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New Mexico Infant Team MANUAL

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New Mexico Infant Team MANUAL State of New Mexico Children, Youth and Families Department New Mexico Infant Team MANUAL Developed by: Jane Clarke, PhD, IMH-E®IV and Deborah Harris, LISW, IMH-E®IV Dedicated to Julie Larrieu, Neil Boris, Soledad Martinez, and Charlie Zeanah Wise Mentors and Gentle Guides 2 Contents Preface 7 Chapter 1 - Overview of New Mexico Infant Teams 8 CYFD – Behavioral Health, Pull Together and Pyramid Partnership 8 Initiatives and Pyramid Offerings 9 New Mexico Infant Mental Health Teams 12 What a New Mexico Infant Team (NM-IT) Does 13 New Mexico Infant Team Logic Model 14 Chapter 2 - Justification for New Mexico Infant Teams 15 Introduction 15 Justification 16 Safety and Memory 16 Reflective Functioning 17 Timing of Supports 17 Principles of IMH Practice 17-19 Treatment Services 19 Referrals 19 Key Points to Know 19-21 References 22-23 Chapter 3 - Goals, Procedures and Building an Infant Team 24 Goal 24 Outcomes 24 Four Main Considerations 25 Core Service Components 25 Procedure 25-29 Results of NM-ITs and Collaborative Work 29-30 References 30 New Mexico Infant Team Assessment/Intervention Protocol 31-33 Chapter 4 - Principles, Getting Started, Possible Roles and Questions about Roles on Infant Team 34 Principles of Service Delivery 34-35 Getting Started 35-38 Example of Infant Team Role Descriptions 38-39 Questions about Infant Team Roles 39-45 3 Chapter 5 - Parent Infant Psychotherapy Services 46 Child Parent Psychotherapy as a Treatment Approach 46 The Tulane Infant Team Model 47 Special Features of NM-IT Services 48 NM-IT Services 49 Visitations and NM-IT Services for Infants/Young Children 50 NM-IT Interventions 51 Reflective Supervision/Reflective Consultation 52 References 53 Chapter 6 -Developmental Assessment and Intervention Considerations 54 Principles of Assessment 54 Factors that may Compromise Development 55 Importance of Shared Engagement and Attention 55 Dynamic Approach 56 DIR-Functional Emotional Developmental Levels (FEDL) 56-57 Developmental Capacities and Domains 57 Competency Domain Rating Summary Table (DC:0-5) 58 Infant’s/Young Child’s Contributions to the Relationship (DC:0-5) 59 References 60 Chapter 7 - Examples of Referral Process and Forms 61 New Mexico Infant Teams: Example of Referral Process and Services 61 Example of New Mexico Infant Team Referral Protocol 62 Example of CAPTA Referral Form 63 Example of New Mexico Infant Team Referral 64 Chapter 8 - Examples of Memorandums of Understanding with CYFD and the FIT Part-C Program 65 Memorandum of Agreement with Child Protective Services (CPS) 65-67 Memorandum of Agreement with Family Infant Toddler (FIT) Part-C Program 68-70 Chapter 9 - Examples of Treatment Goals and Tulane’s Assessment of Progress 71 New Mexico Infant Team Treatment Goals and Objectives 71-73 4 Chapter 10 - Case Formulation, Documentation and Written Reports 74 Case Formulation 74 Documentation 74-75 Written Reports 75-76 Chapter 11 - Expert Testimony Guidelines and Monthly Provider Update Form 77 Expert Testimony in Juvenile Court 77 General Rules and Tips on Testifying 79 Cross Examination: General Rules and Tips 79 Trial Skills: General Guidelines for all Witnesses 80 Examples of Hearsay Rule Exceptions in Testimony 81 New Mexico Infant Team Monthly Provider Update Form 82 Chapter 12 – Infant Mental Health, Child Protective Services, Legal and FIT 83 Early Intervention Glossary of Terms Glossary of Terms A-Z 83-99 References 99-100 Appendices Appendix One – Forms, Assessment Tools and Instruments 101 Flow of Tools and Instruments 101 Data Input Flow Chart 102 Assessments - Periodicity 103 Appendix Two – Decision Trees 104 Example of Tiered Approach for Intensity of Services 104 New Mexico Infant Teams: Level of Engagement 105 New Mexico Infant Teams: Track Recidivism and Permanency 106 New Mexico Infant Teams: CAPTA Referral Process 106 New Mexico Infant Teams: Working with Substance Abusing Parents 107 New Mexico Infant Teams: Working with Bio-Parents with a History of Domestic Violence 108 Circle of Security—Questions for Parents 109 5 Appendix Three – References and Articles on IMH 110 References on Infant Mental Health 110-114 Being In Relationship: Opportunities for Change in Foster Care 115-120 A Guide to Practical Interventions to Help Children Affected by Trauma 121-152 The Foundations of Lifelong Health are Built in Early Childhood 153-182 The Role of Healthy Relational Interactions in Buffering the Impact of Childhood Trauma 183-200 Trauma-Informed Part-C Early Intervention 201-211 NCTSN Testifying in Court about Trauma: The Court Hearing 212-218 6 Preface The vision and intention of the original New Mexico Infant Team (NM-IT), called the First Judicial District Infant Team established in 2009, was to design a community collaboration for infants and toddlers in state custody that integrated infant mental health principles and mental health treatment, with developmental assessments and interventions. This unified approach would be the cornerstone for partnering with Child Protective Services (CPS), Family Infant Toddler (FIT) Part C Program, attorneys, the Judge, CASAs, GALs, Substance Abuse treatment providers, Domestic Violence treatment providers, medical and other essential services that support the best interest of the infant/toddler and family through the judicial process. To implement this vision, we set about articulating the goals and the “deliverables” from the NM IT in clearly stated memorandums of understanding (MOUs) with primary stakeholders (CPS, FIT Part C providers). Through meetings and dialogues with primary stakeholders, these MOUs delineated the: 1) primary focus of our work, 2) the research supporting our work, 3) the intention of our interventions and recommendations, and 4) our commitment to provide our services as stated. As a result, CPS and the FIT Part-C Program delineated specific workers as members of the team to expedite referrals and the provision of services to infants/toddlers in state custody and their families. As subsequent NM ITs were formed in other judicial districts around the state, the partnerships and MOUs between the local CPS department and the FIT Part C Program as well as the collaboration with the legal community and other key partners, has varied depending upon the community resources and operations of the local judicial system. However, each NM IT strives to maintain open communication and collaboration with all involved in the welfare of an infant/ toddler in state custody and his/her family. A major role of the NM ITs has been to provide ongoing psychoeducation in addition to court reports to help all in the judicial process understand and recognize the relational and social- emotional needs of infants/toddlers throughout the reunification and permanency process. Most importantly, NM ITs want the Judge, and others involved in decision-making to consider: 1. Why the period of birth to three is so important for brain development and relationship security, 2. The impact of trauma and stress on the developing brain, 3. The individual needs of an infant/toddler who has experienced abuse or neglect, and 4. The protective capacities of the caregiver. As New Mexico Infant Teams (NM ITs) have been formed in judicial districts statewide, there has been a corresponding and essential growth connecting providers serving infants and young children funded through the CYFD Behavioral Health Division. This manual will describe these connections along with the training and skills required of members of the NM ITs. Through the efforts of NM ITs statewide along with community collaborators, we are confident that the special needs of infants/toddlers and families in the child welfare system, are being addressed to receive the best support possible. —Deb and Jane 7 CHAPTER 1 Overview of New Mexico Infant Teams A FRAMEWORK FOR SUPPORTING THE SOCIAL EMOTIONAL COMPETENCE OF INFANTS, YOUNG CHILDREN, AND FAMILIES CYFD - BEHAVIORAL HEALTH, PULLTOGETHER AND PYRAMID PARTNERSHIP The NM Children, Youth and Families Department (CYFD) Behavioral Health Services - Infant and Early Childhood Mental Health (BHS-IEMH) along with the Pyramid Partnership anticipates an integrated and aligned system of early childhood and infant mental health programs, practitioners and families versed in the Pyramid Framework. CYFD Cabinet Secretary Monique Jacobson’s PullTogether campaign envisions engaged communities helping families with infants and young children to access resources along the Pyramid to meet their needs. Together the BHS-IECMH along with the Pyramid framework and PullTogether effort, will build and integrate a system utilizing existing models to promote the social-emotional competence of children birth to age five in the context of nurturing relationships and quality learning environments. The development of a competent community of behavioral health practitioners includes the CYFD funded New Mexico Infant Mental Health Teams (NM-ITs), which provide infants and young children in state custody a coordinated process for assessment and treatment in order to promote permanency planning, reduce recurrence, and support positive developmental outcomes. The NM-IMHTs utilize a BHS-IECMH assessment and treatment protocol that supports the infant/young child in the context of all of their important caregiving relationships in order to enhance optimal and comprehensive developmental progress in all domains. As part of an integrated statewide system of early childhood and infant mental health programs, the intention of the NM-IT services is to address the top
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