Child welfare intervention outcomes: what does trust in the accessibility and responsiveness of adults look like?

In this the final blog of the series, I will present what I think functional learning about the accessibility and responsiveness of adults in a caregiving role for needs provision looks like. I recommend that the reader also take a look at the previous blog posts in this series, which can be accessed below:

Children and young people who are recovering from a tough start to life often present in a manner that reflects that they are unsure about, or don’t trust, that adults in a caregiving role will be accessible to them, understand their needs (and reasonable wishes), and respond to them in a consistent and predictable manner. This manifests in inordinately demanding behaviour, of caregiver proximity and responsiveness, and/or inordinate self-reliance. Sometimes, they alternate between the two. Their caregivers typically feel overwhelmed and frustrated which, in turn, often leads to withdrawal, restriction, and further unresponsiveness; the impact of which is worsening of the child or young person’s preoccupation with accessibility to needs provision.

This problem behaviour arises because of what the child learns about the accessibility and responsiveness of adults in a caregiving role during the early developmental period where caregiving is inconsistent and inadequate. These children and young people typically learn that you cannot always rely on adults in a caregiving role when their care was adversely impacted by addiction, mental health difficulties, relationship issues, and poor parenting knowledge.

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Children and young people who are recovering from a tough start to life benefit from care that supports new learning that adults in a caregiving role can be relied upon to be accessible and responsive to them. To learn more about caregiving strategies to achieve this I refer the reader to A Short Introduction to Attachment and Attachment Disorder (Second Edition).

Evidence that the children are making this new learning includes acceptance of proffered care, exploration of their world, being able to share with others, age-appropriate dependency, acceptance of temporary separations, independent play, and age-appropriate independence, including with self-care routines.

I cannot underestimate the importance of knowing what success on behalf of children and young people in our care who are recovering from a tough start to life looks like, and have included below and table for quick reference based on the Triple-A Model (Pearce, 2016, 2012, 2011, 2010).

ArousalAttachmentAccessibility (to needs provision)
CalmnessGiving things a goAccepting separations
Restful sleepConfident explorationSharing
A range of natural emotionJoining inSeeking help when needed
Easily soothed(Appropriate) IndependenceIndependent play
CooperationAccepting ChallengesExploration
Sustained attention (focus)Seeking help when neededFeeding self
Bladder and bowel controlHaving funIndependence
Attaining milestonesMaking friends
Academic successAccepting Challenges
Grooming
Using words to communicate
Positive self-esteem

If you enjoyed this series and would like to write about topics related to child protection, therapeutic care, and psychology service provision, do get in touch.

References:

Pearce, C.M. (2016) A Short Introduction to Attachment and Attachment Disorder (Second Edition). London, Jessica Kingsley Publishers

Pearce, C.M (2012). Repairing Attachments. BACP Children and Young People, December, 28-32

Pearce, C.M. (2011). A Short Introduction to Promoting Resilience in Children. London, Jessica Kingsley Publishers

Pearce, C.M. (2010). An Integration of Theory, Science and Reflective Clinical Practice in the Care and Management of Attachment-Disordered Children – A Triple A Approach. Educational and Child Psychology (Special Issue on Attachment), 27 (3): 73-86

Pearce, C.M. (2009) A Short Introduction to Attachment and Attachment Disorder. London, Jessica Kingsley Publishers

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Outcomes in child welfare: What a well-modulated nervous system looks like

In this, the third blog in this series, I will write about what a well-modulated nervous system looks like among children and young people who are recovering from a tough start to life. Please also refer to the first and second blogs in this series, which can be accessed here and here.

Children and young people who are recovering from a tough start to life typically exhibit behaviours associated with an over-activated nervous system, or hyper-arousal. This can manifest in difficulty sleeping, emotional reactivity, and motor restlessness. Coupled with their proneness to approaching life under the influence of negative beliefs about self, other, and world (AKA attachment representations, or internal working models – refer to the second blog in this series) these children and young people are prone to anxiety and behaviours associated with the fight, flight, freeze response, including:

  • controlling, aggressive, and destructive behaviours (fight),
  • hyperactivity, running and hiding (flight), and
  • reduced responsiveness (freeze).

Unfortunately, these behaviours are not always understood to be non-volitional responses to activation of the nervous system’s in-built survival response. Rather, they are often seen simply as bad behaviour, and responded to with anger and disapproval. This only serves to further heighten arousal and confirm the child or young person’s belief that they are bad and unsafe and that others are threatening, leaving them even more prone to future anxiety and behaviours associated with the fight flight freeze response.

We are very good at noticing these signs of a nervous system under stress or duress; albeit that we don’t always see it for what it really is. Harking back to the first article in this series, we are comparatively less likely to recognise evidence of a well-modulated nervous system. If we are not looking for evidence of a well-regulated nervous system, we are likely to miss signs of it, with the result that we continue to notice and respond disproportionately to so-called problem behaviour, to the detriment of the child’s emerging self-image and our own feelings of competency in a care and management role.

So, what does a well-modulated nervous system look like? Children and young people who have a well-modulated nervous system experience longer periods of wellbeing and a range of natural emotions that are congruent with context and [easily] self- or co-regulated (that is, able to be regulated with the assistance of an attuned adult). They perform better in learning tasks and other tasks of daily living. Their developmental progress is within normal limits, or near to. They explore their world, including relationships, unhindered by anxiety. They sleep well and have less sensory issues. They are accepting of adult authority, and comparatively easy to get along with.

So, look for the signs of a well-modulated nervous system. You are more likely to feel optimistic about the future of the child or young person. They will, in turn, feel more positive about themselves.

For a more comprehensive introduction to my work, including a ways of supporting recovery from a tough start to life in the home, classroom, and consulting room, I recommend accessing A Short Introduction to Attachment and Attachment Disorder (Second Edition).

In the final blog of this series, I will present what the third aspect of the Triple-A Model (Accessibility to needs provision) looks like.

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What attachment security looks like

In the first blog of this series about child welfare intervention outcomes, I wrote about the importance of knowing, and being able to say, what progress toward successful outcomes looks like. In this second blog of the series, I will talk about what attachment security looks like.

Before I get into it, I want to make the point that I am not talking about the reduction in a behaviour or behaviours of concern, or symptom reduction. This is still ‘problem-focused’, with the same associated difficulties as I highlighted in the first blog. Rather, I am taking about what progress towards recovery looks like for children and young people who are recovering from a tough start to life.

In the first blog in this series I referred to the Triple-A Model (Pearce, 2016, 2012, 2011, 2010), which I use as an explanatory framework for understanding the impact of early relational trauma on the developing person. The Triple-A Model refers to Attachment, Arousal, and Accessibility to Needs Provision. These constructs also help us to reflect about and identify what progress towards recovery from early relational trauma looks like. In this article I am going to refer to the first construct, attachment, and what progress towards attachment security looks like.

Early relational trauma negatively impacts attachment security in the developing child and, in turn, their approach to life and relationships. This is, perhaps, best represented in the internal working models, or attachment representations, that develop in the context of our early attachment experiences. These take the form of beliefs that, mostly subconsciously, influence our approach to life and relationships. They are the beliefs that are held about ourselves, others, and the world in which we live.

Among children and young people who have experienced early relational trauma, the attachment representations that influence their approach to life and relationships are predominantly negative. They believe themselves to be bad, unlovable, unworthy and incompetent; they believe adults in a caregiving role to be unresponsive, uncaring, and unsafe; and they believe that the world in which they live is a harsh and dangerous place. They approach life and relationships under the influence of these beliefs, and this is reflected in their behaviour. That is, their behaviour reflects their inner world and the beliefs they hold about themselves, others, and their world.

In contrast, children who were raised in safe and nurturing homes predominantly approach life and relationships under the influence of secure attachment representations. They believe themselves to be good, worthy and capable; adults in a caregiving role to be accessible, responsive, and safe; and they believe their world to be safe and full of opportunities. Their behaviour is largely consistent with these beliefs.

In consideration of the above, when intervening to promote recovery from early relational trauma, we need to turn our mind to what needs to happen to strengthen the influence of secure attachment representations over the young person’s approach to life and relationships. As their behaviour reflects their inner world and attachment beliefs, we need to know what behaviour that is under the influence of secure attachment representations looks like.

In my work with children recovering from a tough start to life, the first thing I look for is that they are making some effort in relation to their appearance. Self-care reflects self care. I also look for natural interest in engagement with me and comfort in separating from primary caregivers. I look for positive and realistic self-appraisals and acceptance of praise. I look for awareness of the experience of others and regulation in consideration of others. I look for a transition from behavioural expression to verbal expression about their needs and experiences. I look for preparedness to try new things and tolerance of frustration and failure. I look for emerging interests and participation in related pursuits. I look for persistence in their endeavours born out of a natural desire to be successful. I look for interactions with me that reflect my role and endeavours with them. I look for choices and actions that reflect a positive sense of their worth. I look for anticipation of a career, of enduring relationships, and of a family of their own.

In addition, I am keen to hear about the following aspects of the child’s approach to life and relationships, and I encourage adults who care for or have a caring concern for these children and young people to look for them too:

  • Care about appearance
  • Realistic self-image
  • Consideration of others
  • Giving things a go
  • Confident exploration
  • Joining in
  • (Appropriate) independence
  • Readily soothed or comforted by adult caregivers
  • Seeking help when needed
  • Having fun
  • Making friends
  • Accepting challenges
  • Using words to communicate
  • Empathy
  • Hopefulness
  • Dreams and aspirations
  • Standing up for themself

There are other signs of progress towards recovery from early relational trauma, but these also reflect well-modulated arousal and functional learning about accessibility to needs provision, so I will include these in the next two articles in this series.

For a more detailed representation of my knowledge and work with children and young people recovering from a tough start to life I would be pleased if you would access A Short Introduction to Attachment and Attachment Disorder (Second Edition).

References:

Pearce, C.M. (2016) A Short Introduction to Attachment and Attachment Disorder (Second Edition). London, Jessica Kingsley Publishers

Pearce, C.M (2012). Repairing Attachments. BACP Children and Young People, December, 28-32

Pearce, C.M. (2011). A Short Introduction to Promoting Resilience in Children. London, Jessica Kingsley Publishers

Pearce, C.M. (2010). An Integration of Theory, Science and Reflective Clinical Practice in the Care and Management of Attachment-Disordered Children – A Triple A Approach. Educational and Child Psychology (Special Issue on Attachment), 27 (3): 73-86

Pearce, C.M. (2009) A Short Introduction to Attachment and Attachment Disorder. London, Jessica Kingsley Publishers

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The Practitioner Scientist in Child Welfare

Some know that while attaining my post-graduate qualifications in Psychology I worked for five years as a Research Officer in the local Child and Adolescent Mental Health Service (CAMHS). During this period I worked closely with Psychiatry staff who were both expert practitioners and avid scientists. Looking back, I believe more and more in the importance of expert practitioner’s also conducting research in their areas of practice expertise. Who better to lead research into a field of endeavour than expert practitioners in that space?

I then look at where my own career has taken me, in the field of child welfare. My experience has been that there has not ever been time or allowance to conduct research into the field of endeavour in which I (and many others like me) have built significant expertise through practice. Rather, much of the research that we rely on comes from the academics with a special interest in our area of endeavour.

This is more and more concerning to me, especially in an era where evidence-based practice is the “gold standard”. Where does that leave expert practice built upon years of endeavour working directly with children, young people, and all who play a role in the domains of their lives? What status is accorded to practice expertise? Compared to that which comes out of a university study, I would say less status.

Ideally, expert practitioners in the field of child welfare would have time and allowance to be involved in research into best practice and practice knowledge. There is no substitute for conducting the assessment, making the recommendations, implementing the treatment plan, and reviewing the outcomes across one, or two, or more decades of practice, I believe.

Child welfare leaders and academics with a special interest in knowledge and practice in child welfare, it is time to engage practice leaders in research in child protection and child welfare.

(Please note that my reflection is largely based on my observations and experience in the jurisdictions in which I have worked. If the situation is different elsewhere, I would greatly appreciate hearing from you!)

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Child Welfare Intervention Outcomes: What we know and what we see

What outcomes do you expect to see as a result of my service provision?

This is a question I routinely ask in my work. Put another way:

  • What are the benefits the individual(s) or organisation who engages my services anticipate that they will see and experience?
  • What will success in our joint endeavours look like?
  • How will you know that my involvement has made a positive difference?

These are, perhaps, the fundamental questions that get at the hopes of the engaging entity.

Yet, I have found that these are some of the most difficult questions for the engaging entity, be that a parent or other caregiver, a representative of a school, or a representative of child welfare organisation, to answer.

In straightforward terms, it has been my experience that engaging entities find it very difficult to express what successful outcomes look like.

Why might this be the case? The answer lies, in part, in what we typically attend to as we negotiate our lives and our roles.

Humans are, first and foremost, problem solvers. Problem solving has allowed us to successfully negotiate a myriad of challenges and successfully adapt to our living conditions through history and in our contemporary world. As an illustration of this, when I show the image below during training or supervision, and ask my audience what is the first thing they notice, they almost invariable identify the simple maths equation that is incorrect, in the bottom left corner. No-one, and I have been using this graphic for several years, has ever said that nine of the equations are correct.

No-one has ever said that nine of the equations are correct.

We instinctively notice problems and are very good at saying what they are. We are also very successful, as a species, in solving them, However, in my experience working in child welfare and psychology service provision in this field, where problems abound, there is a manifest difficulty in being able to say what a good outcome of an intervention or process looks like.

The danger here lies in missing the evidence of success in our endeavours. Why? Because child welfare work can be overwhelming. If we miss the evidence of our successes and focus selectively on problems to solve, we are vulnerable to feeling like a failure in our role, and give up. Further, as children and young people see themselves as they experience others to see them, our selective focus on problems results in them seeing themselves as a problem.

Even in writing this article I am guilty of the same selective attention to problems; in that the inordinate focus on problems is a problem!

We need to get better at knowing what success in our endeavours looks like; in responding to the questions posed at the beginning of this article. The knowing supports thinking which, in turn, supports noticing. The noticing supports self-efficacy and identification of effective interventions. Noticing progress and success supports a healthy self-image among children and young people who are recovering from a tough start to life.

During the Kinship CARE Project, which ran from 2018 to 2020 as a training initiative of Secure Start with support from the Department for Child Protection, South Australia, we collected data about a range of outcomes, from attendance data to satisfaction with the training and the like. However, perhaps the most heartening data was the proportion of participant kinship carers who reported feeling more confident in the role as a result of their participation in the Project.

Similarly, in the implementation of the Triple-A Model of Therapeutic Care in the TUSLA Fostering Service in Donegal, Ireland (soon to enter its eighth year of continuous implementation), the most heartening outcome is the longevity of the implementation, the sustained interest of local general and relative foster carers, and the extension to the implementation of a complementary training program in local schools over the last 18 months.

(Pearce, 2009, 2010, 2011, 2012, 2016)

In my clinical work with children and young people who are recovering from a tough start to life I reflect particularly on the Triple-A Model and what positive outcomes in terms of attachment security, arousal modulation, and functional new learning about accessibility to needs provision look like, as reflected in the graphic below which is drawn from a number of my programmes:

In the next article in this series I will write about more what a secure attachment style looks like and, thereafter, about what a well-modulated nervous system looks like and what functional learning about access to needs provision looks like.

References:

Pearce, C.M. (2016) A Short Introduction to Attachment and Attachment Disorder (Second Edition). London, Jessica Kingsley Publishers

Pearce, C.M (2012). Repairing Attachments. BACP Children and Young People, December, 28-32

Pearce, C.M. (2011). A Short Introduction to Promoting Resilience in Children. London, Jessica Kingsley Publishers

Pearce, C.M. (2010). An Integration of Theory, Science and Reflective Clinical Practice in the Care and Management of Attachment-Disordered Children – A Triple A Approach. Educational and Child Psychology (Special Issue on Attachment), 27 (3): 73-86

Pearce, C.M. (2009) A Short Introduction to Attachment and Attachment Disorder. London, Jessica Kingsley Publishers

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Practice alignment: How important is it in child welfare?

A child leaves their placement to attend school, where acceptance and belonging are contingent on adhering to the school’s behaviour expectations. They leave school to go to sports practice, where acceptance and belonging are contingent on being good enough to make the team. The child returns to their placement, where acceptance and belonging are contingent on the model of care being effective. The child leaves school early the following day to attend family contact, where acceptance and belonging are contingent on their parent being able to set aside their enmity towards child welfare authorities in order to focus their attention and love on the child. The child attends psychotherapy, where the therapist attempts to communicate a big enough dose of acknowledgement and care to compensate for all of the inconsistencies in the child’s life and support a strong and healing sense of self-worth. The child leaves care ….


Time to break down the silos and integrate a holistic approach in all of the domains of a child’s life.

I recently wrote about five areas of activity in a child’s life that together play key roles in achieving positive outcomes for children and young people in out-of-home care (read here). These five areas of activity involve contributions from child protection staff, school staff, foster, kinship, and residential carers (and their support agencies), therapists working with the child, and the broader community. Given the number of players involved, how important is it that they are aligned in their approach to the care of the child or young person in out-of-home care? Is it OK for them all to doing their own thing?

Is it OK for everyone to be doing their own thing?

No matter which position you take with respect to practice alignment, I think we can all agree that the child’s experience is the paramount consideration. It is broadly accepted that children ‘need’ consistency. In my own work, I talk about inconsistency being the ‘primary trigger’. We must be careful to not perpetuate that which bears resemblance to the inconsistencies that pervade a child’s experience in the home deemed unfit for their care and protection.

In my experience, children and young people will be triggered by inconsistencies in their care and management, no matter how well-intentioned. Practice misalignment is a very real threat to achieving best outcomes for children and young people who are recovering from a tough start to life.

So, what is the answer? There are comprehensive endeavours out there that support a common understanding and approach among the adults that care for the child across the domains of their life. Dan Hughes was one of my earliest influences and his PACE and DDP curriculums represent an opportunity to achieve the practice alignment children and young people recovering from a tough start to life need. My own work offers practical knowledge and approaches to care and management that bridge home, school, child protection, community, and consultation room.

Is it time to deliver aligned practice to children and young people recovering from a tough start to life across areas of activity and domains of their life? I think it is past time.

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Achieving best outcomes from care

Twenty-seven years continuous work in child protection and child welfare, including ongoing work with young adults who have transitioned from Care, has taught me some extremely valuable lessons about long-term outcomes of a childhood spent in State Care. In particular, it has taught me the importance of five factors that do not always get the attention that is needed when care and protection systems are stretched. In this brief article I will present the five key factors that I think are particularly important for best short- and long-term outcomes for children in State Care, and encourage reflection about what needs to happen when one or more of these five factors are absent. In a nutshell, the content of this article can be summarised in the graphic below:

Best connection with birth parents/family and culture

This first factor is particularly important for a young persons identify, self-worth, and belongingness. Where it is safe to do so, children and young people in State Care benefit from endeavours to promote best connection with their birth parents and/or family, and in the case of indigenous children and young people in particular, their culture (/country and community). Good quality family contact with birth parents and kin supports attachment repair, which is so important to an individual’s overall attachment style and approach to life and relationships. For indigenous children and young people, connection to culture, community, and country counters the negative impacts of systemic racism and supports the worth of their cultural identity.

Stable, Therapeutic Care

It should be a given, but children and young people in State Care do not always receive “Therapeutic Care”. In many jurisdictions, a distinction is made between ‘general’ care and ‘specialist’ or ‘therapeutic’ care. In consideration of the known impacts of maltreatment, separation, and loss, all children and young people in State Care should receive therapeutic care; where therapeutic care incorporates a shared understanding of the impacts of maltreatment, separation, and loss on the developing person, and caregiving measures that mitigate these impacts. I have written extensively in this blog, in periodical articles, and my books about what constitutes trauma-informed, therapeutic care, but it is best encapsulated by the following statement and graphic:

Trauma-informed care is less about developing strategies to address behaviours of concern, and more about responding to the reasons for them.

Trauma informed school

Children and young people in State Care experience further harm when there is misalignment in their care and management between home and school. The harm arises due to the uncertainty this causes for the child or young person about how they will be treated. A common example is the reaction of children and young people in State Care to substitute teachers (aka ‘relief’ teachers). Having experienced maltreatment, separation, and loss, these children and young people crave order. Where there is inconsistency, coercive controlling and testing behaviours represent the child or young person’s endeavours to create order and a sense of predictability, and resolve uncertainty about how they will be treated. Unfortunately for the child or young person, their coercively controlling and testing behaviours are rarely seen for what they are, and negative attributions about self, other, and world are strengthened (thereby necessitating further coercively controlling behaviour to feel safe) when adults respond to the behaviour, as opposed to the reason for the behaviour.

Children and young people in State Care benefit from consistent, trauma-informed care across the domains of their life. This is as true of school as it is the placement, as children and young people (ideally) spend much time at school, and educational participation and attainment is a known predictor of adult outcomes for care-experienced adults.

Community activities and engagement that supports many positive relationships

Attachment theory allows that children and young people form multiple attachment relationships during their formative years. Attachment theory also allows that children and young people form different attachment relationships towards different people, depending on their experience of care from the person. Attachment relationships are formed towards adults who have continuity and consistency in the child’s life, and provide care to them. The child or young person’s overall attachment style is contributed to by all of the significant relationships they form during their formative years. Where some attachment relationships are left unrepaired, the influence of these is buffered by positive attachment experiences; the more, the better.

Trauma-informed therapy

The final factor is access to an experienced therapist who practices in a trauma-informed manner. Ideally, the therapist delivers therapy that supports a secure attachment style, arousal modulation, and functional learning about access to needs provision. The therapist is also a resource for the care team of adults that support the child or young person, including at home and school, in the pursuit of alignment in care experiences across the domains of the child or young person’s life. I have written much about trauma-informed therapy, including in A Short Introduction to Attachment and Attachment Disorder.

Outcomes

In my experience, when all of these factors are in place, children and young people in State Care have the best chance of achieving positive outcomes, including:

  • •Education attainment
  • •Aspirations
  • •Relational connections
  • •Self-worth
  • •Wellbeing
  • •Community Participation
  • •Identity & Belongingness.

Key Reflections

Where one or more of these factors are not in place, how do you think this will impact outcomes for the child or young person in State Care?

What needs to occur to compensate for the absence of this/these factors?

References

Pearce, C.M. (2016) A Short Introduction to Attachment and Attachment Disorder (Second Edition). London, Jessica Kingsley Publishers

Pearce, C.M (2012). Repairing Attachments. BACP Children and Young People, December, 28-32

Pearce, C.M. (2010). An Integration of Theory, Science and Reflective Clinical Practice in the Care and Management of Attachment-Disordered Children – A Triple A Approach. Educational and Child Psychology (Special Issue on Attachment), 27 (3): 73-86

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Children (and Young People) who Foster

I am a child who fosters, but I am not a child.

Only mum and dad think of me that way.

They look after children who cannot live at home.

I thought it would be great at first; someone else to talk to and do things with.

Someone we could help to know what normal family life is.

It started OK.

Now, I feel like I have to fight to be noticed.

Sometimes I feel like the forgotten child.

Mum and dad spend all of their time talking about and responding to the child.

I can see that the child knows it too.

They smile at me whenever mum or dad does something for them.

Like I am the competition in some game they are playing.

And they’re still not satisfied. They want more and more. They have to win.

They get into my things as well. Nothing’s off-limits to them.

Mum and dad don’t even punish them!

They say the child does it because their needs weren’t met at home;

That their parents had problems that got in the way of caring for the child.

That they need consistent care from accessible, responsive, and emotionally-connected adults.

That they need adults who understand them and respond to their experience.

Well, I still need that too.

I need my mum and dad to be there for me without me having to ask; to say the words that show that they understand what is happening for me and our family right now; to show that my needs are important without me having to explain them; and to sit with me and experience what I am feeling.

I need care too.

I want to help my parents, and the child.

I am not a bad person.

It just needs to be fair.

By Colby Pearce

I am a practising Clinical Psychologist with twenty-seven years’ experience working with children and young people recovering from abuse and neglect, and those who care for and have a caring concern for them. I am also an author and educator in trauma-informed, therapeutic caregiving. My programs are implemented in Australia and Ireland, and I am well-known for offering practical and accessible guidance for caregivers and professionals alike.

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What is the infant’s experience of early trauma?

Below are my notes from a twenty-minute presentation I delivered on 15/6/22 on behalf of The Tweddle Foundation, at their event marking Infant Mental Health Awareness Week 2022.

Slide 1

Good morning. My name is Colby Pearce, and I am a practising Clinical Psychologist from Adelaide, South Australia. In my work I have been speaking with children and young people who have experienced early trauma, as well as their caregivers and other professionals who work with and support them, for twenty-seven years.

I am here today to talk about reflections I have made on the experience during infancy, of children and young people who are recovering from early trauma, based on my work.

Slide 2

Specifically, I am going to talk about the infant’s experience of trauma that is complex and relational, where there are multiple incidents of grossly inadequate care and/or harm, and where this occurs in the context of the infant’s early dependency relationships.

I am going to touch on a number of developmental impacts of grossly inadequate care and/or harm during infancy. I also intend to briefly touch on what a reparative environment looks like.

Slide 3

A key understanding here is that the trauma occurred in the infants first learning environment and impacted their learning about how the world works and what to expect of adults in a caregiving role. In a demonstrable way, and without reparative interventions, trauma in the first learning environment continues to profoundly affect learning and development throughout the growing years and life beyond.

In seeking to understand what is the infant’s experience of a grossly inadequate and/or harming care environment, it is necessary to reflect on what is occurring for the parents of the infant. In my experience, in a grossly inadequate and/or harming care environment parents are contending with one or more of (the following):

  • Relationship stressors (Domestic/Family Violence)
  • Mental Health Challenges
  • Substance abuse issues
  • Their own experience of inadequate parental care.
Slide 4

Consistency (The Primary Trigger)

The first aspect of the infant’s experience that I will speak to is consistency. Specifically, what is the infant’s experience of consistency in a grossly inadequate and/or harming care environment, and what are it’s impacts on the developing child?

In a grossly inadequate and/or harming care environment it is more accurate to refer to the infant’s experience of inconsistency. Two of the more commonly found inconsistencies in such environments are inconsistency of carer due to changes and disruptions in the infant’s care arrangements, and carer inconsistency due to the effect of their relationship stressors, mental health issues, substance issues, and poor parenting knowledge.

We know from psychological science that inconsistency is stressful. Those of you who have knowledge of the reaction of many school-aged children to a relief teacher will understand why I refer to inconsistency as the primary trigger.  The central nervous system does not like change and unpredictability. It makes our motor, that is our central nervous system, run faster. It increases arousal. For the infant who is experiencing gross inconsistencies in parental care, it leaves them in a chronically and/or recurrently heightened state at a time when many aspects of central nervous system function are developing, and impacts that development.

Inconsistency also impacts learning, including learning about how the world works and what to expect of adults in a caregiving role. Inconsistency slows learning, conceivably leaving the infant in a prolonged state of uncertainty which is itself a central nervous system irritant.

Inconsistency of carer and carer inconsistency both disrupt the normal process of attachment formation, which has its origins in infancy and profoundly impacts the growing child’s approach to life and relationships.

Slide 4

I refer to the figure on the right as the Triple-A Model. I developed this model to help inform our understanding of the impacts of early trauma and the affected child’s approach to life and relationships (Pearce, 2010).

Accessibility

In a grossly inadequate and/or harming care environment infants experience their caregivers as inconsistently accessible to them. We see this in the ambulant child in the extent of preoccupation the child has with their contemporary caregiver, resistance to separation, and coercive behaviours to maintain caregiver proximity. They respond as though they are being (permanently) abandoned during temporary separations. It is my observation that this stems from an apparent disruption in the natural development of object constancy and permanency that are key developmental milestones during infancy, and which rely on a consistent caregiver who presents consistently during time with the infant, and returns often to the infant following temporary separations.

Where infants experience their caregivers as inconsistently accessible, attachment formation is impacted, especially when one considers the role of attachment in the development of the child’s emerging understanding of themselves, others, and their world. Inconsistent accessibility is also stressful and contributes to the infant being in a persistently and/or recurrently heightened state. Inconsistent accessibility impacts learning, including what the developing child learns about the accessibility of caregiving adults.

The combination of these factors leaves the child who has experienced early trauma prone to anxiety and associated behaviours (and responses from others) that perpetuate heightened states of arousal, maladaptive perceptions of self, other, and world (often referred to as internal working models, attachment representations, or schema), and experiences that confirm old learning about caregiver accessibility. Seen in this way, early trauma becomes self-perpetuating.   

Slide 4

Responsiveness

In a grossly inadequate and/or harming care environment the infant experiences inconsistent acknowledgement of, and responsiveness to their dependency needs. Too often, they do not feel understood or responded to. This leaves them stressed, impacts attachment security, and teaches them that they have to work hard to get their needs met, through inordinately demanding behaviour and/or precocious self-reliance.

Emotional Connectedness (Attunement)

In a grossly inadequate and/or harming care environment the infant experiences inconsistent care and attention in relation to their emotions, including through the provision of a safe and contained space for exploration and help with regulating big emotions. In a grossly inadequate and/or harming care environment the infant experiences reduced opportunity for connection with an adult who is sensitive to their experience and experiencing congruent emotion. Among the consequences of inconsistency in emotional connectedness and attunement are emotional defensiveness and a restricted range of emotions, difficulties with emotional control and self-regulation, and lack of consideration of the experience of others.

Where there has been inadequate emotional connectedness there are consequences in terms of attachment formation, arousal, and learning about how relationships work and what you can expect of them. 

In short, in grossly inadequate and/or harming care environments there are major deficits in the infant’s experience of CARE – consistency, accessibility, responsiveness, and emotional connectedness (Pearce, 2016). This impacts the growing child in many ways, including in terms of attachment formation, arousal, and learning about the accessibility and responsiveness of adults in a caregiving role for needs provision.

Slide 5

In a reparative care environment, the child experiences consistent care from consistently accessible, responsive, and emotionally connected adults, where those adults:

  • Are consistent and recognizable;
  • Spend time with the child and attend to the child whether they are crying or quiet;
  • Acknowledge and respond to the experience of the child (including their needs) in their words and actions;
  • Share the emotions of the child and help them to back to calm.

A reparative care environment leaves the child feeling assured of their worth and of the value of human connection. In time, the goal is for the child to self-regulate their approach to life and relationships in consideration of their own inherent worth and the value of maintaining supportive relational connections with others.

Slide 6

In this presentation I have endeavoured to present key features of the infant’s experience of a grossly inadequate and/or harming care environment, how it impacts the developing child (Triple-A Model), and what a reparative care environment looks like (CARE). What children and young people need from professionals and caregivers alike is that we are mindful or our AURA; that is, the distinctive atmosphere or quality that is projected by us, our organisations, and by the parents and caregivers who are supporting a child’s recovery from a tough start to life.

It is vital that we consistently project an aura of accessibility, understanding, responsiveness, and attunement.

Thank you.

For more about Colby and his work visit:

Secure Start® (business website): https://securestart.com.au/

Attachment and Resilience (Personal Blog): https://colbypearce.net/

References:

Pearce, C.M. (2016) A Short Introduction to Attachment and Attachment Disorder (Second Edition). London, Jessica Kingsley Publishers

Pearce, C.M. (2010). An Integration of Theory, Science and Reflective Clinical Practice in the Care and Management of Attachment-Disordered Children – A Triple A Approach. Educational and Child Psychology (Special Issue on Attachment), 27 (3): 73-86

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What do children in care need to recover from relational trauma?

In recent posts I have referred to three things that children in out-of-home care need, and need adults who are responsible for their care and welfare to understand, to support their recovery from complex relational trauma. These three things are:

  1. ‘therapeutic care’
  2. lots of positive relational connections
  3. meaningful connection with birth parents/family.

In this blog post I will briefly expand upon each of these needs.

Therapeutic Care

Children and young people who are recovering from complex relational trauma need enriched care to compensate for prior care that was inadequate or adverse. I have written much elsewhere about what this looks like, including in other posts on this site. In short, therapeutic care involves reflection and intentional/mindful action in the provision of care. There is a focus on relational connection and needs-based caregiving, where understanding and responding to the child’s experience is the primary focus. Therapeutic carers project a certain a distinctive quality or atmosphere. They have a certain AURA, in that they are Accessible, Understanding, Responsive, and Attuned.

To read more about why children need ‘therapeutic care’, read here.

Positive Relational Connections

Children and young people need opportunities to develop lots of positive relational connections. These are required to buffer the impact of fractured connections and negative relational experiences that occur (and have occurred) for children and young people who are recovering from a tough start to life. In my experience it, and as the saying goes, it takes a village. This means that therapeutic caregiving, and associated positive relational connections, should also occur in domains other than the home, especially at school.

Each arrow represents a relational influence.

Meaningful connection with birth parents/families

In consideration of the aforementioned point and image, it has been my observation, based on 27 years working directly with them, that children and young people benefit greatly from relationship repair (where this is possible and/or appropriate). Relationship repair weakens that negative impact of fractured relationships on the child or young person’s approach to life and relationships. Relationship repair is best able to be realised when birth parents understand the vital role they can continue to have in the lives of the children, though their children might not be in their care (see here), and where those responsible for the care and wellbeing of the child or young person are able to make and maintain a working alliance with birth parents, in consideration of the best interests of the children.

In my experience, children recover best when these three needs are met. In the absence of one or other of these, the intensity of the child or young person’s need in the remaining areas is magnified.

Posted in AAA Caregiving, Adoption, Attachment, Fostering, kinship care, Parenting, trauma informed, trauma informed care | Tagged , , , , , , , , , , | Leave a comment