Guiding Principles

by Deborah Roderick Stark, Rachel Chazan-Cohen, and Judith Jerald

Participants at the Infant Mental Health Forum, held in October 2000 (see article on page 46), recognized that a comprehensive approach to the emotional health of infants and their families must be guided by a set of principles that influence policy, programming, service delivery, materials development and dissemination, training, technical assistance, research, and funding. Like the principles that undergird the Early Head Start program, the principles outlined below convey respect for the individual, appreciation of strengths, and the need for continuous, stable, and accessible relationships and supports. The guiding principles define the ways in which the systems—early care and education, early intervention, health, and higher education—can work individually and collectively to create an environment that honors the relationships necessary for promoting the emotional health of infants and their families.

All pregnant mothers and their partners and new parents need to have relationships that support their emotional well-being and prepare them for the joys and challenges of parenthood. All infants need to have stable, loving relationships with their parents and other primary caregivers for their cues to be understood and addressed in ways that support and nurture their emotional development. For the infant and for the adults who care for them, these relationships need to be—

Individualized: Attention must be given to individual needs. Responsive caregiving that acknowledges and addresses the infant’s needs and behavioral temperament will convey the respect and security essential for early emotional development. It is equally important to recognize the individual needs of parents; attending to the parents’ issues (e.g., maternal depression, substance use) can enable parents to more comfortably engage in a beneficial relationship with their infant.

Strengths-based: Early relationships must emphasize the strengths and resources of each participant. Everyone has strengths, even the newborn. Helping parents understand their own strengths and the strengths of their infant builds their confidence and supports parent and infant interactions. This is not to obscure the fact that many families have significant needs. Rather, by building on strengths, trusting relationships can be built that will make addressing families’ needs more successful.

Continuous and stable: For infants, continuous and stable caregiving builds confidence that their needs will be met. It is important for infants who are cared for out of the home to have a long-term relationship with a primary caregiver. For parents, knowing that there are consistent people they can turn to—the child’s caregiver, a home visitor, extended family—is equally important. There is no silver bullet for promoting emotional development or addressing mental health needs, and emotional wellness will not be realized overnight. The more complex the needs of the family and infant are, the more intense and extensive the services should be. Early care and education programs can promote emotional development through best practices that focus on relationships. But, it is unrealistic to expect that these programs can provide the more intensive services infants and families with complex needs must have. A well-coordinated continuum of community-based services and supports are needed to provide the family with the targeted support they need at any particular point in time.

Accessible: Relationships need to be accessible and responsive to when and how the infant and parent need attention and support. Parents must understand the rhythm of the infant, being mindful of the cues the infant sends. Parents and caregivers also need to be participants in supportive relationships. The availability of family and program staff and administration to the parent and caregiver, helps to meet the individual needs of the adults, making them better able to engage in responsive interactions with the infant.

These early relationships, which provide the foundation for future social, emotional, and cognitive development, must be supported by systems that are—

Child focused and family centered: The services, training, policy, funding, and research of systems must support the well-being of the infant and active involvement by family members to achieve optimal infant development. A true family-centered system includes family members as equal partners with caregivers and administrators in a cohesive, responsive, respectful, and interdependent team focused on meeting the child’s and family’s needs to support emotional health.

Culturally responsive: Systems need to recognize the importance of understanding the values, beliefs, and practices of diverse cultures. Systems should integrate diversity into the policies, practices, and products of the organization so that the ultimate interactions with individual children and their families can be mindful of and honor their culture.

Community-based: Community-based systems offer targeted services and supports that reflect the particular needs, strengths, resources, and cultures of the community. Staff members from the community further enrich the appropriateness of interactions that support infants and their families.

Comprehensive, coordinated, and integrated: In addition to being based in the community, systems need to offer comprehensive services and supports to infants and their families that reflect the continuum of care needed—from promotion to prevention and treatment. No one agency can fulfill all the needs of families and infants. It is critically important that across the community, systems are coordinated so that the broad range of factors, needs, and contexts are addressed. This ensures that resources and opportunities—including training opportunities—are shared.

Committed to continuous improvement and reflective supervision: At every level, systems must be committed to creating an environment that values and practices continuous improvement. Reflective supervision is a very important piece of this safe, nurturing environment. Staff can regularly reflect on their experiences and gain new knowledge and perspectives that will help them better approach their work with infants and families. Fortunately, the early care and education field is increasingly recognizing the value of reflective supervision both for the emotional support it brings to the staff and for the enhancement of services and supports to the family. Many are hopeful that with appropriate information and training, more programs will include this component in their program. Research that helps programs measure the effectiveness of their interventions is another important piece of continuous improvement. Knowing what works for whom and how and why can be a critical guide for ensuring that resources are expended in ways that are most effective and efficient.

ACTION STEPS
Across Head Start and the broader early child care and education field, several themes emerge in the action steps outlined by the Forum participants. These include—

Program guidance: Inform early care and education programs and related providers in the community about the principles of infant mental health and the appropriate roles they can play in supporting emotional wellness.

Public awareness: Increase public awareness about infant mental health to reduce the stigma associated with it and help the general public understand the importance of relationships in overall infant development and well-being.

Public policy: Promote public policy that acknowledges
the importance of early social and emotional development and provides direction and adequate funding to build collaborative systems in communities to support infants and families.

Professional development: Develop evidence-based curriculum and training resources and opportunities that are culturally appropriate and enhance the knowledge and skills of all those working with infants and families.

Reflective supervision: Build the capacity for reflective supervision in early care and education settings to enhance the quality of interactions caregivers are able to offer.

Cross-disciplinary collaboration: Stimulate and formalize cross-disciplinary collaboration—sharing resources, joint training, coordinated planning and service delivery—that will build systems of care in communities to provide the continuum of supports and services needed to focus on emotional health promotion, prevention, and treatment.

Financing: Identify and secure financing to cover the continuum of mental health services needed by infants and their families.

Research and evaluation: Support ongoing evaluation to ensure that practice is informed by research and to measure the long-term community impacts of increased focus on infant mental health.

Demonstration: Conduct demonstration efforts to help the early care and education community gather new knowledge and test models and assumptions, ultimately providing more targeted and effective services to infants and their families.

A national agenda on infant mental health: Build a universal commitment to address infant mental health to transcend the scope and responsibility of Head Start. To offer the continuum of services that will support emotional development, it is imperative that the broader caregiving community and related providers (e.g., social work, psychology, psychiatry, nursing, pediatrics, obstetrics, family health) come together. For more information on this national agenda, contact Lynette Kimes of the EHS National Resource Center at l.kimes@zerotothree.org. 

Deborah Roderick Stark is Principle with Stark Consulting. T: 301-889-0430; E: DRS889@aol.com. Rachel Chazan-Cohen is a Social Research Analyst for CORE. Office of Planning, Research and Evaluation, ACF. T: 202-205-8810; E: rccohen@acf.hhs.gov. Judith Jerald is the Coordinator of Early Head Start in the Head Start Bureau. T: 202-205-8074; E: jjerald@acf.hhs.gov.