InfantMentalHealth (IMH) is an interdisciplinary field and embraces the importance of promoting positive mentalhealth development within a relational framework with the child’s caregiver(s). IMH practice is best understood along a continuum which includes promotion, prevention, intervention and treatment integrated across services and disciplines. IMH principles incorporate developmental, clinical and preventative perspectives that inform the practice of service providers of different disciplines whose original training may have emphasised a different knowledge base and different skills. Some lack knowledge about infant development and behaviour in the early years, but have a strong clinical understanding. Others are well prepared to meet the developmental needs of very young children but may be new to infantmentalhealth principles and practices. For most, working within a relational framework is new and requires specialised education and training relevant to each individual discipline but, more importantly, also on how best to integrate IMH principles across disciplines and services. The work in this document discusses the implementation of this training and an analysis of its benefits in the HSE North Cork Child & Family Psychology Service (NC-CFPS) and Community Work Department (CWD).
Secret, 2012); there is a lack of evidence comparing the attachment relationships between infants and fathers placed in different categories of prison. It is therefore difficult to ascertain from the literature the full impact of repeated arrests and consequently, repeated separations on infantmentalhealth (Rosenberg, 2009). The infrequent and unpredictable presence in the infants life of a father involved in the criminal justice system suggests the onset of inevitable ambivalence towards him (Balbernie, 2003; Tyano et al, 2010). However, evidence implies that it is the style of attachment relationship preceding or surrounding the period of separation that ultimately determines the emotional state and resilience of the infant (Pugh, 2004; Murray and Farrington, 2008). This suggests why family-centred and family-friendly policies in prison to maintain family connections is so important to preserve this resilience (Woodall et al., 2014).
31 “Champions” throughout the state. Most states reported that they worked on laying the foundation for the Endorsement or competences years in advance of actually implementing the Endorsement. In Colorado, for example, work on the Endorsement started in 2004/2006. At that time there was little momentum but a large number of stakeholders from child care systems, community mentalhealth centers, departments of education, and universities. “There were a lot of decision makers. At that time the initiative was stopped due to financial considerations. The project needed more support from the stakeholders and funding.” Colorado’s purchase of the endorsement was unique among the League of States. Before the statewide infrastructure was in place, Weld County used Project Launch funds to pilot and evaluate the endorsement within one agency, Northrange Behavioral Health. The final operational details for a statewide implementation were put in place in 2011, including the creation of the Colorado Association of InfantMentalHealth infrastructure. At this time there are 22 people who have completed their endorsement in Colorado.
These varied sources demonstrate a high contemporary interest in shifting the balance from intervention to prevention in work with young children. The systematic reviews from different nations show that there is international interest and faith that appropriate relationally based intervention and prevention is the best chance of changing outcomes for children in high risk families and communities. The challenge is significant. The topics reviewed in the 10 Cochrane Systematic Reviews identified with the search term ‘infantmentalhealth’ included: perinatal mentalhealth; parent-infant psychotherapy for improving parent and infantmentalhealth; group based programmes for improving psycho-social outcomes for teenage parents; group based programmes for improving emotional and behavioural adjustment; massage for promoting mental and physical health in babies of under 6 months; psychosocial and psychological interventions for treating antenatal depression; financial benefits for child health and well-being in low income or socially disadvantaged families in developed world countries; home-based child development interventions for preschool children from socially disadvantaged families; home visits during pregnancy and after birth for women with an alcohol or drug problem and schedules for home visits in the early postpartum period. (See the Supplement 3, Cochrane Review for more detail). In nearly all cases these reviews showed there was either insufficient research, that research was not of a high quality or that it was inconclusive.
The protocol describes an experimental evaluation of an indicated brief manual- and group-based parenting educa- tional program to enhance parental sensitivity and attach- ment compared to care as usual in a large community sample. This is an evaluation that has not yet been made in Denmark or internationally. Results will provide new evidence regarding the efficacy of a short term indicated parenting group program developed in the Unites States when implemented in a Scandinavian country. Further, COS-P is a promising approach as health nurses can be trained COS-P therapists in a future up-scaling. The effi- cacy of COS-P will be compared to the efficacy of Care as Usual (CAU) offered in Copenhagen to families identified to be at risk and in need of support. Results from this study will inform the City of Copenhagen of whether offering a systematic manual based short term parent intervention is more efficient in targeting infantmentalhealth risks than what is currently offered as indicated prevention. Further, as we are collaborating with econo- mist the study will provide knowledge of the cost- effectiveness of COS-P compared to CAU in the City of Copenhagen. If proved effective the study will represent a notable advance to initiating the COS-P intervention as part of a better infantmentalhealth strategy in Denmark. Conversely, if this system is similar or inferior to the current system, this is also important knowledge in regard to preventing infantmentalhealth risks in a cost effective way in a general population.
professionals need the diagnosis to justify provision of and payment for services (Achenbach & Rescorla, 2004). In addition, training for clinicians with statutory access to infants, such as health visitors and other primary health care workers, does not generally focus on diagnostic frameworks shaped by a medical model derived from adult mentalhealth criteria. However, classification and identification of infantmentalhealth problems, and sensitively probing about emotional difficulties very early on may help implementation of interventions whilst assessing parental willingness to engage with such a process. A substantial number of interventions relevant to infantmentalhealth are available (Barnes, 2003). Appropriate interventions, such as Video Interaction Guidance (Svanberg, Mennet, & Spieker, 2010), parenting programmes (Hiscock et al., 2008), and home- based interventions (Olds, Sadler, & Kitzman, 2007) could be directed to families with infants whose behaviour is challenging, those with a difficult temperament or those who cry excessively and/or are difficult to soothe (Douglas & Hill, 2011).
Statistical analyses were carried out using the SAS version 9.3. Descriptive statistics was used to examine the differ- ences between participants and non-participants regarding child sex, gestational age, birth weight, Apgar score, parent young at child birth, parent born outside Scandinavia, parent more than 10 years of schooling, parent living together at child birth, mother mentalhealth problems and mother-child relationship. Moreover, we examined the frequency of CIMHS problems and differences be- tween boys vs. girls, children born preterm (<37 weeks) vs. term, low birth weight (<2500 g) vs. high, low Apgar score vs. high (statistical testing by chi 2 test, p-value <0.05). Exploratory factor analysis (EFA) was applied for a tentative search of patterns initially supporting the theoretical construct of infant psychopathology .
The appropriateness of the PMHS service to clients’ needs can be addressed statistically, and by capturing service users’ opinions. There can be little constructive debate about the high incidence (often placed between 10% and 20% of the population) of behavioural and emotional problems in pre-school age children, nor of the impact these can have on parenting, family functioning and on carer health, which has been widely researched. The less well researched (and consequently more theoretical) argument that an early solution to attachment problems and family dysfunction reduce the need for later service involvement can also be claimed, if not currently fully evidenced. Pressure on CAMHS to try to manage the more pronounced and acute difficulties present in older children, together with the workload and skills demands in those working in the community, together define the ‘Tier 2 gap’ for this client group, a gap the PMHS service attempts to fill.
DW: Yes, there are many in the league states: Arizona State University, University of Minnesota through CEED, Dual Degree program in IMH and Nursing, Education, and Social Work at Wayne State University in Michigan, Infant Studies graduate program at Michigan State University, University of Wisconsin's Certificate Program. Please see the full PowerPoint in which I gave examples of these higher education programs that are incorporating the competencies into the curriculum. Since they are interdisciplinary, they include early childhood. Montclair State University in NJ offers a graduate certificate in InfantMentalHealth through its Center for Autism and Early Childhood MentalHealth aligning course material with Michigan Competencies.
As in the 2008 review (Korfmacher & Hilado, 2008), certain topics were grouped together under the category of basic principles because they cut across the other categories and represent essential approaches to helping families with young children. All of the topics coded as basic principles were noted in a majority of the systems, with all but two in at least five of the six systems. Referencing culture and diversity was the most frequently coded topic, followed by a focus on the helping relationship that develops between service provider and family, and maintaining a strength-based approach. As would be expected in an infantmentalhealth approach, an emphasis on family issues and having a family-centered practice occurs in all the systems, as does attachment and a focus on relationship-based care. Ethical practice is appropriately emphasized across all systems. A recognition of the impact of the parent’s own past on his or her current relationship with the child, captured in the phrase “ghosts in the nursery” (Fraiberg, 1980) and a signifier of a classic psychodynamically based approach to infantmentalhealth work, is noted across almost all the systems, but much less frequently than the other basic principles codes. One of the topics in the basic principles category, “outcomes-based approaches” (used in four systems, with 30 mentions total) is noteworthy for what it does not emphasize. For example, the Vermont system lists the following competency: “Employs an outcomes-based approach to planning and applying interventions” (Vermont Northern Lights Career Development Center, 2013a, p. 9, 34). This phrase uses “outcomes” in a broadly applied and generally undefined manner. Systems rarely note the importance of services being “evidence-based” or for specialists to have knowledge of or employ empirically-validated interventions. An evidence-based approach was noted in three systems (California, Florida, and Vermont) with only four mentions total, a low number given its current emphasis in both early childhood practice (Khetani & Kasiraj, 2009) and mentalhealth care systems and policy (Substance Abuse and MentalHealth Services Administration, n.d.). 14
Recent developments in neuroscience, infantmentalhealth, and attachment, as well as prenatal and perinatal psychology and health, show us that the optimal, most cost-effective time to make positive interventions in human development is from the very beginning of life. New research demonstrates that many life-enhancing or life-diminishing patterns are found to originate in the pre- and perinatal period, including resiliency and health or chronic disease, self-regulation, and attachment issues. The best outcomes occur when mothers and families are supported in their mental and physical well-being during pregnancy, birth, infancy, and early childhood. Research and clinical practice show us that we need to erase the mental divide that has existed between prenatal and birth and redefine “zero” as conception or
Sustaining the project occurred in several ways; main- taining staff engagement through good communication, focusing on this being an MDT intervention and engraining the project into the culture of the ward were key. Also bene ﬁ cial were the weekly frequency and regu- larity of sessions, the almost daily discussions with staff and patients about the importance of the project. Ongoing engagement through formal (e.g. discussion in MDT meetings) and informal meetings helped to main- tain focus. As the sessions ran over multiple weeks the intervention became more ingrained in the culture of the ward; nurses became used to helping invite patients to attend and patients came to expect the sessions. Physical health leads for the Trust were approached and a presentation given at the Trust physical health confer- ence to engage wider and more top down support.
13 that emerge when using section 136. Despite this, more input is required from health organisations and service users to develop a more holistic understanding of the impact of these innovations. These novel developments align with the aspirations of the World Health Organisation and World Bank in promoting innovative responses to the challenges of mental ill-health and its oft neglected position in public and governmental priorities. The next step is to ensure that innovation is consolidated and embedded as a sustainable development which highlights the economic, social and political benefits of addressing mental ill-health. This is likely to require new legislation to address some of the unresolved human rights issues raised in this paper and it certainly requires institutional level developments to surmount some of the inter-agency working challenges that remain. Best practice examples such as the bespoke mentalhealth emergency response service in Western Australia (2017) may seem a bold and distant ambition but further improvements in collaborative working between the police and health services will lead to significant health benefits and resource savings. These benefits and savings could be amplified further with investment to mobilise third sector agencies to support new initiatives.
Mentalhealth problems have become an increasing focus of attention during the last two decades, both of the public in general and of health care policy makers. Meta-anal- yses demonstrate that common mentalhealth disorders are highly prevalent globally with twelve months prevalence estimates around 30% and lifetime prevalence even higher (86) (87). Furthermore, mentalhealth disorders are associated with immense impairment and disability for individual and society (years lived with disability, work loss days, work productivity, quality of life, etc.) (88). Evidence is growing that, in the Netherlands, costs of mental disorders are comparable to those of physical illnesses and that a substantial part of the costs are caused by new cases (89). These findings are supportive for strengthening preventive mentalhealth care and stepped collaborative care models, where the least intensive treatment is offered in primary care and the treatment intensity is stepped up, when necessary, in specialised mentalhealth care. While the clinical effectiveness of collaborative care models in primary care is well established for different mental disorders, the cost-effectiveness is inconclusive (90), (91). Many studies compared collaborative care with regular GP treatment in primary care, wherein the collaborative care treatments did not seem to be cost-effective for the treatment of depressive symptoms (90), less serious mentalhealth problems (92), panic disorders (93), and prevention of depression and anxiety in elder persons (91). A quantitative Cochrane review conducted by Bower and Rowland (94) indicated that counselling in primary care does not seem to be any better than GP care in the long term and that although some types of healthcare utilization may be reduced, it does not seem to reduce overall healthcare costs. They also concluded that there is very lim- ited evidence comparing counselling with other psychological therapies. The results of available trials seem to be more positive concerning cost-effectiveness. Drummond et al. (95) compared a stepped care intervention with minimal intervention delivered by a practice nurse. He concluded that the stepped care intervention resulted in greater cost savings compared to the minimal intervention.
The findings from the current study may not be generalizable to all teachers and schools. For example, the schools pegged “rural” in the current study may not have much in common with more remote schools in other areas of Ontario. In addition, because this study focused on teachers’ perceptions and self-ratings, it would be inaccurate to draw definitive conclusions about how teachers are actually intervening with students in their classrooms. It would be valuable for future researchers to measure both student and teacher behaviours in the classroom (as they relate to mentalhealth) in order to attain a more accurate description of classroom proceedings. Lastly, the inability to factorize the two survey scales (Actions and Supports) suggests that the survey instrument used in the current study could be revised for future use. Although the items on the questionnaire are still valuable independent of one another, it would have been beneficial to look at the responses in a more parsimonious manner, using congregated test items.
Anxiety disorders and depressive symptoms are two of the most prevalent mental disorders. Both anxiety and depressive symptoms can take a chronic debilitating course, with depressive symptoms particularly related to increased morbidity and mortality from medical condi- tions and decreased quality of life, among other conse- quences [5, 6]. Beyond mental disorders, social support and stressful life events have also been shown to affect an individual ’ s mentalhealth and psychosocial well- being . Individuals need not suffer with mental illness in Canada without treatment, as evidence-based treat- ments for the most common mental disorders , can be accessed within the provincial healthcare systems.
The program also appears to be more beneficial for people with more experience in formal learning settings, who gained an almost two fold greater benefit from par- ticipation than those with fewer years of formal educa- tion. As well as the generally protective effect on mentalhealth of socioeconomic status and better education, it is possible that better educated participants were able to make more effective and sustained use of the psycho- education during admission than those with less educa- tion. The service is currently reviewing the model of care, including simplifying written materials and provid- ing more supported practice of new skills and opportun- ities for individual explanation during the admission. Longer elapsed time to follow up was also associated with greater improvements in infant behaviour. This might be explained by growing infant maturity with the passage of time or resulted from the time taken for par- ents to establish new patterns of infant care before the benefits became apparent.
The importance of speech and language is further emphasised by the redefi nition of some mentalhealth categories that is currently underway. This preface is written a few weeks before the introduction of DSM-S, the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). It is currently assumed that Aspergers will not be part of this edition, which will be published in May 2013. DSM-S will introduce a new category, Social Communication Disorder (SCD), which is a language disorder and as such different from AutismSpectrum Disorder (ASD) as defined in DSM-S. While the exact criteria for SCD are still unavailable at this point in time, it is assumed that this disorder will focus on a "qualitative impairment in social interaction" . This moves the pragmatic aspect of language-the use in social interactions-to centre stage. Hence, the analysis of social interactions by come putational methods will be essential for research on SCD and the development of ... psychological tests.
1 reports the under-reporting rates of prescription drugs. The under-reporting rate of depression drugs is equal to 20%. The under-reporting rates of the other drugs are lower (13%-14%). Table 2 examines under-reporting for a subset of people who use multiple drugs. This analysis is akin to an individual fixed-effects model. For example, we take an individual observed as taking drugs for both depression and diabetes, and examine the relative excess under-reporting of mental illness for the same individual. Column 2 in Ta- ble 2 shows that among people who take both drugs, mental illness diagnosis and drug use is under-reported 45% and 22% of the time, respectively, whereas diabetes diagnosis or drug use is under-reported only 14% of the time. Overall, the results presented in Tables 1 and 2 suggest that the stigma of mental illness can lead to substantial under-reporting of mental disorders in the survey data.
Coronary Artery Risk Development in Young Adults acknowledge that depression can be a risk factor for obesity. In 2010 Needham, et al. found that people who were depressed gained weight significantly faster than people without depression symptoms. Moreover, depression symptoms were positively correlated with a subsequent increase in waist circumference . Depression in adolescents can be a predictor of obesity. The National Longitudinal Study of Adolescent Health found that depressed mood at baseline significantly predicted obesity 1 year later among those who were of normal weight at baseline . Another longitudinal cohort study about the relationship between adolescent depression and adult obesity conducted by Richardson LP, et al. showed that depression in late adolescence is associated with later obesity, but only among girls . Major depression occurred in 7% of the cohort during early adolescence (11, 13, and 15 years of age) and 27% during late adolescence (18 and 21 years of age). At 26 years of age, 12% of study members were obese . There was found bidirectional relationship – obesity increased the risk of depression by 55% and depression increased the risk of obesity by 58% .