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Building Relationships with Vulnerable Children: Attachment, Reflective Practice and Resilience in F


This chapter considers the development and implementation of the BUILD programme as a bespoke training initiative within Barnardo’s Fostering Service Northern Ireland (BFNI).

BUILD aims to support and enhance foster carers’ practice, developing capacity to meet the needs of children who have experienced relational trauma. It promotes stability and resilience in foster care through an attachment-focused approach to nurturing, communicating and strengthening relationships with children.

Critical to all good attachment relationships is the adult’s understanding of what they bring to the carer-child relationship as well as what the child may bring. Reflecting this, BUILD encourages carers to explore the influence of their own attachment history on their caring approach, as well as deepening their understanding of the needs of children, as manifested through their own relationships.

Considering that the most powerful antidote to trauma is the carer-child relationship (Bessel van der Kolk, 2014), BUILD seeks to enable foster carers to develop the quality and strength of this relationship. This includes developing skills in reflection, attunement, self-awareness and self-care (Golding 2003; Hughes, 2004; Dozier et al, 2005; Schofield & Beek, 2005; Blaustien & Kinniburgh, 2010). Strengthening these skills is critical in forming a protective barrier in placement and producing better overall placement progress.

As an innovative early intervention programme, BUILD aims to improve placement stability, longevity and the well-being of children and foster carers. Focusing on promoting positive carer-child relationships through evidence-informed, strengths-based and reflective practice, it encompasses key characteristics of effective social work intervention (Northern Ireland Social Work Strategy, 2012).

CONTEXT

Barnardo’s Fostering Northern Ireland (BFNI) supports looked after children and foster carers across a variety of placements, including long-term, short-term and short-break care. BFNI works in partnership with the five Health and Social Care Trusts and Barnardo’s Children’s House, a residential, short-stay unit for primary school-aged children (7-11 years).

The majority of children referred to Children’s House will have experienced trauma within their early attachment relationships and multiple moves in the care system. The two services (Barnardo’s Fostering and Children’s House) work collaboratively to achieve stability for these children, facilitating transition from the residential unit to foster placement and supporting placements with wrap-around services.

Traditionally, BFNI’s induction of foster carers included support from a supervising social worker, alongside training to develop knowledge of attachment theory and behaviour management. However, with increasingly complex referrals, it was clear this was not sufficient to build carers’ resilience and capacity to help children begin to adapt and recover from relational trauma. Barnardo’s experience was that, despite induction, training and support, foster carers did not always fully understand children’s needs and were frequently overwhelmed by children’s trauma and its impact on family relationships and functioning. Placements where adolescence and school transition were complicating factors proved particularly problematic and had a higher risk of disruption.

The need to increase foster carers’ skills and confidence and reduce the risk of them becoming overwhelmed by the emotional impact and complexity of their role was the driving force behind the development of BUILD. Carers needed better understanding of relational trauma and its impact on children’s development, as well as potential to activate secondary trauma symptoms in themselves.

Introduction

Despite vast research on attachment and its application in social work, many carers will struggle to respond to the needs of looked after children who have experienced trauma within attachment relationships.

The experience and needs of looked after children must be understood. Developing enhanced and sustained competency in this area is critical to support high quality care and promote the emotional health and well-being of children (SCIE, 2010).

It is well recognised that foster carers now care for more troubled children (McAuley and Young, 2006). McSherry et al’s (2015) study of LAC in Northern Ireland found that 40% had been diagnosed with behavioural problems, 35% with emotional problems, and 21% with depression or anxiety. In addition, nearly one-third of the group was believed to suffer from a long-standing illness and/or disability.

Stress levels experienced by carers in all care pathways in Northern Ireland are of concern and, in particular, the high stress levels experienced by foster carers. McSherry et al (2016) report 44% of foster carers in Northern Ireland as experiencing clinical levels of stress. Earlier research (Allen and Vostanis, 2005) indicates that social workers supervising foster carers reported that the most difficult part of their role was supporting carers to manage their emotions.

Intervention in foster care must aim to reduce the risk of carers becoming overwhelmed in responding to children’s trauma. Training and support must develop foster carers’ resilience and ability to address children’s complex developmental need.

Improving the design of foster care services, through quality training and effective access to support, is critical not only for placement stability and longevity, but also to support the mental health and wellbeing of carers and children.

Literature Review

  • Children in Foster Care

Foster care (kinship and non-kinship) as a preferred placement type can be linked to the philosophy running through the Children (NI) Order 1995; that safe family settings are central to supporting and helping children. Recent Children in Social Care Statistics 2016/2017 highlight the highest number of children in care since the introduction of the Children NI Order 1995 with 79% in foster placement (DHSSPS 2018). Barnardo’s Impact Report (2018) shows that, across the UK, 874 children were placed by Barnardo’s Fostering services in 2017-2018.

Permanence is a core childcare policy and working to achieve permanence for LAC is pivotal to BFNI. The purpose of permanency planning is to ensure a permanent and secure upbringing for LAC, either within their original family or by providing high-quality alternative parenting. Its aim is to avoid long periods of insecurity and/or repeated disruptions in children’s lives (Children (NI) Order 1995, Regulations and Guidance, Vol.6, Co-operating to Protect Children).

Children in Care in Northern Ireland statistics (2016/2017) report changes across all placement types and the reason for the latest change; whether the move was planned or due to breakdown. For non-kinship foster care, the most prevalent placement type across all Health and Social Care Trusts, with the exception of the Western Trust, where kinship foster care was most prevalent, 38% of latest placement changes were due to breakdown (DHSSPS, 2018). Notably, this is an increase on the figures reported in 2015/2016 and 2014/2015; 35% and 32% respectively (DHSSPS, 2017 & 2016). Three fifths of all placement moves for the 16 and older age group related to a placement breakdown (59%).

Many factors lead to placement breakdown. In a review of the literature (Sinclair et al, 2000) suggests that the two most common factors are the child’s characteristics and the foster carer’s lack of confidence to manage him/her. These are considered in turn.

  • Looked After Children

A large proportion of children in care have experienced trauma within their primary attachment relationships and multiple adversities in early development. Research, including Barnardo’s Living with Adversity Study, reports consistent and clear evidence that exposure to adverse childhood experiences increases the risk of negative psychological, emotional and health-related outcomes in later life (Webb et al, 2014). Taylor and Lazenbatt, (2013) argue that the experience of multiple adversities in childhood is to be viewed as a chronic long-term condition, and highlight that continual support and/or intervention may be necessary.

Chronic parental neglect and abuse can result in long-term cognitive, behavioural, emotional, social and psychological developmental difficulties (Perry, 2002). Sanderson (2013) contends that trauma within attachment relationships can have pervasive immediate and long-term effects on the developing child, reporting numerous social and emotional difficulties.

Sempik et al, (2008) highlight that the level of mental health needs of looked after children and young people may be underestimated. In their 2008 study of children at the point of entry into care, they report a high number of emotional needs and behavioural problems, and a greater incidence of problems than indicated in previous studies.

Studies of factors associated with the success or otherwise of placements planned to be permanent, identify behaviour and attachment problems as significant factors in placement breakdown. Beckett et al, (2013) in a follow- up study of 59 children involved in care proceedings between 2004 and 2005, showed a 15% placement breakdown rate in permanent placements, with the highest percentage (44%) occurring in permanent foster care and identifying behaviour as the primary cause. These findings reflect those of (Triseliotis, 2002) from a much earlier period despite changes in law and practice.

The Care Pathways and Outcomes Study Northern Ireland (Mc Sherry et al, 2013) concludes that across the various long-term placement types (2002 to 2007) adoption, kinship care, birth parents, residence order and foster care, the foster care pathway provided a lower degree of stability. Similar research results are reported in Great Britain (Sinclair et al, 2005; Biehal et al, 2010).

The literature widely reports that the risk of breakdown in long-term placement increases as the child gets older (McSherry at al 2013; Ward 2009; Sinclair, 2005). Sinclair (2005) highlights that placement disruption is highest for foster children aged 11 to 15 years. Mc Sherry et al, (2013) report the age range 9-14yrs as a possible explanation for the higher percentage of breakdown in the foster care pathway.

Research concludes that by mid-childhood (9-14 years) children with a history of attachment difficulties begin to demonstrate anti-social behaviours such as self-gratification with blatant disregard for family and social rules (Levy and Orlans, 1998). Difficulties with the regulation of emotional states may become more extreme and entrenched in adolescence (Blaustein and Kinniburgh, 2010).

A review by (Rock et al, 2013) highlights the strongest correlates of placement instability:

  • older age of children

  • externalising behaviour

  • longer total time in care

  • residential care as first placement

  • separation from siblings

  • foster-care versus kinship care

  • experience of multiple social workers

Building Fostering Resources

Research indicates that placement stability is directly related to carers’ ability to cope with children’s challenging behaviour. This is a concern given that placement instability is reported as a major reason why longer- term welfare outcomes for children in care are disappointing (Ward, 2009). It is argued that volatility in care replicates children’s experiences within their birth families and impacts on a child’s education, health and emotional development through to adulthood (Ward, 2009).

Baylin and Hughes (2012) contend that the primary source of interference with providing stability and nurturing to children is unmanageable stress usually associated with parenting experiences and, frequently, some aspects of the parent’s own attachment history. Coman and Devaney (2012) report that foster carers’ understanding of the child’s behaviour and their own personality and experience affect outcomes for looked after children.

Quality foster placements, in which children can grow and reach their full potential, must be nurturing. However, developing and sustaining nurturing relationships with children who have suffered traumatic parenting experiences can be extremely difficult. Hughes (2009) reports that between 60% and 80% of children in foster care and adoptive placements have experienced relational trauma, and are highly likely to reject nurturing relationships.

The importance of carers being properly trained and supported is reflected in policy, such as Care Matters (2007) and the UK National Minimum Standards for Foster Care (2011). However, research reveals that training and support of foster carers is far from sufficient and indicates the need for a more effective approach. Sinclair (2005) reports that the major experimental study of the effectiveness of training in behavioural methods for foster carers failed to show a significant effect, and argues that training for foster carers must prepare them for the emotional impact of their job and challenging behaviour they may encounter. Similarly, (Hutchinson, 2005) argues that support for carers should help them recognise the personal impact of fostering and develop strategies.

Rock et al, (2013), in their study of protective factors in foster care recommend that “stake holders develop manualised tools that aid the translation of research evidence into practice” (Rock et al, 2013 p.203) to strengthen placement stability. Barnardo’s BUILD programme follows this recommendation; a pilot took place in 2012 and subsequent to successful development and delivery of the programme, it was manualised in 2016.

Build: Addressing the gap

BUILD is designed to increase carers’ resilience, self-care, self-efficacy and competency. It aims to support carers in the development of positive and strong relationships with children in their care. It addresses the reasons why children behave as they do when they have experienced trauma within attachment relationships, and what can be done to help them develop more positive attachment relationships.

With an emphasis on psycho-educational and experiential training, and integrating key elements from the evidence-base on attachment and developmental trauma, BUILD is a carefully constructed and detailed intervention, delivered in eight training sessions. Sessions are built around 5 key learning objectives, namely:-

  • To gain a meaningful understanding of the importance of attachment relationships.

  • To recognise attachment styles and developmental trauma

  • To reflect on individual attachment history to enhance approach to caring.

  • To identify unmet need that stems from early relational trauma.

  • To develop self-care, self-awareness and effectiveness.

Reflective Practice-Understanding Behaviour

BUILD aims to increase reflective practice and self-awareness, which are pivotal in understanding and responding sensitively to children’s needs. This perspective is supported by Houston (2015) who highlights the importance of social work training that develops understanding of how personal and psychosocial characteristics and experience shape the way we view and we react to others. However, while reflective practice is deeply embedded in social work practice and integral to social work training, it is unrealistic to assume that subsequent to a time-limited fostering assessment and preparation process, foster carers will be as equally versed in reflective practice.

Without the development of reflective practice and self-awareness, there is a risk that carers will misinterpret complex behaviour in children and struggle to identify their needs. BUILD is designed to enhance carers’ capacity to accurately tune into the thoughts, feelings and need that drive behaviour. Carers are also supported to access their own experience in responding to behaviour. Developing capacity to reflect in this way enables carers to support children to regulate their emotions as well as mange the emotional impact of their role.

BUILD incorporates the work of Golding (2006) and Bomber (2007) to promote knowledge and skills in interpreting the meaning behind behaviour; examining the process of projection and the frequent mismatch between expressed and hidden need in the behaviour of children who have experienced trauma and loss. An awareness of projection helps carers empathise with the child and teaches them to understand the distress that the child is communicating rather than react to it (Bomber, 2007).

Based on the work of (Golding, 2006), BUILD enables carers to explore and understand that children who have experienced relational trauma will often give out the wrong messages, for example, avoidant and/or aggressive behaviour masking the need for connection and belonging. Using case studies and role-play, carers are enabled to identify and address the mismatch between children’s expressed and hidden need.

BUILD prepares carers for the likelihood that children in their care may have significant difficulty developing healthy and secure attachment relationships. Golding & Hughes (2012) argue that children with attachment difficulties are afraid of being parented, and will control and reject parenting as a way of ensuring safety. My experience of working in Barnardo’s confirms this where, as a result of their pre-care experiences, many of the children have profound difficulty in forming relationships, with violence and controlling behaviour frequently proving a problem. Baylin & Hughes (2012) contend that when a child does not reciprocate a carer’s love there is a high risk of the carer shutting down care-giving and becoming “blocked” to experiencing nurturing feelings for the child. They argue this is a defence response driven by parental stress and feelings of failure.

Understanding the concept of “Blocked Care” is likely to help carers have greater empathy for themselves at times when they are struggling to parent (Hughes, 2011). Considering this perspective, BUILD is designed to raise awareness of the potential for carers to experience “Blocked Care” and how it creates a reactive style of parenting which is narrowly focused on the most negative aspects of a child. Through paired/group discussion and video clips, carers are encouraged to share and reflect on the impact of coping with persistent, challenging behaviour and explore triggers and defence responses. Importantly, this reflective work counters the shame and isolation associated with carers’ feelings of failure and experiences of stress, and helps prevent placement breakdown.

Reflective Practice-Securing Attachment

BUILD encourages carers to reflect on and identify possible triggers and relationship styles from their own attachment history which might interfere with their capacity to respond sensitively to a child’s behaviour and need. Exploration of triggers and understanding of attachment patterns continues throughout the course, and is later developed to explore these factors as they relate to the child. Raising awareness and understanding of triggers allows carers to prepare for anticipated problematic reactions both in themselves and children. Understanding the significance of triggers and identifying what they are will help carers respond to trauma (Bessel Van Der Kolk 2014; Sanderson 2013).

Attachment theory stresses that attachment history is significant in the capacity of substitute carers to provide a secure base to children who have experienced trauma and loss. Main and Goldwyn (1998) contend that carers with a history of secure attachment, or having resolved past childhood trauma, will be more able to manage a wide range of feelings both in themselves and in the child. They highlight that this is the key to responding to children who display aspects of disorganised attachment. However, it is inevitable that many carers will not have experienced secure attachment and will demonstrate either insecure-avoidant or insecure-ambivalent attachment patterns. Therefore, supporting carers to identify issues and their own attachment pattern can potentially provide an opportunity to begin to adapt and change (Dozier, 2005). For example, carers with an avoidant attachment pattern can be encouraged to be more nurturing when a child becomes distressed. Conversely, carers with an ambivalent pattern can work on being calmer.

Group Support and Experiential Learning

Creating safety within the context of the group is essential so that carers can discuss experiences of fostering without feeling exposed. Carers can feel vulnerable discussing difficulties in their relationships with children. In order to facilitate learning and development, a balance of challenge and support advised by (Jacobsen and McKinnon, 1989) in the context of counselling is required.

A group approach to building capacity in foster care is recommended by (Golding, 2003). Feelings of personal failure and isolation frequently experienced by foster carers trying to cope at home with intensely challenging behaviour are best addressed through group support. BUILD seeks to enable carers to share and reflect on emotions experienced in their relationships with and responses to children within the safety and structure of the group setting, so as to reduce the risk of transference and counter-transference in placement between the child and the carer. An experiential and strengths-based approach to learning is central to BUILD and provides an empowering experience for carers, encouraging them to explore practice and understand how to enhance this.

Drawing on the work of (Golding, 2006; Blaustein and Kinniburg, 2010) carers are encouraged to share and develop strategies for managing stress and implementing self-care. Learning new behaviours and improving practice through structured peer support encompasses a strengths-based approach to implementing change; as outlined in the Northern Ireland Social Work Strategy (2012), this is particularly effective in increasing confidence and skill, and establishing peer networks which are integral to building resilience in foster care.

Considering experiential learning is particularly appropriate for the development of reflective professionals (Howarth and Morrison, 1999), BUILD employs a range of experiential training methods including structured exercises, audio/visual clips, case studies, games, observation tools and role-play which facilitate exploration of practice and generate ideas for improvement.

Experiential learning is essential to ensuring participants understand attachment as a sensory rather than cognitive experience, learning that can then be transferred to their role as foster carers. Crucially, exercises that support carers to access the texture and feeling of their own attachments are used to strengthen capacity to use a sensory approach to providing children with safety and security.

Implementing a Relational Approach

In contrast to BFNI’s previous child-centred, behaviourally-focused approach to responding to children’s needs, BUILD encourages a trauma-informed, relational approach focusing on both the adult and child. Sensory experiences are integral to developing the child’s capacity to attach and form new relationships, and to recover from trauma (Van Gulden, 2008). BUILD encourages carers to provide children with frequent positive and sensory experiences of warmth, value and connection, and teaches that these experiences are essential if they are to be supported to regulate their emotions and progress developmentally.

Exploration of how to create deeply nurturing experiences for both children and adolescents is an important component of BUILD. Video clips, etc. of parent-child interaction provide simple but powerful tools in promoting understanding of bonding behaviour and sensory connection, and their essential role in providing therapeutic care to children and adolescents who have missed these early attachment experiences.

Golding and Picken (2003) stress the importance of touch within the carer-child relationship and its role in helping past trauma to heal and secure attachment to grow. Baylin and Hughes (2012) argue that when carers experience high levels of stress, there is a risk that they will struggle to offer nurturing experiences to the child. Encouraging carers to maintain connection with the child, particularly when conflict arises, so as to reduce the escalation of challenging behavior, and help restore nurturing feelings for them, is a key objective of BUILD.

Importantly, BUILD enables carers to understand the need to achieve a balance between providing safe care and the essential love and nurturing needed by children. Ensuring that safe caring policy and practice do not interfere with carers being able to reach out to children and offer them nurturing experiences can be a challenge. Schofield et al, (2011) argue that therapeutic intervention with children must not be eclipsed by the accountability needs of “corporate parenting”.

Attachment and Development

Based on attachment literature such as (Sinclair, 2005), BUILD addresses the concept of emotional age and promotes understanding of how development and attachment experiences are linked.

Constructing time lines (Van Gulden and Vick, 2005) which provide an effective tool in examining how trauma and missed attachment experiences impact development is a key component of BUILD. The process of mapping a child’s timeline to include significant losses and trauma, and the age at which these occurred, can help identify developmental gaps and the child’s emotional age and stage. Carers are encouraged to think about attachment experiences the child missed and focus on providing these experiences to help them make developmental progress, emphasising that where there is a behavioural problem, it is not the behaviour that becomes the focus of intervention, but the missed developmental attachment experience.

With an emphasis on thinking about and responding to the child based on their emotional age, BUILD facilitates understanding that strategies to manage behaviour should be used flexibly and relate to the child’s emotional and developmental need rather than chronological age (Hughes 2014, DDP level 2).

Developing ‘Attunement’

Research illustrates that positive change in a child’s behavioural presentation can be achieved by interventions that aim to increase carer ‘attunement’ to the child (Golding 2003; Hughes, 2004; Dozier et al, 2005; Schofield & Beek, 2005; Blaustien & Kinniburgh,2010). Improving ‘attunement’ through attachment-focused practice such as PACE, affective–reflective dialogue, relationship repair and commentary is integral to BUILD. These interventions enhance a child’s sense of safety and security, and strengthen the carer-child relationship.

The principles of PACE (Playfulness, Acceptance, Curiosity and Empathy) are based upon theoretical understanding of attachment and inter-subjectivity. PACE offers a framework for building relationships, whether therapeutic, parenting or general (Golding and Hughes, 2012). As a model of communication, affective/reflective dialogue which is PACE-led improves communication between the carer and child.

When faced with conflict, carers tend to focus on behavioural events and consequences, often resorting to lecturing and venting, which can cause negative spirals. Importantly, Affective-Reflective dialogue and PACE keep communication reciprocal and enable exploration of the child’s emotions as they emerge and understanding of the need underlying behaviour. Affective-Reflective dialogue, where a child is encouraged to express inner thoughts, emotions and wishes, and where the carer also makes clear their own experiences, helps the child to develop reflective functioning and to regulate their emotions (Hughes, 2011).

Modelling, role play and scripting are core training tools employed in BUILD to introduce and develop skills in affective/reflective dialogue and PACE-led communication where the focus of communication is more about experiences than behaviours. Carers learn how to respond to behaviour as opposed to react to it, practising responding to and connecting with the child’s inner world of emotions and thoughts. This approach is particularly effective in defusing conflict and developing the child’s capacity for connectedness.

Commentary is a process by which the adult speaks for, about and with the child as a way of modelling and supporting him/her through the steps of a task. The crucial need for guiding children in this way can be missed. Carers can assume that children know how to achieve developmental tasks and are not always aware of missed developmental experiences and gaps. Unrealistic expectations of and assumptions about children’s developmental capabilities can lead to tension in the carer-child relationship and have a destabilising effect on placement and attachment security.

Experience in BFNI of supporting placements where children frequently display challenging behaviour is that carers, in defence, can shut down and minimise the need for repair after ruptures occur. BUILD supports carers to understand and prioritise the need for ongoing repair when breaks occur in the carer-child relationship. Failure to repair, on the part of the carer, or the expectation that the child will initiate repair, will undermine the safety needed to secure attachment and make it a steadying force in the child’s development (Hughes 2009).

Implications for Practice

Many looked after children have experienced relational trauma and multiple adversities and come to placement with complex developmental needs. Behavioural problems and mental health disorders among looked after children are well documented (Mc Sherry et al 2015; Sempik et al, 2008; McAuley & Young, 2006).

Responding to children’s grief and pain and helping them to build healthy attachment relationships requires resilience and skill. Foster carers need robust support and training to protect them from being over-burdened by the emotional impact and complexity of their role. Training and support must be more than teaching theory of attachment and behaviour management. Carers need the opportunity to develop skills in reflective practice, explore and understand the impact of relational trauma and build coping strategies to manage the stresses inherent in fostering. Placements for children between the ages of 11 and 15 are particularly at risk of disrupting and need intensive support.

Within the Voluntary Social Work sector, the BUILD programme is an example of responsive practice which provides an evidence-informed and relational approach to developing carers’ resilience and skill, thereby improving well-being in foster care. In doing so it encompasses important themes in the Northern Ireland Social Work Strategy (2012).

At practitioner level, pushing the boundaries of practice and implementing change in BFNI’s primary model of intervention and support for carers was a complex process. This involved shifting from a behavioural to a relational, trauma-informed approach which was driven not only by my knowledge of a compelling evidence-base, but also a vision and commitment to address my own and other practitioners’ difficulties in building the capacity and resilience of carers. It was clear to me that, within BFNI, relying on behavioural programmes such as Incredible Years did not enable carers to manage the intricacy and impact of their role. I chose to create an intervention that emphasised reflective practice and self-care, as well as strategies for communicating and building relationships with children, so as to more effectively meet the needs of carers and children.

BUILD draws on elements of (Golding’s, 2006) Fostering Attachments in Children who are Looked-After, a support programme for adoptive parents and foster carers and, from an international perspective, addresses core concepts underpinning the ARC Framework of Trauma -Informed Care (Blaustein & Kinniburgh 2010). Both of these programmes however, require much greater investment and time commitment from carers and aim to achieve sophisticated understanding of theoretical concepts relating to attachment. From an organisational context, it was essential to create a bespoke programme which was easily accessible and relevant for newly approved foster carers. Ensuring that programme length was reasonable was a major consideration given the wider context of increasing demands on foster carers, including the need to comply with evolving standards of practice and mandatory training.

In devising BUILD as a bespoke programme so as to fit with the organisational and wider context, I drew on my practice experience, knowledge and values in order to integrate key elements from the evidence base and promote a holistic and accessible package of support for foster carers. Critical judgement and reflection, communication skills, and a person-centred ethos were fundamental factors in the development process. As outlined by the NI Social Work Strategy (2012), they are pivotal in ensuring flexible and responsive services and diversifying the social work role.

Outcomes

BUILD promotes the development of skills in reflection, ‘attunement’, self-awareness and self-care which are pivotal in improving outcomes in foster care. Its effectiveness in building resilience and enhancing fostering practice (nurturance, knowledge and understanding of child attributions) has been tested by standardised and non-standardised assessment tools: Eyberg Child Behaviour Inventory (Eyberg, 1999), Parenting Sense of Competence Scale (Gibaud-Wallston & Wandersman, 1978), Parenting Profile for Developing attachment (Hughes, 2013), as well as being confirmed by participant carers’ qualitative evaluations.

Within BFNI the programme has been instrumental in developing carers’ confidence, understanding and skill and evidences that reflective practice and attachment-focused interventions are essential in helping children begin to adapt and recover from relational trauma.

Attachment-focused interventions are effective in strengthening the carer-child relationship, but practice is crucial to embed skill. Commentary and affective/reflective dialogue both involve engagement in a process of thinking and speaking aloud. Carers can be inhibited about using this approach and so guided practice and mentoring is necessary to counter inhibitions and ensure the development of skill.

Skills developed in training need to be maintained after training. Follow-up to training initially took the form of a single post-training meeting between facilitators, carers and social workers, reviewing learning and identifying areas for growth and development. However, this was not altogether sufficient to embed learning. After training, carers should have access to a focus/mentoring group to augment learning and to problem-solve in relation to cases. Sinclair (2005) suggests that training for carers should be followed up with “problem clinics” to consolidate learning. Developing the programme in this way alongside the introduction of peer-mentoring, in which experienced carers who have successfully navigated the complexities of their role provide additional support, would potentially offer a more effective model of intervention. Importantly, this extended model may be particularly helpful in preventing and dealing with crisis points, improving self-esteem and providing longer-term emotional support to carers.

Conclusion

As a response to high levels of stress and increasing placement breakdown, it is vital that preventive, early intervention programmes are implemented to build capacity and address inherent stresses in foster care.

Intervention in foster care must be robust, accessible and relevant, based on research and evidence of what works, to prevent carers from being over-burdened. Taylor (2010) highlights the importance of social work practice being evidence-based and stresses that experience alone is not enough to inform practice.

As a preventive, early intervention programme, BUILD addresses the needs of both children and foster carers and aims to embed effective, therapeutic foster care.

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McSherry, D., Fargas Malet, M., McLaughlin, K., Adams, C., O'Neill, N., Cole, J., & Walsh, C. (2015) Mind Your Health: The physical and mental health of looked after children and young people in Northern Ireland. Belfast: Queens University Belfast.

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https://pure.qub.ac.uk/portal/files/17213677/mind_your_health_report_october 2015.pdf

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Recommended Reading

Archer, C. (1999). First Steps in parenting the child who hurts, London: Jessica Kingsley.

Archer, C. (1999). Next steps in parenting the child who hurts, London: Jessica Kingsley.

Archer, C. & Gordon, C. (2006) New families, old scripts, London: Jessica

Kingsley.

Blaustein,M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency, New York: Guildford Press.

Bomber, L. (2007) Inside I’m Hurting, London: Worth Publishing

Booth Phyllis B. and Jernberg Ann M. (2010) Theraplay: Helping Parents and Children build better Relationships Through Attachment-Based Play, San Francisco: Jossey-Bass

Golding, K. (2007) Nurturing Attachments: Supporting Children who are Fostered and Adopted, London: Jessica Kingsley

Golding, K. & Hughes, D. (2012) Creating Loving Attachments: Parenting with PACE to Nurture Confidence and Security in the Troubled Children, London: Jessica Kingsley

Hughes, D. (2006) Building the bonds of attachment 2nd ed. Northvale, NJ: Jason Aronson.

Hughes, D. (2000) Facilitating Developmental Attachment: The Road to Emotional Recovery and Behavioural Change in Foster and Adopted Children, London: Rowman & Littlefield.

Hughes, D. (2009) Principles of Attachment-Focused Parenting: Effective Strategies to Care for Children, New York: W.W. Norton.

Hughes D. & Baylin, J. (2012) Brain-based Parenting: The Neuroscience of Caregiving for Healthy Attachment, New York: W.W. Norton

.

Perry, B & Szalavitz (2006) The boy who was raised as a dog, New York: Basis Books.

Shemmings D. & Shemmings Y. (2011) Understanding Disorganised Attachment, London: Jessica Kingsley.

Siegel, D.J. & Hartzell, M. (2003) Parenting from the inside out, New York: Jeremy P. Tarcher/Putnam.

Sunderland, M. (2006) The Science of Parenting, New York: DK Publishing

Tangney, J. & Dearing, R. (2002) Shame and Guilt, NY: Guildford Press.

Web Sites

www.healingresources.com

www.danielhughes.org

www.childtrauma.org

www.radkid.org

www.theyellowkite.co.uk

www.emotionaldevelopment.co.uk

www.nurturegroups.org

www.theraplay.org


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