REFLECTIVE PRACTICE IN ORGANIZATIONAL LEARNING, CULTURAL SELF-UNDERSTANDING, AND COMMUNITY SELF-STRENGTHENING.

The infant mental health field can amplify its effects when it extends its purview beyond the dyad to the larger contexts in which infants and adult caregivers interact and develop over time. Within health, mental health, education, and other human service organizations, the quality of relationships is a critical variable in the individual-level outcomes that such organizations seek. The goals of this work and the means for accomplishing them are highly dependent on human qualities and interactions that are shaped by organizational processes. In communities, too, processes that shape relationships also strongly influence child-, family-, and community-level outcomes. The Touchpoints approach to reflective practice can guide relational processes among professionals, parents, and infants in organizations and communities that influence these outcomes.

The impact of weight normalization on quality of recovery in anorexia nervosa.

BACKGROUND: There is little agreement on what constitutes remission in anorexia nervosa. OBJECTIVE: This study compared the medical, psychological, and social status of 2 female populations previously treated for anorexia nervosa and differing in their achievement of normal weight. DESIGN: One hundred forty-one patients responded to a questionnaire documenting morphometric parameters, subjective perception of outcome, concerns about body shape and diet, and quality of familial, emotional, and professional life. Two groups were defined according to body mass index (BMI): normal (n = 69) with BMI > or = 18.5 kg/m(2), and subnormal (n = 72) with BMI < 18.5 kg/m(2). In addition, subgroups (21 in each category) were interviewed. An age-matched control population composed of 156 women, either students or Health Services employees, responded to a similar questionnaire. RESULTS: Only a minority of patients assessed themselves as recovered, and there was no statistically significant difference in perception of recovery between normal BMI and subnormal BMI groups (27.5% and 15.3%, respectively). As expected, underweight patients reported significantly more frequent purging behaviors, amenorrhea, recent hospitalization, and prolonged student status. In contrast, there were no significant differences in terms of pregnancy rate, psychiatric comorbidities, social integration, sexual activity, and self-assessment of professional and familial life. In comparison to control subjects, former anorexia patients with normalized BMI more frequently reported vomiting, fear of high-calorie foods, and treatment for depression. CONCLUSIONS: These few long-term advantages observed after BMI normalization suggest that normalization of nutritional status remains an important target in anorexia nervosa. However, the persistence of psychological distress after nutritional recovery confirms that more effective treatments are needed that target long-term psychological recovery.

Infant psychomotor development in cases of maternal postpartum depression: Observation of a mother and baby unit.

Studies of the first year of infant psychomotor development in cases of maternal postpartum depression are lacking. The mother and baby unit (MBU) is a healthcare system available to infants and their mothers during the postpartum period in a psychiatric hospital, which provides support and preserves the parent's role in the child's daily care. The aim of the paper is to describe the developmental profile of babies of mothers with severe postpartum depression treated in an MBU through the developmental quotients. Using the Brunet-Lézine scale, we studied six-month-old infants whose mothers were hospitalized. The study population consisted of 15 infants. The mean global developmental quotient score was 96.7. A developmental quotient lower than 80 was not observed for any of the children. We found no global psychomotor developmental delays. Despite this, the posture subscore was the area in which we observed the most difficulties. It is possible that the tonic dialogue between the mother and infant is disrupted by maternal depression.

Newborn behavior, parent-infant interaction, and developmental change processes: research roots of developmental, relational, and systems-theory-based practice.

The discovery of individual and cross-cultural differences among newborns, and their effects on caregiver behaviors, underpins a systems theory of human development and a resulting paradigm shift. This theory accommodates both epigenetics-mediating genes and environment within the individual, and culture-a dynamic, emergent phenomenon transmitting contextually adaptive child-rearing beliefs and practices. Within human systems, children and parents' development is also propelled by mutual adaptation occurring through the microprocesses of early interactions and through normative periods of disorganization and reorganization (touchpoints). This paradigm shift in developmental theory calls for parallel shifts in clinical practice and organizational structures and processes.

Pediatricians' role in supporting parents as they care for infants and young children.

Primary care pediatric health care clinicians can integrate basic principles and strategies of the field of infant mental health within the time constraints of their current practice, while advocating for additional resources to support the expansion of the preventive potential afforded by new scientific advances in this field. Infant mental health is a relatively young field with the potential to reduce human suffering and health care costs associated with early-onset developmental, emotional, and behavioral disorders. This will depend not only on primary care pediatric diagnostic acumen, but also on related investments in health care preventive screenings and interventions, training and infrastructure, as well as community supports. The health and development of infants, young children, and families emerge from the interactions of a wide range of factors-including health, education, and economic policy, as well as attributes of local communities and the larger physical environment-and impact economics and security at national and global levels.