Childhood Mental Health: Working With the Youngest Patients

“The more I can learn about a family’s story and what got them to this point, the better support I can provide,” says Tyesha Durr, MS, LPC, a 2021 graduate of the Troy University Infant and Early Childhood Mental Health Counseling Certificate program.

Durr, owner of Broken Crayons Counseling & Consulting, LLC, became interested in infant and early childhood mental health counseling after hearing about the impact of childhood trauma. “Learning about the Adverse Childhood Experiences (ACEs) study and how early experiences impact littles was the beginning of my career in infant and early childhood mental health,” says Durr. “This caused me to be curious about the impact of trauma, emotional and social development, and culture.”

Emotional and Mental Health Challenges: Birth to 5

The idea that infants can face mental health challenges is surprising to many. “Caretakers of the birth to five population understand children develop quickly but helping them see mental health as a part of development is difficult,” says Dr. Samantha Booker, Assistant Professor in the Department of Counseling, Rehabilitation and Interpreter Training at TROY.

“One of the biggest challenges in the field is being able to educate caretakers, parents, siblings, aunts, uncles, doctors and others that mental health issues exist for this population and that resources can be beneficial,” she adds. “One of the biggest questions I get is what that means for parents — if something is going on with a young child or infant, many parents feel it must be something they’ve done wrong as a parent.”

And that’s not necessarily the case. “It’s important that we look at why a child is being brought to us,” says Dr. Booker. “Maybe it’s a sleep disorder or an infant isn’t eating well. Maybe they’re not bonding with their caretaker. Infant mental health clinicians look at basic emotional needs and functioning up to traumatic events. Anything that had happened from birth to age 5 when these infants and children were in different developmental stages.”

Between 0 to 2 is when a child’s brain forms the most. “If something’s happened to slow down the psychological development, we want to be able to intervene promptly to prevent more severe mental health problems later on,” Dr. Booker adds. “So, whether it’s helping them bond, build relationships, work through trauma, whatever it is, being able to intervene early enough without putting a label on the children will also help the caretakers and other family members know what to do when something’s happening.”

Infant Mental Health Treatment

Many people believe that when very young children experience trauma, they don’t remember it and aren’t affected by it. “That’s one of the misconceptions,” explains Dr. Booker. “Our brains and our bodies imprint differently, but our bodies do carry what’s happened.”

Trauma in childhood can lead to significant impacts in life. But before treatment can be successful, it’s essential to understand the underlying issues.

“Let’s say, for instance, a counselor is working with a 2-year-old who isn’t sleeping well and has become extremely fatigued,” says Dr. Booker. “The child is agitated, irritable, easily frustrated, and has a lot of muscle tension; he’s experiencing generalized anxiety. When the caretaker brings the child in for help, the counselor starts figuring out the family lives in a place where there’s a lot of violence, gunshots, and sirens throughout the evening. From a multicultural perspective, the environment can cause sleep disruption and will be considered to formulate diagnosis and treatment. Additionally, the parents carry a lot of anxiety as well. So working with the family as a unit is important too.”

“Counselors can point out some of the ways they think the anxiety is happening,” Dr. Booker adds. “They can point out how it’s impacting them, how that child is experiencing the persistent anxiety and how it’s presenting itself — it’s causing sleep disturbance, agitation and irritability to the point that it’s carrying over beyond the home into multiple settings like the grandparents’ home and the daycare center.”

Once they’ve pinpointed the root of the problem, they can begin to focus on treatment. “The child doesn’t have a vocabulary yet and isn’t able to say, ‘I’m not sleeping well because I hear all the sounds. I’m scared, and the level of anxiety in our home is up,’” says Dr. Booker.

“We work with the family and other caretakers to find coping mechanisms for helping themselves and the child deal with the anxiety,” she explains. “That also requires working with the daycare workers, schoolteachers, pediatricians and others to make sure treatment is consistent, so every single one of us is doing what’s necessary for the benefit of that child.”

Consequences of Untreated Childhood Mental Health Issues

If young children can’t get help in the early years of childhood development, their chances of severe mental health challenges later in life increase.

“Research shows that between the ages of 6 and 12, the average diagnosis rate for something related to mental health is around 30%,” says Dr. Booker. “Among teenagers, mental health diagnoses increase — and by that point, the problems have become ingrained in their lives and relationships.”

Across the country, we’re seeing the results of increasing mental health challenges. “We see consequences in individuals self-medicating, using alcohol and drugs,” Dr. Booker explains. “The effects become as severe as self-harm — cutting, for example. The worst-case scenario is suicide and the suicide rates in this age group are increasing — especially with mental health coming to the forefront during COVID-19.”

As with any other health issue, early detection and treatment matter. “We don’t need to be so hypervigilant that kids can’t be kids,” says Dr. Booker. “But when you’re seeing issues, it’s important to address them.”

If not, children can grow up with significant mental health problems that increase over time and aren’t diagnosed until much later when they can be even more difficult to treat. “The challenges impact them at multiple levels and carry over into relationships including friendship, partnerships and marriages,” Dr. Booker adds. “Then it repeats itself with their children. But, if they’re able to get to a professional, get diagnosed and treated early enough, hopefully we can intervene and provide coping mechanisms. The long-term goal is for everyone to live the best version of their life possible and stop severe mental health and intergenerational trauma.”

High Demand for Infant and Childhood Mental Health Professionals

The current demand for mental health professionals is so high that many have calendars booked out for weeks, even months. “Many people realize that seeing a counselor is beneficial,” says Dr. Booker. “When you have a counselor, you have someone trained to provide confidential, non-judgemental treatment with the client’s best interest at heart.”

“Because mental health care has been around for a long time, many adults now wish they’d gotten help earlier,” Dr. Booker explains. “They believe it would’ve helped them in grades K-12, through college, in their marriage or as a new parent. As people process this, counselors begin to get younger clients, and parents ask for assistance with their kids.”

Increasing awareness is fueling increasing demand for services. “The first time children under the age of 18 get to a counselor, it’s typically because their behavior isn’t what their family or school wants,” says Dr. Booker. “They’re acting up, not following directions, and even breaking the rules, and we can help figure out what’s causing that behavior. Fast forward to COVID-19, and many realize that mental health is equally important to physical health.”

The Infant and Early Childhood Mental Health Counseling Certificate

The Infant and Early Childhood Mental Health Counseling certificate from TROY consists of five classes that are 100% online. The only exception is a two-day on-campus intensive (8-hour day) where students learn and utilize assessments used with the birth to five population and give presentations on all they’re learning.

“For the certificate itself, you have to have a master’s degree in some type of helping field,” says Dr. Booker. “The certificate works best for someone who can diagnose patients — counselors, psychologists, psychiatrists and doctors. But we put the caveat of the master’s being in ‘a helping field’ because there’s no reason someone with a master’s degree or higher and who works in early childhood education as a teacher or coach shouldn’t be able to get this training. They can’t diagnose, but they can offer resources.”

The certificate in infant and early childhood mental health benefits professionals in many settings. “If it’s a classroom, daycare or early childhood education where someone’s working with the parents of infants and children — the training is outstanding in all these settings,” Dr. Booker adds. “It benefits school counselors. I use it as a professor and as a private practitioner. And the skills translate across the lifespan. I’m trained in birth to 5, but I can still work with children, adolescents, adults and families.”

The program combines practical skills and on-site experience. “We do reflective supervision within the program. Reflective supervision provides a much-needed space for students to practice skills, be heard, watch others, challenge bias, and prevent burnout. The reflective supervisor and students ‘wonder’ together and process how they can be better for their clients and caregivers,” says Dr. Booker. “Throughout the program, students learn about assessments, neurobiology, diagnosis, behavior and pathology specific to this population. They learn how to use the diagnostic manual — Diagnostic Criteria (DC: 0-5) Zero-to-Five — and they complete an internship where they’re working within this population to practice the skills they’ve learned in their classes.”

Core skills for a successful infant mental health professional are some of the most valuable skills practiced. “The program helped me improve my observation and listening skills,” says Durr, who completed her master’s in clinical mental health counseling at TROY in 2017 and became licensed in 2019. “I completed many observations where I could only observe and not provide feedback. As counselors, we can be quick to assess and want to start setting goals. This program really emphasizes the importance of stop, wait and watch. It reiterated the importance of building a rapport with the family.”

When students finish the program, they can be confident in the training they’ve received. “We’re grant funded by PDG-5 and work closely with First 5 Alabama, the Alabama Association for Infant and Early Childhood Mental Health,” Dr. Booker explains. “First 5 Alabama is the state association of the national under ZERO TO THREE organization. When students complete this training, they get a certificate from TROY and are eligible for endorsement with First 5 Alabama and ZERO TO THREE. Endorsement is the highest level of infant and early childhood mental health and shows the time, training, and work that has been completed to work specifically with this population.”

Unique Qualities of TROY’s Certificate Program

TROY’s program is the only one of its kind in the state of Alabama. “The faculty who teach the courses are all infant mental health trained,” says Dr. Booker. “All are in some way going through endorsement, already endorsed and are reflective supervisors. All are also counseling education doctors and some are practicing clinicians.”

Together, the faculty can give students a good picture of what a career in infant and childhood mental health will look like outside the educational setting. “The faculty care about making sure the students are extremely well trained to be endorsed, to diagnose, to make sure that everything meets a standard, whether they’ll be clinicians who are diagnosing mental health or non-clinicians,” says Dr. Booker. “And making sure they’re ready to go in the field and be the best they can be for the youngest population.”

For Durr, the decision to continue her education at TROY was simple. “TROY has a rich history of pedagogic and humanistic practices that provide graduates with the knowledge and experiences needed to excel professionally,” she says. “My professors also allowed me the space to explore, process and discuss what my culture means to me. I attribute many of my professional accomplishments to the knowledge, network and skill sets developed during my graduate tenure.”

Skills Needed To Work in Infant and Childhood Mental Health Services

Dr. Booker knows firsthand the skills it takes to be successful as an infant and childhood mental health professional.

“Before I was a counselor, I taught high school history and loved it,” says Dr. Booker. “But I had more of a passion for it than my students did. However, the connection with the students was there and they felt comfortable talking to me. Some might say, ‘School isn’t going well. My parents are getting divorced,’ or I broke up with my boyfriend or girlfriend.’ Through those conversations, I realized I wanted to help more, so I became a school counselor.”

For others interested in helping young children, developing specific skills is essential. Among those is flexibility. “You can’t be extremely agenda-driven,” says Dr. Booker. “Working with infants and children requires flexibility to change at a moment’s notice. It’s important to meet the clients and their parents where they are and be able to go from there.”

Other skills include being a good listener. “You have to hear what’s being said and pay attention to the nonverbals of the infant, the child and the caretaker,” Dr. Booker explains. “What’s not being said is equally important to what is.”

“The characteristics needed to be an effective counselor include being reflective and self-aware,” Durr adds. “Effective counselors should be able to process their biases and judgments. They should be able to see how those biases show up in the work they do.”

Having the ability to see those biases can help practitioners develop empathy. “Empathy matters because we all come from different backgrounds. When people seek help, the last thing they need is a lecture,” says Dr. Booker. “So, having an open mind is extremely important. A practitioner can work with people from a single-parent home, an adoptive parent home, foster parent home, same-sex marriages and more. Counselors have to be prepared for all of it and have a nonjudgmental attitude to come in and help.”

TROY’s Counseling Certificate Opens Career Opportunities

Career opportunities in mental health counseling abound. “School counselors can use the training in their setting,” Dr. Booker says. “Clinicians working in private practice, mental health centers and in psychiatry offices can all apply the training to their work. And all those who work with students in K-12 setting can use these skills daily.”

Opportunities for many types of counseling positions are found within state organizations, regulatory policy boards, and the legal system. “If you work with trauma victims, there are practices that work with birth to 5-year-olds who’ve had some level of trauma,” explains Dr. Booker. “In states where infant mental health care has existed for a while, there are baby courts. That’s where the infant mental health practitioner advocates for what a child needs, whether in court for adoption, foster care or some other reason. The mental health advocate is on standby to run intervention on behalf of the child.”

To learn more about working with the youngest patients as a childhood mental health practitioner, visit the Infant and Early Childhood Mental Health Counseling Certificate page on the TROY website.

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