Catherine Maguire on Infant Mental Health Practice

Infant Mental Health in
Community & Primary
Care Practice Contexts
Catherine Maguire
Senior Clinical Psychologist and Infant Mental Health Specialist
Child, Adolescent and Family Psychology Service, North Cork
Health Service Executive- South
President, Irish Association of Infant Mental Health
Why Infant Mental Health?
Everybody knows a baby…
What about the baby’s social and
emotional development? Can you
Why is Infant Mental Health important?
1. Why early experiences and early
relationships matter
2. Creating a fluency about early social and
emotional development
3. Two case examples from practice
What is Infant Mental Health?
•To experience, regulate & express emotions
•Form close & secure relationships
•Explore the environment & learn
“All of these capacities will be best
accomplished within the contexts of
caregiving environments that include family,
community, and cultural expectations for
young children” (Zero to Three, 2001)
Copyright Catherine Maguire & Rochelle Matacz ©
Why is Infant Mental Health so
What difference does it make?
● A window of opportunity exists in
infancy and early toddlerhood
● The early years are a sensitive and
critical period of development
● Extensive research on brain
development studies highlight the
crucial role of relationship based
experiences for the child’s future
mental health
Copyright Catherine Maguire & Rochelle Matacz ©
Importance of the parent-child
“Among the most significant
developments during the past quarter
of a century has been the steady
growth in evidence that the quality of
parental care which a child receives
in its earliest years is of vital
importance for his future mental
(John Bowlby, 1953)
Copyright Catherine Maguire & Rochelle Matacz ©
Babies can’t wait
A critical window of
opportunity exists in
the first months
Spurts in brain growth
will occur at a rate that
will not be repeated in
later years
Pathways are
experience dependent
Copyright Catherine Maguire & Rochelle Matacz ©
Importance of the parenting
The majority of parents, provide their children with
• A loving safe home
• Protect & comfort
• Play with, praise & enjoy them
“In more extreme circumstances of hostile,
neglectful environments, babies fail to thrive
and their normal development is very seriously
(Joyce 2005)
Copyright Catherine Maguire & Rochelle Matacz ©
Importance of Parent-Child
• As the P-C relationship develops, the parent helps
the infant develop the ability to regulate his/her
• Predictable and caring parent –infant responses =
infant develops a secure template
• Positive experience of early relationships sets the
stage for other relationships
• Quality of P-C relationship facilitates development
of attachment
• Parents own parenting experiences tend to be
• P-C relationship cannot happen in isolation
Still Face Experiment
Understanding social &
emotional development in
Infancy & Toddlerhood
• Social & emotional development is
largely expressed through behaviour
• Problems at this developmental stage
often misunderstood as
• Parents sometimes struggle to
interpret the meaning of the cues and
signals or misinterpret their child’s
emotional displays
Copyright Catherine Maguire & Rochelle Matacz ©
•Case identified by Clinician with IMH skills
Baby & Mother commenced intervention
when Baby 2 months old
•Denial regarding her pregnancy, absence
of support
• Overwhelming feeling of ambivalence for
her newborn
•Mother’s own dysregulation & unresolved
early childhood experiences
•IMH model of service provision
•Case not identified until 13 months (child taken
into care)
• Unplanned pregnancy, difficult early childhood,
ambivalent relationship with her baby
•Mother known to Social Work Department as an
•Mother places baby in foster care at beginning
second year of life
•2 years later, her toddler is unable to manage a
relationship with her
•Child in long term foster placement until 18yrs
•No relationship based therapeutic intervention to
CASE 1 vs CASE 2
CASE 1-with intervention
CASE 2-without intervention
•Cost to the HSE =
•92 clinical hours of
Clinical Psychologist time
20 hours in travel time
Clinical Supervision
•Cost to the HSE =
• Cost of Foster Care (17yrs)
at €350 approx per week
•Clinical skills of Social Work
• Foster Social Worker,
• Legal costs to HSE.
P-c relationship repair
Family intact
Child remains in his
Society + benefits
Child in secure placement
P-C relationship disrupted
Family no longer in intact
Child removed from her
Community must adjust to
new surroundings
Society will be required to
support their mental health
needs for some time to come
Concluding Remarks
Fluency regarding early social and emotional development on a
par with physical development needs to be fully understood at all
levels of family, community and society.
0-3 period require awareness across society skills especially Promotion, prevention and repairing of parent-child relationships
Integrate the extensive science available regarding this 0-3 into
service delivery.
Workforce capacity skills required - Michigan Association of IMH
endorsement competencies
Future mental health of society can be changed through our
primary care teams.
A critical window of opportunity exists in infancy.
This change must start with the baby and his/her first relationship.
“In my Beginning is my End”
(TS Eliot, 1888-1965) (from the four Quartets No 2 of 4, East Croker 1943)

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