BPS Annual Conference 2013
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ATTACHMENT STYLE
ASSESSMENT OF ADOLESCENTS
IN RESIDENTIAL CARE:
Using the Attachment Style
Interview (ASI)
Catherine Jacobs, Professor Antonia Bifulco
Kingston University, London
Background
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
Attachment frameworks are increasingly used to understand
human development in relation to forming close supportive
relationships and understanding risks for psychological
disorder in children looked after by the state.
Residential Care:
 In England, 11% of the 65,520 ‘Looked After’ children or
adolescents were placed in residential care homes or hostels in
2011 (DfE, 2010).
 Pervasive poor outcomes are shown for all ‘Looked After’
children, with half having emotional and behavioural problems at
clinical levels: HIGHEST rates found for those in residential care
(Ford et al., 2007).
 There has been a move in the UK towards smaller units and
fostering rather than residential care as the smaller units better
imitate the dynamics of a ‘family’ and shed the negative
‘institutional’ connotations of larger homes (Cameron & Maggin,
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2008).
Attachment theory
John Bowlby, Mary Ainsworth
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The theory first developed in the 1940s has now become
mainstreamed in research and practice.
It emphasises the importance of early relationships with
parents in healthy child and adolescent development.
Individuals need closeness, support and feelings of security (ie
close attachment) for normal child and adolescent
development. Secure attachment is formed through close
relationships with parents/carers.
Children develop an ‘internal working model’ about
relationships based on earlier experience. This is open to
change in positive conditions.
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What is insecure attachment?
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Attachment styles can be
 Secure: The most well adapted form - flexibility around trust,
autonomy and closeness to others.
 Insecure: Anxious, Avoidant or Disorganised styles
Disorganised
style represents the lack of clear strategy in responding
to attachment stimuli. Also known as Unresolved (Main & Solomon 1986)
or Dual (Crittenden 1988). Linked to dissociated anger (van Ijzendorn
et al 1999, Liotti, 2004).
Often considered the most damaged attachment style
Insecure attachment style affects long term behavioural,
emotional and social outcomes, particularly relationships and
support seeking.
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Comparing rates of insecure attachment style in
residential care (Use of Adult Attachment Interview AAI)
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Residential homes
(Wallis & Steele, 2001)
Schleiffer & Muller, 2004)
School comparison
(Zegers, et al., 2006)
Aims: action research project
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To import standardised attachment measures in the
routine assessment of YP in care.
To assess the attachment style of young people in
residential care, using the Attachment Style
Interview for adolescents (ASI-AD).
To see whether similarity of rates found to those in
the literature.
To look at preliminary findings on change over time.
To engage with practice staff on assessment and
attachment interpretations
of risk & resilience.
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The Attachment Style Interview
(ASI-AD)
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The ASI (Bifulco et al., 2002) is an attachment measure
originating in a social-psychological approach, which
utilises a pragmatic and transparent interview and
scoring method. This is adapted for use in adolescents
The measure identifies
Current relationship with family and social support.
 Degree of attachment insecurity [Mild, Moderate, Marked]
 Attitudes which define interpersonal style whether secure,
anxious or avoidant. When two or more insecure styles are
present (usually anxious + avoidant) this is described as
‘disorganised’.

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Setting – 9 care homes
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Residential care homes in England and the Isle of
Man (www.stchris.org.uk)
All homes delivering a social learning intervention with
praise and rewards for prosocial behaviour and daily
assessment of progress in achieving aims.
 This combined with attachment-related principles involving
stability of placement, relationship to carers and support
enhancement.
 Baseline assessment of attachment style for young people
entering the home and 6 month follow up.
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Summary report produced for staff and feedback summary
for YP.
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Initial findings – risk profile
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58 young people in SCF residential care (more boys – 64%),
aged 11-17, average 64 months in care,
 Majority (74%, according to SDQ youth report) had
psychological disorder at case level including ADHD, conduct
disorder, or emotional disorder. Clinical notes showed substance
abuse & Deliberate Self Harm also common.
 Most (79%) had some contact with mother , fewer (64%) had
contact with father.
 36% had no closeness mother; 46% high antipathy to mother;
 54% no closeness father; 43% high antipathy to father
 71% had no close confidant (family or friends) and very low
ability to relate to others.
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Findings 1 - Attachment styles
(n=58)
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Oskis et al 2011
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Findings 2 - comparing rates of
insecure attachment style
Residential homes
School comparison
Findings 3 - ASI at follow-up
(preliminary findings - 11 interviews)
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
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7-24 months after first interview.
All but 1* exhibited at least one of the following –
 improvement in ability to relate to others and decrease in
degree of insecurity (e.g. marked to moderate)
 change from dual/disorganised to single style,
 decrease in level of anger, mistrust or fear of rejection
*In one case a high number of severe life events appeared to nullify
any positive change.
Only one changed to ‘mildly insecure’ style (within Secure range)
All YP increased their role involvement eg taking up drama or
sport, or improved school attendance, or had more psychological
service support.
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Measuring change – the challenge
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What constitutes sufficient positive change on a
largely categorical measure of style?
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How to monitor style over time - the ASI is intensive
& difficult to apply as constant monitoring tool,
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E.g. Move from disorganised to single insecure style, or
reduction in intensity of negative attitudes and
behaviour or change to secure style?
timing the follow-up is difficult in care since young
people often leave unexpectedly.
Additional approachs needed to monitor change
more frequently and
to apply dimensional score.
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Q Pack assessment
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The Q pack comprises self-report questionnaires
completed by YP and carer (and occasionally
teachers). It includes symptoms (SDQ), life events and
attachment insecurity score.
Vulnerable Attachment Style Q (VASQ) is a selfreport questionnaire of insecure attachment attitudes
validated against the ASI (Bifulco et al 2003).
Provides total score as well as insecurity-mistrust and
anxious attachment score using cut-offs. Mixed is a
combination of highly anxious and mistrustful-insecure.
 Results on first 11show reduction in mixed styles &
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increase in ‘normal’ levels of security.
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A case for good assessment
in practice
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Attachment interviews and models can be helpful for
practitioners to recognise & understand vulnerability in
children and families.
Attachment vulnerability needs operationalising in social care
and clinical practice to help practitioners undertake meaningful
assessments to inform direct care planning.
Reliable & user-friendly assessments across sites are needed
for consistency of practice.
Understanding the potential for attachment change and better
outcomes needed in assessment and care planning.
Consistent measures and models should ideally be used across
agencies (eg social and psychological services).
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Conclusion
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
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The ASI-AD showed similar rates of insecure/disorganised
attachment style in residential care as other research.
High rates of dual/disorganised style & avoidant shown.
Preliminary results suggest some reduction in attachment
insecurity in relation to stable placement & social learning
intervention. This aided by use of self-report tools.
ASI-AD generated useful information on the young
person’s, social support and family relationships, negative
attachment attitudes as well as overall attachment
categorisation for direct work.
Communicating the ASI data to professionals working with
the young people, enables a greater understanding of an
attachment perspective useful for managing their care.
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Mainstreaming the ASI
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(i)
(ii)
(iii)
Practitioners in residential care at SCF are being
trained to deliver the interview assessment on entry
of young person to the home.
Regular use of a self-report questionnaire pack
including the VASQ, symptom scales (SDQ) and life
events, is being implemented to monitor change more
swiftly at follow-up on a 3-6 monthly basis.
Regular briefing sessions are held with staff about
attachment interpretations of young people’s
behaviour and to influence direct work around
relationships.
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THANK YOU FOR YOUR
ATTENTION
Catherine.p.jacobs@btinternet.com
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