It’s probably high time to talk about the parent infant experts I have been meeting here in NYC. Here are just some of them:
And there are some people I have yet to photograph: Beatrice Beebe, Clinical Professor of Medical Psychology; Tonia Spence, Senior Director-Early Childhood Services; Dr Susan Chinitz, Consultant, Strong Starts Court Initiative. Apologies that not all have photos yet due to camera shyness or my forgetfulness.
In the next few blogs I hope I can share some of their incredible stories and the learning opportunities these people have given. So far there have been fourteen (fourteen!) meetings with inspirational individuals. It seems improbable that this could have happened, given that before this Fellowship I knew no-one and no-body.
With each conversation, pieces of the puzzle have come together. In my first week I found that my head would hurt with the fast pace of the New Yorker dialogue (think machine gun fire compared to the UK tempo which is relatively steady and with actual pauses). There were many acronyms and terms that were beyond me. I had to keep stopping people and asking in my anxious English voice ‘Sorry the what? Pardon?’ Embarrassingly, some of the questions I had to ask were elementary like ‘What is Federal?’.. (it’s the central government of the US). ‘What is a Senator?’ (a bit like an MP) ‘What is CPP?’ (it’s Child Parent Psychotherapy and used by many with parents and babies).
It has been a joy to speak to people in so many places who all have a similar vision and have worked through the very issues that I have faced personally and professionally. It is impossible to capture the depth of the conversations here but I have begun to notice themes and big questions in UK v US differences to practice. This is fascinating and will form the basis of the Winston Churchill Fellowship report back to the UK. Here are some initial findings:
How to approach getting funding? The projects in the US are so different in that many people set up not-for-profits or charities because of the underdevelopment of the public sector. It is not seen as unusual or brave. The paths for ordinary clinicians networking with commissioners are well trodden and less daunting. There are also massive benefactors everywhere it seems. It is possible to raise millions just by being in the right place at the right time!
There is something else, less tangible but one of the reasons that I chose NYC as a place to visit. It is the source of the ‘can do’ attitude that is needed in these situations. There is no fear as people describe setting up their projects, making the right connections and campaigning for a cause they believe in and this is typical New Yorker spirit. Follow your heart and take risks.
ACE as screening? ACE means 'Adverse Childhood Experiences' scale and comes from a highly influential long term study https://www.cdc.gov/violenceprevention/acestudy/. This used a list of 10 items that have long been established as traumatic (e.g. abuse, neglect, having a parent with mental health problems or substance misuse). It's quite easy to ask a parent to tick how many ACES they have had. While ACE’s are common, it is an accumulation of them that is predictive. Nice and simple. The ACE study demonstrated an association of adverse childhood experiences (ACEs) with health and social problems as an adult. 
Importantly, it ALSO suggested that maltreatment and household dysfunction in childhood contribute to health problems decades later. These include chronic diseases (e.g. heart disease, cancer). Most of the projects and researchers I have spoken to assume the use of ACE questions. When I ask about reaching the families we really need to reach, they often say that this is a clear identifier.
Early diagnosis in infants? This has been the biggest surprise and something to think about more. The US diagnostic classification system 
0-3 is all about catching babies early and the established optimum time for an autistic spectrum diagnosis is aged 12 months..12 months! If we compare this to the UK, our National Autistic Society describes aged 2 as 'early'. The average age of diagnosis in the UK is 4 ½.
My initial response to the early diagnosis issue was to recoil in horror. To label babies aged one?! 'What if you are seeing an attachment related issue???' (e.g. not something ‘wrong’ with the baby at all but wrong with his or her environment) I said. However, Gil Foley, an expert in this area who I believe has contributed to the latest as yet unreleased diagnostic manual was very rational in his explanation. He told to me that a diagnosis from every perspective, health cover included, meant that babies and families get the support they so badly need. Recently as I talked to Susan Chinitz, she explained further that it is possible to ‘lose the diagnosis' with the right support. I tried to explain that in the UK we are wary of labels as it can be hard to 'lose' them – but from what I gather this rigidity in thinking is a British thing.
I would like to say thank you to these people who have blessed me with their time and wisdom in the first few weeks of the Fellowship. Also, thank you to the blog commentators so far- it is amazing to get your feedback. So, what do others think of the themes that are emerging? Does this fit with your experience in the US or UK? There are some contentious issues here, do tell me your opinion!
Hey Keza, your blogs are great! Interesting to think about how our cultural perspectives can affect our drive and approach, even if subconsciously. The more diversity we personally experience, perhaps the better our practice and ability to affect change will be. More travel xx
Thank you Luce!
Apologies for the psycho babble but I went to some teaching last night (Columbia University Parent-Infant Psychotherapy) that talked about Winnicott and transitional objects and also the origins of culture/art/play. It was so interesting but took about 5 hours to read the papers and understand them beforehand. In a nutshell, Winnicott says culture originates in the space between the completely subjective (my world) and objective reality. The first experience of 'culture' that a person has is as a baby with the 'transitional object', (e.g. blanket, toy, muslin thing that toddlers have that they like to carry around/sleep with). This allows separation from the attachment figure while holding onto a sense of security. A baby can't do this unless they have a sense of security from a good enough attachment figure in the first place. Now if we can't separate, we can't go forth, explore, travel, widen our sense of culture and experience (without feeling threatened).
So there we have it, Trump never had a 'blankie', 'baa' or 'snuggle' that was his problem. I am glad we have cleared that one up 🙂
Hi Kerry
Your blog post is very interesting with lots of food for thought. I would love to hear more about the actual work of the people you have met - I don't suppose you have been able to see them 'in action', but that would be interesting too.
Their screening methods to reach those who need early intervention sounds positive. Have you also found that they have ways of engaging the hard to reach families that we could learn from?
Just a thought - do you think maybe it is easier to engage them in the US because practitioners are not seen as part of the 'System'? (That could be a benefit of services being delivered by independent funding).
Look forward to hearing your thoughts on this.
Hi Allison,
Thank you for your comments on the blog.
I will reply point by point starting with the last one!
Yes I find that useful that it may be that in the US practitioners are not battling with the same 'them and us' feeling from families who have experienced our system in a negative way. I spoke to some Social Workers about this today (at an inspiring program called Building Blocks) and while they appreciated that it might be slightly easier due to this, they also were nodding and voicing complete recognition when I mentioned the tricky position of our pilot Children's Centre being next door to the Social Care building in Brighton. They agreed that the families where we are most worried about a baby are often very wary of services (statutory or otherwise), fearful and overwhelmed. It seems that whoever you are and whoever funds you, it takes time, years even, to build up trust with a community and get to the point where doors will open. It's all about reputation I think and a recommendation from one family to another is the best possible compliment.
I have recently wondered more about whether we need to go about it differently for some families and consider careful selection and training of local community members to deliver support. This paraprofessional idea is something I have been wary of as it has limited effectiveness. However, I visited a fantastic project in Brooklyn the other week called 'Power of 2'. They use Home Visitors and they are highly successful partly due to the evidence based method they use and the way they select people from the local community to work alongside families.
This brings me very nicely to the engaging families question as it is obvious that a family relate far more quickly to another parent who has grown up in the same community and faced the same challenges than (as they perceive it) some quirky psychologist/psychotherapist type person who has spent half their life in education. There are many little gems I have picked up from asking the practitioners here about being accessible to harder to reach families and that most certainly deserves a blog in its own right....some recent favourites are; photographic portraits of the babies of teen parents which need to be picked up in the next session thus increasing attendance rates and setting up social family events for 9/11 families who could then access valuable social support initially without the stigma of referral for therapy.
Finally I hear your call for the details of the actual work of those I have met and promise to get onto that! It is fascinating talking to those I meet who are often doing very familiar work. As we go along I realise that the stark contrast is that infant mental health and the use of attachment theory is far more established here. It is taken for granted that clinicians work is with babies together with their parents whilst in the UK we are not quite there. US colleagues are in turn surprised when I say this as they say 'But you gave us Bowlby???!!' (he who proposed the original attachment theory). I am not quite sure how to respond to this!