Interfacing Infant Mental Health Knowledge: Perspectives of South African Supervisors Supporting Lay Mother–infant Home Visitors

Abstract

This article is part of a project investigating the interfacing of clinically and research-generated knowledge in the field of infant mental health (IMH) with local cultural models of child care and development. The article explores the experiences and challenges reported by psychology-trained supervisors in supervision with local, lay, trained home visitors. Supervisors and supervisees were drawn from two early intervention programs which apply relational IMH mental health models in socioeconomically deprived townships in South Africa. Literature that considers supervisors' experiences of conducting supervision with lay counselors has been limited, and even more so in settings where there are marked cultural and contextual differences between supervisors and supervisees. These differences pose particular challenges regarding the finding of a shared theoretical understanding of the work as well as to the establishment of a secure working alliance. While it was found that psychoanalytic and attachment-informed theories of infant development are applicable in these South African settings, differences in race, language, education, socioeconomic status, and culture between supervisors and supervisees challenge the supervisor-supervisee relationship and require psychological processing and creative solutions to ensure integrity in the application of the model.

Integrating infant mental health practice models in nursing

“…Culturally competent care and the use of interpreters was also a very important component identified that needs to be considered when implementing interventions identified in the care plan (Bain & Baradon, ; Berg, ). For attachment‐based interventions, careful consideration regarding the resources available to the family or risk factors like untreated mental health problems, unemployment, or housing should be addressed before the implementation of attachment‐based interventions, for more effective treatment (Wotherspoon, & McInnis, ).…”

Lay counselors: Thoughts on the crossing of ecological frameworks and the use of lay counselors in the scale up of early infant mental health interventions

“…This has implications for the skill levels of the staff offering the supervision. Because supervisors are often called on to manage processes that can extend into quasitherapeutic spaces (Bain & Baradon, ), specialized, therapeutically proficient professional staff are required for adequate supervision. The use of nonprofessional peer supervision has been found to be insufficient in programs where lay mental health workers work with at‐risk populations (Daniels, Nor, Jackson, Ekström, & Doherty, ; Petersen et al., ).…”

“…Balancing the home visitors’ needs to be heard with organizational constraints is challenging. While organizational tensions can be processed to some extent within the supervision space (Bain & Baradon, ), management also has been required to address these challenges. Some of the solutions created were to formalize management accessibility through regular staff meetings.…”

“…While additional training can offer opportunities for parent–infant home visitors to become trainers and peer supervisors or to work in other nongovernmental organization programs, the potential for reaching professional levels is limited. This leads to understandable envy and resentment, which then also require management within the supervisory relationship (Bain & Baradon, ).…”

The challenge to prioritise infant mental health in South Africa

“…Work with infants, in particular, requires additional skills and knowledge, since much of the work is non-verbal, and work with at-risk infants demands an emotional toll – feelings of helplessness and fear are intense (Baradon & Bain, 2016; Jones, 2018). Thus, the work also requires regular reflective supervision for infant mental health practitioners (Bain & Baradon, 2018). The need for specialist skills, the time required for intervention, and the need for supervision make these services expensive.…”