Total Attachment is a model which can be used to underpin the leadership and practice in care settings which provides a practical framework for managers and care staff alike. It is rooted in Attachment Theory which has, for decades been used to explain the quality of relationship that children are able to build with their care-givers. At heart, however, attachment is about the communication of security. The need to feel safe, confident and effective never leaves us. It is as relevant to the older person living with dementia as it is to the care workers supporting them. Total Attachment aims to provide a whole system’s approach to the delivery of care that fulfils individuals’ needs to feel accepted, secure, to belong and to be effective.
The value base underpinning Total Attachment is, by definition compassionate but gives a framework to practice...
‘Total Attachment’ was conceived by Jones, M. And Harbottle, C. (2012) and its evidence base for practice with adults is to be presented for peer review and publication in a paper co-written by Harbottle, C., Jones, M. & Thompson L. M. (2013) proposed for the Journal of Adult Protection. Its origins were in the support of foster carers who may require a framework of support to enable them to care for children who can present as extremely distressed.
At its heart, lies a framework based on a model for positive and professional parenting devised by Schofield, G. & Beek, M. (2007) and reflects the notion that true parenting represents a positive and appropriate use of power to enable growth, independence, autonomy, a sense of belonging and effectiveness. Total Attachment regards these outcomes as being the intent of good leadership and of good care in any setting.
To this end, Total Attachment draws on Schofield and Beek’s model of parenting with its 5 planks to scaffold the individual. How Total Attachment differs to this approach is that Schofield and Beek use their model to parent children and do not use the model to support those carers looking after children. Total Attachment uses the approach to scaffold staff and to enable care workers to scaffold their service users.
The 5 planks will be detailed below but it is perhaps firstly useful to consider why this approach can have such resonance in care settings for adults. Although Total Attachment is rooted in a model for parenting, it is not, in anyway, a model for infantalisation. The experiences of attachment insecurities at any point in the life span can, however, be debilitating and terrifying and it is to both allay, and if possible, prevent such anxieties, that Total Attachment can be adopted.
The 5 planks of the model are:
· Being available
· Responding sensitively
· Being effective
At the heart of the model is an absolute commitment to robust care values of ethical conduct, social justice, respect, choice and the promotion of equality of opportunity. The 5 planks can be seen as an approach that should be modelled by leaders and managers and as a stance to be promoted by care staff towards their service users.
This refers to the respect for the uniqueness of the individual; their strengths, needs personal history and identity. It can be demonstrated in the person-centredness of the care and support being delivered but must also be demonstrated by the leader towards their staff team
To be available, requires leaders and care staff to be ‘present’ ‘in the moment’ and attentive. The demonstration of availability comes from the making of time to enable conversations to be heard, concerns to be met with the appropriate reassurances and the genuine curiosity for the wellbeing of others.
This is self explanatory, requiring the modelling of behaviours that give space to individuals to enable them to find expression and operates on a basis of ‘gracious invitation’ in which individuals and encouraged rather than compelled; understood, rather than compelled
This refers to the creation of positive cultures and the value of belonging. In care settings, this can mean the sense of team working and cohesive approaches to supporting each other and the clients with whom they work. For service users, this sense of belonging can equate to a feeling of homeliness and safety.
Finally, this means the ability to be as capable, autonomous and independent as possible. From a service user’s perspective, this would mean the maintenance of skills previously acquired in order to maximise independence and a sense of fulfilment, self esteem and achievement. For care workers, their confidence and efficacy is grown from recognition, guidance and constructive support. This enables them to grow in their creativity and responsiveness because the value of their interpersonal working is recognised.
Total Attachment is a whole systems approach. It requires leaders to model the framework with their staff teams.
The value base underpinning Total Attachment is, by definition compassionate but gives a framework to practice to enable the growth of services that model the behaviours necessary for it to be evident in practice. Firstly, the language of attachment is readily understood by all workers and leaders when explained in ways encouraging reflection on the human experience and the valued qualities of meaningful, trusted relationships. Secondly, the 5 planks of the model give describable and therefore measurable components to underpin the otherwise ethereal quality of compassion. Compassionate caring can therefore be seen as the outcome of the model of Total Attachment.
Total Attachment is a whole systems approach. It requires leaders to model the framework with their staff teams. Too often care staff are individually blamed for the poor quality of care in collective settings and, in a way, it is easy to see why. However, Total Attachment examines whether the culture of the workplace may contribute to the likelihood of bad practice because the values for respectful and dignified human interactions are not modelled by the managers in those settings.