Can Parenting Intervention Prevent Cascading Effects From Placement Instability to Insecure Attachment to Externalizing Problems in Maltreated Toddlers?

Abstract

Multiple placement changes disrupt continuity in caregiving and undermine well-being in children in child welfare. This study conducted secondary data analysis of a randomized controlled trial to examine whether a relationship-based intervention, Promoting First Relationships© (PFR), reduced risk for a maladaptive cascade from placement instability to less secure attachment to elevated externalizing problems. Participants included caregivers (birth or foster/kin) of toddlers (10–24 months) recently transitioned to their care because of child welfare placement decisions. Although main effects of PFR on security and externalizing problems were not previously observed, this study’s results revealed that PFR attenuated the association between multiple placement changes (baseline) and less security (postintervention), and that the indirect effect of placement instability on greater externalizing problems (6-month follow-up) via less security was evident only in toddlers in the comparison condition. These findings shed light on how a history of multiple caregiver changes may influence toddlers’ risk for poor adjustment in subsequent placements, and the promise of supporting caregivers through a parenting intervention to prevent such risk.

Does Parents’ Own History of Child Abuse Moderate the Effectiveness of the Promoting First Relationships® Intervention in Child Welfare?

“…Findings from a prior RCT of PFR in toddlers who had recently entered a new foster/kinship placement or were reunified (Spieker et al, 2012) indicate potential benefits of PFR for reducing risk of poor behavioral outcomes in children who have experienced unstable placements. Specifically, a maladaptive cascade from a history of multiple placement changes to less secure base behavior to greater externalizing problems was mitigated in children whose caregivers participated in PFR versus a control intervention (Pasalich, Fleming, Oxford, Zheng, & Spieker, 2016). The current findings converge with, and extend, these past results, by demonstrating more potent effects of PFR in another high-risk subpopulation of families involved in child welfare—those headed by parents with a physical abuse history.…”

Promoting First Relationships®

“…In our prior RCT, we found positive main effects on competence but not problem behavior (Spieker et al, 2012). We also found, however, a moderated mediation, such that for toddlers with a history of more placements, PFR predicted greater secure base behavior, which in turn buffered them against the development or exacerbation of externalizing problems (Pasalich et al, 2016). Similarly, for a subsample of 43 reunified children and their birth parents in the same RCT, we found stronger effects ( d = .55–.57) on problem behavior (Oxford, Marcenko, et al, 2016).…”

“…In both studies we did not find main effects of PFR on child secure base behavior, at least up to 6 months post-intervention when children were just under two years of age. In follow-up analyses of our prior RCT we found an interaction between PFR and secure base behavior, such that for toddlers with a history of multiple placements, PFR improved secure base behavior (Pasalich et al, 2016). In the current study, thus far, we have only found a PFR main effect for fewer displays of child atypical affective communication on the TAS-45.…”

“…In this study we assessed secure base behavior with the five-card sort that had been used in the ECLS-B study (Andreassen et al, 2006), as opposed to the trilemma sort version we used in our prior study (Pasalich, Fleming, Oxford, Zheng, & Spieker, 2016; Spieker et al, 2012). Across both sorting methods, results using the TAS-45 in our two studies have been mixed.…”

Comparison of the Effectiveness of Family Therapy Program Based on Attachment and Emotion on Anxiety Disorder and Behavior of Gifted Adolescents

“…In addition, the findings of the present study have been tested with studies that have demonstrated the effectiveness of attachment-based interventions in reducing childhood and adolescence problems, such as insecure attachment problems (Diamond et al, 2010), and child anxiety problems (Allen, Timmer, Urquiza, 2014). Sleep problems (Moretti, et al, 2015), adolescent anxiety problems (Siqueland, et al, 2005), externalized problems, and behavioral disorders (Pasalich, et al, 2016) are consistent.…”