Objective Understanding mechanisms and active ingredients of intervention is critical to training clinicians, particularly when interventions are transported from laboratories to communities. One promising active ingredient of parenting programs is clinicians’ in vivo feedback regarding parent-child interactions. The present study examined whether a form of in vivo feedback, in the moment commenting, predicted treatment retention and parent behavior change when the Attachment and Biobehavioral Catch-up (ABC) intervention was implemented in a community setting. Method Observational data were collected from 78 parent-child dyads (96% mothers; mean age = 29 years; 81% minority; infants’ mean age = 12 months; 90% minority) across 640 sessions conducted by 9 clinicians (100% female, mean age = 39; 67% minority) in Hawaii. Parental behavior was assessed with a semi-structured play task before and after intervention. Clinicians’ in the moment feedback to parents was assessed from intervention session videos. Results Clinicians’ frequency and quality of in the moment feedback predicted change in parental intrusiveness and sensitivity at post-treatment. Frequency of in the moment feedback also predicted likelihood of retention. Hierarchical linear modeling demonstrated strong support for these associations at the between-clinician level, and limited additional support at the within-clinician (i.e., between-case) level. Conclusions A hypothesized active ingredient of treatment, in the moment feedback, predicted community-based ABC outcomes. The results complement lab-based evidence to suggest that in vivo feedback may be a mechanism of change in parenting interventions. Helping clinicians to provide frequent, high quality in vivo feedback may improve parenting program outcomes in community settings.
Young children in foster care often experience adversity, such as maltreatment and lack of stability in early caregiving relationships. As a result, these children are at risk for a range of problems, including deficits in executive functioning. The Attachment and Biobehavioral Catch-up for Toddlers (ABC-T) intervention was designed to help foster parents behave in ways that promote the development of young children's emerging self-regulatory capabilities. Participants included 173 parent-toddler dyads in three groups: foster families that were randomly assigned to receive either the ABC-T intervention (n = 63) or a control intervention (n = 58), as well as low-risk parent-toddler dyads from intact families (n = 52). At a follow-up conducted when children were approximately 48 months old, children's executive functioning abilities were assessed with the attention problems scale of the Child Behavior Checklist (Achenbach & Rescorla, 2000) and a graded version of the Dimensional Change Card Sort developed for preschoolers (Beck, Schaefer, Pang, & Carlson, 2011). Results showed that foster children whose parents received the ABC-T intervention and low-risk children never placed in foster care had fewer parent-reported attention problems and demonstrated greater cognitive flexibility during the Dimensional Change Card Sort than foster children whose parents received the control intervention. These results indicate that an attachment-based intervention implemented among toddlers in foster care is effective in enhancing children's executive functioning capabilities.Children in foster care are at risk for negative developmental outcomes as the result of experiences of abuse, neglect, and unstable attachment relationships (Jackson, Gabrielli, Fleming, Tunno, & Makanui, 2014). In addition to the initial removal from their birth parents, children in foster care often experience repeated disruptions in their attachment relationships as they transition between multiple caregivers and placements (Dozier & Lindhiem, 2006;Sanchirico & Jablonka, 2000). As a result, foster children often struggle with effectively regulating their cognitions (Bernedo, Salas, Fuentes, & García-Martín, 2014;Tarren-Sweeney, 2008), emotions (Pears, Kim, Buchanan, & Fisher, 2015), behaviors (Clausen, Landsverk, Ganger, Chadwick, & Litrownik, 1998;Keller et al., 2001), and Address correspondence and reprint requests to: Mary Dozier, Department of Brain and Psychological Sciences, University of Delaware, 108 Wolf Hall, Newark, DE 19716; mdozier@udel.edu. (Bernard, Butzin-Dozier, Rittenhouse, & Dozier, 2010;Bruce, Fisher, Pears, & Levine, 2009). HHS Public AccessIn the United States, about 20% of children in foster care are between the ages of 1 and 3 years old (US Department of Health and Human Services, 2015). Children in this age group face several critical developmental tasks: establishing attachment relationships with caregivers (Sroufe, 2005), using attachment relationships to coregulate difficult emotions (Cassidy, 1994), and developi...
In this paper, we highlight issues we consider key to the development of an evidence-based intervention for the parents of young children who had experienced early adversity. The intervention was initially developed for foster infants, but adapted for infants living with their neglecting parents, then for young children adopted internationally, and finally for toddlers in foster care or living with neglecting birth parents. The intervention and its adaptations share a focus on the importance of providing nurturance to children when they are distressed, and following children's lead when they are not distressed. We approached intervention development from a theoretical position, with attachment theory and stress neurobiology central. But we are, at heart, clinical scientists and have been open to confirmation or disconfirmation of our ideas and hypotheses. In this paper, we describe our approach, discuss issues and challenges central to our work, and share advice for addressing similar issues and challenges.
Bringing evidence-based treatments to community practice is a critical challenge for the field. When implemented in the community, evidence-based treatments often fail to provide the benefits shown in laboratory settings. Therefore, when evidence-based treatments are transported to the community, it is essential to investigate implementation process and outcomes. The present study assessed whether Attachment and Biobehavioral Catch-up (ABC), an intervention for high-risk parents that has been shown to be efficacious in randomized clinical trials (RCTs), changed parent behavior in a community-based setting. This study examined data collected from 78 cases by 9 parent coaches in a diverse community setting in Hawaii, and compared data to benchmarks from RCTs. Parent coach fidelity was coded from intervention session video clips, and was also compared with benchmarks. Caregivers participating in ABC were primarily birth parents, and most were referred through Child Protective Services involvement or for reasons of harsh parenting or neglect. Parental behavior was assessed before and after intervention using a semi-structured play task. Increases in parental following the lead and delight, and decreases in parental intrusiveness, were observed; these changes were comparable to effect sizes observed in RCTs. Intent to treat analyses were conducted using behavioral data from videotaped sessions, and suggested that ABC also improved following the lead in parents who subsequently dropped out of treatment. These results support the viability of ABC for enhancing parenting behavior among parents at high risk for maltreatment, and demonstrate that parent coaches in community agencies can successfully implement ABC.
Attachment and Biobehavioral Catch-up (ABC) is a parenting program developed to enhance sensitivity among parents of infants who experience early adversity. In several randomized clinical trials, the intervention’s efficacy has been demonstrated. Moving interventions into the community with adequate fidelity is challenging, though, and intervention effects are often much smaller than when tested in randomized clinical trials. To enhance the likelihood that ABC is delivered with high fidelity, a micro-analytic fidelity assessment was developed. Using this fidelity tool as a central component of training, supervision, and certification, changes in parent sensitivity for 108 families with children ages 6 months to 2 years were as large as those seen in laboratory settings. These findings are discussed with regard to implications for moving other evidence-based interventions into the community.
Identification of effective consultation models could inform implementation efforts. This study examined the effects of a fidelity-focused consultation model among community-based clinicians implementing Attachment and Biobehavioral Catch-up. Fidelity data from 1217 sessions from 7 clinicians were examined in a multiple baseline design. In fidelity-focused consultation, clinicians received feedback from consultants' fidelity coding, and also coded their own fidelity. Clinicians' fidelity increased after fidelity-focused consultation began, but did not increase during other training periods. Fidelity was sustained for 30 months after consultation ended. Findings suggest that consultation procedures involving fidelity coding feedback and self-monitoring of fidelity may promote implementation outcomes.
Children adopted internationally experience adverse conditions prior to adoption, placing them at risk for problematic social–emotional development. The Attachment and Biobehavioral Catch-up (ABC) intervention was designed to help internationally adoptive parents behave in ways that promote young children's social–emotional competence. Participants included 131 parent–child dyads randomly assigned to receive either ABC (n = 65) or a control intervention (n = 66). In addition, 48 low-risk biologically related parent–child dyads were included as a comparison group. At follow-up assessments conducted when children were 24 to 36 months old, internationally adopted children who received the ABC intervention had higher levels of parent-reported social–emotional competence than children who received a control intervention. In addition, observational assessments conducted when children were 48 and 60 months of age showed that internationally adopted children who received ABC demonstrated higher social–emotional competence than children who received a control intervention. Adopted children who received the control intervention, but not the ABC intervention, displayed more difficulties with social–emotional competence than low-risk children. Finally, postintervention parent sensitivity mediated the effect of ABC on observed child social–emotional competence in parent interactions, controlling for preintervention parent sensitivity. These results demonstrate the efficacy of a parenting-focused intervention in enhancing social–emotional competence among children adopted internationally.
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