AICAFMHA:
promoting mental health for young Australians
Australian Infant, Child, Adolescent and Family Mental Health Association Ltd
ABN 87 093 479 022
Education for Infant Mental Health Professionals: The Sydney
perspective
Beulah Warren, MAPS, NSW Institute of Psychiatry, Parramatta, NSW
Summary
Introduction
Content of the course
Modes of delivery
Recognition by HEB
Responses by students
Conclusion
The NSW Institute of Psychiatry in association with the NSW branch of the Australian Association of Infant Mental Health Inc (AAIMHI) developed and implemented a Graduate Diploma in Infant Mental Health. From its inception, the course was to be multidisciplinery in both the lecturers and supervisors and in eligibility of applicants. There have been three student intakes and the Course is now offered as a mixed mode to distance education students at a variety of sites as well as face to face with on campus students.
In 2000 the Course was approved by the Higher Education Board as a tertiary course with the nomenclature of the award to be confirmed on successful completion of the course of Graduate Diploma in Infant Mental Health (Grad.Dip.IMH.)
Details of when the course began and subsequent intakes, the number and professional disciplines of those who participated are given. The content of the course is discussed with reference to the students’ responses to different components.
The process of how the current status of a Higher Education Board approved tertiary
graduate diploma course with both distance education and on campus students was achieved
is also discussed together with possible future directions in delivering the Course.
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In 1997, the Sydney based Australian Association of Infant Mental Health Inc(AAIMHI) and the NSW Institute of Psychiatry formed a working party of practitioners and academics in the field of ‘infant mental health’ to investigate and implement a course to address the educational needs of professionals working with parents (or caregivers) and infants in a variety of settings. Members of the working party were aware that there
were professionals who worked with parents and infants who had a thorough knowledge of adult pathology and little knowledge of infant development and the infant’s contribution to the parent-infant relationship. On the other hand, there were others who worked with the same population who were knowledgeable and experienced in infant characteristics, needs and development, but who lacked expertise in recognizing and working with adult pathology.
After several months of discussion and consultation, the working party proposed a two-year course of both theoretical and practical content with successful participants receiving a Graduate Diploma in Infant Mental Health. Those invited to teach on the Course were experts in their fields - adult and child psychiatrists, paediatricians, obstetrician, psychologists, social workers, psychotherapists, occupational therapist, early childhood educators, and community workers.
In the first brochure published in April, 1998 the aims were expressed as " This course aims to provide a theoretical and practical basis for clinical work with infants, caregivers and their families in a variety of settings. This is a multidisciplinary programme which takes the infant and his/her development as a central focus and emphasis the complex process of infant and family development through pregnancy and the first three years of life."
Brochures were circulated in the first few months of 1998 and considerable interest was registered. Fourteen students enrolled to be the first intake July, 1998. The participants were child and adult psychiatrists, psychologists, social workers and nurses in a variety of settings. Eleven professionals completed the course June, 2000.
There have been two more intakes of students with equally diverse backgrounds.
Currently there are 38 students participating in the course in New South Wales, Australian
Capital Territory, South Australia and New Zealand. In addition there have been inquiries
from Christchurch in New Zealand and Hong Kong. This has meant a considerable ground swell
to the growing field of Infant Mental Health.
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The content of the Course
Each academic year consists of a theoretical and practical component. In Year 1, the theoretical component, Core Infancy Studies covers pregnancy and the development of the infant from the biological, neurophysiological, and psychosocial perspectives. The influences of family and culture are considered, in particular how they influence the infant’s early attachment and psychological development. Theoretical models for working with parents and infants are introduced.
The practical component of Year 1 is the student observing an infant in the context of the family at home over the first year of life. The students observe for an hour, write up their observations and share these with 3-4 peers with a supervisor. The student is there to learn and so does not offer advice, or counsel the mother or other family members. The observation experience not only assists students to appreciate how families differ in their approaches to nurturing their baby and how those differences may influence child development but it also gives them cause to examine their identification with both the baby and the parents in their struggle to get to know each over the first year. The experience of having an observer come into the family, weekly for a year, is very often a holding experience for the family, akin to the holding experience of a family with an infant in the clinical situation. It initially surprised us, but no longer does, that probably the majority of families who agree to participate do not have a parent that is easily accessible for distance or other reasons.
During Year 2 of the Course, Clinical Infancy Studies consider how families come within the sphere of Infant Mental Health workers through, for example, the following topics:
- Parental psychopathology and disorders of parenting
- Disorders of attachment and regulation
- Loss and trauma in infancy
- Problems of development
- Prematurity and early childhood illness and development.
The students are also introduced to and examine
- Clinical interventions
- Infant mental health services, and
- Advocacy and public health issues.
There is also a unit Research Methodology to prepare students for the major assignment of the second year, a research proposal.
The practical component is clinical supervision of cases the students bring from their
work place. Because students work in a variety of settings the supervision has a
developmental framework but is eclectic as to possible mode and theoretical orientation of
intervention.
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Modes of delivery
In its first year the Course was offered on Campus in Sydney. Only months into the course, further inquiries convinced the Advisory Committee that the Course should be available to professionals who could not get to on campus classes. It was decided to offer the Course again in January 2000 (eighteen months after the first intake) to enable the material presented to be prepared for distance education students. This involved asking twenty contributors to rewrite their presentations. That was no easy task but by January 2000 Study Guides were prepared which gave the students coverage of the material presented together with copies of the core reading, study tasks to assist their learning and a list of supplementary references if they wanted to go further with the topic. We planned to bring Distance Education students onto Campus for a weekly block of Seminars in each Semester.
How the supervision for the Infant Observations was to take place was unknown until we knew where the students were living. However the Institute has considerable experience in supervising distance education students.
It was something of a surprise that of the twenty two applicants that year, 6 were from Adelaide, two from Wellington New Zealand, 2 from rural NSW and two from ACT, and ten from the greater Sydney area. Of those latter10, 2 wanted to do the course as DE students while 8 preferred the option of face to face on Campus. We discovered we had to be very flexible in the packages offered. For example, of this intake,
- The six in Adelaide have a tutor who conducts tutorials with the Study Guide material. They have local clinicians who supervise their infant observations and clinical cases.
- The two in Wellington, NZ work through the Study Guide, attend the Seminar Blocks each Semester and have a local clinician to supervise their infant observations and clinical cases.
- The two in rural NSW and ACT work through their Study Guides, have telephone supervision of their infant observations as a group, and attend the Seminar Blocks where additional infant observation supervision is given. In 2001 this group has been divided as there is a local clinician who can supervise their clinical cases.
- Two in Sydney, work through their Study Guides, attend the Seminar blocks but have face-to-face supervision of Infant Observations and clinical cases.
- The remainder have face-to-face seminars and supervision on campus on a weekly basis.
Recognition by the Higher Education Board
The Institute of Psychiatry was seeking accreditation as a tertiary institution and recommended Advisory Committees to prepare their courses for recognition. Initially we considered applying for a Masters in IMH but were advised to submit for a Graduate Diploma. In our application we indicated our intention, once the course is extended, to apply for recognition of a Masters in IMH. The major component of the Year 3 year will be implementing the research proposal of Year 2. In addition, there will be another module of Research Methodology and Student directed Seminars on a variety of topics.
Recognition by the Higher Education Board will enable the students to gain credit when
applying for programmes at other institutions.
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Responses by students to the Course
The student evaluations at the completion of the Course indicated that their learning objectives were ‘mostly’ or ‘completely’ met, that the Course was highly relevant to their workplaces and that overall they evaluated the course as ‘excellent’.
Overall comments included
" The past two years has been a most memorable and stimulating time. The growth and continuum of the course is an exciting prospect and to have been part of the inaugural group of students, has been an honour. To use an analogy: the importance of a course of this nature is comparable to the grandeur and beauty of a solitary ‘iceberg’ floating in a sea of inexplicable progress, the irony of which being that the majesty that lies beneath the surface is in total obscurity of what we see above."
Most of the students spoke of the previous two years ‘being a wonderful learning experience’. Perhaps not quite the dramatic or romantic language of the above.
Students often spoke of the value of having classmates of different disciplines, how
they learnt a new appreciation of the contribution of different disciplines to early
intervention.
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As an observer of the group over two years it was noticeable how the group came together toward the end of the first year and became a cohesive, supportive group. One of the most successful evenings was when the students participated in a ‘group session’ and learnt by personal experience the value of such participation.
The Graduate Diploma Course in Infant Mental Health conducted by the NSW Institute of Psychiatry is an accredited course meeting the learning objectives of professionals in a range of disciplines working with parents and infants in a variety of settings. The course is contributing to an increasing ground swell of specialist ‘Infant Mental Health’ professionals.
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