Multiple exclusion homelessness, attachment and relationship with care : a missing link?

Abstract

The overlap of issues experienced by those at the sharp end of society in conjunction with the absence of a comprehensive framework for meeting the needs of these severely disadvantaged individuals is evident in existing literature. Sporadic and uncoordinated encounters, premature disengagement, and difficult interactions between service users and support staff are commonly reported by support service providers. Childhood adversity, mental health difficulties, substance misuse and other experiences of social exclusion are prevalent within the homeless population and affect their relationship with support. This study argues that a focus on attachment can produce valuable insights into why and how people with experience of Multiple Exclusion Homelessness (MEH) relate to services in ways that can often be challenging for staff. The study set out to examine the attachment styles and relating patterns of individuals with experience of MEH when engaging with support services. It further aimed to look into staff members’ emotional and cognitive responses to people with complex needs and insecure attachments. A total of 30 participants who had experience MEH were interviewed and four focus groups involving a total of 19 front-line staff members were conducted. Service users’ attachment styles, the degree of insecurity, the quality of the support context and the ability to access support in times of need were assessed through a standardised interview (Attachment Style Interview). Follow-up interviews and questionnaires looked at the relationship with support services and adversity in early and later life. Finally, a vignette technique was applied to focus attention on four highly insecure attachment styles that staff members come across in their daily work. Results showed that the dual/disorganised attachment style was the most prevalent (n=22), and the support context and quality of close relationships was found to be particularly poor amongst participants with experience of MEH. Further analysis revealed that attachment processes limited the capacity for healthy functioning, whilst also being an important influence upon interactions between staff and service users. These findings highlight the potential utility of an attachment-based approach in homeless services, and indicate that understating service users’ attachment styles allows for prediction of and more effective responses to likely patterns of interaction in these settings.