Transcript for
Collaborating to meet infant mental health needs – part one

Narrator (00:02): Welcome to the Emerging Minds podcast. 

 

Vicki Mansfield (00:08): Hi, I’m Vicki Mansfield and you’re listening to an Emerging Minds podcast. Before we start today’s episode, we would like to pay respect to the traditional custodians of the land on which this podcast is recorded, the Awabakal people. We also pay respect to all Aboriginal and Torres Strait Islander peoples, their ancestors and elders, past, present, and emerging from the different First Nations across Australia. 

 

(00:35): Welcome everyone to part one of this two-part Emerging Minds podcast series on collaborating to meet infants and toddlers mental health needs. Through developing the practise strategies for infants and toddlers suite of online courses, we consulted with a range of practitioners about how collaboration between professionals and families improves access to referrals and raises awareness of infants and toddlers’ mental health needs. 

 

(01:03): In these two episodes, you will hear from three practitioners from varied disciplines and roles. We’ll hear from Dr. Rickie Elliot, a clinical psychologist working in private practise. Rickie works with people across the lifespan and has a special interest in perinatal and infant psychology. She works holistically with parents and children and their other health professionals. Our second guest is Dr. Louise Wightman, child and family nurse. Louise’s role is working with families in a secondary level service. She provides support to children and parents around areas such as sleeping, settling, feeding, negotiating with toddlers, and looking after parental mental health. Louise also facilitates parenting courses like Circle of Security, which helps parents understand their attachment and their child’s attachment to them, and understand what’s going on in their child’s world. It’s also a pleasure to have with us, Lindsay Healy, the director of the Children’s Programme at Gowrie, South Australia. Lindsay has over 20 years of experience in helping parents respond to the needs of their children in a way that allows children to feel safe and secure while helping building strong relationships between family members. 

 

(02:18): In today’s episode, our guests will share the context or frame of reference that guides their practise with infants and families. They’ll discuss key points of collaboration during antenatal and postnatal period and share insights on the importance of creating a village of support for all families. 

 

(02:35): In Episode 2, our guests will share how they navigate key developmental and parenting issues in the early years. This includes insights about nurturing emotional regulation, and navigating the distress, rupture and repair in relationships. Finally, they provide insights into how reflective intentional coordination enables professionals and families to form a shared vision for their child’s wellbeing. 

 

(03:01): So to start us off, Rickie, I know you’re an advocate for the importance of antenatal screening and engagement with families. Can you tell us about this important form of early intervention? 

 

Dr Rickie Elliot (03:12): I am so passionate about this topic and really passionate about educating as many professionals as possible about engaging the antenatal period, including having GPs and obstetricians and midwives really assess and identify women who would benefit from antenatal engagement. We can just do so much in those early days before babies even arrive to establish connection and rapport with the person, but prepare them so much for this transition to parenthood in terms of psycho-education as beginning psychotherapy, setting up birthing plans, setting up supports for the postnatal period, doing delivery and breastfeeding preparation. And what happens when those things don’t always go to plan, and the feelings that come up as a result and really normalise that experience. It just reduces so much stress, anxiety, and shame and guilt in the early postnatal period that can take much, much longer to unwind and repair and heal for parents if we haven’t done that preparation work. 

 

(04:13): I normalise that the antenatal and the postnatal period is a really vulnerable time for mental health in families and women in particular. And that how we can do so much preparation work for the feelings that inevitably come up in that early postnatal period and that I’m here to support them on that journey and through it into the postnatal period. And what supports and things can we put in place to put them on the best start for that transition into parenthood. 

 

Vicki Mansfield (04:41): And how can normalising or validating assist in engagement? 

 

Dr Rickie Elliot (04:45): I think the normalising helps incredibly. I think people feel that it’s just them and there’s a lot of guilt and shame still around that in that you should be able to do it on your own. So I think normalising many mood experience, even if it’s not something that’s openly discussed still, I mean, we are getting better with that, but it’s still not always openly discussed. It’s one of the most difficult transitions in life. It’s one of the most joyful times, but it’s also one of the most challenging times with so much pressure. So I think normalising that and what inevitably many women go through is really helpful. 

 

Vicki Mansfield (05:18): You mentioned, Rickie, preparing for birth. Can you explain what that might look like? 

 

Dr Rickie Elliot (05:23): Yeah, it is incredibly important to support women in that. So one of the big things we’ll do in preparation for delivery is birth plans and care plans around that and often work with the client in collaboration of what would be in that. And then, obviously with their permission, sharing that with their obstetrics team or their midwives, their doctors who are involved in that. Because it can be a time where trauma is re-experienced. We can see dissociation through delivery. 

 

(05:53): So we can do things like reduce the amount of medical professionals in the room, increase the amount of communication around procedures if they need to happen, put supports in for post-delivery to check in on them, all those kinds of things. 

 

Vicki Mansfield (06:06): Thanks, Rickie. Louise, sometimes parents see child and family nurses as the people who weigh their baby, but in my experience of working with child and family nurses, their role has much greater depth than basic physical checks. Can you explain child and family nurses’ role with infants and parents? 

 

Dr Louise Wightman (06:26): That’s the key thing I think, with child and family health nursing, that you have more than one client. You’ve got the child who you’re there to advocate for, but you’re there to support the parent as well. And so, it is a case where whatever’s going on for the child can be very much influenced by the family dynamics going on around them. 

 

(06:46): I think for parents who are experiencing difficulties, understanding where to go for help is really challenging. So the role of the child and family health nurse is to help them understand what’s happening for their child, and if they need further support to make referrals and get them connected with another service if they require that. It might be something like going to see a paediatrician, what would that be like? Or a physio if their child’s development, if they’ve got problems with their neck development or head, those sorts of things. You’re there to help parents navigate and stay connected to them to help them move to get the support that they require. 

 

(07:33): One of the skills is working with them. So working in partnership with them, asking them how comfortable they feel. It’s understanding your relationship with them as to what supports they need. Rather than just making an assumption that a parent can’t do this. Actually, what would you like to get out of this? How will we go about doing it? Do we want to do it within this room? Are you comfortable to do that at home? Would you like your partner to do that with you? How would this be? So they get to make the decision about how we go about this process. I think that’s really important because we might see the child for a short period of time and they’re with their child 24-7. So they have a greater understanding of their child and encouraging parents that yes, you do know your child the best and we are here to support you. 

 

Vicki Mansfield (08:26): Thanks, Louise. It sounds like working in partnership with families and collaborating with other professionals is a core skill for child and family nurses. 

 

(08:35): Lindsay, I’d like to get your perspective. As a leader of educators and looking at the Australian Institute of Health and Welfare report for 2022, we see that approximately 30% of infants under the age of one attend childcare, 62% of one-year-olds attend childcare, and 72% of two-year-olds are enrolled in childcare. That’s a significant number and conveys how significant a role childcare educators play in the family’s villages of support. Can you tell me your thoughts on the role educators play in being a part of a family’s village? 

 

Lyndsay Healy (09:17): It’s a massive responsibility to have with families and to be accepted by families as part of that village. And I think it’s one that we don’t take lightly. It’s one that’s a huge honour to have with a lot of families. But I also think there are issues with today’s society around parents feeling really isolated and having to do it on their own. Being able to create a village that we can wrap around a family for the best supports possible, can only support that family and that child to have the best possible outcomes as we work together collaboratively for that. 

 

Vicki Mansfield (09:53): And Lindsay, can you share with us what caregiving model informs your collaboration and engagement with infants, toddlers, and families? 

 

Lyndsay Healy (10:02): We work within what we call a primary caregiving model, which means that every educator has to have a relationship with every child in the room, but they have a particular group of children within the room that they’re responsible for, I guess, developing a more meaningful relationship. And they work in a really close partnership with those children’s families as well around what’s happening for them in the space and at home. 

 

(10:23): And so, when we talk about the educator’s responsibility for that, it means that the educator has a lens of intentional planning for relationship. Some, we know that there are other approaches to doing that where people might watch to see which educator a child might naturally gravitate towards or feel is a good match. Whereas we feel there’s a risk in that, in that what happens if the child doesn’t naturally gravitate towards an educator. And so it’s really about the educator taking on a reflective practise lens, I think, around how they build that relationship, match to the child, and really use something we call Circle of Security, which is a framework that we use and a roadmap that we use for reflecting on how we build relationships with children so that they feel really safe and secure in the space. And we understand that that’s the foundation before children can really engage deeply in the curriculum and the programme. We have to get that right first. 

 

Vicki Mansfield (11:22): And Rickie, when you are working with infants and parents and establishing that safe therapeutic relationship, what guides your thinking and practise? 

 

Dr Rickie Elliot (11:33): I think it’s really important to always have the children’s needs at the centre of your mind, because I think what can happen in a lot of other spaces is the parent’s great mental health needs or past trauma or current relationship needs can take over and fill the entirety of the therapeutic space, and the needs of the infant can often be overlooked. So I think that while we still need to address and help parents with those individual issues, we need to simultaneously work with the parents’ concerns, but also focus on the parent-child relationship and the needs of the infant. 

 

(12:12): I think first and foremost, always thinking about your own attachment with the adult client in the room. So you are always mirroring and it’s a parallel process. So again, what we would like for the parent-infant relationship that is mirrored in the therapeutic relationship. So again, establishing that secure base, that rapport, that engagement, the parent needs to feel safe, not judged, that you’re kind, you’re caring, you’re understanding before we then move into anything else. 

 

(12:43): And then it’s kind of the same thing that we then do with parents once that’s established is reflecting back strengths in the relationship, being curious about the infant’s needs, being curious about what that particular challenging one brings up for the parent and being able to be with them in that. We see then a reciprocal process where the parent’s able to be with that baby in joyful times, but also in challenging times. 

 

(13:10): So I think reflecting back and noticing when the child’s showing attachment behaviours, when they’re coming in for comfort, when they’re coming in for support, when they’re out exploring and what they need in that moment. So we can just observe and be curious about all those behaviours in the room. 

 

(13:29): Because in my experience, a lot of people that come in have never had anyone reflect back their strengths in the parenting before. And sometimes when you do, that’s a profound experience for them in and of itself. I think to point out all the little ways of your meeting needs that you’re not even aware of, there’s the everyday comings ins and going outs of infants. They’re not even aware of the level of work and relationship input that they’re delivering. So I think that’s always helpful. 

 

(13:59): I think it’s really helpful in challenging moments as well. So for example, if a parent’s trying to engage with the baby and wants the baby to smile and have a chat with them and the baby’s looking away, that might bring a sense of rejection, not for the parent, but being able to talk about what the infant’s actually doing in that space is a regulation strategy to not be overwhelmed from a sensory point of view and those kinds of things. So I think reflecting back the challenges as well as the positives is just really helpful and that’s why it’s so important that the infant’s in the room. 

 

Vicki Mansfield (14:34): And Lindsay, your service would see children with a wide range of needs. I’m curious for children who might have additional needs or have experienced trauma, how can educators respond and meet their social and emotional needs in a group environment like childcare? 

 

Lyndsay Healy (14:53): I think it’s absolutely vital that educators have got an understanding of how trauma affects brain development and how that can trigger the flight, fight, or freeze response for children and what that can look like within your service. And then of course, not just what it can look like, but what you might be able to do to support a child who might be experiencing those sorts of things in your service. And a family that might be going through supporting those sorts of things at home. Because it can also duel challenges across multiple environments. 

 

(15:23): As an example, we went through quite, I guess a turbulent period I would call it, in our kindergarten setting where we had a number of children who had experienced trauma in the space, who seemed to be impacting each other, but also the adults and the children in the space as well. What we were finding is that we weren’t really, through our reflective practise and our usual channels, we weren’t really landing on the right strategies to be able to, I guess, support the children the best way we could. 

 

(15:53): We ended up drawing on different bodies of professional knowledge to be able to support us. So we came up with a project that we worked with in partnership with another organisation around filial play therapy, which is a non-directive play therapy. So our team of kindergarten educators undertook workshops around how filial therapy worked, and then they had ongoing weekly sessions with focused children that were supervised by a play therapist. What we found was it actually made a massive difference to the children in the space. They started showing much more higher level skills with being able to read social nuances between children in the space, able to articulate their needs rather than being dysregulated. It really did make a really big difference. 

 

(16:42): It provided a different kind of environment than what children and educators in a group care setting would normally be able to spend a significant amount of time with each other in. It’s rare in a group care setting for us to be able to spend really concentrated one-to-one time with one another without any disruptions. So that project gave those educators that time to do that with those children, and it was a really special time that the children and the educators both loved to spend with each other. 

 

Vicki Mansfield (17:12): What stands out for me, Lindsay, there is that it sounds like educators are really skilled in observing our young children’s needs. What do you think are the benefits of educators and allied health collaboration? 

 

Lyndsay Healy (17:25): I think educators get to have a different kind of relationship with the children that they work with than the allied health workers do. I think it comes from both sides. We both offer different perspectives of the things that we notice and experience when we are working with the child and pulling together our professional knowledge to understand that from multiple perspectives, I guess, provides a richer platform to be able to plan more responsive strategies for children. 

 

Vicki Mansfield (17:55): Rickie, from your perspective as a psychologist, how important is coordinating and working with educators or other professionals in your work with families? 

 

Dr Rickie Elliot (18:06): I’ve been working with early childhood centres. I think with all children, including young children, we have to work holistically with their whole network. Some young children have really important relationships with their early daycare providers. They can even make it onto their important attachment list. So I think that being able to engage those service providers and work with them, one from an understanding of how they see the infant or little one in that context in relationship with them, in relationship with others. 

 

(18:36): It is critical to collaborate and coordinate with other practitioners, the obstetrician, the GP, paediatrician, psychiatrist, whoever else is involved in the care of the person. Because in private practise, we can just work in a silo and it does take extra time for that coordination, but working as a team to support the family always has the greatest outcomes and it becomes that village that surrounds the family that often that they’re missing. Particularly feeding back to the centre person such as the GP what the role is, because often that GP will become that infant and child’s GP as time goes on. So it’s really important from that perspective as well. 

 

Vicki Mansfield (19:14): Thank you Rickie, Louise, and Lindsay for sharing your practise insights with us today. I feel our conversation has really highlighted the importance of reflecting on the systems of care that surround children and families. This enables us better to consider each other’s roles and our practise frameworks, which really helps with that cohesive coordination and communication between professionals and families. And ultimately enables us to all keep infant and toddlers in mind throughout our service. We look forward to continuing this conversation in episode two. 

 

Narrator (19:50): Visit our website at emergingminds.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health. Led by Emerging Minds, the centre is funded by the Australian Government Department of Health and Aged Care under the national support for Child and Youth Mental Health Program.