Circle of Security-Home Visiting-4 (COS-HV4)
The information in this program outline is provided by the program representative and edited by the CEBC staff. This program has been rated by the CEBC in the following Topic Areas:
About This Program
Target Population: Families with children younger than 6 years old in high-risk populations such as child enrolled in Early Head Start, teen moms, or parents with irritable babies
For parents/caregivers of children ages: 0 – 5
COS-HV4 is a version of Circle of Security that includes a mandatory home visiting component consisting of 4 home visits. The overall Circle of Security protocol focuses on:
- Teaching caregivers the fundamentals of attachment theory (i.e., children’s use of the caregiver as a secure base from which to explore and a safe haven in times of distress) by introducing a user-friendly graphic to the caregivers that they can refer to throughout the program
- Exploring not only parenting behaviors but also internal working models
- Presenting caregivers with a simple structure for considering the ways in which their internal working models influence their cognitive, affective, and behavioral responses to their children, thus helping caregivers gain awareness and understanding of the nonconscious, problematic responses they sometimes have to their children’s needs
The Circle of Security approach provides caregivers with the skills to understand their children’s behavior, and the skills to understand and regulate their own cognitive, affective, and behavioral responses to their children.
The goals of Circle of Security- Home Visiting – 4 (COS-HV4) are:
- Increase security of attachment of the child to the parent
- Increase parent’s ability to read child’s cues
- Increase empathy in the parent for the child
- Decrease negative attributions of the parent regarding the child’s motivations
- Increase parent’s capacity to self-reflect
- Increase parents capacity to pause, reflect, and choose security promoting caregiving behaviors
- Increase parent’s capacity to regulate stressful emotional states triggered by the child’s behavior
The essential components of Circle of Security- Home Visiting – 4 (COS-HV4) include:
- Individualized treatment plans for each caregiver are developed by reviewing videos of parent/child interaction.
- The video is used to formulate the linchpin issue for each participant. A linchpin issue is defined as the single, most problematic pattern related to attachment and caregiving, which, if changed successfully, is expected to have the greatest positive impact on the child’s attachment pattern.
- Carefully edited clips from the videos of the interactional assessments are used in the home visitation.
- Over the course of the program, each caregiver is the focus for three video review sessions, during which clips of the caregiver interacting with his or her own child are used to enhance individual strengths and address linchpin struggles.
- The caregiver is taught the Circle of Security as a map to understand the child’s needs as described below:
- When the parent acts as a secure base to explore, the parent is taught to provide:
- Support for exploration
- "Watch over me” as the child explores
- “Help me” when the child cue for help
- “Enjoy with me” when the child engages in play with the parent
- “Delight” as the child plays
- When the child’s attachment behavioral system is activated and the child needs to seek proximity to the parent, the parent is taught to provide:
- “Welcome” when the child seeks proximity
- “Protection” when needed
- “Comfort me” when the child is distressed
- “Organize my feelings” when the child is not easily comforted and may seem angry
- “Delight in me” when the child comes close for intimate contact
- Once the parent understands the “Circle,” the parent is asked to notice moments during the week and recall those “circle stories” at the beginning of each visit.
- The intervener (home visitor) should help the parent see the “Circle” happening with her child during the home visit.
- The intervener should help the parent identify which needs on the circle the parent feels and acts comfortable providing and which needs create discomfort in the parent.
- The intervener should help the parent identify both positive and negative attributions they may have about each need on the circle.
- The intervener should introduce the idea that meeting the needs on the circle increases the likelihood that his/her child will feel and act secure.
Circle of Security-Home Visiting-4 (COS-HV4) directly provides services to parents/caregivers and addresses the following:
- Parent who has an insecure attachment or is at risk of having an insecure attachment with a child under 6 years old that may result in child being difficult to calm after a stressful event or having difficulty in emotional regulation
One 3-hour assessment session followed by a 1.5-hour session every two to three weeks
Four home visits (after an out-of-home assessment) over a period of three months
This program is typically conducted in a(n):
- Birth Family Home
- Foster/Kinship Care
Circle of Security-Home Visiting-4 (COS-HV4) includes a homework component:
Parents are asked to notice “Circle Moments” between sessions. These are moments where their child shows a need on the Circle. Each meeting starts with asking the parent to share what they noticed that week.
Circle of Security-Home Visiting-4 (COS-HV4) does not have materials available in a language other than English.
Resources Needed to Run Program
The typical resources for implementing the program are:
- Room for conducting initial evaluation with video equipment to film parent/child interaction, one-way glass for filming is best but not absolutely needed
- Laptop computer for editing tape and presenting to parent during home visit
Minimum Provider Qualifications
Interveners (who work with the parent throughout the whole intervention) are mental health professionals with a Master’s level degree and must have completed the advanced 10-day Circle of Security training, passed the competency exam, and received supervision from a Circle-of-Security-approved supervisor for 5 complete interventions (each intervention consists of an evaluation and four home visits).
Education and Training Resources
There is a manual that describes how to implement this program, and there is training available for this program.
- Gretchen Cook
Training is obtained:
Offered several times a year at different locations. A site can sponsor training.
Number of days/hours:
10 day (70 hours)
Since Circle of Security-Home Visiting-4 (COS-HV4) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.
Show implementation information...
There are pre-implementation materials to measure organizational or provider readiness for Circle of Security-Home Visiting-4 (COS-HV4) as listed below:
An interview is conducted by the Circle of Security (COS) program originators with key staff at each new potential site. The main topics are:
- Support by the director of the agency for the COS requirements of 10 days of training, approximately one year of supervision, and one hour of preparation for every direct service hour
- Willingness to supply the program’s technical needs: cameras, microphones, tripod, and laptop computer with non-linear editing equipment and training to use all equipment
- Agreement that proper releases will be signed by families to allow the tapes to be done and viewed by the supervisor for fidelity and training purposes
- Agreement that administration will support providers of the program to meet for peer consultation after the formal supervision requirements are completed
Formal Support for Implementation
There is no formal support available for implementation of Circle of Security-Home Visiting-4 (COS-HV4).
There are fidelity measures for Circle of Security-Home Visiting-4 (COS-HV4) as listed below:
Fidelity is maintained by videotaping interventions and reviewing the tape with a qualified supervisor (one of the COS originators) to asses for compliance with COS standards.
Implementation Guides or Manuals
There are no implementation guides or manuals for Circle of Security-Home Visiting-4 (COS-HV4).
Research on How to Implement the Program
Research has not been conducted on how to implement Circle of Security-Home Visiting-4 (COS-HV4).
Relevant Published, Peer-Reviewed Research
This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.
Child Welfare Outcome: Child/Family Well-Being
Show relevant research...
A meta-analysis, see citation following, has been conducted on the Circle of Security-Home Visiting-4 (COS-HV-4), however, this article is not used for rating and therefore is not summarized:
- Yaholkoski, A., Hurl, K., & Theule, J. (2016). Efficacy of the Circle of Security Intervention: A meta-analysis. Journal of Infant, Child, and Adolescent Psychotherapy, 15(2), 95-103. doi:10.1080/15289168.2016.1163161
Cassidy, J., Woodhouse, S.S., Sherman, L.J., Stupica, B., & Lejuez, C.W. (2011). Enhancing infant attachment security: An examination of treatment efficacy and differential susceptibility. Journal of Development and Psychopathology, 23, 131-148. doi:10.1017/S0954579410000696
Type of Study: Randomized controlled trial
Number of Participants: 220
- Age — 1-12 months
- Race/Ethnicity — 43.2% African American/Black, 20.5% White, 18.6% multiracial, 14.1% Hispanic, 2.7% Asian, 0.5% Native American/Alaska Native, and 0.5% Hawaiian Native/Pacific Islander
- Gender — 122 Males and 98 Females
- Status — Participants were irritable infants and their economically stressed mothers recruited at birth.
Location/Institution: 14 hospitals within a large metropolitan area
Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated a brief attachment-based intervention (Circle of Security – Home Visiting-4 [COS-HV4]) aimed at increasing infant-mother attachment security for irritable infants from economically stressed families. Study goals included increasing attachment security in economically stressed families and examining maternal attachment styles in positive and negative environments. Mothers completed the Neonatal Behavioral Assessment Scale (NBAS) and Experiences in Close Relationships (ECR) and dyads were conducted during in-home visits twice during an infant’s first month. Infants were classified as either highly or moderately irritable. At infant age 12 months, mothers and their infants participated in the laboratory Strange Situation Procedure. Participants assigned to the intervention condition received the COS-HV4 intervention and those assigned to the control group received three one-hour psychoeducational sessions. The COS-HV4 intervention developed for this study consisted of three, one-hour home visits that occurred approximately every three weeks when infants were between 6.5 and 9 months of age. Approximately 2 weeks later, a brief fourth visit occurred. When separate analyses were conducted with maternal attachment styles, there were significant three-way interactions among treatment, irritability, and each of the examined maternal attachment style dimensions. Limitations included lack of infants with low irritability which may affect generalizability.
Length of postintervention follow-up: 2 weeks.
Woodhouse, S. S., Lauer, M., Beeney, J. R., & Cassidy, J. (2015). Psychotherapy process and relationship in the context of a brief attachment-based mother-infant intervention. Psychotherapy, 52(1), 145-150. doi:10.1037/a0037335
Type of Study: Randomized controlled trial (secondary data analysis)
Number of Participants: 85 mother-child dyads
- Age — Children: 5.5 months; Adults: 18-38 years (Mean=23.9 years)
- Race/Ethnicity — Children: Not specified; Adults: 40% Black or African American, 29.4% White, 20% Hispanic, 3.5% Asian, and 7.2% Other
- Gender — Children: 46 Male and 39 Female, Adults: 100% Female
- Status — Participants were economically stressed mothers of first-born, 5.5-month-old, temperamentally irritable infants.
Location/Institution: 14 hospitals within a large metropolitan area
Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilized a population from the Cassidy, Woodhouse, Sherman, Stupica, & Lejuez, 2011. The present study investigated links between the observer-rated process of psychotherapy and 2 key psychotherapy relationship constructs (i.e., working alliance and attachment to the therapist) in the context of Circle of Security-Home Visiting 4. Measures utilized include the Experiences in Close Relationship Scale (ECR), the Brief Symptom Inventory (BSI), the Working Alliance Inventory-Short Form (WAI-SF), the Client Attachment to Therapist Scale (CATS), and the Vanderbilt Psychotherapy Process Scale (VPPS). Results indicate therapist warmth, however, was positively associated with maternal ratings of security of attachment to the therapist, and therapist negative attitude was positively related to maternal ratings of preoccupied-merger attachment (assesses the degree to which the client is preoccupied with the therapist and wishes to extend the boundaries of the relationship to the therapist). As expected, both therapist warmth and exploration were positively associated with both maternal participation and exploration. Limitations included lack of infants with low irritability which may affect generalizability, and lack of follow-up.
Length of postintervention follow-up: None.
Cassidy, J., Woodhouse, S., Cooper, G., Hoffman, K., & Powell, B. (2005). Examination of the precursors of infant attachment security: Implications for early intervention and intervention research. In L. J. Berlin, Y. Ziv, L. M. Amaya-Jackson, & M. T. Greenberg (Eds.), Enhancing early attachments: Theory, research, intervention, and policy. New York: Guilford Press.
Powell, B., Cooper, G., Hoffman, K., & Marvin, R. (2009). The Circle of Security. In Zeanah, C. H. (Ed.), Handbook of infant mental health (3rd ed.), Guilford Press.
- Bert Powell, MA
- Agency/Affiliation: Circle of Security
- Email: firstname.lastname@example.org
- Phone: (509) 462-2024
- Fax: (509) 455-4112
Date Research Evidence Last Reviewed by CEBC: June 2017
Date Program Content Last Reviewed by Program Staff: June 2015
Date Program Originally Loaded onto CEBC: July 2014