Effectiveness of attachment based STEEP™ intervention in a German high-risk sample

G J Suess, U Bohlen, E A Carlson, G Spangler, M Frumentia Maier, G J Suess, U Bohlen, E A Carlson, G Spangler, M Frumentia Maier

Abstract

STEEP(TM) was one of the first attachment-based early intervention programs. The program applied findings from the Minnesota Longitudinal Study on Risk and Adaptation to the development of a supportive program for young high-risk mothers and their infants. STEEP's effectiveness was evaluated first in a randomized controlled study launched in 1987. The study showed effects of the one-year intervention on important individual and parenting variables, but not on quality of mother-infant attachment. In the current German study with young mothers at risk for abuse and neglect, a two-year adaptation of STEEP was evaluated within a quasi-experimental design. STEEP mother-infant pairs (N = 78) were compared with pairs who received standard services of the German Child Welfare System (GCWS, N = 29). Compared with GCWS pairs, significantly more mother-infant pairs in the intervention group showed secure attachment patterns in Ainsworth´s Strange Situation when the infants were 12 months of age. At the end of the intervention (infant age = 24 month), attachment security scores derived from Waters' Attachment Q-Sort were in the predicted direction and showed a medium effect size, but did not reach criteria of statistical significance. At both time points, the STEEP group showed significantly fewer signs of attachment disorganization than the comparison group.

Keywords: Attachment based early intervention; STEEP program; translational research; young high-risk mothers.

References

    1. Abidin R.R. Parenting Sress Index - professional manual. 3rd. Lutz: Psychological Assessment Ressources; 1995.
    1. Ahnert L., Eckstein-Madry T., Supper B., Bohlen U., Suess E.S. Waters Attachment Q-Sort nach deutscher Übersetzung und Erprobung. Unveröffentlichtes Arbeitsmaterial des Arbeitsbereichs Entwicklung der Fakultät für Psychologie der Universität Wien. 2012 (unpublished manuscript)
    1. Ainsworth M.S., Blehar M.C., Waters E., Wall S. Patterns of attachment: A psychological study of the strange situation. Oxford: Lawrence Erlbaum; 1978.
    1. Bakermans-Kranenburg M.J., Juffer F., Van IJzendoorn M.H. Interventions with video feedback and attachment discussions: Does type of maternal insecurity make a difference? Infant Mental Health Journal. 1998;19:202–219. doi: 10.1002/(ISSN)1097-0355.
    1. Bakermans-Kranenburg M.J., Van IJzendoorn M.H., Juffer F. Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin. 2003;129:195–215. doi: 10.1037/0033-2909.129.2.195.
    1. Bakermans-Kranenburg M.J., Van IJzendoorn M.H., Juffer F. Disorganized infant attachment and preventive interventions: A review and meta-analysis. Infant Mental Health Journal. 2005;26:191–216. doi: 10.1002/(ISSN)1097-0355.
    1. Bakermans-Kranenburg M.J., Van IJzendoorn M.H., Juffer F. Less is more: Meta-analytic arguments for the use of sensitivity-focused interventions. In: Juffer F., Bakermans-Kranenburg M. J., Van IJzendoorn M. H., editors. Promoting prositve parenting: An attachment-based intervention. New York, NY: Taylor & Francis; 2008. pp. 59–74.
    1. Bavolek S.J. Assessing and treating high-risk parenting attitudes. Early Child Development and Care. Special Issue: Child Abuse and Neglect: Theory, Research and Practice. 1989;42:99–112.
    1. Berlin L.J. Enhancing early attachments: The state of the field today. In: Berlin L. J., Ziv Y., Amaya-Jackson L. M., Greenberg M. T., editors. Enhancing early attachments: Theory, research, intervention, and policy. New York, NY: Guilford Press; 2005. pp. 3–33.
    1. Berlin L.J., Zeanah C.H., Lieberman A.F. Prevention and intervention programs for supporting early attachment security. In: Cassidy J., Shaver P. R., editors. Handbook of attachment, 2nd edition: Theory, research, and clinical applications. New York, London: Guilford Press; 2008. pp. 745–765.
    1. Bernard K., Dozier M., Bick J., Lewis‐Morrarty E., Lindhiem O., Carlson E.A. Enhancing attachment organization among maltreated children: Results of a randomized clinical trial. Child Development. 2012;83:623–636.
    1. Bohlen U. Dissertation thesis Institute of Psychology. University of Erlangen-Nuernberg; Erlangen, Germany: 2015. Evaluation der Effektivität bindungsbasierter Intervention bei hoch belasteten Müttern mit dem Frühinterventionsprogramm STEEP.
    1. Bowlby J. Attachment and loss. Vol. 1. New York, NY: Basic Books; 1969/1982.
    1. Bowlby J. A secure base. New York, London: Basic Books; 1988.
    1. Bretherton I., Munholland K. Internal working models in attachment relationships-elaborating a central construct in attachment theory. In: Cassidy J., Shaver P. R., editors. Handbook of attachment: Theory, research, and clinical applications. New York, NY: Guilford Press; 2008. pp. 102–126.
    1. Carlson E.A. A prospective longitudinal study of attachment disorganization/disorientation. Child Development. 1998;69:1107–1128. doi: 10.1111/j.1467-8624.1998.tb06163.x.
    1. Carlson E.A., Sroufe L.A., Egeland B. The construction of experience: A longitudinal study of representation and behavior. Child Development. 2004;75:66–83. doi: 10.1111/cdev.2004.75.issue-1.
    1. Cassidy J., Woodhouse S.S., Sherman L.J., Stupica B., Lejuez C.W. Enhancing infant attachment security: An examination of treatment efficacy and differential susceptibility. Development and Psychopathology. 2011;23:131–148. doi: 10.1017/S0954579410000696.
    1. Cicchetti D. Editorial: The legacy of development and psychopathology. Development and Psychopathology. 2013;25:1199–1200. doi: 10.1017/S0954579413000552.
    1. Cicchetti D., Rogosch F.A., Toth S.L. Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology. 2006;18:623–649. doi: 10.1017/S0954579406060329.
    1. Cierpka M., Evers O. Editorial: Implementation and efficacy of early-childhood interventions in German-speaking countries. Mental Health and Prevention. 2015;3:67–68. doi: 10.1016/j.mhp.2015.07.005.
    1. Conners N.A., Whiteside-Mansell L., Deere D., Ledet T., Edwards M.C. Measuring the potential for child maltreatment: The reliability and validity of the adult adolescent parenting inventory-2. Child Abuse and Neglect. 2006;30:39–53. doi: 10.1016/j.chiabu.2005.08.011.
    1. Cowan P.A., Powell D., Cowan C.P. Parenting interventions: A family systems perspective. In: Sigel I. E., Renninger K. A., editors. Handbook of child psychology (5th ed.), Vol. 4, child psychology in practice. New York, NY: Wiley; 1998.
    1. Cox J.L., Holden J.M., Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal depression scale. TheBritish Journal of Psychiatry. 1987;150:782–786. doi: 10.1192/bjp.150.6.782.
    1. De Wolff M.S., Van IJzendoorn M.H. Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment. Child Development. 1997;68:571–591. doi: 10.1111/j.1467-8624.1997.tb04218.x.
    1. Dozier M., Lindhiem O., Ackerman J.P. Attachment and biobehavioral catch-up. In: Berlin L. J., Ziv Y., Amaya-Jackson L. M., Greenberg M. T., editors. Enhancing early attachments: Theory, research, intervention, and policy. New York, NY: Guilford Press; 2005. pp. 178–194.
    1. Egeland B., Erickson M.F. Attachment theory and findings. Implications for prevention and intervention. In: Kramer S., Parens H., editors. Prevention in mental health. Now, tomorrow, ever? Northvale: Jason Aronson; 1993a. pp. 21–50.
    1. Egeland B., Erickson M.F. Implications of attachment theory for prevention and intervention. In: Parens H., Kramer S., editors. Margaret S. Mahler child development symposium, May 1992, Philadelphia, PA, US. Lanham: Jason Aronson; 1993b. pp. 23–50.
    1. Egeland B., Erickson M.F. Lessons from STEEPTM: Linking theory, research, and practice for the well-being of infants and parents. In: Sameroff A. J., McDonough S. C., Rosenblum K. L., editors. Treating parent-infant relationship problems: Strategies for intervention. New York, NY: Guilford Press; 2004. pp. 213–242.
    1. Egeland B., Jacobvitz D., Sroufe L.A. Breaking the cycle of abuse. Child Development. 1988;59:1080–1088. doi: 10.2307/1130274.
    1. Egeland B., Weinfield N.S., Bosquet M., Cheng V.K. Remembering, repeating, and working through: Lessons from attachment-based interventions. WAIMH handbook of infant mental health. In: Osofsky J. D., Fitzgerald H. E., editors. Infant mental health in groups at high risk (vol 4). WAIMH handbook of infant mental health. New York, NY: John Wiley & Son; 2000. pp. 35–89.
    1. Erickson M.F., Egeland B. In: STEEP facilitator´s guide. A comprehensive guide to work with parents from pregnancy through the first two years of the child´s life. Simon J., Kreutzer Rose T., editors. Minneapolis: University of Minnesota, Irving B. Harris Training Center for Infant and Toddler Development; 2002.
    1. Erickson M.F., Egeland B. Linking theory and research to practice: The minnesota longitudinal study of parents and children and the STEEP™ program. Clinical Psychologist. 2004;8:5–9. doi: 10.1080/13284200410001672207.
    1. Erickson M.F., Egeland B. Die Staerkung der Eltern-Kind-Bindung. Frühe Hilfen für die Arbeit mit Eltern von der Schwangerschaft bis zum zweiten Lebensjahr des Kindes durch das STEEP™-Programm. 2nd. Stuttgart: Klett-Cotta; 2009.
    1. Erickson M.F., Endersbe J., Simon J. Irving B. Harris Training Center for Infant and Toddler Development. University of Minnesota; 1999. Seeing Is Believing™ - videotaping families and using guided self-observation to build on parenting strenghts .
    1. Fearon P.R.M., Belsky J. Infant-mother attachment and the growth of externalizing problems across the primary-school years. The Journal of Child Psychology and Psychiatry. 2011;52:782–791. doi: 10.1111/j.1469-7610.2010.02350.x.
    1. Fraley R.C. Attachment stability from infancy to adulthood: Meta-analysis and dynamic modeling of developmental mechanisms. Personality and Social Psychology Review. 2002;6:123–151. doi: 10.1207/S15327957PSPR0602_03.
    1. Greenberg M.T. Enhancing early attachments: Synthesis and recommendations for research, practice, and policy. In: Berlin L. J., Ziv Y., Amaya-Jackson L. M., Greenberg M. T., editors. Enhancing early attachments: Theory, research, intervention, and policy. New York, NY: Guilford Press; 2005. pp. 327–342.
    1. Greer A.J., Gulotta C.S., Masler E.A., Laud R.B. Caregiver stress and outcomes of children with pediatric feeding disorders treated in an intensive interdisciplinary program. Journal of Pediatric Psychology. 2007;33:612–620. doi: 10.1093/jpepsy/jsm116.
    1. Groh A.M., Roisman G.I., Booth-LaForce C., Fraley R.C., Owen M.T., Cox M.J., Burchinal M.R. IV. Stability of attachment security from infancy to late adolescence. Monographs of the Society for Research in Child Development. 2014;79:51–66. doi: 10.1111/mono.12113.
    1. Groh A.M., Roisman G.I., Van IJzendoorn M.H., Bakermans-Kranenburg M.J., Fearon R.P. The significance of insecure and disorganized aAttachment for children’s internalizing symptoms: A meta-analytic study. Child Development. 2012;83:591–610.
    1. Grossmann K., Grossmann K.E., Spangler G.J., Suess G.J., Unzner L. Maternal sensitivity and newborns orientation responses as related to quality of attachment in northern Germany. Monographs of the Society for Research in Child Development. 1985;50:233–256. doi: 10.2307/3333836.
    1. Grossmann K.E., Grossmann K., Waters E. Attachment from infancy to adulthood: The major longitudinal studies. New York, NY: Guilford Press; 2005.
    1. Heinicke C.M., Fineman N.R., Ruth G., Recchia S.L., Guthrie D., Rodning C. Relationship-based intervention with at-risk mothers: Outcome in the first year of life. Infant Mental Health Journal. 1999;20:349–374. doi: 10.1002/(SICI)1097-0355(199924)20:4<>;2-Z.
    1. Hoffman K.T., Marvin R.S., Cooper G., Powell B. Changing toddlers’ and preschoolers’ attachment classifications: The circle of security intervention. Journal of Consulting and Clinical Psychology. 2006;74:1017–1026. doi: 10.1037/0022-006X.74.6.1017.
    1. Jungmann T., Brand T., Dähne V., Herrmann P., Günay H., Sandner M., Sierau S. Comprehensive evaluation of the pro kind home visiting program: A summary of results. Mental Health & Prevention. 2015;3:89–97. doi: 10.1016/j.mhp.2015.06.001.
    1. Kovan N., Chung A.L., Sroufe L.A. The intergenerational continuity of observed early parenting: A prospective, longitudinal study. Developmental Psychology. 2009;45(5):1205–1213. doi: 10.1037/a0016542.
    1. Lieberman A.F. Child-parent psychotherapy: A relationship-based approach to the treatment of mental health disorders in infancy and early childhood. In: Sameroff A. J., McDonough S. C., Rosenblum K. L., editors. Treating parent-infant relationship problems: Strategies for intervention. New York, NY: Guilford Press; 2004.
    1. Lieberman A.F., Weston D.R., Pawl J.H. Preventive intervention and outcome with anxiously attached dyads. Child Development. 1991;62:199–209. doi: 10.2307/1130715.
    1. Madigan S., Atkinson L., Laurin K., Benoit D. Attachment and internalizing behavior in early childhood: A meta-analysis. Developmental Psychology. 2013;49:672–689. doi: 10.1037/a0028793.
    1. Madigan S., Bakermans-Kranenburg M.J., Van IJzendoorn M.H., Moran G., Pederson D.R., Benoit D. Unresolved states of mind, anomalous parental behavior, and disorganized attachment: A review and meta-analysis of a transmission gap. Attachment & Human Development. 2006;8:89–111. doi: 10.1080/14616730600774458.
    1. Main M., Solomon J. Procedures for identifying infants as disorganized/disoriented during the ainsworth strange situation. In: Greenberg M. T., Cicchetti D., Cummings M., editors. Attachment in the preschool years: Theory, research, and intervention. Chicago: The University of Chicago Press; 1990. pp. 121–160.
    1. Masten A.S. Resilience in children threatened by extreme adversity: Frameworks for research, practice, and translational synergy. Development and Psychopathology. 2011;23:493–506. doi: 10.1017/S0954579411000198.
    1. Moss E., Dubois-Comtois K., Cyr C., Tarabulsy G.M., St. Laurent D., Bernier A. Efficacy of a home-visiting intervention aimed at improving maternal sensitivity, child attachment, and behavioral outcomes for maltreated children: A randomized control trial. Development and Psychopathology. 2011;23:195–210. doi: 10.1017/S0954579410000738.
    1. O´Connor T.G., Nilsen W.J. Models versus methaphors in translating attachment theory to the clinic and community. In: Berlin L. J., Ziv Y., Amaya-Jackson L. M., Greenberg M. T., editors. Enhancing early attachments: Theory, research, intervention, and policy. New York, NY: Guilford Press; 2005. pp. 313–326.
    1. Olds D.L. The nurse-family partnership: An evidence-based preventive intervention. Infant Mental Health Journal. 2006;27:5–25. doi: 10.1002/(ISSN)1097-0355.
    1. Olds D.L., Henderson C.R., Tatelbaum R., Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation. Pediatrics. 1986;77:16–28.
    1. Pederson D.R., Bailey H.N., Tarabulsy G.M., Bento S., Moran G. Understanding sensitivity: Lessons learned from the legacy of Mary Ainsworth. Attachment & Human Development. 2014;16:261–270. doi: 10.1080/14616734.2014.900094.
    1. Pickreign Stronach E., Toth S.L., Rogosch F., Cicchetti D. Preventive interventions and sustained attachment security in maltreated children. Development and Psychopathology. 2013;25:919–930. doi: 10.1017/S0954579413000278.
    1. Pinquart M., Feussner C., Ahnert L. Meta-analytic evidence for stability in attachments from infancy to early adulthood. Attachment & Human Development. 2013;15:189–218. doi: 10.1080/14616734.2013.746257.
    1. Raby K.L., Steele R.D., Carlson E.A., Sroufe L.A. Continuities and changes in infant attachment patterns across two generations. Attachment & Human Development. 2015;17:414–428. doi: 10.1080/14616734.2015.1067824.
    1. Renner I., Heimeshoff V. Pilot projects in the German federal states: Summary of results. Köln: National Center of Early Prevention (NZFH); 2011.
    1. Sprangler G., Fremmer-Bombik E., Grossmann K. Social and individual determinants of infant attachment security and disorganization. Infant Mental Health Journal. 1996;17:127–139. doi: 10.1002/(ISSN)1097-0355.
    1. Sroufe L.A. Attachment and development: A prospective, longitudinal study from birth to adulthood. Attachment & Human Development. 2005;7:349–367. doi: 10.1080/14616730500365928.
    1. Sroufe L.A., Egeland B., Carlson E.A., Collins W.A. The development of the person: The Minnesota study of risk and adaptation from birth to adulthood. New York, NY: Guilford Publications; 2005.
    1. Sroufe L.A., Rutter M. The domain of developmental psychopathology. Child Development. 1984;55:17–29. doi: 10.2307/1129832.
    1. Steele M., Steele H., editors. Clinical applications of the adult attachment interview. New York, NY: Guilford Press; 2008.
    1. Steele M., Steele H., Bate J., Knafo H., Kinseya M., Bonuck K., Murphy A. Looking from the outside in: The use of video in attachment-based interventions. Attachment & Human Development. 2014;16:402–415. doi: 10.1080/14616734.2014.912491.
    1. Stern D. The motherhood constellation: Therapeutic approaches to early relational problems. In: Sameroff A. J., McDonough S. C., Rosenblum K. L., editors. Treating parent-infant relationship problems. New York, NY: Guilford Press; 2004. pp. 29–42.
    1. Suess G.J., Erickson M.F., Egeland B., Scheuerer-Englisch H., Hartmann H.-P. STEEP: Steps toward effective and enjoyable parenting. In: Steele H., Steele M., editors. Handbook of attachment-based interventions. New York, NY: Guilford Press; in press.
    1. Suess G.J., Grossmann K.E., Sroufe L.A. Effects of infant attachment to mother and father on quality of adaptation in preschool: From Dyadic to individual organisation of self. International Journal of Behavioral Development. 1992;15:43–65. doi: 10.1177/016502549201500103.
    1. Suess G.J., Mali A., Reiner I., Fremmer-Bombik E., Schieche M., Suess E.S. Attachment representations of professionals – Influence on intervention and implications for clinical training and supervision. Mental Health and Prevention. 2015;3:129–134. doi: 10.1016/j.mhp.2015.06.002.
    1. Suess G.J., Sroufe J. Clinical implications of the development of the person. Attachment & Human Development. 2005;7:381–392. doi: 10.1080/14616730500365886.
    1. Toth S.L., Gravener-Davis J.A., Guild D., Cicchetti D. Relational interventions for child maltreatment: Past, present, and future perspectives. Development and Psychopathology. 2013;25:1601–1617. doi: 10.1017/S0954579413000795.
    1. Toth S.L., Maughan A., Manly J.T., Spagnola M., Cicchetti D. The relative efficacy of two interventions in altering maltreated preschool children’s representational models: Implications for attachment theory. Development and Psychopathology. 2002;14:877–908. doi: 10.1017/S095457940200411X.
    1. Van Den Boom D.C. The influence of temperament and mothering on attachment and exploration: An experimental manipulation of sensitive responsiveness among lower-class mothers with irritable infants. Child Development. 1994;65:1457–1477. doi: 10.2307/1131511.
    1. Van IJzendoorn M.H., Bakermans-Kranenburg M.J., Juffer F. Why less is more. From the dodo bird verdict to evidence-based interventions on sensitivity and early attachments. In: Berlin L. J., Ziv Y., Amaya-Jackson L. M., Greenberg M. T., editors. Enhancing early attachments: Theory, research, intervention, and policy. New York, NY: Guilford Press; 2005. pp. 297–312.
    1. Wartner U.G., Grossmann K., Fremmer-Bombik E., Suess G.J. Attachment patterns at age six in south Germany: Predictability from infancy and implications for preschool behavior. Child Development. 1994;65:1014–1027. doi: 10.2307/1131301.
    1. Waters E.1995The Attachment Q-Set (Version 3.0)Waters E., Vaughn B., Posada G., Kondo-Ikemura K.Caregiving, cultural and cognitive perspectives on secure based behavior and working models. New growing points of attachment theory and research Monographs of the Society for Research in Child Development, 60
    1. Waters E., Merrick S., Treboux D., Crowell J., Albersheim L. Attachment security in infancy and early adulthood: A twenty-year longitudinal study. Child Development. 2000;71:684–689. doi: 10.1111/1467-8624.00176.
    1. Weinfield N.S., Sroufe L.A., Egeland B., Carlson E. Individual differences in infant-caregiver attachment. In: Cassidy J., Shaver P. R., editors. Handbook of attachment. 2nd. New York, NY: Guilford Press; 2008. pp. 78–101.
    1. Zwönitzer 2015Mental Health & Prevention, 3

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