Core Components

Circle of Security Intensive (COS-I) is designed for parents of young children, birth to 7 years. In particular, it is aimed for parents would benefit from support to learn about the importance of their relationship with their child and improve their relationship with their child. It is a tailored programme that uses video clips of each parent and child, which are captured by the practitioner in the pre-intervention phase. Given its intensive nature, it is primarily focused on high risk and highly vulnerable families, who are also likely to be receiving additional input alongside, or following COS-I.

The COS-I programme has four phases. In the pre-intervention phase, the practitioner meets with the parents individually for at least two sessions. It involves engagement, assessment and treatment planning. During this phase, the Strange Situation Protocol is undertaken with caregiver-child dyads. As well as classifying the attachment relationship, this contributes to identifying the key issue the parent chooses to work on. The three intervention phases can take place in a group with individuals or couples. Couple and individual delivery may occur in the home, if required. The content of the programme is the same irrespective of delivery format and delivered in weekly sessions. Group delivery is over 20 sessions, couples and individual delivery is between 14-16 sessions. Each phase builds on the previous one, and introduces additional concepts related to attachment. Using the Circle Security graphic caregivers learn about providing a secure base from which their child can explore, and a safe haven to which their child can return. The key message to caregivers is that their role is “Always: be BIGGER, STRONGER, WISER, and KIND. Whenever possible, follow your child’s need and whenever necessary, take charge.”

The intervention phases include the following:

• Demonstration, using video review, of the Circle of Security model of children’s developmental needs emphasising the role of the caregiver in an accessible manner.
• Developing caregivers’ skills in observing the COS model in action.
• Helping caregivers reflect on their own actions in meeting (or not) the needs of their child.
• Promoting reflection of caregivers’ own experience of parenting and how this influences them.
• Providing caregivers an experience of a secure base in the group or with the individual practitioner.
• Co-regulate caregivers’ emotional experiences through facilitation by a trained provider.
• Promote caregivers to reflect on how they co-regulate their children’s emotional experiences.

Core components covering both content and process issues are clearly operationalised within the programme.

Fidelity

Fidelity to intervention is measured on three parameters. (1) Therapist adherence to the intervention protocol, measured using a fidelity monitoring tool, which considers both omission of core components of the intervention, and inclusion of content or processes that are inconsistent with the protocol; (2) Therapist competence in providing the intervention, as assessed by COS-I certified supervisors reviewing videos sessions for both therapist competence and therapist stance; and (3) Session attendance by participants.

Modifiable Components

The programme can be delivered in three different forms: with individuals; with couples; as a group with 5-10 unrelated caregivers. Detailed guidance is provided on each mode of delivery. Reading materials have been designed to be accessible for all those with a basic level of literacy. The COS-I programme has been translated into different languages, and it has been used in a variety of settings and cultures. Further modifications are not supported.

A less intensive version of the intervention has been designed – Circle of Security Parenting (COS-P) which is included as a separate entry.

Circle of Security International is based in the US. Circle of Security Intensive training is not currently offered within the UK.

Support for Organisation/Practice

Implementation Support

The manual includes guidance on requirements for implementation and consideration of organisational readiness. The required supervision also includes implementation factors, such as selection of participants. The manual and training also detail the required outcome measures practitioners need to collect and gives guidance on additional outcome measures.

Licence Requirements

Circle of Security International certifies providers and supervisors. Delivery of COS-I is limited to certified providers, or trained providers working under certified supervision.

Start-up Costs

The training costs approximately $2,100 USD per person. Additional costs of travel and subsistence may be required. There is a required exam which costs $350 USD. Two trained practitioners are required for group delivery. Individual or couple delivery requires a single practitioner. For new practitioners, weekly supervision is required for their first two groups. The specific rates are negotiated with the supervisor directly. However, for a pair of practitioners to complete the supervision of their first two programmes, supervision costs are in the region of $12,000 USD.

There may be additional costs in relation to creating the specific clinic space required to conduct the strange situation attachment assessment.

Building Staff Competency

Qualifications Required

Practitioners need to be qualified and experienced therapists, with experience of facilitating groups. They need to be willing to engage in reflective supervision and have sessions videoed.

Training Requirements

The training is a 10-day intensive training. There is currently limited availability. Certification requires relevant background skills, completion of the 10-day intensive training, passing the qualifying exam and satisfactory completion of COS-I supervision.

Supervision Requirements

For newly trained practitioners, weekly supervision from a COS-I certified supervisor is required for the duration of their first two programme cycles. This is approximately 25 sessions of 1.5 hours, and includes the whole programme for selection of suitable participants to end of programme. For practitioners delivering to individuals or couples, they require weekly supervision for the first five parent-child dyads, until supervisor assesses delivery competence has been achieved. Supervisors are certified by the programme developers.

Theory of Change

COS-I has an explicit logic model based on knowledge and theory about attachment and the link between secure attachment as a protective factor for child development. It has the goal of enhancing secure attachment and reducing disorganised attachment between caregivers and children. The mechanism by which the programme intends to deliver these outcomes is:

• Demonstrate, using video review, an attachment-based model of children’s developmental needs emphasising the role of the caregiver in an accessible manner.
• Develop caregivers’ skills in observing this model in action.
• Help caregivers reflect on their own actions in meeting (or not) the needs of their child.
• Promote reflection of caregivers’ own experience of parenting and how this influences them.
• Provide caregivers an experience of a secure base in the group.
• Co-regulate caregivers’ emotional experiences through facilitation by a trained provider.
• Promote caregivers to reflect on how they co-regulate their children’s emotional experiences.

Through these mechanisms, the programme aims for caregivers to develop more reflective and emphatic responses to their child.

Values

The Circle of Security Intensive (COS-I) programme focuses on the importance of understanding attachment to support child wellbeing. It is an intensive and individualised programme that uses capture and review of video clips of the parents with their children as a core part of the intervention.

• Is the delivery of an attachment focussed intervention aligned with the key values and priorities of your organisation?
• Does the delivery of an intensive and individualised programme fit with the key values and priorities of your organisation?
• Does your organisation support the essential role that video review has within this intervention?

Priorities

• Is working with parents of babies and young children in an early intervention approach a priority for your organisation?
• Is the delivery of targeted services to families with relationship difficulties aligned with the key values and priorities of your organisation?

Existing Initiatives

• Does your service already provide early intervention programmes aiming to improve child development and mental health outcomes?
• Do you have parents and caregivers who would benefit from more intensive and tailored attachment focused interventions?

Workforce

Prior to training, practitioners need to be trained and experienced therapists, with experience of working with young children and caregivers, group delivery and taking part in reflective supervision.

• Do you have practitioner with appropriate experience and competencies?

Circle of Security requires two practitioners to deliver the programme over 20 weeks, with additional work in the selection of participants and the pre-intervention phase. The practitioners require approximately 1 day per week each to deliver the weekly group, review and preparation of video clips and treatment plans and weekly supervision. Delivery of the programme to individuals and couples requires a single practitioner over 14-16 weeks with additional work in the pre-intervention phase. These practitioners also required time for the review and preparation of video clips, treatment plans and weekly supervision.

• Can your organisation protect time needed for training, delivery and supervision for these practitioners?
• Can your organisation provide supervision for practitioners?

Technology Support

Circle of Security Intensive (COS-I) requires that the Strange Situation Protocol is undertaken with caregiver - child dyads at the beginning of the programme. This requires a large playroom, with an adjoining camera/observation room and one-way mirror, and a skilled camera operative.

• Do you have access to a suitable facility and staff?

Practitioners need to take, review, edit and share videos clips as an integral part of the programme. Video materials also need to be transferred to supervisors.

• Do you have suitable technological facilities and supports in your organisation?

Administrative Support

• Do your current administrative procedures support your practitioners to implement a programme like this?
• Do you have the administrative infrastructure to securely manage video recordings?

COS-I can be delivered on a group basis.

• Do you currently have facilities for group delivery to parents?

Financial Support

Training costs approximately £2100 per practitioner. If running a group, two trained practitioners are required. Newly trained practitioners require weekly supervision from a certified supervisor for the delivery of their initial two programme cycles, which costs in the region of $12,000 USD.

• Do you have the finances to pay for practitioners to attend this training and supervision?
• Do you have the finances to pay for the printing of handouts and sharing of video clips for the delivery of the programme?

Comparable Population

Circle of Security Intensive (COS-I) is a 20 week programme for parents of children from birth to 7 years, where parents would benefit from support to learn about the importance of their relationship with their child, and improve their relationship with their child.

• Do you have sufficient demand for an intensive attachment focused parenting intervention to sustain a group or individual delivery of COS-I?

Desired Outcome

The Circle of Security Intensive Programme is associated with positive child outcomes, including a reduction in disorganised attachment and improvements in behavioural problems.

• Are families with children under 7, where there is concern about disorganised attachment and behavioural difficulties, a particular priority for your organisation?
• Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?