VICKI MANSFIELD: Hi. Welcome, everyone. Welcome to today’s webinar. ‘How infant-led practice in family violence settings can nurture hope for infants and families’. I’m Vicki Mansfield. I’m a practice development officer with Emerging Minds, and I’m facilitating today’s webinar. And firstly, I’d like to do an acknowledgement of country. And so, we recognise the land on which we meet today, and pay respect to Aboriginal and Torres Strait Islander peoples, their ancestors, elders, past, present and future, from the different First Nations across the country. And we recognise that the land on which we meet – the importance of the connection to land and culture, spirituality, ancestry, family and community, and the importance of that for the wellbeing of Aboriginal and Torres Strait Islander children.

And I’m meeting on Awabakal country today. And I invite you to add in the chat what country you're meeting on today. And I’m really excited for us today. We have a great panel who have a really diverse wealth of knowledge and skills in working with infants and parents within the family and domestic violence setting. And we know from research that the incidence of family violence can increase during pregnancy and birth, and that infants under four make up the highest cohort of children entering crisis accommodation. And this means that infants and families need to access a range of interdisciplinary services to meet their complex needs.

So it’s great today that each of our panellists will share their experience and knowledge of where they are at in the service sector, and can tell us what infants can show us and tell us in practice, and how that can leverage hope when working with families. And firstly, I will introduce the panellists and I’ll introduce a key contributor to this area, whose research about infant-led interventions I find incredibly inspiring. So welcome Dr Wendy Bunston, a senior clinical consultant, trainer and associate lecturer at La Trobe University. Welcome Wendy.

WENDY BUNSTON: Thank you. How are you?  

VICKI MANSFIELD: I’m great, thank you, and I’m really looking forward to hearing about your work, and we’ll jump and meet the other panellists and then hop into it. And then I’d like to introduce Tauri Smart. Tauri’s a clinical nurse consultant with Child and Family Health Nursing and First Steps Parenting Centre. Welcome Tauri. It’s great to have Child and Family Nursing with us today.

TAURI SMART: Thanks Vicki.

VICKI MANSFIELD: It’s – and then our last panellist with us today is Kristen Walsh. Kristen’s a rural early intervention family counsellor and child and adolescent counsellor with NDIS clients as well. Welcome Kristen. And it’s great to have you with us, Kristen, and it’s great to have a rural perspective as well. Because I think, yeah, there’s some different nuances in where we’re working in different contexts.

KRISTEN WALSH: Yeah.

VICKI MANSFIELD: Yes. I’m aware that this topic and discussion can sometimes be emotionally distressing. So I encourage the audience to be mindful of your own wellbeing and to seek additional support if needed. This could be via professional supervision if it’s work-related, or via Lifeline, on 13 11 14, or on 1800RESPECT. Okay, so let’s jump to the topic. And I’ll invite Wendy first. Wendy, your research focuses on infant observation as the method for investigating the infant’s experience, and particularly looking within the refuse setting, post-family violence. And whilst there’s an increasing lot of research about infants – the first 1000 days, and their early relational experience – not often are we centering the infant as the immediate source.

But yeah, I’m wondering, certainly from my perspective, something that stood out in your research was that the sooner the infant’s acknowledged and tended to, the sooner there are opportunities to capitalise on relational hope that the mother carries for her infant and herself. Can you tell us, Wendy, what you discovered? And explain that discovery of relational hope and the infant’s experience?

WENDY BUNSTON: Yeah. Just a little warning – my poodle’s got a ball in here and might bark, so that’s – so I’ll have to respond and be dog-led!  But basically, essentially the work – my research looked at eight different refuges, some in Australia, some overseas. And the use of infant observation, which has been used in research to some degree, but probably never in this context then within refuge, was really about – it was really a political decision to put the infant at the centre of everything. And that’s largely because, as you quoted at the beginning, it’s more likely that the infant will be present, or nearby, during episodes of violence. And it’s more likely that the infant and younger children will come into refuge, in higher numbers than other children.

So that’s a huge area that has not really garnered much attention in the research and in the sector generally. And from my experience, prior to doing the research as an infant mental health practitioner, I have learnt an enormous amount from infants. And I have learnt an enormous amount as a family therapist about what infants will offer you in the room, in front of you, as you're working with people. And that you can use what is happening in the space in a very, very powerful way. And I took that experience into the research. So that thing of being able to engage with a subjective experience of the infant is being able to notice them. Talking to them. Being curious about what their experience might be, and encouraging the parent to be curious about what the infant is telling us about their experience.

Because infants tell you an enormous amount. Infants are born with exquisite sensory modal capacities. So already there is a huge, extensive emotional range that they offer us, if we see it.

VICKI MANSFIELD: Yeah, and they’re really quite dynamic, Wendy, whereas sometimes I think –

WENDY BUNSTON: Incredibly

VICKI MANSFIELD: – we’ve looked at them quite passively in the past. And I think that’s why I find – yeah, reading your work, is that they’re actually incredibly dynamic little beings that have got so much to tell.

WENDY BUNSTON: Yeah. And not only do they have a lot to tell, and they will show it to you in the presence of you in your session, in your research, in whatever. But also, the other component of my research was that of the women that came into refuge, all of them – all of them – came in because they had a baby. And they were conscious about the outcome for their baby. So at a very innate level it was like, “this isn’t good for my baby.” But a number of them had lived with violence for many years, but it was having the baby that was the facilitator for saying, “yeah, it’s time to do something about this.” And for me then that leaves refuges being in an exquisite spot to actually do some really powerful work right at the beginning.

And when I talk about the subjective experience of the infant, it’s almost a bit of a no-brainer. Because it’s a little bit like we would say about the subjective experience of a verbal child or an adult. An infant does not not have subjectivity from the moment they’re born. They’re born with subjectivity. They’re born with an emotional range. They’re born with an inquisitiveness to engage with others. And we almost don’t think that they come alive until they’re about two or three, when they’re starting to talk or walk. That’s when they come alive. And that’s ridiculous. And it’s that foundation time that basically sets the basis for the rest of their life. So our body remembers those experiences, even if our cognition doesn’t. Because our memory hasn’t actually formed and come online yet in terms of cognition.

But certainly, infants have an enormous subjective experience of the world, of others, and it’s sort of like they’re the smart ones and we’re the ones that aren’t so smart. Because we haven’t actually acknowledged or recognised or even considered that of course we’re born with that innate capacity to engage! Of course we’re born with an extraordinary range of emotional experience! Of course we hold all this stuff in our body, and that existed before our cognition existed. Yet we don’t actually honour that, and we don’t honour that as practitioners in recognising that this is right brain work. We need to sit in our emotional space. We need to sometimes stop talking, and watch and be curious.

And when a parent sees us as curious about their baby, and curious about what things mean, and curious about what the baby might be making of what their parent is experiencing, it’s like a light bulb comes on. And it’s like, “Ah!” So that’s my answer for it, yeah.

VICKI MANSFIELD: Yeah! And so it’s that – as you said, it’s more that it’s we’re not attuning to what they’re – and that sometimes, as adults, with our cognitive brain, going – we might be at a pace that’s really not attuned to maybe the infant’s language. So it’s sort of like – it sounds like in some ways you're saying it’s like being the conduit, really, to bring it to the forefront for maybe parents, when they’ve also got their own level of stress and trauma maybe going on.

WENDY BUNSTON: Yeah. And from our preparation for this today, I know that the other two panellists and I share the same experience, which is that infants hold a vast capacity to engage in the space, if you invite them into the space. They hold a vast capacity for hope for a different future for their parent. And if you bring those two things together, you can sometimes shift things that sort of feel like they’re intractable – I think this work is a way of rapidly attending to the intergenerational thread that exists for all of us. From us to our parents, their parents to their parents, what we imagine ourselves to be as a parent, what we imagine our child will be like in the future.

And our ability to think about, “what will I be like as a grandparent when my baby has a baby? What are my hopes and dreams? And what were the hopes and dreams maybe I had for myself when I was a baby? And how did my parents help facilitate that, or perhaps maybe rob me of that?” So there’s a thread there that’s incredibly powerful; as a therapist, as a researcher, as a practitioner, which all these will speak to – that it’s like you can ride this wave. I’m not a surfer, but you could ride this wave and get to places that I don’t think you could get to in other modalities of working. And I’ve been doing this for over 30 years, and I’ve trained in lots of different things. And I think this way of working, alongside, for me, as a family therapist, just makes an inordinate amount of sense. And a huge one too.

VICKI MANSFIELD: Yeah, and that feeling, right, is, as you said, really important in terms of that observing an infant, and imagining and engaging with their world, is a feeling process in lots of ways.

WENDY BUNSTON: Yeah. And sometimes when you do that – because babies are more ready to engage than a person who’s had – accumulated trauma for 20 plus years. So if you engage with the infant, gently – not intruding on their space – but if you wait for their invitation to engage with them, you’ll see amazing things happen right in front of you, that even the parent might not have been aware of. Because they’ll be like, “oh, they like you!” There’s something about what you're doing. And as you're commenting on their things, it’s like, “ooh, I hadn’t thought of that before!” So we are a conduit. But it’s not just being a conduit. It’s respecting the infant’s right to be involved in, and have a voice about things that directly impact them. As at any age, the infant is entitled to be seen, thought about, and kept safe in work that impacts them.

VICKI MANSFIELD: Yeah. So that very much – as you said at the beginning, very much an intentional, conscious and political decision to say these little beings have a right to service. Yeah.

WENDY BUNSTON: Yes.

VICKI MANSFIELD: Yeah. And a right. And in terms of you said about parents and this modality offers more hope, what was standing out as you were talking is that by noticing and sharing those wonderings with parents, there’s more possibility for leverage of change, by the sounds of it –

WENDY BUNSTON: Yes.

VICKI MANSFIELD:  Than maybe in,  we’ve tried to come from the talking down, maybe, or looking at addressing an adult’s experience

WENDY BUNSTON: But we go to the hardest spot first – the more traumatised, encrusted trauma space first, rather than the most pliable, available, least traumatised. I’m not saying babies aren’t traumatised, but the least traumatised and the most likely and ready to respond person in that space, which is the baby. So we go to the hardest spot instead of the spot which is most pliable and inviting relational opportunities. Plus, we should be doing that anyway, because it’s their right.

VICKI MANSFIELD: Yeah, so their right. And they’re at the developmental prime for it really, aren’t they?

WENDY BUNSTON: Absolutely.

VICKI MANSFIELD: Yeah. And I’m wondering whether that’s a good place for us to invite Tauri. Because Tauri, your bread and butter is talking about the needs – physical needs and developmental needs of infants and toddlers. So Tauri, as a Child and Family Health nurse, I see them as great advocates for infants, in my experience. And I’m wondering, from your experience, what do you see the role of Child and Family Health nursing in supporting infants and families who might be experiencing family and domestic violence?

TAURI SMART: Yeah, thanks Vicki and Wendy. So I think Child and Family Health Nursing can play a really important role, if we’re brave enough to put ourselves in this space. And in New South Wales, child and family health offer a universal health visit to all babies, ideally within two weeks of when they’re born. And we screen all families for domestic and family violence. So I think this helps with that stigma around domestic violence, and that it’s everybody’s business, which I think sometimes, nurses, we can think it’s a bit outside our lane. We capture a large proportion of the population in the community, and it’s a ‘Well Baby’ service. So it’s just a standard part of our practice. So it can be seen as non-threatening.

And I think birth’s the time, as Wendy said, that parents can be quite reflective and motivated for change. And so Child and Family Health Nursing can really sit in that space of supporting parents with their hopes for their infant, and help them to set goals. Yeah, and so I think by looking through the infant lens, and working in the premise that parents do have strengths, and positive intentionality, they are wired to want to do well and want to be good parents. It’s an opportunity for Child and Family Health nurses to engage in a really non-threatening way, and offering the holistic, physical and emotional developmental support. Yeah, so I think we’re really privileged just that we are nurses, and that we advocate for infants.

Because we take out scales and equipment to attend growth and development checks, and this can really align us with parents, as both mums and dads often are very happy to check in and see how their baby’s growing and how it’s doing. I call our scales our ‘magic scales’, because sometimes it can really get us that foot in the door where other professions might have barriers there.

VICKI MANSFIELD: Yeah. So as a universal service, and as a service that’s got – you've got the possibilities of supporting around the physical care, and the practicalities – and everyone knows we need help in those early months of the practicalities! But also about it can be that advocacy for the emotional wellbeing. And I’m wondering if you can describe us an experience – because I know you go from a universal service to also providing more ongoing supports in different roles for children and infants and families. Can you paint us a picture, or describe for us a case example of what you might notice about an infant’s needs when they’re experiencing domestic violence?

TAURI SMART: Yeah. So the case I’ve chosen today is a case example of really significant domestic and family violence, where the mum had presented back to emergency within a week of her baby being born, having been punched in the face. So Child and Family Health Nursing attended our two-week universal check, as we would normally. And at this, it was – the most important part, I think, was engagement for this mum. Because if we didn’t get engagement, then we’re going to really lose that opportunity. So that’s the important thing from the start. And acknowledgement of what had happened ensures that we’re starting the relationship in an open, transparent way. But this acknowledgement comes along with no ultimatum or expectation on the mum’s response to the incident.

It’s just starting and introducing us as a service that’s comfortable to sit with hard conversations. And this can really lend itself to both being non-judgemental, and also trust and transparency when we’re talking about our potential mandatory reporting responsibilities with families. So from the outset, if we can look through the infant lens, the baby, as Wendy said, is just telling us so much in their verbal and non-verbal cues, and also in their physical presentation. And by looking through their lens, we’re immediately aligning with the parents. Because we’ve got the baby at the centre, and they also want to know what’s going on with their baby. So it’s a great way to engage as well. And I think this is where our ‘magic scales’ come in, because it’s just such a nice, common ground to be with parents.

VICKI MANSFIELD: So the ‘magic scales’ can be the start of many conversations, Tauri?

TAURI SMART: Yeah. Yeah. So – and it just – yeah. I would often refer back to it when I needed to; when I was losing engagement or whatever. So in this particular case, in visits, the baby had a noticeably extended startle reflex, which is like your jump scare reflex. And we like that to be coming under control around the two to three-month mark. When she was pulled to sitting, which is another thing to do, just to test the baby’s head lag and stuff, again, we like them to be quite relaxed in their body. And this little bub wasn’t. She was really rigid when you're checking her hips, and you could just feel tension in her body. She rolled early and she walked early, which I found can be other signs that there’s things going on.

So toxic levels of stress will activate the baby’s stress response system, and that’s your cortisol and adrenaline. And what we know is that we want to keep an eye out for these physical signs that that’s constantly activated, because that can lead to that damage to the baby’s brain architecture. And so we just want to look for physical things around this as well.

VICKI MANSFIELD: And in noticing those physical things, and kind of – because you could just notice them. But you're noticing them in a context, aren’t you, and anticipate drawing some – Wendy talked about bringing attention or having conversations about the noticing. So is that the process that you mean?

TAURI SMART: Yeah. So when this baby continued to startle with loud noises and sudden movements, she was really quiet, so you couldn’t get her to vocalise very well. She would look at you but be – wouldn’t really want to engage and talk to you. And she really sought out mum. She was just like this little spider monkey who couldn’t get close enough to mum, to just be her safe space. So the way we did start to address those things, and reflect with mum on those things, was just noticing things. So over the next 12 months, in spite of frequent breastfeeds, and when she started solids – we started her on a high calorie eating for infants diet, which involves adding avocado, cottage cheese, coconut oil, all things like that to her meals – we just couldn’t get this baby above the third percentile.

So at her 12-month check in the June, her weight was eight kilos, and by the October it had dropped to below the third percentile, which literally means it’s fallen off all of the growth charts. So this has coincided with an escalation in the DV, and an incident which ultimately led the family to connecting with Staying Home Leaving Violence. And within six weeks this baby had come up to the 25^th percentile and then again, at an 18-month check and two-year check, it had maintained on that 25^th percentile. So we could now see this toddler growing steadily on its growth chart. So from that picture, we kept engagement over time with this family, and it was such an opportunity that we could have lost.

And it was achieved by transparency, being in the moment with mum, and just drip-feeding her small things that I was seeing in the development, such as the startle or the weight, and noticing what was going on. And reflecting back with mum. So an example was, I came into the room on one day, and I’ve accidentally put myself between mum and the baby. And you just saw her completely have this massive stress response and freeze. And it was just – it was so overt that you really brought her into the space that she was having a reaction. And by staying focused on looking through the baby’s lens, we could provide that non-judgmental service about her – the baby’s health and wellbeing. And focusing on the baby, again, it’s that common goal with mum of keeping her safe and managing her baby’s emotional and physical wellbeing.

So I could just describe and talk about what I noticed in appointments, and ask open questions, if mum had also noticed them. Like, “I notice bub’s really startled when that door slammed there. What do you think might have been going on for her?” It’s just introducing those little small wonderings about the baby’s responses, and it’s role modelling that the baby’s needs are at the centre, and the baby’s feeling validated and heard and valued, and that it is a being with its own little experience. And I think what you said, Vicky, about it being more partnership-inspired, and less lecture-y and authoritative as well when you are working alongside mum in that partnership way.

VICKI MANSFIELD: And Wendy, is that your sense – you just talked about that subjective experience of the infant. Is that – Tauri’s description of noticing the physical, but also the wondering – is that the process that you're referring to?

WENDY BUNSTON: Yeah, very much so. And it is about not telling people what to do, or being definitive in what you say. It’s inviting them into a space that is imagining, “I wonder what it’s like for my little one? I wonder what this means when that happens?” And there’s a mutuality in this approach of when you do that with their baby, you're also wondering about, “what’s it like for them?” So if they’re having moments where they startle, or they feel overwhelmed, it’s being able to connect with their own emotional story, their own emotional narrative, and be able to think, “ah, I get scared. I wonder what that’s like for my baby?” So that’s the inter-subjective stuff there, because there’s stuff that goes on between.

And if we come in in a way, as Tauri described, of being respectful and curious, and endeavouring to not be judgmental – and obviously there’s always a line where the level of risk is such that you have to make a judgement. But if we can engage in that space, we are more likely to get a long-term outcome of the parents having their own ‘a-ha!’ moments than moving to a space that you can’t just come back from.