Core Components

The ABC intervention is available for parents of infants between 6 and 24 months of age (ABC-Infant), and toddlers between 24 and 48 months (ABC-Toddler). ABC has shown benefits for any child living with or at risk for maltreatment, although the most long-term evidence relates to children living with their birth parents who have experienced or who are at high risk of experiencing child maltreatment or adversity.

The ABC programme is home-delivered over 10 weekly 1-hour sessions. The programme is clearly operationalised, with each session content outlined. There are three key targets to the intervention, namely ‘nurturance’ (which includes reinterpretation of child cues and not instinctively responding ‘in kind’ to seemingly rejecting responses from the child), ‘following the child’s lead with delight’ and ‘not being frightening’. The toddler version includes the additional target of ‘calming a dysregulated toddler’ with caregivers described as ‘coregulators’. The key component of the intervention in addressing these targets is specific ‘in the moment’ comments on the parent-child interactions.

Fidelity

ABC has rigorous fidelity monitoring tools integral to programme delivery. Parent coaches must submit weekly videotapes of intervention delivery which are measured in their adherence to programme content as well as frequency and quality of ‘in the moment’ comments. Weekly monitoring takes place for the first year post-training and fidelity must be demonstrated over this period for a practitioner to be recognised as delivering the evidence-based model.

The programme acknowledges the potential time and financial burdens of this fidelity process, and explores this with agencies prior to engagement, however they also highlight that agencies can be assured they can expect to receive the outcomes which have been evidenced and that parent coaches receive the benefits of personalised, detailed feedback on their delivery practice.

Modifiable Components

The programme was originally designed for foster carers and went on to be shown to have evidence of effectiveness for birth parents and adoptive parents. The initial infant intervention (6-24 months) was modified to include toddler populations and include the challenge of parenting a dysregulated toddler.
As testified by the rigorous fidelity measures, the programme is evidence based when implemented in full, without modifications.

Initial training in ABC-Infant takes place in-person and lasts for 2 days. Training for smaller groups is held bi-annually at the University of Delaware. Trainers will travel to the training site for larger groups.

Support for Organisation/Practice

Implementation Support

Implementation support for initial engagement and ongoing delivery is provided by Dr Caroline Roben, Director of Dissemination for ABC. The programme is also currently developing a Webinar resource to support agencies with effective set-up and implementation.

The programme does not have any mandatory data collection in place, however they have recommended measures if agencies wish to be involved with programme evaluation data collection.

Start-up Costs

Cost of initial ABC Infant interview, 2-day training, weekly supervision and fidelity tracking for a year, with administrative support, is $7,000 per person.

Following certification in the Infant programme, the cost for ABC Toddler initial interview, half-day training, weekly supervision and fidelity tracking for a year, with administrative costs, is $5,000 per person.

Training costs include a year of weekly clinical and fidelity monitoring. If any additional weekly fidelity supervision is desired or required, this priced at $200/month.

Building Staff Competency

Qualifications Required

Parent Coaches for training are identified through a 30-minute interview, in which the characteristics screened for have been demonstrated to correlate with later number and quality of ‘in the moment’ comments.

There are no specific qualifications required to be trained in ABC and although the majority of Parent Coaches hold a Masters in Social Work degree, there are also certified nurses, home visiting practitioners, teachers and parents who have themselves gone through the programme.

Training Requirements

Individuals selected through screening to go on to Parent Coach training undergo a 2-day training followed by a year of supervision and fidelity monitoring. Training includes theoretical and practical orientation to the intervention, practice with “In the Moment” commenting and coding, review of session content, consultation concerning site-specific implementation, and planning for the supervision year.

Additional training is required for the toddler programme once certified in the infant programme, which is theoretically another year of twice weekly supervision, however in practice fidelity can be achieved more quickly for skilled, experienced practitioners.

Supervision Requirements

Parent Coach Trainees have 2 obligatory supervision meetings per week for their year of training: General Clinical Supervision (1 hour) and ‘In the Moment’ Commenting Supervision (30 min). Supervision is conducted using video conferencing. The time commitment for session preparation, visit, and supervision is approximately 4 hours per case each week. The cost of this supervision is included in total training costs.

Certified Parent Coaches with high level of fidelity to model can go on to train as Supervisors. For the cost of training in supervision, supervision fidelity training, or training in training, interested sites should contact the developers for creating plans of sustainability.

ABC has consistently demonstrated across RCTs, sustained improvements in child attachment security, child self-regulation and normalised child cortisol patterns.

Theory of Change

Mechanism of change focuses on enhancing caregiver nurturance and ability to follow the child’s lead, with improved sensitivity as a key mediator, through ‘in the moment’ comments, which promote a more organised, secure attachment between caregiver and child, improved regulation of child cortisol production and improved child self-regulation of emotions and behaviours.

Values

The core values of the ABC programme are to develop infant and child self-regulation skills through promoting sensitive, nurturing caregiving.

• Is the delivery of this type of work considered to be in keeping with the core practice of these practitioners?

Priorities

ABC is targeted towards families at high risk of child maltreatment or multiple adversities, with the aim to improve the parent-child relationship and impact on positive child and parent outcomes.

• Is working with parents of babies and young children in a home-visiting early intervention approach a priority for your organisation?
• Is the delivery of targeted services to families of infants and young children at high risk for maltreatment aligned with the key values and priorities of your organisation?

Existing Initiatives

• Does your service already provide early intervention programmes aiming to improve child development and mental health outcomes?

Workforce

ABC practitioners are selected through an interview process to assess their reflective capacity and potential for delivering the programme with fidelity.

• Do your practitioner(s) have experience in working with infants, young children and their families?
• Are your practitioners able to work with a sensitive, reflective approach?

ABC recommend that practitioners implement ABC over 10-weeks with at least 2 families at a time and ideally, with 50% of their overall caseload. In addition, practitioners are required to attend supervision and coaching for up to 1.5 hours per week with another half hour for fidelity coding for at least their first year of implementation.

• Does your agency have capacity for practitioner(s) to work with ABC with at least 2 families at a time and ideally, with 50% of their caseload?
• Will your practitioner(s) have protected time (1.5 hours/week for at least 1 year, with 30 minutes for fidelity coding) to prepare for and attend supervision and coaching with ABC supervisors?

Technology Support

ABC requires practitioners to capture and upload videos of their practice for review in supervision. Practitioners also need access to Zoom to facilitate supervision.

• Do you have the technology to support practitioners to access these tools necessary for effective supervision?

Administrative Support

ABC will require some administrative support in preparing materials and collecting any appropriate data.

• Do your current administrative procedures support your practitioners to implement a programme like this?

Financial Support

The cost of ABC initial interview, 2-day training, weekly supervision and fidelity tracking for a year and administrative support is $7,000. Any additional weekly fidelity supervision which is desired or required is priced at $200/month.

• Do you have the finances to pay for practitioners to attend the initial interview and training?
• Do you have the finances to support any additional fidelity monitoring if required?

In addition, there will be running costs for materials – worksheets and handouts as well as toys and other delivery tools - travel expense for home visits and technology costs to be able to capture and review video footage.

• Do you have the finances to pay for the printing of worksheets, leaflets and handouts for the delivery of the programme?

Comparable Population

ABC is targeted at birth and foster families with children 6-48 months old, experiencing or at high risk of experiencing maltreatment or adversity.

• Is this an identified population of particular concern to your organisation?

Desired outcome

ABC aims to improve children’s social and emotional development through nurturing the parent-child relationship and outcomes have demonstrated higher rates of secure attachment, improved child self-regulation and increased parental sensitivity.

• Are the improvements of children’s social and emotional development, learning and mental health priority outcomes for your organisation?
• Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?