Meeting the Complexity of Supporting Infants, Toddlers, and Families

This is a time of promise for all of us who work with infants, children and families, as the fields of early intervention (EI) and infant mental health (IMH) have burgeoned over the past several decades. As a clinical psychologist and infant mental health specialist, I feel lucky to work in a wide range of settings with a wide range of individuals. On any given day, you might find me:

  • Attending a transitional IEP meeting at a school or district office
  • Conducting a preschool, day care or home based observation
  • Consulting with regional center staff regarding a referral or children in my caseload
  • Attending  a multidisciplinary team meeting
  • Training clinicians at a public or private agency serving young children
  • Working with parents and families in my office or in the field

I find the field of infant mental health invigorating, as it involves complexity and requires clinical thinking across developmental domains and across disciplines. The ability to properly treat each infant and toddler, dyad and family requires assessment and treatment models as complex the work we do: it involves multi-dimensional thinking and practice. Multi-dimensional thinking is by nature transdisciplinary. My own pathway to transdisciplinary practice was through the DIR® certificate program of the Interdisciplinary Council on Development and Learning (ICDL). Founded by Stanley Greenspan, M.D. and Serena Wieder, Ph.D., the groundbreaking work of the DIR® Institute  brought the wisdom of infant mental health  (harnessing growth through relationships) to all aspects of development while training professionals in allied fields (occupational therapy, speech therapy, physical therapy, education, pediatrics, etc.). The training focus involved looking at many aspects (dimensions) of development and how each caregiver and child’s individual differences impact development and social emotional milestones. By working in small groups during our summer institutes, and through regular reflective supervision, practitioners from different disciplines learned a common language, and way to codify how a child’s individual differences impact the growing relationships and their acquisition of social emotional milestones (described as Axis V of the DC:0-3R).

In practical terms, DIR® training provides important tools for understanding how to support caregivers and help the relationship with their children blossom. A large part of this understanding comes from the knowledge base in the fields of speech and language therapy and occupational therapy. With non verbal communication between parent and infant forming the earliest foundation of joint attention, speech and language therapists help us understand, assess and grow the quality of non-verbal communication in dyads and families. Similarly, when joint attention is not coming online, occupational therapists teach us how subtle differences in sensory processing and integration, vision, and the range of praxis (including the ideation, planning, sequencing, executing and adaptation of motor movements) can impact the critical journey of connection and relatedness.

In summary, development itself is complex, involving interconnected neurological processes influenced by personal biology, relationships, experience and the environment.

As a practitioner working with young children and families, understanding how to support relationships in the context of individual differences creates the dimensional framework necessary to work flexibly with families and support social emotional development. Please check out what is happening on a national level to bring much needed multi-dimensional thinking into our homes, clinics and schools.

For more information visit

Mona Delahooke 2013
Mona M. Delahooke, Ph.D.
Licensed Clinical Psychologist
DIR® Certificate: ICDL and Profectum Foundation
Profectum Foundation: Senior Faculty Member
Profectum Mental Health Working Group Co-Chair