1  

 

 

An Evaluation into the Use of the Circle of Security Handouts within the Women and

Children’s Program

The evaluation was conducted into the use of the circle of security handouts within the Women and Children’s Program, to examine staff confidence in supporting mother-child relationships and the effectiveness of the use of circle of security handouts with the target population.

The Circle of Security (original circle) developed by Cooper, Hoffman, Marvin & Powell (1998), provides primary care givers, with a way of understanding a child’s needs both in the immediate moment and within the relationship as a whole. Through use of the circle, adults can develop the means to look beyond a child’s behavior and consider the underlying emotional needs (Dolby, 2007). Further information about the Circle of Security and access to handouts can be obtained at http://circleofsecurity.net  

Whilst the circle of security handouts can be used with primary care givers in many ways, the resources are used with mothers within the Women and Children’s Program to assist mothers with understanding their child’s emotional needs and the roles of both the adult and the child in day to day interactions.

 

Researchers

Melissa Neish & Kimberley Cormack Whale

Program Overview

RichmondPRA Women and Children’s Program (WCP) provides medium term, supported accommodation for women living with mental illness and their dependent children, who are homeless or at risk of homelessness. Staff are available 24-hours per day to provide assistance in all aspects of wellness, relationships, parenting and day to day living. There is a strong emphasis on supporting and strengthening mother-child relationships within the Women and Children’s Program.

Topic of this paper

An evaluation was conducted into the use of the circle of the security resources within the program. The evaluation was conducted in two stages with both staff and clients participating. Throughout the evaluation, the circle of security handouts were used as both resources for staff and as a core component of the support provided to assist mothers with strengthening their relationship with their child.

Permission to conduct this evaluation on the use of the Circle of Security handouts within the WCP, was granted by The Circle of Security Project in 2011.  

October 2012

By Melissa J. Neish

Background to the Evaluation

Recent years have seen an increase in understanding of the challenges encountered by mothers whom parent with mental illness and their children. As a result there has been an increase in services focusing on supporting families were parental mental illness is present. Whilst an increase in specialised services has been observed, there continues to be limited opportunity for mothers and their children to participate in residential programs that provide holistic support to mothers and their children simultaneously.

RichmondPRA Women and Children’s Program (WCP) provides medium term, supported accommodation for women living with mental illness and their dependent children, who are homeless or at risk of homelessness. Families within the program are provided with strengths based, recovery focused support that aims to increase self efficacy and independence. Support is provided holistically, with a strong emphasis on supporting and strengthening mother-child relationships.

In 2011, the National Children of Parents with Mental Illness Initiative (COPMI), provided training to selected participants providing services to families where parental mental illness is present. Several staff from RichmondPRA attended this training.  

  2  

 

During periods of illness, a mother’s ability to meet her child’s emotional needs through interaction and connectedness can become compromised (Williams, 2004). Where a mothers ability to recognize and attend to her child’s emotional needs is compromised, staff require the skills and resource to keep the child in mind whilst supporting the mother to develop or enhance her understanding of her child’s needs and ability to respond to those needs appropriately, (Barlow & Svanberg, 2009).

Whilst the primary intervention for supporting mother-child relationship is stabilization of the mother’s mental state (Ostler, 2008), if concerns for the mother-child relationship remain present following stabilization, interventions that support the relationship can be implemented. Whilst specialist staff provide some forms of mother-child therapies (Williams, 2004), interventions including supportive therapies and developmental guidance can be provided as a component of the families day to day support. Interventions based on the concepts of supportive therapies and developmental guidance are implemented daily with all families within the Women and Children’s Program to support and strengthen mother-child relationships.

Within the Women and Children’s Program, the circle of security handouts are used to provide mothers with a framework that assists them to recognise and respond to their child’s emotional needs and to focus on the relationship between themselves and their child (Cooper, Hoffman, Marvin & Powell, 1998). Educating and supporting all direct care staff in the use of the Circle of Security handouts was intended to increase staff confidence in using the resources in their support of families. It was hoped that in doing so, the frequency of reference to the handouts during daily support would increase, as would the mother’s exposure to the principles of the Circle of Security.

Stage 1 of the evaluation was conducted to support direct care staff in their role in working with families to support and strengthen mother-child relationships. It was hypothesised that through the implementation of targeted interventions, staff confidence in using the circle of security resources would increase. It was also hypothesised that following completion of the intervention period, staff would develop a greater understanding of the benefits in using the circle of security handouts with mothers within the WCP.

Participants

Participants in stage one of the study included all rehabilitation staff providing direct care within the WCP.

In doing so, staff can refer to principles of the circle in their support of the mother in meeting her child’s needs and strengthening the mother-child relationship.

Staff at the Women and Children’s Program come from a wide range of professional disciplines and it was identified that significant difference existed regarding staff knowledge base and experience in providing support to clients regarding mother-child relationships. Whilst the circle of security handouts have been in use within the WCP since the program was opened by RichmondPRA (formerly RFNSW) in 2008, use of these resources with families was primarily facilitated by the specialist parenting worker. This evaluation provided an opportunity to assess staff confidence in using the circle of security handouts and to upskill all staff, enabling them to use the handouts with families.

This report is intended to affirm effective methods of educating staff in the use of resources for parenting education and to emphasise the benefits of using the circle of security resources to support mother-child relationships where parental mental illness is present.

Stage 1: Targeted interventions to support staff in the use of the Circle of Security Handouts

A primary focus of stage one of the evaluation was to assess both staff confidence levels in using the circle of security handouts and their understanding of the benefits associated with this use for families within the WCP. The evaluation provided an opportunity to upskill the team ensuring that all team members received the same level of support and opportunity to strengthen their understanding and enhance their knowledge base. Whilst it is imperative that all staff working within the mental health sector are provided with ongoing professional development opportunities to enhance their skill set and knowledge base (Queensland Government, 2011), enhancing the support provided to clients, staff supporting parents with mental illness and their children; require additional skills in order to address the needs of the family unit (Weatherston, 2000).

Mothers experiencing mental illness can experience difficulty in caring for their children and addressing their child’s developmental needs in an appropriate way. Whilst these difficulties are most pronounced in the presence of acute or chronic symptoms (Williams, 2004), the stress of parenting, particularly when parenting infants and young children, coupled with the need to manage their illness can exacerbate symptoms (Ostler, 2008).

  3  

 

not informed of the evaluation content and intentions of the study.   This was to reduce the possibility of staff accessing superficial knowledge of the Circle of Security for the purpose of their baseline assessment / questionnaire. Staff were informed of the evaluation content and purpose at the commencement of the session and were then required to immediately complete their baseline questionnaire. The in-service was then delivered to the staff as a group. The content of this session included an overview of the evaluation, an introduction to the Circle of Security handouts (including the original circle, and travelling around the circle script). Following an overview of the circle, discussions regarding key concepts were held. This included discussions about the ‘secure base’, ‘safe haven’ and ‘bigger, stronger, wiser and kind’ concepts as well as discussions about transitions into each phase.    Discussions were then held regarding the usefulness of the Circle of Security Handouts within the WCP and ways of introducing and using these resources with clients when providing education about mother-child relationships. Examples of the circle in action were provided and staff were given the opportunity to talk through their own examples. An excerpt from the Circle of Security DVD was then shown and staff were provided an opportunity to ask questions. At the end of the in-service each participant was provided with a resource pack for her personal reference. These packs included the following resources: The original circle of security, Travelling Around the Circle script, Building a Secure Attachment with Your Child, Circle of Security/Attachment Theory Terminology, Understanding the Value of the Circle of Security in Relationship to Adult Psychotherapy, 25 Words or Less, Circle of Trust and the Circle of Repair.   A second questionnaire was completed within one week of the in-service to reassess staff knowledge following this intervention.  

1-1 Mentoring

During this 1-1 time, staff were provided the opportunity to discuss any questions they had following the in-service and provision of handouts. Further discussions took place about the practical application of the Circle of Security concepts into their daily work with clients. Staff were also provided with links to two video clips to watch including the Circle of Security DVD excerpt (utilised in the in-service) and the ‘strange situation’ clip to demonstrate the circle in action and clarify the concepts of the original circle.

The third staff questionnaire was completed within one week of this intervention.

There were 11 participants in total with 10 staff employed as Mental Health Rehabilitation Workers (from various professional backgrounds including but not limited to Psychology, Social Work, Welfare and Youth Work) and one Childcare Worker. Participants took part in the educational interventions as part of their ongoing professional development meetings.

Measurement Tools A staff questionnaire was developed to gather pre and post intervention data. This questionnaire included a combination of scaling questions and short answer responses. The scaling questions used a 7-point scale aimed at measuring staffs’ level of confidence regarding their understanding of the Circle of Security principles and their ability to use these in their work with clients. Staff were also asked to rate their understanding of the benefits of using the circle of security handouts with the clients within the Women and Children’s Program.  The short answer questions aimed to measure staff’s understanding of the key concepts/ terminology used in the Circle of Security model, e.g. secure base, safe haven, whilst encouraging staff to think about the terminology. The same questionnaire was delivered as a baseline measure and after each of the targeted interventions throughout the intervention period. Hence, the questionnaire was delivered to participants on four occasions. Following the completion of the intervention period, participants were also requested to complete a Reflection activity. In this a seven point  scale was utilized for 4 questions with written responses required for a additional two questions further facilitating the inclusion of qualitative and quantitative data. All participant data remained anonymous throughout the evaluation.  

Procedure

The staff interventions were developed and facilitated by the Child Development and Parenting Support Worker (a specialist role within the program and author of report), who has extensive experience in supporting clients in their  parenting role and who frequently utilises the circle of security handouts to assist clients in understanding the mother child relationship. The staff education involved the following interventions:

In-service Education Prior to the delivery of the in-service, staff were    

 

  4  

 

Role play

Following the above interventions staff were requested to participate in a role play demonstrating the way that they would introduce the Circle of Security (original circle) handout to clients and explain the concepts. Staff were asked to pick a client who was then played by the facilitator, providing the staff member with an opportunity to work out ways of discussing the resources. This was completed with consideration of issues that may arise when using the resources with clients within the program, such as client’s mental state, difficulty engaging the client and age of client’s child/ren. This was aimed at supporting staff in implementing the intervention with clients at a later date.

The final staff questionnaire was completed within one week of the role play. At this time staff were asked to complete a reflection, which provided them the opportunity to consider the tools used throughout the education process and provide feedback on the effectiveness of each intervention.

Limitations of the Study

It is acknowledged that staff accessing additional Circle of Security resources outside of the scheduled interventions may have impacted the reliability of this data. This was a factor that could not be controlled due to the ease of access to these handouts, however due to the number of interventions and handouts provided to staff throughout the intervention period, it was deemed that staff accessing additional handouts would not significantly alter results.

Findings

Baseline data collected from staff on their knowledge of and ability to use the circle of security handouts was reflective of their limited experience using the resources. At baseline, staff demonstrated some understanding of the benefits of using the Circle of Security in explanations of mother-child interactions with clients (54.5%), however only nine percent of staff felt confident in using the circle of security handouts with clients themselves. Baseline data also showed that only twenty seven percent of staff had a working knowledge of the Circle of Security and were also actively applying this knowledge to their work with clients.

Researchers were interested in whether staff had a working knowledge of the Circle of Security. This included understanding the principles, transitions and terminology within the original circle. Chart 1 reports staff working knowledge of the Circle of Security

Chart 1

Staff with a Working knowledge of the Circle of Security

n=11

As demonstrated in Table 1, the number of staff who had a working knowledge of the original circle increased from three participants at baseline to include all participants (n=11) following the inservice. It was also observed that staff knowledge of the principles of the Circle of Security increased significantly after the first intervention and were maintained throughout and following the intervention period. This figure was maintained throughout the intervention period with all participants reporting a working knowledge of the Circle of Security in their final questionnaire.

Researchers were also interested in whether an increase in staff knowledge would impact the frequency of staff using the resources with clients. This included the use of handouts and reference to the original circle in discussions with mothers. Chart 2 reports frequency of staff application of their knowledge about the Circle of Security to their work with mothers.

Chart 2

Staff actively applying Circle of Security knowledge to work with mothers within WCP

n =11

  5  

 

As demonstrated in Table 2, throughout the intervention period there was an increase in staff application of their knowledge of the Circle of Security. The number of staff applying their knowledge to their work with mothers was observed to increase following each intervention. Following the last intervention (Role Play), staff application of their Circle of Security knowledge had increased from twenty seven percent to ninety one percent. These findings suggest client exposure to the principles of the Circle of Security increased significantly following the staff intervention period.

Whilst it was hypothesised that increasing staff knowledge of the Circle of Security, would support staff use of the resources with mothers with in the WCP, researchers were interested in staff perception of the benefits of using the Circle of Security in explaining mother-child interactions to mothers. Chart 3 reports staff perception of benefits in using the Circle of Security in discussing mother-child interactions with mothers.

Chart 3

Staff perception of benefits in using the Circle of Security

n=11

It was also hypothesised that an increase in staff confidence would be observed as intervention period. This was expected as a result of increasing staff knowledge and understanding of the benefits of using the Circle of Security with mothers within the WCP.

As predicated, staff confidence levels in using the circle of security handouts increased. Baseline data shows that zero percent of staff felt confident in using the Circle of Security with mothers within the WCP. Following the staff intervention period, one hundred percent of staff reported feeling confident to use the Circle of Security with mothers. This is reported in Chart 4.

Chart 4.

Staff confidence in using the COS

n= 11

These findings support the assumption that increasing staff knowledge about the Circle of Security and confidence in using the Circle of Security handouts would increase the frequency in which staff use the resources with clients.

Following the targeted intervention period staff were significantly more positive about the use of circle of security handouts. Baseline data indicated that fifty five percent of staff saw a benefit in using the circle of security handouts with mothers within the WCP, compared with one hundred percent of staff following the completion of the intervention period. The targeted interventions implemented with staff were effective in increasing staff knowledge about the circle of security and confidence in using the handouts with mothers within the Women and Children’s program. Findings from this stage of the evaluation indicate that staff felt empowered within their work with families as a result of increasing their knowledge and resources for supporting mothers to strengthen their relationship with their child

Staff quotes

“the 1-1 intervention clarified the information and allowed me to feel more confident …..(in using the

circle of security)”

“the role play allowed me to put into practice what I had learnt in a work related scenario”

  6  

 

In supporting mother-child relationships within these families, use of the circle of security has been effective in providing a framework to develop or enhance the mother’s understanding of her role by assisting her child to regulate, particularly at times when they may both be overwhelmed by difficult emotion. This “bigger, wiser, stronger and kind” approach (Cooper, Hoffman, Marvin & Powell, 1998) to parenting assists the development of a secure mother-child relationship.

It is also acknowledged that to adequately support mother-child relationships, the mothers needs require consideration alongside the needs of the child (Weatherston, 2000 ). As part of the holistic support provided within the Women and Children’s Program, support is provided to mothers in addressing their wellness and psychosocial needs. It is common that issues raised by clients win the domain of maintaining wellness, are associated with the client’s role as a mother. Commonly concerns are raised by clients about the impact of the their mental health on their parenting, or the impact of their parenting role on her mental health. This concern is common among parents with mental illness (Sane, 2011).

Whilst all parents can find parenting to be demanding and stressful, parenting with a mental illness results in additional stressors (Sane, 2011). Previous research has found that high levels of maternal stress adversely affect mother-child relationships (Newman, 2008). It is therefore imperative that families at risk are provided with interventions that support mother-child relationships by working with mothers to understand and meet their child’s needs, promoting best outcomes for families and supporting the emotional development of children. The Women and Children’s Program utilises the Circle of Security handouts as a component of the supportive therapies and developmental guidance provided to families to support the mother-child relationship and enhance the mothers confidence to parent her child independent of structured support. This process assists mothers in developing parenting confidence and capacity to care for and respond to their children in a contingent manner, enabling families to transition to independent living following program completion.

Stage 2 of the evaluation was carried out to examine the way that Circle of Security handouts are used within the Women and Children’s Program and to provide a research base for their ongoing use with the target population. It was hypothesised that the use of the Circle of Security resources with mother’s within the Women and Children’s Program would increase the mother’s understanding of their child’s emotional needs.

 

Stage 2: Use of the Circle of Security Handouts with Mothers within The

Women and Children’s Program

In this study the primary care giver was the biological mother of the child in each dyad

within the sample population. Primary care giver as discussed in reference to attachment, is

referred to as ‘mother’ throughout this report.

For human children the need to attach to a primary care giver is instinctual and survival driven, (Williams 2004). An infant’s behavior seeks to gain the attention of the primary care giver enabling the infant’s needs to be addressed. Through care giving and receiving, the primary care giver and infant are provided with frequent opportunities to interact. Through the experiences of these early relationships, a child’s understanding of their impact on others and their environment, begins to form.

When a child knows that their mother will be there to support them, watch over them and protect them, they feel safe to move away from her and explore their world, knowing that if they need her, she will be there for them (Cooper, Hoffman, Marvin & Powell, 1998). It is the mother’s predictability and sensitivity during interactions with the child that forms the basis of the relationship between them (Behrens, Parker & Haitigen, 2011). However if the mother’s response to the child is unpredictable or often inconsistent, the child is unable to predict what the response they will receive. This uncertainty can result in the child feeling less secure in the relationship.

In assisting mothers to look beyond their child’s behaviour and identify underlying emotional needs, the circle of security supports the development of parental reflective functioning, assisting mothers to consider the experience of both her child and herself in interactions that they share (Cooper, Hoffman, Marvin & Powell, 2000). This shift in focus from behavior to emotion is imperative in assisting mothers with responding appropriately to their child at times when they themselves are dysregulated.

Attachment research demonstrates that it is through the relationship with a primary care giver that children develop the ability to self regulate their emotion. However if the primary care giver experiences difficult in self regulating, their ability to assist the child to regulate during periods of high arousal can be compromised (For many families within the Women and Children’s Program it has been observed that mothers can experience difficulty with assisting their children to organise their internal world, particularly at times when the mother herself is feeling overwhelmed and dysregulated.

  7  

It was also hypothesised that mothers would experience a reduction in stress levels associated with parenting following the intervention period.

Participants

Due to nature of the program and the average length of stay for families, six full sets of data were collected over a five month period. This data was collected from four separate families (three single child families and one three child family).

Participants were matched by way of the programs eligibility criteria of maternal mental illness, dependent children in the mother’s full-time care and homelessness or risk of homelessness prior to program placement.

Participants consented to participate in the study throughout their stay. Participation in the evaluation did not alter the intensity or nature of the parenting support that families received with participants completing only data collection in addition to the parenting support provided to all families within the program.

Measurement Tools

The Parenting Stress Index (PSI) short form was utilised as a means to examine three primary components of the parent-child dyad including the parent, the child and the interactions between them (Abidin, 1995). PSI scores allowed researchers to identify the overall levels of parenting stress that mothers were experiencing prior to and following the intervention period.

Following the intervention period, mothers were asked two questions that specifically related to their understanding of the Circle of Security and its relevance to the interactions she shares with her child.

Two activities were also completed by mother’s pre and post interventions. These activites were used as a baseline and final data measurement tool. These activities were developed by the Child Development and Parenting Support Worker (CDPS) and used with all families to assist mothers in acknowledging positive attributes of their child and reflecting upon a positive interaction that they had shared. These activities supported mothers to think about their child in a positive way.

As a baseline and final data collection, mothers were also asked to complete a series of questions reflecting upon their feelings during interactions that they share with their child.

Both of the activities completed were discussed with mother’s at the completion of her involvement in the study. This provided opportunity for reflection and for mothers to observe ways in which their thinking about their child and the time they spend together had changed.

 

Procedure

For consistency, participants were asked to participate in the study for a period of three months from their introduction to the circle of security, regardless of the length of stay in the program.

The primary researcher (functioning as the CDPS within the program) facilitated the introduction to the circle of security and interventions for all families.

Along with others, interventions utilising the Circle of Security handouts are utilised with all mothers within the program regardless of participation in the evaluation.

The interventions completed with families were completed as part of a parenting portfolio, which mothers work in with the CDPS throughout their stay. Mothers keep this as a record of their journey and exploration of their relationship with their child. Whilst the activity content is structured (for all evaluation activities), clients were able to present many of the activities as they choose, enhancing the enjoyment of participating for many clients.

Baseline data collection

Participants were introduced to the evaluation and invited to participate as soon as feasible (depending on family circumstance) following their entry into the program. If the mother was willing to participate, consent was obtained, followed by the collection of baseline data and commencement of the intervention period.

Introduction to the Circle of Security

Mothers were aware of the intent to deliver the introduction following the collection of their baseline data.

The content of this introduction included, viewing the Circle of Security DVD excerpt, an introduction to the Circle of Security – original circle and travelling around the circle script (read aloud by the facilitator). As the language in the script was difficult for some clients to interpret, explanation was provided as required and questions utilsed to clarify participant understanding. Discussions were held with mother’s utilsing examples of the circle in action with reference to children of the same or similar ages to the mother’s child, with an aim of making the content relevant to each participant. Following an overview of the circle discussions regarding key concepts were held. This included discussions about the ‘secure base’, ‘safe haven’ and ‘bigger, stronger, wiser and kind’ concepts as well as discussions about transitions into each phase.

  8  

 1

Examples of this application include staff supporting mothers in their fulfillment of their ‘secure base’ role by recognising and alerting mothers to children checking in during periods of exploration, assisted play with staff assisting mothers to implement ‘watch over me’, ‘delight in me’, ‘help me’ and ‘enjoy with me’. Mothers are also assisted by staff to fulfill their ‘safe base’ role as part of assisted play, in everyday interactions and particularly at times when the mother was dysregulated or experiencing high levels of stress.

Additional support

Where it was identified that difficulty in completing an activity was experienced additional time and support was provided to clarify concepts and understanding prior to the next intervention being commenced.

Final Data Collection

After three months, final data collection was gathered including PSI short form, and a series of reflective questions about the emotion associated with the interactions participants shared with their children. In addition participants were asked two questions about the circle of security as a means of measuring their level of understanding and ability to recognise and respond to their child’s need, as well as the mothers ability to transfer obtained knowledge to her relationship with her child.

These questions included, “Can you tell me what you understand the circle of security to be about” and “Can you tell me about a time that you have seen the circle in action in a recent interaction that you’ve had with you child?”

Limitations of the Study

Due to the nature of the Women and Children’s Program and nature of the support provided, particularly in regards to parenting support, measuring one component of the program was difficult. It is acknowledged that the support provided outside of the interventions related to the study benefit families and therefore have an impact on these findings. However due to the nature of the program, no alterations to the supports provided to families were considered. Despite this, it was believed that the measurement tools used and data collected highlighted findings related to the evaluation and the interventions implemented.

There were also several factors that impacted the number of families able to participate in the study. The length of stay of families with the program limited the amount of families residing within the program throughout stage 2. Other factors that reduced anticipated sample size were related to individual family circumstances including maternal mental health and families exiting the program prematurely.

Interventions

As support is tailored to address the needs of individual families, daily parenting support levels fluctuated between participants. Participants experiencing difficulty either within their relationship with their child or in providing care to their child, received increased parenting support from all staff as part of their participation in the program. All participants received regular 1-1 time with the CDPS, to explore their relationship with their child whilst also receiving daily parenting support from staff. At no time was parenting support provided as part of the program adjusted for evaluation purposes.

Interventions utilised with all participants were conducted over the 3 months period with structured portfolio activities and regular parenting support (including supportive therapies and developmental guidance) provided from all staff as part of their participation in the program.  

All participants

The first intervention required mothers to think about seeing the Circle of Security in action with their own child and representing the event in their portfolio. This activity was completed immediately following the introduction to the Circle of Security.

Participants partook in a further four planned interventions. Three of these interventions utilised photo vignettes to support the development of maternal observation skills and assist mothers in enhancing their ability to consider the role and experience of the parent-child in everyday interactions. These vignette activities consisted of two sets of four photo vignettes of unknown parent – child, and photo vignettes of the mother with her own child.

The final planned portfolio based intervention asked mothers to consider and identify aspects of their daily life. This activity was used as a values identification activity and assisted mothers in evaluating their priorities, for example parenting, friends, self care, desire to return to work etc.

All families received ongoing support in applying the circle of security concepts to their relationship and interactions with their child/ren through the daily parenting support provided by all staff.

 

  9  

2

Findings

The PSI short form was administered to participants at baseline and as pert of the final data collection. Scores from all components of the PSI are useful in examining mother-child relationships and changes within the dyad and have therefore been reported (Table 5).

Researchers were particularly interested in Total Parenting Stress, Parenting Distress (PD) and Parent-Child Dysfunctional Interaction (P-CDI) for the purposes of this study.

The Total Stress scores were used to provide an indication of how much parenting related stress participants were experiencing (Abidin, 1995), both at baseline and following the intervention period. Researchers believed that enhancing a mother’s understanding of her child’s emotional needs and her responsiveness in meeting these needs during everyday interactions would reduce parenting related stress. It was therefore predicted that Total Stress scores would decrease following the intervention period.

Parenting Distress (PD) scores reflect the level of distress a parent is experiencing within their parenting role, related to personal factors associated with parenting.

The Parent-Child Dysfunctional Interaction scores provided researchers with information about mother’s relationship with her child. As these scores relate to the way a mother feels about the child meeting her expectations as well as the reinforcing effects of her interactions with her child (Abidin, 1995), it was predicated that these scores would reduce following the intervention period. Researchers believed that by using the Circle of Security with participants, mothers would gain higher levels of understanding about the roles of herself and her child in their interactions.

Included in the PSI short form is a defensive responsive scale that has been scored per participant but not reported as a mean score. As the scale is utilised to assess the individual participants approach to the questionnaire (Adibin,1995) mean scores for this scale are irrelevant to this study. Mean PSI scores are reported in Table 1.

Table 1

Mean PSI scores pre and post intervention period

Baseline Post interventions

Total Stress 60 40

PD 24 24

DC 26 21

P-CDI 24 17

n=6

 

 

As seen in Table 1, there was a reduction in mean scores across three scales of the PSI Short Form following the introduction to the Circle of Security and subsequent intervention period.  

Parent-Child Dysfunctional Interaction mean scores were also observed to be lower. This finding suggests that within the sample maternal emotion associated with interactions with their child/ren were more positive following the intervention period (Abidin, 1995).

Contrary to expectations, Parental Distress scores did not decrease following the intervention period. It was however acknowledged that, families within the sample continued to experience difficulties in many areas of daily life post interventions that may contribute to parental distress. These factors include but are not limited to maternal mental illness, lack of long-term housing and financial hardships. As these families continued to receive support through ongoing program involvement in addressing psychosocial issues, further collection of Parental Distress scores prior to transition from the residential program is recommended. Whilst difference was observed in PSI short forms as predicated, due the nature of the program and intensity of support provided, it is difficult to determine whether the use of the Circle of Security and the subsequent interventions, other program related supported or participant related factors impacted these scores. Further data was therefore required to support the hypothesis.

Researchers believed that via increased exposure to the Circle of Security, maternal observation skills and understanding of the roles of both the parent and child in everyday interactions would increase thus supporting the mothers ability to provide contingent and supportive responses to her child/ren.

Photo vignettes utilised with families throughout the intervention period provided rich qualitative data. In final vignette activities participant explanation of the parent-child interaction demonstrated an enhanced observation skills and increased understanding of the roles of both the parent and child in each interaction. The same photo was utilised both pre and post interventions with the number of times a participant referenced child behaviors and a parent behaviours in their explanation of the interaction was recorded. Examples of this can be seen in Chart 5.

  10  

 

 

PSI (short form) scores, show that Total Stress scores decreased indicating that mothers were experiencing less parenting related stress following the intervention period. The reduction in Parent-Child dysfunctional Interactions scores suggests that increasing maternal understanding of mother-child interactions and enhancing maternal understanding of children’s emotional needs, assist mothers in feeling more positive about their interactions with their child.

Recommendations

Stage 1

As reported the interventions utilised with staff in stage 1, were effective in supporting staff confidence in using the Circle of Security with mothers and increasing staff understanding of the benefits in using the Circle of Security with mothers within the WCP. It is therefore recommended that as part of continued best practice support to clients, all staff be supported in developing a working knowledge of the Circle of Security.

Stage 2

Findings from stage 2 suggest that use of the Circle of Security within the WCP is effective in supporting mother-child interactions. As everyday interactions form the base of mother-child relationships, it is recommended that the Circle of Security continue to be utilised within the WCP as part of the parenting support provided.

Due to intensity of the support provided to families within the WCP and various methods utilised for the provision of parenting support, further opportunities for evaluation exist. It would be beneficial to utilise the PSI short form as part of further evaluations. In doing so, parenting support could be evaluated over the participant’s duration of stay in the program minimising disruptions to the study and enabling researchers to assess Parental Distress in context of psychosocial factors.

 

Chart 5

Identification of and reference to behaviours during explanation of parent-child interactions

n=11

As observed in Chart 5, increases in participant ability to identify and describe parent and / or child behaviours during interactions were observed for all participants (n=4).

Participant description of the Circle of Security also demonstrated increased understanding of mother-child interactions. Participant descriptions of the Circle of Security when asked, “Can you tell me what you understand the Circle of Security to be about?” are given below:

“It’s about when they want to go out and explore for them to feel safe both being away from you and coming back to you. You having open arms when

they come back”

“It’s more than a play thing. Throughout their (child’s) whole life when they are away from you, like with school or even when they get older and

move out, they need you. They need you for comfort, to watch them do things safely in their life

and to be their for them”

“letting them (my children) know they are safe with me. I’m the center of their whole world. It’s ok to go out and explore because if anything happens

they can come back to me for comfort”

“It’s about trust, communication, relationship bonds and feeling safe”

Findings indicate that the use of the Circle of Security handouts within the Women and Children’s Program, increased maternal understanding of the child/ren’s needs and understanding of the roles of the mother and child in everyday interactions.

  11  

 References

           Abidin, R. (1995). Parenting Stress Index Professional Manual (3rd ed.). Florida, America: Psychological Assessment Resources.

Barlow, J., & Svansberg, P. (2009) Keeping the Baby In Mind. In J. Barlow & P. Svansberg (Ed). Keeping the Baby In Mind: Infant Mental Health In Practice. Hove, East Sussex: Routledge.

Behrens, K., Parker, A., & Haitigan, J. (2011). Maternal sensitivity assessed during the strange situation predicts child’s attachment quality and reunion behaviours. Infant Behaviours & Development, 34, 378-381.

Cooper, G., Hoffman, K., Marvin R., & Powell. B. (1998) The Original Circle. PDF version available at www.circleofsecurity.net

Cooper, G., Hoffman, K., Marvin. R., & Powell, B. (2000) Treatment assumptions. www.circleofsecurity.net

Dolby, R. (2007). The Circle of Security: A Roadmap to Building Healthy Relationships. Australia, Early Childhood Australia. PDF version available at http://www.earlychildhoodaustralia.org.au/pdf/rips/rip0704.pdf

Newman, L. (2008). Trauma and Ghosts in the Nursery: Parenting and Borderline Personality Disorder. In A. Williams & V. Cowling (Ed). Infants of Parents with Mental Illness: Developmental, Clinical, Cultural and Personal Perspectives.Queensland, Australia: Australian Academic Press

Ostler, T. (2008). Assessment of Parenting Competency in Mother’s with Mental Illness. Baltimore, Maryland: Paul. H Brooke’s Publishing Co.

Queensland Government. (2008). The Queensland Plan for Mental Heath. Electronic version. Retrieved October 1, 2012 from www.health.qld.gov.au

Sane Australia. (2011). Research Bulletin 13: Parenting with a Mental Illness – The Early Years. PDF version available at www.sane.org

Weatherston, D. Zerotothree: The Infant Mental Health Specialist. Electronic version. Retrieved September 28, 2012 from www.zerotothree.org/child-development/early-childhood-mental

Williams, A. (2004). Infants of Mothers with Mental Illness. In V. Crowling (Ed). Children of Parents with Mental Illness 2: Personal and Clinical Perspectives. Victoria, Australia: ACER Press.

Acknowledgements

Researchers would like to acknowledge the following organisations and individuals for their support of or contribution to this study.

Organisations

• The National Children of Parents with Mental Illness Initiative (COPMI)

• Monash University • RichmondPRA

Individuals

• Clients of the WCP • Staff of the WCP • Darryl Mayberry • Melinda Goodyear • Kylie Holmes • Janet Ford • Belinda Swinton