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Recently, California named Child-Parent Psychotherapy as one of the evidence-based practices selected for the state’s Children and Youth Behavioral Health Initiative. With $4.4 billion allocated to the initiative, being named in the grant is both a recognition of CPP’s impact and a springboard for training and treatment. It is also an opportunity to celebrate other policy changes that support CPP implementation.
There are ongoing efforts across multiple U.S. states to update Medicaid billing codes to reflect the value of CPP:
- In Arkansas, CPP-rostered clinicians are eligible for a 10% increased reimbursement rate.
- In Minnesota, clinicians can bill the foundational phase (up to four sessions) under the DC:0-5 code.
- In Missouri, CPP has been added to the MO Health Net’s list of evidence-based therapies.
- In North Carolina, one agency negotiated Z-codes for in-person, video, and audio CPP sessions.
Beyond Medicaid, four states—Arkansas, Florida, Ohio, and Washington—have selected CPP as an evidence-based practice in their state plans for the Family First Prevention Services Act, which codify CPP in state systems of child welfare and trauma-informed care.
These policy achievements would not have been possible without the assiduous efforts of many CPP champions. We thank each and every one of you for tilling the earth and helping CPP to flourish. And, of course, this is not an exhaustive list: if you or someone you know is promoting CPP through policy work, please let us know.
Voices from the Field
Our community is growing and thriving! CPP is now implemented in 7 countries and 48 U.S. states and territories. In this and future newsletters, we are spotlighting the voices of our international community so that we can all celebrate the spread of CPP throughout the world.
Current Australian CPP LC Cohort (AUS CPP LC 2022-24)
Previous CPP LC Cohort (AUS CPP LC 2020-22)
Dr. Julie Larrieu at Cape Schanck in 2017
Australia has a thriving infant and early childhood mental health workforce, informed by developmental and psychoanalytic theories. Practice is also awakening to the ways of knowing of Australia’s First Peoples, one of the world’s oldest continuous living cultures.
Beginning in 2016, Dr. Julie Larrieu and Dr. Chandra Ghosh Ippen have led four CPP Learning Collaboratives (LC) in Australia, with a fifth scheduled for November, 2023. LCs have been run in partnership with the South Australian Branch, Australian Association of Infant Mental Health and the child welfare organization, Berry Street Victoria. To date, 60 clinicians have completed CPP training, and 27 clinicians are currently in training.
In collaboration with La Trobe University, Berry Street conducted a feasibility study, including qualitative interviews, of CPP for family violence populations. The impact of CPP on participants’ lives and relationships will be no surprise to the broader CPP community:
“It just had such an amazing impact on all three of us and I'd do it again and again just for the things that I learnt and the things that my girls learnt and the things that we learnt together. I feel like to a degree they got their mummy back” (Hooker et al., 2022).
The Australian CPP workforce is rapidly expanding across a dozen public mental health and community services. Our team is growing a community of practice to sustain professional development; additionally, Berry Street Victoria is piloting the CPP Agency Mentorship Program implementation model.
Dr. Chandra Ghosh Ippen enjoying her first Australian meat pie in 2023
Several Australian CPP clinicians and systems leaders will present their work at the upcoming WAIMH Congress in Dublin, Ireland. The Australian CPP community is looking forward to continuing to foster connections across the seas on behalf of our youngest citizens.
For more information please contact firstname.lastname@example.org.
Honoring Our Angels
More than 40 years after her premature death at age 63, the revelatory power of Selma Fraiberg’s writings and her insights into the inner world of babies remain as revolutionary as ever. She had a gift for noting the transcendence of seemingly ordinary moments in the lives of babies and their parents—an averted gaze, a forlorn cry, a brief but tender touch. In relationships that appeared angry, hopeless, and chaotic, Selma found pathways to understanding, empathy and repair. Nobody has written with greater clarity and emotional force about the desperate maneuvers we employ to fend off unspeakable fear and despair. Babies spoke to her and felt seen and heard. So did their parents.
Selma created infant-parent psychotherapy to free the earliest relationship from the burden of un-exorcised ghostly memories, and her approach remains unparalleled in its healing power. She helped us understand that we may recall what happened to us in vivid detail but must also remember how those events made us feel before we can learn to transform terror and rage into compassion and love.
Dr. Selma Fraiberg
As a social worker and a psychoanalyst, she understood that material needs cannot be separated from emotional needs and intellectual achievement. She advocated for public policies that protected children and families at every level—access to basic resources, physical and mental health care, and reforms to education, child welfare and judicial systems.
More than a clinician, Selma was a humanist, whose commitments extended from the intimate sphere of the psyche to the communal space of society. The field of infant and early childhood mental health would not have flourished as it has without her unmatched contributions. May her legacy continue to bring solace to young children and families in pain and to the clinicians who endeavor to help them find hope and joy in each other.
Carmen Rosa Noroña, LICSW, and Patricia Lakatos, PhD, are leading the cultivation of a new generation of bilingual providers. Carmen Rosa created the Spanish-speaking consult call group seven years ago, as part of a SAMHSA grant. Now as co-facilitators, they continue to lead the monthly consult call group for any of the 120 registered participants. Through case review, they explore the dynamics of culturally and linguistically appropriate service provision for Spanish-speaking families affected by trauma.
Clinicians who experience inequities in the workplace are at risk of vicarious trauma, burnout and secondary traumatic stress. Many bilingual, BIPOC, or immigrant clinicians struggle with witnessing the same effects of structural oppression in their clients as they encounter themselves. For instance, bilingual providers are often asked to carry large caseloads with complex issues and perform additional informal roles as interpreters, translators, or cultural brokers. The Spanish-speaking consult call group seeks to mitigate these negative effects with a reflective space where participants can:
Trained as a clinical psychologist in Ecuador and now working as a clinical social worker in early childhood mental health in the USA, Carmen Rosa Noroña draws on her immigration experience to tackle issues of racism, displacement and trauma in early childhood at Boston Medical Center. Carmen Rosa is also a member of the Steering Committee of the National Child Traumatic Stress Network (NCTSN) and a co-chair of the NCTSN Latin American Children and Families collaborative group. She appreciates how CPP validates the diversity of Latin American families by encouraging clinicians to engage in self-exploration of their values, beliefs and biases.
Patricia Lakatos has been training in CPP for a decade. To her, CPP felt in-sync with her background, specifically the psychoanalytic foundation from her initial training in Argentina and her dyadic, trauma-informed work at Children’s Hospital in Los Angeles. She began collaborating with Carmen Rosa on reflective supervision before joining the Spanish-speaking consult call group as a co-facilitator. Though she works alongside many Spanish speaking clinicians, Patricia nevertheless cherishes the connection with people from all over the country and the exploration of diverse cases and issues in the Spanish-speaking CPP space.
Many participants have affirmed the call group’s value, “People find this to be a very rich experience,” says Patricia, “This is their monthly opportunity to think with others about these types of issues.” She also noted that relationships between call participants have strengthened during difficult times and recent social justice movements. Carmen Rosa highlighted the call group’s validation of the power of CPP, particularly the way the model honors the rightful place of the caregiver and non-dominant ways of knowing and being. One provider even based her dissertation on research from the call group. Both co-facilitators are excited to sustain the space and hope that additional call groups will arise for other languages. “It’s not just the language,” says Carmen Rosa, “It’s about all the things that language represents.”
To apply to join the Spanish-speaking consult call group, fill out this survey.
Joy D. Osofsky, PhD, is a Senior CPP Trainer who has conducted CPP trainings in Arkansas, Florida, Hawaii, Iowa, Louisiana, Nebraska, New Hampshire, and New Jersey, as well as in Hong Kong. She has mentored 14 CPP trainers and worked with multiple systems, including the courts and police, on behalf of babies and young children. Last month, she testified before Congress, offering commentary on the youth mental health crisis in the United States. Her testimony is the latest installment in a rich career that has established Joy as someone who builds things where they do not exist.
As a young professor at Cornell University, Joy reached out to infant and early childhood mental health leaders, including Urie Broffenbrenner, Berry Brazelton, Sally Provence, Albert Solnit, Selma Fraiberg, and Stanley Greenspan. Their mentorship, combined with her own work with adolescent mothers and babies, fueled a lifelong passion to help others better understand the impact of trauma on attachment relationships and development. Joy shared this knowledge with any who would listen and even helped systems, including juvenile courts, that typically had not thought much about infants and young children.
Dr. Joy Osofsky
One of our favorite stories is how earlier in her career, before most mental health professionals were attending to trauma, Joy and her Violence Intervention Program team began approaching high-violence police districts. They attended roll call repeatedly. “We kept showing up until they asked what we wanted.” For those of us who know Joy, we know what she wanted—she wanted them to better understand the effects of trauma on children, their development, and relationships. They earned their seat at the table and were able to provide training to the police officers on trauma-informed practice and also do “ride-alongs” with police. Joy noted that, at first, most officers were unreceptive, “They kept fidgeting [with their police batons], waiting for it to be over. However, at the next training, they told us that a child had been shot right before [this] roll call. They said, ‘We get what you are talking about.’”
In 2000, as the Child Trauma Research Program was applying for a grant to form the Early Trauma Treatment Network (ETTN), one of the original 12 sites of the National Child Traumatic Stress Network (NCTSN), we knew that we needed Joy’s expertise and incredible persistence. We began a partnership with her team at Louisiana State Health Sciences Center along with outstanding leaders at Tulane University Medical Center, and Boston Medical Center. The ETTN collaboration led to the dissemination of Child-Parent Psychotherapy across the NCTSN and beyond. Also, in collaboration with NCTSN following major disasters, she and her team used CPP to support young children and caregivers.
Joy was drawn to CPP because of the model’s emphasis on relationships and belief in talking about attachment, trust, and trauma. Also, because in her experience, “CPP is very well received by clinicians, as well as lawyers and judges.” She partnered with Judge Cindy Lederman, in Florida, to develop a program that has grown into Safe Babies, a court model that is widely disseminated by Zero to Three.
Years of such assiduous, deliberate work have elevated Joy as a leader. She has been President and serves on multiple boards of IECMH organizations, including Zero To Three and, the World Association for Infant Mental Health. In addition, she was recently elected to be President of Division 7 – Developmental Psychology of the American Psychological Association.
Looking forward, Joy plans to continue her work with Safe Babies while also elevating the importance of parent care, “We also need to support parents...whether in child welfare or with mental health problems with children. We need to support parents also receiving self-care so they can be emotionally available to their children.” As with her previous work, these endeavors will doubtlessly reshape the landscape of IECMH and brighten the world for the future generations. Thank you, Joy.
Oh, The Places We've Gone...
After speaking with Joy Osofsky about the impact of CPP, Judge Lederman began to order CPP and early intervention screening from the bench. Through a partnership with the ZERO TO THREE Fellowship Program, the team attracted judicial interest in how courts could attend to the needs of young children and their families. The first Safe Babies™ court teams were initiated in 2005, and the approach has since influenced and been implemented in 124 sites in 28 states. The goal of the approach is to keep families together by igniting collective action to meet the urgent needs of babies, toddlers, and their families. It’s an opportunity to collaborate and build capacity to effectively serve families across all areas of need.
Mike Sherman, PsyD, is the Infant and Early Childhood Clinical Manager within the Safe Babies Court Teams program at ZERO TO THREE. In his role Mike seeks to reconcile the design of child welfare and mental health systems with the dynamics of trauma and early childhood development. “Mental health systems are modeled around an adult system of care, which does not easily lend itself to the determination of medical necessity or treatment planning for infants and young children in the child welfare context. You need an intensive amount of training to identify trauma symptoms and implement effective treatment strategies with young children and families.”
While Safe Babies court teams aren't confined to a specific treatment modality, the approach's orientation to attachment theory and relational work (both between the parent and child as well as between the system and the dyad) maps naturally to Child-Parent Psychotherapy. Mike noted that in child welfare meetings, CPP providers often serve a co-regulating presence and provide incredibly valuable input related to understanding the child and family through a developmentally-informed and trauma-responsive lens.
One of the biggest achievements of the Safe Babies program is integrating the concept of reflective practice–another core aspect of CPP–in Safe Babies court teams. Mike notes that trauma-infused systems often reactively reach for the most expedient fix. “Reflective practice helps us sit with the discomfort of not knowing the right answer,” he says, “We can get into a more regulated state, which unlocks the parts of our brain that can empathize and analyze.” At Safe Babies court teams, being able to sit with the nuances of their work has yielded practical benefits as well as a deeper appreciation of how everyone’s work filters down to families and children.
Dr. Mike Sherman
Safe Babies teams will continue to engage partners in aligning and integrating early childhood systems to strengthen communities and build equitable supports and services that address the needs of infants, babies, and their families. The work of Safe Babies, Mike says, echoes the words of Stanley Greenspan, “If our society were truly to appreciate the significance of children’s emotional ties throughout the first years of life, it would no longer tolerate children growing up or parents having to struggle in situations which could not possible nourish healthy growth.”
Melissa Bond, PhD, completed her pre-doctoral internship and postdoctoral fellowship at the Child Trauma Research Program before starting as an Assistant Professional Researcher in 2023. In this role, Melissa combines her clinical knowledge, research acumen, and web development experience to develop and manage databases, assist in advanced user experience needs, and provide methodological and research support. She is looking forward to further developing CTRP’s research efforts to better understand the nuances of CPP both at the “Mothership” and in the broader community. In her free time, Melissa is usually training with her dogs, cooking (and eating) good food, and playing video games.
The Road Ahead
The 18th World Association for Infant Mental Health (WAIMH) World Congress will be held later this month. The theme of this year's colloquium is Early Relationships Matter: Advancing Practice, Policy, and Research in Infant Mental Health. Many accomplished professionals will share their expertise and experience, including nineteen CPP Trainers! Information about their presentations* is below.
* The names included below are only the CPP Trainers affiliated with the presentations, not an exhaustive list of authors or contributors. We believe this list includes all submissions by CPP Trainers but sincerely apologize if we missed a person or presentation. The Congress will also feature non-trainer members of our CPP community. While their presentations are too numerous to list here, we celebrate their work and encourage you to explore them!
** Below, indicates Poster Workshop Presentations.
Sunday, July 16
- **Child-Parent Psychotherapy to Address Trauma and Grief: “There’s a Monster in the House!” (Devi Miron Murphy, Julie Larrieu) 12:15-1:15pm
- **Confronting Organizational Inequities: Assessment, Barriers, Consultation and Change (Carmen Rosa Noroña) 12:15-1:15pm
- **Intergenerational Health: Lessons Learned from the Opioid Crisis in Maryland (Kathleen Connors) 12:15-1:15pm
- **Impact of Opioid Crisis on Young Children and Family Needs Assessment Survey (Kathleen Connors) 12:15-1:15pm
- **Child-Parent Psychotherapy with Infants Hospitalized in the NeonatalIntensive Care Unit (Tamara Matic, Marian Williams, Patricia Lakatos) 1:15-2:15pm
- Transdisciplinary Approach to Address Sensory Developmental Challenges for Infant and Early Childhood Professionals (Paula Ray) 2:30-4:00pm
- Embracing Structural Humility to Advance Equity in Mental Health Services for Families Experiencing Trauma (Sufna John, Lili Gray, Donna Potter) 4:30-5:30pm
- Benevolent Childhood Experiences and Social Support Promote Maternal Fetal Attachment Despite Adversity (Jody Manly, Sheree Toth) 4:30-6:00pm
- Mentoring in Infant Mental Health: A Symposium Commemorating Robert N. Emde (Alicia Lieberman, Markita Mays-Barideaux) 4:30pm
Monday, July 17
- How Can Perinatal Research that Integrates Developmental Neuroscience Help Us Interrupt Intergenerational Violence? (Erica Willheim) 10:45-12:15pm
- Clinical Decision Making for Young Children with Posttraumatic Stress Disorder (Devi Miron Murphy, Julie Larrieu) 1:15-2:15pm
- **Meeting the Need: A Three State Comparison: Right Start for Colorado's Workforce Development Efforts (Shannon Bekman) 1:15-2:15pm
- Revisioning an Inclusive and Liberating Stance in Reflective Supervision Practice (Carmen Rosa Noroña) 2:30-4:00pm
- Centering Critical Consciousness, Critical Self-Reflection, Racial Equity and Inclusion in Reflective Supervision/Consultation (Carmen Rosa Noroña) 4:30-5:30pm
- Bootstrapping Sustainability: Building Statewide Capacity for Early Childhood Trauma Intervention (Cathleen (Cassie) Yackley) 4:30-6:00pm
- New Fathers' Experiences with an Individual Conversation with the Child Health Nurse (Pamela Massoudi) 4:30-6:00pm
- International Perspectives on the Effects of Trauma on Young Children (Joy Osofsky) 4:30-6:00pm
Tuesday, July 18
- (Re)considering the "Table" while Adding More "Seats" - Diversifying the Infant Mental Health Workforce (Haruko Wanatabe) 10:45am-12:15pm
- Continuum of Infant Mental Health Services for Medically-Fragile Infants: Prenatal to Hospital to Home (Marian Williams, Tamara Matic) 1:15-2:15pm
- "Pandemic as Portal": Lessons learned from Dissemination of the Diversity Informed Tenets (Carmen Rosa Noroña) 1:15-2:15pm
- Illuminating the Importance of Responsive Relationships through Diagnostic Case Studies (Joy Osofsky) 2:30-4:00pm
Our team is currently engaged in developing a strategic plan to support the long-term sustainability of CPP. This work would not be possible without the support of Perigee Fund. Our partnership with Perigee Fund began with a statewide implementation of CPP in Washington State and the training of two Washington State Trainers, Haruko Watanabe and Mindy Davis, in collaboration with the Barnard Center for Infant Mental Health and Development. We are grateful for Perigee Fund’s dedication to deep infant and early childhood mental health practice in their home state and across the country. Through their incredible policy efforts and their thoughtful support of equitable, sustainable practice, they are helping ensure that practices like CPP endure for future generations.