Clinical Topics Community Immune/Lymphatic System Infectious Diseases Mental Health Pediatrics Perspectives Public Health

Why infant mental health is even more critical now

November 13, 2020

By: Stephanie Spain, DNP, MSN, CPNP, PHMS, BSN, RN-BC, IMH-E

No matter what role we play in caring for patients and families, as nurses, we know that the relationship children have with their caregivers is critical for their healthy development. In addition, we know that the COVID-19 pandemic has significantly impacted not only children, but also their families. Fortunately, we can apply infant mental health (IMH) concepts to better meet their needs.

IMH

Often clinicians don’t understand what IMH is, and how we can apply it to the families we work with. Stinson and colleagues define IMH as optimal growth and social-emotional, behavior, and cognitive development between the parent and caregiver during from birth to 3 years old. Using an IMH lens, we can examine the capacity for the child to experience, regulate, and express emotions. We can look at how that infant forms and secures interpersonal relationships, while also taking into account their ability to explore their environment. These early developmental experiences with caregivers serve as a foundation in the developing infant brain throughout the lifetime.

IMH core foundational principles can be applied to families in any healthcare domain, including nursing and social work.

Application of IMH

Trauma is a real or perceived threat to physical and or emotional safety that can affect a child’s development and the family as a unit. IMH can be used to better care for our patients and families during the trauma of the COVID-19 pandemic. Certification through a state-based program is required to become an IMH specialist, but any clinician can apply IMH principles in their practice.

Weatherston suggests that clinicians can use the following IMH concepts to better guide care; nurses can apply these concepts by taking several action steps.

Concepts	Interventions
Providing concrete assistance to meet immediate urgent needs	Screen for basic family needs such as food, clothing, shelter, childcare, and transportation. Screen for any acute family needs. Provide resources for families with any needs noted. Ensure the family has adequate access to supplies that ensure proper hygiene.
Offering family emotional support	Assess emotional support system of the family. Provide emotional support and plan for future ongoing support. Assess for trauma and the impact the pandemic may have on families.
Issuing developmental guidance	Screen for the developmental status of the child. Provide developmental guidance for the family in a concrete and supportive manner. Establish a future developmental screening and guidance plan with the family. Refer to appropriate services if needed. Ensure families are staying up to date with healthcare providers.
Focusing on early relationship assessment and support	Assess family relationships and support. Provide resources for families as needed. Continue to assess and evaluate family relationships and support to meet the needs of the family.
Family and infant advocacy	Provide resources and services for families who need extra support during these difficult times. Remember that resources can be written or virtual. Continue to reassess family needs to ensure current needs are being met and to anticipate future ones.
Referring for infant parent psychotherapy	Refer families to a mental health specialist when indicated. Ensure that families have access to mental health care and explore what options may be most impactful. Stress on-going needs, given the traumatic impact of pandemic. Ensure a child/safety plan is in place to ensure child welfare.

Integrating IMH concepts

Implementing the concepts of IMH and the interventions required is especially challenging during a pandemic. Dividing implementation into three main categories can help.

The first category is preparing clinicians and future clinicians for applying IMH concepts. Because IMH can be used across so many healthcare domains, this is a big task, but one well worth tackling. Helping clinicians understand the importance of IMH and encouraging them to engage in IMH training will greatly benefit children and families.

As an educator, I know that it has been especially challenging to integrate IMH concepts into an already extensive undergraduate and graduate nursing curriculum. But given the sequel from the pandemic that we will likely see for many years to come, the need to educate future nurses in this are is critical.

The second category focuses on implementing IMH concepts into direct family care. Families are stressed and struggling with the new “normal” from the pandemic, which has affected every aspect of family life for many. Therefore, prepared IMH clinicians need to spend extra time integrating the IMH concepts and interventions into practice. Time and safety are always a concern, so we might need to think “out of the box” to provide this optimal care to families. For example, we may need to deliver care via technology. Although this doesn’t allow us for face-to-face, in person relationship building, it enables us to help families.

The third category refers to providing ongoing support for clinicians during these difficult times. Having opportunities to self-reflect and engage in staff development is critical. Burnout is even more concerning given the massive amount of stress the pandemic has caused for clinicians and families. Extra support for clinician mental health is vital.

Caring for children and families

Given these current unchartered times secondary to COVID-19 pandemic, the need to integrate IMH concepts into practice is great and can reduce the adverse effects of trauma on children and families in any healthcare environment. We need to strategically think about how to integrate these concepts and evaluate them to better serve those who entrust us with their care.

Stephanie Spain is visiting faculty and RN to BSN program director at St. John Fisher College in Rochester, New York.

References

Harvard University. Center on the developing child. n.d. developingchild.harvard.edu

Stinson S, Tableman B, Weatherston D. Guidelines for infant mental health practice. 2000. East Lansing: Michigan Association for Infant Mental Health.

Weatherston D. The Infant Mental Health Specialist. Zero to Three. 2000;3-10.

The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.