Family Engagement in Attachment and Biobehavioral Catch-Up and Ratings of Parenting and Potential for Change

• In Event: 3-096 - Stress and Trauma in Home Visiting: Predictors of Family Engagement and Maternal-Child Health Outcomes

Integrative Statement

Introduction. Despite the positive outcomes of evidence-based early interventions (Toth et al., 2013), access to these services within child welfare is often limited (Hurlburt et al., 2004). Furthermore, family engagement in parenting programs is variable, with participation rates as low as 40%-50% and over half of families dropping from treatment (Morawska & Sanders, 2006; Piotrowska et al., 2017). These low rates of engagement are worrisome, as parental involvement in services like early intervention produces several beneficial outcomes for children and families (Haine-Schlagel & Walsh, 2015). Furthermore, if families present with low or variable engagement, providers may develop negative perceptions of families and their capacity to progress in treatment (Morawska & Sanders, 2006).

The current study investigated the effects of parental program engagement factors and provider attitudinal factors on provider perceptions of parent behaviors and independently observed parental outcomes in an evidence-based early intervention, Attachment and Biobehavioral Catch-up (ABC). The ABC home-visiting program is a 10-session trauma-informed parenting intervention for families with early adversity, designed to enhance parental behaviors in order to improve children’s behavioral and physiological outcomes.

Method. Clinicians (i.e., “parent coaches”) completed a Qualtrics survey at the end of each ABC session to provide information regarding program engagement (e.g., no-shows, cancellations, or rescheduled sessions between the last and current sessions), ratings on the intervention targets (e.g., nurturance, following the lead, delight, and frightening behaviors), and caregivers’ potential to change in these targets. Caregiver skill on the intervention targets was rated on a scale of 1 (very low) to 5 (very skilled), with caregiver potential to improve or maintain improvement in each target on a scale of 1 (definitely will not) to 5 (definitely will). Family demographic data were also collected.

Caregivers’ sensitivity was assessed from pre- and post-intervention play interactions on a 1 to 5 scale, based on the NICHD Observational Recording of the Caregiving Environment (NICHD ECCRN, 1996). Parent coach factors, specifically screening scores, were also included in analyses.

Results. Hierarchical linear modeling was used to account for the nested structure of cases within parent coaches. Analyses with 46 parent coaches and 161 cases across the U.S. found that coach ratings of nurturance were predicted by coach screening score (p < .05) on Level 2, and coach perception of likelihood of change in nurturance (p < .0001) and family rate of no-shows (p < .05) on Level 1 (see Table 1). No associations between coach perceptions or family engagement factors and independently observed parent behavior scores were found. Additional models predicting engagement factors and other parent behavior targets will be presented.

Discussion. These results suggest strong associations between provider perceptions of family success with parenting targets, belief in ability to change in those targets, and family use of service. The lack of correlations with observed change in targets suggests that provider perceptions may more strongly influence engagement in services, rather than parental behavioral skills. These patterns point to the need for strengths-based supervision focused on conceptualization and capacity to change to support engagement in evidence-based early interventions.

Authors

• Caroline K.P. Roben, University of Delaware
  Presenting Author

• Amanda H. Costello, University of Delaware
  Non-Presenting Author

• Bo-Ram Kim, University of Delaware
  Non-Presenting Author

• Fabianne Blake, University of Delaware
  Non-Presenting Author

• Stevie S. Schein, University of Delaware
  Non-Presenting Author

• Mary Dozier, University of Delaware
  Non-Presenting Author