The role of child-keyworker attachment in the residential care of Saudi children

Abstract

Background It has been shown that the carer-child relationship is highly important for the wellbeing and development of children residing in care homes. The quality of staff attachment, or child attachment to the staff, affects the quality of life, development and behaviour of children in residential care homes. There is a need for further study regarding the effects that the characteristics of care staff in terms of attachment of staff on child outcomes in orphanages. In Saudi Arabia orphaned children are still cared for in orphanages, although foster care does take place. For social and economic reasons there has been an increase in the number of these children, and while the material provision in terms of facilities is of a high standard, due to the economic wealth of the country, there is a lack of proper emotional care due to a lack of understanding of the importance of carers as attachment figures. Added to this problem is the fact that Saudi orphanage staff are poorly trained and managed, not well paid and overworked, which could have a detrimental effect on the children in their care. Aims Therefore, the present study aims to investigate the role of attachment in the carer – child relationship and current problems and challenges in the provision of routine care and support by carers in residential care in Saudi Arabia, with focus on staff-child interactions. Methods A mixed methods approach was adopted, involving a qualitative study to explore staff perceptions of the problems and challenges in providing care, and a quantitative study to provide data about the moderating and mediating effects of attachment on children’s mental wellbeing. The quantitative study was a longitudinal study carried out in two phases with a 12- month gap and included Study-I and Study-II. The research investigates the mediating effect of child attachment between staff related factors and child behavioural problems, thus was hypothesised that the quality of child attachment to the care staff would mediate the effects of staff attachment style, staff burnout and staff psychological distress on child psychological distress. Furthermore, how staff related factors which include, in addition to staff attachment, burnout and staff psychological distress moderate the impact of child attachment on child psychological distress. To achieve this specialist questionnaires were used. Results The qualitative study (Study I) revealed problems in delivering care to children, issues of social development, how social needs are fulfilled, fostering activities, mechanisms for integrating children into the social stream and behavioural issues. Moreover, it was revealed that staff were deprived of adequate training, career opportunities and suffered poor working conditions. Study-II found that staff attachment avoidance moderates the effect of child attachment avoidance on child distress. Moreover, the effects of staff general distress on the child behavioural problems were moderated by the staff attachment style for interaction avoidance, while the effects of staff burnout were moderated by all child attachment styles. Study-III found that child attachment security at time 2 mediated the effects of both staff attachment and anxiety and avoidance at time 1 on child psychological distress at time 2. Also, child security at time 2 mediated the effects of staff burnout and general distress at time 1 on child distress at time 2. These findings suggest that attachment styles of staff to the children affect the psychological wellbeing of the children. Also, these results suggest that the staff’s undesirable characteristics lead to greater child psychopathology through the development of an insecure staff-child bond. Conclusion Overall, the study has implications for the appropriate provision of care which includes attachment figures, to ensure the proper psychological development of the children and avoid behavioural problems. The study highlights the need for and importance of secure child-staff attachment and how the lack of training, psychological support for staff, and understanding of attachment and psychological needs of the children can have detrimental effects.