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.

The recent call for the scale-up of evidence-based early childhood development interventions, in lower and middle-income countries and for minority groups in high-income countries, has seen numerous suggestions to train greater numbers of lay mental health workers to fulfill these functions. While studies have found that concepts from developed country settings, such as attachment, parental sensitivity, and containment, find purchase and relevance within developing settings, the management of contextual and cultural factors and the tensions of cultural interfacing in the rollout of these programs in developing country settings require consideration. Drawing on the experiences of two successful South African mother-infant home-visiting programs as examples, this article discusses some of the challenges in provision of attachment-based infant mental health programs and highlights the need for careful consideration of a number of factors pertaining to the recruitment, supervision, and management of lay mental health workers before large-scale rollout is conducted.

La reciente llamada para aumentar proporcionalmente las intervenciones sobre el desarrollo en la niñez con base en la evidencia, en países de ingresos más bajos e ingresos medios, y en el caso de grupos minoritarios en países de ingresos altos, ha visto numerosas sugerencias para entrenar un mayor número de trabajadores laicos de la salud mental que puedan realizar estas funciones. Mientras que los estudios han concluido con que conceptos provenientes de ambientes de países desarrollados, tales como afectividad, sensibilidad de los padres y contención, venden y encuentran relevancia dentro de escenarios de países en desarrollo, el tratamiento de factores contextuales y culturales y las tensiones de interconexiones culturales en la introducción de estos programas en escenarios de países en desarrollo requiere consideración. Utilizando las experiencias de dos exitosos programas madre-infante de visitas a casa en Sudáfrica como ejemplos, este artículo discute algunos de los retos en cuanto a la provisión de programas de salud mental infantil basados en la afectividad y subraya la necesidad de la cuidadosa consideración de un número de factores referentes al reclutamiento, supervisión y dirección de trabajadores laicos de la salud mental antes de que se lleve a cabo la introducción a gran escala.

L'injonction récente à intensifier les programmes d'intervention de développement de la petite enfance fondés sur des données probantes, dans des pays en voie de développement, et pour des groupes minoritaires dans les pays riches, a déclenché de nombreuses suggestions de formation d'un plus grand nombre de travailleurs laïcs de la santé mentale afin de remplir ces fonctions. Alors que des études ont établi que des concepts issus de contextes de pays développés, tels que l'attachement, la sensibilité parentale et la discipline trouvent acquisition et raison d'être au sein de contextes développés, la gestion de facteurs contextuels et culturels et les tensions d'interfaçage culturel dans le lancement de ces programmes dans des contextes de pays en voie de développement exigent d'être considérées et tenues en compte. A partir des expériences de deux programmes de Visite à Domicile Mère-Nourrisson Sud- Africains comme exemples, cet article discute certains des défis dans la prestation de programmes de Santé Mentale du Nourrisson basés sur l'attachement et met en lumière le besoin de considération attentionnée à un nombre de facteurs ayant trait au recrutement, à la supervision et à la gestion de travailleurs laïcs de santé avant que soit lancée une version à grande échelle du programme.

The "dreamer" by daylight: imaginative play, creativity, and generative identity.

This paper attempts to answer the question: Why, when most children play imaginatively, do so few go on to become creators? The author reviews ideas about the interplay between psychic reality, imaginative play, and creativity, elaborated by generations of researchers since Freud first linked these. The transformational process of play is seen to cultivate a multifaceted inner world and greater complexity of the creative capacity. Developmental themes, age-specific preoccupations, and the changing nature of play are considered. The author's original contribution is the concept of "generative identity"-proposing that a young child's self-image is configured through growing distinctions of gender (components of which are redefined as embodiment, representation, desire). Generative identity is further consolidated by negotiating issues of generation (cohort), genesis (origins), generativity (procreation) and "genitive" issues-separateness, arbitrariness, and the irreversibility of birth and death.

Freud's prehistoric matrix--owing 'nature' a death.

This paper is informed by contemporary literature in two fields--neonatal research, on the one hand, and the burgeoning interdisciplinary interest in Moses and monotheism, on the other. The author postulates that a cluster of traumatic events during the first two years of Freud's life compelled him to repeat what could not be remembered. Embedded in charged implicit schema, these affects remained unprocessed in Freud, who alone of all psychoanalysts did not have an analysis, manifesting in an uncanny dread/allure of the 'prehistoric' as a dark and dangerous era relating to the archaic feminine/maternal matrix and fratricidal murderousness. Furthermore, she cites evidence to suggest that for Freud this unconsciously excluded subtext of the preoedipal era became associated with ancient Egyptian and Minoan-Mycenaean cultures, a passionate fascination actualized in his collection of antiquities yet incongruously absent in his theoretical work, with three exceptions--Egyptian allusions in Leonardo's unconscious attachment to his archaic mother; the 'Minoan-Mycenaean' analogy on discovering the pre-oedipal mother shortly after the death of Freud's own mother; and Egypt as cradle of humanity in his uncharacteristically rambling, troubled text of Moses and monotheism. The author sees Freud's conceptual avoidance yet compulsive reworking of the prehistoric matrix as a symptomatic attempt to expose early unformulated representations that 'return to exert a powerful effect'.

Treatment for perinatal disturbance.

The perinatal period of transition to parenthood is one of heightened passions, which revive the expectant and new parents' own early experiences, and particularly unresolved emotional issues. For many deprived parents close contact with an infant reactivates old grievances at this time of vulnerability, which may manifest in syndromes of self-pity or in fury and vengefulness over past humiliations. Unprocessed dissatisfactions tend to erupt in disruptive or repetitious behaviours, which inevitably affect the baby in their care. In addition, childbearing in societies undergoing transition, like South Africa, may be fraught with extra stresses. These include socio-economic disadvantages and social adversity arising from geographical relocation and breakdown of traditional patterns, and psychological distress due to past or current experiences of physical or emotional trauma and neglect and relationship difficulties which tend to be exacerbated in times of rapid cultural change in the absence of a wider supportive network. It is argued that, in societies with scarce resources, the mental health focus must be on prevention, detection of high-risk groups and early intervention. Two tables are presented - of risk indicators and treatment guidelines, which may be applied during the perinatal period to minimise postnatal disturbance. Health workers with minimal training can be effective in screening and in some cases, delivering prophylactic or postnatal care to people at potential risk. Offering such help may enable resilient people in a state of crisis or transition to marshal their own resources. For others longer-term professional help may be required to shift the chronic effects of cumulative trauma by reworking emotional predicaments in a caring and safe environment.