Circle of Security Parenting Program: A Wise Early Intervention Investment to Promote Healthy Futures

As New York State transitions children, youth, and family services into Medicaid managed care, there must be far greater attention, capacity, and investment in tools and strategies that promote early childhood development. According to The Heckman Equation, investment in early development is a cost-effective strategy that not only leads to gains in education, health and productivity but can reduce deficits and strengthen the economy.1

Childhood experiences, both positive and negative, have a tremendous impact on lifelong health and wellbeing. It is widely known that Adverse Childhood Experiences (ACEs), a term coined by the seminal research study of the same name, are traumatic childhood events that can have negative, lasting effects on health and well-being, affecting a child’s brain development in profound ways.2 ACEs include physical, emotional or sexual abuse, parental divorce or incarceration of a parent or guardian. Significant adversity in childhood is strongly associated with unhealthy lifestyles and poor health decades later. These experiences show up as adult onset of chronic health conditions, mental health disorders, perpetration of and suffering from violence, early death, and overall lower quality of life. As the number of ACEs increases, so does the risk for these negative outcomes. Repeat exposure to ACEs can lead to a toxic stress response, a prolonged activation of stress response systems in the absence of protective relationships. When toxic stress response occurs continually, or is triggered by multiple sources, it can lead to potentially permanent changes and long-term effects on brain development and have a cumulative toll on an individual’s physical and mental wellbeing for a lifetime.3

The wide-ranging health and social consequences of ACEs underscore the importance of preventing them before they happen. So, while we know that the effects of ACEs can last a lifetime, they don’t have to if we intervene early. Understanding health, social, and economic risks that result from ACEs can help improve recovery and prevention efforts. The social and physical environment can serve as an important safeguard to these negative experiences. Early nurturing, responsive relationships with caring adults as early in life as possible can lead to healthy brain development thus preventing the damaging effects of toxic stress response.4

Parents and caregivers play a vital role in building a healthy future for their children. The quality of the relationship between caregiver and child in the first years of life is central to a child’s later functioning. One approach to building the foundation for healthier lives is by promoting secure attachments between young children and their parents and promoting healthy social-emotional development. Research evidence shows that attachment quality has an important influence on the success of a child’s developmental pathway toward successful adulthood.5

A leading relationship based early intervention program that is designed to enhance attachment security and strengthen relationships between parents and children is Circle of Security Parenting Program (COS-P), a universal primary prevention strategy that has been used nationally and internationally. COS-P focuses on how parent/child relationships can be strengthened, helping parents increase their awareness of their children’s needs and effective ways to respond. Specifically, COS helps parents and caregivers enhance their observational skills, ability to reflect on their experience, capacity for emotional regulation, and empathy for their children’s needs. By building more secure relationships between parents and children, children exhibit increased empathy, greater self-esteem, better relationships with parents and peers, enhanced school readiness, and an increased capacity to handle emotions more effectively. By strengthening the parent-child relationship early in the child’s life, COS aims to alleviate the effects of early-life adversity on child development and may reduce the need for more intensive services later in the child’s life.6

At the Mental Health Association of New York City, we have been proud to partner with the New York City Department of Health and Mental Hygiene (DOHMH) since 2013 to implement the successful COS-P intervention for high risk families in New York City. When the project was initially started through NYC Project LAUNCH, a SAMHSA-funded young child wellness grant, the project evaluation examined the impact of COS-P on parent depression, parent child relationships and family well-being. The findings revealed that parents with mild to severe depression scores at the beginning of COS-P had a significant decrease in depression by the end of COS-P. Parents also showed significant improvements in parenting knowledge and nurturing attachments with their child.7

Over the next two years, we will be working collaboratively with DOHMH to significantly expand this intervention to parents and caregivers in high need communities in the Bronx and Harlem. We have an ambitious aim to reach thousands of parents providing them with the tools they need to build healthy secure relationships and futures for their young children. As Medicaid system reform for families and children offers new opportunities, we hope payers and providers will invest in this cost-effective early intervention model that can mitigate negative life outcomes and serve as a foundation for lifelong health and well-being.

For more information on MHA-NYC’s COS Parent Coaching Department, visit:

Giselle Stolper is the President and CEO of the Mental Health Association of New York City. Kimberly Williams is the Executive Vice President of Integrated Policy and Program Services of the Mental Health Association of New York City.


  1. Heckman, J. (2015). Invest in early childhood development: reduce deficits, strengthen the economy. The Heckman Equation Issue Brief. Retrieved from
  2. Felitti, V. et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14, 245–258. Retrieved from
  3. National Scientific Council on the Developing Child. (2005/2014). Excessive stress disrupts the architecture of the developing brain: Working paper No. 3. Updated Edition. Retrieved from
  4. National Scientific Council on the Developing Child. (2005/2014). Excessive stress disrupts the architecture of the developing brain: Working paper No. 3. Updated Edition. Retrieved from
  5. Kobak, R., Cassidy, J., Lyons-Ruth, K., & Ziv, Y. (2006). Attachment and developmental psychopathology. In D. Cicchetti (Ed.), Developmental psychopathology (2nd; pp. 333–369). New York: Wiley.
  6. Sroufe, L. A., Egeland, B., Carlson, E. A., & Collins, W. A. (2005). The development of the person: The Minnesota Study of Risk and Adaptation from birth to adulthood. New York: Guilford Press.
  7. Circle of Security International.
  8. Auerbach, et. al. (2015). Family strengthening parenting program. NYC Project LAUNCH Local Brief.

Have a Comment?