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Family Systems, Communities of Care, and Mental Health

Gail L. Ensher and Melissa M. Luke


This article is an excerpt from the forthcoming book, Mental Health in the Early Years: Challenges and Pathways to Resilience, by Gail L. Ensher, David A. Clark, and Melissa M. Luke with contributing authors. This excerpt includes the value of a family systems and an ecological perspective; provides an overview of social–emotional development of infants and young children; and discusses the impact of consistent, available, and responsive early caregiving relationships on early brain development and positive mental health outcomes of infants and young children.

An accurate concept of family systems needs to take into consideration multiple contexts and dimensions. Among others, the framework must reflect family histories, places where families reside, individual family membership and perspectives, resources and opportunities available to families, and frequent daily challenges. In particular, respective cultures, ethnic backgrounds, community settings, available medical and educational resources, as well as financial and other advantages and disadvantages all affect the ways in which families function as healthy integrated systems. In turn, each of these factors influences the ways in which families are able to parent their infants and young children, leading to positive mental health outcomes. Families and their young children share several universal qualities and functions; at the same time, every family system is unique. Hanson and Lynch (2013) described families in this way:

A hallmark of the American family is diversity. Families are not unitary, nor can they be narrowly defined. Across the nation, in every community—and within the heart, mind, and experience of each individual—family is personal. Our families help to define who we are and who we are not, how we view the world, how we live, and how we share lives with others. Like the individuals within them, families change over time. In the United States and elsewhere throughout the world, families share many characteristics but differ dramatically in others. (p. 1)

Previously, Urie Bronfenbrenner (1979) described similar concepts when he wrote,

The understanding of human development demands more than the direct observation of one or two persons in the same place; it requires examination of multi-persons of interactions not limited to a single setting and must take into account aspects of the environment beyond the immediate situation containing the subject. In the absence of such a broadened perspective, much of contemporary research can be characterized as the study of development-out-of-context. (p. 2)

In addition to the above concepts, it is important to recognize that “realities” for families—individually or as a whole—differ greatly, depending on the ways in which they perceive situations, events, and specific circumstances. For example, some families are private, opting not to invite special education service providers into their homes, whereas others are eager to access all help offered. Also influencing such decisions are family perceptions of the importance of early childhood education and inclusion of having a child with a disability. It is also important for professionals working with families to understand that what affects one person in the family system has an impact on all the other people. Turnbull, Turnbull, Erwin, Soodak, and Shogren (2015) drew an insightful analogy between family systems and mobiles—that is, for a mobile (i.e., family system) to be in balance, all elements need to be of equal weight and have equal attention. If one arm of the mobile is longer or has more tension than other elements, the mobile (or family system) is out of balance.

Historically, families consist of individuals who are “united” by marriage, relationships, events, and situations; however, they function with unique individuals. Ideally, there is a partnership among members of a family that facilitates cooperation, support, and a sense of community. Over time, some family functions and relationships change, whereas others remain the same—for example, children grow and leave home, parents may or may not remain together, jobs and economic situations change, families may move, or significant events transpire. With that said, the one essential and universal thread that hopefully binds families together is a nurturing, caring, and loving environment on behalf of their young children.

Respective cultures, ethnic backgrounds, community settings, available medical and educational resources, as well as financial and other advantages and disadvantages all affect the ways in which families function as healthy integrated systems.

This central tenet underscores the concept of family-centered practices, a cornerstone of the Individuals With Disabilities Act (U.S. Department of Education, Federal Register, 2011), which was revised and approved in 2004. In particular, this legislation mandates that early intervention services for infants and young children with disabilities and special health care needs be developed and implemented within the context of the family. This noteworthy shift differs from prior provisions of service that focused primarily on the child (Beckstrand, Pienkowski, Powers, & Scanlon, 2016). This approach highlights the essential importance of family relationships for positive mental health outcomes of all infants and young children from birth to 5 years old (ZERO TO THREE, 2016). As infants and young children grow and develop, they obviously have different needs, and families thus give back in different ways, as noted in the following sections.

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