Impact of a Group Intervention for Promoting Maternal Sensitivity in Primary Health Care Dyads at Psychosocial Risk. A Randomized Clinical Trial.

The first three years of life of every child is fundamental for their development, these years offer a unique window of opportunity for future health promotion, and different investigations have proved that investing in this period of life not only has great economic benefits, but social ones too.

In Chile the political decision to invest in these valuable years was translated into the creation of a national social program called "Chile Crece Contigo". This Program seeks to intervene in the physical, cognitive and socioemotional areas of development of every Chilean child since they are conceived until they are 4 years old to promote the best development outcome possible. The program identifies families at psychosocial vulnerability and offers them specific interventions according to the risk detected.

In this context different health and social services are provided to pregnant women during their health care visits, such as screening for different psychosocial risks (eg. Low social support, poverty, tobacco or drug use) and according to this screening various interventions are offered by Primary Health Care centers (eg. home visits).

It has been described that in groups at psychosocial risk the prevalence of interactional problems, specifically alterations in the attachment style between the child and the caregiver, is higher than in populations without these risks. This is relevant given that the quality and style of attachment established in infancy predicts subsequent social, emotional and cognitive development. Attachment styles, other than secure, have been associated with behavioural problems in pre-school and school ages, psychopathology during adolescence, later anxiety disorders and higher rates of using emergency health care services.

One of the factors shown to predict the attachment style established between the child and the caregiver is the parental sensitivity (also called maternal sensitivity)- defined as every caregiver's pattern of conduct toward the child that soothes, and increases his comfort and at the same time reduces his stress and disinterest. It also considers the capacity of the adult to pay attention, interpret and respond to the child´s needs. The literature suggests that having an adequate parental sensitivity is associated with a secure attachment style at the end of the first year of life, and having low parental sensitivity detected early in life (even as early as 6-8 weeks) predicts an insecure style of attachment at age 2.