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A Competency Framework for Infant Mental Health Practitioners

In my previous blog I spoke about the mental health of babies and how we can give them the best start in life, with the help of good research. Today I learn about how the professional workforce in Michigan is equipped to work competently with babies and their caregivers.

A Competency Framework for Infant Mental Health Practitioners

It's Tuesday 16th May 2017, and we're off to Southgate, to the headquarters of Michigan Association for Infant Mental Health (Mi-AIMH) and the Alliance for the Advancement of Infant Mental Health. I m hoping to learn how questions around competency are addressed in Michigan.

Sheryl Goldberg, who is the Executive Director of the Michigan Association for Infant Mental Health (Mi-AIMH) and Nichole Paradis, who is the Associate Director of the Alliance, have kindly agreed to meet with me and to explain how the Association and Alliance have managed to create a competency framework that supports best practice in infant mental health.

I'm looking really chuffed in the picture because Nichole has just given me a copy of the competencies used in Michigan and Sheryl has also given some other useful tools to me, which I aim to share with my work colleagues in London.

First, Sheryl was interested to hear about my work in London before addressing my (many) questions about the Association.

Questions, questions, questions...

There are so many questions around competency that we must address if we are to work safely with vulnerable infants and their caregivers. With professionals coming from such a wide range of

disciplines to work with infants, how can we be sure that all infant mental health workers are equally equipped to work independently with vulnerable families? Professionals are faced daily with serious issues that impact infants when they visit homes; such as depression, domestic violence, alcoholism and drug use. There are issues to do with the relationship such as when a baby cannot even look at his or her caregiver. How will the social worker, nurse or psychologist approach these issues?

How do we measure the competency of professionals from the different fields of social work, education, nursing and psychology, with regard to the treatment of infant mental health issues and feel assured that they are equally equipped to work with infants? These are some of the questions that Mi-AIMH has grappled with over many years.

A Measure of Competency

Sheryl explained that Mi-AIMH exists to support the Infant Mental Health (IMH) workforce to work safely and competently with families; and in so doing has developed a partnership with the federal office in order to tap into resources that are available for work with infants aged zero to three years, within the state of Michigan. The federal office have specified eleven competencies to which infant mental health professionals must adhere in order to have access to state funds. However, over a period of ten years, Mi-AIMH has exceeded the specifications of the state and developed a set of endorsement credentials, to ensure that professionals graduate with enough skills to deal with matters of IMH. The Association also provide In-service training and continuing education to support the growth of professionals after graduation and accreditation.

History of the Competencies

These developments took place in the late 1990's, and in 2005, Texas was the first state to purchase the right to use the competencies (only IMH organisations can purchase the right to use the competencies). Now 27 US States plus Western Australia and Ireland (will join in July) have bought into the competencies.

The development of a framework ensures that each competency has the same value in every state, involves the same number of training hours, supervision, requirements for work experience and processes for qualification.

Keeping the Wheels Turning

I wondered how this massive undertaking is maintained and how it is funded. Sheryl explained that income is generated from the bi-annual conference, training events, state grants and the sale of products, such as the Baby Stages Wheel.

I was quite interested in this resource and plan to introduce it to my team when I return to London. The wheel is a colourful tool to help parents to better understand their baby’s early social and emotional development; guide interaction that encourages social and emotional health, and build a nurturing, secure relationship with their child. It also looks like a useful tool for team members so they can be clear about the developmental stages when working with families. This, and other tools can be ordered online at

Alliance for the Advancement of Infant Mental Health

Michigan is unique in that it has the largest IMH workforce in the world, of which the largest number is concentrated in the Detroit area. The Association continues to grow and due to this rapid growth beyond the state of Michigan the Alliance for the Advancement of Infant Mental Health was launched on 1st July 2016... well, that was the official date but in reality, things started in 2005 when Texas came on board.

The Alliance is a global organisation that includes those states and countries whose infant mental health associations have licensed the use of the Competency Guidelines® and Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health® under their associations’ names. ​

The Question of Infant Observation

I wondered how the Association develops observational skills within the IMH workforce. This skill is central to the training of IMH professionals in the UK, where every trainee is required to complete an observation of a mother and baby dyad for up to two years. Some are also required to undertake observations in the neonatal intensive care unit, special nurseries and other organisations working with infants.

Sheryl explained that these skills are integrated into every level of the Mi-AIMH training and checklists are used to inform observation. The state requires that endorsement be maintained through continuing education, so every community mental health practitioner is exposed to regular training in all competencies. As money drives things the agencies who bill Medicaid must conform to the state's requirements: Mi-AIMH helps professionals to meet the requirements of the state.

Thanks Sheryl for giving me a context for the work of Mi-AIMH. I will definitely be keeping up with how things develop in Michigan when I return to the UK.

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