Michigan Model of Infant Mental Health-Home Visiting (Michigan IMH-HV)

The Michigan Model of Infant Mental Health-Home Visiting (Michigan IMH-HV) is a needs-driven, relationship-focused intervention for pregnant people and families with children through 36 months of age. Families are eligible for Michigan IMH-HV if either the parent or child has risk factors, such as a parent’s mental health or a child’s social-emotional or regulatory concerns, that make them more susceptible to disruptions in the parent-child relationship. Home visitors provide emotional and psychotherapeutic support as well as concrete support by helping families meet their basic needs. The model aims to increase parental competencies and promote mental health and sensitive caregiving—thus, reducing the likelihood of mental health issues during infancy and toddlerhood and of intergenerational transmission of the effects of unresolved loss and trauma in parents. Michigan IMH-HV is delivered weekly in a family’s home by a master’s-level home visitor, who tailors the intensity and duration of services based on the family’s needs.

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The Michigan Model of Infant Mental Health-Home Visiting (Michigan IMH-HV) is a needs-driven and relationship-focused intervention that serves pregnant people and families with infants and toddlers. It was developed in the early 1970s to offer preventative and psychological services to support the developing relationship between the child and parent and, by extension, to prevent infant and toddler mental health issues. The model draws on psychoanalytic and attachment theories, social work practice, and developmental psychology. 

The relationship between the child and parent lays the foundation for the child’s development of future healthy relationships, the ability to get along with others, and resiliency. Together, these may help reduce the child’s risk of developing mental health issues, including emotional, behavioral, social, and cognitive delays. The home visitor helps the parent recognize how the parent’s own early experiences may be affecting how the parent interprets and responds to their child. This understanding can help the parent develop a more nurturing relationship with the child. 

In addition to providing emotional and psychotherapeutic support, the home visitor also provides concrete support by helping families meet their basic needs.

Selma Fraiberg and her colleagues at the University of Michigan developed the model. The Michigan Department of Health and Human Services (MDHHS) administers the model throughout the state. MDHHS also provides ongoing technical assistance, including training for supervisors; regular implementation support calls for site leaders and administrators; and materials to support practice, such as fidelity forms. 

Training, technical assistance, and support for replication outside of the state is available through Zero to Thrive in the Department of Psychiatry at the University of Michigan.

Michigan IMH-HV serves pregnant people and families with children through 36 months of age. Families may enroll at any time within this period. The model is designed for families with (1) a parent who has experienced environmental, familial, or personal factors that can make parenting challenging and may increase the risk of parent-child relational challenges or (2) the child is at risk of developing emotional, behavioral, social, or cognitive delays.

Michigan IMH-HV is designed to reduce the likelihood of mental health issues during infancy and toddlerhood by promoting healthy child-parent relationships, the child’s ability to get along with others, and child and family resiliency. By supporting infant mental health, Michigan IMH-HV also aims to prevent negative consequences for the child and the parent, now and in the future, and for society from increased costs in health care, education, and the justice system.

The home visitor individualizes services for families within the context of the model’s key components: 

• Building an alliance. Creating a strong trusting relationship with parents to provide them the emotional safety they need to explore their past experiences and feelings about parenting. 
• Material needs. Helping families access resources to meet their basic needs to allow parents to focus on caring for and nurturing their child. 
• Emotional support. Supporting families through challenges that may arise that can hinder their ability to care for their child.
• Developmental guidance. Offering parents guidance about their child’s current and expected behavioral capacities, so they can understand the meaning of different behaviors, which builds a foundation for a healthy child-parent relationship. 
• Infant-parent psychotherapy. Supporting parents in exploring painful experiences from the past or present that are heightened through parenting. A child’s behavior can cause a parent to relive a past experience and the negative emotions that arise can be unconsciously associated with the child. The home visitor helps the parent identify the source of their emotions and learn to separate them from the child. 
• Life coping skills and social supports. Helping parents develop meaningful relationships with others who could serve as sources of social support. This could involve resolving familial conflicts, identifying a neighbor that could become a friend, or participating in parent or community groups and services. 
• Culturally responsive and diversity-informed practices. Engaging with families in ways that center their experiences and provide support in a culturally responsive manner that aligns with the family’s expressed goals, wishes, and expectations. 

The Michigan IMH-HV manual provides detailed descriptions of the model’s key components and general guidance for home visiting. Because Michigan IMH-HV is a needs-driven, individualized treatment, the home visitor determines specific session content. But the Michigan IMH-HV fidelity tool helps the home visitor identify specific strategies to use with families to address each of the model’s key components.

Michigan IMH-HV typically provides visits once per week for an hour and a half to two hours. Home visitors tailor the intensity and duration of services based on factors including the family’s needs and age of the child. Services may last from 6 to 45 months.

No adaptations or enhancements have been made to the model.

Licensed community mental health professionals deliver the model throughout Michigan. Organizations in Michigan interested in implementing the model must be able to support these mental health professionals in delivering in-home services for up to 2 hours per week for 12 to 15 families and to provide weekly reflective supervision. Please contact the model developer for information on whether the model has recommendations or requirements about the types or characteristics of organizations that can implement the model outside of Michigan. 

Home visitors may use the Michigan IMH-HV fidelity tool to monitor fidelity to the model. Please contact the model developer for additional information on these fidelity guidelines.

The model is implemented by home visitors and reflective supervisors.

Michigan IMH-HV home visitors must hold a master’s degree and be licensed in social work, psychology, or a related mental health field and meet state, local, and agency licensing requirements. The home visitor should have training in infant development, attachment theory, cultural humility, adult mental health, psychotherapy, and psychopathology. The home visitor should also have familiarity with perinatal, infant, and early childhood mental health, including tools to assess parent, infant, and toddler mental health and social-emotional and relational development. The model also strongly recommends home visitors have or be working toward at least the Michigan Association for Infant Mental Health Level II endorsement (Infant Family Specialist), with Level III (Infant Mental Health Specialist) preferred. In addition, home visitors must be able to engage in reflective practice, including being able to recognize and empathize with the emotions of the child and the struggles of the parent, while regulating their own emotions and reactions. 

Supervisors must have earned at least a master’s degree and be licensed in social work, psychology, or a related field and have completed coursework in psychotherapy skills and practices. Supervisors must meet state, local, and agency licensing requirements. Supervisors should have a foundation in culturally responsive practices, impacts of trauma, infant and child development, parent mental health, attachment theory, child temperament, and interpersonal skills. Supervisors are expected to have or be working toward an Infant Mental Health Specialist endorsement. Administrative, organizational, and clinical skills as well as prior experience as a Michigan IMH-HV home visitor are preferred. 

Michigan IMH-HV home visitors must receive weekly reflective supervision. Typically, a supervisor within the home visitor’s agency provides the supervision. Reflective supervision involves coaching, individual support, and clinical guidance. The supervisors provide space for home visitors to reflect on their experiences with families and address how they absorb the parent or child’s feelings. By supporting the home visitor as they explore their feelings, the supervisor helps the home visitor gain a deeper understanding of and empathy for the parent and child as well as identify potential strategies to explore with the family at subsequent home visits. The developer recommends that supervisors also receive their own reflective supervision. 

Before providing services, home visitors must complete a self-assessment. If gaps in foundational knowledge are identified, recommendations for reading and other resources are provided. Home visitors are required to discuss their self-assessment with their supervisor. Home visitors also participate in a one-year learning collaborative led by certified trainers, which includes instruction and coaching calls. Please contact the model developer for additional information about the pre-service training requirement for home visitors.

Ongoing professional development is available through learning “booster sessions,” which are optional but recommended. Enhanced support is available to help home visitors adhere to the model’s key components. During the learning collaborative sessions and coaching calls, home visitors receive extra support in using the treatment fidelity checklist to ensure adherence to the model. 

Michigan requires that providers participate in 24 hours of continuing education related to children’s mental health. The developer recommends implementing similar ongoing professional development requirements for agencies outside of Michigan. Please contact the model developer for additional information about the ongoing professional development requirement for home visitors.

Please contact the model developer for information about the pre-service and ongoing professional development requirements for supervisors.

In Michigan, contact:
Mary Ludtke
Phone: 517-290-6708 
Email: ludtkem@michigan.gov
Website: https://michiganimhhv.org/ 

Outside of Michigan, contact:
Katherine Rosenblum 
Email: katier@med.umich.edu 
Website: https://zerotothrive.org/