Quality statement 1: Comprehensive assessment

Quality statement

Children and young people who may have attachment difficulties, and their parents or carers, have a comprehensive assessment before any intervention programme.

Rationale

A comprehensive assessment can identify environmental, personal and parental factors linked to the development of attachment difficulties. This can help confirm risk or presence of attachment difficulties, guide decisions on appropriate programmes and minimise harm from unnecessary intervention.

Quality measures

Structure

Evidence of local arrangements to undertake comprehensive assessment before any intervention programme for attachment difficulties.

Data source: Local data collection.

Process

Proportion of intervention programmes commencing for attachment difficulties in children and young people that included a comprehensive assessment before the interventions began.

Numerator – the number in the denominator that included a comprehensive assessment before the interventions began.

Denominator – the number of intervention programmes commencing for attachment difficulties in children and young people.

Data source: Local data collection.

Outcome

a) Social and emotional development and behavioural functioning of children at risk of or with confirmed attachment difficulties.

Data source: Local data collection.

b) Sensitivity and responsiveness in parents of children with attachment difficulties on the edge of care.

Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (providers of attachment interventions) ensure that systems are in place so that children and young people who may have attachment difficulties, and their parents or carers have a comprehensive assessment before any intervention programme.

Health and social care practitioners (groups delivering attachment interventions) ensure they undertake comprehensive assessments for children and young people who may have attachment difficulties before any intervention programmes commence.

Commissioners (clinical commissioning groups and local authorities) ensure that services providing intervention programmes for attachment difficulties undertake comprehensive assessments on children and young people who may have attachment difficulties before initiation of a programme.

What the quality statement means for children, young people and their parents and carers

Children and young people who may have attachment difficulties, and their parents and carers, have an assessment of their personal, parental and environmental circumstances before any intervention programme. This will help ensure any future support related to attachment difficulties is appropriate.

Source guidance

Definitions of terms used in this quality statement

Comprehensive assessment

A comprehensive assessment can include assessment of:

  • personal factors, including the child or young person's attachment pattern and relationships

  • factors associated with the child or young person's placement, such as history of placement changes, access to respite and trusted relationships within the care system or school

  • the child or young person's educational experience and attainment

  • parental sensitivity

  • parental factors, including conflict between parents (such as domestic violence and abuse), parental drug and alcohol misuse or mental health problems, and parents' and carers' experiences of maltreatment and trauma in their own childhood

  • the child or young person's experience of maltreatment or trauma

  • the child or young person's physical health

  • coexisting mental health problems and neurodevelopmental conditions commonly associated with attachment difficulties, including antisocial behaviour and conduct disorders, attention deficit hyperactivity disorder, autism, anxiety disorders (especially post-traumatic stress disorder), depression, alcohol misuse and emotional dysregulation.

[Recommendation 1.3.2 in NICE's guideline on children's attachment]

Equality and diversity considerations

All children, young people with attachment difficulties and their parents or carers should have equal access to assessment 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.

All children and young people with attachment difficulties who enter the UK as unaccompanied asylum-seeking children should be assessed once a stable placement has been found.

[NICE's guideline on children's attachment]