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Infant and Early Childhood Mental Health Consultation in the Midst of a Syndemic: How Does the Field Pivot?

Amy Hunter and Neal Horen, Georgetown University Center for Child and Human Development

Abstract

Infant and early childhood mental health (IECMH) consultation has gained increasing attention over the years as an effective approach to supporting young children’s social–emotional development (Brennan et al., 2008; Hepburn et al., 2013). The current syndemic (the aggregation of two or more concurrent epidemics that interact synergistically to exacerbate the burden of disease; e.g., COVID-19 and racism) highlights the increasing and disparate mental health needs of young children and their families. The syndemic offers an opportunity to shine a light on IECMH consultation as an effective and efficient approach to supporting the mental health needs of young children and their families. This article explores how IECMH consultants shift how they do their work in the midst of the syndemic and describes the benefits of IECMH consultation as a powerful and necessary intervention during this unprecedented time.

“I feel like I can’t breathe,” Jewel, a family child care provider, shared with her infant and early childhood mental health (IECMH) consultant. Jewel went on to mention the stress she was feeling providing care for a few young children in her home, far fewer children than before the pandemic. She described that she was worried about her finances because she didn’t know if her family could survive on the little income she was receiving from the reduced number of children in her care. She shared worries about the health of the children and families and about staying healthy herself. She described particular concerns about not knowing if one of the children or someone in her own family might be an asymptomatic spreader of the coronavirus. She went on to talk about how virtual schooling made it difficult to divide her attention between supporting her own children with their schoolwork and online meetings and providing the needed care for the toddlers and preschoolers in her family child care home. She explained that her reduced income had forced her to lay off a co-caregiver who had previously worked with her. Working alone was particularly hard lately because the children seemed to be acting up and getting on each other’s nerves. Jewel shared that her daughter had been attending protests in the city to express support for Black Lives Matter in the wake of George Floyd’s death. Jewel explained that while she strongly supported peaceful protest and making their voices heard, she worried about her daughter’s health and physical safety. Jewel was almost in tears talking about the pressures and the uncertainty of knowing how or when the situation might get better. As Rhonda, an IECMH consultant, listened to all that Jewel was holding, she took a deep breath and reflected on Jewel’s description of stress as feeling like not being able to breathe. The two women sat for a moment with the weight of the current crises impacting the country.

Michelle, a teacher in New York City, noticed a picture of children on a resource about “returning to school.” The resource offered guidance to teachers and school systems about supporting children upon the eventual return to in-person school after the quarantine, yet, the children in the picture were not wearing masks. Michelle was unnerved. She had two family members pass away as a result of the coronavirus. She expressed her outrage to the IECMH consultant, Joe, who provided support to the preschool. Joe understood that underneath Michelle’s outrage was her grief for the loss of her family members. Joe asked Michelle about her losses. As Michelle was talking, she also shared how very scared and worried she was about going back into the classroom.

Anna has been a home visitor for 20 years. She has supported families through nearly every kind of crisis, yet never a pandemic. The coronavirus pandemic has required that she provide her home visits to young children and their families virtually, which has been very challenging. Not all Anna’s families have Internet access, so many of the visits are phone calls to her families. In the transition from in-person visits to virtual visits, Anna has had time to attend some trainings. In the trainings she has been reminded that substance use, domestic violence, and child abuse and neglect may be on the rise during this time. Anna is worried about a number of her families. She is aware that some of the parents she works with are in recovery. She is concerned that the isolation of the quarantine and the added stress of job loss, the pandemic, and the tensions of the needed attention to racial injustice may contribute to reoccurrence of substance use problems. Anna isn’t sure how to ask the families about these sensitive topics, particularly over the phone or on video calls. Jessie, the IECMH consultant, and Anna explore together how she might be able to sensitively ask her families how they are coping.

These vignettes highlight a few of the many ways the professionals who care for and work with young children and their families are under increased stress during these unprecedented times. The vignettes illustrate some of the types of concerns IECMH consultants may experience during what we will refer to as a syndemic. A recent Lancet article (Horton, 2020) described a syndemic as characterized by “biological and social interactions between conditions and states, interactions that increase a person’s susceptibility to harm or worsen their health outcomes” (p. 874). COVID-19 and other noncommunicable diseases (e.g., diabetes, asthma, cancer, heart disease, obesity) exist in a context of social and economic disparity that exacerbates the adverse effect of each of the diseases. Recognizing COVID-19 as a syndemic acknowledges the impact of patterns of inequality and systemic racism in our society. This article will describe the impact of the syndemic on young children’s mental health and the unique role mental health consultants can have in assisting to mitigate its social–emotional consequences.

Photo: Fiora Watts/shutterstock

Recognizing COVID-19 as a syndemic acknowledges the impact of patterns of inequality and systemic racism in our society.

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