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ZERO TO THREE FELLOWS: Kalani Makanui

Q & A With Kalani Makanui, ZERO TO THREE Fellows class of 2020–2022

1. Briefly describe the burning issue, need, or question that you are addressing through your Fellowship and how it has come to mean so much to you.

One important issue we are addressing through my active engagement as a ZTT Fellow is the universal screening and in-depth assessment of trauma in young children. I became interested in this important topic through early clinical training and research experiences during graduate school, while working with children involved in the foster care system; this interest was further developed and refined through subsequent training and work experiences within various community mental health agencies. Within these organizations, we serve youth who are at disproportionate risk for having experienced stressful and often traumatic occurrences early in life. Traumatic events and adverse childhood experiences can potentially affect development across domains, highlighting the importance of early detection and referral for intervention services with the promising potential to mitigate the effects of these early challenges. Early universal screening (and, where indicated, assessment) can also help to promote communication across disciplines, helping us as professionals to work more effectively in treating the whole child and improving the experience of young children and their families as they navigate often complex services systems.

I have seen firsthand how the early identification of trauma in young children can help both caregivers and professionals better understand the behavioral and emotional responses of young children who have experienced early stressors, and to more holistically support the infant or toddler in attaining early socio-emotional milestones. These early social competencies form the foundations of school readiness and learning, adaptive social functioning, strong relationships, and beyond. In terms of professional scope of practice, in-depth assessment has historically been limited to specific disciplines (for example, psychologists). Better serving the needs of young children exposed to trauma further includes expanding existing workforce capacity to assess young children by developing/implementing training and assessment tools available to a wider range of disciplines serving young children and their families.

This also includes the development of assessment tools that are culturally sensitive/relevant and linguistically accessible to the diverse families that we serve. Early screening and assessment can make a world of difference in terms of promoting health and educational equity in young children.

2. How have the current events, crises, and societal upheavals impacted your work and your perspective of the work ahead of you?

The events of the prior 2 years have reshaped my personal and professional understanding of the scope and purpose of our work with young children. Specifically, families with infants, toddlers, and young children have faced unprecedented challenges posed by the COVID-19 pandemic. Increased parental stress, financial/employment insecurity, limitations in access to affordable/high-quality child care, barriers in access to early screening and assessment services, and limitations in the availability of infant and early childhood mental health services have all posed unique challenges for families. Young children and families from BIPOC communities have faced the additional and additive burdens of long-standing and entrenched societal, institutional, and systemic oppression and racism, which have further exacerbated the stressors experienced by these families.

Acknowledging these disparities, practitioners within the field of infant and early childhood mental health (including those providing screening and assessment services) have had to redefine and adapt practice as typically delivered. Such adaptations have included developing innovative practices and technology in the service of expanding access to care (e.g., delivery of services via telehealth). However, the development of new tools and practices has not completely closed the existing service gap in access to care for specific groups of children (e.g., those from BIPOC communities living in economic poverty).

Prior to the pandemic, I viewed the scope and impact of our work from the perspective of addressing the service needs of whomever could come to the clinic. Throughout the pandemic (and through the ZTT Fellowship), I have expanded my understanding of the scope of our work with young children and their families as a movement toward the promotion of social justice, advocacy for equitable access, and progress toward enduring social change. I have come to understand and acknowledge that our most important work lies outside of the clinic walls, in service of those families without the resources to readily access outpatient services. In terms of next steps, individuals and professionals serving young children and their families must redouble efforts in outreach and engagement of families disenfranchised by existing service systems in ways that are culturally affirming, sensitive, accessible, and relevant. We must also continue to decolonize and examine our respective professions, institutions, policies/procedures, and practices to ensure that we ourselves do not continue to contribute to the various forms of existing systemic inequality.

3. What would you like our members to understand or recognize about the children, families, and professionals with whom you work?

The health and well-being of infants and toddlers is the shared, collective responsibility of all of us. No matter which professional and/or personal space that we show up in, we can all take active steps to improve the lives of infants and toddlers. Whether through our professional work, volunteerism, and/or local/state/federal advocacy, we all carry within us the potential to create a brighter future for the children and families in our communities. The only prerequisites for this work are an earnest desire to improve the lives of young children and their families and the willingness to take action to do so. ZTT provides an expansive network of connections to other like-minded professionals with whom to connect and to develop and share ideas. ZTT is also a treasure trove of information, resources, and avenues for political action and advocacy that inspire all those invested in the well-being of infants and toddlers to gather in support of young children and their families.

What I have found most uplifting in working with others in the field of infant and early childhood mental health is the sense of shared commitment, relationship, and connection within our work. When we are all able to see ourselves within that same child that we are serving, we begin to take true ownership and responsibility for the betterment of the lives of every young child. We all have a valuable role to play, and there is a lot of meaningful work ahead of us in this field. So, roll up your sleeves and jump right in! You will find an amazingly talented, compassionate, and dedicated family of like-minded people with whom to share this challenging yet important work!

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