Efficacy of an Attachment-based Intervention in Residential Care (CareME)

NCT05600439 | Completed

• 1 other identifier: CareME
• Study Type: interventional
• Target: 220
• Locations: 1 country
• Sites: 1

Brief Summary

CareME is a group attachment-based intervention program developed for improving relational abilities in professional caregivers working in Youth Residential Care (YRC) settings. The intervention program was planned to integrate 12 group session (90 minutes each), implemented fortnightly during a 6-month period, and facilitated by two psychologists and expertise researchers on attachment framework. The project aims to produce effects on professional caregivers' behaviors and, as an indirect effect, to produce changes on adolescents' outcomes (age 12 to 18 years old). Regarding professional caregivers' behaviors the project aims to improve reflective functioning, perspective taking, emotion regulation, group intervention practices and quality of relationships in RC (primary outcomes). Additionally, it's expected to reduce levels of professional exhaustion and improve mental health (secondary outcomes). Attachment was considered a moderator. As a result of professional's caregivers behavior change, it is expected to observe subsequent effects on adolescents' psychosocial adaptation indicators, such as improvements on the quality of relationship with professional caregivers, hope, self-efficacy and in emotional regulations processes and a decrease on antisocial behavior, anger control problems and emotional suffering (secondary outcomes). Attachment was considered also a moderator. Program efficacy was evaluated using a randomized control trial (RCT). Institutions were assigned to the experimental (n = 10) and to the control (n = 11) group using a covariate adaptative randomization method. Data was assessed using a 4-wave longitudinal design (baseline, interim, post, 6-month follow-up) with professional caregivers and adolescents' self-reports.

Conditions

Professional Role

Keywords

Attachment, Caregiving, Professionals, Youth

Outcome Measures

Primary Outcomes (5)

• Change from Baseline Reflexive functioning (Professionals) at T1 (seven months), T2 (13 months) and T3 (follow up - 19 months)

  Participants filled in the Reflective Functioning Questionnaire (RFQ, Fonagy et al., 2016; Neto et al, xxx), for assessing certainty (4 items, e.g., "I don't always know why I do what I do") and uncertainty (4 items, e.g., "I always know what I feel.") regarding self and other mental states. Items are rated using 7-point Likert scale from 1 ("Strongly disagree") to 4 ("Strongly agree") .

  baseline

• Change from Baseline Perspective Taking (Professionals) at T1 (seven months), T2 (13 months) and T3 (follow up - 19 months)

  Participants filled in the perspective taking scale from Interpersonal Reactivity Index (IRI; Davis, 1980, 1983; Limpo et al., 2010). It consists of 7 items (e.g., Sometimes I have a hard time seeing things from the young people's point of view), rated on 5-point Likert-scale from 1 (does not describe me at all) to 5 (describes me very well).

  baseline

• Change from Baseline Group intervention practices (Professionals) at T1 (seven months), T2 (13 months) and T3 (follow up - 19 months)

  Participants filled in Group Care Worker Intervention Checklist - GICL (Bastiaanssen et al., 2012; Santos et al., 2019) for assessing support (6 items, e.g., "Offering individual attention") autonomy (7 items, e.g., "Promote social independence") and control (8 items, e.g., "Learning to obey") rated on 3-point Likert scale from 1 ("not true") to 3 ("true").

  baseline

• Change from Baseline Quality of relationships with YRC (Professionals) at T1 (seven months), T2 (13 months) and T3 (follow up - 19 months)

  Quality of relationships with YRC (Mota \& Matos, 2010 adapted) was used for assessing "Caregiver as a Support figure" (6 items, e.g., "I feel youngsters trust me") and "Fear of merging boundaries" (9 items, e.g., "I feel I give more that I should") rated on a 6 point Likert scale from 1 ("I completely disagree") to 6 ("I completely agree").

  baseline

• Change from Baseline Emotion Regulation (Professionals) at T1 (seven months), T2 (13 months) and T3 (follow up - 19 months)

  Participants filled in the Affect Regulation Checklist (ARC; Moretti, 2003; Santos et al, submitted). ARC is a 12 items questionnaire that evaluates 3 dimensions: suppression (4 items, e.g., "I try hard not to think about my feelings"), dysregulation (4 items, "My feelings just take over me and I can't do anything about it"), and adaptive reflection (4 items, "Thinking about why I have different feelings helps me to learn about myself"). Items are rated in a 5-point Likert scale ranging from 1 ("Not like me") to 5 ("A lot like me").

  baseline

Secondary Outcomes (9)

• Change from Baseline Exhaustion (Professionals)at T1 (seven months), T2 (13 months) and T3 (follow up - 19 months)

  baseline

• Change from Baseline Mental health (Professionals) at T1 (seven months), T2 (13 months) and T3 (follow up - 19 months)

  baseline

• Change from Baseline Quality of relationship with Professional Caregivers (Adolescents)at T1 (seven months), T2 (13 months) and T3 (follow up - 19 months)

  baseline

• Change from Baseline Hope (Adolescents) at T2 (13 months) and T3 (follow up - 19 months)

  baseline

• Change from Baseline Psychological adjustment problems (Adolescents) at T1 (seven months), T2 (13 months) and T3 (follow up - 19 months)

  baseline

Other Outcomes (1)

• Change from Baseline Attachment (Professionals) at T3 (follow up - 19 months)

  baseline

Study Arms (2)

Experimental GP

EXPERIMENTAL

CareME Program. Group attachment-based intervention program developed for improving relational abilities in professional caregivers working in Youth Residential Care (YRC) settings.

Behavioral: CareME

Control GP

NO INTERVENTION

The control group had no intervention assigned.

Interventions

CareME BEHAVIORAL

CareME program was planned to integrate 12 group session (90 minutes), implemented fortnightly during a 6-month period, and facilitated by two psychologists and expert researchers on attachment framework. Components included psychoeducation (description of core concepts such as attachment, secure base, safe haven, emotion regulation, mentalization, trauma, and discussion of research on professional caregiving in YRC); experiential and relational exercises (roleplay; cases discussion, film script discussion). The program has 7 moduli: (i) adolescents' "pain-based behaviors" and attachment theoretical lens; (ii) adolescence and main developmental challenges (iii) setting rules and limits; (iv) trust \& secure base (figures and environment); (v) professionals' stories of attachment \& caregiving (vi) personal and structural characteristics that prevent a secure caregiving environment and (vii) professional impairment and strategies promoting healthy secure base provision.

Experimental GP

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Professionals from the educative and technical team working in YRC settings from the selected facilities
• Professionals that work with children age ranging 12 and 18 years old.

You may not qualify if:

• \- RC facilities that didn´t sign up at least 70% of professional caregivers (both from the technical and educative team)
• For adolescents:
• Adolescents currently in YRC facilities
• Adolescents with ages ranging between 12 and 18 years old at the 1st data collection.
• \- Adolescents with severe cognitive or emotional impairment

Sponsors & Collaborators

• University of Trás-os-Montes and Alto Douro: lead
• Universidade do Porto: collaborator

Study Sites (1)

University of Trás-os-Montes and Alto Douro

Vila Real, Portugal

Location

Related Publications (9)

• Ainsworth, M. S., & Bowlby, J. (1991). An ethological approach to personality development. American psychologist, 46(4), 333.

  BACKGROUND

• Bowlby, J. (1973). Attachment and loss: Volume II: Separation, anxiety and anger. In Attachment and loss: Volume II: Separation, anxiety and anger (pp. 1-429). The Hogarth press and the institute of psycho-analysis.

  BACKGROUND

• Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.

  BACKGROUND

• Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2018). Affect regulation, mentalization, and the development of the self. Routledge.

  BACKGROUND

• Moretti MM, Obsuth I, Craig SG, Bartolo T. An attachment-based intervention for parents of adolescents at risk: mechanisms of change. Attach Hum Dev. 2015;17(2):119-35. doi: 10.1080/14616734.2015.1006383. Epub 2015 Mar 18.

  PMID: 25782460 BACKGROUND

• Suresh K. An overview of randomization techniques: An unbiased assessment of outcome in clinical research. J Hum Reprod Sci. 2011 Jan;4(1):8-11. doi: 10.4103/0974-1208.82352.

  PMID: 21772732 BACKGROUND

• Törrönen, M. (2021). Social relationships and their connection to mental health for young people who have been in the care system. The British Journal of Social Work, 51. https://doi.org/10.1093/bjsw/bcab028

  BACKGROUND

• Zegers MA, Schuengel C, Van IJzendoorn MH, Janssens JM. Attachment and problem behavior of adolescents during residential treatment. Attach Hum Dev. 2008 Mar;10(1):91-103. doi: 10.1080/14616730701868621.

  PMID: 18351496 BACKGROUND

• Costa M, Matos PM, Santos B, Carvalho H, Ferreira T, Mota CP. We stick together! COVID-19 and psychological adjustment in youth residential care. Child Abuse Negl. 2022 Aug;130(Pt 1):105370. doi: 10.1016/j.chiabu.2021.105370. Epub 2021 Oct 18.

  PMID: 34756741 RESULT

Related Links

• CareME outputs

Study Officials

• Catarina P Mota, PhD

  University of Trás-os-Montes and Alto Douro

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 30, 2022
• First Posted: October 31, 2022
• Study Start: October 1, 2018
• Primary Completion: January 31, 2020
• Study Completion: September 30, 2022
• Last Updated: February 12, 2024

Record last verified: 2024-02

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, ICF, CSR
• Time Frame: After project completion.
• Access Criteria: Use for research purposes.

Locations

PT (1)