Effectiveness of the circle of security intervention in an Australian community-based clinical population: a consecutive cohort study
thesisposted on 27.03.2022, 21:49 by Angelika Therese Huber
The Circle of Security intensive intervention (COS) is based on attachment theory and aims to promote secure parent-child attachment relationships. Despite extensive uptake of the approach, there is still limited empirical evidence regarding its efficacy, or its effectiveness as a treatment approach with at risk and referred populations. The current research, consisting of three separate studies, seeks to fill a gap in this evidence by testing the use of the Circle of Security intervention with a sample of families referred to an Australian community clinical service with concerns about their young children's behaviour. Archived pre- and post-intervention data were analyzed from 83 clinically referred caregiver-child dyads (child age: 13-88 months) who completed the Circle of Security intervention in sequential cohorts and gave permission for their data to be included in the study. The first study considered questions about the efficacy of the intervention : specificallywhether participation in the 20-week Circle of Security intervention resulted in positive caregiver-child relationship change in four domains: caregiver reflective functioning; caregiver representations of the child and the relationship with the child; child attachment security, and attachment disorganization. Caregivers completed the Circle of Security Interview, and dyads were filmed in the Strange Situation Procedure before and after the intervention. Results supported all four hypotheses: caregiver reflective functioning, caregiving representations, and indices of child attachment security increased after the intervention, and indices of attachment disorganisation decreased for those with high baseline scores. Those whose scores were least optimal prior to intervention showed the greatest change in all domains. This study adds to the evidence suggesting that the 20-week Circle of Security intervention results in significant relationship improvements for caregivers and their children, in line with intervention aims. The next study examined the efficacy and effectiveness of intervention in improving child behavioural and emotional functioning in the referred sample of families who completed the intervention (n = 83). Parents (and teachers, when available) completed questionnaires assessing child protective factors, behavioural concerns, internalising and externalising problems, prior to and immediately after the intervention. The following were considered as potential moderators: child gender and age; parent representations; reflective functioning; child attachment indices; and severity of presenting problems prior to treatment. Results showed significant improvement for parent ratings of child protective factors, and fewer behavioural concerns (internalising and externalising symptoms); children with more severe problems showed most improvement. Teachers also reported improvements, but change was significant only for externalising problems. Findings suggest the intensive Circle of Security intervention is effective in improving child behavioural and emotional functioning in clinically referred children aged 1-7 years. The third study examined the effectiveness of the attachment-based Circle of Security 20-week intervention (COS) in improving parent emotional functioning in the referred population of families who completed the intervention (n = 83). Parenting stress and parent psychological symptoms were assessed pre and post intervention, and mixed design repeated measures (ANOVAs) were used to assess change. Severity of presenting problems was considered as a moderator. Results showed clinically significant improvements in both aspects of parent emotional functioning, with change explained by those with more severe problems at the outset. Improvements were associated with improvements in child behaviour and more positive parent representations of the child and of parenting capacity. Findings suggest the intensive COS intervention is effective in reducing parenting stress and psychological symptoms in parents of children aged 1-7 years. Questions remain about the mechanisms of change and the direction of effects. The findings of the current research add to evidence that the intensive Circle of Security intervention is efficacious in improving the parent-child relationship (achieving the primary aims of the intervention). The research also indicates that the intervention is effective in a real-world clinical context with moderate to high-risk families referred with child behavioural and emotional problems. Results show that the intervention approach was successful in engaging and retaining most families in the treatment, and resulted in statistically and clinically significant reductions in both child and parent symptoms of dysfunction. While there were some substantial limitations to this research, notably the absence of a control group, findings address a significant gap in evidence for the Circle of Security intensive intervention. Important questions are also raised that warrant further investigation, including whether parent behaviour also changes after the intervention, and what the mechanisms of change are. Other theoretical and clinical implications are also discussed, including questions about the construct and measurement of reflective functioning, the value of dimensional measures of attachment and caregiving representations and the likely (but unmeasured) contribution of the therapeutic process to outcomes seen. A novel contribution of the current research was the development of a coding tool to measure caregiving representations on the Circle of Security interview, with research and clinical application. The current research concludes that the Circle of Security Intervention is effective in a treatment context with moderate to high risk families of children aged 1 up to 7 years, referred with child behavioural and emotional difficulties not only in improving parent-child relationships, but also in reducing child and parent symptoms of distress, and that the most troubled families showed most benefit. Further research is needed, comparing outcomes from this version of the intervention with those of other child behaviour interventions, other attachment based interventions and other forms of the Circle of Security intervention to clarify what works for whom.