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Implementing Attachment and Biobehavioral Catch-Up (ABC) Intervention

Meets DHHS criteria for an evidenced based model

Implementation Experiences

Last Updated

April 2017

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Summary of Sources

Information in this section is based on studies included in the HomVEE review. For the ABC Intervention, we reviewed five studies, including four randomized controlled trials or quasi-experimental designs and one standalone implementation article. (Please see the study database for a list of the studies and to link to the characteristics of the samples examined in the impact studies.)

In the following sections, we consider all pieces of research about a particular sample to be a single study. For example, two publications were based on the same group of participants and are cited as one study. There are four distinct samples across the five publications.

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Characteristics of Program Model Participants

Caregivers in the ABC Intervention studies were primarily female: 98 percent were female and 2 percent were male (one study). Thirty-nine to 42 percent of children were female and 58 to 62 percent were male (three studies).

At enrollment, caregivers were on average 25 to 38 years old (three studies). In one of these studies, caregivers’ ranged from about 16 to 47 years old. Children’s average age at enrollment ranged from 10 to 29 months old (three studies). One of these three studies reported that the age of children at enrollment ranged from about 2 to 21 months. A fourth study reported that the average age of children at the completion of the ABC Intervention was 27 months.

Programs served racially and ethnically diverse families (two studies). In one study, 61 percent of caregivers were African American, 15 percent were white, 15 percent were Hispanic, and 9 percent were biracial. Forty-six to 61 percent of children were African American (two studies), 8 to 39 percent were white (two studies), 11 percent were Hispanic (one study), 8 to 20 percent were biracial (two studies), and 8 percent of children were another race (one study).

The percentage of caregivers who did not complete high school ranged from 31 to 68 percent (two studies). One study reported that 46 percent of caregivers completed high school or a high school equivalency degree, 15 percent finished some college, and 8 percent completed college or technical school.

Two studies included families with adopted children. In one study, all children were adopted internationally. Sixty-three percent of the children were adopted from Asia, 17 percent from Eastern Europe, 13 percent from Africa, and 8 percent from Central America (percentages do not add up to 100 percent because of rounding). In another study, 58 percent of children were internationally adopted, 26 percent were domestically adopted, and 16 percent were in foster care.

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Location and Setting

Two studies reported program location; one was a large mid-Atlantic city and the other the state of Delaware.

None of the studies reviewed included information about the implementing agency.

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Staffing and Supervision

ABC Intervention staff included home visitors, referred to as parent coaches or parent trainers (four studies), and a supervisor (one study).

Home visitors had experience working with children and strong interpersonal skills (one study). In another study, the home visitor had a post-baccalaureate degree in clinical work but was not yet licensed.

None of the studies reviewed included information about pre-service or in-service training for home visitors or supervisors.

Supervisory activities included individual and group supervision (one study). The supervisor, the developer of the ABC Intervention, and the home visitor independently reviewed video clips of the home visitor’s visits to assess the frequency and quality of the home visitor’s use of the ABC Intervention strategies. They discussed their assessments of the visits during supervision.

Throughout one year, a home visitor supported 19 families and received supervision for 1.5 hours per week (one study). None of the studies reviewed included information about the ratio of supervisors to home visitors.

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Program Model Components

The programs intended to provide 10 home visits (four studies) lasting one hour each (three studies). Home visits were designed to occur weekly (two studies) over the course of 10 weeks (two studies).

Home visitors followed a manualized curriculum (three studies). The visits focused on the following target caregiver behaviors: (1) nurturance (three studies), (2) following the child’s lead (three studies), and (3) non-frightening behavior (two studies). Home visits also included the following:

  • “In the moment” commenting (four studies). The home visitor gave immediate feedback to the caregiver to reinforce skills, support the caregiver’s efforts, and enhance the relationship between the caregiver and home visitor.
  • Structured activities (two studies). These were opportunities for the caregiver to practice the target caregiver behaviors with the child under the supervision of the home visitor.
  • Video feedback (two studies). The home visitor and caregiver watched a video of the caregiver’s interaction with the child. The home visitor highlighted the caregiver’s strengths, celebrated changes in behavior, and identified areas for improvement.
  • Homework (two studies). Homework gave an additional opportunity for caregivers to practice the skills they learned and record their observations about their and the child’s behavior during the week.

Although most sessions focused on target caregiver behaviors, one session focused on caregivers reflecting about how their experiences with their own caregivers growing up might have influenced their comfort and ability to use the target behaviors (two studies).

None of the studies reviewed included information about assessments.

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Program Model Adaptations or Enhancements

None of the studies reviewed included adaptations or enhancements to the model.

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Dosage

Families received an average of 9 to 10 home visits (three studies). Each home visit lasted one hour (three studies). Home visits occurred weekly for 10 weeks (two studies).

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Lessons Learned

Three studies discussed lessons learned during program implementation. One study recommended conducting additional research to understand the characteristics of families for whom the ABC Intervention works best and then targeting those families. With families for whom the ABC Intervention is less successful, efforts should be made to adapt or enhance the ABC Intervention to meet their needs (two studies). One of these studies noted that if home visitors do not see a change in caregiver behavior after the first few sessions, home visitors should make adjustments to their therapeutic approach.

One study recommended that home visitors receive pre-service and in-service training on how to evaluate the frequency and quality of their “in the moment” commenting using video clips of their visits. The study also noted that this type of video assessment might encourage peer-based supervision and self-supervision, reducing the necessity of formal supervision.

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