Attachment and Safety in Health Settings

Healthy attachment to primary caregivers is at the heart of a child’s ability to relate to others. Children who experience ongoing and persistent exposure to complex trauma, including from their primary caregivers, will often be fearful, disorganised or avoidant or be overly affectionate or familiar, or constantly hugging people they do not know, as a result of lived experience of intergenerational trauma.

Those working on the frontline often see behaviours that are the result of what is occurring in the home environment and broader community. Health professionals do not know what happens to a person between one visit and the next. What is important is how we see these behaviours and make meaning from them in their professional roles and how we respond.

Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.

Bessel A. van der Kolk

This fundamental principle of safety highlights the importance of respectful relationships that are developed throughout the life course. Early relationships, such as with family members, educators and health workers, are some of the first significant relationships children develop.

A felt sense of safety

In a health context, an understanding of what the behaviour is telling us helps us to respond appropriately.

The role health workers can play in creating a felt sense of safety to allow co-regulation and support the child’s development is vital to successful treatment in a range of health settings.

In order to build a safe, caring, nurturing and consistent environment for all children and their parents and carers, health workers need to consider what is happening to the child in the family context, rather than making judgements about their behaviour or reacting without understanding where it is coming from.

Building trust and rapport with families enables open conversations that give insights into a range of issues and deepens understanding of the person's environment.

A felt sense of safety is vital for all of us to thrive.

Polyvagal theory

It is important that in trying to deliver quality health services, we recognise the layers of trauma and disadvantage that some families experience.

Stephen Porges developed the Polyvagal theory that explains that people with lived traumatic experiences are adversely affected by what they have been exposed to. He talks about the importance of creating a calm and regulated environment where vulnerable people can feel better, think better and connect better.

Creating a a calm and regulated environment

According to Porges, safety is a relational experience that becomes embedded in our physiology. As children grow, they are the sum of the experiences they have in their early years. When they are surrounded by perceived danger, their development is impeded. Optimal conditions require a calm, consistent and regulated environment.

We all need to be regulated ourselves in order to help others regulate.

Essentially, the role of health workers and all those working with children is to embrace collective understandings and a shared language about trauma and its effects on those living with it. Healthy childhood development cannot happen until trauma is addressed and we create safe and calm environments, along with strong and nurturing relationships with the child and their families.

Complex, multiple traumas

The effects of complex, multiple traumas are often the underlying causes of the most chronic problems in urban, regional and remote communities. Although trauma may be central to many people’s challenges, in health care, education and social service settings their trauma is often not identified, understood or acknowledged.

Those affected by trauma therefore often do not receive the appropriate care they need, and are at risk of being re-traumatised by the systems that seek to serve them. Every service and support organisation, including health settings, plays an important role in supporting trauma recovery.