Podcast Episode: Why attachment matters beyond early years. SAIA Conference 2013
What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.
IW - Ian Watson
TB - Tam Baillie
JF - Judy Furnivall
SW - Sally Wassell
HM - Helen Minnis
ZD - Zachary Duncalf
IR - Ian Reid
IW Scottish Attachment In Action, (SAIA) annual conference was held in Glasgow on 6th December 2013, on the theme of 'why attachment matters beyond early years'. Tam Baillie, Scotland's Commissioner for Children and Young People, opened the conference by setting attachment in the context of the United Nations Convention on the rights of the child.
TB One of my main responsibilities is the promotion and safeguarding of children's rights. I have to pay attention really to look at the United Nations conventions, the rights of the child as being the most significant document for children and young people in Scotland. And really my way of summing up a better focus, a clearer focus on the United Nations Convention on the rights of the child, is this is about improving children's lives, and so it attachment, so is an understanding of attachment theory, attachment in practice and so this conference which is what attachment in it's core, for me is serving the same ends where I what to be going with the UNCLC and better awareness and understanding of that, because at the end of the day it's about improving children's lives and life experiences.
IW Tam went on to talk about how research into brain development in the early years is beginning to help us understand brain development in adolescence.
TB I am struck by the parallels in what we now know about brain development in early years in children, in babies, particularly that process of rapid growth of synaptic connections and then a pruning out, either something very similar happens in adolescent brains in terms of the development of the pre-frontal cortex, which is really our higher reasoning part of the brain, judgement, the adult part of the brain which matures later, but it goes through exactly the same process of rapid connections being made early in sort of middle childhood, between 9 and 10, and then a pruning out. Now if we, what we know from early years is that the external environment impacts on children's brain development in those early years, I think that there will be a growing body of evidence to develop our understanding of what's happening in the adolescent years. We are not there yet, but everybody knows that we can develop better understanding of adolescent behaviour and the way that we engage with adolescents, and I think part of the unlocking of that is a better link between the neurology and the physiology and the social psychology, or our understanding of the social world in which these young adults are operating.
IW Tam told a story about a young man whose social worker, many years ago, had taken him into his own home to help him in his transition from care. Has practice now become too risk averse in dealing with relationships and attachments?
TB The key part of that was the sustaining of relationships that Steve, who was the young man who made a success of his life, the key part of the relationships that he had in care impacted on him in his later life, so when he came back to Hamilton and we had arranged for him to meet his 'matrons' as he called them, in fact he called them his 'mothers', the 3 of them, and the one person that we couldn't get him to meet was the worker who had taken him into his own home and provided him as that as his transition out of care, that wouldn't happen nowadays but it was something about the strength of the relationship that that worker had with Steve to provide that continuity of safe, secure, attached relationship that provided him with the platform to move on to the adult world. And these are lessons that we have to reflect on, because nowadays that just wouldn't happen because of the way our practices are developed.
I think there's a number of things pressing in on our practice, not least of which are some of the revelations of abuses that have taken place in our residential sector, but there's also been a change to more risk averse practices, of which the protection of the relationship, the professional relationship, whatever that means, has become part of it. But I sense a time and place now where people realise that in fact risk averse practice can be damaging to children and young people and where we don't nearly value the relationships, the attachments that build up in those close, personal relationships, as they develop and we need to question whether this is the best place for us to be in our current state, and I tell the story as a way of jarring people to think about this was what happened previously and that was the lasting effect, the impact that it had on that young man.
IW Are you optimistic that the sort of paradigm shift that Judy Furnivall talked about there is taking place, will take place?
TB Well Judy talked about the importance of touch and I gave an input to a festival 'Dangerous Ideas' last year, giving exactly the same message about the importance of touch. Especially when we know about children in the early years where touch is an integral part of their growth, actual growth but also the security that they feel, and so it goes right the way through. So we have to find ways of moving that risk averse culture back to one which is much more human.
IW I asked Judy Furnivall of CELCIS about the findings of the report 'attachment matters for all' and why an understanding of attachment theory can be transformational for all kinds of professionals. The discussion covered the difficulties facing newly qualified social workers putting attachment into action, a question of professional boundaries, risk averse practice, evidence informed practice and practice informed evidence and finally, how Nelson Mandela might inspire a paradigm shift towards more attachment based practice.
JF It was intended to be a way of mapping what training there was around attachment and what practice there is around attachment throughout Scotland, so we've been talking to Universities, Colleges, Local Authorities, Independent Providers, Voluntary Providers, some key individual consultants who have got a very strong attachment focus in their work about this area.
IW And have you found that while it's routinely talked about to social work students, it's not so in other professions?
JF Absolutely, we got told pretty categorically by teaching training courses that although they could understanding the importance of it, there was so much on the curriculum, there was no space and that it would not, they couldn't see how they could incorporate it into pre-qualifying training with health, nursing and midwives, again there was very, very little, even though midwives and health visitors are working in exactly the moment when looking at the attachment potential of the relationship is key and that they are well placed to improve and support the development of secure attachments. But this isn't something they know about and it hasn't been ... it is beginning to change.
Adult psychiatrist who was very clear that attachment theory, he'd realised that actually what he was seeing in his adult patients had it's roots in failed attachments when they were younger and that really he should be concentrating some of his resources and efforts on ensuring that was happening for future generations.
IW I think you said there that where professionals are taught attachment, it's transformational?
JF For teachers particularly, the experience of teaching teachers about attachment is ... it's like the blinkers come off their eyes, they see things in different ways, they make sense of behaviour differently, it allows them to engage with children in a responsive way rather than punishing behaviour, they try to understand the meaning of the behaviour, clearly they have still got to put boundaries around children, but they do it in a way that comes from the caring, concerned and understanding perspective, rather than having to deal with what feels like very oppositional, defiant, difficult behaviour.
IW Back to the social work training, you indicated that although attachment is taught, some social work managers felt that newly qualified social workers weren't practicing attachment ...
JF I think that's absolutely right and I can completely understand why. What happens is, you are taught in a fairly protected environment and you have a fairly protected placement as a social worker, social work student, but then you come out and you are hit with all the fear and the stress and the difficulties of child protection work, investigations, pressures and although I am sure that if you ask the social worker about attachment theory they might be able to tell you, being able to practice it in an environment which is absolutely the opposite of an attachment informed environment is almost impossible, you can't expect people to manage that. They don't even have ... teachers have a protected year after they qualify, social workers don't have that, even something like allowing a protected year for a social worker so that they had space in which they could practice their craft rather than being bombarded and hit with these really difficult, painful examples of families.
IW I think you said it was difficult to get an attachment focused approach unless we redefine professional boundaries, this seemed to be a subject that came up ...
JF It's something I feel very passionate about, it's ... the reality is that we have created an idea about professionalism that is about not getting too involved, being a bit distant, remembering that you are not the parent of the child and these kinds of comments that are taught and underpin an awful lot of the discourse around social work, and actually all kinds of professions with children. The reality is what we know from young people themselves and from adults who grew up in care, is that it's the adults who didn't do that, the adults who took the step over the professional boundary in the sense of being really committed, genuinely involved, where the child felt I am more than just another case, I matter, and where they went out of their way to maintain relationships, to be prepared to hug or cuddle when a child is distressed, all the things that actually put you slightly wrong footed at the very best, and in some cases end up with you being disciplined if you do nowadays, and I think we have really got to regain a sense that professionalism is about the use of self and that's about connection and engagement and involvement. Of course you need to be accountable and of course you need to be transparent but realistically, children need connections, they need human relationships that are real and genuine and warm and loving.
IW Are you optimistic that this paradigm shift that is necessary is taking place or is about to?
JF I think we have evidence, both positive and negative, there are some awful things happening still in terms of the way that we disrespect attachments, disrupt children's security and relationships that have given them safety and hope because of these kinds of assumptions that I was talking about earlier, and there's some dreadful practice around that. On the other hand, we now have a situation in which residential workers, foster carers are able to talk about loving children without being ... feeling uncomfortable, we have a real shift in an understanding that children need continuity, stability. We were talking about young people being allowed to stay longer with their foster families or even in residential establishments, so we are talking about things are shifting, I think we are at a cusp, it can go one way or the other and we need to be fighting, we need to be actively fighting and resisting any kind of risk averse practice and any kind of lack of respect for attachment based relationships.
IW And does this bring in what you might say, practice based evidence more to the fore, compared to ...
Evidence based practice? I do believe in evidence based practice but I think you need to be clear that we need to create the evidence around more complex theoretical bases, rather than just simple behaviourism. It's easy to measure some things and we can get lured into the apparent scientific certainties of manualised behavioural interventions, when in actual fact what may be happening is the quality of the relationship, the warmth, the involvement between the key people, the child and the adult, may be what is actually permitting change as well as anything that's measurable. We need to be able to find a way of looking at what appears to be working really well, even if we haven't yet learnt to scientifically measure it and translate those practices into evidence, rather than just assuming we can only work with evidence based practice, otherwise we are stuck with just what we have already. If we don't create our own evidence and find our evidence, we stay with the same things that we are doing over and over again.
IW You finished up by drawing on Nelson Mandela for inspiration, on the day after he died. What's his message for social work people?
JF I think his message is about humanity and I think we, as social workers need to remember we are human beings and our relationships with those we serve is about being human. Nelson Mandela enabled a traumatised, distressed, highly stressed group of peoples to survive and to regulate and overcome that stress and distress enough to avoid what looked like it was going to be catastrophic civil war. If Nelson Mandela can hold and contain and help to provide a route forward for South Africa, we in Scotland really ought to be able to manage a paradigm shift that ensures our children and our families are given that kind of attachment focused practice as an absolute basic right and we need to ... everything should be looked at through the lens of attachment in terms of understanding how we progress as a nation, and as a nation we should be judged in what we do or don't do for our children.
IW I asked Sally Wassell about the framework for promoting reflective practice and creating practice based evidence.
SW Yes, I mean the absolute cornerstone is really good effective relationship based supervision. Supervision that's not about work paid management, but it is about helping the worker to reflect on the impact of the work on themselves and the way that that helps them to understand what's going on in families, what's going on with individuals, so that they can be supported to remain centred in the work and not be either overly distressed or driven to cut off from their feelings, so a really essential component of that kind of culture is the sort of supervision that supports that kind of attentive attuned work with people. So it enhances the use of self and another aspect of that is consultation available to working teams to support either the thinking about particularly difficult cases or to think about the operation and functioning of the team, either internally or with other teams, since those dynamics really do affect the way that individual cases are managed and dealt with, and if we are going to keep systems healthy, cultures healthy for relationship working, then we need to attend to those kinds of issues.
IW Something else you mentioned about, midway through your talk was you were going to see practitioners writing books, is practitioner research an important element of creating a sort of practice based evidence as opposed to evidence based practice?
SW Yes, yes ... and I suppose I think, not just research, which puts people off because they think they can't do it, but actually people writing reflectively about their practice. So ideas that they have used in their practice, tools that they used, how they apply those tools, how they generate ideas for constructive creative working, that the more models we have of rich fruitful practice, the more we capture that, the more that encourages a culture in which we are not dependent just on organisational beaurocratic restrictions, but seeking to kind of break through those and develop a culture of effective practice.
IW Is there an appetite amongst practitioners to do this type of reflective ...
SW Oh I think there is, but I think there's also the burden of a great deal of child protection work, the beurocracy which surrounds that more than anything else, so it's a challenge for people to think about permanent plans for children, never mind to think about the creative ways they might be engaging with those young people to make those plans meaningful, for example, to engage with the youngster around making sense of their history, how do you do that, what are the kind of components of that, what needs to be in place, like for example, how to support a young person in developing a language for their feelings. So, I think there's a thirst and an enthusiasm, but there needs to be key practitioners, close ... well if you like, expert practitioners in terms of experience, I don't meant in terms of status in some formal system but people who have great experience of staying close to children and young people who can be very close to practitioners, you know supporting them and mentoring them in developing their own ideas.
IW Helen Minnis is Senior Lecturer in Child and Adolescent Psychiatry at the University of Glasgow. She reported in a study on maltreatment associated psychiatric problems, using identical twins to isolate genetics from social ...
HM The beauty of a twins study is that in identical twins or monozygotic twins, they share 100% of their genetic material, whereas non identical twins, or dizygotic twins share 50%, so what you can do is, you can look at the correlation of symptom scores between non identical and identical twins and you can model statistically according to that, so for example if you had a disorder that was purely genetic, like for example we screen children in the UK, we screen every child for foetal phenylketonuria, (PKU), because it gives profound learning disabilities if you don't know about it, if you know about it you can get a new diet and you will be fine, so really important to know about, but it's a single gene disorder, it's purely caused by a genetic problem. So identical twins would always be what we call concordant, they would both have PKU or not, whereas with non identical twins it would be a 50/50 chance of their sibling having it if they had it, so basically with any disorder you can look at where they are at between 100% and 50% and that's the degree of genetic kind of causation.
IW And these are twins who have been brought up in the same household?
HM Yes, yes, there have been other studies that people have done where they have looked at twins where either both or one of them adopted away, but this was children living in the same family.
IW Adoptive parents sometimes feel that they have to fix all the problems, but maybe that's too ambitious?
HM I think, honestly any parent of any kind, you want to fix problems in your children, you know and you do feel responsible, and I think one of the hardest lessons as a parent, any type of parent, is that actually there are many problems which are beyond your abilities. But I think there's been a particular problem for adoptive parents in that historically they have often gone for help and they have been made to feel it's them that's caused it and I think that's really difficult because, A, they haven't and B, the fact that you have often got negative cycles of communication that have been set up resulting from a child having really, really difficult problems that they brought into the family, that's nobody's fault, that's just what happens, and anybody would need support with that. So I think it is particularly difficult for, it's not just adoptive parents but for foster carers too, to work out what they can help with, while not feeling that they are entirely responsible.
IW I asked Helen about why some children and young people seem to have multiple behavioural problems.
HM From what I was saying earlier about feisty people, the fact that if they are in a negative circumstance they can end up in this group with all the problems, whereas if they are in a situation of good enough parenting they can actually do better. You have got a potential resource of really amazing people here who, if things were turned around, they could really be leaders, so there's that. I think it's been really helpful to be able to show that there is a hidden population, because I just think it's urgent that we find a way of sorting that out. I have been racking my brains ever since we got this finding, which is about 18 months ago, I haven't had any brilliant ideas but I think the fact that the kind of news is out there, that we do have this hidden population, we are just going to have to find a way of doing it. Somebody suggested recently, I was chatting to them ... maybe through schools as a way, because school teachers will see these children every day and if we can find a way of empowering teachers to link in on behalf of children with other professionals, then that might be a way forward.
IW Do you think that links to what Judy Furnivall was saying earlier then about attachment being a more important part of the teacher training?
HM I think attachment is, should be a core part of the training of any professional who interfaces with children, but particularly teaching, and not just in primary school, in secondary school as well, I think that's absolutely right, because I think many teachers become attachment figures for vulnerable children and they don't necessarily know what's going on, they don't feel supported, and actually if they could be supported they could make a really positive impact on these children's lives.
IW And we do randomised controlled trials and social sciences, Helen Minnis explains why we should ...
HM Well it is quite a kind of radical thing to do in that randomised controlled trials haven't been popular in social sciences I suppose, I think that's probably just because it is a very complex thing to do, you have got to get lots of different people on board to achieve it, but I think scientifically it's the thing to do because if you think about it, the work we do is so complex, there is so many different things that could interfere with your understanding about whether an intervention works or not, and the way that randomisation was described to me was if you imagine one of these big old lecture theatres with 300 seats, but an aisle down the middle and you have 300 medical students coming in and you toss a coin and they go to one side or the other, if you then asked everybody on one side to put their hand up and say if they want a holiday to Spain, and there was, say 10, and you did the same on the other side, you would get probably 10, so the beauty of a randomised controlled trial is that it balances out all the complications, so it's balances out all the factors. So we are testing 2 interventions, 1 run by social work and 1 run by multi disciplinary child and adolescent mental health team for children who have been maltreated and come out of foster care, basically what we want to know is which is the best model for working with these children in Glasgow. So I mean, incredibly complex question if you think about it, but the beauty of a randomised controlled trial is that everybody has got a fair chance of getting one intervention or the other, and because of what I have just said about randomisation, it balances out all the really complicated factors like, for example, what was the size of family that the child came from, or did the birth mum use alcohol or drugs, so all of these complications that muck up the research what we do will be ironed out in a randomised controlled trial, and then of course all you have got to do is just get everybody on board to actually do it.
IW Is that the hard bit?
HM That is the challenge ... I say it's a challenge, it's a really exciting challenge though, I mean at the moment we have got social work in Glasgow through Glasgow City Council, we have got NSPCC, we have got the NHS and the University of Glasgow and we have actually all got a partnership, signed in a contract and we are all working together, and that in itself is really important for these children, I think.
IW And what about the work with Dan Hughes, is he involved in the same project?
HM Well we are hoping to launch a randomised controlled trial, we are waiting on funding ... so Dan Hughes' intervention is a therapeutic intervention for children who have been maltreated and who are now either in adoptive placements or permanent foster placements, and we just really don't know yet, we don't have the evidence on how best to help these children, but what we do know is that a fair proportion of children in that situation have had, and they do have really complex, overlapping problems, and DDP's ... there's been some pilot work in the States that suggests it works well. So what we would like to do is do a randomised controlled trial and actually ... and it's the kind of thing that if we were able to show convincingly, through a randomised controlled trial, that DDP was a good model, it's the kind of evidence that would be good for NICE, for example, so the National Institute for Clinical Evidence looks for trial evidence to be able to say whether or not this was a model they would recommend on the NHS. So really if we want eventually to have those kinds of interventions rolled out for these children in the NHS, then we need to do randomised controlled trials.
IW Is there any controversy around this approach?
HM You know it's interesting there's a lot less than you would think. People always said to me 'social workers will never allow randomisation and vulnerable families with certainly never allow randomisation.' But if you explain to people, so take for example the trial that we are doing, we are comparing 2 interventions called 'gift and facts', and there isn't enough of either gift or facts to go around for all the families in Glasgow and we genuinely don't know which is the better model for Scotland, so if you explained to families that the best way of deciding whether they get gift or facts and learning about which is best for future children is essentially to toss a coin, or the way we actually put it to them is that it's a computer that decides. There's a fairness in that and families do understand that, they realise that I think in some ways there's a kind of levelling sense that we are admitting that we don't know, and they are actually helping us to find out, and for a family who has had their child taken into care, I think what we have found is they really like to have the opportunity to help. So we have not found it particularly contradictory.
IW Zachary Duncalf is a research fellow at CELCIS.
Zachary, you were at this mornings session with Tam Baillie, Judy Furnivall and Helen Minnis, tell me what would you pick out was the highlight of this morning?
ZD Gosh, I mean there's so much, I mean one is quite stark really that we have some fantastic experts on our doorstep really, and some connected relational practices going on every day that is across all levels of the care sector, and also say that we have a lot of research that's going on that we don't know about that has come to light today and the way in which different areas of health and research and policy as well, all interact on a very synced way as well, it was really quite strong this morning.
IW Judy talked quite a lot this morning about the big changes over the years in the way attachment is practiced, to the extent to which she felt some practices from her early days would probably get you sacked, and I spoke to some residential care workers at lunch time and they were trying to work out where that balance is, maybe the feeling is you can't go back to what it was back then, but ... do you have any feelings on that, that boundary?
ZD Yes, I mean certainly what tends to happen is bad or poor practice comes to light and in reaction to that we stop all practice related to that, it's classic, we have seen it around historic abuse and survivors who have relayed some wonderful experiences, but because we see it related to the past, it therefore must be bad or negative and we must move forward which is, I think, sometimes interpreted as away from those practices. We now have a wealth of knowledge and research and a commitment to practice that we have never had before where we can relook at things which are about relational, human, interpersonal relationships and incorporate back into working life, tied in with research and training consultancy a better way to work with our young people.
IW Do you find it surprising that apparently school teachers don't study attachment at all, or very little?
ZD I think social pedagogy is highlighted, the fact that we need to have a more holistic approach to working with various groups within society because social work was very specific, teaching was very specific and I can completely see why teachers historically felt that we're here to do the learning, we are not here to build relationships and social workers were here to make things better, we are not here to teach them, you know a kind of ... thing, whereas social pedagogy is highlighted that we need to be all of those and much more if we want to really improve the lives of disadvantaged groups.
IW Over lunch I caught up with some of the delegates about touch, risk and practice based evidence.
A theme running through the whole morning has been the core value and importance of relationships and that underpins all that we do, and has to underpin all that we do. It's a really hopeful, optimistic message coming from the conference, one that says that no matter how small the relation or experience is, it can make a difference and it's the combination of a myriad of small relational experiences that can make a difference and can promote growth, which as I say is a really encouraging message, when, for so many years I think for all of us we have worked in child care in different roles and different settings, there has been a sense of, the damage is done and it can get difficult to see a way forward for youngsters who have had adverse early years experiences, but the message here is we can make a difference through understanding relationships, attachments ... as residential workers, it's also very affirming because it kind of is what we have been doing for years and there's a language and there's a framework and there's permission to be using our relationships as we intuitively know is the right thing to do.
IW Do you see a distinction that also came out from Judy again, talking about evidence informed practice versus practice based evidence, was that something you have a view on?
Again, coming from the residential childcare sector, I think we are becoming more and more and more confident as informed, skilled and equal partners with other services and agencies, and in doing that I think we are increasingly inviting the world, if you like the professional world, to come in and see and understand our practice, which is ... in a professional sense, is non clinical, can actually challenge, as we were talking about this morning, a lot of notions of professionalism, and I think what we are finding is that with that confidence we are able to articulate what we do in a tongue and in a language that's accessible to partner professionals, but also to kids and to families, so we have got ... again it's just one example of practice that we almost no longer need to be apologists for, here's how it can be done and inviting the research world or the academic world in.
Ian Reid of Harmony School, talked about partnership working with Argyle and Bute Council
IR I am delighted that we are sitting having lunch with Tom here, I don't know if Tom is delighted he is having lunch with us residential workers ... but there is something quite significant, I think, that we have worked together with a number of kids, we're from very different settings, we have got different roles, different parts of the country and yet I know, using Tom as an example, that there was something when we were working together, Tom, and I am not being grandiose with this, that we had a shared language, we had a shared understanding, we were coming at how can we help these 2 particular lads from a same position of relationships, understanding their relationships, working with their relationships, rather than us having such different roles that there's almost a tension in the work, we were able to work together.
IW What's your perspective from working in a residential school, lack of touch for example?
IR My perspective on it is I am glad that people are actually talking about the situation and they are actually thinking about things that we can do to help young people and help children and we need to think about what it really is to be a professional, and as a professional carer, the things that we need to provide for the children that they have missed and that they have not had in their lives. The question, the old ideas that it's inappropriate to give somebody a hug if they are upset, really we are all human beings and that's kind of one of the basic essentials that we need.
IW At the end of the conference, I asked SAIA Chair, Paul Gilroy, to sum up the important messages from the day.
PG I think the biggest theme for me today is getting that balance between understanding attachment theory and how you put attachment informed practice into practicalities of practice, and I tried some of that at the end of the conference there ... our title is Scottish Attachment in Action, and it just felt to me that what we were listening to lots of today was about understanding that attachment isn't an event, it's about a continuous way of being, that we can all change, we all are who we are because of our experiences and we can change throughout life because of the experiences that we have, and it was really important, I think, that all the way through all of the speakers today, there was a theme of talking about individuals and personal stories and bringing it to life, and it just made me think about we can often get caught up in the jargon of DIRFEK and the jargon of theory and what we need to remember to see is the person and the human being that is inside the body of the child, because it is about the people and it's about the person and it's not jargon and it's not about budgets, it's about people.
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