Family reunification or restoration refers to the safe return of children from out-of-home care to their biological families or relatives. Reunification has been identified as a policy priority in Australia. This is in large part because of concerns about the long-term effects of removals on children, in particular on Aboriginal children, and in part because reunification is one of the few potentially permanent pathways out of care. Increasing reunification rates has proved harder to achieve in practice (AIHW, 2019).

As both Farmer (2018), Fernandez (2013) and Fernandez and Lee (2013) point out, reunification success (which is usually defined as a period of at least six to 12 months of stability after the return home) is more likely when programs involve intensive and flexible support; parental support and training; practical support; where there have been changes in family composition (e.g., abusive or disruptive person has moved out); and where the reason for being in care was not severe abuse or neglect or serious ongoing family conflict (see Farmer, 2018 for a comprehensive review). However, significant neglect and abuse are common antecedents to the enforced removal of children from their birth families in the context of intergenerational trauma, including in families where reunification is being seriously considered.

Another related difficulty is that a substantial percentage of reunification attempts fail after the children return home. Neil, Gitsels, and Thoburn (2019), in a recent review article, identify that between 45% and 65% of children who are returned to birth parents re-enter care within five years. These children, who are subjected to further neglect, abuse, and re-removal suffer additional harm. It is understandable that this is an outcome that statutory services strive to avoid.

Trauma in child protection

The purpose of this paper is to describe the inclusion of a trauma-responsive intervention in a case work-based reunification service, using two illustrative case studies. In child protection contexts, trauma in any generation can arise from a range of factors. Some of these factors can be structural (e.g., lack of employment, housing difficulties) so that the parent is faced by significant external pressures that subsume their resources to such an extent that it results in neglect or abuse of the child. In addition, many parents experience emotional, mental, and physical health vulnerabilities, including substance misuse, as a result of chronic exposure to trauma in intimate relationships and severely disrupted attachment relationships in infancy (Thompson, 2018). This compounds the effects of structural disadvantage. Parents from First Nations or Aboriginal backgrounds are known to be particularly at risk as a result of previous colonisation histories or forced removal policies. We also recognise the significant association between out-of-home care in parents and the likelihood that their own children will either be notified or enter care (Wall-Wieler et al., 2018).

Thompson (2018), referring to trauma experienced in infancy, childhood, and adulthood identifies that unresolved traumatic stress in a parent is a powerful contributor, not only to parenting difficulties, but also with regard to poor engagement with statutory agencies. She argues that unless the traumatic stress resulting from chronic and early interpersonal traumatisation, and the associated difficulties with forming trusting and open intimate relationships, is resolved, efforts at reunification will be compromised.

The conceptual approach informing the integration of trauma-responsive care into traditional social casework has been described by Amos, Furber, and Segal (2011), Amos (2017), and Amos, Segal, and Cantor (2015) and incorporated into a therapeutic framework adopted by the reunification service. The authors synthesised findings from attachment research with high-risk families (Lyons-Ruth & Jacobitz, 1999; Lyons-Ruth, Yellin, Melnick, & Atwood, 2005; Liotti, 2011; Liotti & Gilbert, 2011), structural dissociation of the personality (Van der Hart, Nijenhuis, & Stell, 2006), a social-systems understanding of mammalian adaptations to resource poor and traumatising environments (Kortmulder & Robbers, 2005), and concepts from psychodynamic and learning theories.

The model asserts that elevated levels of unresolvable fear and shame are central to intergenerational transmission of neglect and abuse. The parent's fear and shame from their infancy is reactivated by parenthood, leading to disrupted emotional communication between the parent and their infant (Lyons-Ruth, Yellin, Melnick, & Atwood, 2005). Acute episodic maltreatment of the child by their parent is understood as the parent's attempt to stabilise the reactivation of fear and shame evoked by the presence of their infant/child (Amos, Furber, & Segal, 2011). Chronic struggles for power in these parent–child relationships are understood as attempts to utilise competitive relationship dynamics to establish a tense, low-level equilibrium which paradoxically provides stability at the expense of emotional relatedness (Amos, Segal, & Cantor, 2015).

This model has been used to predict the objectives of any effective intervention to break the cycles of intergenerational transmission of child maltreatment. These are to identify and process trauma-related emotion, including overwhelming fear and shame, disrupt the reliance on competitive relationship dynamics, support cooperation, and help the parent differentiate themselves from their child, so that the child is seen as a separate individual with their own identity and agency (Amos & Segal 2018).

The reunification service

The reunification service discussed here is provided by a large non-government agency, Centacare Catholic Family Services in Adelaide, Australia. The service integrates practical support to address structural disadvantage with focused therapeutic interventions to address the traumatic origins of less-than-optimal parenting. The team comprises a full-time manager and senior practitioner, seven full-time equivalent (FTE) reunification workers, and 0.3 FTE child and adolescent psychiatrist in a specialist therapist role. The program is funded by the state-wide statutory child protection service to provide intensive support to families where children have been removed by the statutory authority and placed in care.

The children in the service are generally subject to short-term court orders or agreements, between three and 12 months in duration, although the team also provides services to adolescents subject to long-term orders who may have been in out-of-home care for many years. The broad purpose of these services is to support families to address the concerns that led to the removal of the child/ren or adolescents so that they can safely return to their birth family, without statutory oversight.

In 2019–2021, the time period addressed in this report, the reunification service provided voluntary, home visiting services of up to 12 months' duration. Families received up to 11 service hours per week (inclusive of all casework tasks). Family reunification contracts defined eligible families as those whose children were under the custody or guardianship of the statutory authority, where the case plan was reunification/restoration to birth family. In the 2019/2020 time period the service worked with 72 families and in the subsequent year, 55 families.

In this paper, we illustrate how one component of the therapeutic intervention, the Adult Exploration of Attachment Interview (AEAI; Chambers, 2012), helped address the trauma underlying compromised parenting identified by the statutory service as a barrier to reunification.

The Adult Exploration of Attachment interview

The AEAI was developed by Chambers (2012) as a way of addressing unwanted influences from the family of origin, with parents, in family therapy, by assisting them to overcome repetitive and unhelpful relationship patterns in intimate relationships, such as parent–child relationships. Based in attachment theory, Chambers recognises adults are often confused by episodes of intense emotional arousal that impinge on their ability to be the parents they want to be. These reactions are thought to stem from the painful repetition of implicitly encoded relational procedures originating in the traumatising relationships in the parent's infancy and early childhood, which contain information about what parents and children can expect from one another, passed unconsciously from generation to generation.

The AEAI is one part of a semi-manualised four-stage intervention, Parallel Parent and Child Therapy (P-PACT) (Chambers, Amos, Allison, & Roeger, 2006; Amos, Beal, & Furber; 2007). P-PACT has been used in child and adolescent mental health services and private practice in Australia and New Zealand. There is research supporting its use in families where the care and protection of children is compromised but the children remain in the care of their families (Furber, Amos, Segal, & Kasprzak, 2013).

The AEAI was identified by the reunification service as a structured process that could facilitate workers to explore with parents how experiences of trauma in their early attachment relationships impact their parenting. This extends the use of the AEAI, as children in this cohort have been removed because of serious concerns for their safety, we hypothesise, secondary to trauma the parents have experienced in their infancy and early childhood.

Initially the AEAI was delivered by the specialist therapist. Over a period of three years therapeutic caseworkers have taken over the delivery of the AEAI. Prior to therapeutic case workers delivering the AEAI they were required to undertake the full AEAI process with a colleague, both as a participant and facilitator, under the direct supervision of the lead specialist therapist. This followed a period of shadowing the lead therapist during client sessions, alongside formal educational input to develop an understanding of the underpinning theoretical model. The AEAI is now offered to most parents accessing the reunification service. The uptake has steadily increased, with more than 50% of parents now accepting the invitation to explore their AEAI.

During the AEAI the therapeutic caseworker and parent explore in detail what the parent has learned about parent–child relationships based on their own experiences of seeking care and being cared for (Chambers, 2012). Initially the therapeutic caseworker guides the parent in constructing a genogram. Although the client is an adult, the genogram places emphasis on their position as child. This helps to turn the parent's attention to their own childhood experiences and enables the parent and their therapeutic caseworker to identify individuals who played important caregiving roles in their childhood and adolescence.

The second step involves the therapeutic caseworker and client constructing a series of maps of the internal working model for each significant caregiver. This process is guided by two questions: 1) What did you learn from your caregiver about being a parent? and 2) What did you learn from your caregiver about being a child? (Chambers, 2012). Key skills for therapeutic caseworkers include helping the client to explore memories, stories, and gut feelings about their childhood experiences of care; and creating generalised statements about being a parent or being a child from these accounts of their relational experiences. A booklet containing the maps is then created and a copy is given to the parent.

The role of the therapeutic caseworker is to help the parent to verbalise (or make explicit) what otherwise might be a hidden or implicit process and to develop a conceptual framework or ‘map’ that might explain the relationship between Their own experiences and interactions with their child. The storytelling process often reveals a confusing mix of cooperative and competitive patterns of family interactions across generations.

Recognition of these patterns serves to: a) reduce shame and self-blame by contextualising difficulties with parenting; b) provide a coherent narrative and new meaning to their situation; and c) help separate out what aspects of the parenting identity and behaviour are a function of the parent's early circumstances and relational trauma. In addition, by developing empathy for themselves as a child, they are able to strengthen their own identity, whilst increasing their capacity to empathise with their child/children. These outcomes meet the theoretically derived objectives of effective treatment discussed earlier.

Through this process the parent develops conscious awareness of the aspects of their parenting template that fit with the parent they want to be and those that do not. The automaticity of these implicitly encoded experiences means that they often continue to intrude on the parent–child relationship. However, with the booklet of maps as a resource, these beliefs can be re-examined at tough times to understand how the past is influencing the parent–child relational system, and support further work towards change.

Case studies illustrating AEAI as part of a broader reunification program

This paper presents two case studies that used the AEAI process with fathers as part of the reunification program delivered by Centacare Catholic Family Services and funded by the jurisdiction's child protection agency. Ethics approval for the publication of case studies was provided by the University's Human Research Ethics Committee (approval number: H-2017-230). Pseudonyms are used and potentially identifying descriptions have been adapted to protect the anonymity of interview respondents. In both cases the pathway to full reunification was complex. These illustrations do not provide details of the entire casework intervention but consider how the inclusion of the AEAI supported the reunification process in two families where the statutory agency had concerns about the viability of reunification. In each case the process was identified by the participants as exceedingly difficult emotionally. This was reflected in missed sessions and intermittent difficulties with emotional engagement with the AEAI process. Both were able to complete the process with the support and encouragement of their workers.

Case 1: Gary

Case presentation

By the time Gary engaged with the reunification service he was a single parent. His infant had been removed from his and his partner's care at birth, after experiencing withdrawal symptoms having been born affected by illicit substances. The infant was aged six months when Gary was referred to the reunification service and reunification occurred when the infant was 16 months.

In early childhood Gary was cared for by his father, who had a disability. In early adolescence Gary rejected his father and returned to the care of his mother and stepfather. He was introduced to drugs and became the victim of sexual exploitation. His mother and stepfather enabled the abuse in exchange for cheaper supplies of illicit drugs. Gary began using substances regularly from age 14, resulting in a significant period of chronic use, and associated criminal activity. Gary had three children and began treatment after his third child (the infant in question) was removed at birth. He had been clean for four months when the statutory child protection agency seriously considered reunification. Gary had been unable to secure the return of his two older children because of ongoing substance misuse.

The AEAI

Gary was initially reluctant to engage in the AEAI. He had worked with several different therapists over the preceding decade and did not want to revisit painful memories of his relationships with his parents, or decisions he had made in relation to criminal behaviour. A traumatic incident almost precipitated a relapse into drug use and the end of efforts at reunification, providing the motivation for Gary to participate in the AEAI. Engagement was conditional on the specialist therapist and therapeutic caseworker structuring the AEAI in a way that enabled Gary to focus on good, rather than difficult, memories.

The AEAI initially focused on Gary's biological father and was conducted over three sessions. Three pages of positive statements about being a child and being a parent were collected by the therapists. These are summarised in Table 1. Gary reflected on numerous positive activities that parents do with their children, for example, bike riding, reading, fantasy games, community events, building aviaries.

It became evident that during his adolescent years, Gary experienced a complete rupture in his relationship with his father, precipitated by extreme bullying at school, compounded by his father's underlying disability and inability to respond to the needs of a complex adolescent. This was when he reconnected with his mother. The AEAI helped Gary to reflect on this experience and find alternative narratives that explained the breakdown of his relationship with his father (summarised in Table 2).

Reconnecting with his mother marked the beginning of Gary's drug addiction and interpersonal trauma. Gary struggled to uncover positive statements about his mother, only being able to construct two positive statements from his early childhood (summarised in Table 3). He remained unwilling to explore other aspects of their relationship.

Towards the end of the process, Gary started to become protective of his mother. This new development was interpreted as the beginning of an understanding of the vulnerabilities that can lead to poor parenting, both in his mother and in himself. Gary was able to feel some empathy for himself and his failure to look after his children, two of whom had been placed in long-term foster care.

Only then Gary was able to identify how his parenting affected his children. After making this connection, Gary was able to recall an example of when he was unable to provide the emotional support his son needed when he was distressed and how completely alone his son would have felt at that time. It was an emotionally devastating but pivotal moment for Gary to draw parallels between how his son felt and how he had felt with his own biological mother. The awareness of his own enduring and painful loneliness slowly translated into Gary becoming more emotionally available and actively engaged with his son and his needs.

Gary also identified a friend of his mother who acted as a source of significant support for him. Gary described how she had ‘adopted’ him when he was 12 and she was 24 and how they had continued to have a strong friendship. Gary provided several positive statements about this relationship (summarised in Table 4). This aspect of the AEAI continued to solidify Gary's understanding of the positive templates he could draw on for parenting. The Circle of Security-Parent (COS-P) was also completed to embed these templates as the ones to guide his future parenting.

When he was finally reunified with his 16-month-old son, Gary's son quickly showed a strong preference for Gary over his foster mother who had cared for him since he was removed at birth. At childcare when both Gary and the foster mother were present, the child sought out his biological father as his key attachment figure. This demonstrated to Gary how attachments could be repaired and how healthy attachments can continue to form with multiple attachment figures throughout development. Gary and the foster mother remained in contact, and she became part of the child's extended family network. As time passed, contact with the foster mother became less frequent but has not completely ceased.

Case 2: Peter

Case presentation

Peter was a single parent working through the reunification process with his two young children (aged two and three). The primary reason for the removal of the children was the severe domestic violence perpetrated by Peter against his wife and the mother of his children, for which he had been incarcerated. Additional concerns included Peter's mental health issues, anger, a tendency to coercive control in intimate relationships, drug and alcohol misuse, and the physical and medical neglect of his children. At the time of referral to the reunification service Peter was homeless and had been alternating between rough sleeping and couch surfing. Through the coordinated support of multiple services, Peter obtained accommodation that was considered suitable for him to live with two of his children. Peter's children had been out of his care for 23 months at the time of full reunification.

Peter's children had suffered significant trauma which was exacerbated by frequent placement changes when they entered care. They were initially placed in kinship care with their maternal grandmother but, after this broke down, one child entered a specialist foster care placement and the other child was placed with another family member. The children were displaying behavioural issues, including tantrums, hoarding food, emotional withdrawal, and dissociation.

The AEAI

On initial presentation, Peter had limited insight into how his violent behaviour had affected his children. He had already engaged in therapy aimed at resolving his drug and alcohol problems, domestic violence, and related anger issues. Concerns were still raised in a psychological report that Peter had no capacity for empathy, minimising his children's experience of his violence and blaming others for his behaviour. For example, on one occasion Peter broke every window in the family's home while the children were inside. He was unable to see the impact on the children as his conscious intent was to intimidate their mother. The assessor concluded that without developing a capacity for empathy, Peter would not able to understand or respond to his children's needs.

The AEAI was used to explore and increase Peter's capacity for empathy, by drawing on examples from Peter's own childhood. When Peter was able to see the impact of his father's behaviour on him as a child, through the lens of being a child again, he could then see the impact of his adult behaviour on his children (Table 5).

Peter realised that the meaning that he had made of his father's violence towards him was that Peter as a child was so powerful, bad, destructive, and evil, his father had to use violence to control him. Peter was also able to identify the interaction when he first used aggression and violence himself (Table 6).

Through the AEAI, the therapists observed changes in Peter's language and tone of voice, where previously he had argued, challenged, or disagreed with his worker, particularly on topics such as domestic violence and anger management, Peter began to collaborate with his worker. Peter described the AEAI process as ‘challenging’ and ‘confronting’ but that he ‘got a lot out of it’ and would recommend the process for others.

Discussion and Practice Recommendations

The principal aim of the AEAI is to assist parents to understand how their experiences of trauma in their early relationships with their caregivers affect their parenting relationships with their own children in the present. Through a process of supported self-reflection, rather than one focused on guilt and shame, participating in the AEAI helped the parents described here to articulate what otherwise might have remained hidden.

The therapy helped both parents to develop conscious awareness of the aspects of their internal working models of parenting that were both helpful and unhelpful. For example, Gary was able to draw on the positive statements about his relationship with his own father and reframe the breakdown of this relationship. Gary would later remark that this was the first time he had been supported to explore the positive aspects of his early life. He was also able to identify and understand the vulnerabilities that led to his mother's poor parenting that he was mirroring in his own parenting. This encouraged feelings of understanding and forgiveness towards his mother and, by extension, towards himself. Uncovering this more positive internal working model enabled Gary to access the internal working model of the more functional relationship with his father that would be the foundation for becoming the father he wanted to be to his infant. As Gary progressed through the AEAI he was able to draw more automatically on the positive parenting templates that he had identified, but that had previously been obscured by his memories of trauma.

For Peter, understanding the impact of his father's and stepfather's violence on him as a child helped him to identify that one of his children may have understood Peter's family violence as necessary to control his inherent ‘badness,’ just as Peter had done. Although this insight brought Peter face-to-face with the devastating fact that he had harmed his own children and continued the traumatic cycle that he had wished to avoid, he was able to use this awareness constructively in interactions with his son. This began a process of self-forgiveness, similar to that experienced by Gary.

Indeed, a key to progress for both fathers was building ‘empathy’ for themselves through a process of awareness. By reflecting and becoming aware of how their parents' behaviours had affected them as children, both fathers were able to identify how these experiences had influenced their own parenting practices and the effects this had on their own children. Thus, by beginning the process of forgiveness, they were able to make progress towards more nurturing and positive parenting practices and to begin the process of repairing the relationships with their own children.

Two processes supported the successful introduction of the AEAI into the program. These were the requirement for therapeutic caseworkers to experience the AEAI as both participant and facilitator, and being able to access regular clinical supervision. These training and supervision requirements supported skill-building in the early stages of delivering the AEAI and reduced the risk of the therapeutic caseworkers' own vulnerabilities and protective strategies (known and hidden), influencing the therapeutic process. Therapeutic caseworkers have indicated that this has provided them with scaffolding and the confidence to engage parents in, at times, difficult and emotive conversations that support ‘deeper’ reflection.

The AEAI was a significant part of the therapeutic intervention, provided alongside a wider program of work. There were differences between traditional approaches to therapy and the way that the AEAI was delivered. Therapy and casework were combined to create a therapeutic reunification casework process, balancing the therapeutic component of sessions and support for other day-to-day needs including issues relating to life/household management and practical parenting strategies. The process of affording equal importance to the therapeutic requirements of parents and their practical needs within the ‘safety’ of their own home helped the integration of therapeutic insights into everyday life. Practical tasks also provided in-the-moment and unscripted challenges that were incorporated into the therapeutic work. This approach enabled therapeutic caseworkers to highlight the parent's strengths and challenges providing immediate opportunities for positive feedback and development of alternative narratives in real time. Embedding the therapy within everyday tasks afforded an element of ‘control’ and a sense of ‘equality’ to parents and appeared to be a less confronting and more manageable experience compared with more ‘traditional’ office-based therapeutic interventions.

These case studies and the experience of embedding the AEAI into a service setting where therapy would normally be outsourced provide encouragement that, with robust training and ongoing supervision, structured therapeutic interventions such as the AEAI can be safely and successfully incorporated into nonclinical service settings. Our recommendation would be for family-based support services in non-mental health settings to incorporate trauma-responsive interventions such as the AEAI into their programs. This would increase access to trauma-responsive treatments for some very vulnerable and traumatised families.

Limitations and Research Implications

Evaluating interventions of this nature is challenging. When interventions are individualised and tailored to the complex needs of individual families, it is difficult to isolate which elements or factors are linked with outcomes (Malvaso & Delfabbro, 2020). As highlighted by Fraser et al. (1996), it is also difficult to establish whether case success is due to existing intentions or readiness for reunification as opposed to the nature of the intervention provided. However, as Malvaso and Delfabbro (2020) argue, it is important to report that programs can demonstrate success irrespective of the selective nature of reunification samples.

These case reports although encouraging are anecdotal and more rigorous evaluation is required. Further research is planned. This includes contacting parents who have worked with this reunification service to determine the longevity of the placements and understand from their perspective which interventions they identify as most useful. In addition, these outcomes will be mapped against the interventions that were provided to examine whether stability of reunification can be linked to the provision of the AEAI, or a particular combination of interventions. As the number of parents engaging with the AEAI has increased, the North Carolina Family Assessment Scale (Kirk, Kim, & Griffith, 2005) is being incorporated into routine outcome measurement, to begin to generate empirical data.

Conclusion

Although it is not possible to generalise more broadly to all families being considered for reunification, the therapeutic approaches highlighted in this paper indicate that focusing on intergenerational trauma can assist parents in reframing parent–child relationships in ways that lead to observable behavioural changes in parenting that can facilitate successful reunification. At the time of drafting this paper, to our knowledge, the children continued to be cared for by their families.