Circle of Security-Parenting: A randomized controlled trial in Head Start
Circle of Security-Parenting: A randomized controlled trial in Head Start
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DOI：
10.1017/s0954579417000244
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发表时间：
2017-05-01
影响因子：
3.3
通讯作者：
Woodhouse, Susan S.
中科院分区：
文献类型：
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作者：
Cassidy, Jude;Brett, Bonnie E.;Woodhouse, Susan S.
尽管有证据表明，依恋不安全和组织混乱增加了精神病理学发展的风险(Fearon，Bakermann-Kranenburg，van Ijzdoorn，Lapsley，&Roisman，2010；Groh，Roisman，van Ijzdoorn，Bakermann-Kranenburg，&Fearon，2012)，但实施挑战阻碍了依恋干预措施在需要的大范围内传播。安全-育儿干预圈(COS-P；Cooper，Hoffman，&Powell，2009)在设计时考虑到了广泛的实施，通过培训社区服务提供商使用基于视频的手动程序来帮助照顾者为他们的孩子提供安全的基础和安全的避风港，解决了这一差距。本研究是一项COS-P在低收入样本中的随机对照试验，对象为Head Start登记的儿童及其母亲。母亲(N=141人；75人干预，66人等待对照)完成了基线评估，并在为期10周的干预后带着孩子回来进行结果评估，其中包括奇怪的情况。意向治疗分析显示，母亲对儿童痛苦的反应是主效应，被分配到COS-P组的母亲报告的不支持性(但不是更多的支持性)反应比对照组母亲更少，对儿童执行功能的一个维度(当母亲的年龄和婚姻状况得到控制时，抑制控制但不是认知灵活性)的主效应，干预组的儿童表现出更好的控制力。然而，对儿童依恋或行为问题的干预没有主要效果。探索性跟踪分析表明，母亲依恋风格或抑郁症状对干预效果有影响，其中对儿童依恋安全感和组织混乱的干预效果有所缓和，但对回避；对抑制性控制而不是认知灵活性；对儿童内在化但不外化的行为问题出现了缓和的干预效果。这项关于COS-P有效性的初步随机对照试验为进一步探索依恋干预对谁有效奠定了基础。
Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security-Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial randomized controlled trial of the efficacy of COS-P sets the stage for further exploration of what works for whom in attachment intervention.