This annual report - Taranaki District Health Board

playthings or the environment, appear sad or withdrawn, show inappropriate sexualbehaviour or inappropriate impulsive or aggressive behaviour, have excessive fears thatdon’t respond to reassurance or frequent night terrors, have frequent tantrums, havesignificant language delay, or have an unusual need for order and cleanliness [249].Clinical assessment of attachment in young children should involve both an assessment ofcaregiver-child interaction and a narrative interview with the caregiver [443]. Observing theparent-child interaction following a brief separation, as in the “Strange SituationProcedure”, is useful.Securely attached children show affection to their caregiver, seek closeness when needingcomfort, rely on the caregiver for help and cooperate with the caregiver. Atypical parentingbehaviours associated with disorganised attachment include withdrawal (not greeting thechild on being reunited), being frightened/hesitant/uncertain, role confusion (pleading withthe child, threatening to cry, speaking as if the child were an adult partner), affectivecommunication errors (sending contradictory signals e.g. laughing at a child’s distress,using a positive tone of voice to put the child down or tease, expressing distress when thechild smiles) and intrusiveness or negativity (mocking, withholding a toy, pushing the childaway).Clinically concerning features of parent narrative attachment interviews includeexpressions of anger about the child’s needs, indifference to the child’s needs, showinglittle capacity to imagine what the child feels or needs, blaming the child for difficulties likecrying or not sleeping, limited memories about the child, talking about previousexperiences of loss or trauma even if not asked about these, and irritation with theinterviewer [443].Parenting Programmes for Enhancing Infant Mental Health and Parent-Child RelationshipsParent-child relationships are critical for infant mental health so interventions for enhancinginfant mental health focus on working with parents. The U.K. Department of Educationcommissioned researchers at the National Academy of Parenting Research (NAPR) atKing’s College London to evaluate parenting programmes against standards of bestpractice [462]. Programmes were rated from 1-star (requires further development) to fourstars (strong). The highly-rated parent programmes the NAPR evaluated that applied tochildren 0–3 years were:Family Nurse Partnership (4 ): A targeted programme for young, poor, singlemothersFamily Nurse Partnership (FNP) is for young mothers (19 years and younger) expectingtheir first child. Mothers are enrolled in the programme during pregnancy and receiveweekly or fortnightly visits from a Family Nurse until their child’s second birthday (onaverage a total of 59–64 visits, each lasting c. 1.5 hours). The nurse establishes asupportive relationship with the mother and together they develop strategies forunderstanding the mother’s and the child’s needs, and identify resources in the communitythat may support the health and development of mother and child, to which the mother islikely to be referred. Advice and support is provided in six domains: personal health,environmental health (especially housing), life course development (encouraging themother to continue her education, find a job and postpone the birth of a second child),maternal role, managing relationships with friends, family and the baby’s father,connections with health and human services, and pregnancy advice.There have been three randomised controlled trials of FNPs with young, single, lowincome mothers in various parts of the United States: Elimara NY (400 mothers) [463],Memphis TN (734 mothers) [464] and Denver CO (490 mothers) [465]. The Elimara trialfound that, compared to the control group, the mothers in the intervention group hadsignificantly fewer subsequent births, days receiving welfare and arrests and convictionswhile their children were less likely to be abused or neglected, or be arrested or convictedfor a crime. The Memphis mothers participating in FNPs showed significant improvementsin time on welfare benefits, number of children born while they were in their lateIn-Depth Topic: Mental Health Issues in Children - 386