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Disseminating a Parenting Intervention in the Community: Experiences from a Multi-Site Evaluation

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Journal of Child and Family Studies
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Angela N. Maupin
Angela N. Maupin
Angela N. Maupin
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Emily Samuel at Yale-New Haven Hospital
Emily Samuel
Susan Nappi at Yale University
Susan Nappi
Jennifer M. Heath
Jennifer M. Heath
Jennifer M. Heath
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Abstract

Circle of Security-Parenting (COS-P) is a widely used parenting intervention that is gaining popularity globally as it is currently being delivered across several continents. Despite the global uptake of COS-P, there is limited research on its effectiveness with considerable variability in its delivery. Here we present a multi-site evaluation of the group delivery of COS-P to under-resourced mothers (n = 131 enrolled) in an urban community as facilitated by community-based providers (n = 12) from community sites (n = 6) that provide maternal and child services. The feasibility and acceptability of delivering COS-P in the community are highlighted as well as characteristics of sites and providers as they relate to implementation efforts, and pre and post-intervention data examining COS-P and maternal caregiving functioning (i.e., depressive symptoms, reflective functioning) are also included. Several service delivery barriers were encountered at agency, provider and participant levels that created obstacles for program dissemination, participant retention and evaluation. Nonetheless, COS-P was successfully delivered in the community when sites embedded the program within their existing infrastructure and had the internal capacity for delivery, participant recruitment, supervision, and community presence. Mothers who participated in COS-P also reported fewer depressive symptoms following the intervention (n = 25). This multi-site implementation and evaluation study has important implications for the delivery of parenting services to under-resourced communities globally. Implications for future research and service delivery are discussed.
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J Child Fam Stud (2017) 26:3079–3092
DOI 10.1007/s10826-017-0804-7
ORIGINAL PAPER
Disseminating a Parenting Intervention in the Community:
Experiences from a Multi-Site Evaluation
Angela N. Maupin
1
●Emily E. Samuel
1
●Susan M. Nappi
2
●Jennifer M. Heath
2
●
Megan V. Smith
1,3
Published online: 5 June 2017
© Springer Science+Business Media New York 2017
Abstract Circle of Security-Parenting (COS-P) is a widely
used parenting intervention that is gaining popularity
globally as it is currently being delivered across several
continents. Despite the global uptake of COS-P, there is
limited research on its effectiveness with considerable
variability in its delivery. Here we present a multi-site
evaluation of the group delivery of COS-P to under-
resourced mothers (n=131 enrolled) in an urban commu-
nity as facilitated by community-based providers (n=12)
from community sites (n=6) that provide maternal and
child services. The feasibility and acceptability of delivering
COS-P in the community are highlighted as well as char-
acteristics of sites and providers as they relate to imple-
mentation efforts, and pre and post-intervention data
examining COS-P and maternal caregiving functioning (i.e.,
depressive symptoms, reflective functioning) are also
included. Several service delivery barriers were encountered
at agency, provider and participant levels that created
obstacles for program dissemination, participant retention
and evaluation. Nonetheless, COS-P was successfully
delivered in the community when sites embedded the pro-
gram within their existing infrastructure and had the internal
capacity for delivery, participant recruitment, supervision,
and community presence. Mothers who participated in
COS-P also reported fewer depressive symptoms following
the intervention (n=25). This multi-site implementation
and evaluation study has important implications for the
delivery of parenting services to under-resourced commu-
nities globally. Implications for future research and service
delivery are discussed.
Keywords Circle of Security-Parenting ●Parenting
intervention ●Community providers ●Program evaluation ●
Service delivery
Introduction
The child mental health field has seen a rapid proliferation
of preventive and clinical parenting programs (Kaminski
et al. 2008), a majority of which have been studied under
tightly controlled conditions that fail to translate or replicate
in the community or real world settings (Bumbarger and
Perkins 2008; Freire et al. 2015). Moreover, parenting
interventions have traditionally been delivered by trained
clinicians to typically homogeneous populations—scenarios
that are difficult to replicate in the community due to
population differences, limited resources and available staff.
Thus, only a small number of families are ultimately
engaged, limiting the accessibility of preventive, treatment,
and potentially beneficial programming to under-resourced
families. Understanding how best to deliver clinical services
and interventions to parents and communities remains a
significant public health challenge.
Provision of accessible parenting programs requires
rethinking traditional individualized service delivery (Prinz
and Sanders 2007). Large scale implementation of inter-
ventions delivered by non-traditional providers who work
*Angela N. Maupin
angela.maupin@yale.edu
1
Child Study Center, Yale University School of Medicine, New
Haven, CT, USA
2
United Way of Greater New Haven, New Haven, CT, USA
3
Department of Psychiatry, Yale University School of Medicine,
New Haven, CT, USA
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Повечето програми предвиждат сесии веднъж седмично, но има и такива, които оставят по-дълъг период между сесиите с цел натрупване на лични преживявания и опит. Едно изследване не отчита продължителност на сесията (Rostad et al. 2015), а три не уточняват брой участници в група (Adkins, Luyten & Fonagy 2018;Adkins et al. 2021;Maupin et al. 2017). ...
... В сесиите на програмата акцентът е върху емоциите, емоционалната регулация, ментализационните стратегии и теми, специфични за родители на деца от аутистичния спектър. Две от изследванията са върху адаптации на програмата "Кръг на сигурността" -групов формат за родители (COS-P) (Maupin et al. 2017) и DVD вариант (Rostad 2014). Програмите включват разнообразни компоненти -психообразователна част, дискусия относно родителството и ментализирането, учене чрез преживяване, домашна работа, включително задачи за деца и родители у дома, тренинг на умения, гледане на видео материали и обсъждането им, ролеви игри и предварително подготвени материали за участниците в програмата. ...
... В изследването на Adkins et al. (2021) контролната група получава обичайната, предлагана на приемни родители интервенция, докато Alkabez-Esquenazi et al. (2021) използва контролна група от типа "списък на чакащи". Три са програмите, изследвани с дизайн на нерандомизирано контролирано проучване (Adkins et al. 2018;Bammens et al. 2015;Enav et al. 2019), едно с квазирандомизирано контролирано проучване (Rostad et al. 2015), едно с квазинерандомизирано контролирано проучване (Menashe-Grinberg et al. 2021) и две с квазиекспериментален дизайн "тест преди и след" (Maupin et al. 2017;Midgley et al. 2019). За измерване на ефекта от интервенцията са използвани различни самоописателни въпросници, полуструктурирани и неструктурирани интервюта и задачи за изпълнение (табл. ...
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... Research demonstrates the efficacy of the COSP TM intervention, in terms of facilitating change in parents' ability to cope with their children's emotional needs (Maxwell, McMahon, Huber, Reay, Hawkins & Barnett, 2021). Nonetheless, the sample sizes in some of the studies were small and results were based on non-experimental designs (Maupin, Samuel, Nappi, Heath & Smith, 2017). Moreover, most of the existing research involves evaluating parental change using self-report rather than measuring observed behaviors (for an exception, see Risholm Mothander, Furmark & Neander, 2018). ...
... It is contended that the PEM measure would be able to capture shifts in the caregiver's quality of interactive behavior with the infant., Moreover, as parental mentalizing seems to be an important capacity involved in the intervention (Maupin et al., 2017;Maxwell et al., 2021), an outcome measure of parental mentalizing would be important to better understand the role parental mentalizing indeed plays in promoting the intervention aims, especially in infancy. Finally, it appears that the practice applied in COSP TM , namely, watching and discussing parent-infant interactions, fosters and promotes the parent's embodied mentalizing capacities. ...
... This is somewhat surprising because some previous studies have reported significant effects of COSP TM on similar outcomes measured using self-reports (Cassidy et al., 2017;Horton & Murray, 2015;Kohlhoff, Stein, Ha & Mejaha, 2016). Nonetheless, others have failed to document such results (e.g., Maupin et al., 2017). These null findings could be explained by the small sample size, which had enough power enabled us to detect only large effects, thus limiting the ability to reveal less robust significant differences between the groups. ...
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Supported by a large body of work demonstrating the impact of infant attachment representations on subsequent development, numerous therapeutic programs have been developed to promote secure attachment, with increasing focus on parental mentalizing. Nonetheless, empirical evidence supporting their effectiveness has yet to be fully established. The current pilot study ( N = 24) was designed to evaluate whether and to what extent parents' shifts in parental mentalizing following a brief attachment‐based group intervention, namely circle of security parenting (COSP; Cooper, Hoffman & Powell, 2009) can be captured using the parental embodied mentalizing instrument (PEM; Shai & Belsky, 2017). Compared to a waiting list–control group, this small‐scale study examined whether community‐based low‐risk mothers of infants aged 5–48 months show an increase in their observed PEM capacities following the intervention. Secondary self‐reported outcome variables parental stress, feeling of competence, and self‐compassion. Findings show that PEM ratings improved significantly over time in the COSP group, but not in the control group. Intervention group mother–infant dyads also presented significantly longer embodied interactions communication post intervention compared to the control group. No effects of the COSP on parental stress, competence, or self‐compassion were found. Despite the small sample size, these results tentatively suggest that COSP can improve embodied mentalizing abilities.
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... More recently, COS-P was found to improve parental mentalizing and self-efficacy and reduce caregiving helplessness and hostility in a multisite non-randomized waitlist control study (Maxwell et al., 2021). In contrast, three studies investigating whether COS-P can improve parental RF found no effect (Gray, 2015;Maupin et al., 2017;Zimmer-Glembeck et al., 2022). ...
... It is important to note that the present findings regarding COS-P effects on RF do stand in contrast with some previous research (e.g. Gray, 2015;Maupin et al., 2017;Zimmer-Gembeck et al., 2022). One possible explanation for this is the sensitivity of the RF measure we used Journal of Child and Family Studies given our population of study compared to self-report RF measures used in many other studies. ...
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... Mom Power (MP) Muzik et al. (2015), USA "+" n/a "+" n/a n/a n/a n/a n/a n/a K. Rosenblum et al. (2018), USA "+" n/a n/a n/a n/a n/a n/a n/a n/a Franz et al. (2011), Germany n/a n/a n/a n/a n/a "+" n/a n/a n/a Weihrauch et al. (2014), Germany n/a n/a n/r n/a n/a n/r n/a n/a n/a Huber et al., (2015aHuber et al., ( , 2015b, Australia "+" n/a n/a "+" n/a n/a n/a baseline presenting problems n/a Kohlhoff et al. (2016), Australia "0" n/a n/a n/a "+" n/a n/a n/a n/a Maupin et al. (2017), USA "0" n/a "+" n/a n/a n/a n/a n/a n/a Maxwell et al. (2021), Australia "+" n/a "+" n/a n/a n/a n/a n/a n/a Sadowski et al. (2022), Australia "+" n/a n/a n/a "+" n/a n/a n/a n/a ...
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... Previous research show that there are challenges in introducing and using, both COS-VF and the original group model, in mental health and social services (Hoffman et al., 2006;Nielsen et al., 2020). One study also indicated that even with the supposedly "simplest" of the COS models (i.e., COS-P), it can be difficult to use the intervention in its entirety as intended (Maupin et al., 2017). Currently, there are few studies, with some notable exceptions such as Maupin and colleagues (2017), that have systematically investigated aspects of attachmentbased interventions, which may have important consequences for their uptake, use, and implementation in practice. ...
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  • Nov 2015
  • INFANT MENT HEALTH J
Circle of Security is an attachment theory based intervention that aims to promote secure parent-child attachment relationships. Despite extensive uptake of the approach, there is limited empirical evidence regarding efficacy. The current study examined whether 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. Archived pre- and postintervention 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. 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 level of child attachment security increased after the intervention, and level of attachment disorganization decreased for those with high baseline levels. 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.
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After randomised trials: issues related to dissemination of evidence‐based interventions
Article
  • Apr 2008
Demonstrating the efficacy and effectiveness of prevention programmes in rigorous randomised trials is only the beginning of a process that may lead to better public health outcomes. Although a growing number of programmes have been shown to be effective at reducing drug use and delinquency among young people under carefully controlled conditions, we are now faced with a new set of obstacles. First, these evidence‐based programmes are still under‐utilised compared to prevention strategies with no empirical support. Second, when effective programmes are used the evidence suggests they are not being implemented with quality and fidelity. Third, effective programmes are often initiated with short‐term grant funding, creating a challenge for sustainability beyond seed funding. We discuss each of these challenges, and present lessons learned from a large‐scale dissemination effort involving over 140 evidence‐based programme replications in one state in the US.
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Widening the Circle of Security: A quasi-experimental evaluation of attachment-based professional development for family child care providers
Article
  • Apr 2015
  • INFANT MENT HEALTH J
This pilot program evaluation was undertaken to examine the effectiveness of an attachment-based, group professional-development experience, Circle of Security-Parenting, on family childcare (FCC) providers' psychological resources and self-efficacy in managing children's challenging behaviors and supporting children's socioemotional development. Licensed FCC providers with children actively in their care (n = 34) self-selected into the program, offered in English and Spanish through a regional support network for FCC providers; a comparison group of providers was recruited from the state database of licensed providers (n = 17). A significant Time × Group interaction was observed for self-efficacy in managing challenging behaviors, F(1, 46) = 30.59, p = .000, partial η(2) = .40, with participating providers' mean self-efficacy scores increasing, p = .000, d = .78, while comparison providers' decreased, p = .003, d = 1.40. Mean depressive symptoms decreased over time for both groups whereas job stress-related resources were stable over time in both groups. Patterns of association were found between providers' self-report of difficulties considering children's mental states and depressive symptoms, job stress resources, and self-efficacy. Limitations and implications for future research are reviewed, including the impact of conducting this work within an organized support network for FCC providers. © 2015 Michigan Association for Infant Mental Health.
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