PSU graduate program focuses on mental health of infants and toddlers

Conversations about mental health may include adolescents or children, but they rarely focus on babies or toddlers. A graduate program at Portland State University is teaching child care professionals to do just that.

The Infant/Toddler Mental Health graduate certificate is designed to help educators, social workers, counselors and other early childhood specialists foster strong connections between caregivers and their children during the earliest stages of life. Research shows that consistent, loving feedback from caregivers helps build neural connections that support communication and emotional resilience as a child grows up.

We talk with Melissa Williams, an early intervention specialist with the Multnomah Early Childhood Program, and Sally Guyon, the co-coordinator of the Early Childhood: Inclusive Education master’s program and an assistant professor of early childhood care and education at PSU.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Conversations about the mental health of young people often include adolescents and children, but they rarely focus on babies or toddlers. For more than 20 years, a graduate program at Portland State University has been teaching childcare professionals to do just that. The Infant/Toddler Mental Health graduate certificate is designed to help foster stronger connections between caregivers and children during the earliest stages of life.

Sally Guyon is the co-coordinator of PSU’s Early Childhood Inclusive Education master’s program. Melissa Williams is an early intervention specialist with the Multnomah Early Childhood program and a recipient of this PSU certificate. They both join us now. It’s great to have both of you on Think Out Loud.

Sally Guyon: Thank you.

Melissa Williams: Thank you.

Miller: Sally, first – what’s the big idea behind this program?

Guyon: Well, infant/toddler mental health is really about building those early relationships and building the secure attachments. And why that’s so important in the infant years is that it helps children learn to experience, express and manage their emotions. And when children have those capabilities, they’re able to go out and learn and explore.

Miller: Who is this program for?

Guyon: This program is for anyone working with children or families, especially infants and toddlers. It’s been really interesting how we’ve seen the change in our student body for this program. Originally, when we started, it was definitely people working in early intervention, parent-child therapy and early childhood special education. Now, we see a lot more people coming in who are working in early childhood care and education classrooms, as well as some elementary classroom teachers.

Miller: It’s interesting because when I first heard that this certificate program existed – which is as I was prepping for this conversation – I just assumed that it was born sometime around the pandemic, when there was way more public conversation about everybody’s mental health, and in particular, young people’s mental health. So I was really surprised to find out that it started in 2003. How much has changed in this world of taking care of and thinking about the mental health of very young people in those 20-something years?

Guyon: That is such a great question. Kind of our origin story was that we were graduating students in early intervention, early childhood special education and early childhood education, and yet, we were noticing all these different silos, that there was this different terminology, there weren’t connections across the different sectors. And so that’s why we decided to create the program … well, I wasn’t there at that time. But why the program was created was to have this shared understanding and knowledge around early mental health.

What’s changed most drastically over the last 20 years is our understanding of the brain development that happens in the infant and toddler years. When babies are born, their little brains are about 25% of the sizes they are as adults. And when they finish the third year, it’s at 90%. It’s just amazing work. I just recently was looking a little bit deeper into that brain development, and the most interesting statistic is when you think about how much a baby develops from birth to the end of the first year, 60% of their energy is going to their brain development. So think about a baby who cannot roll over, can’t do anything for themselves. By the end of the first year, they’re walking, they’re talking a little bit, they’re able to feed themselves. But most of the energy that they’re working on that first year is going towards that brain development and those neurological connections.

Miller: Melissa, I mentioned briefly in my intro that you are an early intervention specialist for Multnomah Early Childhood Program. For people who have not heard of that particular job before, what does it entail? What do you do?

Williams: Our program provides special education for children birth to 5 [years old]. We serve Multnomah County, but children birth to 5 [years old] who require special education can receive it anywhere in Oregon. So my particular job, I work as a home visitor. So if a child needs special education services, I will come to their home, and my job is to provide the services through their parents. I provide parent coaching, support and modeling. And I’m really working through the parent to support the child.

Miller: That’s an important point here. So you’re not going there and dealing directly with a 1-year-old or a 2-year-old. You’re working directly with their caregivers, with their guardians or parents. Why?

Williams: Because I’m only there for one hour a week, and the parent or the caregiver is with them all the rest of the time. So we want that infant or that toddler to receive the most supportive intervention from their natural caregiver, from the person who loves them, who’s feeding them, playing with them and giving them baths, and taking them on outings. We want them to get that intervention in their natural environment.

Miller: So you spend a lot of time with new parents?

Williams: I do.

Miller: What do you hear most often from them about what they feel like they need?

Williams: That’s a great question. I think that they often don’t know what they need. They spend a lot of time getting ready to have a baby, and then the baby comes, and I think that they often don’t know what they need. And to be honest, the children that I work with are receiving special education services. Oftentimes, parents are surprised by a disability that their child is experiencing. So my job is often to support them through education and also processing whatever the need is around that disability.

Miller: In this case, you’re supporting somebody who is supporting somebody. But when we’re talking or thinking specifically about the babies or toddlers themselves, how do you support people who can’t talk and cannot easily process emotions? It can be hard for a 10-year-old to process emotions, and it’s particularly hard for a 1-year-old to do it. So how do you deal with the lack of language?

Williams: That’s a great question. There’s so many ways, and I think that is such a great piece of what infant/toddler mental health can teach us. Attunement is something that I loved learning about in this program at PSU. Attunement is how we respond to our children, how we notice the subtle things that a baby might give us: the nonverbal cues, the physical little changes in their facial expressions, the little sounds that they might make, and then we respond to them.

There’s something called serve and return. Think about a tennis match. The baby gives you a little something, you give them a little something back. All of that can be nonverbal. And what that teaches a baby is someone is listening, someone is paying attention, and communication is kind of in a circle, it’s cyclical.

Miller: How long had you been doing this job before you decided to get this certificate from PSU?

Williams: Fifteen years.

Miller: A long time. So I imagine you were already good at your job. You had a lot of experience doing it. What were you hoping to get from this professional development?

Williams: Thanks, Dave. I hope I was good at my job. [Laughter]

I think I was hoping to become a better partner with parents. I wanted to show up for them in a different way. I had a lot of knowledge, and I loved working with them, and I loved working with their kids. And I wanted to help them to be able to find joy in their kids. Parenting is so hard. I did this program during the pandemic actually, I graduated with my certificate in 2022. I saw how much everyone was struggling with mental health and with parenting, and parenting in the pandemic.

There’s something in our field that I really love to share, it’s called “good enough parenting,” which is, “it’s OK to mess up.” We teach parents that we repair, there’s ruptures and repairs, and that’s how we teach kids how to be human beings. So yeah, I just wanted to have more than just the technical knowledge. I wanted to be able to show up for parents so that they could show up for their kids.

Miller: Do you feel like you got that?

Williams: I do. I want to go back and do the program all over again. I love it so much.

Miller: Sally, it’s a helpful window to hear Melissa’s experience. You said that there has been, over the years, a little bit of a shift in the careers that people come from for this. What about the level of experience that people bring to this program? How many people are just starting out in their careers, and how many people are like Melissa and are coming to this with significant experience already under their belts?

Guyon: I think it’s more common to have students like Melissa who are coming with a lot of experience and want that really specialized knowledge. Our students, some of them have PhDs. I went through the program after finishing my doctorate. Some of them are home visitors who may just have a bachelor’s degree. It just really depends, and that’s kind of one of the great parts about the program. You are not only learning what’s going to be beneficial to your own profession, but you’re learning more about all the other professions that are supporting children and families, and you’re making connections across sectors. You’re learning who you can reach out to when you’re wondering how you can get more support for a family.

Miller: How much interaction, Melissa, did you have with your fellow students?

Williams: Quite a bit. It was pretty amazing. One thing I really loved about the program is, as an early interventionist, I surround myself with other early interventionists in my day to day work. And in this program, there were only a few early interventionists in my cohort, but there were social workers, preschool teachers and a lot of really diverse early childhood professionals. And actually, Sally was in my cohort, and she had a different kind of job than I did.

So when we did group work, and we would read each other’s papers, it was really fascinating to see the research other people were doing and the kind of work that they were doing. So not only was I doing my own research and writing my own papers, I was getting to learn from these other really diverse professionals.

Miller: Do you have a sense, Melissa, if part of what you’re helping young parents with or often new parents with is attunement or emotional understanding of other people, how much experience do they have themselves with that in their own lives. You’re doing this to help them with their 1-, 2- or 4-year-old. I’m curious how much they’ve been helped, as 30-year-olds or 40-year-olds?

Williams: Everyone comes to this from a different place. I think that’s what’s so beautiful about my job is that everybody has kids, right?

Miller: Well, not everybody, but everybody you deal with has kids.

Williams: Yes, I guess people from all walks of life have kids.

Miller: Everybody was a kid, that’s definitely true.

Williams: Yeah. And everyone that I work with, some people have never held a baby before. Some of the moms I work with, they may have raised all their brothers and sisters. So people are coming to me with all different levels of experience. I get to meet them right where they are, and then we kind of go from there.

And it’s really lovely because the very first time I meet a family, we get two hours together, and I ask them so many questions. Then that’s where we start with that family. So it’s a different jumping off place for each person, so that’s where we start. And for some families, we’re starting at the very beginning, like what do you do with a baby? And for some other families, we’re getting into some pretty deep questions about other deeper mental health things because that’s what they’re interested in.

Miller: Sally, to take a big-picture look statewide and policy-wide, how would you say we’re doing as a state, in terms of policies and practices that support the mental health, or make it easier for adults to support the mental health of really young kids?

Guyon: I would say Oregon is moving in the right direction. It’s been really wonderful to see the different support services that we are receiving from the Department of Early Learning and Care, DELC, the way that the state is looking at opening, eventually, preschool for all children across Oregon [and] how successful that program has been in Multnomah County. And moving toward a really positive spot in making sure that children and families have the access they need.

Miller: OK, moving in the right direction, and you started in a kind of growth mindset with the ways that things are getting better. But what are the challenges?

Guyon: The challenges are, it’s a really difficult job, working in early childhood and supporting children and families, as Melissa really well spoke. Every single person, every single family is a different situation and a different place to start, so you need to be very resilient in your own care. It’s also a job that you’re giving yourself emotionally, cognitively and physically.

Some of the biggest kind of things I see coming down the pike that we might have to work around are just thinking about the work that we’ve been doing since the pandemic. As soon as the pandemic cleared up, there was this need to push children back into school to get them academically ready. And that’s really caused this push down focus of academics in early childhood, when academics in early childhood really should be about social-emotional growing and social-emotional learning.

So what’s happening in a lot of these classrooms is children are feeling a little stressed out because they’re being asked to do things that they’re not developmentally ready for. And that’s when we see these big behaviors, which is just their way of communicating that they’re not feeling safe or there’s a need not being met.

Miller: It makes perfect sense, if there’s a lot of concern and very understandable concerns, say about third grade reading scores, math in seventh grade or whatever, it does make sense, statewide, why there would be an emphasis on “let’s get those skills as early as possible to make sure kids are kindergarten ready.” You’re saying that a more rigorous academic approach to early childhood could actually backfire?

Guyon: A little bit. Because if a child doesn’t have the social-emotional regulation skills that they need to be able to sit through going through a math lesson or being able to follow directions, then they’re automatically going to be responding in ways that look like behaviors that are challenging to a lot of adults. And that causes adults to classify children in maybe a way they shouldn’t be classified.

And when we think about really big picture, this is when children are building their identity and their sense of self. And so if you’re 3 or 4, and you’re constantly getting “in trouble” in your preschool classroom because you are responding to something that’s not comfortable for you to do, then you’re starting to develop an identity that you’re not a good person. So we think about all these big things, but once children have relationships, they have that social-emotional attachment, then they’re excited to explore and learn. If we allow for more opportunities for children to explore and learn, rather than trying to teach into children, but rather let children push out what they’re interested in, then we’re not going to have these worries about academics down the road.

Miller: I’m interested in some of the language you were using there. It went quickly, but it seemed like you were saying, “behavior that adults might identify as challenging,” as opposed to saying, “challenging.” So what’s the distinction there?

Guyon: When we say a child is exhibiting challenging behavior, we are blaming the child. We are putting the ownership on the child. When we say that a child is expressing behavior that adults find challenging, then it becomes the adult’s responsibility to figure out what that child needs to make it better for the child so the child can learn and grow.

Miller: The thinking being, you’re a 2-year-old, and if you’re acting out in this way, it’s because we haven’t given you the tools to not act this way? And it’s up to us to help you, as opposed to just calling you challenging and leaving at that?

Guyon: Yes, you are acting this way because you’re trying to tell us something. It’s our job to listen and figure it out.

Miller: Sally Guyon and Melissa Williams, thanks very much.

Williams: Thanks, Dave.

Guyon: Yeah, thank you so much. We appreciate it.

Miller: Sally Guyon is co-coordinator of the Early Childhood and Inclusive Studies masters program at Portland State University where she is an assistant professor of early childhood care and education. Melissa Williams is a graduate of PSU’s Infant/Toddler Mental Health certificate program. She is an early intervention specialist for the Multnomah Early Childhood program.

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