Local Family Justice Board in Partnership with Salford University - Annual Conference 15 Feb 2017

1. Local Family Justice Board in Partnership with Salford University - Annual Conference 15 Feb 2017 Professor David Shemmings OBE PhD University of Kent UK Visiting Professor of Child Protection Research Royal Holloway University of London Director of the Attachment and Relationship-based Practice Project Co-Director of the Centre for Child Protection, University of Kent Director of the West London Advanced Child Protection Pathway d.shemmings@kent.ac.uk

2. Example A I am concerned about this child’s attachment with his mother. He seems to have an insecure attachment relationship and appears anxious around her. This is clearly affecting his development in that he is not meeting certain developmental milestones. When he is in distress, his mother uses harsh language and this could be the basis of his insecure attachment relationship. In terms of strengths, the family environment is suitable for a child of his age with lots of toys and games available for him.

3. Problems with attachment checklists • Children who have attachment difficulties can express this in a wide range of behaviours and it can sometimes be difficult to recognise that the issue is linked to attachment. These behaviours can be broadly categorised as follows: • Aggression, oppositional or defiant behaviours (e.g. extreme tantrums, open aggression and defiance, or gratuitous violence) • Hyperactivity, poor concentration and risk taking • Lying, stealing and manipulative behaviours • Compulsive caregiving, compliance and self-reliance (the child looks after him or herself as well as their carer) • Indiscriminate approaches to adults and children (the child may treat their carer the same as stranger adults, or may appear to show more interest in or affection for unfamiliar adults than their familiar carer)

4. Problems with attachment checklists • Social withdrawal (e.g. rejecting behaviour towards the main carers) • Sexualised behaviour • Sleeping problems • Eating problems • Wetting and soiling • Self-harm

5. Recent developments around D behaviours – my own ‘take’ • There appear to be three different 'pathways' to disorganised attachment behaviour: • Abusive Parental Behaviour experiences, such as physical or sexual abuse and some extreme forms of intentional emotional abuse or neglect. • Unintentional Parental Maltreatment, comprising caregiving which is inadvertently frightening to the child, extensive unplanned care (see Main et al, 2011), frequent over-night separations (see Main et al, 2011), the combined effect of socio-economic risk factors (Cyr et al, 2010; Gedaly & Leerkes, 2016) as well as gene-environment interaction (but more research is needed here). • Pathways Involving No Maltreatment, such as some children with autism (but as yet it isn't clear precisely what the mechanism might be that produces D behaviours) and the possibility of a more direct genetic influence (again, more research is needed). • Furthermore Robbie Duschinsky points out in his comprehensive review of the history of the development of the D category that some of the more 'extreme' forms of insecure-avoidant and insecure-ambivalent attachment patterns can resemble D behaviour (Duschinsky, 2015).  • At the root of D behaviour appears to be that the child cannot gain any comfort when experiencing high levels of fear or stress. • What the family will often need is help to understand and then stabilise (i.e. 'un-disorganise') the child's attachment system. Ignoring D behaviours is likely to lead to developmental problems later on.

6. Over 7000 professionals trained in 7 years (numbers in brackets indicate how many 4-day courses) • Lewisham (x6) • Tower Hamlets (x8) • Croydon (x7) • Merton (x2) • Enfield – all teams, all staff • Hounslow (x2) • Essex (x16) • SW Essex NHS • PIMH Surrey NHS • Bromley (x5) • Camden (x10) • Surrey NHS (x12) • Barnet (x11) • Brent (x6) • Havering (x2) • Hammersmith and Fulham (x3) • Richmond & Kingston (x5) • Redbridge (x2) • Bedford (x3) • Cork, Ireland • Essex Virtual Schools (x2) • WLA (x9) • Waterford, Ireland • Kent (x3) • Stoke • Surrey (x8) • Stockholm (x2) • Dusseldorf (MoD x 2) • Cyprus (MoD x 2) • Southwark (x2) • Nottingham • Coventry • Manchester • St Michael’s, London (x5) • Medway (x8) • Belfast (NIGALA – x2) • Newham (x2) • Channels & Choices (x6) • Havering (x3) • Devon – all teams (> 600) • Sheffield • TACT UK • ELEVATE CPD • Lewisham NHS (x2) • Barking and Dagenham (x6) • Wigan • Lambeth (all staff)

12. from Eileen Munro (referring to Browne and Saqi) “Browne estimated that, on existing knowledge of risk factors, if we screen 10,000 children in the general population, we would miss seven high risk cases, correctly identify 33 and falsely identify another 1,195 families as high risk”

13. Andy Bilson’s researchBritish Journal of Social Work Bilson & Martin (2016) • Based on a Freedom of Information request with data from 75 per cent of all English children’s services departments covering over half a million children, this paper shows that 22.5 per cent of children born in the 2009–10 financial year were referred to children’s social care before their fifth birthday. • Three-quarters of them were at some point assessed, almost two-thirds found to be in need and a quarter formally investigated.

14. Andy Bilson’s researchBritish Journal of Social Work Bilson & Martin (2016) • One in every nine children born in 2009–10 was suspected by social workers of being abused and this high level of involvement is only justifiable if it is demonstrably reducing harm and promoting well-being of children—an outcome which is contested.

15. Example B I am worried about how this child’s relationship with his mother is affecting the way he learns and plays. I have seen that when he is upset, his mother seems to distance herself from him and tell him off rather than offer him comfort. As a result, the child seems to spend a lot of time checking that she is OK and this means he has less time to play with the toys he has at home. This may partly explain why he is unable to do the kinds of things other children his age can usually do, such as build a tower of 5 bricks, and identify colours and shapes.