Study protocol for Attachment & Child Health (ATTACH^TM) program: promoting vulnerable Children's health at scale.

Area of Science:

• Child development
• Parenting interventions
• Public health

Background:

• Toxic stress in children, including parental depression, violence, and poverty, leads to developmental and health issues.
• Parenting interventions can mitigate toxic stress effects, promoting healthier child outcomes.
• Parental reflective function (RF) interventions may reduce health inequities caused by childhood stress.

Purpose of the Study:

• To conduct an effectiveness-implementation hybrid study of the ATTACH™ program.
• To assess ATTACH™'s impact in real-world settings delivered by community agencies.
• To evaluate the delivery of ATTACH™ in community settings.

Main Methods:

• Quantitative pre/post-test quasi-experimental evaluation with 100 families (children birth to 36 months).
• Qualitative examination of implementation feasibility using Normalization Process Theory (NPT).
• Measures include Parent Child Interaction Teaching Scale, RF questionnaires, Ages and Stages Questionnaire-3, and immune biomarkers; interviews with 60 participants, providers, and administrators.

Main Results:

• Pilot studies (n=64) showed ATTACH™ significantly improved parental RF, parenting quality, immune function, and child cognitive/motor development.
• This study will assess effectiveness and implementation in naturalistic settings.

Conclusions:

• The study will provide insights into the effectiveness and implementation of the ATTACH™ program in community agencies.
• Findings will inform the broader application of ATTACH™ to reduce health inequities associated with childhood toxic stress.