In this episode we explore the topic of mental health for young children ages 0-5. Our conversation will explore ways in which parents/caregivers may foster healthy environments to help promote childhood development. And we discuss how parents/caregivers may look for and identify possible problem areas and where to find specialized mental health resources for young children when needed. This is an incredibly useful conversation for parents/caregivers of young children!
Infant & Child Mental Health with Kerrie Schnake & Dr. Mackenzie Soniak
Introduction 1: This podcast is brought to you by the South Carolina department of mental health a healthcare organization providing innovative mental health and Wellness services across all of South Carolina learn more about our services or resources at www.scdmh.net
Introduction 2: Child and adolescent mental health is a topic in a conversation receiving considerable amounts of attention today and rightfully so and if you look further you'll see a growing body of work focusing on infant and early childhood mental health it's a topic for you may have considered and yet the effective promotion of healthy development from ages 0 to 5 and the ability and power of simple meaningful interactions to influence a child's life while it just can't be overstated in terms of its importance and impact in today's conversation we speak with the CEO of the South Carolina infant mental health association Kerrie Schnake and Dr. McKenzie Zodiac clinical psychologist and the director of infant and early childhood capacity building and what follows is an incredibly important conversation for families as we discussed mental health and young children and effective treatment and resources for those children and their families
Moderator (M): I was really interested and curious about this topic and knowing more and so I think a lot of our viewers our listeners will be really interested in as well. The first question that came to my mind was what is infant mental health and why is it important for us to be thinking about that?
Guest (G): Yeah I think it kind of it doesn't it's not a common combination of words we hear infant and mental health that's so I think it does you know raise a lot of questions and interest from folks sometimes it's you know people are eliciting like an image of a baby on Freud's couch or as we tend to do in the US clear the words mental health and we jump to mental illness yeah and so you know we're the people are thinking about babies with you know like multiple personality disorders or some kind of extreme thing and it's really much more subdued than that it's very consequential but smaller babies are small their signals are small they that there is a mental health concern and so it really tastes kind of a specialized lens to look at it and Mackenzie you jump in and maybe you can talk about I I said what it is and maybe you could talk about what it is.
(G): Yeah I mean I think that when we kind of think about the kind of the formal definitions that have come up about it there's kind of these different components that we really focus in on so but ultimately the underlying piece of it is that there's things that we expect babies to do great and then this shouldn't come as a surprise to anybody right we expect babies to form close relationships with the people who take care of them and so these can be their parents at home. They can be the childcare workers where they spend some of their time while their parents are at work grandparents so on and so forth but we expect them to form those relationships we also expect them to slowly but surely learn how to express and manage their emotions and this is kind of where the crux of the piece when we're talk about how mental health issues will show up and is really kind of one of the most poignant parts that we'll probably talk about later because ultimately, the way that children learn that it's OK for me to have feelings, it's OK for me to signal when I'm not OK when I'm having big sad scary mad feelings. And then I know that there's that somebody there to be with me in that relationship to help manage those feelings and that eventually I'll start to learn how to do it a little bit more independently and then just again learning from their world around them. So when you then have a caregiver who's there who can help you when you're feeling overwhelmed by new tasks such as for some of those first tasks that we think about of reaching up to puzzle or learning how to navigate new peer relationships that ultimately you are able to manage your feelings in those moments. And so your problem solving, you can pay attention for longer periods of time. You can really feel like you can go out and learn from the environment around you and they're all interconnected and also important. But ultimately what you'll hear us talk so much about is that the foundation of this is that relationship.
M: So what do you see in terms of maybe infants that haven't had that environment so maybe there's neglect or there's some sort of trauma situation like early on you know are they presenting as a child in a different way that a caregiver might be able to kind of be mindful of?
G: Yeah I mean I think one of the things that we share when we work with other professionals and we're teaching about infant mental health is one of the answers is it's always it depends right so you a lot of people have kind of heard about this nature versus nurture impact and the reality is that we know from science it's nature and nurture kind of weighing in at different kind of pieces of this and so you know just because a child hasn't had the most optimal environment doesn't necessarily mean that we are going to see really terrible outcomes. But sometimes we know that young children might have just slightly less than optimal environments and we see really big negative outcomes. And so in a lot of ways that's where we mean of it depends right and so it can be that this is a very sensitive child who really needs very specific environmental conditions where it can be impactful or it could be a really resilient child who maybe doesn't have necessarily the most optimal conditions but there's enough there to keep them flourishing and so I think that that is something that we always want to kind of uphold as that piece of resilience and hope.
M: Are there things that parents can sort of a pickup on because you know I mean there's all kinds of things you have a colicky baby or you know maybe there's a baby who seems quiet and you're a little concerned because they might not be picking up on cues and there's also the issue of you know autism spectrum disorder and all of that so there's all these kind of complexities any sort of advice for parents especially new parents that are trying to navigate this and what they may notice or not notice?
G: Yes I think that there's still right there's still those concerns are present and you know the fact of the matter is that young children are at do have diagnosable disorders and there then you know that's zero to five age range. And what a lot of people don't know is they're pretty it's pretty similar to what we diagnose older children and adolescents right the rates are pretty similar but again it can be tricky right? And so Carrie is talking about this earlier of one baby it's babies it's really small and so it's sometimes that you're not necessarily looking at like what the symptom is you're trying to say oh there's some symptom here but what is the cause of this right sometimes our symptoms are signals and most often what we tend to see in infant and early childhood is its behaviors. It's behaviors are signal behaviors are the communication that hey something's not quite right but let's say you have a 2 year old who is being really disruptive and their classroom they're having frequent tantrums and they're in their classroom at their childcare center and it's really giving the teachers a lot of grief. And so the tantrums what like what why are what are those tantrums caused from a child's not gonna say I'm having big bad sad feelings that because my I missed my mom there what if that child's mom has passed away? What if the child witnessed their parent passed away? What if their child has child welfare involvement and has been separated from that parent? And so oftentimes it's not necessarily about what exactly the signs are. It's about you saying hey there's this sign here and I'm curious about it and I want to understand what could be the root behind why this is happening that gives us more information. I often tell parents trust your gut if something feels off get curious about it yeah and they kind of brings up a couple of things. One is sort of the age and just naive about this so we say infant you know what are we looking at in terms of age ranges are just zero to one or because you know you referenced that 2 year old and that sort of thing yeah we identify infant as birth to three. So what we actually call our we describe our work as infant and early childhood mental health because our focus is really on birth to five actually prenatally to five because that relationship between baby and mom starts prenatally. The mother is bringing her own experiences of being parented into the expectations of the baby she's carrying and so already there can be some defining ideas of what this child will be and what their relationship will be. And so it starts very early that would add to you know expanding a little bit on what Mackenzie said about how it shows up that it is it is indeed it's kind of a ruling out the typical features that might explain a child's behavior. That is the behavior that's extreme or persistent so you know in the example of perhaps there's a child a 2 year old or three-year old in childcare and they've got big behaviors in there throwing things and hitting and screaming and it's beyond what the other kids are doing so and kind of question is that environmental does it only happen in the classroom? Is this how the child is in all circumstances? If it's just in the classroom maybe it's overstimulation maybe it's the way that the environment is set up is really encouraging the kid to just run loose. You know there's not nice little areas where they can get engaged in the materials so you kind of rule those things out and then when you're left of those those aren't explaining it then you kind of come to the idea there's some unmet need here and is that need did it was there some trauma in the in the in the past that hasn't been resolved? Is there you don't know what you got you know you have to ask these questions to really dig into what is it behind it but that's kind of the lever that would say OK this more than typical development? There's something else going on here too to address.
Yeah I'm often fascinated by just sort of some things that maybe can happen that a child experiences and even at that young an age where you may not realize they're experiencing and how much of an impact they could have sure and I mean I think that the other I mean you it's you talked about these small signals earlier too and so you know one of the really amazing things about human beings is how adaptable we are but that comes as a consequence sometimes too because you know sometimes we don't necessarily recognize the signals that are not happening as also a way of cueing us in that that we might have concerns and so we we've been talking a lot about kind of these bigger observable behaviors but on the opposite side you also might have these babies or young children who are not going to people for help when they have big emotions um that they're not reaching out to the teacher to their caregiver and you know what research has shown us is that by the age of 10 months old infants have learned what needs make their caregivers uncomfortable and so they will stop signaling their caregiver that they have those needs and so they'll start to signal something else saying this is an approximation of what I can get from you. I know that you will respond to this but I really need to be, for example, comforted in this moment. And so you can literally see these babies who stop crying and oftentimes we hear about this and their label all these kids are so good. I never have any problem with them they're so quiet and for us that's a signal of saying hey maybe we should wonder about why they're not letting you know that they're upset because truly we want babies to cry. We want them to let us know that something's happening that's their way of communicating and then we need to then respond to them. It's like this paradigm shift in terms of the way you might look at you know at the children how they're developing and being mindful of that what does treatment look like for an infant or somebody between zero and age 3.
I think there's a couple of you know evidence based practices that are out there right so there's very specific training for mental health professionals who go who might be treating this age of population and kind of across all of those different treatment modalities that you might see there's kind of this core of the relationship as the focus again right? So we kind of come back full circle to the relationship is what we want to see at that foundation for you know typical development. And the relationship is what we go back to when maybe we see things that we're concerned about. And it's truly this idea of building a house right? So if you can give the parents all the parenting strategies and tell the child all these coping skills but if you do this with how if you do all the scaffolding without the foundation it's going to be unstable. The structure is going to be unstable and so you're constantly going back to the structure with these temporary fixes. If you don't then focus on the relationship the relationship is the vehicle for change and healing and so all of the interventions will do that and admittedly as somebody who does this work that's a hard sell for parents. When you say that we're going to talk about the relationship because right it it's there's I think a lot of parents when I talk with them and I've done this work for a while now there's this the one the one common fear that I have is I don't want to mess up my kid. And so there's a lot of self-blame that sometimes happens. There's a lot of fear that others will see you as not adequate. And so there's a lot of support that has to go in with the parents of saying hey this is just really hard and you didn't do something wrong. This is we're working from strength based lens where we're trying to make sure that you are not blaming yourself because we're not here as the professionals in that spot and just really getting at how does it feel to spend time with your child? Do you feel anxious when this happens when your child behaves in this way or is does it feel hard to be with your child? And most of the times when you kind of end up going down that path that parents will admit yeah it's really hard for me to be with my child especially in the moments where there are these behaviors that I'm not sure how to handle or when the child doesn't seem to be responding to the way that I'm attempting to support and comfort them and I just I'm out of options of what to do. And so it's eventually you end up getting there of saying and This is why we're going to focus on the relationship.
M: Yeah that that's great because I was thinking because he tried you know what brings people you know to you or to someone for help and it's so that kind of gave a nice picture of maybe what that might look like if somebody's feeling anxious or in terms of the relationship that it may be indicator that they may want to talk to somebody are our pediatricians mindful of this I'm trying to think of we're going to get into I want to talk about the association as a resource but you know how do people seek help? I mean what are some of the ways that they do that? We have a lot of growth in this area in South Carolina not that pediatricians necessarily the single them out but just kind of in general you know there's still a lot of belief that like babies won't remember and so just babies won't remember trauma so we don't need to address it. They'll be older it won't be a problem but their bodies remember and so there's a lot of awareness raising that needs to happen across all of our families but professionals as well who serve young children and families in different sectors.
G: Pediatricians, home visitors, child welfare you know social workers there's there is a lot of room for recognizing exactly when there is a concern that qualifies for I needs this child needs something more this family. I should say needs something more then let's wait and see. Sometimes I think the more the most common response at this point from professionals who are picking up that there's something there, something that needs more attention, is managing the child's behavior and adopt and categorizing it as ADD or ADHD when that is that is strictly the symptom not what's underneath. And so it it's not really addressing the root of the problem.
Break: The South Carolina department of mental health is celebrating its 200 year anniversary offering mental health services for children families and adults. SCDMH is one of the first states in the country to provide mental health services learn more at www.scdmh.net.
M: You mentioned evidence based practices - what are some of those just so people can know when they hear something that this is maybe what I'm looking for this is the right track.
G: So the one that we have a circle of security is one and it's a parenting group and you know really kind of thinking about parents being able to be there and support each other and also hear some similar stories of what it is like to parent your child and feel these struggles. And then you get into some of our more one-on-one modalities such as attachment biobehavioral catch up, which sounds scary on the outside but is actually we call it ABC and it is a ten week in home program for families where an ABC coach will come directly to their home and be able to support them in activities and play with their child while learning about some of these things that we've talked about and how it applies specifically to their child. There's also parent child interaction therapy which has been in South Carolina for a bit of time here which focuses on building relationships and then supporting parents with learning about limit setting and how to kind of set consequences and time ends. And then finally we have a child parent psychotherapy which is our big one that we're actually joining with the department of mental health with right now to start a cohort of about 20 clinicians across the state who will be trained in this. It is for the prenatal to five year old population and it's for kids and families and they've experienced trauma early on in their lives. And it's a pretty intensive trauma treatment that responds both to if the child experience that trauma but also when the parent has had their own experience with trauma as well and so that kind of segues for me into yeah let's talk about the South Carolina infant mental health association because you know as I'm asking these questions I could see the bridge between you all and whether it's the treatment modalities or the connection or the awareness building.
M: Would you tell us a little bit more about the association as a starter?
G: We're a nonprofit we're working statewide our focus is very much on supporting and working with professionals already in place in different sectors serving young children and families and providing opportunities to get deeper training in infant mental health and that applies in different ways depending on the profession. So what does it infant mental health what is the knowledge they need to know to support to promote healthy social emotional development in their settings umm all the way to like McKenzie said we're working with department of mental health to have clinicians trained in some of the clinical interventions and so there really hasn't been deep attention on infant mental health in South Carolina prior to you know a few years ago when we got started and so this is the place that we're investing our energy we've already got these professionals working and touching the lives of these families and children so let's just offer these additional skills so that they can really have that infant mental health lens to apply to the work they're already doing as part of a National Association.
M: And you're just coming into South Carolina and how long have you been here?
G: It's called the alliance for the advancement of infant mental health which is it's actually an International Association and then we are an affiliate South Carolina is an affiliate we've started the affiliate with just a few volunteers in 2017. And the focus was very much on workforce competencies and kind of establishing even what those look like and then we moved at the beginning of 2020 just in time for the pandemic to start into really a full you know operating organization with paid staff and we have grown to about 30 staff right now working on this professional development on systems building. We do some direct clinical supports but that's the scale of it is very much about bolstering our existing workforce.
M: Yeah ok so a lot of the education and training and awareness building and alliances.
G: Yeah so we do offer some like Kerry said we do offer some sort of resources we have a couple of family facing programs and circle security is something that we offer regularly once a month however we are training several folks in different agencies them such as head start and early head start folks who work in pediatric offices and those who work in in different settings so that families can access those resources directly in their community. And we kind of see ourselves for those at least as a just in case there's some way that you can't get in there or virtual just works better for you here's an ongoing service. But all of the services that we've talked about also are able to be accessed through help me grow South Carolina which is a service connector system for and promotes developmental screenings and they've come under our schema umbrella.
M: In order to help support families and being able to access resources what would you say in terms of a family and they have some concerns so there's some level of awareness and they have some concerns and they're trying to figure out where to turn to should be can they reach out to you to the association directly and to get some guidance to grow?
G: sc.org is the best entry point and that that does link to our services and more so help me grow is as Mackenzie said. It's a program under our schema umbrella but it's designed to support families and professionals actually who are looking for resources even if they don't know exactly what they're looking for. But there's some sense that you know my child has a need and then through the service referral process there's also opportunity for us a simple developmental screening to be completed by the parent that helps inform maybe where there are needs that the child has and then the help me grow care coordinators help the parent find resources to meet those needs in their local community down to you know what are the hours of operation, does that align with the parents ability to take their child for a visit, do they have transportation, or do they need a practice that's on a bus line. It's very much a warm supportive connection for families.
M: OK so helpmegrowsc.org correct? OK well I mean this I this is really excellent information I really appreciate the time from both of you I don't know if there's anything that maybe each of you might want to say whether it's about the association that we missed in this conversation or just something you might want to share to people who are listening parents, caregivers who might have some concern or anxiety around and their child and what they should do moving forward.
G: I think that one of the my biggest takeaways since I started working with schema and this is for both professionals and the families that I heard from is that this was a thing that a lot of caregivers felt for a long time they had this worry that something was happening that they couldn't put their finger on. And when we would describe a service or describe what infant mental health was it was almost this lightbulb moment of thank gosh somebody is able to identify that this is a real thing right? And so for any caregivers who are out there who are just feeling like things aren't quite right know that you know you're not alone. There's a lot of folks who are here to help you. Part of our organization and other organizations across the state that you feel that there's a validity in that feeling that you're having and there will be an opportunity to set you up with the resources that are going to best fit your unique needs, and your family value, and your family stories.
M: Alright so Carrie, as the CEO of the South Carolina Infant Mental Health Association, as we're closing out here is there anything else that you'd want to share with our audience?
G: Yeah, one of our programs that we haven't talked about yet is called Partners for Early Attuned Relationships or PAIR for short. And this is made-up of our mental health trained professionals around the state and they work specifically in early care and education settings to support children for childcare providers. And the families, when there is a concern being expressed by the child that the childcare provider is unsure of how to handle, and childcare providers are really stretched. Then they're asked to do a lot with very little. And you know sometimes they have elevated stress and that's not when we're at our best and able to interpret and respond sensitively to children. And you know there's sometimes it's just a matter of those children who just are extra active and you know there's just not the capacity for the adults to respond sensitively and sometimes it's just that as simple as that. And it's more about the adults needing to kind of attend to their own well-being, but sometimes there are children as we've been talking about who have experienced trauma or have something else that is driving behavior that is beyond the norm. And so that's when our infant mental health consultants can come in. They work directly with the childcare provider to bring in the family and really kind of uncover what's beneath the meaning and often this intervention will prevent a child from being expelled from the preschool. This happens more frequently than probably most families realize but often the child care program with the best intentions just says we're not the right fit for this child and ask the parent to take the child somewhere else. And unfortunately, there's not a magical childcare center that's perfectly equipped to deal with children that have really really big challenges. And rather the way that we can help is to come in and give the program the teachers and the families the tools to understand the child's behavior and create ways to meet their emotional needs that works out for everybody. It's good for the child. It calms things down in the classroom and creates peace at home.
M: I'm David Diana, host and producer of A Look Within: Conversations on Mental Health and Well-being. We want to thank Carrie Schnake and Dr. McKenzie for joining us today and you may learn more about their work and the work of the South Carolina Infant Mental Health Association at SCIMHA. Org. And of course we want to thank all of you for listening and hope you'll join us next time.
A Look Within: Conversations on Mental Health and Well-being podcast is hosted and produced by David Diana and the South Carolina Department of Mental Health. We hope you'll join us for our next conversation.
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