Can you refer a baby to a therapist? At Children’s Hospital Los Angeles, the answer is yes.
Children’s Hospital Los Angeles has had an infant mental health program in outpatient care since the 1990s. This program worked on referrals; often those children were not referred until they were 4 or 5 years old, and they experienced significant medical diagnoses and challenging behaviors. Leaders began analyzing these children’s charts and realized that many had been coming to the hospital since infancy but did not receive a mental health referral until years later.
“We knew earlier intervention could have prevented many issues,” Marian Williams, PhD, director of the Stein Tikun Olam Early Connections Program at Children’s Hospital Los Angeles, told Becker’s. “We wanted something more universal and preventative to catch concerns early and prevent the need for therapy later.”
About 10 years ago, a social worker in the NICU heard about the outpatient infant mental health program and asked leadership to bring it to her unit. The hospital embedded a psychologist into the medical teams in the NICU, then later the cardiac ICU.
“Once we were there, people couldn’t imagine functioning without that support,” Dr. Williams said.
In April, the hospital received a $25 million donation to expand that program — designed for children 3 and younger — into more hospital units.
How it works
Infant mental health focuses on relationships, especially between babies and their primary caregivers. It starts with screening parents about routines, reactions to new situations, crying and how easily the baby is comforted. An infant mental health specialist then meets with the family to assess coping, review screener results and determine a tier of need.
“Hospitalization early in life can make it harder for parents to feel confident in their role, especially when medical procedures replace typical nurturing touch,” Dr. Williams said. “Some parents are even afraid to touch their babies. We help parents recognize their baby’s cues, learn how to interact and build that connection from the start.”
Some parents need only one meeting for reassurance; others may receive education on early childhood challenges or join parent groups with families that have children of similar ages or concerns. The hospital also has a home visiting program for babies going home from the hospital, which helps families transition. For those with the highest needs, hospital staff connect them to outpatient clinics for weekly play-based, relationship-based therapy.
These services are primarily provided by mental health professionals — primarily psychologists and social workers — who work closely with nurses, developmental-behavioral pediatricians, a perinatal psychiatrist, occupational therapists, speech-language pathologists, chaplains and child life specialists.
The existing outpatient programs serve about 1,800 children up to 3 years old annually. And leaders hope to reach just as many children, if not more, in the hospital setting.
“We’re not the only ones doing infant mental health work, but we may be the most comprehensive,” Dr. Williams said. “For hospitals interested in starting, embedding a psychologist in the NICU is a great first step. And hiring a specialist in infant mental health, whether a psychologist or developmental-behavioral pediatrician, is key.”
