AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
ERICA DORSETT: Good morning. Michael gave you an overview of our presentation, and what I'll do is kind of give you more of program implementation as it relates to mental health of mom, baby and family.
What I plan to do, some of the learning objectives is to describe the social emotional and economic issues surrounding perinatal and infant mental health and to discuss Healthy Start's continuity of care model of perinatal women, their children and partners affected by depression.
So I plan on doing this by briefly giving you a definition of infant mental health, to briefly discuss the theory of attachment, talk about Healthy Start's interconceptional model, to describe our behavioral health program and to talk about the aims that we take to eliminate barriers to mental health care.
Infant mental health has been defined as the developing capacity of child from birth to three. It looks at the infant's ability to experience regulate and express emotions. Form close interpersonal relationships and explore the environment and learn.
All this occurring within the context of the family, community and the surrounding cultural expectations. The term is also synonymous with a healthy social emotional development. This comes from the steering zero to three steering committee 2001. According to the U.S. Surgeon General's report of children's mental health of 2000, his definition reflects the definition that I just gave you but it makes a distinction between mental health as being the successful performance of mental function while mental illness is diagnosable conditions.
When we look at mental health first as mental illness the term infant mental health brings discomfort to many people because of its negative association of mental health with major mental illness. Also because of the belief that early childhood is essentially a happy time and the general cultural biases that surround mental health itself.
Because of this, the term infant mental health has been debated and the use of the term infant wellness has been suggested. But with use of the term wellness, wellness is difficult to define because the values associated with wellness across cultural and ethnic groups differ so much. Values are inherently interwoven and all aspects of children's mental health from how the child will be cared for within the family to how funding decisions are going to be made around programs and services for young children. So the personal experience beliefs, family, attitude, culture, community all impact the values on parenting and the values on what young children need to grow and to be ‑‑ grow and to be productive adults.
Children's mental health can be looked in the context of biology, development, environment and the relationship. The biologic context of children's mental health include intrinsic factors that affect infant development, genetic factors, temperament, physical health and physical attributes. The biologic context is important, too, because it's during this time from the third trimester through the second year of life is the most rapid period of brain development in the human cycle. Structural development of the brain occurs prenatally but the functional development is a result of prenatal and postnatal experiences.
In terms of development, the first three years of life is the most rapid development in the life span. Infants begin to discriminate among caregivers. They can express a variety of emotions and they're increasingly able to communicate their needs. And by the age of three they have developed strategies for learning. They're able to engage in complex interactions with their peers. They can show empathy, and they have the ability to begin to resolve conflicts.
In terms of the environmental context, community violence, poverty, dysfunctional mental health issues, they all exert strong negative influence on the early experiences with young children.
And in the context of the relationship, despite the influence of the environment, the family and the physical health, the infant caregiver relationship is the most important experiential context for the development of the infant. The relationship is paramount when we think of attachment and the theory of attachment.
Attachment is described as the effective bond that develops between an infant and a primary caregiver. And it's a pattern of interaction that develops over time as the infant and the caregiver interact. It's also described as a regulation of the infant's emotions and arousals. So during the first few months in the life, first few months of life, the caregiver has sole responsibility for regulating infant's emotions and this requires sensitivity to the infant's signals, the ability to interpret the meaning of the infant's behavior and the ability to respond in an appropriate and timely fashion.
So you're probably wondering what all this means, and many of you have heard all of this before if you've attended any of the sessions for infant mental health.
So Healthy Start believes in the holistic approach to the care of the family, and we also believe that pertinent education regarding pregnancy, delivery, the postpartum period, the care of the self, the infant, the family should all begin at the time of conception or very soon after.
We look at the interconceptional period when we're thinking about the care of the family. However, the federal government defines the interconceptional period as delivery through the child's second year of life. When we think about a woman who is of child bearing age and we think about the three phases of perinatal health preconception, conception and interconception, when we're looking at this model it kind of puts the people who serve these women in a position to be more reactive in their education and reactive in their implementation or intervention strategies. So we at Healthy Start we refine this model to encompass preconception pregnancy and the postpartum period, all within that interconceptional period. So we look at the interconception period as being from conception to conception.
So everything that we do in our program that makes our program successful basically takes place during this interconceptional period, from our outreach and enrollment activities, our case management through our home visit model with our outreach and our nurses, our health education, promotion, trainings, risk assessments and all of our intervention strategies all occur within this interconceptional period.
Specifically, when we look at postpartum depression, it is our program's protocol to not only screen mother's postnatally, but we also screen and educate our moms during the prenatal period.
The identification as everyone knows of mothers with postpartum depression is extremely important because of the detrimental effects the illness can have not only to the mother but her baby and her family. So by redefining our interconceptional model the way we have, we don't wait to educate. We're not put in the position of being reactive and we're putting ourselves in the position of being more proactive in the education and interventions we provide to our moms.
So when we think of postpartum depression, discuss the whos, the whys and the whats.
Depression is a major issue within the population that Healthy Starts serves. As Michael told you, our participants are low income, underserved. Single mothers. Most of them are African American. Many of them are victims of domestic violence. ‑‑ many of them are victims of domestic violence. Poor birth spacing, poor pregnancy outcomes. And it's these risk factors for depression, these risk factors for depression are con founded by barriers that I have listed here like lack of child care and transportation to enable them to attend mental health care appointments. The stigma associated with mental illness. Historical mistrust of the healthcare system. Lack of awareness how serious the effects of mental illness can be and a lack of motivation, and lack of motivation is actually a symptom of depression whereby making the illness itself a barrier to care.
So with all that in mind, research has shown that the mental health of the caregiver can and will directly impact the mental health of the infant. Mental health problems or mental illness of the caregiver disturbs the caregiver ‑‑ I'm disturbs the caregiver infant attachment process and can result in dysfunctional social and emotional development of the infant.
So we at Healthy Start attempt to address these issues by first we screen all of our female participants for depression using the Ed Domburg postnatal depression scale and as Michael indicated in one of his previous slides the rate of depression in our population is about 25 to 45%. And that's much higher than the general population, which is 10 to 13%.
Also the rate of depression in our male participants is expected to be as high given that they have pretty much the same risk factors. So we are preparing to begin to screen all of our male participants using the prime (inaudible) depression scale within the next coming months.
We also have a behavior health component to our program that consists of a licensed social worker, master level social worker and graduate level interns that go into the homes to provide mental health services to our participants. And in addition to that our nursing staff and our outreach staff is being trained in a counseling technique known as the dialective and behavioral therapy. That will train them to deliver, cook and skill sets to help our participants gain positive functioning that will enable the participants to see the need to go into mental health treatment if it's indicated.
Also our nursing staff, they conduct developmental screenings of infants using the ages and stages assessment tool so it's one way to get in there to see what's going on with the infant if there's any issues, developmentally we can have early identification and push them into treatment and we're also setting up a series of trainings for our staff on specific issues around infant mental health.
I don't want to go to that slide yet. So when we think about all that, the development of attachment and the strategies that we need to use to promote it, it doesn't ‑‑ we need to keep in mind that attachment doesn't occur in isolation, but within a network of influence operating on many levels.
So in summary, issues surrounding mental health, particularly the infant and the child must be approached with a holistic family centered focus and the mental health of the caregiver needs to be insured to ensure the mental health of the child.
Factors such that I have listed here, they come together to influence the course of developing the parent/child relationship and these factors such as resolution of adolescent issues and increased anxiety and depression, economic stress, chaotic violent home environments, family conflict and a lack of social support and limited access to care for the caregiver all increase the likelihood of problems in the parent/child relationship, attachment and bonding and the successful performance of the mental health of the child.
And that's it for me. Next Mary Beth will be up.