The Infant Mental Health Promotion (IMHP) Call to Action: On Behalf of Maltreated Infants, Toddlers and Preschoolers in Canada, launched this May, states:

 “When young children experience adversity, it increases the risk of poor outcomes for them throughout their life. When infants, toddlers and preschoolers become involved with child protection, many of them have already experienced adversity and many, if not all, have been traumatized by it. Today, science is helping us understand just how that adversity is embedded into the body and how it ultimately influences brain development, health, education success and relationships. The science is also showing us that for this very vulnerable group of children a response that is exponentially greater in all respects is essential if we are committed to helping them achieve better outcomes. The time for a change in how we respond to this group of young children is now. The science has never been stronger.

Infants, toddlers and preschoolers served by child welfare need intervention that is relationship-based, child focused and trauma informed. They need a response that goes beyond wait lists. All of those involved in the system need to understand that simply removing a child is not enough. Today we know that infancy is a developmental period when children are most vulnerable and when they present with the greatest potential. Those supporting these children such as birth parents, foster parents, kin, child and family service workers, and others need tools and resources that make it possible to positively influence that child’s outcomes.”

The Call to Action document, downloadable as a pdf, supplies rich evidence-based information about the unique vulnerability of maltreated infants. You will also find interesting policy recommendations, informed by strong scientific evidence. IMHP hope that child protection professionals will be inspired to embrace the powerful role that you can play in the lives of these especially vulnerable young children. “With the demanding tasks and pressures related to your work it is easy to forget how potent your influence can be. You may be the very buffer these infants need against some of the negative forces in their world. You may be the only person who sees the adversity and works to address the impact it has on their development and mental health.”

The IMHP hope is that: “Every child that you work with is an opportunity to change precious lives today, and bring hope for a better future. We hope this Call to Action will be a valuable new tool for you as you advocate on behalf of young children. “

The Call to Action includes:

• Introduction:  A portrait of infants, toddlers and preschoolers in the child protection system:  “Trends in the data demonstrate that the youngest children are those most prone to investigation.  Children under 1 year old are the most reported… The next most reported population is children 1 to 3…”  “Children ages 0 to 3 account for 29% of all foster children (Statistics Canada, 2012)..  Startlingly, nearly half of the children investigated in 2008 had been in previous contact with child protection services (PHAC, 2010). This pattern of return to care suggests a need for systems of care that more effectively address the needs and risks to development faced by infants….Only when all maltreated children ages 0 to 3 are provided with care that reflects the realities of their early development can we be sure that we are providing beneficial protection services.”
   
• What is Infant Mental Health? “Zero to Three (2016) has developed the following definition for infant and early childhood mental health:  Infant and early childhood mental health, sometimes referred to as social and emotional development, is the developing capacity of the child from birth to five years of age to form close and secure adult and peer relationships, experience, manage and express a full range of emotions, and explore the environment and learn – all in the context of family, community, and culture. (Zero to Three, 2016, adapted from Cohen, Oser & Quigley, 2005, pg. 2)”
   
• The Unique Challenge Faced by Maltreated Infants: Factors that threaten healthy development:  ‘..maltreatment occurring prenatally or in the first three years of life is a greater risk to development than maltreatment occurring at other stages in the life course.  Infants who are the victims of maltreatment require early and effective services informed by their unique developmental needs and their social history.  In the absence of this specialized care, maltreated infants become increasingly at-risk for delay and will inevitably bend to the consequences of poor care giving and other early adverse experiences.”
   
  • Exposure to Violence:  “Trends in substantiated maltreatment investigations show that neglect and exposure to intimate partner violence are the most common forms of maltreatment…”
  • Neglect:  “Children who are victims of chronic neglect or severe deprivation can sustain a range of adverse physical and mental health outcomes that actually produce more widespread developmental impairments than overt physical abuse (National Scientific Council on the Developing Child, 2012).  These delays can encompass a wide range of developmental areas including cognitive delays, stunting of physical growth, impairments in executive function and self-regulation skills, and disruptions of the body’s stress response (National Scientific Council on the Developing Child, 2012).  Neglected children must be provided with consistent and responsive care in order to alleviate or reverse the developmental threat posed by this detrimental form of maltreatment.”
  • Toxic Stress:  “When a young child experiences stress in an environment of supportive relationships, the experience is manageable and the risk of negative impact is significantly reduced.  Through the use of these relationships, the physiological effects can be brought back to baseline, resulting in a healthy stress response system.  However, in the absence of supportive relationships with caregivers, long lasting stress can actually hinder brain development (National Scientific Council on the Developing Child, 2012)”
  • Adverse Childhood Experiences:  The Adverse Childhood Experiences (ACE) study is a longitudinal study analyzing the impact of adverse early life experiences on the lifespan.  The ACE study focused on three main categories of adversity including abuse, family dysfunction, and neglect…the study found that the more adversities a child faces, the more likely they are to develop mental and physical illnesses in adulthood (Felitti et al., 1998).  The findings also suggest that life expectancy decreases significantly for individuals with high ACE scores (Felitti et al., 1998).  This study has led to an increased understanding of the urgency to act in the best interest of children in order to prevent them from facing adversities such as abuse, neglect, and family dysfunction that place them at a greater risk for health issues over the lifespan….Children exposed to environments of abuse and neglect before birth and in the first few years of life warrant the greatest concern for early brain development.  In the absence of supportive and consistent caregiving, these children are likely to suffer the inescapable pressures of neglect, toxic stress and trauma.”
     
• Infant Brain Development: Understanding early brain development and mental health, and their connection to lifelong outcomes:  “During the first three years of life, a baby’s brain develops at a rate that is unmatched at any other point in their life…Early experiences, both positive and negative, have a decisive effect on how the brain is wired.  Practitioners who understand even the most basic science of brain development are substantially better equipped to meet the needs of the infants, toddlers and preschoolers they serve….Maltreated infants and toddlers may struggle with poor self-esteem, behaviour control and attachment formation, and may have difficulty showing empathy, controlling their behaviour in social situations, and initiating social interaction.”
   
  • Building Brain Architecture:  “During early sensitive periods of development brain circuitry is most open to the influence of external experiences – negative and positive….The brain is built in a bottom-up sequence, much like a house…Early development builds a foundation for the development yet to come; therefore, when early brain development is hindered or strengthened, this has direct repercussions on a child’s ability to develop effective complex functioning skills in later life.  Much as the walls of a house may lean or tumble if its foundation has cracks, the higher skilled circuits in the brain will be compromised if the lower skilled circuits they are built upon are weak.”
  • Brain Plasticity:  “Current research tells us that the brain is particularly sensitive to experiences in the first three years of life. Additionally there are several process by which early experiences directly influence our brains.  One such process is brain plasticity.  The human brain is malleable and plastic transforming based on a combination of experiences and biology… The circuits become increasingly stabilized as we age, therefore, the plasticity of the brain is at its greatest earlier in life…. As a result, earlier experiences hold a greater influence on the brain than the experiences at any other time in life (National Scientific Council on the Developing Child, 2007).”
  • Sensitive Periods of Development:  “The timing of quality early experiences is crucial to brain development.  There are periods of synaptic growth, or ‘sensitive periods’, in which the brain expects to receive input to strengthen synaptic connections….There is an inherent ‘use it or lose it’ quality of the brain” dependent on use and reinforcement.  Whilst the brain remains open to new learning throughout life, the level of receptivity is strongest in early childhood.
  • Epigenetics:  “The common misconception that genes are “set in stone” has now been debunked.  We know now that early experiences can determine how genes are turned on and off, and even whether some are expressed at all (Harvard Centre on the Developing Child, Deep Dives, Gene-Environment Interaction, 2015).”
     
• The Attachment Relationship: Early relationships build the foundation for lifelong success:  “Infants and toddlers develop in an environment of relationships. They rely on their primary caregivers for security and comfort.  Children who are able to develop secure relationships with their primary caregivers show a greater capacity for self-regulation, effective social interactions, self-reliance, and adaptive coping skills later in life (Goldsmith, Oppenheim & Wanlass, 2004)….Attachment security is established in the first year of life, making early infancy a delicate time that must be supported by a consistent and reliable caregiver….The attachment relationship is essentially an external regulation system that helps the child cope with distress.  A parent’s style of responding to their infant’s expressions of distress establishes a style of emotional expression that will continue in future relationships.  A child attaches to the caregiver regardless of the quality of care received, even if the caregiver is abusive and neglectful.  While a neural system that ensures attachment regardless of the quality of care has immediate benefits, this attachment comes with a high cost.  Traumatic experiences interact with genetics to change the structure and function of the brain, compromising emotional and cognitive development and initiating a pathway to pathology (Sullivan, 2012, p. 1).”
   
  • Serve and Return Interactions:  “Infant development occurs in the context of relationships…. The basic concept of serve and return interactions is that the infant ‘serves’ by offering an opening interaction such as a babble, smile, gesture or laugh, and with words once they are verbal, then the adult responds to that child’s serve with a ‘return’ that acknowledges the communication.  These interactions strengthen brain circuitry, are relationship building and are at the foundation of early language development (National Scientific Council on the Developing Child, 2012).  Because responsive relationships are developmentally expected and biologically essential, their absence signals a serious threat to child well-being, particularly during the earliest years (National Scientific Council on the Developing Child, 2012, p.1).”
     
• Making the Case: The need to act early and effectively:  The remaining sections articulate a detailed case and recommendations for effecting structural change in training and delivery of child protection services.
   
• Key Points to inform Discussions:  “To make a meaningful difference in the lives of Canada’s youngest and most vulnerable population, policies and practices must ensure that:
   
  • Every child welfare decision and service has a goal of enhancing the wellbeing of infants, toddlers, and their families to set them on a more promising developmental path.
  • Every young child in care or service of the system has a stable and caring relationship present in their life every day.
  • Every young child who is in service of child protection is screened regularly for social, emotional and developmental risk, and when such risk is present there is immediate access to early intervention services.
  • Every child and their family must be supported by a community of partners who collaborate to ensure the welbeing of every child.
  • Child welfare administration at the provincial, territorial, and local levels must focus on infants, toddlers, preschoolers and their families in the delivery of services, data collection, research, and attention to special populations.
     
• Policy Recommendations and Action Plan
• Changing Knowledge: Training and Education
• Changing Policy: Inter/Intra-Agency Collaboration
• Changing Practice: Promotion, Prevention and Intervention
• References
• Appendix A – Supporting IMHP Resources
• Appendix B – Adverse Childhood Experiences Study Info-Graphic
• Appendix C – Screening Tools