Psychological Care Of Looked After Children in Kenya: Approaches in Context of Attachment Theory

Many looked-after children have endured traumatic experiences. Provision of psychological based care approaches are implemented to promote their resilience within care setting and to optimize quality of life for those affected by chronic mental health conditions like post stress disorders. However, several prospects remain underutilised on how to best enhance the psychological well-being of children in care contexts in Kenya and globally. This paper situates contemporary approaches to psychological care within the context of attachment theory. The theory will be reviewed highlighting its practical implications for care givers providing psychological care to children and youth in care set up. An approach to integrating attachment theory with practice when working with looked after youth is illustrated using empirical literature on caring the looked after youth, and author’s experience in working with looked after youth. Finally, the article concludes with suggestions for intensification of psychological care research and enhancement of initiatives to improve mental health of looked after children.


INTRODUCTION
The Cambridge online dictionary defines looked after children as those who are taken care of by social services because their own parents are unable to look after them.The term is therefore used to refer to any child who is living with foster parents, at home with their parents under the supervision of child care providers or in residential children's homes.These children/youth could have been put under care willingly by parents striving to cope, or, children's department could have arbitrated because a child was in substantial risk of harm.
Many looked-after children have endured difficult social, physical and psychological experiences.According to Shumba and Moyo (2014), over and above bereavement, many of these children have experienced first-hand severe chronic illness of a parent or caregiver, poverty, hunger, lack of access to services, inadequate clothing or shelter, overcrowding, deficient care, disability, and even physical or sexual violence.These problems have the potential to disrupt a child's growth and development.Therefore, looked-after children need adequate mental health care to guard them from developing abnormalities.Such care can be achieved through provision of targeted psychological programming.
A large body of data concerning specific psychological support provided to vulnerable groups like the looked after youth has been documented (AICCK, 2016).However, for these psychological care approaches to make sense to childcare practitioners there is need to situate them within the context of attachment theory.The theory is key as it expounds on some interrelated factors which explains how young people grow and develops.It proposes that young people gradually internalize events they encounter with carers so that early attachment connections will construct a model for later interactions beyond the immediate family or care environment (Bartholomew & Horowitz, 1991).Practitioners need to be assisted to link the tenets of attachment theory and psychological based approaches used when working with looked after youth and children.This review hopes to fill this gap by highlighting the major principles of attachment theory espoused by Holmes (2014) and linking them to practical implications for care givers providing psychological care to children and youth in care set up.

METHODOLOGY
An integrative review strategy will be adopted to synthesis the work of Holmes and link it to practices in child care.This strategy entails synthesising knowledge and applicability of results of significant studies into practice (Souza, Silva and Carvalho, 2010).The work of Holmes is ideally a biographical description of Bowlby and his ideas and gives an in depth account of attachment theory which currently is a dominant theory in counseling psychology and child development.Through the review strategy, evidences in Holme's work is synthesised and and connected to a mental health question among the looked after children in Kenya.It is expected that this strategy will enable new theoretical framework and perspectives to emerge on how to best offer psychological care to children in Kenyan context

DISCUSSIONS
Attachment theory is the joint work of John Bowlby and Mary Ainsworth (Bretherton, 1992).Bowlby revolutionized thinking about a child's bond to the mother and its disruption through separation, deprivation, and bereavement.Ainsworth on the other hand innovated methodology that made it possible to test some of Bowlby's ideas empirically and also helped expand the theory itself.Ainsworth contributed the concept of the attachment figure as a secure base from which an infant can explore the world.In addition, she formulated the concept of maternal sensitivity to infant signals and its role in the development of infant-mother attachment patterns.
The Attachment theory asserts that how we depict ourselves and others, referred to as internal working models, are seen as key to how young people interact and cope with their relationships.Where a child experiences a secure attachment with a caregiver, she not only feels secure, but she is also motivated to explore her environment and form meaningful relationships with others.However, where a child's formative experiences are of neglectful and even ad hoc care, she grows up lacking belief that others are trustworthy, or that the self is, treasured and effective (International Centre for Research and Innovation in Fostering, 2015).
Children during early years of age undergo rapid growth and development that is greatly influenced by quality of relationships with significant people in their lives.Children who have a nurturing relationship during formative years of life will grow up to be healthier adults resulting in a better social, economic, physical and cognition which will translate to growth of healthier families and communities (Pem, 2015) The study sought to bring to fore the pillars of attachment theory as espoused by Holmes (2014) and then tie them the social work activities in care set up.These principles and practical implications are discussed in the sections below.

Empathetic Interactions and Primary Attachment Relationship
Holmes (2014) observes that an infant develops a primary attachment relationship to a primary caregiver during infancy.Where a child experiences a secure attachment with a caregiver, she not only feels secure, but she is also motivated to explore her environment and form meaningful relationships with others.However, where a child's formative experiences are of neglectful and even ad hoc care, she grows up lacking belief that others are trustworthy, or that the self is, treasured and effective (International Centre for Research and Innovation in Fostering, 2015).
When children are taken into care there is need for caregivers to display emphathy as they interact with them.It is established fact that when a child senses that their primary caregiver is expressing understanding of their feelings and emotions, they feel safe enough to open up and explore the resources within him/herself to solve the problems/issues.When clients receive empathy and know that others are like them, they embrace help from therapists (Marci, 2007).Marci further avers that therapy is most helpful when patients think their therapists empathize with them.Looked-after youth tend to be content with their treatment and tend to accept the assistance if staff members display empathetic disposition when dealing with them.At the same time, a lack of perceived empathy is one of the best predictors of a negative outcome in helping clients heal (Marci, 2007).
There is need, therefore, for care givers to see issues from the youth's perspective through setting aside their views and values and seeing things the way the youth does.Empathetic understanding entails staff understanding a youth from his/her own perspective.It means embedding ones feeling with those of a youth in order to capture what he/she is experiencing.It involves feeling with him/her rather than feeling for him/her (Mutie & Ndambuki, 2011).This way, a looked after youth will experiences a secure attachment with a caregiver which then facilitates exploration of the surroundings and formation of meaningful relationships with others.

Family Counselling and Proximity Seeking Behaviors
Holmes avers that the attachment relationship is demonstrated by the manifestation of proximity seeking which entails tendencies to seek to restore closeness, when an individual is separated from the attachment figure.It is apparent therefore that humans have an impulse to maintain intimacy, to re-establish it if weakened, and to seek help from specific individual if anxious with a situation.Looked after children are bound to experience a sense of loss when they get separared fom their original carers.However, care homes can utilise the institution of family to help manage separation anxieties.The African idea of family characteristically implies the extended one.Research has shown that family is central in existence of African people.Individuals have a shared responsibility to help one another (Gordon & Gordon, 1996).They keep track of one another and assist one another in wealth generation and caring.Strength of family ties and obligations is seen when generosity is extended to struggling members.The African family arrangement is usually the most suitable area to obtain the aid and upkeep to enhance healthy lifestyles that make children adjust easily to things.
When children are taken to care, carers there should take advantage of African family sense of obligation to members to help come up with a social unit that can facilitate proper development of looked after youth.Family consultations, debates, conversation about issues, outlet of feelings, united working of a home, collaborative synergies and joint partaking in communal events and religious rites can embed family concord and life-affirming lifestyles.This approach is vital in care homes where children often display tendencies that seek to restore closeness to the original attachment figure.(National Open University of Nigeria, 2014).

Therapeutic Environment and a Secure Base
As far as secure attachment relationship is concerned, Holmes (2014) reports that it creates a secure base from which a young person can feel safe to explore the world.Secure attachment is achieved by providing a caring style that is warm and sensitive This occurs through young people gradually internalizing events and stimuli in their environment from which they construct a model of behaviour for later interactions beyond the immediate family or care environment (Bartholomew & Horowitz, 1991).It is vital therefore that care homes offer a therapeutic environment to ensure children adapts positive tendencies.(International Centre for Research and Innovation in Fostering, 2015).
A therapeutic environment is realised via the establishment of positive, secure, healing networks and practises based on clear apprehension of shock, damaged relationships and growth needs.This may be achieved by not making psychosocial support a one off event, but ensuring it becomes part of all-encompassing, incorporated programming in the system of care.Such an environment includes: Allowing kids to partake in concerns that impact them; hearkening and reacting to their concerns; giving them room to express their emotions and desires; assisting kids to grasp their past and uniqueness; encouraging kids to define milestones and pursue their optimum; ensuring that they have affirming, cherishing networks in their life paths; facilitating family tracing and linkages providing life competences for the young, and providing them with secure rooms for fun (Ballew & Mink, 1986;Woodside & McClam, 1998).

Relaxation and Inspiration In Management of Separation Protest
Holmes (2014) reports that young people display separation protest when a primary caregiver separates from them.They overtly express distress and show behaviours that point to a need for a reunification with the attachment figure.If permanent separation from the primary attachment figure is not managed well, a child's sense of security becomes impaired which in turn reduces their propensity to explore the opportunities in their environment.In is thus imperative that caregivers manage all aattachments, (even those deemed as damaging) with respect because a child attach a lot of importance to it (International Centre for Research and Innovation in Fostering, 2015).This may be achieved through relaxing and inspiring them.
Relaxation approaches aid in tackling physiological indicators of protracted stress which arise due to separation fear among others (La Greca, Silverman, Vernberg and Prinstein ,1996).A youth is facilitated to tense and relax muscles with a help of a therapist.This according to (Scotland-Coogan & Davis, 2016) helps reduce muscle tension and body stress.In addition to tensing and relaxing muscles the mind is aided to focus on positive and pleasurable images or meditation is performed to help relax the mind.Kleiber (2000) gives a rather different perspective on the nature of relaxation exercise.He posits that encouraging an individual to make an effort to do things that are enjoyable, relaxing and recharging when experiencing difficult times is a powerful way to achieve relaxation.
There is proof that signifies that inspiring the young to get on with life regardless of challenges in beneficial as it infuses energy into them to stimulate some creative effort (Gilligan, 2002).Hence one of the key roles of caregivers in homes with youths from traumatic backgrounds is to inspire the young people and to encourage and stimulate them to engage with the life course in such a way that they begin to generate their own enthusiasm.
The caregiver can use poetry, music, and any other literature that is moving and pertains to the theme like resilience to enable youths to move beyond doubt and fear.These forms of art if chosen well can open room for the youth to find the laughter, fun, spontaneity, and creative expression in massage.In addition, a discussion about what and who inspires and motivates the youths from these artistic expressions would help build relevance between the themes covered and the practice of massage therapy (Smith, 2008).
A caregiver can help create more impact among the youth by welcoming reinforcements to help inspire the youth.This can be done through inviting guest speakers into the care home.High impact target includes persons in community who have transformed themselves, youths who have tackled tragic life situations and stood strong, and even an ex-secondary school drop-out who can testify of the value of schooling.By showing the youth multiple success stories in their own community, a care giver will increase youths' level of hope (McNulty, 2014).Inspiration of looked-after youth can also be enhanced when a caregiver make herself as available as possible to discuss problems and, more importantly, implement solutions.Teaching youth that it is normal to experience challenges in certain sections helps minimise the sense of stress and enabled them to pursue self-growth instead of fearing disappointment (McNulty, 2014).

Behaviour Modification and Internal Working Model
. Holmes (2014) avers that an internal working model develops on the basis of early attachment experiences of young people.This model acts as a template for other relationships.The nature of early life a relationships experienced by a young person, therefore, lays a foundation for for later relationships.This model is based upon the child's sense of self and their experience of others as they navigates through different interactions with agents of socialisation in the environment.Some behaviours modelled by looked after youth are undesireable and need to be altered when they enter care arrangement.This may be achieved through a phased behaviour alteration procedure.
Behaviour modification entails using a set of techniques to try and alter undesirable behaviours among the looked-after youth (ACCIK, 2014).Owing to challenges they have encountered in their backgrounds; these youths often exhibit behaviours that are undesirable and this impacts negatively on them and their relationships with others.Such behaviours may be internalised ones like low self-esteem, giving up easily, isolation and poor social connectedness.According to Smith (2016), behaviour adjustment, in line with behaviourist norms, stands on these grounds: 1) Behaviour is regulated by previous circumstances, events that take place prior to a the behaviour; 2) By consequences, that is, events that take place following a behaviour; 3) These antecedents and consequences may be altered so as to elevate or diminish the possibility of a particular behaviour modification in a care home is aimed at either: Developing a new behaviour, strengthening new behaviours children learn during care, maintaining an established behaviour, stopping inappropriate behaviour and finally altering an existing behaviour.
Many undesirable behaviours exhibited by children in care homes often results from operant conditioning where the environment they come from rewarded the behaviours either knowingly or unknowinglyhence strengthening them (ACCIK, 2014).In addition, some behaviours could have been acquired by means of classical conditioning.An example is where the looked-after children may have acquired phobias because they were classically conditioned to associate the natural response (fear) with harmless situations, objects and events.By understanding the two types of conditioning well, a counsellor in a care home setting can help modify behaviours arising from them and replace them with more desirable ones.

Critical Thinking and Emotional Intelligence As a Basis for Mature Interactions
The final principle of attachment behaviour reported by Holmes (2014) is that it continues throughout life.During childhood, attachment is immature as it is wholly dependent on caregivers.However, it mature with time and by teen years an individual learns to depend on friends and peers.However, as independence years for the youth start, it is important that they are trained to think over issues critically and also to know how to handle their emotions constructively.
Looked after youth come from different socio-cultural environment and therefore have a store house of information and varied experiences.Some of these experiences and situations are complex in nature and may not therefore be easily comprehended by them.Carers need to take them through a process where they conceptualize, analyse, synthesize, and evaluate these information and situations in order to develop clarity over issues.This will help youth chat a course of action which is well thought out.This calls on carers to engage youth in a process where they learn how to: identify a problem, Define the Context, list possible ways of solving problem, analyse possibilities, identify best course of action, and finally relooking at the whole process once again to see if there are gaps.Snyder and Snyder, 2008 posit that critical thinking is a product of education, training, and practice.It is important that carers facilitate programmes through which the youth are helped on how to solve problems.Such a training can help the youth have clearness and exactitude of their discerning as well as the deepness and extent of their thinking (Snyder & Snyder, 2008).
There is a body of research that shows that kids in care arrangement are four times highly likely to experience problems like distress, depression and unhappiness (Ford et al., 2007).Accordingly, looked-after youth desire to be helped to understand how to control such potent feelings beneficially and to keep staying determined.Mathews (2016) assert that learning to understand and handle one's emotions, will lead to a better understanding in how to deal with the emotions of others in a positive way.Carers can , therefore, assist train looked after youth grow their emotional intelligence by having in place programmes that: help them recognize their moods and its effect on others; use emotional knowledge to check on feelings from causing rash behaviour; train on how to make decisions as a result of an inner drive other than for rewards such as monetary gain; help one understand the emotions of others and using such knowledge to respond to people as per their emotional state; and finally train one on how to use emotional intelligence to facilitate interactions with others (Salovey & Mayer, 1990).In addition, care home can teach the following aspects: imploring youth to utilise good non-vocal expressions like eye movement, facial gesticulation, quality of voice and mien and gesticulation when interacting; Using humour to lessen tension or suspicion during conversation; making youth to see work and responsibilities as play; imploring youth to stay focused on goals set; Choosing the right words to use when in a conversation; Learning to let off, and identifying stratagems to diminish high excitements (trekking or strolling, do errands, watch caricatures, and any other ways besides formal engagements) (Salovey & Mayer, 1990;Machera & Machera, 2017).

CONCLUSION AND RECOMMENDATIONS
The study has put forward the key philosophies of attachment theory as promoted by Holmes (2014) and how they can be connected to psychological care activities planned for children and youth in care set up.It was established that looked after youth will experiences a secure attachment with a caregiver if carers habitually display a sense of empathetic understanding during interactions.In order to manage proximity seeking behaviours among looked after children, family contacts and counselling must be facilitated throughout the care period.It is vital also that care homes offer a therapeutic environment to ensure looked after children live in secure and nurturing surroundings.Relaxing and inspiring the looked after children can aid in tackling physiological indicators of protracted stress which arise due to separation fear from significant others.Behaviour modification techniques can be used to alter internal working model which has developed on the basis of early attachment experiences of looked after children.Finally, as children begin independent living, it is important that they are trained to think over issues critically and also to know how to handle their emotions constructively.
It is recommended that research targeting psychological care of looked after children be intensified.Approaches used ought to be situated in theories that explain how children grow and develop.Practitioners need to be assisted to link the key tenets of developmental theories and psychological based approaches used when working with looked after youth and children.In addition, there is need to enhance socio-economic initiatives at all levels to improve mental health of looked after children.