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

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Journal of Child and Family Studies
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Anne-Marie Maxwell at Macquarie University
Anne-Marie Maxwell
Catherine McMahon
Catherine McMahon
Catherine McMahon
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Anna Huber at Macquarie University
Anna Huber
Rebecca E Reay at Australian National University
Rebecca E Reay
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Abstract and Figures

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.
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Journal of Child and Family Studies (2021) 30:1123–1140
https://doi.org/10.1007/s10826-021-01932-4
ORIGINAL PAPER
Examining the Effectiveness of Circle of Security Parenting (COS-P):
A Multi-Site Non-Randomized Study with Waitlist Control
Anne-Marie Maxwell 1●Catherine McMahon1●Anna Huber1●Rebecca E. Reay2●Erinn Hawkins3●
Bryanne Barnett4
Received: 6 July 2020 / Accepted: 20 February 2021 / Published online: 13 March 2021
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021
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.
Keywords Circle of Security ●Parenting self-efficacy ●Parental mentalizing ●Parental depression
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.
Research over many decades has demonstrated the lasting
impact of early life experiences on children’s development,
educational achievement and physical health (Bellis et al.,
2019; Moore et al., 2017). The parent–child relationship is
key to the child’s experience of the world during this critical
period (Scheeringa & Zeanah, 2001), and there is strong
evidence that this foundational relationship influences
developmental trajectories (National Scientific Council on
the Developing Child, 2015). Attachment theory (Ains-
worth, 1964; Bowlby, 1969/1982), with its focus on the
parent–child relationship from the earliest days, underpins
*Anne-Marie Maxwell
am.maxwell15@gmail.com
1Centre for Emotional Health, Department of Psychology,
Macquarie University, Sydney, NSW 2109, Australia
2Academic Unit of Psychiatry and Addiction Medicine, ANU
Medical School, Australian National University, Acton, ACT
2601, Australia
3Menzies Health Institute Queensland, School of Applied
Psychology, Griffith University, Gold Coast, QLD 4222, Australia
4School of Psychiatry, University of New South Wales,
Kensington, NSW 2052, Australia
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1234567890();,:
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Of the 166 coded videos (n = 88 at T1, n = 61 at T2, n = 17 at T3), 23% (n = 38) were double coded (ICC = 0.99, 95% CI, 0.98-0.96). Parent-reported mentalization was assessed using Diamond's reflective functioning scale (DRFS; [27]) administered as part of the Composite Caregiving Questionnaire (CCQ; [60]). The DRFS comprises 18 parent-report items, each answered on a 4-point scale. ...
... Parental self-efficacy regarding empathy and emotional understanding was assessed using the empathy and emotion subscales of the Tool to Measure Parenting Self-Efficacy (TOPSE; [48]), administered as part of the CCQ [60]. The TOPSE-empathy and the TOPSE-emotion scales each comprise 7 items answered on a fivepoint scale. ...
... Caregiving helplessness was assessed using the 'mother helpless' subscale of the Caregiving Helplessness Questionnaire (CHQ; [79]), administered as part of the CCQ [60]. The CHQ-mother helpless scale comprises 7 items, each answered on a five-point scale. ...
Optimizing parenting and child outcomes following parent–child interaction therapy – toddler: a randomized controlled trial
Article
Full-text available
  • Nov 2024
Background Parent–Child Interaction Therapy—Toddler (PCIT-T) is an attachment-informed intervention model designed to meet the specific developmental needs of toddlers aged 12–24 months presenting with challenging behaviors. Methods This study used a randomized controlled design to evaluate outcomes of PCIT-T for children aged 14–24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior were randomly allocated to PCIT-T (intervention), an active control condition (Circle of Security– Parenting™; COS-P), or a non-treatment control condition (wait-list; WL). Outcomes were assessed at baseline (Time 1), post treatment/post waitlist (Time 2) and 4-month follow-up (Time 3). Results At follow-up, the PCIT-T group displayed the highest levels of parenting sensitivity and positive parental verbalizations, and the lowest levels of negative child-directed verbalizations and non-attuned mind-minded statements. Of the three groups, the PCIT-T group showed the greatest degree of change on these variables, followed by the COS-P group and then the non-treated controls. The PCIT-T group were also the only group to show significant within-group improvements in sensitivity, self-reported parental reflectiveness, empathy and emotional understanding, parent-reported child social competence, child internalizing problems, and general behavior issues. Significant reductions in parental stress, child externalizing behaviors and parenting behaviors were seen for both the PCIT-T and COS-P groups. Conclusions Delivered in the early intervention period of toddlerhood, Parent–Child Interaction Therapy—Toddler has the potential to bring about significant changes for children presenting with early onset behavioral issues. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), 12,618,001,554,257. Registered 24 September 2018 – retrospectively registered, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001554257.
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... To evaluate these outcomes, observer-rated measures were predominantly used (n = 36, 90%) and 14 studies (35%) combined the observation with caregiver self-report measures (ABC: Berlin et al., 2018;COS: Røhder et al., 2022;Ramsauer et al., 2019;Cassidy et al., 2010Cassidy et al., , 2011GABI: Myers et al., 2022;Steele et al., 2010;Lighthouse MTB Parenting Programme: Byrne et al., 2019;MB;Alhusen et al., 2020;MTB: Slade et al., 2020;Sadler et al., 2013;New Beginnings: Bain, 2014;Sleed et al., 2013;Mellow Babies: Raouna et al., 2021). Three studies (7.5%) adopted caregiver self-report measures related to the caregiver-infant relationship only (COS: Maxwell et al., 2020; The Solihull Approach: Douglas & Bateson, 2017;Harris-Waller et al., 2019). ...
... A significant reduction in depression symptoms was most frequently reported following intervention (n = 8; COS: Maxwell et al., 2020;Cassidy et al., 2010;Røhder et al., 2022;Mellow Babies: Puckering et al., 2010;MB: McFarlane et al., 2017;MTB: Slade et al., 2020;WWW : Cohen et al., 1999). UCLA Family Development Project evaluated caregiver social support in two included studies and was reported to improve significantly following the intervention at 12 months (Heinicke et al., 1999) and 24 months (Heinicke et al., 2001). ...
... The review findings highlighted the predominant use of observational methods of the caregiver and infant, with few studies using only caregiver self-report measures (COS: Maxwell et al., 2020; The Solihull Approach: Douglas & Bateson, 2017;Harris-Waller et al., 2019). This finding was unexpected and offers contradictory evidence to Broberg's (2000) suggestion that attachment-based intervention outcomes are often reported through parental self-report measures. ...
Manualised Attachment-Based Interventions for Improving Caregiver-Infant Relationships: A Two-Stage Systematic Review
Article
Full-text available
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  • CLIN CHILD FAM PSYCH
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... It combines six subscales and one single item drawn from previously validated measures, retaining the original response formats and scoring procedures for each subscale. Focus Groups, Self-Confrontation Interviews (N = 6) Evaluate participants' subjective experiences sample of parents [29] and is being used in the current study to assess the impact of COS-P on these key parenting capacities. This questionnaire has also undergone validation with a sample of N = 1181 French foster carers as part of a larger research project on foster care conducted by our research team. ...
Enhancing foster care relationships through attachment-based intervention: the safe families study protocol, a randomized controlled trial of the circle of security parenting program
Article
Full-text available
  • Feb 2025
Background Children in out-of-home care constitute a vulnerable population often experiencing mental health challenges related to early adversity and placement disruptions. The Circle of Security Parenting program® (COS-P) is an attachment-based intervention designed to enhance carer sensitivity and reflective competence, ultimately improving the quality of carer-child relationships. Methods This study protocol follows a mixed-methods randomized controlled trial evaluating the effectiveness of the COS-P program for foster carers in France. A total of 70 foster carers will be randomly assigned to either the intervention group (receiving COS-P in addition to Treatment as Usual) or the waitlist control group (receiving Treatment as Usual only). Quantitative measures, including the Caregiving Composite Questionnaire, Parenting Stress Index, and the Marschak Interaction Method, will be administered at baseline and at follow-up). Qualitative data will be collected through focus groups with foster carers and COS-P facilitators, and through self-confrontation interviews with a subset of foster carers. Discussion This study is the first to evaluate the COS-P program for foster carers in France. Findings will provide valuable insights into the program’s effectiveness in improving carer-child relationships and foster carer well-being, ultimately contributing to better outcomes for children in out-of-home care. The study will also explore potential moderators of treatment outcome, and shed light on the subjective experiences of participants. Trial registration This trial is registered on ClinicalTrials.gov : NCT06701877.
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... Clarifying underlying physiological mechanisms may offer a feasible approach to interrupt the transmission of parental attachment insecurity and pathological narcissism to offspring (Cerniglia & Cimino, 2020). Fourth, our results support the implementation of family-based interventions aimed at reducing attachment insecurity (e.g., Circle of Security-Parenting [COS-P] and Attachment-based family therapy [ABFT]), which may be effective in ameliorating pathological narcissism (Diamond et al., 2007;Lordello, 2024;Maxwell et al., 2021). More importantly, our findings help identify which populations (e.g., anxiously attached narcissists) are more likely to benefit from attachmentbased interventions that can enhance the accuracy and efficiency of interventions targeting pathological narcissism. ...
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The detrimental effects of pathological narcissism on individual development and intimate relationships have been widely studied. Although the exact origins of this phenomenon are still debated, the important role that family dynamics play in its emergence is increasingly being recognized. Previous researchers have pointed out that insecure attachment is associated with pathological narcissism; however, empirical findings are inconsistent. Hence, this study conducted a three-level random-effects meta-analysis based on 183 effect sizes from 29 articles (N = 8247 participants). Our findings have demonstrated the significant and positive link between insecure attachment and pathological narcissism (r = .18; 95% CI: 0.14, 0.22; p < .001). In addition, a moderator analysis was carried out to explore factors that may weaken or strengthen the primary association of interest. In total, there are five significant moderators, including insecure attachment style (F (3,176) = 13.72; p < .001), measurement tool of attachment insecurity (F (8,171) = 4.59; p < .001), measurement tool of pathological narcissism (F (6,173) = 5.21; p < .001), percentage of participants identifying as male (F (1,174) = 4.04; p = .046), and age (F (1,178) = 19.94; p < .001). This research highlights the positive correlation between attachment insecurity and pathological narcissism, providing family theorists with insights into how early family experiences influence personality formation and guiding family therapists in interventions for narcissistic pathology. K E Y W O R D S insecure attachment, meta-analysis, moderator analysis, pathological narcissism
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Article
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Child abuse is a significant public health concern that impacts children worldwide. Efforts to connect at-risk parents with prevention and intervention programs require the use of high-quality measures that evaluate child abuse potential. Researchers frequently use the Child Abuse Potential Inventory (Milner, 1986) and the Brief Child Abuse Potential Inventory (BCAP; Ondersma et al., 2005) which contain Validity indices that evaluate response patterns such as social desirability responding. The measure developers recommended that abuse risk scores from invalid profiles be disregarded in clinical and research settings; however, little is known about factors that may relate to invalid responses and whether these validity scales may aid in the identification of high-risk parents. Using a sample of 90 mothers and their toddler-aged children clinically referred for child behavior problems, the current study investigated factors that determined the likelihood of participants having an invalid profile on the BCAP. Results indicated that greater parental emotion dysregulation (χ2(1) = 16.117, p < .001), parental stress (χ2(1) = 13.453, p < .001), parental depressive symptoms (χ2(1) = 5.889, p = .015), and observed negative parenting behaviors (χ2(1) = 3.875, p = .049) were related to increased odds of having an invalid BCAP profile. Further, parents with invalid BCAP profiles experienced less improvement from pre- to post-treatment in observed negative parenting behaviors (F(1) = 4.279, p = .044, η2p = .076). These findings suggest that parents with invalid BCAP profiles may be a high-risk subset of parents that should be thoughtfully evaluated for child abuse potential. As parents with invalid BCAP profiles have historically been overlooked within the extant literature, findings from the current research may help to inform best practices and enhance accuracy in parenting evaluations for child abuse risk across clinical and research contexts.
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Non-normal data: Is ANOVA still a valid option?
Article
Full-text available
  • Oct 2017
  • PSICOTHEMA
Background: The robustness of F-test to non-normality has been studied from the 1930s through to the present day. However, this extensive body of research has yielded contradictory results, there being evidence both for and against its robustness. This study provides a systematic examination of F-test robustness to violations of normality in terms of Type I error, considering a wide variety of distributions commonly found in the health and social sciences. Method: We conducted a Monte Carlo simulation study involving a design with three groups and several known and unknown distributions. The manipulated variables were: Equal and unequal group sample sizes; group sample size and total sample size; coefficient of sample size variation; shape of the distribution and equal or unequal shapes of the group distributions; and pairing of group size with the degree of contamination in the distribution. Results: The results showed that in terms of Type I error the F-test was robust in 100% of the cases studied, independently of the manipulated conditions.
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Reflective Functioning on the Parent Development Interview: Validity and reliability in relation to socio-demographic factors
Article
  • Dec 2018
The Reflective Functioning coding of the Parent Development Interview (PDI-RF) is a widely used method for assessing a caregivers’ capacity for mentalization. However, little is known about its psychometric properties. The aim of this study was to examine the distributions and discriminant and criterion validity of the PDI-RF scale in relation to a number of demographic and socioeconomic factors. Mothers of infants and toddlers (N = 323) from low, medium, and high-risk samples were interviewed with the PDI and transcripts were coded for RF. Demographic and socio-economic data were recorded. The PDI-RF scale showed high inter-rater reliability, internal consistency, and criterion validity. Modest associations with some sociodemographic variables and PDI-RF were found, but together these only accounted for a small amount of variance in the measure, suggesting adequate discriminant validity. Overall, the scale had good psychometric properties, although some caveats for its use were identified.
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Learning to provide children with a secure base and a safe haven: The Circle of Security‐Parenting (COS‐P) group intervention
Article
  • May 2018
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.
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