CASE STUDY

Tailoring or personalising our treatment to suit individual children's needs has always been the National Adoption and Fostering Clinic’s philosophy. But that doesn't mean giving up on evidence based approaches. It just means knowing how to track the modifications you make to ensure it is working.

 We saw an older child in a preadoptive placement, with a complex mix of attachment issues and challenging behaviours most severely seen around separation problems, following on from a history of severe maltreatment and neglect. She didn't fit into any “neat boxes” diagnostically and so neither for an obvious off-the-shelf-treatment. So we made up a new intervention to fit her needs and measured it to see if it worked.

 First we did a live coaching program with the parent (Personalised Intensive Parent Training-PIPT) to help her refine her skills to suit this child's complex needs. For example, with PIPT we gave the mother confidence to set limits on the child's violent behaviour around separation in an attachment friendly way that worked for this child [different children need different attachment friendly styles].

Once those skills were in place, we extended the PIPT program to deal with separations, again using live coaching to keep the interactions sensitive and attuned to the child's needs. Actually, it looked rather like the Ainsworth strange situation, the gold standard way to assess attachment security. We filmed the separations and reviewed them to really understand what was going on.

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  In the graph you can see the first separation was difficult. As usual, we coached mum through it using a tiny, hidden ear piece, from another room. We helped her focus, in the moment, to use the best words to make it successful. It's difficult in the heat of the moment not to get sucked into familiar, unhelpful patterns! The next week the separation was significantly quicker, but in the work we do after the session, reviewing and measuring the video, we identified there were still issues in the interaction. We kept on working for several weeks until the interaction looked stable, after session 4, otherwise there was a possibility that the patterns could have re-emerged once the family went home again.

 Various different measures indicated this intervention worked, but the most important is that a placement on the verge of breakdown stabilised and survived.