Effects of Early Intervention on Child and Parent Outcomes: An Analysis of Attachment Biobehavioral Catchup

Background/Purpose: Attachment and Bio-Behavioral Catchup (ABC) is an evidence-based early childhood home visiting intervention designed to mitigate the effects of early childhood adversity that can lead to toxic stress. By focusing on positive and sensitive parenting, ABC promotes resilience and enhances coping and self-regulation skills in young children ages 0 to 3.

The ABC Early Childhood Initiative is a mixed methods implementation evaluation testing the replicability and efficacy of ABC when integrated into the service array of early childhood home visiting programs throughout one midwestern state. This presentation focuses on child and family outcomes observed among participating families of the ABC Early Childhood Initiative over a three-year period across five Kansas sites.

Methods: In Phase I, instruments measuring child, caregiver and family outcomes were collected via parent coaches delivering the intervention. Evaluation measures included Ages and Stages Questionnaire-Social and Emotional Scale (ASQ-SE); Maternal Self-Efficacy Scale; Infant Crying Questionnaire (ICQ); the North Carolina Family Assessment Scale (NCFAS-G), and for a subsample of randomly selected families, cortisol (i.e. stress hormone) testing via saliva collection.. Measures were collected at two time points: prior to the start of the intervention and following delivery of ten in-home sessions. Paired samples t-tests compared child, caregiver, and family outcomes from Time 1 and Time 2. Additionally, analyses were conducted to compare cortisol at children’s waking and bedtime, pre and post intervention, as well as six months later.

The final sample included 402 families with 171 participating in cortisol testing. A total of 121 families withdrew from ABC services prior to completion. Approximately 55% of children in the sample were male; 45% identified as Hispanic and the average child age was 16.5 months. Nearly 45% of the sample families reported earning less than $15,000 a year, with a majority of families reporting significant financial strain.

Results: Regarding child outcomes, analyses found a statistically significant decrease in reports of negative child behavior following ABC, and results indicate significant changes in morning and evening child cortisol levels, resulting in more normative diurnal cortisol patterns post-intervention. For caregiver outcomes, participants reported a statistically significant increase in confidence, their understanding of child developmental stages, and attachment with their child. In regards to family environment, there were statistically significant improvements in the family environment and interactions, as well as family health and safety.

Implications: Findings suggest ABC is having a positive impact on Kansas’s children and families, replicating findings from other sites across the country. Specifically, findings indicate the ABC intervention is helping to improve caregiver interactions with their young children and caregiver self-efficacy. In addition to caregiver level benefits, findings from this study also indicate ABC infants and children show improvements in social and emotional outcomes. There are numerous implications for these findings. First, the replication of positive findings concerning the ABC initiative is encouraging, as it shows the intervention is generalizable to multiple populations. Additionally, these findings are particularly relevant, given the importance of early childhood interventions and prevention efforts and their impact on long term physical and emotional health.