Implementation of Attachment and Biobehavioral Catch-up: Preliminary Findings of Effectiveness and Predictors of Change

Bringing evidence-based treatments to community practice is a critical challenge for the field. However, treatments and predictors of outcome can fail to perform as expected when treatments leave the lab setting. Therefore, when evidence-based treatments are implemented in the community, it is essential to investigate treatment effectiveness, as well as predictors of treatment success.  The present study assessed the community-based effectiveness of an intervention for high-risk parents that had been shown to be effective in randomized clinical trials.  The study also examined whether in the moment feedback, considered a critical component of the intervention, was a predictor of parent behavior change.

The Attachment and Biobehavioral Catch-up (ABC) intervention is a 10-session, home-based intervention that helps parents to learn to interact in nurturing, synchronous, and non-frightening ways with their infants and toddlers.  ABC has been shown to improve infants’ attachment and self-regulation in randomized clinical trials.  During sessions, parent coaches give parents “in the moment” feedback about their behavior to support and encourage targeted behavior.  We consider in the moment feedback to be an active ingredient of the ABC intervention.  In a randomized clinical trial of ABC, frequency of parent coaches’ in the moment comments early in intervention predicted later parent sensitivity. 

Method: Participants included 57 parent-child dyads that completed ABC at a dissemination site.  ABC was administered by 8 parent coaches that were completing a training year. Parents, infants and clinicians were ethnically diverse and multi-cultural, including Native Hawaiian, Asian, and other Pacific Islander backgrounds.  Prior to intervention, parents completed a video-recorded semi-structured play assessment with their children.  Following 10 sessions of intervention, parents again completed the play assessment.  Play assessments were coded for targeted parent behavior, and intervention session videos were coded for parent coaches’ use of in the moment comments.  Coders were undergraduate students who were blind to hypotheses.

Results: Improvement in parental sensitivity and positive regard for the child, and decreases in parental intrusiveness, were observed in the play assessment.  Further, parent coaches’ frequency and quality of in the moment comments predicted reductions in parental intrusive behavior.

Conclusions: This study provides preliminary support for the ABC intervention’s effectiveness in the community.  Results also provide support for in the moment feedback’s role as an active ingredient of the ABC intervention.