Scottish Government

Growing Support

2. Holistic frameworks

The theoretical models that underpin services for families with young children can take many forms. Given that legislation requires the child's welfare to be the paramount consideration, we outline here four primary frameworks that place children's development at the centre, though in different ways. These are:

• cumulative factors approaches;
• attachment theory;
• ecological models; and
• social construction approaches.

This is not intended to be an exhaustive account of relevant approaches. For example, attention to the gendered nature of family relations, child care and employment is also essential to a full understanding of the nature and impact of services. Conventional medical models of prevention are also relevant. Hardiker et al (1996) applied this framework to child protection and elaborated the usual three-fold levels by adding a quaternary level:

• Primary prevention - taking universal action to promote conditions so that problems do not arise;
• Secondary prevention - focusing on individuals or families who are at high risk, but may not yet have problems;
• Tertiary prevention - targeting individuals or families who have problems to minimise the adverse effects; and
• Quaternary prevention - optimising the prospects for children where family problems have resulted in their placement in substitute care.

Cumulative factors

This is an important orientation in the literature, which is often implicit rather than formulated into a coherent theory. The assumption is that children's lives and life chances are affected by various discrete factors which reinforce or offset each other. Hence interventions should seek to minimise children's exposure to negative factors or aim to overcome their consequences.

There is a wealth of mainly medical and psychological literature, based largely on quantitative surveys, which identify characteristics of children, their families or their environments which affect the chances of children achieving favourable or unfavourable outcomes. Risk factors are those characteristics that are statistically associated with poorer outcomes, while protective factors help shield children from difficulties. Resilience factors are those that appear to enable children to do well even though they have experienced adversity in early life (Rutter 1985). Sophisticated statistical analysis is possible, but in broad terms the assumption is that it is the balance in number and intensity of risk and preventive or resilience factors that largely determine outcomes (See section 3 for further discussion of the meaning of outcomes).

Among the risk factors that have been shown to be associated with higher proportions of health, behavioural or educational difficulties in children are: parents' physical or mental illness, parental substance or alcohol misuse, marital breakdown, lone parenthood and economic disadvantage (Rutter 1995; Rutter and Smith 1995; Steinhauer 1996). This does not mean that all children in such circumstances turn out poorly, but the chances of doing so are higher than average, sometimes markedly so. Rutter (1995) emphasises that the impact of risk factors depends on their interaction with protective and resilience factors in the individual and the environment. Even so, the methods used to identify so-called vulnerable populations have been criticised for producing inaccurate or misleading results, since vulnerability results from individual clusters of reasons (Upshur 1990).

The initial risks to very young children are biological and environmental, but the quality of their family environment becomes increasingly important (Rutter and Rutter 1993). For instance, evidence now indicates that brain damage can be a result of poor parenting, as nurturing is now thought to play an important part in healthy brain development and the capacity for learning and regulation of emotions (for more details see Keating 1992, Carnegie Corporation New York 1994, Norrie et al 1999.)

Long-term follow-up studies have identified a number of qualities that help children cope well despite being brought up in situations of poverty and family disruption (Werner et al 1982; Beardslee 1989; Garmezy 1991). These resilience factors may reside in the child (e.g. high IQ; equable temperament; positive orientation to problem-solving) and some are part of the environment (e.g. help of a supportive adult, good educational opportunities) (Fonagy et al 1994, Gilligan 1998). While some of these are relatively fixed, others can be modified, such as access to support.

The notion of resilience has gained considerable recent attention, partly because it focuses on the actual or potential strengths of vulnerable individuals and families, whereas the risk factor perspective has concentrated on 'pathology' and deficits. From this perspective Gilligan (2000) claims that through decisively exploring the strengths in families, positive experiences and resources issues can be built on and enhanced. However, Dingwall (1993) warns that staff working with families in this way should be careful not to adopt 'a rule of optimism', which discounts evidence of serious family malfunctioning.

Evidently, risk, protective and resilience factors can act at different points in a child's life and often they change over time. A pathway or career perspective helps take into account either the persistence of circumstances or significant alterations (Rutter 1989; Little et al 1996; Boushel et al 2000). A child's life-course may be characterised by both continuities and discontinuities of factors and outcomes. This is most evident when there are major changes in household composition or other life events, e.g. parental separation, remarriage, entering or leaving foster care. One advantage of the pathway approach is that it avoids a sense of inevitability about good or bad outcomes. It also helps to focus on crucial turning points or decisions, where great care is vital to ensure a child has supports and options which maximise the chance of a good outcome.

Attachment theory

Attachment theory provides a means of assessing the qualities needed by, or experienced by, young children in their relationships with parents and other carers. This theory has gone through several stages of development and some of the initial ideas have been rejected by critics and modified by proponents.

In the original formulation, Bowlby (1954; 1965; 1969) argued that infants have an inborn tendency to form a primary attachment to one individual, normally their mother or mother figure. The infant treated the attachment figure as a 'secure base', feeling comfortable and confident in their presence, but sad and disoriented when separated. The primary evidence for this was provided in studies of children's distress when separated short term in unfamiliar surroundings and the negative effects of long-term impersonal and inconsistent care in residential institutions. Initially Bowlby and others used these ideas to suggest that it was harmful for children to be placed in day care. Subsequent reviews of the evidence indicated that this was an inaccurate extrapolation on at least three counts (Rutter 1971). Children generally form multiple not sole strong attachments, though the number and types of attachment vary considerably depending on the cultural and household contexts (Schaffer and Emerson 1964; Hill 1987). They are usually not distressed if separated from parents in a familiar setting or with another familiar adult (Schaffer 1990). Children can thrive in day care, provided the care is stimulating and carers consistent (Hughes et al 1980).

Despite these major shortcomings in its initial formulation, some of the original concepts (like secure base or indicators of attachment) are useful. Later developments are also pertinent to understanding services that involve separation from parents, like nurseries and childminding. Classifications of infant-adult relationships into secure, avoidant, ambivalent and disorganised have been found to have wide applicability and extend into later childhood or even adulthood (for further details, see Appendix 1; Parkes and Stevenson-Hinde 1991; Howe 1995). Bowlby's later idea that children have an internal working model of relationships is also interesting. This suggests their early experiences dispose them to expect similar treatment form all or most adults. Thus children securely attached to their parents will expect trust, while others will anticipate (and perhaps therefore provoke) rejecting or inconsistent responses (Rutter and Rutter 1993).

Attachment theory has implications for parenting programmes too, since there is evidence that parents' bonding with their own children and treatment of them is affected by the nature of their own earlier attachment history and internal working models (Main 1995). Taking a broader view of attachment than is often the case, Howe et al (1999) classify four types of intervention, depending on the degree of focus on the child or parents and include one category where the target of work is broader (Type 4 in the table overleaf):

The ecological approach

The ecological perspective to child development places much greater stress on the wider environment than cumulative factors or especially attachment theories. It identifies the complex interplay of influences, opportunities and stresses that affect children and influence their parents' ability to raise them. Ecological approaches examine the interaction of levels and contexts in the household, the neighbourhood and the wider world of work and society. Development in one setting (such as the family home or a family centre) is contingent on what is going on in other areas.

The most developed ecological analysis is probably still that developed by Bronfenbrenner (1979) who provides a more holistic view of child-parent dynamics and their relation to services, employment and social attitudes. He identified four concentric systems beginning with the microsystem of a child's immediate activity and extending via mesosystems and exosystems to the macrosystem of society as a whole. Opportunities for development and risks to development do not simply arise from a deficiency in parenting skills but as a result of the interaction between the make-up of the child (physical and genetic), the parent(s) and the child's social environment. Stresses on families and access to support services are affected not only by local factors, but structural inequalities related to gender, race and disability. Acheson (1988) used the example of low birth weight in poor neighbourhoods to illustrate this point. She indicates that babies born in poor areas often have lower than average birth weights. This is not the result of failures by individual parents, but the result of structural inequalities which result in limited access to services and resources and increased pressures on a group of society who have the least resources and abilities to cope. More generally, Garbarino (1980:81) stated that the quality of the carer-child microsystem is dependent on it's ability to provide 'enduring, reciprocal, multi-faceted relationships that emphasise playing, working and loving'. If the quality is poor, development will be restricted. However, parents' or other carers' capacities to provide that quality are not simply due to their own characteristics but are much affected by external opportunities, supports and constraints. Policies related to employment such as hours of work and relocation may have a detrimental affect on the child-parent relationships. Similarly, writing in the context of child protection, Boushel (1994) noted that children's good and safe care depends not just on parents' behaviour, but the nature of family support and supervision, as well as general attitudes towards women and children.

Another model, which did not simply view the child in isolation, was proposed by Belsky (1984). He drew on aspects of the ecological approach by focusing on deficits of the micro and mesosytems, but made no comment on aspects of the wider systems. Belsky identified three determinants, in order of importance, which he believed affect parental functioning:

• personal psychological resources of parents;
• contextual sources of stress and support; and
• characteristics of the child.

This model puts most importance on the psychological resources of parents. Belsky argued that psychological developmental history and personality are most important in shaping the quality of parenting. He did consider external influences and emphasised that positive networks of social support help people act more effectively as parents. Unlike Bronfenbrenner, though, Belsky ignored the affect of structural and legislative variables that will inevitably affect families in different ways.

Social construction approaches

The terms parenthood, childhood and family life represent powerful socially constructed meanings that vary significantly according to culture, time, place and individual family process. For example care of young children in different cultures varies greatly. In some cultures a wide network of female carers undertakes the care of young children. This has been criticised in the West as critics have argued that it leads to less intense affection and loyalties. However, studies in Africa and the Pacific (Freeman 1983, Rashid 1996) have indicated that this type of care can be accompanied by close attachments. Whereas Western cultures foster and adopt children into families outside the kin network, other cultures would not consider this (Hill 1991; Dickens and Watts 1996). Similarly attitudes to care by siblings is very different in modern Britain compared with other places and times (Weisner and Gallimore 1987; Kosonen 1996).

Whereas other theories tend to write in terms of relatively fixed factors or characteristics, and describe quasi-universal accounts of child development and good parenting, social construction emphasises the fluidity of notions such as children's needs and the varied meanings attached to aspects of family life (Rogers and Rogers 1994; Rodger 1996; Woodhead 1998). Since the 1990s, the sociology of childhood has challenged traditional assumptions in much developmental psychology based on a universal unfolding of abilities and a tendency to judge children in terms of deficiencies compared with adults, instead of in their own right (Mayall 1996; James and Prout 1998). It has been argued that too often children have been judged largely in terms of who or what they will 'become', rather than for what they currently are (Shamgar-Handelman 1994).

Implications

The approaches outlined above are not necessarily in conflict or tension, but have different perspectives and emphases. They can help identify broad orientations to intervention and specific targets for action.

Interventions can reduce or compensate for risk factors by providing or enhancing protective and resilience factors. The aims will range from reducing poverty to promoting problem-solving skills. Attachment theory emphasises the importance of consistency in relationships and sensitive understanding of reactions to separation, loss and rejection. Ecological approaches suggest the need for comprehensive and co-ordinated programmes, since otherwise input to a child or parent may be undermined by other aspects of the environment (and vice versa). From the social construction perspective, it is important for interventions not simply to begin with professional or academic presumptions about the aims and nature of services, but to adopt a questioning approach to the goals of parenthood and child development and to engage in dialogue with parents and children about their particular perceptions. Although it is essential to be conscious of how early experiences may affect children's later prospects (including employment prospects, adult health and life expectancy), it is equally crucial not to neglect their needs here and now through an excessive focus on future development.

An example of a practice model that reflects an integration of at least the first three approaches outlined here is that of the Department of Health. Its 'Framework for the Assessment of Children in Need' (DoH 2000) is summarised in a triangle representing three domains which correspond roughly to three systems in the ecological approach. These are:

• the developmental needs of children;
• the capacities of parents or caregivers to respond appropriately to those needs; and
• the impact of wider family and environmental factors on parenting capacity and children.

Attachment is a central component of the child's needs, which comprise the seven dimensions devised by the Looking After Children programme (Parker et al 1991; Ward 1995):

• health;
• education;
• emotional and behavioural development;
• identity;
• family and social relationships;
• social presentation; and
• self-care.

The other two domains (parental capacities and the wider environment) incorporate many of the protective and risk factors that have been identified by research, such as stimulation and stability for parenting, income and community recourses in the wider environment. According to the DoH document, the significance of understanding the child-parent relationship has long been a salient factor in child welfare practice, while the consequences of poverty are well known. However the interface between environmental factors and the child's development have been largely ignored, especially the influence of these factors on the parents' ability to parent effectively (DoH 2000).