Current approaches and future directions for addressing ethics in infant and early childhood mental health

Abstract

In this paper, we consider whether the field of infant and early childhood mental health (IECMH) needs its own code of ethics. We begin by describing unique features of infant and early childhood mental health (IECMH) and the diverse strategies that the field has developed to address complex clinical dilemmas, among them workforce development, clinical supports, policy statements, and statements of ethical values. Because of the field's interdisciplinary nature, we also consider how various contributing professions and organizations address ethical issues. While these are important resources that can inform ethical decision‐making, we identify some of the limitations of the current approaches. We argue that it is time for the field of IECMH to take an intentional, systematic approach to directly address the complex and unique ethical dilemmas faced by infant and early childhood mental health practitioners, and we grapple with some of the challenges developing such a code might entail. We suggest several avenues for better understanding the scope of ethical issues and ethical decision‐making processes in IECMH that could be used to support developing an ethics code that is responsive to the unique and challenging world of infant and early childhood mental health.

A vision for implementing equitable early mental health and resilience support in pediatric primary care: A transdiagnostic, developmental approach.

“…One form this bias may take is that clinicians act on the basis of “benevolent” bias, wherein a watch-and-wait approach is deemed preferable to action (Scherr et al, 2024). This can create an ethical conundrum between autonomy and beneficence that may disproportionately impact families from marginalized communities (Zeanah et al, 2023). As has been noted (Scherr et al, 2024), clinicians’ sensitivity to families’ socioeconomic circumstances is based on presumptions of families’ resources and capabilities.…”

“…Consequently, well-intentioned clinicians may be least likely to discuss social–emotional concerns and referrals with the most disadvantaged families (Merle et al, 2023). Concerns about too much or too complex or too uncertain information can also inhibit patient-centered care because clinicians may withhold such information, which constrains families’ opportunities to serve as partners in their children’s health care planning, particularly for marginalized communities and in underresourced settings (Zeanah et al, 2023).…”