The Need to Measure a Relationship

As the author of a recently published workbook in support of dyadic service providers, I have prepared this article to examine the purpose for the text “How to Measure a Relationship”

Workforce Development

As the field of Infant Mental Health continues to grow, there is an ongoing need for quality training for providers across multiple service delivery systems. Our knowledge of early brain development has pushed many service sectors towards investments in prevention, and increased referrals to services for children under three. Service systems are creating increased linkages; one such example is the Child Protective Services (CPS) linking with Public Mental Health to recommend intervention for younger children. As a result, mental health providers may be experiencing an increase in referrals of children birth to five. Another impact at the service level is the increasing collaboration between Early Intervention (Part C Providers) and CPS. As a result of federal legislations within the US, providers in the Developmental Disabilities arena are serving greater numbers of children referred by CPS. Many mental health providers are serving younger and younger children. Furthermore, greater numbers of children birth to five, with traumatic histories may now be entering the developmental disabilities service sector. These ongoing trends across service sectors have brought on the need to enhance workforce knowledge in support of Infant Mental Health theory, application, and specifically relationship focused interventions.

When considering workforce development one can target pre-service (student populations) or the current workforce. How to Measure a Relationship targets both the current workforce and serves as a valuable learning tool for college level courses in the areas of Child Development, Special Education, Mental Health and Developmental Disabilities. When working within any system that requires a service provider to write a goal that considers the context of the child’s relational experience, How to Measure a Relationship is the provider’s must have manual.

Complexity of Development

The developmental needs of children are informed by multiple factors including the physical, intellectual, and neurological state of the child. As it is well documented, a child’s developmental outcomes, both positive and negative, are highly influenced by the caregiving relationships within the child’s experience. In addition, environmental influences such as risk issues or protective factors contribute to developmental outcomes.

Given the complexity of development in the early years, many practitioners need a structured approach to organizing their thinking about the observed behaviors in young children and the relational influences on expressed behavior. A strategy is needed for practitioners to organize the multiple influences underlying the meaning of behavior as informed by child specific issues, relationship factors, and environmental conditions. The ‘Causal Rubric’ presented in How to Measure a Relationship offers the practitioner a useful decision tree to organize their thinking regarding the causes of problematic interactions. Additionally, this text aids the practitioner in determining where to target their interventions to best support the child at his specific level of need within the cultural context of the child’s individual family unit.

The Causal Rubric questions consider:

  • The child’s internal state
  • The significant attachment relationships within the child’s world
  • Experiences of toxic stress or trauma within the environment

Following a systematic set of questions to find these answers, practitioners are offered sample interventions designed to address the underlying cause of the behavior/symptoms. Therefore, shifting our intervention lens from a focus on altering challenging behaviors to targeting relationship changes that create lasting systems level shift within the ongoing interactions of the caregiving dyad.

Practitioner’s Need

In my experience birth to five practitioners (over various disciplines) struggle with the task of designing relationship-based goals and interventions. Practitioners can often understand the significant influences of relationships on developing interpersonal norms and work to address caregiver interactions as a change agent. The challenge often becomes articulating the target of the relationship as a change agent for service delivery. This becomes a greater challenge within the confounds of the single payee or individual patient model common within the US. How to Measure a Relationship fills a void in the practitioner’s tool kit and serves at the bridge from theory to practice.

Organizing Constructs to provide Structure Guideline

How to Measure a Relationship serves as a practitioner’s guide to organizing, discussing, and documenting relationship-based interventions. This text has been written to support the interdisciplinary provider community within the Infant Mental Health field. How to Measure a Relationship serves as a learning tool that is best used with the support of a supervisor and a senior Infant Mental Health provider to aid in the personal growth of the provider.

How to Measure a Relationship is one valuable educational resource for practitioners. There are a host of good tools which address, theory, practice strategies, and evidence based treatments. This text provides the glue that links all the available information into a coherent core. Thus creating the integration of multiple streams of information for practical use in the field

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Barbara Stroud, PhD

ZERO TO THREE Graduate Fellow
IFECMH Endorsement- Reflective Facilitator Mentor Level