Assessment tools for the quality of the caregiving relationship / attachment

by Robin Balbernie

This page is an edited extract from a paper written by Robin Balbernie on assessment and evaluation measures / tools that can be used in early intervention services. See the full paper here. Robin divides all the tools he describes into nine areas of which quality of the care-giving relationship / attachment is the fourth, each of the nine areas has a separate page on this wiki, links to all nine areas are available on an overview page.)

Pritchett, et al. (2010) have overviewed measures of family relationships / functioning. (Copy available.) They have split the measures in terms of 6
different aspects of family functioning: parent-child relationships; parental practices and discipline; parental beliefs; marital quality; global family
functioning, and situation-specific measures. They are not limiting to infancy. Also there is a very useful review by Michelle Sleed from the AFC, which I
have a copy of. Another handy online list (all ages and not all measures relevant here) and review is available from The National Child Traumatic
Stress network

1. The Parent Infant Relationship Global Assessment Scale (PIR-GAS). The PIR-GAS is a research-based rating instrument covering the full
range of parent/infant relationships used to describe the strengths of a relationship as well as to capture the severity of a disorder.
( ) A clinical interview with the parent coupled
with observed behaviour patterns allows the clinician to place the relationship into one of nine categories, ranging from ‘well adapted’
(scoring 100-91) to ‘documented maltreatment’ (10 and under). There is a risk that caregivers might act out positive behaviours while being
observed, but the rating can be changed with new information. Relationship difficulties are assessed based on the intensity, frequency,
and duration of maladaptive interactions and a score below 40 marks a disordered relationship. Three aspects of the parent/infant relationship
are evaluated in order to classify a disordered relationship: the behavioural quality of interactions, affective tone, and psychological
involvement. A bit subjective, but does focus the mind on relationships, and how these have changed. This is best combined with a structured
observation form, for example one from the Merrill Palmer Institute or even the Relationship Problem Checklist from Zero to Three. For all its
faults is widely used in America and Australia, and is central to Zero to Three’s DC:0-3. ( ) It should be
discussed in supervision; and could be used on a team level, perhaps applied to video material. This is the only measure that specifically can
be used to evaluate a change in the quality of the caregiving relationship, which might well be an obvious target that is useful for
local services, delivery partners and commissioners. The risk is that the latter may notice how easily the scores can be falsified, and so they
need to be backed up. It is best applied to video of interaction, in which case could be combined with KIPS. Note: This measure has been
superseded in the new DC:0-5 from Zero to Three.