Home visits support mental health of the youngest Minnesotans

The last year and a half has been tough on families. Parents have had to juggle work, child care and school. Older kids have had to adjust to online learning, isolation and major schedule changes. Even infants, the youngest members of the family, felt the strain as their developing brains and bodies picked up on family members’ responses to the stress of navigating this strange new world.

At St. David’s Center for Child and Family Development, a 60-year-old nonprofit focused on providing services to children and families, early childhood workers focus on those youngest family members by offering home visits where parents and their young children meet with trained professionals to learn healthy ways to interact and cope with life stressors.

Julie Sjordal, St. David’s chief executive officer, explained that her nonprofit works from the belief that supporting the youngest among us has long-term benefits; nurturing children’s early growth and development builds healthier families and supports youth as they grow into adulthood. St. David’s programs serve more than 4,000 children and families across the Twin Cities metro area.

“Our services range from early support to deep-end support of infants and toddlers and their families,” Sjordal said. “I can’t think of anything more important than helping parents be more engaged in parenting from healthy places.”

Recently, I spoke with Sjordal, and with Paula Frisk, St. David’s senior program director of parent child services, about the importance of supporting the mental health of infants and their adult caregivers during trying times — and about ways St. David’s staff engages the entire family to bolster communication, connection and overall well-being.

MinnPost: For many people, the concept of infant mental health might feel a little confusing. Infants can’t talk or do much for themselves. How can a person support their mental health?

Paula Frisk: I think that the term can be really confusing. People think, “What do infants or babies have to do with mental health?” What we’re talking about is focusing on the overall well-being of infants and children up to age 3. This includes not only their social and emotional growth but also their brains and bodies.

Julie Sjordal: We work with children across the spectrum of ages, but Paula’s program is focused on children age 0-6. The focus of her program is the parent/child relationship in the first years of life.

MinnPost: Why is it important to focus on the mental health needs of infants? Isn’t it more important to make sure they are getting the basics, like enough food and sleep?

PF: We know that what happens in those first years of life set a template for how a child views the world and their relationships with people. For infants, the basics are important, but part of that is also a focus on very basic human needs, like, “Are the adult caregivers in my life helpful to me?” “Are they not helpful?” “If I show my needs, will someone support me?” “Will they provide comfort to me when I’m distressed?” Those are the important things children learn over time in their interactions with their caregivers.

MinnPost: How does St. David’s staff address the mental health needs of the youngest children in their programs?

PF: Our programs do what we call dyadic work with the parent or other caregiver and child together. We think of this relationship as one combined parent/child relationship. We know that this relationship can go really well or be really challenging. We do one-on-one sessions, usually in the family home, providing opportunities for positive interaction with the parent/child and the home visitor. We help families think about responding to the needs of children, especially during those early years. In these visits, we’re walking alongside families, learning about how to read cues, how to understand them and how to model healthy interactions.

We follow a parenting intervention known as Attachment Biobehavioral Catch Up. It was developed out of the University of Delaware. There is a lot of great research behind it. It is an opportunity for the clinician to meet with the family and strengthen those behaviors that a child needs, such as nurturing support. It is a way to teach and model nurturing support, to have nurturing behaviors, to follow a child’s lead and avoid unhealthy behaviors.

MinnPost: How do families learn about your services?

PF: Families come from all over the place. Other professionals in the community sometimes refer them to us, or they may hear about our services from another mental health provider or a pediatrician or a nurse or a social worker that they have interacted with. These outside professionals might contact us, saying, “This family could use some additional support.”

JS: Maybe one of these professionals is seeing a parent who is experiencing post-partum depression and is not reaching out to their infant or is flat in affect. When a baby is searching for maternal contact and they cry, sometimes they get a bottle or other comfort from their caregiver. In some cases, for whatever reason, some infants get ignored for hours. A baby who is ignored tends to shut down emotionally because their outreach to their parent is not being responded to consistently. Sometimes, parents don’t understand that their lack of response could be hurting their child.

MinnPost: What techniques do your staff use to work with struggling infants and their parents?

PF: We do a lot of talking for the baby. Maybe mom is experiencing some depression. In those cases, we might say something to help mom, to bring her attention to the baby. We’ll say something like, “Look at how she’s reaching out to you. She wants you to give her a hug,” or “Look at how she turns to you. She loves it when you give her that bottle.”

Home visitors often videotape the interactions. Later, those interactions are shown back to the family so they can observe the situation from two steps back. We’ll say things like, “I wonder what she was thinking when she did that?” It opens up opportunities for us to talk about how to do things differently. Families seem to really enjoy this approach and feel supported by it. We do see a lot of growth and shifts in behavior that happen over time.

MinnPost: Is it important to start with this kind of work as early as possible, to limit mental health struggles later in a child’s life?

JS: Trying to repair problems when a child is 15, when they’ve had a lifetime of uneven experiences with their primary caregiving adult, is harder. At that point they’ve already developed a working model of what they can expect from other people and relationships. We want to be part of this repair early, to have an opportunity where we can help parents find a way on their own to recognize times when they are not showing up for their children in the way they would hope to. This gives parents an opportunity to make change on their own.

It is such an honor to be part of that early brain development where we can both help parents reflect and help them engage with their babies.

MinnPost: Beyond postpartum depression, are there other reasons why parents or other caregivers might have a hard time adequately responding to cues from their infants?

PF: We often see families who face specific challenges for some reason in their lives that make it more difficult for them to be available to their infant. We also see caregivers who never experienced supportive parenting themselves. They were brought up in families where their mother was depressed or distracted and they didn’t get the experience of a nurturing caregiver. How can we do that for others if we’ve never experienced it ourselves?

MinnPost: What usually happens during your home visits?

JS: This intervention is multigenerational. The home visitor is working with the parent and their child and focusing on the parent-child relationship. This is a long-term relationship between the home visitor and the family. The idea is that the home visitor keeps showing up every week. They provide a consistent base for that parent to provide a parallel process. They say, basically, “I’m going to show up every Wednesday for our appointment. If you’re not here this week, I’m going to keep showing up every Wednesday after that.” It’s that parallel process where you are helping the parent feel safe so they can create a safe and caring environment for their child.

MinnPost: You have two sites, one in Minnetonka and one in Minneapolis. Do you ever see infants and their caregivers there?

PF: The majority of the families we serve are in their homes. We have found that it is easier to work with little ones in the home environment. That way you can get an idea about what interventions can be most helpful for them. Some families do come into our center, but it is more limited than the home visits.

MinnPost: Can you describe a successful, long-term partnership between a parent and St. David’s?

PF: We had a parent who came to us because she realized that when she was a child her upbringing wasn’t what she would like to give to her own child. She had experienced a traumatic upbringing where they had a lot of changes in their life. Her family moved a lot. She didn’t feel like they were settled in one place. This mom knew she would struggle with this as a parent. She was raising her child by herself and had really limited resources.

We know that even in the best of circumstances parenting is one of the hardest jobs in the world. When you have housing insecurity it makes it even more difficult to be consistently available and give your child what they need. This mom reached out to us for additional support. We know it is hard to get on the floor and play with your child when it is going to be difficult to put food on the table the next day. We try to connect parents with resources to help alleviate those basic needs. We did that with this mom.

MinnPost: What kind of things did you discuss when you met with this family in their home?

PF: We would meet regularly with this mother and her child and take opportunities to have conversations, like, “How is it going this week? Were you able to connect with some of the resources we told you about?” We want to be able to make the parent feel heard and have her needs met. We would also talk about her interactions with the child and how she could build a strong relationship with her.

MinnPost: Over time, was this parent able to make some of the changes she was hoping for?

PF: We did see an improvement. We made sure that the mother felt heard and that her needs were met so she could help her meet her child’s needs. At the beginning we were visiting this family twice a week. Over time, we started to see progress where Mom seemed emotionally regulated. Eventually she got to the point where she could go two weeks without seeing us. She was able to regulate herself and support and nurture and regulate her child.

MinnPost: What are ways that very young children show that they are struggling with mental health challenges?

PF: When children are infants, we see it in some of their regular routines. Maybe the child’s sleep is disrupted. You might see changes in toileting habits, in eating —  the general basic functions of an infant. The infant might seem more dysregulated. If a child stops reaching out for comfort, that’s a clear sign of distress.

You might also see a child whose behaviors are expanding. They might start acting out. They think they have to get bigger or louder or throw things and increase behaviors to get their parent to respond. If those patterns continue you might see a child going inward, not reaching out for support.

MinnPost: Is the overall stress and exhaustion of living through a global pandemic showing up in infant mental health?

PF: I think parental burnout has become a huge issue. It is a cruel joke to have to be a parent and to do your job at the same time. We’ve all had to let go of many of our social supports and our regular coping mechanisms. What we’ve seen over this pandemic is more and more families struggling with mental health issues. Sometimes this means that some parents have been less accessible to their children.

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JS: The expectation is that parents are secure and always there to respond to their children’s needs, but when that parental base is stressed it is going to be felt by those dependent little humans. The time we’re most dependent on that parent being responsive and settled is the first few years of life. We’ve been in this for a year and a half, almost two years.

At St. David’s, our role is to show up and think about creative ways that parents can care for themselves so they can recharge and be an emotionally available secure base for their children — even when they are oozing stress and anxiety.

PF: Little ones are attuned to our bodies, to our reactions. They are impacted by our emotions and our stress. It is important for us to be honest about our struggles, to care for our children and to narrate what we are doing, to say, “This is hard but we’re OK. We will always be there for you and we will be OK.” By providing that reliable base of support, we can help give our children the strength they’ll need to get through tough times like these in the future.