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

Narrator (00:02): 

Welcome to the Emerging Minds Podcast. 

 

Vicki Mansfield (00:07): 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. Welcome to episode two of collaborating to meet infants and toddlers mental health needs. 

 

(00:40): In our second episode, we continue our conversation with Dr. Rickie Elliott is a clinical psychologist, Dr. Louise Wightman, a child and family nurse, and Lyndsay Healy, the Director of Children’s Programmes at Gowrie South Australia. And today we’ll explore how their reflective practise guides their work with parents and how they navigate some key developmental areas that influence children’s mental health. We’ll explore the importance of nurturing emotional regulation and what being with big emotions looks like and the importance of navigating rupture and repair and relationships. 

 

(01:18): Welcome back, Louise. Can you share with us, Louise, how reflective practise and collaborative case discussion or case review might inform child and family nursing practise? 

 

Dr Louise Wightman (01:29): I think in the case of a complex family dynamic, it’s helpful to map out who’s in the family, what part do they play in this child’s life because you’re trying to keep the child in the centre of this interaction, looking at what the child brings to the situation, looking at the strengths or vulnerabilities of the families, the barriers, what might get in the way of making that change. And then looking at the goal for this family because it’s very easy for clinicians to slip into what they think should happen rather than going, what does the family want in this. 

 

(02:10): Exploring what questions you might need to ask the family, what do they want to get out of this, how do they feel they’ve got the capabilities to make change or what supports they need to make that change. Because unless the parents are ready to make a change, unless they’re feeling comfortable or confident that they can take the next steps, it actually doesn’t matter what the clinician wants to get out of this. It’s really about the family. And when you have the opportunity to sit down and explore this with other clinicians, then you also get ideas and their experience that comes to the play. 

 

(02:49): So it makes you reflect and ask a lot of questions. And that way you may have been working with a client and you’re on the right track, but you can’t see that. And so by having this discussion, it helps you plan the next steps with the client. 

 

Vicki Mansfield (03:06): Okay. So it helps you plan your next step. It seems it’s also an opportunity to consider our blind spots and assumptions because I think we all have those blind spots and assumptions when we’re working with families. 

 

Dr Louise Wightman (03:20): I think that’s very helpful because sometimes we can think, right, I need to go in and help this parent get connected with a paediatrician, or they might need to do a parenting programme or their child’s doing really well, but they can’t see that someone might need to refer them on. But we need to go back and remember this is the clients, this is the family’s journey, and so they need to be the people who make that decision. And helping parents understand their children, they will be more on board in helping them get support if required. 

 

Vicki Mansfield (03:55): Louise, I’m wondering, is there a role for child and family nurses to be an advocate or voice for the child? How might child and family nurses notice or be curious about child and parent relationship? 

 

Dr Louise Wightman (04:08): I guess it’s how they interact with their parent. Do they use a parent as a secure base and are comfortable experiencing that with their parent or will they be coming towards the clinician and seeking out our support? And it’s observing that interaction that helps us be able to say to the parent, look what’s working really well. Look how your child is so enjoying this experience with you. You are enabling them to see what’s going on, but you’re also being there as the voice for the child, particularly with non-verbal children like babies. 

 

(04:48): Helping parents to see how their child connects with them I think is really important. And that pointing out what I see so that parents, if they’re not able, if they’re anxious or they’re not able to see what’s going on, that I get to experience the joy, I suppose. 

 

Vicki Mansfield (05:07): Lyndsay, in our earlier conversation you spoke about how educators consider behaviour as communication and the importance of educators being aware of the impact of trauma on young children. And what role can educators play in assisting infants and toddlers to build their confidence or their sense of security in their social interactions? 

 

Lyndsay Healy (05:30): I think educators being sensitively attuned to the child is really important. And again, like I’ve mentioned before, this idea of meeting the child where they’re at and where an educator understanding I guess parts of the physical environment within the space where they would feel most comfortable. For example, if a child prefers to be in the outdoors, then we would be planning for, I guess, doing some really safe and supported connection with other children in their preference. So say it’s the sandpit outdoors, then we would be doing some things in the sandpit and inviting children in. 

 

(06:05): We also have training for an approach called Matamayo, which means on one’s own strength, which was developed by Maria Arts. And as part of the Matamayo approach, you would use something that we call sports casting where we would be naming all the initiatives of the other children around that particular child so that the other children were actually very predictable for that child and there were no kind of surprises coming at them. But also that idea of naming that child’s initiatives to the group as well, so that we’re threading them together and linking them together in their play. 

 

Vicki Mansfield (06:41): 

So you’re giving language to what’s happening around the child and also fostering predictability. And Lyndsay, you’ve spoken a few times about being with and matching energy. Can you explain what you mean by matching energy? 

 

Lyndsay Healy (06:57): I guess when I talk about matching energy, I’m talking about being in tune with one another. It means that if a child is a quieter or more withdrawn child, there’s no point an educator going in all over the top and bubbly and loud. It’s about kind of understanding how the child operates and probably the way that the child would be used to their family kind of being emotionally in the space as well. And it’s about how you create that emotional atmosphere around the child through your relationship. 

 

(07:33): So if they’re quieter, then you would kind of bring your energy much lower to kind of match them at where they’re at. If they’re quite a soft speaker, then you would also speak in really soft tones, so really mirroring perhaps the child’s physical and emotional affect. Yeah. 

 

Vicki Mansfield (07:50): Thanks, Lyndsay. That’s a beautiful response and description. And what a powerful experience for a child to have someone be so attuned to their presence and to match and validate their sense of emotional well-being. 

 

Lyndsay Healy (08:06): I think it’s the delight that you see between educators and children together. And there’s this idea that I think it was Kent Hoffman talks about as part of attachment theory with this idea of one of the most important things that you need as any person, particularly a child, is to know that you’re held in the heart and the mind of another person even when you’re not together. And that’s an incredibly important part of what we try to help children feel as part of our work. 

 

Vicki Mansfield (08:37): We know family is often looked at child and family nurses for support around sleep and settle or eating or food concerns. How do you balance child and parents’ needs and perspective in this work? 

 

Dr Louise Wightman (08:50): Starting from what is actually happening for the family, explaining what a child is capable of in terms of sleep and regulation at this particular age and stage of their life. And then working with the family, explaining ways that we can support children to do it differently or parents to do things differently. And then working out with them, getting them to make some decisions about what’s the next step, what would they like to try, how might that work for them? Who can they involve to help them make that support? 

 

(09:25): Because parents really need to be able to make choices, and then it might be practically being with them at the time when you’re making that change as so you can offer them encouragement or help them acknowledge this is really tricky. What do I need to do if I need to step out of this space so that I can have some emotional regulation myself before I help my child have emotional regulation? So the key is really thinking about what are the family’s goals in this situation. I think parents are always looking for evidence-based information. 

 

(10:03): So sometimes it’s being able to explore where they’ve got that knowledge and be able to step them through the development of that child. Because once they understand where the child’s at, what they’re capable of, how much support they need with regulation, then parents often find it much easier to make a decision about what their next steps are. And that’s the really important thing. It’s sort of dispelling some of the myths that are out there. And with the evolution of various platforms that have various bits of information directing them to some reputable website sometimes or providing them with some detailed information can help them understand that perhaps actually what they’re experiencing is right for that child’s development. 

 

(10:55): And it might be just be patient and wait for a little bit longer and your child will get there rather than there might not be anything that needs to change right now. 

 

Vicki Mansfield (11:06): Great. Thank you. Similarly, what might be the ways you work in partnership with families around food challenges? 

 

Dr Louise Wightman (11:14): One of the ways is to actually explore what happens with the family. What do they eat? How do they eat? Where do they eat? Do they have particular concerns around particular foods? Are they concerned about allergies? And then again, it’s what’s the capability of that child at that time around the taste, texture, volume of food. So providing that really good evidence-based information is important and then unpacking with the family how they eat in their family and what might they do differently or the same or more of. 

 

(11:54): And that enables parents to really understand what’s going on for their child and the capability of their child. And so it can reduce a lot of tension with food because we talk about ways to incorporate it, that it’s a social event and it’s not just about nutrition and it’s not just about volume and how we can help to bring a calmer experience in that space and what we might need to do if things are not going well. So it’s working, understanding the family before you come in and give them a whole lot of information that may overwhelm them. 

 

Vicki Mansfield (12:38): And what I hear there, Louise, is the importance of conversation with families to understand their unique context rather than just providing information that’s prescriptive or a one-size-fits-all. And this leads me to be curious about one of the most vulnerable parts of parenting in the early years is how to navigate big emotions or distress. How can child and family health nurses support parents and children with emotional regulation? 

 

Dr Louise Wightman (13:07): I think reflective practise supervision is really important because it helps you understand where you are in the space, what might be going on for you in the interaction with your clients and helps you sit back and look at the situation from a broader perspective. So for me, that reflective process is really important because you can often get caught up in the emotion that’s happening in that family. And in order for us to be able to guide the family, we need to be able to sit back and think, where am I in this situation? What skills do I have? 

 

(13:46): What might I need to enable me to have the knowledge that I need to support this family in this space? So for me, that’s a really important part, being able to be reflective so that I can be there for both the parent and the child. 

 

Vicki Mansfield (14:01): And so does that help you navigate the relational aspects with parents as well?  

 

Dr Louise Wightman (14:05): I think that’s really important because this work is relational and we need to understand how we are building a relationship with these clients. I think that’s really important. And when you unpack that in clinical supervision, you can often see, oh, perhaps I need to do something differently. Perhaps what I’m doing might be getting in the way or how’s what’s happening in this family working? And then you can help the parents understand better what’s going on because it’s understanding that relational aspect. And I think that’s a key element. 

 

(14:41): We often come into this role thinking we need guidelines and we need to follow those, but that’s not actually what’s the most important thing is understanding that we have a relationship with this client and how does our relationship influence them? How does their relationship with their child influence what’s going on? 

 

Vicki Mansfield (15:10): Louise, in that process, I hear that sometimes you’re following the lead of the parent and sometimes we might need to be more directive if someone’s in complete distress or overwhelm, what helps you make those decisions? 

 

Dr Louise Wightman (15:17): I think it’s your understanding of the development of that child and what’s happening for them, what do they need to be emotionally regulated at that moment. And it might be that we need to be the voice of the child for that parent to explain at this moment, I’m feeling really upset. I just need you to hold me. You might be voicing that child’s thoughts, I suppose, or anticipating what might be happening for that child so the parent can get a better understanding that this is about the child’s emotional regulation, what they need from them rather than seeing the child as the behaviour. 

 

(16:00): So it’s that understanding of growth and development that’s really important that a child and family health nurse can bring to that situation. So parents’ expectations are realistic of what their child can actually manage at that time, but it’s also acknowledging and saying, this is really hard. So sort of supporting the parent to understand that this is really hard and we can reach out to people when things are really hard. 

 

Vicki Mansfield (16:29): And Rickie, from your perspective, what key points do you hold in mind when you’re supporting a parent who may be feeling overwhelmed or angry with their toddler’s big emotions or behaviours? 

 

Dr Rickie Elliot (16:43): I think that we spend a lot of time validating that anger and that frustration and giving space for it before we’re just trying to get rid of it and fix it. We want to explore what that means for the parent. We want to explore their feelings towards their child. We want to explore what certain things really are tricky for them, and we want to explore whether that’s shark music in circle security speak, something from perhaps their own upbringing or if it’s other challenges around needing more supports or things like that. 

 

(17:18): So we’re going to look at what the challenges are perhaps from the past that are coming in and what’s currently happening in the now. And we always want to reflect on the child’s experience of that, how might the child see that or view that or what feelings and needs in the child might be driving their behaviour that’s triggering the parent. So we always want the parent to try and see beyond what’s frustrating, annoying, and what the child might be trying to express, because often they can’t express things verbally. 

 

Vicki Mansfield (17:51): And what about rupture and repair? 

 

Dr Rickie Elliot (17:59): I really normalise how normal it is for us to all rupture and repair all the time, that we’re human and in any relationship you have, whether it’s with your partner, a friend or your children, you’re going to miss cues or miss signs. And the more we get to know each other, the better we get at that. And infants and babies, we don’t know them yet. It’s a new relationship, so it takes time for both people to understand each other so that it’s so normal and that hundreds of ruptures occur in any given day and we get better over time about noticing the cues and repairing them with more significant ruptures. 

 

(18:35): So parents got really distressed at a toddler over something. Again, we just talk about that’s really normal, that lots of ruptures happen in the course of the day. And if we don’t have ruptures and we don’t have the opportunity for repair, the child misses out on learning a great deal about emotion, regulation and social skills. So if we are perfect robotic parents and never have ruptures with our young children, then the child never learns how to repair. So by the parent naming what they’ve done, taking responsibility saying to the child, I’m so sorry, I just yelled then that must’ve been scary for you. 

 

(19:15): What was that like for you? And they’re go, yeah, it was scary. And they go, I’m sorry. I was stressed or I was busy with this, but I shouldn’t have done that. I’m sorry, that was scary. Would you like a hug? That teaches the child that their parent is human, their human emotions get the best of all people, their human emotions are going to get the best of them at times because they’re human and that causes conflict. That’s normal. But you own it, you take responsibility and you repair it. 

 

(19:43): And that’s such a good social skill because that’s a big reason why relationships break down is when one or both parties don’t take responsibility and do repair. I often get them to think on their own childhood and what it meant even if their parents had had these ruptures, if they had have received repair. And a lot of adults and parents go, it would’ve been such a nice thing to have repair then or even now because people care less about the rupture and more that their parents never discussed it around it. 

 

(20:16): And I quote child psychologist Alicia Lieberman, who’s an author, a well-known person in the field who writes in our book that parents and young toddlers have hundreds if not thousands of ruptures in any given day because that no, is that child’s favourite word. So to normalise it, have compassion. And often I bring a lot of humour into that around what parenting and children and how they can drive you crazy. Those kind of things help disarm shame and defence against shame, I think, and fear that you’re going to judge them as a parent. 

 

(20:49): And also that ruptures and repair in any relationship, bring you closer together with that person once you’ve talked that out and apologised rather than it never happened at all. Because it’s often in moments of distress, we can be more close with other people rather than just the happy, fun, playful times. 

 

Vicki Mansfield (21:12): Thanks, Rickie, for your compassionate perspective on navigating rupture and repair in relationship. Finally, I’d like to thank Lyndsay, Louise and Rickie for being so very generous in sharing your practise skills and insights. What stands out for me is that a key aspect of collaboration is understanding other disciplines perspectives and the context which in may work. And each of you have generously provided rich insights into your respective areas of practise and how you work with infants and toddlers and families. Thank you so very much. 

 

Narrator (21:47): 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