UCSF Infant-Parent Program

San Francisco
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The Infant-Parent Program is an infant and early childhood mental health program focusing on the relationships between young children and their caregivers.

Infant-Parent PsychotherapyThe initial focus and a central direction of the Infant-Parent Program involves clinical work with children birth through three years of age and their parents. The program provides intensive clinical assessments of infants, toddlers, and parents, and psychotherapy aimed at ameliorating difficulties in the parent-child relationship and the child’s functioning. These difficulties may clearly originate in the parent, as in the case of a chronically mentally ill woman who finds herself responsible for the care of an infant. They may originate in the child, as in the case of an autistic spectrum child. Or –as is most commonly the case – difficulty may arise as a result of troubles between the two of them, such as with an infant who has special vulnerabilities as a consequence of substance exposure in utero and a parent who has limited capacities and tolerance stemming from struggles with chemical dependency.

The disturbances in infants and toddlers include failure-to-thrive, reactive attachment disorder, post-traumatic stress disorder, and pervasive developmental disorder; while the parents’ diagnoses include schizophrenia, bipolar disorder, major depression, multiple personality disorder, post-traumatic stress disorder, and a variety of personality disorders. These clients typically have very great difficulty functioning as parents, particularly in understanding their children’s feelings and needs and in responding appropriately to these. Family chaos and disruption are frequent, and 1/3 of the current caseload has experienced the removal of children for abuse or neglect. Referrals come from pediatric providers, public heath nurses, social workers in obstetric and pediatric settings, workers in special education and childcare programs, social workers in the Department of Human Services, residential treatment programs, and mental health workers from several disciplines. The work is supported financially by San Francisco Community Behavioral Health Services, San Francisco Department of Human Services, foundation grants and private donations.

Each year the program serves more than 100 families of many cultures and ethnicities, responding especially to those families seen to be the most vulnerable to health and mental health difficulties, child abuse and neglect and family dissolution. Treatment is provided in the home to gain a better understanding of the child’s daily circumstances and to be available to those most in need. Several specific psychotherapeutic approaches have been developed for this work– used in flexible combination depending upon the particular child-parent difficulties. Underlying all our efforts, however, is an understanding that the relationship created between therapist and parent isa powerful force in helping the parent experience and enact new possibilities in interaction. The therapist’s unswervingly conveyed awareness, understanding of, and responsiveness to the parent’s feelings can over time promote crucial changes. Additional particular approaches figure in infant-parent therapy, as well. The therapist explores ways in which hurtful experiences in the parent’s past have colored what she expects of her child and how she understands him. The therapist’s task is to help free the child from these distorted perceptions so that the child’s own feelings and needs can be seen by the parent more clearly and responded to more successfully. Often, additional information about children’s typical development is needed for parents to more fully understand their child. The infant-parent therapist can offer help about what to expect of small children and can discuss appropriate ways torespond which feel comfortable to the parents. The work is always shaped by each family’s need, and it continues for as long as parent and therapist feel it to be useful. Originating at the Infant-Parent Program, relationship –focused, dyadic treatment is now recognized as the evidence-based best practice for mental health intervention with troubled infants and toddlers. Expanded to include preschoolers who have experienced trauma due to domestic violence the treatment modality is now referred to as child-parent psychotherapy.

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