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disorders in three speech and language groups. Journal of Communication Disorders , 20 , 151–160. Cooper, G., Hoffman, K., Marvin, R., & Powell, B. (2001). Retrieved 5 Dec. 2008 from http://circleofsecurity.org/ Egeland, B., Weinfield, N. S., Bosquet, M., & Cheng, B. C. (1999). Remembering, repeating and working through: Lessons from attachment-based interventions. In J. D. Osofsky & H. E. Fitzgerald (Eds.), WAIMH Infant mental health groups at high risk , 1–4 , 35–89. New York, Wiley. Field, T. (1995). Infants of depressed mothers. Infant Behaviour and Development , 18 , 1–13. Forman, D. R., O’Hara, M. W., Stuart, S., Gorman, L. L., Larsen, K. E., & Coy, K. C. (2007). Effective treatment for postpartum depression is not sufficient to improve the developing mother–child relationship. Development and Psychopathology , 19 , 585–602. Givens, D. (1978). Social expressivity during the first year of life. Sign Language Studies , 20 , 251–274. Gwynne, K., Blick, B. A., & Duffy, G. M. (2009). Pilot evaluation of an early intervention programme for children at risk. Journal of Paediatrics and Child Health , 45 , 118–124. McCain M., & Mustard, J. F. (1999). Early years study: Reversing the real brain drain . Toronto: Publications Ontario. NCAST-AVENUW(1995). Keys to caregiving study guide . School of Nursing, Center on Human Development and Disability, University of Washington, Seattle. http://www. ncast.org/ NCAST-AVENUW. (1995). Parent child interaction teaching scales – Teaching manual . School of Nursing, Center on Human Development and Disability, University of Washington, Seattle. http://www.ncast.org/ The Parent–Child Mother Goose Programme®. (2003). Toronto, Ontario. http://www.nald.ca/mothergooseprogram/ van den Boom, D. (1995). Do first year intervention effects endure? Follow up study during toddlerhood of a sample of Dutch irritable infants. Child Development , 66 , 1789–1816. Van IJzendoorn, M. (1995). Adult attachment representations, parental responsiveness, and infant attachment: A meta-analysis on the predictive validity of the adult attachment interview. Psychological Bulletin , 117 , 387–403. Wetherby, A. M., & Prizant, B. M. (2001). Communication and Symbolic Behavior Scales™ (CSBS) Infant toddler checklist . Baltimore: Paul H. Brooks Publishing. Wilkinson, R., & Marmot, M. (Eds.). (2003). The solid facts: Social determinants of health . Retrieved 3 July 2009, from http://www.who.int/social_determinants/en/index.html Zero to Three, National Centre for Clinical Infant Programs. (1994). Diagnostic classification of mental health and development disorders of infancy and early childhood: 0–3 . Arlington, VA: National Centre for Clinical Infant Programs. Lisa Dyer is a speech pathologist who graduated in 1985, and completed a Master in Counselling in 2007. She has predominantly worked with a paediatric caseload, in Australia, the UK and Zimbabwe where she worked for four years as a development worker with the goal of handing over speech pathology skills to local health workers. For the past six years Lisa has worked in Child and Adolescent Mental Health and currently combines this with community health work and private practice.

communication skills, and the Parent Child Interaction Teaching Scales , a tool used widely in the United States of America and the United Kingdom. As per the Teaching Scales criteria, videoing of a structured teaching task enables the clinician to assess dyad reciprocity, caregiver sensitivity to infant cues and the caregiver’s capacity to provide an environment that is conducive to the development of social, emotional and cognitive skills. The interaction also enables assessment of the clarity of the infant’s cues. Each week caregivers and infants join the clinicians for an hour and a half of floor time to enjoy a variety of songs and rhymes. Repetition ensures that mothers and infants become highly familiar with their favourite songs or rhymes and learn adaptive use of the material to meet their individual needs (e.g., to increase alertness, to settle, or to alleviate distress). The benefits of routine are demonstrated using key songs to signal program changes. Broad smiles are elicited when the mums become cognizant that the song “I’m a little teapot” means they can sit back, sip a cuppa, chat and be waited upon for 20 minutes. The song “This is the way we pack away” is soon understood by even the youngest of infants to signal the end of bubble-and-ball time and returning to their mothers’ arms. A brief “mothers only” time is always a challenge to the facilitator left to manage up to six infants and sometimes toddlers (bubbles are truly a blessing!) while the second speech pathologist leads a discussion with the mothers. First Words Project Home Activities (http://www.firstwords. fsu.edu/) introduce early communication development. The NCAST Baby Cues: A Child’s First Language (http://www. ncast.org/) flash cards explore the concepts of engagement and disengagement cues (Givens, 1978). Most parents, adept in identifying potent engagement cues (moving arms towards caregiver/ babbling) or equally potent disengagement cues (back arching/withdrawal from quiet alert to active sleep state), learn to use songs to facilitate transitions from one state to another – from active alert where the baby is fussing to quiet alert where the baby’s eyes are focused (http://www.ncast. org/). Recognising more subtle engagement cues (brow raising/facial brightening) or subtle disengagement cues (diffuse body movements/tongue showing), and identifying clusters of cues can be a new experience for some. Preliminary outcome measures (sample size of 6) have shown encouraging results. Caregivers improved in their ability to interpret their child’s communication and foster a sensitive reciprocal interactional style that promotes cognitive and emotional development interaction. Caregivers accessed support for their own mental health concerns and infants were streamed, where required, into community programs and ongoing developmental programs at an early age. Feedback from the mothers has been heartening. Responses included “I realised that talking to my child is the best thing I can do for her” and “I can read her body language better”. Early results thus indicate that the START group provides caregivers with increased knowledge of early communication development and the importance of sensitive interaction. Gwynne, Blick and Duffy (2009) conducted a pilot program in Sydney, utilising a relationship-based model of care, which highlighted the benefits of integrated centre-based interventions. Similarly, the START group is an additional building block in the development of at risk mother–infant interaction that fosters attachment, communication skills and global development. References Bowlby, J. (1988). A secure base . London: Routledge. Cantwell, D. P., & Baker, L. (1987). The prevalence and type of psychiatric disorder and developmental

Correspondence to: Lisa Dyer email: Lisa.Dyer@southernhealth.org.au

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ACQ uiring knowledge in speech, language and hearing