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.

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How do I get my child to go to sleep in their own bed?

In this blog I describe a methodology I used with my own children, and recommend in my practice. Before doing so, I would advise that this is a routine that I sustained across years. My children and I enjoyed this special time together, and in the context of the ongoing juggle of work and family commitments, it became a regular time for togetherness. Indeed, I maintained a consistent (though evolving over time) bedtime ritual with my youngest child until he reached his early teens. This is not to say that the methodology described below takes years to work! In fact, I anticipate that it will assist with getting your child off to sleep in their own bed within days. However, in order for there to be a lasting effect I would suggest that you be prepared to implement this methodology for at-least three months before gradually weaning the child from it (more on this below).

To the methodology! Once it is bed-time, I suggest that you put your child to bed and sit or lay alongside them for approximately twenty minutes. In that time, and depending on the age of your child, you might read and sing lullabies to them. When my own children were pre-school aged, I read two or three books before singing to them. As with other aspects of parenting and caregiving, consistency is important here. Consistency is soothing. I suggest rotating through a small number of books and a small number of lullabies across consecutive nights. Children draw comfort from the predictability of the bed-time routine, thus preparing them for the separation involved in going to sleep. After a while, the books lullabies are likely to become associated with feelings of comfort and sleepiness, with the result that the child begins to feel sleepy when the same books are read and lullabies are sung.

When my children reached school-age, we transitioned to longer books, reading approximately a chapter each night. I read books that they were interested in but not able (yet) to read themselves. I remember reading the Magic Faraway Tree to my older children. The last books I read to my youngest son were the Harry Potter series of novels. I stopped singing to them when it seemed developmentally-appropriate (for them) to do so. This was when they were four or five years of age.

If your child falls asleep during the above, you are free to leave the room. If they are still awake after you have read (and sung) to them, you move to the next stage of the methodology. This is more likely to be the case when you are implementing this methodology for the first time with a school-aged child. In such instances, and depending on their age, your child may still be awake after twenty minutes of reading. The next stage involves providing the profound reassurance children require to cope with separation and go to sleep. If it works, it will circumvent your child’s effort to engage in proximity-seeking behaviour, such as calling out, getting out of bed, searching for you, complaining of having a tummy ache, asking to go to the toilet, and so on.

After you have read (and sung) to your child, say to them something like “I am just going to put the light on in the next room and I will be right back. You can stay awake until I come back”. Then, you literally walk out of the room and walk back in almost straight away. You acknowledge that your child is okay and then say “I am just going to put the kettle on and I will be straight back. You can stay awake until I come back”. You then do this and when you return to your child you say something like “I am just going to the toilet and I will be straight back. You can stay awake until I come back”. You then do this and when you return to your child you say something like “I am just going to have my cup of tea and I will be straight back. You can stay awake until I come back”. With each separation, you tell your child that you are doing an activity that takes longer and longer to complete. You keep doing this until, when you return to your child, you find them to be asleep.

Speaking of activities that have temporal (i.e.time) meaning is more easily understood by your child than saying “I’ll be back in a minute”. Choosing longer and longer activities involves exposing children gradually to separations, such that they do not become overly anxious, call out or get out of bed. It is important to return to your child before they call out or get out of bed, because parent-initiated proximity is more reassuring than child-initiated proximity. So adjust the separation as required to ensure that you get back to them before they leave their bed to find you! Telling your child to stay awake is an important way to circumvent potential conflict and associated parental frustration, with the result that your child is calmer and more likely to fall asleep. Put in a different way, this is a helpful way of making use of “reverse-psychology”.

If your child is an infant and, therefore, pre-verbal, I suggest leaving the room for longer and longer intervals, and returning, though you need not use the words I recommend. Rather, try to return before they start crying or otherwise become unsettled. This is a gentle alternative to controlled crying and one that I also used effectively with my own children.

If you are looking to wean your child off an extended bedtime ritual, I suggest gradually reducing the amount of time spent reading (and singing) to them, and implementing the second stage of temporary separations and reunions. Eventually, you might only being doing the separations and reunions, before finally being able to put them to bed to go of to sleep themselves.

Playing relaxing classical music softly in your child’s bedroom is a useful adjunct to the above. Try starting the music when you first put your child to bed (i.e. while you are reading and singing). Set the volume so low that it can only just be heard in a quiet room. Set it to play all night. Relaxing classical music soothes the nervous system and can be expected to further assist your child to go to sleep, stay asleep, and sleep more deeply and restfully. It can also reduce the incidence of nightmares. Your child is likely to be happier during the day that follows as a benefit of a deeper and more peaceful sleep. I used the Dream Children Compilation by the Adelaide Symphony Orchestra, but there are many children’s sleep playlists on Spotify (and the like) these days. If you find that your (older) child is distracted by the device you are playing the music on, put the device in an adjacent room or in the hallway outside the child’s bedroom. If your child complains that the music is “keeping them awake” try putting it on after they are asleep. Remember, keep the music on all night, every night.

Finally, enjoy this special time spent with your child. I did, and  experienced sadness when my youngest said “dad, I don’t need you to stay with me anymore”.

This methodology is also presented in my book about attachment and attachment trauma. Click the link here to find out more about my book.

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How long does it take for therapeutic care strategies to work?

The ‘failure’ of a therapeutic care strategy to achieve the desired outcome on first administration does not necessarily mean that it will not or that it is a worthless strategy. Children and young people who are recovering from a tough start to life spend too much time approaching life and relationships under the influence of beliefs that caregivers are unresponsive and uncaring and they, themselves, are bad and undeserving. A therapeutic caregiving strategy takes time to exert it’s influence over the attachment beliefs that influence responses to caregiving endeavours. At first, it may not be noticed by the child or young person who is selectively attending to behaviours that reflect their beliefs. If it is noticed, it may be experienced as inconsistent with their expectations of caregiver behaviour and responsiveness and difficult to trust. Further, as inconsistency is a central nervous system irritant, the implementation of a therapeutic care strategy may, in the first or early stages, give rise to a heightened response. Hence, the adage that behaviour often gets worse before it gets better.

Notwithstanding the above, in my experience therapeutic care strategies can and do ‘work’, with some being quite powerful.

In order for a therapeutic care strategy to achieve a desired outcome, it has to live up to its name. A therapeutic care strategy is a strategy that is intended to address some aspect of the way in which the child or young person approaches life and relationships that is maladaptive. It has to target something. In my view, a therapeutic care strategy addresses a maladaptive coping or survival strategy (and the beliefs that support them) that developed and was adaptive in an inadequate care environment but which is no longer adaptive, such as when it precipitates exasperation and overwhelm in the contemporary caregiver. A therapeutic care strategy supports functional beliefs about life and relationships, and a functional approach to life and relationships.

This takes time; time to understand on some level that old ways of thinking and doing are no longer necessary or helpful, and to develop new ways of thinking and doing. Remember, I am talking about children and young people. This can be difficult for adults too.

A related factor that influences success in applying therapeutic care strategies is the nature of the strategy. Is it derived from psychological science and what we know about child development, or some other source? In my experience, the strategies most likely to achieve desired therapeutic outcomes are those that have a strong scientific and developmental basis to them.

Finally, in consideration of my earlier point that children and young people can be heightened by caregiver behaviours that are inconsistent with their beliefs and expectations, it is important to choose your strategy carefully and only implement it at a rate that you can sustain over time. It is better to not do anything than to start implementing a strategy, only to revert back to previous caregiving practices. This only reinforces the belief that caregivers are unpredictable and cannot be relied upon. Rather, start with something simple, something that can easily be sustained over time and, inevitably, in the face of questions about whether the strategy is or will be successful. After a while, add another strategy. In my opinion, the simple things are not as foreign to children and young people who are recovering from a tough start to life as you might think. I am talking here about simple routines, checking in proactively with the child, communicating understanding of their experience and proactively responding to their needs, and being attuned to their emotional state. The majority of children and young people who are recovering from a tough start to life are familiar with, and have experienced some level of, these conventional aspects of care.

If you would like to know and learn more about how conventional approaches to caregiving and relating can be therapeutic, I would refer you to my books (click the images below) and The CARE Curriculum.

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Why does my child need ‘therapeutic care’?

A child’s adjustment, like many aspects of their functioning, is usefully thought of as sitting on a spectrum ranging from maladjustment at one end to positive adjustment at the other end. Where a child is on this spectrum depends on influential experiences in their life. Considered in this way, their adjustment is something of an average of influential experiences.

Relational experiences play a key role in how a child approaches life and relationships. Relational experiences impact attachment security. Attachment security is also usefully thought of as a spectrum, ranging from secure attachment to disordered attachment. Where a child is on this spectrum is influenced by their experiences of relationship and dependency with key adults in their life. In turn, attachment security influences their approach to life and relationships based on beliefs about self, other, and world that reflect relative attachment security.

Where children have had grossly deficient experiences of care and relationship during the developmental period, their attachment security and adjustment is likely to be adversely impacted. These children need positive experiences of care and relationships to compensate for prior negative experiences and support movement towards attachment security and successful adjustment.

However, across twenty years of continuous work in child welfare it has become clear to me that conventional nurturing care is not sufficient to compensate for grossly deficient experiences of care and relationships. Returning to the idea of a spectrum and where a child sits being something like an average of their experiences, it will only get a child part of the way towards attachment security and positive adjustment. Rather, the child who has experienced grossly deficient care needs one or more of the following:

  • A (much) higher number of positive relationships;
  • Enriched experiences of care and relationships;
  • Repair of early relationships where care was grossly deficient.

So, in terms of the question that gives rise to this post, children and young people who have experienced grossly deficient care during the developmental period need enriched care to buffer against and compensate for the impacts of deficient care and relationships. Thought of in this way, enriched care is therapeutic inasmuch as it supports progress towards a desirable outcome for the child in terms of their attachment security, adjustment, and approach to life and relationships.

The Triple-A Model of Therapeutic Care and the CARE Curriculum are two examples of programmes that I have developed for foster and kinship care, and have been implemented in out-of-home care sectors in Australia and Ireland. Perhaps, the broadest coverage of my recommended approaches to therapeutic care can be accessed through Pearce, C (2016). A Short Introduction to Attachment and Attachment Disorder (Second Edition). London: JKP.

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Why is the child I am caring for unsettled after contact with their birth parent?

Children and young people who could not be safely cared for at home by their mum and/or dad are afforded contact with their birth parents where it is safe and appropriate to do so. Contact done well preserves a sense of connection to birth family that helps with emerging identity, and repairs relationships that have suffered harm. In almost thirty years of continuous work in child welfare, it has been my observation that having birth parents positively involved and interested in the life of their children plays an important role in the success of alternate care placements and children’s outcomes more generally.

Nevertheless, many children are reported by their alternate carers to be unsettled after contact with their birth parents, even when professional observers advise that the child seemed fine and the contact seemed to go well. On some occasions their unsettled behaviour is provided as a reason to reduce or even eliminate contact with birth parents, citing that contact is just too triggering for the child and has the potential to jeopardise their placement.

Before reducing or eliminating contact with birth parents it is important to consider what might be triggering for the child about contact, and whether these issues can be addressed.

I have written a lot about four key aspects of caregiving that have a strong influence on relational and developmental outcomes for children: consistency, accessibility, responsiveness, and emotional connectedness; or CARE for short. A child’s experience of parental CARE is almost certainly inadequate in circumstances where children cannot safely be cared for at home by their birth parent(s). Inadequate care is associated with disturbances in attachment, central nervous system functioning, and learning about access to needs provision (Pearce, 2016).

Birth parents may not attend scheduled contact consistently due to their ambivalence towards the agency that removed their children, and/or a lack of resources to attend. When they do attend, they may be distracted by their strong feelings about their children being removed from their care and towards the agency who removed them. This can leave them inconsistently accessible and emotionally-connected to their children during contact. The location and duration of contact may negatively impact the parent’s ability to be responsive to the dependency needs of the children.

In short, contact may perpetuate the child’s experience of inadequate CARE from their parents, leaving them insecure, heightened, and unsure about access to needs provision. Viewed in this way, the trigger for unsettled and demanding behaviour after contact is inadequate opportunities for children and young people to experience parental CARE during (and in relation to) contact.

Before reducing or eliminating contact with birth family it is important to consider what measures can be undertaken to improve children’s experience of parental CARE during and in relation to contact. This involves developing a working alliance with birth parents in consideration of the valuable role they continue to play in the lives of their child. This is necessary to reduce strong parental feelings that can impact negatively on their attendance for contact, and leave them distracted, misattuned, and inconsistently responsive when contact occurs. It also involves supporting parents to attend, and scheduling contact at a time and place and in circumstances where the children have the opportunity to experience their parents as accessible and responsive to their dependency needs. Further, it is important for contact to be fun for parents and children alike, thus supporting experiences of emotional connectedness during contact.

We need to eliminate the potential triggers before eliminating contact. Supporting children’s experience of parental CARE during and in relation to contact represents a necessary starting point.

Where CARE has been inadequate during contact, your child needs you to enrich CARE when they get home.

If you took something useful away from this article, please consider liking it and making a comment. I am interested to read what other behaviours you would like me to turn my mind to.

Reference:

Pearce, C (2016) A Short Introduction to Attachment and Attachment Disorder (Second Edition). London: JKP

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Why does my child chew their clothes?

Chewing their clothes is not necessarily evidence of wilful damage or a lack of respect. For many children it is an exaggeration of a very natural way in which they regulate their nervous system. As such, it is better conceptualised as evidence of a nervous system under stress. It follows that the management of the behaviour is better targeted towards changing the child’s state as opposed to their attitude.

When children are born one of the first positive signs of life is a healthy wail. At this moment, the infant is overwhelmed by their change in circumstances. Ordinarily they are soon placed on their mother and encouraged to suckle. Skin to skin contact results in the release of a natural calm down chemical called oxytocin. As a result of being held to the mother’s breast and encouraged to suckle, there is a release of oxytocin and the infant is soothed. Whether they are breast- or bottle-fed thereafter, being held and fed is one of the first go-to strategies in the subsequent hours, days, and weeks when the infant is distressed, with the result that a powerful association is formed between having something in their mouth and the restoration of feelings of wellbeing. Later, the same result is observed with the use of teething rings, pacifiers, (comfort) food, tea, coffee, smoking, etc. To a greater or lesser extent, as a result of this process, we are all oral soothers. And the effect is so powerful that we adults can take rest breaks to drink tea and coffee, eat chocolate, or smoke; all of which have stimulant properties but are soothing nonetheless!

Chewing their clothes, nails, or anything else, really, can be a sign that your child needs help to calm. Telling them off for damaging their clothes or other items will only perpetuate the problem. Rather, offer them something else to suck or chew on, such as a healthy smoothie, ice block, or sugar-free lollypop. Have them drink from open cups through a straw, play relaxing classical music quietly in their their sleeping environment, or put on a fan where they sleep. Consult a paediatric occupational therapist who can assess for sensory issues and recommend a sensory diet. All of these strategies have been observed by me and the people I work with to help to calm the nervous system and satisfy the need that gives rise to the chewing. When the need is satisfied, the behaviour becomes redundant.

If you took something useful away from this article, please consider liking it and making a comment. I am interested to read what other behaviours you would like me to turn my mind to.

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