Month: December 2016

It's the final blog for Winston Churchill! Here he is waving me off.

By some strange co-incidence he was right outside the Hilton Riverside, exactly where the Zero to Three conference (https://www.zerotothree.org/events/2-annual-conference-2016-building-powerful-connections#overview) was held which was the grand finale of my Fellowship trip.  My benefactor looks more jaunty in New Orleans as you can see.  It was good to see him and silently say a very big warm THANK YOU to him for all of the learning and opportunity to develop that the WCMT (http://www.wcmt.org.uk/categories/early-years-prevention-intervention) has enabled for myself and for many many other Fellows.

I am briefly in JFK airport, NY on the way back from the New Orleans conference.  On the television monitor, New York is still reeling from the election.  The headline at CNN is 'Trump challenges CIA over Russia hack swaying vote'.  Unlike the east and west coast areas, New Orleans was not mourning the election result.  Louisiana is indeed a red state.  Apart from this, my experience in New Orleans was progressive, uplifting and incredibly inspiring.  Zero to Three is a statewide organisation representing all that is needed for this precious age group.  They are an informed and strong voice for babies.  Thankfully we now do have such representation in the UK e.g. The WAVE Trust http://www.wavetrust.org/and 1001 critical days http://www.1001criticaldays.co.uk/).  However this is just beginning.  Zero to Three has been running for nearly 40 years and so has an established middle-aged presence in government lobbying and co-ordination of knowledge and all professionals in the field.

The conference was accessible in that it didn't take itself so seriously. It was alternately passionate, emotionally moving and playful with a lot of jazz music thrown in around the edges with requirements for participants to have fun and dance along.

Highlights of the conference can be seen on Twitter @ZEROTOTHREE or #ZEROTOTHREE2016, my highlights included under #ZEROTOTHREE2016 @BrightPIP.  For me, this Fellowship came together at the conference.  It was as if the pieces of the puzzle about what I had learned in NYC and why I had come on this Fellowship fell into place. Why? How?  Well there were some moments of clarity. They were:
1. #ThinkBabies
The Zero to Three network launched the #ThinkBabies http://www.thinkbabies.org/campaign at this conference.  This is a catchy soundbite and way of lobbying congress. This, together with a film from No Small Matter http://www.nosmallmatter.com/about-the-film/ illustrated the power of raising national and local awareness.  The campaigns argue so clearly, 'when babies thrive we all benefit'. The scene of parent infant in NYC and across the US where there are many people campaigning and creating maximum impact led me to understand how far practitioners here have come in creating national awareness and how we can do the same in the UK.
2. Prevention of toxic stress
Dr Sarah Watamura gave a capturing Science Plenary about toxic stress and mitigating the impact of this on the developing infant.  This re-emphasised for me the use of ACE as this was predictive of everything they measure in her research department.  Some interesting data was presented on pre-natal stress and the impact of this on the foetal brain (Dr Sherri Alderman).  We also heard that this can be greatly reduced with the right support.  The impact we can have as professionals working with parents and babies to buffer this stress and enable parents to recover enough to protect their babies was emphasised.  This is heart warming indeed in terms of all of the hard work parent-infant practitioners do with families and the long-term impact of this.
3. Leadership
In the last five years, the biggest learning curve (and still being at the very beginning of this curve), has been leading in an area where I passionately feel we need change.  It was not intentional to be the person to co-ordinate and facilitate a very small parent infant psychology organisation - but it turns out if you feel the most strongly about something then you end up being the person who steers the ship.  Paul Schmitz in his inspiring lecture last Friday at Zero to Three placed this into context and gave a containing framework.  He talked about needing a whole system to change a system - not an individual.  The type of leadership we now need for infant mental health is powerful leadership to change the way everyone thinks about and values babies.  This is collective and collaborative and about working together.  He gave some prerequisites for this (see #4 below).  The reason this held personal meaning for me is that I have felt frequently like a failure or lost (as well as occasionally energised and happy!) in setting up BrightPIP.  Most of all it has been a lonely journey not knowing many peers who are in the same position.  There are many people in the field in the US who have struggled with the same dilemmas, questions and feelings.  Meeting these people has been hugely reassuring.  This confirmed the need for collaboration and working together - driven by the cause of the families.

Back in NYC, in a conversation with Tonia Spence about leadership, she said she has conjured a 'virtual board' of advisors around her and I love this idea.  This trip has given a newfound confidence and leadership identity simply by connecting to others with the same story who have followed their beliefs to set up a service.

4. Collective impact
The required qualities for leadership of an organisation to have collective impact were useful and reaffirming. These are a) To be doing with a community (not to or for) and based on building relationships.  b) About collaboration and building TRUST with others within and outside of the organisation.  There may be conflict but this can constructive.  c) With diversity and inclusion as essential in steering the organisation; 'when you change who is at the table you change the table itself'.  d) With continuous learning emphasised and talking about mistakes.  Paul placed a list of 'things I suck at' in front of the staff team and reminded us, that these will be no secret to everyone who works with you (!).  Others will hold strengths we do not. e) Integrity and holding oneself and organisation accountable are critical for collective impact.  This means not putting an individual organisation above a cause.
5. Being open about personal story (and not English 'stiff upper lip')
Setting up a not-for-profit is a given for many practitioners in the US and these people often come at things from a personal perspective.  This is no big deal for Americans..

Paul Schmitz described his history of drug dependency before inspiring others to become leaders.  In NYC, when meeting people in the projects, there were many conversations about who we are and why we do what we do.  It's not a coincidence, we are all working out our own stuff.  The other day Erasma Monticciolo wrote to me 'It’s so important to share, as that is part of our healing'.  We had an exchange where I thanked her for talking so openly about her own level of adverse childhood experiences and about growing up in poverty in Brooklyn and later having PND.  This gave me permission to be honest about my own similar background.  As clinicians we know why we are so driven to do this work yet it is so rarely talked about openly.                                                                                                                                       6. Humility in approach
Finally, an idea I frequently come back to was echoed in the conference.  This was about humility through self-compassion and self-care.   Berry Brazelton's quote about attunement and repair sums this up: 'when you do something that doesn't work, you have an opportunity to learn something and grow closer' .  In the Reflective Approach for Promoting Family Engagement seminar (Armstrong and colleagues), self-care was talked about as a key part of the model for working successfully with families.  Mindfulness is integrated into the approach supporting each Home Visitor and also integral to supervision.  A lovely example was given of a Home Visitor and how she used mindfulness before each meeting with a family.  The Home Visitor said that as part of this she would, on the approach to a family's house, walk mindfully to the door placing each foot carefully and consciously.  Then she would give a particular knock on the door 'knock knock...knock knock' (four altogether; two and then two).  This little sequence corresponded to the words in her head 'I'm here, to listen'.  I like this very much as it's a reminder of the frame of mind to be in to practice this work.

So this is the end of the adventure although the learning will continue forever.  I am so grateful for everyone who made this trip possible.  The Winston Churchill Memorial Trust of course and the supportive colleagues and friends who encouraged this application and held the BrightPIP baby so competently in my absence.  However, there is no way I could have done this without two people in the world; my husband and my mum.  Both of whom had to hold everything together, childcare, household and various other projects whilst I jetted around.  They have not complained about this massive imposition even once.  I will always remember being able to do this, and would like to end by dedicating this blog to both of them.  You are two amazing, kind, tolerant people...THANK YOU!

Illuminations on the way to be accessible and non-stigmatising for families began for me 12 years ago - during my doctoral thesis.  I chose to study the stories of asylum-seeking families.  They are notoriously an elusive group for services to engage due to completely understandable and obvious reasons; fear of statutory authorities, high level of trauma, stigma and often a very different cultural explanation for mental health symptoms.

I spent 6 months (6 months!) trying in vain to recruit participants via schools and organisations. Despite a lot of effort, travel and payments to interpreters I was failing entirely to find even ONE family.  Then, having exhausted my resources and everyone else's resources so that I had no childcare options left, I came across a friend of the family who ran a drop-in group for asylum-seeking and refugee families.  She invited me to come in and help.  I had to take my son (aged 8 months) with me. With baby on hip I made a few cups of tea for families.  We chatted about them and their appreciation of the drop-in family centre.  Then...bingo! I had 8 families to participate in my study!

The lessons learned: be where people enjoy and value going, be human, approachable, make sure people know you are not judging or critical.  I have had numerous situations of engaging families in community work since then and I don't think this 'discovery' has become any more sophisticated - common sense after all.

There is some great practice in engagement that I have encountered on the Fellowship which I hope will enrich BrightPIP in reaching Brighton families.   All in all, I have visited and talked to people about nearly 20 programmes.  They all approached things in unique ways using different combinations of clinical interventions but all with the mission to reach the babies that most need preventative infant mental health.  Here are some of the best ideas:

Universal screening proposed in the Early Intervention city wide project within 'Thrive New York City' helped me learn about the power of their strategic work group (Evelyn Blanck).  This will ensure the policy is that all professionals will be involved in making sure no family goes unseen or unheard.   This includes ACE and ASD screens (see Blog 20/11/16).

Early is best and the research based program of PREPP: Practical Resources for Effective Postpartum Parenting http://pregnancy.bmedcumc.org/ (Dr Catherine Monk) gathers pregnant women in a non-stigmatising way using a screen for likelihood of PND.  The support offered is focused on bonding and caring for baby so that crying is reduced and ability to regulate and settle at night is increased (a tempting offer for all parents-to-be!) and it is called ‘coaching’ rather than therapy.

Avoiding stigma of therapy is a big challenge.  This can permeate those of all social groups and backgrounds.  The power of sharing and talking to others during normal family social events may be just as therapeutic.  This was used by a post 9/11 project specifically for families with babies (Candi Cuchero, NYS-AIMH) as families were rejecting of the stigma of therapy.  It was fascinating to learn from Bonnie Cohen (Early Childhood Division, University Settlement) about a similar approach which she coined 'stealth mental health'.  In their Early Intervention model, there is a whole range of possible services that a family can access (e.g. baby groups, play sessions, parent groups, parenting skills).  Child Parent Psychotherapy work is only offered as an additional if needed and then when the family are engaged in other support.

In stealth mental health there is what the Americans term a 'warm hand-off', an expression I have heard a lot in New York.  This means that the family are introduced to the therapist by an already trusted worker.   Meeting Tonia Spence at the Jewish Board, Harlem Child Development Centre, we discussed the success of instigating a service that is essentially 'familiar' in every way to the families.  This would mean training the key referrers already working with the families to do this warm hand-off as well as considering the importance of ensuring workers are from the same ethnic and social group as the families we are trying to reach.

Community presence can mean stepping outside what we expect to deliver and starting by designing the service requested by the parents.  This means building trust with a community (and might include less clinical work to begin with).  An agency needs to simply provide the very information that families need at any given time e.g. showing them a nearby food pantry or providing information if they become homeless.  From the 'Power of Two' programme (Erasma Monticciolo) I have learned that a person who makes those contacts locally and gets to know key leaders in the community can then build the trust and respect of that community from grass roots up (always the best way!).  The ideas from this programme link to the discussion with Tonia as they use specially selected and trained Home Visitors to deliver intervention, often with more of a history in common with the families.

When building trust with fearful or ambivalent families who are in the system and are having to participate due to mandatory court ordered treatment, it is essentially a make or break time to engage.  I spoke with Dr Susan Chinitz 'Strong Start Court Initiative' ( http://www.courtinnovation.org/project/strong-starts-court-initiative) and Hazel Gacman about the 'Babies First' programme. This works alongside the court process but making it very clear that the therapeutic work is with the family rather than against them.  This, like the 'Babies Can't Wait' programme (Dr Marcy Safyer) helped me understand further about combining early work with parents and babies and Child Protection Plans while not alienating the families due to the helping stance that we take.  It is such a fine line for clinicians to tread - but such programmes show that it can be done.

The right location is essential and from the GABI programme: Group Attachment Based Intervention  http://www.attachmentresearch.com/gabi (Dr Anne Murphy) I learned that a key way to hold families when they most need it is to provide groups regularly (they provide 6 per week!) in their community.  The groups are nurturing and containing and use key reflective clinical skills.   Also, hospital based programmes, such as the teen-parents group at Bellevue (Susan Linker), the Family PEACE Trauma Treatment Centre at New York Presbyterian (Dr Erica Wilheim) and national Healthy Steps (http://healthysteps.org/) where clinicians link with paediatric services confirm that the best way to meet these families is to be where they are at.  In the US this happens to be their regular checking appointment with their paediatrician (they don't have Midwife led-care or universal Health Visiting here so the hospital is where it's at).  These, like all good programmes, demonstrate very good relationship building with other professionals in the hospital.

Personally, it is reassuring to see the same dilemmas and to see ways of approaching and successfully overcoming barriers - even in another system and culture.  The value of seeing first-hand the success of innovative thinking and diverse projects gives confidence in the work in the UK and is energising and inspiring.  But what stands out?  What can we take back to the UK for those families?  I think all of this and more.

There is, as with all such dilemmas, a tidy way to think about engagement.  I am at the excellent Zero to Three national conference (http://annualconference.zerotothree.org/right now and this morning in a talk about leadership in this field, Paul Schmitz outlined collective impact and 'doing with the community (not to or for)'.  This approach requires integrity, humility and commitment to the cause of infant mental health.  In the same way, engagement with a community of families needs us to be alongside respectfully.  This takes some attunement, just as when trying to form a secure attachment.  My understanding is that often this comes back to ourselves.  We can be good (enough) attuned parents if we can attune to ourselves, think clearly and attune to our children.  We can be good engaging practitioners if we hold the same genuine qualities.   This goes back to my first steep learning 12 years ago.  If we can be real, then families will know this and work with us.

Did you find the ideas here surprising? Obvious? Different?  Please go to the comments button below and let me know!

This is a commercial break kind of blog where I promise not to talk about psychology.  The place called home this month is a little room in a shared apartment in East Harlem, also known as 'Spanish Harlem'.  This was chosen as it's not way too expensive but apparently it's not 'the ghetto'.

This is a vibrant place and to begin with it was a fair old culture shock compared to white, middle class Brighton.

Strangely, I don't notice anymore.  It's amazing how quickly it just becomes life as we know it.  But for your entertainment, here are the first nine things I noticed in my culture shock...

1.  Music is everywhere.  People hanging on the street, on stalls, on the subway (img_subway).
In the park....

Also, people are carrying their music with them and playing it nice and loud - whether walking, selling corn cobs or sweeping rubbish. It's good music, especially in Harlem; a bit of reggae, a bit of samba, a blast of Stevie Wonder.  In Brighty it is only the very eccentric gentlemen of Hove who rides his mobility scooter (laden with crazy stuffed toy decorations) who does this.  He is the only one.

2. White people do not live in East Harlem.  I am an alien.  There are only Hispanic and Black people.  Getting on the subway at 116th to go downtown, it is marked that the White people only get on at 96th.  Everyone looks green on the subway - but you know what I mean.

3.  People stand around.  People just stand and hang out. They just stand on a corner and look about enjoying the scene. Often with (see #1) their music for company.  We would be far too self-conscious to do this.  It's also November and it's cold.

4. Poverty is everywhere.  So much so in East Harlem.. but also in pockets elsewhere.  It is especially shocking so near to the wealthiest places in the world 20 blocks away. There are 3 soup kitchens near me, many pawnbrokers, people sleeping rough and oh, a methadone clinic around the corner.

5. Indomitable spirit.  There is an approach 'if we fall we will rise again stronger'.  This seems an unspoken philosophy.  Some New Yorkers have looked crestfallen at the timing of my visit, shaking their heads apologetically and saying 'We are normally so positive and smiling in this city but we are all so fearful now'.  Yet there is no sense of giving up.  NYC will always celebrate diversity and the belief in equality and justice.  Thousands of post-it notes in Union Square subway are testimony.

6. Mid-town is a different culture entirely.  Ladies dressed head to toe in Chanel...oh is that Madonna's apartment? Or Lady Gaga? And being trampled by professional dog walkers wielding 8 pampered poodles at a time.

7. You can do ANY exercise you imagine.  Being different and unique is acceptable.  A candle lit spin class whilst listening to spiritual affirmations? Yes, it's a franchise.  You want to go to a class cycling underwater (4ft of salt water) no problem.  Pregnant?  That's okay, there are special underwater cycling classes for pregnant ladies with some calming prenatal yoga thrown in.

8. Sweaters in the oven.  People generally have apartments that are 3m by 2m, that's normal.  Maybe even a luxury.  In their apartments people don't cook.  There is no room for cooking and no room for sitting.  I heard of a girl who used her oven to store clothing, this is entirely normal.

9. Sunglasses on the subway even on a cloudy November day? Yes!