Group Attachment-Based Intervention (GABI)

About the program

The program aims to improve the mother-child relationship and prevent abuse for mothers at risk of maltreating their children because of a heavy trauma burden, mental health challenges, or prior removal of a child. The program is based on attachment theory (Ainsworth et al. 1978; Bowlby 1982, 1969).

Who does it work for?

The program was designed for mothers at risk of maltreating their children because of a heavy trauma burden, mental health challenges, or prior removal of a child. One RCT was conducted in the USA with an initial sample of 193 mothers, of which 115 completed the treatment and subsequently 78 provided data for the final analysis (Steele et al. 2019). Of those who provided data at program completion, 43 were in the intervention group and 35 were in the control group. Referrals came from paediatrics, child welfare, and court systems throughout the Bronx, New York. Children were aged 0 - 36 months; 3.8% were White; 32.1% Black; 43.6% Hispanic; and 20.5% biracial. Mothers were from a low socioeconomic background: 63% were unemployed, and 47.4% did not finish or did not attend high school. The study only included biological parents of a 0-36-month old child with custody of their child. Parents who were unable to provide informed consent due to mental illness or cognitive impairment, and those not fluent in English, were excluded from the study. The control group received the Systematic Training for Effective Parenting (STEP) intervention as ‘treatment as usual’.

The review did not identify any evidence that the program has been evaluated in Australia or with First Nations communities.

What outcomes does it contribute to?

Positive outcomes:

Maternal hostility, Dyadic constriction: These were measured using the coding of interactive behavior (CIB) tool, through observation of the parent–child relationship. Outcomes were measured at baseline and post-program. Maternal hostility and dyadic constriction are proxy measures of maltreatment risk. Mothers in the intervention group showed significantly less dyadic constriction and less hostility at the end of treatment than those in the control group (Steele et al. 2019).

Maternal supportive presence, Dyadic reciprocity: These were measured using the coding of interactive behavior (CIB) tool, through observation of the parent–child relationship. Outcomes were measured at baseline and post-program. Mothers in the intervention group showed a significant increase in maternal supportive presence, significantly greater dyadic reciprocity than mothers in the control group (Steele et al. 2019).

No effect:

None..

Negative outcomes:

None.

Is the program effective?

Overall, the program had a positive effect on client outcomes.

How strong is the evidence?

Promising research evidence:

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects

How is it implemented?

The program is delivered in a multifamily group setting. It consists of 120-minute sessions, three times weekly over 26 weeks. The program operates in a clinical setting with trained clinicians. There is a specified time for parents and children under 3 years of age to interact with one another, a time for parents to interact with other parents while their children experience individual time with their age-mates in the presence of trained clinicians who help them to engage with peers, and finally, a “reunion” where children and parents are together again for a period that signals the end of a session. Video filming and video feedback is an important component. There is a program manual.

How much does it cost?

Information not available

Where does the evidence come from?

One RCT study was conducted in the USA with an initial sample of 193 mothers, and a final sample of 78 mothers (Steele et al. 2019).

Further resources

• Ainsworth, M., Blehar, M.,Waters, E., andWall, S. (1978). Patterns of attachment. Hillsdale, NJ: Erlbaum.
• Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment. New York: Basic Books. (Original work published 1969)
• Steele, H., Murphy, A., Bonuck, K., Meissner, P., and 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, 203-217.