Attachments and Relationships

Attachment refers to the pattern and quality of interactions between a child and their parents and other caregivers. Healthy attachment begins early, including when caregivers interact with babies while they are still in the womb and during the first few days of life. Once the baby is born, a caregiver might gently rock with or sing to a crying infant, feed a hungry one, or pat the infant's back to help it feel secure. These activities help the infant to recognize caregivers by voice and smell and, later, to recognize their faces.

Consistently and effectively responding to an infant does three important things:

• It builds a sense of safety for the infant in an environment where she can anticipate being cared for and loved; this helps to give her the confidence and security needed to grow, learn, and engage with the world.
• It promotes development, fosters resiliency, and provides a healthy model of communication for the child’s first understanding of human interaction.
• It reduces the infant’s distress and helps the baby direct his energy to growing and learning. Infants have a low tolerance for distress. Their little bodies and developing brains cannot handle stress the way an adult or older child can. Infants cannot independently feed or clothe themselves; they depend on caregivers to meet all of their basic needs and to minimize or eliminate distress.

Caregivers bring their own experiences as children—both positive and negative—into the child/caregiver relationship. Positive experiences can strengthen their ability to respond to infants and children. If caregivers have unresolved negative experiences, their ability to respond to children in a positive manner may be affected.

Healthy development requires security, trust, and consistency from caregivers. Both infants and caregivers are born with the ability to respond to each other. The attachment process is one way that caring, support, and love are passed from generation to generation.

Resiliency is a community, family, or person’s ability to bounce back from an unexpected event. It includes learning from experiences, applying that knowledge to future experiences, and building in redundancy. People who have high resiliency are better able to maintain a positive outlook and to remain focused, flexible, and creative as they solve problems.

Protective factors are positive influences that help protect a person or group against diseases and other bad outcomes. Protective factors increase a person's resiliency and help families build positive relationships. They strengthen all families, not only those at risk.

Protective factors for young people include:

• Involvement with a positive group of friends (peer network).
• Healthy self-esteem.
• Good coping skills.
• Family stability.
• The presence of parents, guardians, and other caring adults who provide emotional support.
• Involvement with school and community.
• Social values such as helping others, volunteering, and mentoring.
• Social competencies such as decision-making skills, assertiveness, and interpersonal skills.

In Your Practice

When you work with people, families, and your community to increase protective factors, you help build natural supports. Caregivers, friends, schools, parents, and community members can promote resiliency by providing positive influences and support.

• When you assess someone’s risk and resiliency, be sure to consider their protective factors.
• Work with families to increase protective factors and build natural supports within the family and village.
• Encourage caregivers, schools, parents, and community members to provide positive influences and support.

When working with children, adolescents, and vulnerable adults, it is important to involve the caregivers in their lives. This process is called engaging caregivers. See: Caring for Elders for information on engaging elder caregivers.

A caregiver is anyone who plays a significant role in the life of a child or adolescent through activities such as parenting, mentoring, and providing guidance or support. People in the caregiving role may include parents, teachers, childcare providers, foster parents, aunts, uncles, grandparents, extended family members, elders, and other adult figures involved in the child's community and culture.

It is common for parents to feel uncertain and anxious about parenting at some times. This may be true especially for new parents or parents caring for a child with special needs. Caring for an infant or a child with above-average needs can be physically and emotionally exhausting. When parents and primary caregivers receive support, they can support their children better. Elders, more experienced parents, and community members may help caregivers by providing emotional and practical support.

Engaging caregivers includes:

• Involving them as active participants in the child or adolescent’s social or emotional development.
• Offering them the chance to work collaboratively with you and the child or adolescent to support healthy behaviors and work towards treatment goals.
• Building culturally important connections with elders and others who share the client’s cultural background.

Engaged caregivers are invested in positive outcomes for your client. Strong connections to safe, stable adults helps build resiliency in children and adolescents. For more information on resiliency, See Chapter C-3: Wellness and Prevention.

In Your Practice

Encourage caregivers to participate in treatment planning and interventions. Invite elders, mentors, and other potential caregivers to engage.

Create opportunities for minor clients to invite caregivers to be part of their behavioral health work. Help develop therapeutic activities in which caregivers can easily get involved, such as hunting, beading, and berry-picking.

Educate caregivers about how their involvement will benefit the child. Let them see how they might help by modeling the things you are working on with the child (such as consistency or boundaries).

When engaging caregivers, remember to:

• Follow all client privacy rules. See Chapter B-4: Confidentiality and Release of Information.
• Maintain healthy boundaries. See Chapter B-1: Values and Ethics for BHA/Ps.
• Consult with your supervisor in cases of child abuse and neglect. See Chapter B-5: Mandatory Reporting and Duty to Warn.
• Be realistic. Sometimes your efforts will not succeed. You can’t force caretakers to participate.
• Document your efforts and results. See Chapter B-8: Documentation and Billing.

Historical trauma is the unresolved emotional and psychological injury caused by the cumulative effects of colonization, epidemics, boarding schools, and racism. It occurs across generations as a result of widespread traumatic experiences shared by groups of people, often based on their ethnicity or culture. Examples range from young children being removed from their families and sent to boarding schools to famines and wars that kill entire generations. This trauma is a kind of "psychological baggage" that, unless healed, is passed down through generations. While Alaska Native people share a past of trauma-related colonization, different regions had very different experiences and periods of exposure to newcomers and their ways of life.

Historical traumas have resulted in long-term separations between generations of children and their families, creating a loss in traditional parental role models. These historical events may impact how people learned about attachment and how they attach with their children today.

Caregivers tend to bond with infants and children in similar ways across many different cultures and regions of the world, with certain cultural variations. For example, some cultures emphasize language development through singing and storytelling while others emphasize facial expressions and talking to the infant. Some emphasize physical contact by using baby slings that keep the child close to the caregiver at all times.

Families also have their own individual culture of attachment and parenting. These patterns are passed from generation to generation.

In Your Practice

Be thoughtful. Suggesting or imposing ideas that represent ideals outside of community or family values can cause people to shut down or feel they are being judged for their character or cultural beliefs and practices. Pay careful attention and work within the unique culture and cultural values of each individual, family, and community when supporting efforts related to attachment.