Promoting Mental Health

Child Mental Health

The notion of promoting social-emotional development and mental health is not new to Head Start. In his 1979 critique of the Head Start Program, Edward Zigler, one of its founders stated, "We should have never allowed the intelligence (IQ) score to become the ultimate indicator of compensatory education's success or future...The goal of Head Start is the production of socially competent human beings."

The development of social competence and school readiness is of paramount concern to our society. Social and economic changes in the country are posing challenges to parents as they attempt to balance spending quality time with their children with making a living and protecting them from environmental risks affecting their health and development.

As a national laboratory, Head Start has always been a leader in the field of early childhood, recognizing the needs of low-income young children and acknowledging the impediments that need to be addressed to help them learn and grow. Children's school experience is more positive and productive when they have a sense of personal well-being and when they are grounded in stable, caring relationships in their early lives. Unhappy, fearful, or angry children are preoccupied with their struggles and their pain. This makes them unable to give their full attention and engagement to learning experiences.

Mental health needs exist on a continuum. Services to address those needs can range from activities and interventions designed to help children develop self-confidence; to interventions for children dealing with socio-economic disadvantages and social disorganization, abuse, and family disruptions; to diagnosed disabilities and health challenges. The relatively new field of infant mental health brings a multi-disciplinary perspective that enhances our understanding of infant competency, the parent/infant relationship, child development, and risk and protective factors that affect development, assessment, prevention, and intervention. This perspective seeks to enhance a family's strengths while addressing those circumstances that can threaten it.

The impacts of poverty, substance abuse, violence, physical and sexual abuse, and teen pregnancy are undeniable. Early Head Start and Head Start can help facilitate the unfolding of healthy self-esteem and internal regulation. They can teach how to tolerate, experience, and modulate deeply felt emotions-skills that lead to social competence and the capacity to participate in a learning environment.

Some key social skills are respecting the rights of others, relating to peers without being too submissive or too overbearing, being willing to give and receive support, and treating others the way one would like to be treated. Recent early childhood research, such as From Neurons to Neighborhoods and the Surgeon General's Report on Children's Mental Health, has demonstrated that developing social skills are seriously affected by the infant or young child's early experiences and the quality of early relationships. What Early Head Start and Head Start staff members do in a variety of settings and with a variety of populations can have a monumental effect on families and on society. We know that the chances of favorable outcomes, particularly when working with extremely vulnerable, emotionally damaged populations, are increased when we create nurturing, responsive environments and well-informed, well-planned interventions based on current knowledge and outcomes-based research.

As Head Start continues to encourage increased knowledge and advanced credentials within its programs, staff must also bring an increased sensitivity, awareness, sophistication, and skill level in addressing creatively the mental health needs of our children and families. The emotional needs of children and families dealing with serious life issues require a new level of emotional commitment and strength from the staff who works with them. Staff members who work with families dealing with challenging situations need to identify and reinforce their strengths, celebrate their successes, and build on the positive relationships and experiences that Head Start provides. This, in turn, demands that administrators and program supervisors provide adequate training, supervision, and emotional support for staff facing the challenge of remaining emotionally present in the face of tremendous stress, emotional pain, and challenging behaviors.

The articles in this issue of the Head Start Bulletin describe some of the most current interventions and issues affecting pregnant women, father involvement, and children birth to five, as well as some innovative program models. The Head Start Bureau and its collaborative partners are committed to reinforcing the message that mental health does not just refer to interactions between patients and therapists but to the quality of relationships in our centers and the confidence we feel in successfully creating happiness in our lives. The ways that we use curriculum to support emotional connections, the honest acknowledgement of strengths and challenges, and how we support and encourage staff all reflect Head Start's mandate to create atmospheres of social competence and mental health. We invite you to consider how your program might be able to incorporate some of the successes described here to improve the lives of your children and families. In this Bulletin, we also introduce you to Windy Hill, the Associate Commissioner for the Head Start Bureau. Windy has been involved with Head Start for many years, as a child in the program and as a parent, and she is a strong advocate for all that is best for Head Start children, families, and staff.

Beverly Gould was a 2000-2001 Head Start Fellow. T: 202-554-0484; E: priyadarsa@aol.com.

on-line...For more information on Head Start, visit our site at http://www.acf.hhs.gov/programs/hsb/

A Welcome To Associate Commissioner Windy Hill

Windy M. Hill was named the Associate Commissioner for the Head Start Bureau on January 7, 2002. She brings a lifetime of involvement and commitment to the principles of the Head Start Program. As a child, she was enrolled in Head Start in Bastrop, Texas. Her child was also enrolled in the program. She has served as a parent representative on the center's policy council and later was part of the community group that developed and received a Head Start grant. Prior to joining the Head Start Bureau, since 1993, Associate Commissioner Hill served as Executive Director of Cen-Tex Family Services, Inc. which administers nine Head Start centers in a four-county region of central Texas.

At the Region 12 Migrant and Seasonal Head Start Annual Conference held in March 2002, Associate Commissioner Hill affirmed the initiatives affecting Head Start that include fatherhood, positive youth development, literacy, faith-based, and the rural initiatives. She explained, "We see these initiatives as tools to deliver better outcomes for Head Start children and their families."

Associate Commissioner Hill described the President's early childhood initiative at the NHSA conference in Phoenix in April 2002, "The President's Good Start, Grow Smart initiative will help states and local communities strengthen early learning for young children to make sure that they have the skills they need to start school ready to learn–to ensure that No Child Is Left Behind. To strengthen Head Start's school readiness efforts, the Administration will support the development of appropriate standards of learning in early literacy, language, and numeracy skills." She explained that "Good Start, Grow Smart is about making sure that programs have the support, guidance, and leadership that ensures quality Head Start environments; healthy, successful children; and empowered parents."

Associate Commissioner Hill is very committed to the Head Start vision. "I have experienced Head Start from different vantage points and seen how it has benefited my life and the life of my daughter. These experiences have taught me the value of Head Start and the importance of putting children first." Welcome Associate Commissioner Windy Hill.

on-line...For more information on Head Start, visit our site at <http://www.acf.hhs.gov/programs/hsb/>.

The Infant Mental Health Approach

From their first moments, infants are busy building an emotional and social life.
by Gambi White-Tennant and Gerard Costa

When the Infant Mental Health (IMH) Specialist walks into the playroom, she sees Karina and her mother Karen. Six-month-old Karina sits in her infant seat on the table and Karen sits in a chair. They both face the door. Karen reads a magazine as Karina gazes at the side of her face. The IMH Specialist softly says, "Karina, is Karen the prettiest mommy you've ever seen?" Karen looks up and smiles at the IMH Specialist. The IMH Specialist then says, "Did you see how lovingly Karina was looking at you?" Karen laughs and tickles Karina's belly, saying, "You're such a silly baby!" Karina and her mother exchange sounds and giggles as the IMH Specialist looks on.

The home visitors happily chat over the complimentary breakfast that the agency provides for their meeting every Friday morning. They are also getting ready for their meeting with the Mental Health Consultant (MHC). Every Friday the MHC meets with the home visitors as a group and then holds a reflective supervision session with the home visitor supervisor. The supervisor, in turn, conducts individual supervision sessions with the home visitors. Everyone looks forward to Fridays because they feel appreciated, taken care of, and important.

These scenarios are typical of any infant/toddler program that provides mental health services. Mental health services for pregnant women, infants and toddlers, and their families can take many forms, depending on the program and the families (e.g., consulting with staff, consulting with children and families, providing direct mental health services, etc.). Regardless of how mental health services are delivered, the understanding of mental health is the same: prevention first, promotion always, and intervention when necessary.

Before making recommendations and decisions to guide the mental health services in a program, the first step is to understand infant mental health. This article will illustrate the infant mental health approach by providing a historical and philosophical context, identifying infant mental health guiding principles, and outlining examples of infant mental health program features.

Infants and Mental Health
The term "infant mental health" conjures up odd images for many-even for those people who have worked for years in early childhood settings. Some have never considered the words "infant" and "mental health" together. Some think of the negative and stigmatizing meanings of "mental health" and are surprised that infants can have mental health problems. Unfortunately, some view mental health as a human quality or a field of work that is concerned with deficits in people.

Infant mental health affirms that mental health is a positive aspect of human development (although we address problems when they arise) and the field of mental health is both proactive and reactive-hence the prevention, promotion, and intervention approaches noted earlier.

From their first moments, infants are busy building an emotional and social life. Infants' emotional development forms basic notions about the self and the world. Development in all other areas-cognition, communication, and motor skills-is organized by the emotional development of the child. Most importantly, the infant's development begins and continues within the context of an emotional relationship. As Donald Winnicott (1987), famed pediatrician turned child analyst stated, there is no such thing as an infant alone. We must always consider the infant/caregiver relationship. Emotional life is fundamentally a relational life. We must always view infants in the context of their earliest attachment relationships. This relational focus is relevant throughout early childhood-and throughout life.

Infant Mental Health as a Field
The process whereby infants and parents attach or have difficulty attaching to each other, and the factors that influence this dynamic and vulnerable process constitute the field of infant mental health. It is an interdisciplinary field that studies the optimal emotional, social, physical, communicative, and motor development of infants within the context of their earliest primary relationships.

Selma Fraiberg (1987), Social Worker and Child Analyst at the University of Michigan at Ann Arbor, is credited as the founder of infant mental health as a distinct field of intervention. She founded the Child Development Project at Ann Arbor which created influential ways of understanding and treating problems in the infant/parent relationship-most notably the notion that all work must be dyadic, meaning that the dyad, or pair, to always consider is that of the infant and parent. This gave rise to unique methods of intervention, particularly infant/parent psychotherapy and home-based services (sometimes called "kitchen-based" therapy, see article on page 39). This emphasis on the relationship, rather than on the child or parent alone, forever changed the methods used in understanding and helping infants and their families.

While students and professionals who study and work with infants and their families come from many different fields, there are certain principles that guide this work for everyone.

Guiding Principles

1. The human infant comes into the world with remarkable capacities for human relatedness-with Attachment Promoting Behaviors (APBs)-that help invite, inform, and regulate relationships with the caregiver. From the earliest moments, infants require consistency, stability, predictability, availability, and attuned love.
2. The period of life from birth to three is a sensitive period of development for the formation of character or personality. The greatest period of brain development, the brain "growth spurt", occurs from the last trimester of pregnancy through the first 18 months of life. During this period, nutritional, physical, social, and emotional satisfactions and failures will be "biologized," meaning that actual changes occur in the physical and chemical structures in the brain.
3. Pregnancy and childbirth are powerful conscious and unconscious reminders in the parent of childhood issues that can help or hinder the parent in responding to, caring for, and loving the infant. In every birth, the infant can serve as a powerful transference object for the parent-meaning that thoughts, feelings, and beliefs about other figures and events in the parent's past can become associated and confused with the infant. Pregnancy, birth, and the first two years of maternal care require the availability of psychological resources, emotional support, and parent/infant psychotherapy. Parenting is a relationship, not a skill, and the belief that parenting can be "taught" as we do other skills is not clearly supported.
4. Those of us who work with infants and their parents also have our own emotional histories that influence how we work with families-especially those families where infants are not adequately cared for or are hurt. We are not immune from the same psychological forces that influence the parent/child relationship. Infant mental health requires that these feelings be addressed. Delivery systems and child protective agencies must provide protected time for intensive and rigorous staff training and ongoing regular supervision.
5. The nature of the infant/parent relationship is best understood within the setting of the family home because the context of family events (eating, sleeping, relating, nurturing) as well as the alternate ways parents communicate to us (through pictures, objects and toys, family stories and memories) are rooted in the family home.
6. The infant/parent relationship emerges within a unique set of cultural and economic factors that provides a historical and practical context to the family and to the intervention. Infant care, expression of affection, use of health care, and relationships with mental health professionals are strongly influenced by these factors.

As we consider ways to integrate principles of infant mental health into Early Head Start and Head Start programs, we should consider the following points-

• Understanding infant mental health and working with a relationship-based approach are skills that are not exclusive to mental health professionals. These skills belong to all of us who work with infants and their families. Teachers, pediatricians, speech therapists, occupational therapists, bus drivers, nutritional staff, and all others within the Head Start family can learn ways to implement IMH practices.
• There are many strategies of intervention, including building an alliance with families and providing services and systems advocacy; developmental/parental guidance; supportive counseling; and more specialized services of infant/parent assessment and dyadic psychotherapy.

Integrating IMH practices into Early Head Start and Head Start programs does not mean that everyone must now become a psychotherapist. Those who wish to develop these specialized mental health skills can participate in the growing number of graduate and post-graduate programs being developed throughout the United States. It does, however, mean that awareness of infant mental health and the importance of working in a relationship-based way with families must be supported through training, supervision, and consultation to ensure that the guiding principles are achievable.

To incorporate these principles, programs should consider several strategies to become more infant mental health centered.

Infant Mental Health Program Features
The following features for an infant mental health program are typically implemented by using the program's internal capacity to provide mental health consultation or through collaboration with external consultants from local agencies. Any combination of employee or consultant services can be used. The design depends on the strengths and needs of the children, families, and staff, as well as on the program's human and fiscal resources.

When staff identifies children needing mental health assessment or services, a mental health professional can provide direct consultation to the children and families. This can be accomplished through playgroups that may include parents. These groups assist children in the initial learning of social skills, such as the capacity to wait, take turns, read the cues of adults and peers, and accept support from others. Groups with parents and their young children allow time for parents to enjoy their children and learn to play with them in sensitive and attuned ways. Staff is able to observe the interaction between the caregiver and child, assess the need for intervention, and model emotional presence and ways of handling emotionally challenging behaviors. This consultant would communicate and maintain documentation with the appropriate staff and parents as well as maintain communication with teachers and parents to support the outcomes of the intervention.

Another option is to provide direct consultation services to the program staff. This can take the form of regular reflective supervision with the staff members who have direct contact with children and families, or supervision of the supervisors, strengthening their ability to provide support and technical expertise to their staff. Within this context, challenging classroom interactions or difficult family situations can be discussed in depth. In this model, the primary focus is on providing training to staff rather than clinical services to the children and families.

Staff members who are trained to conduct developmental screenings and psychological assessments and to create developmental plans also provide valuable consultative services in Early Head Start and Head Start programs. Through the use of insights gained through formal and informal assessments, staff and parents can develop a deeper understanding of their child's behavior and needs.

Collaborations with local agencies, clinics, hospitals, and universities providing services to the Early Head Start and Head Start population can be formed or expanded. Students being trained as professionals within the variety of disciplines that make up infant and preschool mental health can be a valuable source of providing counseling services and playgroups as well as formal assessments.

As you design or make improvements to your IMH program keep the following in mind-

• The design must fit the strengths and needs of the children and families.
• The program's resources must be able to support the design or outside resources should be cultivated.
• Contracted services are only as good as the contract's content.
• Communication is vitally important to the success of the program.

Paraprofessionals and professionals involved must have a piece of the family picture.

These are exciting times for families and those of us who work with them. Programs that invest in knowledge and skill development will yield priceless dividends for both families and staff. Our goal is to regard every infant and family with respect, consideration, and empathy to better support their loving and attuned relationships. n

References

Brazelton, T.B. 1992. Touchpoints: The essential reference. Reading, MA: Addison-Wesley/Lawrence.

Costa, G. 1996. Guiding principles in infant mental health and their implications. Keynote Address. New Jersey Association for Infant Mental Health.

Fraiberg, S. 1987. The clinical dimensions of baby games. In Selected writings of Selma Fraiberg, ed. L. Fraiberg. Columbus: Ohio State University Press.

Stern, D. & N. Bruschweiler-Stern. 1998. The birth of a mother. New York: Basic Books.

Winnicott, D. 1987. Babies and their mothers. New York: Addison-Wesley Publishing Co.

Gambi White-Tennant is an Infant Toddler Specialist at NYU Steinhardt School of Education, Head Start Quality Improvement Center. T: 212-998- 5550; E: gambi. whitetennant@nyu.edu. Gerard Costa is the Director for the Institute for Training in Infant & Preschool Mental Health, Youth Consultation Service. T: 973-483-2532; E: gcosta@ycs.org.

on-line...For more information on Head Start, visit our site at <http://www.acf.hhs.gov/programs/hsb/>.

Relationship As Curriculum

"Child care must be understood as a profound influence on the lives of children, not as a service to parents like ATM machines." Dr. Gil Foley, Ed.D.
by Linda Lloyd-Jones

At the Zero to Three National Training Institute in Washington, D.C. in December 2000, Dr. Gil Foley suggested that we are engaged in a vast social experiment-the venue and style of child rearing are being dramatically altered. For the first time, large numbers of children are being cared for by non-family members who have a professional rather than personal investment in them. Millions of babies are now in child care, some for 50 hours a week or more. How do we as early childhood professionals provide care for young children that meets their most basic human needs?

Regardless of the setting, the experts agree that the primary need of infants and toddlers is emotional connection. Relationships are the key and emotional development is the critical domain. As Dr. Foley said, "Child care must be organized to protect, sustain, and support emotional development. What is most at risk for children in care outside the home is the development of the capacity for relationships and endeavoring sense of inner security and spark of self that are spawned in relationships."

This view is also expressed in the current report, From Neurons to Neighborhoods. In the executive summary, we learn that research has "generated a much deeper appreciation of the emotional role of early relationships as a source of either support and adaptation or risk and dysfunction. Complex emotions have powerful capabilities for the development of the essential social skills during the earliest years of life." Given the essential nature of deep emotional relatedness, how are we to capture these most profound and formative human experiences of infancy and toddlerhood in the context of a curriculum?

What does curriculum mean? According to the Head Start Program Performance Standards, curriculum is a written plan that indicates goals for children's development and learning, the experiences through which they will achieve these goals, how staff and parents will help them achieve these goals, and the materials that are needed to support these goals.

The needs of babies in group care are the same as those of babies at home-a safe, secure, and predictable environment; routines that are dictated by their own unique patterns and rhythms; and the presence of a primary caregiver who loves them. This caregiver needs to be attuned to the baby and able to recognize the baby's signals and respond appropriately. These are aspects of a good home environment that group care should replicate. As Dr. Foley put it, "The environment itself should be as home-like as possible. It should be designed to be nurturing and informal, in support of the experiences and interactions between children, caregivers, and families."

A misconception about the use of a written curriculum for infant/toddler care is that it will lead to the notion that quality care should be based on a school model rather than a home model. There is a certain pressure to define quality care as skills based and focused on cognitive development. Existing curricula look at infant/toddler development in separate domains (cognitive, gross motor, fine motor, language, and social-emotional) and set goals and objectives for babies in each of these domains. But, a rigid, fragmented perspective to infant/toddler curricula is not in the spirit of the Performance Standards. The standards clearly indicate that social and emotional development is to be encouraged by-

• enhancing each child's individual strengths;
• providing a setting that allows for building trust;
• fostering independence;
• having realistic expectations;
• encouraging respect for feelings and for the rights of others;
• supporting and respecting a child's home language and culture; and
• planning routines and transitions so that they occur in a timely, predictable, and unrushed manner, according to each child's needs. (See Performance Standard 1304.21 [A] [3].)

These mandates enumerated in the Performance Standards cannot truly be accomplished in any other way but within the context of a relationship attuned to the individual child.

Babies in group care live there. They live with caregivers and other babies and children while their parents are temporarily away. When looking at what constitutes quality care for infants and toddlers, think of it in terms of quality of life. What are the minute-by-minute, day-to-day experiences of babies in care and how does this stack up against a "good natural home environment?" One feature that distinguishes home from school is that the home does not have a rigid set of activities. Even though home has basic routines and predictability, in between the necessary daily activities that families engage in are long leisurely periods when people do the activities that reflect their priorities within the protective shelter of love.

The strong and secure attachment that infants and toddlers need to share with their primary caregivers is described as a secure home base by noted child psychoanalyst, Margaret Mahler (1975). From this home base, infants and toddlers can venture out to explore their environments, engage with others, experiment, and problem solve. This secure home base, where children can relate to and connect with their primary caregiver as they need, has to be the central focus of any curriculum. It is through and in the context of relationships that infants and toddlers learn how to be in the world.

According to research described by Dr. Ronald Lally (1997), an Early Head Start collaborator in the Program for Infants and Caregivers, infants and toddlers develop their sense of who they are from the adults who care for them. They learn from their caregivers what to fear, what behaviors are appropriate, and how their communications are received and acted upon.

They learn how successful they are at getting their needs met by others, what emotions and intensity levels of emotions to safely display, and how interesting others find them.

None of these can be taught with a narrow focus on the behavioral aspects of curriculum, but are learned through awareness in relationships.

Children everywhere are becoming themselves and experiencing their feelings in increasingly complex ways during infancy and toddlerhood. Identity formations occur and it is the relationship with babies rather than the activities planned for them that profoundly affects the child's sense of self and emotional development. Beneficial environments, high quality toys and equipment, and a variety of developmentally appropriate activities are, of course, desirable in infant and toddler care. But, the only indispensable aspect of quality care is the relationship between babies and their caregivers. All the activities and materials in the world will not make up for the lack of bonded, loving relationships.

So what should be done to ensure quality of care? One idea is to expand the focus on curriculum for babies to include a curriculum for grown-ups. Dr. Lally has provided curricula for training staff that focus on helping caregivers develop attachments with babies. This program emphasizes watching, asking, and adapting as the steps to follow when interacting with infants and toddlers.

A curriculum will set goals and objectives for adults who care for babies. For example, one goal may be that caregivers will learn and demonstrate skills that promote children's curiosity. The effects will be seen in the happy, well-adjusted, and active children who feel free to explore their environment. Helping caregivers learn to engage in authentic, deep, loving relationships with infants and toddlers is something that must be done for the long-term benefit of social and emotional competence.

We need to turn caregivers' attention away from planning what babies will do all day in care and onto what their babies are actually doing all day. Noted infant specialist Jeree Pawl (1998) offers this wise advice, "Don't just do something, stand there and pay attention." We should watch and observe our babies much more closely. What are they doing? How are they playing? What are they trying to achieve? Ask them who they are, what they need, how they can be helped. Then listen and watch for the answer and let that guide what we choose to do with our babies. In this way the baby will truly direct his or her care. The baby will lead.

This is hard work for caregivers. To truly attend to and "be there" emotionally for babies is not a skill, but a way of being. Engaging in loving, responsive relationships with each individual baby while at the same time fully supporting the family/child relationship is a tall order. It requires that caregivers have a depth and breadth of knowledge about infant and toddler development; a high degree of self-awareness; a wellspring of emotional resources; and intense dedication to the well-being of other people's children. As a society we do not yet sufficiently value the people who take on this responsibility, nor do we give them the support they need. This is an area where Head Start and Early Head Start can take the lead as a national laboratory for best practice.

Alison Clarke-Steward (1993) stated that one of the primary goals for child care is to facilitate a happy childhood. When we focus fully on training and supporting caregivers to love their babies and be responsive to their needs, this will allow for the optimal expression of each infant's needs and abilities in a curriculum. Babies in the hearts and hands of such caregivers have a real chance for a happy childhood and the development of social and emotional competence. Loving, responsive, and well-trained caregivers will know how to meet their babies' needs because they will listen to what their babies are telling them and respond from the heart.

References

Clarke-Stewart, A. 1993. Daycare: Rev. Ed. Cambridge: Harvard University Press. Foley, G. 2000.

Child care from a trandisciplinary perspective: A relationship centered approach. Presentation at the Zero to Three National Training Institute, Washington, D.C., December 1-3, 2000.

Lally, J.R. 1997. Curriculum and lesson planning: A responsive approach. Unpublished manuscript. Sausalito, CA: WestEd.

Mahler, M., F. Pine & A. Bergman. 1975. The psychological birth of the human infant: Symbiosis and individualization. New York: Basic Books.

Pawl, J. & M. St. John. 1998. How you are is as important as what you do. Washington, D.C.: ZERO TO THREE/ National Center for Clinical Infant Programs.

Shonkoff, J. & D. Phillips, eds. 2000. From neurons to neighborhoods. Washington, D.C.: National Academy Press.

Linda Lloyd-Jones is an Early Head Start Teacher, Teen Aide High School, LYFE-Early Head Start. T: 718-935-9836; E: JLloyd8475@aol.com.

Daily Separations and Reunions

Daily separations and reunions are part of the fabric of relationships. In center-based programs, they provide opportunities to develop a young child's skill at making positive transitions.
by Libby Zimmerman

From birth, positive give and take in relationships fosters social and emotional well-being and resilience. Secure relationships are particularly important for a very young child's language development, problem solving, social interaction, and emotional regulation. The patterns of interpersonal exchanges during the early years have significance for the developing brain, including the development of a young child's sense of self, as well as what the child thinks, remembers, and feels. Researchers have found that although brains are impressive in their continuing ability to change and adapt throughout the life cycle, early relationships are significant in influencing future development.

Relationships described as "secure attachments" involve identifying and enhancing positive emotional states such as joy and elation and identifying and supporting painful emotional states such as fear, sadness, and anger. Hellos and goodbyes-times when young children's emotions are often heightened-provide golden opportunities to build and enhance relationships. It is important to take into account the reality that parents and professionals often experience intense emotions themselves and are influenced by their past experience with comings and goings from loved ones.

In Early Head Start and Head Start center-based programs, reunions and separations happen simultaneously. Every morning, young children separate from their parent and reunite with their teacher. Every evening, young children separate from their teacher and reunite with their parent. Since the mental health of young children depends on the emotional well-being of the adults who care for them, providing support for the adults is equally as important as providing support for the children.

The pattern of give and take that occurs among young children and their parents and teachers shapes how children feel about themselves. Both infants and adults contribute to the quality of the relationship. Some patterns lead to a child's sense of safety and well-being. For example, an adult who generally responds to the specific emotions and non-verbal requests of an infant by remaining emotionally present and focused while not being intrusive helps a child to feel noticed and valued. As infants grow older, their contributions evolve from non-verbal signals to a mixture of non-verbal and verbal signals as the adults' verbal responses become more detailed.

Misunderstandings are inevitable in the course of the normal give and take between young children and adults. The key component in secure relationships is the ability to repair a misunderstanding. For example, when a mother realizes that her nine-month-old is fussy because he wants her to look at the light on the ceiling, not at the toy on the shelf, she will be rewarded by a delighted smile and squeal as she redirects her attention to the light, smiles, and begins to talk about it with him.

How children express emotion during hellos and goodbyes evolves with age and with their length of time in a program. A newly enrolled three-month-old baby rarely says goodbye in a pronounced way; however, she might withdraw or take time to observe another baby rather than engage with a toy or person. This apparent lack of response may be difficult for some parents to understand. Loud protests are taken as a more common sign of connection.

Older infants (six to nine months of age), toddlers, and preschoolers might say goodbye with cries of protest when they begin a new program or they might walk in with a smile and a wave goodbye. Each response merits the teacher's and parent's acknowledgement and affirmation.

Separations and reunions are stressful for the adult, especially at the beginning of a relationship. Acknowledging the adult's emotions, whatever they might be, mitigates the stress. Supervisors and peers can provide this for the teacher and the teacher can support the parent, as can other parents. A parent's feelings might range from sadness and fear about separating to relief and elation about having time away.

Saying goodbye to a crying or withdrawn child might make a parent sad. Finding and talking to another parent in the hall who is also feeling sad or finding it hard to say goodbye can be comforting. At other times the educational coordinator or site manager might be the right person to chat with for a few moments.

Staff members generally report that by the end of the first month in a center-based program, even young infants look to the teacher for comfort and stimulation and indicate preferences through calling to, looking at, and wriggling with delight towards specific staff. Teachers are rewarded by these interactions and by their ability to comfort a crying child. However, some children who are temperamentally slow to warm up may not demonstrate delight for a long period of time. They also may be quick to cry when they are getting to know a new person. Supervisors and peers can support the teachers through this process by acknowledging their feelings of frustration or anxiety.

Over time, young children begin to express joy in reunions with their teacher. How staff and parents interact can support the well-being of the adults as well as the child. When nine-month-old Leah leans out of her mother's arms with a broad smile on her face and eagerly goes to the teacher in the morning, her mother smiles warmly and says, "Oh, you are happy to see Sarah." Many mothers appreciate the pleasure their children experience in their expanding social world. However, some parents might feel concerned or anxious about whether their baby still loves them.

The teacher can have a pivotal role in reassuring the parent that the baby has room for more than one significant relationship and keeps each person "straight" in his or her own mind. The teacher can point out how the baby might wriggle or crawl towards the parent when he arrives, or help a parent understand that an older child might need time to reconnect through playing or reading a book before going home.

Infants, toddlers, and young children may cry when they separate from their parent. At times the separation from the parent may not be done in an optimal way and even exacerbate the child's distress. Here is an example of how a teacher in Early Head Start responded to the distress of a young child in a way that built her relationship with the toddler and her parent and affirmed the child's relationship to both adults.

Darlene, two years of age, bundled up in a snowsuit, hat, and scarf, arrives crying at the gate to the infant/toddler room in the arms of her mother. The mother, in a rush that morning, hands Darlene to a teacher standing at the other side of the gate. The mother dashes off after quickly saying goodbye.

The teacher says, "Goodbye, see you later." The teacher brings the child to a cozy corner with large animals. Darlene stays in the teacher's arms and sobs. The teacher talks to her gently saying, "It's okay, mommy will be back after work." The teacher's first overture to take off Darlene's hat and scarf are met with louder sobbing. The teacher holds Darlene and continues holding her, reassuring her that it is okay to feel sad and angry and reminding her that her favorite giraffe is waiting to play. Within a minute, Darlene's sobs begin to subside and she lets the teacher take off her hat, scarf, and snowsuit. Within the next minute, she is calm and explores a giraffe sitting next to the teacher.

With preschool children, we might begin to wish they would not cry or cling. We may see the tears as a failure rather than as an opportunity for connection. Parents and program staff struggle with fears that it may be "bad for the child" if we respond immediately to a crying child, especially a boy. In fact, boys, as well as girls, need to know that they can express their feelings, be comforted by caregivers, and develop their own coping mechanisms.

Whatever a child's emotional state might be, the quality of interaction between all the participants influences a child's sense of well-being when saying goodbye to a parent and hello to a teacher.

Susi, a little over three years of age, arrives walking and holding her father's hand. Susi and her father enter the room and the father greets the teachers. He kneels down and helps Susi take off her snowsuit, hat, and scarf, talking to her about what he is doing. A teacher comes over and talks to them and asks how Susi's morning was and the father describes what they ate. Susi stays close to her father as he hangs up her clothes and puts some things in her cubby. Susi observes what the teachers and other children are doing and smiles when a teacher invites her to come and sit and read a book with her and several other children. The father walks over with her and stays while she settles in and then says goodbye. Susi waves goodbye to her father and the teacher says, "Bye Dad, we will see you later." The father leaves and Susi sits close to the teacher, focusing on the pictures in the book. In a minute or two, Susi gets up and walks over to the housekeeping corner and begins "cooking" with a friend.

Although many parents and staff know that even young infants are aware of comings and goings, at times it still might be tempting to leave without saying goodbye-generally at a moment when the child is engaged in play or snuggling in the teacher's arms. The understandable goal is to prevent a child's protests and tears. However, the hidden cost is a missed opportunity for the child to develop the skills necessary for making positive transitions. Over time, adults' comforting helps children learn to comfort themselves.

Tips For Programs

Supporting emotionally meaningful separations and reunions

• Provide parents with access to staff after saying goodbye to their children. If a baby was crying when the parent left, the parent might be comforted by talking to the teacher or the director and hearing how the baby is doing.
• Spending time in the morning observing the classroom can give the parent a concrete image of other babies in the arms of caregivers singing and talking and reminding the babies that "mama or dada will be back later."
• Create a welcoming environment for parents so that they can enter the room, help children get settled, connect with a teacher, and hang out at the end of day. These moments allow the staff and parents to interact and share their feelings and knowledge of the child.
• Arrange for and invite parents to regular (monthly) parent/staff meetings to talk about their children and hear how other parents and children are doing.
• Provide regular, reflective supervision so staff can discuss their emotions and responses to children and parents.

Libby Zimmerman is a Senior Early Childhood Associate at Early Head Start National Resource Center @ ZERO TO THREE, E: Lzimmerman@acf.hhs.gov.

Stress and the Developing Brain

Some people believe that babies and young children are not affected by events that take place when they are very young, but what we do in the first three years has a tremendous impact on children's future development.
by Beverly Gould

Recent research and technological advances have changed our understanding of the developing brain. With this new information, parents and educators have the opportunity to provide children with interactions and settings that will allow them to reach their greatest potential. We now have a greater appreciation for the fact that the early years are a very fertile period in the child's life. We need to make conscious choices about how we treat children so that impact can be positive.

Research has demonstrated that there is an interaction between one's genetic endowment (nature) and the environment (nurture). Structural, hormonal, and chemical influences that are present during pregnancy affect the growth and development of the fetus. As early as three weeks after conception, a baby's brain cells begin to form (Berg 1994). These nerve cells then migrate to sections of the brain that will eventually control the reflexes, voluntary body movement, perception, language and thought. These structural changes-the cellular linkages being made-are unique to each individual infant. The linkages form as a result of the infant's experiences, both in the womb and once they are born.

Medical science continues to demonstrate the far-reaching harmful effects of stress. Stress is defined as an emotional reaction that elevates cognitive and physiological activity levels. It places demands upon the system for physical or cognitive productivity. When those demands are activated over a period of time, it progresses to a series of changes leading to exhaustion.

The degree of stress experienced by a woman while she is pregnant can have a negative affect on the fetus (Gunnar & Barr 1998). When maternal hormones, such as corticosterone and tryptophan, become overstimulated due to her own stressful conditions, there is a harmful chemical effect on the fetus' brain development.

The adult "fight or flight" response to stress is not an option for an infant or young child. Exposure to intense anger, loud screaming, or physical violence creates fear within the child that floods the brain with stress hormones. Being left alone and crying when hungry or wet are also conditions that create fear and stress in a young child. Various types of unpredictable, traumatic, chaotic, or neglectful environments physically change the brain by over-activating the neural pathways. As a result, there may be an increase in the child's muscle tone, profound sleep difficulties, an increased startle response, and significant anxiety. These responses, in turn, can lead to a permanent state of high alert, a tendency to misperceive the intentions and behavior of others, and the tendency to react with aggression.

Conscious memories of the first years of life are lost but the emotional part of the brain, referred to as the limbic system, and the body remember (Karr-Morse & Wiley 1997). An infant's first sense of what the world is like is recorded in the body. Without intervention, young children who have experienced high levels of stress will be at serious risk for emotional, behavioral, and learning difficulties.

Early Learning
Neuroscientist Dr. James LeDoux (1993) agrees that events early in life, experienced with strong emotions, can and do remain an influence throughout our lives. He suggests that what we feel is processed before what we think. Feelings experienced precognitively and preverbally continue to play out in later life even though the individual may have no conscious memory of the association. A significant trauma that takes place often or intensely enough can rob a child of the ability to learn normally by pulling away brain circuitry meant for other tasks.

An area of the brain, referred to as the amygdala, is central in understanding how stress affects learning. The amygdala governs attention, memory, planning, and behavior-all skills necessary for the child to be able to take in and process information. Difficulties in attention often include distractibility and impulsivity, which impair problem solving. In social situations, children who are overly active, impulsive, and unable to focus tend to have trouble reading others' social cues and responding appropriately to others in the environment.

Role of Relationships
Research links the external environmental influences on brain development with the quality of stimulation and degree to which the caregiver is attuned to the needs of the infant. Social interaction with an empathetic and attuned caregiver plays the major role in the growth and regulation of the child's nervous system and in helping the child develop the strength needed to become socially competent and able to learn. The consistent experience of empathy that takes place with an emotionally available caregiver gradually builds the child's capacity to empathize with others.

Relationships that a child experiences provide the foundations for approaches to learning, which, hopefully, will be enthusiastic, curious, and persistent. Stanley Greenspan (1997), a noted child psychiatrist, explains that the capacity to feel a full range of emotions-learned through relationships-allows children to organize events and ideas before they have the words to express them. Children learn how to think by creating ideas based on their experiences and how it feels to engage in those experiences. For example, young children become more focused and interactive through being able to enjoy the excitement of reciprocal play. The playful and creative give and take with an emotionally present, verbal adult motivates the development of language and encourages the child toward discriminating, generalizing, categorizing, and organizing her experiences. This is the basis for the ability to think first concretely and then abstractly.

The Abecedarian Project at the University of Alabama (Campbell & Ramey 1994) found that when at-risk young children were exposed to a stimulating environment, appropriate toys, playmates, and good nutrition, they developed less mental retardation than the control group. Early intervention in infancy, when the neurological circuits for learning are being formed, resulted in higher IQs in comparison to the control group. The conclusion was that early enrollment in a high quality, enriched day care setting is paramount to the children's significant and long-lasting improvements.

How Head Start Can Help
Head Start is in a unique position to assist in healthy brain development.

• Through services to pregnant women, expectant mothers can be helped to receive pre-natal care, get adequate nutrition, and be educated about the dangerous effects that drugs and alcohol have on the developing fetus. During pregnancy, families can be helped to identify areas of stress and provided with the necessary emotional support and assistance.
• Parents need to be educated about the child's need for appropriate stimulation. As caregivers learn to read the child's cues, undue stress can be avoided. Parents need to understand the importance of talking and reading to the child, holding a child during feedings, making eye contact, singing, and playing games that provide novelty and fun.
• Parents also need to be supported in maintaining their own mental health. Untreated depression and anxiety interferes with the parent/child bond and interrupts a parent's ability to be fully aware of the child's needs.
• Abuse, neglect, and family violence must be prevented. The population at large needs to be aware of the devastating impact these things have on growing children.

In addition to the developmental assessments required by the Head Start Program Performance Standards, an assessment of the interaction between the caregiver and the child can identify relationship issues that might need mental health intervention. The ability of caring and well-informed Head Start staff to recognize problems early can prevent difficulties that would be much more difficult to remedy later.

Classroom teachers and home visitors play a crucial role in optimizing healthy brain development. Infant researcher Ron Lally (1995) points out the key role the infant/toddler caregiver plays in the development of the child's sense of identity. Through imitation and absorption of the environment, children form their sense of who they are in the world. Helen Raikes (1993) cited the importance that a relationship between a child and a high quality teacher plays in "modulating attention, creating interest, building trust, and assuring predictability for the infants." This is especially true when the child is given the time needed with one teacher, as opposed to multiple interactions from a variety of caregivers. The time spent building this attachment allows the teacher to fine-tune her interactions based on her intimate knowledge of the individual child and his needs and responses. Both parents and children can be supported in Head Start to minimize stressful situations that impede healthy development.

References

Berg, B. 1994. Child neurology: A clinical manual. Philadelphia: J.B. Lippincott Company.

Campbell, F.A. & C.T. Ramey. 1994. Effects of early intervention on intellectual and academic achievement: A follow-up study of children from low-income families. Child Development 65: 684-698.

Gunnar, M.R. & R.G. Barr. 1998. Stress, early brain development, and behavior. Infants and Young Children 11(1): 1-14.

Greenspan, S. & B. Benderly. 1997. The growth of the mind: And the endangered origins of intelligence. Boulder, CO: Perseus Books Group.

Karr-Morse, R. & M. Wiley. 1997. Ghosts from the nursery. New York: The Atlantic Monthly Press.

Lally, J.R. 1995. The impact of child care policies and practices on infant/toddler identity formation. Young Children 51(1): 58-67.

LeDoux, J. 1993. Emotional memory systems in the brain. Behavioral Brain Research 58.

Raikes, H. 1993. Relationship duration in infant care: time with high ability teacher and infant-teacher attachment. Early Childhood Research Quarterly 8: 309-325.

on-line...For more information on Head Start, visit our site at <http://www.acf.hhs.gov/programs/hsb/>.

Beverly Gould was a 2000-2001 Head Start Fellow. T: 202-554-0484; E: priyadarsa@aol.com.

THE PSYCHOLOGICAL WORK OF PREGNANCY

There is no other activity in a woman's life that will require her full emotional presence and involvement as much as raising a child. This is especially true for the birth of the first child.
by Beverly Gould

The Head Start Program Performance Standards mandate that family and health care providers offer services for pregnant women that address both physical and mental health needs. Head Start is in a position to provide invaluable support to expectant and new mothers. This article will explore some of the emotional needs of mothers and discuss areas for fruitful exploration and intervention to help in that process. Pregnancy ushers in a tremendous physical and psychological transformation. Besides the bodily changes, there are disruptions in basic physiological processes that affect sleep, appetite, and digestion. Hormonal surges can affect mood and the ability to think and to remember. There are also intensely ambivalent emotions and fantasies about the process of labor and delivery.

A woman also experiences changes in her sense of self. She has to expand her sense of who she is to incorporate her child as a part of herself, yet also as a separate being. The appearance of a child will change her intimate relationships, such as with extended family members, as well as her role in society.

Mental Work and Reworking
In looking at the period surrounding a woman's giving birth, Daniel Stern (1995) described this as a time when she must engage in the greatest amount of "mental work and reworking" in her life. He says that this is especially true for the birth of the first child since no amount of babysitting or exposure to siblings can prepare a woman for the intense empathic connection needed to mother successfully a child. There is no other activity in a woman's life that will require her full emotional presence and involvement as much as raising a child. Stern identifies four concerns that preoccupy the expectant mother.

First, the expectant mother is afraid of not being able to maintain the baby's life. She has fears for her own and the new baby's survival. Once the child is born, she wonders if she will be able to provide the care that will allow the infant to grow, progress, and thrive. She is very vulnerable to the criticism and judgment of others. Society expects the birth of a new baby to be a happy time. For many women, even those who are in the most supportive circumstances, it is conflictual and stressful.

Second, the expectant mother wonders if she will really be able to feel love for her baby. Will she feel the bond that society says she is supposed to feel? Will that bond allow her to develop the special sensitivity that will allow her to read and respond to her baby's needs?

The next concern is the expectant mother's ability to create and maintain an adequate support network for herself. There are no societal structures that function in place of the extended family. As a result, there is greater stress on the father, if he is present, to provide the emotional support so that the mother will be able to devote herself to the child. Stern sees inherent dangers for a mother who has a limited support network and therefore, limited sources for feedback, information, and emotional support. She may be seen as an inadequate mother by the father or the extended family; the father may compete with the baby for her attention; or the father may compete with her to be the "better" parent.

A new mother may fear emotional as well as physical abandonment. In the past, a supportive network of women who surrounded the mother and baby, keeping males outside of the protective circle, used to be something that all women could rely upon. Besides her baby, the new mother's major involvement would have been with these maternal figures.

A new mother also reflects on her relationship to her own mother. This allows her to remember the intricacies of this first important relationship, and to form either positive or negative models of parenting to guide her own behavior.

The fourth concern deals with a woman's need to rework her sense of identity from "daughter to mother, companion to parent." A preoccupation with the memories and emotions connected to the long line of women throughout the family history causes a woman to reconsider her beliefs and her choices. Stern says that this is how the intergenerational transmission of family values and behaviors occurs.

Babies cannot wait. During their waking hours, the mother must be able to set aside her own preoccupations and concerns so that she can be attuned to her child's needs. The work of Selma Fraiberg (1980) and other infant researchers tells us that an infant stirs up many intense, raw emotions that reflect the mother's unresolved conflicts with her own mother and father.

Reviving Old Patterns
These "ghosts" from the mother's past can have an enormous impact on her entire pregnancy experience and on her ability to connect to her child. Simply having mixed feelings about being a mother can raise significant conflict and guilt for women who are not comfortable accepting emotions typically seen as negative. For example, a woman may expect her child to be active and controlling, as her own mother always described her and this would influence the way she perceives the needs and behaviors of her child. The key for a healthy relationship between mother and child is for the mother to be consciously aware of the issues between her and her mother, thereby avoiding displaced anger or feelings of abandonment or loss. This will help her not to be preoccupied with winning or avoiding power struggles as they arise with her young child.

For those women who have had significant difficulties growing up or have been the victims of trauma or abuse, it is important to help them identify the good qualities of their mother among the difficult memories of their early lives. The demands of being in the mothering role can be a terrifying experience for women unable to resolve a deep-seated belief in their own "badness" or fear of "turning into their mother." Attempting to relate to a helpless, crying, demanding, and dependent infant can trigger old patterns of behavior from the mother's childhood where she was perceived negatively because of her own mother's unmet needs and psychological difficulties. Without awareness of her past and the feelings associated with the trauma or abuse, she may in fact treat her child the way she was treated rather than in a more healthy, protective, and nurturing fashion.

Family Dynamics
A new baby also changes the dynamics between the couple and within the nuclear family. The father experiences a significant change in role and identity. In today's western culture, a father's role is more than financial; men are expected to take on increasing amounts of responsibility for the child's emotional and physical care. A man may feel ambivalence about the changes in his partner. He may also feel abandoned and excluded as the woman turns her attention to her pregnancy and new baby. On the mother's part, it may not be easy to share caretaking with the father since it has traditionally been the domain of women. Without awareness, issues of power and control may arise. As the partners move from being a couple to a family, all decisions will need to consider the needs and the role of the child.

Emotional Stress and the Infant
Current research, particularly the work of Megan Gunnar (1998), demonstrates the negative effects that emotional stress has on the developing fetus. Those who provide services to pregnant women and their families need to help expectant parents talk openly and fully about positive and negative feelings associated with pregnancy and their role as parents, including fears about the pain of childbirth. They need to explore how the new child will affect their relationship with extended family and discuss boundary issues that may arise if a family member is perceived as too helpful, too distant, or too critical. Important discussions can occur about the values that each parent holds, such as around discipline or religious matters. Older siblings also need to be prepared for the new baby and helped to deal with the anxious and jealous feelings before and after the birth.

Women need to be educated about maternal depression and its consequences for the development of their child. Support groups for pregnant women, a doula (a labor and post-childbirth support person), non-medical childbirth coaching, mother/baby groups, and father/baby groups can be useful in providing the needed support and in assessing potential difficulties. Pairing more experienced mothers with new, young mothers who can mentor and be positive role models may also be useful.

Teaching parents about the stages of development allows them to anticipate the joys and challenges that they will face as their child grows. In those situations where the mother's emotional difficulties require more than community support, or a child's temperamental or constitutional factors lead to a difficult fit between parent and child, referrals to early intervention or qualified infant mental health practitioners can be necessary.

Helping our Head Start families become emotionally prepared during pregnancy can go a long way in preventing emotional difficulties after the baby is born. We know that times of change can bring great opportunities. The birth of a new baby should be a joyful time. For many of our families who have severe external stressors, such as financial difficulties, young or unwanted pregnancies, traumatic abuse, or substance abuse histories, this is a time when our active intervention can open up unseen possibilities and provide much needed insight and support.

References

Fraiberg, S. 1980. Clinical interventions in infant mental health: The first year of life. New York: Basic Books.

Gunnar, M.R. & R.G. Barr. 1998. Stress, early brain development, and behavior. Infants and Young Children 11 (1).

Stern, D. 1995. The motherhood constellation. New York: Basic Books.

PUTTING THIS TO WORK IN YOUR CENTER
Steps that programs can take to promote the mental health of new mothers and fathers-

• Form support groups for pregnant women to share fears and expectations and educate them about pregnancy, childbirth, and child development;
• Form activity groups like knitting or craft groups as a vehicle for support and discussion;
• Pair young mothers with older, more experienced mothers as mentors;
• Form support groups for fathers;
• Form mother/baby and father/baby groups to encourage responsive interactions and reciprocal play;
• Use videotapes as a tool in teaching how to respond to an infant's cues;
• Provide anticipatory guidance showing new parents what to expect at each phase of development;
• Explore in-depth the themes described in this article with both parents, whether or not they are together.

Head Start Program Performance Standard 1304.40c iii
Early Head Start grantee and delegate agencies must assist pregnant women to access comprehensive prenatal and postpartum care, through referrals, immediately after enrollment in the program. This care must include mental health interventions and follow-up, including substance abuse prevention and treatment services, as needed.

Beverly Gould was a Head Start Fellow (2000-2001). T: 202-554-0484; E: priyadarsa@aol.com.

Buffering the Effects of Maternal Depression*

Did you know approximately one in ten women with young children experience depression? Rates often reach two times this level for mothers living in poverty. Depression is likely to touch someone in our lives as well in as the lives of the families we serve.
by Tisha Bennett

Fortunately, some children escape the negative effects of maternal depression. In a review of several decades of research, Shonkoff and Phillips (2000) emphasize that many depressed women do raise children who demonstrate no social or behavioral difficulties. Some studies suggest ways to prevent or protect damaging processes from occurring in young children's lives. Early Head Start and Head Start programs are in a position to benefit from this research and intervene to support young children and their parents who might be experiencing depression. Their intervention efforts can be guided by research findings related to the complexity of maternal depression, the effects of maternal depression on young children, and the importance of prevention and early intervention.

The Complexity of Maternal Depression
Depressed mothers typically have difficulty providing optimal levels of stimulation for their babies. Mothers who suffer from untreated depression engage in two distinctive interaction styles with their infants (Field 2000). One style is characterized by the caregiver's withdrawal from the infant's cries or smiles, minimal display of facial expression, and difficulty expressing emotion or even talking to the infant. The other style is characterized by the caregiver's irritability, expressions of anger, and demands for a reaction from the child. It is unclear as to why mothers with depression display these differing interaction profiles; one, withdrawn, the other, intrusive. But, it is clear that each style is painful for the adult. One mother described the feeling of "moving through water" to reach her crying infant.

Effects on Young Children
Research suggests that each mother/child interaction style has different effects on the infant or young child (Field 2000). Infants of withdrawn mothers display low activity levels, inattentiveness to people, activities, and objects, and low expressiveness in response to the facial expressions of adults. In contrast, infants of intrusive mothers display higher activity levels, a mix of positive and negative facial expressions, and high attentiveness and expressiveness in response to the facial expressions of adults. Preschoolage children of withdrawn mothers appear less socially responsive, less able to regulate their own behavior and impulses, and more inhibited. They also show internalizing behaviors, such as liking to be alone. In contrast, preschoolers of intrusive mothers are more responsive, more able to regulate their behaviors, and less inhibited. Furthermore, they are likely to show externalizing behaviors, such as getting in fights and teasing others.

The Importance of Prevention and Early Intervention
Even though maternal depression may have negative developmental outcomes for children from a wide range of life circumstances and family environments, certain factors serve to minimize, or buffer, the effects of maternal depression on young children. For instance, research by Hossain and colleagues (1995) shows that involved, supportive, and emotionally healthy fathers and child care providers cushion children from negative effects of maternal depression.

In addition, when maternal depression occurs in a family experiencing marital harmony, mothers are better able to sustain positive and healthy interactions with their children. In turn, the children are more likely to display sound social-emotional behaviors. Recent studies also suggest that depressed mothers who use excessive verbal stimulation with their infants may actually facilitate better cognitive and language development. Understimulation may be worse than overstimulation during infancy. Furthermore, since the effects of maternal depression begin as early as pregnancy and appear to be long lasting, findings emphasize the importance of early intervention.

Implications for Programs
One of the primary goals of Early Head Start is to enhance infants' and toddlers' overall social, emotional, physical, cognitive, and linguistic development. Therefore, it is vital that Early Head Start as well as other Head Start programs promote the physical and mental health of mothers. Programs are in a unique position to support the mental health of pregnant women and mothers, but must be sensitive to the barriers depressed parents experience in receiving services.

Depression makes it difficult to mobilize and focus energy. Many parents experience shame and fear that professionals might see them as incapable of parenting. However, given that parents love their children, the birth of a child can provide the impetus to seek services to provide a better life for the new son or daughter. In addition to benefiting from the direct support and therapy offered them, depressed parents are reassured knowing that their infants and toddlers are receiving nurturance and support within center-based or family child care programs.

By looking for brief moments of positive interaction and reflecting on them with a parent, program staff help build the parent's confidence. Low self-esteem often accompanies depression and the home visitor and center-based teacher can provide positive images and reinforcement. For example, a home visitor could support a depressed mother with a more demanding interaction style by noting when the mother takes turns vocalizing with her baby and admiring the interactions when they occur. Or, a teacher working with a depressed mother with more withdrawn interactions could highlight when the parent smiles or talks in a lively way with the child.

Providing staff with access to mental health consultation can support timely and effective referral to mental health services. Regular, consistent mental health consultation services are key for supporting staff and families and can help distinguish the parent's or staff member's normal emotional ups and downs of life from clinical depression. A skilled mental health consultant can help staff find ways to connect with a depressed parent as well as support them through the parent's potential resistance to getting help. Furthermore, the mental health consultant acknowledges that staff and parents approach the issue of depression, or mental health, from their own beliefs, values, and family history with mental health services.

* The research discussed within this article is specific to mothers with depression. However, the mental health of the primary and other significant caregivers is important for the well-being of infants and young children. [back]

References
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