Community implementation outcomes of Attachment and Biobehavioral Catch-up

Abstract

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.

In Vivo Feedback Predicts Parent Behavior Change in the Attachment and Biobehavioral Catch-up Intervention

“…In previous work with this community sample, we had found evidence of changes in parental behaviors after participation in ABC (Caron, Weston-Lee, Dozier & Haggerty, 2016). In this study, we examined whether the frequency and quality of clinicians’ in vivo feedback predicted parent behavior change and treatment retention.…”

“…As clinicians implement ABC in families’ homes, they encourage targeted parent behaviors through manual-guided discussion, video feedback, and in the moment comments. ABC has been successful in improving these parent behaviors in both randomized clinical trials (Bernard, Simons & Dozier, 2015) and in community settings (Caron et al, 2016). …”

Unique neurobiology during the sensitive period for attachment produces distinctive infant trauma processing

“…Although there are natural variations in maternal care, extremely stressful circumstances can push these normal variations into abusive, neglectful, and trauma-associated maternal care; these can engender a disordered attachment, which is associated with a decreased regulatory capability in the caregiver (Carlson, Hostinar, Mliner, & Gunnar, 2014; Hostinar, Sullivan, & Gunnar, 2014). In humans, disordered attachment related to trauma is linked with social behavioral problems in later life (Bryant, 2016; Caron, Weston-Lee, Haggerty, & Dozier, 2016) and there is some evidence for a link with depressive symptoms (Shevlin, Boyda, Elklit, & Murphy, 2014; but see Fearon, Bakermans-Kranenburg, Van Ijzendoorn, Lapsley, and Roisman, (2010); however, the mechanisms for these changes remain poorly understood.…”

“…In the nest, pups receive a breadth of cues from the mother, including not only normal nurturing in the absence of abuse but also varying degrees of maternal care in the form of licking and grooming. Rodent models of maternal responsiveness, including genetically engineered variants in levels of licking and grooming, have been shown to program stress reactivity in rat pups throughout the lifespan (Claessens et al, 2011); these results parallel the importance of attunement and responsivity in human parenting, especially in highly stressful environments (Asok, Bernard, Roth, Rosen, & Dozier, 2013; Caron et al, 2016). Variations in maternal responsivity can be potentiated by environmental conditions; specifically, high levels of anxiety and/or neophobia resulting from low resources can result in low licking and grooming (Caldji et al, 1998).…”

Trauma-Exposed Infants and Toddlers: A Review of Impacts and Evidence-Based Interventions

“…In a study of the effects of the ABC intervention with mothers and infants in a residential substance-abuse treatment program, mean scores on observed sensitive parenting behavior measures were three times higher for the ABC intervention group than for the control group (Berlin, Shanahan, & Carmody, 2014). Additionally, ABC has proven successful at improving parenting behaviors even when translated into community practice models of care (Caron, Weston-Lee, Haggerty, & Dozier, 2016), demonstrating the ability to translate the ABC intervention successfully into social work agencies and community practice.…”