (BDNF), and the genetic element, long interspersed nuclear element‐1 (LINE1). Results For mothers, baseline methylation of BDNF, SLC6A4, NR3C1, or LINE1 was largely not associated with baseline measures of their childhood adversity, adverse life experiences, demographic characteristics related to structurally driven inequities, or to IMH‐HV treatment effect. In infants, there were suggestions that methylation in SLC6A4 and LINE1 was associated with parenting attitudes. Infant BDNF methylation suggested an overall decrease in response to IMH‐HV psychotherapy over 12 months. Conclusions Overall, our findings suggest that the epigenome in infants and young children may be sensitive to both early life experiences and parent–infant psychotherapy.

The way caregivers think of their infants and young children may impact caregiving behavior. One way to assess caregivers’ thoughts of their young children is to prompt them to describe the child's personality. Popular methods to analyzing valenced language include the use of software approaches, which have limitations in scoring and application. The present investigation offers an alternative scoring system for the emotional tone of words and phrases relevant to descriptions of infants and children. Using a database of personality descriptions provided by pregnant people and parents to describe their child's personality, we asked experts in infant mental health and related disciplines (N = 51) to rate the words/phrases with regard to the emotional tone or connotation of the descriptive words provided (e.g., positive, neutral, or negative). Experts (i.e., participants) were individuals with self-reported expertise in infants and young children via their profession. Participants were recruited via email to known infant and early childhood mental health practicians and researchers and through participant referral. A total of 496 unique words or phrases were rated by the experts, and in order to reduce participant burden, experts were randomly assigned approximately half of the words. From these ratings, we computed a continuous measure of average valence score across all raters and a categorical variable representing expert consensus (i.e., if ≥80 % of experts agreed it was positive or negative it was assigned that category, otherwise it was assigned neutral). As such, the data provided include caregiver adjectives used to describe their young children, expert ratings of the emotional tone of the provided description, average emotional tone for each word, and expert consensus for each word.

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]

Because healthy psychosocial development in the first years of life is critical to lifelong well‐being, governmental, and nongovernmental organizations are increasingly interested in monitoring psychosocial behaviors among populations of children. In response, the World Health Organization is developing the Global Scales of Early Development Psychosocial Form (GSED PF) to facilitate population‐level psychosocial monitoring. Once validated, the GSED PF will be an open‐access, caregiver‐reported measure of children's psychosocial behaviors that is appropriate for infants and young children. This study examines the psychometric validity evidence from 45 items under consideration for inclusion in the GSED PF. Using data from N = 836 Nebraskan (USA) children aged 180 days to 71 months, results indicate that scores from 44 of the 45 (98%) items exhibit positive evidence of validity and reliability. A bifactor model with one general factor and five specific factors best fit the data, exhibited strong reliability, and acceptable model fit. Criterion associations with known predictors of children's psychosocial behaviors were in the expected direction. These findings suggest that measurement of children's psychosocial behaviors may be feasible, at least in the United States. Data from more culturally and linguistically diverse settings is needed to assess these items for global monitoring. [ABSTRACT FROM AUTHOR]

Reflective practice is a core component of Infant Mental Health (IMH) training and work in the form of reflective supervision/consultation (RS/C). RS/C supports and facilitates relationship‐based practice, and is considered to help prevent burnout and promote work satisfaction. In response to an identified gap in empirical research on RS/C, this scoping review aimed to give an overview of the broad range of study designs and outcomes by systematically charting empirical studies on RS/C in IMH‐based work with children and families. Searches of Academic Search Complete, CINAHL, MEDLINE, APA PsychArticles, APA PsycInfo, and Web of Science were supplemented with a Google Scholar search and citation searching. Following title/abstract screening (n = 233) and full‐text review (n = 168), 35 reports met criteria for inclusion. Key findings were organized into four categories: Essential components and processes of RS/C; Experiences and outcomes of RS/C; Emerging issues in RS/C literature; and Measuring, researching, and reporting on RS/C. Results describe the components and experience of engaging in quality RS/C, and show that practitioners generally experience RS/C as supportive and beneficial. The existing literature has some methodological limitations and further empirical research is needed on outcomes of RS/C. Practice implications and potential future research directions are discussed. [ABSTRACT FROM AUTHOR]

IntroductionClinical services require feasible assessments of parent-infant interaction in order to identify dyads requiring parenting intervention. We assessed the reliability and predictive validity of two observational tools and tested whether briefer forms could be identified which retain acceptable psychometric properties over short observation periods.MethodsA stratified high-risk community sample of 250 mother-infant dyads from The Wirral Child Health and Development Study completed 7-min play-based interaction at 6–8 months. Film-footage was independently coded by two trained raters using PIIOS and NICHD-SECCYD systems. Incremental predictive validity was assessed from 3, 5 and 7 min observation to attachment outcomes (Strange Situation; 14 months) and infant mental health (BITSEA; 14 and 30 months).ResultsExcellent inter-rater reliability was evident at code and subscale level for each tool and observation period. Stability of within-rater agreement was optimal after 5 min observation. ROC analysis confirmed predictive (discriminant) validity (AUCs >0.70) to top decile age 2 mental health outcomes for PIIOS total score and a brief 3-item composite from NICHD-SECCYD (sensitivity, intrusiveness, positive regard; NICHD-3), but not to attachment outcomes. Logistic regression showed dyads rated at-risk for externalizing problems using NICHD-3 were also at significantly higher risk for insecurity at 14 months (OR = 2.7, p = 0.004).ConclusionPIIOS total and NICHD-3 ratings from 5 min observation are both reliable and valid tools for use in clinical practice. Findings suggest NICHD-3 may have greater utility due to its comparative brevity to train and code, with suitability for use over a broader developmental time frame (3–24 months).

Lucy and Robyn have created an e-book called 'Baby Brain Growth', which Robyn presented last July at the World Association for Infant Mental Health (WAIMH) conference in Dublin. The book is dedicated to the memory of Kyle Taylor, Robyn's daughter Erin's partner, who was born with the condition gastroschisis and passed away in January 2023. Kyle fulfilled his life purpose to have a family of his own. His daughter, Sophie Helena, was born in August, 2022. Due to Kyle's health, he wasn't able to work, so in the early months, Kyle was either sitting on the couch watching over Sophie as she slept beside him, or standing close with Erin gazing at her. These few months are a priceless gift that Kyle gave to Sophie. [ABSTRACT FROM AUTHOR]

BackgroundOver nearly three years, the COVID-19 pandemic has had a lasting impact on people's lives and mental health worldwide with its far-reaching restrictions and concerns about infections and other personal consequences. Families were particularly affected and showed increased stress and psychological problems. Long-term effects cannot be ruled out. So far, data on young families are sparse. The present longitudinal analysis (n = 932) of the CoronabaBY study investigated the development of parenting stress, parental affective symptoms, and child's mental health in young families with children aged 0–3 years in Germany as well as potential influencing factors.MethodsThe observational study includes two measurement points over the course of the pandemic (baseline and follow-up). Data was collected by app using standardized questionnaires.ResultsN = 932 participants, mainly mothers (94.7%) born in Germany (93.1%) with higher education (61.3% with at least high school diploma) and a comfortable financial situation participated in the longitudinal study. Children were on average 14.7 months old at baseline (SD: 12, range: 1–39 months). While the proportion of parents who perceived the pandemic as stressful decreased significantly from baseline (60%) to follow-up (52.3%), the proportion with parenting stress increased significantly (from 40.1% to 45.4%). Both parental and child mental health problems remained constant over time, with infants crying/feeding/sleeping problems ranging above pre-pandemic comparative data. Most predictive for high parenting stress at follow-up was high parenting stress at baseline. This was also true for parental affective symptoms (depression/anxiety) and child mental health problems.ConclusionsDespite faded pandemic restrictions, parents remained burdened. Support services do not appear to have been sufficient to help families out of their stressful situation. Our results indicate a need for action regarding low-threshold services that effectively reach affected families.Trial registrationThe study was pre-registered in OSF (https://osf.io/search/?q=tksh5&page=1).

Introduction: Despite compelling evidence that high-quality early care has an enduring impact, there has been little coordinated effort to transform services delivery to infuse Trauma-Informed Family Centered (TI-FC) principles into community-based agencies serving children and their families. A need for more culturally attuned, family-sensitive, evidence-based, and trauma-informed supports, especially for vulnerable children, their families and fathers, is apparent in evidence amassed by key stakeholders within the geographic area of this study. This report details the planning process, TI-FC training series, and organizational profile assessments. Authors conclude with recommendations regarding the establishment of multi-agency collectives, to include fathers, toward betterment of infant-family mental health at the community level. Methods: The current case study details the community-level transformational effort in which major health, mental health, substance abuse, and child welfare organizations serving families of children age 0-3 worked collaboratively to enhance TI-FC services. We describe a four-stage process (1 - planning, 2 - assessment of organizational readiness, 3 - surveys, document reviews and focus groups, 4 - delivery of a training series) detailing the work of the collaborative, guided by key agency decision-makers. Results: The study found significant initial success in adapting approaches to serving children 0-3 and their families through TI-FC perspectives. By proactively engaging several lead organizations in a deliberative planning process with universal aims and transformational principles, the collaborative team was able to coordinate organizational assessment, staff training and consultation, self-monitoring of organizational shifts, and problem-solving of obstacles and solutions to TI-FC services delivery. Discussion: All agencies succeeded in completing comprehensive, multi-faceted analyses of organizational culture, preparing personnel for TI-FC services through comprehensive training, and utilizing this collaborative to make deliberate and customized changes within their programs, as concerns both support of families and father engagement. Preliminary data indicate that important shifts took hold and signified changes across key domains of TI-FC care. [ABSTRACT FROM AUTHOR]

This qualitative study explores infant‐family mental health experts' perspectives and experiences regarding the inclusion of infants in the family therapy setting. Infant socioemotional development is relational in nature and evolves in the context of both dyadic attachment relationships and broader multi‐person co‐parenting systems. Given this, we sought to understand why family therapy interventions involving families with infants rarely include the infant in a triangular or family systemic approach. Interviews were completed by clinical and/or research experts whose work integrates tenets of both infant mental health (IMH) and family theory and therapy. All interviewees brought at least 5 years of expertise and were actively engaged in the field. Interviewees expressed consistent beliefs that infants have a rightful and helpful place in family therapy approaches. They maintained that infants' innate social drive and communicative capacities position them to make meaningful and clinically significant contributions within family and systemic psychotherapy contexts. Noting that infants have remained on the periphery of these practices, experts advocated expansion and greater integration between IMH and family therapy, while preserving each field's distinctive identity. Experts reported that the interplay between IMH and family therapy fields has been uni‐directional as family systems concepts are embedded within IMH approaches, but few IMH premises are incorporated in mainstream family therapy practices. The disconnect was attributed to multiple factors, including graduate and professional training and theoretical, clinical, research, and sociocultural barriers, which were mutually reinforcing. Experts also identified clinical gains for both infants and family members when infants were meaningfully included in family interventions. Common ground was identified between the disciplines, with a belief that relationally distressed young children and parents are best served by clinical engagement with their network of relationships. Results call for greater collaboration between disciplines to challenge existing traditions and to more fully include infants in mainstream family therapy. Recommendations for integration of family therapy and IMH in clinical, theoretical, research, training, and sociocultural domains are offered. [ABSTRACT FROM AUTHOR]

This position paper from a core group of infant mental health academics and clinicians addresses the conspicuous underrepresentation of the infant in mainstream family therapy. Despite infants' social capacities and clear contributions to family dynamics, they remain largely overlooked within this therapeutic context. We suggest that family therapists have moral and professional responsibilities to support the participation, protection, and well‐being of all family members, including the infant. Here, we emphasise the importance of including the infant in the family therapy setting. By highlighting their frequent omission, we aim to amplify infants' often unheard 'voice,' role, and contributions to family development, especially recovery from distress. A shift towards infant inclusion as the rule rather than the exception represents a new frontier of integration. We first highlight the relational nature of infant development with a focus on the infants' psychosocial capacities and vulnerabilities. We then consider reasons why the infant may be overlooked in family and systemic therapies and offer a rationale for inviting the infant into these settings, illustrated through the use of a clinical case vignette. To facilitate infant inclusion, we propose a series of guidelines to meaningfully incorporate infants into family therapy practices. We conclude by encouraging shifts in family therapy research, training, and practice to better incorporate and understand the unique contributions of the infant to family life. [ABSTRACT FROM AUTHOR]

Training in infant observation, highly valuable in the infant mental health (IMH) field, has an enormous amount to offer family therapists. These two fields of practice, both hold working with the relational world of their clients as central. As two senior family therapists who are also IMH practitioners, we invite those reading this paper to explore the possibilities inherent in undertaking infant observation training as a pathway to enriching and expanding their practice. We provide an overview of infant observation training, how this approach was conceived, and explore the benefits of honouring the subjectivity of the infant, that of bringing the infant's experience alive in the therapeutic space. We provide direct examples from our own practice. We conclude with how infant observation might be incorporated into family therapy training and practice. [ABSTRACT FROM AUTHOR]

This paper shares a far‐ranging set of conversations between professors Jennifer McIntosh, Louise Newman, and Carol George, all child and family practitioners, and infant mental health (IMH) and attachment specialists. They explore the domain of infant–family work with high‐risk populations experiencing complex relational and intergenerational trauma. George and McIntosh discuss the intersection between family therapy and IMH from an attachment perspective. They explore what family therapy can offer to supporting coherence in caregiving states of mind, beyond the offerings of traditional dyadic mother–baby models of intervention. They highlight the infant's contribution to family work, and the application of attachment theory in a family therapy context. Newman and McIntosh discuss a sensitive and graded approach to high‐risk family work with an infant. Newman reflects on when and whom to invite to a family session and the power of enabling the family to speak the unspeakable in the presence of the baby, supporting a future focused path for trauma integration and recovery. For family therapists who may be new to IMH work, there are some important offerings about integrating these fields, bringing into play the family therapist's deep grasp of curiosity, circularity, and capacity to reconceptualise with an IMH perspective on early relational trauma. [ABSTRACT FROM AUTHOR]

Despite the weight of scientific evidence demonstrating the importance of fathers in the social and emotional development and well‐being of infants, infant mental health services struggle to engage fathers. Commonly, fathers are assumed to be unavailable, uninterested, unnecessary, or even unsafe in relation to infant mental health work. These outdated perspectives perpetuate the myth that this work pertains exclusively to the infant–mother dyad. This paper aims to explore some of the reasons for and barriers to involving fathers in infant mental health services. We present an imagined conversation between three mental health professionals working in a child and adolescent mental health service. Presented as a script, the various arguments, counterarguments, and reflections made by the three characters aim to bring the subject matter to life and capture something akin to an actual discussion between colleagues working in a child mental health service. A junior clinician notices that an infant case presented at the multidisciplinary team meeting did not mention the child's father. A senior clinician explains that the team's work usually focuses on the infant–mother relationship, as this is considered of primary importance clinically. A psychiatrist, who has only recently joined the team, explores some of the aspects of team culture that might exclude fathers from participating in the service. Several plausible objections to involving fathers are explored as the discussion unfolds between the three professionals. Infant mental health services should consider how their culture and processes influence whether fathers and/or other adult caregivers engage in these services. For clinicians, thinking about the infant's immediate interpersonal context from their unique development perspective can reveal opportunities and resources within the family that may lead to effective systemic treatment approaches. [ABSTRACT FROM AUTHOR]

Caregiving relationships in the postnatal period are critical to an infant's development. Preterm infants and their parents face unique challenges in this regard, with infants experiencing separation from parents, uncomfortable procedures, and increased biologic vulnerability, and parents facing difficulties assuming caregiver roles and increased risk for psychological distress. To better understand the NICU parent‐infant relationship, we conducted a review of the literature and identified 52 studies comparing observed maternal, infant, and dyadic interaction behavior in preterm dyads with full‐term dyads. Eighteen of 40 studies on maternal behavior found less favorable behavior, including decreased sensitivity and more intrusiveness in mothers of preterm infants, seven studies found the opposite, four studies found mixed results, and 11 studies found no differences. Seventeen of 25 studies on infant behavior found less responsiveness in preterm infants, two studies found the opposite, and the remainder found no difference. Eighteen out of 14 studies on dyad‐specific behavior reported less synchrony in preterm dyads and the remainder found no differences. We identify confounding factors that may explain variations in results, present an approach to interpret existing data by framing differences in maternal behavior as potentially adaptive in the context of prematurity, and suggest future areas for exploration. [ABSTRACT FROM AUTHOR]

Tweddle's Parenting Assessment and Skill Development Service (PASDS) is a 10‐day residential programme for families at risk of child maltreatment. The service aims to conduct a comprehensive parenting capacity assessment to inform case management and improve parenting practices. The aims of the study were to (1) describe the psychosocial functioning of parents taking part in PASDS, (2) describe the key parenting assessment outcomes, and (3) explore parents' experiences of participation in PASDS including (a) perceived barriers and enablers of participation and (b) perceived outcomes for their family. Participants were 18 parents who participated in Tweddle's PASDS in Melbourne, Australia. A mixed methods study comprising a case file review and qualitative interviews was conducted. Parents accessing PASDS had experienced adverse childhood events, and many were experiencing mental health difficulties. Interviews with parents revealed perceived benefits of PASDS in improving parenting knowledge and skills, family relationships, and parenting confidence. At the time of discharge, 33% of families were assessed as unable to provide independent care for their child. The current findings have important implications for the further evaluation of evidenced‐based services which can improve the accuracy of parenting capacity assessments, aiding in child protection decision‐making related to child placement and safety. [ABSTRACT FROM AUTHOR]

Abstract Background Families with young children are particularly vulnerable for the stressors induced by the COVID-19 pandemic. However, studies on their psychosocial situation during the course of the crisis are still sparse. Methods In a comparison of three survey waves (wave I and III = high COVID-19 incidences), we cross-sectionally investigated the proportion of families (Ntotal = 2940) with children aged 0–3 years experiencing pandemic burden, parenting stress, and parental and child mental health problems in relation to COVID-19 incidences and restrictions in Southern Germany via validated questionnaires. Potential influencing factors were also explored. Results The number of parents with a high pandemic burden decreased over the course of the pandemic with a peak of 65.3% in wave I (significant changes except wave II versus III). Participants with high parenting stress significantly increased from 38.2% in wave I to 51.2% in wave III. The number of parents with symptoms of depression and anxiety remained constantly high with a maximum of 28.4% being affected. Infants with crying/sleeping problems increased significantly from 26.4% in wave I to 35.5% in wave III. Toddlers’ emotional and behavioral problems showed a peak of 23.9% in wave III (no significant changes). Increased family conflicts were the strongest predictor for parenting stress (ß = 0.355), maternal (ß = 0.305), infants’ (ß = 0.149) and toddlers’ (ß = 0.216) mental health problems during the pandemic. Conclusions Psychosocial stress factors in families with infants and toddlers remained highly pronounced and even partly increased irrespective of pandemic events. The findings suggest a staggered negative impact of pandemic-related factors on young children’s mental health. Promoting infants’ mental health as well as strengthening parental resources by reducing parenting stress should be a top healthcare priority in the aftermath of COVID-19. Trial registration The study was pre-registered in OSF ( https://osf.io/search/?q=tksh5&page=1 )

Hickey et al.'s scoping of infant mental health (IMH) services and the challenges faced in ensuring that vulnerable infants can access them highlights important issues and suggests some solutions (Hickey et al., Child and Adolescent Mental Health, 2023). Their synthesis of useful research in the field is limited only by its focus on more affluent English‐speaking countries, which is acknowledged. Writing from an Australian perspective, they highlight the need for culturally sensitive service delivery. This commentary draws attention to the concept of candidacy as a helpful way of thinking about patents' journeys into services. It can support a deeper understanding of the barriers to referral for infants most in need. One key issue is the knowledge and understanding of both professionals and the public about the importance of the early years for later well‐being. Infants cannot advocate for themselves and depend on those around them to exercise their right to services. Good relationships between professionals and between family members and clinicians are essential for IMH service development and delivery. [ABSTRACT FROM AUTHOR]

IntroductionDespite compelling evidence that high-quality early care has an enduring impact, there has been little coordinated effort to transform services delivery to infuse Trauma-Informed Family Centered (TI-FC) principles into community-based agencies serving children and their families. A need for more culturally attuned, family-sensitive, evidence-based, and trauma-informed supports, especially for vulnerable children, their families and fathers, is apparent in evidence amassed by key stakeholders within the geographic area of this study. This report details the planning process, TI-FC training series, and organizational profile assessments. Authors conclude with recommendations regarding the establishment of multi-agency collectives, to include fathers, toward betterment of infant-family mental health at the community level.MethodsThe current case study details the community-level transformational effort in which major health, mental health, substance abuse, and child welfare organizations serving families of children age 0-3 worked collaboratively to enhance TI-FC services. We describe a four-stage process (1 - planning, 2 - assessment of organizational readiness, 3 - surveys, document reviews and focus groups, 4 - delivery of a training series) detailing the work of the collaborative, guided by key agency decision-makers.ResultsThe study found significant initial success in adapting approaches to serving children 0-3 and their families through TI-FC perspectives. By proactively engaging several lead organizations in a deliberative planning process with universal aims and transformational principles, the collaborative team was able to coordinate organizational assessment, staff training and consultation, self-monitoring of organizational shifts, and problem-solving of obstacles and solutions to TI-FC services delivery.DiscussionAll agencies succeeded in completing comprehensive, multi-faceted analyses of organizational culture, preparing personnel for TI-FC services through comprehensive training, and utilizing this collaborative to make deliberate and customized changes within their programs, as concerns both support of families and father engagement. Preliminary data indicate that important shifts took hold and signified changes across key domains of TI-FC care.

In this paper, we consider whether the field of infant and early childhood mental health (IECMH) needs its own code of ethics. We begin by describing unique features of infant and early childhood mental health (IECMH) and the diverse strategies that the field has developed to address complex clinical dilemmas, among them workforce development, clinical supports, policy statements, and statements of ethical values. Because of the field's interdisciplinary nature, we also consider how various contributing professions and organizations address ethical issues. While these are important resources that can inform ethical decision‐making, we identify some of the limitations of the current approaches. We argue that it is time for the field of IECMH to take an intentional, systematic approach to directly address the complex and unique ethical dilemmas faced by infant and early childhood mental health practitioners, and we grapple with some of the challenges developing such a code might entail. We suggest several avenues for better understanding the scope of ethical issues and ethical decision‐making processes in IECMH that could be used to support developing an ethics code that is responsive to the unique and challenging world of infant and early childhood mental health. [ABSTRACT FROM AUTHOR]

Infant mental health is explicitly relational and strengths based as a field. Ethical dilemmas in infant mental health have received insufficient attention at the level of infant mental health professionals (IMHP) and other professionals caring for infants who must grapple with questions of when caregivers and infants have conflicting interests. We present composite cases drawn from North American and Australian contexts, using three systems in which such conflicts may commonly manifest: child protection, home visiting, and medical settings. The field of infant and early childhood mental health (IECMH) should begin to discuss such dilemmas and how best to balance the needs of caregivers and infants when they are not well aligned. [ABSTRACT FROM AUTHOR]

Ethics is concerned with the basis for moral judgments of "right" and "wrong" and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use of ethical principles and frameworks can help navigate clinical decision‐making when there is a sense of moral conflict or ambiguity about the "right" course of action. This article aims to highlight the key concepts and principles in clinical ethics as they apply to IECMH practice and stimulate a bigger conversation in the profession around how to support each other to maintain high ethical standards in working with young children and their families. Specifically, the authors consider the relevance of Beauchamp and Childress' four principles framework (respect for autonomy, beneficence, non‐maleficence, and justice), and address some of the special ethical challenges in the field, namely, the vulnerability of the infant, the need for a competent workforce, caring for caregivers, and the problem of multiple patients. Finally, the role of infant rights is briefly explored, noting the significant interest and debate that has been generated by the publication of the World Association of Infant Mental Health's Position Paper on the Rights of Infants. [ABSTRACT FROM AUTHOR]

Little work has examined longitudinal associations between parental reflective functioning (PRF) and mind-mindedness (MM), limiting the understanding of separate or bidirectional trajectories of these related but distinct forms of mentalization. We examined cross-lagged associations between PRF, assessed via interview, and MM, coded from play interactions, over 12 months among 90 parents (86% female; 57% White, 43% Black) of infants (Mage = 10.56 months, SD = 8.20) who were participating in The Michigan Model of Infant Mental Health Home Visiting. Data were collected at study enrollment Time 1 (T1) and at 6-month Time 2 (T2) and 12-month Time 3 (T3) postenrollment. Mind-minded comments were coded as appropriate, reflecting accurate interpretation of mental states or nonattuned, characterizing inaccurate interpretations. PRF and appropriate MM each remained stable over time. PRF at the T1 positively predicted appropriate MM at T2. No other cross-lagged associations between PRF and appropriate MM were significant. Concurrent correlations between appropriate MM and PRF were significant only at T3. Nonattuned MM showed stability from T1 to T2 but nonattuned MM at the T2 did not predict nonattuned MM at T3. Greater PRF at T1 predicted less nonattuned MM at T2. No other cross-lagged associations between PRF and nonattuned MM were significant. [ABSTRACT FROM AUTHOR]

The development of infant mental health (IMH) services globally is still in its early stages. This qualitative study aims to understand the challenges of setting up IMH services and explores the views and experiences of 14 multi‐disciplinary stakeholders who are part of the IMH implementation group in a large Scottish health board. Six major themes were identified through thematic analysis. This paper examines the most prominent theme "Systems" alongside the theme "Gaps in Current Service". The theoretical framework of "candidacy" is found to be a valuable way to conceptualize the complex systemic layers of micro, meso, and macro factors that contribute to the challenges of setting up services. At the micro level, key themes included the view that services must be accessible, individualized, and involve families. At the meso level, in line with the aims of the service, multiagency integration, aspects of early intervention, and clear operating conditions were all seen as important. Finally, at the macro level, perhaps the biggest challenge perceived by stakeholders is delivering a service that is entirely infant‐focused. These findings will help inform policy makers about factors considered by professionals to be vital in the establishment of IMH services in Scotland and across the globe. [ABSTRACT FROM AUTHOR]

This study was conducted to gather information to inform key stakeholders in Virginia's Early Childhood Mental Health workforce who are involved in the Infant Mental Health Endorsement®. An "Endorsement® indicates an individual's efforts to specialize in the promotion and practice of infant or early childhood mental health within his/her own chosen discipline" (Virginia Association for Infant Mental Health, 2021). The following research questions guided this study: (1) who is part of the infant mental health endorsed workforce in Virginia; (2) what are the benefits and barriers to the Endorsement® process. A total of 115 individuals who were or are involved in the Endorsement® as endorsees or advisors were participants in the study. Participants cited many benefits of obtaining their Infant Mental Health Endorsement®, including general professional development and connecting to other professionals in the field. Barriers to obtaining the Endorsement® included time and financial restraints related to obtaining reflective supervision from a qualified Reflective Supervisor. Results from the study will be used to inform the Infant Mental Health Endorsement® process, and applied to the Early Childhood Mental Health Endorsement® in 2023. [ABSTRACT FROM AUTHOR]

Background: Families with young children are particularly vulnerable for the stressors induced by the COVID-19 pandemic. However, studies on their psychosocial situation during the course of the crisis are still sparse. Methods: In a comparison of three survey waves (wave I and III = high COVID-19 incidences), we cross-sectionally investigated the proportion of families (Ntotal = 2940) with children aged 0–3 years experiencing pandemic burden, parenting stress, and parental and child mental health problems in relation to COVID-19 incidences and restrictions in Southern Germany via validated questionnaires. Potential influencing factors were also explored. Results: The number of parents with a high pandemic burden decreased over the course of the pandemic with a peak of 65.3% in wave I (significant changes except wave II versus III). Participants with high parenting stress significantly increased from 38.2% in wave I to 51.2% in wave III. The number of parents with symptoms of depression and anxiety remained constantly high with a maximum of 28.4% being affected. Infants with crying/sleeping problems increased significantly from 26.4% in wave I to 35.5% in wave III. Toddlers' emotional and behavioral problems showed a peak of 23.9% in wave III (no significant changes). Increased family conflicts were the strongest predictor for parenting stress (ß = 0.355), maternal (ß = 0.305), infants' (ß = 0.149) and toddlers' (ß = 0.216) mental health problems during the pandemic. Conclusions: Psychosocial stress factors in families with infants and toddlers remained highly pronounced and even partly increased irrespective of pandemic events. The findings suggest a staggered negative impact of pandemic-related factors on young children's mental health. Promoting infants' mental health as well as strengthening parental resources by reducing parenting stress should be a top healthcare priority in the aftermath of COVID-19. Trial registration The study was pre-registered in OSF (https://osf.io/search/?q=tksh5&page=1) [ABSTRACT FROM AUTHOR]

This paper follows the 22‐year journey of a small community‐based program with roots in a psychoanalytic training institute, to the program's current status as an independent non‐profit organization serving families throughout the Bronx with psychodynamic, attachment‐based parent‐infant treatment. The product of an unusual collaboration among a psychoanalytic training institute, a program of the NYC Department of Education and several generous foundations, we aimed to offer teen mothers a dyadic model of parent‐infant intervention based on the principles of psychodynamic theory, attachment theory, and mentalization through the lens of an infant mental health perspective. Underlying the creation, implementation, and expansion of the Chances for Children organization at every level were questions of basic trust and mistrust, class, and culture. With this in mind, we describe the development of the model, collaborations with institutions and communities, and the obstacles we encountered along the way. On a macro level, we consider questions of class, culture, and institution that we encountered on every level in institutional bureaucracy, in community outreach, and in collaborating programs. On a more micro level, we use the contexts of a teen‐parent therapeutic group and a dyadic mother‐child treatment to address issues that arise when white, middle‐class clinicians of privilege work in communities of color that are frequently suffering insufficiencies in food, housing, jobs, and experiencing random violence. Finally, we reflect on what has made the work of Chances for Children possible, successful, and enduring even as we embarked on the telehealth practices necessary during the COVID pandemic. [ABSTRACT FROM AUTHOR]