Integrated Children’s System – Resiliency - Attachment - Attachment disturbances – and Trauma

1. Integrated Children’s System – Resiliency - Attachment - Attachment disturbances – and Trauma An Introduction Irene Søndergård and Godette Walmod

2. Introduction • Presentation • Introduction to the topics • The objective of the lecture

3. Integrated Children’s System (ICS)An approach to social work with children and families • Denmark and 14 other countries have adapted ICS as a framework for assessment, planning and intervention in social work with children and their families. It is a model on how to get necessary data and knowledge about children in need • Currently, about half of the municipalities in Denmark are currently using the system – most of them in combination with an IT system. • The main objectives are to strengthen the social work by securing a holistic and thorough assessment and supplying social workers in children’s services with a common ”language” and approach.

4. ICS - History • Developed in England in the 1980’s by social workers and researchers because there were serious problems in the field – many children in foster family care were maltreated and were having serious problems • Implemented in other countries – in Denmark in 2007

5. ICS – theoretical base In working with ICS, you as a social worker has to useboththeoriesand reseachfindingsalong with experiencedbasedknowledge. The theoretical base is mainlysystemic and relational. • The maintheoriesare: • Theoriesaboutresiliency • Attachmenttheories • Uri Bronfenbrenner’secologicaltheory • Other (newer) theoriescanbeincluded as long as they do not contradict the theoretical base.

6. The ICS triangle (English edition)

7. The ICS triangle (Danish edition)Selected perspectives

8. The ICS triangle (Danish version) The child’s/ young person’s developmental needs: • Health matters • School matters and learning • Leisure time and friendships • Development and behavior • Emotional and behavioural development • Identity • Social appearance • Independence • Family – family relationships

9. The ICS triangle (Danish version) Parenting skills: • Basic care • Safety aspects • Eotional warmth • Stimulation • Guidance and setting boundaries • Stability

10. The ICS triangle (Danish version) • Family conditions – family and surroundings: • Family history and functioning • Extended family and others in the familynetwork • Housing • Employment • Finances • The family’srelationships to the broadercommunity • Social integration of the family • Local communityresources

11. ICS – and the social work • The ICS approach includes a lot of (printed) forms that helps the social worker do a good job when assessing children in need and their families. • The forms are also targeted at school teachers and staff in day-care institutions so that the collaboration between for instance teachers reporting on a child in need and social workers can function more smoothly. • A lot of effort is made to make sure that ICS is not about filling in forms but about securing a holistic and thorough approach to casework with children and families.

12. Risk and resiliency in children’s lives

13. A definition of resiliency • ”Resiliency are processes that causes a development to reach a satisfactory result in spite of the fact that the child have had experiences with situations involving a relatively high risk of developing problems or deviations.” (Rutter, 2002)

14. A model of resiliency (Jakobsen, 2008) Protective factors Positive adjustment measured as positive psychosocial behaviour Resiliency processes (time) Stressors Risk factors

15. Risk factors and risk processes • Children at risk in the Kauaistudy: (Borge, 2004) Children at risk in thisstudy had beenexposed to four of the followingninerisk factors: • Perinatal stress (medicalconditions) • Powerty • Parents with no or a short formal education • Desorganiseredfamilyenvironment • Limited stability in the family • Parents with an alcoholabuse • Violence in the family • Young teenagemothers • Child neglect • A third of thesechildrenweredoing fine at age 40

16. Protective factors within the child (Luthar m.fl., 2000) • Hardiness and an easy temperament • Social competences (being charming) • Cognitive capacity (normal or above average IQ) • Creativity and interests • Dealing with stress and controlling emotions • Experiencing meaning, hope and coherence

17. Protective factors within the family and in the environment (Luthar m.fl., 2000) • Periods of positive emotional relationships with the parents • At least one resilient parent • Parents that allow help form others • Participation in leisure interests • Pier groups with good role models • Attachment relationship to at least one adult

18. Environments promoting development and resiliency • Environments promoting development and resiliency allows the child: • To be exposed to stressors adjusted to the child’s developmental level • To be prepared to deal with hardship and disappointments in later life • To recover from stress and disappointments • To repair broken relationships • To regain trust in oneself and the environment (Broberg, 2008)

19. A narrative approach to resiliency • A narrative stimulates the child’s perception of coherence and causality • A narrative structures the child’s own experiences • A narrative can create a distance to and a perspective upon ones own situation • A narrative can ascribe meaning and importance to events happening around the child • Narratives can be changed (inspired by Bovbjerg & Kahler, 2007)

20. Resiliency and the importance of childrens play • Play creates coherence in the child’s daily living • Play helps the child overcome challenges that would otherwise be too difficult for the child • Play allows the child to express emotions • Play allows the child to develop skills • Play allows the child to feel free

21. Attachment theory The Concepts of AttachmentTheory(1907-1990) (Broberg, 2008) • Attachment: A lasting internalrepresentation of the relationship with the caregiverincluding a strongtendency to seekproximity to the caregiver in stressful situations. • Attachmentbehaviour: Any behaviourthathelps the childcreate and sustainphysicalcontact with the adultcaregiver in order to guaranteesurvival.

22. The Content of Attachment Theory • The theory deals with the proces resulting in a psychological ”bond” between the child and its closest caregivers. The theory also describes how the attachment relationship is developed into mental representations within the child. (Broberg, 2008) • Biologically, attachment guarantees the survival of the child and, psychologically, leads to a sense of security.

23. The Bonds of Attachment The longlasting emotional bonds of attachment are characterized by the following: • They are specific (directed towards specific individuals) • They express a wish for physical proximity • They result in comfort and security • Breaking the bond leads to separation anxiety

24. Other attachment figures Howe et. al (2000): Criteria for being accepted as an attachment figure: • provide continuity and consistency in the child's life • have the emotional investment in the child • provide physical and emotional care

25. Attachment hierarchy Colin (1996) • Children form in their first year of life a small hierarchy of significant caregivers. Ones place in the hierarchy depends on: • How much time each caregiver spend with the child • The quality of the caregiving • How much each caregiver invest in the child emotionally • Caregivers repeated presence over time (Cassidy, 1999)

26. Stages in the Development of Attachment • Preattachment (0-2 months): • Indiscriminate sociability/social responsiveness • Attachment in the making (2-7 months): • Learning the basic rules of interaction • Manifest, clear-cut attachment (7-24 months): • Separation and stranger anxiety • Goal-corrected partnership (24 months and beyond): • The child is beginning to understand the needs, perspectives and points of view of its caregivers

27. Internal working models • ”No variables have more far-reaching effects on personality development than a child’s experiences within the family. Starting during his first months in his relation to both parents, he builds up working models of how attachment figures are likely to behave towards him in any of a variety of situations, and on all those models are based all his expectations, and therefore all his plans, for the rest of his life”. (Bowlby, 1973)

28. Internal working models • An internal mental organisation • A generalized representation of oneself, the attachment figure and the relationship - including the related emotions. • Once the internal working models have been formed, they are most often non-conscious/unconscious • The internal working models develop from primitive, models into more complex and stabile models. • The functions of the internal working models is to help the individual understand what is happening in present relationships, to predict what will happen in future relationships and to work out behavioural strategies.

29. Developmental pathwaysin stead of developmental stages • Bowlby uses the concept of developmental pathways as a model for the interaction between heredity and invironment. The personality of the individual is seen as progressing along one or another of an array of potential, separate developmental pathways. The interaction between the individual and the possibilities of the environment determine which pathways are chosen.

30. Attachment and Separation There are three stages in Bowlby’s theory on the way children react to separation: • Protest (anxiety, intense crying and an attempt to ”find” the caregiver) • Despair (the child seems calmer but is sad and in despair. There can be anger towards the caregiver that has ”let down” the child. The anger can be directed both inwards and outwards). • Detachment (the child reacts towards the caregiver as if he or she is a stranger)

31. A secure base (1913-1999) • ”Familial security in the early stages is of a dependent type and forms a basis from which the individual can work out gradually, forming new skills and interests in other fields. Where familial security is lacking, the individual is handicapped by the lack of what might be called a secure base from which to work” (Mary Salter, 1940)

32. Basic Caregiving Ratingscales for the assessment of attachment relevant behaviour of caregivers (mothers) (Ainsworth and others 1971): • Sensitivity vs. Insensitivity (to the baby’s signals) • Cooperation vs. Interference (with baby’s ongoing behaviour) • Availability (physical and psychological) vs. Ignoring and neglecting • Acceptance vs. Rejection (of the baby’s needs) The quality of caregiving is important to the development of the child

33. The Strange Situation Procedure for 12-18 month old children • Mother and baby are shown into the room and mother is given instructions (30 sec.) • Mother sits on a chair – baby is free to explore (3 min.) • Stranger enters, greets mother and baby and sits down opposite mother. After 1 min. stranger engages mother in conversation and attempts to engage baby in play. Mother leaves quietly (3 min.) • Stranger sits on a chair and attempts to comfort baby if necessary (3 min.) • Mother calls baby’s name and enters. The stranger leaves quietly. Mother comforts baby if necessary and sits down on the chair. Mother leaves, saying ”Bye-bye; I’ll be back.” (3 min.)

34. The Strange Situation Procedure for 12-18 month old children • The baby remains alone (max. 3 min.) • The stranger enters, comforting baby if required. If she cannot comfort the baby, the episode is curtailed (3 min.) • Mother returns and stranger leaves quietly (3 min.)

35. Examples of secure and insecure attachment • http://www.youtube.com/watch?v=QTsewNrHUHU&feature=related • https://www.youtube.com/watch?v=DH1m_ZMO7GU

36. Attachment Classification based on the Strange Situation The classification is mainly based on the baby’s behaviour in separation and reunion situations. Patterns of attachment observed by Ainsworth: • ”A” children: Insecure avoidant attachment • ”B” children: Secure attachment • ”C” children: Insecure ambivalent/resistant attachment A fourth pattern was observed by Main • ”D” children: Insecure disorganized attachment There are subgroups to each attachment pattern and different categories of insecure attachment are proposed

37. Patterns of Attachment • Insecure avoidant children: The child plays most of the time but his playing seems superficial and it does not seem to matter much to him whether the mother is present or not. When the mother returns, the child ignores or avoids her actively. The child seems to have no confidence that when he seeks help/care, he will be responded to helpfully – on the contrary, he expects to be rebuffed and tries to protect himself against this rejection. The strategy of the child is to maintain a distance to the mother.

38. Patterns of Attachment • Secure children: The child plays confidently and is often open towards the stranger while the mother is present. The child seems to miss the mother when she leaves, and he hurries towards her when she returns. If the child has been distressed in the absence of the mother, he is easily comforted by her and is able to return to his play activities. The child uses his mother as a secure base. He is confident that his mother will help him in stressful situations. The strategy of the child is a confident approach.

39. Patterns of Attachment • Insecure ambivalent/resistant children: The child is preoccupied with the mother, whom he constantly observes. He cannot focus on playing and appears anxious about exploring the world. The child seems ambivalent in reunion (both seeking comfort and expressing anger). It is difficult for the mother to comfort the child, and he seems uncertain as to whether his mother will be helpful when called upon. The child is therefore prone to separation anxiety and tends to be clinging and anxious about exploring the world. The strategy of the child is to cling to the mother and try to control her.

40. Disorganized or desorientated Attachment Pattern • Disorganized children: The child appears disorganized, self-contradictory, confused and unpredictable in his reactions to reunion with the mother. He reacts in a strange manner. One child appears dazed, another freezes to immobility and a third engages in stereotype movements. The child seems confused and frightened of the mother’s reactions and it seems difficult for him to handle her reactions in a normal manner. The child does not seem to have a specific attachment strategy.

41. Attachment • “…a strong disposition to seek proximity to and contact with a specific figure and to do so in certain situations, notably when frightened, tired or ill.” (Bowlby, 1969/1982)

42. Bowlby’s Theory: • The attachment system • motivates the infant to seek proximity to the attachment figure • the internal goal of the infant is to seek felt security

43. Attachment exploration balance activated attachment exploration deactivated

44. “Internal Working Model” of Relationships • Internal working model - an abstraction of related memories and generalized event representations • Consists of representations of self, other, and relationships, including feelings, beliefs, expectations, behaviors, intentional strategies, and memories • Formed during the first year of life

45. Infant attachment classifications Secure pattern: • Secure (B) Insecure patterns: • Avoidant (A) • Resistant (C) Disorganized pattern: • Disorganized (D)

46. Circle of Security • Created by Glen Cooper, Bert Powell, Kent Hoffman, Bob Marvin • Method of parent education, guide to clinical assessment and intervention

47. Circle of Security Interview • is managed to get access to the caregiver's internal working models, • i.e.the capacity for empathy, the ability to take the child's perspective and imagine that the child may have internal representations. • to identify the types of sensitivity caregiver has associated with, respectively separation, performance and security.

48. Circle of Security Is an attachmentbasedmethod for early intervention, to helpcaregivers to become a ”secure base” and a ”safe Haven” for theirchildren in all ages. • The top of the circlerepresentingexploration • The bottom of the circlerepresentsproximityseeking • The hands of the caregiverillustrate, thatshe has to bebigger, stronger, clever and nice.

49. SECURE BASE SAFE HAVEN Circle of Security Parent Attending to the Child’s Needs I need you to I need you to • Watch over me • Help me • Enjoy with me • Delight in me Support My Exploration I need you to I need you to • Protect me • Comfort me • Delight in me • Organize my feelings Welcome My Coming To You

50. Top of the Circle: Facilitating Exploration • Watch over me • Help me • Enjoy with me • Delight in me