ATTACHMENT STYLE ASSESSMENT OF ADOLESCENTS IN RESIDENTIAL CARE: Using the Attachment Style Interview (ASI)

1. BPS Annual Conference 2013 ATTACHMENT STYLE ASSESSMENT OF ADOLESCENTS IN RESIDENTIAL CARE: Using the Attachment Style Interview (ASI) Catherine Jacobs, Professor Antonia Bifulco Kingston University, London

2. Background • Attachment frameworks are increasingly used to understand human development in relation to forming close supportive relationships and understanding risks for psychological disorder in children looked after by the state. Residential Care: • In England, 11% of the 65,520 ‘Looked After’ children or adolescents were placed in residential care homes or hostels in 2011 (DfE, 2010). • Pervasive poor outcomes are shown for all ‘Looked After’ children, with half having emotional and behavioural problems at clinical levels: HIGHEST rates found for those in residential care (Ford et al., 2007). • There has been a move in the UK towards smaller units and fostering rather than residential care as the smaller units better imitate the dynamics of a ‘family’ and shed the negative ‘institutional’ connotations of larger homes (Cameron & Maggin, 2008). BPS Annual Conference 2013

3. Attachment theoryJohn Bowlby, Mary Ainsworth • The theory first developed in the 1940s has now become mainstreamed in research and practice. • It emphasises the importance of early relationships with parents in healthy child and adolescent development. • Individuals need closeness, support and feelings of security (ie close attachment) for normal child and adolescent development. Secure attachment is formed through close relationships with parents/carers. • Children develop an ‘internal working model’ about relationships based on earlier experience. This is open to change in positive conditions. BPS Annual Conference 2013

4. What is insecure attachment? Attachment styles can be • Secure: The most well adapted form - flexibility around trust, autonomy and closeness to others. • Insecure: Anxious, Avoidant or Disorganised styles • Disorganised style represents the lack of clear strategy in responding to attachment stimuli. Also known as Unresolved (Main & Solomon 1986) or Dual (Crittenden 1988). Linked to dissociated anger (van Ijzendorn et al 1999, Liotti, 2004). • Often considered the most damaged attachment style Insecure attachment style affects long term behavioural, emotional and social outcomes, particularly relationships and support seeking. BPS Annual Conference 2013

5. Comparing rates of insecure attachment style in residential care (Use of Adult Attachment Interview AAI) Residential homes School comparison Schleiffer & Muller, 2004) (Zegers, et al., 2006) (Wallis & Steele, 2001)

6. Aims: action research project • To import standardised attachment measures in the routine assessment of YP in care. • To assess the attachment style of young people in residential care, using the Attachment Style Interview for adolescents (ASI-AD). • To see whether similarity of rates found to those in the literature. • To look at preliminary findings on change over time. • To engage with practice staff on assessment and attachment interpretations of risk & resilience. BPS Annual Conference 2013

7. The Attachment Style Interview (ASI-AD) • The ASI (Bifulco et al., 2002) is an attachment measure originating in a social-psychological approach, which utilises a pragmatic and transparent interview and scoring method. This is adapted for use in adolescents • The measure identifies • Current relationship with family and social support. • Degree of attachment insecurity [Mild, Moderate, Marked] • Attitudes which define interpersonal style whether secure, anxious or avoidant. When two or more insecure styles are present (usually anxious + avoidant) this is described as ‘disorganised’. BPS Annual Conference 2013

8. Setting – 9 care homes • Residential care homes in England and the Isle of Man (www.stchris.org.uk) • All homes delivering a social learning intervention with praise and rewards for prosocial behaviour and daily assessment of progress in achieving aims. • This combined with attachment-related principles involving stability of placement, relationship to carers and support enhancement. • Baseline assessment of attachment style for young people entering the home and 6 month follow up. • Summary report produced for staff and feedback summary for YP. BPS Annual Conference 2013

9. Initial findings – risk profile 58 young people in SCF residential care (more boys – 64%), aged 11-17, average 64 months in care, Majority (74%, according to SDQ youth report) had psychological disorder at case level including ADHD, conduct disorder, or emotional disorder. Clinical notes showed substance abuse & Deliberate Self Harm also common. Most (79%) had some contact with mother , fewer (64%) had contact with father. 36% had no closeness mother; 46% high antipathy to mother; 54% no closeness father; 43% high antipathy to father 71% had no close confidant (family or friends) and very low ability to relate to others. BPS Annual Conference 2013

10. Findings 1 - Attachment styles (n=58) Oskis et al 2011 BPS Annual Conference 2013

11. Findings 2 - comparing rates of insecure attachment style Residential homes School comparison

12. Findings 3 - ASI at follow-up(preliminary findings - 11 interviews) 7-24 months after first interview. All but 1* exhibited at least one of the following – improvement in ability to relate to others and decrease in degree of insecurity (e.g. marked to moderate) change from dual/disorganised to single style, decrease in level of anger, mistrust or fear of rejection *In one case a high number of severe life events appeared to nullify any positive change. Only one changed to ‘mildly insecure’ style (within Secure range) All YP increased their role involvement eg taking up drama or sport, or improved school attendance, or had more psychological service support. BPS Annual Conference 2013 12

13. Measuring change – the challenge • What constitutes sufficient positive change on a largely categorical measure of style? • E.g. Move from disorganised to single insecure style, or reduction in intensity of negative attitudes and behaviour or change to secure style? • How to monitor style over time - the ASI is intensive & difficult to apply as constant monitoring tool, • timing the follow-up is difficult in care since young people often leave unexpectedly. • Additional approachs needed to monitor change more frequently and to apply dimensional score. BPS Annual Conference 2013

14. Q Pack assessment The Q pack comprises self-report questionnaires completed by YP and carer (and occasionally teachers). It includes symptoms (SDQ), life events and attachment insecurity score. Vulnerable Attachment Style Q (VASQ) is a self-report questionnaire of insecure attachment attitudes validated against the ASI (Bifulco et al 2003). Provides total score as well as insecurity-mistrust and anxious attachment score using cut-offs. Mixed is a combination of highly anxious and mistrustful-insecure. Results on first 11show reduction in mixed styles & increase in ‘normal’ levels of security. BPS Annual Conference 2013 14

15. A case for good assessmentin practice • Attachment interviews and models can be helpful for practitioners to recognise & understand vulnerability in children and families. • Attachment vulnerability needs operationalising in social care and clinical practice to help practitioners undertake meaningful assessments to inform direct care planning. • Reliable & user-friendly assessments across sites are needed for consistency of practice. • Understanding the potential for attachment change and better outcomes needed in assessment and care planning. • Consistent measures and models should ideally be used across agencies (eg social and psychological services). BPS Annual Conference 2013

16. Conclusion • The ASI-AD showed similar rates of insecure/disorganised attachment style in residential care as other research. High rates of dual/disorganised style & avoidant shown. • Preliminary results suggest some reduction in attachment insecurity in relation to stable placement & social learning intervention. This aided by use of self-report tools. • ASI-AD generated useful information on the young person’s, social support and family relationships, negative attachment attitudes as well as overall attachment categorisation for direct work. • Communicating the ASI data to professionals working with the young people, enables a greater understanding of an attachment perspective useful for managing their care. BPS Annual Conference 2013

17. Mainstreaming the ASI • Practitioners in residential care at SCF are being trained to deliver the interview assessment on entry of young person to the home. • Regular use of a self-report questionnaire pack including the VASQ, symptom scales (SDQ) and life events, is being implemented to monitor change more swiftly at follow-up on a 3-6 monthly basis. • Regular briefing sessions are held with staff about attachment interpretations of young people’s behaviour and to influence direct work around relationships. BPS Annual Conference 2013

18. BPS Annual Conference 2013 Thank you for your attention Catherine.p.jacobs@btinternet.com