The Copenhagen Infant Mental Health Programme – Development and testing of a pragmatic service-setting-based approach to screening and intervention

Background: Universal programmes that systematically address mental health problems in infancy are needed. This study describes the development and testing of a community-based programme combining screening with standardized guidelines for feedback and intervention to be completed by educated community health nurses (CHNs). Methods: The manual of the previously validated Copenhagen Infant Mental Health Screening, CIMHS, was updated in collaboration with experts in the field and practising CHNs to systematically include parents in child assessment and in intervention planning intervention. Furthermore, formalized training for CHNs was included. The resulting programme, the Copenhagen Infant Mental Health Programme (CIMHP), was evaluated in a multi-method study in seventeen municipalities using data from the municipality database and Danish National registries. Qualitative data included questionnaires and interviews with CHNs. Results: The CIMHP comprises a manual for educated CHNs’ screening 9-10 months infants in dialogue with the parents and guidelines providing suggestions for action to address infant regulatory and developmental vulnerabilities within community settings. A total of 280 CHNs used CIMHP at home visits to a total of 7,079 infants and found two problems of regulation (feeding, sleep, emotional regulation) or development (cognitive and motor functions) in 12.1% (N=860) of the infants and 10.4% (N=736) having three or more problems. A pattern of risks associated with regulatory and developmental problems at 9-10 months were associated male gender and being exposed to pre- and perinatal and family-related adversities. Qualitative data suggest face validity, usability, and parental acceptance of the programme as evaluated by CHNs. Conclusions: CIMHP integrates a global screening of mental health vulnerabilities, to be completed in dialogue with parents, together with guidelines to support CHNs’ feedback and actions to promote child health. Validity and feasibility seem promising. Still, further improvements to the guidelines for action in community settings and education of health professionals are needed.