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Using Reflective Practice to Promote Interconnectedness in Safe Babies Court Team Systems

Dec 15, 2020

Kimberly Renk, University of Central Florida; Giovanni Billings, Vanderbilt University Medical Center; Angie Hilken, Kinder Konsulting & Parents, Too; Stacey Leakey, Tulsa, Oklahoma; and Mindy Kronenberg, Memphis, Tennessee

Abstract ZERO TO THREE’s Safe Babies Court Team™ (SBCT) approach was developed to address incidents of abuse and neglect in infants and young children through relationship-based practice. This evidence-based approach was guided most recently by 12 core components that delineated the importance of each SBCT member and service in support of the well-being of infants and young children, along with their parents and caregivers, as they progress through the child welfare system (ZERO TO THREE, 2016). To promote a parallel process in which positive ways of being permeate all relationships, it is imperative that SBCTs embed reflective practice into their work. To inform this practice, Watson and colleagues’ (2016) five essential elements of reflective supervision/consultation can provide a context for reflective practice in SBCTs. This article will describe how these essential elements can be embedded into ZERO TO THREE’s (2016) 12 SBCT core components and support optimal outcomes for infants and young children in the child welfare system.

ZERO TO THREE’s Safe Babies Court Team™ (SBCT) approach was developed to address incidents of abuse and neglect in infants and young children through relationship-based practice. This evidence-based approach was guided most recently by 12 core components that delineate the importance of each SBCT member and service in support of the well-being of infants and young children, along with their parents and caregivers, as they progress through the child welfare system (ZERO TO THREE, 2016). ZERO TO THREE’s (2016) SBCT 12 core components are rooted in developmental science with the recognition that healthy child development is most likely to occur in the context of healthy relationships (National Research Council & Institute of Medicine, 2000). Consistently, family intervention is most likely to be successful through the relationships of infants/young children and their parents/caregivers with judges, child welfare providers, attorneys, infant mental health providers, and all others involved. All SBCT professionals recognize that “babies can’t wait” (Dicker & Gordon, 2004).

Photo: shutterstock/BlurryMe

Family intervention is most likely to be successful through the relationships of infants, young children, parents, and caregivers with judges, child welfare providers, attorneys, infant mental health providers, and all others involved.

Even with these core components in mind, it is difficult to build relationships in the child welfare system, which, by definition, addresses safety concerns, impaired relationships, separations, substance misuse, and emotional dysregulation occurring transgenerationally. When the SBCT approach is operating optimally, a parallel process can occur in which SBCT professionals pass along the positive consideration and care that they receive to the families being served. Professionals who work in the child welfare system can be impacted disproportionately by vicarious traumatic stress and burnout, however, as they witness the pain and lack of care given to the infants and young children whom they serve (Sprang et al., 2011). Reflective capacity consequently becomes especially important. So that SBCT professionals can achieve this positive parallel process, it is imperative that SBCTs embed reflective practice into their work. To inform this practice, Watson and colleagues’ (2016) five essential elements of reflective supervision/consultation should be considered as a context for reflective practice in SBCT. These essential elements, as originally defined for reflective supervision/consultation and as adopted for the purpose of this article, are provided in Table 1.

Note. When any :of these elements are included in the discussion of Safe Babies Court Teams (SBCT) core components, it should be assumed that this inclusion was inspired by Watson et al. (2016). Quotes in the table are from the College of Educatin and Human Development (CEHD) Institute of Child Development and Reflective Practice Center (2019).

The following sections will describe how these essential elements can be embedded into ZERO TO THREE’s (2016) SBCT 12 core components and support optimal outcomes for infants and young children.

Judicial Leadership

“Before there is a SBCT, there is a judge or child welfare agency leader who is tired of seeing the children become the parents and then the grandparents of babies in foster care, who is passionate about doing right by babies, and who recognizes the importance of the first 3 years” (ZERO TO THREE, 2016, p. 1). Many SBCT judges have wrestled with finding a solution to the transgenerational cycles of abuse and neglect and are looking for bridges between the science of early childhood development and the court work that they do every day. An interesting component of the judges’ role is that they have both legal and perceived power (L. Hudson, personal communication, December 5, 2015), allowing them to personally invite people to the table in a way that few can for a strong reflective alliance. They can set the stage with a tone of dignity and respect for families’ experiences, a healing-centered approach to child welfare practice, and a reduction in the anxiety-producing discourse typical of judicial proceedings.

Without realizing it, judges often have begun incorporating reflective practice into their work. They listen and seek to understand the family story, take time to recognize the developmental course of trauma, and identify how the system contributes to the struggles that families face. Perhaps most important, judges consider the impact of the parallel process in relationships. Judges set the tone and become the main role models for SBCT professionals and families in their courtrooms. When judges do not consider reflective practice, the felt sense of the court is vastly different. Parents may be penalized for normal setbacks (e.g., in their substance misuse) by having their visits leveraged or suspended as a means of “encouraging” treatment attendance without consideration of the role of trauma. When judges are able to successfully promote parallel process, family progress toward reunification is enhanced.

Photo: shutterstock/wavebreakmedia

Judges can set the stage with a tone of dignity and respect for families’ experiences, a healing-centered approach to child welfare practice, and a reduction in the anxiety-producing discourse typical of judicial proceedings.

Local Community Coordinator

Community coordinators work most closely with judges and often are chosen for their inherent reflective capacity. Community coordinators typically are steeped in child development knowledge, allowing them to identify and coordinate services and resources while holding the infant or young child in mind. Their leadership experience and related professional use of self help create safety and balance when opposing views are considered or barriers become evident when bringing together disconnected or siloed stakeholders.

When reflective practice is incorporated, SBCT proceedings, including stakeholder meetings, family team meetings, and hearings before judges, are held to judges’ standards. These standards allow the coordinator to shape the community toward a more trauma-informed, culturally sensitive, and less marginalizing way of serving families. All parties can commit to a healing-centered approach through reflective alliance, and the experiences of infants, young children, and families can be held in mind. When there is an absence of reflective practice, either due to increased stress or lack of reflective practice support, the position of the community coordinator can feel overwhelming. Lack of support felt in this position can trickle down via the parallel process to other SBCT participants, resulting in empathy fatigue, burnout, and decreased effectiveness.

Active Court Team Focused on the Big Picture

The third core element is the court team composed of attorneys, treatment and service providers, court appointed special advocates, medical professionals, and stakeholders committed to restructuring the ways in which the community responds to the needs of infants and young children. Family team meetings are held monthly, balancing the needs of infants, young children, and their families. Infants and young children are held in mind. Their unmet needs are identified and brought to the forefront so that barriers can be negotiated. When reflective practice is at work, SBCT members partner with the family in a reflective alliance toward the successful identification of untapped community resources through trust, safety, and security. Through professional use of self, SBCTs become a source of motivation for the family and a pathway for healthy change.

A red flag indicating a lack of reflective practice is when “difficult” community partners are not invited to the table. The members of the SBCT may not be aware of the ways in which they keep people from joining their efforts. A good series of questions for the SBCT to consider is: Who is missing? Why are they missing? What are we doing to keep it this way? If such polarization continues, community dynamics are likely to play out in the courtroom, presenting as themes of blame, avoidance, and/or disrespect. It is imperative to hold a place for reflection so that the SBCT has support for shifting these dynamics.

Targeting Infants and Toddlers Under the Court’s Jurisdiction

Historically, the experiences and needs of infants and young children in the child welfare system have not always been acknowledged or well understood. The SBCT approach highlights that infants and young children indeed are impacted by their involvement in this system, allowing the opportunity to hold them in mind. SBCTs aim to understand who infants and young children are in order to provide them with a voice in child welfare proceedings. Because infants and young children cannot communicate their thoughts and feelings verbally, the SBCT can discover how best to help by maintaining a stance of curiosity and intentionally considering the infant or young child’s perspective. Questions that can guide a SBCT’s discussion include: What do the team members see and hear the infant or young child doing? What might this behavior be telling the team about experienced thoughts and feelings? What is it like for this infant or young child in relationships with birth parents and caregivers?

When the SBCT is not holding the infant or young child in mind, it can be apparent in different ways. In some cases, the impact of unique trauma experiences and child welfare involvement on infants and young children might be minimized. For example, it is all too common for it to be suggested that infants and young children do not remember because of their young age the stressful experiences in their lives. In other cases, a focus on the perspective of infants or young children can be lost when SBCT meetings are dominated by discussion of birth parents’ needs or system challenges. By holding infants and young children in mind, SBCTs can better understand the needs of infants and young children, empathize, and respond with decisions that are developmentally appropriate, culturally sensitive, and individualized.

Valuing Birth Parents

Members of SBCTs also have important relationships with birth parents. If SBCTs offer empathy, consistency, respect, and caring guidance to birth parents, birth parents then will have relational experiences upon which to draw when interacting with their infants and young children. Because courts represent a symbol of authority, relationships within SBCTs can be particularly powerful for birth parents. Birth parents may have perceptions about people being unsafe and untrustworthy that are reenacted in SBCT relationships and might avoid meetings and hearings because the child welfare system serves as a trauma reminder (Child Welfare Collaborative Group et al. , 2013). Such responses from birth parents, while rooted in their own history of trauma, have the potential to repel SBCT members and interfere with effective working relationships. As birth parents often have histories of being parented that are conflictual, SBCTs can provide birth parents with reparative experiences of benevolent authority.

Reflective practice can be a helpful antidote for identifying and better understanding the ways in which birth parents’ trauma histories and challenging presentations are impacting their relationships with SBCT members. Just as SBCTs might hold the infant or young child in mind, they also can have curiosity about what birth parents’ behaviors communicate about their feelings and experiences. When SBCTs are not using reflective practice with birth parents, there may be a tendency to be judgmental. SBCTs may overly focus on compliance to case plans and address only behavioral manifestations of birth parents’ difficulties (e.g., substance abuse, anger outbursts, perceived noncompliance). When SBCT members modulate their reactions and seek to understand birth parents’ perspectives, however, a new relational experience for birth parents can promote their own healing and that of their infants and young children.

Concurrent Planning and Limiting Placements

Concurrent planning refers to an approach in which at least two alternate permanency outcomes are considered simultaneously as families work with SBCTs (Cohen, 2016). One of these potential outcomes generally is reunification with birth parents. At the same time, at least one other potential permanency outcome (e.g., permanent guardianship, adoption) is under consideration. By pursuing multiple permanency alternatives in a transparent manner from the start of each case, time to permanency can be reduced, and appropriate permanency goals, efforts to engage parents and caregivers, and time reductions in finalizing adoptions can be achieved (Cohen, 2016).

Given the many reactions that may transpire with concurrent planning, transparent discussion and appropriate reflective practice are necessary. Even those professionals, parents, and caregivers with high reflective capacity may struggle with the idea of concurrent planning. For example, birth parents may feel that they are not being supported in pursuing reunification with their infants and young children when concurrent planning is discussed. Caregivers also must be supported, as they may be the most appropriate alternate permanent placement should reunification not occur. Certainly, the potential tension between birth parents and caregivers can cause difficulty for the collective work. Although the ideal situation would include caregivers supporting infants, young children, and birth parents, birth parents can feel replaced and disconnected when they see their infants and young children attach to caregivers. Birth parents need a space in which they can reflect upon difficult feelings (e.g., jealousy, fear of loss) while recognizing their gratitude for the care that caregivers are providing.

If reflective practice is not used, birth parents may not be fully informed (or may not be informed at all) about the potential permanency plans for infants and young children, prompting an array of difficult emotions, particularly if the birth parents’ family story is not well understood. Further, caregivers may be surprised or experience other unexpected emotions when they learn of the birth parents’ emotional reactions and that they may be considered as the alternate permanent placement for the infant or young child. In addition, SBCTs may feel at odds in their decision making surrounding concurrent planning and limiting placements, prompting them to feel compromised in their professional use of self and their reflective alliances. Finally, and most important, infants and young children may experience confusion amidst potential mixed messages, particularly if their needs are not being held in mind.

The Foster Parent Intervention: Mentors and Extended Family

Foster parents/caregivers have a unique position on SBCTs because they care for the daily physical and emotional needs of infants and young children, maintain relationships with birth parents, and participate in reunification efforts. Ambivalence can be a common reaction for foster parents/caregivers, as they feel protective of and bonded to the infants and young children for whom they are caring while being asked to fulfill these other tasks. This tension can be heightened if foster parents/caregivers are extended family members. Discussing and being curious about the experiences of foster parents/caregivers can support their ability to tolerate ambivalence. If SBCTs can accept the full range of these experiences and feelings, then foster parents/caregivers will be more able to accept others’ emotional experiences through parallel process. To explore and understand the perspectives of foster parents/caregivers, they need to be included in family team meetings and hearings where complicated discussions occur.

When SBCTs are not using reflective practice, SBCT members may minimize the role of foster parents/caregivers as only providing for basic needs of infants and young children while they devalue the importance of relationships between birth parents and foster parents/caregivers. At other times, SBCTs might not consider the perspectives of foster parents/caregivers because they are idealized. For example, it may be assumed that, because foster parents/caregivers have many years of experience, they do not have feelings for and reactions about the infants and young children for whom they are caring. By involving all foster parents/caregivers and reflecting on each of their perspectives, SBCTs can facilitate foster parents/caregivers’ role as a bridge to birth parents as well as demonstrate how to tolerate a range of different emotions.

Pre-Removal Conferences and Monthly Family Team Meetings

One of the unique features of SBCTs is the monthly frequency with which birth parents meet with SBCT members. Early meetings (e.g., pre-removal conferences) can set the tone for later family team meetings. Monthly family team meetings then allow for close monitoring of the family’s progress, appropriate and prompt actions to improve outcomes, preparation for court hearings, and for communication to be built among those who have an interest in the well-being of the infants and young children (Supreme Court of the State of Florida, 2018).

If reflective practice is not incorporated into family team meetings, SBCTs will not work effectively in their sharing, evaluating, and imparting of information. Birth parents may not be ready or willing to share information with the team. If not invited openly, caregivers may not feel as if they are part of the team, thereby impacting any reflective alliance that may have been built. Further, SBCT members may not effectively hear each other, particularly if they are not capitalizing on their relationships and professional use of self. Among all of these difficulties, infants and young children may not be held in mind. By using reflective practice, SBCTs can recognize when disagreements have the potential to derail the family team meeting process and correct their path. Reflective family team meetings also can provide opportunities to observe families in the context of their support system, thereby yielding valuable information about how they are able to access support from others.

Frequent Family Time (Visitation)

A main goal for family time is to provide parental presence for infants and young children and to provide parents with opportunities to work on responsiveness to the cues of their infants and young children (ZERO TO THREE, 2016). Thus, family time provides opportunities to observe family dynamics, observe interactions between parents and their infants and young children, and promote birth parents’ reflective capacity. Frequent family time is particularly important because there is a strong connection between (increased) frequency of family time and (decreased) time to permanency (Potter & Klein-Rothschild, 2002). If reflective practice is not used as part of family time, there may be less understanding of the behaviors and triggers shown by birth parents and infants/young children around and during visits. Birth parents may experience missed opportunities for gaining insights into their own behaviors and for building a more securely attached relationship with their infants and young children. Infants and young children may feel as if they are not heard, understood, or protected, as their needs are not being held in mind. Given the implications for birth parents as well as their infants and young children, SBCTs should reflect thoughtfully about how visits should be structured.

Continuum of Mental Health Services

It is critical for providers who serve SBCT families to work collaboratively rather than in silos. Families served by SBCTs are often dealing with separation in addition to transgenerational trauma, domestic violence, substance use, and/or mental health issues and need the support of numerous providers. SBCTs benefit from providers who present as open to and appreciative of various perspectives, thereby setting a powerful example for the families being served. Through reflective practice, more collaborative and transparent interactions are ensured across SBCT members. When mental health service providers understand their own responses to interactions, they are better able to be open to understanding the reactions of others.

SBCTs often incorporate child–parent psychotherapy (CPP; Lieberman et al., 2015) as the intervention of choice. CPP is a relationship-based, trauma-informed, and culturally sensitive approach to (re)building relationships between parents/caregivers and infants or young children after difficult relational experiences. During CPP, ensuring safety is a primary goal, allowing for enhanced emotional regulation and more reflective interactions. Parents/caregivers and infants/young children acknowledge, verbalize, and make meaning of their trauma and connect these experiences with emotion and behavior. Providers attend and respond through compassionate wondering about participants’ emotion and behavior, including transgenerational patterns of relating. As an outcome, parents and caregivers recognize both the ghosts (Fraiberg et al., 1975) and angels (Lieberman et al., 2005) behind their parenting patterns and become better able to nurture and protect their children. In turn, infants and young children experience their parents/caregivers as protectors and return to a normal developmental trajectory.

Photo: shutterstock/CC7

Historically, the experiences and needs of infants and young children in the child welfare system have not always been acknowledged or well understood.

Hearing the experiences of SBCT families can evoke strong emotional responses (e.g., vicarious trauma), making affect dysregulation contagious and the maintenance of a reflective stance challenging. Reflective supervision/consultation allows providers to examine the thoughts, feelings, actions, and reactions that are evoked while doing this work (Eggbeer et al., 2008), thereby allowing providers to hold infants, young children, and their parents and caregivers in mind. Reflective supervision/consultation supports providers’ abilities to tolerate their own emotional reactions as well as the emotional reactions of the families whom they serve and to remain confident in the context of ambiguity and uncertainty. The parallel process of providers’ ability to remain regulated promotes SBCT families’ abilities to regulate their own emotion and behavior.

Training and Technical Assistance

By offering consultation through regular team meetings and individual supervisory calls, ZERO TO THREE creates a chain of support and enables a parallel process in which a national entity supports local professionals, local professionals support parents/caregivers, and parents/caregivers support infants and young children. Technical assistance includes opportunities for SBCTs to reflect on the family story, hold the infant or young child in mind, and explore team members’ thoughts and feelings about families. When SBCTs take this time to reflect, they can individualize interventions to suit families’ cultures, strengths, and needs. They also are better able to understand factors associated with successes, regressions, and barriers and interact intentionally with families, rather than respond in a reactive manner.

In the absence of reflective practice, SBCTs are not aware of what they do not know and consequently do not seek new knowledge. It can be difficult to find time to attend trainings in the midst of schedules that are full of hearings, meetings, and administrative tasks. It may take vulnerability to recognize a need for training and support. Nonetheless, prioritizing time to receive new training, support, and reflective supervision/consultation facilitates the well-being of all SBCT members.

Understanding the Impact of the Work

Evaluation is a fundamental type of reflection, reflection-on-action (Schön, 1983), which allows for progress monitoring and continuous quality improvement. Reflective SBCTs are open to exploring why their work is or is not going well, and they come together to seek innovative responses, rather than maintaining the status quo or becoming stuck in a cycle of blame. When possible, ruptures in relationships are recognized and repaired. It can be humbling and overwhelming to acknowledge the life-altering impact that SBCTs have on infants, young children, and their families. A reflective SBCT appreciates the monumental impact that each team member has. Knowing that effective work is achieved when the time for intentional reflective practice is valued, SBCT members support each other in continuous quality improvements to support infants, young children, and their families.

Conclusion

The SBCT approach was developed to use evidence-based practices to meet the specific needs of infants, young children, and their families. Ideally, the safe, sensitive, caring, and responsive interactions among SBCT members are replicated through parallel process, with the judge supporting the SBCT members, the SBCT members supporting parents and caregivers, and the parents and caregivers fostering safe and secure parent–child relationships in support of infants and young children. This SBCT parallel process is the epitome of Jeree Pawl and Maria St. John’s (1998) famous quote from their book, “How We Are Is As Important As What We Do.” Ironically, a central paradox of SBCT work is that the intentional slowing down involved in reflective practice supports the goal of speedier exits for infants and young children being served by SBCTs (Casanueva et al., 2017). With this evidence-based approach and reflective practice in mind across ZERO TO THREE’s (2016) SBCT 12 core components, parents are less likely to maltreat their infants and young children (Casanueva et al., 2017), thereby providing more nurturing parenting and ultimately breaking the transgenerational cycle of abuse and neglect.

Suggested Citation

Renk, K., Billings, G., Hilken, A., Leakey, S., & Kronenberg, M. (2020). Using reflective practice to promote interconnectedness in Safe Babies Court Teams systems. ZERO TO THREE Journal, 41(Supp.).

Authors

Kimberly Renk, PhD, IMH-E®, is an associate professor in the clinical psychology doctoral program at the University of Central Florida in Orlando, a licensed psychologist in the state of Florida, and an infant mental health mentor-clinical. Dr. Renk discovered her real passion when she completed her predoctoral internship at Louisiana State University Health Sciences Center in New Orleans, where she completed fellowship training in infant mental health under the supervision of Joy D. Osofsky, PhD. Although Dr. Renk has diverse clinical experience, the majority of her work has addressed the needs of infants and young children who are already experiencing emotional and behavioral difficulties, particularly due to trauma in their families. Dr. Renk currently directs the Understanding Young Children and Families Research Clinic and Laboratory, through which she has been examining the utility of Circle of Security-Parenting for mothers who are receiving residential treatment for substance misuse, parents who are child welfare-involved, and early childhood education providers in culturally diverse, low-income child care centers. Dr. Renk also is actively involved with the Early Childhood Court in her judicial circuit and throughout Florida, has collaborative relationships with many community agencies in Central Florida, and is rostered as a provider of child–parent psychotherapy. She most recently has received research funding from the Central Florida Foundation/100 Women Strong, Florida State University’s Florida Institute for Child Welfare, and Nemours Children’s Hospital. Dr. Renk is published widely and has been fortunate to present her work across local, regional, national, and international venues.


Giovanni Billings, PsyD, IMH-E®, is an assistant professor of clinical psychiatry and behavioral sciences at Vanderbilt University Medical Center and a team member at the Center of Excellence for Children in State Custody. He trained at Children’s Hospital Colorado, The Kempe Center, and in the Irving Harris Fellowship at University of Colorado Health Sciences Center in Denver. Throughout his education, training, and work, Dr. Billings’ focus has been on serving children and families who have experienced trauma, with a particular focus on infant and early childhood trauma. This work includes parent–child relational assessment, relationship-based therapeutic interventions, and training/consultation in the court and child welfare systems on the needs of young children. Dr. Billings is a rostered child–parent psychotherapy therapist and endorsed as a clinical mentor in infant mental health. 


Angie Hilken, LCSW, IMH-E®, is a licensed clinical social worker in the state of Florida. She is endorsed as an infant mental health clinical mentor, specializing in supporting children and families from birth to 6 years old. Ms. Hilken completed infant mental health training through the Florida State University Harris Institute. She has provided training around the state of Florida. Ms. Hilken is a former board member of Florida Association of Infant Mental Health and currently serves on the Advisory Board. She is involved with building Florida’s reflective supervision network. Ms. Hilken’s professional awards and recognitions include Social Worker of the Year, the JJ Daniels Award for work with children, and the Florida Times Union Child Abuse Prevention Award.


Stacey Leakey, PhD, IMH-E®, has worked in the field of infant mental health (IMH) and child abuse prevention and treatment for the past 15 years. She is owner and principal at O2 Consulting, LLC, where she provides training in trauma-informed and evidence-based practices in infant and early childhood mental health, helping mental health systems and stakeholders apply this knowledge via regular consultation. She provides reflective consultation for professionals seeking Endorsement® as IMH professionals, for nonprofit agency leadership, and for child welfare stakeholders. She was the IMH community consultant for The Parent Child Center of Tulsa for 6 years, where she was responsible for building an IMH community of practice, training child welfare stakeholders and legal systems to apply the science of early childhood development in the courtroom, and preparing the community for infant and early childhood mental health interventions and practices. She is the consultant for the Tulsa County Safe Babies Court Team, the state’s first IMH specialty court, where she supports judges, attorneys, law enforcement, and medical professionals in both their work and in recognizing the impact of their work on them personally.


Mindy Kronenberg, PhD, IMH-E®, is a clinical psychologist who specializes in infant mental health and the assessment and treatment of trauma across the lifespan. She completed the Irving Harris Infant Mental Health Fellowship at Louisiana State University Health Sciences Center, where she previously served as an assistant professor. She has written articles in the areas of infant mental health and disaster and co-edited Treating Traumatized Children: A Casebook of Evidence-Based Psychotherapies. Dr. Kronenberg has provided direct and consultative services in multiple settings including state agencies, schools, Head Start programs, dependency courts, and child welfare agencies. She is a National Child Traumatic Stress Network affiliate member, a past co-chair of the Network’s Zero to Six Workgroup, and founding board member of the Association of Infant Mental Health in Tennessee (AIMHiTN). Dr. Kronenberg is committed to infant and early childhood workforce development and addresses this issue by providing reflective supervision/consultation, serving as endorsement co-chair for AIMHiTN, teaching infant mental health principles in higher education, and serving as a national child–parent psychotherapy trainer.

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