Building new attachments

Kinship care

Placements with family can offer many advantages for children who are unable to live safely with their parents. If children can remain safely in their families of origin, they may feel claimed, avoiding the trauma of additional separation from their kinship network.

However, depending on their experience of care, they may bring with them complex challenges in trusting adults, which will have many implications for their relative carers.

Alper and Edwards (2017) offer helpful guidance to practitioners involved in assessing kinship carers. They comment:

The individual may be someone who is supportive of the birth parent and believes that the child should be kept within the family. They could be the mother or father of a birth parent, still harbouring protective feelings towards their son or daughter. Or as grandparents they may feel angry with the birth parent for the suffering they have caused their grandchild.(p149).

They recommend the careful exploration of the dynamics and characteristics of the kinship placement before a placement is made. Children placed in kinship care will bring with them additional needs arising from the impact of previous caregiving, including the effects of loss and any developmental trauma they may have suffered.

Tools for the analysis of carers’ strengths and capacities are summarised by Alper and Edwards (2015) as follows:

• The carers’ ability to:
  • manage challenging behaviour
  • build the child’s attachment and help them feel safe while remaining resilient
  • learn
• Their capacity
  • to repair breaks in relationships
  • for ‘reflective functioning’ which is defined as the ability to tune in to the child’s feelings and thoughts
  • for empathy for the child
• The degree to which past traumas have been resolved
• Their willingness to ask for and use support
• The absence of rigidity in approach

Purposeful contact which retains important attachments can be soothing to the child and an assessment of the kinship carer’s attitudes towards the child’s birth parents will be a key consideration for practitioners.

Each child’s predicament needs to be carefully assessed in order to ensure that the contact supports rather than undermines the child’s developing security and their increasing ability to trust their carers.

Sydney and Price (2014) give a helpful exploration of issues to be considered when planning parental contact in kinship care. Observations of signs of a less than secure attachment style do not rule out the possibility that relatives may be able to offer much to the child placed with them.

A key consideration is how the carers will help the child to develop a clear understanding of their history and heritage, regardless of whether there is direct contact. When discussing contact with birth parents, Sydney and Price (2014) comment:

While there are clear arguments for the benefits of contact, contact, and particularly high levels of contact, can also activate the child’s attachment wounds. Some of the childrens’ experiences during such contacts may be unsettling. (p187)

Children’s needs also change over time and arrangements for contact should reflect their wishes, feelings and needs over time.

Careful assessment of the impact and meaning of such contact for the child will be necessary if it is to contribute to the child’s ability to heal in the kinship placement. While some level of distress is to be expected, and may be managed in a way that contributes over time to the development of a ‘coherent story’ of the past, the effects on the child, and specifically the degree to which the contact interrupts emotional healing, should be a guide to contact planning.

The complexity of many of the children’s needs and the added strain on the kinship carers of their relationships with birth parents, strongly indicate the need for skilled, ongoing support. As stated in the Independent Care Review, The Promise:

Whatever the mode of arrangement, Scotland must ensure that children living in kinship care get the support they need to thrive.

The professional skills required to understand and respond sensitively to the carers’ needs are no less important than in adoption and fostering placements since the children arrive with similar needs.

Fostering and adoption

Foster and adoptive placement brings together the impact of the child’s previous experience of close attachment relationships with the new carers’ accumulated experience of emotional closeness from childhood onwards.

Many children are placed in short term foster care while decisions are made about the possibility of a safe return to nurturing parental care. Their carers need both continuing training and support to help them to understand each child’s particular needs, which may be complicated by experiences of multiple moves and losses or neglect and/or abuse. They need to be ‘mind minded’ in their care, attuning to the emotional lessons the child has learned from previous caregiving and the ways in which this affects the child’s understanding of the separation. The Solihull approach, introduced earlier, is widely used in Scotland to build the carers’ skills in developing the hurt child’s ability to build trust and feel secure away from home. This approach helps carers to build skills in responding to children with different responses to their offers of affection and care.

The child’s attachment style

Walker (2008) discusses the relevance of the child’s attachment style for matching children with carers for permanent placement. He suggests that the observation of the child’s reactions and response to fearful experiences is a helpful guide for practitioners who have not had the opportunity to be trained in more formal frameworks. He comments:

Times of separation from attachment figures are particularly informative: an avoidant child is likely to display no upset or fear, while an ambivalent child is likely to exaggerate distress or show separation anxiety.(p53)

A child whose attachment figure has been frightened or frightening by, for example, environmental chaos or domestic violence, may view the attachment figure as potentially threatening rather than a source of security and the child’s behaviour may be described as disorganised. Their experience is that closeness is dangerous, and it is easy to appreciate why these children present the most acute challenges to their new carers.

Carers need to be helped to understand that these behaviours conceal enormous fear and anxiety.

Story Stem assessment, for which practitioners need specialist training, may be helpful in assessing the child’s attachment style. The child’s view of adults arising from past caregiving can guide matching with permanent carers.

The adult’s attachment style

Walker (2008) acknowledges that many adults who apply to be foster or adoptive carers do not have a secure attachment style, but nevertheless they may be able to re-parent hurt children.

What then becomes important is the degree of problems: someone who is mildly avoidant may become a capable substitute carer, whereas a strongly avoidant person probably will not. (p54)

A study at the Anna Freud Centre found that many carers showed an avoidant style and that their ability to resolve past losses was a strong indicator of positive progress for the child (Steele and colleagues, 2003).

The process of assessment offers applicants the opportunity to reflect on their history and to begin to make changes following reflection. Avoidant adults may be helped to learn to be caring and nurturing while more ambivalent applicants need to learn to calm rather than increase the child’s distress, supporting their ability to explore.

The assessment of the adult’s attachment style will be important when considering matching them with a child.

It will also be important to consider an assessment of the relationship between any joint carers applying.

An understanding of the attachment patterns of a couple can also inform whether one individual can compensate for deficiencies in the other’s parenting style. For instance, a mildly avoidant person may be able to add order, structure and consistency to the style of a more ambivalent person. In turn, the more ambivalent person may be able to add warmth and excitement to the avoidant parent. (Walker, 2008, p54)

However, it is important that the adults’ attachment styles are not too extreme. If the attachment patterns are very similar it may be more challenging for them to compensate for one another.

The shortage of available carers and the increasingly complex needs of the children placed with them suggests that training beyond assessment will be essential in order to extend the skills available within the pool of carers available to any local authority.

Among the programmes currently available, the Secure Base framework (Schofield and Beek, 2014) is increasingly used throughout Scotland to enhance the skills of foster and adoptive families in strengthening the child’s security in their care. The key elements of this approach encourage a focus on several aspects of care designed to build attachment security while also encouraging healthy exploration and learning. It includes:

• Being available, with a focus on emotional availability
• Responding sensitively
• Accepting the child
• Cooperative caregiving which supports the child’s independence through collaboration with their carer
• Promoting family membership, both with the child’s family of origin and the carers’ family

Another framework which is used both in local authorities in Scotland and specialist independent fostering and adoption agencies is Theraplay, an approach to enhancing the carer-child attachment through attuned, close interaction.

Contact with family and other significant attachment figures

Considerations of family contact will be important when the child is placed in foster care. Meetings with parents or other family members need to be purposeful as clarity about the reasons why it is occurring will help in structuring the location, duration and circumstances within which it can best be organised to further the plan for the child.

Useful question might include:

• What are the purposes of contact and how can it meet the child’s needs?
• Do the current arrangements fit with the purposes?
• What messages are communicated to the child in family meetings; eg ‘You’re being well cared for’, or ’You’re coming home soon’?
• What is the impact of meetings on the child, before, during and afterwards? What effects do we see on the child’s development, behaviour, attachment security and self-esteem?
• What changes, if any, need to be made to meet the child’s needs in the context of the current plan?

If the placement is short-term and there is an ongoing assessment of the possibility of returning home, contact may well offer an important opportunity to rebuild attachments with key adults in order to contribute to decisions about long-term plans.

If the child is placed permanently away from home, the following questions may be relevant:

• Does or can direct or indirect contact heal past hurts?
• Does it or can it support developmental recovery?
• Does it or can it build self-esteem?
• What form of contact will meet the child’s needs now?
• How will this be reviewed?
• What support is available to the birth family, the child and the permanent carers?
• How can links be maintained if face-to-face contact is currently contraindicated?

Many children placed in permanent foster care can benefit from some form of continuing direct contact with family members. Based on observed benefits for the child, birth parent and also adoptive parents, Neil and colleagues (2015) support consideration of continuing direct parental contact post adoption. However, this is still an emerging area of practice in Scotland and it is vital that birth family members, whether parents, siblings or other relatives are able to give their emotional permission to the child to be settled and secure, and to establish secure attachments in their new families.

Whatever the arrangements for maintaining links for children with their families of origin, all parties will need ongoing support, especially as childrens’ needs for different forms and frequencies of contact changes as they reach different stages of development and face important questions about their early history.

The Independent Care Review emphasises the need for carers to receive continuing support to enable them to offer predictability of care:

In order to help carers to continue to care, Scotland must recognise that kinship, adoptive and foster families may need ongoing, intensive support. Access to support must not be predicated on a particular care setting or where children and families live. (Care Review, the Promise, p20)

Residential care

Many young people establish important relationships with members of residential staff which help them to begin to trust adults, perhaps for the first time, and develop a sense of security and belonging. Residential care should not be seen as a less desirable placement option, as it may well be the placement of choice for young people who have suffered early adversity, and yet, retain a primary loyalty to their birth family. They may be able to begin to rely on particular staff members when family placement could place them in an uncomfortable conflict of loyalty. Many advantages can follow which promote the young person’s resilience in crucial domains. From a base of increased security, they may allow themselves to be helped to rehearse skills in establishing and maintaining friendships, exploring their talents and abilities, enhancing problem solving and becoming meaningfully involved in their communities which will help them as they move into adulthood. (Daniel and Wassell, 2002).

While acknowledging the contribution of attachment theory, Smith and colleagues (2017) cite the risk of giving undue prominence to one framework and undervaluing the benefits of relationships with supportive adults other than parent figures, for example, for those young people looked after in residential care. They suggest a concept of ‘mattering’ to someone as significant.

The concept of mattering, developed through co-constructed relationships of meaning, would suggest that, when a young person feels they matter to others and to themselves, they tend to do well.’ (p1611)

Smith and colleagues (2017) propose consideration of recognition theory as an additional, broader framework which goes beyond primary attachment relationships to reflect wider needs (Honneth, 1995). These include:

• emotional recognition of the need for love and care
• legal recognition of rights as a human being
• solidarity or social esteem as part of one’s contribution to a community

Recognition does not prioritise a biological attachment relationship but does acknowledge the important source of comfort, warmth and familiarity to be gained from close relationships with a small number of people.’ (p1161)

These authors echo the findings from the Independent Care Review which emphasise the crucial importance of relationships for children separated from home.