Collaborative Consultation with Parents and Infants in the Perinatal Period - Softcover

Zack Boukydis, Ph.D., was a developmental/clinical psychologist whose career was devoted to research and clinical work with mothers, families, and babies. He was the editor or coeditor of three books: Support for Parents and Infants: A Manual for Parenting Organizations and Professionals (Routledge & Kegan Paul, 1986), Research on Support for Parents and Infants in the Postnatal Period (Ablex, 1987), and Infant Crying: Theoretical and Research Perspectives (with Barry M. Lester, Plenum Press, 1985), as well as the author of numerous research publications and grants.

Throughout his career, Dr. Boukydis’s work focused on the influence of infant crying on parents, the neurobehavioral development of at-risk infants (including preterm and substance-exposed infants), interventions to support families in neonatal intensive care units and mothers and infants in drug treatment programs, and an ultrasound consultation program in which practitioners joined with mothers and families in watching their baby during routine ultrasound screens in obstetric clinics. He was a focusing coordinator and focusing-oriented therapist with the Focusing Institute of New York and developed a special international training program, Focusing- Oriented Parent-Infant Consultation: Bringing Focusing to Work with Parents and Infants. He was also a trainer on the NICU Network Neurobehavioral Scale (NNNS™; Paul H. Brookes Publishing Co., 2004) in the United States, Europe, and Africa. Dr. Boukydis was a member of the Harris Professional Development Network and was a Fulbright Fellow between the United States and Hungary.

Dr. Boukydis was on the editorial review board of the Journal of Visualized Experiments and was a reviewer for Acta Paediatrica

. He was on the faculty of the Department of Pediatrics, Semmelweis Medical School, and the Institute of Psychology, Eotvos Lorand University, Budapest, Hungary, and was Visiting Professor, Department of Pediatrics, University of Turku, Turku, Finland.

Excerpted from the Introduction of Collaborative Consultation with Parents and Infants in the Perinatal Period, by Zack Boukydis, Ph.D. Copyright© 2012 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Introduction: Essentials of Consultation in the Perinatal Period

The primary purpose of this book is to develop the ability of practitioners to listen to, support, and help parents and infants in the perinatal period. The book teaches several essential frameworks and methods for relating to and working with parents and infants. This book has an interdisciplinary basis and is relevant to a wide range of health and mental health professionals. The book discusses how various professionals working with infants and families can integrate the material in the book with their particular foundational professional training. Much of the content of this book arises from the interdisciplinary field of infant mental health (Fraiberg, Adelson, & Shapiro, 1975; Heffron, 2000; Heffron, Ivins, & Weston, 2005; Sameroff, McDonough, & Rosenblum, 2004; Shah, 2007; Tomlin & Viehweg, 2003; Tronick, 2010; Weatherston, 2001; Zeanah, 2009), a relatively new and important field that has, at its core, practices involved with nurturing the parent-infant attachment relationship (Raval et al., 2001; Sroufe, 2000; Stern, 2004). One basic assumption of infant mental health practice is that to the extent mothers are well supported and emotionally healthy, their infants will receive the essential nurturing and emotional sustenance they need for healthy development. As infant mental health practice has evolved, so has understanding about how to attend to all relationships that are integral to the lives of infants (mothers, fathers, siblings, relatives, caregivers, and others; Fivaz, Frascarolo, Keren, & Fivaz-Depeursinge, 2009; Stern, 2004).

Overview of the Book

The organization of the book represents essential frameworks for

• Observing and documenting infant neurobehavior and behavioral organization
• Understanding the implications for using the observational framework to engage in joint observations and commentary with parents and infants
• Listening to parents and engaging in an equal, collaborative consultation about care and interaction with their infant
• Understanding change in parent–infant interactions

Rationale for the Book

A great deal of writing in the interdisciplinary field of infant mental health pertains to older infants and toddlers, but less has special emphasis on the perinatal period. This book focuses on that important time. In the framework presented in this book, the role of the consultant is to recognize and support the intrinsic abilities (Papousek & Papousek, 1987) that most adults have in becoming parents; help parents, at times, to perceive their infant more clearly; and, when necessary, help resolve emotional difficulties that may be preventing a parent from being able to see and respond consistently to the infant. The book addresses the complex work of seeing who an infant is and what he or she presents in his or her neurobehavioral functioning, learning about the parent and family, and then seeing how this infant and this parent match up.
    Research and evaluation evidence is accumulating that well-developed programs and services in the pre- and perinatal period can reduce later human and economic costs (O'Connor & Parfitt, 2009). This book is intended to increase the capability of those who work in programs or services aimed at prevention and intervention with parents and infants in the perinatal period. Along with this understanding of the importance of early intervention is a continuing recognition of the indigenous supports that are present in naturally occurring relationships and families—including families who have not received early intervention services organized by various governmental or private organizations. Parallel to learning the consulting emphasis in this book, professionals should be able to recognize existing, naturally occurring supports for parenting and learn how to support and strengthen informal contacts between parents and other parents, including self-help parenting groups (Boukydis, 1986, 1987; Boukydis & Moses, 1995).

How the Term Consultant Is Used in This Book

The use of the term consultant in this book is slightly different from several other uses as a professional designation. The term was chosen to recognize a practitioner who provides a special kind of service and attention to parents and infants in the perinatal period. There are several variations in how the term and the associated activities apply. A practitioner may already be trained in his or her foundational discipline and may be providing care and services that are similar to the activities in this book. In this situation, the practitioner is taking on an expanded role as a consultant, taking time to observe an infant with his or her parents and discuss implications for care, play, and loving interaction. The expanded role may or may not be recognized as part of the practitioner's daily activities. In other situations, the practitioner may be a specialist who provides services similar to the ones indicated in this book and who joins an existing team of care providers as an infant-parent specialist, developmental care specialist, and/or infant mental health specialist. Practitioners may also be providing other care, such as visiting homes or visiting mothers involved in drug treatment programs, a role in which many of their responsibilities overlap with those indicated in this book.

Important Considerations in the Consultation Process

The model of consultation in this book involves observing babies with parents and learning how to communicate with the parents about their infant's behavior and their own perceptions and feelings. Underlying the consultation are several important considerations.

1. The consultant must have a differentiated understanding of infant behavior. Chapter 1 presents a framework for observing infant behavior and for understanding interrelationships between five levels of infant behavior. Consultants must be competent in this type of observation so that they can recognize deviations from typical neurobehavioral functioning and, by watching on all five levels simultaneously, can determine when the parent is able to respond to the infant and promote infant attention, soothing, and so forth.
       In a current program with nurses and doctors in a neonatal intensive care unit (NICU) in Turku, Finland (Boukydis, Ahlqvist-Björkroth, & Lehtonen, 2011), staff received training in the observational system detailed in Chapter 1. They then learned to engage parents who are watching their infant, comparing observations and noticing the infant's unique response to the timing and intensity of different modalities (talk, touch, look) of parental care. This training program highlights the importance of having a differentiated framework for understanding infant neurobehavior as the basis for talking and consulting with parents.
2. The consultant must have an understanding of infant neurobehavior, socioemotional development, and parents' attributions of intentionality to infant behavior. Consultants must already be trained in recognizing and assessing expected patterns of socioemotional development in infants (Damon & Lerner, 2006; Kopp, 2003; Leach, 2010). With this knowledge they can compare their observations with a parent's verbal and behavioral responses to his or her infant and offer input when a parent attributes intentionality to the infant's behavior. Sometimes the...