The DIMH programme (DIMHP) includes a standardised and validated method for identifying mental vulnerability in infants. It is used by the community health nurse at the child’s ninth to tenth month of life, at which time research shows that there are special opportunities to detect vulnerabilities of importance for the child's further development. DIHMP stands for The Danish Infant Mental Health programme (in Danish PUF: Psykisk Udvikling og Funktion).
Background of the DIMHP
The DIMHP is a relatively new tool for the preventive work of community health nurses. It was developed between 2016 and 2018 by Danish early childhood researchers and community health nurses. The aim was to fulfil the need for research-based methods for early prevention that integrate new scientific advances and the practical possibilities for prevention in Denmark (Vidensråd for Forebyggelse, 2021). Read more about who contributed to developing the DIMHP here.
The DIMHP in brief
- Includes a standardised examination of the infant’s psychological development and functioning, guidelines for feedback to parents and preventive interventions as well as training of community health nurses.
- Based on scientific evidence and covers the full spectrum of developmental vulnerability at the child’s ninth to tenth month of life.
- Developed by early childhood researchers and community health nurses with a view to being used directly in municipal healthcare.
- Validation studies have documented face validity (credibility) and feasibility in Danish community child health care.
- Provides community health nurses with an overview and prerequisites for organising preventive interventions in the municipality.
The overall goal of the programme is to strengthen the work of the community health nurses in detecting and intervening in mental vulnerability in all infants between nine and ten months of age, taking into account the full spectrum of the child’s development. Specifically, the aim is to enable community health nurses to provide specific instructions on relevant preventive interventions for children with developmental vulnerability, and that this is based on dialogue with the parents.
What is special about the method
The DIMHP differs from other methods in healthcare by covering the various forms of developmental vulnerability in infants documented by recent research. In particular, these are problems with regulating sleep, eating, emotional and behavioural expression, as well as disturbances in the development of attention, concentration, motor functions, language and social interaction. Vulnerabilities of this kind may develop into permanent problems if the child does not receive targeted support. The DIMHP systematically involves parents in identifying their child’s strengths and any vulnerabilities and in supporting their child when needed.
The DIMHP is a basic healthcare intervention offered to all infants aged nine to ten months and their parents. The programme has built-in structures and guidelines for more specific interventions in which the role of the parents is central.
The training of community health nurses in using the DIMHP includes: a general introduction to the latest knowledge about infants’ development and developmental vulnerabilities and potentials, as well as training in doing the DIMH assessment and how to involve parents in initiatives specifically addressing the particular vulnerability(ies) observed in their child.
The DIMHP is based on scientific evidence obtained from research based on Danish community child health care. The applicability of the programme within the existing framework in the municipalities has been the point of departure, and community health nurses have been actively involved in the research that underpins the DIMHP.
Read about children’s mental development and functioning at 9–10 months of age here.
Read more about the scientific background and the DIMHP here.
The core elements of the DIMHP
The DIMH assessment
The community health nurse follows a manual that ensures that all essential areas of the child’s development are reviewed in dialogue with the parents, including the areas: motor skills, attention and concentration, curiosity and interest, sleep regulation, eating and emotional state, as well as contact, communication and language development. The community health nurse reviews the results of the examination in dialogue with the parents as a basis for providing advice and guidance on how to support the child’s development.
DIMHP guidelines
The guidelines include short descriptions of the respective development areas which can be used in combination with the community health nurse’s basic experience and knowledge in the field. The guidelines are based on the latest scientific evidence and are continuously updated. They are written by experts in child psychology and early childhood psychiatry and experienced community health nurses. They include suggestions for initiatives that are possible to implement within the existing framework of the municipality.
Training in the DIMHP
In order to use the DIMHP, the community health nurse must complete a 3–4 month training programme. The programme includes the theoretical and empirical background for assessing psychological development and functioning at the infant’s ninth to tenth month of age and training in the practical application of the DIMHP.
Read more about the training in the DIMHP method here.
Experiences from practice in municipalities
The DIMHP has currently been implemented in 38 municipalities across the regions in Denmark. The overall experience is that parents are very satisfied with the systematic approach, and for the community health nurses there is a clear pattern: the more they learn to use the method and the guidelines, the more necessary and indispensable the DIMHP is perceived to be.
Read about the community health nurses' experiences with the DIMHP here.