This thesis describes the development of a parent-to-infant attachment based questionnaire for use by health visitors as a discussion tool. An interpretive methodology was followed incorporating a sequential multi-method design. The original purpose of the study, to develop an attachment screening tool, changed due to reflexive decision making and the impact of changes in service delivery. This presented an opportunity to develop a tool that supported focused conversation between health visitors and parents about early relationships. Parallels between parent infant relationships and health visitor parent relationships were identified in four parent focus groups and four health visitor interviews. The resulting data were used to inform the development of the pilot questionnaire. Five parent-to-infant attachment relationship constructs were developed from attachment theory and current practice in infant mental health. These were combined with parent terminology preferences, and formed into a twenty-five item questionnaire. The twenty-five item questionnaire was used to collect data from twelve parents. Statistical testing on twenty-four test-retest completions of the tool resulted in a ten-item discussion tool that showed face and construct validity. Evidence of acceptability to practitioners and parents was gathered using a health visitor survey.

Four decades of research demonstrates that infant-caregiver attachment has important implications for subsequent socio-emotional functioning, with attachment security predictive of a wide range of positive outcomes, and attachment insecurity—and the insecure-disorganized pattern in particular—predictive of later difficulties. This early risk can be ameliorated with early prevention, yet effective prevention depends on a more thorough understanding of the etiology of attachment disorganization. Because measures of caregiver behaviors shown to predict infant-caregiver attachment yield modest to moderate effect sizes, some researchers have suggested the field refocus on understanding the caregiver cognitive processes that underlie infant-caregiver attachment. In an effort to better understand these cognitive mechanisms underlying the development of infant-caregiver attachment disorganization, a previous study by the current author found that compared to women who go on to have a secure attachment relationship with their infant, those who go on to have a disorganized attachment relationship identified more infant faces as expressing anger and fewer as expressing sadness. The current study aimed to expand on this research linking specific patterns of caregiver recognition of negative infant affect with subsequent caregiver-infant attachment outcomes. More specifically, I expected the above findings would generalize to a postnatal (non-exclusively primiparous) sample. I also tested whether these hypothesized effects were unique or overlapping with two existing predictors of attachment—i.e. the Caregiving Helplessness Questionnaire (George and Solomon, 2011) and Adult Attachment Interview (George, Kaplan, & Main, 1985). Counter to hypotheses, I did not find that maternal recognition of infant anger or sadness predicted infant-mother attachment. I did, however, find that maternal helplessness predicted attachment categorization, and that compared to the mothers who went on to have secure attachment relationships with their infants, those who went on to have disorganized attachment relationships labeled more ambiguous infant faces as surprised. The other two facets of caregiver helplessness (caregiver and child fright and child caregiving) and overall unresolved State of Mind scores did not significantly predict infant-caregiver attachment outcomes, nor did adding these predictors to a model including emotion recognition predictors change the pattern of results. Limitations that may explain these null results and future directions are discussed.

Research has shown that early signs of behaviour problems can be identified in infancy and toddlerhood and, while some of these challenges may resolve over time, often they continue and place children at risk for later mental health problems. To identify infants with early signs of emotional-behavioural problems who may benefit from intervention, psychometrically strong infant mental health measures could be helpful. Unfortunately, measures for assessing infant mental health often cannot be used to assess children under 12 months old or do not comprehensively address clinically-relevant mental health domains in infants. The Brief Child and Family Outcome System for Infants (BCFOSI) is a questionnaire for parents of infants 8 to 17 months old with evidence on its reliability and factor structure and promising preliminary evidence on validity (Niccols et al., 2018). Stability and validity of the BCFIOSI were examined in a community sample of 50 infants at 8-, 14-, and 18-months. Total scale scores demonstrated moderate stability over 4, 6, and 10 months, rs = 0.48, 0.31, and 0.39, respectively, ps < 0.05. Criterion validity correlations with other measures of emotional-behavioural functioning (ASQ:SE, BITSEA, CBCL) were significant at 8, 14, and 18 months, rs = 0.36 to 0.61, ps < 0.05. There were two significant concurrent validity correlations with measures of infant and maternal physiological regulation: 8-month BCFIOSI Total scores and infant vagal withdrawal, r = -0.35, and 8-month BCFIOSI Sleeping and maternal baseline RSA, r = 0.32, ps < 0.05. With regard to maternal behaviour, 8-month BCFIOSI Eating was correlated with observational measures of maternal sensitivity, non-hostility, and structuring, rs = -0.35, -0.44, and -0.28, respectively, ps < 0.05. Measures of parental stress and parenting attitudes also were correlated with 8-month BCFIOSI Total scores, rs = .029 to 0.48, ps < 0.05. Predictive validity was supported by significant longitudinal associations with the CBCL 4 and 10 months later, rs = 0.33 and 0.31, respectively, ps < 0.05. Findings provide additional evidence to support the use of the BCFIOSI with infants at potential risk for later mental health problems who may benefit from intervention. / Thesis / Master of Science (MSc)

Infants who experience multiple risk factors, such as preterm birth, developmental delay, and low socioeconomic status, are at greater risk for mental health problems. Mental health interventions for infants typically target infants from high-risk groups, and there is strong evidence that some intervention programs for infants can prevent long-term negative outcomes and promote long-term positive outcomes. Despite emerging research and federal initiatives promoting early intervention, minimal research has examined community-based mental health services during infancy. Improving the effectiveness and efficiency of routine care requires close examination of current practices. The current study characterized current usual care practices in infant mental health through a survey of mental health providers. Provider, practice, and client characteristics, provider use of intervention strategies and intervention programs, and provider attitudes toward and knowledge of evidence-based practices are described. Study findings are discussed in the context of previous usual care research. Implications and directions for future research are discussed.

Background: Mothers with HIV often face personal and environmental risks for poor maternal health behaviors and infant neglect, even when HIV transmission to the infant was prevented. Maternal-fetal attachment (MFA), the pre-birth relationship of a woman with her fetus, may be the precursor to maternal caregiving. Using the strengths perspective in social work, which embeds MFA within a socio-ecological conceptual framework, it is hypothesized that high levels of maternal-fetal attachment may protect mothers and infants against poor maternal health behaviors. Objective: To assess whether MFA together with history of substance use, living marital status, planned pregnancy status, and timing of HIV diagnosis predict three desirable maternal health behaviors (pregnancy care, adherence to prenatal antiretroviral therapy–ART, and infant’s screening clinic care) among pregnant women with HIV/AIDS. Method: Prospective observation and hypothesis-testing multivariate analyses. Over 17 consecutive months, all eligible English- or Spanish-speaking pregnant women with HIV ( n = 110) were approached in the principal obstetric and screening clinics in Miami-Dade County, Florida at 24 weeks’ gestation; 82 agreed to enroll. During three data collection periods from enrollment until 16 weeks after childbirth (range: 16 to 32 weeks), participants reported on socio-demographic and predictor variables, MFA, and pregnancy care. Measures of adherence to ART and infant care were extracted from medical records. Findings: Sociodemographic, pregnancy, and HIV disease characteristics in this sample suggest changes in the makeup of HIV-infected pregnant women parallel to the evolution of the HIV epidemic in the USA over the past two decades. The MFA model predicted maternal health behaviors for pregnancy care (R2 = .37), with MFA, marital living status, and planned pregnancy status independently contributing ( = .50, = .28, = .23, respectively). It did not predict adherence to ART medication or infant care. Relevance: These findings provide the first focused evidence of the protective role of MFA against poor maternal health behaviors among pregnant women with HIV, in the presence of adverse life circumstances. Social desirability biases in some self-report measures may limit the findings. Suggestions are made for orienting future inquiry on maternal health behaviors during childbirth toward relationship and protection.

For six years, under the informal leadership of a few professionals committed to fostering the healthy social and emotional development of infants and young children in Tennessee, a group of passionate individuals and agencies came together on a bimonthlly and subsequently quarterly basis for the purpose of building relationships, identifying existing resources and opportunities, and beginning to identify what is needed to address the mental health needs of the birth through age 5 population. From the initial meeting of 25 or so individuals, the attendance and agency representation steadily grew and the group’s identity as a valuable initiative was established. In this presentation, the expansion of this informal grassroots initiative into a formal non-profit corporation receiving funding from the Tennessee Department of Health to support developing the capacity and quality of the early childhood workforce will be described. The presenter also will describe the current work of the Association of Infant Mental Health in Tennessee (AIMHiTN), including the implementation of the Infant Mental Health (IMH) Endorsement® for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health (IMH-E®), an internationally recognized credential.

Disertacijoje analizuojami pusantrų metų amžiaus kūdikių emocijų ir elgesio sunkumai bei juos prognozuojantys biomedicininiai, psichologiniai bei socialiniai veiksniai. Atliktas perspektyvusis kohortinis kūdikių, gimusių 2009 m. gegužės – rugsėjo mėnesiais LSMU ligoninėje Kauno klinikose, tyrimas. Duomenys surinkti vykdant tris tyrimo etapus: (1) ligoninėje surinkti biomedicininiai duomenys bei atlikta anketinė motinų apklausa, (2) atlikta anketinė motinų apklausa kūdikiams sulaukus trijų mėnesių amžiaus ir (3) anketinė motinų apklausa kūdikiams sulaukus pusantrų metų amžiaus. Pusantrų metų amžiaus kūdikių emocijų ir elgesio sunkumai buvo įvertinti naudojant Vaiko elgesio aprašo (CBCL/1½–5) (Achenbach, Rescorla, 2000) Lietuvoje adaptuotą ir standartizuotą versiją (Jusienė, Raižienė, 2006). Emocijų ir elgesio sunkumai buvo labiau išreikšti kūdikiams, kurie gimė atliekant cezario pjūvį bei kurių fiziologinė būklė po gimimo nebuvo optimali. Tyrimas atskleidė tokių psichologinių ir socialinių veiksnių svarbą prognozuojant emocijų ir elgesio sunkumus, kaip sudėtingas motinos emocinis nėštumo priėmimas, negatyviai motinos vertinami santykiai su vyru / partneriu nėštumo metu, dažnas motinos negatyvių emocijų patyrimas, dideliu nerimu dėl vaiko pasižymintis motinos pogimdyminis prieraišumas ir nelanksčios, į tėvus orientuotos motinos nuostatos kūdikio auginimo atžvilgiu. Disertacijoje taip pat analizuojamos ir aptariamos tirtų biomedicininių, psichologinių ir socialinių veiksnių... [toliau žr. visą tekstą] / The Dissertation analyses infants’ emotional and behavioral problems at the age of 1.5 years and their predictive biomedical and psychosocial factors. The Dissertation is based on data from prospective birth-cohort study. Study participants were infants born in the Hospital of Lithuanian University of Health Sciences (LUHS) Kauno Klinikos from May to September in 2009. The analysis included the data from three stages of the study: (1) biomedical data during and after childbirth and a questionnaire survey given to mothers 2 to 3 days after childbirth in hospital, (2) questionnaire survey of mothers three months postpartum, and (3) questionnaire survey of mothers 1.5 years postpartum. Emotional and behavioral problems were more expressed in infants born via caesarean section and whose physiological functioning after birth was not optimal. Study also revealed the importance of such psychosocial predictors of emotional and behavioral problems as complicated emotional acceptance of pregnancy, poor couple’s relationship during pregnancy, frequent negative maternal emotions, maternal postpartum attachment characterized by high anxiety regar¬ding child, and inflexible and parent-oriented attitudes toward infant-rearing. The associations between biomedical and psychosocial factors are also analyzed and discussed.

The optimal relational experiences of infants and young children demand a cross-sector workforce informed by Infant and Early Childhood Mental Health (IECMH) principles and practices. A recent review by the Alliance for the Advancement of Infant Mental Health, Inc identified seven themes that help define “What makes an IECMH association strong?”: (1) Identity, (2) Cross-Systems Collaborations, (3) Sound Organizational Structure, (4) Competency-Informed Training, (5) Reflective Supervision Capacity, (6) Policy, and (7) Higher Education. The present paper documents the story of the Association of Infant Mental Health in Tennessee (AIMHiTN) and the role of the Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting IECMH in that growth across those seven themes with the additional themes of (8) Funding and, (9) Diversity, Equity, Inclusion, and Belonging. First, foundational literature is reviewed to summarize IECMH-informed workforce development. Next, AIMHiTN's story of workforce development is mapped onto the nine themes and challenges and lessons learned are summarized. The article aims to serve as a roadmap for other states, provinces, territories, or nations hoping to develop their own Association for Infant Mental Health (AIMH) as well as a guide for those with existing AIMHs for promoting continued growth and sustainability.

Doctor of Philosophy / Department of Family Studies and Human Services / Anthony Jurich / Ann Murray / Despite the intensified research efforts into the field of Infant Mental Health and Marriage and Family Therapy, a truly systemically designed program has not been developed. This formative evaluation study illuminates the design phase, its developmental process, and the professional staff member’s experience of this newly implemented “Options” program. I focused specifically on Crawford County Community Mental Health Center’s innovative systemic approach to issues related to infant mental health. In this body of work, I describe the process of creating this innovative approach, identified how the program originators made decisions about their approach and how the approach is being operationalized on a daily basis by interviewing the clinicians, who are providing the services and the administrators who created and oversee the program. I utilized a qualitative approach in the design, transcription categorization, and data analysis. This formative evaluation used the “flashback approach” to tell the story of the evaluation findings, this included an Executive Summary. This study’s exploration yielded a clearer understanding of the developmental process of the infant mental health program and its initial implementation. The results of this evaluation revealed that there are a number of core program components (three levels of focus: child and family, program, and community and catchment area) that were organized and clearly disseminated throughout the staff. The interviews revealed that the program has encountered problematic issues including; policy and procedural agreements and mandates, staff turnover, program ownership and funding limitations. It grew increasingly clear that the value of the program’s positive impact on families outweighed the perceived hassle of establishing and implementing the program. This evaluation produced a number of program recommendations for program perpetuation and potential improvements. The program recommendations addressed the challenges facing the “Options Program” are explained. The future research implications of this formative evaluation are enumerated.

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