Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in the recommendations section.

Principles of care in all contexts

  • Ensure that all children, young people and their parents or carers get equal access to interventions for attachment difficulties regardless of whether they:

    • are on the edge of care, accommodated under Section 20 of the Children Act 1989, subject to a care order, under special guardianship or adopted from care

    • are placed with birth parents, foster carers (including kinship carers), special guardians or in residential care

    • are from a minority ethnic group

    • have a disability or a mental health problem

    • are from the UK or overseas.

  • Ensure that the health, education and social care processes and structures surrounding children and young people with attachment difficulties are stable and consistent. This should include:

    • using a case management system to coordinate care and treatment

    • collaborative decision making among all health, education and social care professionals, the child or young person if possible and their parents and carers

    • having the same key worker, social worker or personal adviser or key person in school throughout the period the child or young person is in the care system or on the edge of care.

Supporting children with attachment difficulties in schools

  • Schools and other education providers should ensure that all staff who may come into contact with children and young people with attachment difficulties receive appropriate training on attachment difficulties, as set out in recommendation 1.2.2.

Assessing attachment difficulties in children and young people in all health and social care settings

  • Health and social care provider organisations should train key workers, social care workers, personal advisers and post‑adoption support social workers in the care system, as well as workers involved with children and young people on the edge of care, in:

    • recognising and assessing attachment difficulties and parenting quality, including parental sensitivity

    • recognising and assessing multiple socioeconomic factors (for example, low income, single or teenage parents) that together are associated with an increased risk of attachment difficulties

    • recognising and assessing other difficulties, including coexisting mental health problems and the consequences of maltreatment, including trauma

    • knowing when and how to refer for evidence‑based interventions for attachment difficulties (see sections 1.4, 1.5 and 1.6).

Interventions for children and young people on the edge of care

  • Health and social care professionals should offer a video feedback programme to the parents of preschool‑age children on the edge of care to help them:

    • improve how they nurture their child, including when the child is distressed

    • improve their understanding of what their child's behaviour means

    • respond positively to cues and expressions of the child's feelings

    • behave in ways that are not frightening to the child

    • improve mastery of their own feelings when nurturing the child.

Interventions for attachment difficulties in children and young people in the care system, subject to special guardianship orders and adopted from care

Preschool‑age children

  • Health and social care professionals should offer a video feedback programme to foster carers, special guardians and adoptive parents, as described in recommendation 1.4.2.

Primary school‑age children

  • Consider intensive training and support for foster carers, special guardians and adoptive parents (see recommendations 1.5.5 and 1.5.6 before the placement and for 9–12 months after, combined with group therapeutic play sessions for the child for the same duration (see recommendation 1.5.7).

Late primary and secondary school‑age children

  • Consider a group‑based training and education programme for foster carers, special guardians and adoptive parents to maintain stability in the home and help transition to a new school environment (see recommendation 1.5.9), combined with a group‑based training and education programme for late primary and early secondary school‑age children and young people in the care system, subject to special guardianship orders and adopted from care to improve social skills and maintain positive peer relationships (see recommendation 1.5.10).

  • Modify interventions for young people in the care system, subject to special guardianship orders and adopted from care when needed to allow for:

    • physical and sexual development

    • transition to adolescence

    • re-awakening of emotions about their birth parents or original family.

Take into account that these factors can complicate therapeutic interventions and relationships with foster carers, special guardians and adoptive parents. Discuss making contact with their birth parents or original family sensitively.

  • National Institute for Health and Care Excellence (NICE)