A consistent, warm relationship with primary caregivers creates a basis for infants' future ability to form other relationships. That's why the focus of infant mental health programs is to "identify relationship issues at the point where they begin to emerge, and not wait until the child is school-aged and the problem is full blown," says Deborah Bremond, family services director at the Alameda County Children and Family Commission.

The relationship-based approach to infant mental health looks at three factors, says Sara Grunstein, a mental health specialist at Children's Hospital of Oakland: the baby, the primary caregiver (usually the mother), and the "fit" between the two.

When a primary caregiver is depressed, for example, or is dealing with other issues like a sibling with disabilities, homelessness, or addiction, she may not be able to interact much with her newborn. If a child has a disability that makes him difficult to hold, if he can't smile, or he cries all the time, this can also make bonding difficult.

When Grunstein visits parents at home, they try to figure out what might be getting in the way of a positive, healthy parent-child relationship. The idea, she explains, is to create a "parallel process-if you feed the parent with support and understanding, the parent will be able to feed the baby with the same."

Although infant mental health programs are still scarce, some pioneering institutions, like Children's Hospital of Oakland, and some county mental health departments, like Fresno's, have developed relationship-based infant mental health services.

Fresno County: Infant Family Mental Health

"Strengthening and improving the parent/child attachment" is the focus of Fresno County's Infant Family Mental Health Program, says Program Director Arlene Costa. Half the families are referred by clinics or schools; the other half have court orders to participate.

Samantha Axsom, 32, for example, had her youngest daughter, Skylar, taken into county custody just two days after she was born, along with her two-and-a-half-year-old sister, Mystic. While the children were in foster care and Axsom was receiving treatment for addiction, a judge ordered her to participate in the Infant Family Mental Health Program to help her develop healthy bonds with her children.

The program has three elements.

In the Parent Therapy Group, parents "can talk about how they were parented as a child and can compare their methods of parenting with the other moms," says Costa. When one mother revealed that she never spanked her child, Axsom was surprised. "I thought that spanking was the answer to solving problems," she says. "My parents were very strict with me so that's how I was with my kids."

In the group sessions, Axsom says, she learned to discipline her children with consistent routines-"Bedtime is at a certain time every night"-and by giving them choices with clear consequences: "If Mystic [now four and a half] won't clean her room when I ask her to, she knows she'll have a time out."

"One time my kids were fighting about orange juice in the supermarket," Axsom adds, "and I finally said 'no orange juice for either of you!' They cried some more, but 'no' meant 'no,'" and the children soon calmed down-"It really does work!"

In the Parent/Child Play Therapy Group, parents learn how to "nurture and engage their babies in a positive way" through activities like massage and simple games, says therapist Peggy Thompson. "We ask parents who their child feels safe with and who they felt safe with as a child," Thompson says, "to help parents to understand what makes a person emotionally safe." Axsom remembers a time when Skylar cried during an activity. Axsom went to get a snack to soothe her. "It's good that you remembered to take care of the child first," Thompson complimented.

Individual Therapy offers parents the one-on-one attention they may need to deal with their own emotional problems and assists them in coping with the day-to-day struggles that challenge every parent.

Today, Mystic and Skylar have been reunited with Axsom, who works at Spirit of Women in Fresno, the same substance-abuse program she graduated from last month. 

• Fresno County Infant Family Mental Health Program, 559-453-8405

Extra resources from the Children’s Advocate bulletin (updated 12-07)

• Supporting Healthy Relationships Between Young Children and Their Parents, from the Center for Child and Family Policy, offers guidelines for supporting healthy relationships and parent tips (scroll down).
  
  
• Social and Emotional Health in Early Childhood discusses infusing services and supports for young children's mental health into early childhood services. $40. Brookes Publishing, 800-638-3775
  
  
• Children's Mental Health: Promoting School and Life Readiness, from the spring 2007 Early Report from the Center for Early Education and Development, discusses early childhood mental health, including parent tips and program profiles.

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