Program Goals

The goals of The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) are:

• For children:
• Increase likelihood of having secure and healthy attachment relationships with parent
• Reduce the risk of developmental delays, relationship disturbances, and/or socio-emotional disorders
• For parents:
• Enhance caregiving competencies
• Promote mental health and sensitive caregiving
• Increase likelihood of providing a secure and healthy attachment with infant/toddler

Logic Model

View the Logic Model for The Michigan Model of Infant Mental Health Home Visiting (IMH-HV).

Essential Components

The essential components of The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) include:

• Services delivered in families’ homes:
• Focus on parent-child relationship
• Parent and child are seen together
• Can include multiple primary caregivers, including therapeutic contact with biological parents, foster parents, and/or kin with parenting roles
• Typically lasts 90-120 minutes weekly
• Frequency of visits driven by family-need with the potential for more frequent visits during a crisis
• Multifaceted and needs-driven intervention:
• Guided by the unique needs and situation of each family
• Addresses needs of child welfare involved families
• Duration of treatment dependent on the needs of the family
• Core intervention components include:
• Building an alliance or working relationship between provider and parent
• Providing for material needs, advocacy, and health care
• Developing social support, problem-solving skills, and life course planning
• Providing emotional support
• Providing development guidance
• Culturally responsive & diversity-informed practice
• Use of videotaping for assessment and ongoing review with families
• Grounding in infant-parent psychotherapy:
• Exploring child’s emotional experience in relation to current or past experiences
• Wondering with the parent about the emotional content or meaning of a child’s play or behavior and/or speak to the infant or toddler about the emotional content or meaning of play or behavior
• Acknowledging or discussing parent’s perceptions and representations of child and/or self as parent
• Exploring parent’s capacity to nurture and respond to child
• Exploring or linking current issues or conflicts to parent’s responses to child or relationship
• Focus on parent emotion regarding child
• Addressing negative experiences and/or unresolved loss/trauma that may be affecting the parent-child relationship
• Addressing and supporting positive internal resources that may strengthen relationship with child
• Reflective supervision:
• Providers should receive regular reflective supervision, typically by supervisor within their agency and/or clinician consultant, to explore the emotional content of IMH-HV work
• Explores the relationship between parent and infant/toddler, parent and provider, provider, and supervisor

Program Delivery

Child/Adolescent Services

The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) directly provides services to children/adolescents and addresses the following:

• Disruptions and/or disturbances in primary attachment relationships; developmental delays; socio-emotional/behavioral problems or disorders related to the impact of experiences including neglect, abuse, separations, domestic violence, medical conditions, lack of resources and/or emotional/behavioral outcomes associated with being parented by an adult with experiences related to the impact of trauma, stress/adversity (e.g., mental health concerns and/or other familial/environmental stressors)

Parent/Caregiver Services

The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) directly provides services to parents/caregivers and addresses the following:

• Disruptions and/or disturbances in primary attachment relationships, and/or caregiving experiences related to the impact of past trauma, or stress/adversity, and/or a range of behavioral and/or environmental concerns that impact parenting and the child-parent relationship including unresolved loss, mental health issues (i.e., depression, anxiety), domestic violence, economic deprivation, systemic oppression, and lack of social support.

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: The needs and contributions of significant adults (including other parents who are not direct recipients of services) and other young children in the household are considered and included in the IMH-HV intervention. This may include biological parents, foster parents, and/or kin; and may also involve coordination of care with child welfare system providers, medical providers, early care and education providers, and other professionals involved in support for the infant/toddler and/or family.

Recommended Intensity:

Typically, one 90- to 120-minute weekly session in the infant/toddler and family’s home; can be more frequent depending on family need

Recommended Duration:

Duration of services varies based on factors, including family need and age of the child; typical duration is between 6-45 months (from pregnancy through infant/toddler aged 36 months)

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Foster / Kinship Care
• Shelter (Domestic Violence, Homeless, etc.)
• Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

This program does not include a homework component.

Resources Needed to Run Program

The typical resources for implementing the program are:

• Cell phones
• Computer and telecommunication capabilities (equipment and software should be HIPAA-compliant and accessible to clients)
• Method of transportation to/from home and/or travel expense reimbursement
• Ability to record video (e.g., cell phone, video recorder)
• Adequate space for reflective supervision, or phone/telecommunication capabilities
• Master’s level clinician and reflective supervisor/consultant
• Toys and materials to support developmental guidance and infant-parent psychotherapy components
• Assessment tools

Manuals and Training

Prerequisite/Minimum Provider Qualifications

For service providers, minimum qualifications include master's degree in social work, psychology or a related field and meet any local state, and/or agency licensing requirements. Providers should also have training in infancy and toddlerhood, early relationship development, and mental health intervention techniques. Clinicians and should have a foundation in culturally responsive practices, impacts of trauma, infant, and child development, parent mental health, attachment theory, child temperament, and interpersonal skills. It is assumed that clinicians and supervisors will have completed master’s degree level training, including course work in psychotherapy skills and practices, and that they will have engaged in additional learning to address foundational topics. IMH-HV providers are expected to obtain or be working toward endorsement as an Infant Mental Health Specialist.

For supervisors, minimum qualifications include master’s degree in social work, psychology or a related field. Additionally, administrative, organizational, and clinical skills and prior experience as an IMH-HV Home Visitor is preferred. Must meet any local, state, and/or agency licensing requirements. Supervisors should have a foundation in culturally responsive practices, impacts of trauma, infant and child development, parent mental health, attachment theory, child temperament, and interpersonal skills. It is assumed that clinicians and supervisors will have completed masters-level training, including course work in psychotherapy skills and practices, and that they will have engaged in additional learning to address foundational topics. Supervisors are expected to obtain or be working toward endorsement as an Infant Mental Health Mentor.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Program Manual Information:

• Weatherston, D., & Tableman, B. (2015). Infant Mental Health Home Visiting: Supporting competencies/reducing risks, manual for early attachments: IMH Home Visiting (3rd edition). Michigan Association for Infant Mental Health. This manual is available for purchase from the Michigan Association for Infant Mental Health at https://mi-aimh.org/store/imhmanual/.

Training Information

There is training available for this program.

Training Contact:

• Mary Ludtke
  ludtkem@michigan.gov

Training Type/Location:

Training is delivered via in-person training sessions and bi-weekly phone (or virtual) coaching calls that include case presentations.to provide clinicians and their supervisors with tools and skills to deliver IMH-HV. Provision of ongoing reflective supervision from supervisors/consultants to providers is a requirement for participation. Additional ongoing training opportunities are regularly provided by the Alliance for the Advancement of Infant Mental Health and the Michigan Association for Infant Mental Health (MI-AIMH), which also has an endorsement program.

Number of days/hours:

Training is delivered across 12-months through 7 days of in-person training sessions and bi-weekly phone (or virtual) coaching calls that include case presentations. Both providers and supervisors participate in training activities.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) as listed below:

Providers are given a formal structured Self-Assessment of Readiness tool as part of their initial training preparation. This self-assessment tool reviews each participant’s foundational knowledge to identify areas of strength and for growth in the following domains: attachment, case management, child development, culturally informed care, depression, foundations in infant mental health concepts and assessment, and trauma. Providers complete the self-assessment and review scores with their supervisor to determine whether the training is an appropriate fit, or if more background, experience and/or learning in foundational knowledge for the IMH-HV model would be best before pursuing this opportunity. The self-assessment tool also includes suggested further reading for each domain. For more information, please contact the program representative (see bottom of the page).

Formal Support for Implementation

There is formal support available for implementation of The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) as listed below:

Coaching calls provide implementation support throughout the training period.

Fidelity Measures

There are fidelity measures for The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) as listed below:

Fidelity to the IMH-HV model is assessed through a self-rated IMH-HV Treatment Fidelity Checklist. Use of the fidelity tool is included in the standard model training curriculum. The adapted fidelity checklist includes broad categories representing key IMH-HV strategies. Within each category are items that provide specific activities or examples of possible interventions. Providers are asked to select all applicable items that reflect what they did during each home visit. The fidelity checklist can be used to support clinical practice by identifying the broad categories of strategies or interventions that have been employed, as well as to help guide attention to core components and/or specific strategies that have, or have not, been used in the work with the family. This checklist is meant to be used in reflective supervision as part of case conceptualizations and treatment planning.

Implementation Guides or Manuals

There are implementation guides or manuals for The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) as listed below:

Infant Mental Health Home Visiting has a manual that offers an overview of principles and practices of infant mental health, referral procedural home visiting processes, assessment and intervention strategies, termination planning, special circumstances, administrative and organizational issues, staff training and supervision, and a case example. Tables supporting intervention structures, anecdotal materials, and an appendix with forms for carrying out relationship centered work with infants/toddlers under 3 and their caregivers guide infant mental health home visitors in their practice are included. The final piece includes suggested guidelines for training and an outline for psychotherapy training. The manual’s framework includes components for service: building an alliance, material needs, emotional support, developmental guidance, life-coping skills and social supports, and infant-parent psychotherapy. The manual is available for purchase from the Michigan Association for Infant Mental Health at https://mi-aimh.org/store/imhmanual/:

• Weatherston, D., & Tableman, B. (2015). Infant Mental Health Home Visiting: Supporting competencies/reducing risks, manual for early attachments: IMH Home Visiting (3rd edition). Michigan Association for Infant Mental Health.

Implementation Cost

There are no studies of the costs of The Michigan Model of Infant Mental Health Home Visiting (IMH-HV).

Research on How to Implement the Program

Research has been conducted on how to implement The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) as listed below:

• Huth-Bocks, A. C., Jester, J. M., Stacks, A. M., Muzik, M., Rosenblum, K. L., & Michigan Collaborative for Infant Mental Health Research (2020). Infant Mental Health Home Visiting therapists' fidelity to the Michigan IMH-HV model in community practice settings. Infant Mental Health Journal, 41(2), 206–219. https://doi.org/10.1002/imhj.21839
• Jester, J. M., Rosenblum, K. L., Muzik, M., Niec, L. N., Stringer, M. K., Handelzalts, J. E., Brophy-Herb, H. E., Stacks, A. M., Weatherston, D. J., Torres, C., Julian, M. M., & Lawler, J. M. (2023). Demographic and psychological factors that predict retention in infant mental health home visiting. Early Childhood Research Quarterly, 62, 64–75. https://doi.org/10.1016/j.ecresq.2022.07.010
• Lawler, J. M., Rosenblum, K. L., Muzik, M., Ludtke, M., Weatherston, D. J., & Tableman, B. (2017). A collaborative process for evaluating Infant Mental Health Home Visiting in Michigan. Psychiatric Services (Washington, D.C.), 68(6), 535–538. https://doi.org/10.1176/appi.ps.201700047
• Shea, S. E., Jester, J. M., Huth-Bocks, A. C., Weatherston, D. J., Muzik, M., Rosenblum, K. L., & Michigan Collaborative for Infant Mental Health Research (2020). Infant Mental Health Home Visiting therapists' reflective supervision self-efficacy in community practice settings. Infant Mental Health Journal, 41(2), 191–205. https://doi.org/10.1002/imhj.21834
• Torres, C., Rosenblum, K. L., Jester, J. M., Julian, M. M., Niec, L. N., Muzik, M., & Michigan Collaborative for Infant Mental Health Research. (2022). Clinician racial biases: Preliminary investigation on predictors of poor therapeutic alliance and retention in home visiting intervention program. Maternal and Child Health Journal, 26, 953–961. https://doi.org/10.1007/s10995-021-03369-z

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Additional References