Community- Based Effectivesness of the ABC Intervention

Interventions that have demonstrated efficacy in labs are often disseminated in the community with disappointing results. One of the key challenges of effective dissemination is maintaining adequate fidelity to intervention models (NIMH, 2013). Therefore, it is critical that assessments be designed to ensure that intervention fidelity can be monitored in community settings. This study examines whether an intervention with demonstrated efficacy can be implemented effectively in the community and whether fidelity is associated with effectiveness.

The Attachment and Biobehavioral Catch-up (ABC) intervention is a 10 session, home based intervention where trained parent coaches help parents to become more nurturing and follow their children’s lead. Through randomized clinical trials, the intervention has established a strong evidence base, with effects on child attachment, cortisol production, inhibitory control, and on parental sensitivity (Bernard et al., 2012, 2015a, 2015b; Lind et al., in press). In the moment comments have been identified as a key ingredient to the intervention’s effectiveness, with more comments associated with greater parental change (Caron et al., 2016).

In this effectiveness study, participants included eighteen parent- child dyads that completed the ABC intervention at a dissemination site. ABC was administered to these parent- child dyads by 11 parent coaches. In the current study, parental sensitivity was measured pre- and post- intervention through a play assessment. The 10- minute video- recorded play assessment was coded for sensitivity and intrusiveness. Intervention fidelity was measured through the quality and frequency of in the moment comments. Randomly selected, 5- minute clips from the recorded intervention sessions were coded to assess the rate of comments, the number of comments, and the number of components the comments included (i.e., description of behavior, link to intervention target, link to outcome). For both sensitivity and fidelity measures, coders were trained, demonstrated good reliability and were blind to the hypotheses.

Preliminary results show a significant improvement in parents’ sensitivity and a decrease in parental intrusiveness. The percentage of on- target in the moment comments predicted change in parental sensitivity. Results provide support for the ABC intervention’s effectiveness in changing parent behavior in dissemination sites. Second, these results provide support that intervention fidelity drives the change in parental behavior.