Circle Of Security-Parenting Research Articles

Enhancing attachment-based aspects of PCIT for young children with a history of maltreatment.

Disruptive behavior difficulties, such as aggression, non-compliance, and emotional outbursts, are common among children exposed to maltreatment. Parent-Child Interaction Therapy (PCIT) is an effective parenting intervention for addressing child behavior difficulties, however, treatment retention and engagement among parents remain a concern in the clinical setting. This paper describes how the delivery of an intervention that teaches attachment theory concepts (Circle of Security-Parenting, COS-P) prior to PCIT can increase engagement and retention among parents of maltreated children and inform new coaching practices. A detailed description of how to extend and integrate COS-P concepts with PCIT for maltreated families using specific strategies is provided. Recommendations, limitations, and next steps for research are presented.

The COSI trial: a study protocol for a multi-centre, randomised controlled trial to explore the clinical and cost-effectiveness of the Circle of Security-Parenting Intervention in community perinatal mental health services in England

BackgroundPerinatal mental health difficulties affect up to 27% of birthing parents during pregnancy and the first postnatal year, and if untreated are associated with difficulties in bonding and long-term adverse outcomes to children. There are large evidence gaps related to psychological treatment, particularly in group therapy approaches and parent-infant interventions. One intervention showing preliminary efficacious findings and user acceptability is Circle of Security-Parenting (COS-P), which is a brief, weekly, group programme. However, these studies were underpowered and predominantly non-randomised, and there has never been a research trial in England or with birthing parents experiencing severe and complex perinatal mental health difficulties. The aim of the research is to conduct a randomised control trial to test whether COS-P will reduce perinatal mental health symptoms in birthing parents accessing NHS perinatal mental health services, compared to treatment as usual (TAU). Secondary objectives include exploring whether the intervention improves parenting sensitivity, emotion regulation skills, attachment security and infant development. Additionally, the project aims to examine whether the intervention is acceptable to parents and NHS staff, and whether it is cost-effective.MethodsCOSI is an individually randomised, single-blind parallel arm controlled trial with an embedded internal pilot aiming to recruit 369 participants in a 2:1 ratio (intervention: TAU). Participants will be recruited from ten NHS community perinatal mental health services in England and screened based on clinical levels of both mental health symptoms (average CORE-OM score ≥ 1.1) and postnatal bonding difficulties (total PBQ score ≥ 12). This trial has 90% power to detect a MCID of 5 points on the CORE-OM. Primary and secondary outcomes will be measured at baseline, 3, 7 and 12 months after baseline. Service use and quality of life measures will also be collected alongside a process evaluation of parents’ and interveners’ views and experiences.DiscussionThis will be the first large pragmatic trial to test whether COS-P is effective for birthing parents with severe and complex perinatal mental health difficulties in improving their mental health symptoms. If shown to be effective, the intervention could be delivered widely across the NHS and other similar services globally.Trial registrationISRCTN, ISRCTN18308962. Registered 18 February 2022.

From seeing difficult behaviour to recognizing legitimate needs – A qualitative study of mothers' experiences of participating in a Circle of Security Parenting program in a public mental health setting

ABSTRACT Objective Mental health challenges can interfere with caregivers’ self-efficacy and their ability to engage with their children in developmentally appropriate ways. The goal of this study was to explore whether the intervention Circle of Security Parenting (COS-P) was experienced as a meaningful adjunct to psychological treatment. Method Individual qualitative semi-structured interviews were conducted with twelve female COS-P participants, exploring how taking part in COS-P had changed the way they related to themselves and others. Data were analyzed using a team-based, reflexive thematic analysis. Results The analysis resulted in three main themes: (i) Connecting dots: A new perspective on one’s past, (ii) Seeing oneself more clearly: Increased capacity to recognize and tend to own needs, and (iii) Gaining a map: Becoming a more competent parent. Conclusion Taking part in COS-P as an adjunct to psychological treatment positively impacted participants’ sense of competence as mothers. They used the COS-P framework to make sense of their interaction with their child, enabling them to understand the child’s behaviour and communication as expressing legitimate attachment needs. They also experienced that the course strengthened central psychological capacities, such as insight into their own developmental histories as well as increased self-awareness and self-care. Implications are discussed.

4.4 Building Community Through Circle of Security Parenting Groups in a Perinatal Psychiatry Intensive Outpatient Program: Relationships as Agents of Change

Relationships and connection are essential ingredients of healthy development. Approximately 90% of the brain is developed during the first 5 years of life and is greatly impacted by the quality of the primary caregiver relationship. Investing in this relationship through teaching attachment theory through the reflective practice that is the Circle of Security Parenting (COS-P) lays the foundation for secure attachment. This presentation illustrates the power of building community through remote COS-P groups in a perinatal psychiatry intensive outpatient program and how nourishing positive, secure relationships between the caregiver and the infant can be the most potent agents of change.

4.1 Neurobiology of Attachment and Sensitive Periods of Brain Development

The interplay of nature and nurture are primary pieces to the formation of attachment, which sets the stage for all future development. The Circle of Security Parenting (COS-P) is a powerful model to use for translating this complicated neurobiology of attachment into a powerful tool for relationship change. Clinicians are essential in bridging this language gap to improve family care.

4.2 Launching Virtual Parenting Groups in Multiple Settings and Populations

The parent-child relationship is often the first and foundational relationship for a child that then sets up a framework of how he or she will relate to others. Much of what parents know and do is learned from the way they were parented. This presentation aims to explore the implementation challenges and opportunities of an attachment-based reflective group, the Circle of Security Parenting (COS-P), virtually within the general community and within primary care pediatrics during the COVID-19 pandemic, with a focus on the unique experience of facilitating within parents of Asian American and African American heritage.

Effects of an attachment-based parent intervention on mothers of children with autism spectrum disorder: preliminary findings from a non-randomized controlled trial

BackgroundCaregivers of children with autism spectrum disorders (ASD) often experience difficulties in responding appropriately to the needs of those children, who typically express attachment in distinct and nonconventional ways. This highlights the need for an attachment-based approach targeted at caregivers of children with ASD. Circle of Security Parenting (COSP), an attachment-based parenting program, is designed to increase caregivers’ sensitivity to children’s attachment needs. The aim of this study was to provide verification of the effectiveness of COSP in mothers of children with ASD.MethodsThis study was a non-randomized controlled trial. Sixty mothers of children with ASD aged 4–12 were recruited. Twenty mothers received the COSP intervention, while 40 did not. The characteristics of children in the control group were matched with those of the intervention group. To evaluate the outcomes of the intervention, changes in parental self-efficacy and mental health were assessed using the Tool to Measure Parenting Self-Efficacy (TOPSE) and the General Health Questionnaire-30 (GHQ-30). The children’s improvement in emotional and behavioral problems was assessed from the mothers’ perspective using the Child Behavior Checklist (CBCL). Both groups completed the assessments in parallel. Evaluations were compared between baseline (T1) and 6-month follow-up (T2).ResultsScores for self-efficacy and mental health of mothers and behavior of children were significantly improved from T1 to T2 in the intervention group, but not in the control group. Participants’ mental health was markedly worsened in the control group.ConclusionThis study demonstrated that the COSP program for mothers of children with ASD improved their parental self-efficacy and mental health, and reduced their subjective sense of difficulties related to their children’s behaviors. Our findings support the effectiveness of the attachment-based program for mothers of children with ASD, providing the groundwork for further studies of the attachment-based intervention for children with ASD and their families. Future studies with larger samples and randomization are also needed for direct evaluation of the improvement of children's attachment security, and for exploration of the synergistic relationship between various family support strategies and COSP.Trial Registration This trial was registered with the University Hospital Medical Information Network Clinical Trial Registry (No. UMIN000039574)

A Mixed-Methods Study of Two Modes of the Circle of Security

Purpose: This study compared the impact, challenges, and benefits of the Circle of Security-Parenting (COS-P) intervention across two delivery modes: group center-based (GCCOS-P) and individual home-based (IHCOS-P). Methods: This mixed-methods study compared the impact of the COS-P on parental reflective functioning and parental stress across two delivery modes: GCCOS-P ( n = 7) and IHCOS-P ( n = 7). It compared the challenges and benefits of each, from the qualitative perspectives of participants ( n = 2 IHCOS-P; n = 3 GCCOS-P) and facilitators ( n = 4). Results: Quantitative statistical analysis comparing pre- and postintervention measures suggest that each delivery mode was equally effective in reducing parental stress and generally noneffective with respect to parental reflective functioning. Challenges and benefits of each mode, inherent in the peer/shared learning environment of the GCOS-P and the individualized, flexible delivery of the IHCOS-P, were identified. Discussion: This study adds to knowledge about the widely utilized COS-P, highlighting challenges and benefits of two modes of delivery.

Parent and practitioner perspectives on Circle of Security Parenting (COS-P): A qualitative study.

Circle of Security Parenting (COS-P) is an attachment-theory-informed program for parents of infants and young children. Designed for scalability, COS-P has been widely adopted internationally. Evidence for the program's effectiveness is limited, however, restricting capacity to make informed decisions about program allocation, and threatening ongoing program funding. To help address this evidence gap, this qualitative study explored the experiences and perceptions of 20 COS-P facilitators and 14 parent recipients in Australia, where COS-P uptake has been particularly widespread. Thematic analysis of combined interview and focus group data revealed a perception that COS-P primarily changes the lens through which parents view (a) their child, (b) themselves in the parenting role, and (c) the parent-child relationship, and that this was a pathway to increased empathy, compassion, and parenting confidence. Participants identified four components that underpinned program impact: key content, skills practice, group processes, and facilitator support. Although COS-P was considered suitable for broad application, limitations were noted. Findings can guide clinical application of COS-P and inform empirical research.

Examining the Effectiveness of Circle of Security Parenting (COS-P): A Multi-Site Non-Randomized Study with Waitlist Control

Recognition of the protective value of secure parent–child relationships has prompted a growing interest in parenting interventions informed by attachment theory. Circle of Security Parenting (COS-P) is one such program, specifically designed for scalability. Although widely disseminated internationally, evidence for the effectiveness of COS-P is very limited. This non-randomized controlled effectiveness study was designed to help address this gap. A sample of 256 parents of children aged 0–6 years was recruited from four community child and family health organizations. Assessments were undertaken pre- and post-intervention for the treatment group (n = 201) and at comparable times for the waitlist control group (n = 55). Analysis of data for mothers (89% of sample) revealed a significant Time x Group interaction for six of the seven outcomes examined. Compared to mothers in the control condition, treatment group mothers reported significantly: (a) improved parental mentalizing and self-efficacy regarding empathy and affection toward the child; (b) reduced caregiving helplessness and hostility toward the child; and (c) reduced depression symptoms, at the end of COS-P treatment. There was no difference between groups for change in perceived child difficultness. Within-treatment-group analyses indicated that mothers with older children reported greatest reductions in caregiving helplessness, and mothers with probable clinical depression pre-intervention reported greatest reductions in hostility and depression symptoms. Improvements in other study outcomes did not differ by depression severity or child age. Exploratory analyses indicated that treatment group fathers showed the same pattern of change as mothers. Clinical implications and directions for future research are discussed.

Talking with parents of children with learning disabilities: Parents’ ideas about the Circle of Security parenting programme

Accessible Summary The Circle of Security Parenting (COS‐P) programme can be helpful for some parents of children with learning disabilities to think about their relationship with their child. Parenting a child with learning disabilities is different, and COS‐P can highlight this difference. This can feel painful for parents and may stop them engaging with the programme. AbstractBackgroundBackground: The promotion of secure attachment relationships in childhood leads to better outcomes in later life (British Psychological Society 2017, Incorporating Attachment Theory into Practice: Clinical Practice Guideline for Clinical Psychologists Working with People who have Intellectual Disabilities). The Circle of Security Parenting Programme (COS‐P) provides a clear framework for reflecting on attachment relationships (Cooper et al 2009, Zero to Three, 37, 27).MethodsMethods: Semi‐structured interviews were conducted with parents of children with learning disabilities who attended a COS‐P programme to find out about their experiences of the course and how applicable it was to them. The data were analysed using thematic analysis.FindingsFindings: Four key themes were identified: these related to (1) COS‐P concepts are relevant to all children but (2) parenting a child with a learning disability is different and (3) COS‐P can create a focus on their child as different, which can be painful, and (4) changes recommended to make COS‐P suitable for parents of children with learning disabilities.ConclusionsConclusions: This paper outlines the benefits and challenges of COS‐P in sharing concepts related to attachment, whilst highlighting differences for parents of children and young people with learning disabilities, which can be painful.

Circle of Security-Parenting: A Systematic Review of Effectiveness When Using the Parent Training Programme with Multi-Problem Families

Introduction: Circle of Security-parenting (COS-p) is a simplified, relationship-based programme with the intention of developing parents’ observation and inferential skills related to understanding their child’s needs, increasing sensitivity to their child, aiding in emotional regulation, as well as decreasing any of their negative attributions to their child. COS-p is a widely used parenting programme that is gaining global popularity, as it is currently being delivered across several continents. Despite being one of the most frequently used interventions in Norwegian child protective services (CPS), no research has been conducted on this programme’s effectiveness when used in the CPS context. This study therefore aims to establish a systematic overview of the programme’s effectiveness for families within the CPS system, regarding both caregivers and benefits for the children. Method: The database searches were originally conducted in June 2018 and updated in April 2020, encompassing 13 international bibliographical databases. The search for grey literature was conducted, and the generated articles these were then manually searched. A non-statistical narrative approach was used to analyse the studies due to the heterogeneity of the outcome measures. Research studies on the effectiveness of COS-p intervention, where the participants reported a minimum of two specifically defined risk factors, were included for further analysis. Results: Seven studies met the inclusion criteria. The studies included in the review focus on a diversity of separate and isolated factors concerning caregivers but not the effect of the accumulation of risk factors and how this may or may not influence the potential effectiveness of COS-p. The findings’ strengths include some improvements in reducing parental stress, increasing self-efficacy and parenting skills, and promoting an understanding of child behaviour. There is no conclusive evidence that COS-p assists in increasing the security of the parent-child attachment relationship. Discussion: Given the limited number of studies, further research is needed to examine if COS-p improves child behaviour, if its effects can be sustained over time and if it is more effective for particular populations.

Attachment-based intervention improves Japanese parent-child relationship quality: A pilot study

As attachment-based interventions are widely practiced in the community, more evidence of intervention effect is necessary and there are few studies in non-Western contexts. This pilot study aimed to test the effectiveness of the attachment-based intervention, the Circle of Security Parenting (COSP) program, in an urban community in Japan. A one-group pretest, post-test, follow-up design was used. Twenty-six mothers with 1- to 6-years-old children attended group intervention sessions that consisted of COSP and additional individual video review sessions. The assessments were conducted four times for each participant: before COSP, after COSP, after the first phase of video review sessions, and 6-months after the intervention. COSP was effective in reducing parenting stress in the child domain, and the additional video reviews improved the quality of child attachment over time, as the number of children classified as secure increased at 6 months after the intervention. Mothers’ attachment representations and mothers’ stress in the parent domain did not change over time. The current pilot study provides the groundwork for further tests of the effectiveness of attachment-based interventions in Japan and other non-Western countries. Future studies with larger samples, control group, and randomization are needed including the addition of follow-up assessments to capture sleeper effects in the improvement of child attachment security, as well as the use of dimensions to capture subtle changes in attachment quality in the shorter term.

Addressing the Evidence Gap: Protocol for an Effectiveness Study of Circle of Security Parenting, an Attachment-Based Intervention.

Background: Parenting interventions informed by attachment theory are an increasingly popular choice for clinical services that work with parents of babies and young children. Circle of Security Parenting (COS-P) is one such intervention, which has had extraordinary uptake internationally. Evidence for COS-P is very limited, however; there are few published studies, most with very small samples, and findings are mixed. This paper describes a multi-site evaluation of COS-P, designed to help address this evidence gap.Methods/Design: This is a non-randomized controlled effectiveness study of COS-P in four community child and family health settings. Participants are caregivers of children aged 6 years and under, who present to study sites with parenting challenges in the early parenting period. Participants are recruited through these sites, and allocated to either treatment or waitlist control condition based on their capacity to attend the next available COS-P group. Outcomes (changes in caregiving attitudes and capacities linked to child social and emotional development, and caregiver depression symptoms) are assessed at baseline and post-treatment/waitlist using self-report questionnaires (all participants), and a narrative interview and 5-min parent-child interaction (a sub-sample of participants). Additionally, potential moderators of the intervention (demographic, symptom severity) will be tested.Discussion: This is one of the first controlled evaluations of COS-P, and the first in Australia where COS-P dissemination has been particularly widespread. Results from this study will provide valuable information about the effectiveness of COS-P for caregivers with early parenting challenges, and will increase understanding of what works for whom.

Postintervention and follow-up changes in caregiving behavior and representations after individually or group delivered hybrid Circle of Security-intensive intervention with New Zealand caregiver-child dyads

ABSTRACT The Circle of Security Intensive intervention (COS-I) aims to improve child attachment security and reduce disorganisation by improving caregiver capacities, including caregiving behavior and representations. Research on COS-I effectiveness with these goals is limited and none examines if positive changes are sustained. A recently revised hybrid COS-I protocol (COS-I-RH) incorporates Circle of Security-Parenting (COS-P) material and individual or group delivery options. We examined (1) post intervention and follow-up changes in caregiving behavior and representations after COS-I-RH and (2) if individual or group delivery moderated changes. New Zealand parent-child dyads with relationship concerns (n=36; child age M =35 months) referred to a community-based program completed COS-I-RH. Four caregiver capacities (supportive and unsupportive parenting (CTNES), parenting self-efficacy and satisfaction (PSOC)) were measured pre- and post-treatment, and one year later. Regardless of delivery mode, after COS-I-RH, parents showed large improvements on all 4 indices of caregiving behavior and representations, maintained at one-year follow-up.

Does knowing translate to doing? Practitioners' experiences of Circle of Security-Parenting (COS-P) training and implementation.

This study sought to understand how practitioners perceive and experience the Circle of Security-Parenting (COS-P) training, and further, how they integrate and implement it into practice, and how these experiences influence their use and understanding of the program and its underlying model. A thematic analysis of semistructured interviews at two time points (shortly after training and 3-6 months after training) was used to explore 12 practitioners' experiences of COS-P training and subsequent implementation. Three main themes were identified; clinical salience, personal salience, and partial use of the program. The findings reflected participants' common perception that the model is relevant and generalizable to a wide variety of contexts. It also highlighted potential barriers to implementation, particularly practitioners' experiences using only components of the COS-P program in isolation. The results suggest practitioners' assumptions about client complexities, vulnerabilities, and/or incapacities, can prompt practitioners to withhold the use of COS-P (in part or whole), thereby potentially neglecting key components required for client change. The only participants who implemented the COS-P training in full had additional training in Circle of Security.

Multifaceted Family Therapy: systemic‐dialogical therapy, circle of security parenting, mileu therapy, collaborative foster and kinship care, and more

Multifaceted Family Therapy: systemic‐dialogical therapy, circle of security parenting, mileu therapy, collaborative foster and kinship care, and more

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

This study examined the perspectives of clinicians who facilitate Circle of Security‐Parenting (COS‐P) groups in community health settings. The therapists were from two services: a specialist perinatal and infant mental health consultation service and a child at risk health service. In particular, we were interested in their perceptions of the strengths, weaknesses, challenges, and possible improvements to the model as applied to their clinical settings. Two focus group interviews, involving eight clinicians and clinical supervisors from a diverse range of professional backgrounds, were conducted by an independent interviewer. A discussion guide consisted of a series of open‐ended questions related to the participants’ experiences of delivering COS‐P. Therapists found COS‐P to be effective, feasible to deliver, user‐friendly, flexible, and generalisable to diverse client subgroups. The compassionate and non‐judgmental therapeutic stance was considered a strength of the model. Clinicians highlighted their adoption of the model across their professional and personal lives and the critical importance of supervision. In conclusion, COS‐P is a popular and promising intervention which targets the parent–child relationship that can be successfully delivered to mothers affected by moderate to severe mental health problems.

Learning to provide children with a secure base and a safe haven: The Circle of Security-Parenting (COS-P) group intervention.

Insecure attachment is linked to a host of negative child outcomes, including internalizing and externalizing behavior problems. Circle of Security-Parenting (COS-P) is a manualized, video-based, eight unit, group parenting intervention to promote children's attachment security. COS-P was designed to be easily implemented, so as to make attachment interventions more widely available to families. We present the theoretical background of COS-P, research evidence supporting the COS approach, as well as a description of the COS-P intervention protocol. The case example of "Alexa," mother of three children (aged 7, 6, and 4 years), illustrates how parents can make use of the COS-P intervention to better understand children's needs, build skills in observing and interpreting children's signals, learn to recognize and regulate their own responses to their children, and learn new ways of responding to children's needs.

Adding "Circle of Security - Parenting" to treatment as usual in three Swedish infant mental health clinics. Effects on parents' internal representations and quality of parent-infant interaction.

This study presents effects of adding Circle of Security-Parenting (COS-P) to an already established comprehensive therapeutic model for early parent-child intervention in three Swedish infant mental health (IMH) clinics. Parents' internal representations and quality of parent-infant interaction were studied in a clinical sample comprised of 52 parent-infant dyads randomly allocated to two comparable groups. One group consisted of 28 dyads receiving treatment as usual (TAU) supplemented with COS-P in a small group format, and another group of 24 dyads receiving TAU only. Assessments were made at baseline (T1), 6 months after inclusion (T2) and 12 months after inclusion (T3). Changes over time were explored in 42 dyads. In the COS-P group, the proportion of balanced representations, as assessed with Working Model of the Child Interview (WMCI), significantly increased between T1 and T3. Further, the proportion of emotionally available interactions, as assessed with Emotional Availability scales (EA), significantly increased over time in the COS-P group. Improvements in the TAU-group were close to significant. Limitations of the study are mainly related to the small sample size. Strength is the real world character of the study, where COS-P was implemented in a clinical context not otherwise adapted to research. We conclude by discussing the value of supplementing TAU with COS-P in IMH treatment.