Attachment Theory And Risk Assessment
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Linking Theory, Research, and Practice: Risk-Assessments and Child Protection. The primary goal of this paper was to broaden my knowledge and understanding around the theory, research, policies, and procedures guiding risk-assessment decision making within child protection service. Individuals and group identified as at-risk-, for one or more myriad reasons have been the broad focus of a decade s worth of academic and professional purists. Although the initial concern for all at-risk individual remains, practical and academic experiences have narrowed the scope to include children under the age of twelve, at risk- of, or currently residing out-of-home-care placements (hereafter referred to as care environments).
Of all at-risk- populations, I believe these children are the most vulnerable to negative outcomes in the near and distant futures. Substantiated allegations of child maltreatment1 are responsible for 80% of child protection investigations, and preceded out-of-home care placements of at least 90% of the current care-population (Gough, 2000; Wiley, 2009). For several helpless years, I witnessed the devastating consequences for those children that child protection services failed. When child protection workers would report risk-assessment results, I was repeatedly astonished by outcomes, which failed to remove from unhealthy home environments. Consequently, I developed an interest in contributing factors in risk- assessment.
To convey the complexity of competing factors that influence risk-assessment outcomes, the following section provides some brief background information about child protection services and additional information around the risk-assessment process.
Canada s Child, Family, and Community Services Act (CFCS) (1996), is the major source of information that guides each province in the development, regulation and implementation of child protection services. Recent amendments to the Canadian Criminal Code (1985), such as the controversial) legal obligation to report suspected child abuse/maltreatment, provide additional legal guidelines. In British Columbia (BC), the Ministry of Child and Family Development (MCFD), is responsible for overseeing the quality and delivery of Child Protection Services. Independent arrangements exist between the MCFD and twenty-four separate Aboriginal child protection Agencies.
National estimates suggest that on any given day, more than 67 000 Canadian children (9.2 children per 1000) will be living in out-of-home care (Garrison, 2004; Gough, 2007; Trocm , Tourigny, MacLaurin, & Fallon, 2003) British Columbia`s contribution to this figure represents 1% of the province`s children, although a disproportionate amount of these children are Aboriginal2. Approximately equal numbers of females (48%) and males (52%) live in care settings with a combined average age of 9.0 years (Child and Youth Officer for British Columbia, 2005; Connolly, 2007; Hardiker, Exton & Barker, 1991).
Risk-assessment and Decision Making
Out-of-home care environments primarily refer to kinship care (family member), foster care, and residential/group care facilities, independent or assisted living facilities, and formal institutionalization (e.g., hospitals or mental health institutions) (Rosen 1999; Trocm et al, 2003; Waechtera et al, 2009). Child in short-term care (awaiting a permanent placement) comprise 40% of this population, and the remaining 60% represents children in long-term care placements (minimum of five uninterrupted years) (Fisher, Burraston, & Pears, 2005; Kelly & Milner, 1996; Solomon, 2002). Research has identified areas of significant concern associated with each of these environments, including but not limited to child maltreatment from caregivers, isolation, inadequate foster parent screening, training, poor parenting skills, negative peer influences, deviant peer clustering, and instability (Garrison, 2004; Okagaki & Luster, 2005; Rosen, 1999; Solomon, 2002).
Risk-assessment refers to the decision making process of child welfare workers investigating the potential dangers associated with a child s primary care environment (Connolly, 2007; Kelly & Milner, 1996). Typically, these assessments are intended to validate allegations of child maltreatment (Gilbert et al., 2009; Wiley, 2009). Despite the high stakes associated with each of these outcomes, there are no mandated procedural standard associated with the assessment process. This assessment is a largely subjective judgement or evaluation of the severity of potential harm to the child (Drury-Hudson, 1999). There are three possible outcomes of a risk assessment corresponding to perceived severity of the risk and age of the child (see Figure 1).
Family Development Response (FDR) is likely when the risk- is considered high, yet manageable through interventions that target adult behaviours. If the risk is moderate or higher (and the child is old enough) Youth Services Response may be considered. When the risk- is immediate, and severs, the only available recourse is to begin a child protection investigation.
Child Protection: Goals
Child protection services are one way that children's rights are enforced and upheld and to the increase the likelihood of the child to develop the characteristics (personality and behavioural) associated with success and wellbeing in adulthood. The intended purpose of child protection is to safeguard children from immediate and future harm. The focus of most protection investigations is on the efforts and ability of caregivers to provide a supportive environment that does not threaten the safety and wellbeing of the child, and promotes cognitive, physical, and emotional developmental process (Waechtera et al., 2009).
Unfortunately, these goals rarely achieved. When compared to non-care population, research investigations consistently describe children in care as more aggressive, antisocial and are more likely to demonstrate pathological and or problem behaviours (Chamberlain, 2003; Simms, Dubowitz, & Szilagyi, 2000; Rosen, 1999). Additionally, children in care are four times as likely (65% of children in care) to be diagnosed with one or more clinical mental health condition (e.g., Oppositional Defiance Disorder, Reactive Attachment Disorder, Attention Deficit/Hyperactivity Disorder, & Post-Traumatic Stress Disorder) (Three, 2001; Provincial Health Officer of BC, 2001; Wiggins, Fenichel, & Mann, 2007). Furthermore, children in care are prescribed more pharmacological treatments (e.g., Ritalin) for longer periods, at higher dosages (Vitally, 2001).
The purpose of this paper is to examine theoretical and empirical support for the practices associated with the risk-assessment process and outcomes. Attachment Theory has been extensively applied within social services practices and research. Direct references to Attachment Theory are found throughout practice guidelines for child protection services.
Attachment Theory has traditionally been regarded as the theoretical bridge between early childhood development research and clinical social work practices (McMillan, 1992). The influence of Attachment Theory within child protection services is pervasive to the point of being indistinguishable (Byrne, 2005; Haight, Kagle, & Black, 2003). According to Attachment Theory, critical, developmental periods in the first years of life where the quality of a child-caregiver attachment relationship is crucial for health development (Bowlby, 1999; Bretherton, 1992). Bowlby believed that the critical function of the parent-child attachment relationship was the formation of an internal working model that formed the basis for lifelong patterns of interpersonal behaviours and shaped all aspects of subsequently formed relationships (Bacon & Richardson, 2001).
Attachment Theory and Child Protection Practices: Summary of Research
It is evident that Attachment Theory has exerted considerable influence upon child protection practices (Axford, Little, Morpeth, & Weyts, 2005; Schore & Schore, 2008). Child protection guidelines frequently and specifically refer to Attachment Theory when describing theoretical support for recommended practices (Bacon & Richardson, 2001; Trevithick, 2000). For example, practitioners guidelines recommend that when child welfare workers respond to allegations of abuse, the risk-assessment should consider the style of the attachment relationship between a child and mother, and balance the consequences of breaking a secure attachment against the consequences of perceived risk- (Harris, 2009; Simms et al., 2000). Consistent with central tenants of Attachment Theory, the importance of familial relationships is emphasized throughout policies and practices, including the screening of adoptive parents (e.g. the recommendation that child welfare workers assess adoptive parent in terms of the attachment potential), child custody determinations, therapeutic support (i.e., Family focused therapy), and risk- assessment (Barth, Crea, John, Thoburn, & Quinton, 2005; Lopex, 1995; McMillen, 1992).
Moderate evidence indicates that under specific conditions, there is empirical evidence to support assessment of attachment relationship (Axford et al., 2005; Byrne, O'Connor, Marvin, & Whelan, 2005). These conditions include risk assessment involving infants and/or children less than two year of age, availability of high quality alternative care environment, use of standardized attachment measures (i.e., Ainsworth s Strange Situation test) and sufficient time available for a minimum of two assessment opportunities (O'Connor & Byrne, 2007).
Unfortunately, there appears to be little research support for the above recommendations in all but the specific conditions described above. Recent research indicates that key elements of Attachment Theory are often misinterpreted by practitioners and inappropriately applied to situations that contradict research recommended parameters (Holland, 2001). No evidence links style of attachment with a course of action in risk- assessment (Barth et al., 2005). Practitioner guidelines seem to overstate the extent of empirical support justifying use of attachment assessment in high stakes decision-making processes (Connolly, 2007; Trevithick, 2000). Additional concerns have been raised around a concerning tendency in the attachment research to draw unsupported conclusions, an erroneous use of correlational research designs (vs. experimental), inappropriate use of assessment methods, discounting environmental confounds, a lack of regard for extra-familial relationships, and a tendency to attribute problems to deficiencies in parenting (Harris, 2009; Solomon, 2002)
Overall, Attachment Theory is consistent with the family focus of child protection practices, however, there is no evidence linking this framework with improved long-term outcomes. Reported benefits and related successes appear to occur almost randomly, and rare, and often are limited to unrealistic example of care environments that in no way represent the much harsher reality. There appears to be a need for practitioner education to improve their understanding and interpretation of Attachment Theory. It appears there is also a need to establish standardized assessment procedures, including the development and introduction of research validated assessment tool.
As it currently exists, the range, severity, and prevalence of developmental problems noted among children in care, the high financial costs to society, the lack of intervention strategies, and the twenty years of negative growth, are undeniable evidence of our dismal failure as a society to protect our most vulnerable members (Chamberlain, 2003; Farruggia, Greenberger, Chen, & Heckhausen, 2006; Okagaki & Luster, 2005; Sims, Dubowitz, Szilagy, 2006).
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