Episode 38: Understanding Infant Mental Health

Dr. Bob Boland  00:02

Welcome to the mind dive podcast brought to you by the Menninger Clinic, a national leader in mental health care where your host, Dr. Bob Boland,

 

Dr. Kerry Horrell  00:11

and Dr. Kerry her L. twice monthly, we dive into mental health topics that fascinate us as clinical professionals, and we explore those unexpected dilemmas that arise while treating patients. Join us for all of this, plus the latest research and perspectives in the minds of distinguished colleagues near and far. Let's dive in.

 

Dr. Kerry Horrell  00:43

We are thrilled today to be joined by Jyrah Knight. She is an early intervention specialist and professional development director of First Three Years, which is an organization that nurtures early relational and mental health of infants and toddlers in Texas. It was formerly known as the Texas Association for infant mental health in her work with children and families. gyres technique stems from working with children's microsystem, as in their home, daycare or school community to impact their development Jyrah believes it is best practice to implement therapy in the home around individuals who can implement the same strategies into the child's daily routine. She has a master's degree in Human Development and Family Studies from a Texas Women's University and a bachelor's in Child Development, also from Texas Woman's. Welcome, thanks for joining the show.

 

Jyrah Knight  01:31

Thank you so much for having me. I am delighted to be here with you all today.

 

Dr. Kerry Horrell  01:35

So we you know, we're going to start where we pretty much always start, which is to hear a little bit about you and your interest. We know that you've been particularly an advocate for early intervention. And as mentioned in your bio, these kind of family based approaches to working with young kids, and you want to tell us a little bit about your career so far, how you became interested in this part of the field?

 

Jyrah Knight  01:55

Absolutely. So I began my career, right out of college as a politics teacher. So I was very hands on right out of the gate with children who were essentially in this first three years of life, right. And so I spent a lot of time observing them, observing their interactions with their caregivers, as well during drop off and pickup. And I love and this is kind of where I found my niche. I knew I love this age range. But I also knew that I wanted to get into more direct service work. So I then transitioned from being a toddler to teacher to an early intervention specialist. And during that time, is when I had the opportunity to do a lot of home visiting, visiting with families, seeing what's happening in their natural environment. So what's going on in the home. And then that's where I really kind of saw the impact of influencing a child's microsystem. And I said a microsystem because essentially, that is their home, their child care center. But essentially, it was bigger than that. It's it's their entire ecosystem, right. So I love that work. I loved being at home with families. But the one thing that I really noticed during that time is when working with children and families nearly all the time, we're starting at basic trust with children and their families. So when we think about implementing therapy in the home, before we can teach anything, we first have to go back to trust. And so that was it was during that time where I understood, essentially Eric Erickson, psychosocial development, right? Classic trust versus mistrust, really teaching and supporting parents around how to develop that trust, really teaching and supporting what they're already doing. Right. So a lot of my parents were already doing a lot of the classic things that we know, right? When a baby cries, we see them or we change their diaper or we give them snuggles and cuddles, right? And so really supporting them and the things that they were already doing, but also making some minor tweaks here and there to continue to support that brain development that happened during that stage of trust versus mistrust. So in that time, and it was I got to thinking more about brain development and how this happens and how it works. So that essentially led me down a rabbit hole of mental health and wanting to learn more about that approach and how we implement it in our day to day practices as caregivers to essentially help children develop well from the start. Yeah. Can you

 

Dr. Bob Boland  04:52

talk a little bit more about that? Because, I mean, I'm sure everyone's heard of that, but I'm not sure it's always clear like why why would it be hard for some kids to develop trust, you know, it's just a normal process.

 

Jyrah Knight  05:02

Absolutely. So when we talk about infant mental health, I say we can't talk about infant mental health without speaking about early relational health, to essentially go hand in hand. And so when we speak about early relational health, again, taking that strength phased approach with parents and with caregivers, to help them know that safe, stable and nurturing relationships are essentially the foundation for all other brain development that happens, right? We take simple things like a game of peekaboo, and we talked to parents, when we talked to caregivers about how in that moment, those repeated positive experiences are what we're going after every single day. Because those repeated real positive positive experiences are essentially what gets the neurons firing in the brain, right. That's where we see a lot of that brain activity occurring for children. And we also know within the first three years of life, their kids are like sponges, they're soaking up everything. And so as much as possible, we want them to be able to soak up those positive experiences. Again, for the laying of that foundation, there are so many different things that happens, we were talking brain development, we're talking about foundations of relationships, even emotional regulation, before we get to a point where children are able to self regulate and regulate their own emotions, we first have to have co regulation, it's a must. And so really giving parents and caregivers the tools to be able to co-regulate with their children, and also self regulate themselves, in order to co-regulate with their children. Because that is also a part of the process. And then there's other things that develop with that, like sense of self, the independence and exploration from learning, stress, coping, all of these things are dependent on the foundational level of trust between a parent and a child.

 

Dr. Kerry Horrell  07:14

Gotcha. Jyrah, you and I are talking the same language because I am definitely like attachment informed as sort of my base of how I think about things. And yeah, I teach a group here for our young adults on on mentalizing and emotion regulation. And I feel like one of the things that can feel like a leap or can be sort of confusing at times is why would mental it what would mentalizing have to do with a attachment and be with these early experiences like pre verbal slash, I don't even remember them. And I think you're really speaking to that, that these early years is when not only there's so much going on in the brain. And honestly, that part I find fascinating, but I don't know nearly as much about these connections are being made in the brain. But also, these lenses are beginning to develop even around like, if I have this feeling in my body. That's an emotion. Is it intended? Is that something wrong with me? And I wonder, and this is kind of a broad question. But in your work, do you find kind of similar patterns that like, do you get a lot of pushback? And people are like, Oh, how could this be that they're not even going to remember? How could this be important? Why? And so I wonder if you want to speak a little bit to that of, you know, if you imagine being like, these are years that these kids aren't even going to remember as long as they're fed, and they're alive? Who cares about the rest?

 

Jyrah Knight  08:36

Yes, absolutely. So we do get that pushback a lot. And I'll also take it a step further, in hearing the term or the phrase infant mental health, a lot of people begin to think, wow, they know a baby could be bipolar, or a baby could have schizophrenia because they associate mental health with mental illness. Right. And so we essentially have to debunk that. We're talking about helping children develop well from the start, right? So we're not talking about a baby essentially, having a mental illness, but we're talking about helping that health having Healthy Beginnings, right. So I want to say that first and then I want to go back to what you were saying. Yes. So we get a lot of times people saying, I don't remember when I was at age, my child does not gotta remember, but to that point, I always say that, yes, they may not have that memory of this exact moment, but their brain is keeping score, right how their brain is being wired is keeping score of every time a need is met. Every time mom or dad or caregiver comes when I cry, my body is keeping score of that. I am, I am aware of how I feel when I cry. I'm also aware of how I feel when mommy hugs me, and holds me and swaddles me in a blanket. And so I to that point, I always say, yes, the brain is always keeping score of those interactions, even when a memory is not present.

 

Dr. Bob Boland  10:21

That's a good way to think of it keeping score. I like that.

 

Dr. Kerry Horrell  10:24

I wonder, do you ever have folks ask the question of what happens if it goes wrong? Absolutely. And I wonder what you think about that? Because I because I'm thinking about A) if you have someone who's kind of a skeptic of of infant mental health, or sort of like, I just think that's not that big of a deal. Yeah, how you would like help them understand, like, what could go wrong? And how that impacts the child's future? Or, on the flip side, I'm making this kind of a complicated question. Yeah, you know, I do that. But on the flip side, I could imagine not the skeptic, but the super anxious person being like, Oh, my God, I'm gonna screw up my baby, before they can even talk. And so again, I wonder, I wonder how you think through with people like, what are the consequences slash? Also? How are children and babies resilient?

 

Jyrah Knight  11:15

Absolutely. This is why a strength-based perspective is always the road that we want to take, typically, because as a parent or a caregiver, you can hear this information and say, Oh, my goodness, this is a lot. The future of my baby's emotional regulation is the same term relational templates. Absolutely, absolutely. And so that can feel really heavy. And so this is why we always kind of take that strengths based approach, and look at the things that parents and caregivers are already doing well, right. So just when we use positive reinforcement for children, it works for parents and for caregivers, too, right? What works for us as adults. And so we want to really highlight the things that we are seeing going great going well, between that parent and child dyad. And so for a lot of clinicians, I always say focus there, we want to bring our focus there, with the things that we see maybe going a little awry, we want to utilize resources in order to help with that. But when we're talking with parents and caregivers, we're lighting them up with the positive of what's happening. Because what happens with that, the more we give them praise and recognition for the positive, the more they're gonna repeat, it makes sense. They're gonna feel empowered to do that more and more.

 

Dr. Bob Boland  12:52

Can you tell us a bit about the organization? So First Three Years, Texas, and

 

Jyrah Knight  12:55

absolutely, absolutely. So as I tell you, we work in in kind of three main buckets, if you will. One is education. One is intervention, and the other is awareness. So in our education department, we really focus on professional and parent education, through webinars through conferences, and really focusing on building the early childhood workforce. in that department, as well, we also have our endorsement program. And so this is a program it's our infant mental health endorsement. And it's internationally recognized, and it is to recognize early childhood professionals who are infant mental health proficient. So they have gained a number of hours of training regarding infant mental health and met those core competencies to be infant mental health- endorsed. So that is our department. Yeah, yeah. And then our intervention department is our Safe Babies Program. And our Safe Babies Program works with infants and toddlers in the child welfare system, and ultimately, surrounding foster parents and bio parents and getting them speaking the same language and also developing the same goals for this child. So with our Safe Babies Program, we'd like to see family reunification whenever possible, or a family determined outcome or the basic needs that are in the child welfare system. And then lastly is our awareness program and that houses our community systems work, our bright by text work in baby name. So community systems, our Houston infant toddler coalition, our babies in Baytown program, and also our newest Help Me Grow Gulf Coast really worked from a systems level you to figure out how we create change on a systems level, which then ultimately trickles down to our professionals, to families and to children., Bright by Text is essentially a service that parents and caregivers can sign up for, to receive text messages to them regarding activities regarding events, based on their child's age and the location in which they live. And then lastly, but certainly not least, is our Baby Day. So just like we have, yes, it's so much fun, so much fun. Baby Day is like, just like we have Mother's Day and Father's Day, it's Baby Day. So it is a time for bonding and delight amongst children and their caregivers. And we hosted in several cities across the state, but really promoting activities and bonding for children. That is First Three Years in a nutshell.

 

Dr. Kerry Horrell  16:01

I remember at some point being like, Mom, why is there no daughter's day? And my mom would say things like everyday is daughter's day. Every day,

 

Jyrah Knight  16:12

Is Baby Day, maybe

 

Dr. Bob Boland  16:14

people I mean, how do people really encounter you like what brings them to yours? Is it through referral? Is it the advertisement like how, how do they find you.

 

Jyrah Knight  16:22

So it can be a multitude of ways. So sometimes it looks like this, I've been on a podcast and been hearing about for three years in this way, a lot of times, we have a lot of professionals coming to us because they are professional members, right. And so they are aware of our work already. For our Safe Babies Program, it does look like referrals a lot of the time. And for things like Baby Day, a lot of our parents and caregivers essentially have found us through events. They're their community organizations promoting our Baby Day event. And they essentially connect with us that way, and then are able to register for our parent membership after they have have made that connection with this.

 

Dr. Kerry Horrell  17:08

I'm just thinking about, you know, I primarily worked with adolescents and young adults. And usually most of the people that I've worked with, I would say like at least a majority of them have some variant of attachment trauma. And often I think attachment trauma is a really, it's a tough one to conceptualize because of how often folks will say I didn't have trauma, because I had I had my basic needs met or was safe in my home. Um, how could I have experience something you're calling trauma? Where can we even point to it where the trauma was kind of this chronic pattern of their attachment needs being disrupted and their emotional experience being neglected, or not attended to or miss mentalize, whatever want to call. So I just want to say I feel so thrilled about this work because, you know, seeing the ways where when this stuff isn't attended to it shows up as suicidality, depression sad. Like it's showing up in our young people and beyond. So again, I think it's just really intensely important work. And I wonder you we mentioned in your bio, and you've you have specialized a bit in trust based relational intervention, I wonder if we can spend a little bit more time thinking about like, how, how you approach this work? Yeah, as a way to help sort of like, protect and foster something in these kids that help them, you know, hopefully be protected a bit from some of these mental health outcomes later on down them later down the line. A little bit about like that type of therapy and like, what what it looks like what you

 

Jyrah Knight  18:41

do, you're aware for sure. So I'll give you a little bit of background regarding TBRI or Trust Based Relational Intervention. It was developed by Dr. Carrie Purvis and Dr. David Cross from the Karen Purvis Institute of Child Development, and it is very grounded in research regarding emotional and behavioral well being, and how these essentially promote these attachment relationships that we've been talking about today. And so they really kind of dive into three key principles of empowerment, connection and correction. And I really love this empowerment piece. Because I think that sometimes within our work, depending on where we are, in the grand scheme of our interactions with children and families, a lot of times we take this approach of either empowering children or empowering parents, and I like to bring this together because it has to be well, when we talk about early relational health, we talk about everything being bi directional and dyadic. Right. And so I believe this empowerment piece has to be both right. We want to empower parents, but we also want to empower children .  How we want to empower parents is through that strengths-based approach that we talked about earlier, how we want to empower children is essentially supporting their autonomy, right, giving them some autonomy over their lives, supporting them and giving them choices, and allowing them to have a voice in respecting their boundaries and preferences. And so this therapy is essentially very important for children who have experienced any type of trauma. Right. So this empowerment piece for kids, again, always ties back to that trust versus mistrust data that we talked about earlier as well. So we're giving children some autonomy over their lives so that they essentially trust us, right, once they trust us, we can then build connection, right, without trust, the connection piece is essentially lost, right. And so for children who have had trauma, we want to make sure that we go back and kind of build that layer of trust, before we before we are seeking connection. And then in that connection piece, we're essentially seeking, those strong, stable, trusting relationships, right between caregiver and their children. So this really involves creating the space or an environment that is has attunement, and is really a safe environment for their emotions, really exudes empathy, and responsiveness to kids. And then that correction piece involves like setting those clear, consistent and appropriate boundaries for children. Because while we can give them empowerment and autonomy, they're still children. And we also have to set boundaries. But in doing this in this distinct order, of empowering, connection, and then correction, we essentially lay the foundation again, For though the relationship to evolve.

 

Dr. Kerry Horrell  22:06

I love I remember to remind me of what you were saying earlier that like our Body Keeps the Score our body keeps, it has all this memory. And I think that I just really appreciate this piece around trust, because I think when we are feeling that we are in trusting attachment relationship, our body literally like has better capacity to feel our feelings and access some of this, like our bodies know when we're in a safe emotional environment.

 

Jyrah Knight  22:30

Absolutely. So providers a lot, think about it from an adult perspective as well. Right? If we were essentially able to look at it from our lens, think about the things that stress you out. Think about how you feel when you are stressed out.

 

Dr. Kerry Horrell  22:48

I've never stressed out.

 

Jyrah Knight  22:52

You know what your body feels in those moments, when you need when you're stressed out? Is it that you need a hug from a friend. Is it that you need to call them after a long day of work and talk through things. So that same co- regulation and things that we talked about earlier between between children, children, we also need those things as an adult. And so it's sometimes it's easier for us to look at it from that perspective. And recognize that even as adults, we need these things. So when the children need they absolutely need this.

 

Dr. Bob Boland  23:27

Wow. Sounds so it's obviously a lot of work. And I my guess is you're making it sound. Not necessarily easy. But but but I have to appreciate the amount of time and effort you must all be putting into this to make this work. Absolutely. Takes a long time.

 

Dr. Kerry Horrell  23:43

Just that just developing trust.

 

Jyrah Knight  23:46

Right, that'll home. It definitely takes time and repeated experiences. Yeah. Yeah.

 

Dr. Bob Boland  23:54

I mean, as Carrie said before, I think, you know, a lot of clinicians do listen to this and stuff. And yeah, what advice do you have for them? Like, how can clinicians? How can we all help?

 

Jyrah Knight  24:03

Yes, well, I think you all sit in a very, very powerful place, one of which we also talk a lot about at First Three Years is screening and assessment. And a lot of people aren't necessarily aware that there are screenings and assessment to assess the relational health between caregivers and infants and toddlers. And so by by administering these developmental and behavioral screenings, you get the opportunity to essentially identify any potential concerns for infants and toddlers. And through those tools can kind of pinpoint those signs of emotional or social and developmental challenges that may require intervention, and then ultimately helping parents caregivers receive that intervention and receive intervention that is based in parent-child interaction therapy or play therapy, or even referring to some early intervention programs. Because we know that these first three years of life are so critical and so great in helping through these these things, the more we can refer to early intervention services and or provide therapy for children and families. In these first three years of life, the better.

 

Dr. Kerry Horrell  25:33

It is such a nice reminder that we, I think, as therapists, I don't know if you feel this way, this is me, I'll just speak for me. I think as a therapist, I can often feel like, I'm the one who needs to be kind of handling this or like, you know, gosh, you know, if it's a work of the parent, like I'm the one needs to coach them in this way, or whatever it might be. And just remind us, like, there's help out there. There's other resources there programs to utilize, and especially for those here in Texas. This is a wonderful organization where it looks like there's a lot of support for this. Yeah. Speaking

 

Dr. Bob Boland  26:03

of which, how, how do people access you? website or Yeah,

 

Jyrah Knight  26:08

our website is www dot first three, First3Yearstx.org. And they can always reach out to our general email line, which is info. First3Yearstx.org

 

Dr. Bob Boland  26:29

was first three years tx.org. are free. I'm sure if I just Google first three years.

 

Dr. Kerry Horrell  26:38

That's what I did. Yeah,

 

Jyrah Knight  26:39

that's right. That's right. You can always google first three years,

 

Dr. Kerry Horrell  26:42

Texas, it showed up. Well, Jyrah, we do like to give our guests the last word, anything you'd want to leave our listeners with as we wrap up for today.

 

Jyrah Knight  26:53

Absolutely. I would just like to say thank you for all that you do on behalf of children and their families. You all play such an amazing role, doing the great work that you do and impacting children across the state. We really appreciate you

 

Dr. Kerry Horrell  27:09

retweet.... thank you so much for joining us

 

Jyrah Knight  27:14

me, thank you for having me.

 

Dr. Kerry Horrell  27:16

I'm just so thrilled about the work y'all are doing because like, we can't we cannot talk about attachment enough. No, we

 

Dr. Bob Boland  27:22

can't. We can't stress really the importance of that. That's right. You've been

 

Dr. Kerry Horrell  27:26

you've been listening to Jyrah Knight who is working with the first three years, Texas and we've been your hosts. I'm Dr. Kerry Horrell

 

Dr. Bob Boland  27:34

Dr. Bob Boland.

 

Dr. Kerry Horrell  27:35

Thanks for diving in. The mind dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

 

Dr. Bob Boland  27:47

For more episodes like this, visit www dot Menninger clinic.org.

 

Dr. Kerry Horrell  27:52

To submit a topic for discussion, send us an email at podcast@menninger.edu