Nurse-Family Partnership Home Hosting Program: A Case Study

“All children, at the core of their beings, need to be attached to someone who considers them to be very special and who is committed to providing for their ongoing care.” In this very first sentence Daniel Hughes expresses the importance of attachment in children in order for them to live rich and fulfilling lives. He outlines the issues surrounding the poorly attached child (particularly foster and adopted children) and shows how it is possible, using specific therapeutic interventions, to help them to “heal and grow”.

The representations of attachment disorder in children include such thoughts as: “I am bad and unlovable,” “my caregiver will not protect me from traumatic experiences,” and I am not able to get my caregiver to “respond consistently to my needs”. These children view their caregivers as unreliable, unresponsive, rejecting, and threatening. They should be responded to with empathy and calm as a means to reduce their arousal, as opposed to anger and discipline which can heighten the adverse physiological and behavioral outcomes the child is experiencing.

Reactive Attachment Disorder (RAD) was first introduced just over 20 years ago, with the publication of DSM-III (American Psychiatric Association, 1980). In the DSM-IV. The disorder is defined by aberrant social behavior that appears in early childhood and is evident cross contextually(1994). The disorder describes aberrant social behaviors in young children that are believed to derive from being reared in caregiving environments lacking species-typical nurturance and stimulation, such as in instances such as maltreatment or institutional rearing. (First, M., & Tasman, A. 2010) . In cases of RAD two major types of abnormalities have been cited; these include an emotionally withdrawn/inhibited type and an indiscriminately social/disinhibited pattern (First, M., & Tasman, A. 2010).Conditions in in foreign orphanages and institutions such as, multiple caregivers, maltreatment, abuse, neglect, and others contribute to the inability for internationally adopted children to form secure attachments. All of these factors contribute to internationally adopted children being at a higher risk to develop attachment disorders such as RAD and other behavioral problems.

The importance of a healthy attachment in early childhood development can lead to a better adult development and skills for daily life. A secure and healthy attachment to the caregiver in infancy to adolescence showcases the importance of building strong relationships and coping skills during periods of stress and anxiety. The research that has been found, goes into detail about the different types of attachments that infants and children can develop as well as what negative and positive aspects come along with the attachments.

According to modern attachment theory, a “good enough” mother needs to be psychobiologically attuned with her infant in order to co-regulate the shifts in the Central Nervous System (CNS) and Automatic Nervous System (ANS) that the infant will experience (J. Schore & A. Schore, 2012). The mother’s ability to co-regulate the infant through the mother-infant affect synchrony, meaning the process of attunement, misattunement, and re-attunement will ultimately determine the child’s attachment style and if the child will be resilient as well as if the child will be able to self-regulate (J. Schore & A. Schore, 2012). A mother does not need to be perfectly attuned with her infant’s needs because moments of misattument that consist of mild to moderate stress followed be re-attunement are necessary in order to help foster the child’s resiliency (Mulligan, 2014a). However, during a moment of misattunement, the mother needs to re-attune with the infant in an appropriate amount of time in order to ensure that the child becomes

Foster care has a major impact on children and adolescents. There are several areas of a child’s life that is affected by being placed in foster care. When children and adolescent enter into foster care due to abuse or neglect their world can change for better or for worse. A child’s experience before entering foster care predetermines their behavior(s) that will occur while in foster care. Often time’s children have to deal with these life changing events due to a mistake that their parent/guardian made or a lifestyle that their parent/guardian has chosen. In particular, several foster children and adolescent have attachment issues upon entering care (Kelly & Simon, 2014). This topic is concerning because it can help identify the issues that occur when children and adolescents enter into care and help front line service workers assist their families in a more appropriate manner in order to decrease the issues that are due to attachment. The outcome for every child is different, but understanding that attachment disorders is the problem and possible ways to deal with it can assist in making a positive social change in the foster care world.

As implied by many physiologist a child’s attachments style is the building blocks to his or her mental development. A child like a structure is sure to crumble if there is a crack in their foundation. Foster children have the potential to stand tall or crumble due to neglect. Attachment styles tend to vary in foster children since they bounce from home to home. In this paper I will discuss the attachment styles foster children share with both their biological and foster parents, as well as the foster child’s potential outcome due to these styles. In order for children to develop

Bartholemew and Horowitz (1991) described a model of attachment in which the child’s image of the self and others are the most important roles. The four categories in this model are secure attachment in which the child has a sense of worthiness and that others are accepting (Bartholomew & Horowitz, 1991). Preoccupied attachment describes a feeling of unworthiness but with positive feelings towards others, fearful attachment combines unworthiness with a negative feeling towards others (Bartholomew & Horowitz, 1991). Dismissing attachment describes a feeling of worthiness with negative feeling towards others (Bartholomew & Horowitz, 1991). Pignotti (2011) explored the effects that early institutional care has on kids that are later adopted and their risk of RAD. Kemph & Voeller (2007) describe how RAD is seen to occur because of poor nurturing from the mother as well as several other prenatal factors. Minnis, Green, O’Conner, Liew, Glaser, Taylor, & Sadiq (2009) compare RAD with insecure attachment patterns and find that RAD is not the same as attachment insecurity, especially because it occurs early on. Other studies have tried to go further and study RAD and possible biological mechanisms that cause it. Kočovská, Wilson, Young, Wallace, Gorski, Follan, & Minnis (2013) studied the effects of reactive attachment disorder (RAD) and cortisol

This literature review focuses on a general understanding of the history of attachment, as well as the basis of what attachment means in early childhood development. It will also review how the diagnosis of RAD has evolved over the years since it was first introduced as a condition in 1980. This paper will reveal what scientists suggest happens when a child’s attachment to his/her primary caregiver is

A child’s ability to function and comply with society’s rules and regulations rely on a healthy early childhood attachment. Attachment is the biological instinct for infant to seek closeness to their caregiver. A secure attachment develops through consistent and positive, interactions between the caregiver and the child. A child’s physical development, mental development, social development, and ability to form daily living skills, all begin to develop through that secure development but continues to develop through continued nurture throughout that child’s life. Children who fail to receive a secure attachment will most likely struggle with self-regulation making it hard to control behaviors and impulses.

As of 2006, approximately 1.5% of urban infants in the US were in foster care (Cole, 2006). This is a system and a lifestyle that will likely affect the rest of their lives via developmental and relational problems, for the most part against their will. John Bowlby, one of the main scientists behind Attachment Theory once wrote about forming a secure attachment “the infant and young child should experience a warm, intimate, and continuous relationship with his mother (or permanent mother substitute) in which both find satisfaction and enjoyment” (1951, p. 13). This is a challenging feat for foster children, who don’t necessarily have a permanent mother substitute. While I expected the literature to describe foster kids to typically have some degree of Reactive Attachment Disorder, it turns out that this is fairly rare, occurring in less than ten percent of children who were severely neglected as children (American Psychiatric Association, 2013). The literature more often refers to insecure and avoidant attachment as the main attachment style among foster and institutionalized children. Individuals with avoidant attachment styles have learned through interaction with caregivers that any support-seeking or emotional expression will be met with rejection, and therefore avoid doing so. The following will detail and at points expand on or critique articles supporting the notion that foster children often have avoidant attachment styles, and that this is often problematic.

Although secure attachment during infancy is the foundation for continued healthy positive development during the lifespan, it is important to understand that other factors can have a significant effect on development later in life (i.e. illness, loss, and trauma). However, research has shown the importance of consistent care giving that is responsive and nurturing and the caregivers’ ability to effectively accommodate more difficult temperament characteristics ,as well as other factors, influence the development of healthy attachment{{64 Bakermans-Kranenburg, Marian 2003}}. Research has also shown that infancy and early childhood is the period of development where scaffolding begins and continues (Vygotsky, 1978; Zhao & Orey,1999).

Lehmann and Coady (2001) state that attachment theory adheres to the notion that mental health issues come from detrimental early childhood caregiver relationships. Lehmann and Coady (2001) further state that this can include a breakdown in relationships that fail to give a child emotional security, comfort and protection. Lehmann and Coady (2001) reiterate that this can also include bad reactions with caretakers that are inconsistent, unreliable, insensitive and abusive. This theory is critical in a rural social work setting as it pertains to trauma.

In the first few months of life, the sole purpose of any child’s behaviour is to survive. This, more often than not, results in actions that reduce the risk of harm and increase the chances of longevity. Of these behaviours, some argue that the most influential is attachment behaviour. “Attachment behaviour is any form of behaviour that results in a person attaining or maintaining proximity to some other clearly identified individual who is conceived as better able to cope with the world”(Bowlby, 1982). Therefore, children will make an effort to stay close to and under the protection of their primary caregiver. According to Webster, “through interactions with their primary caregiver, the child develops expectations and understandings about the workings of relationships. These mental representations of relationships become internalized to the degree that they influence feelings, thought and behaviour automatically and unconsciously” (1999, p.6). Moreover, the response of the identified individual plays a huge role in the child’s perception of the outside world. If the caregiver responds to the child’s needs in a caring and protective manner, the child will feel safe and comfortable in his or her surroundings. If, on the other hand, the caregiver is often emotionally and/or physically unavailable, the child is likely to

Facilitating Developmental Attachment by Daniel A Hughes is an in depth look at the work of Dr Hughes, a clinical psychologist who specialises in child abuse and neglect, attachment and works with children in foster care or adoption. Hughes discusses every facet of his practice including the theory and research surrounding attachment, the qualities and expectations required by each of the people involved in the therapeutic process as well as including four case studies. Hughes states the book is written for those working with children who have “…severe forms of attachment problems that correspond to