The Michigan infant mental health home visiting model

Abstract

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent–child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.

Infant mental health home visiting therapists’ fidelity to the Michigan IMH‐HV model in community practice settings

“…Not surprisingly, IMH‐HV therapists at varying levels of training and experience reported using developmental guidance and infant–parent psychotherapy most frequently throughout the duration of treatment with families. These interventions are two of the model's identified core components (see Weatherston & Ribaudo, this issue), and thus, IMH‐HV therapists likely felt both familiar with and confident in using these intervention strategies with families. It is important to remind the reader that all therapists in the study received reflective supervision from the agency at which they were employed, with the vast majority receiving both group and individual reflective supervision.…”

“…Michigan's Infant Mental Health Home Visiting (IMH‐HV) model is a relationship‐focused home visiting intervention serving parents and their infants and toddlers across the state in community mental health settings. Rooted firmly in attachment and other relational theories, IMH‐HV was initially developed by Selma Fraiberg in the mid‐1970s (Fraiberg, ) and later formalized over many years by IMH leaders across the state of Michigan (Weatherston & Tableman, ; for a comprehensive description of the model, see Weatherston & Ribaudo, this issue). The model is flexible and family driven; thus, there is neither a predetermined “dose” of the intervention nor a required sequence of intervention strategies.…”

Community‐delivered infant–parent psychotherapy improves maternal sensitive caregiving: Evaluation of the Michigan model of infant mental health home visiting

“…Given the importance of early parenting and parent–child relationships, and indications that maternal sensitivity is open to influence and change (Shin et al., ), the current study aimed to (a) explore the impact of the intensive Infant Mental Health‐Home Visiting model (IMH‐HV; Weatherston & Tableman, ) on maternal sensitivity, and (b) as a secondary question given accumulating evidence supporting the use of video feedback techniques, to further examine whether the use of video feedback with parents enhances treatment effectiveness among families participating in this service.…”

“…The IMH‐HV model in Michigan is a multi‐faceted, needs‐driven, relationship‐focused home visiting intervention serving parents and their infants or toddlers (Lawler et al., ; McKelvey et al., ; Weatherston & Ribaudo, this issue; Weatherston & Tableman, ). Services are delivered to families who have environmental or familial concerns that place their children at risk for developing a variety of emotional, behavioral, social, and cognitive delays.…”

“…IMH‐HV is based on well‐established clinical and developmental theories, with refinement based on clinical implementation among thousands of families in Michigan over the past four decades. The intervention uses a manual (Weatherston & Tableman, ) and includes a fidelity monitoring tool (see Huth‐Bocks et al., this issue) and a case studies compilation volume (Weatherston & Shirilla, ). Clinicians delivering IMH‐HV in Michigan are required by the state Department of Health and Human Services to have at least a masters‐level degree in social work, psychology, or a related field; be licensed by the State of Michigan to provide psychotherapy services; and achieve endorsement by the Michigan Association for Infant Mental Health in Culturally Sensitive, Relationship‐focused Practice Promoting Infant Mental Health ® as an Infant Family Specialist, with endorsement as an Infant Mental Health Specialist preferred.…”