All Together Now
Infant and Early Childhood Mental Health
Specialists, Child Welfare Staff, and Court
Teams
Clay Latimer, JD
Joaniko Kohchi, MPhil, LCSW
claylatimer504@aol.com
jkohchi.lcsw@gmail.com
Learning Objectives
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Articulate the importance of early attachment
relationships for infants and young children, and
the means by which relationships may be
assessed and promoted.
Demonstrate a familiarity with both court- and
agency-based multi-disciplinary teams formed in
support of promoting healthy parent-child
relationships.
Learn about the connection between infant mental
health team objectives and compliance with
federal mandates for permanency.
National Center for Children in Poverty: SocialEmotional Development in Early Childhood
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Studies show that many young children with
identified needs and their parents do not
receive services
Between 80 and 97 percent of children ages 3
to 5 with identified behavioral health needs did
not receive services
Even in structured early learning settings,
such as Head Start, 80 percent of parents
needing mental health services did not receive
them
WAIMH’s Definition of
Infant Mental Health
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The ability to develop physically,
cognitively, and socially in a manner which
allows them to master the primary
emotional tasks of early childhood without
serious disruption caused by harmful life
events. Because infants grow in a context
of nurturing environments, infant mental
health involves the psychological balance
of the infant-family system.
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WAIMH Handbook of Infant Mental Health, vol 1, p. 25
Infant and Early Childhood Mental
Health
 The
quality of the attachment
relationship bears directly on the
emotional health of the infant
and young child and is
predictive of future health or
pathology in ALL domains.
Infant and Early Childhood Mental
Health
The assessment and
intervention focus on the
caregiver-child relationship/s.
The caregiver is as much a part
of the therapeutic process as
the infant or child.
Qualities of Relationship-Based
Practice
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Values early developing relationships
between parents and young children as the
foundation for optimal growth and change;
Directs all services to nurture early
developing relationships within families;
Values the working relationship between
parents and professionals as the
instrument for therapeutic change;
From http://www.mi-aimh.org/
Relationship-Based Practice…
 Values
all relationship experiences,
past and present, as significant to
one’s capacity to nurture and support
others.
From http://www.mi-aimh.org/
Some Relationship Assessment Tools
(require special training/supervision)
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Working Model of the Child Interview
(Zeanah & Benoit, 1995)
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Face-to-Face Still-Face Paradigm (Tronick)
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Modified Parent-Child Relationship
Assessment (Crowell et al.)
9
Evidence-Based / Empirically-Based
Interventions
National Registry for Evidence-based
Programs and Practices
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http://www.nrepp.samhsa.gov
Search for ages 0-5 = 31 interventions
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ONE is based on the relationship between a
caregiver and child:
 CHILD-PARENT PSYCHOTHERAPY
 TRAUMA-INFORMED CHILD-PARENT
PSYCHOTHERAPY
Infant Mental Health Specialists
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Are from a variety of disciplines
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Have a range of core competencies
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Practice in diverse settings, including multidisciplinary teams dedicated to high-risk
populations
Infant Mental Health in/around/for
the Child Welfare System
Refer out to community providers and
programs
 Create a coordinated team of providers,
including Part B and Part C programs,
community mental health, substance
abuse treatment programs, parenting
classes and support, child care
programs, etc.
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Infant Mental Health in/around/for the
Child Welfare System
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Create a multi-disciplinary team funded by the
Department, based in a specialized setting,
such as a medical school
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Create court-based teams dedicated to
coordinating experts and community providers
 Or partnering with an expert multi-disciplinary
team
Focus today on…
teams supporting infants
and young children
in foster care,
their families and caregivers.
Infant Mental Health Teams in Court
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Federal laws and corresponding state laws
that guide us in planning for children in
foster care.
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Adoption and Safe Families Act
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Fostering Connections Act
ADOPTION AND SAFE
FAMILIES ACT/ASFA (1997)
Focus on safety and permanence for children
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HIGHLIGHTS FOR 0 – 5 POPULATION
A. Establishes new time line and conditions for filing of termination of
parental rights - Must file if child has been in custody of department for 15
of the last 22 months.
Exceptions:
Compelling reasons – state is authorized to define the compelling reasons.
Examples are child is being cared for by a relative or state has not provided
services necessary to return child to a safe home.
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B. Modifies reasonable efforts requirement to relieve state of obligation to
make reasonable efforts to reunite if a court finds that parent has subjected
the child to certain aggravating circumstances (abandonment, torture,
chronic abuse, sexual abuse, murdered another child of the parent,
committed a felony resulting in serious bodily injury to the child or another
child of the parent, or the parental rights of the parent to a sibling of the
child have been terminated.) If the state is relieved of the reasonable
efforts obligation, there must be a permanency hearing within 30 days of
the court’s determination.
ASFA (1997)
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C. Authorizes concurrent planning allowing states to
make reasonable efforts to place a child for adoption
(i.e., in dually certified foster home) while concurrently
attempting to return child with his/her parents.
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D. Sets new/tighter time frame for permanency
hearings: within 12 months instead of 18 months
(Plans: Return to parents, Adoption, Refer for legal
guardianship, or an alternative permanent living
arrangement after documenting a compelling reason for
determining that other options are not appropriate.)
FOSTERING CONNECTIONS TO
SUCCESS AND INCREASING
ADOPTIONS ACT (2008)
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HIGHLIGHTS FOR 0 – 5 POPULATION
Requires states to make diligent efforts within 30 days of
child’s placement in foster care to identify and notify all of the
child’s adult relatives of the child’s placement in foster care
and (1) explain the relative’s options to care for the child, (2)
explain procedures/requirements for foster care certification,
and (3) inform relatives of availability of kinship care
payments. (Note: Family/domestic violence exception)
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Requires states to make reasonable efforts to place siblings
together or, if contrary to the safety or well-being, requires
frequent visitation among siblings or other on-going
interaction unless contrary to safety or well-being of the
children.
Fostering Connections (2008)
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Requires states to coordinate healthcare for
children in foster care and to ensure
appropriate screenings and assessments,
like early childhood screenings, and to
follow-up on services.
Federal support to train people who are
caring for and working with children in foster
care including guardians, court personnel,
attorneys, and CASAs.
Achieving Permanency for Infants in
Foster Care
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Infants have a better chance of achieving
permanency in an alternative setting than
older children do.
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Although there are different models of IMH
teams, they share three core beliefs
(Hudson, Klain, et al. via the Zero to Three
Policy Center):
Goals of IMH Teams
 Improve
outcomes for abused or
neglected infants
 Reduce the recurrence of
abuse/neglect
 Change the Court’s culture to focus
on needs of infants and toddlers
 Cindy Lederman, Science in the Courtroom, 2010.
Three Core Beliefs:
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Valuing the importance of relationships among
professionals, between professionals and families,
and between the parents and their children.
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Interventions informed by science and experience
lead to better outcomes.
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Communication and collaboration between
professionals and families are necessary to create
plans that meet children’s and families’ needs.
Key Components
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Judge as leader and catalyst guiding the
partnership between family service workers and
the infant mental health team.
DCS must have training and expertise in
working with the multi-disciplinary team of IMH
professionals.
Attorneys must have training/expertise in
working with IMH professionals.
Interventions must be research-based.
Key Components, continued
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Early intervention services must be in place
(IDEA and CAPTA).
Mental health services for parents and infants
must be available from IMH professionals.
Case monitoring and tracking occurs frequently.
Appropriate resources are available (parenting
programs, etc.).
Funding supports the team.
Models We Know
 Tulane
Infant Team, New
Orleans, LA
 LSU Court Team / Orleans
Infant Team
 Infant-Parent Court Affiliated
Intervention Project, Bronx, NY
Achieving Permanency through IMH
Teams
 Enhancing
quality of expert
testimony.
 Guiding parents to a clear and timely
understanding of what will be entailed
in providing appropriate care.
 Assisting parents in their own selfassessments.
Results: Achieving Permanency
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Parents reunifying are more confident and
better able to implement parenting lessons.
Good evidence and testimony for successful
outcomes when termination is indicated.
Parents can accept and be comfortable with
decisions about surrendering.
Relative adoptions can occur more smoothly
because parents participate in locating and
recruiting with the help of an IMH clinician.
Considerations for Best Practice
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Clear boundaries between the bench and the
team of professionals supporting the child and
family. Leadership vs. membership.
Inclusive practice vs. healthy boundaries: does
everyone come to every meeting?
Relationship-specific assessment and
intervention focusing on the needs of each child.
Safety for children, parents and professionals.