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CARE-Index

aai1The CARE-Index (Crittenden 2005, 2007) is an assessment of the developing relationship between a ‘parent’ and child. It uses a videotaped 3-5 minute free play observation in which the adult is asked ‘to play with your child as you would normally’.

The infant CARE-Index is unique in its ability to measure the beginnings of attachment behaviour from birth (until 15 months, after which the Toddler version should be used).  The CARE-Index is also flexible in where it can be carried out; it can, for example, be conducted in the parents’ home.  The CARE-Index is assessed by reliable, trained coders. As well as attachment figures (usually parents or foster parents) it can be used with adults who do not have direct care of the child. The Toddler (preschool) CARE-Index is applicable for use with children aged from 16 to about 72 months (before then the Infant version should be used), but is currently being used in research with children up to the age of 6. The CARE-Index takes account of developmental changes in its assessment of the parent child relationship.

The CARE-Index can provide information about parents’ sensitivity and responsiveness to children’s signals and children’s strategies for coping with parents’ behaviour. Parental sensitivity is assessed by the extent to which the parent (or parent figure) does things that please the child, or rather looks to control the child (because the child does not please them), or is unresponsive (and so is failing to connect with the child).  The child’s strategies can include being cooperative, protesting what they don’t like, passive acceptance, and compulsive behaviour (where the child inhibits their own signals of need to fit in with parental expectations). The different patterns of insensitive parental care, and the child strategies that result from them, each carry a different sort of threat to the child’s development.  Using the manualised system, which analyses discrete areas such as facial expression, voice, and turn-taking, ratings can be given of children’s attachment strategies and of the degree of risk to the child’s future development. The CARE-Index was designed as a screening tool and should always be considered in the light of other evidence.

The CARE-Index aims to:

•Identify at-risk relationships, such as cases where children display a falsely positive presentation in order to comply with the demands of maltreating parents or prop up the functioning of a depressed or withdrawn carer.

•Identify patterns of behaviour in parents and children that either indicate risk or concern, or promote positive development.

•Offer clear opportunities for primary prevention and early intervention

The power of the CARE index is well illustrated by the Sunderland Parent Infant Project (Svanberg et al. 2010), who used the measure (administered universally by health visitors) to offer differentiated intervention to relationships that needed it.  A programme group showed three times better rates of secure attachment in children that the control group (who received no intervention). There was a similarly large drop in the number of children with ‘at risk’ attachment classifications (as measured by the Ainsworth Strange Situation).  The service was found to have paid for itself and more, through the drop in the take up of health and mental health services of the group who had received intervention based upon the CARE index (compared to those who did not).