Using attachment research to improve the lives of vulnerable young children

Research led to new assessment tools for measuring parent-child attachment that are now used in a variety of clinical services, innovative prevention and intervention programmes deployed throughout the world.

UCL Psychology & Language Sciences is home to one of the world's leading centres of excellence in the study of parent-child attachment and its importance for lifespan mental health. The work is led by three clinical academics - Professors Peter Fonagy, Mary Target and Pasco Fearon - who combine expertise in developmental psychology, clinical psychology and neuroscience.

UCL researchers, in partnership with the Anna Freud Centre, have translated research findings into major new clinical programmes. One example is the Parent-Infant Psychotherapy programme (PIP), which supports parents in understanding and responding sensitively to their baby's needs, thereby promoting the development of secure attachments. This programme was initially set up in 2005-2008. In the period 2008-2013, it was delivered to nearly 2,000 vulnerable mothers, including mothers in four UK prisons. The programme is recommended by the Department of Education as an evidence-based intervention for parents and infants experiencing difficulties in the parent and baby relationship.

It would be difficult to overstate the contribution the ground-breaking research conducted at UCL in attachment... has had on our services... It has profoundly influenced the design of our clinical services... Crucially, the research and trainings provided have equipped us with effective measures that allow for accurate assessment in both Court and clinical cases and to measure outcomes following our treatment programmes. - Clinical Lead for the Family Assessment and Safeguarding Service and the Infant Parent Perinatal Service at Oxford Health NHS Foundation Trust

Based directly on UCL work, colleagues at Yale University developed the Minding the Baby (MTB) programme, which supports impoverished mothers to develop their capacity to think about what is happening in their baby's mind. This helps mothers to respond sensitively, improving the quality of their relationship.

Recently UCL initiated a new partnership with the National Society for the Prevention of Cruelty to Children (NSPCC) to support the development and evaluation of MTB for highly vulnerable families in the UK. This five-year programme involves delivery of a comprehensive home visiting package to 320 high-risk families in three UK cities. The Head of Strategy and Development at the NSPCC reports the impact of the work as follows:

"Fearon and Fonagy have made an important and distinctive contribution to national policy in the field of early years intervention and prevention... Their developmental approach has influenced the policy narrative around the importance of sensitive and critical periods for intervention across different stages of early childhood... The Unit has also had a significant impact on practice. Fonagy and Fearon have delivered training in early child development and attachment to almost all of the NSPCC's workforce of social workers, psychologists and midwives delivering services to babies. Their work has also been highly influential on shaping NSPCC's strategy and pioneering programme of new services for babies and their families. All of the new services are influenced by a strong attachment perspective and several have integrated a very explicit focus on the role of maternal reflective function as a protective factor against abuse and neglect".

Using a related model of intervention, UCL researchers worked with a team in Ethiopia to train mothers with malnourished infants in an attachment-based intervention, Play Therapy. It has been shown that malnutrition has a negative effect on the quality of the parent-child relationship, and has serious physical, social and emotional consequences. The intervention helps mother and child re-engage and has been found to facilitate children's weight gain and faster discharge from hospital. Mothers are trained by local volunteers in the community. Since 2010, nearly 200 mothers have been trained in the intervention. The results have been presented to the Ethiopian Health Minister, and Play Therapy is to be rolled out to wider populations in East Africa.

UCL researchers have developed a range of specialised measurement instruments that are now widely used by clinicians to assess attachment and reflective function and have provided training in these to hundreds of professionals working with vulnerable children and families. These measures are now frequently used in childcare proceedings by social workers needing to advise Child Protection Services and the Courts. Boroughs which use the UCL measures include Southwark, Surrey and Fife.