Assessing and rebuilding attachments

When there are concerns about a child’s safety, development or wellbeing, a key task will involve an assessment of the child’s existing attachment relationships. Careful observation can reveal both existing strengths within the relationship and areas for intervention.

Practitioner approaches

Kenny Toshack talks about approaches they use in his team, particularly those linking to PACE and theraplay.

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Cycles of interaction

Fahlberg (1981) discusses the ways in which attachment relationships ordinarily develop and the following questions drawn from her work can help to identify patterns of interaction. An analysis of ruptures or breaks in the mutual flow of initiative and response can guide work with parents to enhance the child’s security:

• Does the parent pick up the child’s signals and do they respond? How?
• Does the parent reach out to the child to initiate interaction? How?
• Does the child signal their needs to the adult? How?
• Does the child respond to the parent’s initiative? How?

These questions invite the practitioner to tune in to the underlying emotional exchange between the child and their primary caregiver. Both existing strengths and gaps can be identified and guide strategies to promote effective change.

A minefield of information

Kenny Toshack explains that attachment can be a minefield of information, but it’s mainly about understanding relationships

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Attachment – sensitive aspects of parenting

Howe (2005) identified the following aspects of care as effective in promoting secure attachment. They may be used to assess the quality of current care, also guiding work to enhance nurturing. These key elements of parenting can be used to support parents when children are still at home and/or when using contact opportunities to enhance the possibility of return home:

Nurturing routines

These include ordinary parental initiatives which provide the child with reassurance that they can rely on predictable care. They convey positive messages about the child’s worth.

Emotional warmth

This cannot be over-emphasised in its importance in offering comfort to the child, enhancing self-esteem.

Behavioural limits

Reliable, non-punitive limits are reassuring to the child and an essential feature of a secure base.

Comfort when ill, hurt or sad

Recognition of the child’s distress and soothing responses help them to develop a language for their feelings.

Help with transitions

Because transitions provoke anxiety, the child experiences the adult as sensitive and soothing.

Emotional support with experiences of loss

Not only comfort, but also validation of the child’s feelings is supportive of healthy emotional development.

Help to master new skills

This supports the development of a sense of mastery and agency in the child.

Praise

Recognition of effort as well as achievement builds self-esteem giving the child the message that they are valued.

Help to make sense of frightening experiences

This helps the child to build a coherent story of their history over time, a marker of resilience in later life

Assessment of harm

It is important to assess whether harm has or is occurring. The National Risk Framework (Calder and colleagues, 2012) sits alongside the GIRFEC framework to support the assessment of risk to children and young people. These are some of the most challenging assessments for multi-disciplinary teams.

Donald and Jureidini (2004) suggest a framework for assessing parenting capacity which goes beyond the simple observation of interaction to considering the parents’ underlying motivation and, in particular, their empathy for the child following maltreatment. Their framework identifies groups of factors to be considered. These include an assessment of the parent’s ability to:

• Put the child’s needs before their own
• Provide emotional as well as physical care appropriate for the child’s stage of development
• Accept responsibility for the maltreatment

Of particular significance is the ‘meaning’ the child carries for the parent as this influences parenting. This was first considered relevant by Reder and Lucey (1996) from their assessment of parent-child dynamics in circumstances of serious maltreatment. They identified three domains:

• Parenting capacity. The child’s idiosyncratic meaning for the parent is a key factor in assessing future risk, as well as the parent’s history of attachment and the degree to which they are able to reflect on any traumatic experiences.
• The child’s parentability, including the child’s developmental progress and the impact of any past harm.
• The scaffolding available to support positive parenting and reparative care, including reflection of the outcome of previous attempts to provide support.

Bentovim and colleagues (2009) offer a similar framework, outlining twelve crucial considerations where maltreatment has already occurred. These largely mirror the factors considered central by Donald and Jureidini (2004), the quality of emotional care and the parents’ own attachment history being seen as relevant. These authors equally recommend assessment of the environmental stresses on the family alongside available supports.

These and other frameworks are available to guide future planning, including the provision of support services.

Recent authors criticise the use of attachment theory in decision making in child protection which fails to take adequate account of the parents’ circumstances. (Featherstone and Gupta, 2018). They argue that a simplistic reliance on attachment theory can lead to the unfair blaming of parents who are struggling with multiple adversities. This could be mediated by appropriate provision of support networks which address the impact of socio-economic and environmental adversities in assessment and resource provision. They conclude that policies and practices designed to protect children ‘have come to exemplify a punitive state in many respects.’ (p2).

These criticisms imply the need for full consideration of the parents’ potential to offer safe, nurturing care in an environment which offers them support, and resources that give them the best and fairest opportunity to retain or resume care of their children.

Building relationships

Corry McDonald talks about how to build relationships between the child/parent when that child has been removed from the parent’s care

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Support services

Various programmes of work with parents and their children are available in different parts of Scotland which focus on enhancing the parent-child relationship, for example:

• Mellow Parenting and The Incredible Years. These frameworks offer parents the chance to build on existing strengths and to develop new skills alongside other parents. They may also include an opportunity to reflect on their own history, which can offer parents or carers the chance to reflect on their own early attachments.
• Family Nurse Partnership (FNP) works with young first-time mothers and their families from pregnancy until their child is two years old. It is being delivered across 11 health boards in Scotland. FNP can maximise the support to mothers of babies who have themselves experienced adversities and/or face current challenges. These services chime with observations of researchers in the field of neurobiology of the crucial importance of close nurturing relationships in the first year when the child’s brain is at a crucial stage of neural development.
• Home Start offers individual group support to parents and services are available to parents in many areas of Scotland.
• Early years provision in numerous authorities seeks to acknowledge the importance of early development and is supported by the Scottish Government through the Early Years Initiative).
• The Solihull approach of parent training is a well-established approach to helping parents to understand their children’s behaviours and to respond in ways which enhance security. The approach begins with close consultation with parents about desired goals.

When there are specific identified concerns about a child’s wellbeing, the local authority may be involved in conducting both parenting assessments and work to rebuild parent-child relationships. Advice and regular feedback are offered consistently in ways which respect each parent’s particular needs and learning style.

These initiatives offer opportunities to explore the possibility of sustained and meaningful change and may result in further work to maximise the chance for children to remain at home or return. A sensitive and respectful approach to work with parents who have never experienced positive attachment relationships in early childhood will be important.

Parenting assessments

Use of working agreements

These can be used to set out a clear process of work, initially in assessment, and thereafter in structuring trial interventions, to test the possibility of meaningful and sustainable change. Parents should be consulted about their contribution to any work, especially as it is known that the greater their sense of involvement in the process, the more likely the chance of success (Platt and Riches, 2016). These authors focus on a key consideration in parenting assessment, namely the parent’s capacity to change. Working agreements can be used with parents while the child is still at home in work, to avoid child removal or when seeking to establish whether a return home for a separated child can be achieved in their best interests.

It is important to consider how the stage will be set for the work to be undertaken and a clear, transparent working agreement should set out expectations as to how the child’s needs can be met in any contact or observed interaction at home.

Any fair and reasonable programme of work engages parents in clear explanations of the specific worries about their child’s wellbeing, seeking their views and ideas.

Use of video

Some practitioners in Scotland are trained in an approach to work with parents and their children called Video Interactive Guidance. Use of video can be especially helpful for some parents who are able to see for themselves the ways in which their interaction with their child unfolds. Although some parents find this too challenging, many others have been able to identify ways in which their positive initiatives and responses can be enhanced and to value the chance to practise new skills under guidance. Video Interactive Guidance is used in many settings by practitioners from different disciplines, for example, in early years centres and in therapeutic work and training.

Observation and reflection

Corry McDonald speaks about the ways in which they monitor, observe and reflect on parent/child interactions when they are in the service