Intervention to help caregivers nurture and respond sensitively to their infants and toddlers to foster their development and form strong and healthy relationships.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
Australian Study
Risk of Bias
Cost
Target Age Group
About
Attachment and Biobehavioral Catch-up (ABC) focuses on decreasing the disorganised attachment style common among young children exposed to maltreatment. It is identified by the lack of a coherent strategy for regulation, such that children with disorganised attachment styles present with pervasive dysregulation. It is specifically designed for maltreated young children aged 6 to 48 months, with a focus on decreasing problems with attachment and psychobiological regulation that characterise this group.
Aims
- Increase caregiver nurturance, sensitivity and delight
- Decrease caregiver frightening behaviours
- Increase child attachment security and decrease disorganised attachment
- Increase child behavioural and biological regulation.
Impact
Evidence suggests positive effects on parenting, the only outcome that was measured in this study. Mothers in the study were observed to show more emotionally supportive parenting behaviours after intervention.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| Parent/caregiver | Parenting | Yes | Not found | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
ABC has an evidence rating of Supported.
This means that ABC has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, short-term impact on at least one child and family outcome.
This assessment is based on one research output of RCT design. ABC has not received a Well-supported rating as it has not yet replicated its results in another RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 1 |
| Quasi-experiment | Not identified or included |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and the quality of evidence from the study.
The study was conducted in the United States and does not include Aboriginal children and families.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The study was conducted in the United States.
Sample characteristics
- 21 mothers (11 intervention, 10 control) participated in the study.
- The age of the mothers ranged from age 19 to 43.
- The mothers were receiving substance-abuse treatment with young infants.
- 86% of participants identified as White.
- Mothers in the intervention group received 10, 1-hour sessions in their apartments, delivered weekly by one of 2 Parent Coaches. Mothers in the control group received 10 brief, home-based appointments with the same two clinicians, during which the clinicians made general inquiries about the mothers’ and infants’ wellbeing and gave mothers a developmentally appropriate book for their child.
Implementation
Delivery model, mode and setting
- ABC is delivered in-person, to the parent, by Parent Coaches.
- It is typically conducted in the adoptive home, birth family home or foster/kinship care.
Target cohort
- Mothers receiving substance-abuse treatment with young infants
- Maltreated young children aged 6 to 48 months.
Program delivery
- The ABC intervention consists of 10 manualised sessions addressing the three targets of nurturance, synchrony and frightening and intrusive behaviour. Specific sessions also address the underlying thoughts and feelings of parents that may increase risk of maltreatment and insensitivity, as well as how to navigate child behaviours that push parents away.
- The goals of the ABC intervention are accomplished through manual guided discussion, structured practice activities, video feedback, and ‘in the moment’ comments by parent coaches.
- Qualitative coding of parenting behaviours during sessions is central to client assessment throughout the ABC intervention.
- ABC includes a homework component, where parents make observations over the week and record observations.
- There are fidelity measures for ABC.
Duration and intensity
- ABC involves 10 sessions over a period of 10 weeks.
Manuals and guides
- Two manuals have been developed for ABC implementation:
- The first manual includes the content of the intervention, describing in detail what material should be covered in each of the 10 sessions. Content is provided with example language that parent coaches may use with the parent. The manual also includes lists of materials needed for each session as well as a summary of the critical adherence items for each session.
- The second manual details procedures and rules for coding ‘in the moment’ commenting. The manual is designed to help coaches better understand the targets for commenting as well as how to code selected segments on their own sessions.
- Implementation materials are supplemental to the intensive supervision provided across a year of training.
- ABC has materials available in the following languages in addition to English: German, Mandarin, Norwegian, Russian, Spanish, Swedish.
Additional information
The ABC organisation website has more information about the program.
Staffing
- There is no educational level requirement for Parent Caches. Potential Parent Coaches participate in a screening prior to training, which predicts which individuals are likely to have success training in ABC.
Training
- Becoming a certified Parent Coach involves 2-days of in-person training and one year of supervision. Training includes theoretical and practical orientation to the intervention, practice with ‘in the moment’ commenting and coding, review of session content, consultation concerning site-specific implementation and planning for the supervision year. The one-year supervision involves 2 supervision meetings per week: 1) general clinical supervision for one hour and 2) ‘in the moment’ commenting supervision for 30 minutes.
- After a year of supervision, Parent Coaches' adherence and fidelity are evaluated for certification. If they pass, coaches are certified for 2 years, after which time adherence and fidelity are re-evaluated.
- After being certified in ABC-Infant for infants between 6 and 24 months of age, Parent Coaches are eligible to learn the toddler intervention for toddlers between 24 and 48 months. There is an additional cost that includes another training and additional supervision time.
To our knowledge, ABC is currently delivered by Accoras in Brisbane South East and Gold Coast, Queensland.
Cost
The in-person training and year of supervision costs $7,000 per trainee and reimbursement of travel costs. There is additional cost for equipment.
Coaches need to bring laptops and cameras to each visit and require video editing software to create video clips to play back to parents.
References
Studies identified and included in the review
- Berlin LJ, Shanahan M & Carmody KA (2014). Promoting supportive parenting in new mothers with substance-use problems: A pilot randomized trial of residential treatment plus an attachment-based parenting program. Infant Mental Health Journal, 35(1):81-85.
Studies identified but not counted towards the evidence rating due to study quality
No studies that were identified were excluded due to study quality.