What are “placed-based” approaches to improving health? What is “social climate change”? And why might these concepts matter for the health and wellbeing of children and families?

The Centre for Community Child Health at the Royal Children’s Hospital in Melbourne has just released a policy brief examining these issues. I’m sorry I don’t have time to do a cut-down version for Croakey readers but the Centre has kindly agreed to let the full document be published below.

Place-based approaches to supporting children and families (it can be downloaded here)

Families are often faced with a range of different, complex health and psychosocial problems.

Place-based approaches aim to address these complex problems by focusing on the social and physical environment of a community and on better integrated and more accessible service systems, rather than focusing principally on the problems faced by individuals.

A place-based approach targets an entire community and aims to address issues that exist at the neighbourhood level, such as poor housing, social isolation, poor or fragmented service provision that leads to gaps or duplication of effort, and limited economic opportunities.

By using a community engagement approach to address complex problems, a place-based approach seeks to make families and communities more engaged, connected and resilient.

Why is this issue important?

Over the past few decades, the world has witnessed significant and rapid change. These changes have been so fast and so far-reaching, they have had a dramatic impact on the physical wellbeing of the planet in the form of climate change1,2,3,4 as well as on the physical and psychological wellbeing of societies in the form of social climate change5.

We can see the evidence of social climate change in the rapid changes that have occurred for communities, families and children. These include:

• people’s sense of community has become less tied to locality, as seen in the emergence of online communities
• our social relationships have taken on new forms
• the structure of the family has changed (e.g. smaller families)
• Australia has greater cultural and ethnic diversity
• the circumstances in which families are raising young children have changed, for example, more parents work longer hours6,7,8,9,10,11.

Additionally, the circumstances in which children are growing up have changed10.

Children now have fewer models of caregiving, community environments are less child-friendly and electronic media has become a dominant feature in children’s lives12,13,14.

Social climate change is also evident in the increasing complexity of modern society15. One manifestation of this complexity is the increase in ‘wicked’ problems16 such as obesity, child abuse and social exclusion. These problems are beyond the capacity of any one organisation to understand and respond to, and there is often disagreement about their causes and the best way to tackle them.

Wicked problems “cross departmental boundaries and resist the solutions that are readily available through the action of one agency”17. However, government departments typically focus on acute problems and do so unilaterally, rather than coordinating efforts to address factors that lead to wicked problems occuring in the first place. Governments also seek to integrate services so as to improve access and thereby improve outcomes. However, while integrating services is important, it is also important to build more supportive communities. This will ensure that parents of young children have stronger social support and the interface between communities and services is improved so that service systems can be more responsive to community needs18. Both integrating services and building more supportive communities are best done through a place-based approach.

What does the research tell us?

Rationale for place-based approaches

The rationale for adopting place-based approaches is based on various factors:

Place shapes people’s wellbeing. Both social and physical environments influence health and wellbeing. Children’s daily experience of living and learning in the environment around them is a significant factor in their overall wellbeing6-8,19-23.

Feeling connected and having social networks matters for people’s wellbeing. Children’s welfare and family functioning are crucially dependent upon the social support available within local communities24, and social isolation is a risk factor for both child development and family functioning24-27.

Some communities are trapped by locational disadvantage28-32. Despite Australia’s recent strong economic growth, some communities remain caught in a spiral of disadvantage such as low school attainment, high unemployment, poor health, high imprisonment rates and child abuse31. When social disadvantage becomes entrenched in a particular locality, a disabling social environment can develop, leading to intergenerational disadvantage.

The economic collapse of certain localities30,33,34. Neighbourhoods that were reliant on the old economy have been devastated by globalisation, economic rationalism, restructuring and closure of manufacturing industries. Some of these neighbourhoods have become almost entirely dependent on welfare benefits and publicly funded services.

Orthodox approaches fail to reduce inequalities and prevent problems35,36. The strategies that have been used so far to reduce inequalities – such as making existing services more accessible and seeking to alter the individual behaviour of vulnerable people – do not address the root cause of the problems33, and have been unable to produce sustainable change. There has been a disproportionate reliance on the deployment of strategies and programs for the treatment of existing conditions rather than on true prevention, which is defined as occurring prior to the onset of disorder36. A place-based approach addresses the broader problems that impact upon families at the community level (e.g. unsafe physical environments, non-family-friendly transport, limited social connectedness) as well as the barriers to families accessing services (e.g. fragmented service systems, lack of outreach capacity).

Local services are not able to respond effectively to the complex needs of families and communities10,37. Designed at a time when the demands on families were simpler, many local service systems struggle to provide support to all families who are eligible, and to meet the needs of families facing multiple challenges in a holistic way.

It is difficult to engage and retain vulnerable families38-44. Some families make little or no use of services, even if they have concerns about their children or are experiencing family difficulties. The reasons for this lack of engagement – more common among vulnerable families – include difficulties negotiating a fragmented service system, not knowing services exist, and an unwillingness and/or inability to access services38. With a focus on collaboration and partnership between services, a place-based approach seeks to reduce these barriers by building integrated service systems that are more flexible and responsive to family and community needs, and have an outreach capacity to engage vulnerable and socially isolated families.

Cumulatively, this is a formidable list of factors that provide a powerful rationale for a place-based approach. However, it is important to consider the evidence regarding the effectiveness of place-based approaches.

The effectiveness of place-based approaches

Establishing the efficacy of place-based initiatives, policy and planning is challenging. A lack of well-designed outcome evaluations of place-based initiatives limits the extent to which firm conclusions about their effectiveness can be made45,46. While some place-based initiatives have led to measurable improvements, others have not. Reviews of Australian efforts suggest that it is still too early to tell what difference these will make over the long term37,47.

Despite this cautious conclusion, there is some evidence as to what successful place-based interventions involve.

Characteristics of successful place-based interventions

Communities participate, lead and own the intervention. At the heart of all successful place-based partnerships are communities that provide maximum practicable input in all decision making. This is the key to community strengthening32 and extensive community engagement, as well as engagement with public and private sector stakeholders37,48. Knowledge of the local community decreases the amount of time required to identify needs and develop plans and programs, thereby leading to greater efficiency.

Investment in capacity building. This investment includes time and resources for communities as well as long-term capacity building of staff48.

Adequate time. Problems that have been decades in the making will not be reversed in a few short years32. Similarly, service transformation through behaviour change takes a long time50,51.

Adequate funding. Governments can help to support community-strengthening outcomes by investing in core public infrastructure48 and facilitating investment from other sources (e.g. private sector funding) to support initiatives and ideas that flow from the project37, and fund pilot and demonstration projects48.

Strong leadership and support from governments. Wiseman (2006) notes that governments can support community-strengthening outcomes by articulating and demonstrating their commitment.

Effective relationships between stakeholder groups. Effective coalitions or partnerships between key community stakeholders increase the likelihood that a prevention effort will be successful52. Key factors that contribute to effective relationships between stakeholders include high levels of trust and communication, and the establishment of shared vision and values between service providers. Governance structures need to be established through which the various stakeholders and service providers can effectively engage with users of the service system to develop planning mechanisms that respond to community need, and through which services can be jointly planned and delivered.

Evaluation. Processes to rigorously measure and evaluate outcomes need to be built into the project from the start37.

A ‘good fit’. The scale of the project needs to be appropriate to the policy challenges it addresses. The community needs to be prepared to implement a prevention program37 and any programs or interventions need to meet the identified needs of the community and be appropriate for the targeted cultural groups52.

The evidence also suggests that a place-based approach is only one feature of a comprehensive community-based service framework that can respond more effectively to the wicked problems that affect communities, families and children53. Other features include:

• a strong universal service system backed by a tiered set of additional supports for families experiencing particular stresses
• an integrated service system providing holistic support to families
• multi-level interventions to address all factors that directly or indirectly shape the development of young children and the functioning of their families
• a partnership-based approach based on partnerships between families and service providers; between different service providers; and between government and service providers
• a robust governance structure that allows different levels of government, different government departments, non-government services and communities to collaborate in developing and implementing comprehensive place-based action plans.

Although there are no place-based initiatives that have all of these features, there are some valuable local and overseas examples that demonstrate many of these characteristics. Australian initiatives include Neighbourhood Renewal in Victoria and the federal Communities for Children program. Overseas examples include Sure Start in the UK and Choice Neighbourhoods in the US.

Place-based approaches are typically delivered within disadvantaged areas. However, we know that disadvantage is not necessarily confined to such areas – family problems and poor child outcomes are widespread and not limited by geography. For this reason, place based approaches can be validly applied within any community.

Combining approaches

Place-based approaches represent a significant advance on the traditional service system. However, place-based approaches are not sufficient on their own to ensure a sustainable improvement in child and family outcomes. Two other complementary approaches are needed: person-based and national approaches.

A person-based approach focuses on direct help to the individual person or family with the problem, regardless of their circumstances or where they live35. A place-based approach addresses the collective problems of families and communities at a local level, usually involving a focus on community-strengthening. These approaches have usually been deployed separately but there are good grounds for combining them30. Such a strategy would be consistent with calls for multi-level approaches to social and behavioural change49. Significantly disadvantaged communities require programs targeted at individuals as well as renewal and development programs that address social infrastructure and the environment (e.g. public spaces, housing etc.)37.

Although place-based approaches seek to address the conditions under which families are raising young children, they can only address those factors that can be modified at a community level (e.g. social networks, integrated services). There are other factors that can have a major impact on families and communities that are beyond the control of place based initiatives. These include national and global economic policies and market forces that can contribute to disparities in housing, employment, education and health. National approaches are needed to minimise the impact of these factors on families of young children.

What are the implications of the research?

Rapid, sweeping social changes have had widespread impacts on communities, families and children. The current service system is not equipped to deal with the fallout from these social changes and struggles to meet the needs of all families effectively. As an alternative to this current system, place-based approaches:

• are an efficient way of addressing place-based disadvantages
• address the conditions under which families are raising young children as well as the presenting problems
• involve the community in the development of initiatives and interventions, and provide services and facilities that are more responsive to community needs and more acceptable to families
• build the capacity of communities to take responsibility for their own issues over time
• create integrated service systems that are able to reach out to and engage families more successfully and respond to their needs in a holistic fashion.

This analysis suggests that meeting the needs of vulnerable families and communities requires a three-pronged approach – a combination of person-based, place-based and national approaches.

Considerations for policy and programs

Implementing a comprehensive approach – including place-based strategies – to effectively meet the needs of today’s young children and their families is a formidable undertaking that requires a sustained commitment by many stakeholders.

• Community involvement should be viewed as a long term goal of any place-based initiative as it takes time to build community capacity.
• Close monitoring of and continuous learning and research from a comprehensive community-based approach will be important to ensure that the future roll-out of the model is fully effective.
• More work is needed on developing a full program logic model of the framework for place-based approaches, showing how it leads to improved outcomes for children, families and communities.
• Place-based approaches should be seen as just one feature of a broader framework; a combined approach (person, place and national) is required to more efficiently and effectively respond to wicked problems that affect communities, families and children.

• Cite as: Centre for Community Child Health (2011). Place-based approaches to supporting children and families. CCCH Policy Brief No. 23. Parkville, Victoria: Centre for Community Child Health, The Royal Children’s Hospital.

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Attachment Facilitating Parenting

Arthur Becker-Weidman, Ph.D.

Center For Family Development

Many adopted and foster children have had very difficult and painful histories with their first parents. These children have experienced chronic early maltreatment within a caregiving relationship. Such a history can lead to the development of Complex Trauma (Cook et. al., 2003; Cook et. al., 2005), disorders of attachment, and Reactive Attachment Disorder. Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems (Gauthier, Stollak, Messe, & Arnoff, 1996; Malinosky-Rummell & Hansen, 1993). These children are likely to develop Reactive Attachment Disorder (Greenberg, 1999; Lyons-Ruth & Jacobvitz, 1999). Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms (Carlson, Cicchetti, Barnett, & Braunwald, 1995; Cicchetti, Cummings, Greenberg, & Marvin, 1990). Many of these children are violent (Robins, 1978) and aggressive (Prino & Peyrot, 1994) and as adults are at risk of developing a variety of psychological problems (Schreiber & Lyddon, 1998) and personality disorders, including antisocial personality disorder (Finzi, Cohen, Sapir, & Weizman, 2000), narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder (Dozier, Stovall, & Albus, 1999). Therapeutic Parenting is often necessary to help these children heal (Becker-Weidman, A., & Shell, D., 2005/2008). This approach to parenting is often not familiar to most parents and requires a significant amount of work and preparation. Attachment facilitating parenting is grounded in attachment theory and is based on a set of principles that include:

• Sensitivity
• Responsiveness
• Following the child's lead
• The sharing of congruent intersubjective experiences
• Creating a sense of safety and security

The effective implementation of these principles requires parents who:

• Are strongly committed to the child.
• Have well developed reflective abilities
• Have good insightfulness
• Have a relatively secure state of mind with respect to attachment

This type of parenting is consistent with Dyadic Developmental Psychotherapy, which is an evidence-based and effective treatment for children with trauma and attachment disorders (Becker-Weidman & Hughes, 2008). Many foster and adoptive parents find their children's behaviors strange, frightening, disturbing, and upsetting. They often don't understand why their child behaves as the child does; aafter all, my child is now safe, doesn't he get it?a It can be difficult to appreciate the depth and pervasiveness of the damage caused by earlier maltreatment.

Therapeutic parenting based on Dyadic Developmental Psychotherapy relies of helping parents understand what is causing the child's behaviors. Looking deeper in order to understand what is motivating the child. All behavior is adaptive and functional; however sometimes the behaviors that were adaptive in one environment are ill-suited for the new home. If your first parents were neglectful, unreliable, and inconsistent so that you were often hungry and left alone for long periods of time, hoarding food, gorging, and going to aanyonea for help is adaptive. When that child is placed in a foster or adoptive home with caring, responsive, sensitive parents, that same behavior is no longer adaptive. By understanding what is driving the behavior and appreciating the child's fear, anxieties, shame, and anger, the new parent will be better able to respond to the emotions driving the behavior rather than the surface behavior or symptoms. Unless the underlying emotions are addressed with sensitivity and within a safe, unconditionally loving, and supportive home, the behavior or symptoms are not likely to stopathey may change into other problems, but if the underlying cause remains, then the problems will surface again and again.

Let's discuss the principles required. These principles are more fully elaborated elsewhere (Becker-Weidman & Shell, 2005; Becker-Weidman, 2007)

SENSITIVITY. Because children with trauma and attachment disorders are often unable to describe their internal states, emotions, or thoughts, it becomes the job of the parent to do this with and for the child so that the child learns to do this. Of course, this is precisely what one does with a newborn, toddler, and child. We often help children manage their internal states by doing that with them. When a baby cries, we pick up the baby, comfort the child, and by so doing, regulate the child's level of arousal. Over time the infant becomes increasingly proficient at doing this independently. The parent of a foster or adopted child must be sensitive to the internal states of their child so that the parent can respond to the underlying emotions driving behavior.

RESPONSIVENESS. Once the underlying emotion is identified, the parent must respond to this need or emotion, with sensitivity. By meeting the child's need (to feel safe, loved, cared about, for food, drink, joy, etc) the child will internalize new and healthier models of relationships and parents.

FOLLOWING THE CHILD'S LEAD. By this I mean that the parent will need to respond to the child and follow the child's lead in the sense of providing what the child is needing (comfort, affection, support, structure, etc) and at the child's pace. It is very important to move at the child's pace to create the necessary sense of safety and security that these children need.

THE SHARING OF CONGRUENT INTERSUBJECTIVE EXPERIENCES. Intersubjectivity refers to shared emotion (also called attunement), share attention, and share intention. You can understand this if you think of playing a board game with your child. When you are playing some game together and enjoying the experience, you are sharing emotions (joy and a sense of competence), sharing attention (focusing on the game), and sharing intention (playing by the rules, both trying to win, having fun, etc.). Or another example, when talking about the death of the child's loved grandparent, you both may share the same emotions (grief), both are recalling memories of the grandparent (shared intention and attention). It is the sharing of congruent intersubjective experiences, experiences in which all three elements are the shared, that helps the child heal and learn about intimacy and relationships.

CREATING A SENSE OF SAFETY AND SECURITY. Safety comes first. Unless the child is physically, emotionally, and psychologically safe, healing cannot occur. So, it is the job of the parent to create safety and security for the child. This then allows for the exploration of underlying feelings, thoughts, and memories. Without an alliance there can be no secure base. Without a secure base there can be no exploration. Without exploration there can be no integration. Without integration there can be no healing.

Unless the child feels safe, exploration is not possible.

So, what sort of parent is needed? We know form extensive research, that one of the best predictors of placement stability is the parent's commitment to the child (Dozier, Grasso, Lindhiem, & Lewis, 2007). Therefore, building or rebuilding parental commitment is an important first step. Unless there is strong commitment, the child cannot feel safe and, as discussed above, safety is the most important first step in helping a hurt child heal.

Reflective capacity is also vital to placement stability and to the healing of adopted and foster children. The parent must be able to reflect on the child's underlying emotions, how the past may be re-enacted in the present, and what in the parent's own past is being triggered by the child. A well developed reflective function is necessary if the parent is to respond to the child in a healthy and healing manner. We all have buttons. The job of the therapeutic parent is to understand one's buttons so that these can be disconnected so that when pushed, nothing happens.

Insightfulness (Koren-Karie, Oppenheim, Dolev, Sher, & Etzion-Carasso, 2002; Oppenheim, Koren-Karie, & Sagi, 2001; Oppenheim, & Koren-Karie, 2002; Oppenheim, Goldsmith, & Koren-Karie, 2005) is related to reflective capacity.

A parent's state of mind with respect to attachment is the best predictor of the child's. (Main, & Cassidy, 1988; Main, & Hesse, 1990). If the parent has a Secure state of mind with respect to attachment, then the adopted or foster child is more likely to develop a healthy and secure pattern of attachment and heal (Steele, Hodges, Kaniuk, Steele, Hillman, & Asquith, 2008). We know that when young children are placed in a foster home, the child will begin to develop a pattern of attachment that is the same as the foster parent's state of mind with respect to attachment (Dozier, Stovall, Albus, & Bates, 2001). Obviously, in older children, this is a more difficult task. In the general population, about 60% of the adults have a secure state of mind with respect to attachment. For parents who have an insecure state of mind with respect to attachment, they can still learn to parent effectively with help (Becker-Weidman, A., & Shell, D., 2005/2008; Bick & Dozier, 2008).

USEFUL RESOURCES FOR PARENTS

1. Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.
2. Becker-Weidman, A., & Shell, D., (Eds.) (2005/2008) Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes/ Williamsville, NY: Center For Family Development.
3. Golding, K., (2008). Nurturing Attachments. London: Jessica Kingsley.
4. Hughes, D. (2006) Building the Bonds of Attachment, 2nd edition, Jason Aronson, Lanham, MD. .
5. Siegel, D., & Hartzell, M., (2003). Parenting from the Inside out. Tarcher.

REFERENCES

Becker-Weidman, A., & Shell, D., (Eds.) (2005, 2008). Creating Capacity for Attachment, Oklahoma City, OK: Wood N Barnes & Williamsville, NY: Center for Family Development.

Becker-Weidman, A., (2007). Principles of Attachment Parenting. 3-set DVD. Williamsville, NY: Center for Family Development.

Becker-Weidman, A., & Hughes, D., (2008) aDyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,a Child & Adolescent Social Work, 13, pp.329-337.

Bick, J., & Dozier, M., (2008). Helping Foster Parents Change. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 452-471). NY: Guilford.

Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1995). Finding order in disorganization: Lessons from research on maltreated infants' attachments to their caregivers. In D. Cicchetti & V. Carlson (Eds.), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect (pp. 135-157). NY: Cambridge University Press.

Cicchetti, D., Cummings, E. M., Greenberg, M. T., & Marvin, R. S. (1990). An organizational perspective on attachment beyond infancy. In M. Greenberg, D. Cicchetti & M. Cummings (Eds.), Attachment in the preschool years (pp. 3-50). Chicago: University of Chicago Press.

Cook, A., Blaustein, M., Spinazolla, J. & van der Kolk, B. (2003) Complex Trauma in Children and Adolescents. White Paper from the National Child Traumatic Stress Network Complex Trauma Task Force. National Center for Child Traumatic Stress, Los Angeles, CA.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M. et al. (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35, 390-398.

Dozier, M., Stovall, K., Albus, K., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 1467-1477.

Dozier, M., Grasso, D., Lindhiem, O., & Lewis, E., (2007) aThe role of caregiver commitment in foster care,a in D. Oppenheim & D. Goldsmith, (Eds.) Attachment Theory in Clinical Work with Children. NY: Guilford.

Dozier, M., Stovall, K. C., & Albus, K. (1999). Attachment and psychopathology in adulthood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 497-519). NY: Guilford Press.

Finzi, R., Cohen, O., Sapir, Y., & Weizman, A. (2000). Attachment styles in maltreated children: A comparative study. Child Development and Human Development, 31, 113-128.

Gauthier, L., Stollak, G., Messe, L., & Arnoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20, 549-559.

Greenberg, M. (1999). Attachment and psychopathology in childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 469-496). NY: Guilford Press.

Koren-Karie, N., Oppenheim, D., Dolev S., Sher, E., & Etzion-Carasso, E. (2002). Mothers' insightfulness regarding their infants' internal experience: Relations with maternal sensitivity and infant attachment. Developmental Psychology, 38, 534-542.

Lyons-Ruth, K., & Jacobvitz, D. (1999). Attachment disorganization: Unresolved loss, relational violence and lapses in behavioral and attentional strategies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 520-554). NY: Guilford Press.

Main, M., & Cassidy, J. (1988). Categories of response to reunion with the parent at age six: Predictable from infant attachment classifications and stable over a one-month period. Developmental Psychology, 24, 415-426.

Main, M., & Hesse, E. (1990). Parents' unresolved traumatic experiences are related to infant disorganized attachment status. In M. T. Greenberg, D. Ciccehetti & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161-184). Chicago: University of Chicago Press.

Malinosky-Rummell, R., & Hansen, D. J. (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin, 114, 68-69.

Oppenheim, D., Koren-Karie, N., & Sagi, A. (2001). Mothers' empathic understanding of their preschoolers' internal experience: Relations with early attachment. International Journal of Behavioral Development., 25, 16-26.

Oppenheim, D. & Koren-Karie, N. (2002). Mothers' Insightfulness Regarding their Children's Internal Worlds: The capacity underlying secure child-mother relationships. Infant Mental Health Journal, 23(6), 593-605.

Oppenheim, D., Goldsmith, D., & Koren-Karie, N. (2005). Maternal Insightfulness and preschoolers' emotion and behavior problems: Reciprocal influences in a day-treatment program. Infant Mental Health Journal.

Prino, C. T., & Peyrot, M. (1994). The effect of child physical abuse and neglect on aggressive withdrawn, and prosocial behavior. Child Abuse and Neglect, 18, 871-884.

Robins, L. N. (1978). Longitudinal studies: Sturdy childhood predictors of adult antisocial behavior. Psychological Medicine, 8, 611-622.

Schreiber, R., & Lyddon, W. J. (1998). Parental bonding and current psychological functioning among childhood sexual abuse survivors. Journal of Counseling Psychology, 45, 358-362.

Steele, M., Hodges, J., Kaniuk, J., Steele, H., Hillman, S., & Asquith, K., (2008). Forcasting Outcomes in Previously Maltreated Children. In H. Steele & M. Steele (Eds.), Clinical Applications of the Adult Attachment Interview (pp. 427-452). NY: Guilford.

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