Promoting Children’s Mental Health Awareness

Linda Gilkerson and Pamela Epley

Linda Gilkerson, Ph.D., LSW, is a professor at Erikson Institute where she directs the graduate training programs in infancy and infant mental health.

Pamela Epley, Ph.D., is an associate clinical professor and director of special education at Erikson Institute.

ED: We are celebrating Children’s Mental Health Awareness Day in May. Could you tell us what efforts you have been involved in to improve the quality of early childhood programs and services to better address young children’s mental health?

Infant and early childhood mental health (IECMH) is synonymous with healthy social-emotional (SE) development and robust early learning, including the ability to regulate and express emotions; form close personal relationships; and explore the environment and learn in the context of family, community, and culture. Over the past years, we have worked with Illinois’ Early Intervention (EI) system to increase its focus on children’s SE development. We’ve done this by promoting relationship-based services, more systematic screening of SE development, and the addition of SE Consultants.

We have also focused on addressing adverse experiences of stress and trauma in young children — factors known to influence IECMH. In fact, Illinois’ EI system has prioritized addressing the impacts of trauma on infants and young children. As part of this priority, Erikson conducted a direction-setting study of the needs of Illinois’ EI system to serve children with trauma histories and found that EI professionals did not feel they had the full preparation needed to work with families with high-intensity needs related to trauma. Barriers included: a) the belief that infants and young children are too young to be affected by trauma experiences; b) reticence of parents to talk about trauma and mental health concerns and, importantly, providers reticence to ask; c) an absence of appropriate tools or processes for trauma screening and assessment; and d) lack of preparation and supervision for professionals in the field to address the SE domain.

We were thrilled to receive an Office of Special Education Programs personnel preparation grant in 2019 specifically focused on preparing EI professionals to support children’s mental health through trauma-focused practice. Erikson’s Project TIP (Trauma-focused Interprofessional Preparation) will prepare 40 social workers and developmental therapists to engage in trauma-focused practice with infants and toddlers and their families in EI. The program includes course work on IECMH, EI methods courses that integrate trauma-focused practice, and a brand new three-semester course on interprofessional trauma-focused EI. Our goal is to share the curriculum of the new interprofessional trauma course, along with an online Faculty Institute to support its implementation, nationally with other OSEP-funded projects.

ED: What are some of the challenges you have experienced in your work and what strategies have you tried to overcome them?

There are so many different ways that young children can experience trauma. This ranges from witnessing violence to medical trauma from repeated hospitalizations or painful procedures. In addition, there is often the belief that young children are not impacted by early events and a hesitance to talk about traumatic events. We try to overcome these challenges by providing future EI providers with a strong foundation in child development, including brain development, SE development, and the impact of stress and trauma on develop across domains. We also focus on relationship-based, reflective practice. Reflective practice is an intentional process in which EI providers look within themselves to better understand their own values and biases, the perspectives of others, and how these interact to influence their work with children and families.

While EI providers embrace reflective practice, they often need help in learning how to actualize it in their work. The FAN (Facilitating Attuned Interactions) is a conceptual model and practical tool for family engagement and reflective practice developed at Erikson. FAN is based on the concept of attunement to parents, reading their cues and matching interactions to what they can most use in the moment. FAN trained home visitors focus more on the parent’s agenda, spend more time in visits on parenting, and move from “doing to” to “doing with” parents. They report increased reflective capacity including a greater capacity to hold uncomfortable emotions, resist the urge to fix, and greater openness and acceptance. For EI providers, the FAN increases the provider’s empathy for the family, promotes collaboration with parents, and increases the provider’s satisfaction with their roles.

ED: What suggestions do you have for others interested in improving services for young children’s mental health?

Improving services for young children’s mental health requires intentional planning and action at a systems level. This includes increasing the number and capacity of SE consultants and EI providers who can support SE development and address the impacts of trauma. Implementing ongoing, monthly reflective consultation is important for supporting providers dealing with vicarious trauma to prevent burn-out and enhance their capacity to provide ongoing support to young children and families. Training providers in effectively trauma-screening is also critical. For example, some service coordinators in Illinois added a trauma-screening question into their initial family interviews. They asked, “Have you, your child, or your family experienced anything that was stressful or scary that you feel is important for us to know?” It was important to service coordinators that this question felt like a “humble inquiry” that would be part of developing a trusting relationship. Families have shared about deportation, terminal illness, family members with mental health diagnoses, witnessing or experiencing violence, financial struggles, and children’s aggressive behaviors. For some families, the question deepens the team’s understanding and helps with immediate planning and service coordination. For others, the question opens space for disclosure of family stressors later, when support can be added for the family or team.

Linda Gilkerson, Ph.D., LSW, is a professor at Erikson Institute where she directs the graduate training programs in infancy and infant mental health. She founded Erikson’s Fussy Baby Network, a national model program for parents of infants under one year.

Pamela Epley, Ph.D., is an associate clinical professor and director of special education at Erikson Institute. She teaches Early Intervention and Early Childhood Special Education courses and is currently the co-director of the OSEP funded Project TIP.