Infant Mental Health in African-American Families: A Sociocultural Perspective

Suzanne M Randolph & Sally A Koblinsky. Handbook of Racial & Ethnic Minority Psychology. Editor: Guillermo Bernai. Sage Publications. 2003.

In raising young children, families adopt child-rearing practices rooted in a culture that defines their beliefs and values, organizes their physical and social interactions, shapes their learning and coping styles, and influences their receptivity to developmental interventions. Accepting and respecting cultural diversity means recognizing that there are strengths and resources in families from all cultural backgrounds (Kaufmann & Dodge, 1997). Because culture and family provide a foundation for the development of children’s cognitive and social competence, researchers, practitioners, and policymakers must recognize and build on cultural strengths inherent in families and communities.

Currently, there is a need to provide culturally responsive mental health services and programming to families from diverse backgrounds (Surgeon General of the United States, 2001), particularly those with young children (Randolph & Koblinsky, 2000). Culturally responsive programming incorporates “the importance of culture, the assessment of cross cultural relations, vigilance toward the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs” (Cross, Bazron, Dennis, & Isaacs, 1989, p. 1). Although many scholars support the importance of such programming, they also recognize serious shortcomings in the knowledge base examining how culture affects the developmental pathways of infants and toddlers (Shonkoff & Phillips, 2000).

A number of recent reports and volumes have emphasized the need to explore how cultural values and child-rearing practices influence infant and child development (Osofsky & Fitzgerald, 2000; Shonkoff & Phillips, 2000; Zeanah, 2000). In 1996, Head Start researchers and policymakers were among the first to recommend that highest priority be given to new research that examines the challenges posed to early childhood programs such as Head Start as a result of increasing ethnic diversity, explores how ethnically diverse homes and Head Start environments interact to affect children’s development, and embeds research studies within a community context (Phillips & Cabrera, 1996). The 1996 report further recognized that new pressures on low-income families to move toward economic self-sufficiency may influence the ways in which families from different cultural backgrounds are able to fulfill their parenting aspirations. Of particular importance is the need to examine how family members in multigenerational families (e.g., grandparents, aunts, and uncles) from various cultural backgrounds participate in the rearing of young children. Although the Head Start report focused largely on preschoolers in stable urban or rural family situations, the Head Start recommendations also highlight the need to consider cultural factors in providing services to children from birth to age 3, children in immigrant families, and children in migrant families. A more recent report, From Neurons to Neighborhoods: The Science of Early Childhood Development (Shonkoff & Phillips, 2000), further underscores these points by noting that

the extent to which both the capacity and the resolve to learn more about the relationship between culture and early childhood development are strengthened will determine the ability to understand the rich diversity of human cognitive, social, emotional, and moral development beginning in the earliest years of life. (p. 69)

Within recent decades, the population of the United States has become increasingly culturally diverse (Fisher, Jackson, & Villarruel, 1998; Hernandez, 1999). In this chapter, we focus on African American families to illustrate how culture might influence parenting behaviors, attitudes toward mental health, and children’s mental health outcomes. More specifically, we focus on low-income African American families. African American families represent only 12.9% of the U.S. population (U.S. Bureau of the Census, 2001). Yet African American children are more likely to live in poor families and experience persistent poverty than children in families from other racial/ethnic groups. For children younger than age 18, the poverty rate is 33%for African Americans, 30% for Hispanics/Latinos, and 9% for Whites. The poverty rate for young children (younger than age 6) is 37% for African Americans, 31% for Hispanics/Latinos, and 10% for Whites (National Center for Children in Poverty, 2000). For many years, poor African American families have been receiving services through programs funded by the federal government and other sources. Yet only recently have federal policymakers recognized the importance of giving mental health needs of young children a meaningful place on the national agenda (Chazan-Cohen, Jerald, & Stark, 2001; Kmtzer, 2000; Mann, 1997; U.S. Department of Health and Human Services [DHHS], 2001; Yoshikawa & Kmtzer, 1997). There is currently a paucity of research to guide the development of culturally appropriate interventions for these families.

Educators know relatively little about the normative development of African American children, the parenting values and behaviors of their parents, or the characteristics of the neighborhoods in which they live. In particular, relatively few studies explore the strengths and resources of African American families that reduce risks, protect children, and contribute to optimal development (Allen & Majidi-Ahi, 1989). Information is especially needed about parent and child mental health during the children’s early years because the influence of a parent’s (usually defined as mother’s) mental health status on children’s outcomes is well documented (Carnegie Task Force, 1994). Recent brain research provides further evidence that child functioning from preschool onward hinges significantly on experiences before age 3 (Shonkoff & Phillips, 2000).

Given the limited knowledge base on the mental health of young African American children and other children of color, we explore in this chapter the sociocultural context of African American infant/toddler development in an effort to identify factors that contribute to understanding and addressing infant mental health from a sociocultural perspective. The purposes of this chapter are to increase awareness of how expectations and perceptions of infant mental health might differ by culture, discuss how the culture of the family and community can be used as a resource in addressing infant mental health issues, and increase awareness of the variations in experiences, beliefs, and practices within cultures that are important to the development of sound interventions. In addition, we provide suggestions about how practitioners can provide culturally competent mental health services and supports to infants and toddlers of color and their families. This sociocultural perspective has implications for the design of prevention programs, family and community outreach, and research and policy in childhood mental health.

This chapter is organized into three sections. The first section reviews contemporary theoretical frameworks that guide our analysis of early childhood development and other models to consider as we explore the role of culture in infant mental health. The second section reviews research that reflects the importance of understanding cultural variations in experiences, beliefs, and practices that might influence infant mental health. The third section presents a framework that can be applied to promote cultural competence in services and programs. Last, the chapter presents implications for practice, policy, and research to more appropriately address the mental health needs of infants and families of diverse backgrounds.

Conceptual Frameworks

Traditional Models. One of the most widely used conceptual models for understanding child development is the ecological approach. The social ecology model (Bronfenbrenner, 1986), also labeled a contextualist model, views child outcomes as dependent on characteristics of the child, parent, family, and community (or macrosystem), as well as the complex interactions among these variables. Some have argued that traditional ecological models are limited because issues in the macrosystem such as social history, social location, majority or minority status, and discrimination are excluded or so external that they make the model irrelevant. Therefore, an expanded conceptual framework—the integrative model of the development of competence in children of color—was developed by Garcia Coll et al. (1996) to account for such variables. This model considers the centrality of cultural form and meaning and extends the role of family and kin networks beyond that seen in traditional ecological models.

Macrosystem, or cultural-level, components of the integrative model include factors such as race, ethnicity, social class, and gender. The effects of social position are mediated by mechanisms such as racism and discrimination and may directly affect children through processes such as segregation or the direct experience of prejudice or, in the case of infants, indirectly through the experiences of racism or oppression of their parents. Thus, although all children in our society are exposed to similar settings, such as child care, preschool, and other early childhood environments, the impact of these environments on children of color must be considered from the standpoint of whether they inhibit, promote, or both inhibit and promote competence (Garcia Coll et al, 1996; Phillips, 1994). Inhibiting environments result from limited resources, such as the lack of mental health services in segregated neighborhoods, and from an incompatibility between the values and goals of the family and the particular environment (e.g., the child care setting or early childhood program).

A central premise of the integrative model is that families of color develop adaptive cultures—or systems of goals, values, behaviors, and social networks—that set them apart from the dominant culture. The coping mechanisms of these families, which develop in response to cultural/social stratification, are a product of both the group’s cultural/political history and the demands of the immediate environment. Such demands directly influence family processes and child characteristics, which interact to influence the development of child competence. At the heart of the integrative model is the assumption that children of color cannot be judged by some universal standard but must be understood in the context of their specific ecological circumstances. Later in this chapter, we focus on a number of these contexts at the parent, family, and neighborhood levels in an effort to identify how culture may differentially contribute to outcomes among African American infants. Before presenting this review, we discuss some of the dimensions of the worldview of African Americans to better understand how these values may shape parenting behaviors and practices that have implications for infant mental health and mental health service delivery.

The Africentric Worldview. Many researchers have noted the failure of traditional social science approaches to tap the underlying cultural processes that guide the behavior of African American parents and their children (e.g., Akbar, 1974; Baldwin, 1981; Nobles, 1986). In response to this problem, several scholars have developed Africentric models for understanding African American individual, family, and community development (Akbar, 1974; Asante, 1980; Baldwin, 1981; Boykin & Toms, 1985; Hilliard, 1997; Myers, 1988; Nobles, 1986). These models recognize that strands of ancient African history, culture, and philosophy manifest themselves in contemporary African American life and communities (Staples & Boulin Johnson, 1993). Central to these models is the notion of a worldview, a “complex, interacting set of values, expectations, and images of oneself and others, which guide and are guided by a person’s perceptions and behavior, and which are closely related to … feelings of well being” (Frank, 1977, p. 27). This focus on worldview is not unique to African Americans but extends to other racial/ethnic groups in that most descriptions of these other groups also begin with identifying characteristics or preferences related to the group’s region of origin (Frank, 1977; Shonkoff & Phillips, 2000).

The African worldview includes numerous dimensions that reflect ways in which African American people may think, feel, and act. Although some of these dimensions are found in other groups, it is the unique blend that defines the particular culture. It should also be noted that there are variations in the degree to which members of racial/ethnic groups adhere to the dimensions of their group’s worldview. At least 10 dimensions comprise the African worldview (Boykin & Toms, 1985; Randolph & Banks, 1993) and may be helpful in interpreting African American parents’ goals and behaviors, as well as the developmental outcomes among their infants.

The first dimension, spirituality, goes beyond religiosity to focus on the spiritual qualities of people rather than material possessions. For example, when asked what they want for their children in the future, some African American mothers may answer “to be happy” (a spiritual goal) rather than to “graduate from college” (a material goal). Gommunalism or an interpersonal orientation reflects an emphasis on group over individual goals, a preference for cooperation rather than competition, and a focus on people-related versus task-specific activities. Mothers with this communal focus may place a high value on young children learning to share their toys or engaging in play activities with other children, rather than pushing their children to “be the best” or “have the best” in the group. Harmony refers to the importance of integrating one’s life into a whole, recognizing one’s interdependency with the environment, and seeking unity rather than control.

A fourth dimension of the African world-view, expressive communication or orality, emphasizes transmitting and receiving information orally, through rhythmic communication and call and response. Affect sensitivity to emotional cues reflects the integration of feelings with cognitions and a synthesis of the verbal and nonverbal. For example, parents may signal children to alter their behaviors with a simple gesture or look. Rhythmic movement is expressed in gross motor behavior and reflects an interest in flexible yet patterned action. Multidimensional perception or verve is illustrated in the preference for stimulus variety in learning (e.g., visual, auditory, tactile, motor); both parents and children value experimentation. Stylistic expressiveness refers to the valuing of the individual’s unique style, flair, or spontaneity of expression (e.g., the way one walks, talks, or wears an article of clothing) but is emphasized only when it facilitates group goals.

Still another Africentric dimension, time as a social factor, reflects the view that time is spiritual, not material or linear. For example, an event begins when the first person arrives and ends when the last person leaves, rather than at fixed points on a clock. There is also a recognition of the linkages of present time to the past and the future. Finally, positivity refers to the desire to see good in all situations no matter how bad they seem on the surface. This positive perspective—”making a way out of no way”—is thought to stop self-defeating behavior and generate positive problem solving.

Proponents of this model acknowledge there is much work to be done to identify African cultural dimensions that may be present in contemporary African American behavior. However, these cultural characteristics already have been associated with positive functioning among African American school-age children (Boykin, 1983; Boykin & Allen, 2000; Boykin & Bailey, 2000), adolescents (Roberts, 1997), and adults (Gary & Berry, 1985). Moreover, parents of children who engage in racial and ethnic socialization practices that reflect Africentric values have been found to have more socially and academically competent children than those who have not adopted these practices (Greene, 1992; Spencer, 1983; Stevenson, 1994).

This chapter provides examples of how these Africentric dimensions may shape family and community perceptions of mental health, as well as parent-child interactions and family patterns of help-seeking behavior. This approach recognizes that not all African American parents may value these dimensions, so it is important to understand within-group differences in parenting beliefs that have implications for infants’ mental health. Moreover, some contemporary social conditions that disproportionately affect African American families, such as poverty, HTV7 AIDS, substance abuse, and community violence, may pose threats to values that have traditionally been viewed as strengths or protective factors and processes in African American families. We must be cognizant that the current state of our science limits our ability to systematically capture these Africentric values and socialization practices. A better science of African American children’s early development will provide the most promising basis for addressing child mental health needs.

Sociocultural Context of African American Infant Development

Infant and toddler development in African American families is shaped by numerous factors in the ecology of the child: parents’ goals, values, and behaviors; parental work demands; parental mental health; family organization; family strengths; and neighborhood contexts. A brief review of the existing literature, which focuses largely on the mother as parent, illustrates the important role of these ecological variables.

Parenting Goals, Values, and Behaviors

The parent is the most salient figure in the social world of most infants. Differences in parenting style and child-rearing strategies have been found to be associated with differences in children’s cognitive and socioemotional development (e.g., Baumrind, 1972; Bradley et al., 1989). African American parents, like parents in any ethnic or cultural group, share a unique system of values and practices that overlap but differ in some ways from those of other cultures (Garcia Coll, 1990). With respect to infancy, for example, parents from different cultural groups may differ in their views concerning the fragility of newborns, their perceptions of and responses to crying, and the importance of encouraging specific developmental skills (Garcia Coll & Meyer, 1993; Lewis, 2000). For example, some researchers have speculated that the early motor maturity of African American infants is the result of mothers’ frequent handling of the infants during the neonatal period (Lester & Brazelton, 1981), as well as mothers’ expectations that their infants master motor tasks at earlier ages than White infants (Rosser & Randolph, 1989, 1996).

Unfortunately, researchers have conducted few comprehensive studies of the developmental expectations, socialization goals, or caregiving practices of African American parents of infants (Rosser & Randolph, 1989). Yet the growing number of young African American children living in poor, single-parent families (Children’s Defense Fund, 1998) and the special child-rearing challenges of mothers within the context of welfare reform argue for the urgency of such research. McLoyd (1994) asserts that “culturally anchored” research on racial/ethnic minority children of all ages is “a moral imperative.”

Researchers have claimed that it is inappropriate to use standards of parenting derived from the study of middle-class White families to evaluate the functioning of minority, often low-income, parents and children (e.g., Levine, 1977; Ogbu, 1981). These researchers note that like other parents, minority parents attempt to foster behavioral competencies they feel children need to survive in their environment. For example, in a study of African American parenting in inner-city neighborhoods, Ogbu (1981) found that parents expressed abundant warmth in infancy, followed by an absence of warmth, inconsistent demands for obedience, and the use of physical discipline in the postinfancy period. Ogbu suggested that these strategies promoted traits that parents felt are essential for child survival, including self-reliance, resourcefulness, mistrust of authority, and ability to fight back.

To understand the socialization goals and parenting strategies of African American families, we must consider the sociocultural context in which they occur. Low-income African American mothers disproportionately experience situations that present threats to parenting, such as poor housing and violent neighborhoods (Stevenson, 1994). African American parents and other parents of color are also faced with the challenge of preparing children for environments that may be racially hostile. Yet despite these challenges, many parents succeed in raising healthy, competent children. To determine predictors of child resilience, we need to identify whether dimensions of parenting routinely addressed in the literature—such as warmth, nurturance, responsivity, and positive control—are expressed in culturally specific ways. The existing literature is limited by the fact that these parenting practices are understudied in ethnic minority populations and may not be well tapped by traditional parenting measures developed with populations of predominantly White families.

Maternal Work Demands

Another parent variable that may influence infant mental health is maternal work demands. African American women in working-class and middle-class families have a long history of labor force participation (Lerner & Noh, 2000; McLoyd, 1993; Randolph, 1995). Today, there is also a large number of low-income African American mothers with histories of receiving public assistance who are joining the workforce. Government programs such as Temporary Assistance to Needy Families (TANF) now have mandatory work requirements and lifetime limits. Many of the jobs available to low-income parents are stressful and unstable and demand variable work hours (Center for Future of Children, 1997). When work and family demands are in conflict, mothers may significantly reduce the time they have available to interact with their children (Howes et al., 1995). Moreover, demanding jobs may create psychological distress and dysfunctional parenting behaviors (McLoyd, 1990). Alternatively, the opportunity to work may provide parents with a sense of self-esteem and emotional reward, enhancing the mother’s sense of competency in the child-rearing role (Howes et al., 1995). Given the potential for work involvement to be linked with child outcomes, it is important to understand the impact of work demands on specific populations of parents of infants and toddlers, such as parents moving from welfare to work, parents who migrate for seasonal employment opportunities, and immigrant parents.

Parental Mental Health

Parental mental health is a factor likely to be related to both effective parenting and child outcomes (Crnic & Acevedo, 1995; Field, 1992, 1995; McLoyd, Jayaratne, Ceballo, & Borquez, 1994; NICHD Early Child Care Research Network, 1999). Living in a low-income family and neighborhood may increase the probability of parents’ emotional distress or depression because of exposure to negative situations and events, such as unpredictable income and community violence (Belle, 1990; Yu & Williams, 1999). For African Americans, parents’ direct encounters with racism or discrimination are other major sources of emotional distress that have been found to relate to disrupted parenting practices, difficulties with parent-child interaction, and child adjustment problems (Johnson, 2001; Peters, 1981; Peters & Massey, 1983). Depression is a major problem among low-income women generally (Downey & Coyne, 1990; Lennon, Blome, & English, 2001). Samples of low-income African American mothers, in particular, show a high prevalence of depression (e.g., Harley, 2000; Koblinsky, Randolph, Roberts, Boyer, & Godsey, 2000). Previous research suggests that depression hinders mothers’ ability to provide the nurturance, attention, and stimulation that children need to achieve developmental milestones (Downey & Coyne, 1990; NICHD Early Child Care Research Network, 1999), as well as develop a healthy self-concept and secure attachment (Cichetti, Rogosch, & Toth, 1998). When parents experience depression or emotional distress, they may lose interest in activities previously experienced as rewarding, including caring for their children (Willner, 1985). Depressed parents’ preoccupation with basic survival issues reduces their physical energy, undermines their sense of competence, and diminishes their sense of self-control (Halpern, 1993). Several studies have reported a relationship between psychological distress and a reduction in the quality of parenting (e.g., Colletta, 1983; Simons, Beaman, Conger, & Chao, 1993).

Previous research has found that poor parents experiencing emotional or physical problems may provide inconsistent care for infants, pushing their children’s needs into the background when they feel distressed. In an early study of Washington, D.C., parents in a public housing project, Jeffers (1967) found that parents experienced mood swings that contributed to discontinuity in the day-to-day care of infants. In another early study involving African American inner-city families in St. Louis, Rainwater (1970) discovered that low-income mothers alternated between enjoying and ignoring their children as a function of crises and other events that were demanding their attention.

A mother’s temporary or persistent emotional distress reduces the attentiveness necessary to interpret and respond appropriately to infant moods and needs (Eldridge & Schmidt, 1990). Moreover, when an infant responds anxiously to a mother’s depression, the child’s response may overwhelm the mother, who then withdraws further in a kind of downward spiral. After a period, the infant may begin to withdraw from both the mother and other social interactions. Field, Heal, Goldstein, Perry, and Bendell (1988) found that 3- to 6-month-old infants with chronically depressed mothers appeared to internalize their mothers’ psychological state, even when confronted with animated strangers. In view of the recognized importance of nurturance, consistency, and maternal validation in optimal development, there is a need to conduct additional research exploring how parents’ mental health influences the developmental trajectories of low-income African American infants. Although currently understudied, the roles of African American custodial and noncustodial fathers and the influence of their mental health status on young children’s development are also in need of attention. According to Knitzer (2000), “Evidence suggests that many low income fathers may have more contact with their children than the ‘noncustodial’ label implies, especially when their children are young” (p. 11).

Family Organization

Researchers and mental health professionals acknowledge the critical role of families in infant development. However, researchers and practitioners may need to define families in ways that more accurately describe elements of culture and ethnicity, relationships, and economic circumstances (e.g., Phillips & Cabrera, 1996; Randolph, 1995). For example, dimensions of the family sociocultural context such as income, education, language, country of origin, and acculturation should be considered. The family contexts of African American infants and other infants of color may differ from those of the majority population in several ways, and these differences may influence infant development and family interaction with the mental health system. For example, low-income African American families tend to be characterized by younger mothers, a higher percentage of single mothers, and a greater likelihood of kin residence (Dickerson, 1995; Staples & Miranda, 1980; U.S. Bureau of the Census, 1995, 2001). The presence of multiple caregivers (kin residence) may be a positive adaptation to the unpredictability that many poor families encounter (Halpern, 1993; Ornstein & Ornstein, 1985). Alternatively, infants living with multiple caregivers may experience inconsistent parenting practices that jeopardize the development of secure attachment and other positive socioemotional and cognitive outcomes.

Consideration of whether the African American family has a multigenerational configuration, with its implications for child-rearing responsibilities, will also provide better guidance about who to involve in mental health treatment strategies. Traditional approaches assume that the mother is the principal caregiver. However, knowledge of the specific family configuration may dictate that other family members should be included in parent involvement activities and educational or clinical interventions to handle an infant’s special needs. Although there have been numerous studies of African American family structure, there is currently an absence of research concerning the influence of kinship on child rearing, parent-infant interaction, or developmental processes during childhood (Garcia Coll & Meyer, 1993; Jackson, 1993; Wilson, 1984). Studies of the sociocultural context of African American infant development need to explore who is parenting the infant and the impact of family configuration on infant mental health.

Family Strengths

One way in which African culture manifests itself in contemporary African American life is through family strengths. Twenty-five years ago, R. B. Hill (1997) developed a typology of African American family strengths that remains relevant today. This typology includes high achievement orientation, strong work orientation, flexible family roles, close kinship bonds, and strong religious orientation. Hill linked several positive aspects of African American family functioning and child and adult development to African cultural legacies: the resilience of low-income children, the high achievement orientation of single-parent families, the role flexibility of Black female-headed families, the low levels of substance abuse among Black youth, and the continuing influence of Black extended families. The extent to which African American family strengths serve to buffer the stressors experienced by low-income mothers with infants and toddlers is not known. However, it is presumed that mothers in families with multiple strengths are less likely to be socially isolated and better able to engage infants in warm, sensitive interactions than mothers in families with fewer strengths. More research is needed to identify the ways in which African American family strengths contribute to specific developmental outcomes among infants and toddlers.

Social Support

Social support is another aspect of family functioning with the potential to influence parenting and child development. Social support has traditionally been recognized as critical to the well-being of individuals in African American families (Hays & Mindel, 1973; R. B. Hill, 1993). Both relative and nonrelative (“fictive”) kin networks have played an especially important role in providing support for poor urban African American families (Billingsley, 1968; Stack, 1974). African American families are more likely to receive child care assistance from extended kin, to perceive extended kin as significant, and to live in close proximity to extended families or in multigenerational family households than White families (Hofferth, 1984; Jayakody, Chatters, & Taylor, 1993).

The ability to form and maintain social networks can be crucial to a low-income mother’s psychological well-being and parental functioning (McLoyd, 1990). Yet despite some studies showing that social support networks provide parents with child care, assistance with household tasks, and opportunities to pursue educational or employment goals (Hogan, Hao, & Parish, 1990; Letiecq, Anderson, & Koblinsky, 1996), the relationship between social support, parental functioning, and African American infant/toddler outcomes remains unclear. Moreover, some members of social networks may introduce stress into families rather than serving as a protective factor (McAdoo, 1986; Randolph, 1995). For example, nonparental caregivers may differ from parents in their attitudes about discipline or their developmental expectations for children at certain ages. Thus, before developing programs for families or individual plans for infants that rely on sources of informal support, staff should explore whether the parents’ social support operates as a protective factor or a risk factor.

Neighborhood and Community Characteristics

Neighborhoods have been defined as physically bounded areas characterized by some degree of relative homogeneity and/or social cohesion. Recently, educators have stressed the importance of investigating neighborhood-and community-level variables that may affect parenting and child development. Potential variables for examination include the degree of neighborhood organization or disorganization, availability of resources, neighborhood norms and expectations for parenting and child development, and level of community violence. A few previous studies have found relationships between the quality of parenting, the availability of neighborhood resources for child rearing (Garbarino & Sherman, 1980), the perceived danger in the community (Kriesberg, 1970), and the degree of neighborhood transience and the proportion of older adults in the community (Cotterell, 1986).

Many families of color, including those of African American heritage, experience different neighborhood or other residential environments than the majority population because of their lower socioeconomic status. As a result, these families and their infants may encounter numerous problems associated with socioeconomic disadvantage, including substandard housing, seasonal migration, residential segregation, neighborhood disorganization, and high levels of community violence. Many minority neighborhoods are experiencing a loss or breakdown of the religious, social, and economic institutions that are vital to family life and provide potential routes out of poverty (Halpern, 1993). These neighborhood characteristics may contribute to survival-oriented patterns of parenting and relating to others (the “adaptive culture”), including isolation from family and friends, mistrust of neighbors (with whom parents formerly shared child care responsibilities), and restriction of infants and children from virtually all outdoor neighborhood play (Randolph, Koblinsky, & Roberts, 1997). Thus, neighborhood characteristics of low-income African American families may force parents to focus on particular dimensions of caregiving such as physical care and child protection at the expense of other behaviors such as play and language stimulation.

A basic issue in investigating the impact of sociocultural context on development is the definition of developmental or socioemotional skills and problems in infancy (Garcia Coll & Meyer, 1993). Generally, the normative standards by which child development specialists identify developmental strengths and problems reflect the dominant Anglo culture. Past traditions of using parenting and infant measures normed on Anglo families have resulted in the interpretation of differences as deficits, masked the strengths of many minority parents and children, and produced misguided intervention approaches (Garcia Coll & Meyer, 1993; Myers, Rana, & Harris, 1979). For example, a practitioner may try to reduce an African American toddler’s “overactive, aggressive” behaviors, whereas parents reinforce those same behaviors because they feel they will protect the toddler in the violent neighborhood where they live. Thus, to better serve African American and other minority families, practitioners must not only seek parents’ views about their infants’ behaviors and their own parenting needs but must also address the challenges of the family’s living environment. Devoting time to understanding important elements of infants’ sociocultural environment will enable practitioners to incorporate family and community strengths in intervention efforts and honor the cultural diversity of families (Bredekamp & Copple, 1997; Phillips & Crowell, 1994).

The Macrosystem

This “adaptive culture” also includes the development of informal networks of support for child care, family assistance, and social and emotional support that could be tapped to provide services to families. The Black church has traditionally been one of these strongholds in African American communities (Billingsley & Caldwell, 1994), and “religion continues to be a vital resource for black parents in rearing their children” (S. A. Hill, 1999, p. 142). However, the church may be a less likely candidate for intervention today because of the migration of affluent African Americans from inner cities and inner-city churches, the diminishing communal orientation of many Black churches, and the decline in church attendance among African American youth (Randolph, Billingsley, & Caldwell, 1994). Sororities, fraternities, and other social or public service organizations abound in the Black community and have the potential to supply both instrumental and emotional support to needy families. Still another resource in the larger macrosystem is the system of historically Black colleges and universities, which have increasingly been recruited by federal agencies to partner with low-income communities in knowledge development and service delivery programs.

Framework to Improve Cultural Responsiveness

An evolving framework that acknowledges the many influences on child development and attempts to provide more responsive mental health services for children of color is the cultural competence framework (Cross et al., 1989). Cross and his colleagues defined cultural competence as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enables that system, agency or professionals to work effectively in cross cultural situations’” (Cross et al., 1989, p. 13). In an effort to operationalize this concept and apply it to systems of child mental health services, Cross et al. (1989) identified five elements of culturally competent organizations:

  • They value diversity, recognizing that other cultures may exhibit certain values, behaviors, and preferences that differ from the dominant culture.
  • They have a system for cultural self-assessment, allowing them to select policies and practices that reduce barriers to participation for members of various cultural groups.
  • They are aware of the differential dynamics that occur when persons from diverse cultures interact, including differences in communication styles, help-seeking behaviors, and problem-solving styles.
  • They institutionalize cultural knowledge through the provision of cross-cultural training for staff, culturally appropriate services for clients, and the establishment of support networks of community leaders from different cultural groups.
  • They are able to adapt to diversity, adopting policies and procedures that reduce negative stereotyping and prejudice and promote greater appreciation of difference (Hernandez, Isaacs, Nesman, & Burns, 1998).

Cross et al. (1989) described a 6-point continuum of cultural competence anchored at the low end by cultural destructiveness and at the high end by advance cultural competence or proficiency. At the highest level, agencies hold families of racially/ethnically diverse backgrounds in high esteem. These agencies understand how individual, family, community, and cultural factors influence child development and parenting practices. Individual staff members at the advanced or proficient level draw on their cultural knowledge and contacts to design innovative approaches to service delivery, disseminate the lessons they have learned, and advocate effectively for children and families.

Implications for Practice, Policy, and Research

Today there is a compelling need to develop new knowledge about families of color in order to develop culturally competent practices and policies that promote infant mental health. Although there is abundant new research to be done, the existing literature suggests a number of steps that can be taken to enhance culturally responsive programming and policies for infants, their families, and their principal caregivers.


Both ecological and sociocultural approaches to infant mental health emphasize the need to understand the infant within the context of the family, the community, and the culture. In assessing the family’s well-being, practitioners working with African American and other infants of color must identify which members of the family serve as “parental figures,” including parents, grandparents, other relatives, and “fictive kin.” Efforts should also be made to learn about the cultural values, beliefs, and parenting goals that may influence parent/caregiver responses to infant behavior (e.g., crying, high verbal or physical activity). Equally important, mental health practitioners should attempt to identify strengths and resources in each family so that they may be used to enhance the success of intervention. For example, the emphasis on communalism and oral expressiveness in many African American families may facilitate bringing family members together in a cohesive, responsive, interdependent team to address infant needs. Early identification of family and cultural strengths, as well as challenges, will help mental health personnel to individualize services that promote infant emotional health and target problems at an early stage. Time invested in learning about the family will likewise improve the “working alliance” between the practitioner and parent(s) as they come together for the benefit of the child.

For some infants, parental factors such as maternal depression pose serious threats to mental health promotion. African American mothers may be especially vulnerable to depression because of their disproportionate exposure to poverty, racism, discrimination, and related stressors. Mental health specialists should draw on their knowledge of the values, worldviews, and life experiences of mothers from specific cultural groups to provide needed outreach and lessen the stigma often associated with mental health assistance. Practitioners working with African American mothers, for example, may employ strategies that focus on communalism, harmony, and positivity to expand social support networks, reduce isolation, and increase mothers’ expression of positive affect toward their infants. Establishing a trusting relationship with the depressed mother, which includes respect for her culture and life experiences, will help her to obtain therapeutic services for herself and her child.

Practitioners should also consider maternal work demands in planning and designing mental health services for families with infants and toddlers. In some instances, work pressures such as temporary placements or frequent shift changes may interfere with optimal parenting and adherence to mental health appointments. Agencies may need to offer flexible service hours or arrangements to accommodate parents’ variable work schedules. Some parents of color may encounter racism and discrimination on the job, draining their emotional reserves for parenting. Such parents may need assistance in dealing with work-related stress so that they can be more emotionally available to their children. Still other working parents may have access to job-related resources that will help them to address their children’s mental health needs, such as health insurance, employee assistance, child care subsidies, or family and medical leave. In conducting mental health assessments of client families, practitioners should also include the work environment as a potential source of both assets and problems.

Culturally responsive mental health services focus not only on the family but also on the larger community. Knowledge of community factors that may compromise mental health is particularly important in working with ethnic minority families, as African American and Hispanic families are more likely to confront poverty and other adverse circumstances than White families (Shonkoff& Phillips, 2000). Practitioners must be aware of the specific challenges that families encounter in their neighborhoods and communities, including the presence of poor housing, homelessness, violence, drug activity, and other problems linked to poverty. Such information may dictate the times, places, and conditions under which families will seek mental health assistance for themselves and their children.

Community assessments should not only investigate neighborhood stressors but also identify community strengths, including the activities of health agencies, churches/mosques, educational programs (e.g., Early Head Start), community organizations (e.g., Big Brothers/ Big Sisters, Urban League), and public service sororities/fraternities. Home visitation programs, in particular, provide opportunities for practitioners to enhance infant mental health in a community context because of their focus on environmental health, quality of caregiving, cultural rituals and routines, and the family’s social support system. Mental health specialists who maintain partnerships with community agencies and cultural groups will increase opportunities for families to obtain culturally sensitive assistance that promotes family stability and infant emotional health.


With our increasingly diverse society, it is especially important that public policies recognize cultural differences in child development and extend mental health outreach to more families of color. The U.S. Surgeon General’s reports on mental health (Surgeon General of the United States, 2000,2001) and the Healthy People 2010 objectives (DHHS, 2000) articulate the need to offer a wider range of mental health services to infants and parents from diverse cultural backgrounds. The Head Start performance standards (DHHS, 1995–1996) for mental health recognize the critical importance of the early parent-child relationship in emotional adjustment and provide guidelines for promoting infant mental health in a community and cultural context.

Comprehensive, community-based mental health systems are needed to address the specific problems, strengths, and resources of families within targeted communities. Mental health agencies must incorporate diversity issues and messages into their policies, services, program materials, and office decor so that families will experience respect for their individual cultures. Hiring mental health staff who reflect the cultural groups and neighborhoods served is one way to affirm commitment to culturally responsive practice. However, it should be noted that the hiring of such staff is not sufficient for cultural competence; diversity training and retraining of all agency staff, from board members to frontline workers, are essential. Policymakers should seek to ensure a broad continuum of respectful care by providing training in culturally competent mental health practices for current practitioners, early childhood educators, college students entering the mental health professions, and others involved in working with infants and toddlers. Policies may establish ways for agencies within a community network to meet regularly, exchange information, discuss referrals, and identify neighborhood resources (e.g., grandmothers who may counsel depressed mothers from the same cultural background) to address infant and parental mental health needs. The challenge is to develop and maintain a coordinated system of practitioners, educators, caregivers, and programs that value cultural diversity and support healthy emotional development of young children.


Ultimately, the development of sound, culturally responsive policies and practices to promote positive infant mental health will require the expansion of basic and applied research involving African American and other families of color. Scientific evidence is needed to address the complexity of designing programs for these families and their communities and to help policymakers formulate strategies that recognize minority family strengths and challenges. Researchers must begin by expanding traditional theoretical and conceptual frameworks to incorporate the worldviews of the target populations and to acknowledge the cultural integrity of the communities to which this research, policy, and practice will be directed. This conceptual shift, or “new way of knowing,” requires use of more integrative models (e.g., Garcia Coll et al., 1996), as well as a research agenda that targets more diverse populations and issues of cultural relevancy.

Future research on infant mental health must develop and employ culturally sensitive measures for tapping the parenting values, skills, and behaviors of ethnic minority families. In assessing these families, researchers must also take note of the potential heterogeneity within cultural groups. For example, African American parents living in the same neighborhood may have childhood roots in the United States, Haiti, or East Africa, bringing different beliefs and perspectives to their parenting of infants. Investigators must make efforts to learn more about family histories than the parents’ racial/ethnic group. It should also be emphasized that despite the preponderant focus on poor single-parent families in this chapter, African American families are found across a wide range of socioeconomic categories and family forms. There is a particular need for studies that examine the impact of fathers and father figures on infant mental health.

Additional research is also needed to develop culturally appropriate tools for assessing parent-infant interaction and infant emotional development and mental health. Observational measures of parent-infant interaction in naturalistic settings—such as homes, child care centers, and community programs—offer opportunities to identify emotional tones, approaches to learning, and interactive styles that are more prevalent among parents or caregivers from particular cultures and that may be influencing infant mental health. Finally, there is a need to examine which types of infant mental health interventions work best for specific families and why. Such investigations may address a variety of factors, including age of the child, cultural background of the family, other family characteristics, and community strengths and stressors.


Mental health practitioners, early childhood educators, and policymakers have unique opportunities to work with families from diverse backgrounds to promote infant mental health. There is an urgent need to examine how cultural knowledge and culturally responsive health practices can be used as a resource in mental health prevention and intervention. Development of a research, policy, and practice agenda that is based on greater understanding of the worldviews, values, and life experiences of families of color will enable researchers to offer improved guidance, support, and mental health services to infants and their parents or caregivers.