Integrating infant mental health practice models in nursing.

PROBLEM: During the first years of life, the brain is developing rapidly and is especially vulnerable to the effects of trauma and or stress. Early exposure to such early trauma or stress predisposes young children to mental health problems. The practice of infant mental health (IMH) focuses on preventing negative mental health outcomes in infancy and toddlerhood. Currently, IMH is not standard practice in nursing. To enhance IMH in nursing, this manuscript provides an overview of IMH practice models, discusses nursing implications of each model and presents a model for integrating IMH into nursing practice. METHODS: A scoping review was conducted with a literature search utilizing the keywords "infant mental health" AND "models of care" in the PubMed and CINHAL databases from 2002 to 2018. FINDINGS: Twenty of the publications retrieved met search criteria. Among the 20 articles, 10 addressed clinical-based content related to IMH practice and 10 addressed nonclinical-based content associated with IMH educational training, policy development, or system-based models of care. CONCLUSIONS: Nurses are well positioned to impact IMH. The model presented provides the nursing process as a practical framework for the integration of IMH in nursing practice that can be expanded upon as IMH evolves.

An illustrative case for addressing infant mental health referrals.

PROBLEM: Despite knowing the importance of the early detection of adverse experiences, mental health disorders beginning or occurring during early childhood can be difficult to recognize. To address this gap, this manuscript describes the care of a parent-child dyad utilizing the nursing process in an illustrative case. METHODS: This illustrative case provides a scenario that includes the early detection of infant mental health (IMH) in primary care with referral to a psychiatric mental health advanced practice nurse (PMHNP) and highlights how integrative care with PMHNP can facilitate the use of the nursing process to promote optimal early childhood growth and development and prevent long-term mental health problems. FINDINGS: The collaboration between the primary care provider and PMHNP in addressing a common diagnosis observed in IMH (i.e., feeding disorder) where a 6-month-old infant presented with poor weight gain due to detached parenting, secondary to maternal depression, resulted in early infant-parent intervention that reduced maternal depression and normalized infant growth. CONCLUSIONS: The screening of IMH in pediatric primary care promotes early referral and collaboration with the PMHNP to address IMH problems to promote optimal growth and social-emotional development in early childhood.

Integrating behavioral health in the pediatric medical home.

TOPIC: Behavioral health disorders (psychiatric illness and substance abuse disorders) represent a significant burden across the nation's health care system. The number of children and adolescents requiring behavioral health care has increased while at the same time the behavioral health workforce continues to experience a shortage of providers. The current model of care is failing to meet the behavioral health needs of children and adolescents. Initiatives are underway that call for improved integration of behavioral health services into primary care. Patients and families often seek behavioral health care in the primary care setting. PURPOSE: The purpose of this article is to describe how one large urban pediatric practice began to integrate behavioral health services. Opportunities and challenges are discussed along with a review of three integrated care delivery models. SOURCES USED: Literature search was performed using PubMed and CINAHL; we also used Substance Abuse and Mental Health Services Administration, American Academy of Child and Adolescent Psychiatry, and American Academy of Pediatrics Guidelines, which describe the need for integration of behavioral/mental health into pediatric primary care.