Circle of Security–Parenting: A randomized controlled trial in Head Start

Abstract

Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security–Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial randomized controlled trial of the efficacy of COS-P sets the stage for further exploration of “what works for whom” in attachment intervention.

Clinician Perspectives on the Circle of Security‐Parenting (COS‐P) Program: A Qualitative Study

“…The generalisability of the COS‐P program has been evident in previous studies that have concluded its efficacy in a number of settings and populations. For example, COS‐P has been successfully delivered to low‐income families in Head Start program (Cassidy et al., ); parents with infants under two years (Kohlhoff, Stein, Ha, & Mejaha, ); mothers in residential substance‐abuse treatment (Horton & Murray, ); and mothers with depressive symptoms (Maupin et al., ).…”

Helping, Sharing, and Comforting in Young Children: Links to Individual Differences in Attachment

“…Participants were 137 three‐ to five‐year‐old children ( M = 4.32 years; SD = 0.50; 79 female; 91 African American), recruited from four Head Start centers in low‐income Baltimore neighborhoods as part of a randomized controlled trial (RCT) of an attachment‐based parenting intervention (Cassidy et al., ). Participation was restricted to children and their mothers, who were also required to be the primary caregiver and to live with the child.…”

Does Training in the Circle of Security Framework Increase Relational Understanding in Infant/Child and Family Workers?

“…Cassidy et al. () found no main effects of intervention for child attachment, child executive functioning, or child behavior problems after a randomized controlled trial of 10 sessions of COS‐P with low‐income parents with children enrolled in Head Start programs. They did find that mothers who participated in COS‐P reported fewer unsupportive responses to child distress than did control mothers, and intervention effects emerged for some child outcomes moderated by mothers’ attachment style or depressive symptoms, suggesting that further work should explore if COS‐P might benefit some dyads and not others.…”

“…Two small studies ( n = 15 in each) have reported different benefits with different samples: increased parent reflective functioning, decreased caregiving helplessness and reduced anger and rejection toward the child in an Australian sample (Kohlhoff, Stein, Ha, & Mehaja, 2016), and improved emotion regulation and more positive parent attributions and discipline practices in American mothers with substance‐abuse problems (Horton & Murray, ). Limitations of these studies (with the exception of the studies by Cassidy et al., ; Cassidy et al., ) include very small sample sizes, no control conditions, and no follow‐up assessments to see if gains are maintained. Furthermore, research has not yet examined whether characteristics of intervention facilitators are related to outcomes.…”