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Contact Information:

Dr Camilla Rosan
+44 (0)20 7794 2313
Camilla.rosan@annafreud.org


More information about this study, what is involved and how to take part can be found on the study website.

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Be Part of Research - Trial Details - Exploring the clinical and cost-effectiveness of the Circle of Security Intervention for mothers in perinatal mental health services
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Exploring the clinical and cost-effectiveness of the Circle of Security Intervention for mothers in perinatal mental health services

Not Recruiting

Open to: All Genders

Age: Adult

Newcastle upon Tyne Exeter Chester Darlington Prescot Worthing Kettering Wakefield

Medical Conditions

Perinatal mental health

This information is provided directly by researchers, and we recognise that it isn't always easy to understand. We are working with researchers to improve the accessibility of this information. In some summaries, you may come across links to external websites. These websites will have more information to help you better understand the study.


One in five women experience mental health difficulties in pregnancy or in the first year after giving birth (often called the perinatal period). Around 7% of women in the perinatal period experience complex and severe mental health difficulties (such as bipolar disorder, complex post-traumatic stress disorder) and receive specialist support from NHS community perinatal mental health services. Research tells us that if women experiencing these kinds of mental health difficulties are not able to get treatment, their symptoms are unlikely to get better on their own and for some women it can make it difficult to parent their new baby. In England, untreated perinatal mental health difficulties costs over £8 billion each year. Perinatal mental health services provide a range of support for new mothers with mental health difficulties, but there are still gaps in the research about what interventions and therapies work for which mothers. Two of these gaps are in group therapy approaches and parent-infant bonding therapies that are adapted to the needs of women with complex and severe mental health problems One therapy that is showing some promise in filling these gaps outside of the perinatal period is the Circle of Security-Parenting Intervention. Circle of Security-Parenting is a parent-infant bonding, group intervention developed in America that is delivered over 10 weekly sessions. Circle of Security-Parenting is designed to help parents understand more about their young children and their emotions, as well as manage their own difficult emotions and how they may affect their relationship with their child. The group environment also encourages peer support. A number of previous research studies have explored whether Circle of Security-Parenting works to improve parenting quality and mental health. These studies show that mothers find it a helpful approach and that it does improve their mental health and relationship with their child. However, these research studies have been poor quality and there has never been a research trial in England or in perinatal mental health services. Researchers are therefore aiming to address this gap by doing the first large study to test whether Circle of Security-Parenting works for women using perinatal mental health services in improving their mental health symptoms and the quality of their bond with their babies. It addresses an area of key concern to women, families and the NHS and is an opportunity to reduce the burden of its long-term effects. If shown to be effective the intervention could be delivered widely across the NHS in perinatal mental health services. The aim of this study is to find out whether Circle of Security-Parenting is more effective than usual care in improving symptoms of maternal mental health difficulties and mother-infant bonding for mothers in perinatal mental health services.

Start dates may differ between countries and research sites. The research team are responsible for keeping the information up-to-date.  

The recruitment start and end dates are as follows:

04 Jan 2022 01 Jan 2024

Publications

2023 Protocol article in https://doi.org/10.1186/s13063-023-07194-3 (added 15/03/2023)2025 Results article in https://pubmed.ncbi.nlm.nih.gov/40583740/ interparental conflict between families who are, and are not, experiencing complex or severe mental health difficulties (added 02/07/2025)

Participants are divided into two groups at random to either receive Circle of Security-Parenting (COS-P) alongside usual care in their perinatal mental health service, or to receive their usual care only. The researchers will compare women’s mental health symptoms and parent-infant bonding levels at the start of the study, 3 months later (when one group of the women will have received the COS-P group) and then 7 and 12 months after the women first joined the study. The researchers will also interview women to find out their views of receiving COS-P. There will be a recorded play and parenting task with their child to complete. The proposed research has also received feedback from a group of experts by experience who have used perinatal mental health services, to make sure it is adapted and relevant to the needs of women in the perinatal period with complex or severe mental health difficulties.


Women or birthing parents, at least 18 years of age with a child aged 0 – 12 months, who are accessing an NHS perinatal mental health service in one of the nine sites that are taking part in the study

You can take part if:



You may not be able to take part if:


Women and other birthing parents who:1. Do not meet the inclusion criteria2. Do not have a minimum of conversational English3. Have received COS-P previously4. Are experiencing active psychosis

NHS staff:1. NHS staff members who do not meet the inclusion criteria


Below are the locations for where you can take part in the trial. Please note that not all sites may be open.

  • Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
    St Nicholas Hospital Jubilee Road Gosforth
    Newcastle upon Tyne
    NE3 3XT
  • Devon Partnership NHS Trust
    Wonford House Hospital Dryden Road
    Exeter
    EX2 5AF
  • Cheshire and Wirral Partnership NHS Foundation Trust
    Trust Headquarters Redesmere The Countess of Chester Health Park Liverpool Road
    Chester
    CH2 1BQ
  • Tees, Esk and Wear Valleys NHS Foundation Trust
    Trust Headquarters West Park Hospital Edward Pease Way
    Darlington
    DL2 2TS
  • Mersey Care NHS Foundation Trust
    V7 Building Kings Business Park
    Prescot
    L34 1PJ
  • Sussex Partnership NHS Foundation Trust
    Trust Hq Swandean Arundel Road
    Worthing
    BN13 3EP
  • Northamptonshire Healthcare NHS Foundation Trust
    St Marys Hospital 77 London Road
    Kettering
    NN15 7PW
  • South West Yorkshire Partnership NHS Foundation Trust
    Trust Headquarters Fieldhead Hospital Ouchthorpe Lane
    Wakefield
    WF1 3SP

The participants will help the researchers to better understand whether Circle of Security-Parenting works for women in NHS perinatal mental health services. It will help them to shape the care provided to new mothers whilst under these services, as they adjust to their role within their new family. It will also help their Trust’s and other perinatal mental health services across the country to ensure the care offered to all service users is as beneficial as possible.
The researchers do not expect that taking part in the study will put participants at any particular disadvantage. However, one of the elements of taking part involves participants completing questionnaires about their mental health and their relationship with their child, which may bring up difficult emotions or memories. Similarly, the intervention will involve discussions around their parenting and their experiences of being parented, which some may find challenging. The researchers have set in place safeguarding measures to make sure participants are supported throughout their time in the study. There will also be time commitments involved in taking part in both terms of completing the different questionnaires and the intervention.

Dr Camilla Rosan
+44 (0)20 7794 2313
Camilla.rosan@annafreud.org



More information about this study, what is involved and how to take part can be found on the study website.


The study is sponsored by Anna Freud Centre and funded by NIHR Evaluation, Trials and Studies Co-ordinating Centre (NETSCC); Grant Codes: NIHR131339.



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Read full details for Trial ID: ISRCTN18308962

Or CPMS 50730

Last updated 02 July 2025

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