Attachment plays key role in study of Early Head Start outcomes

CHDD research affiliates Drs. Kathryn Barnard and Susan Spieker are working with Families First Early Head Start program of the Children's Home Society of South King County. In their study, Barnard, professor of family and child nursing and psychology, and Spieker, research associate professor of family and child nursing, are measuring outcomes of an intervention known as Parent-Child Communication Coaching, which is designed to boost a child's cognitive and language development and prevent learning and emotional problems. They are also seeking to determine if the intervention, with its focus on nurturing secure attachment relationships between mothers and babies, can increase participation in the variety of Early Head Start activities that promote parenting skills and help low-income parents prepare for and find jobs and child care.

Barnard and Spieker's study, which is funded by the Administration on Children Youth and Families (ACYF), is part of a national consortium of 15 projects evaluating the Early Head Start program. The program was launched in 1994 when Congress reauthorized Head Start, the successful program for low-income preschoolers, and extended comprehensive child development and support services to low-income families with children under 3 and pregnant women.

The study was sparked by results of an earlier program run by the Children's Home Society of South King County that provided services to low-income children younger than one year and their families. Although the earlier program had an overall favorable outcome, measured by gains in the parents' development and self-sufficiency, staff found that about a third of the enrolled families were difficult to draw into program activities. Barnard and Spieker suspect that in those families the mother's personal feelings of security played a crucial role. "We think that those mothers who are hard to engage have an insecure pattern of attachment relationships. From their earliest years they've learned that they can't depend on people," says Barnard.

"Attachment develops over the first year of life between the mother and the baby in order to provide the type of protection and opportunities for learning that the human infant needs," explains Spieker. Attachment has two aspects. The mother monitors the child and the safety of the environment, and the infant monitors the mother and learns about the world from her reactions. One of the major lessons is self-image.

"Basically, the infant develops a working model of the availability of the caregiver," says Spieker. "As the infant develops a picture of the caregiver, he is also developing a picture of himself. Essentially, there are two possibilities. Either he is someone who has an effect on the environment by being able to make the caregiver respond, and he is worthy of that, or he is someone who is helpless, has no control over the environment and is not worthy of care and responsiveness. Those, of course, are the two extreme models. There is also everything in the middle."

This model of attachment is carried through life and has a major impact on long-term social and emotional development. An insecure model of attachment can pass from generation to generation. However, Spieker points out, attachment is subject to continual revision based on experience. "Some people have an insecure model of attachment laid down when they are children, but through interactions with close friends or a partner, or with therapy, they are able to change their internal model and find security that enables them to be a secure base for their child," she says.

"We're interested in whether the intervention that we're dealing with can have some impact that will help change the approach to caregiving taken by mothers who themselves have insecure representations of attachment," says Spieker. To find out, Barnard and Spieker will study 200 families enrolled in the Families First program. They will look closely at how mothers' initial and changing attachment styles affect family functioning, child development and relationships between family and Head Start. Half of the families in the study will receive the intervention and half of the them will serve as a control group.

The intervention consists of weekly home visits with structured activities. The visits start when the mother is pregnant and continue until the child turns 2. Each home visitor has a background in early childhood development and is trained in building relationships, particularly with people who are uncomfortable in that situation.

During pregnancy, the home visitor helps the mother prepare for the new family member to come. The first visits center on working with the mother to survey her support network of family and friends. This process helps identify any problematic relationship issues the mother may have. It also gives the home visitor an opportunity to discuss dependable relationships and help determine who the mother can look to for support.

"We actually talk with the mother about what an attachment relationship means and how babies need to develop a sense of security. We talk with her about ways that she can help this happen," says Barnard. "We encourage her to begin thinking during pregnancy about the need to have the baby close to her, especially in the first six months, before the baby is able to get around independently. We encourage them to use soft carriers. Research demonstrates that babies who are nestled in a carrier on their mother's body develop a more secure attachment." If the baby is close to the caregiver when he or she squirms and gets upset, the caregiver is more likely to respond quickly.

After the baby is born, home visits support the mother as she is getting to know her baby. The home visitor helps her to identify her infant's sleep states and recognize the baby's nonverbal cues. "We teach the mother to teach her baby to use infant sign language. When the child is about two, we teach the mother a style of reading to the child that helps improve the child's vocabulary and parent-child interaction," says Barnard. The reading piece of the intervention is directed by Dr. Colleen Morisset, assistant professor of health services and a co-investigator on the project.

"We're hoping that this spotlight on the communication process will insure that conditions for secure attachment will be laid down by the mother's closeness and responses to her baby," says Barnard. "And, we're hypothesizing that through positive experience in communicating and relating to her baby, the mother may begin to rework her own mental schema about attachment relationships."

Periodic follow-up with control and intervention families will allow Barnard and Spieker to assess quality of mother-child attachment and parent-child interaction. For the intervention group, they will also evaluate the relationship between the mother and the Early Head Start program staff, the mother's participation in program activities and any changes in the mother's internal models of attachment relationships.

"I think we're going to find that the relationship that develops between the home visitor and the mother is one aspect of the intervention that will be effective in changing attachment," says Spieker. "For some mothers, it may not matter so much what the home visitor says, but how she says it, along with the fact that she comes every week--she's there, she's available, she's responsive. She's modeling what a secure relationship is, even though the mother might not be reciprocating. Over time, even a mother who for good reason is suspicious and distrustful can experience trust in this relationship and begin to change some of her expectations about what relationships are like."

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