Efficacy of Group Attachment Based Intervention for Vulnerable Families

Study Overview
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Brief Summary
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The study examines the effectiveness of parent-child Group Attachment Based Intervention (GABI) in reducing risk of maltreatment in infants and toddlers compared with parenting skills classes. GABI directly addresses the needs of isolated, marginalized families, with the goals of of enhancing parent coping and resilience, and improving parent-child attachment relationships. We hypothesize that compared to usual care, GABI will be associated with improved child, parent and parent-child outcomes.

Detailed Description
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Child abuse and neglect (maltreatment) pose enormous short- and long-term risks to children. Yet despite the critical importance of the U.S. Department of Health and Human Services, Maternal and Child Health Bureau's goal to reduce fatal and non-fatal child maltreatment, non-empirically supported parenting skills classes remain child welfare agencies' standard approach to meeting this goal. The study examines the effectiveness of parent-child Group Attachment Based Intervention (GABI) in reducing risk of maltreatment in infants and toddlers compared with parenting skills classes. GABI directly addresses the needs of isolated, marginalized families, with the goals of of enhancing parent coping and resilience, and improving parent-child attachment relationships. Seventy families with children aged 2-36 months who are referred for parenting help will be randomly assigned to either GABI or treatment as usual that consists of parents-only parenting skills classes. Treatment will be offered for up to 6 months. Both groups will be assessed at baseline, end of treatment and at 6 months follow up.

Official Title
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Birth to Three: A Pragmatic Clinical Trial for Child Maltreatment Prevention

Conditions
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Child Maltreatment, Domestic Violence

Intervention / Treatment
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* Behavioral: Systematic Training for Effective Parenting (STEP)
* Behavioral: Group Attachment Based Intervention (GABI)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Parents with children age 0-36 months Parent(s) is/are biological parent of child (mother or father) Parent(s) has/have custody of their child even if he/she/they have lost custody of previous children Risk of maltreatment from referral source or intake interview, including parent's own childhood adversity, parent's current exposure to relationship violence, history of parental substance abuse or history of parental incarceration If history of substance abuse, enrolled in treatment program Willing to sign informed consent Exclusion Criteria: Parent is unable to provide informed consent due to cognitive impairment Parent not fluent in English Child has diagnosis of an autistic spectrum disorder or severe cognitive delay

Ages Eligible for Study
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Maximum Age: 36 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group Attachment Based Intervention (GABI)<br> | Behavioral: Group Attachment Based Intervention (GABI)<br>* Parent-child group, 3x/week, 26 weeks<br>|
| Active Comparator: Systematic Training for Effective Parenting (STEP)<br> | Behavioral: Systematic Training for Effective Parenting (STEP)<br>* Parenting skills training class, 1x/week, 12 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in child exposure to trauma and maltreatment to end-of-treatment and at 6-month follow-up (Child Adverse Childhood Experiences Screener) |  | Measured at Baseline, End-of-Treatment (12 Weeks for Control/26 Weeks for Intervention), and at 6-Month Follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Child cognitive development (Bayley III Screening Test) |  | Measured at Baseline, End-of-Treatment (12 Weeks for Control/26 Weeks for Intervention), and at 6-Month Follow-Up | 
| Parent mental health (Symptoms Checklist-90) |  | Measured at Baseline, End-of-Treatment (12 Weeks for Control/26 Weeks for Intervention), and at 6-Month Follow-Up | 
| Child social-emotional development (Ages and Stages Questionnaire) |  | Measured at Baseline, End-of-Treatment (12 Weeks for Control/26 Weeks for Intervention), and at 6-Month Follow-Up | 
| Parent social support (Interpersonal Support Evaluation List) |  | Measured at Baseline, End-of-Treatment (12 Weeks for Control/26 Weeks for Intervention), and at 6-Month Follow-Up | 
| Parenting stress (Parenting Stress Index) |  | Measured at Baseline, End-of-Treatment (12 Weeks for Control/26 Weeks for Intervention), and at 6-Month Follow-Up | 
| Child-parent attachment (Strange Situation Procedure) and Free -Play Observation coded with Coding Interactive Behavior (CIB) dimensions |  | Measured at Baseline, End-of-Treatment (12 Weeks for Control/26 Weeks for Intervention, and at 6-Month Follow-Up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Parent Child Relationship, Maltreatment, Risk Behaviors, Social and Emotional Development, Violence and Abuse, Policy