Our Model of Care
Clover Care Services understand that children’s early life experiences and exposure to trauma shape their internal working model and type of attachment, thus impacting on the child’s development.
Children and young people in the care of Clover Care Services, will receive care that is focussed on the individual requirements of each young person. Each centre provides a secure base through the relationships with staff who are sensitive and responsive attachment figures and trauma informed.
Trauma is a prevalent problem for children entering the care system. It results from exposure to a series of events that are emotionally disturbing or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, and/or spiritual well-being.
Experiences that may be traumatic include:
• Physical, sexual, and emotional abuse
• Childhood neglect
• Living with a family member with mental health or substance use disorders
• Sudden, unexplained separation from a loved one
• Poverty
• Racism, discrimination, and oppression
• Violence in the community, war, or terrorism
Although trauma can occur at any age, it has particularly debilitating long-term effects on children’s developing brains. Often referred to as adverse childhood experiences (ACEs), exposure to these experiences is common across all sectors of society.
People affected by trauma may develop coping mechanisms to help alleviate the emotional and/or physical pain they feel because of trauma. Sometimes, these strategies involve maladaptive behaviours — such as unhealthy eating, tobacco use, or drug and alcohol use. These coping mechanisms may provide some relief, but they can also simultaneously contribute to anxiety, social isolation, and chronic diseases.
Regardless of the type of trauma a person has experienced, traumatic experiences impact relationships. This includes, but is not limited to, relationships between people, communities, and the delivery systems that support individuals’ health and social needs. When a person experiences trauma, he or she may feel unsafe, betrayed, and/or have difficulty trusting others. This can lead to heightened emotions, such as anger or aggression, or a tendency toward shame, numbing, and/or isolation. Within the context of residential care, this can negatively impact the bond between the young person and their care providers, and thus a young person’s engagement in their placement .
Clover Care Services recognise that a secure base helps children and young people to:
• Trust
• Develop social emotions
• Think logically
• Develop their conscience
• Cope better with feelings of stress and anxiety
• Overcome their fears and worries.
This secure base supports secure attachments in children and young people and helps them to:
• Make sense of the world around them
• Self-regulate their behaviour
• Become self-reliant which increases feelings of self-worth and supports them to reach their full potential.
Young People who are placed in the care of Tusla present with different types of attachment styles and although we cannot diagnose our young people, we can assess. Young People struggle to form secure attachments and have often formed coping strategies that have helped them to cope in the past.
Clover Care Services’s model of care aims to support the young people in forming positive relationships through the application of attachment theories.
Purpose
The purpose of this policy is to:
Outline the Model of Care that Clover Care Services implements throughout the organisation by Social Care Workers and Management.
Attachment Theory
John Bowlby was the first attachment theorist to describe an attachment as a, ‘lasting psychological connectedness between human beings’.
Bowlby was interested in understanding the separation anxiety and distress that children experience when separated from their primary caregivers. Bowlby found that attachment was characterised by clear behavioural and motivation patterns. When children are frightened, they will seek proximity from their primary caregivers in order to receive both comfort and care.
An attachment is an emotional bond with another person. John Bowlby believed that the earliest bonds formed by children with their caregivers have a tremendous impact that continues throughout Life.
The central theme of attachment theory is that primary caregivers who are available and responsive to an infant’s needs allow the child to develop a sense of security.
Mary Ainsworth in the 1970s expanded considerably on John Bowlby’s work on attachment theories. Ainsworth described three major styles of attachment;
1. Secure attachment
2. Ambivalent – insecure attachment
3. Avoidant-insecure attachment
Later a fourth attachment style called Disorganised insecure attachment was later developed back on research by Main and Solomon 1986.
Stages of Attachment
- Pre-attachment stage: From birth to three months, infants do not show any particular attachment to a specific caregiver. The infant’s signals, such as crying and fussing, naturally attract the attention of the caregiver and the baby’s positive responses encourage the caregiver to remain close.
- Indiscriminate attachment: From around six weeks of age to seven months, infants begin to show preferences for primary and secondary caregivers. During this phase, infants begin to develop a feeling of trust that the caregiver will respond to their needs. While they will still accept care from other people, they become better at distinguishing between familiar and unfamiliar people as they approach seven months of age. They also respond more positively to the primary caregiver.
- Discriminate attachment: At this point, from about seven to eleven months of age, infants show a strong attachment and preference for one specific individual. They will protest when separated from the primary attachment figure and begin to display anxiety around strangers.
- Multiple attachments: After approximately nine months of age, children begin to form strong emotional bonds with other caregivers beyond the primary attachment figure. This often includes the father, older siblings, and grandparents.
Factors That Influence Attachment
In Clover Care Services we acknowledge that there are some factors that can influence how and when attachments develop for the young people in our care, including:
- The opportunity for attachment: Children that do not have a primary care figure, such as those raised in orphanages, may fail to develop the sense of trust needed to form an attachment.
- Quality caregiving: When caregivers respond quickly and consistently, children learn that they can depend on the people who are responsible for their care, which is the essential foundation for attachment. This is a vital factor.
Types of Attachment
There are four patterns of attachment that frame Clover Care Services’ model of care:
1. Secure attachment: Secure attachment is marked by distress when separated from caregivers and joy when the caregiver returns. Remember, these children feel secure and able to depend on their adult caregivers. When the adult leaves, the child may be upset but he or she feels assured that the parent or caregiver will return. When frightened, securely attached children will seek comfort from caregivers. These children know their parent or caregiver will provide comfort and reassurance, so they are comfortable seeking them out in times of need. Secure attachments support mental processes that enables the child to:
a. Regulate their emotions
b. Reduce fear
c. Attune to others
d. Have Self-understanding and insight.
e. Empathy for others
f. Appropriate moral reasoning.
2. Ambivalent attachment: Ambivalently attached children usually become very distressed when a parent leaves. Ambivalent attachment may be a result of poor parental availability. These children cannot depend on their parents (or caregiver) to be there when the child is in need. The young peoples’ parents or caregivers may be presenting with depression or mental health issues. Ambivalent Children;
a. Have a tendency to give and receive mixed emotional message.
b. Tend to be highly vulnerable to distress but cannot come up with solutions to manage it.
c. In a constant state of overwhelm.
d. Hopes for closeness from others but fear the loss at the same time.
3. Avoidant attachment: Children with an avoidant attachment tend to avoid parents or caregivers. Children have experienced insensitive, intrusive or rejecting care giving. When offered a choice, these children will show no preference between a caregiver and a complete stranger. Research has suggested that this attachment style might be a result of abusive or neglectful caregivers. Children who are punished for relying on a caregiver will learn to avoid seeking help in the future. Children seek to meet their needs on their own as they have not been able to trust or rely on their caregiver. Children with an avoidant attachment;
a. Are task orientated, self – reliant and high achieving in some aspects but are or can be socially uncomfortable
b. Find it difficult to seek help
c. Prone to sudden outbursts
4. Disorganised attachment: arises when a parent or caregiver is abusive, either emotionally or physically. The parent’s behaviour is unpredictable; therefore, no organised strategy allows the child to feel safe and get their needs met without fright or terror. Children may both avoid or resist the parent. The lack of a clear attachment pattern is likely linked to inconsistent behaviour from caregivers. In such cases, parents may serve as both a source of comfort and a source of fear, leading to disorganized behaviour. Children with a disorganized attachment often display.
a. A confusing mix of behaviour
b. May seem disoriented, dazed, or confused known as Disassociation
c. Poor Social and emotional regulation skills
d. Find it difficult to form or sustain relationships
e. Difficulty managing stress
f. Demonstrate hostile or aggressive behaviours
Clover Care Services helps our young people to strengthen their attachments in the following ways;
• Focusing on building the here and now with them.
• Being able to connect with them on an emotional level.
• Maintain predictability by ensuring implementation of routines, structures and natural consequences.
• Establishing safety and security for the young people.
• Biological: Food, Accommodation, daily programmes and medication.
• Emotional: Acceptance and validation and opportunity to share experiences and relate.
• Surroundings: Safe place, meaningful things to do and people to be with.
• Thinking Style: Allow the young people to learn, practice new coping skills, and adaptive techniques/ strategies. The development of new techniques and coping skills is reinforced by the application of Therapeutic Crisis Intervention.
Contemporary Ireland has brought with it a greatly increased awareness about the impact of trauma on children, which has, in turn, led to a focus on the treatment of trauma-related conditions. Arising from the research and clinical literature is the suggestion that much of the healing from trauma can take place in non-clinical settings. Greenwald (2005), for example, observes that “Parents, counsellors, teachers, coaches, direct care workers, case managers, and others are all in a position to help a child heal” (p. 37). There is some evidence to suggest that trauma-informed living environments in which healing and growth can take place are a critical ingredient in therapeutic transformation.
A trauma-informed approach incorporates three key elements:
• Realising the prevalence of trauma;
• Recognising how trauma affects individuals residing in the service, including the workforce;
• Responding by putting this knowledge into practice.
As part of our Model of Care training Clover Care Services will train staff members to use the five guiding principles below so that any and every interaction is mindful and aware.
• Safety
• Trustworthiness
• Choice
• Collaboration
• Empowerment
Underpinned by Howard Bath’s 3 Pillars of Trauma informed care, these principles ensure an individual’s emotional and physical safety.
Guiding Principles
As part of our Model of Care training Clover Care Services will train staff members to use the five guiding principles below so that any and every interaction is mindful and aware.
Safety
Trustworthiness
Choice
Collaboration
Empowerment
Underpinned by Howard Bath’s 3 Pillars of Trauma informed care, these principles ensure an individual’s emotional and physical safety.
Safety
When working with young people who may have experienced any level of trauma, assurance of their emotional and physical safety is first and foremost. Major developmental theorists such as Abraham Maslow, Erik Erikson, and John Bowlby saw safety as a core developmental need of infants. Maslow numbered it among the primary survival needs while Erikson understood that the first “psychosocial” crisis for any infant is the establishment of trust (which is based on a sense of being safe). The brain-based stress response systems of these children appear to become permanently changed as they focus attention on the need to ensure safety rather than on the many growth- promoting interests and activities that secure children find attractive and stimulating. Bruce Perry (2006) observed that “Traumatised children reset their normal level of arousal. Even when no external threats exist, they are in a constant state of alarm” (p. 32). In particular, such children come to view adults as potential sources of threat rather than sources of comfort and support. In care settings such children are often described as hypervigilant because they constantly scan the environment for potential sources of danger and they can go into fight, flight or freeze mode.
Trustworthiness
Care providers must show young people that they are trustworthy enough for young people to feel safe enough to open up and become vulnerable. Consistent boundaries and clear expectations of the service can show that they are worthy of trust and young people can depend on consistent approaches and unconditional positive regard.
Choice
By the time a young person finds themselves in the centre, they might have spent a significant period of their lives feeling out of control. Trauma-informed care can empower young people with making active choices within their placement plan and their daily lives. Often young people who do not have secure attachment need to feel in control in order to feel safe and Clover Care Services provide opportunities for young people to be central in all aspects of their care and empower them wherever possible to make choices and gain some control in their life.
Collaboration
Trauma-informed care is genuinely a collaboration between the organisation, staff, young people and the wider multidisciplinary team. It is not a strict protocol with defined rules but relies more on empathy, flexibility, safeguarding and natural consequences. Collaboration looks different for each young person because each has different experiences and individual needs.
Empowerment
This approach to care provision empowers young people to discover and build on existing strengths. They develop healthier coping skills and, ultimately, a more solid foundation that they can fall back on when needed in the future. Trauma-informed care promotes resilience and provides the hope that successful outcomes are possible for the future lives of young people.
Clover Care Services believe that our culture reflects what we consider to be essential. We dedicate ourselves to the principles of trauma-informed care and continuously work to be more inclusive and empathic in any way that we can.