thepresentationpeople.com

1
Child Protection and Social Work What Needs to
Change? Professor David Shemmings
2
the critical aspect of social work practice

• concerns the assessment of risk
• 350 Serious Case Reviews (over 4 years)
• Most cases were too complex for serious injury
  and death to be predictable
• Children who were abused usually become abusers
  (?)
• Analogy with flu

3
new developments in attachment theory offer
another lens
4
Strange Situation
5
strange situation

• Provides information about
• An infant's confidence in the availability and
  responsiveness of a primary caregiver
• The way that caregiver is used as a secure base
  from which to explore and as a haven of safety
• what Howard Steele refers to as our ability to
  know that we are heard, seen, held and
  understood

6
(No Transcript)
7
(No Transcript)
8
Unclassified behaviours Hesse and Main (2000)

• Unclassifiable infants exhibited inexplicable,
  odd, disorganised, disoriented, or overtly
  conflictual behaviours in the parents presence
• For example (dont panic!)
• Moving away from the parent to the wall when
  apparently frightened by the stranger
• Screaming by the door upon separation from the
  parent and then moving silently away upon reunion
• Raising hand to mouth in an apprehensive gesture
  immediately upon seeing the parent
• While in an apparently good mood, swiping at the
  parents face with a trance-like expression

9
Darwins experiment
10
DA - fear without solution

• Bowlby in a letter to his wife, Ursula on 3 May
  1958
• Most people think of fear as running away from
  something. But there is another side to it. We
  run TO someone, usually a person Its
  screamingly obvious, but I believe it to be a new
  idea, and quite revolutionary
• When frightened, animals go to a place whereas
  humans go to people
• Child showing DA is frightened by its haven of
  safety inexplicably afraid and unable to do
  anything about it
• Effect of abuse and neglect on the mind
• unloveable? (chronically unloved)

11
What is known about DA? Hesse and Main (2000)

• About 77 of D children experienced abuse and/or
  neglect
• Cortisol levels of D infants significantly higher
  in Strange Situation procedure
• Meta-analytic review of 13 studies of
  neurologically normal infants
• no relation between difficult temperament, or
  even severe health problems, and DA
• DA observed in low risk groups (c15)- almost
  always connected with the infant being frightened
  by - or of - the parent in very bizarre ways

12
frightening, frightened and anomalous parental
behaviour non-risk groups

• Predatory stalking, creeping silent (cat-like),
  mauling, teeth-baring (remember to an infant
  and not playfully)
• Child pushing toy car
• Mother screams OH NO, theres gonna have an
  accident everyones gonna get KILLED
• Backing away while stammering in an unusual and
  frightening voice
• D-dont follow me, d-dont
• Another parent jerked her head away with an
  extremely fearful grimace, and with her eyes wide
  open, when the infant reached out to pat her face
  in an exploratory manner

13
frightening, frightened and anomalous parental
behaviour non-risk groups

• Changing very quickly into normal voice mode
• Accompanying dissociation
• All of the above parental behaviours were
  strongly associated with unresolved loss in the
  adult and D classified infants/children
• Repeating what we cant remember

14
example of unresolved loss

• Immediately upon being asked about loss, one
  woman responded Yes, there was a little man
  and then began to cry. The person lost was an
  elderly workman who had been employed briefly by
  her parents when she was eight years old.
  Jokingly, he had asked her to marry him when she
  grew up, and she replied No youd be dead.
• killed him with one sentence (unmonitored)
• Own child coded D

15
To recap Hesse and Main (2000)

• DA may appear not only as a result of an infants
  traumatic experience of maltreatment, but also as
  a second generation effect of more subtle
  behaviours resulting from the parents own
  frightened or frightening memories of trauma
• 77/15 (possible overlap)
• Virtually impossible to coach a child
• Risk factor for developing severe psychological
  problems later

16
Assessment of Disorganised Attachment and
Maltreatment (ADAM) Project

• Three London boroughs
• Enfield, Lewisham and Merton
• Exploring how these methods and ideas translate
  into social work practice in child protection
• PhD scholar (Patricia Ruiz de Azua)
• New Book (Jessica Kingsley, Jan 2010)
• New MA in Advanced Social Work with Children and
  Families (2010)

17
The ADAM Project Methods

• Naturally-occurring observable behaviours (all
  ages)
• Troubled reunion behaviour when an abusing
  caregiver leaves the child for a short period and
  then returns (c.12-36 months)
• Story-stem completion tasks and analysis of
  picture response attachment-related drawings
  (c.4-9 years)
• The Child Attachment Interview (c.8-15 years)
• The Adult Attachment Interview (adults and
  caregivers)
• Infants (i.e. below 12 months)
• Assessment of Parental Sensitivity

18
Use of story-stem completion tasks and analysis
of picture response attachment-related drawings
(c.4-9 years)

• Babysitter Stem
• Examples of narratives shown a photo of a
  parent-child separation
• Catastrophic fantasies
• Probably gonna lock himself up (lock himself
  up?) Yeah, probably in his room (then what will
  he do?) Probably kill himself
• Disorganisation in language
• Happy (whats he happy about?) Cos he likes his
  grandfather coming (child jumps on back of
  stuffed animal and hits it) Bad lion! (hits it
  more) Bad lion!

19
evidence base 1Van IJzendoorn et al (1999)

• Meta-analysis of nearly 80 studies involving more
  than 6000 infant-parent pairs.
• Established the reliability, and the discriminant
  and predictive validity, of disorganised
  attachment (DA)
• Although DA is necessarily difficult to observe
  and often subtle, many researchers have managed
  to become reliable coders

20
evidence base 2 - molecular genetics
Bakermans-Kranenburg and Van IJzendoorn (2008)

• (Early G-E interactions - non zero-sum)
• e.g. irritable infants can develop a different
  emotional profile at 9 months and secure
  attachment by 12 months
• Connected to Jay Belskys (2008) notion of
  differential susceptibility within
  gene-environment (G-E) interactions
• Leads to more negative outcomes for susceptible
  children in unfavourable environments
• but also positive outcomes for susceptible
  children in favourable environments
• Serotonin transporter (5-HTT) and oxytocin
  receptor (OXTR) genes explains some of the
  differences in sensitive parenting

21
evidence base 2 - molecular genetics Van
IJzendoorn and Bakermans-Kranenburg (2006)

• Insensitive parenting and unresolved loss or
  trauma are moderated by the dopamine DRD4 gene
  receptor but frightening and anomalous
  parenting isnt
• Again, children are differentially susceptible to
  unresolved loss or trauma dependent on the
  presence of the DRD4 gene
• Increase in externalising behaviours in children
  with the DRD4 gene receptor exposed to
  insensitive care, compared to children without
  combined risks, was sixfold

22
evidence base 3 - connectionsMadigan et al
(2006) mediational pathway (play without toys)
NB - satisfies all four of Baron and Kennys
conditions for mediation
23
Finally, is early intervention effective?Bakerman
s-Kranenburg, M.J., Van IJzendoorn, M.H.,
Juffer, F. (2003)

• Meta-analysis
• 70 studies traced
• 88 intervention effects on sensitivity (n7,636)
  and/or attachment (n1,503).
• Randomized interventions effective in changing
• insensitive parenting (d0.33)
• infant attachment insecurity (d0.20).
• Interventions more effective in enhancing
  parental sensitivity were also more effective in
  enhancing attachment security, which supports the
  notion of a causal role of sensitivity in shaping
  attachment.
• Most effective interventions used moderate number
  of sessions and clear focus in families with (and
  without) multiple problems.

24
Child Protection and Social Work What Needs to
Change?

• Email
• d.shemmings_at_kent.ac.uk
• Website
• http//www.kent.ac.uk/sspssr/staff/academic/shemmi
  ngs.html

25
references

• Bakermans-Kranenburg, M.J., Van IJzendoorn, M.H.,
  Juffer, F. (2003).
• Bakermans-Kranenburg, M.J van IJzendoorn, M.H,
  (2008) Oxytocin receptor (OXTR) and serotonin
  transporter (5-HTT) genes associated with
  observed parenting, Social Cognitive and
  Affective Neuroscience 3(2)128-134
• Belsky, J. (2008). Origins of Attachment
  Security Differential Susceptibility or Genetic
  Vulnerability? Attachment Current Focus and
  Future Directions. ACAMH Occasional Papers
  Series, Number 29. London ACAMH.
• Brandon, M., Belderson, P., Warren, C., Howe, D.,
  Gardner, R., Dodsworth, J. Black, J (2008),
  Analysing child deaths and serious injury through
  abuse and neglect what can we learn? A biennial
  analysis of serious case reviews
  20032005http//www.childdeathreview.org/Reports/
  7444DCSFAnalysingChildDeaths.pdf Research Report
  DCSF-RR023
• Hesse, E. Main, M. (2000) Disorganized infant,
  child and adult attachment Collapse in
  behavioral and attentional strategies. Journal of
  the American Psychoanalytic Association, 48,
  1097-1127.
• Madigan, S., Moran, G. Pederson, D.R. (2006)
  Unresolved states of mind, disorganized
  attachment relationships, and disrupted
  interactions of adolescent mothers and their
  infants Developmental Psychology, 42, 293304.
• Van IJzendoorn, M. H., Schuengel, C. Bakermans-
  Kranenburg, M.J. (1999) Disorganized attachment
  in early childhood Meta-analysis of precursors,
  concomitants and sequelae. Development and
  Psychopathology, 11 225-250.
• Van IJzendoorn. M. H. Bakermans-Kranenburg, M.
  J. (2006). DRD4 7-repeat polymorphism moderates
  the association between maternal unresolved loss
  or trauma and infant disorganization. Attachment
  and Human Development, 8, 291-307.