Is the Attachment and Biobehavioural Catch-up (ABC) intervention effective with a child welfare population?

Date Published

Lind, T., Bernard, K., Ross, E. and Dozier, M. (2014). Intervention Effects on Negative Affect of CPS-referred Children: Results of a Randomized Clinical Trial. Child Abuse & Neglect, 38(9), 1459-1467. 

Reviewed by
Emmaline Houston
Tara Black
Megan Pratt

Study Purpose and Intervention: Children involved with Child Protection Services (CPS) who have adverse early childhood experiences are at higher risk for poor regulation of behaviour, physiology, and affect.  Parents play a key role in helping their children adapt and develop regulatory capabilities. Many CPS-referred parents require assistance in learning supportive behaviours that promote a child’s ability to self-regulate. The Attachment and Biobehavioural Catch-up (ABC) intervention helps parents behave in nurturing, synchronous, and non-frightening ways. The authors of this study aimed to evaluate the effectiveness of the ABC intervention on the expression of negative affect in CPS-referred children.

Sample: Participants (parents and children) were referred by their caseworkers following CPS involvement due to allegations of maltreatment. Caseworkers referred 404 children to the study. The final sample enrolled in the intervention consisted of 117 children and 112 biological caregivers (5 parents had two children enrolled in the study). Inclusion criteria required children to have CPS involvement, to be under the age of two years at the time of referral, and to be living with their biological parents.

After consent was obtained for study participation, families were randomly assigned to the experimental intervention (ABC) group or to the control intervention group (Developmental Education for Families: DEF). Children were excluded prior to enrollment for reasons including difficulty contacting family for pre-intervention research visits, the child’s removal from parental care, and the family relocating out of area. Children in the experimental intervention and control intervention groups did not differ significantly with regard to age, gender, or minority status. Similarly, there were no significant differences in parent age, education or minority status.

Intervention: The parents in both groups participated in ten training sessions led by trained parent coaches. The sessions were based on structured manuals and were conducted in the families’ homes. Parents in the ABC intervention received frequent in the moment feedback to enhance the parent’s understanding, as well as video feedback. The DEF intervention sessions focused on enhancing motor, cognitive, and language skills.

Follow up and Measures: The study’s follow up schedule included a post-intervention home visit approximately one month after the intervention, as well as yearly post-intervention visits. A total of 183 children were retained for study follow-up. Of those children, the majority (117) participated in the outcome assessment of negative affect regulation. This assessment, called “Tool Task,” is a parent-child interaction procedure designed to assess children’s emotional expression during a challenging task. Videotapes of the children completing three Tool Task assessments were blindly coded using the Revised Manual for Scoring Mother Variables in the Tool-Use Task on scales of anger, anger toward parent, and global sadness/anger. Variables for analysis were created by transforming scale scores to z-scores. Coders established inter-rater reliability prior to coding and 21 percent of the videotapes were double coded to further assess reliability

Results: Analyses of variance on the negative affect composite variable showed that, when compared to the control intervention group, children in the ABC intervention group exhibited lower levels of negative affect expression on all three scales of anger, anger toward parent, and global sadness/anger.  These findings suggest that a brief, early intervention program could be effective for helping children develop the ability to regulate negative affect.

Methodological notes

This study is an important contribution to the child welfare literature because of the randomized design, high-risk community sample identified by the child welfare system, and the use of blind observational assessment. However, there are several limitations. The study authors do not specify whether workers referred all cases during a particular time period. The authors did not have access the CPS records, and were therefore unable to measure the reason for referral or the history of other risk factors. As the authors aimed to intervene with families regardless of substantiation status and did not administer a pre-test, they are unable to determine whether the differences in risk moderated the effectiveness of the intervention. Additionally, the study lacks validated clinical assessment tools. The DEF control intervention steps were not fully described, leaving the reader unsure of the intervention those families received. Finally, the authors failed to disclose that the developer of the ABC intervention model was one of the authors of this study.