Skip to main content
SpringerLink
Log in

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

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

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.

Highlights

  • This is one of few studies of the popular COS-P intervention that includes a control condition.

  • Parents receiving COS-P reported greater improvements than control group parents.

  • Mothers with likely clinical depression pre-intervention reported greatest reductions in hostility towards the child and depression symptoms.

  • Mothers with pre-schoolers reported greatest reductions in caregiving helplessness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Abel, K. M., Hope, H., Swift, E., Parisi, R., Ashcroft, D. M., Kosidou, K., Osam, C. S., Dalman, C., & Pierce, M. (2019). Prevalence of maternal mental illness among children and adolescents in the UK between 2005 and 2017: a national retrospective cohort analysis. The Lancet Public Health, 4(6), e291–e300.

    Article  Google Scholar 

  • Ainsworth, M. D. S. (1964). Patterns of attachment behavior shown by the infant in interaction with his mother. Merrill-Palmer Quarterly of Behavior and Development, 10(1), 51–58.

    Google Scholar 

  • Bandura, A. (1996). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior (Vol. 4, pp. 71–81). Academic Press.

  • Bauer, D. J., Sterba, S. K., & Hallfors, D. D. (2008). Evaluating group-based interventions when control participants are ungrouped. Multivariate Behavioral Research, 43(2), 210–236.

    Article  Google Scholar 

  • Bellis, M. A., Hughes, K., Ford, K., Rodriguez, G. R., Sethi, D., & Passmore, J. (2019). Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. The Lancet Public Health, 4(10), e517–e528.

    Article  Google Scholar 

  • Berlin, L. J., Dodge, K. A., & Reznick, J. S. (2013). Examining pregnant women’s hostile attributions about infants as a predictor of offspring maltreatment. JAMA Pediatrics, 167(6), 549–553. https://doi.org/10.1001/jamapediatrics.2013.1212.

    Article  PubMed  PubMed Central  Google Scholar 

  • Berlin, L. J., Zeanah, C. H., & Lieberman, A. F. (2016). Prevention and intervention programs to support early attachment security: a move to the level of the community. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment (3rd ed., pp. 739-758). The Guilford Press.

  • Blanca, M. J., Alarcón, R., Arnau, J., Bono, R., & Bendayan, R. (2017). Non-normal data: Is ANOVA still a valid option? Psicothema, 29(4), 552–557. https://doi.org/10.7334/psicothema2016.383.

    Article  PubMed  Google Scholar 

  • Bloomfield, L., & Kendall, S. (2012). Parenting self-efficacy, parenting stress and child behaviour before and after a parenting programme. Primary Health Care Research & Development, 13(4), 364–372. https://doi.org/10.1017/S1463423612000060.

    Article  Google Scholar 

  • Bowlby, J. (1982). Attachment and loss Volume I: Attachment. Basic Books. (Original work published 1969).

  • Caldwell, J. G., Shaver, P. R., Li, C.-S., & Minzenberg, M. J. (2011). Childhood maltreatment, adult attachment, and depression as predictors of parental self-efficacy in at-risk mothers. Journal of Aggression, Maltreatment & Trauma, 20(6), 595–616. https://doi.org/10.1080/10926771.2011.595763.

    Article  Google Scholar 

  • Callender, K. A., Olson, S. L., Choe, D. E., & Sameroff, A. J. (2012). The effects of parental depressive symptoms, appraisals, and physical punishment on later child externalizing behavior. Journal of Abnormal Child Psychology, 40(3), 471–483. https://doi.org/10.1007/s10802-011-9572-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cassidy, J., Brett, B. E., Gross, J. T., Stern, J. A., Martin, D. R., Mohr, J. J., & Woodhouse, S. S. (2017). Circle of Security–Parenting: A randomized controlled trial in Head Start. Development and Psychopathology, 29(2), 651–673. https://doi.org/10.1017/S0954579417000244.

    Article  PubMed  PubMed Central  Google Scholar 

  • Coleman, M. (2014). An attachment-based parenting training program for opiate dependent carers. Journal of Addiction Research & Therapy, 5(4), 1–7. https://doi.org/10.4172/2155-6105.1000201.

    Article  Google Scholar 

  • Cooper, G., Hoffman, K., & Powell, B. (2018). Circle of Security Parenting: A relationship based parenting program. Facilitator DVD Manual. (Original work published 2009).

  • Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-Item Edinburgh postnatal depression scale. British Journal of Psychiatry, 150(6), 782–786. https://doi.org/10.1192/bjp.150.6.782.

    Article  Google Scholar 

  • Cox, J. L., Chapman, G., Murray, D., & Jones, P. (1996). Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. Journal of Affective Disorders, 39(3), 185–189. https://doi.org/10.1016/0165-0327(96)00008-0.

    Article  PubMed  Google Scholar 

  • Demetriou, C., Ozer, B. U., & Essau, C. A. (2015). Self‐report questionnaires. In R. L. Cautin & S. O. Lilienfeld (Eds.), The encyclopedia of clinical psychology (Vol. 5, pp. 1–6): John Wiley & Sons, Inc.

  • Diamond, C. (2014). Keeping baby in mind: The development of a maternal reflective functioning scale for primary health services [Unpublished doctoral dissertation]. James Cook University.

  • Fonagy, P., Steele, M., Steele, H., Moran, G. S., & Higgitt, A. C. (1991). The capacity for understanding mental states: the reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12(3), 201–218.

    Article  Google Scholar 

  • Frieden, T. R. (2017). Evidence for health decision making: Beyond randomized, controlled trials. New England Journal of Medicine, 377(5), 465–475. https://doi.org/10.1056/NEJMra1614394.

    Article  Google Scholar 

  • Gardner, F. (2000). Methodological issues in the direct observation of parent–child interaction: do observational findings reflect the natural behavior of participants? Clinical Child and Family Psychology Review, 3(3), 185–198.

    Article  Google Scholar 

  • Gardner, F., Leijten, P., Melendez‐Torres, G., Landau, S., Harris, V., Mann, J., Beecham, J., Hutchings, J., & Scott, S. (2019). The earlier the better? Individual participant data and traditional meta‐analysis of age effects of parenting interventions. Child Development, 90(1), 7–19. https://doi.org/10.1111/cdev.13138.

    Article  PubMed  Google Scholar 

  • George, C., & Solomon, J. (1996). Representational models of relationships: Links between caregiving and attachment. Infant Mental Health Journal, 17(3), 198–216.

    Article  Google Scholar 

  • George, C., & Solomon, J. (2011). Caregiving helplessness: The development of a screening measure for disorganized maternal caregiving. In J. Solomon & C. George (Eds.), Disorganized attachment and caregiving (pp. 133–166). The Guilford Press.

  • Hammar, Å., & Årdal, G. (2009). Cognitive functioning in major depression-a summary. Frontiers in Human Neuroscience, 3, 26 https://doi.org/10.3389/neuro.09.026.2009.

    Article  PubMed  PubMed Central  Google Scholar 

  • Horton, E., & Murray, C. (2015). A quantitative exploratory evaluation of the Circle of Security––parenting program with mothers in residential substance-abuse treatment. Infant Mental Health Journal, 36(3), 320–336. https://doi.org/10.1002/imhj.21514.

    Article  PubMed  Google Scholar 

  • Hutchings, J., Bywater, T., Daley, D., Gardner, F., Whitaker, C., Jones, K., Eames, C., & Edwards, R. T. (2007). Parenting intervention in Sure Start services for children at risk of developing conduct disorder: Pragmatic randomised controlled trial. British Medical Journal, 334, 678–685. https://doi.org/10.1136/bmj.39126.620799.55.

    Article  PubMed  Google Scholar 

  • IBM. (2019). Statistical package for the social sciences (Version 26.0).

  • Jones, T. L., & Prinz, R. J. (2005). Potential roles of parental self-efficacy in parent and child adjustment: a review. Clinical Psychology Review, 25(3), 341–363. https://doi.org/10.1016/j.cpr.2004.12.004.

    Article  PubMed  Google Scholar 

  • Kendall, S., & Bloomfield, L. (2005). Developing and validating a tool to measure parenting self‐efficacy. Journal of Advanced Nursing, 51(2), 174–181.

    Article  Google Scholar 

  • Kim, M., Woodhouse, S. S., & Dai, C. (2018). Learning to provide children with a secure base and a safe haven: the Circle of Security‐Parenting (COS‐P) group intervention. Journal of clinical psychology, 74(8), 1319–1332. https://doi.org/10.1002/jclp.22643.

    Article  PubMed  Google Scholar 

  • Kochanska, G., Radke‐Yarrow, M., Kuczynski, L., & Friedman, S. L. (1987). Normal and affectively ill mothers’ beliefs about their children. American Journal of Orthopsychiatry, 57(3), 345–350.

    Article  Google Scholar 

  • Kohlhoff, J., & Barnett, B. (2013). Parenting self-efficacy: links with maternal depression, infant behaviour and adult attachment. Early Human Development, 89(4), 249–256. https://doi.org/10.1016/j.earlhumdev.2013.01.008.

    Article  PubMed  Google Scholar 

  • Kohlhoff, J., Stein, M., Ha, M., & Mejaha, K. (2016). The circle of security parenting (COS-P) intervention: Pilot evaluation. Australian Journal of Child and Family Health Nursing, 13(1), 3–7.

    Google Scholar 

  • Lecompte, V., & Moss, E. (2014). Disorganized and controlling patterns of attachment, role reversal, and caregiving helplessness: links to adolescents’ externalizing problems. American Journal of Orthopsychiatry, 84(5), 581–589. https://doi.org/10.1037/ort0000017.

    Article  Google Scholar 

  • Luyten, P., Mayes, L. C., Nijssens, L., & Fonagy, P. (2017). The parental reflective functioning questionnaire: development and preliminary validation. PLoS ONE 12(5), e0176218. https://doi.org/10.1371/journal.pone.0176218.

  • Lyons-Ruth, K., & Jacobvitz, D. (2016). Attachment disorganization from infancy to adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications. 3rd ed. (pp. 667–695). The Guilford Press.

    Google Scholar 

  • Matijasevich, A., Munhoz, T. N., Tavares, B. F., Barbosa, A. P. P. N., da Silva, D. M., Abitante, M. S., Dall’Agnol, T. A., & Santos, I. S. (2014). Validation of the Edinburgh postnatal depression scale (EPDS) for screening of major depressive episode among adults from the general population. BMC Psychiatry, 14, 284.

    Article  Google Scholar 

  • Matthey, S., Barnett, B., Kavanagh, D. J., & Howie, P. (2001). Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. Journal of Affective Disorders, 64(2–3), 175–184.

    Article  Google Scholar 

  • Matthey, S., Henshaw, C., Elliott, S., & Barnett, B. (2006). Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale – implications for clinical and research practice. Archives of Women’s Mental Health, 9(6), 309–315. https://doi.org/10.1007/s00737-006-0152-x.

    Article  PubMed  Google Scholar 

  • Maupin, A. N., Samuel, E. E., Nappi, S. M., Heath, J. M., & Smith, M. V. (2017). Disseminating a parenting intervention in the community: Experiences from a multi-site evaluation. Journal of Child and Family Studies, 26(11), 3079–3092. https://doi.org/10.1007/s10826-017-0804-7.

    Article  Google Scholar 

  • Maxwell, A.-M., McMahon, C., Huber, A., Hawkins, E., & Reay, R. E. (2020). Addressing the evidence gap: Protocol for an effectiveness study of Circle of Security Parenting, an attachment-based intervention. Frontiers in Global Women’s Health, 1, 575752. https://doi.org/10.3389/fgwh.2020.575752.

  • McCall, R. B., & Green, B. L. (2004). Beyond the methodological gold standards of behavioral research: Considerations for practice and policy. Social Policy Report, 18(2), 1–20.

    Article  Google Scholar 

  • Moore, T. G., Arefadib, N., Deery, A., & West, S. (2017). The first thousand days: an evidence paper. https://www.rch.org.au/uploadedFiles/Main/Content/ccchdev/CCCH-The-First-Thousand-Days-An-Evidence-Paper-September-2017.pdf.

  • Murray, L., Cooper, P., & Fearon, P. (2014). Parenting difficulties and postnatal depression: Implications for primary healthcare assessment and intervention. Community Practitioner, 87(11), 34–38.

    PubMed  Google Scholar 

  • National Scientific Council on the Developing Child. (2015). Supportive relationships and active skill-building strengthen the foundations of resilience: Working Paper 13. http://www.developingchild.harvard.edu.

  • Pazzagli, C., Laghezza, L., Manaresi, F., Mazzeschi, C., & Powell, B. (2014). The Circle of Security Parenting and parental conflict: A single case study. Frontiers in Psychology, 5, 1–10. https://doi.org/10.3389/fpsyg.2014.00887.

    Article  Google Scholar 

  • Powell, B., Cooper, G., Hoffman, K., & Marvin, B. (2014). The Circle of Security intervention: Enhancing attachment in early parent–child relationships. The Guilford Press.

  • Prior, M., Sanson, A., Smart, D., & Oberklaid, F. (2000). Pathways from infancy to adolescence: Australian Temperament Project 1983-2000. https://aifs.gov.au/sites/default/files/institute/pubs/resreport4/aifsreport4.pdf.

  • Risholm Mothander, P., Furmark, C., & Neander, K. (2018). 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. Scandinavian Journal of Psychology, 59(3), 262–272. https://doi.org/10.1111/sjop.12419.

    Article  PubMed  Google Scholar 

  • Ruppert, D. (2006). Trimming and winzorization. In S. Kotz, C. B. Read, N. Balakrishnan, B. Vidakovic, & N. L. Johnson (Eds.), Encyclopedia of Statistical Sciences. John Wiley & Sons, Inc.

  • Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical psychology review, 34(4), 337–357. https://doi.org/10.1016/j.cpr.2014.04.003.

    Article  PubMed  Google Scholar 

  • Scheeringa, M. S., & Zeanah, C. H. (2001). A relational perspective on PTSD in early childhood. Journal of Traumatic Stress, 14(4), 799–815.

    Article  Google Scholar 

  • Sleed, M., Slade, A., & Fonagy, P. (2018). Reflective functioning on the parent development interview: validity and reliability in relation to socio-demographic factors. Attachment & Human Development, 1–22. https://doi.org/10.1080/14616734.2018.1555603.

  • Stern, J. A., Borelli, J. L., & Smiley, P. A. (2015). Assessing parental empathy: a role for empathy in child attachment. Attachment & Human Development, 17(1), 1–22. https://doi.org/10.1080/14616734.2014.969749.

    Article  Google Scholar 

  • The Longitudinal Study of Australian Children, Wave 2. (2006). Australian Institute of Family Studies. https://growingupinaustralia.gov.au/sites/default/files/w5-w2-02-p1lb.pdf.

  • Thompson, R. A. (2016). Early attachment and later development: Reframing the questions. In J. Cassidy & P. R. Shaver (Eds.), Handbook of Attachment: Theory, Research and Clinical Applications (3rd ed., pp. 330–348). The Guilford Press.

  • Woodhouse, S. S., Powell, B., Cooper, G., Hoffman, K., & Cassidy, J. (2018). The Circle of Security Intervention: Design, research and implementation. In H. Steele & M. Steele (Eds.), Handbook of attachment-based interventions (pp. 50–78). The Guilford Press.

  • Zeegers, M. A., Colonnesi, C., Stams, G.-J. J., & Meins, E. (2017). Mind matters: a meta-analysis on parental mentalization and sensitivity as predictors of infant–parent attachment. Psychological Bulletin, 143(12), 1245–1272. https://doi.org/10.1037/bul0000114.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the collaboration of our four partner agencies, their managerial staff and clinicians: Tresillian Family Care Centres; Raphael Services NSW, St John of God Healthcare Social Outreach; ACT Health Perinatal and Infant Mental Health Consultation Service; Marymead Centre for Early Life Matters. We would also like to acknowledge the families who gave their time to participate in this study. We are grateful for research assistance provided by Caitlin Hamilton (material preparation), Emma Smith and Kate Wright (data collection), Sijal Ansari, Aswathi Neelakandan and Saddha Fernando (data entry), and Naomi Sweller (statistical advice). This study was funded by Macquarie University Higher Degree Research Fund & an Australian Government Research Training Scholarship (as part of the university’s PhD provision for AM) and Canberra Hospital Private Practice Fund (a competitive minor grant awarded to RR).

Author information

Authors and Affiliations

  1. Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia

    Anne-Marie Maxwell, Catherine McMahon & Anna Huber

  2. Academic Unit of Psychiatry and Addiction Medicine, ANU Medical School, Australian National University, Acton, ACT, 2601, Australia

    Rebecca E. Reay

  3. Menzies Health Institute Queensland, School of Applied Psychology, Griffith University, Gold Coast, QLD, 4222, Australia

    Erinn Hawkins

  4. School of Psychiatry, University of New South Wales, Kensington, NSW, 2052, Australia

    Bryanne Barnett

Authors
  1. Anne-Marie Maxwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherine McMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Huber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rebecca E. Reay
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erinn Hawkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bryanne Barnett
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne-Marie Maxwell.

Ethics declarations

Conflict of Interest

Anne-Marie Maxwell facilitates COS-P groups in her work with a non-profit organization, and Dr Anna Huber facilitates one COS-P facilitator training session per year, for which she receives payment from Circle of Security International. All other authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maxwell, AM., McMahon, C., Huber, A. et al. Examining the Effectiveness of Circle of Security Parenting (COS-P): A Multi-Site Non-Randomized Study with Waitlist Control. J Child Fam Stud 30, 1123–1140 (2021). https://doi.org/10.1007/s10826-021-01932-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-021-01932-4

Keywords

Search

Navigation