Infant mental health training had its beginnings in the Child Development Project, a research unit at the University of Michigan engaged in longitudinal developmental studies of infants blind from birth (Fraiberg, 1977). This work identified the unique adaptive problems of blind infants and the extraordinary emotional and interaction challenges facing their parents who had to overcome significant problems to experience themselves as adequate parents. Well-trained clinician-researchers responded to the concerns of these parents and infants. Building on the understanding and methods developed with these families, the clinician-researchers developed the first infant mental health program for blind infants and their families. Subsequently, these ideas were developed into diagnostic and treatment methods for another population, high-risk, emotionally impoverished infants and their families. In this new approach to mental health, there was, of course, no resource of "infant mental health specialists," and so the program included training that served both staff education needs as well as that of graduate students and residents in the program. Very soon after its inception in 1972, the Child Development Project's Infant Mental Health Program collaborated with the Michigan Department of Mental Health to begin a training program for professionals already working in community agencies in the state mental health system (Fraiberg, 1980; Shapiro, Adelson, & Tableman, 1978). From these auspicious beginnings, training in infant mental health has evolved in many directions.

Consideration of some current training challenges may benefit from first framing the question "What is infant mental health?" The phrase has somewhat different connotations depending on whether we are talking about infants, about practitioner education, or about infant mental health practice. In discussions about infants, infant mental health is defined in terms of well-being-healthy social and emotional development. In relation to practitioner education however, infant mental health has primarily been defined in terms of salient areas of knowledge-the infant-toddler knowledge base-including areas such as infant and toddler development, developmental theory, infant-parent and family relationships, indicators of functioning across the full range from wellness to extremes of unwellness, and circumstances that support, strengthen, or undermine wellness. In infant mental health practice, direct services embrace work with children, with parent-child dyads, and with families who may face few or many of the risk factors that undermine wellness. Across this diversity of services, the work itself involves understanding of practitioner-family relationships, effects of relationships on relationships (relationship-based practice), and reflective supervision. Clearly, these suggestive meanings are not mutually exclusive and are certainly incomplete, but this delineation does display the breadth of meanings connoted by the phrase infant mental health. These differences have not always been clearly articulated in discussions of training or of practice and contribute to some ongoing debates and disagreements within the infant mental health arena.

Some confusion has emerged as the term infant mental health has expanded in meaning spurred by growth of discipline-specific knowledge and characteristics of specific practice settings. For example, the meaning of "infant mental health practice" has broadened to include promotion, prevention, preventive intervention, and treatment. The term "infant mental health specialist" has also expanded to accommodate the specialties of a range of disciplines, in addition to mental health, that make essential contributions to the well-being of infants, toddlers, and their families. These paths of evolution have resulted in confusion about types of direct service and the specific skills and knowledge necessary for individual practitioner competence in a variety of practice settings; these confusions must be sorted out in training programs so that training objectives can be clearly envisioned.

Training concepts have been influenced by several important sources. ZERO TO THREE has been at the forefront of training, both through its fellowship programs and conferences as well as initiatives such as the interdisciplinary TASK project. The World Association for Infant Mental Health also has provided leadership through the Infant Mental Health Journal, international conferences, and activities of state chapters. In recent years, a number of formal training programs have developed in locations around the world (for examples of these programs, see http://www.zerotothree.org). Irving Harris provided leadership by his longstanding commitment to ZERO TO THREE and financial assistance through the Harris Foundation's support for training (Harris Network, 2004). Experience gained in workshops, academic courses, staff development initiatives, and other training venues has increased our understanding of significant training issues that continue to be topics of discussion and debate. For example, use of self and reflective practice concepts have increasingly been recognized as important additional emphases in training at all levels. Best practice standards and approaches to certification, credentialing, or licensing are emerging as areas for careful thought.

In a recent retrospective on building professional competence in the new infant-family field, Eggbeer, Mann, and Gilkerson (2003) identified the extensive and ever-growing character of the infant-toddler knowledge base as among the challenges to training. Drawing on lessons learned over the past quarter century in the infant mental health arena to provide some perspective for future training directions, Eggbeer and colleagues concluded that (1) all individual practitioners deserve training and support, (2) all individuals working with infants and toddlers need a professional development plan that assists them in developing essential skills in self-awareness and reflection, and (3) all individuals working with infants and toddlers deserve a work environment that values and supports their efforts to learn, to observe closely, and to strive to be more responsive to the children in their care and to the parents of those children. These recommendations highlight that training and support should be readily available to all practitioners; that self-awareness and reflection are essential skills regardless of the particular type of work with families; and that program competencies are as essential as are individual professional competencies (Bertacchi, 1996; Weston, Ivins, Heffron, & Sweet, 1997).

The articles in this special issue offer views on established training practices and present examples of new directions represented in current training activities. Training as used in this special issue comprises initiatives for training with diverse objectives. This includes introducing reflective practice to all staff of a state's Part C programs, educational programs for individual practitioners, and training for program competence. Ideas offered in these contributions suggest that focusing only on knowledge bases or individual practitioner preparation no longer meets identified needs in infant mental health practice. Both training and practice require relationship-based organizational models that enable programs and agencies to provide relationship-based services to families, to support all practitioners to understand the role of reflection in their work, and, as emphasized here, to facilitate ongoing professional development for all staff. These conclusions set an exhilarating and demanding agenda for future training that embraces all levels and types of infant mental health practice.

Donna R. Weston, PhD

Special Issue Editor, Department of Family and Child Nursing, University of Washington, Seattle

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