Objective
Understanding mechanisms and active ingredients of intervention is critical to training clinicians, particularly when interventions are transported from laboratories to communities. One promising active ingredient of parenting programs is clinicians’ in vivo feedback regarding parent-child interactions. The present study examined whether a form of in vivo feedback, in the moment commenting, predicted treatment retention and parent behavior change when the Attachment and Biobehavioral Catch-up (ABC) intervention was implemented in a community setting.
Method
Observational data were collected from 78 parent-child dyads (96% mothers; mean age = 29 years; 81% minority; infants’ mean age = 12 months; 90% minority) across 640 sessions conducted by 9 clinicians (100% female, mean age = 39; 67% minority) in Hawaii. Parental behavior was assessed with a semi-structured play task before and after intervention. Clinicians’ in the moment feedback to parents was assessed from intervention session videos.
Results
Clinicians’ frequency and quality of in the moment feedback predicted change in parental intrusiveness and sensitivity at post-treatment. Frequency of in the moment feedback also predicted likelihood of retention. Hierarchical linear modeling demonstrated strong support for these associations at the between-clinician level, and limited additional support at the within-clinician (i.e., between-case) level.
Conclusions
A hypothesized active ingredient of treatment, in the moment feedback, predicted community-based ABC outcomes. The results complement lab-based evidence to suggest that in vivo feedback may be a mechanism of change in parenting interventions. Helping clinicians to provide frequent, high quality in vivo feedback may improve parenting program outcomes in community settings.