Supporting carers using the secure base star

Supporting carers using the secure base star Professor Gillian Schofield Co-Director of the Centre for Research on the Child and Family

Helping carers to balance concern and hope for troubled children • Children are significantly harmed by abuse, neglect, separation and loss. • Many children will suffer to some extent all their lives as a result. • But many children can benefit from therapeutic caregiving experiences and go on to lead successful stable lives as adults, partners and parents • The goal is to promote security and resilience

What does attachment theory help carers understand about troubled children? • Abuse, neglect and rejection affect the child’s internal working model (beliefs and expectations of self, others and relationships) • Separation and loss raise anxiety and intensify a child’s defensive strategies. • There is a risk that children will recreate their previous experiences of caregiving in new families /new relationships – the child may think good care is just a trick (Crittenden 1995)

Use of attachment theory in developing a secure base parenting / caregiving model for carers • Key to promoting security and resilience is mind-mindedness - in carers and children • Attachment focuses attention on the quality of the child’s experience in the relationship with the caregiver as an active source of therapeutic care. • Security and resilience comes not just from relationships with specific attachment figures but from the whole environment (family, friends, school, activities) –but carers can be helped to influence these other environments

The cycle of caregiving Child’s needs / behaviour Child thinking and feeling Effect on child’s development Carer thinking and feeling Parenting behaviour

Parenting dimensions that promote security and resilience • Being available – helping children to trust • Responding sensitively – helping children to manage feelings and behaviour • Accepting the child - building self esteem • Co-operative caregiving – helping children to feel effective (and be co-operative) • Promoting family membership – helping children to belong http://www.uea.ac.uk/providingasecurebase

Dimensions of parenting interact: secure base star

Working with carers :the secure base star in practice • Assessing, preparing and supporting foster carers • Matching children and carers • Setting goals with carers for each secure base dimension and monitoring child and carer progress (new and existing placements) • Assessing and providing help to placements in difficulties

Tasks for social workers who support carers - while also remaining child focussed • Be available – helping carers to trust /managing carers’ anxiety/enabling them to explore • Respond sensitively – understanding what is in the carers’ mind. What is the child-what is the carer? • Accept the carer – accepting this carer/ building self-esteem / managing set-backs • Be co-operative – empowering/forming an alliance/helping carer form alliance with child – • Promote family membership- helping the carers family to offer temporary membership/support them in work with the birth family

Being available Child’s needs/ behaviour Carer thinking/ feeling Child thinking/feeling What does this child expect from adults? How can I show this child that I will not let him down? I matter, I am safe I can explore and return for help Other people can be trusted Helping children to trust Alert to child’s needs/signals Verbal and non-verbal messages of availability Parenting behaviour

What carers need to understand: why children lack trust • Troubled children have often lacked consistent care and protection from reliable parents • Parents were unavailable through drugs, mental health, learning disabilities, own childhoods • Parents may have • rejected the child’s emotional demands • responded unpredictably • been frightening or frightened • Children will have developed defensive strategies to cope with this lack of trust

Being available – helping children to trust: examples • Carers need to be available physically and emotionally– and signal availability in age appropriate ways • Provide predictable routines • Time the relationship ‘dance’ at the pace of the child • Make sure child feels special/cared for when unwell or troubled • Help the child know that they are thinking of him or her when apart

When tiny babies have switched off • When Jennie came to me at 12 weeks old, she was completely unresponsive, not waking for feeds, not responding to me, not showing any emotion. She had just switched off. I had to stay close to her and respond to even the slightest sound or facial movement and keep talking to her and touching her. It took time to replace those first weeks, but gradually she started to show different feelings and become more responsive. (Carer)

Having the patience to let the child approach • Sam (6) found it impossible to trust me and watched my face warily all the time. I found that if I sat with a drink for him on the settee with children’s television on, he would circle the house for a long time dragging his favourite blanket and eventually end up sitting on my lap wrapped in the blanket, drinking his drink. I needed just to be there and he needed to have the confidence that I would wait for him to come to me.(Carer)

When children are anxious and away from their secure base • When Aiden (4) had contact with his father he was always very anxious about what might happen and whether he would come back to me and I would be here for him. On one occasion I gave him a small cushion to take with him so that he had something to hold onto, but also so that he would know he would be coming home. (Carer)

Foster carers who have difficulties in being available Some carers may be • Overwhelmed by the child’s demands • Feel marginalised • Distance themselves- emotionally or physically AND / OR • Don’t believe a child should need that much attention • Do not have enough time for the child • Lack ‘commitment’ to this child Support worker’s role • Help to understand a) child’s needs and signals b) carer’s feelings/ideas about parenting

Responding sensitively Child’s needs/ behaviour Child thinking /feeling Carer thinking/feeling My feelings make sense -and can be managed Other people have feelings and thoughts What might this child be thinking and feeling? How does this child make me feel? Helping children to manage feelings and behaviour Tuning in to the child. Helping child to understand /express feelings appropriately Parenting behaviour

Children who find it difficult to manage their feelings and behaviour • Feelings have often not been acknowledged or understood in their birth families • From infancy, children have been overwhelmed by feelings that can’t be managed • Feelings often mislabelled/distorted–what is the truth? • Cannot appropriately express feelings – so excessively expressed or denied and repressed or dysregulated and chaotic or dissociated. • Feelings expressed through their bodies in confused ways

Responding sensitively- helping carers to help children manage thoughts and feelings : examples • Tuning in – reading signals, anticipating distress, containing anxiety • Naming thoughts and feelings– providing a ‘commentary’. • Scaffolding experience- giving a predictable shape to events e.g. feeds, nappy change, school • Modelling expression and management of carers’ own thoughts and feelings • Promoting empathy – how do you/how might other people think and feel?

Promoting mind-mindedness, perspective taking and empathy • I think Jenna (9) spent so long in self defence and looking after herself that she never learned to look at things from any one else’s point of view. She missed that out when she was little. And even things like stories.. When you say, what do you think is going to happen next? or why is that person thinking that? she hasn’t got a clue, she doesn’t follow the motives of what people are doing, or how they are feeling. So we do a lot of story reading together and I talk it through. (carer)

Using an experiences book : making it safe to think and remember • Paula (8) couldn’t remember or didn’t want to remember what happened this morning or yesterday or last week and couldn’t anticipate ‘next week’. So we started to do an Experiences Book together - each day writing down what had happened and her feelings about it. This helped her to reflect on the shape of each day and the immediate past and build her capacity to remember. (carer)

Helping carers who have difficulties in responding sensitively Some carersmay • Lack mind-mindedness-about self/others • Have difficulty in thinking about the child’s past- too painful/want to give the child a ‘fresh start’ • Have difficulty in thinking flexibly – have rigid, inflexible theories about the child’s thinking/behaviour • Tend to be negative -so children withdraw /act out –so react negatively... Support worker’s role Carers need help to think about the mind of the child/reflect on their own minds

Accepting the child Child’s needs/ behaviour Carer thinking/feeling Child thinking/feeling I need to value and accept myself. I can value and accept this child. Building self-esteem I am accepted and valued for who I am Helping child to fulfil potential, feel good about himself- and accept setbacks Parenting behaviour

Children with low self-esteem • Many troubled children feel profoundly worthless • They have often experienced parenting that was negative and lacked warmth/sensitivity • Tend to see the world /other people in extremes - all good or all bad • Multiple separations within the birth family/once in care may also move • Defend against feelings of worthlessness –boastful/ or won’t compete • Often won’t take risks /try new things

Accepting the child-building self-esteem: examples • Promote the idea in the (foster) family- ‘Nobody’s good at everything but everybody’s good at something.’ • Look for special strengths/talents in the child • Find activities to do and to share – ‘orchestrate’ achievements • But allow failures and setbacks to happen and be managed. • Model and teach the child to accept and celebrate difference in self and others– ethnicity, personality, talents.

Accepting the child for better or worse Just look at her. She’s got such a twinkle. She’s an absolute rogue. And you would never want that squashed. It’s lovely. It’s just got to be channelled the right way. (Carer)

Promoting positives -showing pride • Rob (11) loves his fish pond. Now he’s in charge of his own and he’s totally reliable in that department. We encourage him all we can. We say ‘Rob’s the top pond man’. He gave his talk at school on goldfish and got top marks. (foster carer)

Helping carers to help children to be accepted by others -including disabled children • For Ben (10) to be accepted someof his behaviour had to be modified and he will get the benefits of that. We go to a nice hotel and he’ll walk into the dining room on his walker and everyone thinks he’s so wonderful and it’s so great for him. They say ‘Ben, you’re so clever, you’re marvellous, you’re such a beautiful boy’. I think, that’s part of what’s building him up, not me, but the response of all these other people. And he’d never have got that, not how he was before. (Carer)

Carers who have difficulties in accepting the child-building self-esteem Some carers • May focus on the negative – to avoid child being ‘big-headed’ • Find it hard to accept the child being different from the foster family • Carers- Have low-self-esteem child seen as a burden • Less likely to take time to help child do activities • Again- children feel ‘different’ and rejected- withdraw (sometimes attack/break placement) Support worker’s role • Carers need help to accept/empathise/enjoy the child

Co-operative caregiving Child needs/ behaviour Child thinking /feeling Carer thinking/feeling The child needs to feel effective and competent How can we work together? I can make things happen within safe limits I can compromise and co-operate Helping children to feel effective Promoting autonomy and choice Co-operating/ negotiating within firm boundaries Parenting behaviour

Children who do not feel effective- cannot compromise/co-operate • Lack confidence in getting their needs met • Have rarely experienced co-operative parenting – parents were often either too controlling and intrusive or too passive and ineffective • Children have often felt powerless or too powerful NB Feelings like this can be made worse in the care system

Co-operative caregiving- helping children to feel effective: examples • Carer offers choices- even in small things • Help children follow through/achieve results-both on their own and with help e.g. plan a trip, take photos and see them developed and framed. • Involve child in family tasks that all can see the benefit of. • Model co-operative behaviour with other family members as well as showing it with the child.

The therapeutic effect of supporting a child to take the lead George (3) would only relax in the garden, so although it was winter we wrapped up warm and everyday we spent time outside. He would potter about, looking at stuff and I would follow him sometimes and talk occasionally and he would stop and he’d look at an insect, or whatever it was he’d found. I pretty much let George lead, but sometimes I’d draw his attention to things. Yes, he pulled out all the plants and I just decided that I wasn’t going to have a garden that year and I just thought – yeah, I can have a garden next year. (Carer)

Promoting co-operation-avoiding a battle • We try, actually, never to tell Salim (7) to do anything. It’s a matter of phrasing it differently, so that you are not triggering his feelings of threat. So, instead of saying, ‘Please wash your hands before you have a sandwich’ we might just say ‘Would you like to come and have a sandwich after you’ve washed your hands?’ or ‘We’ll have a nice long story time if you brush your teeth quickly’. (Carer)

Helping carers who find it difficult to be co-operative Some carers • Emphasise control – a battle with the child that they must win • Can’t accept /enjoy child’s need for autonomy • Can’t take risks • SO child feels powerless- OR becomes defiant /oppositional Support worker’s role • Explore the reasons behind carers’ attitude to co-operation • Help carers to see the value and benefits for the child of feeling effective and for the family of co-operation

Promoting family membership Child’s needs/ behaviour Carer thinking/feeling Child thinking/feeling This child is part of my family as well as part of his/her birth family I can belong comfortably to both of my families Helping children to belong Verbal and non-verbal messages of inclusion in both families Parenting behaviour

Children who do not feel they belong- in any family • Children may have been rejected in their birth family – singled out for rejection or became excluded when parents separated and remarried • Their identity may have been confused and uncertain –but still feel ‘loyal’ to their original family /parents • In a foster family they find it hard to ‘join in’ – to accept the patterns/rituals of a new family • Make carers feel that they don’t want to belong

Promoting family membership-helping children to belong: examples • Have special places for the child in the family /residential home - for their clothes, at table, in the garden • Ensure the child understands how this family does things - include the child in foster family life/photos • Enable the child to talk about and value their birth family identity • Manage contact in ways that promote the child’s well-being and comfortable sense of belonging in both families.

Leroy (age 18 – placed at 8) talking about his foster mother • ‘My mum’s helped me a lot because she was determined for me to do well. That’s a really important thing, other people believing that you can do well... It was my home - whereas before it was just somewhere I was staying.’

Part and parcel of our family • ‘We always say – from the moment you walk through the door, you are part of us. No matter how long you’re staying or how many other families you relate to, you are part and parcel of our family, the same as everyone else who lives here. We say it and we show it to them as well.’ (carer)

Difficulties for some carers in promoting family membership Some carers • Treat child differently to own /other foster children • Don’t include the child fully in family occasions • Have extended family that excludes the child • Dismiss importance of the birth family to the child • Talk negatively about birth family • Make contact difficult for child and birth relatives Support workers’ role • to help carers (and other family members) to reflect on the child’s experience of family life, their own responses - and their commitment to the child

Supporting carers across the dimensions • Work with foster carers so that they can identify their strengths /difficulties –from first placement onwards • Alert at the time of a foster care match to gaps in carers’ capacity – few foster carers are equally good at all dimensions • Have some practical suggestions for carers to try – appeal to their empathy and creativity • Goal of the model is – for parents / carers to enjoy as well as help the children to do well and to enjoy their lives.

Supporting carers/ the child’s journey through different types of placement • ‘Respite’ care – from birth family, from other foster placements • Emergency care – child injury / parental mental health crisis • Planned short-term care – from home/from emergency placement/from ended long-term • Bridging to another placement • Staying on in long-term foster care • Adolescent transitions / leaving care

Tasks for carers: Manage strong feelings - hope and anxiety In the foster family • Child • Other children in the family – foster, birth • Other adults in the family - partners, grandparents Outside the foster family • Family friends, neighbours • Birth family - parents, grandparents, siblings • Social workers – fostering / child • Teachers • Doctors • Psychologists

A child’s journey through placement: supporting foster carers at each stage, using the secure base model • Welcome the child • Settle the child • Get to know the child • Plan /review therapeutic goals • Form a relationship with the child • Help the child with contact • Help the child to move on – or to stay • Help the child with the past, present and uncertain future

Providing a secure base: Helping the child with the past, present and uncertain future Infants/toddlers/pre-school/middle childhood/adolescents Carers • Holds in mind the child’s life trajectory – factually and as experienced by the child • Available to help child explore past • Gives message – ‘you are safe and cared for here’ • Explores possible futures with child –listening to the child Support worker • Ensures carers are informed and involved • Helps carers to live with uncertainty • Manage their own uncertainty

Dimensions of support for carers secure base star

Final thoughts from George’s foster mother • ‘I think if you can just catch children in time, they really can start to heal and recover well enough to go on and just enjoy their childhoods and become reasonably adjusted adults - and that’s a great result, really.’

Supporting carers using the secure base star