Catherine Jacobs Senior Research Psychologist Centre for Abuse & Trauma Studies 2nd July /7/2013 Swanwick, Derbys 1 The Attachment Style Interview for young people in care (ASI-AD) National Children’s Commissioning and Contracting Training Conference Programme 1-2 July 2013

Background Attachment issues important in children looked after by the state Attachment theory emphasises relationships with parents in healthy child and adolescent development (John Bowlby). Individuals need closeness, support and feelings of security (i.e. close attachment) for normal Secure development. This formed through close relationships with parents/carers. Insecure attachment follows from neglect/abuse in childhood. This can continue to adult life. 2/7/2013 Swanick, Derbys 2

What is insecure attachment? Secure: The most well adapted form - flexibility around trust, autonomy and closeness to others. Insecure: Anxious, Avoidant or Disorganised styles Disorganised style represents the lack of clear strategy in responding to attachment stimuli. Also known as Unresolved (Main & Solomon 1986) or Dual (Crittenden 1988). Linked to dissociated anger (van Ijzendorn et al 1999, Liotti, 2004). Often considered the most damaged attachment style. Insecure attachment style affects long term behavioural, emotional and social outcomes, particularly relationships and support seeking. 2/7/2013 Swanick, Derbys 3

What is the Attachment Style Interview for Adolescents (ASI-AD)? The ASI (Bifulco et al., 2002) is an attachment measure originating in a social-psychological approach, which utilises a pragmatic and transparent interview and scoring method. This is adapted for use in adolescents Current relationship with family and social support. Degree of attachment insecurity [Mild, Moderate, Marked] Attitudes which define interpersonal style whether secure, anxious, or avoidant. When two or more insecure styles are present (usually anxious + avoidant) this is described as ‘disorganised’. 2/7/2013 Swanick, Derbys 4

5 ENMESHED, ANXIOUS AMBIVALENT young people are Dependent, afraid of separation, dislike being alone FEARFUL, ANXIOUS AVOIDANT young people are afraid of rejection ANGRY DISMISSVE AVOIDANT young people are Independent, mistrustful, angry WITHDRAWN, AVOIDANT young people are Independent, unemotional, private CLEARLY SECURE young people are Adaptable, seeks support when upset.

Setting – 14 St Christopher’s Fellowship Residential care homes in England and the Isle of Man Principal aims import standardised attachment measures in the routine assessment of YP in care, assess the attachment style of young people in residential care, using the Attachment Style Interview for adolescents (ASI-AD) & To engage with practice staff on assessment and attachment interpretations of risk & resilience. All homes delivering a social learning intervention with praise and rewards for pro-social behaviour and daily assessment of progress in achieving aims. This combined with attachment-related principles involving stability of placement, relationship to carers and support enhancement. Baseline assessment of attachment style for young people entering the home and at a follow up period. A Summary report of outcomes, risks and resiliencies produced for staff and professionals and feedback summary for YP. 2/7/2013 Swanick, Derbys 6

7 Initial findings – risk profile 58 young people in SCF residential care (more boys – 67%), aged 11-17, average 64 months in care completed the ASI.  Most (79%) had some contact with mother, fewer (64%) had contact with father. 42% had no closeness mother; 49% high antipathy to mother; 54% no closeness father; 57% high antipathy to father 56% had no close confidant (family or friends) and very low ability to relate to others. 100% showed some inability to make and maintain relationships BPS Annual Conference 2013

Rates of insecure style – ASI (n=58) 2/7/2013 Swanick, Derbys 8

Comparing rates ASI and VASQ 2/7/2013 Swanick, Derbys 9

ASI Baseline and follow-up (10 cases) 2/7/2013 Swanick, Derbys 10

Initial Conclusions The ASI-AD showed high rates of dual/disorganised style & angry- avoidant style. This consistent with other research. Preliminary results suggest some reduction in dual/disorganised style and angry-avoidance in relation to stable placement & social learning intervention. This mirrors self-report tools. ASI-AD generated useful information on the young person’s, social support and family relationships, negative attachment attitudes as well as overall attachment categorisation for direct work. Communicating the ASI data to professionals working with the young people, enables a greater understanding of an attachment perspective useful for managing their care. 2/7/2013 Swanick, Derbys 11

‘ASI case study: ‘Penny’ 16 years old at her baseline ASI in November 2012 and living in a St Christopher’s small residential home with one other resident. Family of Origin Her mother died when she was 4 years old Penny currently had contact with her father every three weeks but said she was not close to him. Current Relationship with Father Closeness rated – LOW Antipathy rated – LOW I would miss him if he went away. There has been bad feeling between us since the age of 7-8 years of age. Current Relationship with siblings Closeness rated – LOW Antipathy rated – HIGH I want to have a big sister to be there for me and not the one I am arguing with. 2/7/2013 Swanick, Derbys 12

Penny’s Angry-Avoidant Attachment Ability To Make and Maintain. At her first interview Penny did not confide in a range of people in enough emotional depth.. She was rated in the ASI as having a POOR ability to make and maintain relationships. Penny’s Key Insecure Attachment Attitudes HIGH MISTRUST Well it took me a year to trust me Granddad., "I need to learn that I can trust them" HIGH CONSTRAINTS ON CLOSENESS Penny is clear she finds it hard to get close to people. CONTRADICTORY SELF-RELIANCE When I was at home, I had to cope with things on my own. Has it ever been the other way where you have had to rely on people? When I first come into care and I didn't know anyone. HIGH ANGER Penny has high levels of anger reporting she gets into arguments a lot, in particular with certain people such as her friends and her older sister calling them very rude names. 2/7/

Penny’s Anxious attachment: Overall Disorganised HIGH FEAR OF REJECTION I don't often get close to people, I get scared. HIGH FEAR OF SEPARATION Penny has high negative attitudes about separation anxiety and worries about key people including her keyworker and her Grandad. " How do you feel when people close to you are away"? "Lost, especially with my Grandad, I always worry about them”. OVERALL DISORGANISED style as she has three discernable insecure styles ANXIOUS - Moderately Fearful (deer – fears rejection), Moderately Enmeshed (clingy monkey – fear separation). AVOIDANT - Moderately Angry-dismissive (grizzly bear – angry mistrust) 2/7/2013 Swanick, Derbys 14

‘Penny’ ASI – follow up 7 months later. ‘Penny’ has been working on her anger management with her care staff, in addition to having a stable and supportive care experience. At follow up she had lost her high anger and no longer categorised as Angry-Dismissive. She has reduced anxious attachment – with her Fear of Rejection reduced. Her Self-reliance is no longer contradictory but high self-reliance. Her fear of separation remains. Her overall style shows fewer substyles and no anger: Moderately Withdrawn & Enmeshed Recommendations for continued care-planning made in light of these styles in an 11 page follow up risk & resilience report. 15

Summary: A case for good assessment in practice Attachment interviews and models can be helpful for practitioners to recognise & understand vulnerability in children and families. Attachment vulnerability needs operationalising in social care and clinical practice to help practitioners undertake meaningful assessments to inform direct care planning. Reliable & user-friendly assessments across sites are needed for consistency of practice. Longer term evaluation of follow-ups needed. Understanding the potential for attachment change and better outcomes needed in assessment and care planning. Consistent measures and models should ideally be used across agencies (e.g. social and psychological services). 2/7/2013 Swanick, Derbys 16

Copy of presentation: 2/7/2013 Swanick, Derbys 17 Thank you for your attention!