A golden opportunity at a precious time

The goal of Infant Mental Health Awareness Week 2021 (IMHAW) is to encourage everyone working with children and young people to think about and include babies and infants in all aspects of policy and practice.

The First 1001 Days Movement, (a group of organisations working together to campaign about the importance of the emotional wellbeing of babies and infants), argue that the term 'children and young people' is too often focussed on older children and creates, what they refer to as, a 'baby blind spot'.

IMHAW 21 has encouraged us, as three EPs with a special interest in the early years, to reflect on how we are including babies and infants in our own practice and hope that this inspires other psychologists to do the same.

What is Infant Metal Health?

The term infant mental health describes the emotional development of children from conception up until their second birthday, a period also known as the first 1001 days. It is sometimes referred to in other ways e.g., early child development, infant wellbeing and parent-infant mental health.

This is an important phase in a child's development. There is strong evidence to suggest that supporting the early emotional development of children promotes a child's future learning, wellbeing, resilience and adaptability – the capabilities they need to thrive.

Early intervention during this period makes sense at a human and economic level. It not only decreases unnecessary emotional distress for our most vulnerable citizens, but also helps to set them on a positive developmental path that lessens the need for later, often more costly, intervention.

The Parent-Infant Foundation recently shared the results of an online workforce survey of over 300 mental health professionals, which highlighted how infants are often overlooked in children and young people's policies and provision.

Some key findings showed that only 52% of respondents said their local mental health service took referrals for children aged two and under, and almost a third (31%) of Mental Health Practitioners felt they didn't understand infant mental health, rating their understanding as only 1 out of 5.

These findings made us wonder about the findings that would have resulted if EPs were asked the same questions. For example, how many requests for involvement do Educational Psychology Services receive for children under two? Would similar disparities in the training, understanding and confidence of EPs in supporting children in the 0-2 age range have been found? How would EPs have rated their understanding of infant mental health?

A recent article by McGuiggan (2021), reported how Educational Psychologist Tommy MacKay argued over 15 years ago that the EP profession needed to move towards a 'community psychology' approach where, "applied psychology can contribute to meeting the key outcomes for all children and their families", with "all children" including babies and infants who may not yet be part of an educational system.

With a (relatively) new emphasis on EPs working with children 0-25 years, could it be argued that there has been clear efforts made to support the top end of this age range but not for the 0-2s? Could it also be argued that, in the main, EPs are only asked to become involved with very young children when there is a perceived problem 'within the child' and/or in order to help identify an additional learning need?

The role of the Educational Psychologist during the first 1001 days

We strongly believe that Educational Psychologists have the skills, knowledge and expertise required to help create the fertile soil that children need to thrive during the first 1001 days and beyond.

As EPs we have a thorough understanding of the complex and interactional nature of early child development. We also have a detailed understanding of a theoretical and evidence base that tells us about the things young children need to thrive and 'what works' to support this.

The current literature tells us that, within this particular age range, our work needs to focus on; promoting positive parent-infant interactions and relationships, helping caregivers to develop their confidence, skills and abilities and reducing the stressors that families face in their day-to-day lives.

Below are some examples, based on our own experiences as EP's with a specialised role in supporting children and families in the early years, of how this looks in everyday practice.

Examples of indirect EP work during the first 1001 days:

• Using our assessment and observational skills to support the formulation of interventions that support parent-infant interactions and relationships.
• Offering consultation and supervision to those working directly with parents and infants e.g., parenting practitioners, early years practitioners, social workers, etc.
• Identifying systemic stressors that a family is facing and working closely with other systems/organisations to help reduce these (e.g., housing issues, domestic violence, etc.).
• Working at a strategic level to influence policy and practice e.g., designing anti-racist practices that are inclusive of the families we work with; connecting with professionals from local authority, health and education services to provide coherent pathways for families.
• Planning, designing and developing participatory action research with families to develop our understanding of 'what works' for them.
• Creating accessible information around the psychology of early child development and wellbeing/infant mental health.
• Designing and delivering training and workshops around early child development, attachment and trauma informed approaches to enhance the knowledge and understanding of practitioners.

Examples of direct EP work during the first 1001 days

• Facilitating antenatal and early childhood groups that focus on supporting parent-infant interactions and relationships.
• Working therapeutically with parents (using a range of modalities e.g., motivational interviewing, narrative approaches, solution focused coaching, ACT, etc.) to explore parents' own experiences of being parented, their transition to parenthood, to help parents recognise their strengths and to help them move towards becoming the type of parent they wish to be.
• Working directly with the parent-infant dyad (or triad) and applying specific interventions that have shown to improve attuned interactions between children and adults, promote parental mentalisation and mind-mindedness and promote secure relationships e.g., Video Interaction Guidance.

IMHAW provides us with a platform to raise awareness of the importance of children's early social and emotional development and to share the wonderful work that we can offer during a child's first 1001 days. It also provides us with an important opportunity to reflect on whether there is a 'baby blind spot' in our own particular areas of work and to think about how this could be addressed.

We have a golden opportunity to make a difference during this precious time in a child's life – let's make sure we seize this opportunity so that all children can benefit from what we have to offer.

About the authors

Dr Nicola Canale is an Educational Psychologist and Clinical Lead for Parents Plus: Cardiff Early Help. Nicola has developed a special interest in parent-infant relationships, early child development and infant mental health and is co-lead of AiMH UK's Wales Infant Mental Health Hub.

Dr Rebecca Stewart is an Educational Psychologist in Parents Plus: Cardiff Early Help. Rebecca has developed a special interest in attachment, trauma, parent-infant relationships and Video Interaction Guidance (VIG) through research and practice.

Dr Abi Wright is an Early Years Lead Educational Psychologist in an Educational Psychology Service.