Group Attachment Based Intervention (GABI)

Child(ren) 0-47 months old and their parent(s) who has experienced significant trauma, who has mental health challenges, and/or experienced the removal of a previous child

The goal of Group Attachment Based Intervention (GABI) is to meet the needs of parents with very young children who expressed the desire to be a different kind of parent than the parent who raised them. GABI was developed to meet that need by bringing together groups of parents who are socially isolated and affected by disparities across multiple systems of care. GABI is designed to help parents manage stress, increase their social support network, foster secure attachment, and improve parent-child relationships. GABI was developed for parents who have experienced significant trauma, who have mental health challenges, and/or experienced removal of a child.

Anne Murphy, PhD

• Agency/Affiliation: Montefiore Medical Center
• Website: https://www.cham.org/programs-centers/gabi
• Email: Amurphy1@montefiore.org
• Phone: (718) 839-7295

Kelsey Armusewicz, PhD

• Agency/Affiliation: Montefiore Medical Center
• Website: https://www.cham.org/programs-centers/gabi
• Email: kamusewi@montefiore.org
• Phone: (718) 839-7295

The goals of Group Attachment Based Intervention (GABI) are:

For Children:

• Improved social-emotional development
• Improved secure attachment to parent

For Parents:

• Reduced social isolation
• Reduced depression
• Improved secure attachment to child

The essential components of Group Attachment Based Intervention (GABI) include:

• Trauma-informed space (large group room + parent group room)
• Trained linguistically diverse staff
• Onsite sessions offered multiple times during the week and additional telehealth parent groups offered multiple times per week
• GABI session:
• 2 hours in length
• 5 clinicians facilitating at different points
• Part 1: Parent and Child Together
• Opening:
• Time: 15 minutes
• Location: Parents and children in trauma-informed group space
• Content:
• Welcome Song
• Check in how each family is doing
• Parent-child dyadic psychotherapy
• Time: 45 minutes
• Location: Trauma-informed large group space
• Content: REARING as described below:
• Dyadic session focuses on increasing parental:
• Reflective functioning
• Emotional attunement
• Affect regulation
• Reticence (i.e., child-led play)
• With a focus on:
• Intergenerational transmission of attachment patterns
• fostering Nurturance
• providing Group support
• Part 2: Separation:
• Parent Psychotherapy Group
• Time: 45 minutes
• Location: Trauma-informed parent group room
• Content: Parent psychotherapy group session focuses building interpersonal supports while also utilizing the group model to foster REARING
• Child Psychotherapy Group
• Time: 45 minutes
• Location: Trauma-informed large group space
• Content: Child psychotherapy session focuses on social-emotional development by supporting the child in identifying emotions (Reflective functioning and Emotional attunement), supporting in calming strategies (Affect regulation) and supporting children in peer play (Reticence, Nurturance, and Group)
• Closing
• Time: 15 minutes
• Location: Trauma-informed large group space
• Content:
• Parent and child reunion
• Goodbye songs

Child/Adolescent Services

Group Attachment Based Intervention (GABI) directly provides services to children and addresses the following:

• High risk of involvement in child welfare system, social emotional development (dysregulation), difficulties attaching to parent

Parent/Caregiver Services

Group Attachment Based Intervention (GABI) directly provides services to parents/caregivers and addresses the following:

• Parental depression, intergenerational trauma, parental social isolation

Recommended Intensity

Average number of sessions per month is 1x per week but sessions are offered 6x a week and families can attend as many as they wish. Session is 2 hours long.

Recommended Duration

Average length is 12 months

Delivery Settings

This program is typically conducted in a(n):

• Community-based Agency / Organization / Provider
• Outpatient Clinic

Homework

This program does not include a homework component.

Languages

Group Attachment Based Intervention (GABI) has materials available in the following languages other than English:

• Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed in this page).

Interpretation services should be provided for other languages, if possible.

Resources Needed to Run Program

The typical resources for implementing the program are:

• Trauma-informed space as described in the online/paper manual
• Computers for telehealth sessions and private spaces to ensure confidentiality

Prerequisite/Minimum Provider Qualifications

Licensed mental health provider (e.g., LMSW, LMHC, LMFT, LCSW, PhD, PsyD)

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

• Murphy, A., Steele, M., & Steele, H. (2016). Group Attachment-Based Intervention: A clinical training manual. Center for Attachment Research at The New School for Social Research, Center for Babies, Toddlers & Families, Rose F. Kennedy Children’s Evaluation and Rehabilitation Center, Montefiore Medical Center.

The manual is available online via a password protected portal to those trained in the model.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Online via gabionline.org (password-protected website) and in person at Montefiore Medical Center

Number of days/hours:

For clinicians:

• Online training completed asynchronously/independently within a 2-week period
• Apprenticeship training onsite with a supervisor for 12 months, including reflective supervisions 3x weekly
• Regular adherence/competence checks

For supervisors:

• Minimum 3-5 years of experience as GABI clinician
• Clinicians are provided weekly reflective supervision by program’s assistant clinical director

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Group Attachment Based Intervention as listed below.

The organization has to have the ability to obtain treatment measures (PHQ-9, Social Isolation Screener, etc.) and have licensed mental health providers who are willing to obtain the training. For more information, contact Michella Calix, MS, Quality Analyst at GABI, email: mcalix@montefiore.org

Formal Support for Implementation

There is formal support available for implementation of Group Attachment Based Intervention as listed below:

A quality assurance and quality improvement person is provided by GABI along with fidelity monitoring.

Fidelity Measures

There are fidelity measures for Group Attachment Based Intervention as listed below:

The Rearing Coding System (RCS; a competency-based video-recorded measure) and an adherence checklist are provided by GABI. For more information, contact the training contact in the section above.

Established Psychometrics

Armusewicz, K., Steele, M., Steele, H., & Murphy, A. (2022). Assessing therapist and clinician competency in parent-infant psychotherapy: The REARING coding system (RCS) for the Group Attachment Based Intervention (GABI). Research in Psychotherapy: Psychopathology, Process, and Outcome, 25(1), Article 562. https://psycnet.apa.org/record/2022-76319-003

Fidelity Measures Required

It is required to use the fidelity measure when using the program.

Implementation Guides or Manuals

There are no implementation guides or manuals for Group Attachment Based Intervention.

Implementation Cost

There are no studies of the costs of Group Attachment Based Intervention.

Research on How to Implement the Program

Research has not been conducted on how to implement Group Attachment Based Intervention.

Child Welfare Outcome: Child/Family Well-Being

“What is included in the Relevant Published, Peer-Reviewed Research section?”

• Steele, H., Murphy, A., Bonuck, K., Meissner, P., & Steele, M. (2019). Randomized control trial report on the effectiveness of Group Attachment-Based Intervention (GABI©): Improvements in the parent–child relationship not seen in the control group. Development and Psychopathology, 31(1), 203–217. https://doi.org/10.1017/S0954579418001621

  Type of Study: Randomized controlled trial

  Participants: 78 families

  Sample / Population:

  • Age — Mothers: Not specified; Children: Under 3 years of age
  • Race/Ethnicity — Mothers: 34 Latino, 25 Black, 16 Biracial, and 5 White
  • Gender — 100% Mothers; Children: Not specified
  • Status —

    Participants were families at risk for child maltreatment.
    

  Location/Institution: The Rose F. Kennedy Children’s Evaluation and Rehabilitation Center (RFK CERC), Bronx, New York

  Summary:

  The purpose of the study was to report on a randomized control trial involving children less than 3 years old and their mothers who were regarded as at risk of maltreating their children by referral agencies. Participants were randomly assigned to either Systematic Training for Effective Parenting (STEP) or the Group Attachment-Based Intervention (GABI). Measures utilized include the Coding Interactive Behavior (CIB) system and the Clinical Adverse Childhood Experiences Questionnaire. Results indicate that in comparison to STEP, GABI was linked to significant improvements in maternal supportive presence and dyadic reciprocity, and significant declines in maternal hostility and dyadic constriction (proxies for risk of child maltreatment). These medium-to large-sized effects remained significant even after controlling for mothers’ prior ACEs in analysis of covariance procedures. In addition, two small interaction effects of ACEs by treatment type were found, underlining the need for, and value of, treatments that are sensitive to parents’ traumatic histories. Limitations include the free-play outcome measure that was filmed and rated on four discrete 5-point scales calls into question whether this can actually serve as a proxy for maltreatment risk and a healthy secure parent–child relationship, the self-report measure of exposure to abuse and household dysfunction over the first 18 years of life is vulnerable to social desirability influences, and the differing length of treatment in the two arms of the RCT makes the two treatment programs difficult to compare.

  Length of controlled postintervention follow-up: None.

• Myers, L., Steele, H., Steele, M., & Murphy, A. (2022). Exploring maternal reflective functioning as a predictor of mother-child dyadic behaviour over time in a clinical context. Research in Psychotherapy 25(1), Article 594. https://pubmed.ncbi.nlm.nih.gov/35532024/

  Type of Study: One-group pretest–posttest study

  Participants: 20

  Sample / Population:

  • Age — Children: 2–25 months (Mean=14 months); Mothers: Not specified
  • Race/Ethnicity — Children: Not specified; Mothers: 7 Hispanic/Latino, 5 Black or African-American/Afro-Caribbean, 2 Bi-Racial or Multi-Racial, and 1 White
  • Gender — Children: 9 Female and 6 Male; Mothers: Not specified
  • Status —

    Participants were referred by pediatricians, word-of-mouth, and child welfare.
    

  Location/Institution: Montefiore Medical Center in the Bronx, New York

  Summary:

  The study used a subset of the population from Steele et al. 2019. The purpose of the study was to examine 20 participants from Group Attachment Based Intervention (GABI), who completed the adult attachment interviews (AAI) as part of a RCT to test the efficacy of GABI compared with treatment as usual, in order to explore the possible benefits of higher reflective functioning (RF) for treatment outcome in terms of interactive mother and child behaviour. Measures utilized include the Coding interactive Behaviour (CIB), the Reflective Functioning Scale (RF) and Adult Attachment Interview (AAI). Results indicate that lower overall RF was linked to T1 levels of higher intrusiveness from mothers. At end of treatment (T2), mothers’ higher spontaneous RF scores were significantly linked to maternal praising (of the child), child positive affect, child alertness. At 6-month follow up (T3), mother’s spontaneous RF scores correlated significantly and positively with maternal elaborating with child positive affect. Limitations include the small sample size, the lack of randomization, and lack of a control group.
  

  Length of controlled postintervention follow-up: 6 months.

• The Evidence Portal. (2023, Feb. 16). Group Attachment-Based Intervention (GABI). Available at this link.

• Joyce, K. (2019, Feb. 25). The crime of parenting while poor. https://newrepublic.com/article/153062/crime-parenting-poor-new-york-city-child-welfare-agency-reform

• Metrofocus. (2017, Nov. 8). Helping those at-risk. [Video]. https://www.thirteen.org/metrofocus/2017/11/helping-those-at-risk/