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Introduction to the ILAIMH Infant/Early Childhood Mental Health Competencies

“Competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served.” -Epstein & Hundert, 2002, p.227

There have been many frontiers in the psychological study of infancy and early childhood in the last fifty years, all characterized by the confluence of multiple fields of thought in a “climate in which diversity and even audacity…were accommodated” (Fraiberg, 1977, p. xv). And now we gather at the border of a new frontier: the growing national effort to systematically define “what constitutes a knowledgeable and skilled early childhood mental health … provider” (Korfmacher & Hilado, 2008, p.1).

The Illinois Association for Infant Mental Health (ILAIMH) has been an active player in the effort to promote professional development since it was incorporated in 1979 and before. The Association grew out of uniquely creative programs committed to the protection and nurturance of infants, children, and their families. These programs and their visionary leaders exist in the community, hospitals, schools, university settings, and early intervention programs.

These programs often grew in the context of the tension that arises when resources are required and must be redirected for new, but critical undertakings. Advocacy for the work, therefore, has been a constant in Illinois. Indeed, advocacy efforts have gone well above and beyond state efforts at child protection and education and into the private sector. The pioneering concept of “infant mental health” took energy and enormous commitment to promote. The state of Illinois and the ILAIMH have been the fortunate beneficiaries of strong philanthropic support and leadership, particularly from the Irving Harris and McCormick Foundations. Today, in Illinois, both infant and early childhood programs and education are core arenas for study, intervention, and advocacy – their vitality arising from state and private partnerships.

Historically and currently, the study of infancy and early childhood mental health in Illinois has been influenced by broad multidisciplinary engagement. Theoretical formulation, assessment, and clinical intervention have grown in the fields of psychiatry, social work, psychology, pediatrics, obstetrics, nursing, early childhood education, and many more. Illinois has leaders that have influenced thinking nationwide in the areas of reflective supervision, the neurobiology of development, strategies for parental empowerment, and perinatal depression.

Multidisciplinary work has provided a rich and vibrant culture for debate and momentum, but has also created a challenge for efforts to integrate and define goals both for service provision and professional development. The demography and geography of Illinois have added to this challenge. Counties and the programs that exist within them are very independent. What may be highly relevant for the rural areas of southern Illinois may not be so for the urban, densely populated areas of northern Illinois.

Therefore, the development of core competencies has many valuable purposes as it creates:

  • a pathway for integrating objectives of multiple disciplines in different parts of the state
  • a baseline for interdisciplinary quality assurance
  • a basis for work force development and guidelines for higher education course work
  • a basis for guiding and developing best practices in promotion, prevention, intervention, and advocacy
  • a system of protection for the public

 

The Framework for the Practitioner

The infant/child mental health provider from any discipline and in every setting is heir to a history of bold innovation in thought and skills. Developments in the field have moved apace in rapid non-linear sequences that have come in scattered starbursts of research and new insights, some embedded one in the other. No sooner was there an integrative breakthrough in how to really see the complexities and communication-ready skills of the neonate (Brazelton, 1973), than we learned that the infant could only be understood in context: first of the maternal relationship, then paternal, followed by the community, the impact of cultural determinants and on and on through sibling and peer relationships and early education refs. Finally, came the key understanding that the practitioner is a critical component of the context of development.

Most importantly, reflective again of the spirit of parallel process, the practitioner, in the private as well as the professional world, must be able to hold in mind all the intersections of infant/child, family relationships, caregivers, community, and self. An understanding of the implications of these intersections thus becomes a critical competency in and of itself and becomes an expectation for the credential.

At the very core of the ILAIMH credentialing process, therefore, is the status of the practitioner. In any skill realm, the overarching measure must be the practitioner’s ability for self-examination in response to a situation (e.g., a mother’s avowal that she does not love or want a previously longed for baby, a father’s neglect or abuse of his toddler with special needs, a teacher’s favoritism of one needy pre-school-age child over another). The questions are: 1) What do these scenarios evoke in the practitioner self-knowledge? 2) How do these scenarios intersect with the practitioner’s own sense of self as an attachment figure or with one’s own history of separation and loss (Schafer, 1992) /Personal/professional/cultural values and belief systems, assumptions?

The Organization of the Competencies: Foundational and Functional

The fields of medicine, psychology, social work, psychiatry, nursing, and education are awash with initiatives to define and measure competence rather than focus on course objectives and curriculum to measure completion of those objectives (Kaslow et al., unpublished paper). In psychology, it has been only fairly recently that the distinction has been made between foundational and functional competencies (Fouad et al., in press). Foundational competencies are defined as and serve to provide reflective practice, knowledge of relationships, cultural diversity, and interdisciplinary systems, with a strong knowledge of the research and theory that underlie these competencies. In contrast, Functional competencies focus on/describe….in part, skills in:

  • Assessment, with a well-developed ability for observation of the individual infant/child and family
  • Intervention, with sensitivity to cultural and ethnic influences on the family and a strong focus on empowerment
  • Supervision, with a focus on collaboration and affirmation
  • Advocacy, for the individual infant/child or family facing obstacles in social service systems that undermine optimal care (Kaslow, 2009). A corollary of advocacy is a broad range of knowledge regarding the systems that can solve a patient’s problems, and the capacity for organized trouble shooting.
  • Relationship-building skills, related to both family and agency work

While this distinction between foundational and functional competencies is an important conceptual tool, it is clear that no one aspect of acquired competencies can be employed without simultaneously employing some or all of the others. As one pursues the work, one becomes rapidly aware that foundational and functional competencies are intimately related: one is embedded in the other.

Acquisition of the credential, therefore, is seen as the culmination of a dynamic process of critical reflection on one’s portfolio of core skills and knowledge and key points of intersection of one set of competencies, and, where relevant, with all other sets of competencies. The competencies are therefore arrayed in four columns:

Column 1 is the set of required foundational and functional competencies in the designated arena. Columns 2, 3 and 4 are required competencies at the points of intersection with the other designated arenas.

core_competencies

Fig.1. Core competencies are embedded one in the other. They exist in dynamic and fluid tension with alternating ascendancy in any given context. Whatever the context, they occur simultaneously: a reflection of the complexity and originality of infant/child mental health work.

Core Competencies: Scope

The core competencies are just that: general skills and knowledge that are relevant and essential to all aspects of work related to infant/early childhood (0-5) mental health, regardless of specific specialties. They are designed for professionals from multiple fields with a Master’s degree or above who work in various settings including, but not limited to: early care and education, home visiting, health care settings, early intervention, treatment, and child welfare.

To apply for the I/ECMH-C, email credential@ilaimh.org