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.

Prospective analysis of the transition to sexual experience and changes in sexual self-esteem among adolescents attending therapeutic schools.

Given increased sexual risk-taking among youth with mental health problems, this study sought to understand the developmental trajectory of sexual self-esteem (SSE) among this vulnerable population and how it is impacted by sexual experiences. Participants were 185 adolescents who attended therapeutic/alternative schools in southern New England. Changes in five domains of SSE identified by Zeanah and Schwarz (1996) were examined across adolescents who either: 1) were sexually active at baseline, 2) transitioned to activity during the study, and 3) remained inexperienced at follow-up.

Infant mental health and the "real world" -- opportunities for interface and impact.

A growing literature highlights established and developing approaches to infant mental health assessment and treatment. Like other evidence-based and theory-based interventions, real world application of these approaches requires an understanding of the theoretical and empirical foundations of infant mental health as well as consideration of cultural, systemic, and logistical factors. In this article, the authors present models of universal and targeted interventions in infant mental health, with attention to the adaptations used to apply evidence-based practice in real world settings.

The process and promise of mental health augmentation of nurse home-visiting programs: Data from the Louisiana Nurse-Family Partnership.

The Nurse-Family Partnership (NFP) model is a well-studied and effective preventive intervention program targeting first-time, impoverished mothers and their families. Data documenting the negative impact of maternal depression and partner violence on the developing young child can be used to make a strong case for augmenting NFP programs to focus on mental health problems impacting the mother-child relationship. This article reviews the rationale for and process of augmenting an NFP program in Louisiana.

Nurse home visiting: Perspectives from nurses.

Nurses working in the Nurse Family Partnership (NFP) program provide intensive home-visitation services for first-time, low-income mothers. The goals are to improve maternal health outcomes, child health and development outcomes, and to enhance maternal life-course development; however, many of the families face significant psychosocial and mental health issues that can impede progress achieving their goals. Because of the importance of the nurse-client relationship in achieving positive outcomes, these non-mental-health nurses must shift their approaches and techniques from a medical to a psychosocial model.