Monday, 18 May 2015

Attachment-informed transformational change

Health and social care providers are under pressure to change the way they work from traditional find-and-fix treatments to predict-and-prevent approaches.


Attachment matters for all allows us to see that in the field of child care, a predict-and-prevent approach which is being developed at the moment is based on attachment theory. This theory asserts that the first few years of life are crucial for child development and depend on the bond that exists naturally between babies and their carers. "In the optimal situation babies experience care giving from one or two adults which is predominantly reliable, sensitive and attuned to their individual temperament and needs."

Of course, if parents get it wrong, a baby will keep making a fuss until they get it right. There is nothing intellectually challenging about this and it is surprising that what has worked for endless generations requires expert guidance these days. However, the early intervention approach favoured by policy makers needs a theory to ground itself on, and attachment theory fits the bill.

The theory has its flights of fancy: "Through facial expressions and verbal cues ... care givers reflect back to their baby what they believe is happening in the baby`s mind. This `affect mirroring` process repeated several times a day from birth enables securely attached children not only to develop a sense of their own internal world but also helps them to recognise others as beings with minds, emotions and intentions." It is the beginning of empathy.

Early childhood aggression and violence has to be unlearned, according to this view, through secure organised attachments otherwise it continues into later childhood, adolescence and beyond. At this point it becomes clear what is to be predicted and prevented. Childhood behavioural problems will be seen as failures of parenting with long term consequences at the societal level:  low educational attainment, unemployment, criminality, drug addiction and so on.

It should be noted that these problems are often associated with deprivation and poverty. There is no question of predicting psychopathy and criminality amongst the more affluent. No-one will be looking out for future banking fraudsters, paedophiles in high places or war-mongering politicians. It is, as if, only the poor have a problem with attachment.

Social work

Social workers come in for some heavy criticism in the report ."As well as demonstrating a lack of knowledge about all child development, not just attachment, there was concern that social workers were often unable to exercise any analytical or critical thinking skills. Because social workers have a statutory responsibility to make assessments that inform key decisions about children’s lives, there was a particular focus on the lack of understanding and assessment skills displayed by them,"

Oh dear ! Social workers have been getting it wrong but there are many children, now grown up, who can testify to that.

The answer, according to the Celcis report, is an understanding of attachment theory. Of course, "some of the effects of attachment interventions may not be apparent until children reach full adulthood and take on for themselves the responsibilities of sustaining employment and parenting."  So all of this must be taken on trust, and note the importance of sustaining employment which comes before parenting.   

Proxy measures 

"Although a variety of assessment measures are available they are time consuming and are usually only used in a clinical or research context. They are not necessarily suitable for front line professionals attempting to make rapid assessments when children are at risk, although they can be very useful as part of a rigorous assessment and intervention programme. There is, however, convincing evidence that certain care giver characteristics are associated with the development of disorganized attachment." They do not say what those characteristics are.

What this means is that it is parents/carers who will be assessed as to their character "as most effective attachment based interventions target the care giver and the relationship rather than the child directly. " If ever there was a dangerous idea, this is it.

Building a web to trap parents

Not only must there be a shared language about wellbeing but there needs to be a shared language about attachment. A whole new industry in attachment training and consultancy is in the making, as if there has not already been enough training in GIRFEC, data sharing and the eight wellbeing indicators. We are told that midwives, health visitors, social workers, teachers , children`s panel members and even sheriffs need to develop this shared language and understanding of attachment. As an example: "Highland Council are creating a Framework for Training across Integrated Children`s Services to support the implementation of Getting it Right for Every Child ."(GIRFEC)

The important practice principles that should inform interventions: "identifying, developing and maintaining secure attachments in children`s lives is a priority; safe touch is an important component." [whatever safe touch is in a care system that abuses so many children]

Armed with attachment-informed practice, professionals will be able to act with great cruelty, all for the greater good, for we are told that:

"It is important to recognise that adults who are unable to provide this kind of sensitive mentalising care may still genuinely love their children. It is also, however, important not to privilege the fact of parental love over other aspects of the child`s needs."

It is also recognised that young people in care can still be profoundly distressed and anxious when detached from their attachment figures.

They may feed and clothe their children, keep them safe and warm, and so on. It does not matter. Parents will be judged on the basis of their general characteristics to have failed in effective mentalisation, whatever that really is. Nobody needs to examine the child. Imagine how difficult it will be for any parent to make a stand against a group of child care professionals sharing the language of attachment, to say, but you do not understand, you have got it wrong. This is the problem with collaboratives. It provides an impenetrable power bloc which no parent can overcome. So we must suspect that that is what it is designed to do.


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