Composite Caregiving Questionnaire (CCQ) 综合护理量表

synopsis（简介）

The Caregiving Composite Questionnaire (CCQ) is a 42-item questionnaire completed by parents/caregivers of children aged 0 to 6 years. It measures five parenting constructs that are important in reducing attachment insecurity and promoting attachment security in young children:

Parenting self-efficacy in empathy

Parenting self-efficacy in expressing affection and managing child emotion

Caregiving helplessness

Hostile perceptions of the child

Parent mentalisation

The CCQ is intended to provide clinicians with information about caregivers’ perceptions of their caregiving role and their thoughts and feelings about their child.  It is not designed to categorise parent-child attachment relationships, but it provides important information about factors related to child attachment security that can inform the assessment process and help with treatment planning. The CCQ can also be used to monitor outcomes of attachment-based treatments that are focused on shifting the cognitive aspects of caregiving associated with attachment security.

照顾综合问卷（CCQ）是一份由 42 个项目组成的问卷，由 0-6 岁儿童的父母/照顾者填写。它测量了对减少幼儿依恋不安全感和促进幼儿依恋安全感非常重要的五种养育构建：
父母在移情方面的自我效能
父母在表达爱意和管理儿童情绪方面的自我效能感
照料无助感
对孩子的敌意认知
父母心理化
CCQ旨在为临床医生提供有关照顾者对其照顾角色的看法以及他们对孩子的想法和感受的信息。 它不是用来对亲子依恋关系进行分类的，但它提供了与儿童依恋安全相关因素的重要信息，可为评估过程提供参考，并有助于制定治疗计划。CCQ 还可用于监测以依恋为基础的治疗结果，这些治疗的重点是改变与依恋安全相关的护理认知方面。

Validity and Reliability（信效度）

The CCQ is made up of 5 subscales selected from already validated measures that assess constructs associated with attachment security in young children. Subscales were selected because of their ease of administration and scoring and theoretical alignment with precursors of attachment relationships (Maxwell, McMahon, Huber, Reay et al., 2021). Original scale authors granted permission for each subscale to be included in this composite questionnaire. The information below shows the origins of questionnaire items and subscales. Questionnaire items aimed at parents of infants were reworded to be relevant for parents of children 0 – 6 years.

Empathy & Understanding: taken from empathy and understanding subscale of the Tool to Measure Parenting Self-Efficacy (TOPSE; Kendall & Bloomfield, 2005). Items = 6.

Emotion & Affection: taken from emotion and affection subscale of the TOPSE (Kendall & Bloomfield, 2005). Items = 6.

Caregiving Helplessness: taken from Helpless subscale of Caregiving Helplessness Questionnaire (CHQ; George & Solomon, 2011). Items = 7

Hostility: taken from Hostile Parenting scale, The Longitudinal Study of Australian Children (LSAC; 2006). Items = 5

Parental Mentalising: taken from Diamond Maternal Reflective Functioning Scale (Diamond et al. 2013). Items = 18

Parent self-efficacy. The initial TOPSE development study suggested good internal consistency of each subscale, with good internal consistency for the empathy (alpha = 0.89) and affection subcales (alpha = 0.81) in a sample of 63 parents of children 0 – 6 years (Kendall & Bloomfield, 2005). A systematic review of self-reported parenting self-efficacy measures also concluded that the TOPSE had good content validity and acceptable construct validity (Wittkowski et al., 2017).

Caregiving helplessness.  The original scale development study revealed good factor structure for the measure’s three subscales in a sample of 208 mothers of children aged 3 – 11 years. The helpless subscale showed good internal consistency (alpha = 0.85), and convergent and divergent validity in a smaller subset of the larger sample (George & Solomon, 2011). Specifically, the helpless subscale was significantly related to helplessness ratings from interviews, and not significantly related to mothers’ stress levels in non-caregiving domains, such as stress about health. A subsequent validation study showed good internal consistency of the helpless subscale with mothers of infants (alpha = 0.80; Huth-Bocks, Guyon-Harris, Calvert, Scott & Harris, 2016), and good convergent validity with concurrent measures of maternal risk factors and infant problems. The helpless subscale was correlated with maternal BDI-II depression (r = 0.53), maternal PCL post-traumatic stress symptoms (r = 0.53), and infant problems as measured by the BITSEA (r = 0. 32).

Hostility. The hostility subscale was developed for use in the Longitudinal Study of Australian Children (LSAC, 2006), which is a large, longitudinal study following the development of 10,000 children and families from all parts of Australia. It has shown good internal consistency, with H coefficients ranging from 0.85 to 0.92 across multiple waves of the LSAC (Giallo, Cooklin, Wade, D’Esposito, & Nicholson, 2013). It has also shown predictive validity with significant associations with child outcomes in major population-based studies.

Parental mentalising. The parent mentalising scale was developed and validated on a sample of 219 mothers of infants (Diamond, Caltabiano, Caltabiano, & Goodman, 2013). It showed acceptable internal consistency and evidence of convergent and divergent validity.

The CCQ was piloted for use as a tool for monitoring outcomes of attachment-based interventions in a non-randomized waitlist control trial examining the effectiveness of Circle of Security Parenting (Maxwell, McMahon, Huber, Reay et al., 2021).  In this sample of 255 parents of children aged 0-6 years, internal consistency of all subscales was good (alphas ranged from 0.78 to 0.88). Associations among subscales aligned as expected, supporting convergent validity of the subscales. For example, hostility was positively correlated with caregiving helplessness (r = 0.56) and negatively with empathy (r = -0.40) and affection (r = -0.38); empathy was positively correlated with affection (r = 0.66); caregiving helplessness was negatively correlated with empathy (r = -0.57) and affection (r = -0.50); and parent mentalising was positively correlated with empathy (r = 0.45) and affection (r = 0.30). All subscales successfully differentiated treatment from waitlist control group in the study, and all were sensitive to change in the intervention group.

A study by Byron & Hawkins (2022) using the CCQ with a community sample of 80 parents/caregivers of children aged between 1 and 4 (mean age 2) found the following means (and standard deviations):

Empathy & Understanding: mean = 48.3 (9.3)

Emotion & Affection: mean = 54.7 (9.98)

Hostility: mean = 11.6 (9.2)

Caregiving Helplessness: mean = 9.4 (3.4)

Parental Mentalising: mean = 37.7 (6.2)

Percentiles are computed using percentile tables from Byron & Hawkins (2022), with the exception of the Affection scale, where simple mean and standard deviation were used to compute norms given data artefacts in the percentile table.

CCQ 由 5 个分量表组成，这些分量表是从评估幼儿依恋安全相关建构的已验证量表中挑选出来的。之所以选择这些子量表，是因为它们易于施测和计分，而且理论上与依恋关系的前兆一致（Maxwell, McMahon, Huber, Reay et al.） 原量表作者同意将每个子量表纳入本综合问卷。以下信息显示了问卷项目和分量表的来源。针对婴儿父母的问卷项目经过重新措辞，使之与 0-6 岁儿童的父母相关。
移情和理解：取自 "衡量为人父母自我效能感的工具"（TOPSE；Kendall 和 Bloomfield，2005 年）中的 "移情和理解 "分量表。项目 = 6。
情感与亲情：取自 TOPSE 的情感与亲情分量表（Kendall & Bloomfield, 2005）。项目 = 6。
照顾无助感：取自照顾无助感问卷（CHQ；George & Solomon，2011 年）的无助感分量表。项目 = 7
敌意：摘自《澳大利亚儿童纵向研究》（LSAC；2006 年）中的 "敌意养育 "量表。项目 = 5
父母心智化：摘自 Diamond 母亲反思功能量表（Diamond 等，2013 年）。项目 = 18
家长自我效能感。TOPSE 最初的开发研究表明，每个子量表都具有良好的内部一致性，在对 63 名 0-6 岁儿童的父母进行的抽样调查中，移情（α = 0.89）和亲情子量表（α = 0.81）具有良好的内部一致性（Kendall 和 Bloomfield，2005 年）。对自我报告的养育自我效能感测量的系统性回顾也得出结论，TOPSE 具有良好的内容效度和可接受的建构效度（Wittkowski 等人，2017 年）。
照料无助感。 最初的量表开发研究显示，在 208 名 3-11 岁儿童的母亲样本中，该量表的三个分量表具有良好的因子结构。无助感分量表显示出良好的内部一致性（α = 0.85），并在较大样本的较小子集中显示出收敛效度和发散效度（George & Solomon，2011 年）。具体而言，无助感分量表与访谈中的无助感评分有显著相关性，而与母亲在非照料领域的压力水平（如健康压力）无显著相关性。随后的验证研究表明，无助感分量表与婴儿母亲的内部一致性良好（α = 0.80；Huth-Bocks、Guyon-Harris、Calvert、Scott & Harris，2016 年），与母亲风险因素和婴儿问题的并行测量具有良好的收敛效度。无助分量表与产妇 BDI-II 抑郁症（r = 0.53）、产妇 PCL 创伤后应激症状（r = 0.53）以及 BITSEA 测量的婴儿问题（r = 0.32）相关。
敌意。敌意子量表是为澳大利亚儿童纵向研究（LSAC，2006 年）开发的，该研究是一项大型纵向研究，跟踪调查了澳大利亚各地 10,000 名儿童和家庭的成长情况。该研究显示了良好的内部一致性，在 LSAC 的多个波次中，H 系数在 0.85 至 0.92 之间（Giallo, Cooklin, Wade, D'Esposito, & Nicholson, 2013）。在基于人口的主要研究中，它还显示出与儿童结果显著相关的预测有效性。
父母心理化。父母心理化量表是在 219 位婴儿母亲的样本中开发和验证的（Diamond, Caltabiano, Caltabiano, & Goodman, 2013）。该量表显示了可接受的内部一致性以及收敛性和发散性有效性。

在一项研究 "安全圈育儿法"（Circle of Security Parenting）有效性的非随机等待对照试验（Maxwell、McMahon、Huber、Reay 等人，2021 年）中，CCQ 被试用为监测依恋干预结果的工具。 在这个由 255 名 0-6 岁儿童的父母组成的样本中，所有分量表的内部一致性都很好（校正系数在 0.78 到 0.88 之间）。各分量表之间的关联符合预期，支持了分量表的趋同有效性。例如，敌意与护理无助正相关（r = 0.56），与同理心（r = -0.40）和亲情（r = -0.38）负相关；同理心与亲情正相关（r = 0. 66）；照料无助与移情（r = -0.57）和亲情（r = -0.50）呈负相关；父母精神化与移情（r = 0.45）和亲情（r = 0.30）呈正相关。在这项研究中，所有分量表都成功地将治疗组与候补对照组区分开来，而且所有分量表都对干预组的变化很敏感。
拜伦和霍金斯（Byron & Hawkins，2022 年）使用 CCQ 对 80 名 1 至 4 岁儿童（平均年龄为 2 岁）的父母/照顾者进行了社区抽样调查，结果发现平均值（和标准差）如下：
同情与理解：平均值 = 48.3 (9.3)
情感与亲情：平均值 = 54.7 (9.98)
敌意：平均值 = 11.6 (9.2)
照顾无助感：平均值 = 9.4 (3.4)
父母心理化：平均值 = 37.7 (6.2)
百分位数使用 Byron & Hawkins（2022 年）的百分位数表计算，但亲情量表除外，由于百分位数表中的数据存在误差，因此使用简单平均值和标准差计算常模。

Scoring and Interpretation（得分解释）

Each scale of the CCQ is scored separately. A total score is not computed.

Empathy & Understanding (items 4 – 9): a total raw score from 0 – 60. A higher score indicates more empathic parenting. A cutoff score below 38 indicates possible clinical concern.

Emotion & Affection (items 10 – 15; item 15 is reverse-scored): a total raw score from 0 – 60. A higher score indicates more affectionate parenting. A cutoff score below 47 indicates possible clinical concern.

Hostility (items 16 – 20): a total raw score from 0 – 50. A high score indicates more parental hostility. A cutoff score of above 21 indicates possible clinical concern.

Caregiving Helplessness (items 21 – 27): a total raw score from 7 – 35. A high score indicates more parental helplessness. A cutoff score of above 16 indicates possible clinical concern.

Parental Mentalising (items 28 – 45; items 31, 36, 41 are reverse-scored): a total raw score from 0 – 54. A high score indicates keeping the child more in mind and thinking about own childhood more. A cutoff score below 31 indicates possible clinical concern. The Parental Mentalising scale has three subscales:

Cue Recognition (items 28, 31, 33, 36, 39, 41, 44): being aware of the child’s needs and wants

Mentalisation of Infant (items 29, 32, 35, 37, 40, 43, 45): being aware of child’s own internal world

Own Childhood Experience (items 30, 34, 38, 42): an awareness of the parents’ own childhood experiences

Normative percentiles are presented from a community sample of parents/caregivers of children aged between 1 and 4 (Byron & Hawkins, 2022). A percentile of 50 indicates that the individual’s scores are average when compared to other parents/caregivers.

A scaled score (out of 10) is presented for the Parental Mentalising subscales so that a comparison can be made between them (given there are different numbers of items between each one).

CCQ 的每个量表分别计分。不计算总分。
移情与理解（项目 4 - 9）：原始总分 0 - 60 分。分数越高，表示父母越能感同身受。分界点分数低于 38 分表示可能存在临床问题。
情感与亲和力（项目 10 - 15；项目 15 为反向计分）：原始总分 0 - 60 分。分数越高，表示父母的亲子关系越亲密。临界值低于 47 分表示可能存在临床问题。
敌意（项目 16 - 20）：原始总分 0 - 50 分。得分越高，表示父母的敌意越强。分界点高于 21 分表示可能存在临床问题。
照顾无助感（项目 21 - 27）：原始总分在 7 - 35 之间。得分越高，表明父母越无助。临界值高于 16 分表示可能存在临床问题。
父母心理化（项目 28 - 45；项目 31、36 和 41 为反向计分）：原始总分在 0 - 54 之间。得分越高，表明父母对孩子的关注越多，对自己童年的思考也越多。分界点分数低于 31 分，表示可能存在临床问题。父母心智化量表有三个分量表：
线索识别（项目 28、31、33、36、39、41、44）：意识到孩子的需求和愿望
婴儿心智化（项目 29、32、35、37、40、43、45）：意识到孩子自己的内心世界
自己的童年经历（项目 30、34、38、42）：了解父母自己的童年经历
标准百分位数是根据 1 至 4 岁儿童的父母/照顾者的社区样本得出的（Byron 和 Hawkins，2022 年）。百分位数为 50 表示与其他父母/照顾者相比，个人得分处于平均水平。
父母心智化分量表采用了比例分数（满分 10 分），以便进行比较（因为每个分量表的项目数不同）。