Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers

About This Program

Target Population: Caregivers (biological parents, foster parents, kinship caregivers, etc.) of preadolescents (ages 8-12) and adolescents ages (13-19)

For parents/caregivers of children ages: 8 – 19

Program Overview

Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers is a structured 10-session manualized program delivered in a group format to parents and caregivers of preteens and teens with serious behavioural and internalizing problems. Connect aims to promote parental reflective function, emotion regulation, sensitive care, and parent-child mutuality and cooperation. Sessions introduce attachment principles that specifically focus on adolescence and parenting and include experiential and emotion-focused role-plays and reflection activities. The program integrates a trauma-informed, strength-based, and collaborative approach to promoting the development of new parenting skills and parent-child attachment security. Connect is designed to be delivered by a range of health and education professionals in hospitals, mental health centers, community agencies, and schools. Connect is available in five languages and via virtual program delivery.

Program Goals

The goals of Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers are:

  • Increase parental reflective function – that is, the capacity to be aware of your own feelings, thoughts, and internal experiences, and those of your child, that influence your parent-child interactions and the quality of your relationship with your child.
  • Increase parental sensitivity – the capacity to interpret your child’s behavior through an attachment lens, and to respond in a developmentally attuned and empathic manner.
  • Learn skills to regulate your own and your child’s emotional distress, especially as it relates to your relationship with your child.
  • Learn skills to promote mutuality and partnership within your relationship with your child, especially as it relates to challenges and conflict.
  • Decrease your child’s externalizing problems including symptoms of conduct disorder, oppositional defiant disorder, attention-deficit hyperactivity disorder (ADHD), and parent-child conflict.t
  • Decrease your child’s internalizing problems including anxiety and depression.
  • Decrease your depressed mood and caregiving stress.
  • Increase attachment security within your relationship with your child.
  • Increase your sense of parenting satisfaction and efficacy, and family satisfaction.
  • Logic Model

    The program representative did not provide information about a Logic Model for Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers.

    Essential Components

    The essential components of Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers include:

    • Connect adopts a structured, strengths-focused, trauma-informed, relational perspective that engages parents in experiential learning and skill development.
    • Detailed program manuals provide trained and certified group facilitators with the clinical-developmental foundations for each session as well as an explicit session protocol.
    • The program begins with a structured interview with each caregiver, that welcomes them to the program, integrates Motivational Interviewing, and addresses barriers to attendance:
      • Facilitators are trained to listen for themes of trauma, particularly those related to transgenerational trauma and attachment loss, and to respond with empathy and support.
      • This interview also provides an opportunity to understand parents’ unique cultural backgrounds and contexts as they relate to parenting, as well as unique stressors (e.g., COVID-19).
      • This information is used by facilitators to guide their delivery of the program; thereby aiming to ensure:
        • Client and group safety
        • Cultural relevance and respect
        • Discussion of unique population-based stressors
    • Two group facilitators then deliver ten sessions, each 1.5 hours in length, to groups of 8-14 caregivers:
      • Each session begins with the discussion of a developmental and trauma-informed attachment principle as it relates to preadolescent and adolescent development and caregiving.
      • Role plays are used to:
        • Illustrate the application of each principle
        • Lead parents through a set of reflective questions designed to promote:
        • Parent reflective function
        • Parenting sensitivity
        • Skills in identifying and regulating parent and child distress
        • Skills required to sustain mutuality and partnership with their child especially during conflict
        • Engage parents in discussing how to apply the attachment principles to rescript the role-plays with the goal of concurrently:
          • Understanding the attachment meaning of the child’s behavior
          • Promoting security within the parent-child relationship
          • Setting limits and upholding expectations
        • Consolidate learning by having the group facilitators engage in the rescripted role-plays.
        • Allow parents to take the role of the child and encourage them to reflect with the group on their feelings, thoughts, and behaviors in this role.
        • Help the group facilitators to guide discussion about the importance of stepping into the experience of the child while maintaining a parental role.
      • Structured discussions are led by the group facilitators regarding the impact of trauma in relation to the background and needs of caregivers in each group:
        • Reflection questions are used to promote parental understanding of the impact of their child’s and their own past experiences in shaping the expression of attachment needs, with sensitivity to issues of interpersonal trauma and loss.
        • The importance of verbal and nonverbal communication skills is taught and illustrated in each session.
      • Parent handouts that provide a summary of the key points of each session are distributed and discussed.
      • Throughout the sessions, group facilitators apply and integrate therapeutic techniques adapted from:
        • Attributional retraining
        • Cognitive-Behavioral Therapy
        • Mindfulness-based therapy
        • Communication training
        • Relapse prevention
      • Group facilitators apply the attachment principles in managing group dynamics to better understand the needs of caregivers and to provide a safe haven and secure base during the program.
      • The program concludes with a Feedback and Integration Session:
        • Provides caregivers the opportunity to:
          • Complete a client survey
          • Participate in a semistructured group interview reflecting on:
            • Their experience in the program
            • Recommendations for program modifications
            • Feedback to group facilitators
        • Led by an agency lead or alternate clinician
        • Provides standardized information on the fit and perceived helpfulness of program which can be:
          • Complemented with standardized treatment evaluation protocols
          • Compared to an established database
          • Used for service delivery planning
      • Group facilitators provide booster sessions to support caregivers following program completion.

    Program Delivery

    Parent/Caregiver Services

    Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers directly provides services to parents/caregivers and addresses the following:

    • Parents/caregivers of preteens and teens with serious behavioral and internalizing problems and/or of teens who have poor emotion regulation and disrupted and insecure attachment, and who experience significant caregiver stress, depressed mood, low sense of parenting efficacy and satisfaction, and low family satisfaction themselves

    Recommended Intensity:

    Contact includes a pretreatment engagement interview (1-2 hours), followed by weekly 90-minute group. Booster sessions are available and are optional. Caregivers also receive weekly session reminders, and catch-up appointments if sessions are missed.

    Recommended Duration:

    Parents are recruited through a pretreatment engagement interview that can be scheduled between one week and one month prior to the beginning of the group. Once enrolled, the program runs for 10 weeks.

    Delivery Settings

    This program is typically conducted in a(n):

    • Hospital
    • Outpatient Clinic
    • Community-based Agency / Organization / Provider
    • School Setting (Including: Day Care, Day Treatment Programs, etc.)
    • Virtual (Online, Telephone, Video, Zoom, etc.)

    Homework

    This program does not include a homework component.

    Languages

    Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers has materials available in languages other than English:

    French, Italian, Mandarin, Spanish, Swedish

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

    Resources Needed to Run Program

    The typical resources for implementing the program are:

    Two trained Connect group facilitators, meeting space to accommodate 10-15 people, whiteboard/standing flipchart, recommended provision of babysitting and transportation supplements, and food and beverages for a snack or meal. Videotaping is required for supervision during the certification period.

    Manuals and Training

    Prerequisite/Minimum Provider Qualifications

    Minimum educational requirements are not specified; however, the majority of service providers who complete Connect training possess a minimum of a specialized bachelor’s degree or graduate training. Trainees should possess a background in mental health or have education in clinical service delivery with a strong commitment and focus on working with families. Experience in the delivery of group-based interventions is recommended. Trainees should be comfortable with structured and manualized programs. This program is best suited to trainees who are open to relational-based interventions, familiar with concepts of attachment and trauma, and ready to engage in collaborative and reflective supervision. Experience in working with teens or with caregivers of teens is helpful.

    Manual Information

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

    Program Manual(s)

    The manual information is:

    • Moretti, M. M. (2020). Connect®: An Attachment-Based and Trauma-Informed Program for Parents and Caregivers (3rd ed.). Simon Fraser University.

    Training Information

    There is training available for this program.

    Training Contact:
    • Dr. Marlene Moretti
      Simon Fraser University, Burnaby, BC, Canada

      phone: (778) 782-4956
    Training Type/Location:

    Connect training is organized nationally and internationally onsite, scheduled regionally based on interest and training needs, and available virtually. In British Columbia, Canada, Connect training is provided provincially through government services. For more information on Connect contact the Adolescent Health Lab (email: ConnectProject@sfu.ca) or Dr. Marlene M. Moretti (email: moretti@sfu.ca).

    Number of days/hours:

    Trainees must complete a mandatory three-day intensive Connect training workshop. Additional time is required for reviewing the program manual in advance of the training workshop and for homework during the workshop. Subsequently, trainees receive clinical supervision based on videotape review to achieve certification on a weekly basis. Each week, trainees review their own tapes and receive supervision by teleconference from a certified Connect supervisor. In total, trainees participate in a minimum of 10-12 hours of clinical supervision to achieve certification. Additional supervision can be provided, if needed, to achieve certification.

    Additional Resources:

    There currently are additional qualified resources for training:

    Training is also available through a number of North American and international sites/agencies. Information is provided upon request.

    Implementation Information

    Pre-Implementation Materials

    There are no pre-implementation materials to measure organizational or provider readiness for Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers.

    Formal Support for Implementation

    There is formal support available for implementation of Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers as listed below:

    Before implementation, the organizational and practitioner readiness is discussed with the program developer. During implementation, support is provided by Connect trainers and through contact with the Connect Training Team to discuss engagement and implementation challenges. Connect supervisors provide support to trainees on how to engage families and to support program completion. For more information, contact the Adolescent Health Lab (email: ConnectProject@sfu.ca) or Dr. Marlene M. Moretti (email: moretti@sfu.ca).

    Fidelity Measures

    There are fidelity measures for Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers as listed below:

    Sessions are videotaped and reviewed during the certification period to monitor treatment adherence and fidelity. Trainees and their supervisors review the tapes and complete a Session Reflection Form that focuses on key session components.

    Program delivery is also monitored through the standardized client feedback form and the semi-structured group interview that is completed by a third party in the final session of the program. Client feedback can be compared across Connect groups to assess the relative fit and utility of the intervention for caregivers.

    Implementation Guides or Manuals

    There are no implementation guides or manuals for Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers.

    Implementation Cost

    There are no studies of the costs of Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers.

    Research on How to Implement the Program

    Research has not been conducted on how to implement Connect: A Trauma-Informed and Attachment-Based Program for Parents and Caregivers.

    Relevant Published, Peer-Reviewed Research

    Child Welfare Outcome: Child/Family Well-Being

    Stattin, H., Enebrink, P., Özdemir, M., & Giannotta, F. (2015). A national evaluation of parenting programs in Sweden: The short-term effects using an RCT effectiveness design. Journal of Consulting and Clinical Psychology, 83(6), 1069–1084. https://doi.org/10.1037/a0039328

    Type of Study: Randomized controlled trial
    Number of Participants: 908

    Population:

    • Age — Adults: Not specified, Children: 3-12 years (Mean=12.46 years)
    • Race/Ethnicity — Not specified
    • Gender — Not specified
    • Status — Participants were parents with youth who had externalizing problems.

    Location/Institution: Sweden

    Summary: (To include basic study design, measures, results, and notable limitations)
    The purpose of this study was to test the effectiveness of Comet, Community Parent Education (COPE), Incredible Years, and Connect in reducing child behavior problems and attention-deficit/hyperactivity disorder (ADHD) symptoms, in improving positive parenting and parenting competence, and in decreasing negative parenting and parents’ stress and depressive symptoms. Parents were randomly assigned to 1 of 2 parent training programs or to a wait-list condition. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Parents’ Sense of Competence measure (PSOC), the Caregiver Strain Questionnaire, the 20-item Center of Epidemiological Studies—Depression Scale, the Swanson, Nolan, and Pelham Rating Scale (SNAP- IV), the Angry Outbursts Scale, and the Parents Practice Interview. Results indicated at posttreatment, children whose parents had received interventions showed a strong decrease in child conduct problems and a moderate to strong decrease in ADHD symptoms. About half of parents whose children scored over the 95th percentile on the behavior measures (ECBI, SNAP-IV), reported that their children were no longer above the cutoff after the intervention. Parents showed considerably fewer negative behaviors toward their children at posttest compared with pretest and they increased in parental competence and decreased in both stress and depressive symptoms. Limitations include reliance on self-reporting measures and length of follow-up.

    Length of postintervention follow-up: 3-4 months.

    Högström, J., Olofsson, V., Özdemir, M., Enebrink, P., & Stattinet, H. (2017). Two-year findings from a national effectiveness trial: Effectiveness of behavioral and non-behavioral parenting programs. Journal of Abnormal Child Psychology, 45(3), 527–542. https://doi.org/10.1007/s10802-016-0178-0

    Type of Study: Randomized controlled trial
    Number of Participants: 749

    Population:

    • Age — Adults: Not specified; Children: 3-12 years
    • Race/Ethnicity — Not specified
    • Gender — Adults: Not specified; Children: 63% Male
    • Status — Participants were parents who had sought help at 30 local service sector units (e.g., child psychiatric clinics and social services centers) for major problems in managing their children’s externalizing behavior.

    Location/Institution: Four sites in Sweden: Stockholm, Örebro, Göteborg, and Lund

    Summary: (To include basic study design, measures, results, and notable limitations)
    This study uses the same sample as Stattin et al. (2015). This study evaluated the 2-year effects of 4 programs: Comet, Incredible Years, Community Parent Education (COPE), and Connect and differences in the rate of change among programs were investigated using Latent Growth Modeling (LGM). Parents were randomized to one of the four parent training programs. Measures utilized include the Eyberg Child Behavior Inventory (ECBI); the Swanson, Nolan, and Pelham Questionnaire (SNAP-IV); the Parents’ Practice Interview (PPI); the Parenting Sense of Competence scale (PSOC); and the Parental Behavioral Control Scale. Results indicated at 2-year follow-up, there were no differences in any of the child outcomes among the programs. All programs had reduced externalizing behaviors with large effect sizes, and negative parenting practices with moderate to large effect sizes. LGM analyses showed that the 2 behavioral programs, Comet and Incredible Years, produced more rapid reductions in externalizing behavior during the course of the intervention than the nonbehavioral program, Connect. Connect, however, was the only program where children continued to improve after the intervention. Overall, the results indicate that the 4 programs were equally effective in a clinical setting, despite differences in their theoretical origin. Limitations include the study did not include reports from multiple sources (e.g., teachers or observations), two of the parent training programs were compared despite the fact that children in these programs did not overlap in terms of age (Incredible Years and Connect), and only able to compare the programs with each other and not with an untreated control group at the 2-year follow-up.

    Length of postintervention follow-up: 2 years.

    Osman, F., Flacking, R., Schön, U., & Klingberg-Allvin, M. (2017). A support program for Somali-born parents on children’s behavioral problems. Pediatrics, 139(3), Article e20162764. https://doi.org/10.1542/peds.2016-2764

    Type of Study: Randomized controlled trial
    Number of Participants: 120

    Population:

    • Age — Adults: 44–45 years; Children: 11–16 years
    • Race/Ethnicity — 100% Somalian
    • Gender — 80 Females and 40 Males
    • Status — Participants were parents with stress in relation to parenting practices recruited from Somali associations, social services, and schools; a family center; and through key persons.

    Location/Institution: Sweden

    Summary: (To include basic study design, measures, results, and notable limitations)
    The purpose of this study was to evaluate the Connect parenting support program for Somali-born parents and to determine its effectiveness on children’s emotional and behavioral problems. Parents were randomized either to Connect (intervention group=IG) or a wait-list control group (CG). Measures utilized include the Child Behavior Checklist for Ages 6 to 18 (CBCL 6–18). Results indicated significant improvement in the children in the IG for behavioral problems after a 2-month follow-up. Limitations include cannot determine whether it was the Connect program alone, the culturally tailored societal information alone, or the combination of both factors that improved the children’s behavioral problems; cannot be generalized to other immigrants in Sweden; and length of follow-up.

    Length of postintervention follow-up: 2 months.

    Osman, F., Salari, R., Klingberg-Allvin, M., Schön, U. K., & Flacking, R. (2017). Effects of a culturally tailored parenting support programme in Somali-born parents’ mental health and sense of competence in parenting: A randomised controlled trial. BMJ Open, 7(12), Article e017600. https://doi.org/10.1136/bmjopen-2017-017600

    Type of Study: Randomized controlled trial
    Number of Participants: 120

    Population:

    • Age — Adults: 44–45 years; Children: 11–16 years
    • Race/Ethnicity — 100% Somalian
    • Gender — Adults: 80 Female and 40 Male; Children: 69 Male
    • Status — Participants were parents with stress in relation to parenting practices recruited from Somali associations, social services, schools, and a family center; and through key persons.

    Location/Institution: Sweden

    Summary: (To include basic study design, measures, results, and notable limitations)
    This study used the sample from Osman, Flacking et al. (2017). The purpose of this study is to evaluate the effectiveness of a culturally tailored parenting support programme (Connect) on Somali-born parents’ mental health and sense of competence in parenting. Parents were randomized either to Connect (intervention group=IG) or a wait-list control group (CG). Measures utilized include the General Health Questionnaire 12 (GHQ-12) and the Parenting Sense of Competence (PSOC) scale. Results indicated that parents in the Connect group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up. Further, significant improvement was found for efficacy and satisfaction for parents in the Connect group. Limitations include reliance on self-reported measures, cannot be generalized to other immigrants in Sweden, and length of follow-up.

    Length of postintervention follow-up: 2 months.

    Ozturk, Y., Moretti, M., & Barone, L. (2019). Addressing parental stress and adolescents’ behavioral problems through an attachment-based program: An intervention study. International Journal of Psychology & Psychological Therapy, 19(1), 89–100. https://www.ijpsy.com/volumen19/num1/509/addressing-parental-stress-and-adolescents-EN.pdf

    Type of Study: Randomized controlled trial
    Number of Participants: 44

    Population:

    • Age — Adults: Mean=49.9 years; Children: Mean=15 years
    • Race/Ethnicity — Not specified
    • Gender — Adults: Not specified; Children: 34% Female
    • Status — Participants were parents of adolescents.

    Location/Institution: Italy

    Summary: (To include basic study design, measures, results, and notable limitations)
    The purpose of this study is to address parenting stress and adolescents’ behavioral and emotional problems through an attachment-based parenting intervention, Connect, for parents of adolescents; in particular to test whether this intervention led to reduced levels of parenting stress, and adolescents’ emotional and behavioral problems. Parents of adolescents were randomly assigned to one of two groups: An attachment-based intervention group (Connect), or a wait-list control group. Measures utilized include the Stress Index for Parents of Adolescents (SIPA) and the Strengths and Difficulties Questionnaire Parent and Youth Version (SDQ). Results indicate compared to the control group, parents completing the Connect program reported significant reductions in their adolescents’ externalizing behavior problems at treatment completion. Mediation model showed that, among parents completing the Connect program reductions in parental stress were mediated through decreases in adolescents’ externalizing behavior problems. Decrease in adolescents’ externalizing behavioral problems affected parental stress experienced in caring. Limitations include reliance on parents’ reports of their teens’ functioning and lack of follow up.

    Length of postintervention follow-up: None.

    Barone, L., Carone, N., Costantino, A., Genschow, J., Merelli, S., Milone, A., Polidori, L., Ruglioni, L., & Moretti, M. (2020). Training parents to adolescents’ challenges: The CONNECT parent program. Quaderni di Psicoterapia Cognitiva-Open Access, 46. https://journals.francoangeli.it/index.php/qpcoa/article/view/10160

    Type of Study: Randomized controlled trial
    Number of Participants: 118

    Population:

    • Age — Adults: Mean=49.97 years; Children: Mean=15.26 years
    • Race/Ethnicity — Not specified
    • Gender — Adults: Not specified; Children: 64% Male
    • Status — Participants were parents of adolescents who looked for consultation for their offspring behavioral problems.

    Location/Institution: Three Italian centres

    Summary: (To include basic study design, measures, results, and notable limitations)
    The purpose of this study was to investigate whether helping parents reduce their reliance on coercive or unproductive parenting strategies and understand changes occurring during adolescence from an attachment-based perspective would reduce their adolescents’ externalizing and internalizing symptoms. Parents of adolescents were randomly assigned to the intervention group, Connect, or to the wait-list control group. Measures utilized include the Strength and Difficulties Questionnaire (SDQ-parent version) and the Adolescent Attachment Anxiety & Avoidance Inventory (AAAAI). Results indicate parents attending the Connect program reported significant reductions in their adolescents’ externalizing symptoms, and slightly significant reductions in their adolescents’ internalizing symptoms by a reduction of anxiety and avoidance attachment strategies. Limitations include reliance on parent report, high attrition rate (28.8%), and lack of an accurate analysis of maternal vs. paternal participation in the program.

    Length of postintervention follow-up: 4 months.

    Barone, L., Carone, N., Costantino, A., Genschow, J., Merelli, S., Milone, A., Polidori, L., Ruglioni, L., & Moretti, M. (2021). Effect of a parenting intervention in decreasing adolescents’ behavioral problems via reductions in attachment insecurity: A longitudinal, multicenter, randomized controlled trial. Journal of Adolescence, 91, 82–96. https://doi.org/10.1016/j.adolescence.2021.07.008

    Type of Study: Randomized controlled trial
    Number of Participants: Study 1: 100; Study 2: 80

    Population:

    • Age — Study 1: Adults: Mean=48.84–50.52 years, Adolescent: Mean=14.88–14.90 years; Study 2: Adults: Mean=47.60–50.15 years, Adolescent: Mean=14.90 years
    • Race/Ethnicity — Not specified
    • Gender — Study 1: Adults: 100 Female, Adolescent: 60 Male and 40 Female; Study 2: Adults: 40 Female, Adolescent: 24 Male and 16 Female
    • Status — Participants were mothers who looked for consultation for their adolescents’ behavioral problems. They were referred by community mental health centres or schools to three Italian mental health facilities sites: Pavia, Milan, and Pisa.

    Location/Institution: Italy. Three mental health facilities: Pavia, Milan, and Pisa

    Summary: (To include basic study design, measures, results, and notable limitations)
    This study used the sample from Ozturk et al. (2019) and Barone et al. (2020). The purpose of this study was to present two studies evaluating the effectiveness of the Connect program in regards to reductions in adolescents’ internalizing problems, externalizing problems and attachment insecurity (avoidant and anxious attachment). In addition, Study 2 examines the association between post-intervention decrease in attachment avoidance and attachment anxiety and reduction in externalizing and internalizing problems in adolescents at follow-up. Study 1 and 2 present findings based on a wait-list control evaluation of Connect, including posttreatment and four-month follow-up outcomes. Measures utilized include the Strength and Difficulties Questionnaire (SDQ-parent version) and the Attachment Anxiety and Avoidance Inventory (AAAAI). Results indicate that mothers who attended Connect reported a significant reduction in their adolescents’ behavioral problems and attachment insecurity, compared to mothers in the wait-list group, both at postintervention and 4 months after the end of the intervention (Study 1). These findings were confirmed on a separate sample in Study 2. In addition, both studies indicated that participating in Connect reduces adolescents’ internalizing and externalizing problem 4 months after the intervention via postintervention decrease in attachment anxiety and attachment avoidance, respectively. Limitations include a short follow-up period, reliance on parent-reports, and lack of assessment of the association between attachment and co-occurring internalizing and externalizing problems in adolescents, and length of follow-up.

    Length of postintervention follow-up: 4 months.

    Pasalich, D. S., Craig, S. G., Goulter, N., O’Donnell, K. A., Sierra Hernandez, C., & Moretti, M. M. (2021). Patterns and predictors of different youth responses to attachment-based parent intervention. Journal of Clinical Child & Adolescent Psychology. Advance online publication. https://doi.org/10.1080/15374416.2021.1923022

    Type of Study: Randomized controlled trial
    Number of Participants: 1,174 (682 parents and 487 youth)

    Population:

    • Age — Parents: 24.00–65.00 years (Mean=42.83 years); Youth: 7.53–18.33 years (Mean=13.95 years)
    • Race/Ethnicity — Parents: Not specified; Youth: 71.9% White, 13.9% Indigenous, 9.0% Other, and 5.2% Asian
    • Gender — Parents: 86% Female; Youth: 52.5% Female
    • Status — Participants were referred by community mental health centers, schools, and hospitals due to their youth’s behavioral and emotional problems.

    Location/Institution: British Columbia, Canada

    Summary: (To include basic study design, measures, results, and notable limitations)
    The purpose of this study was to examine distinct patterns and multilevel predictors of intervention response among youth with serious behavioral and mental health problems whose parents participated in Connect. Measures utilized include the Brief Child and Family Phone Interview (BCFPI), the Inventory of Callous-Unemotional Traits (ICU), the Risk-Taking and Self-Harm Inventory for Adolescents (RTSHIA), the Adolescent Attachment Anxiety & Avoidance Inventory (AAAAI), the Caregiver Strain Questionnaire (CGSQ), and the Family Satisfaction Scale (FSS). Results indicate three distinct trajectory classes in both the parent and youth models based on different patterns of co-occurring externalizing (EXT) and internalizing (INT) behaviors and degree of improvement over time. Youth with severe EXT showed the largest and fastest improvement, and, interestingly, were characterized by higher callous-unemotional traits and risk-taking at program entry. Youth with comorbid EXT/INT demonstrated a partial or moderate response to Connect in the parent and youth model, respectively, and were characterized by more attachment anxiety at baseline. Most youth showed relatively moderate/low levels of EXT/INT at baseline which gradually improved. Caregiver strain also predicted trajectory classes. Limitations include all variables were measured using questionnaire reports, results may not generalize to more diverse or disadvantaged population, results are limited by missing data at follow-up time points and study did not examine other important parent factors that may also influence trajectory outcomes in attachment-based interventions, such as parents’ attachment status and history of adverse childhood experiences.

    Length of postintervention follow-up: 6, 12, and 18 months.

    Pasalich, D. S., Moretti, M. M., Hassall, A., & Curcio, A. (2021). Pilot randomized controlled trial of an attachment-and trauma-focused intervention for kinship caregivers. Child Abuse & Neglect, 120, Article 105178. https://doi.org/10.1016/j.chiabu.2021.105178

    Type of Study: Randomized controlled trial
    Number of Participants: 26

    Population:

    • Age — Parents: Mean=55 years; Youth: 8-16 years (Mean=10.58 years)
    • Race/Ethnicity — Parents: 65% Australian European and 19% Aboriginal or Torres Strait Islander; Youth: 58% Australian European and 38% Aboriginal or Torres Strait Islander
    • Gender — Parents: 54% Grandparents and 23% Aunts; Youth: 38% Female
    • Status — Participants were kinship caregivers with youth and practitioners from child protection and out-of-home care services.

    Location/Institution: Canberra, Australia

    Summary: (To include basic study design, measures, results, and notable limitations)
    The purpose of this study was to examine research feasibility and the acceptability, fidelity, and preliminary outcomes of an attachment- and trauma-focused intervention for kinship caregivers in Australia. Kinship caregivers were randomized to Connect for Kinship Parents (Connect-KP) [also known as Connect] or care-as-usual (CAU). Measures utilized include the Caregiver Strain Questionnaire (CGSQ), the Parenting Sense of Competence Scale (PSOC), the Conflicts and Tactics Scale (CTS), the Affect Regulation Checklist (ARC), the Strengths and Difficulty Questionnaire (SDQ), the Adolescent Attachment Anxiety & Avoidance Inventory (AAAAI), and data provided by a state child protective services from their administrative database regarding placement moves. Results indicate practitioners rated the training highly and demonstrated excellent fidelity to program content and process. Results supported the research feasibility and all kinship caregivers reported high levels of program satisfaction and had very high attendance and completion rates. Direction of effects favored Connect-KP vs. CAU for all nine caregiver and youth outcomes, with the largest effects observed for significant reductions in caregiver strain, caregiver psychological aggression, and youth affect suppression following intervention. At 6-month follow-up, more youth from CAU (15%) vs. Connect-KP (0%) experienced an unplanned placement change. Limitations include the small sample and the use of an inactive control that only received CAU.

    Length of postintervention follow-up: 6 months.

    Additional References

    Dangaltcheva, A., Booth, C., & Moretti, M. M. (2021). Transforming Connections: A trauma-informed and attachment-based program to promote sensitive parenting of trans and gender nonconforming youth. Frontiers in Psychology, 12, Article 643823. https://doi.org/10.3389/fpsyg.2021.643823

    Moretti, M. M., Obsuth, I., Craig, S. G., & Bartolo, T. (2015). An attachment-based intervention for parents of adolescents at risk: Mechanisms of change. Attachment & Human Development, 17(2), 119-135. https://doi.org/10.1080/14616734.2015.1006383

    Moretti, M. M., Pasalich, D. S., & O’Donnell, K. A., (2017). Connect: An attachment-based program for parents of teens. In H. Steele & M. Steele (Eds.), Handbook of attachment-based interventions (1st ed.). Guilford Publications.

    Contact Information

    Dr. Marlene Moretti, PhD
    Agency/Affiliation: Simon Fraser University
    Website: connectattachmentprograms.org
    Email:
    Phone: (778) 782-4956

    Date Research Evidence Last Reviewed by CEBC: February 2021

    Date Program Content Last Reviewed by Program Staff: February 2022

    Date Program Originally Loaded onto CEBC: April 2018