María Pía Santelices

Enhancing early attachment: Design and pilot study of an intervention for primary health care dyads

The attachment style of an infant with his caregiver can greatly influence his future development. Many interventions have been proposed to enhance early secure attachment styles, but few have characteristics that make them suitable for primary health care. The objective of the study wasto design a complex intervention for promoting secure attachment in dyads detected in Primary Health Care with altered patterns of attachment styles. The methodology proposed by the UK Medical Research Council was used: (1) theoretical phase: literature review; (2) modelling phase: the main components of the intervention were defined through qualitative research; and (3) exploration phase: pilot study of the preliminary intervention. The attachment style of the dyads was evaluated using the Massie-Campbell scale prior to and four months after the pilot intervention. The preliminary intervention was designed: a group workshop (five to seven dyads, with children aged between 6 and 12 months and two health care professional monitors) structured around various activities that specifically dealt with the skills associated with parental sensitivity and addressed relevant issues to child rearing. The intervention was then tested in a pilot study of 11 dyads in two primary health care centres. The analysis was done with nine dyads (two were lost in the second evaluation), and showed an improvement of 33 per cent in the secure attachment style in the dyads (not statistically significant). An original intervention is designed and proposed for dyads who have early indicators of altered styles of attachment in primary health care.The attachment style of an infant with his caregiver can greatly influence his future development. Many interventions have been proposed to enhance early secure attachment styles, but few have characteristics that make them suitable for primary health care. The objective of the study wasto design a complex intervention for promoting secure attachment in dyads detected in Primary Health Care with altered patterns of attachment styles. The methodology proposed by the UK Medical Research Council was used: (1) theoretical phase: literature review; (2) modelling phase: the main components of the intervention were defined through qualitative research; and (3) exploration phase: pilot study of the preliminary intervention. The attachment style of the dyads was evaluated using the Massie-Campbell scale prior to and four months after the pilot intervention. The preliminary intervention was designed: a group workshop (five to seven dyads, with children aged between 6 and 12 months and two health care professional monitors) structured around various activities that specifically dealt with the skills associated with parental sensitivity and addressed relevant issues to child rearing. The intervention was then tested in a pilot study of 11 dyads in two primary health care centres. The analysis was done with nine dyads (two were lost in the second evaluation), and showed an improvement of 33 per cent in the secure attachment style in the dyads (not statistically significant). An original intervention is designed and proposed for dyads who have early indicators of altered styles of attachment in primary health care.

Promoting secure attachment: evaluation of the effectiveness of an early intervention pilot programme with mother-infant dyads in Santiago, Chile.

BACKGROUND Research indicates that the early attachment patterns of babies could influence their socio-emotional development and prevent the emergence of problematic behaviours in the child later in life. Many studies in the field of early attachment interventions have promoted a secure attachment bond between mother and infant. The purpose of this study was to evaluate the effectiveness of an early pilot intervention programme designed to promote a secure attachment bond in mother-infant dyads belonging to a population seeking regular treatment at urban health centres in Santiago, Chile. METHODS Primipara mothers were randomly assigned to two intervention conditions: a secure attachment promotion programme (experimental group = 43) or an educational talk (control group = 29). The Strange Situation Assessment was used to collect data on the attachment patterns of babies. RESULTS The results show that after the intervention, there were more babies with secure attachment in the experimental group than in the control group. CONCLUSIONS These findings represent a preliminary step towards evaluating interventions aimed at promoting secure attachment in Chilean mother-child dyads. While the effect of the intervention is not significant, the effect size obtained is respectable and consistent with other meta-analytic findings.

Efectividad de las Intervenciones en Apego con Infancia Vulnerada y en Riesgo Social: Un Desafío Prioritario para Chile

espanolEl articulo revisa los problemas que enfrentan los ninos y ninas vulnerados en diversas esferas de su desarrollo psicosocial, asociado en ocasiones a un trastorno de apego inseguro habitualmente de tipo desorganizado. Se plantean conceptos de la teoria del apego que resultan esenciales para comprender gran parte de los fundamentos que actualmente orientan las intervenciones desarrolladas en el campo de la salud mental infantil, los programas sociales y los sistemas de proteccion a la infancia. Luego se desarrolla una revision de la literatura especializada sobre intervenciones preventivas en apego y se revisan brevemente tres modalidades de psicoterapia basadas en evidencia con prometedoras aplicaciones en el campo de la infancia vulnerada. Se concluye relevando la importancia de difundir e incorporar practicas basadas en evidencia en el trabajo con infancia vulnerada en sus derechos, especialmente para el contexto chileno, en el cual actualmente es una prioridad la prevencion en salud mental infantil. EnglishThe paper review the problems that face traumatized children on diverse areas of their psychosocial devel-opment, linked sometimes to an insecure attachment disorder, commonly of a disorganized kind. Essential concepts of attachment theory are described, to understand a great part of the pillars that are orienting the interventions developed on the field of infant mental health, social programs, and childhood protection sys-tems. Later, a review of the specialized literature about preventive interventions on attachment is developed, and three psychotherapy modalities are briefly reviewed based on evidence with promisingly applications on the field of traumatized children. It concludes emphasizing the importance of diffusing and incorporat-ing evidence based practices in the work with traumatized childhood, especially for the Chilean context, in which today prevention on infant mental health is a priority.Resumen es: El articulo revisa los problemas que enfrentan los ninos y ninas vulnerados en diversas esferas de su desarrollo psicosocial, asociado en ocasiones a un ...

Evaluación del Apego en el Adulto: Una Revisión

En los ultimos anos se ha incrementado el interes en el apego de adultos, tanto desde una perspectiva teorica como empirica. Parte de este interes ha sido la evaluacion del constructo del apego en estas etapas del desarrollo. Esto ha generado dos tradiciones o lineas de investigacion, basadas en los modelos representacional y comportamental del apego, con sistemas de clasificacion categoriales y/o dimensionales y con instrumentos distintos. A traves de una exhaustiva revision del surgimiento y desarrollo de estas tradiciones se describen sus caracteristicas principales, sus ventajas y desventajas, asi como sus ambitos de aplicabilidad. Se concluye sobre la falta de unicidad del constructo del apego y se discute sobre los limites de su medicion y aplicacion.

Building infant–mother attachment: the relationship between attachment style, socio‐emotional well‐being and maternal representations

The pilot study explored differences in maternal representations between primiparous pregnant woman with different attachment styles and different levels of socio‐emotional well‐being. The sample included 55 pregnant women between the ages of 18 and 38, between 4 and 7 months pregnant. Representations were assessed using the ‘R’ Interview, attachment styles using the CaMir, and socio‐emotional well‐being using the OQ‐45.2. According to the results, prenatal representation of own mother‐as‐mother may be significantly related with pregnant women’s attachment experiences, but this representation may not be significantly related to the woman’s prenatal socio‐emotional well‐being. On the other hand, representation of the child and self‐as‐mother may not be significantly related to attachment experiences, but rather with prenatal socio‐emotional well‐being. This implies that the prenatal socio‐emotional context plays a great role as a protective factor with respect to the representations of the child and self‐as‐mother and, therefore, has strong implications for the future mother–infant attachment and child development, which is very relevant in terms of prevention of attachment difficulties.

Transmisión Intergeneracional del Apego y Función Reflexiva Materna: Una Revisión

The research about intergenerational transmission of attachment has reported strong associations between the adult and child patterns of attachment. Evidence has shown parent’s sensibility as an important precursor of infant’s security. Nevertheless the transmission gap still isn’t clear. Some authors have suggested the reflective function of the mother as a variable that could explain the gap. This article offers a discussion about this issue, showing some evidence that supports reflective function, and it’s behavioral aspects in the mother-child early relationship, as an essential dimension in the explanation of the transmission. Finally we discuss the relevance of considering this evidence in the design of preventive interventions.

Intervenciones psicológicas perinatales en depresión materna y vínculo madre-bebé: una revisión sistemática

Perinatal depression constitutes a high prevalence disorder, with negative repercussions in the mother and the baby. From these precedents, this article reviews different psychological interventions developed to re- duce depression and/or to promote a mother-infant bond-quality, from pregnancy to childrens second year of life. There are considered 27 studies published between 1996 and 2012, with inclusion of experimental and control groups. Results show that most of the interventions are focused in perinatal depression as a vari- able, differentiating between interventions during pregnancy and at postpartum. A minor number of studies focused on the mother-baby bond quality and to modify both variables in a simultaneous way. Interventions that were reported to be successful considered group and individual interventions focused on promoting maternal sensitivity and corporal techniques.

Apego y Ajuste Socio Emocional: Un Estudio en Embarazadas Primigestas

Este articulo se centra en el estudio del apego adulto y su relacion con el ajuste socioemocional durante el primer embarazo. Se utiliza una investigacion descriptiva correlacional de caracter transversal. La muestra se compone de 139 embarazadas primigestas de 19 a 40 anos y nivel socio-economico medio, medio bajo y bajo. El estilo de apego fue evaluado con el Cuestionario de Apego en Adultos, CaMir, y el ajuste socioemocional con el Cuestionario de Salud Mental, OQ-45.2. Se realizan analisis descriptivos de la muestra y correlaciones entre estilos de apego y las dimensiones del Cuestionario de Ajuste Socioemocional con el Coeficiente Producto Momento de Pearson. Los resultados muestran una relacion significativa entre los estilos de apego y los indicadores de ajuste.

Medición de la Sensibilidad del Adulto con Niños de 6 a 36 Meses de Edad:Construcción y Análisis Preliminares de la Escala de Sensibilidad del Adulto, E.S.A.

Resumen es: La sensibilidad del adulto ha sido ampliamente estudiada en la primera infancia, por asociarse a un vinculo de apego seguro con el nino(a). Existen difer...

Barreras de acceso a tratamiento de la depresión posparto en Centros de Atención Primaria de la Región Metropolitana: un estudio cualitativo

Background: In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers. Aim: To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile. Material and methods: Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used. Results: There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions. Conclusions: Patient and provider related barriers restricting treatment of postpartum depression were identified.BACKGROUND In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers. AIM To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile. MATERIAL AND METHODS Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used. RESULTS There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions. CONCLUSIONS Patient and provider related barriers restricting treatment of postpartum depression were identified.