Enhancing Foster Care Relationships Through Attachment-Based Intervention: Protocol of SAFE FAMILY STUDY

NCT06701877 | Completed

• 1 other identifier: SAFE FAMILIES (ULL2/ONPE)
• Study Type: interventional
• Target: 70
• Locations: 1 country
• Sites: 1

Brief Summary

Background: Children in out-of-home care constitute a vulnerable population often experiencing mental health challenges related to early adversity and placement disruptions. The Circle of Security Parenting® (COS-P) program is an attachment-based intervention designed to enhance carer sensitivity and reflective functioning, ultimately improving the quality of carer-child relationships. Methods This study protocol follows a mixed-methods randomized controlled trial evaluating the effectiveness of the COS-P program for foster carers in France. A total of 70 foster carers will be randomly assigned to either the intervention group (receiving COS-P in addition to Treatment as Usual) or the waitlist control group (receiving Treatment as Usual only). Quantitative measures, including the Caregiving Composite Questionnaire, Parenting Stress Index, and the Marschak Interaction Method, will be administered at baseline and at follow-up). Qualitative data will be collected through focus groups with foster carers and COS-P facilitators, and through self-confrontation interviews with a subset of foster carers. Discussion: This study is the first to evaluate COS-P for foster carers in France. Findings will provide valuable insights into the program's effectiveness in improving carer-child relationships and foster carer well-being, ultimately contributing to better outcomes for children in out-of-home care. The study will also explore potential moderators of treatment outcome and shed light on the subjective experiences of participants.

Conditions

Parenting Sensitivity; Foster Care

Keywords

foster care, Attachment, Circle of Security Parenting intervention, resilience, intervention evaluation

Outcome Measures

Primary Outcomes (2)

• Caregiving composite questionnaire (CCQ)

  The CCQ is a 43-item self-report measure specifically designed to assess parent capacities targeted by the COS-P program, namely: parental mentalizing, parenting self-efficacy, and parent perceptions of the child. It combines six subscales and one single item drawn from previously validated measures, retaining the original response formats and scoring procedures for each subscale. The CCQ has demonstrated good reliability and validity in a pilot sample of parents and is being used in the current study to assess the impact of COS-P on these key parenting capacities.

  at baseline and at 3 month f/u

• Parent Development Interview-Revised

  This semi-structured interview consists of 31 questions, administered in approximately one hour, covering four domains: (a) perception of the child, (b) perception of the relationship, (c) parental affective experience, and (d) separation experiences.

  At baseline and at 3-month f/u

Secondary Outcomes (2)

• Parenting Stress Index - IV - Short Form (PSI)

  At baseline and 3-month f/u

• Marschak Interaction Method (MIM)

  At baseline and 3-month f/u

Study Arms (2)

COSP Intervention Group

EXPERIMENTAL

The intervention group will participate in the COS-P program in addition to TAU. Foster carers will be assigned to groups of 8 to 10 participants and will attend sessions in dedicated training facilities.

Waitlist control group

ACTIVE COMPARATOR

Waitlist control groupe will continue to receive Treatment as Usual (TAU), which consists of Psycho-Educational Support (PSE) provided by Child Protection Services. PSE typically involves home visits, educational and psychological support for foster carers and/or children in placement, and efforts to support and monitor contact between children and their birth families. The control group will be placed on a waiting list to receive the COS-P program as part of continuing education at a later date.

Behavioral: Traitement as usual (TAU)

Interventions

Circle of security Parenting (COS-P) BEHAVIORAL

The Circle of Security Parenting® (COS-P) program is an attachment-based intervention designed to enhance caregiver sensitivity, parental reflective functioning, and the quality of the child's attachment to their caregiver. This manualized intervention, with both educational and therapeutic components, empowers caregivers to better understand and respond to their child's needs, fostering secure attachment (22).

Traitement as usual (TAU) BEHAVIORAL

TAU typically involves home visits, educational and psychological support for foster carers and/or children in placement, and efforts to support and monitor contact between children and their birth families.

Waitlist control group

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Foster carers:
• Signed informed consent form.
• Commitment to attend all eight sessions of the COS-P program.
• Employed by CPS Haute-Loire or by one of the two participating private agencies.
• Foster children:
• Placed with a foster carer participating in the study.
• Aged from 1 to 6 years.
• In permanent placement (5 or more days per week with the foster carer).
• Consent obtained from all individuals holding parental responsibility.

Sponsors & Collaborators

• Centre Hospitalier Emile Roux: collaborator
• Shankland Rebecca: lead
• Observatoire National de la Protection de l'Enfance (ONPE): collaborator

Study Sites (1)

DEPARTEMENT de la Haute-Loire

Le Puy-en-Velay, France, 43000, France

Location

Related Publications (4)

• Maxwell AM, McMahon C, Huber A, Hawkins E, Reay RE. Addressing the Evidence Gap: Protocol for an Effectiveness Study of Circle of Security Parenting, an Attachment-Based Intervention. Front Glob Womens Health. 2020 Oct 22;1:575752. doi: 10.3389/fgwh.2020.575752. eCollection 2020.

  PMID: 34816157 BACKGROUND

• Helle J, Vollestad J, Schanche E, Hjelen Stige S. From seeing difficult behaviour to recognizing legitimate needs - A qualitative study of mothers' experiences of participating in a Circle of Security Parenting program in a public mental health setting. Psychother Res. 2023 Apr;33(4):482-493. doi: 10.1080/10503307.2022.2132888. Epub 2022 Oct 31.

  PMID: 36314235 BACKGROUND

• Engler AD, Sarpong KO, Van Horne BS, Greeley CS, Keefe RJ. A Systematic Review of Mental Health Disorders of Children in Foster Care. Trauma Violence Abuse. 2022 Jan;23(1):255-264. doi: 10.1177/1524838020941197. Epub 2020 Jul 20.

  PMID: 32686611 BACKGROUND

• Pereira M, Sedes L, Gadea E, Shankland R. Enhancing foster care relationships through attachment-based intervention: the safe families study protocol, a randomized controlled trial of the circle of security parenting program(R). BMC Psychol. 2025 Feb 8;13(1):107. doi: 10.1186/s40359-025-02424-6.

  PMID: 39923102 DERIVED

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Full Professor of health and developmental psychology

Study Record Dates

• First Submitted: November 19, 2024
• First Posted: November 22, 2024
• Study Start: October 10, 2024
• Primary Completion: September 1, 2025
• Study Completion: December 1, 2025
• Last Updated: March 17, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

FR (1)