The American Psychological Association (APA) has stated that Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. The purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention.
The COS Network provides an evidence-based intervention program for parents and children that focuses on relationships. The Network serves a wide range of families raising children and adolescents across Virginia suffering from disrupted relationships, complex trauma, and attachment difficulties due to developmental issues, reactive attachment disorder, and maltreatment.
The Network’s assessment and intervention protocols have been scientifically developed and tested . The assessment yields family-specific goals that are incorporated into a service plan. The service plan guides the step-by-step movement through the intervention phases, and identifies specific treatment goals within each phase, as well as overall lynchpin issues. In addition to the intervention goals, the program promotes collaboration with community agencies and other service providers to create comprehensive and integrated services that meet families’ therapeutic needs.
The Network Promotes Agency and Family Needs
Click Here to View Intervention Outcomes
The Circle of Security Protocol was specifically designed: to be theory- and research-driven; to be individualized for each dyad [relationship]; to utilize standardized, evidence-based assessment procedures; to yield specific intervention goals based on those assessment procedures; and to focus theinterventions on the caregiver as the partner more likely to induce change.
The COS Protocol directly includes many of the ideas reflected in current theory and research in childdevelopment generally, and attachment and early parent–child interaction in particular.Especially important among these are the ideas of emotion regulation; interactivesynchrony; states of mind regarding attachments and intimate relationships; shared states of consciousness, affect, and perspectives; and reflective functioning.
The core constructs for the assessment and intervention components of the protocol are Ainsworth’s ideas of a Secure Base and a Haven of Safety (e.g. Ainsworth, Blehar, Waters, & Wall, 1978). Our goal is to present these ideas to the parents in a ‘user-friendly’, common-sense fashion that is cognitively and emotionally accessible to them, and that also guides the intervention.
The intervention is individualized for each of the major patterns, or strategies, of attachment–caregiving interactions and internal working models (IWMs). This is based on differential identification of each child’s attachment pattern and his or her parent’s caregiving pattern, followed by a specific treatment (sub-)protocol assigned to that dyadic pattern. This design optimizes the ‘goodness of fit’ between parent and child, and helps to eliminate the potential problems of a ‘one size fits all’ approach to intervention.
The videotapes and questionnaires from each assessment are coded by clinical psychologists or clinical graduate students appropriately trained and certified in the attachment procedures. The child’s attachment pattern is coded. The parent’s caregiving classification is coded from the same Strange Situation. Intervention goals are derived from the classifications, ratings and clinical observations.
In designing the Circle of Security protocol, the originators decided to capitalize on the fact that the caregiver, as an adult, has more ‘degrees of freedom’ in changing patterns of attachment– caregiving interactions than does the child. This focus specifically does not imply that the problematic pattern is ‘caused’ by the caregiver. Rather, the implication is that even for a pre-schooler or an older child, a most effective intervention for problematic attachment–caregiving patterns may be to focus directly on the caregiver, and work toward shifting the caregiver’s patterns of behavior and/or her IWMs of attachment– caregiving interactions with this particular child. This shift should then lead to a change in patterns of parent–child interaction, and in turn shift the child’s patterns of attachment-and exploratory-behavior toward a more adaptive developmental pathway.
The seminal project -- The 20-week intervention takes place in a small group of five or six caregivers, and one or two therapists. The group sessions are videotaped. The therapist edits key segments of the assessment videotapes for use in the group sessions.
There is a sequence of five overarching therapeutic goals used for all parents:
Click Here to View Intervention Outcomes
Individual Family Model (In-Home or Outpatient)
Intervention Phases |
Summary of key service goals identified in the service plan |
Phase I: Assessment |
|
Phases II-VI: Therapy |
|
Experiential Parent Group Model (Abbreviated)
More about the COS Evidence Base and International Influence