Relationship builders
The story of how a college center, a
state project, and two remarkable alumni are planting CEEDs to
grow better lives for young children and families in Minnesota
by Mary Beth Leone-Getten
“Do you want to help me put some fur on the bunny?” Mary Zubrzycki
dips cotton balls into glue and pastes them on a paper rabbit, trying
to tempt the involvement of two-year-old Cherish.
Zubrzycki, an early childhood special education teacher, and
Margie Paller, an occupational therapist, both with Minneapolis
Public Schools, sit on the floor in the girl’s Minneapolis home with Jessie Erving,
the child’s great-aunt and foster mother, for a weekly home visit.
Despite the group’s joint efforts to engage her, Cherish is not
interested in the art project, nor is she interested in the live
bunny that the teachers have brought to show her. When a new activity
is introduced, Cherish becomes frustrated and momentarily yells,
stomps, then seeks comfort.
The activity she is most excited about is snack time. While Erving
helps her get the right grip on her spoon, Paller uses illustrated
cue cards to help her with transitions, showing the “snack over”
picture and explaining, “When the pudding is all gone, we’ll throw
the cup in the trash and snack will be done.”
But Cherish screams, cries, and tugs at her hair when her snack
is gone. It is, according to Erving, perhaps the 10th such outburst
of the day for Cherish. From a traditional view of teaching and
learning this might seem like an unsuccessful session. But when
viewed through the lens of the overarching method that Paller and
Zubrzycki employ—infant mental health and relationship-based practice—today
has been a great day for Cherish.
Infant mental health
The field of infant mental health focuses on relationship-based
interaction, with the understanding that relationships are central
to healthy development and that a child is best understood within
the context of the important adults in his or her life.
Paller (M.A., ’89, educational psychology) and Zubrzycki (M.Ed.,
’85, therapeutic recreation; licensed in early childhood special
education and family education) learned about infant mental health
through a class they took offered by the college’s Center for Early
Education and Development (CEED). “Through the CEED course, we were
both formally introduced to the field of infant mental health and
it was like a lightbulb went on for us,” Paller says. “This was
a huge need that we saw firsthand every day and the ideas presented
in class inspired us to learn more about our roles in the homes
we visit,” Zubrzycki adds.
“Humans are vulnerable and dependent on adults for a long time,”
says Christopher Watson, assistant director of CEED, who helped
to develop the course in infant mental health. “The whole point
of relationship-based interaction is to promote that parent/child
relationship because all other development builds on it.”
Professionals who use this approach do not zero in on the initial
diagnosis, but place greater importance on understanding and supporting
the child/family relationship as a means to aid development.
As part of CEED’s mission to expand awareness and effect change
throughout Minnesota about early childhood development, Watson coordinated
the Minnesota Infant Mental Health Project, a cross-agency initiative
funded from 1996 to 2004 by the Minnesota Department of Education.
The project sought to identify the best ways to support the mental
heath of infants and toddlers with special needs, ranging from the
universal need for healthy relationships to intensive therapeutic
intervention.
Under Watson’s direction, project staff conducted a statewide
needs assessment, set forth recommendations, held trainings and
public forums, and produced the course titled Introduction to Infant
Mental Health.
“When we offered the class, student after student—teachers and
therapists alike—said the same thing: ‘I need to know more about
this because infant mental health is the greatest need out there,’”
Watson says.
It was through this course that Paller and Zubrzycki began to
examine their role in promoting infant mental health. Because they
work with parents and young children in their homes, the teachers
realized that they were in a strong position to nurture relationships,
yet both struggled with their limitations to provide a therapeutic
role.
Using the course as a jumping-off point, the teachers embarked
on a joint sabbatical to further define their role in infant mental
health and relationship-based practice and to develop ways to improve
service to families and outcomes for the children they serve.
The pair undertook an exhaustive look at infant mental health,
including an extensive review of literature, curricula, tools, and
strategies for the delivery of services; conducted practice sessions
with families using three intervention models; attended lectures,
workshops, and conferences; and interviewed dozens of professionals
who specialize in parent/infant interactions.
They used many resources from the college to guide their study,
interviewing faculty and staff from CEED, the Harris Center, and
the Institute of Child Development and using the libraries of the
Institute and centers.
As teachers in Minneapolis Public Schools Early Childhood Special
Education’s Birth to Three program, Paller and Zubrzycki work with
a team that includes teachers; physical, occupational, and speech
therapists; social workers; psychologists; and nurses; to serve
children with a wide range of disability designations, including
autism, Down Syndrome, developmental delays, speech and language
delays, and physical, visual, or hearing impairments through weekly
home visits.
Mary Zubrzycki (left) works with Neil
and his personal care attendant.
To best reflect a child’s natural development, the 250 children
in the program are served in settings with their caregivers where
they are likely to be most comfortable. By the late 1990s, Paller
and Zubrzycki, who have worked in the program for 16 and 19 years
respectively, began to feel less prepared to address the complexities
of family needs—including mental health, employment, poverty, and
violence issues—they witness on a daily basis through their work.
Zubrzycki explains it this way: “Sometimes I would begin to uncover
a family’s needs and think, I’m not a therapist—this is out of the
scope of my practice, expertise, and knowledge.” However, both knew
that they were in a unique position to consider the whole reality
of the children they serve, and felt good about their ability to
develop relationships with the families. While they understood that
each child’s success is linked to the stability of their home life,
their professional training did not teach them about their role
in supporting or helping to create a healthy home life.
Learning and unlearning:
Changing their practice
In relationship-based practice, teachers seek to partner with
families, rather than instruct, removing the barriers that the “teacher
as expert” scenario creates. Instead practitioners seek to understand
the environment, share information, and problem-solve and work through
challenges together with the family. This approach promotes greater
parent involvement, self-observation, and discovery.
Both practitioners describe their work with families in the past
as one of “doing.” Now, by putting relationship-based practice at
the center of their work, they have shifted the focus from “doing”
to “being”—creating an agenda with the family rather than imposing
their own agenda on the family.
It is a role where keen observation, dialog, listening, and self-reflection
become as important as the special education services they provide.
“I have slowed down, become more observant, and less fearful of
asking questions,” says Paller. “I understand how important it is
that each parent has the opportunity to share his or her experiences,
feelings, and desires for their child, and how that knowledge and
trust is crucial to our success with the child.”
This approach first seeks to understand each family’s reality.
Encouraging dialog about the successes and challenges that have
occurred since the last visit gives parents and caregivers a chance
to voice their perspectives and be heard, further validating their
role as an essential member of the team. “Parents know the child
and we know the educational theory and practice,” says Zubrzycki.
“Together we address the whole child.”
Paller and Zubrzycki use a method called “parallel process” that
Jeree Pawl, a leader in the field of infant mental health explains
as, “Do unto others as you would have others do unto others.” In
other words, home-visiting professionals should nurture parents
in the manner that parents should nurture their children.
Margie Paller (left) and Mary Zubrzycki tempt Cherish
with a cottonball.
“In our practice, we strive to interact and treat the parent
with caring, respect, and nurturance so that the parent can care
for his or her baby in the same way,” explains Paller. “We learned
that listening, acknowledging, and affirming parents can be valuable
therapeutic techniques themselves.”
Adults who are recognized and affirmed for their role in parenting
are much more able to pass on those positive feelings to their child.
That means acknowledging the reality of the parent, active listening,
and eliciting parent opinions, feelings, and frustrations, even
if teachers don’t have all the answers.
Getting more help
“Before we began to study infant mental health, I was quite fearful
of getting too involved because it might open this Pandora’s Box
of feelings and issues that I wouldn’t know how to respond to or
solve,” says Paller.
Both teachers admit to intentionally not asking questions for
fear of uncovering problems that they might not be trained or qualified
to address. Although they usually could identify the problems—things
like depression, or family violence—and knew of resources to help
the family, they often felt ill-equipped to broach the subject.
When they did work up the courage, the families almost never acted
on the suggestion.
Paller used her sabbatical to address this issue, and developed
a model and guidelines for home interventionists to follow to make
successful referrals for other services. “Making a successful referral
is not just about exchanging a business card,” says Paller. “It
is about establishing trust and planting the seeds over time, until
the family is ready to take the next step.” Paller found that additional
support—such as accompanying the family to an appointment—helps
teachers act as a bridge to other services, then allows them to
step back.
After the study, the teachers redefined their main role as one
of facilitating relationships, while fulfilling three responsibilities:
promoting the parent/child relationship, working toward meeting
established educational goals for the child, and making referrals
when the child/family requires more intensive assistance in any
area.
The impact of the CEED project goes beyond Paller and Zubrzycki
as they have shared their knowledge with colleagues through the
Minneapolis school system. They’ve written articles for district
bulletins, are active on their staff development committee, and
have initiated training sessions and presentations for colleagues
focusing on infant mental health. They’ve created handouts and tip
sheets for school staff and have shared with CEED the knowledge
they’ve gained from their sabbatical research and consequent changes
in practice. Their goal is to help to improve the CEED class that
started it all.
Promising outcomes
We know things are going well when the parent meets us at
the door, so excited to tell us about a child’s latest
milestone.
Although Paller and Zubrzycki haven’t, through formal research
methods, tracked changes in their outcomes with families since adopting
infant mental health practices, the anecdotal evidence is promising.
Removing the barriers of “teacher as expert,” and paying closer
attention to each family and child’s reality has led to better attendance,
more productive sessions, fewer conflicts and power struggles, and
a feeling of mutual respect and collaboration to serve the child.
“We know things are going well when the parent meets us at the
door, so excited to tell us about a child’s latest milestone,” adds
Zubrzycki.
To understand how this model has helped Cherish progress under
her aunt’s care, it helps to see how far she’s come. In addition
to the problems associated with being drug-exposed in utero, Cherish
was moved to three different foster homes before she turned two,
and has been diagnosed with reactive attachment disorder. In addition
to Paller and Zubrzycki, Cherish is served by a speech pathologist
and physical therapist, part of the Minneapolis Public Schools team
that handles her care.
“When Cherish first came into my home, she behaved in ways I’d
never seen a child do before—constantly banging her head, biting
and scratching herself, pulling her hair, and stuffing herself with
food—even from the garbage can,” says Erving, the mother of two
teenage kids and foster mother to Cherish’s one-year-old sister.
A happy Neil with mom,
Christine Brown.
One year later, through cooperative sessions with Paller and
Zubrzycki, Erving has helped Cherish learn to interact in a way
that is not far from that of others in her age group. During the
sessions, Erving’s input and interaction is solicited and praised.
“My role is to be right down there with the teachers, interacting
with Cherish as they do,” says Erving.
Over a few months of visits, it became obvious to Paller and
Zubrzycki that Erving might need some additional help to care for
the child. Slowly, as their relationship developed, they offered
information and then referrals for respite care and mental health
services. Eventually, Erving took them up on both, giving herself
some needed time off and additional support for Cherish’s mental
health needs.
Today, Cherish has learned to communicate some of her needs—a
big step. Her teachers note that, with Erving providing a safe foundation,
Cherish still has tantrums that are more frequent and intense than
most kids her age, but she is now better able to calm herself down.
When asked about her hopes for Cherish’s future, Erving says,
“Let me put it this way—I want this little girl to get better and
have a good life. I know our work with Cherish is a long haul, but
I feel like I can do it with Mary and Margie—we’re in this together.”
Building the right team
At another home visit, Zubrzycki works with Neil, a grinning
two-year-old boy, and his parents Christine and Doug Brown, and
his personal care attendant, Michelle. Neil was born at 37 weeks
weighing just over four pounds, was chronically fussy, and gained
weight slowly.
The parents of three other children, the Browns knew something
was wrong immediately, but it took them months, and dozens of doctor
visits, to get the diagnosis: cerebral palsy, a disorder that causes
impaired control of movement of varying severity. Today, Neil uses
a feeding tube to get most of his nutrition, and uses a walker.
Today’s session is a scene of collaboration. Although Zubrzycki
is the only licensed teacher in the room, it is clear that everyone
present plays a big role in Neil’s care—a hallmark of successful
relationship-based practice.
At Christine’s suggestion, they use a toy microphone to encourage
Neil to vocalize—he’s still learning to talk. As he happily shouts
into the toy, Zubrzycki thanks Christine for the idea. Next, Zubrzycki
leads the group in songs that use a variety of motions—shaking,
clapping, rolling, and jumping to practice different kinds of motor
control.
When it is time to practice walking, Zubrzycki gives a running
commentary: “I’m helping you stand up. Walk to Mom. Okay, want to
come back to me?” When Neil loses interest, Michelle tells Zubrzycki
that Neil loves his bouncing Tigger doll, so they use the toy as
a goal to get him to cross the room.
Christine views her job to be building the best team to support
her son, and has changed care providers in the past—even if they
worked well with Neil—because they didn’t share the Browns’ team
vision. “We open our home to these people, and we can’t help our
son progress if we don’t all respect one another,” she says.
Perhaps the best endorsement of what Paller and Zubrzycki have
done for the family comes from Doug: “I was always scared to handle
Neil, thinking he was fragile, but this team of teachers has helped
me become much more comfortable with my son. Now, I’m not afraid
to hug and play with him, and I have the confidence that I know how to do it right.”
See also:
Babies and Toddlers R Us
College research and service centers with a focus on young
children
Center for Early Education and Development
(CEED)
Minnesota Infant Mental Health Project
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