Research Watch

Effective intervention for families receiving child welfare services: Attachment Video-feedback Intervention (AVI)

Year of Publication
Date Reviewed
Reviewed By
Larissa Wright & Tara Black

Eguren, A., Cyr, C., Dubois-Comtois, K., & Muela, A. (2023). Effects of the Attachment Video-feedback Intervention (AVI) on parents and children at risk of maltreatment during the COVID-19 pandemic. Child Abuse & Neglect, 139 (1), 1-12.


There has been international recognition that instances of child neglect and abuse have increased in both frequency and complexity during the COVID-19 pandemic (Bhatia et al., 2021; Council of Europe, 2022). With child protective services facing their own challenges to adequately detect and address these harms and risks of harm, there is an increasing opportunity for new interventions to better address these growing barriers in child protection (Katz et al., 2022). This study presents Attachment Video-feedback Intervention (AVI) as a tool that can be implemented within the context of this COVID-19 pandemic, as an in-home tool to lower the risk of future maltreatment for already at-risk parents and their children. As an intervention, AVI is well evidenced to enhance parent-child interactions and parental sensitivity by engaging parents in the reflexive study of their own actions and relationships. This study theorized that delivering in-home AVI to parents and their children would help to enhance emotional availability and other protective factors such as parental stress, household chaos, parent-child emotional availability, and parental reflective functioning. Each of these indicators were measured separately at pre- and post- evaluations and the research was aided by an observational measure of parent-child interaction during the delivery of the AVI session. The outcome of this study once again shows Attachment Video-feedback Intervention as an effective intervention and calls for greater consideration of AVI implementation across Child Protective systems.

Participants for this randomized control trial were identified by the Child Protective Services of the City Council of Donostia-San Sebastián, Spain. Of 53 eligible families, 41 children (ages 0-5) and their parents were invited to participate in randomization to define an intervention group (n=24) and a control group (n=17). Over a 3-month window, families in the target group received weekly, in-home AVI sessions lasting 90-minutes each, while families in the control group were placed on the waitlist for future intervention. AVI is an attachment-based intervention program that includes the recording of a parent-child interaction, followed by the facilitated review of the interaction through facilitated positive-video feedback.

The overall outcomes of this study were promising. Parents in the treatment group showed a range of optimized behaviours, including increased reflectivity as well as a greater sensitivity to the needs and emotional states of their child. Findings also showed an evident increase in emotional availability in both parents and their children as well as an overall improvement in most other protective factors.  As one of the first studies to assess an attachment-based intervention for maltreating relationships in the pandemic, this study offers complimentary findings to reinforce the wider implementation of AVI in the domain of child protective services.

Methodological Notes

As a Spanish study, implementing AVI successfully with this population compliments previous research with North American populations to show a transferable quality to AVI as an intervention in parent-child relationships at risk of maltreatment. With more than half of the participants also having immigrated to Spain, the study shows success with a dynamic population while suggesting further consideration into the potential moderating effects of immigration status. Future research may find observational evaluation more effective than the post-test evaluation, due to communication barriers seen in the self-reporting process.

Unlike some other studies in AVI, long-term impacts were not assessed in this study to measure participant outcomes or progress with Child Protective Services involvement following the period of intervention, so it is unclear if gains were maintained. Additionally, this article does not outline the process Child Protective Services took to identify families as being at-risk of maltreatment, or power differentials during recruitment (e.g., child welfare workers asking their clients to participate), which could impact participant response bias. Without this information it is unclear what criteria was used to determine participant eligibility. Similarly, a lack of information about the nature of child maltreatment type or risk-level limits the sample composition from ensuring generalizable results. Closer consideration to these areas may be warranted in future studies to rule out moderating effects from characteristics unspecified. This study is additionally limited by some demographic challenges, including a small sample size (n=41) and a population consisting of mostly male children (85.4%) and their mothers (75.6%), thus limiting generalizability.