Current approaches and future directions for addressing ethics in infant and early childhood mental health.

In this paper, we consider whether the field of infant and early childhood mental health (IECMH) needs its own code of ethics. We begin by describing unique features of infant and early childhood mental health (IECMH) and the diverse strategies that the field has developed to address complex clinical dilemmas, among them workforce development, clinical supports, policy statements, and statements of ethical values. Because of the field's interdisciplinary nature, we also consider how various contributing professions and organizations address ethical issues.

Ethical dilemmas in infant mental health: Examples from child protection, home visiting, and medical contexts.

Infant mental health is explicitly relational and strengths based as a field. Ethical dilemmas in infant mental health have received insufficient attention at the level of infant mental health professionals (IMHP) and other professionals caring for infants who must grapple with questions of when caregivers and infants have conflicting interests. We present composite cases drawn from North American and Australian contexts, using three systems in which such conflicts may commonly manifest: child protection, home visiting, and medical settings.

The ethics of infant and early childhood mental health practice.

Ethics is concerned with the basis for moral judgments of "right" and "wrong" and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use of ethical principles and frameworks can help navigate clinical decision-making when there is a sense of moral conflict or ambiguity about the "right" course of action.

Coordination challenges and promising practices for pediatric healthcare-community partnerships: A multi-site study.

There have been delays integrating universal screening and referral for social needs in pediatric practice. The study investigated two frameworks for clinic-based screen-and-refer practice in eight clinics. The frameworks depict different organizational strategies to bolster family access to community resources.

Examining program quality in early childhood home visiting: From infrastructure to relationships.

Although there are many examples of evidence-based early childhood home-visiting programming, the field itself struggles with modest outcomes and variable levels of program effectiveness. This article documents the experience of creating a statewide monitoring system to assess home-visiting program quality and compliance to identified standards, integrating multiple sources of information across different domains of functioning. Monitoring results from 57 programs are summarized, with variable but promising levels of quality.

Father participation in a community-doula home-visiting intervention with young, African American mothers.

This article examines the extent and nature of father participation in a perinatal, community-based doula home-visiting intervention that served young, African American mothers from low-income backgrounds and their infants. Home-visitor service records were used to assess the quantity, setting, and content of father-attended visits. Correlates of fathers' participation and thematic insights from mothers' and home-visitors' perspectives on how fathers perceived and interacted with the home-visiting program were analyzed to further characterize the nature of father participation.

Creating a national home visiting research network.

Home visiting can play a key role in the early childhood system of services. For home visiting to achieve its potential, decision-makers must make informed choices regarding adoption, adaptation, coordination, scale-up, and sustainment. We need a coordinated, focused, and theory-based home visiting research infrastructure to inform such decisions.

Breastfeeding and complementary food: randomized trial of community doula home visiting.

Objectives: Despite recent efforts to increase breastfeeding, young African American mothers continue to breastfeed at low rates, and commonly introduce complementary foods earlier than recommended. This study examines the effects of a community doula home visiting intervention on infant feeding practices among young mothers.

Methods: Low-income, African American mothers (n = 248) under age 22 years participated in a randomized trial of a community doula intervention.

The good, the bad, and the ambivalent: Quality of alliance in a support program for young mothers.

The relationship that develops between early childhood service providers and parents is seen as a critical component in program implementation, although little is known about how service providers and parents view this relationship. The current qualitative study examines the helping relationship between doulas and 12 African American adolescent mothers who participated in a larger study of prenatal and postnatal support. Mothers and their doulas were interviewed separately at the beginning and the end of program participation about the quality of the helping relationship and how they spent their time together.

The helping relationship and program participation in early childhood home visiting.

As researchers have focused on better understanding those circumstances under which home visiting can lead to positive effects on parent and child outcomes, there has been growing interest in examining variation in the experiences of families within these programs, including the quality of the helping relationships between home visitors and parents. The current study examined how participating mothers perceive the helping relationship, using information collected from the Early Head Start National Research and Evaluation Project. Results suggest that although maternal report of the helping relationship is biased towards positive ratings, it remains a significant predictor of program participation, over and above general program satisfaction.

At what age can children report dependably on their asthma health status?

Objective: This study examined psychometric properties and feasibility issues surrounding child-reported asthma health status data.

Methods: In separate interviews, parents and children completed 3 visits. Child questionnaires were interviewer administered.

Home visiting by paraprofessionals and by nurses: a randomized, controlled trial.

Objective: To examine the effectiveness of home visiting by paraprofessionals and by nurses as separate means of improving maternal and child health when both types of visitors are trained in a program model that has demonstrated effectiveness when delivered by nurses.

Methods: A randomized, controlled trial was conducted in public- and private-care settings in Denver, Colorado. One thousand one hundred seventy-eight consecutive pregnant women with no previous live births who were eligible for Medicaid or who had no private health insurance were invited to participate.