Poster #165 - Predictors of Parent Engagement in Attachment and Biobehavioral Catch-up in the Context of Community-Based Implementation

• In Event: 3-159 - Poster Session 12
  In Poster Session: PS 12 Section - Prevention and Interventions

Integrative Statement

Given emerging evidence for the efficacy of attachment-based prevention programs for young children exposed to early adversity, increasing attention has turned towards effective dissemination (Roben, Dozier, Caron, & Bernard, 2017; Temple, 2011). Attachment and Biobehavioral Catch-up (ABC; Dozier et al., 2013) is a 10-session home-based intervention that aims to increase nurturance to distress, increase following the lead, and decrease frightening behaviors. As parenting interventions, like ABC, are implemented by community clinicians, it is critical to continue to examine their effectiveness, as well as explore predictors of treatment engagement. Previous studies have identified several factors that predict poor treatment engagement in parenting interventions, such as low social support (McWey, Holtrop, Stevenson-Wojciack & Claridge, 2014), elevated parental stress, lack of perceived need (Barth et al., 2015; Faver et al., 1999), and parents’ own psychopathology (Atkin & Gomi, 2017). The current study examined predictors of treatment engagement in the context of a community-based effectiveness study of the ABC intervention.
Participants included 98 parents (99.0% racial/ethnic minority) of infants assigned to the intervention group (i.e., ABC) in a two-arm randomized clinical trial (comparison group was a waitlist-control condition). Indicators of treatment engagement included: treatment drop-out (i.e., discontinuing ABC before completing all 10 sessions), number of sessions completed (out of 10), and weeks to completion (i.e., number of weeks to finish all 10 sessions). Predictors included parental depressive symptoms, measured using the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977); parental history of childhood adversity, measured using the Adverse Childhood Experiences questionnaire (ACE; Felitti et al., 1998); and composite sociodemographic risk, computed by summing 6 dichotomized risk factors (i.e., poverty [income-to-needs ratio < 1 or receiving public assistance, 94.9%], housing risk [living in shelter or public housing, 63.3%], less than high school education [29.6%], child protective services involvement [30.6%], single parent status [58.2%], young parent [less than 21 years, 15.3%]).
Thirty-six parents (36.7%) dropped out of ABC prior to completion. Results of binary logistic regression (predicting treatment drop-out) and linear regression (predicting number of sessions completed and weeks to completion) showed that higher cumulative sociodemographic risk consistently predicted poorer engagement in ABC (See Table 1). More specifically, for every additional risk factor, the odds of treatment drop-out increased by 1.63 (p = .007), the number of sessions completed decreased by .92 sessions (p = .004), and the weeks to completion increased by .68 weeks (p = .083); see Figure 1. Depressive symptoms and childhood adversity did not predict any indicators of treatment engagement.
Findings suggested that high sociodemographic risk may interfere with parent engagement in a parenting intervention. Given that cumulative sociodemographic risk is also associated with less sensitive parenting (Burchinal, Vernon-Feagans, Cox, & Key Family Life Project Investigators, 2008), children most in need of programs like ABC may be least likely to receive them due to parent barriers. Further research about predictors of treatment engagement is critical in ensuring the effective dissemination of evidence-based interventions as they are implemented with high-risk parents in community settings.

Authors

• David Morris, Stony Brook University
  Presenting Author

• Steven Imrisek, Stony Brook University
  Non-Presenting Author

• Melanie Rodriguez, Stony Brook University
  Non-Presenting Author

• Allison Dash, Power of Two
  Non-Presenting Author

• Kristin Bernard, Stony Brook University
  Non-Presenting Author