Scottish Attachment In Action’s first annual conference took place in September 2010 and over 200 delegates attended. Four leading figures in attachment theory, research and practice (Dan Hughes, Phil Wilson, Alan Sinclair and Sally Wassell) presented overwhelming evidence about the central importance of understanding attachment and early intervention in best political and social care practice.

Residential child care, Scottish attachment, personal reflections.

Edwina Grant, Independent psychotherapist.

In healthy families a baby forms a secure attachment with her parents as naturally as she breathes, eats, smiles and cries – this occurs easily because her parents are attuned to her needs: they ‘dance’ with her. There are other families where the baby neither dances nor even hears the music. In these families she does not form a secure attachment. Rather her task – her continuous ordeal is to learn to live with parents who are little more than strangers. Babies who live with strangers do not live or grow well; (Hughes, 2006). Scottish Attachment In Action’s first annual conference took place in September 2010 and over 200 delegates attended. Four leading figures in attachment theory, research and practice (Dan Hughes, Phil Wilson, Alan Sinclair and Sally Wassell) presented overwhelming evidence about the central importance of understanding attachment and early intervention in best political and social care practice. As members of the Executive Committee, we were justifiably proud of the work our organisation had done to get to this point – a national conference and a spreading network of professional connections across Scotland. We felt we were becoming a growing influence on social and economic policy. What is emblazoned on our brains, however, is the fact that although the UK (alongside the USA) is leading the field in research on attachment and early intervention, we occupy the bottom average ranking (yes bottom!) of 18 countries in the Organisation for Economic Co-operation and Development (OECD) with respect to measures of children’s well-being. These measures include material well-being, health and safety, educational well-being, families and peer relationships, behaviours and risks, and subjective well-being. In Scotland we currently invest far more resources in further education than we do in early years intervention. As a Dutch colleague commented recently – ‘we (in Holland) love our children, you (in Britain) just tolerate them’.

Just so we know what we are talking about, attachment theory is a theory of personality development in the context of close relationships. The process of attachment between a baby and its primary caregiver (usually, but not necessarily, the mother) occurs over the first two to three years of life. We know that the nature of the enduring bond between a baby and her caregiver greatly influences all aspects of development of the child into adulthood. Neurological, physical, emotional, social, relational, cognitive and moral development are nurtured when a baby’s needs have been met in a sensitive, loving and timely way by at least one parent/caregiver. The child is set on a positive developmental pathway. Children who were securely attached as babies have a sense of trust and confidence in themselves. Securely attached children do better at school. They are likely to be good at making friends. Their early attachment helps them to form close relationships later in life.

Attachment is a fundamental building block of human relationships across the lifespan. We know that severe problems in parent-infant or parent-child interaction are now recognised to be a contributing factor to many serious social problems including mental health, violence, difficulties in school and future parenting. In the last 20 years, there has been an explosion of new scientific evidence especially from neuroscience that supports attachment theory. It has been described as ‘the leading edge of a revolution that promises to change the way we think about ourselves, our relationships, our children and our society’ (Hughes, 2006, p.3).

Back to the story of Scottish Attachment In Action (SAIA). SAIA was born, on May 22nd 2006, and is a unique group with a common understanding that an understanding of attachment has to be at the very top of society’s agenda for the care and well-being of children. How did we both end up on the executive committee of SAIA? 

As chair of SAIA, my own involvement in this agenda goes back to 2003. Over the 30 years of my professional life I have worked in many different roles (psychologist, social groupworker, residential social worker and manager, therapist among others) with children and young people who have been abused, neglected and traumatised in their birth families and in their communities. Often these children are looked after and accommodated either in residential care or in foster or adoptive care. I remain in touch with some of the ‘children’ I have worked with – now in their 30s and early 40s! I know that with good and sustained personal and professional support they have made it to adulthood, and if not fully recovered from the trauma of their early years, are on the road to recovery. They are leading ordinary lives and not repeating the patterns of their own distressing childhoods with their children. Sadly, however, I also know of many who are dead, through suicide or drug and alcohol abuse, in prison for violent offences, or who suffer debilitating mental health issues.

Until 2003, I was puzzled by why some children who had suffered early years trauma were able to be reached emotionally. From considering themselves to be unlikeable and unlovable, being full of rage and shame, they were able to accept that what had happened to them was not their fault. With support, they were able to turn their lives around. Others, no matter how much support and love was afforded them, could not accept that they were likeable, let alone lovable.

In 2003, I undertook training in Dyadic Developmental Psychotherapy (DDP) with an American clinical psychologist called Dan Hughes. Dan has integrated recent research in the areas of neurobiology of trauma, early child development and attachment theory to produce a therapeutic approach that assists professionals to understand and support effectively the healing of vulnerable children and young people. DDP recognises the vital role which adoptive parents, foster carers and residential practitioners play as primary attachment figures in the recovery of traumatised, attachment-resistant children.

These were ‘light bulb’ moments – now I knew not only how to understand but also how to assist those children so traumatised in early years that the only life path they could tread was violence or depression. I was completely convinced that attachment was the key to understanding and improving the lives of all children and families. I was a bit ‘slow off the mark’ here as John Bowlby (1965) knew this 50 years ago, and researchers/practitioners such as Mary Ainsworth (1978) and Mary Dozier (2006) have produced ample evidence! We also have home-grown research and expertise – such as that of Colwyn Trevarthen (Professor Emeritus, Edinburgh University) and Dr Helen Minnis (Senior Lecturer, Glasgow University) both of whom are committee members of SAIA.

In 2004, supported by, and in partnership with Ballikinrain (Crossreach Children’s Services) and Aberlour (National Parenting Development Project) I invited Dan Hughes to Scotland to start to train professionals and adoptive and foster carers in DDP and in attachment focused parenting. Dan’s input in Scotland has inspired not only much-needed specialised therapeutic work but also attachment-focused in-service training for teachers, training and support for residential staff, foster and adoptive carers, and also research.

In May 2006, on the back of such successful training, Ballikinrain, Aberlour and I invited 24 key ‘well-kenned’ and well respected professionals to an Attachment Seminar: a scoping day about the future direction in Scotland of direct practice and training on attachment.

I have worked for 27 years as a psychologist in a local authority context, and have had direct involvement with countless numbers of children whose early lives have been characterised by traumatic change and disruption. Throughout my working life I have been committed to collaborative working and have focused on how social and psychological theory can ensure common scripts across professionals, and can build confidence and capacity in the key people who are working with children and families.

It was in March 2006 that I received an email from Edwina, about a national scoping day relating to attachment. Edwina was a psychologist colleague and I had shared my belief with her that a clearer and more practical understanding of attachment theory across professionals working with vulnerable young people had the potential to lead to more positive outcomes for children and families. We had shared common experiences of working in a multi-disciplinary planning context for vulnerable children and young people, where there was passion and commitment in the professionals to make a positive difference, but where the evidence base for assessment approaches and interventions was far from rigorous. There was often no common understanding of attachment theory and the practical implications of attachment difficulties in children’s lives. Professionals, and that included me, needed to better consider and explore how attachment theory could influence and support more informed intervention strategies. We both agreed that we came across some professionals for whom attachment theory was rarely ‘on their radar’ and other professionals who had an awareness that attachment theory was important to consider when assessing a child and young person, but vagueness persisted when it came to working out how to address the difficulties once assessed. We also shared a concern at how many early intervention programmes seemed uninformed by attachment theory. Edwina’s email asking me if I was interested in a scoping day on the usefulness of attachment theory in informing how we support vulnerable children and families, therefore met with delight on my part! I printed off the email and still have that in my SAIA folder – in capital letters handwritten across the top is ‘MUST ATTEND’.

As Principal psychologist in South Lanarkshire Council, I have worked to raise awareness of attachment theory within our department of Education Resources and across the authority. The real impetus to have attachment on the agenda within the authority, however, came with the appointment of a new psychologist to the team. This psychologist was fully cognisant with current research and evidence-based practice around attachment and was passionate and knowledgeable about how understanding a child’s attachment can make a difference to how children are supported. The service produced a booklet on attachment called Attachment Psychology: a child development perspective (2009), and this is now on the SIRCC website. There has also been awareness training offered to all schools in South Lanarkshire Council and a more focused training for specific groups, like behaviour support teachers. Psychological Services in South Lanarkshire Council have very close working relationships with our social work colleagues and our Integrated Children’s Services colleagues and along with the NHS Lanarkshire ‘CAMHS for Accommodated Young People’ team, we are constantly looking for ways to build capacity, and improve practice with regard to attachment.

The 24 professionals who attended were all experienced in developing both understanding and therapeutic practice in attachment. They came from social work, residential care, fostering and adoption, research, health, psychiatry, psychology, education and therapeutic services. The purpose of the day was to discuss and explore ways of maintaining and developing effective practice across Scotland in work with children and young people who suffer from the multiple and complex effects of chronic abuse and neglect.

As a group we knew that effective practice across Scotland demanded a more strategic approach to training, resourcing and researching our work with children and families in this arena. This was no longer only about DDP but about sharing and pooling knowledge, resources and skills across the whole field of attachment.

The atmosphere in the room on that day in May 2006 was inspiring – there was no professional ‘preciousness’ or ‘hidden agendas’. This ethos of generosity, cooperation and sharing – of self, of ideas and of resources – continues to be embedded in SAIA. All were (and continue to be) committed to promoting a robust universal way of understanding all aspects of human development – social, emotional, neurological, cognitive and physiological. We were all convinced – and research supports – that promoting better experiences of attachment in the Scottish population was the key to improving Scotland’s current record on poor health and socially destructive behaviours (Lewis et al., 2001; UNICEF, 2007). We needed to push for positive changes in social policy, education and mental health with the underlying knowledge that the first two to three years of a child’s life (from conception to three) are critical in laying the foundations for a life of ‘being all one can be’.

These were our hopes on the day:

• An exponential shift concerning the use of attachment research and theory – that is, for all professionals who work with children and families to be ‘singing from the same song sheet’ and for that song sheet to be attachment. By all professionals we meant all – social work, health, education, therapists, police, legal services and children’s hearing members;

• Consistent information, support and advice offered to all parents on attunement and attachment;

• Attachment raining to become a core component in professional courses for those working with children and families, thus creating a common value base, common multi-disciplinary knowledge and understanding, common skills, and a shared language – and for attachment training to continue during the professional life;

• More robust assessment of attachment;

• The development and promotion of early interventions that work, by professionals and researchers, in partnership with parents/carers;

• Influence policy and interventions concerning mental health and emotional/behavioural difficulties;

• Intergrating attachment in practice into the inspection frameworks;

• Addressing the issues of under-resourcing, particularly in early years;

• Improved therapeutic services and post-adoption services for abused children;

• Improved services for drug abusers;

• Continuity for children and families;

• Development of attachment centres (multi-disciplinary) – inclusive in ethos.

An action plan was created including the most simple acts – ‘All those attending today’s seminar talk about attachment everywhere!’ – to the more complex – producing a strategic paper and targeting key people in the Scottish Government, organising national events, finding funding, improved co-ordination of existing knowledge and resources on attachment. Since 2006 we have – individually and as a group – been busy! We currently have a committee of 20 professionals representing health, social work, education, psychology, police, adoption and fostering, therapeutic services, statutory and voluntary sector. The hopes we had in 2006 remain our aims. A writing group produced our policy paper – currently being re-drafted in line with the Scottish Government’s National Performance Framework (2010). We contributed to the government’s GIRFEC consultation with our views on an attachment service in Scotland and we connected with ATTACh in the USA (www.attach.org). We also contributed to the Scottish Government’s infant mental health policy (Puckering, 2007).

The current development business of SAIA includes:

• Involvement in the government’s consultation on Developing the Common Workforce, with its focus on developing a coherent, collaborative and aspirational approach to developing the Children’s Workforce;

• SAIA has presented to the HMIe Additional Support Needs and Alternative Provision group who have expressed interest in good practice in addressing attachment issues. HMIe are keen to know how they can contribute to raising awareness;

• SAIA has been invited to speak to a group of educational psychologists who provide a service to LAAC, about ‘Why and how attachment matters’.

Until 2009, SAIA remained as an interest group. There was no money and no infrastructure –just the continuing passion of the committee members. On September 11th 2009 we launched, at the Marriott Hotel in Glasgow, as a constituted group with our seminar on ‘Why Attachment Matters’. This phrase remains SAIA’s mantra. The conference was attended by 300 delegates. The speakers (Dan Hughes, Colwyn Trevarthen, Helen Minnis and Joe Nee) gave their time for free – as all the committee members continue to do: we had no money to pay them! The Scottish Institute of Residential Child Care hosted the seminar, providing the organisation of the event for minimum cost and generously giving the profit to SAIA. The organisation had money – not a lot, but sufficient to employ a much-needed administrator and to purchase basic equipment and resources. Several organisations and individuals have been generous with their support and time, assisting with SAIA’s development: Ballikinrain Crossreach – one of our original sponsors – with administrative presence and support at events; the Institute for Research and Innovation in Social Services (IRISS) who are helping us with the setting up of SAIA’ s website (www.saia.org.uk) and audio pod-casting events; Adoption UK who hosted our conference this year and who are providing an office base for our administrator; and finally the Notre Dame Child and Family Centre and SIRCC for providing a meeting place for the committee. From 2009 to 2010 SAIA had 80 individual memberships and 3 organisational members. As well as an annual conference SAIA holds two network seminars a year with input on ‘Why Attachment Matters’ from leading professionals and we also produce a bi-annual newsletter.

We continue to be a multi-professional group committed to promoting better experiences of attachment in the Scottish population and effecting positive changes in social policy, education and mental health. Our objectives are stated in our policy document as:

• Promote positive experiences of attachment in Scotland;

• Advocate for attachment theory and practice to be a fundamental element of the education of all professionals;

• Develop training opportunities on attachment;

• Advance effective attachment-informed practice;

• Develop, promote and disseminate research into attachment

All this we continue to do. We are, however, aware that we need to spread our geographical wings and network beyond the central belt. SAIA remains hopeful for the future. Despite the economic recession there is a growing political recognition, and will, to resource early intervention and secure attachment processes. This has to be at the core of getting it right for every child and will lead to a healthier Scottish population. Attachment matters because we all need to learn how to: Love your child by learning the song that is in her heart and singing it to her when she forgets it; (anon).

Ainsworth, M.S. & Bowlby, J. (1965). Child care and the growth of love. London: Penguin. Ainsworth, M.S., Blehar, M.C., Waters, E. & Wall, S. (1978). Patterns of attachment. Hillsdale, NJ: Erlbaum. Dozier, M. Peloso, E., Lindhiem, O., Gordon, K.M., Manni, M., Sepulveda, S., Ackerman, J., Bernier. A. & Levine. S. (2006). Developing evidence-based interventions for foster children: An example of a randomized clinical trial with infants and toddlers. Journal of Social Issues, 62(4), 767-785.

Hughes, D.A. (2006). Building the bonds of attachment: Awakening love in deeply troubled children. New York: Jason Aronson.

Lewis, T., Amini, F. & Lannon, R. (2001). A general theory of love. London: Vintage.

Puckering, C. (2007). Infant mental health: A guide for practitioners. Edinburgh: Heads Up Scotland. Accessed on 15th January 2011 at http://www. wimhp.co.uk/Documents/Reports/Infant%20Mental%20Health.pdf

Scottish Government (2010). National Performance Framework. Accessed on 10th January 2011 at http://www.scotland.gov.uk/About/scotPerforms

South Lanarkshire Council (2009). Attachment Psychology: A Child Development Perspective. South Lanarkshire: The Psychological Services.

UNICEF (2007). Child poverty in perspective: An overview of child well-being in rich countries. Report Card 7. Florence: UNICEF Innocenti Research Centre.